Intersectional stigma and the non-communicable disease syndemic in the context of HIV: protocol for a multisite, observational study in the USA.

Autor:	Friedman MR; Department of Urban-Global Public Health, Rutgers University, Newark, New Jersey, USA mf1061@rutgers.edu., Badri S; Hektoen Institute of Medicine, Chicago, Illinois, USA., Bowleg L; Department of Psychology, The George Washington University, Washington, District of Columbia, USA., Haberlen SA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Jones DL; Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA., Kempf MC; Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA., Konkle-Parker D; Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA., Kwait J; Whitman-Walker Institute, Washington, District of Columbia, USA., Martinson J; Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Mimiaga MJ; Center for LGBTQ+ Advocacy, Research & Health and Department of Epidemiology, University of California-Los Angeles, Los Angeles, California, USA., Plankey MW; Department of Medicine, Georgetown University, Washington, District of Columbia, USA., Stosor V; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Tsai AC; Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.; School of Medicine and Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA., Turan JM; Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA., Ware D; Department of Medicine, Georgetown University, Washington, District of Columbia, USA., Wu K; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2024 Apr 25; Vol. 14 (4), pp. e075368. Date of Electronic Publication: 2024 Apr 25.
DOI:	10.1136/bmjopen-2023-075368
Abstrakt:	Introduction: 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 and Analysis: 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. Ethics and Dissemination: 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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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