A Longitudinal Mixed-Methods Investigation of Masculinity, Stigma, and Disclosure on Men's ART Initiation in South Africa

对南非男性接受 ART 的男子气概、耻辱和披露的纵向混合方法调查

基本信息

批准号：
10350678
负责人：
Jessica F Magidson
金额：
$ 16.57万
依托单位：
UNIV OF MARYLAND, COLLEGE PARK
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-02-15 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10350678
关键词：
Acquired Immunodeficiency Syndrome Address Adverse effects Affect Behavior Behavioral Sciences Belief Caring Clinic Conflict (Psychology)Continuity of Patient Care Country Data Depressed mood Dimensions Disclosure Economics Emotional Emotions Epidemic Female Feminine Goals HIV HIV Infections Health Healthcare High Risk Woman Home Human immunodeficiency virus test Individual Infection Intervention Interview Investigation Life Link Measures Mediating Mediation Methods Modeling NIH Office of AIDS Research Newly Diagnosed Outcome Persons Pharmaceutical Preparations Play Process Provider Research Research Infrastructure Research Priority Risk Risk-Taking Role Savings Sexual Transmission Social support South Africa Telephone Testing Viral Load result Woman Work aged antiretroviral therapy base care outcomes design experience high risk improved internalized stigma man men mortality partner violence recruit response self reliance social stigma substance misuse substance use success theories therapy adherence therapy development trait transmission process treatment as prevention young woman

项目摘要

Project Summary South Africa is home to over 7.9 million people living with HIV, the largest of any country globally. One significant barrier to ending the HIV epidemic is engaging and retaining men in care throughout the HIV care continuum. At each step, men are less likely than women to be engaged in care. Hegemonic masculinity, or idealized forms of what it means to ‘be a man,’ is documented as a major reason why men do not seek and stay engaged in care. Hegemonic masculinity in South Africa involves risk-taking, self-reliance, being sexually desirable, physical strength and health, having emotional control, and being an economic provider. Although these traits may be protective for men under certain circumstances, they are also inconsistent with seeking HIV care, which requires vulnerability, experiencing emotions traditionally viewed as more feminine (e.g., sadness), and invoking a relational dimension (as opposed to self-reliance). Further, the extent to which men internalize hegemonic masculinity, called hegemonic masculinity beliefs (HMBs), makes disclosure of their HIV status challenging for the same reasons; yet, disclosure is often the avenue through which men gain the necessary social support needed to seek and be retained in HIV treatment. In this mixed-methods study, we use Connell’s definition of hegemonic masculinity and the Disclosure Process Model to examine modifiable mechanisms that link HMBs to antiretroviral therapy (ART) initiation in newly-diagnosed men living with HIV (MLWH) in Cape Town, South Africa. We propose to do the following: (1) Examine whether disclosure mediates the association between HMBs and ART initiation, such that stronger HMBs will be associated with a decreased likelihood of HIV disclosure, which in turn will be associated with a decreased likelihood of ART initiation. We will also examine whether internalized stigma moderates the association between HMBs and disclosure, such that the negative association between HMBs and disclosure will be stronger in the context of high internalized stigma. We will recruit newly-diagnosed MLWH (N = 220) and assess HMBs within two weeks of testing positive and then again 3 and 6 months later. Data on ART initiation will be assessed at the 6-month assessment via chart review. (2) Examine whether, and how, the process of disclosure shifts men’s views of their own masculinity. We predict that men who disclose their HIV status during the study will experience a decrease in HMBs at the 6-month assessment, because theoretically disclosure as a behavior is inconsistent with HMBs. A subset of men who disclose their HIV status (n = 10) and those who do not disclose (n = 10) will be randomly selected to participate in a qualitative individual interview to further explain if, and how, disclosure led to a shift in HMBs. This proposed study is in line with the NIH Office of AIDS Research’s cross-cutting research priority on behavioral sciences focused on individual and interpersonal dynamics that influence HIV care. Results will be used for subsequent intervention development.

项目摘要南非拥有超过790万艾滋病毒的人，这是全球任何国家中最大的艾滋病毒。一结束艾滋病毒流行的重大障碍正在吸引并在整个艾滋病毒护理中保留男性连续。在每个步骤中，男人比女人不太可能受到护理。霸权男性气质或 “成为男人”的理想化形式被记录为男人不寻求和的主要原因保持护理。南非的霸权男性气质涉及冒险，自力更生，性行为理想的，身体的力量和健康，具有情感控制并成为经济提供者。虽然在某些情况下，这些特征可能会受到男性的保护，它们也与寻求艾滋病毒不一致需要脆弱性的护理，传统上经历情绪更加女性化（例如悲伤），并调用关系维度（与自力更生相反）。此外，男人内在化的程度霸权男性气质，称为霸权男性化信仰（HMB），披露其艾滋病毒状况出于相同的原因而挑战；但是，披露通常是男人获得必要的途径需要寻求并保留在艾滋病毒治疗中的社会支持。在这项混合方法研究中，我们使用康奈尔对霸权男性气质的定义和披露过程模型，以检查可修改将HMB与艾滋病毒新诊断的男性的抗逆转录病毒疗法（ART）倡议联系起来的机制（MLWH）在南非开普敦。我们建议进行以下操作：（1）检查是否披露是否披露介导HMB与Art Initiative之间的关联，使得更强的HMB将与降低艾滋病毒披露的可能性，这又与艺术的可能性下降有关引发。我们还将检查内部化的污名是否会调节HMB和HMBS之间的关联披露，因此，在HMB和披露之间的负面关联将在高内在的污名。我们将招募新诊断的MLWH（n = 220），并在两周内评估HMB 测试阳性，然后在3个月后再次进行测试。关于艺术计划的数据将在6个月的时间内评估通过图表审查进行评估。（2）检查披露过程是否以及如何转移男人的观点他们自己的男性气质。我们预测，在研究期间披露艾滋病毒状况的男人将经历在6个月的评估中减少HMB，因为从神圣的行为上披露是不一致的与HMB。披露其艾滋病毒状况（n = 10）的男性和未披露的人（n = 10）将会随机选择参加定性的个人面试，以进一步解释是否以及如何披露导致HMB的转变。这项拟议的研究与NIH艾滋病研究办公室一致对行为科学的研究优先级，专注于影响艾滋病毒的个人和人际动态关心。结果将用于随后的干预开发。