Synergistic epidemics of non-communicable diseases, stigma, depression, and material insecurities among sexual and gender minorities living with HIV in Nigeria

项目摘要 全球艾滋病毒相关非传染性疾病(HIVNCD)的负担越来越大，这些疾病往往 在长期面临社会和经济不平等的人群中聚集。这样的人群中有一个是性的 和性别少数群体(SGM)，对他们来说，歧视造成的压力会导致更差的健康结果。 SYDEMIC框架已经被用来解释SGM人群中艾滋病毒风险的增加，但只有 最近被应用于HIVNCD的研究。身为SGM与真实的和感知到的歧视有关 和污名化。因此，SGM经历了更高水平的受害者，包括亲密伴侣 暴力(IPV)以及随之而来的压力、抑郁、使用多种物质和物质不安全。这些因素 是SGM连续护理过程中脱离接触的有充分证据的风险因素。有一个关键的问题 然而，开发可修改的干预策略的知识差距，关于这些 共同因素导致HIVNCD的疾病聚集，并促进进一步的不平等和脆弱性 低收入和中等收入国家(LMIC)，在这些国家，艾滋病毒流行率和社会/经济障碍 获得医疗保健的比例非常高。在尼日利亚，马里兰大学、约翰·霍普金斯大学 大学和美国军方艾滋病毒研究计划自2012年以来一直与SGM合作，SGM中70%的人 TRUST/RV368的研究(84%的男性与男性发生性关系，16%的人自认为是女性)经历了 与歧视性政策和导致回避的社会规范有关的中度至严重耻辱 爱滋病护理中心。在这项建议之前，我们进行了横断面初步分析，认为 耻辱和抑郁与一系列心脏代谢风险因素有关。建议的工作构建 关于TRUST/RV368研究，撒哈拉以南非洲(SSA)最大的SGM队列，并汇集了一个 多学科研究团队：1)检查共同因素与HIVNCD之间的联系 结果；2)评估社区层面和结构层面的因素是否以及如何加剧总体情况； 以及3)确定以HIVNCD患病率和预后为特征的综合征是否相关 有脱离HIVNCD连续护理的风险。

PROJECT ABSTRACT There is an increasing burden of HIV-associated noncommunicable diseases (HIVNCD) globally, which often cluster among populations facing persistent social and economic inequalities. One such population is sexual and gender minorities (SGM), for whom stress resulting from discrimination leads to poorer health outcomes. Syndemic frameworks have been utilized to explain elevated HIV risk in SGM populations but have only recently been applied to study HIVNCD. Being an SGM is associated with real and perceived discrimination and stigmatization. As a result, SGM experience elevated levels of victimization including intimate partner violence (IPV) and subsequently, stress, depression, polysubstance use, and material insecurity. These factors are well-documented risk factors for disengagement in the continuum of care among SGM. There is a critical knowledge gap for the development of modifiable intervention strategies, however, regarding how these syndemic factors leads to disease clustering of HIVNCD and promotes further inequities and vulnerabilities in low- and middle-income countries (LMIC) where both HIV prevalence and social/economic barriers to accessing health care are remarkably high. In Nigeria, where the University of Maryland, the Johns Hopkins University, and the U.S. Military HIV Research Program have worked with SGM since 2012, 70% of SGM in the TRUST/RV368 study (84% men who have sex with men and 16% self-identified as women) experience a moderate-to-severe level of stigma related to discriminatory policies, and social norms that leads to avoidance of HIV care. Prior to this proposal, we conducted a cross-sectional preliminary analysis, which suggested that stigma and depression are associated with clusters of cardiometabolic risk factors. The proposed work builds on the TRUST/RV368 study, the largest cohort of SGM in sub-Saharan Africa (SSA) and brings together a multidisciplinary team of researchers to: 1) Examine association between syndemic factors and HIVNCD outcomes; 2) Assess whether and how community-level and structural-level factors exacerbate the syndemic; and 3) Determine whether the syndemic characterized for HIVNCD prevalence and outcomes is associated with risk of disengaging from HIVNCD care continua.