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

描述（由申请人提供）：男性在采用目前证明有效的减少性传播艾滋病毒/性传播疾病风险的方法方面发挥着关键作用，包括坚持使用避孕套和男性包皮环切术（MC）。男子还影响伴侣使用避孕药具。然而，男性获得性健康和生殖健康信息和服务的切入点较少，因为大多数计划生育和怀孕相关方案都以妇女为中心。最后，男子往往比妇女更少地利用许多保健服务;就艾滋病毒而言，这导致治疗延误，抗逆转录病毒疗法效果较差，并可能导致更多的艾滋病毒传播。乌干达的Rakai保健科学方案记录了正在进行的Rakai社区队列研究-一项对50个村庄进行的行为和艾滋病毒纵向研究-中与一般人口中男性使用性健康和生殖健康服务有关的许多挑战，尽管Rakai保健科学方案通过总统艾滋病紧急救援计划免费提供服务。 在这RO 1中，我们建议进行混合方法定性和定量研究的个人，社会和结构的促进者和障碍的接受和使用的关键性健康和生殖健康相关服务的青少年和成年男子，并探讨态度的潜在方法，以增加性健康和生殖健康的使用。在服务的男性使用者和非使用者、家庭（例如，配偶、父母）和社区成员（例如，将包括重点小组，以审查社区规范;深入访谈，以探讨影响性健康和生殖健康使用的个人因素、社会影响和感知的结构性障碍（如服务质量）。我们亦会在提供服务的地点进行有系统的观察，以找出与场地有关的障碍，并在其他社区环境中进行观察，以研究可否在这些地方提供选定的服务。定性研究将嵌入RCCS，提供了一个独特的机会，有目的地招募男性参与者的基础上的风险行为和服务的使用/不使用，并探讨社会和家庭背景和男性性健康和生殖健康行为的影响。根据家庭幸福指数和国际发展指数的数据，我们还将设计一个关于男性性健康和生殖健康的模块，并将其纳入对约14 000名成年人的RCCS年度调查，以检查Rakai人口定性调查结果的普遍性，并确定主要态度、看法和行为的分布情况。 这份报告1将提供迄今为止最全面的信息，说明在非洲环境中男性接受/使用性健康和生殖健康服务的障碍和潜在动机，并将为今后设计社区和诊所战略干预研究提供信息，以改善男性接受避孕套、避孕药具、计划生育等服务的情况，并为艾滋病毒阳性男子提供抗逆转录病毒治疗。这也将对改善男性对其他保健和预防服务的利用产生影响。

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.