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Principal Investigator: Elliott Royal Weinstein
Organization: UNIVERSITY OF MIAMI CORAL GABLES
Fiscal Year: 2024
Award: $50,000
Funding agency: National Institute on Drug Abuse
Project Summary
Overview. This study addresses gaps in HIV and behavioral health research among older sexual minority men
(OSMM). Specifically, this project assesses the relative severity and impact of contextually relevant age-related
syndemic factors (age-related discrimination, internalized ageism, aging anxiety, sexual minority specific aging
concerns, social isolation, economic marginalization, and perceived cognitive impairment) and traditional
syndemic conditions (mental health via depression, PTSD, childhood sexual abuse; intimate partner violence;
substance use) among OSMM.9,10 Background. With high prevalence and rising incidence rates, OSMM are
uniquely burdened by HIV.1 This is particularly true for Florida (proposed study site), a state with one of the
highest HIV incidence rates nationally.11 The framework for the study is based on three relevant theories. First,
syndemic theory2 contends that HIV and quality of life (QOL) disparities are propagated by the synergistic co-
occurrence of disease (e.g., health issues, substance use behaviors, sociocultural factors), some of which are
unique to OSMM. Second, the minority stress model3,4 extends syndemic theory by positing that OSMM face
enduring unique stressors resulting from their marginalized identities that perpetuate psychological adversity.
Lastly, intersectionality theory5 posits that OSMM experience worse health outcomes compared to their
younger SMM peers due to the compounding systems of oppression they face due to their multiple minoritized
identities. Objectives & methods. This study’s three aims center on investigating the relative severity and
impact of age-related psychosocial factors and traditional syndemic conditions in explaining HIV and health
disparities among HIV-negative OSMM. Aim 1 examines the severity, frequency, and co-occurrence of
theoretically linked psychosocial problems occurring in HIV-negative OSMM. Aim 2 assesses the influence of
age-related psychosocial and traditional syndemic conditions on engagement in HIV prevention outcomes
(condomless anal sex without PrEP, PrEP adherence) and QOL among this population of OSMM as well as a
potential moderator of these relationships. Aim 3 utilizes tree-based-machine learning to explore interaction
effects between the most influential age-related psychosocial factors and an additive index of traditional
syndemic conditions on HIV risk and QOL outcomes. HIV-negative OSMM (N = 250) between the ages of 55
and 70 years will complete one psychosocial quantitative assessment. Data will be analyzed using tree-based-
machine learning approaches and traditional regression models. Innovation and Impact. This dissertation
study will identify age-related syndemic conditions unique to OSMM to better understand QOL, HIV, and
behavioral health, among OSMM, an under-researched and multiple marginalized group. Findings gleaned will
aid in the future development of HIV and behavioral health related tailored to OSMM and, as a dissertation, lay
the groundwork for the PI’s programmatic research focused on HIV and behavioral health disparities among
older sexual minorities. This proposal is relevant to the NIDA priorities (NOT-MD-19-001).
Terms: <AIDS Virus><AIDS prevention><AIDS/HIV><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Address><Adherence><Affect><Age><Ageism><Aging><Anxiety><Behavior><Behavior Conditioning Therapy><Behavior Modification><Behavior Therapy><Behavior Treatment><Behavioral Conditioning Therapy><Behavioral Modification><Behavioral Therapy><Behavioral Treatment><Bi-sexual><Bisexual><Buffers><Child Sexual Abuse><Child Sexual Molestation><Cognitive Discrimination><Cognitive Disturbance><Cognitive Impairment><Cognitive decline><Cognitive function abnormal><Complex><Conditioning Therapy><Data><Development><Discrimination><Disease><Disorder><Disparities><Disparity><Disturbance in cognition><Economics><Enrollment><Epidemic><Face><Florida><Fostering><Frequencies><Future><Gays><Glean><HIV><HIV Prevention><HIV Seronegativities><HIV Seronegativity><HIV diagnosis><HIV disparities><HIV inequalities><HIV inequities><HIV negative><HIV related disparities><HIV related inequities><HIV risk><HIV/AIDS><HIV/AIDS disparities><HIV/AIDS inequities><HIV/AIDS prevention><HIV/AIDS related disparities><HTLV-III Seronegativities><HTLV-III Seronegativity><Health><Health behavior><Heterosexuals><High Prevalence><Human Immunodeficiency Viruses><Impaired cognition><Incidence><Individual><Individuals from minority><Individuals of minority><Inequality><Influentials><Investigators><LAV-HTLV-III><Link><Literature><Lymphadenopathy-Associated Virus><Machine Learning><Marriage><Medical><Mental Depression><Mental Health><Mental Hygiene><Methodology><Methods><Minority><Minority Groups><Minority People><Minority Population><Minority Status><Minority individual><Modeling><Morbidity><Morbidity - disease rate><NIDA><NIH><National Institute of Drug Abuse><National Institute on Drug Abuse><National Institutes of Health><Older Population><Outcome><PTSD><Pattern><Population><Post-Traumatic Neuroses><Post-Traumatic Stress Disorders><Posttraumatic Neuroses><PrEP><Psychological Health><Psychosocial Factor><QOL><Quality of life><Research><Research Personnel><Researchers><Role><Severities><Site><Social isolation><Subgroup><System><Techniques><Testing><Trauma><Trees><United States National Institutes of Health><Virus-HIV><age associated><age associated effects><age correlated><age dependent><age effect><age linked><age related><age related effects><age specific><aged><ages><aging effect><anal intercourse without condom><anal sex without condom><behavior intervention><behavioral health><behavioral intervention><career><childhood sexual abuse><co-morbid><co-morbidity><cognitive dysfunction><cognitive loss><comorbidity><condomless anal intercourse><condomless anal sex><depression><developmental><disparity in health><economic><enroll><ethnic diversity><ethnically diverse><experience><faces><facial><health disparity><health related behavior><impact of age><improved><indexing><influence of age><innovate><innovation><innovative><insight><intersectionalities><intersectionality><intimate partner violence><juvenile sex abuse><machine based learning><marginalization><marginalized group><marginalized individual><marginalized people><marginalized population><men><minority stress><novel><older adult><older adulthood><older groups><older individuals><older person><ostracism><ostracize><pandemic><pandemic disease><peer><peer exclusion><physical conditioning><physical health><poor health outcome><post-trauma stress disorder><posttrauma stress disorder><pre-exposure prophylaxis><prevention service><programs><protective effect><psychologic><psychological><psychosocial><psychosocial variables><racial diversity><racially diverse><reduced health outcome><reduced substance use><reduction in substance use><resilience><resilient><sex><sexual minority><sexual minority group><sexual minority individual><sexual minority men><sexual minority people><sexual minority population><social cultural factor><social culture determinant><social exclusion><social role><sociocultural determinant><sociocultural factor><stress among minorities><stress in minorities><stress to minorities><stressor><substance use><substance use reduction><substance using><syndemic><synergistic epidemic><theories><traumatic neurosis><unprotected anal intercourse><unprotected anal sex><unsafe anal intercourse><unsafe anal sex><worse health outcome>