Influence of Stigma and Discrimination on HIV Risk among Men in China

耻辱和歧视对中国男性艾滋病毒风险的影响

• 批准号: 8074960
• 负责人: KYUNG HEE CHOI
• 金额: $ 43.05万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-07 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8074960
• 关键词: AIDS prevention; Address; Affect; China; Chinese People; Cognitive; Country; Data; Discrimination; Epidemic; Face; Future; HIV; HIV Infections; Individual; Intervention; Interview; Link; Literature; Measures; Mediating; Mediator of activation protein; Mental Health; Modeling; Outcome; Participant; Phase; Play; Population; Prevalence; Prevention strategy; Public Health; Research; Respondent; Risk; Role; Sampling; Sex Orientation; Sexual Partners; Sexual Transmission; Sexually Transmitted Diseases; Shapes; Social status; Societies; Specific qualifier value; Stigmata; Stigmatization; Surveys; Syphilis; Techniques; Time; Unsafe Sex; Validity and Reliability; Woman; Work; base; coping; evidence base; experience; follow-up; innovation; interest; men; men who have sex with men; next generation; physical conditioning; prevent; psychological distress; sex risk; social stigma; therapy development

DESCRIPTION (provided by applicant): By the end of 2007, sexual transmission was responsible for more than half (52%) of the estimated 700,000 HIV infections in China and is expected to drive the country's future HIV epidemic. The prevalence of HIV among men who have sex with men (MSM) in China is on the rise (1%-10.4%). Efforts to control the emerging HIV epidemic among these men may be hindered by stigma and discrimination related to sexual orientation. Our work found that experiences of MSM stigma were highly prevalent among Chinese MSM and that those who had had such experiences were more likely to engage in unprotected sex with men or with both men and women. Similarly, studies of MSM in other countries have found a similar relationship between MSM stigma and sexual risk behaviors. However, the exact mechanisms by which such experiences of MSM stigma become linked to sexual risk behaviors remain largely unknown. Accordingly, we propose a three-phase study to identify the specific mechanisms by which MSM stigma affect sexual risk behaviors among MSM in Beijing, China. The proposed study will be guided by Major and O'Brien's identity threat model of stigma that connects stigma to mental and physical health outcomes via a stigma management mechanism. In Phase 1, we will explore the range of management strategies used to cope with MSM stigma via 30 in-depth qualitative interviews with MSM. In Phase 2, we will develop, using Phase 1 qualitative data and adapting existing quantitative scales, culturally-relevant measures of explanatory constructs of interest (e.g., MSM stigma management) to establish reliability and validity (N=170). In Phase 3, we will examine potential mediators (e.g., stigma management strategies, psychological distress, sexual contexts/situations) that explain how MSM stigma are linked to sexual risk for HIV with a respondent-driven sample of 500 MSM who will complete baseline and two follow-up assessments at 6 and 12 months. We will also conduct 20 in-depth qualitative individual interviews with a subset of men selected from the Phase-3 participants to examine the acceptability of potential intervention components to address the link between MSM stigma and HIV risk. This study will break new ground in our understanding of the influence of MSM stigma management strategies on sexual risk for HIV among MSM. It will also advance theoretical understanding of HIV risk by examining potential mechanisms through which MSM stigma and discrimination impact sexual risk. PUBLIC HEALTH SIGNIFICANCE: The proposed study addresses a critical public health issue by informing the next generation of HIV prevention strategies targeting those mechanisms of MSM stigmatization, which in turn may help prevent the worsening of the HIV epidemic among MSM throughout the world, including those in China.

描述（由申请人提供）：到2007年底，性传播造成了中国估计70万名HIV感染的一半以上（52％），预计将推动该国未来的HIV流行病。在中国与男性发生性关系的男性中艾滋病毒的患病率正在上升（1％-10.4％）。这些男性中控制新兴的艾滋病毒流行的努力可能受到与性取向有关的污名和歧视。我们的工作发现，在中国MSM中，MSM污名的经历非常普遍，并且那些经历过这样的经验的人更有可能与男人或男人和男女进行无保护的性行为。同样，在其他国家对MSM的研究发现MSM污名与性风险行为之间存在类似的关系。但是，这种MSM污名经历与性风险行为相关的确切机制仍然未知。因此，我们提出了一项三相研究，以确定MSM污名会影响中国北京MSM的性风险行为的具体机制。拟议的研究将以少校和奥布莱恩的身份威胁模型为指导，该模型通过污名管理机制将污名与心理和身体健康结果联系起来。在第1阶段，我们将通过30个对MSM的深入定性访谈来探讨用于应对MSM污名的管理范围。在第2阶段，我们将使用第1阶段的定性数据并调整现有的定量量表，从文化上与现有的定量量表进行相关的衡量意义的解释性构造（例如MSM污名管理）来建立可靠性和有效性（n = 170）。在第3阶段，我们将研究潜在的调解人（例如，污名管理策略，心理困扰，性环境/情况），以解释MSM污名如何与500 MSM的受访者驱动样本相关联，他们将在6和12个月中完成两次基线和两次随访评估。我们还将与从第三阶段参与者中选出的一部分男性进行20次深入定性的个人访谈，以检查潜在干预组件的可接受性，以解决MSM污名与HIV风险之间的联系。这项研究将使我们理解MSM污名管理策略对MSM中HIV的性风险的影响，从而打开新的基础。它还将通过检查潜在的机制来提高对艾滋病毒风险的理论理解，而潜在的机制和歧视会影响性风险。 公共卫生意义：拟议的研究通过告知针对MSM污名机制的下一代HIV预防策略，以解决关键的公共卫生问题，这反过来又有助于防止全球MSM中的HIV流行恶化，包括中国。