Health disparities, stress pathways, and stress-related comorbidities among MSM living with HIV

HIV 感染者中 MSM 的健康差异、压力途径和压力相关合并症

• 批准号: 9892889
• 负责人: CARL A LATKIN
• 金额: $ 47.99万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9892889
• 关键词: Acute; Adrenal Glands; Affect; Alcohol or Other Drugs use; Behavior; Biological Markers; Buffers; Cardiovascular Diseases; Cellular Phone; Chronic; Cross-Sectional Studies; Data; Data Analyses; Discrimination; Disease; Disease Progression; Ecological momentary assessment; Effectiveness; Equation; Event; Exposure to; Future; Goals; HIV; HIV antiretroviral; HIV risk; Health; Home environment; Hydrocortisone; Hypothalamic structure; Immune; Individual; Inflammatory; Intervention; Lead; Linear Models; Link; Literature; Longitudinal Studies; Measures; Medical; Mental Depression; Minority; Modeling; Monitor; Neighborhoods; Outcome; Participant; Pathway interactions; Pattern; Personal Satisfaction; Pharmaceutical Preparations; Physiological; Pituitary Gland; Protocols documentation; Race; Research; Research Design; Risk Behaviors; Role; Saliva; Signal Transduction; Social Conditions; Social Environment; Social Network; Social support; Stress; Stressful Event; Structure; Substance abuse problem; Surveys; Sympathetic Nervous System; System; Testing; Time; Violence; Viral Load result; Virus Diseases; antiretroviral therapy; assault; base; behavioral health; behavioral outcome; black men who have sex with men; comorbidity; depressive symptoms; experience; health disparity; heart rate variability; hypothalamic-pituitary-adrenal axis; immune function; macrophage; medication compliance; men who have sex with men; mobile computing; monocyte; psychosocial; racial difference; racial disparity; resilience; response; social; social deficits; social structure; stressor; support network; theories

Project Summary Stress is associated with HIV risk behaviors, immune dysregulation, and among people living with HIV (PLWH) it has been associated with viral load and disease progression. The goal of this study is to better understand the mechanisms of stress and stress-related comorbidities and how they exacerbate HIV-related health disparities among HIV-infected Black men who have sex with men (BMSM). Studies in many parts of the US suggest that BMSM often live or spend much of their time in impoverished neighborhoods where physical and social disorders (e.g., physical decay, violence, discrimination) are clustered. These socio-structural factors can be conceptualized as chronic and acute stressors and may promote other stressors that lead to HIV-related outcomes. While much of the literature on minority stress has focused on major discriminatory events, this proposed study will examine microaggressions. We will comprehensively assess chronic, acute, and daily psychosocial stressors that are particularly relevant to MSM, especially BMSM. Moreover, we will use measures of hypothalamic–pituitary– adrenal (HPA) axis responses, sympathetic nervous system (SNS), and inflammatory biomarkers to identify specific stress pathways among HIV-infected BMSM and White MSM (WMSM) that can be targeted in future interventions. We aim to provide an extension of minority stress theory by utilizing intensive longitudinal protocols to assess daily discriminatory events and other stressors, and to explore the association with HIV-related behaviors and physiological outcomes. Built upon the evidence of feasibility and acceptability from our previous research, this aim will be accomplished by using ecological momentary assessment (EMA) of stressors and stress, Medication Event Monitoring System (MEMS), and home-based testing for cortisol. We propose a longitudinal study of 450 HIV-infected BMSM and WMSM who have common stress-related comorbidities (e.g., cardiovascular disease, depression, substance abuse) assessed at baseline, 6, 12, 18, and 24 months. Participants will provide 9 days of smartphone- based EMA and MEMS for ART medication adherence every 6 months for 24 months. Every 6 months, we will collect stress and immune function biomarkers.

项目概要 压力与艾滋病毒危险行为、免疫失调以及生活在 对于艾滋病毒（PLWH），它与病毒载量和疾病进展有关。 这项研究是为了更好地了解压力和压力相关合并症的机制， 它们如何加剧了感染艾滋病毒的黑人男性中与艾滋病毒相关的健康差距 美国许多地区的研究表明，BMSM 经常生活或消费。 他们大部分时间生活在贫困社区，那里的身体和社会失调（例如， 这些社会结构因素可以集中在一起。 概念化为慢性和急性压力源，并可能促进其他压力源，导致 虽然许多关于少数群体压力的文献都集中于主要的结果。 歧视性事件，这项拟议的研究将研究微侵犯。 全面评估慢性、急性和日常心理社会压力源，尤其是 与MSM相关，尤其是BMSM，此外，我们将使用下丘脑-垂体-的测量。 肾上腺 (HPA) 轴反应、交感神经系统 (SNS) 和炎症 生物标记物可识别 HIV 感染的 BMSM 和白人 MSM 之间的特定途径压力 （WMSM）可以成为未来干预措施的目标，我们的目标是扩大少数群体的范围。 通过利用密集的纵向协议来评估日常歧视事件的压力理论 和其他压力源，并探讨与艾滋病毒相关行为和生理学的关联 基于我们之前研究的可行性和可接受性的证据， 这一目标将通过使用压力源的生态瞬时评估（EMA）来实现 和压力、药物事件监测系统 (MEMS) 以及皮质醇的家庭测试。 我们建议对 450 名感染 HIV 的 BMSM 和 WMSM 进行一项纵向研究，他们有共同点 与压力相关的合并症（例如心血管疾病、抑郁症、药物滥用） 在基线、6、12、18 和 24 个月时进行评估，参与者将提供 9 天的智能手机使用时间。 基于 EMA 和 MEMS 的 ART 药物依从性每 6 个月一次，持续 24 个月每 6 个月一次。 几个月后，我们将收集压力和免疫功能生物标志物。