Stigma, Cohesion and HIV Outcomes Among Vulnerable Women Across Epidemic Settings

流行病环境下弱势妇女的耻辱、凝聚力和艾滋病毒结果

• 批准号: 10206641
• 负责人: DEANNA L KERRIGAN
• 金额: $ 51.36万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10206641
• 关键词: Address; Africa South of the Sahara; Attention; Behavior; Biological; Biological Markers; Blood; Caring; Communities; Community Workers; Complex; Country; Data; Data Analyses; Development; Dominican Republic; Drops; Effectiveness; Elements; Epidemic; Equation; Funding; Gender; General Population; Geography; HIV; Health; Health Services Accessibility; Incidence; Interruption; Interview; Longitudinal Studies; Measurement; Measures; Mediating; Meta-Analysis; Methodology; Modeling; National Institute of Mental Health; Occupations; Outcome; Participant; Pathway interactions; Prevention; Preventive Intervention; Principal Investigator; Qualitative Methods; Research; Research Infrastructure; Risk; Role; Services; Social Environment; Socioeconomic Status; Structure; Subgroup; Tanzania; Time; Treatment outcome; USAID; Variant; Viral; Woman; Work; antiretroviral therapy; base; care systems; cognitive interview; cohesion; cohort; condoms; consistent condom use; empowerment; experience; female sex worker; improved; individualized medicine; mathematical model; novel; primary outcome; programs; protective behavior; public health relevance; response; sex; social; social cohesion; social determinants; social stigma; social structure; solidarity; structured data; systematic review; theories; therapy adherence; transmission process; treatment services

 DESCRIPTION (provided by applicant): Stigma, cohesion and HIV outcomes among vulnerable women across epidemic settings Female sex workers (FSW) are at significantly heightened risk for HIV. Globally, FSW have a 13.5 times greater odds of being HIV-infected compared to women who are not sex workers. Despite this burden, less than half of FSW have access to antiretroviral therapy (ART). HIV stigma is a critical social determinant known to negatively influence HIV outcomes including access to treatment and ART adherence. For FSW living with HIV, the impact of HIV stigma may be further compounded by other forms of stigma related to their occupation, gender, and/or socioeconomic position. In response to such stigmas, FSW in many settings have come together in solidarity to address the socio-structural context of their HIV-related risk. Social cohesion within the sex worker community has been a central element of community-based responses to HIV and is significantly associated with protective behaviors. However, the role of social cohesion, and its potential mediating influence on HIV and sex work stigma, has yet to be explored in relation to HIV treatment outcomes. While significant attention has been paid to the measurement of HIV stigma in past studies, much less emphasis has been placed on other intersecting social stigmas, including the measurement of sex work stigma. Utilizing the existing research infrastructure of two ongoing cohorts located within distinct social and epidemic settings, we propose to longitudinally examine the role of HIV and sex work stigma and social cohesion as key social determinants of HIV outcomes among FSW living with HIV in Tanzania and the DR. Our specific aims are to: (1) Develop a valid and reliable aggregate measure of sex work-related stigma tailored to the realities of FSW living with HIV in distinct social and epidemic contexts; (2) Determine the roles of HIV and sex work stigma and social cohesion as predictors of biologic HIV outcomes (e.g. ART in the blood, viral suppression) across settings; and (3) Qualitatively explore the dynamic context of HIV and sex work- related stigma and social cohesion among FSW in relation to HIV services and outcomes. For Aim 1 we will use qualitative methods to inform measurement development including both in-depth and cognitive interviews (n=40). We will then employ IRT and factor and reliability analysis to establish shared and distinct items related to the domain of sex work stigma per context. In Aim 2, we will conduct longitudinal structural equation modeling to examine predictors and pathways between HIV and sex work stigma, social cohesion and viral suppression in the context of other known correlates of viral suppression among cohorts of FSW living with HIV in Tanzania and the DR (n=400). In Aim 3 will explore the dynamic social context of HIV and sex work stigma and social cohesion through longitudinal qualitative in-depth interviews among a subset of cohort participants in each country (n=40). Findings will inform tailored treatment as prevention interventions among FSW across geographic and epidemic settings.

 描述（由适用提供）：在流行病的女性性工作者（FSW）中，弱势妇女的污名，凝聚力和HIV结局（FSW）显着增加了艾滋病毒的风险。在全球范围内，与不是性工作者的女性相比，FSW感染HIV的几率高13.5倍。尽管有这种伯恩（Burnen），但不到一半的FSW可以使用抗逆转录病毒疗法（ART）。艾滋病毒污名是一种关键的社会决定因素，已知会对艾滋病毒的结果产生负面影响，包括获得治疗和艺术依从性。对于患有艾滋病毒的FSW，艾滋病毒污名的影响可能会被与其发生，性别和/或社会经济地位相关的其他形式的污名化进一步加剧。为了应对这种污名，在许多情况下，FSW团结一致地融合在一起，以应对与HIV相关风险的社会结构背景。性工作者社区内的社会凝聚力一直是基于社区的艾滋病毒反应的核心因素，并且与受保护的行为显着相关。但是，社会凝聚力的作用及其对艾滋病毒和性工作污名的潜在中介作用尚未与HIV治疗结果有关。尽管在过去的研究中对艾滋病毒污名的衡量已经引起了极大的关注，但对其他相交的社会污名，包括对性工作的污名的衡量，更少的重点。利用位于不同社会和流行病环境中的两个正在进行的人群的现有研究基础设施，我们建议纵向研究HIV和性工作污名和社会凝聚力的作用，作为HIV艾滋病毒成果的关键社会决定者，在坦桑尼亚与HIV生活的FSW生活中，这是HIV的关键社会决定者。我们的具体目的是：（1）制定一种有效且可靠的总体度量，该衡量与性工作相关的污名是针对在不同的社会和流行病背景下针对HIV生活的现实量身定制的； （2）确定艾滋病毒和性工作污名和社会凝聚力的作用，作为生物艾滋病毒结果的预测因素（例如，血液中的艺术，病毒抑制）； （3）定性地探讨与艾滋病毒服务和结果有关的FSW与FSW中与性工作有关的污名和社会凝聚力的动态背景。对于目标1，我们将使用定性方法为测量开发提供信息，包括深入和认知访谈（n = 40）。然后，我们将员工的雇员以及因素和可靠性分析建立与性工作污名领域相关的共享和不同的项目。在AIM 2中，我们将进行纵向结构方程模型，以检查HIV和性工作污名之间的预测因子和途径，社会凝聚力和病毒抑制，在其他已知的已知病毒抑制相关性的背景下，坦桑尼亚与HIV的FSW同类群体之间的病毒抑制相关性和DR（n = 400）。在AIM 3中，将通过纵向定性的深入访谈探索艾滋病毒和性工作的污名和社会凝聚力的动态社会背景。调查结果将为量身定制的治疗提供信息，作为在地理和流行病环境中FSW中的预防干预措施。