Social environmental drivers of stimulant use and its impact on HIV prevention and treatment in Black men who have sex with men

意义重大。兴奋剂的使用在美国是一个日益严重的问题。日益严重的公共卫生危机要求 扩大研究，以探索其影响范围、驱动因素和影响，包括对黑人等边缘化群体的影响 男同性恋、双性恋和其他与男性发生性行为的男性(MSM)，这是一个不成比例的关键人群 受艾滋病毒的影响。还需要估计黑人MSM中兴奋剂使用的发生率和持久性 随着对它如何与其他药物使用(即多物质使用)共存的研究，其社会环境驱动因素， 以及它对艾滋病毒传播的影响。研究计划。在目标1中，我们将描述在已建立的 黑性MSM的队列，包括与其他药物共同使用(即多物质使用)和随时间使用 (例如，发病率、持久性)。在目标2中，我们将确定网络一级(例如，混杂的种族混杂、网络 营业额)和社区层面(例如，社会凝聚力，在同性恋社区度过的时间)的兴奋剂驱动因素 在Black MSM中使用。在目标3中，我们将评估兴奋剂的使用如何通过以下途径影响黑人MSM中的艾滋病毒传播 艾滋病毒预防(例如，遵守PrEP、使用避孕套)、艾滋病毒治疗(例如，坚持抗逆转录病毒疗法、病毒抑制)和 生物脆弱性(如直肠细胞因子)。正在进行的社区和网络(N 2)队列研究 (R01MH112406；PI：Duncan&Schneider)为开展拟议的研究提供了理想的机会。氮气 包括186名艾滋病毒阳性和227名艾滋病毒阴性的黑人MSM居住在芝加哥。正在收集的数据包括 在多个周期使用兴奋剂，深入评估社区(包括实时地理空间方法 以跟踪社区内部和社区之间的流动性)、多种社交网络类型以及与艾滋病毒相关的 预防和治疗行为。拟议的研究将使用氮气数据来实施目标1-3。我们还提议 利用现有的氮气基础设施招募30名目前使用兴奋剂的人和10名非使用兴奋剂的艾滋病毒阴性者 来自氮气研究的黑人男男性接触者，并使用时间表跟踪调查对他们进行深入访谈 重点关注兴奋剂使用和性危险行为，以及收集直肠拭子、尿液和血液样本作为 目的建立生物标志物，以深入探讨兴奋剂使用如何促进HIV传播。结果是 这项研究将为R34提案的制定提供信息，以开发和测试干预措施，以解决 关键人群中的兴奋剂使用和艾滋病毒。团队。具有兴奋剂使用、艾滋病毒、社交方面专业知识的调查人员 网络分析、空间流行病学、免疫学、生物学和行为研究的整合，以及混合 方法研究部将共同开展这项研究。公共卫生影响。拟议的研究将是一项大型的、 对兴奋剂的使用、其社会环境驱动因素及其对艾滋病毒的影响进行严格和创新的研究 在黑人MSM中传播，这是一个使用兴奋剂和艾滋病毒负担沉重的群体。拟议的研究是一致的 具有多个NIDA资金优先事项，包括NOT-DA-19-066药物滥用流行病学，具有很高的 通过利用现有队列获得成功的可能性，并将直接为R34提案提供信息，以开发和 在关键人群中测试针对兴奋剂使用和艾滋病毒的干预措施。

Significance. Use of stimulants is a growing problem in the US. This growing public health crisis requires expanded research to explore its reach, drivers and impact, including on marginalized groups, such as Black gay, bisexual and other men who have sex with men (MSM), a critical population that is disproportionately impacted by HIV. Estimates of the incidence and persistence of stimulant use in Black MSM is needed, as well as research on how it co-occurs with other drug use (i.e. polysubstance use), its social-environmental drivers, and its impact on HIV transmission. Research Plan. In Aim 1, we will characterize stimulant use in an established cohort of Black MSM, including co-occurring use with other drugs (i.e. polysubstance use) and use over time (e.g., incidence, persistence). In Aim 2, we will identify network-level (e.g. disassortative racial mixing, network turnover) and neighborhood-level (e.g., social cohesion, time spent in gay neighborhoods) drivers of stimulant use in Black MSM. In Aim 3, we will assess how stimulant use impacts HIV transmission in Black MSM through HIV prevention (e.g. PrEP adherence, condom use), HIV treatment (e.g. ART adherence, viral suppression) and biological vulnerability (e.g. rectal cytokines). The ongoing Neighborhoods and Networks (N2) Cohort Study (R01MH112406; PIs: Duncan & Schneider) provides an ideal opportunity to conduct the proposed study. N2 includes 186 HIV-positive and 227 HIV-negative Black MSM living in Chicago. Data being collected include stimulant use at multiple cycles, in-depth assessments of neighborhoods (including real-time geospatial methods to track mobility within and between neighborhoods), multiple social network typologies, and HIV-related prevention and treatment behaviors. The proposed study will use N2 data to conduct Aims 1-3. We also propose to use existing N2 infrastructure to recruit 30 current stimulant-using and 10 non-stimulant-using HIV-negative Black MSM from the N2 study, and conduct in-depth interviews with them using a timeline follow-back survey focused on stimulant use and sexual risk behavior, as well as collect rectal swabs, urine and blood samples as objective biomarkers, in order to explore in-depth how stimulant use contributes to HIV transmission. The results of this study will inform the development of an R34 proposal to develop and test an intervention that addresses stimulant use and HIV in a critical population. Team. Investigators with expertise in stimulant use, HIV, social network analysis, spatial epidemiology, immunology, integration of biological and behavioral research, and mixed methods research will conduct this research together. Public Health Impact. The proposed study will be a large, rigorous and innovative study of stimulant use, its social-environmental drivers and its impact on HIV transmission in Black MSM, a group with a heavy burden of stimulant use and HIV. The proposed study is aligned with multiple NIDA funding priorities, including NOT-DA-19-066 Epidemiology of Drug Abuse, has a high likelihood of success by leveraging an existing cohort, and will directly inform an R34 proposal to develop and test an intervention that addresses stimulant use and HIV in a critical population.