Developing and Testing a Novel Multidimensional Stigma-Resilience Measure for Stigma Reduction Research with Black Men Who Have Sex with Men

摘要 与男性发生性关系的黑人男性（BMSM）相比， 美国的其他MSM亚群。这种不平等因多层次的交叉污名而加剧， BMSM的脸，包括那些基于种族，同性吸引/行为，和假定的艾滋病毒阳性状态， 这会导致严重的心理困扰和艾滋病预防效果不佳。韧性是一个关键的 研究中的一个组成部分，以减轻多层次交叉污名对艾滋病毒预防的负面影响 在BMSM中使用。然而，现有的复原力措施是为非边缘化人口设计的 并且不足以评估BMSM对多层次交叉污名的恢复力。为了弥补这一差距， 我们建议开发一种新的，BMSM特定的，多维的耻辱弹性量表， 针对跨多个社会生态层面的交叉污名的细微差别的复原机制。的 拟议的研究将在纳什维尔进行，这是美国南部的艾滋病毒热点地区，那里的艾滋病毒负担不断增加 和交叉性柱头。这项研究有两个具体目标。目标1： 将定义BMSM用于对抗交叉污名的多维弹性机制。我们 将在纳什维尔对30名艾滋病毒阴性的BMSM进行深入访谈， 整合了社会生态模型，弹性理论和交叉性框架。我们将探讨如何 恢复力被开发、表现和实施以克服交叉形式（例如，内化，制定， 经验的和预期的）和类型（例如，对种族主义、同性恋和推定艾滋病毒感染状况的污名化） 跨多个社会生态层面的耻辱（例如，个人、人际、社区和保健）。目的 2将需要一个迭代和系统的BMSM社区参与过程，以制定和验证一个 为BMSM量身定制的新的多维耻辱弹性措施。Aim 1的见解将有助于告知 现有尺度的调整（例如，艾滋病毒感染者的黑人成年人的多层次复原力措施） 适合BMSM的情境和以污名为重点。然后我们将评估表面有效性和文化相关性 通过对10名BMSM进行认知访谈，然后对250名BMSM进行心理测量分析， 测试新量表的可靠性（例如，内部一致性）和有效性（例如，收敛、发散和预测 有效性）。这项研究对于提供一个强有力的、文化定制的污名弹性测量方法具有重要意义， 这将为我们未来的R34/R01研究提供信息，以开发和评估基于多水平依从性的干预措施， 减轻BMSM之间的交叉耻辱和艾滋病毒预防的吸收。此外，新的BMSM 多维度污名-复原力量表将为未来的研究提供基础，以完善和适应 与其他边缘化人群（例如，拉丁裔/西班牙裔MSM; transwomen of color）。

ABSTRACT Black men who have sex with men (BMSM) continue to experience disproportionate burdens of HIV compared to other MSM subgroups in the US. This disparity is exacerbated by the multilevel intersectional stigmas that BMSM face, including those based on race, same-sex attraction/behavior, and presumed HIV-positive status, which results in high levels of psychological distress and poor HIV prevention outcomes. Resilience is a critical component in studies to mitigate the negative impact of multilevel intersectional stigmas on HIV prevention uptake among BMSM. However, existing resilience measures are designed for non-marginalized populations and are inadequate for assessing BMSM's resilience to multilevel intersectional stigmas. To address this gap, we propose to develop a novel, BMSM-specific, multidimensional stigma-resilience scale that captures the nuanced resiliency mechanisms countering intersectional stigmas across multiple socioecological levels. The proposed study will be conducted in Nashville, an HIV hotspot in the Southern US, where growing HIV burdens and intersectional stigmas among BMSM have been identified. The study has two specific aims. In Aim 1, we will define the mechanisms of multidimensional resilience that BMSM use to counter intersectional stigmas. We will conduct in-depth interviews with 30 HIV-negative BMSM in Nashville, guided by a conceptual framework that integrates the Socioecological Model, Resilience Theory, and Intersectionality Framework. We will explore how resilience is developed, manifested, and implemented to overcome intersecting forms (e.g., internalized, enacted, experienced, and anticipated) and types (e.g., stigma against racism, homosexuality, and presumed HIV status) of stigmas across multiple socioecological levels (e.g., individual, interpersonal, community and healthcare). Aim 2 will necessitate an iterative and systematic BMSM community engagement process to develop and validate a new multidimensional stigma-resilience measure tailored for BMSM. Insights from Aim 1 will help inform the adaptation of an existing scale (e.g., Multilevel Resilience Measure for Black Adults Living with HIV) to be contextually appropriate and stigma-focused for BMSM. We will then assess face validity and cultural relevancy through cognitive interviews with 10 BMSM, followed by conducting psychometric analyses with 250 BMSM to test the new scale's reliability (e.g., internal consistency) and validity (e.g., convergent, divergent, and predictive validity). The proposed study is significant in providing a robust, culturally-tailored stigma-resilience measure, which will inform our future R34/R01 study to develop and evaluate a multilevel resilience-based intervention to mitigate intersectional stigmas and HIV prevention uptake among BMSM. Additionally, the new BMSM Multidimensional Stigma-Resilience Scale will provide the groundwork for future studies to refine and adapt the scale for resilience-focused research conducted with other marginalized populations (e.g., Latino/Hispanic MSM; transwomen of color).