Mitigating sexual stigma within healthcare interactions to improve engagement of MSM in HIV prevention

减轻医疗保健互动中的性耻辱，以提高 MSM 在艾滋病毒预防中的参与度

• 批准号: 10160243
• 负责人: Bryan A. Kutner
• 金额: $ 17.56万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10160243
• 关键词: AIDS prevention; Algorithms; Anal Sex; Anus; Attitude; Award; Behavior; Behavior Therapy; Behavioral; Belief; Bisexual; Caring; Collaborations; Competence; Counseling; Data; Development Plans; Disclosure; Discrimination; E-learning; Educational workshop; Environment; Epidemic; Equipment and supply inventories; Evaluation; Evidence based program; Expert Opinion; Funding; Future; Gays; Goals; HIV; HIV Infections; HIV/STD; HIV/STI intervention; Health; Health Personnel; Healthcare; Human; Incidence; Information Resources; Intention; Intervention; Interview; Knowledge; Lead; Learning; Link; Longitudinal Surveys; Lubricants; Malignant Neoplasms; Mediation; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Minority Groups; Modeling; Outcome; Pamphlets; Persons; Physiology; Population; Prevention; Process; Prophylactic treatment; Provider; Quality of Care; Reading; Recording of previous events; Reporting; Research; Research Personnel; Research Training; Resources; Risk; Risk Factors; Sampling; Scientist; Services; Sex Behavior; Sexual Health; Sexual and Gender Minorities; Sexuality; Stigmatization; Structure; Techniques; Technology; Testing; Theoretical Domains framework; Theory of Change; Training; Triage; United States National Institutes of Health; Viremia; Visit; Well in self; Work; Workforce Development; base; behavior change; care outcomes; career; career development; condoms; design; effectiveness testing; follow-up; health care settings; health communication; hybrid type 2 design; implementation framework; implementation intervention; implementation outcomes; implementation science; improved; information model; mHealth; men; men who have sex with men; novel; prevent; rectal microbicide; response; screening; skills; social stigma; theories; therapy development; tool; transmission process; uptake

Long-term objective. My long-term objective is to explore, identify and evaluate acceptable, feasible and appropriate techniques and mechanisms to mitigate HIV-related stigma in healthcare, and thereby to improve the quality of care and outcomes for populations that would otherwise remain deterred from HIV services. Specific aims. I plan to integrate stigma and implementation science frameworks to delineate components of human behavior and environment that influence the manifestation—and mitigation—of stigma during healthcare interactions. I will target a high HIV incidence population, men who have sex with men (MSM), and a rarely studied but important marker of HIV-related stigma, anal sexuality. First, I will explore stigma drivers and mitigators by interviewing 30 healthcare workers (HCWs) responsible for HIV-related screening and care, as well as 30 MSM, both purposively sampled for diversity and variable comfort discussing anal sexuality during healthcare encounters. Then I will develop, with an 8-person advisory board of HCWs and MSM, an intersectional stigma-mitigation intervention to help HCWs navigate discussion of this sensitive topic, improve the quality of care, and thereby promote prevention. The intervention will include educational mHealth, workshop and coaching components. Finally, I will pilot the intervention in a stepped wedge hybrid type 2 design to evaluate acceptability, feasibility, and appropriateness; preliminary impact on HCW behavior (e.g., knowledge, comfort, screening practices); and remaining barriers. The pilot will be among 120 HCWs working in two high MSM incidence regions but who do not specialize in MSM care. Aims respond to OAR priorities, including evaluation of interventions that lead to behavior change by consumers or providers to improve the quality of care and engagement in services. Career-development plan. The above aims rely on a robust, mentored training plan that will prepare me for a career as an independent investigator. My plan involves coursework, directed readings, workshops, and visits to research labs of mentors, to advance my knowledge, proficiency and capacity across five training goals: (1) to learn how to leverage health communication to mitigate stigma; (2) to understand how to develop theory- informed behavioral interventions; (3) to acquire advanced knowledge in mHealth tools; (4) to build expertise in implementation science to accelerate the uptake of interventions in settings where mitigation of stigma is urgently needed; and (5) to strengthen professional skills to develop a successful NIH-funded research career. Environment. NYSPI/Columbia will host my research and training, with mentorship from a team of internal experts in sexuality studies, health communication, and workforce development, and external experts in intersectional stigma (UAB), mHealth (UNC), implementation science (UW), and structural stigma (Yale). In Year 4, I plan to submit an R01 to test the K23 intervention’s techniques, mechanisms, and implementation in a larger stepped wedge trial, with the goal of reducing incidence and viremia. Skills and findings from this award will be broadly applicable to HIV stigmas; future technologies, like rectal microbicides; and other related health domains.

长期目标。我的长期目标是探索，识别和评估可接受的，可行的和