YMSM Drug Use, Sexual Risk & Health Promoting Behaviors

尽管在减少男同性恋者参与与艾滋病毒风险有关的性行为和减少这一人群中新感染的发生率方面取得了重大进展，但在减少年轻男同性恋者感染艾滋病毒的风险方面进展甚微。预防努力失败的部分原因是，我们对广泛的个人、家庭、社会和社区特征的理解存在重大差距，这些特征既是个人的，也是集体的，影响年轻的同性恋和双性恋男性从事风险和保护因素。洛杉矶儿童医院以我们自己对年轻男同性恋者和双性恋者以及其他高危青年的研究为基础，提议进行理论驱动(即社会生态模型) 在个人经历(例如，性认同和出柜经历；种族/民族认同)和家庭(例如，家庭组成和环境；家庭支持/拒绝)的背景下，对年轻男同性恋者和双性恋者使用毒品和参与艾滋病毒风险和保护行为进行纵向研究，这将在青年的人际关系(例如，亲密关系的数量和性质；同伴关系和融合；同伴支持)和社区背景(例如，与居住社区、种族/民族社区的融合和联系；宗教组织；学校；工作场所；同性恋社区；和社会服务机构)。拟议的研究将包括两个阶段的研究。在第一阶段，将进行形成的人种学研究，以进一步描述感兴趣的结构以及这些结构与拟议的从属变量或结果变量之间的拟议关系，并完善和/或调整适合目标人群使用的现有调查工具。在第二阶段，纵向流行病学研究将通过跟踪880名年龄在18至22岁的不同种族的年轻同性恋和双性恋男性组成的队列进行，持续30个月(基线时，然后是基线后的6、12、18、24和30个月)；受试者将使用基于地点的概率抽样设计，按种族/民族城市和代际地位进行分层。还将对从更大的队列中招募的200名受试者进行纵向人种学研究；数据收集将在基线、12个月和24个月进行。

Despite significant advances made in reducing gay men's involvement in HIV risk-related sexual behaviors and the incidence of new infection in this population, there has been little progress made in reducing young gay men's risk for HIV infection. Prevention efforts have in part failed because significant gaps exist in our understanding of the broad array of individual, familial, social, and community characteristics that both individually and collectively influence young gay and bisexual males to engage in both risk and protective factors. Building on our own research with young gay and bisexual men, as well as other high risk youth, Childrens Hospital Los Angeles is proposing to conduct theory-driven (i.e., the social ecological model) longitudinal research to examine young gay and bisexual males' use of drugs and involvement in HIV risk and protective behaviors in the context of individual experiences (e.g., sexual identity and coming out experience; racial/ethnic identity) and the family (e.g., family composition and environment; familial support/rejection), which in turn will be examined in the context of the youth's interpersonal relationships (e.g., number and nature of intimate relationships; peer ties and integration; peer support), and community contexts (e.g., integration and linkage with community of residence, racial/ethnic community; religious organizations; school; workplace; the gay community; and social service agencies). The proposed study will involve two phases of research. During Phase 1, formative ethnographic research will be conducted to further characterize and contextualize the constructs of interest and the proposed relationship between these constructs and the proposed dependent or outcome variables, and refine and/or adapt existing survey instruments that are appropriate for use with the target population. During Phase 2, longitudinal epidemiologic research will be conducted by following a cohort of 880 ethnically diverse young gay and bisexual males, ages 18 to 22, for 30 months (at baseline and then at 6, 12, 18, 24, and 30 months following baseline); subjects will be recruited using a venue-based probability sampling design, stratefied by race/ethncity and generational status. Longitudinal ethnographic research will also be conducted with a subset of 200 subjects recruited from the larger cohort; data collection will occur at baseline, 12 and 24 months.