Synergistic epidemics of non-communicable diseases, stigma, depression, and material insecurities among sexual and gender minorities living with HIV in Nigeria

尼日利亚艾滋病毒感染者中性少数群体和性别少数群体中非传染性疾病、耻辱、抑郁和物质不安全感的协同流行

• 批准号: 10540034
• 负责人: Manhattan E Charurat
• 金额: $ 76.21万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10540034
• 关键词: AIDS/HIV problem; Africa South of the Sahara; Blood; Caring; Chronic Obstructive Pulmonary Disease; Communities; Continuity of Patient Care; Data; Data Analyses; Development; Diabetes Mellitus; Discrimination; Disease; Disease Clusterings; Disease Outcome; Dyslipidemias; Economics; Exposure to; HIV; HIV risk; Health; Health behavior; Heart; Hypertension; Inequality; Interdisciplinary Study; Intervention; Interview; Knowledge; Lead; Lung; Maryland; Measures; Mental Depression; Military Personnel; Modeling; National Heart, Lung, and Blood Institute; Nigeria; Obesity; Outcome; Participant; Police; Policies; Population; Prevalence; Public Health; Research; Research Personnel; Risk; Risk Factors; Sexual and Gender Minorities; Social status; Social support; Stigmatization; Stress; Testing; Time; Universities; Victimization; Violence; Woman; Work; cardiometabolic risk; cohort; deviant; experience; follow-up; gender minority group; health care availability; indexing; intimate partner violence; life history; low and middle-income countries; men who have sex with men; multidisciplinary; perceived discrimination; polysubstance use; programs; social; social capital; social norm; social stigma; syndemic

PROJECT ABSTRACT There is an increasing burden of HIV-associated noncommunicable diseases (HIVNCD) globally, which often cluster among populations facing persistent social and economic inequalities. One such population is sexual and gender minorities (SGM), for whom stress resulting from discrimination leads to poorer health outcomes. Syndemic frameworks have been utilized to explain elevated HIV risk in SGM populations but have only recently been applied to study HIVNCD. Being an SGM is associated with real and perceived discrimination and stigmatization. As a result, SGM experience elevated levels of victimization including intimate partner violence (IPV) and subsequently, stress, depression, polysubstance use, and material insecurity. These factors are well-documented risk factors for disengagement in the continuum of care among SGM. There is a critical knowledge gap for the development of modifiable intervention strategies, however, regarding how these syndemic factors leads to disease clustering of HIVNCD and promotes further inequities and vulnerabilities in low- and middle-income countries (LMIC) where both HIV prevalence and social/economic barriers to accessing health care are remarkably high. In Nigeria, where the University of Maryland, the Johns Hopkins University, and the U.S. Military HIV Research Program have worked with SGM since 2012, 70% of SGM in the TRUST/RV368 study (84% men who have sex with men and 16% self-identified as women) experience a moderate-to-severe level of stigma related to discriminatory policies, and social norms that leads to avoidance of HIV care. Prior to this proposal, we conducted a cross-sectional preliminary analysis, which suggested that stigma and depression are associated with clusters of cardiometabolic risk factors. The proposed work builds on the TRUST/RV368 study, the largest cohort of SGM in sub-Saharan Africa (SSA) and brings together a multidisciplinary team of researchers to: 1) Examine association between syndemic factors and HIVNCD outcomes; 2) Assess whether and how community-level and structural-level factors exacerbate the syndemic; and 3) Determine whether the syndemic characterized for HIVNCD prevalence and outcomes is associated with risk of disengaging from HIVNCD care continua.

项目摘要 全球与艾滋病毒相关的非传染性疾病（HIVNCD）的负担越来越大，通常 聚集在面临持续的社会和经济不平等的人群中。这样的人是性 和性别少数族裔（SGM），歧视造成的压力导致健康结果较差。 联合框架已被用来解释SGM人群中的HIV风险升高，但仅具有 最近应用于研究HIVNCD。成为SGM与真实和感知的歧视有关 和污名化。结果，SGM的受害水平升高，包括亲密伴侣 暴力（IPV）以及随后的压力，抑郁，多物质的使用和物质不安全感。这些因素 是SGM连续护理中有据可查的风险因素。有关键 然而，知识差距开发了可修改的干预策略，关于这些策略的知识差距 联合因素导致HIVNCD的疾病聚类，并促进进一步的不平等和脆弱性 低收入和中等收入国家（LMIC），艾滋病毒的患病率和社会/经济障碍 获得医疗保健非常高。在尼日利亚，马里兰大学约翰·霍普金斯大学 自2012年以来，大学和美国军事艾滋病毒研究计划与SGM合作，SGM的70％ Trust/RV368研究（84％与男性发生性关系的男性和16％的女性身份）经历了 与歧视性政策有关的中等至重度污名水平，以及导致回避的社会规范 艾滋病毒护理。在此提案之前，我们进行了横断面初步分析，这表明 污名和抑郁症与心脏代谢危险因素的簇有关。拟议的工作建立 在Trust/RV368研究中，撒哈拉以南非洲（SSA）最大的SGM队列 研究人员的多学科团队：1）检查联合因素与HIVNCD之间的关联 结果； 2）评估社区级别和结构级别的因素是否加剧了集团； 3）确定HIVNCD患病率和结局的特征是否与之相关 有脱离Hivncd Care Continua的风险。