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

描述（由申请人提供）：超过2500万人死于艾滋病，使其成为历史上最大的公共卫生危机之一。全世界有超过3300万人感染艾滋病毒。大多数新发艾滋病毒病例发生在25岁以前，并且发生在边缘人群中。“传染病”理论假定，多种正在出现和趋同的社会心理流行病是导致艾滋病毒传播的驱动机制。我们建议，为了解释艾滋病毒风险，需要对综合症理论进行发展解释和应用。性少数青年（认同某种程度的同性吸引、同性行为和/或同性身份的青年）是一个理想的人群，可以用作测试综合症过程纵向发展的模型。性少数青年被高度边缘化，缺乏理解，服务严重不足。他们经历了流行病程度的多重社会心理问题，这些问题被认为是综合征效应的核心组成部分。与异性恋青年相比，性少数青年使用毒品的可能性是异性恋青年的5倍，成为受害者的可能性是异性恋青年的7倍，出现精神健康问题的可能性是异性恋青年的6倍，从事艾滋病毒风险行为的可能性是异性恋青年的5倍。然而，由于文化和方法上的障碍，对性少数群体青少年的纵向研究很少进行。本研究项目的总体目标是在性少数青年和异性恋青年的对比组的纵向研究中检查物质使用和艾滋病毒风险行为。由于所提出的方法和理论的许多重要特征，这将是第一个此类青年研究。这些特征包括：(A)纵向、准实验设计；(B)评估青少年药物使用和危险性行为随时间的个人成长或变化；(C)检查药物使用和危险性行为风险的调节因子和调节因子；(D)确定与这些新出现的多种流行病趋同有关的风险和保护因素，以及它们如何导致艾滋病毒/艾滋病。这一项目的成果将产生关于这一高度脆弱和边缘化群体健康问题发展的丰富信息。他们将为发展解释和应用综合症框架提供经验支持。它们将成为一种模式，帮助人们了解在边缘化人群中如何展开流行病进程，从而增加感染艾滋病毒/艾滋病的风险。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: The primary goal of this study is to identify critical risk and protective factors to help prevent HIV transmission among high-risk, marginalized youth. A growing body of evidence shows that multiple psychosocial health problems emerge in adolescence and intertwine to produce vulnerability to HIV/AIDS. This longitudinal study will determine: (A) what those psychosocial health problems are, (B) how and when they emerge, and (C) how and when they converge to cause HIV transmission in young people.