Structural barriers to HIV prevention service utilization among Black MSM

黑人男男性接触者利用艾滋病毒预防服务的结构性障碍

• 批准号: 8410305
• 负责人: Manya Magnus
• 金额: $ 19.81万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-10 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8410305
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Adolescent; Adult; Affect; African American; Behavior; Behavior Therapy; Behavioral; Benchmarking; Biological Models; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Color; Communities; Data; Development; Device or Instrument Development; Dimensions; District of Columbia; Epidemic; Evaluation; Funding; Future; HIV; HIV Infections; HIV Seropositivity; HIV prevention trials network; Health Services; Health Services Accessibility; Healthcare; Healthcare Systems; Individual; Infection; Infection prevention; Intervention; Life; Methods; Minority; Modeling; Persons; Population; Prevention; Prophylactic treatment; Provider; Public Health; Questionnaires; Research; Research Personnel; Research Project Grants; Risk; Role; Sampling; Screening procedure; Services; Sex Behavior; Testing; Universities; Washington; Work; base; care seeking; cohort; experience; follow-up; high risk; high risk sexual behavior; innovation; insight; instrument; instrumentation; male; meetings; member; men; men who have sex with men; multidisciplinary; novel; novel strategies; outreach; peer; prevent; prevention service; prospective; service utilization; sex; social; success; therapy development; tool; transgender; transmission process

DESCRIPTION (provided by applicant): In the District of Columbia (DC), where 3.2% of the population and 7.1% of black males are living with HIV, men having sex with men (MSM) remains the leading mode of transmission, accounting for 62% of all AIDS cases. Throughout the US, black MSM (BMSM) are most severely affected by the epidemic, representing an urgent public health crisis. Research done by Dr. Magnus and colleagues in DC corroborates findings of other studies that individual-level sexual behavior of BMSM is not alone responsible for the alarming rates of HIV/AIDS in this population. Structural barriers to HIV and sexual transmitted infection prevention and treatment, and general healthcare have been posited as correlates of the alarming HIV rates among BMSM and are poorly characterized. Previous data suggest that BMSM often receive culturally insensitive and alienating HIV prevention or care services, experience healthcare disparities, and have other unique structural barriers to care that have not been fully explored. While behavioral risk screening is generally performed for those engaging in high risk sex behavior should they access services, no validated, brief tool exists to rapidly and effectively screen for structural barriers to care. Despite recent advances in HIV prevention, including efficacy of pre-exposure prophylaxis (PrEP), treatment of the infected partner in a discordant pair (as found in HPTN 052), and current exploration of "test and treat" paradigms (HPTN 065), the new tools to prevent HIV are found primarily in clinics; as a result, they will be given to persons regularly and comfortably accessing care. For BMSM who experience structural or societal barriers to care, these men will not reap the benefits of prevention advances. Detailed information regarding these structural barriers to care is required in order to inform new interventions to meet the unique needs of the population of BMSM: it is clear that current biomedical and behavioral interventions will not be able to slow the HIV/AIDS epidemic among BMSM if we cannot overcome these barriers by altering the healthcare system paradigms that prevent people from seeking care. This study will use a mixed-method approach to systematically examine the role of structural barriers to prevention and care services among BMSM. The investigators will base novel instrumentation on the Dynamic Social Systems Model, looking beyond individual-level barriers to care and characterizing societal and structural ones. Upon completion of instrument development with N=45 men, qualitative and quantitative methods will be used on a sample of N=100 peer-referred BMSM to enable evaluation of the instrument's ability to screen for structural barriers to care, and the resultant new rapid assessment structural barrier questionnaire piloted for feasibility on N=30 additional men. Data from this study will be used to inform development of a structural intervention in future studies. Given that the overwhelming majority of new infections are among BMSM, identifying barriers to biomedical and behavioral prevention services is critical to meeting the National HIV/AIDS Strategy benchmarks for reduction in HIV in the US. PUBLIC HEALTH RELEVANCE: Structural barriers to biomedical and behavioral HIV prevention services exist among black men who have sex with men, but are poorly characterized, presenting challenges in slowing the epidemic among those at highest risk. Through development and use of a novel and effective screening instrument among 175 BMSM, this study will inform structural intervention development for BMSM.

描述（由申请人提供）：在哥伦比亚特区（DC），其中3.2％的人口和7.1％的黑人男性患有艾滋病毒，男性与男性发生性关系（MSM）仍然是传播的领先模式，占所有艾滋病案件的62％。整个美国，黑人MSM（BMSM）最严重受流行病的影响，代表着紧急的公共卫生危机。 Magnus博士及其同事在DC佐证的研究表明，其他研究的发现，BMSM的个人级别性行为并不是该人群中艾滋病毒/艾滋病的令人震惊的率。艾滋病毒和性传播感染预防和治疗以及一般医疗保健的结构性障碍已被认为是BMSM中令人震惊的艾滋病毒率的相关性，并且特征的特征很差。先前的数据表明，BMSM经常会接受文化上不敏感的预防艾滋病毒或护理服务，经历医疗保健差异，并且具有其他独特的护理障碍，但尚未得到充分探索。尽管通常为从事高风险性行为的人访问服务的人通常进行行为风险筛查，但不存在经过验证的简短工具，可以快速有效地筛选出结构性的护理障碍。尽管最近预防HIV的进展，包括预防前预防的功效（PREP），但在不一致的一对中对受感染伴侣的处理（如HPTN 052中发现）以及当前对“测试和治疗”范式的探索（HPTN 065），在临床中，可预防艾滋病毒的新工具主要可预防艾滋病毒；结果，他们将定期舒适地提供护理人员。对于经历结构性或社会障碍的BMSM，这些人不会从预防进步中获得好处。为了告知新的干预措施以满足BMSM人群的独特需求，因此需要有关这些结构性护理障碍的详细信息：很明显，如果我们无法通过改变寻求医疗保健护理的医疗保健系统来克服这些障碍，那么当前的生物医学和行为干预措施将无法减慢BMSM的HIV/AIDS流行病，如果我们无法克服这些障碍。这项研究将使用一种混合方法方法来系统地检查BMSM中预防和护理服务结构障碍的作用。研究人员将基于动态社会系统模型的新颖仪器基础，超越了个人护理和表征社会和结构性的障碍。用n = 45名男性完成仪器开发后，定性和定量方法将用于n = 100个同伴引用的BMMSM的样本，以评估该仪器筛选筛查结构性障碍的能力，并产生新的快速评估结构性屏障问卷，以便在n = 30名男性= 30名男性中可行。这项研究的数据将用于为未来研究的结构干预提供信息。鉴于绝大多数新感染是BMSM中的，因此确定生物医学和行为预防服务的障碍对于满足美国艾滋病毒降低HIV的国家艾滋病毒/艾滋病战略基准至关重要。 公共卫生相关性：在与男性发生性关系但特征性不佳的黑人中存在生物医学和行为艾滋病毒预防服务的结构性障碍，这在降低风险最高的人的流行方面面临着挑战。通过开发和使用175 BMSM中新颖有效的筛选工具，这项研究将为BMSM的结构干预开发提供信息。