Physicians and Health Related Services for Male to Female Transgender Persons

为男性跨性别者提供的医生和健康相关服务

基本信息

批准号：
8827855
负责人：
MARK B PADILLA
金额：
$ 19.3万
依托单位：
UNIVERSITY OF PUERTO RICO MED SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-04-01 至 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8827855
关键词：
AIDS prevention AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Affect Alcohol or Other Drugs use Area Attitude Behavior Caring Case Study Centers for Disease Control and Prevention (U.S.)Clinic Clinical Communities Data Documentation Epidemic Female Focus Groups Fostering Future Gender Growth HIV HIV Infections Health Health Services Heterosexuals Human Resources Improve Access Intervention Interview Island Knowledge Latino Light Literature Masks Measures Medical Methods Persons Physicians Population Population Research Prevention approach Probability Puerto Rican Puerto Rico Quality of Care Questionnaires Recruitment Activity Reporting Research Research Personnel Resources Risk Behaviors Sampling Services Stigmatization Surveys Technology Testing Tetanus Helper Peptide Training Vulnerable Populations West Indies Work cultural values design experience health care quality high risk sexual behavior improved interest intravenous drug user male medical schools men men who have sex with men neglect prevention service service intervention sex social exclusion social stigma transgender willingness

项目摘要

DESCRIPTION (provided by applicant): HIV/AIDS continues to affect the Latino community disproportionately, with more than 200,000 cases in the US attributed to this population. Puerto Ricans are US citizens residing in the Caribbean Island and are a significant part of the growing epidemic among Latinos. Due in part to social stigma, Male-to-Female Transgenders (MTF-TG) constitutes an invisible and underserved group in general, and particularly among Latino communities. Nationally, the proportion of MTF-TG infected with HIV is increasing, as evidenced by the growth from 3% to 8% in new reported cases per year. Extensive research demonstrates that MTF-TG are highly stigmatized and often overlooked in research, interventions, and services. Stigmatization of MTF-TG may have serious health implications given the fact that studies in other contexts have demonstrated that a significant proportion of MTF-TG are infected with HIV, use substances, engage in high risk sexual behaviors, and are not reached by existing health services. The emerging literature on TG health has emphasized the need to focus research and interventions on physicians, many of which have received little training on these issues and may therefore lack the knowledge, experience, and sensitivity to provide quality health care. In addition, the literature emphasizes that a lack of access to quality health care resources can have compounded negative effects on MTF-TG by: decreasing their probability of accessing such services; reducing their access to knowledge about health and HIV prevention; and increasing their perceived stigmatization and marginalization through the medical encounter. These factors highlight the need to focus research on transgender health issues, emphasizing research contributing to interventions to improve access to quality health care for MTF-TG. In order to address this gap we propose a study with the following aims: 1. Explore qualitatively four areas of physician treatment of MTF-TG among a sample of professional physicians in Puerto Rico: (1) physician knowledge of MTF-TG health; (2) competency in treating MTF-TG; (3) willingness to provide services to MTF-TG; (4) and attitudes toward MTF-TG. 2. Document quantitatively the relationship between the stigmatization of MTF-TG (i.e., negative attitudes or behaviors toward MTF-TG) and areas 1-4 identified in Aim 1 (i.e., knowledge, competency, willingness, and attitudes). 3. Identify key intervention targets and strategies to be prioritized for an effective stigma-reduction interventio aiming to improve: (1) physician knowledge of transgender health issues; (2) physician competency to implement transgender-appropriate care; (3) physician willingness to provide quality services; and (4) physician attitudes towards MTF-TG among physicians in Puerto Rico. In order to achieve these objectives, we will implement a mixed method design using qualitative in- depth interviews, focus groups and quantitative questionnaires administered via iPad technology. For aim 1, we will carry out (N = 30) in-depth interviews with physicians who work in HIV-related clinical settings in Puerto Rico. The qualitative information will be used to develop a meaningful understanding of the factors of interest (i.e. knowledge, competency, willingness to treat, and attitudes). For aim 2, we will draw on qualitative data to culturally adapt and pilot tet quantitative measures to assess our variables of interest. We will then administer our survey to a purposive sample of 300 physicians in Puerto Rico, including those who work in HIV-related service delivery and those who do not. Aim 3 will draw on data from focus groups with 30 key personnel from medical schools and medical organizations, as well as 15 MTF-TG recruited by our team's transgender Community Advisory Board, to identify key intervention targets and strategies for reducing stigma and improving access and quality of care. The gathered data will contribute to developing and testing a future intervention that can foster access to quality HIV prevention and health services for MTF-TG in Puerto Rico.

描述（由申请人提供）：艾滋病毒/艾滋病继续对拉丁裔社区产生不成比例的影响，美国有超过 200,000 例病例归因于这一人群。波多黎各人是居住在加勒比岛屿的美国公民，是拉丁美洲人中日益流行的流行病的重要组成部分。部分由于社会耻辱，男变女跨性别者（MTF-TG）总体上构成了一个看不见且得不到充分服务的群体，特别是在拉丁裔社区中。在全国范围内，MTF-TG 感染 HIV 的比例正在增加，每年新报告病例从 3% 增长到 8% 就证明了这一点。大量研究表明，MTF-TG 受到高度侮辱，并且在研究、干预和服务中经常被忽视。 MTF-TG 的污名化可能会产生严重的健康影响，因为其他背景下的研究表明，相当大比例的 MTF-TG 感染了 HIV、使用药物、从事高风险性行为，并且现有健康状况无法达到这一要求服务。关于 TG 健康的新兴文献强调需要将研究和干预措施的重点放在医生身上，其中许多医生在这些问题上接受过很少的培训，因此可能缺乏提供优质医疗保健的知识、经验和敏感性。此外，文献强调，缺乏获得优质健康的机会护理资源可能通过以下方式对 MTF-TG 产生复合负面影响：降低他们获得此类服务的可能性；减少他们获得健康和艾滋病毒预防知识的机会；并通过医疗遭遇增加他们所感受到的耻辱和边缘化。这些因素凸显了将研究重点放在跨性别健康问题上的必要性，强调研究有助于采取干预措施，以改善 MTF-TG 获得优质医疗保健的机会。为了弥补这一差距，我们提出一项具有以下目标的研究： 1. 在波多黎各专业医生样本中定性探索 MTF-TG 医生治疗的四个领域：（1）医生对 MTF-TG 健康的了解； (2) 治疗MTF-TG的能力；（三）愿意向MTF-TG提供服务； (4)以及对MTF-TG的态度。 2. 定量记录 MTF-TG 的污名化（即对 MTF-TG 的消极态度或行为）与目标 1 中确定的领域 1-4（即知识、能力、意愿和态度）之间的关系。 3. 确定有效减少耻辱干预的关键干预目标和策略，旨在提高： (1) 医生对跨性别健康问题的了解； (2) 医生实施适合变性人的护理的能力； (3)医师愿意提供优质服务； (4) 波多黎各医生对 MTF-TG 的态度。为了实现这些目标，我们将采用定性深度访谈、焦点小组和通过 iPad 技术进行的定量问卷来实施混合方法设计。对于目标 1，我们将对波多黎各从事 HIV 相关临床工作的医生进行 (N = 30) 深度访谈。定性信息将用于开发对感兴趣的因素（即知识、能力、治疗意愿和态度）的有意义的理解。对于目标 2，我们将利用定性数据进行文化适应和试点定量测量来评估我们感兴趣的变量。然后，我们将有目的地对波多黎各 300 名医生进行调查，其中包括从事艾滋病毒相关服务工作的人员和不从事此类工作的人员。目标 3 将利用由来自医学院和医疗组织的 30 名关键人员以及我们团队的跨性别社区咨询委员会招募的 15 名 MTF-TG 组成的焦点小组的数据，以确定关键干预目标和策略，以减少耻辱并改善获得和接受治疗的机会。护理质量。收集到的数据将有助于开发和测试未来的干预措施，从而促进波多黎各 MTF-TG 获得优质的艾滋病毒预防和卫生服务。