NEXUS: A novel social network approach to study the effects of intersectional stigma on HIV prevention among Latino MSM

NEXUS：一种新颖的社交网络方法，用于研究拉丁裔 MSM 中交叉耻辱对艾滋病毒预防的影响

• 批准号: 10202462
• 负责人: Laramie Rae Smith
• 金额: $ 69.8万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10202462
• 关键词: AIDS prevention; Accounting; Acculturation; Adherence; Adult; Affect; Age; California; Characteristics; Communities; County; Data; Diagnosis; Environment; Epidemic; Equipment and supply inventories; Ethnic Origin; Exposure to; Family; Family member; Fostering; Friends; Fright; Future; Gender; Gender Identity; Geographic state; HIV; HIV Infections; HIV Seronegativity; HIV diagnosis; HIV risk; Health; Homophobia; Human immunodeficiency virus test; Incidence; Individual; Intervention; Latino; Masculine; Measures; Mediating; Medical Records; Methods; Outcome; Pathway Analysis; Population; Prevention; Prevention strategy; Process; Provider; Public Health; Puerto Rico; Research; Sexual Partners; Sexuality; Site; Social Environment; Social Network; Social support; Source; Stigmatization; United States National Institutes of Health; Work; community organizations; density; ethnic identity; experience; health disparity; improved; innovation; member; men; men who have sex with men; novel; pre-exposure prophylaxis; prevent; primary outcome; prospective; racism; recruit; resilience; response; sexual identity; social; social relationships; social stigma; uptake

220.7 PROJECT SUMMARY/ABSTRACT Stigma is a pervasive barrier to HIV testing and PrEP use among US Latino men who have sex with men (LMSM). Routine HIV testing and large scale PrEP coverage are essential HIV prevention strategies for ending the HIV epidemic. LMSM further contend with intersectional stigma, meaning they experience or fear unjust treatment from others due to their ethnic, sexual, and masculine identities (i.e. adherence to masculinity norms). Specific to intersectional stigma, emerging quantitative research suggests exposure to stigma towards >1 intersectional identity is associated with worse health outcomes than exposure to stigma towards a single intersectional identity. While research on intersectional stigma has been largely qualitative, advanced quantitative methods offer an opportunity to identify novel actionable intervention mechanisms and targets; improving our public health response to ending the US HIV epidemic. Social network analysis is a robust method for examining how LMSM interact with and are affected by others in their social network. Social networks are important intervention targets, since network members are capable of (1) stigmatizing LMSM (i.e. stigma sources) and (2) fostering resilience and social support to reduce the negative impact of intersectional stigma on LMSM’s HIV testing and PrEP use. The current study will prospectively assess how anticipated and enacted intersectional stigma are experienced by LMSM in their social networks at baseline to effect HIV testing and PrEP use 12-months post-baseline. We will recruit 500 HIV-negative adult LMSM from MSM and Latino community organizations. Study measures, including an egocentric social network inventory, will be collected at Months 0, 6, and 12. Our primary outcomes, HIV testing and PrEP use, will be abstracted from medical records at Month 12. We will use social network analysis to: (1) Identify how LMSM experience intersectional stigma in their social networks across diverse social context (i.e. types of social relationships [e.g. family, friends, sex partners, providers], expression of intersectional identities [e.g. acculturation, outness, masculinity]) (AIM 1, primary). (2) Prospectively evaluate the effect of social network exposure to intersectional stigma on HIV testing and PrEP use (AIM 2, primary). (3) Identify novel points of intervention to reduce the harmful effects of intersectional stigma on HIV testing and PrEP use (AIMS 3-4, exploratory) and develop data–and–community-informed intervention strategies for future piloting. As the first study to use social networks to evaluate the effects of intersectional stigma on health outcomes, NEXUS is significant because new HIV diagnoses among US LMSM are increasing–due to low rates of HIV testing (undiagnosed HIV) and PrEP use–while new diagnoses among non-LMSM have stabilized or decreased. A SN approach to studying intersectional stigma is highly innovative because it reflects a substantial departure from how intersectional stigma has been studied, opening new opportunities to end the HIV epidemic. Without such efforts, intersectional stigma will persist in producing and maintaining HIV disparities among LMSM.

220.7项目摘要/摘要 污名是与男性发生性关系（LMSM）的美国拉丁裔男人中艾滋病毒测试和准备使用的普遍障碍。 常规的艾滋病毒测试和大规模准备覆盖范围是结束艾滋病毒的基本预防艾滋病毒 流行性。 LMSM进一步与交叉污名抗衡，这意味着他们经历或害怕不公正的治疗 由于其种族，性和男性身份（即遵守男性气质规范），他人都来自其他人。具体的 对于交叉污名，新兴的定量研究表明，暴露于> 1个交叉的污名 身份与对单个相交的污名相比，健康状况差的健康结果差 身份。虽然有关交叉污名的研究在很大程度上是定性的，先进的定量方法 提供机会来识别新颖的可操作的干预机制和目标；改善我们的公共卫生 终结美国艾滋病毒流行的反应。社交网络分析是研究LMSM的强大方法 与其社交网络中的其他人互动并受到其他人的影响。社交网络是重要的干预目标， 由于网络成员能够（1）污名化LMSM（即污名来源）和（2）促进弹性 和社会支持，以减少交叉污名对LMSM的HIV测试和PREP使用的负面影响。 当前的研究可能会评估如何经历预期和颁布的交叉污名 由LMSM在基线的社交网络中进行，以实现艾滋病毒测试和准备后使用12个月后 - 基线。我们 将从MSM和拉丁裔社区组织招募500名HIV阴性成人LMSM。研究测量， 包括以自我为中心的社交网络清单，将在第0、6和12个月收集。我们的主要成果， HIV测试和准备使用将从第12个月从病历中抽象出来。我们将使用社交网络 分析：（1）确定LMSM如何在其社交社会社交网络中体验交叉污名 上下文（即社会关系的类型[例如，家人，朋友，性伴侣，提供者]，交叉表达 身份[例如适应，外向，男性气质]）（AIM 1，主要）。 （2）前瞻性评估 社交网络暴露于HIV测试和PREP使用中的交叉污名（AIM 2，主要）。 （3）识别小说 干预点，以减少交叉污名对艾滋病毒测试和准备使用的有害影响（目标） 3-4，探索性）并为未来的试验制定了数据和社区信息的干预策略。 作为第一个使用社交网络评估交叉污名对健康结果的影响的研究， Nexus很重要，因为美国LMSM中新的HIV诊断正在增加 - 艾滋病毒率低 测试（未诊断的艾滋病毒）和PREP使用 - 非LMSM中的新诊断已经稳定或改进。 研究交叉污名的SN方法具有很高的创新性，因为它反映了实质性的出发 从交叉污名化的研究中，为结束艾滋病毒流行的新机会开辟了新的机会。没有 这样的努力，交叉污名将持续产生和维持LMSM之间的HIV差异。