NEXUS: A novel social network approach to study the effects of intersectional stigma on HIV prevention among Latino MSM

220.7项目概要/摘要 污名是美国拉丁裔男性与男性发生性关系（LMSM）中艾滋病毒检测和PrEP使用的普遍障碍。 常规艾滋病毒检测和大规模PrEP覆盖是结束艾滋病毒传播的基本艾滋病毒预防战略。 疫情LMSM进一步与交叉污名作斗争，这意味着他们经历或害怕不公正的待遇 由于他们的种族、性别和男性身份（即遵守男性规范）而与他人不同。具体 交叉污名，新兴的定量研究表明，暴露于污名对>1交叉 身份认同与更糟糕的健康结果相关，而不是暴露于单一交叉领域的耻辱。 身份虽然交叉污名的研究主要是定性的，但先进的定量方法 提供一个机会，以确定新的可操作的干预机制和目标;改善我们的公共卫生 结束美国艾滋病流行的对策。社会网络分析是一个强大的方法来检查如何LMSM 在社交网络中与他人互动并受他人影响。社交网络是重要的干预目标， 由于网络成员能够（1）污名化LMSM（即污名来源）和（2）培养弹性 和社会支持，以减少交叉污名对LMSM的艾滋病毒检测和PrEP使用的负面影响。 目前的研究将前瞻性地评估如何预期和制定交叉污名的经验 在基线时，LMSM在其社交网络中进行HIV检测，并在基线后12个月使用PrEP。我们 将从男男性行为者和拉丁裔社区组织招募500名艾滋病毒阴性的成年LMSM。研究措施， 包括以自我为中心的社交网络清单，将在第0、6和12个月收集。我们的主要成果， 将从第12个月的病历中提取HIV检测和PrEP使用情况。我们将使用社交网络 分析：（1）确定LMSM如何在其社交网络中经历交叉污名， 背景（即社会关系的类型[例如家庭，朋友，性伴侣，供应商]， 身份[例如，文化适应，外向，男性气质]）（AIM 1，主要）。(2)专业评估的效果 社交网络暴露于艾滋病毒检测和PrEP使用的交叉耻辱（AIM 2，主要）。(3)鉴定新 干预点，以减少交叉污名对艾滋病毒检测和PrEP使用的有害影响（AIMS 3-4，探索性），并为未来的试点制定数据和社区知情的干预战略。 作为第一个使用社交网络来评估交叉污名对健康结果影响的研究， NEXUS意义重大，因为美国LMSM中新的艾滋病毒诊断正在增加-由于艾滋病毒感染率低 检测（未确诊的艾滋病毒）和PrEP使用，而非LMSM的新诊断已经稳定或减少。 研究交叉污名的SN方法是高度创新的，因为它反映了一个实质性的偏离 从交叉污名的研究，开辟了新的机会，以结束艾滋病毒的流行。没有 在这些努力中，交叉污名化将继续在LMSM中产生和维持艾滋病毒差异。

220.7 PROJECT SUMMARY/ABSTRACT Stigma is a pervasive barrier to HIV testing and PrEP use among US Latino men who have sex with men (LMSM). Routine HIV testing and large scale PrEP coverage are essential HIV prevention strategies for ending the HIV epidemic. LMSM further contend with intersectional stigma, meaning they experience or fear unjust treatment from others due to their ethnic, sexual, and masculine identities (i.e. adherence to masculinity norms). Specific to intersectional stigma, emerging quantitative research suggests exposure to stigma towards >1 intersectional identity is associated with worse health outcomes than exposure to stigma towards a single intersectional identity. While research on intersectional stigma has been largely qualitative, advanced quantitative methods offer an opportunity to identify novel actionable intervention mechanisms and targets; improving our public health response to ending the US HIV epidemic. Social network analysis is a robust method for examining how LMSM interact with and are affected by others in their social network. Social networks are important intervention targets, since network members are capable of (1) stigmatizing LMSM (i.e. stigma sources) and (2) fostering resilience and social support to reduce the negative impact of intersectional stigma on LMSM’s HIV testing and PrEP use. The current study will prospectively assess how anticipated and enacted intersectional stigma are experienced by LMSM in their social networks at baseline to effect HIV testing and PrEP use 12-months post-baseline. We will recruit 500 HIV-negative adult LMSM from MSM and Latino community organizations. Study measures, including an egocentric social network inventory, will be collected at Months 0, 6, and 12. Our primary outcomes, HIV testing and PrEP use, will be abstracted from medical records at Month 12. We will use social network analysis to: (1) Identify how LMSM experience intersectional stigma in their social networks across diverse social context (i.e. types of social relationships [e.g. family, friends, sex partners, providers], expression of intersectional identities [e.g. acculturation, outness, masculinity]) (AIM 1, primary). (2) Prospectively evaluate the effect of social network exposure to intersectional stigma on HIV testing and PrEP use (AIM 2, primary). (3) Identify novel points of intervention to reduce the harmful effects of intersectional stigma on HIV testing and PrEP use (AIMS 3-4, exploratory) and develop data–and–community-informed intervention strategies for future piloting. As the first study to use social networks to evaluate the effects of intersectional stigma on health outcomes, NEXUS is significant because new HIV diagnoses among US LMSM are increasing–due to low rates of HIV testing (undiagnosed HIV) and PrEP use–while new diagnoses among non-LMSM have stabilized or decreased. A SN approach to studying intersectional stigma is highly innovative because it reflects a substantial departure from how intersectional stigma has been studied, opening new opportunities to end the HIV epidemic. Without such efforts, intersectional stigma will persist in producing and maintaining HIV disparities among LMSM.