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，美国有超过20万例病例归因于该人群。波多黎各人是居住在加勒比岛上的美国公民，是拉丁美洲人中日益流行的艾滋病的重要组成部分。部分由于社会污名，男变女变性人（MTF-TG）通常是一个被忽视和得不到充分服务的群体，尤其是在拉丁裔社区。在全国范围内，MTF-TG感染艾滋病毒的比例正在增加，每年新报告病例从3%增长到8%就是证明。广泛的研究表明，MTF-TG在研究、干预和服务中受到高度歧视，经常被忽视。对MTF-TG的污名化可能会产生严重的健康影响，因为在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，从事高风险的性行为，并且没有得到现有保健服务。关于TG健康的新文献强调需要将研究和干预的重点放在医生身上，许多医生在这些问题上几乎没有接受过培训，因此可能缺乏提供高质量卫生保健的知识、经验和敏感性。此外，文献强调缺乏获得高质量健康的机会