HIV Risk Behavior and Drug Use Over Time: Syndemic Production in High Risk Youth

摘要 超过2500万人死于艾滋病，使其成为最大的公共卫生之一 历史上的危机。全世界有超过3300万艾滋病毒携带者。大多数新的艾滋病毒 病例发生在25岁之前，并且发生在边缘人群中。“符号学”理论假设 多种新出现的和汇聚的心理社会流行病是推动 导致艾滋病毒传播。我们提出了一种发展性的解释和应用 为了解释艾滋病毒的风险，需要综合符号学理论。性少数群体青年(青年 认可一定程度的同性吸引力、行为和/或身份)是理想的人群 用作测试同步过程的纵向发展的模型。性少数群体 青年被高度边缘化，缺乏理解，服务严重不足。他们经历了 被认为是核心的流行病比例的多重心理社会问题 共性效应的组成部分。与异性恋青年相比，性少数青年 吸毒的可能性高达5倍，受害的可能性高达7倍，受害的可能性高达6倍 可能有心理健康问题，从事艾滋病毒危险行为的可能性是其他人的5倍。 然而，对性少数族裔青年的纵向研究很少进行，因为 文化和方法上的障碍。这项研究项目的首要目标是检查 性少数族裔青年和老年人的药物使用与HIV危险行为的纵向研究 与之匹配的异性恋青年对照组。由于有许多重要的功能， 提出的方法和理论，这将是此类青年研究的第一次。这些功能 包括：(A)纵向、准实验设计；(B)评价个人成长或 青少年药物使用和危险性行为随时间的变化，(C)检查 物质使用和危险性行为风险的调解人和调解人，以及(D) 确定与这些多重因素汇聚相关的风险和保护因素 新出现的流行病及其如何导致艾滋病毒/艾滋病。这个项目的结果将产生一个 关于高度脆弱人群中健康问题发展的丰富信息 和被边缘化的群体。它们将为发展性解释提供经验支持 以及Syndemics框架的应用。他们将成为理解 如何在边缘化人群中展开共同进程，以增加艾滋病毒/艾滋病的风险。

Abstract Over 25 million people have died of AIDS, making it one of the largest public health crises in history. There are over 33 million people with HIV world-wide. The majority of new HIV cases occur before age 25, and within marginalized populations. "Syndemics" theory postulates that multiple emerging and converging psychosocial epidemics are the driving mechanisms that cause HIV transmission. We are proposing that a developmental interpretation and application of syndemics theory is needed in order to explain HIV risk. Sexual minority youth (youth who endorse some level of same-sex attraction, behavior, and/or identity) are an ideal population to use as a model for testing the longitudinal development of syndemic processes. Sexual minority youth are highly marginalized, poorly understood, and severely underserved. They experience multiple psychosocial problems of epidemic proportions that are considered the core components of the syndemic effect. Compared with heterosexual youth, sexual minority youth are up to 5 times more likely to use drugs, 7 times more likely to be victimized, 6 times more likely to have mental health problems, and 5 times more likely to engage in HIV risk behavior. Yet longitudinal studies with sexual minority youth have rarely been conducted due to a host of cultural and methodological barriers. The overarching goal of this research project is to examine substance use and HIV risk behaviors in a longitudinal study of sexual minority youth and a matched comparison group of heterosexual youth. Due to the many important features of the proposed methodology and theory, this will be the first youth study of its kind. These features include the: (A) longitudinal, quasi-experimental design, (B) evaluation of individual growth or change in adolescent substance use and risky sexual behaviors over time, (C) examination of mediators and moderators of risk for substance use and risky sexual behavior, and (D) identification of risk and protective factors associated with the convergence of these multiple emerging epidemics and how they lead to HIV/AIDS. Results from this project will generate a wealth of information about the development of health problems among this highly vulnerable and marginalized group. They will provide empirical support for a developmental interpretation and application of the syndemics framework. And they will serve as a model for understanding how syndemic processes unfold in marginalized populations to raise risk for HIV/AIDS.