The HIV epidemic in the US is characterized by enormous demographic disparities, leaving certain sub- population to carry a disproportionate burden of disease. Young men who have sex with men (YMSM) have been particularly hard hit by this epidemic. The research and prevention efforts aimed at reducing transmission in this high risk population have been extensive. And while these efforts have resulted in marked behavior change on the level of the individual participants, we have failed to affect the type of population level change that is necessary to slow the epidemic. In fact, recent CDC surveillance reports suggest that not only are rates of HIV infection among YMSM increasing, they are increasing at a higher rate than among any other risk group. Currently, prevention inteventions rely on a model that suggests that risk behaviors (depression, alcohol use, substance use) mediate the relationship between adversity (violence/victimization) and HIV sexual risk (unprotected anal intercourse). Therefore, HIV prevention interventions rely on diminishing risk in order to promote health. Resilience theory, on the other hand, suggests that the relationship between adversity and risk behaviors, and the relationship between risk behaviors and UAI can be buffered by strengths and protective factors. This project will utilize resilience theory to guide the investigation of strengths and protective factors that exist among YMSM. The short-term goal of the proposed project is to identify factors that protect against HIV sexual risk behaviors. The long term goal ofthe proposed project is to inform the development of youth HIV prevention interventions. With knowledge of protective factors, prevention specialists will be able to develop interventions that rely not only on diminishing risks, but also on promoting strengths. This two-fold approach may give prevention programs the extra potency to reverse the current trends in infection.
The specific aims ofthis study are: 1) Using in-depth qualitative interviews, identify strengths and protective factors that help young MSM avoid HIV risk behaviors. 2) Using the strengths and protective factors identified in Aim 1, develop a survey instrument that can be used to measure the Protective Factors construct of the resilience model. 3) Using mediation and moderation analysis test the resilience model in a sample of 200 young MSM aged 16 to 21. This project will contribute to the field of public health by addressing a current gap in our understanding of HIV prevention among youths. The information gained from this project will inform much-needed interventions to address significant health disparities in a highly vulnerable and understudied population.
| Herrick, Amy; Stall, Ron; Egan, James et al. (2014) Pathways towards risk: syndemic conditions mediate the effect of adversity on HIV risk behaviors among young men who have sex with men (YMSM). J Urban Health 91:969-82 |
