DISCRIMINATION, HEALTH CARE ATTITUDES AND HIV TREATMENT

歧视、医疗保健态度和艾滋病毒治疗

• 批准号: 7119800
• 负责人: Laura M Bogart
• 金额: $ 40.65万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-05-01 至 2010-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7119800
• 关键词: AIDS therapy; African American; HIV infections; antiviral agents; attitude; behavioral /social science research tag; belief; clinical research; conflict; environmental stressor; health behavior; health care service evaluation; health care service utilization; health disparity; health services research tag; high risk behavior /lifestyle; homosexuals; human subject; longitudinal human study; male; outcomes research; patient care personnel relations; patient oriented research; prejudice; psychological stressor; racial /ethnic difference; therapy compliance

DESCRIPTION (provided by applicant): As outlined in the goals of Healthy People 2010, eliminating racial/ethnic health disparities, especially with regard to HIV/AIDS, is a major priority in the U.S. Across all racial/ethnic groups and both genders, the highest rates of HIV and AIDS are among African American men, and the predominant mode of transmission among African American men is sex with men. African American men who have sex with men (MSM) are more than two times as likely to be infected with HIV than are MSM of other races/ethnicities. This application proposes a longitudinal study to investigate perceived stress and negative health care attitudes as possible barriers to antiretroviral treatment adherence among 200 HIV-infected African American MSM. Although effective HIV treatments are now available, patients must closely adhere for maximum reductions in HIV viral load and increased survival time. Some research indicates that African Americans are less likely to receive and adhere to antiretroviral medications than are Whites, and these differences in treatment patterns could contribute to observed lower survival times among African American, versus White, people with HIV/AIDS. Although discrimination is thought to contribute to racial/ethnic disparities in treatment behavior, research has not examined the manifold effects of discrimination on adherence among African American MSM, a subgroup at the nexus of the HIV/AIDS epidemic. In this application, discrimination is proposed to influence the health of African American MSM with HIV via multiple pathways, by increasing their chronic, environmental, general, and traumatic stress burden. These discrimination-related stressors are hypothesized to influence treatment behavior directly, via decreased ability to adhere to antiretroviral treatment regimens, as well as indirectly, through the formation of negative attitudes about the health care system (e.g., conspiracy beliefs about HIV). Findings will provide information concerning specific cultural barriers to quality health care among African American MSM with HIV and will be used to make policy recommendations for targeted culturally-relevant outreach measures that address identified barriers at multiple levels, including patients, communities, and health care organizations. In so doing, the conclusions of the proposed research will inform public policy regarding racial/ethnic disparities in health by suggesting factors that may place African American MSM at risk for treatment nonadherence and decreased survival.

说明（由申请人提供）：正如《2010 年健康人民》的目标所述，消除种族/民族健康差异，特别是艾滋病毒/艾滋病方面的差异，是美国的一个主要优先事项。对于所有种族/民族群体和性别来说，非洲裔美国男性的艾滋病毒和艾滋病发病率最高，而非洲裔美国男性的主要传播方式是与男性发生性行为。与男性发生性行为的非裔美国男性 (MSM) 感染艾滋病毒的可能性是其他种族/民族的 MSM 的两倍多。本申请提出了一项纵向研究，旨在调查 200 名感染 HIV 的非裔美国 MSM 中感知到的压力和消极的医疗保健态度是否可能阻碍抗逆转录病毒治疗的依从性。尽管现在已经有了有效的艾滋病毒治疗方法，但患者必须严格遵守，才能最大程度地减少艾滋病毒病毒载量并延长生存时间。一些研究表明，与白人相比，非洲裔美国人接受和坚持使用抗逆转录病毒药物的可能性较小，而治疗模式的这些差异可能导致非洲裔美国人与白人艾滋病毒/艾滋病患者的生存时间较短。尽管歧视被认为是导致治疗行为中种族/族裔差异的原因之一，但研究尚未检验歧视对非洲裔美国人男男性接触者（艾滋病毒/艾滋病流行的一个亚群体）依从性的多重影响。在本申请中，歧视被提议通过多种途径影响感染艾滋病毒的非裔美国男男性接触者的健康，增加他们的慢性、环境、一般和创伤性压力负担。据推测，这些与歧视相关的压力源会通过降低遵守抗逆转录病毒治疗方案的能力而直接影响治疗行为，也会通过形成对医疗保健系统的负面态度（例如，对艾滋病毒的阴谋论）来间接影响治疗行为。调查结果将提供有关感染艾滋病毒的非裔美国 MSM 的优质医疗保健的具体文化障碍的信息，并将用于为有针对性的文化相关外展措施提出政策建议，以解决多个层面（包括患者、社区和医疗保健组织）已确定的障碍。在此过程中，拟议研究的结论将通过提出可能使非裔美国男男性接触者面临治疗不依从和生存率下降风险的因素，为有关种族/民族健康差异的公共政策提供信息。