Structural Influences on Methamphetamine Use among Black Gay and Bisexual Men in Atlanta

项目总结 新数据显示，在黑人同性恋、双性恋者和其他人中，甲基苯丙胺的使用量有所上升 男男性行为者(GBMSM)。冰毒与无数的身体和社会危害有关，并具有 有可能加剧影响黑人GBMSM的现有健康不平等。现有的冰毒预防和 治疗干预没有解决黑人GBMSM的独特社会地位或相关健康问题 结构性种族主义和歧视的影响(SRD)。根据我们的初步研究，我们假设 SRD的四种形式可能会影响黑人GBMSM中的冰毒使用：住房歧视、士绅化、 种族和收入隔离，以及歧视性的LGBT社区氛围。此外，我们假设这些 各种形式的SRD通过住房不稳定和服务机会不足来运作，增加了使用冰毒的风险 在黑色GBMSM中。这个项目的目标是产生知识，为设计多个 在黑人中防止冰毒使用和相关危害的水平和文化一致性的结构性方法 GBMSM。我们的研究将设在佐治亚州的亚特兰大--考虑到 对美国黑人、大量黑人GBMSM以及最近与SRD相关的文化意义 人口结构的变化。以风险环境框架为理论基础，本研究将 追求三个具体目标：(1)审查人口普查区域层面的SRD措施对住房的影响 亚特兰大黑人GBMSM的不稳定、服务准入和冰毒使用情况；(2)为引起对冰毒使用的叙述， 黑色GBMSM中的住房不稳定性、服务访问和SRD；以及(3)检查结构系统 影响和制定将各种形式的SRD、服务准入、住房和冰毒联系起来的定性因果关系图 在黑色GBMSM中使用。对于第一个目标，我们将招募N=300名黑色GBMSM进入纵向队列 研究，并在两年的随访期内每6个月进行一次系列调查。其他位置和 每月将利用生态瞬时评估技术获得冰毒使用数据。单项调查 答复将与地理位置的人口普查地区一级的可持续发展和服务准入措施挂钩。对于第二个 目的，我们将进行纵向的定性研究，包括深度访谈和行走的民族志 N=40名队列参与者，收集他们在SRD、住房、服务准入和 吸食冰毒。对于第三个目标，我们将使用基于社区的系统动力学方法来召集一个小组 与关键利益相关者(N=25)一起举办模型构建研讨会，这将直接导致因果关系的发展 将为结构性干预提供信息的地图。拟议的研究具有非常重要的意义，因为它 为预防使用冰毒和减少与冰毒有关的危害提供有效的结构性战略的可能性 在黑色GBMSM中。

PROJECT SUMMARY Emerging data demonstrates a rise in methamphetamine (meth) use among Black gay, bisexual and other men who have sex with men (GBMSM). Meth is associated with myriad physical and social harms, and has the potential to exacerbate existing health inequities impacting Black GBMSM. Existing meth prevention and treatment interventions do not address the unique social position of Black GBMSM or the related health impacts of structural racism and discrimination (SRD). Based on our preliminary studies, we hypothesize that four forms of SRD are likely to influence meth use among Black GBMSM: housing discrimination, gentrification, racial and income segregation, and discriminatory LGBT community climate. Additionally, we posit that these forms of SRD operate through housing instability and inadequate service access to increase risk for meth use among Black GBMSM. The goal of this project is to generate knowledge that will inform the design of multi- level, culturally congruent structural approaches to prevent meth use and associate harms among Black GBMSM. Our study will be based in Atlanta, Georgia – an ideal setting to examine these questions given the cultural significance for Black Americans, large population of Black GBMSM, and recent SRD-related demographic shifts. Drawing on the risk environment framework as its theoretical foundation, this study will pursue three specific aims: (1) to examine the impacts of census-tract level measures of SRD on housing instability, service access and meth use among Black GBMSM in Atlanta; (2) to elicit narratives of meth use, housing instability, service access and SRD among Black GBMSM; and (3) to examine systems of structural influence and develop qualitative causal maps linking various forms of SRD, service access, housing and meth use among Black GBMSM. For the first aim, we will recruit N=300 Black GBMSM into a longitudinal cohort study, and conduct serial surveys every 6 months over a two-year follow-up period. Additional location and meth use data will be obtained monthly using ecological momentary assessment technology. Individual survey responses will be linked to geolocated census-tract level measures of SRD and service access. For the second aim, we will conduct a longitudinal qualitative study including in-depth interviews and walking ethnographies with N=40 cohort participants, to gather insights on their experiences with SRD, housing, service access and meth use. For the third aim, we will use a community-based system dynamics approach to convene a group model building workshop with key stakeholders (N=25), which will lead directly to the development of causal maps that will inform structural interventions. The proposed research is highly significant because of its potential to inform effective structural strategies for preventing meth use and ameliorating meth-related harms among Black GBMSM.