The literature reveals that hypertension (HTN) is considerably higher among HIV-positive individuals than HIV-negative individuals. However, the systemic/individual determinants (including behavioral, clinical, macro- social, and psychosocial factors) for this health co-morbidity is not fully understood in the literature. To fill these scientific gaps, we propose to use a longitudinal design to systematically examine a systemic/individual approach -- modeling after the NIMHD?s ?Minority Health and Health Disparities Research Framework? -- to examine and elucidate the multiple determinants of HTN observed in two ethnic-sexual men who have sex with men (MSM) living with HIV/AIDS. To that end, we will address three specific aims and hypotheses:
Aim 1 : To examine the association of macro-social determinants (i.e., homophobia, racial/ethnic discrimination), behavioral risk factors (e.g., substance misuse), and psychosocial factors (e.g., stress) with HTN among a cohort of African American or AA (200 AA in Philadelphia) and Asian Pacific Americans or APA (200 APA in Honolulu) MSM living with HIV -- We hypothesize that greater exposure to homophobia and racial/ethnic discrimination is associated with a greater prevalence of HTN among HIV-positive MSM.
Aim 2 : To determine the underlying systemic/individual determinants which account for the relationship between inflammation and HTN over time, given common forms of hypertension have been postulated to be immune mediated -- We hypothesize that the greater exposure to homophobia and racial/ethnic discrimination is associated with dysregulation of pro-inflammatory cytokines (D-dimer, hsCRP, IL-6, IL-8, MCP-1, P-selectin), where they mediate HTN among these men.
Aims 3 : To examine whether associations between these factors and health outcomes are moderated by coping and social support -- We hypothesize that greater social support would mitigate HTN among these men. This is the first study that uses systemic/individual and multi-disciplinary approaches to examine the impact of multiple determinants on HTN co-morbidity over time among AA and APA MSM living with HIV. Our multi-disciplinary team with expertise in HIV prevention science, clinical HIV medicine, ethnic-sexual MSM, and chronic diseases are uniquely positioned to address risk and protective factors of multiple influences of HTN co-morbidity over time among AA and APA MSM with HIV. By conceptually and empirically testing novel hypotheses, we will provide evidence of etiology and validated tools and measures that advance our understanding of mechanisms of disparities in HIV-related co-morbidities. Findings from this longitudinal observational study will inform the management of HIV and its HTN co-morbidity as a chronic disease, especially among the two disparity groups of MSM (AA and APA) who continue to bear the burden of health disparities. This study is guided by NIMHD?s conceptual framework to address multiple influences of health disparities on HTN comorbidity among HIV-positive MSM disparity populations.
Our knowledge of the of systemic/individual determinants on ?? the effect of HIV related co-morbidities on the complexity of HIV/AIDS diseases progression? is not fully understood. Given these scientific gaps, we propose to use a longitudinal design to systematically examine a systemic/individual approach -- modeling after the NIMHD?s ?Minority Health and Health Disparities Research Framework? -- to examine and elucidate the multiple determinants including behavioral, clinical, macro-social, and psychosocial factors -- herein known as ?systemic/individual determinants) of hypertension observed among a cohort of racial/ethnic (African American; Asian Pacific American) men who have sex with men living with HIV/AIDS in two metropolitan cities (Philadelphia and Honolulu).