Characterizing intersecting sexual, gender, and race-based stigmas affecting communities of US transgender women and cisgender men who are sexually active with men

本研究的目的是描述与性别认同，性行为， 性取向、种族和贫困，作为性和性别问题中艾滋病毒相关健康的社会决定因素 在美国的少数民族（SGM）。该提案是为了响应NIH的特别关注通知而制定的。 （NOSI）的重点是了解交叉污名的作用以及它们如何损害健康。 精神、身体和性健康问题的高患病率一直被记录在 SGM，包括性传播感染（STI），抑郁症和物质使用。虽然耻辱是 据了解，影响这些结果，有有限的共识，最佳的交叉污名测量 为变性妇女（TW）和与男性发生性关系的顺性别男子（cis-MSM）或 交叉污名驱动健康差距的机制，包括通过健康可以改变的机制 和行为干预。我们的调查团队有一个积极的NIMH资助的R 01（R 01 MH 110358）集中 衡量与性行为有关的耻辱感，并研究这种耻辱感如何导致艾滋病毒感染率的差异， 使用来自世界各地的数据，包括来自美国男性互联网调查的数据， （AMIS）在美国。此外，我们制定并试行了变性妇女互联网调查， 测试（TWIST）平台，表明预期的，感知的和制定的污名相关的高负担 性别认同及其与艾滋病毒预防服务使用减少的关系， 压力和自杀意念之间的TW在美国。在此，我们建议收集关于污名化趋势的数据， 两项性活跃TW（第2、4年n= 3，000）和三项顺式MSM的横断面在线调查中的健康状况 （第1年、第3年、第5年n= 10，000），同时对500名TWIST参与者自行采集的生物标本进行检测 每次调查有500名非盟特派团信息系统参与者（共2 500人）。与NIH的NOT-MH-20-020一致，我们将建立 在我们之前的基础工作，以更好地评估交叉污名及其对艾滋病毒和其他健康的影响， TW和cis-MSM在美国使用混合方法，旨在满足以下目标的变革性研究。 目标1：优化跨性别妇女和顺性别妇女所经历的交叉羞辱的指标 在美国网上抽样的男性发生性关系的男性。 目标2：定性探讨跨性别女性和与男性发生性关系的顺性别男性的观点 (MSM)交叉的耻辱如何影响艾滋病毒预防和治疗服务的参与。 目标3a：描述交叉污名与艾滋病毒参与之间的横截面关系 预防/治疗和性别平权护理之间的TW和顺式MSM在美国的国家样本。 目标3b。确定人口统计学，地理，和时间异质性的负担交叉 耻辱感和与性健康、心理健康和复原力的关联，以及参与艾滋病毒预防 和治疗的后续横断面全国调查TW和cis-MSM。

The goal of this study is to characterize intersectional stigma related to gender identity, sexual behaviors, sexual orientation, race, and poverty, as a social determinant of HIV-related health among sexual and gender minorities (SGM) in the US. This proposal was developed in response to NIH’s Notice of Special Interest (NOSI) to focus on understanding the role of intersectional stigmas and how they harm health. A high prevalence of mental, physical, and sexual health problems has consistently been documented among SGM, including sexually transmitted infections (STIs), depression, and substance use. While stigma is understood to affect these outcomes, there is limited consensus on optimal intersectional stigma measurement strategies for both transgender women (TW) and cisgender men who have sex with men (cis-MSM) or on the mechanisms by which intersecting stigmas drive health disparities, including those modifiable through health and behavioral interventions. Our investigative team has an active NIMH-funded R01(R01MH110358) focused on measuring stigma related to sexual behavior and examining how this stigma drives disparities in HIV outcomes for cis-MSM using data from around the world, including from the American Men’s Internet Survey (AMIS) in the US. In addition, we developed and piloted the Transgender Women’s Internet Survey and Testing (TWIST) platform, demonstrating high burdens of anticipated, perceived, and enacted stigmas related to gender identity and their association with decreased use of HIV prevention services, greater psychological stress, and suicidal ideation among TW in the US. Here, we propose to collect data on trends in stigma and health in two cross-sectional online surveys of sexually active TW (n=3,000 in Years 2,4) and three of cis-MSM (n=10,000 in Years 1,3,5) accompanied by testing of self-collected biospecimens from 500 TWIST participants and 500 AMIS participants per survey (n=2,500 total). Consistent with NIH’s NOT-MH-20-020, we will build upon our prior foundational work to better assess intersectional stigma and its HIV and other health impacts for TW and cis-MSM in the US using a mixed-methods, transformative study designed to meet the following aims. Aim 1: Optimize metrics of intersectional stigma experienced by diverse transgender women and cisgender men who have sex with men sampled online in the US. Aim 2: Qualitatively explore perspectives of transgender women and cisgender-men who have sex with men (MSM) of how intersecting stigmas shape engagement in HIV prevention and treatment services. Aim 3a: Characterize cross-sectional relationships between intersectional stigmas and engagement in HIV prevention/treatment and gender affirmative care among national samples of TW and cis-MSM in the US. Aim 3b. Determine demographic, geographic, and temporal heterogeneities in the burden of intersectional stigmas and associations with sexual health, mental health and resilience, and engagement in HIV prevention and treatment in follow-up cross-sectional nationwide surveys of TW and cis-MSM.