Developing a Computer Based intervention to Prevent HIV among Native Amer. MSM

开发基于计算机的干预措施以预防美洲原住民中的艾滋病毒。

基本信息

批准号：
8350890
负责人：
KARINA L. WALTERS
金额：
$ 18.42万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-02 至 2017-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8350890
关键词：
AIDS diagnosis AIDS prevention AIDS/HIV problem ARHGEF5 gene Accounting Acquired Immunodeficiency Syndrome Address African American Alaska Native Alcohol or Other Drugs use American Anxiety Area Asians Behavior Cardiovascular Diseases Categories Censuses Centers for Disease Control and Prevention (U.S.)Chlamydia Chronic Disease Communities Computers Data Diabetes Mellitus Disease Drug usage Environment Epidemic Epidemiology Ethnic group Exposure to Faculty Focus Groups Forcible intercourse Gender General Population Gonorrhea HIV HIV Infections HIV Seropositivity Health Health Insurance Health behavior Heterosexuals Hispanics Homicide Household Illicit Drugs Income Indigenous Injury Insurance Coverage International Internet Intervention Interview Latino Life Location Mental Depression Mental Health Minority Morbidity - disease rate Native Americans Native-Born Needs Assessment Pacific Island Americans Pattern Personal Satisfaction Population Population Sizes Post-Traumatic Stress Disorders Poverty Premature Mortality Preventive Intervention Psychopathology Race Relative (related person)Reporting Reproductive Health Research Research Institute Research Personnel Research Project Grants Reservations Risk Risk Behaviors Rural Schools Sex Behavior Sexual Health Sexually Transmitted Diseases Social Network Source Suicide Surveys System Trauma Tribes Unemployment United States Universities Variant Vehicle crash Violence Visual Washington Woman Work alcohol misuse base combat design experience health disparity innovation interest men men who have sex with men mortality motor vehicle injury peer post intervention prevent programs racial and ethnic respiratory sex risk sexual assault socioeconomics therapy development transmission process virtual

项目摘要

As of 2003 there were 4.4 million AIAN in the U.S., constituting 1.5% of the total U.S. population, with 2.8 million or 1% self-identifying exclusively as AIAN. The U.S. Census Bureau estimates that by 2050 the AIAN population will grow to 3.2 million with a projected rate of increase of 55%, exceeding the projected rate of increase for Whites and comparable to the rate for African Americans. Despite their wealth in cultural and tribal diversity. Natives in the U.S. experience considerable socio-economic disparities. For example, in 2003, AIAN compared to the U.S. population, reported a greater likelihood of living below the poverty level (27% vs. 15%) and lower overall median household incomes ($34,700 vs. $43,500); and reported higher unemployment (15.1% vs. 5.9%).¿ Moreover, 30% of the AIAN population lacks health insurance coverage. Indigenous populations suffer from pervasive patterns of health disparities, unequal burden of chronic illnesses, as well as disproportionate levels of morbidity (e.g., diabetes, cardiovascular disease) and injury-related mortality (e.g., suicide, motor vehicle collisions). Natives also experience high rates of trauma (e.g., injury, motor vehicle accidents, homicide) and violence exposure (e.g., rape, sexual assault, combat exposure) with co-occurring disproportionate rates of psychopathology (i.e., PTSD, depression, anxiety, suicide, AOD disorders). In the U.S., Natives have escalating rates of HIV and other sexually transmitted infections (STI), respiratory and reproductive health problems, as well as premature mortality related to chronic disease states. HIV/AIDS and STI have become major sources of concern for Natives. In a comprehensive review of STI and HIV among AIAN, Kaufmann and colleagues (2007) noted that the epidemiologic evidence points to excessively high case rates of STI among AIAN compared to the general population; with a greater burden borne by Native populations living in closer proximity to one another. For example, in the U.S., AIAN have the second highest rates of Chlamydia and gonorrhea. The potential for exposure to and transmission of HIV is greatly enhanced by these elevated STI rates. Indeed, elevated rates of STI may provide a 2-5 fold increased risk for HIV infection among AIAN in the U.S. According to data from the National HIV/AIDS Surveillance System through December 2008, a cumulative total of 3,741 AIDS cases among AI/AN have been reported to the CDC. In terms of the major modes of transmission, percentages for AIAN men were: MSM (64%), IDU (14%), and MSM/IDU (14%). Note that this last category is higher for AIAN men than any other ethnic group. For AIAN women, the percentages were IDU (37%) and heterosexual contact (50%). Note that the IDU transmission category for Native women is higher than for any other ethnic group. Since 1995, the rate of AIDS diagnosis for AIAN has been consistently higher than the rate for Whites or Asian/Pacific Islanders in the U.S. Additionally, when one takes the relative population size into account, a more disturbing picture emerges. The AIDS case rates for AIAN per 100,000 were 8.5 (11.9 for HIV rates), ranking them just behind Blacks (49.3; 73.7 for HIV rates) and Hispanics/Latinos (15.0; 25.0 for HIV rates). In our research (N=447; HONOR Project, R01MH65871), 30% of Native two-spirit (i.e., AIAN sexual and/or gender minority) men reported that they were HIV+ (19% reported they did not know their status). These numbers are unprecedented and suggest that the HIV/AIDS epidemic for Native MSM may be similar to Black MSM. Natives suffer disproportionate exposure to trauma and mental health disparities. Recent reports demonstrate that Native communities experience higher rates of sexual and physical violence than any other ethnic or racial group in the U.S/^ Among MSM in our HONOR project, 31% had experienced

截至 2003 年，美国有 440 万 AIAN，占美国总人口的 1.5%，其中 280 万人（即 1%）仅自认为是 AIAN。美国人口普查局估计，到 2050 年，AIAN 人口将增至 320 万。预计增长率为 55%，超过白人的预计增长率，与非洲人的增长率相当美国人。尽管美国原住民拥有丰富的文化和部落多样性，但他们仍经历着相当大的社会经济差距。例如，2003 年，与美国人口相比，AIAN 生活在贫困线以下的可能性更大（27% 与 27%）。 15%）和较低的总体家庭收入中位数（34,700 美元 vs. 43,500 美元）；并且失业率较高（15.1% vs. 5.9%）。此外，30% 的 AIAN 人口缺乏医疗保险覆盖，普遍存在健康差距、慢性疾病负担不均、发病率（例如糖尿病、心血管疾病）和伤害相关死亡率过高（当地人遭受创伤（例如受伤、机动车事故、凶杀）和暴力（例如强奸、性侵犯、打斗）的几率也很高。在美国，原住民的艾滋病毒和其他性传播感染 (STI)、呼吸道和生殖健康问题的发病率不断上升。以及与慢性疾病状态相关的过早死亡。艾滋病毒/艾滋病和性传播感染已成为当地人关注的主要问题。 Kaufmann 及其同事（2007 年）对 AIAN 中的性传播感染和艾滋病毒进行了全面审查，指出流行病学证据表明，与一般人群相比，AIAN 中性传播感染的发病率过高，而居住在附近的原住民群体承受的负担更大；另一个例子是，在美国，衣原体和淋病的发病率位居第二。性病感染率的升高大大增加了艾滋病毒的暴露和传播的可能性。在美国，性传播感染可能会使 AIAN 感染艾滋病毒的风险增加 2-5 倍。根据国家艾滋病毒/艾滋病监测系统截至 2008 年 12 月的数据，已向 AI/AN 累计报告了 3,741 例艾滋病病例。 CDC。就主要传播方式而言，AIAN 男性的百分比为：MSM (64%)、IDU (14%) 和 MSM/IDU (14%)。 AIAN 男性的最后一类比例高于任何其他族裔群体，其中注射吸毒者 (37%) 和异性接触 (50%) 的百分比请注意，原住民女性的注射吸毒者传播类别高于任何其他族裔。自 1995 年以来，美国白人或亚裔/太平洋岛民的艾滋病诊断率一直高于白人或亚裔/太平洋岛民。此外，如果考虑到相对人口规模，情况会更加令人不安。在我们的研究中，每 10 万人中艾滋病病例率为 8.5 例（艾滋病毒感染率 11.9 例），仅次于黑人（49.3 例；艾滋病毒感染率 73.7 例）和西班牙裔/拉丁美洲人（15.0 例；艾滋病毒感染率 25.0 例）。 =447；荣誉项目，R01MH65871)，原生二灵30% （即 AIAN 性和/或性别少数）男性报告称，他们是 HIV+（19% 的报告称他们不知道自己的状况）。这些数字是前所未有的，表明土著 MSM 的艾滋病毒/艾滋病流行可能与黑人 MSM 类似。。当地人遭受过多的创伤和心理健康差异。最近的报告表明，原住民社区遭受性暴力和身体暴力的比例高于美国任何其他族裔或种族群体/^ 在我们的 HONOR 项目中的 MSM 中，31% 的人经历过