Sociocultural Influences on Mental Health Service Utilization for Young Black Gay, Bisexual and other Men who have Sex with Men

项目摘要 年轻的黑人同性恋，双性恋和其他与男性发生性关系的男性（YB-GBMSM）经历高艾滋病毒 流行率和发病率，但整个艾滋病毒连续护理（HIV-CoC）的参与率不佳。 可治疗的精神健康（MH）状况，如抑郁症、焦虑症、创伤和 压力源相关疾病和物质使用是HIV-CoC结果的主要决定因素;然而， 这一人群的服务利用率很低。有必要采取适合文化的干预措施， 提高YB-GBMSM中的MH服务利用率，以改善HIV-CoC和MH结果。我们 长期目标是确定新的方法，以促进和提供卫生保健服务的YB-GBMSM生活 感染了艾滋病毒本R21应用程序的目的是了解对MH服务的影响 YB-GBMSM艾滋病毒感染者的使用情况。该项目的基本原理是， 护理往往是重叠和/或协同作用的，文化因素对 了解这些因素。我们的研究将在格鲁吉亚的亚特兰大进行--那里是艾滋病的中心。理论 研究的基础是基于Andersen的健康行为模型的初步概念模型 服务使用，我们使用与YB特别相关的理论和框架进行文化适应- GBMSM（少数民族压力，交叉性和弹性）。这项研究将追求三个具体目标：（1） 定性探讨YB-GBMSM艾滋病毒感染者对MH服务利用的概念，包括 调查相关的社会文化，人口统计学和临床影响;（2）定量检查 我们的概念模型中的结构、MH服务利用率和HIV-CoC结果之间的关系; (3)制定方案目标和方法，以进行文化定制干预， 在感染艾滋病毒的YB-GBMSM中，提高对卫生保健服务的接受和利用，并改善艾滋病毒CoC的结果。 对于第一个目标，我们将进行N=40定性访谈，以了解MH和MH的概念化 服务，并完善基于Andersen的行为模型的概念模型。第二个目标，我们将 使用来自N=200个横截面调查的定量数据来测试我们模型中的关系， 与携带艾滋病毒的YB-GBMSM进行接触。关于第三个目标，我们将综合目标1和2的结果， 开始制定干预措施，以提高感染艾滋病毒的YB-GBMSM对卫生保健服务的利用， 使用干预映射方法。由于其潜力，拟议的研究非常重要 为改善YB-GBMSM中HIV-CoC结果的有效策略提供信息，具有重要意义 对个人和公众健康的影响。

PROJECT SUMMARY Young Black gay, bisexual and other men who have sex with men (YB-GBMSM) experience high HIV prevalence and incidence, but suboptimal rates of engagement across the HIV Continuum of Care (HIV-CoC). Treatable mental health (MH) conditions such as depressive disorders, anxiety disorders, trauma- and stressor-related disorders, and substance use are major determinants of HIV-CoC outcomes; however, MH services utilization rates are low in this population. There is a need for culturally -tailored interventions to improve MH service utilization among YB-GBMSM, in order to improve both HIV-CoC and MH outcomes. Our long-term goal is to identify novel approaches to promoting and delivering MH services for YB-GBMSM living with HIV. The objective of this R21 application is to develop an understanding of influences on MH service utilization among YB-GBMSM living with HIV. The rationale for the project is that the influences on HIV and MH care are often overlapping and/or synergistic, and that cultural considerations are critically important to understanding these factors. Our study will be based in Atlanta, Georgia – an HIV epicenter. The theoretical foundation for the study is a preliminary conceptual model based on Andersen’s Behavioral Model of Health Service Use, which we have culturally adapted using theories and frameworks with particular relevance for YB- GBMSM (minority stress, intersectionality, and resilience). This study will pursue three specific aims: (1) to qualitatively explore conceptualizations of MH service utilization among YB-GBMSM living with HIV, including investigation of associated sociocultural, demographic and clinical influences; (2) to quantitatively examine relationships between constructs in our conceptual model, MH service utilization, and HIV-CoC outcomes; and (3) To develop program objectives and methods for a culturally-tailored intervention designed to enhance acceptability and uptake of MH services, and improve HIV-CoC outcomes, among YB-GBMSM living with HIV. For the first aim, we will conduct N=40 qualitative interviews to understand conceptualizations of MH and MH services, and to refine a conceptual model based on Andersen’s Behavioral Model. For the second aim, we will test the relationships in our model using quantitative data from N=200 cross-sectional surveys that we will conduct with YB-GBMSM living with HIV. For the third aim, we will synthesize the findings from Aims 1 and 2 to begin development of an intervention to enhance MH service utilization among YB-GBMSM living with HIV, using the Intervention Mapping approach. The proposed research is highly significant because of its potential to inform effective strategies for improving HIV-CoC outcomes among YB-GBMSM, with important implications for both individual and public health outcomes.