Exploring the Role of Novel Aging-Focused Syndemic Conditions on HIV Risk and Quality of Life among HIV-Negative Older Sexual Minority Men

探索新型老龄化流行性疾病对 HIV 阴性老年性少数男性的 HIV 风险和生活质量的作用

• 批准号: 10762121
• 负责人: Elliott Royal Weinstein
• 金额: $ 5万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762121
• 关键词: AIDS prevention; Address; Adherence; Affect; Age; Ageism; Aging; Anxiety; Behavior; Behavior Therapy; Bisexual; Buffers; Child Sexual Abuse; Complex; Data; Development; Discrimination; Disease; Disparity; Economics; Elderly; Enrollment; Epidemic; Face; Florida; Fostering; Frequencies; Future; Gays; Glean; HIV; HIV Seronegativity; HIV diagnosis; HIV disparities; HIV risk; HIV/AIDS; Health; Health behavior; Heterosexuals; High Prevalence; Impaired cognition; Incidence; Individual; Inequality; Influentials; Link; Literature; Machine Learning; Marriage; Medical; Mental Depression; Mental Health; Methodology; Methods; Minority; Minority Groups; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Older Population; Outcome; Pattern; Population; Post-Traumatic Stress Disorders; Psychosocial Factor; Quality of life; Research; Research Personnel; Role; Severities; Site; Social isolation; Subgroup; System; Techniques; Testing; Trauma; Trees; United States National Institutes of Health; age related; aged; behavioral health; career; comorbidity; condomless anal sex; ethnic diversity; experience; health disparity; improved; indexing; innovation; insight; intersectionality; intimate partner violence; marginalization; marginalized population; men; minority stress; novel; pandemic disease; peer; physical conditioning; poor health outcome; pre-exposure prophylaxis; prevention service; programs; protective effect; psychologic; psychosocial; racial diversity; reduced substance use; resilience; sex; sexual minority; sexual minority group; sexual minority men; social exclusion; sociocultural determinant; stressor; substance use; syndemic; theories

Project Summary Overview. This study addresses gaps in HIV and behavioral health research among older sexual minority men (OSMM). Specifically, this project assesses the relative severity and impact of contextually relevant age-related syndemic factors (age-related discrimination, internalized ageism, aging anxiety, sexual minority specific aging concerns, social isolation, economic marginalization, and perceived cognitive impairment) and traditional syndemic conditions (mental health via depression, PTSD, childhood sexual abuse; intimate partner violence; substance use) among OSMM.9,10 Background. With high prevalence and rising incidence rates, OSMM are uniquely burdened by HIV.1 This is particularly true for Florida (proposed study site), a state with one of the highest HIV incidence rates nationally.11 The framework for the study is based on three relevant theories. First, syndemic theory2 contends that HIV and quality of life (QOL) disparities are propagated by the synergistic co- occurrence of disease (e.g., health issues, substance use behaviors, sociocultural factors), some of which are unique to OSMM. Second, the minority stress model3,4 extends syndemic theory by positing that OSMM face enduring unique stressors resulting from their marginalized identities that perpetuate psychological adversity. Lastly, intersectionality theory5 posits that OSMM experience worse health outcomes compared to their younger SMM peers due to the compounding systems of oppression they face due to their multiple minoritized identities. Objectives & methods. This study’s three aims center on investigating the relative severity and impact of age-related psychosocial factors and traditional syndemic conditions in explaining HIV and health disparities among HIV-negative OSMM. Aim 1 examines the severity, frequency, and co-occurrence of theoretically linked psychosocial problems occurring in HIV-negative OSMM. Aim 2 assesses the influence of age-related psychosocial and traditional syndemic conditions on engagement in HIV prevention outcomes (condomless anal sex without PrEP, PrEP adherence) and QOL among this population of OSMM as well as a potential moderator of these relationships. Aim 3 utilizes tree-based-machine learning to explore interaction effects between the most influential age-related psychosocial factors and an additive index of traditional syndemic conditions on HIV risk and QOL outcomes. HIV-negative OSMM (N = 250) between the ages of 55 and 70 years will complete one psychosocial quantitative assessment. Data will be analyzed using tree-based- machine learning approaches and traditional regression models. Innovation and Impact. This dissertation study will identify age-related syndemic conditions unique to OSMM to better understand QOL, HIV, and behavioral health, among OSMM, an under-researched and multiple marginalized group. Findings gleaned will aid in the future development of HIV and behavioral health related tailored to OSMM and, as a dissertation, lay the groundwork for the PI’s programmatic research focused on HIV and behavioral health disparities among older sexual minorities. This proposal is relevant to the NIDA priorities (NOT-MD-19-001).

项目摘要 概述。这项研究解决了年龄较大的少数族裔艾滋病毒和行为健康研究的差距 （OSMM）。特别是，该项目评估与上下文相关年龄相关的相对严重性和影响 联合因素（与年龄相关的歧视，内在年龄歧视，老龄化动画，性少数族裔老龄化 关注，社会隔离，经济边缘化和感知的认知障碍）和传统 联合状况（通过抑郁症，PTSD，儿童性虐待的心理健康；亲密的伴侣暴力； OSMM.9,10背景中的物质使用）。随着较高的患病率和事件率上升，OSMM为 艾滋病毒的独特燃烧。1对于佛罗里达州（拟议的研究地点）尤其如此，这是一个具有其中之一的状态 艾滋病毒在全国范围内最高的事件。11研究框架是基于三个相关理论。第一的， Syndemity Theory2涉及艾滋病毒和生活质量（QOL）分布由协同共同传播 疾病的发生（例如，健康问题，药物使用行为，社会文化因素），其中一些是 OSMM独有。其次，少数族裔压力模型3,4通过发布OSMM面扩展了联合理论 由于其边缘化的身份而导致的独特压力源使心理广告永存。 最后，相互裂缝理论5认为OSMM与他们的健康状况相比较差 年轻的SMM同行，由于其多个少数化的意见系统的复合体系 身份。目标和方法。这项研究的三个目的是研究相对严重性和 与年龄相关的社会心理因素和传统的联合疾病在解释艾滋病毒和健康的影响 HIV阴性OSMM之间的差异。 AIM 1考试的严重性，频率和同时发生 理论上联系了HIV阴性OSMM中发生的社会心理问题。 AIM 2评估的影响 与年龄相关的社会心理和传统联合疾病有关预防艾滋病毒预防结果 （无避孕套肛交没有准备，准备依从性）和QOL，以及OSMM群体中的QoL 这些关系的潜在主持人。 AIM 3利用基于树的机器学习来探索互动 最有影响力的年龄相关的社会心理因素与传统的额外指数之间的影响 艾滋病毒风险和质量结果的联合条件。 HIV阴性OSMM（n = 250）年龄在55岁之间 并且70年将完成一项心理定量评估。将使用基于树的 - 机器学习方法和传统回归模型。创新和影响。这篇论文 研究将确定OSMM独有的年龄相关联合条件，以更好地了解QOL，HIV和 在OSMM中，行为健康，是一个研究不足和多个边缘化的群体。发现收集的意志 协助未来针对OSMM量身定制的艾滋病毒和行为健康的发展，作为论文， PI的程序研究的基础工作着重于艾滋病毒和行为健康差异 年龄较大的少数群体。该提案与NIDA优先级有关（非MD-19-001）。