Health disparities, stress pathways, and stress-related comorbidities among MSM living with HIV

HIV 感染者中 MSM 的健康差异、压力途径和压力相关合并症

• 批准号: 9765389
• 负责人: CARL A LATKIN
• 金额: $ 72.79万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9765389
• 关键词: Acute; Adrenal Glands; Affect; Alcohol or Other Drugs use; Behavior; Biological Markers; Buffers; Cardiovascular Diseases; Cellular Phone; Chronic; Comorbidity; Cross-Sectional Studies; Data; Data Analyses; Discrimination; Disease; Disease Progression; Ecological momentary assessment; Effectiveness; Equation; Event; Exposure to; Future; Goals; HIV; HIV antiretroviral; HIV risk; Health; Home environment; Hydrocortisone; Hypothalamic structure; Immune; Individual; Inflammatory; Intervention; Lead; Linear Models; Link; Literature; Longitudinal Studies; Measures; Medical; Mental Depression; Minority; Modeling; Monitor; Neighborhoods; Outcome; Participant; Pathway interactions; Pattern; Personal Satisfaction; Pharmaceutical Preparations; Physiological; Pituitary Gland; Protocols documentation; Race; Research; Research Design; Risk Behaviors; Role; Saliva; Signal Transduction; Social Conditions; Social Environment; Social Network; Social support; Stress; Stressful Event; Structure; Substance abuse problem; Surveys; Sympathetic Nervous System; System; Testing; Time; Violence; Viral Load result; Virus Diseases; antiretroviral therapy; assault; base; behavioral health; behavioral outcome; black men who have sex with men; depressive symptoms; experience; health disparity; heart rate variability; hypothalamic-pituitary-adrenal axis; immune function; macrophage; medication compliance; men who have sex with men; mobile computing; monocyte; psychosocial; racial difference; racial disparity; resilience; response; social; social deficits; stressor; support network; theories

Project Summary Stress is associated with HIV risk behaviors, immune dysregulation, and among people living with HIV (PLWH) it has been associated with viral load and disease progression. The goal of this study is to better understand the mechanisms of stress and stress-related comorbidities and how they exacerbate HIV-related health disparities among HIV-infected Black men who have sex with men (BMSM). Studies in many parts of the US suggest that BMSM often live or spend much of their time in impoverished neighborhoods where physical and social disorders (e.g., physical decay, violence, discrimination) are clustered. These socio-structural factors can be conceptualized as chronic and acute stressors and may promote other stressors that lead to HIV-related outcomes. While much of the literature on minority stress has focused on major discriminatory events, this proposed study will examine microaggressions. We will comprehensively assess chronic, acute, and daily psychosocial stressors that are particularly relevant to MSM, especially BMSM. Moreover, we will use measures of hypothalamic–pituitary– adrenal (HPA) axis responses, sympathetic nervous system (SNS), and inflammatory biomarkers to identify specific stress pathways among HIV-infected BMSM and White MSM (WMSM) that can be targeted in future interventions. We aim to provide an extension of minority stress theory by utilizing intensive longitudinal protocols to assess daily discriminatory events and other stressors, and to explore the association with HIV-related behaviors and physiological outcomes. Built upon the evidence of feasibility and acceptability from our previous research, this aim will be accomplished by using ecological momentary assessment (EMA) of stressors and stress, Medication Event Monitoring System (MEMS), and home-based testing for cortisol. We propose a longitudinal study of 450 HIV-infected BMSM and WMSM who have common stress-related comorbidities (e.g., cardiovascular disease, depression, substance abuse) assessed at baseline, 6, 12, 18, and 24 months. Participants will provide 9 days of smartphone- based EMA and MEMS for ART medication adherence every 6 months for 24 months. Every 6 months, we will collect stress and immune function biomarkers.

项目摘要 压力与艾滋病毒风险行为，免疫失调以及生活中的人有关 使用HIV（PLWH），它与病毒负荷和疾病进展有关。目标 这项研究是为了更好地了解压力和压力相关的合并症的机制和 他们如何加剧与艾滋病毒相关的健康差异 在我们许多地方的研究表明，BMSM经常生活或启用 他们在身体和社会障碍的贫困社区中的大部分时间（例如 物理衰减，暴力，歧视）聚集。这些社会结构因素可能是 被概念化为慢性和急性压力源，可能会促进其他压力源 与HIV相关的结果。虽然许多关于少数派压力的文献都集中在主要的 歧视性事件，这项拟议的研究将检查显微攻击。我们将 全面评估了慢性，急性和日常的社会心理压力源 与MSM有关，尤其是BMSM。此外，我们将使用下丘脑 - 垂体 - 肾上腺（HPA）轴反应，交感神经系统（SNS）和炎症 生物标志物鉴定受HIV感染的BMSM和白色MSM之间的特定应力途径 （WMSM）可以在以后的干预措施中针对目标。我们旨在提供少数派的扩展 通过使用密集的纵向方案来评估日常歧视性事件，通过压力理论 和其他压力源，并探索与HIV相关行为和生理学的关联 结果。基于我们先前研究的可行性和可接受性的证据， 该目标将通过使用压力源的生态瞬时评估（EMA）来实现 和压力，药物监测系统（MEMS）和基于家庭的皮质醇测试。 我们建议对具有共同的450个HIV感染的BMSM和WMSM进行纵向研究 与压力相关的合并症（例如心血管疾病，抑郁症，药物滥用） 在基线，6、12、18和24个月时进行评估。参与者将提供9天的智能手机 - 每6个月，每6个月遵守一次ART药物的EMA和MEMS。每6个 几个月，我们将收集压力和免疫功能生物标志物。