Testing a Biopsychosocial Model of Minority Stress and Health for HIV-Positive Men

测试艾滋病毒阳性男性的少数群体压力和健康的生物心理社会模型

基本信息

批准号：
10394542
负责人：
H. Jonathon Rendina
金额：
$ 65.55万
依托单位：
WHITMAN-WALKER INSTITUTE, INC.
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-18 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10394542
关键词：
AIDS prevention AIDS/HIV problem Acquired Immunodeficiency Syndrome Acute Address Advanced Development Affect Attention Basic Behavioral and Social Science Research Behavioral Biological Biological Markers Bisexual CD4 Lymphocyte Count Caring Chronic Cognitive Continuity of Patient Care Depressed mood Development Drug usage Ecological momentary assessment Emotional Enrollment Event Feedback Focus Groups Future Gays Goals Guidelines HIV HIV Infections HIV Seronegativity HIV Seropositivity Health Health behavior Homophobia Hydrocortisone Immune Immune System Diseases Immune response Incidence Individual Inflammation Inflammatory Intervention Learning Link Measurable Measures Mediating Men&apos s Role Mental Health Minority Modeling Morbidity - disease rate Neurocognitive Outcome Participant Pathway interactions Patient Self-Report Physiological Pilot Projects Play Population Predisposition Prevention strategy Process Psychological Impact Psychosocial Factor Recommendation Research Research Priority Risk Behaviors Role Secondary Prevention Short-Term Memory Stress Surveys Testing Time United States National Institutes of Health Variant Viral Load result Work antiretroviral therapy anxious behavioral health behavioral/social science biological adaptation to stress biopsychosocial cognitive process comorbidity cytokine emotion dysregulation emotion regulation experience health disparity immune activation immune function improved infection rate men men who have sex with men mortality multilevel analysis novel physical conditioning pre-exposure prophylaxis prevent prospective test response sexual HIV transmission sexual minority sexual role social social interventions social stigma stressor substance use theories therapy adherence therapy development transmission process

项目摘要

Project Summary Gay and bisexual men (GBM) in the U.S. are burdened by a high and disproportionate rate of HIV infection and more than half of all HIV+ individuals are GBM. Improving viral load (VL) suppression is associated with a significant reduction in the sexual transmission of HIV. Moreover, research is needed to better understand the modifiable social and behavioral factors that influence their long-term health. Chronic experiences of sexual minority stressors (e.g., internalized homonegativity) have been shown to influence a variety of mental, behavioral, and physical health outcomes for GBM, including general stress (e.g., cortisol) and immune (e.g., cytokines) outcomes, as well as HIV-specific health outcomes (e.g., CD4 count) among HIV+ GBM. Chronic experiences of HIV-related stressors have also been shown to impact mental health and health behaviors for HIV+ GBM, though there is substantially less research on their role in the health of HIV+ GBM. Previous research, including our own, has shown that fluctuations in sexual minority and HIV-specific stressors (i.e., acute experiences of these stressors) are measurable and meaningfully associated with health outcomes. Both HIV infection and substance use are associated with declines in neurocognitive function and emerging evidence suggests that emotional processing may help explain the impact of psychological phenomena on health outcomes. To develop interventions that are robust and durable, research is needed that examines the unique and overlapping influence of sexual minority and HIV-related stressors on health outcomes for HIV+ GBM within a unified biopsychosocial model. Such a model should take into account both individual-level (i.e., chronic) and situational (i.e., acute) experiences of these stressors to examine their independent associations with health, and should consider whether emotional interference in cognitive processing might moderate these associations. Aim 1 of the study is to test a biopsychosocial model of sexual minority and HIV-related stress and health, examining direct and indirect effects of these stressors on each outcome. Aim 2 is to test the moderating role of emotional interference in cognitive processing on these associations. Finally, Aim 3 is to examine the extent of intraindividual variability over one year in sexual minority and HIV-related stressors, VL, CD4, and cytokines. Although not an aim, the study will culminate in the development of guidelines for future intervention development and we will gather participant feedback on these recommendations. To accomplish these aims, we will enroll 250 HIV+ GBM and follow them for 12 months. We will use ecological momentary assessment (EMA) for 21 days and quarterly longitudinal follow-ups over one year to test the impact of sexual minority and HIV-related stress on physiological stress (diurnal cortisol) and long-term immune outcomes (VL suppression, CD4 count, cytokines). This study will address novel questions about the relative role of sexual minority and HIV-related stress in the health of HIV+ GBM to guide the development of interventions to improve health and reduce HIV transmission, morbidity, and mortality among HIV+ GBM.

项目概要美国的男同性恋者和双性恋者 (GBM) 承受着高且不成比例的艾滋病毒感染率的负担，超过一半的 HIV+ 个体患有 GBM。改善病毒载量 (VL) 抑制与显着减少艾滋病毒的性传播。此外，还需要进行研究以更好地了解影响他们长期健康的可改变的社会和行为因素。长期性经历少数压力源（例如，内在的同性消极）已被证明会影响各种心理、 GBM 的行为和身体健康结果，包括一般压力（例如皮质醇）和免疫（例如 HIV+ GBM 中的 HIV 特异性健康结果（例如 CD4 计数）。慢性的艾滋病毒相关压力源的经历也被证明会影响心理健康和健康行为 HIV+ GBM，尽管对其在 HIV+ GBM 健康中的作用的研究要少得多。以前的包括我们自己在内的研究表明，性少数群体和艾滋病毒特异性压力源的波动（即这些压力源的急性经历）是可测量的，并且与健康结果具有有意义的相关性。两个都 HIV 感染和物质使用与神经认知功能下降和新出现的有证据表明情绪处理可能有助于解释心理现象对人的影响健康结果。为了制定强有力和持久的干预措施，需要进行研究来检验性少数和艾滋病毒相关压力源对艾滋病毒+的健康结果产生独特且重叠的影响 GBM 采用统一的生物心理社会模型。这样的模型应该考虑到个人层面（即这些压力源的慢性）和情境（即急性）经历，以检查它们的独立关联与健康有关，并且应该考虑认知过程中的情绪干扰是否可能会缓和这些协会。该研究的目标 1 是测试性少数和艾滋病毒相关压力的生物心理社会模型和健康，检查这些压力源对每个结果的直接和间接影响。目标 2 是测试情绪干扰在认知处理中对这些关联的调节作用。最后，目标 3 是检查一年内性少数和艾滋病毒相关压力源的个体差异程度，VL， CD4和细胞因子。尽管不是目的，但该研究最终将制定未来的指导方针干预措施的制定，我们将收集参与者对这些建议的反馈。为了完成为了实现这些目标，我们将招募 250 名 HIV+ GBM 患者并跟踪他们 12 个月。我们将用生态瞬间为期 21 天的评估（EMA）和一年内每季度的纵向随访，以测试性的影响少数民族和艾滋病毒相关压力对生理压力（昼间皮质醇）和长期免疫结果（VL 抑制、CD4 计数、细胞因子）。这项研究将解决有关性的相对作用的新问题少数群体和艾滋病毒相关压力对 HIV+ GBM 健康的影响，以指导干预措施的制定改善 HIV+ GBM 的健康状况并减少 HIV 传播、发病率和死亡率。