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.

项目摘要由于系统性的少数派压力和社会伤害，健康不平等显现出来。种族主义和歧视是黑人性少数民族（SMM）的显着少数压力和社会伤害，因为黑人SMM在不同的生态层面（人际，人际关系，人际，和社区）由于其相互联系的身份（例如种族，性少数群体状况，艾滋病毒状况）。这些多次暴露伴随着黑色MSM之间的HIV脆弱性增加：1中1黑色如果当前趋势仍然存在不变。了解个人适应或抵抗生命的能力越来越兴趣逆境或压力事件（即少数族裔优势框架）。那是一个综合的少数社会结构压力和少数族裔优势理论模型将在拟议的应用中测试以描绘多级歧视艾滋病毒预防结果的预测因素，并了解弹性如何调节这些协会。首先，我们假设更多的期望和歧视经验是预测的不经常测试性传播感染，包括HIV和较低的暴露前预防（PREP）在黑色的36个月后续期间使用，保留护理，准备依从性和准备保护 MSM在深南部。接下来，我们假设不同级别的弹性将减轻关联在歧视和预防艾滋病毒之间。最后，我们将与社会进行定性焦点小组映射以验证目标1和2中的定量结果，并确定和/或适应有效的社会结构和/或基于优势的干预措施，以减轻SRD对黑色SMM的准备结果的影响。提出了三个集成的特定目的来检验这些假设。在特定目标1中，要评估SRD因素和准备之间的关系在36个月的随访期间，美国东南部两个城市的黑色SMM使用多级建模技术。在特定目标2中，确定弹性因素对关系的调节作用在美国东南部两个城市的黑人SMM中，SRD因素和PREP之间的结果继续通过适度分析。最后，在特定的目标3中，到a。获得上下文的解释通过焦点组的定量结果； b。黑色SMM地理环境的“地理叙事” 使用社交映射；和c。通过数据三角测量方法综合定量和定性结果。从广义上讲，这项研究将增强我们对SRD歧视如何促进不平等的理解在艾滋病毒中，并洞悉艾滋病毒流行病学领域的三个长期问题：（1）少数民族有助于预防HIV的压力机制少数派压力源与艾滋病毒预防的关联，以及（3）社会的识别和/或适应基于结构或优势的干预措施，以减轻黑人SMM中的HIV。