HIV/AIDS Stigma Behaviors in Clinical Encounters

临床遇到的艾滋病毒/艾滋病耻辱行为

• 批准号: 9036973
• 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
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9036973
• 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

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）：拟议的K02独立科学家奖申请申请国立药物滥用研究所（NIDA）是我对旨在应对拉丁裔人群中艾滋病毒/艾滋病污名的持续承诺的扩展，尤其是波多黎各人。波多黎各是一个与美国有关的加勒比岛，据估计，艾滋病毒感染的患病率为1％（报告的病例超过35,000例）。该岛的流行病主要由注射毒品使用（IDU）的不洁针共享驱动，并嵌入到加勒比地区，该地区的艾滋病毒/艾滋病率是世界上第二高的。因此，对污名的需求 - 不断增长。我的研究生涯的特征是在这种情况下，持续致力于解决污名化对艾滋病毒/艾滋病（PWHA）获得优质卫生服务的作用。在我以前的NIH资助研究中，我专注于卫生专业人员中艾滋病毒/艾滋病污名的识别和降低。提出的K02将使我能够扩展该研究议程，以解决临床相互作用所表现出的HIV/AIDS污名的行为成分。 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测量指南和干预措施，以减少该人群中艾滋病毒/艾滋病的污名态度和行为。 作为拟议的K02应用程序的一部分，我提出了几种职业发展策略，以促进我的长期职业目标。其中包括：1）通过与波多黎各标准化的患者计划的扩展接触与使用标准化的患者模拟技术有关用于研究的新技能，以及2）与视觉方法论和观察数据分析领域的专家合作，在佛罗里达大学，佛罗里达大学国际大学和加利福尼亚大学的佛罗里达大学弗朗西斯科大学。具有技能 通过这些相互作用获得，我将更好地实施提出的研究计划，在该计划中，我建议研究医师/患者互动的动态，这可能会通过使用标准化患者（SP）计划在波多黎各中的标准化患者（SP）进行模拟相互作用的观察性研究，从而研究了可能有助于PWHA的污名化的医师/患者互动的动态。拟议的研究具有以下目的：目标1-记录艾滋病毒/艾滋病污名态度及其在波多黎各医学居民样本中医师/患者相互作用期间在污名上的作用；目标2-在为具有不同艾滋病毒传播模式的客户提供服务时，请记录医师/患者互动期间艾滋病毒/艾滋病行为的变化；和目标3-确定文化因素（即吸毒者的传统性别角色宗教，同性恋恐惧症和污名化的传统性别角色）对波多黎各医疗居民中艾滋病毒/艾滋病污名的态度和行为表现的作用。 为了实现这些目标，我提出了使用混合方法技术（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的医学科学校园的SP计划进行。我将招募波多黎各的154名医疗居民的样本参加嵌入其正在进行的SP培训中的实验，并分配他们参与以下所有患者条件，并随机呈现顺序：1）通过静脉注射吸毒的HIV感染，通过静脉内吸毒，2）通过未经保护的HORSOXAIL RETICTION HIV-INTRECTICARTIC HIV-INFRETICARITIAL，3）HIV-INFRETICARTIC 3），3）HIV-3）未经保护的异性恋关系或静脉药使用，5）通过未受保护的同性恋关系或静脉药使用的HIV感染，6）通过未经保护的同性恋或异性恋关系感染HIV，以及7）7）普通感冒作为污名的自由比较控制。相互作用将进行视频记录，然后使用我的NIH资助研究的初步开发和试验测试的措施对污名的行为表达进行编码。参与模拟后，所有参与者将完成针对艾滋病毒/艾滋病污名态度的定量问卷，并遵守波多黎各人环境中重要的文化因素。 这项研究将是第一个在波多黎各的医学居民中记录艾滋病毒/艾滋病污名的行为表现的一项，从而扩展了几乎完全关注其污名化态度的科学文献。此外，这将是第一个解决文化因素在波多黎各人群中艾滋病毒/艾滋病污名表现以及与感染手段有关的变化的研究。该研究的发现有可能为这一人群的污名测量指南和污名降低干预措施的制定提供信息，并考虑到污名的态度和行为表现，以及当地文化在这些指标上的作用。