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

项目摘要/摘要 缅甸正面临着一场迫在眉睫的艾滋病毒危机，并被联合国艾滋病规划署列为“关注国家”。在第一个案例之后 1988年在缅甸被诊断出艾滋病病毒，在接下来的十年中，艾滋病毒疫情迅速升级， 特别是在被边缘化的人群中，如吸毒者和性工作者。这导致了 缅甸是东南亚第三大人口大国，仅次于印度尼西亚和泰国。 目前，PLWH的死亡率仍然很高，比美国高16倍，比美国高20% 高于国际平均水平。死亡率如此之高的一个重要原因是治疗覆盖面 仍然很低，目前只有56%的PLWH正在接受药物治疗。因此，艾滋病毒仍然位居前10名 缅甸的死因。增加挑战的是，主要的国际援助组织计划 在2020年前撤出缅甸。因此，迫切需要收集证据来开发最佳的艾滋病毒 在当地医疗保健环境中提供医疗服务，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极其有限，几乎没有研究 协助缅甸公共卫生署处理护理方面的障碍，例如艾滋病毒污名。与艾滋病毒相关的耻辱是负面的 影响PLWH的健康和生活的多个领域。例如，艾滋病毒的耻辱可能会阻止PLWH的使用 为他们的健康和生存提供必要的卫生服务。然而，目前还没有发表的研究探讨如何 在联合国艾滋病规划署关于社会排斥的报告之外，缅甸公共卫生部门经历和管理艾滋病毒污名 在缅甸的PLWH所经历的。此外，由于缅甸是一个典型的佛教国家，有超过 85%的人口认为自己是佛教徒，因此有必要考虑对佛教的理解 以及对疾病和痛苦的一般解释，特别是对艾滋病毒的解释。因此，在这个项目中，我们 建议通过采访30名HIV+来探索佛教对缅甸艾滋病毒污名的概念化 然后在文化上调整基于证据的干预措施，以减少缅甸人对艾滋病毒的污名 PWLH。这两个具体目标是1.我们将在#年对30名艾滋病毒感染者进行深入访谈 缅甸探索和确定佛教对艾滋病毒污名的概念化。2.基于AIM的结果 1，我们将调整Bogart和同事的减少耻辱干预措施，使其适应缅甸的需求 PLWH，采用改进的适应-ITT方法，有六个重点小组，涉及不同的小组 吸毒者、性工作者、男男性接触者、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.