Intersectional Stigma and Pre-Exposure Prophylaxis Continuation among Female Sex Workers in Namibia

纳米比亚女性性工作者的交叉耻辱和暴露前预防的继续

• 批准号: 10160481
• 负责人: Kaitlyn M Atkins
• 金额: $ 4.55万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-11-01 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10160481
• 关键词: AIDS prevention; Address; Adult; Affect; Africa South of the Sahara; Age; Alcohol or Other Drugs use; Behavior; Behavioral; Behavioral Sciences; Caring; Characteristics; Country; Data; Decision Making; Discrimination; Epidemic; Equation; Ethnic Origin; Factor Analysis; Fellowship; Goals; Government; HIV; HIV Infections; Human immunodeficiency virus test; Improve Access; Incidence; Infrastructure; Interview; Logistic Regressions; Measurement; Measures; Mental Depression; Mental Health; Mentors; Methods; Modeling; Namibia; National Institute of Mental Health; National Research Service Awards; Occupational; Outcome; Parents; Pattern; Perception; Population; Prevalence; Provider; Psychosocial Factor; Public Health Schools; Qualitative Research; Race; Research; Research Methodology; Research Personnel; Research Priority; Respondent; Risk; Role; Scientist; Services; Social Sciences; Social support; Structure; Tenofovir; Time; Training; Treatment outcome; United States National Institutes of Health; Variant; Vulnerable Populations; Woman; Work; antiretroviral therapy; base; design; disparity reduction; doctoral student; experience; female sex worker; health disparity; improved; indexing; innovation; insight; lens; pre-exposure prophylaxis; prevention service; programs; psychosocial; racial discrimination; resilience; scale up; service delivery; service intervention; sex; skills; social; social determinants; social stigma; testing services; theories; therapy adherence; transmission process; uptake

PROJECT SUMMARY/ABSTRACT Background. HIV continues to disproportionately impact female sex workers (FSW) in sub-Saharan Africa (SSA), highlighting the urgent need to address factors that put them at risk. Stigma is a key structural barrier to accessing HIV testing and prevention services among marginalized populations, but few HIV scientists have considered it from an intersectional lens. Further, studies assessing PrEP-related stigma have largely not considered the ways in which PrEP stigma intersects with other forms of stigma, such as sexual practices stigma or occupational stigma, to influence patterns of PrEP use. Study Goal and Aims. The goal of this study is to understand how intersectional stigmas, as experienced by FSW in Namibia, influence PrEP continuation. Specifically, the study aims to (1) qualitatively explore experiences of intersectional stigma among in Namibia and how it influences their PrEP outcomes; (2) estimate the burden and predictors of intersectional stigmas among ; and (3) determine the relationship between intersectional stigmas and PrEP continuation. Approach. This study will use an exploratory sequential mixed-methods approach to gain an in-depth understanding of intersectional stigmas and their impact on PrEP access and continuation among FSW FSW a marginalized population in Namibia. Aim 1 will utilize secondary data from approximately 20 in-depth interviews with FSW and primary data from approximately 15 in-depth interviews with PrEP providers to better understand experiences and definitions of stigma. Aim 2 will estimate the burden of intersectional stigmas, using multiple measures of attribute specific stigma (e.g. PrEP stigma) and non-attributed stigma (i.e. stigma related to one’s overall identity, rather than specific attributes or behaviors). Aim 2 will also estimate factors associated with experiencing intersectional stigmas among FSW . In Aim 3, the relationship between multiple intersectional stigmas and PrEP continuation will be estimated using structural equation modeling. Fellowship Information. The proposed research aligns with NIH HIV research priorities to reduce health disparities in HIV infection outcomes and with NIMH research priorities to integrate social and behavioral science with an effective biomedical strategy for HIV prevention. In-depth understanding of intersectional stigmas among this vulnerable population will provide important insights into stigma as a structural barrier to PrEP access and use, and will inform further implementation and scale-up of PrEP programs with FSW in SSA. This NRSA will be dissertation research for Ms. Kaitlyn Atkins, a PhD student at the Johns Hopkins Bloomberg School of Public Health. Ms. Atkins will be mentored by a Sponsor, two Co-Sponsors, a Scientific Advisor, and a Measurement Consultant. A training plan has been developed to provide her with tailored experience to support her towards achieving her goal of becoming a leading, independent HIV researcher.

项目总结/摘要 背景艾滋病毒继续不成比例地 女性性工作者 在撒哈拉以南非洲 (SSA)，强调迫切需要解决使他们处于危险之中的因素。污名是一个关键的结构性障碍， 在边缘化人群中获得艾滋病毒检测和预防服务，但很少有艾滋病毒科学家 从交叉透镜的角度考虑。此外，评估PrEP相关污名的研究基本上没有 考虑了PrEP耻辱与其他形式的耻辱交叉的方式，例如性行为耻辱 或职业污名，影响PrEP使用模式。 研究目的和目标。本研究的目的是了解交叉污名，如经验丰富的 FSW 在纳米比亚，影响PrEP的延续。具体而言，本研究旨在（1）定性探索经验 交叉污名在纳米比亚之间，以及它如何影响他们的PrEP结果;（2）估计 负担和交叉柱头之间的预测;（3）确定之间的关系 交叉柱头和PrEP延续。 Approach.本研究将使用探索性的顺序混合方法的方法，以获得深入的 了解交叉污名及其对PrEP获取和延续的影响， FSW FSW 边缘化的 人口 在纳米比亚。Aim 1将利用大约来自 与FSW的20次深入访谈 和 来自大约15个PrEP提供者深入访谈的主要数据，以更好地了解经验 以及污名的定义。目标2将估计交叉柱头的负担，使用多种措施， 归因于特定的耻辱（例如PrEP耻辱）和非归因的耻辱（即与一个人的整体身份有关的耻辱， 而不是特定的属性或行为）。目标2还将估计与经历相关的因素 交叉柱头 FSW .在目标3中，多个交叉柱头与PrEP之间的关系 将使用结构方程模型来估计延续性。 奖学金信息。拟议的研究与NIH HIV研究优先事项保持一致，以减少健康 艾滋病毒感染结果的差异，以及NIMH研究优先考虑整合社会和行为科学 有效的预防艾滋病的生物医学战略。深入了解交叉柱头， 这一脆弱人群 将提供重要的见解耻辱作为一个结构性障碍，以准备访问， 使用，并将为进一步实施和扩大PrEP计划提供信息， FSW 在SSA。这个NRSA将是 约翰霍普金斯布隆伯格公共学院博士生凯特琳阿特金斯女士的论文研究 健康阿特金斯女士将由一名申办者、两名联合申办者、一名科学顾问和一名测量人员指导 顾问。已制定培训计划，为她提供量身定制的经验，以支持她 她的目标是成为一名领先的独立艾滋病研究人员。