A Longitudinal Mixed-Methods Investigation of Masculinity, Stigma, and Disclosure on Men's ART Initiation in South Africa

项目摘要 南非有790多万艾滋病毒感染者，是全球最大的国家。一 终止艾滋病毒流行的一个重大障碍是在整个艾滋病毒护理过程中让男子参与并留住他们 连续体在每一步，男子都比妇女更不可能从事护理工作。霸权的男子气概，或 “成为一个男人”的理想化形式被记录为男人不寻求和追求的一个主要原因 继续从事护理工作。南非的男性霸权包括冒险，自力更生， 理想的，体力和健康，有情绪控制，并成为一个经济供应商。虽然 在某些情况下，这些特征可能对男性有保护作用，但它们也与寻求艾滋病毒感染不一致。 护理，这需要脆弱性，体验传统上被视为更女性化的情感（例如，悲伤）， 并唤起关系维度（而不是自力更生）。此外，男性内化的程度 霸权男子气概，称为霸权男子气概信念（HMBs），使披露他们的艾滋病毒状况 挑战出于同样的原因;然而，披露往往是男人获得必要的途径， 在艾滋病毒治疗中需要寻求和保持社会支持。在这项混合方法研究中，我们使用 康奈尔的霸权男性气质的定义和披露过程模型，以检查修改 在新诊断的HIV感染男性中，HMB与抗逆转录病毒治疗（ART）启动之间的联系机制 （MLWH）在南非的开普敦。我们建议采取以下措施：（1）审查披露是否 介导HMB和ART启动之间的关联，使得更强的HMB将与 艾滋病毒暴露的可能性降低，这反过来又与ART的可能性降低有关 入会仪式我们还将研究内化的耻辱感是否会调节HMB与 披露，这样，HMB和披露之间的负面联系将在以下情况下更强： 高度内化的耻辱感。我们将招募新诊断的MLWH（N = 220），并在两周内评估HMB 三个月和六个月后又检测出阳性将在6个月时评估关于ART启动的数据 通过图表评审进行评估。(2)检查是否，以及如何，披露的过程改变了男人的看法， 自己的男子气概。我们预测，在研究过程中披露自己艾滋病毒状况的男性将经历一个 6个月评估时HMB减少，因为理论上披露作为一种行为不一致 HMB的。一个披露其艾滋病毒状况（n = 10）和那些不披露（n = 10）的男性子集将 被随机挑选参加定性个人访谈，以进一步解释是否以及如何披露， 导致了HMB的转变。这项拟议的研究符合NIH艾滋病研究办公室的横向研究， 行为科学的研究重点是影响艾滋病毒的个人和人际动力学 在乎结果将用于后续干预措施的制定。

Project Summary South Africa is home to over 7.9 million people living with HIV, the largest of any country globally. One significant barrier to ending the HIV epidemic is engaging and retaining men in care throughout the HIV care continuum. At each step, men are less likely than women to be engaged in care. Hegemonic masculinity, or idealized forms of what it means to ‘be a man,’ is documented as a major reason why men do not seek and stay engaged in care. Hegemonic masculinity in South Africa involves risk-taking, self-reliance, being sexually desirable, physical strength and health, having emotional control, and being an economic provider. Although these traits may be protective for men under certain circumstances, they are also inconsistent with seeking HIV care, which requires vulnerability, experiencing emotions traditionally viewed as more feminine (e.g., sadness), and invoking a relational dimension (as opposed to self-reliance). Further, the extent to which men internalize hegemonic masculinity, called hegemonic masculinity beliefs (HMBs), makes disclosure of their HIV status challenging for the same reasons; yet, disclosure is often the avenue through which men gain the necessary social support needed to seek and be retained in HIV treatment. In this mixed-methods study, we use Connell’s definition of hegemonic masculinity and the Disclosure Process Model to examine modifiable mechanisms that link HMBs to antiretroviral therapy (ART) initiation in newly-diagnosed men living with HIV (MLWH) in Cape Town, South Africa. We propose to do the following: (1) Examine whether disclosure mediates the association between HMBs and ART initiation, such that stronger HMBs will be associated with a decreased likelihood of HIV disclosure, which in turn will be associated with a decreased likelihood of ART initiation. We will also examine whether internalized stigma moderates the association between HMBs and disclosure, such that the negative association between HMBs and disclosure will be stronger in the context of high internalized stigma. We will recruit newly-diagnosed MLWH (N = 220) and assess HMBs within two weeks of testing positive and then again 3 and 6 months later. Data on ART initiation will be assessed at the 6-month assessment via chart review. (2) Examine whether, and how, the process of disclosure shifts men’s views of their own masculinity. We predict that men who disclose their HIV status during the study will experience a decrease in HMBs at the 6-month assessment, because theoretically disclosure as a behavior is inconsistent with HMBs. A subset of men who disclose their HIV status (n = 10) and those who do not disclose (n = 10) will be randomly selected to participate in a qualitative individual interview to further explain if, and how, disclosure led to a shift in HMBs. This proposed study is in line with the NIH Office of AIDS Research’s cross-cutting research priority on behavioral sciences focused on individual and interpersonal dynamics that influence HIV care. Results will be used for subsequent intervention development.