Synergistic epidemics of non-communicable diseases, stigma, depression, and material insecurities among sexual and gender minorities living with HIV in Nigeria

尼日利亚艾滋病毒感染者中性少数群体和性别少数群体中非传染性疾病、耻辱、抑郁和物质不安全感的协同流行

• 批准号: 10674991
• 负责人: Manhattan E Charurat
• 金额: $ 73.71万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10674991
• 关键词: Africa South of the Sahara; Blood; Caring; Chronic Obstructive Pulmonary Disease; Communities; Continuity of Patient Care; Data; Data Analyses; Development; Diabetes Mellitus; Discrimination; Disease; Disease Clusterings; Disease Outcome; Disparity; Dyslipidemias; Economics; Exposure to; HIV; HIV risk; HIV/AIDS; Health behavior; Heart; Hypertension; Inequality; Inequity; Interdisciplinary Study; Intervention; Interview; Knowledge; Lead; Lung; Maryland; Measures; Mental Depression; Military Personnel; Modeling; National Heart, Lung, and Blood Institute; Nigeria; Obesity; Outcome; Participant; Police; Policies; Population; Prevalence; Public Health; Research; Research Personnel; Risk; Risk Factors; Sexual and Gender Minorities; Social status; Social support; Stigmatization; Stress; Testing; Time; Universities; Victimization; Violence; Woman; Work; cardiometabolic risk; cohort; deviant; experience; follow-up; gender minority group; health care availability; indexing; intimate partner violence; life history; low and middle-income countries; men who have sex with men; multidisciplinary; perceived discrimination; polysubstance use; poor health outcome; programs; remediation; social; social capital; social norm; social stigma; syndemic

PROJECT ABSTRACT There is an increasing burden of HIV-associated noncommunicable diseases (HIVNCD) globally, which often cluster among populations facing persistent social and economic inequalities. One such population is sexual and gender minorities (SGM), for whom stress resulting from discrimination leads to poorer health outcomes. Syndemic frameworks have been utilized to explain elevated HIV risk in SGM populations but have only recently been applied to study HIVNCD. Being an SGM is associated with real and perceived discrimination and stigmatization. As a result, SGM experience elevated levels of victimization including intimate partner violence (IPV) and subsequently, stress, depression, polysubstance use, and material insecurity. These factors are well-documented risk factors for disengagement in the continuum of care among SGM. There is a critical knowledge gap for the development of modifiable intervention strategies, however, regarding how these syndemic factors leads to disease clustering of HIVNCD and promotes further inequities and vulnerabilities in low- and middle-income countries (LMIC) where both HIV prevalence and social/economic barriers to accessing health care are remarkably high. In Nigeria, where the University of Maryland, the Johns Hopkins University, and the U.S. Military HIV Research Program have worked with SGM since 2012, 70% of SGM in the TRUST/RV368 study (84% men who have sex with men and 16% self-identified as women) experience a moderate-to-severe level of stigma related to discriminatory policies, and social norms that leads to avoidance of HIV care. Prior to this proposal, we conducted a cross-sectional preliminary analysis, which suggested that stigma and depression are associated with clusters of cardiometabolic risk factors. The proposed work builds on the TRUST/RV368 study, the largest cohort of SGM in sub-Saharan Africa (SSA) and brings together a multidisciplinary team of researchers to: 1) Examine association between syndemic factors and HIVNCD outcomes; 2) Assess whether and how community-level and structural-level factors exacerbate the syndemic; and 3) Determine whether the syndemic characterized for HIVNCD prevalence and outcomes is associated with risk of disengaging from HIVNCD care continua.

项目摘要 全球范围内与艾滋病毒相关的非传染性疾病（HIVNCD）的负担日益增加，这通常 面临持续社会和经济不平等的人口聚集。其中一类人群是有性行为的 性别少数群体（SGM），对他们来说，歧视造成的压力会导致健康状况较差。 流行病框架已被用来解释 SGM 人群中艾滋病毒风险升高的原因，但仅 最近被应用于研究 HIVNCD。成为 SGM 与真实的和感知到的歧视有关 和污名化。结果，SGM 遭受的伤害程度升高，包括亲密伴侣 暴力 (IPV) 以及随之而来的压力、抑郁、多物质使用和物质不安全感。这些因素 是 SGM 脱离持续护理的有据可查的风险因素。有一个关键的 然而，在制定可修改的干预策略方面的知识差距 综合症因素导致艾滋病毒非传染性疾病的聚集，并进一步加剧不平等和脆弱性 低收入和中等收入国家 (LMIC) 的艾滋病毒流行率和社会/经济障碍 获得医疗保健的比例非常高。在尼日利亚，马里兰大学、约翰霍普金斯大学 自2012年以来，大学和美国军方艾滋病毒研究计划与SGM合作，SGM的70%在 TRUST/RV368 研究（84% 的男男性行为者和 16% 的自认为女性）经历了 与歧视性政策和导致回避的社会规范相关的中度至重度耻辱 艾滋病毒护理。在此提案之前，我们进行了横截面初步分析，结果表明 耻辱和抑郁与一系列心脏代谢危险因素有关。拟议的工作构建 TRUST/RV368 研究是撒哈拉以南非洲 (SSA) 最大的 SGM 队列，汇集了 多学科研究团队：1) 检查流行病因素与 HIVNCD 之间的关联 结果； 2) 评估社区层面和结构层面的因素是否以及如何加剧这一流行病； 3) 确定以 HIVNCD 流行率和结果为特征的综合征是否相关 存在脱离 HIVNCD 护理连续性的风险。