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个是非裔美国人。最近有大量的学术和流行文献都涉及与男性和女性发生性行为的黑人男性传播艾滋病毒（BMSMW）。然而，BMSMW人群的心理健康状况、认知、动机以及可能的艾滋病毒性传播保护因素相对未知。了解艾滋病毒在非裔美国人社区中的性传播方式对于制定有关解决艾滋病毒在非裔美国人社区传播的规划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，不安全的依恋类型与性风险行为的增加和心理健康的下降（例如，更多的抑郁）有关。这些研究主要是在异性恋参与者中进行的，而忽略了包括性少数群体。了解依恋类型与性行为和心理健康之间的关系可以帮助卫生界的许多方面（例如，咨询、公共卫生、社会工作等）为那些可能面临更高传播风险的人量身定制艾滋病毒预防工作。目的：本研究是一项探索性研究，主要有两个目的：1)描述黑人女青年的每周压力、抑郁和性危险行为水平；2)采用混合方法，了解黑人女青年依恋类型、压力、抑郁和性危险行为之间的关系。方法：80名BMSMW完成为期12周的在线结构化日记。日记将包括抑郁清单、压力清单、成人依恋清单和性行为问题。从80名原始样本中抽取12名男性进行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：成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。一个扎根的理论方法将被用来分析定性访谈。我在这个申请中提出的培训计划，不仅可以培养我进行论文研究的定量和定性研究方法技能，还可以帮助我获得成为一名学术研究者所必需的学术专业技能。

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.