背景:非传染性疾病负担日益增加,比如高血压,糖尿病和血脂异常,提出了在老年艾滋病毒感染者中实现最佳艾滋病毒护理结果的关键挑战。这些疾病往往是合并症,并因社会心理和结构不平等而加剧。多种健康状况和社会因素之间的这种相互作用被称为共病。在美国,社会地位存在巨大的差异(即,种族,种族和社会经济地位)在非传染性疾病和艾滋病毒的流行和/或控制方面。交叉柱头,比如种族主义,阶级和同性恋恐惧症,可能会通过避免医疗保健和导致社会心理综合症(压力,抑郁症,暴力受害和物质使用),减少艾滋病毒和非传染性疾病持续护理的成功。我们的假设是,边缘化人群在非传染性疾病发病率方面存在差异,患病率和控制,由交叉的污名和社会心理综合症介导。
方法:收集4年的数据,我们将招募参加MACS/WIHS联合队列研究的性少数男性(计划n=1800),美国一个长期的混合血清状态观察队列,调查以下具体目标:(1)评估社会地位之间的关系,在中年和老年性少数群体男性中,交叉的污名和社会心理综合症,(2)评估社会地位与非传染性疾病发病率和患病率之间的关系,(3)评估社会地位与艾滋病毒和非传染性疾病持续护理结果之间的关系,由交叉的污名和社会心理综合症介导。将使用交叉滞后面板模型设计使用广义结构方程模型进行分析。
背景:该方案被批准为单一IRB研究(Advarra机构审查委员会:方案00068335)。我们将通过同行评审的学术期刊传播结果,科学会议,一个专门的网站,在参与站点举办的站点社区咨询委员会和论坛。
BACKGROUND: The increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a
syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial
syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic.
METHODS: Collecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort
Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial
syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design.
BACKGROUND: This protocol is approved as a single-IRB
study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.