Reducing AIDS stigma among health professionals in South India

描述(由申请者提供)：长期以来，艾滋病污名一直被认为是全球抗击艾滋病毒的一个重要障碍。在印度和其他地方，艾滋病的耻辱 事实一再表明，这不仅会给艾滋病毒携带者带来困难和痛苦，而且会干扰寻求艾滋病毒咨询和检测的决定，限制艾滋病毒感染者向他人透露其状况的意愿，并阻止感染者因艾滋病毒相关问题而寻求和坚持接受治疗。边缘化群体的成员经常遭受额外的耻辱，迫使他们隐藏自己的生活方式，并使其更难 参加艾滋病相关的预防和治疗计划。尽管一些污名研究人员呼吁严格评估、基于理论的污名减少干预措施，但很少有这样的计划到位。我们提出的研究旨在填补这一空白。这一合作应用程序建立在我们在南印度长达十年的合作研究项目以及国际妇女研究中心(ICRW)进行的研究成果的基础上。我们的数据显示，卫生专业人员往往是印度艾滋病污名的一个重要来源，这突显了在卫生保健环境中开发和测试干预措施的必要性。ICRW制定并实施了这样一种干预措施，已被认为是可以接受和可行的。在我们的试点干预中，修改后的版本减少了印度护理学生的耻辱。这一有希望的干预措施的有效性现在已经准备好在一项随机对照试验中进行正式评估，对象是护生和病房服务员，这两种类型的医疗保健提供者在我们的初步工作中表现出最大程度的艾滋病污名。为了使干预产生重大和持久的影响，干预还需要是可持续的，并考虑到工作人员的时间限制等方面。因此，我们建议使用创新的交付模式来实现这些目标：1.采用交互式触摸屏方法和为参与者工作类型量身定做的视频片段，将ICRW医疗保健提供者减少耻辱的干预措施调整为部分基于平板电脑的交付。2.进行整群随机对照试验，评估这一干预措施在24个机构中的效果：a)认可歧视艾滋病毒患者的强制性政策和意图；b)工具性和象征性污名；这两个因素已被发现在这种情况下导致污名的表现。

DESCRIPTION (provided by applicant): AIDS stigma has long been recognized as a significant barrier in the worldwide fight against HIV. In India, as well as elsewhere, AIDS stigma has repeatedly been shown, not only to inflict hardship and suffering on people with HIV, but also to interfere with decisions to seek HIV counseling and testing, limit HIV-infected individuals willingness to disclose their status to others, and to deter infected individuals from seeking and adhering to medical treatment for HIV-related problems. Members of marginalized groups often experience additional stigma, forcing them to hide their lifestyles and making it more difficult to attend AIDS-related prevention and treatment programs. Although several stigma researchers have called for rigorously evaluated, theory-based stigma reduction interventions, few such programs are in place. Our proposed research aims to fill this gap. This collaborative application builds on findings from our decade-long collaborative research program in South India as well as on research conducted by the International Center for Research on Women (ICRW). Our data show that health professionals often represent a crucial source of AIDS stigma in India, highlighting the need to develop and test interventions in health care settings. ICRW has developed and implemented such an intervention, which has been found acceptable and feasible. A modified version reduced stigma among Indian nursing students in our pilot intervention. The efficacy of this promising intervention is now ready to be formally evaluated in a randomized controlled trial with nursing students and ward attendants; the two types of health care providers who showed the greatest levels of AIDS stigma in our preliminary work. In order for an intervention to have a significant and lasting impact, it also needs to be sustainable, and consider aspects such as staff time constraints. We thus propose to use an innovative delivery model to accomplish these goals: 1. Adapt the ICRW health care provider stigma reduction intervention for partial tablet PC-based delivery, using interactive touch screen methodology and video vignettes tailored to participant job type. 2. Conduct a cluster randomized controlled trial to evaluate the efficacy of this intervention in 24 institutions on a) the endorsement of coercive policies and intentions to discriminate toward HIV+ patients; b) instrumental and symbolic stigma; two factors which have been found to drive the manifestations of stigma in this setting.