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Routine HIV Testing Among Adolescents and the Shifting Culture of AIDS

青少年的常规艾滋病毒检测和艾滋病文化的转变

基本信息

批准号：
7503510
负责人：
Lori Leonard
金额：
$ 24.13万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-28 至 2011-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7503510
关键词：
AIDS prevention AIDS/HIV problem Accident and Emergency department Acquired Immunodeficiency Syndrome Address Adolescent Adolescent Medicine Affect African American Age Alcohol or Other Drugs use Baltimore Behavior Behavioral Blood Blood Circulation Caring Centers for Disease Control and Prevention (U.S.)Cessation of life Characteristics Chronic Cities Clinic Clinical Clinical Medicine Consent Consent Forms Disease Effectiveness Elements Epidemic Ethnic Origin Ethnic group Ethnography Government HIV HIV Infections Health Health Personnel Health care facility Healthcare Hispanics Human immunodeficiency virus test Infection Interview Life Low income Maryland Measures Mediation Medical Modeling Nature Neighborhoods Patient Self-Report Patients Pharmaceutical Preparations Play Policies Population Positioning Attribute Prevalence Prevention intervention Prevention program Prisons Procedures Provider Public Health Race Recommendation Recording of previous events Rest Risk Risk Assessment Role Sampling Sexual Partners Site Staging Standards of Weights and Measures Surveys Test Result Testing Thinking Treatment Protocols United States Visit base case finding ethnographic method experience improved interest member prevent racial and ethnic response sex social transmission process

项目摘要

DESCRIPTION (provided by applicant): There have been important shifts in the clinical understanding and treatment of HIV/AIDS and in public culture as it relates to HIV/AIDS since the epidemic began in the US in the early 1980s. Some of these shifts are reflected in the latest HIV testing recommendations from the CDC. The recommendations suggest that all patients between 13 and 64 be tested; that consent for testing be incorporated into patients' general consent for medical care; and that HIV testing be routinely conducted unless patients 'opt-out.' Though conceived as a supplement to existing prevention programs, the recommendations represent an important shift in the focus of HIV prevention activities. They set the stage for what could be the largest-scale HIV prevention intervention among adolescents in the US to date. The objective of the proposed study is to examine how the new recommendations might be received by adolescents and might be implemented by their health care providers. Interim measures to offer routine testing (though with a separate consent form as mandated by the state) in health care facilities in Baltimore provide an opportunity to assess this. The new recommendations reflect cultural shifts toward a view of HIV as a chronic but manageable disease that is no longer `special.' It is important to understand how adolescents and their care providers respond to the new ideas about HIV that these recommendations embody. This is particularly the case since the effectiveness of the recommendations is premised not only on their ability to promote testing, but on their ability to engender a chain of responses to a test result including adolescents' identification of sexual partners, engagement in care, and change in behaviors to reduce HIV risk. Adolescent medicine providers are cultural brokers. The idea introduced in the clinic that HIV is no longer `special' competes with other cultural views of the disease prevalent in adolescents' social worlds, such as notions about HIV as a death sentence; HIV as a disease that only certain kinds of people get; or HIV as a government plot against people of a particular race or ethnicity. We propose to examine how two adolescent patient populations - one African-American and one Hispanic - negotiate the shifting culture of HIV both inside the clinic and outside of it. We propose to use three distinct, but interrelated, methodological approaches to do this: a patient survey; critical incident interviews with adolescent health care providers; and ethnographic interviews with a sub-sample of adolescent patients. Ethnographic interviews will be conducted with three groups of adolescents: those who come to the clinic seeking an HIV test; those who do not seek a test but who accept one when it is offered as a routine part of care; and those who refuse the offer of an HIV test. These layers of understanding will inform the implementation of the new testing recommendations and highlight culturally inflected barriers to implementation that need to be addressed in order for the recommendations to attain their stated objectives.

描述（由申请人提供）：自20世纪80年代初美国开始流行以来，艾滋病毒/艾滋病的临床理解和治疗以及与艾滋病毒/艾滋病相关的公共文化发生了重要变化。其中一些变化反映在CDC最新的HIV检测建议中。这些建议建议，所有13至64岁的患者都应接受检测;将检测同意纳入患者对医疗护理的一般同意;除非患者选择退出，否则应定期进行艾滋病毒检测。“虽然被认为是对现有预防计划的补充，但这些建议代表了艾滋病毒预防活动重点的重要转变。他们为可能是迄今为止美国青少年中最大规模的艾滋病预防干预奠定了基础。拟议的研究的目的是研究如何新的建议可能会收到青少年和可能会被他们的医疗保健提供者实施。在巴尔的摩的医疗机构提供常规检测的临时措施（尽管有州政府规定的单独同意书）提供了一个评估这一点的机会。新的建议反映了文化上的转变，即艾滋病毒是一种慢性但可控制的疾病，不再是“特殊的”。“重要的是要了解青少年和他们的护理提供者如何回应这些建议所体现的关于艾滋病毒的新想法。这一点尤其重要，因为这些建议的有效性不仅取决于它们促进检测的能力，而且取决于它们对检测结果产生一系列反应的能力，包括青少年确定性伴侣、参与护理以及改变行为以减少艾滋病毒风险。青少年医药提供者是文化经纪人。在诊所中提出的艾滋病毒不再是“特殊”的想法与青少年社会中流行的其他文化观点相竞争，例如艾滋病毒是死刑的概念;艾滋病毒是只有某些人才会患的疾病;或者艾滋病毒是政府针对特定种族或民族的人的阴谋。我们建议研究两个青少年患者人群-一个非洲裔美国人和一个西班牙裔-谈判的转变文化的艾滋病毒无论是在诊所内外it. We建议使用三个不同的，但相互关联的方法来做到这一点：一个病人的调查;关键事件采访青少年医疗保健提供者;和人种学采访青少年患者的子样本。将对三组青少年进行人种学访谈：来诊所寻求艾滋病毒检测的青少年;不寻求检测但接受检测的青少年;拒绝艾滋病毒检测的青少年。这些层次的理解将为新的测试建议的实施提供信息，并强调需要解决的文化影响的实施障碍，以使建议实现其既定目标。