Understanding Delayed Access to HIV Prevention Services among Black MSM

描述(由申请人提供)：艾滋病毒艾滋病仍然是非洲裔美国男性男男性行为者(AA MSM)的主要健康危机。在最近的一项大规模艾滋病毒血清阳性率调查中，AA男男性接触者的患病率最高(28%)，而所有其他种族的男男性接触者的患病率为16%。这是一种健康差异，自艾滋病流行以来，许多不同的研究都重复了这种差异。考虑到艾滋病在AA男男性接触者中的流行规模，我们无法阻止HIV在美国的持续传播，除非我们找到为AA MSM提供有效的艾滋病毒预防计划的方法。艾滋病毒/艾滋病的联合预防方法为实现这一目标提供了相当大的希望，因为它解决了一些增加再生障碍性男男性接触者传播风险的高风险环境。然而，我们是否有能力设计有效的联合预防方法，以降低艾滋病男男性接触者中艾滋病毒的传播风险，取决于对艾滋病毒检测的障碍和促进者的流行病学清楚了解，是否能为艾滋病毒阳性的男性获得反应检测结果，以及在艾滋病毒阳性的情况下及时获得医疗保健。不幸的是，我们目前解释再障男男性接触者中艾滋病毒检测和卫生保健获得行为的能力有限，因为招募足够大的再障男男性接触者样本很困难，这些样本推迟了获得艾滋病毒预防和护理服务的机会。这些缺陷阻碍了我们就针对AA MSM的有针对性的预防工作得出有效结论的能力，最根本的是，包括必须建立组合预防战略的知情证据基础。Syndemics理论考察了与边缘化和脆弱人群中风险增加相关的多种心理社会健康状况(即药物滥用、抑郁、暴力受害)之间的影响和相互作用，为研究这些行为提供了重要的理论框架，特别是因为它涵盖了高危人群中的脆弱性和复原力。本应用程序建议通过从AA MSM(N=6000)的大规模样本中收集数据来解决这种情况：1.测量AA MSM中HIV检测的流行率并确定接受HIV检测的共性关联2.测量AA MSM中未知HIV血清阳性的流行率并确定共性关联3.测量HIV+AA MSM中的流行率并确定及时获得护理的共性关联通过与成熟的社区团体合作招募大量易受伤害的男性，我们将能够表征障碍和促进者，以构建基本的组合预防方法块，从而为制定有效的计划来降低AA MSM中的HIV传播提供关键信息。

DESCRIPTION (provided by applicant): HIV AIDS remains a major health crisis among African American men who have sex with men (AA MSM). In a recent large-scale HIV seroprevalence survey, prevalence rates were highest among AA MSM (28%), compared to 16% among MSM of all other ethnicities. This is a health disparity that has been replicated in many different studies since the start of the AIDS epidemic. Given the scale of the HIV epidemic among AA MSM, we cannot prevent the ongoing spread of HIV in the United States until we find ways to field effective HIV prevention programs for AA MSM. Combination prevention approaches to HIV/AIDS offer considerable promise to achieve this goal by addressing some of the high risk contexts that increase transmission risk among AA MSM. However, our ability to design effective combination prevention approaches to lower HIV transmission risk among AA MSM depends on achieving a clear epidemiological understanding of both barriers and facilitators to HIV testing, receiving reactive test results for men who are HIV positive and timel access to medical care if HIV positive. Unfortunately, our ability to explain HIV testing and health care access behaviors among AA MSM is currently limited due to the difficulties of recruiting sufficiently large samples of AA MSM who are delaying access to HIV prevention and care services. These shortcomings hamper our ability to draw effective conclusions about targeted prevention efforts for AA MSM, including most fundamentally an informed evidence base upon which combination prevention strategies must be built. Syndemics theory, which examines the effects and interactions among multiple psychosocial health conditions (i.e. substance abuse, depression, violence victimization) associated with increased risks within marginalized and vulnerable populations provides an important theoretical framework to examining these behaviors, especially since it encompasses both vulnerabilities and resiliencies in high risk populations. This application proposes to address this situation by collecting data from a large scale sample of AA MSM (N=6000) to: 1. Measure the prevalence and identify syndemic associations of uptake of HIV testing among AA MSM 2. Measure the prevalence and identify syndemic associations of unknown HIV seropositivity among AA MSM 3. Measure the prevalence and identify syndemic associations of timely access to care among HIV+ AA MSM By partnering with well-established community groups to recruit large samples of vulnerable men, we will be in a position to characterize the barriers and facilitators to the essential buildig blocks of combination prevention approaches and so provide crucial information for developing effective programs to lower HIV transmission among AA MSM.