Minority Stress, Stimulant Use, and HIV among Sexual Minority Men: A Biopsychosocial Approach

项目摘要/摘要 美国的性少数男性(SMM；即非异性恋男性)受到艾滋病毒相互交织的流行的影响 和兴奋剂的使用(如甲基苯丙胺、粉末可卡因、强效可卡因)的比率与其 异性恋同龄人。我们团队和其他人的发现表明，使用兴奋剂的艾滋病毒携带者SMM 有更大的困难成功地导航艾滋病毒护理连续体，以及展示大幅提升 病毒载量、放大的艾滋病毒传播风险和更快的临床艾滋病毒进展。占主导地位的理论用于 解释SMM之间健康差异的是少数民族压力理论，该理论认为这些差异是 消除与污名有关的社会压力(例如歧视、内化的同性性)。虽然有证据表明 少数族裔压力和兴奋剂使用之间存在联系，很少有研究直接检查这种联系 少数族裔的压力和生物学上的艾滋病毒结果之间的关系，如病毒载量，许多人完全依赖自我报告 评估这些结果的措施(相对于实验室测试)。生物心理社会少数民族应激 已提出将少数群体应激与生物健康联系起来的框架(BMSF)，并假定：(A)少数群体 压力直接影响SMM的健康行为和心理健康；(B)SMM的健康行为和心理 心理健康指标相互关联；以及(C)这些因素通过以下途径影响SMM的生物健康 免疫系统。将BMSF应用于患有艾滋病毒、兴奋剂使用和ART不依从性的SMM(健康 行为)可作为少数人应激影响病毒载量的中介(这一结果对 免疫健康)，从而导致其他健康后果(例如机会性感染和癌症)。此外， 与交叉性理论一致，种族/少数民族SMM可能会经历少数民族的强化影响 在有色人种SMM中观察到的可能导致艾滋病毒负担增加和兴奋剂使用的压力 美国。了解少数人应激影响病毒载量的机制，从而影响其他 健康结果，对使用兴奋剂的携带艾滋病毒的SMM的干预具有重要意义。因此， 我们建议系统地测试BMSF在这个高优先级人群中设定的关联，使用一系列 调解分析。具体地说，我们的目标是通过测试纵向关联来检查BMSF组件 在少数人应激、兴奋剂使用、ART不依从性和实验室检测-使用衍生病毒载量 来自两个使用兴奋剂的艾滋病毒感染的SMM的独立样本的现有数据：(1)居住在旧金山的110名SMM 加利福尼亚州旧金山和(2)从美国各地招募的350名SMM。此外，我们的目标是测试这些关联是否 少数民族压力、兴奋剂使用、抗逆转录病毒药物不依从性和病毒载量在种族/少数民族之间存在差异。 与使用兴奋剂的大多数(即非西班牙裔白人)SMM相比，使用多组分析 评估目标1和目标2中检查的效果的不变性。对该项目的支持将极大地帮助进一步 他的长期目标是成为一名具有以下专长的独立学术临床心理学家 研究性和性别少数群体健康差异背后的生物心理社会机制。

PROJECT SUMMARY/ABSTRACT Sexual minority men (SMM; i.e., non-heterosexual men) in the US are impacted by intertwining epidemics of HIV and stimulant use (e.g., methamphetamine, powder cocaine, crack cocaine) at disparate rates compared to their heterosexual peers. Findings from our team and others demonstrate that SMM with HIV who use stimulants have greater difficulties successfully navigating the HIV care continuum as well as display substantially elevated viral load, amplified HIV transmission risk, and faster clinical HIV progression. The dominant theory used to explain health disparities among SMM is minority stress theory, which states that these disparities are the result of stigma-related social stressors (e.g., discrimination, internalized homonegativity). While evidence of the association between minority stress and stimulant use exists, few studies have directly examined associations between minority stress and biological HIV outcomes, such as viral load, and many rely solely on self-report measures (as opposed to laboratory testing) to assess these outcomes. The Biopsychosocial Minority Stress Framework (BMSF) has been proposed to link minority stress to biological health, and posits that: (a) minority stress directly affects the health behaviors and psychological health of SMM; (b) SMM’s health behaviors and psychological health indicators are interrelated; and (c) these factors influence biological health among SMM via the immune system. Applying the BMSF to SMM with HIV, stimulant use and ART nonadherence (health behaviors) may serve as mediators through which minority stress impacts viral load (an outcome critical to immune health) and, thereby, other health outcomes (e.g., opportunistic infections and cancers). Further, consistent with intersectionality theory, racial/ethnic minority SMM may experience intensified effects of minority stress that could contribute to the increased burden of HIV and stimulant use observed among SMM of color in the US. Understanding the mechanisms through which minority stress impacts viral load, and thereby other health outcomes, has important implications for intervention among SMM with HIV who use stimulants. As such, we propose to systematically test associations posited by the BMSF in this high-priority population using a series of mediation analyses. Specifically, we aim to examine BMSF components by testing longitudinal associations between minority stress, stimulant use, ART nonadherence, and laboratory testing-derived viral load using existing data from two independent samples of SMM with HIV who use stimulants: (1) 110 SMM residing in San Francisco, CA and (2) 350 SMM recruited from across the US. Further, we aim to test whether the associations between minority stress, stimulant use, ART nonadherence, and viral load differ among racial/ethnic minority versus majority (i.e., non-Hispanic White) SMM with HIV who use stimulants, using multigroup analyses to assess the invariance of effects examined in Aims 1 and 2. Support for this project will greatly help in furthering the PI toward his long-term goal of becoming an independent academic clinical psychologist with expertise in studying the biopsychosocial mechanisms underlying sexual and gender minority health disparities.