Physicians and Health Related Services for Male to Female Transgender Persons

为男性跨性别者提供的医生和健康相关服务

• 批准号: 8827855
• 负责人: MARK B PADILLA
• 金额: $ 19.3万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 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 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8827855
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Alcohol or Other Drugs use; Area; Attitude; Behavior; Caring; Case Study; Centers for Disease Control and Prevention (U.S.); Clinic; Clinical; Communities; Data; Documentation; Epidemic; Female; Focus Groups; Fostering; Future; Gender; Growth; HIV; HIV Infections; Health; Health Services; Heterosexuals; Human Resources; Improve Access; Intervention; Interview; Island; Knowledge; Latino; Light; Literature; Masks; Measures; Medical; Methods; Persons; Physicians; Population; Population Research; Prevention approach; Probability; Puerto Rican; Puerto Rico; Quality of Care; Questionnaires; Recruitment Activity; Reporting; Research; Research Personnel; Resources; Risk Behaviors; Sampling; Services; Stigmatization; Surveys; Technology; Testing; Tetanus Helper Peptide; Training; Vulnerable Populations; West Indies; Work; cultural values; design; experience; health care quality; high risk sexual behavior; improved; interest; intravenous drug user; male; medical schools; men; men who have sex with men; neglect; prevention service; service intervention; sex; social exclusion; social stigma; transgender; willingness

DESCRIPTION (provided by applicant): HIV/AIDS continues to affect the Latino community disproportionately, with more than 200,000 cases in the US attributed to this population. Puerto Ricans are US citizens residing in the Caribbean Island and are a significant part of the growing epidemic among Latinos. Due in part to social stigma, Male-to-Female Transgenders (MTF-TG) constitutes an invisible and underserved group in general, and particularly among Latino communities. Nationally, the proportion of MTF-TG infected with HIV is increasing, as evidenced by the growth from 3% to 8% in new reported cases per year. Extensive research demonstrates that MTF-TG are highly stigmatized and often overlooked in research, interventions, and services. Stigmatization of MTF-TG may have serious health implications given the fact that studies in other contexts have demonstrated that a significant proportion of MTF-TG are infected with HIV, use substances, engage in high risk sexual behaviors, and are not reached by existing health services. The emerging literature on TG health has emphasized the need to focus research and interventions on physicians, many of which have received little training on these issues and may therefore lack the knowledge, experience, and sensitivity to provide quality health care. In addition, the literature emphasizes that a lack of access to quality health care resources can have compounded negative effects on MTF-TG by: decreasing their probability of accessing such services; reducing their access to knowledge about health and HIV prevention; and increasing their perceived stigmatization and marginalization through the medical encounter. These factors highlight the need to focus research on transgender health issues, emphasizing research contributing to interventions to improve access to quality health care for MTF-TG. In order to address this gap we propose a study with the following aims: 1. Explore qualitatively four areas of physician treatment of MTF-TG among a sample of professional physicians in Puerto Rico: (1) physician knowledge of MTF-TG health; (2) competency in treating MTF-TG; (3) willingness to provide services to MTF-TG; (4) and attitudes toward MTF-TG. 2. Document quantitatively the relationship between the stigmatization of MTF-TG (i.e., negative attitudes or behaviors toward MTF-TG) and areas 1-4 identified in Aim 1 (i.e., knowledge, competency, willingness, and attitudes). 3. Identify key intervention targets and strategies to be prioritized for an effective stigma-reduction interventio aiming to improve: (1) physician knowledge of transgender health issues; (2) physician competency to implement transgender-appropriate care; (3) physician willingness to provide quality services; and (4) physician attitudes towards MTF-TG among physicians in Puerto Rico. In order to achieve these objectives, we will implement a mixed method design using qualitative in- depth interviews, focus groups and quantitative questionnaires administered via iPad technology. For aim 1, we will carry out (N = 30) in-depth interviews with physicians who work in HIV-related clinical settings in Puerto Rico. The qualitative information will be used to develop a meaningful understanding of the factors of interest (i.e. knowledge, competency, willingness to treat, and attitudes). For aim 2, we will draw on qualitative data to culturally adapt and pilot tet quantitative measures to assess our variables of interest. We will then administer our survey to a purposive sample of 300 physicians in Puerto Rico, including those who work in HIV-related service delivery and those who do not. Aim 3 will draw on data from focus groups with 30 key personnel from medical schools and medical organizations, as well as 15 MTF-TG recruited by our team's transgender Community Advisory Board, to identify key intervention targets and strategies for reducing stigma and improving access and quality of care. The gathered data will contribute to developing and testing a future intervention that can foster access to quality HIV prevention and health services for MTF-TG in Puerto Rico.

描述（由申请人提供）：艾滋病毒/艾滋病继续不成比例地影响拉丁裔社区，在美国有超过20万例病例归因于这一人群。波多黎各人是居住在加勒比岛屿的美国公民，是拉丁美洲人中日益增长的流行病的重要组成部分。部分由于社会耻辱，男变女跨性别者（MTF-TG）构成了一个无形的和服务不足的群体，特别是在拉丁美洲社区。在全国范围内，MTF-TG感染艾滋病毒的比例正在增加，每年新报告的病例从3%增加到8%。广泛的研究表明，MTF-TG是高度污名化的，往往被忽视的研究，干预和服务。由于其他情况下的研究表明，很大一部分MTF-TG感染了艾滋病毒，使用药物，从事高风险性行为，并且没有得到现有的卫生服务，因此对MTF-TG的污名化可能会产生严重的健康影响。关于TG健康的新兴文献强调了将研究和干预措施集中在医生身上的必要性，其中许多医生在这些问题上几乎没有接受过培训，因此可能缺乏提供优质医疗保健的知识，经验和敏感性。此外，文献强调，缺乏获得优质保健的机会， 护理资源可能对MTF-TG产生复杂的负面影响：降低了他们获得此类服务的可能性;减少了他们获得健康和艾滋病毒预防知识的机会;并增加了他们通过医疗接触而感到的耻辱和边缘化。这些因素突出了需要把重点放在跨性别健康问题的研究，强调研究有助于干预措施，以改善获得优质的医疗保健MTF-TG。为了解决这一差距，我们提出了一项研究，具有以下目标：1。定性探讨医生治疗的MTF-TG在波多黎各的专业医生样本中的四个领域：（1）MTF-TG健康的医生知识;（2）治疗MTF-TG的能力;（3）愿意提供服务的MTF-TG;（4）和对MTF-TG的态度。2.定量记录MTF-TG的污名化（即，对MTF-TG的消极态度或行为）和目标1中确定的区域1-4（即，知识、能力、意愿和态度）。3.确定关键的干预目标和战略，以优先有效的污名减少干预，旨在提高：（1）医生的跨性别健康问题的知识;（2）医生的能力，以实施跨性别适当的护理;（3）医生愿意提供优质服务;（4）医生对MTF-TG的态度在波多黎各的医生。 为了实现这些目标，我们将实施混合方法设计，使用定性深入访谈，焦点小组和通过iPad技术管理的定量问卷。对于目标1，我们将对波多黎各在艾滋病毒相关临床环境中工作的医生进行（N = 30）深入访谈。定性信息将用于制定 对利益因素（即知识，能力，治疗意愿和态度）的有意义的理解。对于目标2，我们将利用定性数据进行文化适应和试点泰特定量措施，以评估我们感兴趣的变量。然后，我们将对波多黎各的300名医生进行有目的的抽样调查，包括那些从事艾滋病毒相关服务的医生和那些不从事艾滋病毒相关服务的医生。目标3将利用来自医学院和医疗组织的30名关键人员以及我们团队的跨性别社区咨询委员会招募的15名MTF-TG的焦点小组的数据，以确定关键干预目标和战略，以减少耻辱感，改善护理的可及性和质量。收集的数据将有助于制定和测试未来的干预措施，以促进波多黎各的MTF-TG获得高质量的艾滋病毒预防和保健服务。