Exploring the Role of Novel Aging-Focused Syndemic Conditions on HIV Risk and Quality of Life among HIV-Negative Older Sexual Minority Men

项目摘要 概述。这项研究解决了老年性行为少数民族男性在艾滋病毒和行为健康研究方面的差距 (OSMM)。具体地说，这个项目评估了与年龄相关的背景相关疾病的相对严重性和影响 共同因素(与年龄有关的歧视、内在化的年龄歧视、衰老焦虑、性少数群体特有的老龄化 关注、社会孤立、经济边缘化和认知障碍)和传统 精神疾病(抑郁症、创伤后应激障碍、儿童期性虐待、亲密伴侣暴力； OSMM.9，10背景。OSMM患病率高，发病率不断上升， 1对佛罗里达州(拟议的研究地点)来说尤其如此，该州拥有 11这项研究的框架基于三个相关理论。第一, 共同理论2认为，艾滋病毒和生活质量(QOL)的差异是通过协同作用共同传播的 疾病的发生(例如，健康问题、物质使用行为、社会文化因素)，其中一些是 这是OSMM独有的。其次，少数应力模型3，4通过假设OSMM面扩展了共线理论 承受着独特的压力，这些压力源于他们被边缘化的身份，这种身份使心理上的逆境永久化。 最后，交叉性理论假设OSMM的健康结果比他们的 年轻的SMM同龄人由于他们的多重矿化而面临复杂的压迫制度 身份。目的与方法。这项研究的三个目的集中在调查相对严重性和 年龄相关心理社会因素和传统合并症对解释HIV与健康的影响 艾滋病毒阴性OSMM之间的差异。目标1检查严重程度、频率和共同发生的 艾滋病毒阴性OSMM中出现的理论上相关的心理社会问题。目标2评估了 与年龄有关的心理社会和传统社会状况对艾滋病毒预防结果的影响 (无避孕套肛交，PrEP坚持)和生活质量在OSMM人群中以及 这些关系的潜在调解人。AIM 3利用基于树的机器学习来探索交互 最具影响力的年龄相关心理社会因素与传统心理健康加性指数的关系 HIV风险和生活质量结果的共同条件。年龄在55岁之间的HIV阴性OSMM(N=250) 而70年将完成一次心理社会量化评估。数据将使用基于树的- 机器学习方法和传统回归模型。创新和影响力。本论文的主要内容是 研究将确定OSMM特有的与年龄相关的综合症状，以更好地了解QOL、HIV和 行为健康，在OSMM中，这是一个研究不足和多重边缘化的群体。收集到的调查结果将 协助艾滋病毒和行为健康相关的未来发展，为OSMM量身定做，作为一篇论文， 国际和平研究所的计划研究重点是艾滋病毒和行为健康方面的差异 年龄较大的性少数群体。该提案与NIDA的优先事项相关(非MD-19-001)。

Project Summary Overview. This study addresses gaps in HIV and behavioral health research among older sexual minority men (OSMM). Specifically, this project assesses the relative severity and impact of contextually relevant age-related syndemic factors (age-related discrimination, internalized ageism, aging anxiety, sexual minority specific aging concerns, social isolation, economic marginalization, and perceived cognitive impairment) and traditional syndemic conditions (mental health via depression, PTSD, childhood sexual abuse; intimate partner violence; substance use) among OSMM.9,10 Background. With high prevalence and rising incidence rates, OSMM are uniquely burdened by HIV.1 This is particularly true for Florida (proposed study site), a state with one of the highest HIV incidence rates nationally.11 The framework for the study is based on three relevant theories. First, syndemic theory2 contends that HIV and quality of life (QOL) disparities are propagated by the synergistic co- occurrence of disease (e.g., health issues, substance use behaviors, sociocultural factors), some of which are unique to OSMM. Second, the minority stress model3,4 extends syndemic theory by positing that OSMM face enduring unique stressors resulting from their marginalized identities that perpetuate psychological adversity. Lastly, intersectionality theory5 posits that OSMM experience worse health outcomes compared to their younger SMM peers due to the compounding systems of oppression they face due to their multiple minoritized identities. Objectives & methods. This study’s three aims center on investigating the relative severity and impact of age-related psychosocial factors and traditional syndemic conditions in explaining HIV and health disparities among HIV-negative OSMM. Aim 1 examines the severity, frequency, and co-occurrence of theoretically linked psychosocial problems occurring in HIV-negative OSMM. Aim 2 assesses the influence of age-related psychosocial and traditional syndemic conditions on engagement in HIV prevention outcomes (condomless anal sex without PrEP, PrEP adherence) and QOL among this population of OSMM as well as a potential moderator of these relationships. Aim 3 utilizes tree-based-machine learning to explore interaction effects between the most influential age-related psychosocial factors and an additive index of traditional syndemic conditions on HIV risk and QOL outcomes. HIV-negative OSMM (N = 250) between the ages of 55 and 70 years will complete one psychosocial quantitative assessment. Data will be analyzed using tree-based- machine learning approaches and traditional regression models. Innovation and Impact. This dissertation study will identify age-related syndemic conditions unique to OSMM to better understand QOL, HIV, and behavioral health, among OSMM, an under-researched and multiple marginalized group. Findings gleaned will aid in the future development of HIV and behavioral health related tailored to OSMM and, as a dissertation, lay the groundwork for the PI’s programmatic research focused on HIV and behavioral health disparities among older sexual minorities. This proposal is relevant to the NIDA priorities (NOT-MD-19-001).