PS11-003 Minority AIDS Research Initiative

描述（由申请人提供）：健康差异的病因涉及一系列复杂的因素，这些因素相互作用，对社会的特定阶层产生有害的健康结果。在美国，目前人类免疫缺陷病毒（HIV）的情况继续受到病例分布差异的影响，因为非洲裔美国人（AA）比任何其他种族/族裔群体占更多的新HIV病例和HIV相关死亡。重要的是，有更多的新的艾滋病毒感染（52%）的年轻AA男性与男性发生性关系（MSM;年龄13-29岁）比任何其他种族/民族性取向/行为组。最近的研究发现，地理和邻里环境（环境广泛理解为包括物理和社会属性）与性行为和艾滋病毒的流行和发病率有关。虽然地理和邻里环境在艾滋病毒中的可能作用经常被强调，但对环境因素的严格调查很少。部分原因是艾滋病毒感染者的住址信息具有敏感性，而且难以确定和描述相关的社会和物质环境。 艾滋病毒的地理和邻里研究（GANSH）的总体目标是研究地理空间和邻里环境特征和心理社会因素之间的关联和流行的艾滋病毒/性传播感染的AA男男性接触者在杰克逊，MS大都市统计区（杰克逊MSA）。本研究采用多层次的横断面设计来检验这些关联。非线性（即，将使用具有随机邻域截距和随机协变量效应的多水平模型来检查地理和邻域特征与艾滋病毒/性传播感染状况测量之间的关系。将使用经验贝叶斯和地理信息系统方法来估计和绘制特定地区艾滋病毒的相对风险以及行为和心理社会因素与艾滋病毒/性传播感染状况之间的关联的空间分布。 据我们所知，这是第一项研究，以探讨地理空间和邻里特征和社会心理因素和流行的艾滋病毒/性病在AA男男性接触者之间的关联。拟议的研究将为一系列具有公共卫生重要性的问题提供答案，并对疾病预防产生直接影响。此外，拟议研究的结果可能会改变现有艾滋病毒/性传播感染干预措施和/或预防研究的方法/理论概念。 公共卫生相关性：艾滋病毒/性传播感染研究传统上侧重于个人层面的风险因素，如行为，最近则侧重于社会文化因素。地理和邻里对艾滋病毒的影响研究的概念框架以社会生态模型为基础，该模型综合了个人、关系、社区和社会层面因素之间复杂的相互作用，并考虑到个人经历或增加艾滋病毒/性传播感染风险的多个层面因素。本研究的结果将为了解AA MSM中的HIV/STI风险和确定疾病预防的高风险区域提供关键信息。

DESCRIPTION (provided by applicant): The etiology of health disparities involves a complex web of factors that interact to produce detrimental health outcomes for particular segments of society. In the United States, the current landscape of human immunodeficiency virus (HIV) continues to be shaped by disparities in case distribution, as African Americans (AA) account for more new HIV cases and HIV related deaths than any other racial/ethnic group. Importantly, there were more new HIV infections (52%) among young AA men who have sex with men (MSM; aged 13-29 years) than any other racial/ethnic-sexual orientation/behavior group. Recent studies have found that geographical and neighborhood environments (with environment broadly understood to encompass both physical and social attributes) are associated with sexual behavior and HIV prevalence and incidence. Although the possible role of geographic and neighborhood contexts in HIV has often been emphasized, rigorous investigations of environmental factors are rare. This is due, in part, to the sensitive nature of residential address information of HIV-infected persons and difficulties in identifying and characterizing the relevant social and physical environments. The overall aim of the Geographic and Neighborhood Study of HIV (GANSH) is to examine the associations between geospatial and neighborhood environmental characteristics and psychosocial factors and prevalent HIV/STI among AA MSM in the Jackson, MS metropolitan statistical area (Jackson MSA). The proposed study uses a cross-sectional, multi- level design to examine these associations. Non-linear (i.e., a dichotomized outcome variables) relationships between geographic and neighborhood characteristics and measures of HIV/STI status will be examined using multi-level models with a random neighborhood intercept and random covariate effects. Empirical Bayes and Geographic Information Systems (GIS) methods will be used to estimate and map the area-specific relative risk of HIV as well as the spatial distribution of the associations between behavioral and psychosocial factors and HIV/STI status. To our knowledge, this is the first study to examine the associations between geospatial and neighborhood characteristics and psychosocial factors and prevalent HIV/STI in AA MSM. The proposed research will provide answers to a wide range of questions of public health importance with direct implications for disease prevention. Moreover, results from the proposed study may change the methodological/theoretical concepts of existing HIV/STI interventions and/or prevention research. PUBLIC HEALTH RELEVANCE: HIV/STI research has traditionally focused on individual-level risk factors such as behaviors, and more recently, socio-cultural factors. The conceptual framework for the Geographic and Neighborhood Effects on HIV Study is based on the socio-ecological model, which integrates the complex interaction between individual, relationship, community, and society-level factors and allows for the consideration of factors at multiple levels in an individual's risk for experiencing or increasing HIV/STI risk. Results from this study will provide critical information in the understanding of HIV/STI risk among AA MSM and identification of high-risk areas to target for disease prevention.