Building Capacity to Reduce HIV-Related Stigma among Adolescents in Western Kenya

项目摘要/摘要 肯尼亚是世界上艾滋病毒和艾滋病流行最严重的国家之一，约有160万艾滋病毒携带者和 2018年有2.5万人死于艾滋病。青少年，特别是女孩，特别容易感染艾滋病毒。在……里面 在肯尼亚西部，超过50%的青少年在18岁之前有过性行为；然而，年轻人在 15-19岁的人使用避孕套和艾滋病毒检测的比率很低。耻辱对艾滋病毒预防产生负面影响 行为，包括使用避孕套和艾滋病毒检测。在肯尼亚，社会资本、 宗教信仰和生理性别塑造了社会对被认为感染的年轻人的歧视态度 感染艾滋病毒(即社会耻辱)，这反过来又影响艾滋病毒的预防。爱荷华大学正在与 坦加扎大学学院(内罗毕)和妇产科妇女和瘘管医院(Eldoret)，以阐明 青少年中社会资本、宗教信仰、性别和艾滋病毒相关污名之间的复杂关系(年龄 15-19)及其对肯尼亚西部艾滋病毒预防的影响。 这个为期两年的混合方法项目将重点放在肯尼亚西部的三个县，并将结合实际情况进行开发 衡量社会资本、宗教信仰和艾滋病毒相关污名(目标1)；确定 社会资本、宗教信仰、性、艾滋病毒相关的污名和艾滋病毒预防行为 (目标2)；并阐明社会资本、宗教信仰、性别和艾滋病毒相关污名之间的关系 定性方法(目标3)。对于目标1，将使用有目的的样本的认知访谈技术 对12个女孩和12个男孩进行情境分析和验证13个项目的社会资本工具，10个项目的宗教信仰 量表，以及评估与艾滋病毒有关的社会耻辱的27项工具。这些人的心理测量学特性 将通过对100名青少年进行抽样调查来评估因地制宜的措施。 对于目标2，包括在目标1中制定的经过验证的测量的调查将被管理到765 从肯尼亚西部随机挑选未婚女孩和男孩(年龄在15-19岁之间)。多元回归分析 将被用来检验(1)社会资本和艾滋病毒预防行为(即避孕套)之间的联系 (2)社会资本和社会耻辱， 以及宗教信仰和性的潜在调节作用。对于目标3，将进行36次深入访谈 与青少年(15-19岁)、父母、宗教领袖、教师和卫生保健提供者一起更好地 理解目标2中确定的复杂关系。 在经验丰富的执行委员会和咨询委员会的领导下，这项研究将制定三个新的量表和 找出减少艾滋病毒相关耻辱和增加艾滋病毒预防行为的潜在途径 肯尼亚西部的青少年。该项目还将增加两个肯尼亚机构的研究能力 审查与艾滋病毒相关的耻辱及其后果。最终，这一合作关系将使我们能够设计 有效的干预措施，以解决耻辱问题并促进肯尼亚各地年轻人的健康。

Project Summary/Abstract Kenya has one of the world's largest HIV and AIDS epidemics, with about 1.6 million people living with HIV and 25,000 people dying from AIDS in 2018. Adolescents, especially girls, are particularly vulnerable to HIV. In western Kenya, over 50% of adolescents had sexual intercourse before the age of 18; however, youth between the ages of 15-19 have low rates of condom use and HIV testing. Stigma negatively affects HIV prevention behaviors, including condom use and HIV testing. In Kenya, complex interactions between social capital, religiosity, and biological sex shape societies' discriminating attitudes towards youth perceived to be infected with HIV (i.e., social stigma), which, in turn, affects HIV prevention. The University of Iowa is partnering with Tangaza University College (Nairobi) and Gynocare Women's and Fistula Hospital (Eldoret) to elucidate the complex relationship between social capital, religiosity, sex, and HIV-related stigma among adolescents (ages 15-19) and its impact on HIV prevention in western Kenya. Focusing on three counties in western Kenya, this two-year, mixed-methods project will develop contextualized measures of social capital, religiosity, and HIV-related stigma (Aim 1); determine the relationship between social capital, religiosity, sex, HIV-related stigma, and HIV-preventive behaviors using quantitative methods (Aim 2); and explicate the relationships between social capital, religiosity, sex, and HIV-related stigma using qualitative methods (Aim 3). For Aim 1, cognitive interviewing techniques will be used with a purposive sample of 12 girls and 12 boys to contextualize and validate a 13-item social capital instrument, a 10-item religiosity scale, and a 27-item instrument to assess social stigma related to HIV. The psychometric properties of these contextualized measures will be assessed through a pilot survey administered to a sample of 100 adolescents. For Aim 2, a survey that includes the validated measures developed in Aim 1 will be administered to 765 randomly selected unmarried girls and boys (ages 15-19) from in western Kenya. Multiple regression analysis will be used to examine the association between (1) social capital and HIV-preventive behaviors (i.e., condom use and HIV testing), and the potential mediating role of social stigma; and (2) social capital and social stigma, and the potential moderating role of religiosity and sex. For Aim 3, 36 in-depth interviews will be conducted with adolescents (ages 15-19), parents, religious leaders, teachers, and health care providers to better understand the complex relationships identified in Aim 2. Led by an experienced Executive Committee and Advisory Board, this study will develop three new scales and identify potential pathways to reduce HIV-related stigma and increase HIV-preventive behaviors among adolescents in western Kenya. This project will also increase the research capacity of two Kenyan institutions to examine HIV-related stigma and its consequences. Ultimately, this partnership will allow us to design effective interventions to address stigma and promote young people's health throughout Kenya.