Validation of Stigma Metrics for Marginalized Men

这项拟议研究的总体目标是利用现有的和正在进行的数据来检查 性行为对获得艾滋病毒医疗保健以及性健康和精神健康结果的污名 与男性发生性关系的男性(MSM)。在世界范围内，男男性接触者是一个关键人群，他们承受着不成比例的负担 艾滋病毒的高流行率和高发病率，但他们的吸收率和/或获得治疗的机会较低， 预防。根据国家卫生研究院艾滋病毒/艾滋病研究的优先事项，拟议的项目旨在减少健康 艾滋病毒感染和治疗结果的差异，通过在以下背景下解决对MSM的耻辱 交叉的耻辱和潜在的可修改的媒介(例如，抑郁)。特别是，经过验证的措施 对于性行为污名，需要有效地衡量与污名相关的干预措施，并更好地 了解污名如何在这一关键人群中增加艾滋病毒风险的机制。我们建议 利用从撒哈拉以南非洲7个不同国家的15,000多名男男性接触者收集的现有数据， 美国男性互联网调查(AMIS)、加州大学洛杉矶分校mSTUDY和艾滋病毒预防试验网络(HPTN) 078美国艾滋病男男性接触者加强招募、关爱和治疗的研究。这个 这项工作的具体目标是：目标1)开发用于评估性行为污名的有效措施 对男男性接触者进行因素分析和效度和信度检验。这将导致最终的污名指标 以及整合MSM污名项目的建议，可在未来的研究中使用。目标2)确定 使用结构方程模型在污名和艾滋病毒相关结果之间的特定中介关联。 此外，测试多种形式的污名(例如，性别、艾滋病毒状况、种族/族裔)的交叉性 一种范畴间和范畴内的方法。交付的结果将包括量化的性关系 行为污名与艾滋病毒相关的结果，可用于通过设置 减轻污名干预的可行目标。目标3)将最终验证的污名指标包括在 即将到来的AMIS周期和生物验证耻辱指标。生物验证将由测试关联组成 性传播感染(衣原体和淋病)检测呈阳性的性行为污名， 并使用端粒DNA长度测量慢性应激。参与者将自行收集尿液、直肠和 唾液样本使用家庭性传播感染检测试剂盒。总的来说，拟议的研究将导致一项彻底的 MSM性行为污名量表的评估及其与其他类型性行为污名量表的比较 耻辱。经过验证的污名指标将为未来的研究提供建议，试图 这一关键人群中的耻辱及其与艾滋病毒的关系。

The overarching goal of this proposed study is to leverage existing and ongoing data to examine the role of sexual behavior stigma on access to HIV healthcare as well as sexual and mental health outcomes among men who have sex with men (MSM). Worldwide MSM are a key population that bear a disproportionate burden of HIV with high prevalence and incidence yet they have low uptake and/or access to treatment and prevention. Consistent with NIH HIV/AIDS research priorities, the proposed project aims to reduce health disparities in HIV infection and treatment outcomes by addressing stigma towards MSM in the context of intersecting stigmas and potentially modifiable mediators (e.g., depression). In particular, validated measures of sexual behavior stigma are needed to effectively measure stigma-related interventions and to better understand the mechanisms of how stigma potentiates HIV risks among this key population. We propose to leverage existing data collected from over 15,000 MSM across 7 different Sub-Saharan African nations, the American Men's Internet Survey (AMIS), the UCLA mSTUDY, and the HIV Prevention Trials Network (HPTN) 078 study on Enhancing Recruitment, Linkage to Care and Treatment for HIV-Infected MSM in the US. The specific aims of the work are: Aim 1) Develop validated measures used to assess sexual behavior stigma among MSM using factor analysis and validity and reliability testing. This will result in finalized stigma metrics and recommendations for integration of MSM stigma items that can be used in future studies. Aim 2) Identify specific mediated associations between stigma and HIV-related outcomes using structural equation modeling. In addition, test for intersectionality of multiple forms of stigma (e.g., gender, HIV status, race/ethnicity) using an inter- and intra-categorical approach. The delivered outcomes will include quantified associations of sexual behavior stigma with HIV-related outcomes that can be used to inform HIV intervention planning by setting feasible targets for stigma mitigation interventions. Aim 3) Include final validated stigma metrics in an upcoming cycle of AMIS and bio-validate the stigma metrics. Bio-validation will consist of testing associations of sexual behavior stigma with testing positive for sexually transmitted infections (chlamydia and gonorrhea), and with chronic stress measured using telomere DNA length. Participants will self-collect urine, rectal, and saliva specimens using home-based STI test kits. Overall, the proposed study will result in a thorough assessment of a sexual behavior stigma scale for MSM and how it operates comparatively with other types of stigma. The validated stigma metrics will provide recommendations for future studies that seek to measure stigma and its relation to HIV among this key population.