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：
10151796
负责人：
Jessica F Magidson
金额：
$ 20.56万
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 2023-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10151796
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 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.

项目概要南非有超过 790 万艾滋病毒感染者，是全球最多的国家之一。结束艾滋病毒流行的一个重要障碍是在整个艾滋病毒护理过程中让男性参与并留住护理人员在每个步骤中，男性比女性更不可能参与到霸权男性气质中。 “成为一个男人”的理想化形式被记录为男人不寻求和南非的霸权男性气质涉及冒险、自力更生、性行为。理想的、体力和健康、有情绪控制能力、并且是一个经济提供者。这些特征在某些情况下可能对男性有保护作用，但它们也与寻求艾滋病毒不一致照顾，这需要脆弱性，体验传统上被视为更女性化的情绪（例如悲伤），并援引关系维度（而不是自力更生）此外，人们内化的程度。霸权男子气概，称为霸权男子气概信念（HMB），揭示了他们的艾滋病毒状况出于同样的原因，具有挑战性；然而，披露往往是人们获得必要的途径。在这项混合方法研究中，我们使用了寻求和保留艾滋病毒治疗所需的社会支持。康奈尔对霸权男性气质的定义和检查可修改性的披露过程模型将 HMB 与新诊断的艾滋病毒感染者开始抗逆转录病毒治疗 (ART) 联系起来的机制 (MLWH) 南非开普敦我们建议采取以下措施： (1) 检查是否披露。介导 HMB 和 ART 启动之间的关联，因此更强的 HMB 将与 HIV 披露的可能性降低，这反过来又与 ART 的可能性降低相关我们还将研究内在的耻辱是否会调节 HMB 和 HMB 之间的关联。披露，使得 HMB 与披露之间的负相关性在以下情况下会更强：我们将招募新诊断的 MLWH (N = 220) 并在两周内评估 HMB。测试呈阳性，然后在 3 个月和 6 个月后再次评估 ART 启动的数据将在 6 个月时进行评估。 (2) 检查披露过程是否以及如何改变人们的观点。我们预测，在研究期间公开自己的艾滋病毒感染状况的男性将会经历一种男性气质。 6 个月评估时 HMB 减少，因为理论上披露作为一种行为是不一致的一部分公开其 HIV 状况的男性 (n = 10) 和未公开的男性 (n = 10) 会进行 HMB 检测。被选择参加定性个人随机访谈，以进一步解释是否以及如何披露导致了 HMB 的转变。这项拟议的研究符合 NIH 艾滋病研究办公室的跨领域研究。行为科学的研究优先重点是影响艾滋病毒的个人和人际动态结果将用于后续干预措施的制定。