Developing a Computer Based intervention to Prevent HIV among Native Amer. MSM

开发基于计算机的干预措施以预防美洲原住民中的艾滋病毒。

• 批准号: 9044607
• 负责人: KARINA L. WALTERS
• 金额: $ 38.62万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2018-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9044607
• 关键词: AIDS diagnosis; AIDS prevention; AIDS/HIV problem; ARHGEF5 gene; Accounting; Acquired Immunodeficiency Syndrome; Address; African American; Alaska Native; Alcohol or Other Drugs use; American; American Indians; Anger; Anxiety; Area; Asians; Behavior; Cardiovascular Diseases; Caring; Categories; Censuses; Centers for Disease Control and Prevention (U.S.); Childhood; Chlamydia; Chronic Disease; Clinic; Cocaine; Communities; Computers; Counseling; Country; Data; Diabetes Mellitus; Disease; Drug usage; Education; Environment; Epidemic; Epidemiology; Ethnic Origin; Ethnic group; Exposure to; Faculty; Family member; Feeling suicidal; Focus Groups; Forcible intercourse; Fright; Future; General Population; Gonorrhea; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health; Health Insurance; Health behavior; Heterosexuals; Hispanics; Homicide; Household; Illicit Drugs; Income; Indigenous; Individual; Inhalant dose form; Injury; Insurance Coverage; International; Internet; Intervention; Intervention Studies; Interview; Knowledge; Latino; Life; Link; Location; Mediating; Mental Depression; Mental Health; Methamphetamine; Morbidity - disease rate; Narcotics; Native Americans; Native-Born; Needs Assessment; Newly Diagnosed; Outcome; Pacific Island Americans; Patients; Pattern; Personal Satisfaction; Persons; Population; Population Sizes; Post-Traumatic Stress Disorders; Poverty; Premature Mortality; Prevention; Provider; Psychopathology; Race; Recommendation; Recording of previous events; Reporting; Reproductive Health; Research; Research Infrastructure; Research Institute; Research Personnel; Research Project Grants; Reservations; Risk; Risk Behaviors; Rural; Sampling; Schools; Sex Behavior; Sexual Health; Sexual abuse; Sexually Transmitted Diseases; Social Network; Social isolation; Source; Substance abuse problem; Suicide; Surveys; System; Time; Trauma; Tribes; Unemployment; United States; Universities; Variant; Vehicle crash; Violence; Virus; Visual; Washington; Woman; Work; alcohol misuse; base; black men who have sex with men; club drug; cocaine use; combat; design; emotional abuse; emotional distress; experience; gender minority; health disparity; high risk sexual behavior; illicit drug use; innovation; interest; member; men; men who have sex with men; mortality; motor vehicle injury; non-Native; patient oriented research; peer; peer support; post intervention; prevent; preventive intervention; programs; psychologic; racial and ethnic; reservation-based; respiratory health; rural area; sex; sex risk; sexual assault; skills; social stigma; socioeconomics; substance abuse treatment; therapy development; transmission process; traumatic event; treatment strategy; tribal health; virtual

As of 2003 there were 4.4 million AIAN in the U.S., constituting 1.5% of the total U.S. population, with 2.8 million or 1% self-identifying exclusively as AIAN. The U.S. Census Bureau estimates that by 2050 the AIAN population will grow to 3.2 million with a projected rate of increase of 55%, exceeding the projected rate of increase for Whites and comparable to the rate for African Americans. Despite their wealth in cultural and tribal diversity. Natives in the U.S. experience considerable socio-economic disparities. For example, in 2003, AIAN compared to the U.S. population, reported a greater likelihood of living below the poverty level (27% vs. 15%) and lower overall median household incomes ($34,700 vs. $43,500); and reported higher unemployment (15.1% vs. 5.9%). Moreover, 30% of the AIAN population lacks health insurance coverage. Indigenous populations suffer from pervasive patterns of health disparities, unequal burden of chronic illnesses, as well as disproportionate levels of morbidity (e.g., diabetes, cardiovascular disease) and injury-related mortality (e.g., suicide, motor vehicle collisions). Natives also experience high rates of trauma (e.g., injury, motor vehicle accidents, homicide) and violence exposure (e.g., rape, sexual assault, combat exposure) with co-occurring disproportionate rates of psychopathology (i.e., PTSD, depression, anxiety, suicide, AOD disorders). In the U.S., Natives have escalating rates of HIV and other sexually transmitted infections (STI), respiratory and reproductive health problems, as well as premature mortality related to chronic disease states. HIV/AIDS and STI have become major sources of concern for Natives. In a comprehensive review of STI and HIV among AIAN, Kaufmann and colleagues (2007) noted that the epidemiologic evidence points to excessively high case rates of STI among AIAN compared to the general population; with a greater burden borne by Native populations living in closer proximity to one another. For example, in the U.S., AIAN have the second highest rates of Chlamydia and gonorrhea. The potential for exposure to and transmission of HIV is greatly enhanced by these elevated STI rates. Indeed, elevated rates of STI may provide a 2-5 fold increased risk for HIV infection among AIAN in the U.S. According to data from the National HIV/AIDS Surveillance System through December 2008, a cumulative total of 3,741 AIDS cases among AI/AN have been reported to the CDC. In terms of the major modes of transmission, percentages for AIAN men were: MSM (64%), IDU (14%), and MSM/IDU (14%). Note that this last category is higher for AIAN men than any other ethnic group. For AIAN women, the percentages were IDU (37%) and heterosexual contact (50%). Note that the IDU transmission category for Native women is higher than for any other ethnic group. Since 1995, the rate of AIDS diagnosis for AIAN has been consistently higher than the rate for Whites or Asian/Pacific Islanders in the U.S. Additionally, when one takes the relative population size into account, a more disturbing picture emerges. The AIDS case rates for AIAN per 100,000 were 8.5 (11.9 for HIV rates), ranking them just behind Blacks (49.3; 73.7 for HIV rates) and Hispanics/Latinos (15.0; 25.0 for HIV rates). In our research (N=447; HONOR Project, R01MH65871), 30% of Native two-spirit (i.e., AIAN sexual and/or gender minority) men reported that they were HIV+ (19% reported they did not know their status). These numbers are unprecedented and suggest that the HIV/AIDS epidemic for Native MSM may be similar to Black MSM. Natives suffer disproportionate exposure to trauma and mental health disparities. Recent reports demonstrate that Native communities experience higher rates of sexual and physical violence than any other ethnic or racial group in the U.S. Among MSM in our HONOR project, 31% had experienced "extreme" sexual abuse in childhood. Our previous research with two spirit populations, particulariy MSM, suggest that a history of sexual abuse, substance abuse, poverty, and involvement in sex trade are all related to risky sexual behaviors. Mental health is an important factor in Native HIV risk. Not surprisingly, given the high rates of trauma exposure, it is well documented that Natives have high lifetime rates of both depression and PTSD (15% and 8% respectively; higher than in non-Native groups.^® Mental health issues such as depression, anxiety, PTSD are common mental health outcomes to high rates of trauma exposure and have also been linked to risky sexual behaviors among Natives and two-spirits. Over the past three decades, studies have indicated that there are also high rates of substance use and alcohol misuse among AIAN, although there is tremendous variation over time, by tribe, and by reservation/ Results of the 2005 National Survey on Drug Use and Health indicate that the rate of current illicit drug use was higher among American Indians and Alaska Natives (12.8%) than among persons of other races or ethnicities. The relationship between drug use with precocious sexual activity and potential HIV sexual-risk behavior has been well documented. Moreover, research indicates that substance use may mediate the relationship between traumatic event exposure and sexual risk. Findings in our HONOR study indicated that over 40% of the sample reported lifetime use of narcotics, stimulants, inhalants, and methamphetamine (60% reported lifetime cocaine use). Over 35-40% reported having used stimulants, cocaine, narcotics, methamphetamine, inhalants, and club drugs in the past year. Additionally, over 25% ofthe Native MSM had injected illicit drugs and had traded sex in their lifetime. Native HIV/AIDS risk is both structurally and behaviorally determined and interventions research needs to investigate multiple levels for the highest impact. Concurrent with structural interventions, individual level STI-specific knowledge and skills directly impact choices that influence risk and are also important intervention targets, particulariy for Native MSM and IDUs. At this moment, there is a window of opportunity to intervene with respect to HIV preventive interventions among Native MSM, particularly substance using MSM. This study could provide a body of data upon which to make recommendations for national HIV treatment strategies planning for Native MSM. Our preliminary work among AIAN MSM has been very successful and points to gaps in care and areas for new patient oriented research. Based on our research, reports from individuals we spoke with over the past 7 years and our community forums in the two-spirit communities- the need for HIV preventive intervention development-particularly among substance using twospirit MSM~has become a community imperative. Community members note that rural and reservation-based two-spirit men should also be included in future prevention efforts. The difficulty in accessing or unintentionally outing rural and reservation-based Native MSM requires innovative intervention development and sampling strategies. Moreover, Native MSM who are faced with newly diagnosed HIV are often in psychological crisis. They report depression and anxiety, social isolation, stigma, demoralization, anger, and, in the extreme, suicidal ideation. Their emotional distress is compounded by fears about transmitting the virus to family members and partners. Despite their urgent need for psychological and substance abuse intervention, most newly diagnosed two-spirit men do not receive any culturally tailored mental health or substance abuse treatment, even rudimentary counseling. Urban Native health clinics as well as tribal health clinics lack the mental health and HIV prevention infrastructure to address these needs in the general Native population already, and few professionals are available to provide education to providers or care to two-spirit patients. We propose to develop an online HIV preventive intervention for two-spirit MSM. The project has the potential to fill an enormous gap in HIV prevention needs among two-spirit men and, because of its online delivery format, could be widely disseminated throughout the country. Two-spirit men in rural areas, particularly isolated, would be ideally suited to benefit from such a program. Our plans are to incorporate a social networking peer component in the online intervention to provide a culturally grounded two-spirit intervention that facilitates positive sexual health behaviors, decreases substance use and HIV risk behaviors, and provides the peer support that may best address their needs.

截至 2003 年，美国有 440 万 AIAN，占美国总人口的 1.5%，其中 280 万人（即 1%）仅自认为是 AIAN。美国人口普查局估计，到 2050 年，AIAN 人口将增至 320 万。预计增长率为 55%，超过白人的预计增长率，与非洲人的增长率相当美国人。尽管美国原住民拥有丰富的文化和部落多样性，但他们仍经历着相当大的社会经济差距。例如，2003 年，与美国人口相比，AIAN 生活在贫困线以下的可能性更大（27% 与 27%）。 15%），家庭总收入中位数较低（34,700 美元 vs. 43,500 美元）；失业率较高（15.1% vs. 5.9%）。 30% 的 AIAN 人口缺乏医疗保险覆盖面，普遍存在健康差距、慢性病负担不平等以及发病率（例如糖尿病、心血管疾病）和伤害相关死亡率（例如，当地人遭受创伤（例如受伤、机动车事故、凶杀）和暴力（例如强奸、性侵犯、战斗）的几率也很高不成比例的精神病理学（即创伤后应激障碍（PTSD）、抑郁症、焦虑症、自杀、AOD 障碍）的同时发生率在美国，原住民的艾滋病毒和其他性传播感染（STI）、呼吸系统和生殖健康问题以及生殖健康问题的发病率不断上升。与慢性疾病状态相关的过早死亡。 艾滋病毒/艾滋病和性传播感染已成为当地人关注的主要问题。 Kaufmann 及其同事（2007 年）对 AIAN 中的性传播感染和艾滋病毒进行了全面审查，指出流行病学证据表明，与一般人群相比，AIAN 中性传播感染的发病率过高，而居住在附近的原住民群体承受的负担更大；另一个例子是，在美国，衣原体和淋病的发病率位居第二。性病感染率的升高大大增加了艾滋病毒的暴露和传播的可能性。在美国，性传播感染可能会使 AIAN 感染艾滋病毒的风险增加 2-5 倍。根据国家艾滋病毒/艾滋病监测系统截至 2008 年 12 月的数据，已向 AI/AN 累计报告了 3,741 例艾滋病病例。 CDC。就主要传播方式而言，AIAN 男性的百分比为：MSM (64%)、IDU (14%) 和 MSM/IDU (14%)。 AIAN 男性的最后一类比例高于任何其他族裔群体，其中注射吸毒者 (37%) 和异性接触 (50%) 的百分比请注意，原住民女性的注射吸毒者传播类别高于任何其他族裔。自 1995 年以来，美国白人或亚裔/太平洋岛民的艾滋病诊断率一直高于白人或亚裔/太平洋岛民。此外，如果考虑到相对人口规模，情况会更加令人不安。在我们的研究中，每 10 万人中艾滋病病例率为 8.5 例（艾滋病毒感染率 11.9 例），仅次于黑人（49.3 例；艾滋病毒感染率 73.7 例）和西班牙裔/拉丁美洲人（15.0 例；艾滋病毒感染率 25.0 例）。 =447；荣誉项目，R01MH65871)，原生二灵30% （即 AIAN 性和/或性别少数）男性报告称，他们是 HIV+（19% 的报告称他们不知道自己的状况）。这些数字是前所未有的，表明土著 MSM 的艾滋病毒/艾滋病流行可能与黑人 MSM 类似。 。 当地人遭受过多的创伤和心理健康差异。 最近的报告表明，原住民社区遭受性暴力和身体暴力的比例高于美国任何其他族裔或种族群体。在我们的 HONOR 项目中的 MSM 中，31% 的人在童年时期经历过“极端”性虐待。我们之前对两个精神群体进行的研究。 ，特别是 MSM，表明有性虐待、药物滥用史、 贫困和参与性交易都与危险的性行为有关。心理健康是土著人艾滋病毒风险的一个重要因素，鉴于创伤暴露率很高，有充分证据表明土著人一生中患抑郁症的几率很高。和 PTSD（分别为 15% 和 8%；高于非原住民群体。^® 心理健康问题，如抑郁症、 焦虑、创伤后应激障碍 (PTSD) 是高比例创伤暴露造成的常见心理健康结果，并且也 与原住民和双魂之间的危险性行为有关。 研究表明，在过去的三十年里， AIAN 中物质使用和酒精滥用，尽管不同国家之间存在巨大差异 时间、部落和保留地/2005 年全国吸毒和健康调查结果 表明目前美洲印第安人和阿拉斯加人的非法药物使用率较高 土著人（12.8%）与其他种族或民族的人之间的吸毒关系。 性早熟和潜在的艾滋病毒性风险行为已得到充分记录。 此外，研究表明，物质使用可能会介导创伤性创伤之间的关系。 我们的 HONOR 研究结果表明，超过 40% 的样本存在这种情况。 报告终生使用麻醉剂、兴奋剂、吸入剂和甲基苯丙胺（60%报告终生使用 （使用可卡因）超过 35-40% 报告使用过兴奋剂、可卡因、麻醉剂、甲基苯丙胺、 此外，超过 25% 的本地 MSM 在过去一年中注射过注射剂。 他们一生中曾吸毒并进行过性交易。 本土艾滋病毒/艾滋病风险是由结构和行为决定的，干预措施也是如此 研究需要在多个层面上进行调查，以获得最大的影响。 干预措施、个人层面的性传播感染特定知识和技能直接影响选择 风险，也是重要的干预目标，特别是对于本地 MSM 和注射吸毒者而言。 此时此刻，存在一个干预艾滋病毒预防的机会之窗 对本地 MSM 的干预，特别是使用 MSM 的物质这项研究可以提供一个参考。 为国家艾滋病毒治疗战略规划提出建议的数据体 本土男同性恋者。 我们在 AIAN MSM 中的初步工作非常成功，并指出了在这方面的差距 基于我们的研究和个人报告的护理和新领域。 在过去的 7 年里，我们与两种精神社区的社区论坛进行了交谈—— 需要制定艾滋病毒预防干预措施——特别是在使用双重酒精的物质中 MSM~ 已成为社区的当务之急。社区成员指出，农村和地区。 保留型的双魂男人也应该被纳入未来的预防工作中。 访问或无意中外出农村和保留地的本地 MSM 需要创新 此外，本土 MSM 面临着新的挑战。 被诊断出艾滋病毒的人往往处于心理危机中，他们报告抑郁和焦虑、社会孤立、 耻辱、士气低落、愤怒，以及极端的自杀意念是他们的情绪困扰。 由于担心将病毒传播给家庭成员和伴侣，情况更加复杂。 迫切需要心理和药物滥用干预，大多数新诊断为双重精神 男性没有接受任何针对文化的心理健康或药物滥用治疗，甚至 城市原住民健康诊所和部落健康诊所缺乏基本的咨询服务。 心理健康和艾滋病毒预防基础设施，以满足一般原住民的这些需求 人口已经增加，并且很少有专业人员可以为提供者提供教育或照顾 双神病人。 我们建议为双性男男性行为者开发在线艾滋病毒预防干预措施。 该项目有潜力填补两种精神男性在艾滋病毒预防需求方面的巨大差距， 由于其在线交付形式，可以在全国范围内广泛传播。 农村地区的男性，特别是偏远地区的男性，非常适合从我们的这一计划中受益。 计划将社交网络同行部分纳入在线干预中，以提供 一种基于文化的双重精神干预，促进积极的性健康行为， 减少物质使用和艾滋病毒危险行为，并提供最有效的同伴支持 满足他们的需求。