Latinx MSM PrEP Disparities due to Immigration Stress and Drug Use Networks

项目摘要/摘要 背景：佛罗里达州迈阿密戴德县(MDC)是美国艾滋病毒发病率最高的地区。截至2017年6月，61% 在争取民主变革运动中，新诊断的艾滋病毒病例中有一半是拉丁裔；与男男性行为者的性接触 在拉丁裔男性中，男男性接触者(MSM)占新诊断艾滋病毒病例的92%。2017年被诊断为艾滋病毒携带者的拉丁裔 争取民主变革运动，85%是外国出生的。令人震惊的是，在MDC的拉丁裔MSM中，新的艾滋病毒诊断增加了% 自2010年以来。虽然PrEP在美国的使用率显著上升，但只有6%的Latinx MSM 参加了MDC的PrEP计划。同质性的社会网络理论可以解释为什么这些差异 如此积极地影响LMSM社区：LMSM友谊二人组在特征上的相似之处可能 影响社交网络的配置。反过来，这些网络配置会影响LMSM对 准备信息、沟通和提供者。这项F31训练计划的首要目标是 研究二元同质性的影响(基于原籍国、移民压力、拉丁裔文化价值观和 LMSM友谊网络内的PrEP信息以及提供者在地理上的可访问性。 F31培训计划的目的是提高我的研究技能，并为我的职业生涯提供经验 作为一名独立科学家，完全有资格在一所主要的研究型大学获得博士后职位。至 寻求F31奖学金，我得到了强大的赞助商团队和高级咨询委员会的支持 将在以下方面提供培训：1)针对艾滋病毒和药物使用之间相互交织的流行的临床研究 MSM；2)社交网络分析，以解决Latinx健康差距；3)全面以客户为中心和 响应文化的LMSM PrEP服务；以及4)使用地理信息系统的地理空间分析。研究内容：I Will 使用Mariano Kanamori博士(F31共同主要赞助商)项目PrEParados进行次要数据分析， 使用专门为该F31应用程序收集的数据(N=156个LMSM分组到12个友谊网络)。目标 1将确定同质性--基于原籍国、移民压力、拉丁裔文化价值观和 物质使用-在LMSM友谊中，二人之间与PrEP知识和沟通有关 网络。目标2将确定由于同质性对LMSM二联体的移民应激，Latinx的密度 文化价值，物质使用与地理可达性有关(步行、公共交通、 和驾驶；时间和距离)到可用的临床PrEP服务。中心假设是：1)存在 原籍国、移民压力、拉丁裔文化价值观和物质上的同质性之间的联系 使用以及社交LMSM社交网络的配置，以及2)该社交网络配置相关联 能够在网络内访问PrEP信息，并且PrEP提供商可以在地理上访问。重要意义： 这项F31研究的结果将引导临床试验的发展，以测试PrEP信息传播 在LMSM社交网络中实施的模型，以确定能够解决艾滋病毒差异的枢纽 在艾滋病毒热点地区有经验。

PROJECT SUMMARY/ABSTRACT Background: Miami-Dade County, FL (MDC) has the highest HIV incidence in the US. As of June 2017, 61% of new HIV diagnoses in MDC were attributed to Latinxs; and sexual contact with men who have sex with men (MSM) accounted for 92% of new HIV diagnoses among Latinx men. Of Latinxs diagnosed with HIV in 2017 in MDC, 85% were foreign-born. Alarmingly, new HIV diagnosis have increased 64% among Latinx MSM in MDC since 2010. While rates of PrEP usage in the US have significantly increased, only 6% of Latinx MSM were enrolled in a PrEP program in MDC. The Social Network Theory of Homophily can explain why these disparities impact LMSM communities so aggressively: similarities in characteristics between LMSM friendship dyads can impact the configuration of social networks. In turn, these network configurations can affect LMSM access to PrEP information, communication, and providers. The overarching goal of this F31 training program will be to study the effect of dyadic homophily (based on country of origin, immigration stress, Latinx cultural values, and substance use) on PrEP information within LMSM friendship networks and geographic accessibility to providers. The purpose of F31 training program is to sharpen my research skills and to provide the experiences for a career as an independent scientist well-qualified to obtain a postdoctoral position at a major research university. To pursue this F31 fellowship, I am supported by a strong team of Sponsors and a Senior Advisory Committee who will provide training in: 1) clinical research targeting the intertwining epidemics of HIV and substance use among MSM; 2) social network analysis to address Latinx health disparities; 3) comprehensive client-centered and culturally responsive LMSM PrEP services; and 4) geospatial analysis using GIS. Research component: I will conduct secondary data analyses using Dr. Mariano Kanamori’s (F31 Co-Primary Sponsor) project, PrEParados, with data specifically collected for this F31 application (N=156 LMSM grouped into 12 friendship networks). Aim 1 will determine whether homophily—based on country of origin, immigration stress, Latinx cultural values, and substance use—between dyads is associated with PrEP knowledge and communication within LMSM friendship networks. Aim 2 will determine whether the density due to homophily on LMSM dyads’ immigration stress, Latinx cultural values, and substance use is associated with geographic accessibility (walking, public transportation, and driving; times and distances) to available clinical PrEP services. The central hypotheses are that 1) there is an association between homophily on country of origin, immigration stress, Latinx cultural values, and substance use, and the configuration of social LMSM social networks, and 2) this social network configuration is associated with access to PrEP information within networks and geographic accessibility to PrEP providers. Significance: Findings of this F31 study will lead the development of a clinical trial to test a PrEP information dissemination model implemented within LMSM social networks to identify hubs capable of addressing HIV disparities experienced in HIV hotspots.