Multilevel strategies to understand and modify the role of structural and environmental context on HIV inequities for sexual and gender minorities of color

了解和改变结构和环境背景对有色人种和性别少数群体艾滋病毒不平等的作用的多层次战略

• 批准号: 10594549
• 负责人: H. Jonathon Rendina
• 金额: $ 221.13万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-18 至 2024-05-03
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10594549
• 关键词: AIDS prevention; Address; Adolescent; Adult; Affect; Age; Age Years; Behavior; Black race; Color; Communities; Data; Disparity population; Ecological momentary assessment; Enrollment; Ensure; Environment; Epidemic; Epidemiology; Equity; Exposure to; Future; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV disparities; HIV risk; Health Policy; Healthcare; Home; Human immunodeficiency virus test; Incidence; Individual; Inequity; Insurance Coverage; Intervention; Latino; Laws; Lesbian Gay Bisexual Transgender Queer; Measures; Medical; Methodology; Methods; Modality; Modeling; Participant; Persons; Phase; Policies; Population; Prevalence; Public Health; Puerto Rico; Quality of Care; Research; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Sexual and Gender Minorities; Social Environment; Structural Models; Structural Racism; Structure; Surveys; System; Techniques; Technology; Testing; Translating; Unsafe Sex; Update; Viral Load result; Work; aged; cisgender; cohort; community partnership; design; digital; digital technology; disparity reduction; economic indicator; experience; gender diversity; high risk; improved; intersectionality; maltreatment; medical services inaccessibility; men; multi-racial; next generation; nonbinary; novel; policy recommendation; pre-exposure prophylaxis; preventive intervention; recruit; response; sex; sexual minority men; social; social media; social stigma; social structure; socioeconomic disadvantage; socioeconomics; structural determinants; systematic review; transfeminine; transmasculine; transmission process; working group

PROJECT SUMMARY/ABSTRACT Black, Latino/a/e/x, and Multiracial (BLM) sexual and gender minorities who have sex with men (SGMSM) in the U.S. continue to experience a high and disproportionate burden of HIV, particularly younger BLM SGMSM for whom HIV incidence continues to rise despite advances in HIV prevention. Evidence suggests that differences in individual risk behaviors do not account for HIV inequities, and underscore the need to move beyond models of individual-level risk factors to identify and intervene upon the socio-structural factors that create and maintain inequitable risk environments. However, much of the research to date is limited in scope and focuses individual-level risk or on cross-sectional HIV prevalence, which limits the ability to treat socio- structural factors as dynamic or to investigate the environments within which risk behaviors occur. We are submitting this application in response to RFA-AI-21-018 Limited Interaction Targeted Epidemiology to Advance HIV Prevention (UG3/UH3). We propose to enroll a cohort of approximately 5,500 BLM SGMSM ages 16 and older in the U.S. and Puerto Rico who are at high risk for HIV infection. We will use a combined approach to recruitment (sexual networking apps, social media, and other digital recruitment techniques) that is adaptive to known shifts in digital technology. Participants will complete a survey and home-based sampling for lab-based HIV testing at enrollment and annually thereafter for three years and an ecological momentary assessment (EMA) for six weeks after enrollment. Concordant with study enrollment, we will develop novel metrics to quantify socio-structural factors (state-level policy and social climate indicators) that create intersectional oppression for BLM SGMSM, specifically structural racism, anti-LGBTQ stigma, and restrictive HIV-related healthcare (Aim 1a). We will subsequently utilize the newly developed metrics from Aim 1a along with local socio-structural factors (local-level HIV prevalence and socioeconomic indicators) and baseline and EMA data to test the inequitable risk environments hypothesis to understand the role of state and local socio- structural risk factors in HIV risk—this hypothesis will specifically test both the impact of socio-structural factors on daily exposure to intersectional stigma and the interaction of socio-structural risk with individual behaviors on undiagnosed HIV infection at baseline (Aim 2). These data will also be used to test a longitudinal model of mechanisms through which state and local socio-structural factors directly and indirectly influence HIV seroconversion and access to emerging HIV prevention technologies (e.g., emerging PrEP modalities) (Aim 3). Study findings will be systematically reviewed and translated into guidelines for Ending the HIV Epidemic- related public health policy and community-level interventions to reduce HIV inequities (Aim 1b). Developing and testing a socio-structural model of HIV risk has strong potential to move the field beyond individually- focused models of risk and improve the next generation of HIV prevention interventions aimed at reducing disparities for this population.

项目摘要/摘要 黑色，拉丁裔/a/e/x，以及与男人发生性关系的多种族性和性别少数群体（SGMSM） 美国继续经历艾滋病毒的高度燃烧，尤其是年轻的BLM SGMSM 艾滋病毒事件继续在预防艾滋病毒预防方面的目的地进展。有证据表明这一点 个体风险行为的差异并不能解释艾滋病毒的不平等，并强调了搬家的需求 除了识别和干预社会结构因素的个人级别风险因素模型之外 创建并维护不平等的风险环境。但是，迄今为止的许多研究范围有限 并集中于个人级别的风险或横断面HIV患病率，这限制了治疗社会的能力 结构性因素是动态的，或调查发生风险行为的环境。我们是 根据RFA-AI-21-018提交此申请，有限的相互作用针对性流行病学 预防艾滋病毒（UG3/UH3）。我们建议招募约5,500 BLM SGMSM年龄的队列 在美国和波多黎各的16岁及以上的人患艾滋病毒感染的风险很高。我们将共同使用 招聘方法（性网络应用程序，社交媒体和其他数字招聘技术） 适应数字技术的已知转变。参与者将完成调查和家庭采样 基于实验室的艾滋病毒测试在入学术中，此后每年三年，生态瞬间 入学后六周评估（EMA）。与研究入学率一致，我们将开发新颖 量化社会结构因素（州级政策和社会气候指标）的指标 BLM SGMMSM的交叉压迫，特别是结构性种族主义，抗LGBTQ污名和限制性 与HIV相关的医疗保健（AIM 1A）。随后，我们将利用AIM 1A的新开发的指标 与当地的社会结构因素（地方级的艾滋病毒流行和社会经济指标）和基线和 EMA数据以测试不平等的风险环境假设，以了解国家和地方社会的作用 艾滋病毒风险中的结构性风险因素 - 该假设将特别检验社会结构因素的影响 每天暴露于交叉污名以及社会结构风险与个人行为的相互作用 在基线时未持续的艾滋病毒感染（AIM 2）。这些数据还将用于测试 州和地方社会结构因素直接或间接影响艾滋病毒的机制 血清转化并访问新兴的HIV预防技术（例如，新兴准备模式）（AIM 3）。 研究结果将被系统地审查并转化为结束HIV流行的准则 相关的公共卫生政策和社区水平的干预措施，以减少艾滋病毒不平等现象（AIM 1B）。发展 测试艾滋病毒风险的社会结构模型具有使该领域超越单独的强大潜力 - 重点的风险模型并改善旨在减少的艾滋病毒预防干预措施 这个人群的差异。