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

项目摘要/摘要 背景资料。艾滋病毒继续产生不成比例的影响 女性性工作者(FSW) 在撒哈拉以南非洲 (SSA)，强调迫切需要解决使它们面临风险的因素。耻辱是一个关键的结构性障碍 在边缘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做到 从一个交叉的角度来考虑。此外，评估PrEP相关耻辱的研究基本上没有 考虑到PrEP污名与其他形式的污名相交的方式，如性行为污名 或职业耻辱，以影响PrEP的使用模式。 学习目标和目的。这项研究的目标是了解交叉耻辱是如何经历的 FSW 在纳米比亚，影响PrEP的继续。具体地说，本研究的目的是(1)定性地探索经验 纳米比亚人之间的跨部门耻辱及其如何影响他们的PrEP结果；(2)估计 负担和预测因子之间的交叉污名；和(3)决定之间的关系 相交的柱头和PrEP延续。 接近。这项研究将使用探索性的顺序混合方法来获得深入的 了解交叉柱头及其对PrEP通路和延续的影响 FSW FSW 一个被边缘化的人 人口 在纳米比亚。AIM 1将利用来自大约 对FSW的20次深度采访 和 主要数据来自对PrEP提供商的约15次深入访谈，以更好地了解体验 以及污名的定义。目标2将使用多种测量方法来估计交叉柱头的负担 属性特定污名(例如PrEP污名)和非属性污名(即与一个人的整体身份相关的污名， 而不是特定属性或行为)。目标2还将评估与体验相关的因素 柱头相交在 FSW 。在目标3中，多个相交柱头与PrEP的关系 将使用结构方程建模来估计延展性。 团契信息。这项拟议的研究与美国国立卫生研究院减少健康的艾滋病毒研究重点一致。 艾滋病毒感染结果的差异以及整合社会和行为科学的NIMH研究优先事项 具有有效的预防艾滋病毒的生物医学战略。对相交柱头的深入了解 这一弱势群体 将为耻辱作为PrEP获取的结构性障碍和 使用，并将通过以下方式进一步实施和扩大PrEP计划 FSW 在SSA。这个NRSA将是 约翰霍普金斯大学彭博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赞助商、两名联合赞助商、一名科学顾问和一名测量人员指导 顾问。已经制定了一项培训计划，为她提供量身定制的经验，以支持她 实现了成为一名领先的、独立的艾滋病毒研究人员的目标。

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.