Family influences on HIV-related sexual risk of young men who have sex with men

描述(由申请人提供)：男男性行为者(YMSM)青年受到当前艾滋病毒流行的严重影响。虽然通过所有其他艾滋病毒传播类别的发病率最近保持稳定或下降，但导致艾滋病毒感染的男性与男性之间的性接触继续增加，特别是在年轻男子中。艾滋病毒在基督教青年会人群中的流行率高得令人震惊(以前估计15-22岁的青年会感染率为7%)，但还没有为23岁以下的男男性同性恋者制定有效的干预措施来减少危险行为。 YMSM的父母已被确定为该人群中未来减少风险干预的未充分利用的资源，但我们几乎不知道父母对YMSM性行为的影响。对一般青少年样本的研究表明，父母对青少年的性行为有重大影响。父母监督、父母对青少年性行为的反对、家庭联系和亲子沟通与青少年的性行为相关，包括避孕套的使用、性行为频率、性伴侣数量和首次性行为。目前尚不清楚这些发现是否适用于青年男性同性恋者与艾滋病毒相关的性行为。先前有限的证据表明，家庭联系可能对YMSM中的性危险行为具有保护作用，但监测、反对或沟通的影响尚未在YMSM中进行检验。此外，当孩子是同性恋时，发生的独特的父母-青少年动态，包括出柜和父母对性取向的拒绝，可能会改变先前确立的家庭因素影响YMSM风险的方式。 鉴于家庭因素在确定艾滋病毒相关性行为中的重要性，本研究的目的有三：1)使用一项大型全国性研究的数据，确定哪些成熟的青春期性风险家庭预测因素也预测YMSM和同性恋或双性恋青年男性的风险；2)通过定性方法确定在孩子是同性恋或双性恋的家庭环境中可以预测风险的独特家庭因素；以及3)测试新的以家庭为重点的YMSM性风险行为模型，该模型结合了以前建立的和新确定的与家庭相关的预测因素。这项拟议的研究结果可以通过提高关于如何最有效地将父母纳入预防工作的知识，显着改善未来针对YMSM的艾滋病毒预防干预措施。 这些目标旨在通过一项研究培训计划来实现，该计划的重点是发展艾滋病毒预防科学、先进的混合方法统计方法以及家庭因素和青少年健康等领域的专门知识。拟议的培训计划包括完成一些具体的课程，密切监督和个性化指导，与教职员工进行多学科合作，科学写作和演示经验，以及与家庭和艾滋病毒阳性个人实践临床工作。

DESCRIPTION (provided by applicant): Young men who have sex with men (YMSM) are severely affected by the current HIV epidemic. While incidence via all other HIV transmission categories has recently remained stable or decreased, male-to-male sexual contact resulting in HIV infection continues to increase, particularly among young men. HIV prevalence is alarmingly high within the YMSM population (previously estimated at 7% for YMSM ages 15 - 22), but no effective interventions to reduce risk behaviors have been developed for MSM under 23. Parents of YMSM have been identified as an underutilized resource for future risk-reduction interventions within this population, but we know virtually nothing about parental influences on sexual behavior among YMSM. Studies of general adolescent samples reveal that parents have a significant influence on the sexual behaviors of their adolescents. Parental monitoring, parent disapproval of teen sex, family connectedness, and parent-child communication are associated with adolescents' sexual behaviors, including condom use, sex frequency, number of sex partners, and sexual debut. Whether these findings generalize to HIV-related sexual risk behaviors of YMSM is unclear. Limited previous evidence suggests that family connectedness may be protective against sexual risk behaviors among YMSM, but the influences of monitoring, disapproval, or communication have not been examined among YMSM. Moreover, the unique parent-adolescent dynamics that occur when a child is gay, including coming out and parent rejection of sexual orientation, could alter the ways in which previously established family factors influence risk among YMSM. Given the importance of family factors in determining HIV-related sexual risk behaviors, the aims of the current study are threefold: 1) to use data from a large national study to determine which well-established family predictors of adolescent sexual risk also predict risk among YMSM and gay or bisexual young men; 2) to identify through qualitative methods the unique family factors that could predict risk within a family environment where a child is gay or bisexual and 3) to test new family-focused models of YMSM sexual risk behaviors that combine both previously established and newly identified family-relevant predictors. The results of the proposed study could significantly improve future HIV prevention interventions targeting YMSM by advancing knowledge of how to most effectively incorporate parents into prevention efforts. These goals aim to be accomplished within the context of a research training plan focused on developing expertise in the areas of HIV prevention science, advanced mixed-method statistical approaches, and family factors and adolescent health. The training plan proposed includes completion of a number of specific courses, close supervision and individualized mentoring, multidisciplinary collaborations with faculty members, scientific writing and presentation experience, and hands-on clinical work with families and HIV positive individuals.