Multilevel Racism & Discrimination and PrEP Outcomes Among Black SMM in the Southeastern U.S.

多层次的种族主义

基本信息

批准号：
10474834
负责人：
DEMARC A HICKSON
金额：
$ 61.87万
依托单位：
US HELPING US, PEOPLE INTO LIVING, INC.
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-08 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10474834
关键词：
AIDS prevention AIDS/HIV problem Adherence Awareness Biological Biological Markers Black race Blood Buffers Caring Cities Cohort Studies Collection Communities Conscious Data Deep South Development Diagnosis Discrimination Economic Factors Environmental Risk Factor Epidemic Epidemiology Failure Fibrinogen Focus Groups Funding Future Geography HIV HIV Seronegativity HIV diagnosis Health Health system Healthcare Homophobia Homosexuality Human immunodeficiency virus test Hydrocortisone Incidence Individual Intervention Knowledge Life Link Location Measurement Measures Medical Methodology Methods Minority Modeling National Institute of Mental Health National Institute on Minority Health and Health Disparities Neighborhoods Outcome Participant Pathway interactions Patient Self-Report Perception Pharmaceutical Preparations Phase Phenotype Political Factor Population Prevention strategy Public Health Race Research Risk Behaviors Role Sampling Sexually Transmitted Diseases Site Social Adjustment Social support Southeastern United States Stress Stressful Event Structural Racism Surveys Techniques Testing Time United States United States National Institutes of Health Washington base black men black men who have sex with men cardiovascular health experience follow-up health care settings health inequalities innovation insight interest male health men men who have sex with men men&apos s group minority stress minority stressor multidisciplinary multilevel analysis novel perceived discrimination pre-exposure prophylaxis prevention service prospective racism recruit resilience self esteem sexual minority sexual minority community sexual minority men social social factors social stigma social structure stressor study population success theories trait trend uptake

项目摘要

PROJECT SUMMARY Inequities in health manifest as a result of systemic minority stressors and social injustices. Racism and discrimination are salient minority stressors and social injustices for Black sexual minority men (SMM) because Black SMM anticipate and experience discrimination at different ecological levels (intrapersonal, interpersonal, and community) due to their interconnected identities (e.g., race, sexual minority status, HIV status). These multiple exposures concomitantly contribute to increased HIV vulnerability among Black MSM: 1 in 2 Black SMM will be diagnosed with HIV in their lifetime, compared to 1 in 11 for White MSM, if current trends remain unchanged. There is increasing interest in understanding an individual's ability to adapt to or resist life's adversities or stressful events (i.e., minority strengths framework). Thus, an integrated minority social-structural stress and minority strengths theory model will be tested in the proposed application to delineate the multilevel discrimination predictors of HIV prevention outcomes, and understand how resilience moderates these associations. First, we hypothesize that greater anticipation and experiences of discrimination are predictive of infrequent testing for sexually transmitted infections, including HIV, and lower pre-exposure prophylaxis (PrEP) use, retention in care, PrEP adherence, and PrEP protection over a 36-month follow-up period among Black MSM in the Deep South. Next, we hypothesize that differing levels of resilience will moderate the associations between discrimination and HIV prevention. Finally, we will conduct qualitative focus groups with social mapping to validate the quantitative results in Aims 1&2 and to identify and/or adapt effective social-structural and/or strengths-based interventions to mitigate the effect of SRD on PrEP outcomes among Black SMM. Three integrated specific aims are proposed to test these hypotheses. In Specific Aim 1, to evaluate the relationships between SRD factors and PrEP continuum outcomes among Black SMM in two Southeastern U.S. cities over a 36-month follow-up period, using multilevel modeling techniques. In Specific Aim 2, to determine the moderating effects of resiliency factors on the relationships between SRD factors and PrEP continuum outcomes among Black SMM in two Southeastern U.S. cities through moderation analyses. And finally, in Specific Aim 3, to a. gain contextually-grounded explanations of the quantitative results via focus groups; b. “geo-narratives” of the geographical landscape of Black SMM using social mapping; and c. synthesize the quantitative and qualitative results via data triangulation methods. Broadly, this research will enhance our understanding of how SRD discrimination contributes to inequities in HIV and provide insight into three long-standing questions in the field of HIV epidemiology: (1) minority stress mechanisms that contribute to HIV prevention outcomes, (2) intrapersonal traits that buffer the associations of minority stressors with HIV prevention, and (3) identification and/or adaptation of social- structural or strengths-based interventions to mitigate HIV among Black SMM.

项目概要健康方面的不平等表现为系统性少数群体压力和社会不公正。对于黑人性少数男性（SMM）来说，歧视是显着的少数压力源和社会不公正，因为黑人 SMM 预期并经历不同生态层面的歧视（个人内部、人际、和社区），因为他们相互关联的身份（例如种族、性少数群体状况、艾滋病毒状况）。多重接触同时导致黑人男男性接触者中艾滋病毒易感性增加：二分之一的黑人如果目前的趋势保持下去，SMM 将在其一生中被诊断出感染艾滋病毒，而白人 MSM 的这一比例为十分之一人们越来越有兴趣了解个人适应或抵抗生活的能力。逆境或压力事件（即少数族裔优势框架）因此，一个综合的少数族裔社会结构。压力和少数优势理论模型将在所提出的应用程序中进行测试，以描绘多层次艾滋病毒预防结果的歧视预测因子，并了解复原力如何调节这些结果首先，我们发现，更大的预期和遭受歧视的经历可以预测。性传播感染（包括 HIV）检测不频繁，暴露前预防 (PrEP) 较低黑人在 36 个月的随访期内使用、保留护理、PrEP 依从性和 PrEP 保护接下来，我们勇敢地承认，不同程度的恢复力将缓和这种关联。最后，我们将与社会开展定性焦点小组讨论。绘制地图以验证目标 1 和 2 中的定量结果，并确定和/或调整有效的社会结构和/或基于优势的干预措施，以减轻 SRD 对黑人 SMM 中 PrEP 结果的影响。提出了三个综合的具体目标来检验这些假设。在具体目标 1 中，评估 SRD 因素与 PrEP 连续结果之间的关系使用多层次建模对美国东南部两个城市的黑人 SMM 进行 36 个月的随访在具体目标 2 中，确定弹性因素对关系的调节作用。美国东南部两个城市黑人 SMM 的 SRD 因素与 PrEP 连续结果之间的关系最后，在具体目标 3 中，获得基于上下文的解释。 b. 通过黑人 SMM 地理景观的定量焦点小组得出的结果；使用社会测绘；以及 c. 通过数据三角测量方法综合定量和定性结果。总的来说，这项研究将加深我们对SRD歧视如何导致不平等的理解艾滋病毒流行病学领域的三个长期存在的问题提供见解：（1）少数群体有助于艾滋病毒预防结果的压力机制，(2) 缓冲少数民族压力源与艾滋病毒预防的关联，以及（3）识别和/或适应社会压力源采取结构性或基于优势的干预措施，以减轻黑人 SMM 中的艾滋病毒感染。