The Problem With Male Sexual/Repro Health:Qualitative/Quantitative Study, Uganda

描述(由申请人提供)：男性在采用目前已被证实的降低艾滋病毒/性传播感染风险的方法方面发挥着关键作用，包括持续使用避孕套和男性包皮环切术。男性也会影响伴侣对避孕措施的使用。然而，男性获得性和生殖健康(SRH)信息和服务的入口点较少，因为大多数计划生育和怀孕相关项目都是以妇女为中心的。最后，男性往往比女性更少地利用许多医疗保健服务；就艾滋病毒而言，这些结果导致治疗延迟，抗逆转录病毒疗法(ART)结果较差，并可能导致更多艾滋病毒传播。乌干达Rakai健康科学方案(RHSP)在正在进行的Rakai社区队列研究(RCCS)--对50个村庄进行的纵向行为和艾滋病毒研究--中记录了与一般人口中男性使用SRH服务有关的许多挑战，尽管RHSP通过PEPFAR免费提供服务。在这个RO1中，我们建议对青少年和成年男性接受和使用关键的SRH相关服务的个人、社会和结构性促进者以及障碍进行定性和定量的混合研究，并探索关于增加SRH使用的潜在方法的态度。在男性服务使用者和非服务使用者、家庭(例如配偶、父母)和社区成员(例如有影响力的同辈、服务提供者)中进行的定性研究将包括焦点小组，以审查社区规范；以及深入访谈，以探索影响使用性健康服务的个人因素、社会影响和感知的结构性障碍(如服务质量)。我们还将在服务提供地点进行有系统的观察，以确定与场地有关的障碍，并在其他社区环境中研究是否可以在那里提供选定的服务。定性研究将嵌入农村社区卫生中心，提供一个独特的机会，根据危险行为和服务使用/不使用有目的地招募男性参与者，并探索男性SRH行为的社会和家庭背景及其影响。在FGD和IDI数据的基础上，我们还将设计一个关于男性SRH的模块，并将其纳入RCCS对约14,000名成年人的年度调查中，以检查定性结果在Rakai人群中的概括性，并确定关键态度、看法和行为的分布。该RO1将提供迄今为止关于非洲环境中男性性激素服务接受/使用的障碍和潜在动机的最全面的信息，并将为未来社区和诊所战略的干预研究的设计提供信息，以改善男性对避孕套、MC、计划生育等服务的接受，并为艾滋病毒男性提供抗逆转录病毒治疗。将在非洲区域传播的研究结果也将对改善男性对其他卫生和预防服务的使用产生影响。

DESCRIPTION (provided by applicant): Men play a pivotal role in the adoption of currently proven methods of sexual HIV/STI risk reduction, including consistent condom use and male circumcision (MC). Men also influence partners' use of contraception. However, males have fewer entry points to sexual and reproductive health (SRH) information and services, since most family planning and pregnancy-related programs are woman-centered. Finally, men tend to utilize many health care services less than women; in the case of HIV, these results in delayed treatment, poorer antiretroviral therapy (ART) outcomes, and potentially more HIV transmission. The Rakai Health Sciences Program (RHSP), Uganda, has documented many challenges related to male use of SRH services in the general population of the ongoing Rakai Community Cohort Study (RCCS) - a longitudinal behavioral and HIV study of 50 villages - despite the fact that the RHSP offers services free of charge through PEPFAR. In this RO1, we propose to conduct mixed method qualitative and quantitative research on personal, social and structural facilitators and barriers to the acceptance and use of key SRH-associated services by adolescent and adult men, and to explore attitudes regarding potential approaches to increase SRH use. Qualitative research, conducted among male users and non-users of services, family (e.g., spouses, parents) and community members (e.g., influential peers, service providers), will include focus groups to examine community norms; and in-depth interviews to explore personal factors, social influences and perceived structural barriers (such as quality of services) which influence use of SRH. We will also conduct structured observations in service provision sites to identify venue-related obstacles and in other community settings to examine if selected services may be provided there. The qualitative research will be embedded within the RCCS, providing a unique opportunity to purposively enroll male participants on the basis of risk behaviors and service use/nonuse, and to explore social and familial contexts of and influences on male SRH behaviors. On the basis of FGD and IDI data, we will also design and incorporate a module on male SRH into the annual RCCS survey of ~14,000 adults, in order to examine the generalizability of the qualitative findings in the Rakai population and to determine the distribution of key attitudes, perceptions and behaviors. This RO1 will provide the most comprehensive information to date on barriers to and potential motivators of male SRH service acceptance/use in an African setting, and will inform the design of future intervention studies of community and clinic-based strategies to improve male uptake of services such as condoms, MC, family planning, and for HIV+ men, ART. Findings, which will be disseminated in the African region, will also have implications for improving male use of other health and preventive services.