A Longitudinal Mixed-Methods Investigation of Masculinity, Stigma, and Disclosure on Men's ART Initiation in South Africa

项目摘要 南非有超过790万艾滋病毒携带者，是全球最大的国家。一 结束艾滋病毒流行的重大障碍是在整个艾滋病毒护理过程中吸引和留住男性 连续体。在每一步中，男性参与护理的可能性都低于女性。霸道的男子汉气概，或者 “作为一个男人”的理想化形式，被记录为男人不追求和不追求的主要原因 全神贯注于照顾。在南非，霸权男子气概包括冒险、自力更生、性 令人满意的，体力和健康，有情绪控制力，并成为一个经济提供者。虽然 这些特征在某些情况下可能对男性有保护作用，但它们也与寻求艾滋病毒的行为不一致 照顾，这需要脆弱，体验传统上被视为更女性化的情绪(例如，悲伤)， 以及调用关系维度(与自力更生相对)。此外，男性内化的程度 霸权男子气概，称为霸权男子气概信念(HMBS)，披露他们的艾滋病毒状况 出于同样的原因而具有挑战性；然而，披露往往是人们获得必要的 在艾滋病毒治疗中需要寻求和保留社会支持。在这项混合方法的研究中，我们使用 康奈尔对霸权男子气概的定义和揭示过程模型考察可修改的 HMBS与新诊断的艾滋病毒携带者开始抗逆转录病毒治疗(ART)相关的机制 (MLWH)，南非开普敦。我们建议做以下工作：(1)审查披露是否 调解HMBS和ART启动之间的关联，从而更强的HMBS将与 艾滋病毒披露的可能性降低，这反过来又与抗逆转录病毒治疗的可能性降低有关 入会仪式。我们还将研究内化的污名是否缓和了HMB和HMBS之间的联系 披露，使得住房抵押贷款证券化和披露之间的负面关联在以下背景下将更加强烈 高度内化的污名。我们将在两周内招募新诊断的MLWH(N=220)并评估HMBS 检测呈阳性，然后在3个月和6个月后再次出现。关于ART启动的数据将在为期6个月的 通过审阅图表进行评估。(2)研究披露过程是否以及如何改变男性对以下问题的看法 他们自己的男子气概。我们预测，在研究期间披露自己艾滋病毒状况的男性将经历 在6个月评估时HMBS减少，因为理论上披露作为一种行为是不一致的 与HMBS合作。一组披露艾滋病毒状况的男性(n=10)和未披露的男性(n=10)将 被随机挑选参加定性的个人访谈，以进一步解释是否以及如何披露 导致了HMBS的转变。这项拟议的研究与美国国立卫生研究院艾滋病研究办公室的交叉研究一致 行为科学的研究重点集中在影响艾滋病毒的个人和人际动态 关心。结果将用于后续的干预开发。

Project Summary South Africa is home to over 7.9 million people living with HIV, the largest of any country globally. One significant barrier to ending the HIV epidemic is engaging and retaining men in care throughout the HIV care continuum. At each step, men are less likely than women to be engaged in care. Hegemonic masculinity, or idealized forms of what it means to ‘be a man,’ is documented as a major reason why men do not seek and stay engaged in care. Hegemonic masculinity in South Africa involves risk-taking, self-reliance, being sexually desirable, physical strength and health, having emotional control, and being an economic provider. Although these traits may be protective for men under certain circumstances, they are also inconsistent with seeking HIV care, which requires vulnerability, experiencing emotions traditionally viewed as more feminine (e.g., sadness), and invoking a relational dimension (as opposed to self-reliance). Further, the extent to which men internalize hegemonic masculinity, called hegemonic masculinity beliefs (HMBs), makes disclosure of their HIV status challenging for the same reasons; yet, disclosure is often the avenue through which men gain the necessary social support needed to seek and be retained in HIV treatment. In this mixed-methods study, we use Connell’s definition of hegemonic masculinity and the Disclosure Process Model to examine modifiable mechanisms that link HMBs to antiretroviral therapy (ART) initiation in newly-diagnosed men living with HIV (MLWH) in Cape Town, South Africa. We propose to do the following: (1) Examine whether disclosure mediates the association between HMBs and ART initiation, such that stronger HMBs will be associated with a decreased likelihood of HIV disclosure, which in turn will be associated with a decreased likelihood of ART initiation. We will also examine whether internalized stigma moderates the association between HMBs and disclosure, such that the negative association between HMBs and disclosure will be stronger in the context of high internalized stigma. We will recruit newly-diagnosed MLWH (N = 220) and assess HMBs within two weeks of testing positive and then again 3 and 6 months later. Data on ART initiation will be assessed at the 6-month assessment via chart review. (2) Examine whether, and how, the process of disclosure shifts men’s views of their own masculinity. We predict that men who disclose their HIV status during the study will experience a decrease in HMBs at the 6-month assessment, because theoretically disclosure as a behavior is inconsistent with HMBs. A subset of men who disclose their HIV status (n = 10) and those who do not disclose (n = 10) will be randomly selected to participate in a qualitative individual interview to further explain if, and how, disclosure led to a shift in HMBs. This proposed study is in line with the NIH Office of AIDS Research’s cross-cutting research priority on behavioral sciences focused on individual and interpersonal dynamics that influence HIV care. Results will be used for subsequent intervention development.