PrEP and substance use among sexual minority young adults

本申请要求为新/早期研究者提供研究独立性方面的支持和培训， 开展艾滋病毒和药物使用预防研究。PI和导师团队将探索性别认同， 性身份披露和少数民族的压力，因为它涉及接触前预防（PrEP）与护理的联系 和物质使用的经验，非洲裔美国人和西班牙裔/拉丁美洲年轻男子谁发生性关系， 男性（AA/HL YMSM）。物质使用加剧了艾滋病毒的风险，并破坏了PrEP护理的连续性。这 该提案的重点是AA/HL YMSM，因为这些人群中HIV感染的发病率很高 以及不成比例的高药物使用率。PrEP是应对艾滋病毒流行病的关键方法， 但在艾滋病高危人群中，感染率是不平等的。此外，PI发现， 在性少数青年男同性恋者中，药物使用正在增加。研究在很大程度上没有考虑到 人际，社区和社会因素，阻碍PrEP吸收和加剧物质使用 AA/HL YMSM。提出了一个强有力的培训计划，其中包括三个核心领域的技能发展：（1）艾滋病毒- 相关干预措施的发展;（2）定性方法，以深入了解的观点和 少数群体使用药物的经验;以及（3）艾滋病毒预防、问题药物 使用和少数人的压力。该计划涉及一个由六名艾滋病毒和药物使用预防人员组成的辅导小组 学者，个性化培训，课程和专业会议。职业目标包括 随后的R 01申请和在艾滋病毒和药物使用方面建立一个以性为重点的利基市场 预防职业发展将在康涅狄格大学与领先的 新英格兰的机构和中心。基于我们的初步工作，我们提出了三项研究，探讨 性身份和披露在PrEP和PrEP护理中的物质使用经历中的作用 连续体我们将讨论三个具体目标。具体目标1：通过少数压力模型，评估 在全国队列中YMSM的PrEP摄取和物质使用。我们将收集新的国家数据 （N = 3，000名18至29岁的AA/HL YMSM），以评估人际、社区和社会 影响PrEP摄取和物质使用的因素。具体目标2：为YMSM定义PrEP护理连续体， 不使用药物（目标1）。我们将通过四项每两年一次的随访调查（N = 300）进行研究， 从艾滋病毒高发病率地区的参与者那里获得的资金。具体目标3：进行半结构化面试 在YMSM中进行未来性行为知情的PrEP/SU干预（N = 30）。多个障碍之间的关系 物质使用和PrEP摄取将被探索。此外，使用ADAPT-ITT模型并基于 以前的研究结果，我们将确定当前干预措施中可以修改的特征， 适用于针对YMSM的预防计划。该项目有可能系统地解决 在侧重于高艾滋病毒感染率和药物使用率的干预措施中，对性行为缺乏关注。

This application requests support and training for a New/Early Stage Investigator in research independence to conduct HIV and substance use prevention research. The PI and mentorship team will explore sexual identity, sexual identity disclosure, and minority stress as it relates to pre-exposure prophylaxis (PrEP) linkage to care and substance use experiences among African American and Hispanic/Latino young men who have sex with men (AA/HL YMSM). Substance use compounds HIV risk and disrupts the PrEP care continuum. This proposal is focused on AA/HL YMSM because of the high incidence of HIV infection among these populations and disproportionately high rates of substance use. PrEP is a key approach to addressing the HIV epidemic, but uptake is unequal across populations at elevated risk for HIV. Furthermore, the PI has found that rates of substance use are increasing among sexual minority YMSM. Research has largely failed to consider the role of interpersonal, community, and societal factors that thwart PrEP uptake and exacerbate substance use among AA/HL YMSM. A robust training plan is proposed that includes three core areas for skill development: (1) HIV- related intervention development; (2) qualitative methods to gain in-depth understanding of perspectives and experiences of minorities with substance use; and (3) content expertise in HIV prevention, problem substance use, and minority stress. The plan involves a mentorship team of six HIV and substance use prevention scholars, individualized trainings, coursework, and professional conferences. Career goals include a subsequent R01 application and the creation of a sexuality-focused niche in HIV and substance use prevention. Career development will take place at the University of Connecticut in collaboration with leading institutions and centers in New England. Based on our preliminary work, we propose three studies that explore the role of sexual identity and disclosure in PrEP and substance use experiences across the PrEP care continuum. We will address three specific aims. Specific Aim 1: Informed by a minority stress model, evaluate PrEP uptake and substance use among YMSM in a national cohort. We will collect new national data (N = 3,000 18 to 29-year-old AA/HL YMSM) to evaluate how diverse interpersonal, community, and societal factors affect PrEP uptake and substance use. Specific Aim 2: Define the PrEP care continuum for YMSM with and without substance use (from Aim 1). We will do so via four biyearly follow-up surveys (N = 300) over 24 months from participants in areas of high HIV incidence. Specific Aim 3: Perform semi-structured interviews among YMSM for future sexuality-informed PrEP/SU interventions (N = 30). How multiple barriers are related to substance use and PrEP uptake will be explored. Additionally, using the ADAPT-ITT model and based on previous findings, the we will identify the modifiable characteristics among current interventions that can be applied to prevention programs targeting YMSM. This project has the potential to systematically address the lack of attention to sexuality in interventions that focus on high rates of HIV and substance use.