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: 10462238
• 负责人: H. Jonathon Rendina
• 金额: $ 215万
• 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 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10462238
• 关键词: AIDS prevention; Address; Adolescent; Adult; Affect; Age; Age-Years; Behavior; Black race; Color; Communities; Data; Ecological momentary assessment; Enrollment; Ensure; Environment; Epidemic; Epidemiology; Exposure to; Fibrinogen; Future; Gender; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health Policy; Healthcare; Home; Human immunodeficiency virus test; Incidence; Individual; Insurance Coverage; Intervention; Latino; Laws; Lesbian Gay Bisexual Transgender Queer; Measures; Medical; Methodology; Methods; Modality; Modeling; Participant; Persons; Phase; Plant Roots; 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; base; cisgender; cohort; community partnership; design; digital; disparity reduction; experience; high risk; improved; intersectionality; maltreatment; medical services inaccessibility; men; multi-racial; next generation; novel; policy recommendation; pre-exposure prophylaxis; preventive intervention; recruit; response; sex; sexual minority men; social; social media; social stigma; social structure; socioeconomic disadvantage; socioeconomics; 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.

项目概要/摘要 与男性发生性关系的黑人、拉丁裔/a/e/x 和多种族 (BLM) 性少数群体 (SGMSM) 美国继续承受着沉重且不成比例的艾滋病毒负担，尤其是年轻的 BLM SGMSM 尽管艾滋病毒预防工作取得了进展，但艾滋病毒感染率仍在持续上升。 个人风险行为的差异并不能解释艾滋病毒的不平等，并强调需要采取行动 超越个人层面的风险因素模型来识别和干预社会结构因素 创造和维持不公平的风险环境 然而，迄今为止的大部分研究范围有限。 并侧重于个人层面的风险或横截面艾滋病毒流行率，这限制了治疗社会艾滋病毒的能力 动态的结构因素或调查我们所处的风险行为的环境。 将此申请提交给 RFA-AI-21-018 有限互动目标流行病学 我们建议招募大约 5,500 名 BLM SGMSM 年龄的队列。 美国和波多黎各 16 岁及以上的 HIV 感染高危人群我们将使用联合疗法。 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变化 参与者将完成一项调查和家庭抽样。 在入学时和随后的三年内进行基于实验室的艾滋病毒检测以及生态瞬时检测 入学后六周的评估（EMA），我们将开发新的。 量化社会结构因素（州级政策和社会气候指标）的指标 BLM SGMSM 的交叉压迫，特别是结构性种族主义、反 LGBTQ 耻辱和限制性 与艾滋病毒相关的医疗保健（目标 1a）随后将利用目标 1a 中新开发的指标。 与当地社会结构因素（当地​​艾滋病毒流行率和社会经济指标）以及基线和 EMA 数据用于测试不公平风险环境假设，以了解州和地方社会的作用 HIV风险中的结构性风险因素——该假设将专门测试社会结构因素的影响 关于日常接触交叉耻辱以及社会结构风险与个人行为的相互作用 基线时未确诊的 HIV 感染情况（目标 2）。 国家和地方社会结构因素直接和间接影响艾滋病毒的机制 血清转化和获得新兴艾滋病毒预防技术（例如新兴的 PrEP 模式）（目标 3）。 研究结果将被系统审查并转化为结束艾滋病毒流行的指南 相关公共卫生政策和社区一级的干预措施，以减少艾滋病毒不平等（目标 1b）。 测试艾滋病毒风险的社会结构模型具有很大的潜力，可以使该领域超越个人- 集中风险模型并改进下一代艾滋病毒预防干预措施，旨在减少 这个人群的差异。