Dr. Raifman?s long-term career development goal is to become an independent researcher working to reduce sexual minority health disparities with a focus on reducing the burden of HIV among men who have sex with men (MSM). MSM in the United States have a lifetime risk of human immunodeficiency virus (HIV) nearly 80 times that of men who have sex with women, but just 4% reported using pre-exposure prophylaxis (PrEP) to prevent HIV in 2014. Structural stigma based on sexual orientation may contribute to slow PrEP uptake. Dr. Raifman will evaluate the role of structural stigma in MSM PrEP awareness and uptake and will develop and refine a clinic-level intervention to reduce structural stigma and improve PrEP uptake. She has the following research aims: (1) Assess state-level structural stigma and PrEP awareness and uptake among MSM through a difference-in-differences analysis; (2) Assess the relationship between sexual minority stigma in healthcare settings and PrEP awareness and uptake, and whether stigma in healthcare setting mediates any relationship between state-level stigma and PrEP awareness and uptake; and (3) Develop and refine a PrEP and structural stigma intervention for primary care settings. Dr. Raifman will use Centers for Disease Control and Prevention repeated cross-sectional National HIV Behavioral Surveillance Data collected from MSM in 21 cities and national Internet survey data from MSM collected by Fenway Health in 2013. She will also conduct qualitative interviews with clinic administrators, primary care providers, and MSM patients in Massachusetts and Georgia, states with differing levels of disparities in MSM health. The proposed research builds upon Dr. Raifman?s prior research on the health effects of structural stigma affecting sexual minorities, on HIV prevention and PrEP implementation, and on HIV treatment and care. She will pursue the following K01 training aims to prepare her for the proposed research and for her career goals: (1) Acquire training on health and social policymaking in the US; (2) Acquire high-level training in statistical methods for causal mediation analysis to evaluate different levels of stigma; (3) Acquire training on developing and evaluating multi-component, clinical interventions; and (4) Acquire training in health informatics in order to integrate interventions into electronic medical records. To achieve these training goals, Dr. Raifman has assembled a mentorship team lead by Dr. Michael Stein, the chair of Health Law, Policy, and Management at Boston University School of Public Health (BUSPH); Dr. Kenneth Mayer, Medical Director of Fenway Health; Dr. Colleen Barry, the Julie and Fred Soper Professor and Chair of Health Policy and Management at Johns Hopkins; and Dr. Debbie Cheng, BUSPH Professor of Biostatistics. Dr. Raifman?s training will prepare her to achieve her long-term career goal of becoming an independent investigator reducing the disproportionate burden of HIV and other health disparities among sexual minorities.
Men who have sex with men (MSM) in the United States have nearly 80 times the lifetime HIV risk of men who have sex with women. Dr. Raifman will train in policymaking, in statistical methods for mediation analysis, in intervention development, and in health informatics to prepare her to complete her research aims and for a career as an independent investigator focused on reducing the disproportionate burden of HIV other health disparities among sexual minorities. In the proposed research aims, Dr. Raifman will investigate whether state- and clinic-level structural stigma affecting sexual minorities is associated with HIV pre-exposure prophylaxis (PrEP) awareness and uptake among MSM and develop and refine a clinic-level intervention to reduce structural stigma and improve MSM PrEP uptake.