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。13-24 岁的性别少数群体面临不成比例的风险 HIV，但他们预防 HIV 的暴露前预防 (PrEP) 率是所有关键风险中最低的 美国的这一群体（>10%）。 大量且越来越多的人认为自己是非二元性别、不合规者或性别酷儿， 此处称为“性别扩张”个体（我们将人口称为“YTGE”）。 与白人 YTGE 相比，拉丁裔 (BL) YTGE 人群的 HIV 发病率较高，但 PrEP 使用率较低。 影响 BL-YTGE 参与 PrEP 护理连续体的具体因素及其原因和 拟议的研究是基于性别少数压力和性别。 肯定模型并检查显着的近端和远端压力源及其影响（例如物质使用），以及 复原力因素，包括性别肯定，即支持以自己的性别认同/表达方式生活 然而，由于性别肯定是一个新的研究领域， 我们对其与 PrEP 护理连续体参与度的关系知之甚少。 解释性顺序混合方法设计，以增进对促进或促进特定因素的了解 阻碍 BL-YTGE 的 PrEP 结果 主要结果是 PrEP 意图以及 PrEP 意识、使用、 和持久性是次要结果。该研究旨在：检查性别少数压力的影响， 包括近端和远端压力源以及对压力（物质使用）的行为反应对 PrEP 结果的影响 在证明有艾滋病毒风险的不同 YTGE 中（目标 1a）；检查是否有复原力（例如，性别肯定）、 种族/族裔或其他社会人口因素会加剧或缓冲性别少数群体压力的影响 物质使用和 PrEP 结果（目标 1b）；探讨 BL-YTGE 对目标 1 中确定的因素的看法 促进或阻碍 PrEP 结果及其含义（例如物质使用、歧视），重点是 各种类型的性别肯定以及新兴因素（目标 2）和目标 1 的调查结果； 2 确定不同的 YTGE 如何体验 PrEP 连续体并识别差异和相似之处 阻碍或支持 PrEP 吸收的社会人口特征（目标 1）将使用 有调节的中介结构方程模型方法来分析种族/民族多样化（54％的非 White）参与横断面调查（CDC START 目标 2）的 N=1029 YTGE 全国样本。 将依赖于来自纽约当地社区的 BL-YTGE 的半结构化访谈（N=30，一半规定 对于目标 3，将使用联合显示方法对所有结果进行比较、对比和整合，以 统计和研究方法培训将是其中的一个关键组成部分。 如果获得资助，该 F31 将为申请人提供受保护的时间，并将包括项目的第一阶段。 研究旨在降低艾滋病毒高危人群的艾滋病毒发病率，但 PrEP 存在严重障碍。