Buddhism and HIV Stigma in Thailand: An Intervention Study

泰国的佛教和艾滋病毒耻辱：一项干预研究

• 批准号: 10541764
• 负责人: Wei-Ti Chen
• 金额: $ 19.77万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10541764
• 关键词: Address; Adherence; Adult; Affect; Affective; Asia; Asian; Behavior; Belief; Buddhism; Caring; Cognitive; Compassion; Country; Data; Discrimination; Epidemic; Family member; Future; Goals; HIV; Health; Health Promotion; Health Services; Hour; Image; Income; Individual; Intervention; Intervention Studies; Interview; Manuals; Measures; Mental Health; Methods; Modeling; Modernization; Myanmar; Outcome; Participant; Pathway interactions; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Phase; Philosophy; Pilot Projects; Population; Prevalence; Procedures; Process; Protocols documentation; Psyche structure; Randomized; Randomized Controlled Trials; Research; Risk Factors; Role; Sampling; Self Management; Sexual and Gender Minorities; Social support; Thailand; Time; Treatment Efficacy; Underserved Population; United States; Viral Load result; Woman; acceptability and feasibility; arm; base; ethnic minority; evidence base; feasibility testing; health care availability; innovation; insight; internalized stigma; men who have sex with men; mindfulness; mortality; operation; physical conditioning; primary outcome; protective behavior; psychoeducational; secondary outcome; sex; social; social stigma; substance user; transgender; treatment group

Project Summary/Abstract Thailand has the highest HIV prevalence rate in the Asian-Pacific region, with an estimated 1.2% of its adult population infected. Currently there are 0.5 million of PLWH living in Thailand, with a handful of populations more vulnerable to HIV, including men who have sex with men (MSM) (9.2-40%), transgender individuals (12%), sex workers (1-16%), and substance users (19%). Also, the overall mortality rate among Thai PLWH was 3.56%. This high mortality rate explained the notable HIV treatment cascade issues in Thailand. An important reason is HIV-related stigma still poses significant barriers for Thai PLWH to access healthcare and carry out health-protective behaviors to engage in care, including adherence to medications. The purpose of this study is to culturally adapt and evaluate the feasibility of a 4 weekly 2-hour group-based stigma reduction intervention protocol to promote health engagement. The scientific premise is, Buddhist-Thai culture provides a unique cultural context for Thai PLWH to understand HIV stigma and sufferings. Our hypothesis is that Thai PLWH will display lower internal stigma and more care engagement following the intervention. This study addresses the critical need to optimize care engagement through addressing HIV stigma within the local cultural contexts. Our long-term goal is comprehensive, culturally-sensitive stigma reduction intervention for Thai PLWH. We will conduct a mixed-methods study with two study phases. In Phase 1, we will collect qualitative data through conducting 30 in-depth interviews with Thai PLWH to revise our cultural conceptualization of stigma process. In Phase 2, we will conduct a pilot randomized-controlled trial (RCT) to test the feasibility, acceptability, and preliminary efficacy of the adapted stigma reduction intervention among 80 Thai PLWH. Innovations include: 1. proposing a cultural approach to examining HIV stigma and intervention, to increase feasibility and acceptability for PLWH in Thailand, and allow for generalizability of findings to other PLWH populations in countries influenced by Buddhist culture; and 2. contributing to further expanding the toolbox of interventions for HIV stigma reduction, given many modern interventions have adapted principles of Buddhist philosophy. Aims are to: 1. Follow the ADAPT-ITT model to culturally adapt an evidence-based stigma reduction intervention (Phase 1). 2. Evaluate the feasibility, acceptability, and preliminary efficacy with a randomized-controlled trial among 80 Thai PLWH and assess outcomes with both subjective and objective measures (Phase 2). 3. Revise and finalize the study protocols for future project operation by documenting emerging difficulties and solutions throughout this pilot project implementation. Culturally-sensitive stigma reduction intervention is a promising intervention to assist Thai PLWH in decreasing internal stigma and promoting health engagement, and hence help address HIV epidemics in this underserved population.

项目总结/摘要 泰国是亚太地区艾滋病毒感染率最高的国家，估计有1.2%的成年人感染艾滋病毒。 人口感染。目前有50万艾滋病毒携带者生活在泰国， 更容易感染艾滋病毒，包括男男性行为者（9.2-40%），变性人 (12性工作者（1-16%）和药物使用者（19%）。此外，泰国艾滋病毒携带者和艾滋病患者的总体死亡率 为3.56%。这一高死亡率解释了泰国艾滋病毒治疗级联问题的显著性。一个 一个重要的原因是，与艾滋病毒有关的耻辱感仍然对泰国艾滋病毒携带者获得医疗保健构成重大障碍， 开展健康保护行为，参与护理，包括坚持服药。的目的 本研究旨在评估每周4次、每次2小时的小组性污名消除活动的可行性， 干预协议，以促进健康参与。科学的前提是，佛教泰国文化提供了一个 泰国艾滋病毒感染者和艾滋病患者了解艾滋病毒耻辱和痛苦的独特文化背景。我们的假设是， PLWH将显示较低的内部耻辱和更多的护理参与后的干预。本研究 通过解决当地艾滋病毒污名化问题，满足优化护理参与的迫切需要。 文化背景我们的长期目标是全面的、对文化敏感的减少耻辱感的干预， 泰国PLWH。我们将进行混合方法研究，分为两个研究阶段。在第一阶段，我们将收集 通过对泰国PLWH进行30次深入访谈， 污名化过程的概念化。在第2阶段，我们将进行一项初步随机对照试验（RCT）， 测试适应性污名减少干预的可行性、可接受性和初步疗效， 80名泰国PLWH。创新包括：1.提出一种文化方法来审查艾滋病毒的耻辱感， 干预，以提高泰国艾滋病毒携带者的可行性和可接受性，并允许普遍性， 在受佛教文化影响的国家，对其他PLWH人群的研究结果; 2.有助于进一步 扩大减少艾滋病毒污名化的干预措施工具箱，因为许多现代干预措施 佛教哲学的原则。目标是：1.遵循ADAPT-ITT模型， 减少污名化的循证干预（第1阶段）。2.评估可行性、可接受性和 在80名泰国PLWH中进行随机对照试验的初步疗效， 主观和客观测量（第二阶段）。3.修订并最终确定未来项目的研究方案 通过记录在整个试点项目实施过程中出现的困难和解决办法， 对文化敏感的减少耻辱干预是一种有希望的干预措施，可以帮助泰国艾滋病毒携带者减少 内部耻辱和促进卫生参与，从而帮助解决艾滋病毒流行病在这个服务不足的国家， 人口