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

长期目标。我的长期目标是探索、确定和评估可接受的、可行的和 适当的技术和机制，以减轻医疗保健中与艾滋病毒有关的耻辱，从而改善 人口的护理质量和结果，否则就会被艾滋病毒服务吓倒。 明确的目标。我计划整合耻辱和实施科学框架，以确定各组成部分 影响耻辱的表现和减轻的人类行为和环境 医疗保健互动。我将针对艾滋病毒高发人群、男男性行为者(MSM)和 很少被研究，但却是艾滋病毒相关耻辱的重要标志，肛交。首先，我将探讨耻辱的驱动因素和 通过采访30名负责艾滋病毒相关筛查和护理的医护人员(HCW)来缓解 作为30名MSM，两人都进行了有目的的抽样，以寻找多样性和讨论肛门性行为的不同舒适度 医疗保健方面的遭遇。然后，我将与一个由卫生工作者和男男性接触者组成的8人顾问委员会一起，制定一个交叉部门 减少耻辱的干预措施，以帮助卫生工作者引导对这一敏感话题的讨论，提高 护理，从而促进预防。干预措施将包括教育mHealth、研讨会和辅导 组件。最后，我将在阶梯式楔形混合型2设计中试行干预，以评估可接受性， 可行性和适当性；对HCW行为的初步影响(例如，知识、舒适度、筛查 实践)；以及剩余的障碍。这名飞行员将是在两个MSM高发区工作的120名医务工作者中的一员 但他们不是专门从事男男性接触者护理的。目标是对行动纲领的优先事项作出反应，包括对下列干预措施进行评价 促使消费者或提供者改变行为，以提高护理质量和服务参与度。 职业发展计划。上述目标依赖于一个强大的、有指导的培训计划，这将为我做好准备 独立调查员的职业生涯。我的计划包括课程作业、定向阅读、研讨会和参观 研究导师的实验室，在五个培训目标上提高我的知识、熟练程度和能力：(1) 学习如何利用健康传播来减轻耻辱；(2)了解如何发展理论- 知情的行为干预；(3)获取移动健康工具的高级知识；(4)建立专业知识 实施科学，以加速在迫切需要减轻耻辱的情况下采取干预措施 需要；以及(5)加强专业技能，以发展成功的NIH资助的研究事业。 环境NYSPI/Columbia将主持我的研究和培训，并由一个内部团队提供指导 性研究、健康传播和劳动力发展方面的专家，以及 交叉污名(UAB)、移动健康(UNC)、实施科学(UW)和结构性污名(耶鲁大学)。以年计 4，我计划提交一份R01来测试K23干预的技术、机制和在更大范围内的实现 阶梯式楔形试验，目的是减少发病率和病毒血症。该奖项的技能和发现将是 广泛适用于艾滋病毒污名；未来的技术，如直肠杀微生物剂；以及其他相关的健康领域。

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.