Using mixed methods to understand barriers to PrEP use among Black and Latinx transgender and gender-expansive youth and emerging adults: The impact of gender minority stress and gender affirmation.

使用混合方法了解黑人和拉丁裔跨性别者以及性别扩张型青年和新兴成年人使用 PrEP 的障碍：性别少数压力和性别肯定的影响。

• 批准号: 10548065
• 负责人: Sabrina R Cluesman
• 金额: $ 3.82万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10548065
• 关键词: Age-Years; Area; Awareness; Behavior; Black Populations; Black race; Buffers; Centers for Disease Control and Prevention (U.S.); Characteristics; Communities; Continuity of Patient Care; Cross-Sectional Studies; Data; Diagnosis; Discrimination; Distal; Eligibility Determination; Epidemic; Equation; Ethnic Origin; Funding; Gender; Gender Identity; General Population; Goals; HIV; HIV Infections; HIV risk; Incidence; Individual; Intervention; Interview; Joints; Knowledge; Latinx; Latinx population; Legal; Literature; Mediation; Medical; Methodology; Methods; Modeling; Nature; Outcome; Outcome Study; Participant; Persons; Play; Population; Populations at Risk; Prevalence; Prophylactic treatment; Race; Recording of previous events; Research; Research Methodology; Resources; Risk; Role; Sampling; Statistical Methods; Stress; Structure; Time; Training; United States; United States National Institutes of Health; Vulnerable Populations; Youth; age group; behavioral response; clinical practice; design; effective intervention; emerging adult; ethnic diversity; experience; gender expression; gender minority; gender minority group; gender minority stress; gender minority youth; genderqueer; high risk; minority stressor; peer; pre-exposure prophylaxis; prevent; primary outcome; programs; psychologic; racial and ethnic; racial and ethnic disparities; recruit; resilience; secondary outcome; social; sociodemographic factors; sociodemographics; stressor; substance use; transgender; uptake

PROJECT SUMMARY. Gender minority individuals 13-24 years of age experience disproportionate risk for HIV, yet their rates of preexposure prophylaxis (PrEP) uptake to prevent HIV are the lowest of any key risk group in the United States (>10%). This population includes young transgender individuals, as well as substantial and growing numbers of those who identify as gender nonbinary, non-conforming, or genderqueer, referred to here as "gender-expansive” individuals. (We refer to the population as “YTGE”). Further, Black and Latinx (BL) YTGE individuals have higher HIV incidence, but lower PrEP use rates, than White YTGE. Yet, the specific factors that influence engagement in the PrEP care continuum among BL-YTGE, and their causes and meanings, are not well understood. The proposed study is grounded in the gender minority stress and gender affirmative models and examines salient proximal and distal stressors, their effects (e.g., substance use), and resilience factors, including gender affirmation, i.e., support for living in one’s gender identity/expression in social, psychological, medical, and legal domains. Yet, because gender affirmation is a new area of research, we know little about its relationship to engagement along the PrEP care continuum. The proposed study uses an explanatory sequential mixed methods design to advance knowledge about specific factors that promote or impede PrEP outcomes among BL-YTGE. The primary outcome is PrEP intentions, and PrEP awareness, use, and persistence are secondary outcomes. The study aims to: examine the effects of gender minority stress, including proximal and distal stressors, and behavioral responses to stress (substance use) on PrEP outcomes among diverse YTGE who evidence HIV risk (Aim 1a); examine whether resilience (e.g., gender affirmation), race/ethnicity or other sociodemographic factors heighten or buffer the effects of gender minority stress on substance use and PrEP outcomes (Aim 1b); explore BL-YTGE’s perspectives on factors identified in Aim 1 that promote or impede PrEP outcomes and their meanings (e.g., substance use, discrimination), with a focus on various types of gender affirmation, as well as emergent factors (Aim 2); and integrate findings from Aims 1 and 2 to determine how diverse YTGE experience the PrEP continuum and identify differences and similarities across sociodemographic characteristics that impede or support PrEP uptake (Aim 3). Aim 1 will use a moderated mediation structural equation modeling approach to analyze a racially/ethnically diverse (54% non- White) national sample of N=1029 YTGE who engaged in a cross-sectional survey (CDC START study). Aim 2 will rely upon semi-structured interviews with BL-YTGE from the local NYC community (N=30, half prescribed PrEP). For Aim 3 all results will be compared, contrasted, and integrated using the joint display method, to contextualize and interpret findings. Statistical and research methods training will be a key component of this study. If funded, this F31 will give the applicant protected time and will comprise the first stages of a program of research to decrease HIV incidence in this population at high-risk for HIV but with serious barriers to PrEP.

项目摘要。性别少数族裔个人13-24岁的年龄经历不成比例的风险 艾滋病毒的预防率（预防）预防艾滋病毒是任何关键风险中最低的预防率（准备） 在美国（> 10％）。这个人口包括年轻的跨性别者，以及 大量和越来越多的人将其识别为性别非二进制，不合格或性别的人 在这里称为“性别表达”个体。 （我们将人口称为“ YTGE”）。此外，黑色和 Latinx（BL）YTGE个体的HIV事件较高，但使用率较低，而PrEP使用率则比白色YTGE较低。但是， 影响Bl-Ytge之间参与预科护理连续体的特定因素及其原因和 含义不太了解。拟议的研究基于性别少数压力和性别的基础 肯定的模型和考试显着的近端和盘状压力源，其影响（例如，使用物质），以及 弹性因素，包括性别肯定，即支持生活在一个人的性别认同/表达中的支持 社会，心理，医学和法律领域。但是，由于性别肯定是一个新的研究领域， 我们对沿预期护理连续体的参与关系一无所知。拟议的研究使用 一种剥夺的顺序混合方法设计，以提高有关促进或 阻碍BL-YTGE中的准备结果。主要结果是准备意图和准备意识，使用， 持久性是次要结果。该研究的目的是：检查性别少数压力的影响， 包括近端和远端应力源，以及对预期的压力的行为反应（使用物质） 在证明艾滋病毒风险的潜水员中（AIM 1A）；检查是否弹性（例如，性别影响）， 种族/民族或其他社会人口统计学因素增强或缓冲性别少数压力对 物质使用和准备结果（AIM 1B）；探索Bl-Ytge对AIM 1中确定因素的看法 促进或阻碍了准备成果及其含义（例如，使用物质，歧视），重点 关于各种类型的性别肯定以及新兴的因素（目标2）；和目标1的整合发现 和2确定YTGE的多样化经验继续前进并确定差异和相似之处 跨越阻碍或支持准备摄取的社会人口统计学特征（AIM 3）。 AIM 1将使用 调解中介结构方程模型方法分析大致/种族多样性（54％非 - 白色）n = 1029 ytge的国家样本，从事横断面调查（CDC开始研究）。目标2 将依靠来自当地纽约社区的BL-YTGE的半结构化访谈（n = 30，一半处方 准备）。对于AIM 3，将使用关节显示方法比较，对比和集成所有结果， 情境化和解释发现。统计和研究方法培训将是其中的关键组成部分 学习。如果资助，该F31将给出适用的受保护时间，并构成计划的第一阶段 研究以减少艾滋病毒高风险的该人群中的艾滋病毒事件，但有严重的准备障碍。