The Effects of HIV/AIDS Stigma on Use of Services by Pregnant Women in Kenya

描述（由申请人提供）：我的职业目标是通过减少艾滋病毒/艾滋病对孕妇和育龄妇女身心健康的不利影响，开展有助于改善资源匮乏地区孕产妇健康的研究。对于K01奖，我提议就艾滋病毒/艾滋病污名作为非洲孕妇利用基本孕产和艾滋病毒服务的障碍的作用进行研究和培训。这一奖项将有助于我从孕产妇和生殖健康方面的背景转变为一名专注于艾滋病毒/艾滋病污名及其对非洲孕产妇健康影响的独立调查员。我的目标是获得社会科学方法的专业知识来研究耻辱，先进的统计方法来分析纵向和集群数据，非洲艾滋病毒/艾滋病的文化背景，以及干预发展。我建议在肯尼亚使用结构化访谈和医疗记录数据进行前瞻性研究，以及使用深度访谈进行定性研究。目标是：1)确定预期污名和感知社区污名对使用ANC服务的孕妇接受HIV检测的影响；2)前瞻性研究预期污名和感知社区污名对孕妇后续使用ANC、分娩和产后服务的影响。3)研究耻辱感是否能够揭示ANC和HIV服务整合对HIV阳性孕妇使用孕产妇服务和HIV服务的影响机制；4)采用定性研究方法阐明HIV/AIDS耻辱感作为社区中不使用设施性孕产妇服务的妇女使用卫生服务的障碍的作用。我的研究将与一项由美国疾病控制与预防中心资助的研究一起进行，该研究将由肯尼亚医学研究所- ucsf合作小组进行，并将利用该更大研究的资源。拟议的培训和研究计划将使我准备设计和测试一项干预措施，以减少肯尼亚孕妇对艾滋病毒/艾滋病的耻辱和歧视。这项研究将有助于公共卫生工作，以改善资源匮乏地区孕妇的健康。对艾滋病毒/艾滋病的歧视可能是孕妇利用保健服务的一个重要障碍，了解和减少对艾滋病毒/艾滋病的歧视的努力将对艾滋病毒的预防和治疗以及孕产妇保健和死亡率产生重要影响。

DESCRIPTION (provided by applicant): My career goal is to conduct research that contributes to improvements in maternal health in low-resource settings through reduction of the adverse effects of HIV/AIDS on the physical and mental health of pregnant and childbearing women. For this K01 Award, I am proposing research and training on the role of HIV/AIDS stigma as a barrier to utilization of essential maternity and HIV services by pregnant women in Africa. This award will facilitate my transition from a background in maternal and reproductive health, to an independent investigator focusing on HIV/AIDS stigma and its effects on maternal health in Africa. My goals are to gain expertise in social science approaches to the study of stigma, advanced statistical methods for analyzing longitudinal and clustered data, the cultural context of HIV/AIDS in Africa, and intervention development. I propose to conduct a prospective study in Kenya using structured interviews and data from medical records, as well as a qualitative study using in-depth interviews. The aims are: 1) to identify the effects of anticipated stigma and perceived community stigma on acceptance of HIV testing among pregnant women who use ANC services, 2) to prospectively investigate the effects of anticipated stigma and perceived community stigma on pregnant women's subsequent use of ANC, delivery, and postpartum services, 3) to investigate whether stigma can shed light on the mechanisms through which ANC and HIV service integration may affect HIV-positive pregnant women's use of maternity and HIV services, and 4) to use qualitative research methods to elucidate the role of HIV/AIDS stigma as a barrier to health service use among women in the community who do not use facility-based maternity services. My research will be conducted in conjunction with a CDC-funded study to be carried out by the Kenya Medical Research Insititute-UCSF Collaborative Group and will take advantage of the resources of that larger study. The proposed program of training and research will prepare me to design and test an intervention for reducing HIV/AIDS stigma and discrimination experienced by pregnant women in Kenya. This research will contribute to public health efforts to improve the health of pregnant women in low-resource settings. HIV/AIDS stigma may constitute an important barrier to pregnant women's use of health services and efforts to understand and reduce HIV/AIDS stigma will have important implications for HIV prevention and treatment, as well as for maternal health and mortality.