HIV/AIDS Stigma Behaviors in Clinical Encounters

临床遇到的艾滋病毒/艾滋病耻辱行为

基本信息

批准号：
8820903
负责人：
NELSON VARAS-DIAZ
金额：
$ 11.55万
依托单位：
UNIVERSITY OF PUERTO RICO RIO PIEDRAS
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 2019-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8820903
关键词：
AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Anti-Retroviral Agents Antiretroviral resistance Attitude Behavior Behavioral California Caribbean region Case Study Centers for Disease Control and Prevention (U.S.)Client Clinical Code Collaborations Common Cold Communication Communities Data Analyses Development Distant Documentation Drug usage Drug user Epidemic Experimental Designs Face Faculty Florida Fostering Funding Future Gender Role Goals Guidelines HIV HIV Infections Health Health Personnel Health Professional Health Services Healthcare Heterosexuals Hispanics Homophobia Homosexuals Independent Scientist Award Individual Infection International Intervention Island Latino Link Literature Measurement Measures Medical Medical Students Methodology Methods National Institute of Drug Abuse Needle Sharing Observational Study Outcome Participant Patient Education Patient Simulation Patients Perception Performance Physicians Population Population Intervention Positioning Attribute Prevalence Provider Puerto Rican Puerto Rico Questionnaires Randomized Recruitment Activity Reporting Research Research Design Role Sampling San Francisco Science Series Services Stigmatization Structure Techniques Technology Testing United States United States National Institutes of Health Universities Variant Video Recording Visual Fields West Indies base career career development experience improved intravenous drug use member programs research study simulation skills social stigma transmission process

项目摘要

DESCRIPTION (provided by applicant): The proposed K02 Independent Scientist Award application to the National Institute on Drug Abuse (NIDA) is an extension of my ongoing commitment to research aiming to address HIV/AIDS stigma among Latino populations, specifically Puerto Ricans. Puerto Rico is a Caribbean Island linked to the United States, where HIV infection prevalence has been estimated at 1% (more than 35,000 reported cases). The Island's epidemic is mainly driven by unclean needle sharing for injected drug use (IDU) and is embedded in the Caribbean region which has the second highest rates of HIV/AIDS in the world. Therefore, the need for stigma- free health services is ever-growing. My research career has been characterized by an ongoing commitment to addressing the role of stigmatization on access to quality health services for people with HIV/AIDS (PWHA) in this setting. In my previous NIH funded studies I have focused on the identification and reduction of HIV/AIDS stigma attitudes among health professionals. The proposed K02 will allow me to extend this research agenda to address the behavioral components of HIV/AIDS stigma as manifested in clinical interactions. My long-term career goals include: 1) advancing the understanding of the interrelation between HIV/AIDS stigma attitudes and behaviors (i.e. verbal and non-verbal) manifested by health professionals in Puerto Rico, 2) documenting the underlying predictors and cultural correlates of HIV/AIDS stigma attitudes and behaviors in the Puerto Rican setting, and 3) developing scientifically tested stigma measurement guidelines and interventions to reduce both HIV/AIDS stigma attitudes and behaviors among this population. As part of the proposed K02 application I propose several career development strategies to foster my long-term career goals. These include: 1) the acquisition of new skills related to the use of Standardized Patient Simulation Technology for use in research via extended contact with the University of Puerto Rico's Standardized Patient Program, and 2) collaborations with experts in the field of visual methodologies and observational data analysis at the University of Rochester, Florida International University and the University of California at San Francisco. With the skills acquired through these interactions, I will be better positioned to implement the proposed research plan in which I propose to study the dynamics of physician/patient interaction that may contribute to stigmatization of PWHA, through an observational study of simulated interactions using a standardized patient (SP) program in Puerto Rico. The proposed study has the following aims: Aim 1 - To document HIV/AIDS stigma attitudes and their role on behavioral manifestations of stigma during physician/patient interactions in a sample of medical residents in Puerto Rico; Aim 2 - To document variations of HIV/AIDS stigma behaviors during physician/patient interactions when providing services to clients with different modes of HIV transmission; and Aim 3 - To determine the role of cultural factors (i.e., traditional gender roles religiosity, homophobia, and stigmatization of drug users) on attitudinal and behavioral manifestations of HIV/AIDS stigma among medical residents in Puerto Rico. To achieve these aims I propose an experimental design using mixed method techniques (structured observations, quantitative questionnaires, and SP simulations). The study will be conducted through the SP program at the University of Puerto Rico's Medical Sciences Campus. I will recruit a sample of 154 medical residents in Puerto Rico to participate in an experiment embedded within their ongoing SP training, and assign them to engage in all of the following patient conditions, with randomized order of presentation: 1) HIV-infected through intravenous drug use, 2) HIV-infected through unprotected heterosexual relations, 3) HIV-infected through unprotected homosexual relations, 4) HIV-infected through unprotected heterosexual relations or intravenous drug use, 5) HIV-infected through unprotected homosexual relations or intravenous drug use, 6) HIV-infected through unprotected homosexual or heterosexual relations, and 7) the common cold as a stigma- free comparison control. Interactions will be video-recorded and subsequently coded for behavioral expressions of stigma using a preliminary developed and pilot-tested measure from my NIH funded studies. After participation in the simulation, all participants will complete quantitative questionnaires addressing HIV/AIDS stigma attitudes and adherence to cultural factors of importance in the Puerto Rican setting. The study will be the first to document behavioral manifestations of HIV/AIDS stigma among medical residents in Puerto Rico, thereby extending the scientific literature that has focused almost exclusively on their stigmatizing attitudes. Furthermore, it will be the first study to address the role of cultural factors on the manifestations of HIV/AIDS stigma among this population in Puerto Rico and variations related to means of infection. The findings from the study have the potential to inform the development of guidelines for stigma measurement and stigma reduction interventions for this population, taking into consideration both attitudinal and behavioral manifestations of stigma, and the role of local culture on these indicators.

描述（由申请人提供）：向国家药物滥用研究所 (NIDA) 提出的 K02 独立科学家奖申请是我持续致力于研究的延伸，旨在解决拉丁裔人群（特别是波多黎各人）中的艾滋病毒/艾滋病耻辱问题。波多黎各是一个与美国相连的加勒比岛屿，那里的艾滋病毒感染率估计为 1%（报告病例超过 35,000 例）。岛上的流行病主要是由注射吸毒（IDU）时不洁的共用针头造成的，并且根源于加勒比地区，该地区的艾滋病毒/艾滋病发病率位居世界第二。因此，对无耻辱的医疗服务的需求不断增长。我的研究生涯的特点是持续致力于解决污名化对艾滋病毒/艾滋病患者 (PWHA) 在此环境中获得优质卫生服务的影响。在我之前由美国国立卫生研究院资助的研究中，我重点关注卫生专业人员中对艾滋病毒/艾滋病的污名态度的识别和减少。拟议的 K02 将使我能够扩展这一研究议程，以解决临床相互作用中表现出的艾滋病毒/艾滋病耻辱的行为组成部分。我的长期职业目标包括：1) 增进对波多黎各卫生专业人员表现出的艾滋病毒/艾滋病耻辱态度和行为（即言语和非言语）之间相互关系的理解，2) 记录艾滋病毒/艾滋病耻辱的潜在预测因素和文化相关性。波多黎各环境中的艾滋病毒/艾滋病耻辱态度和行为，以及 3) 制定经过科学检验的耻辱测量指南和干预措施，以减少艾滋病毒/艾滋病耻辱态度以及该人群中的行为。作为拟议的 K02 申请的一部分，我提出了几项职业发展策略，以促进我的长期职业目标。其中包括：1) 通过与波多黎各大学标准化患者项目的广泛接触，获得与使用标准化患者模拟技术进行研究相关的新技能，以及 2) 与视觉方法和观察领域的专家合作罗切斯特大学、佛罗里达国际大学和加州大学旧金山分校的数据分析。凭借技能通过这些互动获得的知识，我将能够更好地实施拟议的研究计划，在该计划中，我建议通过使用标准化患者（SP）进行模拟互动的观察性研究，研究可能导致 PWHA 污名化的医生/患者互动的动态。）在波多黎各的计划。拟议的研究有以下目标：目标 1 - 记录波多黎各住院医师样本中的艾滋病毒/艾滋病耻辱态度及其在医患互动期间对耻辱行为表现的作用；目标 2 - 记录在向不同艾滋病毒传播方式的客户提供服务时，医生/患者互动期间艾滋病毒/艾滋病耻辱行为的变化；目标 3 - 确定文化因素（即传统性别角色、宗教信仰、恐同和对吸毒者的耻辱）对波多黎各住院医生艾滋病毒/艾滋病耻辱的态度和行为表现的影响。为了实现这些目标，我提出了一种使用混合方法技术（结构化观察、定量问卷和 SP 模拟）的实验设计。该研究将通过波多黎各大学医学科学校区的 SP 项目进行。我将在波多黎各招募 154 名住院医师作为样本，参加一项嵌入他们正在进行的 SP 培训中的实验，并分配他们参与以下所有患者状况，并按随机的呈现顺序进行：1) 通过静脉注射感染 HIV吸毒，2) 通过无保护的异性关系感染 HIV，3) 通过无保护的同性恋关系感染 HIV，4) 通过无保护的异性关系或静脉吸毒感染 HIV，5)通过无保护的同性恋关系或静脉吸毒感染 HIV，6) 通过无保护的同性恋或异性关系感染 HIV，以及 7) 作为无耻辱比较对照的普通感冒。互动将被视频记录，随后使用我在美国国立卫生研究院资助的研究中初步开发和试点测试的措施，对耻辱的行为表达进行编码。参与模拟后，所有参与者将完成定量调查问卷，以解决波多黎各环境中对艾滋病毒/艾滋病的耻辱态度和对重要文化因素的坚持。该研究将首次记录波多黎各住院医师中艾滋病毒/艾滋病耻辱的行为表现，从而扩展了几乎完全关注他们的耻辱态度的科学文献。此外，这将是第一项探讨文化因素对波多黎各人群艾滋病毒/艾滋病耻辱表现的作用以及与感染方式相关的变化的研究。该研究的结果有可能为制定针对该人群的耻辱测量和减少耻辱干预措施的指南提供信息，同时考虑到耻辱的态度和行为表现，以及当地文化对这些指标的作用。