As outlined in the goals of Healthy People 2010, eliminating racial/ethnic health disparities, especially with regard to HIV/AIDS, is a major priority in the U.S. Across all racial/ethnic groups and both genders, the highest rates of HIV and AIDS are among African American men, and the predominant mode of transmission among African American men is sex with men. African American men who have sex with men (MSM) are more than two times as likely to be infected with HIV than are MSM of other races/ethnicities. This application proposes a longitudinal study to investigate perceived stress and negative health care attitudes as possible barriers to antiretroviral treatment adherence among 200 HIV-infected African American MSM. Although effective HIV treatments are now available, patients must closely adhere for maximum reductions in HIV viral load and increased survival time. Some research indicates that African Americans are less likely to receive and adhere to antiretroviral medications than are Whites, and these differences in treatment patterns could contribute to observed lower survival times among African American, versus White, people with HIV/AIDS. Although discrimination is thought to contribute to racial/ethnic disparities in treatment behavior, research has not examined the manifold effects of discrimination on adherence among African American MSM, a subgroup at the nexus of the HIV/AIDS epidemic. In this application, discrimination is proposed to influence the health of African American MSM with HIV via multiple pathways, by increasing their chronic, environmental, general, and traumatic stress burden. These discrimination-related stressors are hypothesized to influence treatment behavior directly, via decreased ability to adhere to antiretroviral treatment regimens, as well as indirectly, through the formation of negative attitudes about the health care system (e.g., conspiracy beliefs about HIV). Findings will provide information concerning specific cultural barriers to quality health care among African American MSM with HIV and will be used to make policy recommendations for targeted culturally-relevant outreach measures that address identified barriers at multiple levels, including patients, communities, and health care organizations. In so doing, the conclusions of the proposed research will inform public policy regarding racial/ethnic disparities in health by suggesting factors that may place African American MSM at risk for treatment nonadherence and decreased survival.
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