HIV Risk Behavior and Drug Use Over Time: Syndemic Production in High Risk Youth

超过2500万人死于艾滋病，使其成为历史上最大的公共卫生危机之一。全世界有3300多万艾滋病毒感染者。大多数新的艾滋病毒病例发生在25岁之前，并且发生在边缘化人群中。“综合征”理论假定，多种新出现和汇合的心理社会流行病是导致艾滋病毒传播的驱动机制。我们建议，一个发展的解释和应用的syndemics理论是必要的，以解释艾滋病毒的风险。性少数青年（支持某种程度的同性吸引力，行为和/或身份的青年）是一个理想的人群，可以用作测试syndemic过程纵向发展的模型。性少数青年被高度边缘化，了解甚少，服务严重不足。他们经历了流行病程度的多种心理社会问题，这些问题被认为是流行病效应的核心组成部分。与异性恋青年相比，性少数青年使用毒品的可能性高出5倍，受害的可能性高出7倍，有心理健康问题的可能性高出6倍，从事艾滋病毒危险行为的可能性高出5倍。然而，由于文化和方法上的障碍，很少对性少数青年进行纵向研究。本研究项目的总体目标是在对性少数青年和异性恋青年的匹配对照组的纵向研究中检查物质使用和艾滋病毒风险行为。由于所提出的方法和理论的许多重要特点，这将是第一次青年研究。这些功能包括：（A）纵向、准实验设计，（B）评估青少年物质使用和危险性行为随时间的个体增长或变化，（C）检查物质使用和危险性行为风险的中介和调节因素，（D）确定与这些多种新兴流行病的汇合有关的风险和保护因素，以及它们如何导致艾滋病毒/艾滋病。该项目的成果将产生大量关于这一高度脆弱和边缘化群体健康问题发展情况的信息。他们将提供实证支持的发展解释和应用的综合征框架。它们将作为一个模型，用于了解在边缘化人群中如何出现并发症过程，以增加艾滋病毒/艾滋病的风险。 公共卫生相关性：这项研究的主要目标是确定关键的风险和保护因素，以帮助预防艾滋病毒在高危、边缘化青年中传播。越来越多的证据表明，青春期会出现多种心理社会健康问题，这些问题相互交织，导致人们容易感染艾滋病毒/艾滋病。这一纵向研究将确定：（A）这些心理社会健康问题是什么，（B）它们如何以及何时出现，（C）它们如何以及何时汇集在一起导致青年人中的艾滋病毒传播。

DESCRIPTION (provided by applicant): Over 25 million people have died of AIDS, making it one of the largest public health crises in history. There are over 33 million people with HIV world-wide. The majority of new HIV cases occur before age 25, and within marginalized populations. "Syndemics" theory postulates that multiple emerging and converging psychosocial epidemics are the driving mechanisms that cause HIV transmission. We are proposing that a developmental interpretation and application of syndemics theory is needed in order to explain HIV risk. Sexual minority youth (youth who endorse some level of same-sex attraction, behavior, and/or identity) are an ideal population to use as a model for testing the longitudinal development of syndemic processes. Sexual minority youth are highly marginalized, poorly understood, and severely underserved. They experience multiple psychosocial problems of epidemic proportions that are considered the core components of the syndemic effect. Compared with heterosexual youth, sexual minority youth are up to 5 times more likely to use drugs, 7 times more likely to be victimized, 6 times more likely to have mental health problems, and 5 times more likely to engage in HIV risk behavior. Yet longitudinal studies with sexual minority youth have rarely been conducted due to a host of cultural and methodological barriers. The overarching goal of this research project is to examine substance use and HIV risk behaviors in a longitudinal study of sexual minority youth and a matched comparison group of heterosexual youth. Due to the many important features of the proposed methodology and theory, this will be the first youth study of its kind. These features include the: (A) longitudinal, quasi-experimental design, (B) evaluation of individual growth or change in adolescent substance use and risky sexual behaviors over time, (C) examination of mediators and moderators of risk for substance use and risky sexual behavior, and (D) identification of risk and protective factors associated with the convergence of these multiple emerging epidemics and how they lead to HIV/AIDS. Results from this project will generate a wealth of information about the development of health problems among this highly vulnerable and marginalized group. They will provide empirical support for a developmental interpretation and application of the syndemics framework. And they will serve as a model for understanding how syndemic processes unfold in marginalized populations to raise risk for HIV/AIDS. PUBLIC HEALTH RELEVANCE: The primary goal of this study is to identify critical risk and protective factors to help prevent HIV transmission among high-risk, marginalized youth. A growing body of evidence shows that multiple psychosocial health problems emerge in adolescence and intertwine to produce vulnerability to HIV/AIDS. This longitudinal study will determine: (A) what those psychosocial health problems are, (B) how and when they emerge, and (C) how and when they converge to cause HIV transmission in young people.