A Sequential Mixed Methods Study Evaluating the Influence of Violence on HIV Care and Viral Suppression among Young Black and Latinx MSM

摘要 在美国，抑制病毒对国家艾滋病预防战略至关重要， 据估计，只有大约一半的艾滋病毒感染者（PLWH）受到病毒抑制。绝大多数 PLWH是指与男性发生性关系的男性（MSM）。在艾滋病毒方面存在明显的基于种族和族裔的差异， 流行率，护理参与，保留和随后的病毒抑制MSM之间。较 白色男男性接触者、感染艾滋病毒的黑人和拉丁裔男男性接触者实现病毒抑制的可能性明显较低。 与年龄较大的黑人和拉丁裔男男性行为者艾滋病毒感染者相比，13-24岁的黑人和拉丁裔男男性行为者艾滋病毒感染率较低， 与护理的联系率、继续护理率和病毒抑制率。 除了基于种族和性取向的歧视外，黑人和拉丁裔男男性接触者还经历其他歧视。 可能对艾滋病毒护理相关成果产生不利影响的暴力形式，如亲密伴侣暴力， 社区暴力。几乎没有同时研究社区暴力的研究 （包括污名化和歧视）和亲密伴侣暴力。 建议的顺序混合方法研究的首要目标是表征，随着时间的推移， 空间，暴力的经历（即，亲密伴侣和性，社区，种族-和性取向- 以及这些经历如何影响年轻黑人和拉丁裔男男性接触者的艾滋病毒护理， 艾滋病。这些结果将为采取干预措施和政策填补护理连续体的空白提供经验基础 在年轻的黑人和拉丁裔男男性接触者中 本研究的具体目的是： 目标1：地理定位年轻的黑人和拉丁裔MSMLWH经历暴力的空间， 他们如何解释和评估这些经验对健康，福祉和艾滋病毒护理相关的影响， 结果。 目标2：评估暴力经历与艾滋病毒护理相关结果在时间和空间上的关联。 为了实现这些目标，我们将进行一个连续的混合方法研究。在基线处，50名年轻的黑人 和Latinx MSMLWH将完成一个简短的基线计算机辅助调查工具（CASI）;一个社区 使用Google Earth绘制资产和风险图;抽血;以及定性深入访谈（IDI）。之间 在基线访视和3个月随访期间，参与者将前瞻性地完成每日日记和地理空间 使用智能手机应用程序，以真实的时间绘制地图， 体验并描述他们的情绪和其他反应。在3个月的随访中，参与者将 完成另一个CASI，抽血，和深入的定性访谈。随着CASI，日记，和基于应用程序 数据，我们将描述参与者层面的暴力经历，主观 反应，地区一级的特点（通过普查数据）和艾滋病毒护理相关的结果（自我报告的抗逆转录病毒治疗） 依从性，医疗预约出勤率和HIV病毒载量，通过定量HIV-1 RNA进行评估， PCR）。IDI数据将使基线时的标测数据以及随访时的日志和应用程序数据处于背景中。作为 探索性的目标，我们将构思特定位置，视觉或社交媒体为基础的消息，以减少暴露于 暴力和/或通过设计charrette解决心理社会影响，初步结果和 提出了示范性的运动，并产生和讨论了新的想法。

Abstract Viral suppression is critical to the national HIV prevention strategy in the United States, where it is estimated that just about half of people living with HIV (PLWH) are virally suppressed. The vast majority of PLWH are men who have sex with men (MSM). There are marked race- and ethnicity-based disparities in HIV prevalence, care engagement, retention, and subsequent viral suppression among MSM. Compared with White MSM, HIV-infected Black and Latinx MSM are significantly less likely to achieve viral suppression. Relative to older Black and Latinx MSM living with HIV, Black and Latinx MSM aged 13-24 years have low rates of linkage to care, retention in care, and viral suppression. In addition to race- and sexual orientation-based discrimination, Black and Latinx MSM experience other forms of violence that may adversely impact HIV care-related outcomes, such as intimate partner violence and community violence. There are almost no studies that have simultaneously studied community violence (including stigma and discrimination) and intimate partner violence among young minority MSM. The overarching aim of the proposed sequential mixed methods research is to characterize, over time and space, experiences of violence (i.e., intimate partner and sexual, community, and race- and sexual orientation- based violence) and how these experiences influence HIV care among young Black and Latinx MSM living with HIV. These results will yield an empirical basis for interventions and policies to fill gaps in the care continuum among young Black and Latinx MSM. The Specific Aims of the study are: Aim 1: Geolocate the spaces where young Black and Latinx MSMLWH experience violence and characterize how they interpret and assess the impact of those experiences on health, well-being, and HIV care-related outcomes. Aim 2: Assess associations among violence experiences and HIV care-related outcomes over time and space. To achieve these aims, we will conduct a sequential mixed methods study. At baseline, 50 young Black and Latinx MSMLWH will complete a brief baseline computer-assisted survey instrument (CASI); a community asset and risk mapping using Google Earth; a blood draw; and a qualitative in-depth interview (IDI). Between the baseline visit and 3-month follow-up, participants will prospectively complete daily diaries and geospatial mapping, in real time, using a smartphone app, geolocating the precise times and locations of violence experiences and characterizing their emotional and other responses. At the 3-month follow-up, participants will complete another CASI, blood draw, and in-depth qualitative interview. With the CASI, diary, and app-based data, we will characterize statistical associations among participant-level violence experiences, subjective responses, area-level characteristics (via census data) and HIV care-related outcomes (self-reported ART adherence, medical appointment attendance, and HIV viral load, assessed via quantitative HIV-1 RNA by PCR). IDI data will contextualize mapping data, at baseline, and diary and app data, at follow-up. As an exploratory aim, we will ideate location-specific, visual- or social media-based messages to reduce exposure to violence and/or address the psychosocial impacts via a design charrette where preliminary results and exemplary campaigns are presented and novel ideas are generated and discussed.