Project BURMESE: Buddhist Understanding and Reduction of Myanmarese Experiences of HIV Stigma and Exclusion

项目总结/摘要 缅甸正面临迫在眉睫的艾滋病毒危机，被联合国艾滋病规划署列为“关注国家”。在第一个案子之后 1988年，缅甸诊断出艾滋病毒感染者，艾滋病毒流行在接下来的十年中迅速升级， 特别是在吸毒者和性工作者等边缘化群体中。这导致 缅甸是东南亚第三大艾滋病病毒携带者，仅次于印度尼西亚和泰国。 目前，艾滋病病毒携带者的死亡率仍然很高，比美国高16倍， 高于国际平均水平。死亡率如此之高的一个重要原因是， 仍然很低，目前只有56%的艾滋病毒携带者接受药物治疗。因此，艾滋病毒仍然排在前10位， 缅甸的死亡原因。除了挑战之外，主要的国际援助组织计划 到2020年撤出缅甸。因此，迫切需要收集证据，以开发最佳的艾滋病毒 在地方医疗保健环境中提供护理，并扩大治疗覆盖面，以应对这一即将到来的过渡。 然而，关于缅甸艾滋病毒护理的现有证据仍然非常有限，几乎没有研究 协助缅甸艾滋病毒携带者和艾滋病患者管理获得护理的障碍，如艾滋病毒污名化。与艾滋病毒有关的耻辱感 影响艾滋病毒携带者健康和生活的多个领域。例如，艾滋病毒的耻辱感可能会阻止艾滋病毒感染者利用 他们的健康和生存所必需的卫生服务。然而，仍然没有发表的研究探讨如何 缅甸艾滋病毒感染者经历并管理艾滋病毒污名化，超越艾滋病规划署关于社会排斥的报告 缅甸的艾滋病毒携带者的经历。此外，由于缅甸是一个典型的佛教国家， 85%的人口认同为佛教徒，有必要考虑对佛教的理解 以及对疾病和痛苦的解释，特别是艾滋病毒。因此，在本项目中，我们 我建议通过采访30名艾滋病毒阳性者，探讨佛教对缅甸艾滋病毒污名化的概念 然后在文化上调整以证据为基础的干预措施，以减少缅甸人对艾滋病毒的污名化 PWLH。这两个具体目标是1。我们将对30名艾滋病毒感染者进行深入访谈， 缅甸探讨和确定佛教对艾滋病毒污名化的概念。2.根据Aim的结果 1，我们将调整Bogart和同事的减少耻辱干预措施，以适应缅甸的需要 PLWH，应用修改后的ADAPT-ITT方法，有六个焦点小组，涉及单独的小组， 物质使用者、性工作者、男男性行为者、变性人和异性恋男女。

Project Summary/Abstract Myanmar is facing a looming HIV crisis and is listed as a “country of concern” by UNAIDS. After the first case of HIV was diagnosed in Myanmar in 1988, and the HIV epidemic rapidly escalated over the next decade, in particular among marginalized populations, such as substance users and sex workers. This resulted in Myanmar having the third largest population of PLWH in Southeast Asia, after only Indonesia and Thailand. Currently, the mortality rates among PLWH remain high, and are 16 times higher than that of the US and 20% higher than the international average. An important reason for this high mortality is that treatment coverage is still low, with only 56% of PLWH currently receiving medications. As a consequence, HIV remains in the top 10 causes of death in Myanmar. Adding to the challenges, major international aid organizations are scheduled to withdraw from Myanmar by 2020. Hence, there is an urgent need to collect evidence to develop optimal HIV care in a local healthcare setting and to scale up treatment coverage in response to this pending transition. Yet, the existing evidence regarding HIV care in Myanmar remains extremely limited, and there are few studies to assist Myanmar PLWH to manage barriers to care, such as HIV stigma. HIV-related stigma is negatively impact multiple domains of PLWH's health and lives. For example, HIV stigma may deter PLWH from utilizing health services necessary for their health and survival. Yet, there is still no published study exploring how Myanmar PLWH experience and manage HIV stigma beyond the UNAIDS report of social exclusion experienced by PLWH in Myanmar. In addition, as Myanmar is a typical Buddhist country where more than 85% of the population identify as Buddhists, it is necessary to take into consideration Buddhist understanding and interpretations of illness and suffering in general, and HIV specifically. Therefore, in this project, we propose to explore the Buddhist conceptualizations of HIV stigma in Myanmar by interviewing 30 HIV+ individuals and then culturally adapting an evidence-based intervention to reduce HIV stigma among Myanmar PWLH. These two specific aims are 1. We will conduct in-depth interviews with 30 people with HIV in Myanmar to explore and identify Buddhist conceptualizations of HIV stigma. 2. Based on the results from Aim 1, we will adapt Bogart and colleagues' stigma-reduction intervention to tailor it to the needs of Myanmar PLWH, applying a modified ADAPT-ITT approach with six focus groups that involves separate groups for substance users, sex workers, MSM, transgender individuals, and heterosexual men and women.