Using mixed methods to understand barriers to PrEP use among Black and Latinx transgender and gender-expansive youth and emerging adults: The impact of gender minority stress and gender affirmation.

项目总结。13-24岁的性别少数群体患上 然而，他们预防艾滋病毒的暴露前预防(PrEP)接受率是所有关键风险中最低的 集团在美国(&gt；10%)。这一群体包括年轻的变性人以及 大量且越来越多的人认为自己是性别非二元、不一致或性别酷儿， 这里指的是“性别膨胀”的个体。(我们称人口为“YTGE”)。此外，黑人和 Latinx(BL)YTGE个体的艾滋病毒发病率高于白人YTGE，但PrEP使用率低于白人YTGE。然而， 影响青少年儿童医院参与PrEP护理连续体的具体因素及其原因和 含义，还没有被很好地理解。拟议的研究以性别、少数民族压力和性别为基础 积极的模型和检查显著的近端和远端应激源及其影响(例如，物质使用)，以及 复原力因素，包括性别肯定，即支持生活在一个人的性别认同/表达中 社会、心理、医学和法律领域。然而，由于性别肯定是一个新的研究领域， 我们对它与PrEP护理连续体中的参与度的关系知之甚少。拟议的研究使用 一种解释性的顺序混合方法，旨在促进对促进或 阻碍了BL-YTGE的PrEP结果。主要结果是PrEP的意图和PrEP的意识、使用、 和坚持不懈是次要的结果。这项研究的目的是：考察性别少数群体压力的影响， 包括近端和远端应激源，以及对压力(物质使用)的行为反应对PrEP结果的影响 在证明艾滋病毒风险的不同YTGE中(目标1a)；审查复原力(例如，性别肯定)， 种族/族裔或其他社会人口因素加强或缓冲了性别少数群体压力对 物质使用和预诱发电位结果(目标1b)；探讨青年会对目标1中确定的因素的看法 促进或阻碍PrEP结果及其意义(例如，药物使用、歧视)，并有重点 关于各种类型的性别肯定以及紧急因素(目标2)；综合目标1的调查结果 以及2确定YTGE体验PrEP连续体的多样性，并确定差异和相似之处 涉及阻碍或支持PrEP吸收的社会人口特征(目标3)。AIM 1将使用 缓和调解结构方程建模方法，用于分析种族/民族多样性(54%的非 进行横断面调查(CDC START研究)的全国样本N=1029。目标2 将依靠与来自纽约市当地社区的BL-YTGE的半结构化访谈(N=30，一半规定 准备)。对于目标3，将使用联合显示方法对所有结果进行比较、对比和整合，以 将调查结果与背景联系起来，并加以解释。统计和研究方法培训将是这方面的一个关键组成部分 学习。如果获得资金，F31将给予申请者受保护的时间，并将包括以下计划的第一阶段 减少这一人群中艾滋病毒发病率的研究，这些人群是艾滋病毒的高危人群，但在预防预防接种方面存在严重障碍。

PROJECT SUMMARY. Gender minority individuals 13-24 years of age experience disproportionate risk for HIV, yet their rates of preexposure prophylaxis (PrEP) uptake to prevent HIV are the lowest of any key risk group in the United States (>10%). This population includes young transgender individuals, as well as substantial and growing numbers of those who identify as gender nonbinary, non-conforming, or genderqueer, referred to here as "gender-expansive” individuals. (We refer to the population as “YTGE”). Further, Black and Latinx (BL) YTGE individuals have higher HIV incidence, but lower PrEP use rates, than White YTGE. Yet, the specific factors that influence engagement in the PrEP care continuum among BL-YTGE, and their causes and meanings, are not well understood. The proposed study is grounded in the gender minority stress and gender affirmative models and examines salient proximal and distal stressors, their effects (e.g., substance use), and resilience factors, including gender affirmation, i.e., support for living in one’s gender identity/expression in social, psychological, medical, and legal domains. Yet, because gender affirmation is a new area of research, we know little about its relationship to engagement along the PrEP care continuum. The proposed study uses an explanatory sequential mixed methods design to advance knowledge about specific factors that promote or impede PrEP outcomes among BL-YTGE. The primary outcome is PrEP intentions, and PrEP awareness, use, and persistence are secondary outcomes. The study aims to: examine the effects of gender minority stress, including proximal and distal stressors, and behavioral responses to stress (substance use) on PrEP outcomes among diverse YTGE who evidence HIV risk (Aim 1a); examine whether resilience (e.g., gender affirmation), race/ethnicity or other sociodemographic factors heighten or buffer the effects of gender minority stress on substance use and PrEP outcomes (Aim 1b); explore BL-YTGE’s perspectives on factors identified in Aim 1 that promote or impede PrEP outcomes and their meanings (e.g., substance use, discrimination), with a focus on various types of gender affirmation, as well as emergent factors (Aim 2); and integrate findings from Aims 1 and 2 to determine how diverse YTGE experience the PrEP continuum and identify differences and similarities across sociodemographic characteristics that impede or support PrEP uptake (Aim 3). Aim 1 will use a moderated mediation structural equation modeling approach to analyze a racially/ethnically diverse (54% non- White) national sample of N=1029 YTGE who engaged in a cross-sectional survey (CDC START study). Aim 2 will rely upon semi-structured interviews with BL-YTGE from the local NYC community (N=30, half prescribed PrEP). For Aim 3 all results will be compared, contrasted, and integrated using the joint display method, to contextualize and interpret findings. Statistical and research methods training will be a key component of this study. If funded, this F31 will give the applicant protected time and will comprise the first stages of a program of research to decrease HIV incidence in this population at high-risk for HIV but with serious barriers to PrEP.