Minority Stress, Stimulant Use, and HIV among Sexual Minority Men: A Biopsychosocial Approach

性少数男性中的少数压力、兴奋剂使用和艾滋病毒：一种生物心理社会方法

• 批准号: 10762699
• 负责人: Michael Joseph Miller-Perusse
• 金额: $ 3.75万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2026-08-16
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762699
• 关键词: Acceleration; Address; Affect; Biological; Clinical; Cocaine; Communities; Conduct Clinical Trials; Continuity of Patient Care; Crack Cocaine; Data; Discrimination; Disparate; Disparity; Epidemic; Fellowship; Funding; Future; Goals; HIV; Health; Health Disparities Research; Health behavior; Heterosexuals; Immune system; Intervention; Knowledge; Laboratories; Link; Malignant Neoplasms; Measures; Mediation; Mediator; Mental Health; Methamphetamine; National Institute of Drug Abuse; Not Hispanic or Latino; Opportunistic Infections; Outcome; Outcome Assessment; Participant; Pathway interactions; Patient Self-Report; Population; Powder dose form; Psychologist; Publishing; Research Methodology; Research Support; Risk; Sampling; San Francisco; Series; Sexual and Gender Minorities; Testing; Training; Viral; Viral Load result; Work; biopsychosocial; career; efficacious intervention; ethnic minority; ethnic minority population; experience; gender minority health; gender minority health disparity; health disparity; high risk population; homonegativity; immune health; improved; intersectionality; member; men; men of color; minority stress; non-heterosexual; novel; outcome disparities; peer; programs; racial minority; recruit; secondary analysis; sexual minority health; sexual minority men; skills; social stigma; social stress; social stressor; stimulant use; stressor; substance use; theories; transmission process

PROJECT SUMMARY/ABSTRACT Sexual minority men (SMM; i.e., non-heterosexual men) in the US are impacted by intertwining epidemics of HIV and stimulant use (e.g., methamphetamine, powder cocaine, crack cocaine) at disparate rates compared to their heterosexual peers. Findings from our team and others demonstrate that SMM with HIV who use stimulants have greater difficulties successfully navigating the HIV care continuum as well as display substantially elevated viral load, amplified HIV transmission risk, and faster clinical HIV progression. The dominant theory used to explain health disparities among SMM is minority stress theory, which states that these disparities are the result of stigma-related social stressors (e.g., discrimination, internalized homonegativity). While evidence of the association between minority stress and stimulant use exists, few studies have directly examined associations between minority stress and biological HIV outcomes, such as viral load, and many rely solely on self-report measures (as opposed to laboratory testing) to assess these outcomes. The Biopsychosocial Minority Stress Framework (BMSF) has been proposed to link minority stress to biological health, and posits that: (a) minority stress directly affects the health behaviors and psychological health of SMM; (b) SMM’s health behaviors and psychological health indicators are interrelated; and (c) these factors influence biological health among SMM via the immune system. Applying the BMSF to SMM with HIV, stimulant use and ART nonadherence (health behaviors) may serve as mediators through which minority stress impacts viral load (an outcome critical to immune health) and, thereby, other health outcomes (e.g., opportunistic infections and cancers). Further, consistent with intersectionality theory, racial/ethnic minority SMM may experience intensified effects of minority stress that could contribute to the increased burden of HIV and stimulant use observed among SMM of color in the US. Understanding the mechanisms through which minority stress impacts viral load, and thereby other health outcomes, has important implications for intervention among SMM with HIV who use stimulants. As such, we propose to systematically test associations posited by the BMSF in this high-priority population using a series of mediation analyses. Specifically, we aim to examine BMSF components by testing longitudinal associations between minority stress, stimulant use, ART nonadherence, and laboratory testing-derived viral load using existing data from two independent samples of SMM with HIV who use stimulants: (1) 110 SMM residing in San Francisco, CA and (2) 350 SMM recruited from across the US. Further, we aim to test whether the associations between minority stress, stimulant use, ART nonadherence, and viral load differ among racial/ethnic minority versus majority (i.e., non-Hispanic White) SMM with HIV who use stimulants, using multigroup analyses to assess the invariance of effects examined in Aims 1 and 2. Support for this project will greatly help in furthering the PI toward his long-term goal of becoming an independent academic clinical psychologist with expertise in studying the biopsychosocial mechanisms underlying sexual and gender minority health disparities.

项目摘要/摘要 美国的性少数民族男性（SMM;即非异性恋男人）受到艾滋病毒的交织影响 与刺激性使用（例如甲基苯丙胺，粉末可卡因，可卡因裂纹），以不同的速度相比 异性恋同龄人。我们团队和其他人的发现表明，使用兴奋剂的艾滋病毒的SMM 有更大的困难，因此成功地导航HIV护理连续体并显示出大幅提升 病毒负荷，扩增HIV传播风险和更快的临床HIV进展。曾经的主导理论 解释SMM之间的健康差异是少数派压力理论，该理论指出这些差异是结果 与污名相关的社会压力源（例如，歧视，内在的同性恋）。而证据 少数族裔压力和兴奋剂使用之间存在关联，很少有研究直接检查了关联 在少数族裔压力和生物艾滋病毒结局（例如病毒载荷）之间，许多人仅依靠自我报告 评估这些结果的措施（而不是实验室测试）。生物心理社会少数派压力 框架（BMSF）已被提议将少数族裔压力与生物健康联系起来，并认为：（a）少数民族 压力直接影响SMM的健康行为和心理健康； （b）SMM的健康行为和 心理健康指标相互关联； （c）这些因素会影响SMM之间的生物健康 免疫系统。将BMSF应用于艾滋病毒，刺激性使用和艺术不遵守（健康） 行为）可以用作少数压力会影响病毒负荷的介体（这是至关重要的结果 免疫健康），从而其他健康结果（例如，机会性感染和癌症）。更远， 与交叉性理论一致，种族/族裔少数民族可能会经历少数民族的强烈影响 可能导致艾滋病毒燃烧和兴奋剂使用的压力在颜色中观察到的压力 美国。了解少数压力会影响病毒负荷的机制，从而其他 健康结果，对使用兴奋剂的艾滋病毒的SMM干预具有重要意义。像这样， 我们建议使用一个系列的BMSF系统测试BMSF在此高优先级人群中定位的关联 调解分析。具体而言，我们旨在通过测试纵向关联来检查BMSF组件 在少数族裔压力，兴奋剂使用，不遵守和实验室测试衍生的病毒负荷之间 来自使用兴奋剂的HIV的两个独立SMM样本的现有数据：（1）居住在SAN中的110 SMM 加利福尼亚州弗朗西斯科和（2）350 SMM从美国招募。此外，我们旨在测试协会是否 种族/族裔少数族裔之间的少数压力，刺激性使用，不遵守和病毒载荷不同 与多数（即非西班牙裔白色）SMM与使用兴奋剂的HIV相比 评估目标1和2中检查的效果的不变性。对该项目的支持将极大地有助于进一步发展 PI朝着他的长期目标，即成为具有专业知识的独立学术临床心理学家 研究性行为和性别少数族裔健康差异的生物心理社会机制。