Structural Racism and HIV-Associated Cognitive Impairment Among Hispanics

摘要 尽管可以获得抗逆转录病毒治疗(ART)，但其控制病毒载量和疾病的有效性 进展，艾滋病毒相关性认知障碍(HIV-CI)在20%-50%的艾滋病毒感染者中盛行 (威尔斯亲王医院)。HIV神经发病机制尚不清楚。健康差距有 HIV-CI的流行在西班牙裔、妇女和老年PWH中更为普遍。一个 最近对美国威斯康星医院的研究显示，拉美裔(波多黎各人和墨西哥人) 自我报告血统)与非西班牙裔白人相比，患认知障碍的风险更高。 此外，公关后裔的西班牙裔，在这个样本中，主要来自纽约市(NYC)，表现出增加 与来自加利福尼亚州圣地亚哥的墨西哥人相比，HIV-CI的比率。健康素养、获得保健服务的机会，以及 语言障碍被归因于这些差异。然而，仅靠这些因素可能不足以证明 观察到拉美裔之间的差异。结构性种族主义和歧视(SRD)可能导致这些 这种差异会导致种族/族裔少数群体的健康状况恶化。SRD指的是所有的方式 其中社会助长种族歧视(例如，住房、教育、就业、医疗保健和犯罪 正义)。在生物医学研究中，评估SRD作为健康决定因素的研究有限，包括 HIV-CI。我们的总体目标是确定生物、行为和环境因素 PR的PWH(PR-PR)、美国的波多黎各人(PR-NYC)和圣地亚哥的墨西哥人(Mex-SD)的队列 确定可确定可解释HIV-CI差异的独特因素的异同 在西班牙裔美国人中。通过将不同的国家拉美裔群体聚集在一起，我们将有一个独特的机会 提出一个常见的假设。提出了以下目标：1.确定SRD之间的关联 感觉到/感觉到耻辱、压力和全身炎症。2.确定SRD与 HIV-CI。3.测试我们的假设，即居住在波多黎各的PWH显示出SRD和HIV之间更大的关联- CI，与其他两组比较。这项研究的发现将增加我们对 西班牙裔HIV感染人群中SRD与HIV-CI的关系及其可能的影响因素 修改过的。这些都是迈向卫生公平、改善艾滋病毒结果和结束 艾滋病毒流行。

ABSTRACT Despite the access to antiretroviral therapy (ART), and its effectiveness controlling viral load and disease progression, HIV-associated cognitive impairment (HIV-CI) prevail in 20-50% of the people with HIV infection (PWH). The mechanisms involved in HIV neuropathogenesis remain to be elucidated. Health disparities have been identified in the prevalence of HIV-CI being more prevalent in Hispanics, women, and older PWH. A recent study on PWH in the United States (US) revealed that Hispanics (of Puerto Rican [PR] and Mexican self-reported descent) are at higher risk of developing cognitive impairment compared to non-Hispanic white. Moreover, Hispanics of PR descent, in this sample largely from New York City (NYC), demonstrated increased rates of HIV-CI when compared to Mexicans from San Diego, CA. Health literacy, access to health care, and language barrier have been attributed to these disparities. However, these factors alone may not justify the observed disparities among Hispanics. Structural racism and discrimination (SRD) may contribute to these discrepancies and lead to poorer health outcomes for racial/ethnic minorities. SRD refers to the totality of ways in which societies foster racial discrimination (e.g., housing, education, employment, healthcare, and criminal justice). There are limited studies evaluating SRD as determinants of health in biomedical research including HIV-CI. Our overall objective is to determine the biological, behavioral, and environmental factors within the cohorts of PWH in PR (PR-PR), Puerto Ricans in the US (PR-NYC), and Mexicans in San Diego (Mex-SD) to determine similarities and differences that could identify unique factors explaining the disparities in HIV-CI among Hispanics. By bringing together diverse national Hispanic cohorts we will have a unique opportunity to address a common hypothesis. The following aims are proposed: 1. Determine the association between SRD and perceived/felt stigma, stress, and systemic inflammation. 2. Determine the association between SRD and HIV-CI. 3. Test our hypothesis that PWH living in Puerto Rico show greater association between SRD and HIV- CI, compared to the other two groups. The findings from this study will increase our understanding about the relationship between SRD and HIV-CI in a Hispanic HIV infected population and identify factors that may be modified. These are important steps in advancing towards health equity, improve HIV outcomes, and end the HIV epidemic.