Understanding and Addressing Internalized Stigma and Shame as Barriers to Engagement in HIV Care among Men who Have Sex with Men who Use Substances.

背景资料。与NIDA和NIH的艾滋病毒优先事项一致，这个早期职业奖项旨在阐明 与药物使用和优化男性治疗成功相关的行为和社会机制 与从事次优护理的男性(MSM)发生性关系。内在化污名及其相关 情感，如羞耻感，是在全国范围内参与艾滋病毒护理的可修改的障碍 级联，这一理论表明，可能通过回避应对行为机械地发生，包括 物质使用。众所周知，与耻辱相关的情绪被低估了，因此改进了测量和 需要对这些途径进行评估，以便更具战略性地干预艾滋病毒护理的这些障碍。 研究。使用两个预先存在的数据集(n=313)，我将评估艾滋病毒护理之间的相互关系 级联指标(即护理中的联系和参与)、物质使用和与污名相关的情绪， 通过三种测量(最近验证的非语言行为编码、叙述性编码和自我- 报告)。我还将评估回避性应对是否会调节这些关系。然后我会进行聚焦 将此目标人群分组，并将获得的反馈与来自二级数据的结果一起使用 分析以告知先前开发的情绪调节干预措施的精细化(Pi Batchelder) 旨在改善使用HIV+MSM次优从事的物质对艾滋病毒护理的参与度 关心。然后，我将进行一项精细化干预的试点随机对照试验(RCT) 利用HIV+MSM次优从事HIV护理。该试验的结果数据将用于评估 提高艾滋病毒护理参与度和减少药物使用的临床效用。训练。解决以下方面的差距 在我的培训中，我将发展1)内容和方法方面的专业知识，以更好地理解相互关系 在艾滋病毒护理级联、药物使用和内在化污名及相关情绪之间，2)有针对性 高级统计，以及3)开发和进行使用HIV+MSM亚组物质的临床试验 最好地从事护理工作。师徒关系。为我的研究提供核心的补充专业知识 培训目标：Conall O‘Cleirigh博士是艾滋病毒相关干预措施制定和实施方面的专家 涉及MSM和约翰·凯利博士是物质使用治疗干预方面的专家。两人都曾指导过 K名获奖者已成功过渡到独立调查人员。咨询团队将提供 与培训目标有关的其他专门知识，包括艾滋病毒的医疗、情感科学、 污名、潜在变量建模和调解、包括EMA在内的高级随机对照研究统计，以及文本干预。 候选人。作为一名研究生和博士后研究员，我的工作很有成效，发表了20多篇论文(4 正在审查的其他手稿)。我作为首席调查员获得了两笔试点资金，这使我能够 开发和开展上述干预的公开试点。这款K23将针对目标 我的培训中的差距对我的研究议程和作为一名独立调查员的发展至关重要。

Background. Consistent with NIDA's and NIH's HIV priorities, this early career award aims to elucidate behavioral and social mechanisms associated with substance use and optimize treatment success among men who have sex with men (MSM) who are sub-optimally engaged in care. Internalized stigma and related emotions, such as shame, are under-addressed modifiable barriers to engagement in HIV care across the cascade, which theory indicates may mechanistically occur via avoidance coping behaviors, including substance use. As stigma-related emotions are notoriously under-reported, improved measurement and assessment of these pathways are needed to more strategically intervene on these barriers to HIV care. Research. Using two pre-existing datasets (n=313), I will assess the interrelationships between HIV care cascade indicators (i.e., linkage and engagement in care), substance use, and stigma-related emotions, informed by three measurements (recently validated nonverbal behavioral coding, narrative coding, and self- report). I will also assess whether avoidant coping mediates these relationships. I will then conduct focus groups with this target population, and use the obtained feedback with the results from the secondary data analysis to inform the refinement of a previously developed emotion regulation intervention (PI Batchelder) designed to improve engagement in HIV-care among substance using HIV+ MSM sub-optimally engaged in care. I will then conduct a pilot randomized controlled trial (RCT) of the refined intervention with substance using HIV+ MSM sub-optimally engaged in HIV care. Outcome data from this pilot will be used to assess the clinical utility for improving engagement in HIV care and reducing substance use. Training. To address gaps in my training, I will develop expertise in 1) content and methods to better understand the interrelationships between the HIV care cascade, substance use, and internalized stigma and related emotions, 2) targeted advanced statistics, and 3) developing and conducting clinical trials with substance using HIV+ MSM sub- optimally engaged in care. Mentorship. Providing complementary expertise central to my research and training goals, Dr. Conall O'Cleirigh is an expert in HIV-related intervention development and implementation involving MSM and Dr. John Kelly is an expert in substance use treatment interventions. Both have mentored K awardees that have successfully transitioned to independent investigators. The advisory team will provide additional expertise related to the training goals including the medical treatment of HIV, affective science, stigma, latent variable modeling and mediation, advanced RCT statistics including EMA, and text interventions. Candidate. I have been productive as a graduate student and postdoctoral fellow, with over 20 publications (4 additional manuscripts under review). I have received two pilot grants as principal investigator that enabled me to develop and conduct an open pilot of the aforementioned intervention. This K23 would address targeted gaps in my training that are crucial to my research agenda and development as an independent investigator.