Developing and Validating New Measures of Multilevel Intersectional Stigma to Improve the HIV Prevention Continuum for Young Black Gay Bisexual and Other Men who Have Sex with Men in the South

制定和验证多层次交叉耻辱的新措施，以改善南方年轻黑人同性恋双性恋和其他男男性行为者的艾滋病毒预防连续性

• 批准号: 9981031
• 负责人: Ingrid Alisa Bowleg
• 金额: $ 19.73万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9981031
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Age; Bisexual; Censuses; Church; Cities; Communities; Data; Development; Discrimination; Ecology; Epidemic; Future; Gays; Gender; Group Structure; HIV; HIV Seronegativity; HIV diagnosis; HIV risk; Health; Heterosexuals; Human immunodeficiency virus test; Incidence; Individual; Intervention; Interview; Knowledge; Laws; Literature; Maps; Measures; Methodology; Methods; National Institute of Mental Health; Outcome; Participant; Patient Self-Report; Phase; Policies; Population; Positioning Attribute; Prevention Research; Preventive Intervention; Principal Investigator; Property; Psychometrics; Public Health; Race; Religion and Spirituality; Research; Sampling; Self Assessment; Sexual and Gender Minorities; Social Processes; Stigmatization; Surveys; Testing; Visualization; Washington; Woman; base; cognitive interview; data space; experience; follow-up; improved; innovation; intersectionality; member; men; men who have sex with men; multidisciplinary; pre-exposure prophylaxis; programs; recruit; sexual minority; social; social media; social stigma; social structure; sociodemographics

PROJECT SUMMARY/ABSTRACT The disproportionate impact of the HIV/AIDS epidemic among U.S. Black gay, bisexual, and other men who have sex with men (GBMSM) is staggering. The epidemic is particularly dire for Black GBMSM who are young and live in the South. Black GBMSM between the ages 13 to 34 and those who live in the South accounted for 75% and 63% of HIV diagnoses among Black GBMSM in 2016, respectively. Most conceptualizations of intersectional stigma have been almost exclusively individualistic. Consequently, substantial gaps exist about how multilevel intersectional stigma — individual (e.g., internalized HIV stigma, interpersonal discrimination), community (e.g., anti-gay stigma at church) and social-structural (e.g., criminal HIV exposure laws) — interconnects to hinder HIV testing and PrEP use for young Black GBMSM in the South. There is also a dearth of validated measures of multilevel intersectional stigma available for HIV prevention research. To address these critical empirical gaps, a longitudinal exploratory-sequential mixed methods study (QUAL à QUANT) is proposed to: (1) develop and validate self-report measures of individual, community, and social-structural-level intersectional stigma; (2) develop objective/non-self-report measures of social-structural stigma (e.g., based on Census data, laws, policies); and (3) produce visualizations of spatial stigma (e.g., living in and/or navigating impoverished and other stigmatizing places) for young Black GBMSM in two high HIV incidence southern cities: Washington, DC and Jackson, MS. Purposive sampling will be used to recruit 210 HIV-negative young Black GBMSM, ages 15 to 34. Phase I involves: (a) literature and policy reviews to identify existing measures of intersectional stigma and stigma-related laws and policies; (b) 60 in-depth individual interviews (30/city) to gain a rich and contextually-grounded understanding of multilevel intersectional stigma, and the use of maps to collect social and health activity space data relevant to spatial stigma; and (c) content validity assessments of the self-report measures by expert judges (n = 5 to 7) and Community Advisory Board (CAB) members (n = 24; 2 CABs/city). Phase II involves: (a) cognitive interviews with 20 participants (10/city) to refine the self-report measures; and (b) baseline and 6-month follow-up surveys of 130 participants (65/city) for psychometric analyses. Phase III involves the synthesis of the qualitative, spatial, and quantitative results and validity assessments of the synthesized results with CAB members in each city. The significance of the proposed research lies in the development of new multilevel intersectional stigma measures. The proposed research makes an innovative paradigmatic shift from the status quo with its theoretical and methodological fidelity to intersectionality’s core tenets. The expected outcome is the development of new self-report and objective/non- self-report measures of multilevel intersectional stigma that reflect the “specific and particular” experiences of young Black GBMSM who live in two distinct southern cities. These measures will inform future HIV prevention research and interventions to improve the HIV prevention continuum for young Black GBMSM in the South.

项目摘要/摘要 艾滋病毒/艾滋病流行的美国黑人同性恋，双性恋和其他男人的影响不成比例 与男人发生性关系（GBMSM）令人震惊。对于年轻的黑色GBMSM而言，这种流行病特别可怕 并住在南方。 13至34岁之间的黑色GBMSM和居住在南方的黑人GBMSM为 2016年，黑色GBMSM中艾滋病毒诊断的75％和63％。大多数概念化 交叉污名几乎完全是个人主义的。因此，存在很大的差距 多级交叉污名如何 - 个体（例如内部化的HIV污名，人际歧视）， 社区（例如，教会的反同性恋污名）和社会结构（例如，刑事艾滋病毒暴露法） - 互连以阻碍HIV测试和对南部的年轻黑色GBMSM的使用。还有死亡 可用于预防艾滋病毒的多层交叉污名的经过验证的量度。解决 这些关键的经验差距，一项纵向探索性的混合方法研究（QualàQuant）是 提议：（1）制定和验证个人，社区和社会结构层面的自我报告衡量标准 交叉污名； （2）制定社会结构污名的客观/非自我报告措施（例如，基于 人口普查数据，法律，政策）； （3）产生空间污名的可视化（例如，生活在和/或导航中 在两个高艾滋病毒事件中，年轻的黑色GBMSM贫穷和其他污名化的地方）南部 城市：华盛顿特区和杰克逊（MS）。有目的的抽样将用于招募210 HIV阴性年轻人 黑色GBMSM，15至34岁。第一阶段涉及：（a）文献和政策评论以确定现有措施 交叉污名和与污名有关的法律和政策； （b）60个深入的个人访谈（30/城市） 获得对多层交叉污名的丰富和情境的理解，并使用地图来 收集与空间污名相关的社会和健康活动空间数据； （c）内容有效性评估 专家法官（n = 5至7）和社区顾问委员会（CAB）成员的自我报告措施（n = 24； 2个出租车/城市）。第二阶段涉及：（a）与20名参与者（10/城市）的认知访谈以完善自我报告 措施； （b）130名参与者（65/城市）的基线和6个月的随访调查 分析。第三阶段涉及定性，空间和定量结果和有效性的合成 在每个城市中与CAB会员的合成结果评估。提议的意义 研究在于开发新的多层交叉污名测量值。拟议的研究 使创新的范式从现状及其理论和方法论上的忠诚转变为 交叉性的核心原则。预期的结果是发展新的自我报告和客观/非 - 自我报告的多层交叉污名的衡量标准，反映 年轻的黑色GBMSM生活在两个不同的南部城市中。这些措施将告知未来的艾滋病毒预防 研究和干预措施，以改善南部的年轻黑色GBMSM的HIV预防连续体。