HIV/AIDS Stigma Behaviors in Clinical Encounters

临床遇到的艾滋病毒/艾滋病耻辱行为

• 批准号: 8658905
• 负责人: NELSON VARAS-DIAZ
• 金额: $ 11.55万
• 依托单位: UNIVERSITY OF PUERTO RICO RIO PIEDRAS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8658905
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Anti-Retroviral Agents; Antiretroviral resistance; Attitude; Behavior; Behavioral; California; Caribbean region; Case Study; Centers for Disease Control and Prevention (U.S.); Client; Clinical; Code; Collaborations; Common Cold; Communication; Communities; Data Analyses; Development; Distant; Documentation; Drug usage; Drug user; Epidemic; Experimental Designs; Face; Faculty; Florida; Fostering; Funding; Future; Gender Role; Goals; Guidelines; HIV; HIV Infections; Health; Health Personnel; Health Professional; Health Services; Healthcare; Heterosexuals; Hispanics; Homophobia; Homosexuals; Independent Scientist Award; Individual; Infection; International; Intervention; Island; Latino; Link; Literature; Measurement; Measures; Medical; Medical Students; Methodology; Methods; National Institute of Drug Abuse; Needle Sharing; Observational Study; Outcome; Participant; Patient Education; Patient Simulation; Patients; Perception; Performance; Physicians; Population; Population Intervention; Positioning Attribute; Prevalence; Provider; Puerto Rican; Puerto Rico; Questionnaires; Randomized; Recruitment Activity; Reporting; Research; Research Design; Role; Sampling; San Francisco; Science; Series; Services; Simulate; Stigmatization; Structure; Techniques; Technology; Testing; United States; United States National Institutes of Health; Universities; Variant; Video Recording; Visual Fields; West Indies; base; career; career development; experience; improved; intravenous drug use; member; programs; public health relevance; research study; simulation; skills; social stigma; transmission process

DESCRIPTION (provided by applicant): The proposed K02 Independent Scientist Award application to the National Institute on Drug Abuse (NIDA) is an extension of my ongoing commitment to research aiming to address HIV/AIDS stigma among Latino populations, specifically Puerto Ricans. Puerto Rico is a Caribbean Island linked to the United States, where HIV infection prevalence has been estimated at 1% (more than 35,000 reported cases). The Island's epidemic is mainly driven by unclean needle sharing for injected drug use (IDU) and is embedded in the Caribbean region which has the second highest rates of HIV/AIDS in the world. Therefore, the need for stigma- free health services is ever-growing. My research career has been characterized by an ongoing commitment to addressing the role of stigmatization on access to quality health services for people with HIV/AIDS (PWHA) in this setting. In my previous NIH funded studies I have focused on the identification and reduction of HIV/AIDS stigma attitudes among health professionals. The proposed K02 will allow me to extend this research agenda to address the behavioral components of HIV/AIDS stigma as manifested in clinical interactions. My long-term career goals include: 1) advancing the understanding of the interrelation between HIV/AIDS stigma attitudes and behaviors (i.e. verbal and non-verbal) manifested by health professionals in Puerto Rico, 2) documenting the underlying predictors and cultural correlates of HIV/AIDS stigma attitudes and behaviors in the Puerto Rican setting, and 3) developing scientifically tested stigma measurement guidelines and interventions to reduce both HIV/AIDS stigma attitudes and behaviors among this population. As part of the proposed K02 application I propose several career development strategies to foster my long-term career goals. These include: 1) the acquisition of new skills related to the use of Standardized Patient Simulation Technology for use in research via extended contact with the University of Puerto Rico's Standardized Patient Program, and 2) collaborations with experts in the field of visual methodologies and observational data analysis at the University of Rochester, Florida International University and the University of California at San Francisco. With the skills acquired through these interactions, I will be better positioned to implement the proposed research plan in which I propose to study the dynamics of physician/patient interaction that may contribute to stigmatization of PWHA, through an observational study of simulated interactions using a standardized patient (SP) program in Puerto Rico. The proposed study has the following aims: Aim 1 - To document HIV/AIDS stigma attitudes and their role on behavioral manifestations of stigma during physician/patient interactions in a sample of medical residents in Puerto Rico; Aim 2 - To document variations of HIV/AIDS stigma behaviors during physician/patient interactions when providing services to clients with different modes of HIV transmission; and Aim 3 - To determine the role of cultural factors (i.e., traditional gender roles religiosity, homophobia, and stigmatization of drug users) on attitudinal and behavioral manifestations of HIV/AIDS stigma among medical residents in Puerto Rico. To achieve these aims I propose an experimental design using mixed method techniques (structured observations, quantitative questionnaires, and SP simulations). The study will be conducted through the SP program at the University of Puerto Rico's Medical Sciences Campus. I will recruit a sample of 154 medical residents in Puerto Rico to participate in an experiment embedded within their ongoing SP training, and assign them to engage in all of the following patient conditions, with randomized order of presentation: 1) HIV-infected through intravenous drug use, 2) HIV-infected through unprotected heterosexual relations, 3) HIV-infected through unprotected homosexual relations, 4) HIV-infected through unprotected heterosexual relations or intravenous drug use, 5) HIV-infected through unprotected homosexual relations or intravenous drug use, 6) HIV-infected through unprotected homosexual or heterosexual relations, and 7) the common cold as a stigma- free comparison control. Interactions will be video-recorded and subsequently coded for behavioral expressions of stigma using a preliminary developed and pilot-tested measure from my NIH funded studies. After participation in the simulation, all participants will complete quantitative questionnaires addressing HIV/AIDS stigma attitudes and adherence to cultural factors of importance in the Puerto Rican setting. The study will be the first to document behavioral manifestations of HIV/AIDS stigma among medical residents in Puerto Rico, thereby extending the scientific literature that has focused almost exclusively on their stigmatizing attitudes. Furthermore, it will be the first study to address the role of cultural factors on the manifestations of HIV/AIDS stigma among this population in Puerto Rico and variations related to means of infection. The findings from the study have the potential to inform the development of guidelines for stigma measurement and stigma reduction interventions for this population, taking into consideration both attitudinal and behavioral manifestations of stigma, and the role of local culture on these indicators.

拟议的K 02独立科学家奖申请国家药物滥用研究所（NIDA）是我正在致力于研究的延伸，旨在解决拉丁美洲人口，特别是波多黎各人中的艾滋病毒/艾滋病耻辱。波多黎各是一个与美国相连的加勒比岛屿，艾滋病毒感染率估计为1%（报告病例超过35，000例）。该岛的流行病主要是由共用不洁针头注射毒品造成的，并植根于世界上艾滋病毒/艾滋病发病率第二高的加勒比地区。因此，对无耻辱感的保健服务的需求日益增长。我的研究生涯的特点是持续致力于解决污名化在艾滋病毒/艾滋病（PWHA）患者获得优质医疗服务方面的作用。在我以前的国家卫生研究院资助的研究中，我集中在识别和减少卫生专业人员对艾滋病毒/艾滋病的耻辱态度。拟议的K 02将使我能够扩展这一研究议程，以解决艾滋病毒/艾滋病的耻辱表现在临床互动的行为组成部分。我的长期职业目标包括：1）增进对艾滋病毒/艾滋病污名化态度和行为之间相互关系的理解（即口头和非口头）表现出的卫生专业人员在波多黎各，2）记录潜在的预测因素和文化相关的艾滋病毒/艾滋病的耻辱态度和行为，在波多黎各设置，（3）制定经过科学检验的艾滋病污名测量指南和干预措施，以减少这一人群的艾滋病污名态度和行为。 作为K 02申请的一部分，我提出了几个职业发展战略，以促进我的长期职业目标。其中包括：1）通过与波多黎各大学标准化患者计划的长期接触，获得与使用标准化患者模拟技术用于研究相关的新技能，以及2）与罗切斯特大学，佛罗里达国际大学和加州大学弗朗西斯科分校的视觉方法和观察数据分析领域的专家合作。的技能 通过这些相互作用获得的，我将更好地定位于实施拟议的研究计划，其中我建议通过在波多黎各使用标准化患者（SP）计划进行模拟相互作用的观察性研究，研究可能导致PWHA污名化的医生/患者相互作用的动态。拟议的研究有以下目的：目的1 -记录艾滋病毒/艾滋病污名化的态度和他们的作用，在医生/病人的互动过程中的污名化的行为表现在波多黎各的医疗居民的样本;目的2 -记录艾滋病毒/艾滋病污名化行为的变化，在医生/病人的互动过程中提供服务的客户与不同的艾滋病毒传播模式;目标3 -确定文化因素的作用（即，传统的性别角色，宗教信仰，同性恋恐惧症和吸毒者的污名化）对波多黎各住院医生艾滋病毒/艾滋病污名化的态度和行为表现的影响。 为了实现这些目标，我提出了一个实验设计，使用混合方法技术（结构化观察，定量问卷调查，SP模拟）。该研究将通过波多黎各大学医学院的SP项目进行。我将在波多黎各招募154名住院医师参加一项实验，该实验嵌入他们正在进行的SP培训中，并将他们分配到以下所有患者条件中，随机顺序呈现：1）通过静脉注射毒品感染艾滋病毒，2）通过无保护的异性关系感染艾滋病毒，3）通过无保护的同性关系感染艾滋病毒，4）通过无保护的异性性关系或静脉注射毒品感染HIV，5）通过无保护的同性性关系或静脉注射毒品感染HIV，6）通过无保护的同性性关系或异性性关系感染HIV，以及7）普通感冒作为无耻辱感的比较对照。互动将被录像，随后使用我的NIH资助的研究的初步开发和试点测试的措施编码的耻辱的行为表达。参加模拟后，所有参与者将完成定量问卷调查，解决艾滋病毒/艾滋病的耻辱态度和坚持在波多黎各设置的重要文化因素。 这项研究将是第一个记录波多黎各医疗居民中艾滋病毒/艾滋病污名化行为表现的研究，从而扩展了几乎完全集中在他们污名化态度上的科学文献。此外，这将是第一项研究，探讨文化因素对波多黎各人口中艾滋病毒/艾滋病耻辱表现的作用以及与感染方式有关的各种差异。研究结果有可能为制定针对这一人群的污名化衡量和减少污名化干预措施的指导方针提供信息，同时考虑到污名化的态度和行为表现以及当地文化对这些指标的作用。