Testing a Biopsychosocial Model of Minority Stress and Health for HIV-Positive Men

项目摘要 在美国，同性恋和双性恋男性(GBM)背负着高而不成比例的艾滋病毒感染率和 超过一半的HIV+感染者是GBM。改善病毒载量(VL)抑制与 艾滋病毒的性传播显著减少。此外，需要进行研究才能更好地理解 影响他们长期健康的可改变的社会和行为因素。慢性性体验 少数人应激源(例如，内在化的同负性)已被证明影响各种心理， GBM的行为和身体健康结果，包括一般应激(例如皮质醇)和免疫(例如， 在HIV+GBM中，包括细胞因子)结果，以及艾滋病毒特有的健康结果(例如，CD4计数)。慢性 艾滋病毒相关应激源的经历也被证明影响心理健康和健康行为 艾滋病毒+基底膜，尽管关于它们在艾滋病毒+基底膜健康中的作用的研究要少得多。上一首 包括我们自己在内的研究表明，性少数群体和艾滋病毒特有的压力源(即， 这些应激源的急性经历)是可测量的，并与健康结果有意义地相关。两者都有 HIV感染和物质使用与神经认知功能下降和出现 有证据表明，情绪处理可能有助于解释心理现象对 健康结果。为了开发稳健和持久的干预措施，需要进行研究，检查 性少数群体和HIV相关应激源对HIV+患者健康结局的独特和重叠影响 在一个统一的生物-心理-社会模型内的GBM。这样的模型应该考虑到个人级别(即， 这些应激源的慢性)和情景(即急性)经历，以检查它们的独立关联 健康，并应考虑认知过程中的情绪干预是否可能缓和这些 联想。这项研究的第一个目标是测试性别少数群体和艾滋病毒相关压力的生物心理社会模型。 和健康，检查这些应激源对每个结果的直接和间接影响。目标2是测试 情绪干预在认知加工中对这些联系的调节作用。最后，目标3是 检查性别少数群体和艾滋病毒相关应激源在一年内个体内变异的程度， 和细胞因子。虽然这不是一个目标，但这项研究将最终为未来制定指导方针。 制定干预措施，我们将收集参与者对这些建议的反馈。要完成 为了达到这些目标，我们将招募250名HIV+GBM，并跟踪他们12个月。我们将用生态瞬间 为期21天的评估(EMA)和一年多的季度纵向跟踪，以测试性行为的影响 少数民族和艾滋病毒相关应激对生理应激(昼夜皮质醇)和长期免疫结局(VL)的影响 抑制、CD4计数、细胞因子)。这项研究将解决有关性行为相对作用的新问题。 少数民族与HIV相关应激对HIV+GBM健康的指导制定干预措施 改善健康，减少HIV+GBM中的艾滋病毒传播、发病率和死亡率。

Project Summary Gay and bisexual men (GBM) in the U.S. are burdened by a high and disproportionate rate of HIV infection and more than half of all HIV+ individuals are GBM. Improving viral load (VL) suppression is associated with a significant reduction in the sexual transmission of HIV. Moreover, research is needed to better understand the modifiable social and behavioral factors that influence their long-term health. Chronic experiences of sexual minority stressors (e.g., internalized homonegativity) have been shown to influence a variety of mental, behavioral, and physical health outcomes for GBM, including general stress (e.g., cortisol) and immune (e.g., cytokines) outcomes, as well as HIV-specific health outcomes (e.g., CD4 count) among HIV+ GBM. Chronic experiences of HIV-related stressors have also been shown to impact mental health and health behaviors for HIV+ GBM, though there is substantially less research on their role in the health of HIV+ GBM. Previous research, including our own, has shown that fluctuations in sexual minority and HIV-specific stressors (i.e., acute experiences of these stressors) are measurable and meaningfully associated with health outcomes. Both HIV infection and substance use are associated with declines in neurocognitive function and emerging evidence suggests that emotional processing may help explain the impact of psychological phenomena on health outcomes. To develop interventions that are robust and durable, research is needed that examines the unique and overlapping influence of sexual minority and HIV-related stressors on health outcomes for HIV+ GBM within a unified biopsychosocial model. Such a model should take into account both individual-level (i.e., chronic) and situational (i.e., acute) experiences of these stressors to examine their independent associations with health, and should consider whether emotional interference in cognitive processing might moderate these associations. Aim 1 of the study is to test a biopsychosocial model of sexual minority and HIV-related stress and health, examining direct and indirect effects of these stressors on each outcome. Aim 2 is to test the moderating role of emotional interference in cognitive processing on these associations. Finally, Aim 3 is to examine the extent of intraindividual variability over one year in sexual minority and HIV-related stressors, VL, CD4, and cytokines. Although not an aim, the study will culminate in the development of guidelines for future intervention development and we will gather participant feedback on these recommendations. To accomplish these aims, we will enroll 250 HIV+ GBM and follow them for 12 months. We will use ecological momentary assessment (EMA) for 21 days and quarterly longitudinal follow-ups over one year to test the impact of sexual minority and HIV-related stress on physiological stress (diurnal cortisol) and long-term immune outcomes (VL suppression, CD4 count, cytokines). This study will address novel questions about the relative role of sexual minority and HIV-related stress in the health of HIV+ GBM to guide the development of interventions to improve health and reduce HIV transmission, morbidity, and mortality among HIV+ GBM.