Jamaica CARES Project: Connecting HIV/AIDS Resources to Engage Jamaican Sexual and Gender Minorities

项目摘要/摘要 年，牙买加的艾滋病毒/艾滋病在性和性别少数群体中的流行是加勒比地区最严重的。 关于其广度和后果的条款。据估计，男男性行为者中艾滋病毒的感染率为 在变性女性中分别为33%和51%，显著高于一般情况下的1.8% 人口。跨界别的污名(通常与不同的身份有关)和暴力是贫穷的主要驱动因素 心理健康和艾滋病毒护理参与度，导致更高的抑郁、焦虑和低病毒感染率 抑制(21%)。拟议研究的目标是1)获得和了解影响和 跨部门污名和暴力影响心理健康和参与艾滋病毒护理的机制； 和2)完善我们的概念框架，以帮助制定有助于性和性别的干预发展 少数群体从事艾滋病毒护理。应聘者：我是一名护士科学家，有健康行为背景 艾滋病毒背景下的变化理论和健康的社会决定因素。我正在申请一份K23职业 发展奖，以获得培训、指导和研究经验，成为专家和 以理论为基础的独立调查者，行为干预设计，以改善性行为和健康 加勒比和其他资源匮乏地区的性别少数群体。指导：我已经整理了一份 杰出的指导团队，在跨部门污名测量研究方面拥有丰富的经验， 在像牙买加这样的资源有限的环境中，卫生以及艾滋病毒的治疗和预防。Sheri Weiser博士和 Carol Dawson-Rose将担任联合小学导师，并带来艾滋病毒治疗和治疗方面的互补专业知识 预防、创伤、概念模型框架改进以及制定和实施 资源有限环境下的行为干预。我的合作导师、科学顾问和合作者 我的团队带来了特定的内容和方法专业知识，总部设在美国和 牙买加，包括：Mallory Johnson博士(临床心理学家，干预设计和评估；可行性 实施，艺术坚持)；Tor Neilands博士(心理学，量化方法，设计和分析 纵向数据)；Sharlene Jarrett博士(牙买加的临床心理学家、心理健康和艾滋病毒治疗 背景)；Carmen Logie(临床社会工作者，交叉和混合方法研究)；Jae Sevelius博士 (临床心理学家、交叉污名测量、认知访谈和性别肯定)； 安妮塔·斯图尔特(心理学家，测量适应和测试专家)和马克·帕迪拉博士(医学 人类学家、加勒比海性学研究人员)。培训：我建议接受收购方面的培训 交叉污名测量的基础知识(适应和测试)，高级定量 培训以收集和分析技能，并获得开发、试验和评估艾滋病毒的专业知识 行为干预。培训将通过辅导会议、课程作业、研讨会、 在牙买加指导直接阅读和初步研究。研究：拟议研究的目标是 1)确定跨部门污名、暴力、心理健康和艾滋病毒护理参与之间的途径 在牙买加感染艾滋病毒的性少数群体和性别少数群体中；2)制定和编制多层次的 针对跨部门污名、暴力和糟糕的精神健康问题的干预措施，以优化艾滋病毒 牙买加感染艾滋病毒的性少数群体和性别少数群体的护理参与；以及3)试点测试多- 性和性别少数艾滋病毒携带者及其家属可接受性和可行性的水平干预 医疗保健提供者。我们将计划在计划于年内提交的R01版本中对干预进行全面测试 5.摘要：卫生部最近宣布结束艾滋病毒流行(ETH)，并处于可持续发展之下 联合国艾滋病毒/艾滋病规划署的发展目标3突出表明迫切需要研究 解决SGM和其他关键人群之间的差异，以寻求到2030年在全球遏制艾滋病毒感染。 拟议的研究和培训活动将使我能够进行创新的、有影响力的研究，以 解决在资源匮乏的环境中感染艾滋病毒的性别歧视、暴力和心理健康问题 以提高艾滋病毒治疗参与度。

PROJECT SUMMARY/ABSTRACT Jamaica’s HIV/AIDS epidemic among sexual and gender minorities is the most severe in the Caribbean in terms of its breadth and consequences. HIV prevalence among men who have sex with men is estimated at 33% and 51% among transgender women, which is significantly higher than the 1.8% observe in the general population. Intersectional stigma (often related to intersecting identities) and violence are key drivers of poor mental health and HIV care engagement, leading to higher rates of depression, anxiety, and low viral suppression (21%). The goals of the proposed research are to 1) gain and understanding of the influences and mechanisms by which intersectional stigma and violence impact mental health and engagement in HIV care; and 2) refine our conceptual framework to aid in intervention development that assists sexual and gender minorities to engage in HIV care. Candidate: I am a nurse-scientist with a background in health behavior change theory and social determinants of health in the context of HIV. I am applying for a K23 Career Development Award to obtain training, mentorship, and research experience to become an expert and independent investigator in theory-based, behavioral intervention design to improve the health of sexual and gender minorities in the Caribbean and in other low-resource settings. Mentoring: I have put together an exceptional mentoring team with extensive experience in intersectional stigma measurement research, mental health, and HIV treatment and prevention in resource-limited settings like Jamaica. Drs. Sheri Weiser and Carol Dawson-Rose will serve as co-Primary mentors and bring complementary expertise in HIV treatment and prevention, trauma, conceptual model framework refinement, and development and implementation of behavioral interventions in resource-limited settings. My co-mentors, scientific advisor, and collaborator round out my team to bring specific content and methods expertise and are based both in the United States and Jamaica, including: Dr. Mallory Johnson (clinical psychologist, intervention design and evaluation; feasibility implementation, ART adherence); Dr. Tor Neilands (psychology, quantitative methods, design and analysis of longitudinal data); Dr. Sharlene Jarrett (clinical psychologist, mental health and HIV treatment in the Jamaican context); Carmen Logie (clinical social worker, intersectionality and mixed methods research); Dr. Jae Sevelius (clinical psychologist, intersectional stigma measurements, cognitive interviewing, and gender affirmation); Dr. Anita Stewart (psychologist, measurement adaptation and testing expert); and Dr. Mark Padilla (medical anthropologist, Caribbean sexualities researcher). Training: I propose to obtain training in acquiring foundational knowledge in measures of intersectional stigma (adaptation and testing), advanced quantitative training to collect and analysis skills, and to attain expertise in developing, piloting, and evaluating HIV behavioral interventions. Training will be achieved through mentoring meetings, coursework, workshops, mentored direct readings and primary research in Jamaica. Research: The goals of the proposed research are to 1) identify the pathways between intersectional stigma, violence, mental health and HIV care engagement among Jamaican sexual and gender minorities living with HIV; 2) develop and manualize a multi-level intervention that addresses intersectional stigma, violence, and poor mental health in order to optimize HIV care engagement among Jamaican sexual and gender minorities living with HIV; and 3) pilot test the multi- level intervention for acceptability and feasibility among sexual and gender minorities living with HIV and their healthcare provider. We will plan for a full-scale testing of the intervention in a planned R01 submission in year 5. Summary: The recently announced Ending the HIV Epidemic (EtHE) by the DHHS and under Sustainable Development Goal 3 of the United Nations Program on HIV/AIDS highlight the pressing need for research to address disparities among SGM and other key populations in the quest to halt HIV infections globally by 2030. The proposed research and training activities will position me to conduct innovative, high-impact research to address intersectional stigma, violence and mental health among SGM living with HIV in low-resource settings to improve HIV treatment engagement.