Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, 256 Crittenden Blvd, Ste. 3305, Rochester, NY, 14642, USA.
Meharry Medical College, Nashville, TN, USA.
J Racial Ethn Health Disparities. 2022 Aug;9(4):1114-1124. doi: 10.1007/s40615-021-01052-1. Epub 2021 May 13.
Few studies examine racial differences (e.g., Black vs. White) regarding the psychosocial pathways linking mental health burdens and various HIV-related outcomes among young men who have sex with men (MSM) in the U.S. We conducted a community-based study to examine the racial differences of mental health burdens (e.g., depression, anxiety, stress), the psychosocial determinants (e.g., HIV stigma, homonegativity, resilience, social support, loneliness, housing/food security) and impact on HIV-related outcomes (e.g., event-level alcohol/drug use before sex, condomless insertive/receptive anal sex, recent HIV testing, and PrEP awareness/willingness/use) among young Black MSM (YBMSM; n = 209) and young White MSM (YWMSM; n = 109) from two cities (Nashville, TN and Buffalo, NY) in the United States. Overall, we found YBMSM were more likely (p < 0.05) to experience anxiety and depression compared to YWMSM. Among YBMSM, we found structural inequities (housing instability, food insecurity, internalized homonegativity) were positively associated with anxiety/depression/stress (p < 0.001); we also found anxiety/depression was associated with increased alcohol/drug use before sex, and stress was associated with reduced recent HIV testing and pre-exposure prophylaxis awareness/willingness/use. Among YWMSM, we found psychological buffers (perceived social support, resilience) were associated with reduced anxiety/depression/stress (p < 0.001); anxiety was associated with increased condomless insertive/receptive anal sex and recent HIV testing among this subgroup. YBMSM and YWMSM differed in psychosocial determinants and HIV-related consequences regarding their mental health. Our findings provide important implications for developing culturally and contextually tailored interventions to address mental health burdens and HIV prevention outcomes among young MSM at highest risk for HIV acquisition.
很少有研究探讨在美国，与心理健康负担和各种与 HIV 相关的结果相关的心理社会途径方面的种族差异（例如，黑人与白人），这些结果与男男性行为者（MSM）中的年轻男性有关。我们进行了一项基于社区的研究，以检验心理健康负担（例如，抑郁，焦虑，压力），心理社会决定因素（例如，HIV 耻辱感，同性恋反感，韧性，社会支持，孤独感，住房/食品安全）的种族差异，以及对 HIV 相关结果的影响（例如，性行为前的酒精/药物使用，无保护的插入性/接受性肛交，最近的 HIV 检测，以及 PrEP 的意识/意愿/使用），其中包括来自美国两个城市（田纳西州纳什维尔和纽约州布法罗）的 209 名年轻黑人 MSM（YBMSM）和 109 名年轻白人 MSM（YWMSM）。总体而言，我们发现 YBMSM 比 YWMSM 更有可能（p <0.05）经历焦虑和抑郁。在 YBMSM 中，我们发现结构不平等（住房不稳定，食品安全，内化的同性恋反感）与焦虑/抑郁/压力呈正相关（p <0.001）；我们还发现焦虑/抑郁与性行为前的酒精/药物使用增加有关，而压力与最近的 HIV 检测和暴露前预防意识/意愿/使用减少有关。在 YWMSM 中，我们发现心理缓冲（感知到的社会支持，韧性）与焦虑/抑郁/压力降低有关（p <0.001）；焦虑与该亚组中无保护的插入性/接受性肛交和最近的 HIV 检测有关。 YBMSM 和 YWMSM 在心理社会决定因素和与心理健康有关的 HIV 相关后果方面存在差异。我们的研究结果为制定文化和背景相适应的干预措施提供了重要启示，以解决最易感染 HIV 的年轻 MSM 的心理健康负担和 HIV 预防结果。
