Gender Disparities in High-Risk PITC: The Role of Policy on Provider Practices

高风险 PITC 中的性别差异：政策对提供者实践的作用

• 批准号: 8789975
• 负责人: Kathryn L Dovel
• 金额: $ 3.44万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-12 至 2016-09-11
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8789975
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Affect; Africa South of the Sahara; Caring; Child; Client; Clinic; Consequences of HIV; Counseling; Country; Data Analyses; Developing Countries; Development; Failure; Fellowship; Female; Fright; Future; Gender; HIV; HIV Seropositivity; HIV risk; Health; Health Personnel; Health Policy; Health Services; Health care facility; Healthcare; Human immunodeficiency virus test; Income; Individual; Institution; International; Interview; Knowledge; Lead; Learning; Life; Malawi; Methods; Mission; Morbidity - disease rate; National Health Policy; National Institute of Mental Health; Perception; Play; Policies; Policy Research; Postnatal Care; Prevalence; Protocols documentation; Provider; Public Health; Publishing; Recommendation; Regulation; Research; Risk; Role; Services; Sex Characteristics; Sexual Health; Sexually Transmitted Diseases; Site; Surveys; Testing; Text; Training; Woman; career; design; high risk; implementation research; improved; innovation; insight; male; men; mortality; public health relevance; service utilization; therapy design; training project; tuberculosis treatment

DESCRIPTION (provided by applicant): The proposed fellowship will prepare the applicant for a research career focused on HIV policies and their implementation in practice. A comprehensive training plan accompanies the proposed study and has the following objectives: (1) develop knowledge of both HIV policies and the implementation of HIV testing protocols in sub-Saharan Africa (SSA); (2) increase methodological capacity in surveys, in-depth interviews, and policy discourse analysis; and (3) publish and present research findings. The specific focus of the proposed study is to examine men's underutilization of HIV testing, and thus life-prolonging treatment. Men constitute the majority of AIDS-related morbidity and mortality in SSA even though they are less likely than women to be infected. A primary contributor to men's high rate of AIDS-related mortality is their failure to access HIV testing: in Malawi, where the study will be conducted, men comprise only 33% those tested for HIV. A common explanation is that men are more reluctant than women to learn their HIV status due to concerns that a positive status would compromise their masculinity. A plausible additional explanation is structural rather than individual: as a result of feminized policies that emphasize women's excess vulnerability to HIV, healthcare providers offer fewer HIV testing services to men than women. In Malawi, virtually all women seeking antenatal care are tested for HIV, but men must specifically request testing. Yet even in venues where all clients should be offered HIV testing, as is the case for Malawians with TB or sexually transmitted infections (STIs), men are less likely to be tested. A possible explanation could be that feminized HIV policies affect how providers interact with male versus female clients. Although studies in high-income countries show that feminized sexual health policies can lead providers to offer fewer health services to men than women, there are no equivalent studies in the high HIV-prevalence countries of SSA. The proposed study in Malawi will be the first to examine if HIV policy influences providers' perceptions of gender and HIV, and whether this affects providers' implementation of HIV testing protocols for TB and STI clients. The study has three aims: (1) To use policy discourse analysis to examine how men and women are portrayed in HIV policy, using as texts both national policies and provider-training materials; (2) To collect and analyze data from in-depth interviews with healthcare providers to assess whether there are differences in their perceptions of male and female clients; (3) To collect and analyze data from exit surveys with TB and STI clients to test whether providers offer HIV testing differently to male versus female clients. Findings from the three aims will be examined together through mixed methods analysis in order to explore the relationship between HIV policy, provider perceptions, and provider implementation of HIV testing protocols. Findings will have implications for HIV policies and can inform interventions designed to increase men's use of HIV services. The project aligns with the mission and objectives of NIMH by addressing the causes of disparities in HIV service utilization among high-risk groups.

描述（由申请人提供）：拟议的奖学金将准备申请人的研究生涯侧重于艾滋病毒政策及其在实践中的实施。一项综合培训计划伴随着拟议的研究，并有以下目标：（1）在撒哈拉以南非洲（SSA）发展艾滋病毒政策和艾滋病毒检测协议的实施知识;（2）提高调查，深入访谈和政策话语分析的方法能力;和（3）出版和介绍研究结果。拟议研究的具体重点是审查男子对艾滋病毒检测利用不足的情况，从而审查延长生命的治疗。在撒南非洲，男子占艾滋病相关发病率和死亡率的大多数，尽管他们受感染的可能性低于妇女。男性艾滋病相关死亡率高的一个主要原因是他们未能获得艾滋病毒检测：在马拉维，在进行研究的地方，男性仅占艾滋病毒检测的33%。一个常见的解释是，男子比妇女更不愿意了解自己的艾滋病毒状况，因为他们担心阳性状况会损害他们的男子气概。另一个合理的解释是结构性的，而不是个人的：由于强调妇女对艾滋病毒过度脆弱性的女性化政策，保健提供者向男子提供的艾滋病毒检测服务少于妇女。在马拉维，几乎所有寻求产前护理的妇女都接受了艾滋病毒检测，但男子必须特别要求检测。然而，即使在所有客户都应接受艾滋病毒检测的场所，如患有结核病或性传播感染的马拉维人，男性接受检测的可能性也较小。一个可能的解释是，艾滋病毒政策的女性化影响了服务提供者与男性客户和女性客户的互动方式。虽然在高收入国家的研究表明，女性化的性健康政策可能导致提供者向男子提供的保健服务少于妇女，但在撒哈拉以南非洲艾滋病毒高流行率国家没有类似的研究。在马拉维进行的拟议研究将首次审查艾滋病毒政策是否影响提供者对性别和艾滋病毒的看法，以及这是否影响提供者对结核病和性传播感染客户实施艾滋病毒检测方案。这项研究有三个目标：（1）使用政策话语分析，以国家政策和提供者培训材料为文本，研究艾滋病毒政策中如何描绘男子和妇女;（2）收集和分析与保健提供者深入访谈的数据，以评估他们对男女客户的看法是否存在差异;（3）收集和分析结核病和性传播感染患者的离职调查数据，以测试提供者是否对男性和女性患者提供不同的艾滋病毒检测。三个目标的结果将通过混合方法分析，以探讨艾滋病毒政策，供应商的看法，和供应商执行艾滋病毒检测协议之间的关系一起检查。调查结果将对艾滋病毒政策产生影响，并为旨在增加男子使用艾滋病毒服务的干预措施提供信息。该项目通过解决高危群体之间艾滋病毒服务利用率差异的原因，与国家艾滋病和家庭卫生研究所的使命和目标保持一致。