HIV risk in Urban populations of Black men who have sex with men and women

描述（由申请人提供）：在美国，每年每2个感染艾滋病毒的人中就有1个是非洲裔美国人。最近有大量的文献-包括学术文献和流行文献-关于与男性和女性发生性关系的黑人男子传播艾滋病毒的问题。然而，心理健康状况，认知，动机，以及可能的保护因素对性传播艾滋病毒的BMSMW人群是相对未知的。了解BMSMW中艾滋病毒传播的性模式对于制定有关解决非裔美国人社区内艾滋病毒传播的方案和干预措施至关重要。因此，有必要更好地了解这一人群的心理健康状况和性行为。有一小部分文献表明，不安全的依恋风格与性风险行为增加和心理健康下降有关（例如，更多的抑郁症）。这些研究主要是在异性恋参与者的队列中进行的，忽略了包括性少数群体。了解依恋风格与性行为和心理健康的关系可以帮助健康社区的许多方面（例如，咨询、公共卫生、社会工作等）针对那些可能面临更大传播风险的人开展艾滋病毒预防工作。目的：本研究是一项探索性研究，有两个具体的目的：1）描述每周的压力，抑郁和性风险行为的黑人MSMW的水平，2）使用混合方法的方法，以了解BMSMW的依恋风格，压力，抑郁和性风险行为之间的关系。方法：80名BMSMW将完成12周的在线结构化日记。日记将包括抑郁量表、压力量表、成人依恋量表和性行为问题。1-将对从80名原始样本中选出的12名男子进行1小时的开放式访谈。这些问题将主要集中在评估参与者与他们的主要童年照顾者的关系如何影响他们成年后的心理健康和性行为。分析：生长曲线模型将用于从结构化日记数据中检测依恋、压力、抑郁和性风险之间的任何现有关系。定性访谈采用扎根理论方法进行分析。我在本申请中提出的培训计划将使我不仅能够发展定量和定性研究方法论技能来进行论文研究，而且还将帮助我获得必要的学术专业技能，成为一名学术研究人员。 公共卫生相关性：拟议的研究将有助于公共卫生研究和实践，为艾滋病毒阳性和阴性的黑人男性与男性和女性发生性关系提供二级预防干预措施-这是一个潜在的高风险群体，几乎没有被证明有效的干预措施。因此，重要的是要制定针对艾滋病毒阳性和阴性BMSMW的干预措施，特别是那些非同性恋身份和不向其主要性伴侣透露的人，以有效预防艾滋病毒疾病的传播。本研究通过对城市黑人男、女工作者依恋、心理健康与性风险行为关系的研究，为全面、有效、多层次（即：个人、夫妇和设定水平）干预。

DESCRIPTION (provided by applicant): In the United States, 1 in every 2 people infected with HIV each year are African American. There is a large body of recent literature--both academic and popular--concerning the transmission of HIV from Black men who have sex with men and women (BMSMW). However, the mental health status, cognitions, motivations, and possible protective factors against sexual transmission of HIV in populations of BMSMW are relatively unknown. An understanding of sexual modes of HIV transmission among BMSMW is crucial to creating programming and interventions concerned with addressing HIV transmission within African American communities. Thus, the need to better understand the mental health status and sexual behaviors of this population is imperative. There has been a small body of literature that suggests that insecure attachment style is related to increased sexual risk behavior and decreased mental health (e.g., more depression). These studies have been primarily conducted with cohorts of heterosexual participants and have neglected to include sexual minorities. Understanding how attachment style relates to sexual behavior and mental health can help many facets of the health community (e.g., counseling, public health, social work, etc.) tailor HIV prevention efforts for those who may be at increased risk of transmission. Aims: The current study is an exploratory study with two specific aims: 1) to describe the weekly levels of stress, depression, and sexual risk behavior among Black MSMW, and 2) using a mixed-methods approach, to understand what the relationships between attachment style, stress, depression and sexual risk behavior among BMSMW. Methods: 80 BMSMW will complete an online 12-week structured diary. The diary will include a depression inventory, stress inventory, adult attachment inventory, and sexual behavior questions. 1-hour open ended interviews will be conducted with 12 men drawn from the original sample of 80. The questions will mainly focus on assessing how participants' relationship with their primary childhood caregiver may have affected their mental health and sexual behavior as adults. Analysis: Growth Curve Modeling will be used to detect any existing relationships between attachment, stress, depression, and sexual risk from the structured diary data. A grounded theory approach will be used to analyze the qualitative interviews. The training program I have proposed in this application will allow me to not only develop the quantitative and qualitative research methodology skills to carry out my dissertation research but it also will help me obtain the necessary academic professional skills to become an academic researcher. PUBLIC HEALTH RELEVANCE: The proposed research will contribute to public health research and practice by informing secondary prevention interventions for HIV-positive and negative Black men who have sex with men and women - a potentially high-risk group for which there are few proven effective interventions. Therefore, it is important to develop interventions that target HIV-positive and negative BMSMW, particularly those who are non-gay identified and non-disclosing to their primary sexual partner, in order to effectively prevent the transmission of HIV disease. By elucidating the relationship between attachment, psychological well-being and sexual risk behavior among urban populations of Black MSMW, this study and the further research that will stem from it have great potential in contributing to the development of comprehensive, effective, multi-level (i.e., individual, couple, and setting level) interventions.