"There Is a Lot of Practice in Not Thinking about That": Structural, Interpersonal, and Individual-Level Barriers to HIV/STI Prevention among Reservation Based American Indians.
"There Is a Lot of Practice in Not Thinking about That": Structural, Interpersonal, and Individual-Level Barriers to HIV/STI Prevention among Reservation Based American Indians.
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DOI：
10.3390/ijerph18073566
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发表时间：
2021-03-30
影响因子：
--
通讯作者：
Gaines TL
中科院分区：
文献类型：
--
作者：
Armenta RF;Kellogg D;Montoya JL;Romero R;Armao S;Calac D;Gaines TL
美洲印第安人 (AI) 在艾滋病毒/性传播感染发病率和死亡率方面存在显着差异，历史、结构、人际关系和个人层面的障碍阻碍了预防工作。本文的目的是研究基于预约的人工智能中艾滋病毒/性传播感染预防的障碍。我们对南加州 17 名保留型 AI 社区领导人和社区成员进行了面对面的定性访谈，了解 HIV/STI 知识、态度以及预防障碍。传统的应对机制和治疗过程受到历史创伤的破坏，这使得耻辱在以前不存在的地方得以存在。这影响了获得医疗保健服务和对医学的信任，并与个人采取消极应对行为有关，这些行为会带来艾滋病毒/性传播感染的风险（例如药物滥用和性行为）。大多数参与者报告说，他们的保留地社区没有讨论艾滋病毒/性传播感染，许多参与者对传播风险有误解。耻辱还与缺乏对艾滋病毒/性传播感染的了解和认识有关。可用服务有限、社区偏远、缺乏隐私以及提供者的文化能力低下进一步阻碍了艾滋病毒/性传播感染预防服务的获取和使用。这些发现强调需要解决影响个人行为的历史、结构和人际因素，这些因素可能会增加保留地人工智能中艾滋病毒/性传播感染的传播。预防工作应利用社区优势，增加艾滋病毒/性传播感染知识，减少耻辱，并增加获得预防性护理的机会，同时使用基于文化的方法。
American Indians (AI) face significant disparities in HIV/STI morbidity and mortality, and historical, structural, interpersonal, and individual level barriers stymie prevention efforts. The objective of this paper is to examine barriers to HIV/STI prevention among reservation-based AI. We conducted face-to-face qualitative interviews with 17 reservation-based AI community leaders and community members in Southern California on HIV/STI knowledge and attitudes and barriers to prevention. The disruption of traditional coping mechanisms and healing processes were compromised by historical trauma, and this allowed stigmas to exist where they did not exist before. This impacted access to healthcare services and trust in medicine, and is linked to individuals adopting negative coping behaviors that confer risk for HIV/STI transmission (e.g., substance use and sexual behaviors). Most of the participants reported that HIV/STIs were not discussed in their reservation-based communities, and many participants had a misperception of transmission risk. Stigma was also linked to a lack of knowledge and awareness of HIV/STI’s. Limited available services, remoteness of communities, perceived lack of privacy, and low cultural competency among providers further hindered the access and use of HIV/STI prevention services. These findings highlight the need to address the historical, structural, and interpersonal factors impacting individual-level behaviors that can increase HIV/STI transmission among reservation-based AIs. Prevention work should build on community strengths to increase HIV/STI knowledge, reduce stigma, and increase access to preventative care while using culturally grounded methodologies.
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影响因子：
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作者：
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DOI：
10.1097/01.alc.0000153789.59228.fc
发表时间：
2005-01-01
影响因子：
3.2
作者：
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通讯作者：
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