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(申请人提供)：艾滋病毒/艾滋病继续对拉美裔社区造成不成比例的影响，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海岛上的美国公民，他们是拉美裔日益流行的流行病的重要组成部分。部分由于社会耻辱，男女变性者(MTF-TG)总体上是一个看不见的、服务不足的群体，特别是在拉丁裔社区中。在全国范围内，MTF-TG感染艾滋病毒的比例正在增加，每年新报告病例的比例从3%增长到8%就是明证。广泛的研究表明，MTF-TG被高度污名化，在研究、干预和服务中往往被忽视。对MTF-TG的污名化可能具有严重的健康影响，因为在其他情况下的研究表明，相当大比例的MTF-TG感染艾滋病毒、使用药物、从事高风险的性行为，并且不是现有卫生服务所能触及的。关于TG健康的新兴文献强调了将研究和干预的重点放在医生身上的必要性，他们中的许多人几乎没有接受过这些问题的培训，因此可能缺乏提供高质量医疗保健的知识、经验和敏感度。此外，文献强调，缺乏获得高质量健康的机会 护理资源可通过以下方式对MTF-TG产生复杂的负面影响：减少他们获得这类服务的可能性；减少他们获得健康和艾滋病毒预防知识的机会；以及通过就医增加他们感受到的污名化和边缘化。这些因素突出了将研究重点放在变性人健康问题上的必要性，强调有助于干预措施的研究，以改善MTF-TG获得高质量医疗保健的机会。为了弥补这一差距，我们提出了一项研究，目的如下：1.在波多黎各的专业医生样本中，定性地探索医生治疗MTF-TG的四个方面：(1)医生对MTF-TG健康的知识；(2)治疗MTF-TG的能力；(3)向MTF-TG提供服务的意愿；(4)对MTF-TG的态度。2.量化地记录MTF-TG的污名化(即对MTF-TG的负面态度或行为)与目标1中确定的领域1-4(即知识、能力、意愿和态度)之间的关系。3.确定关键干预目标和战略，以便为有效的减少污名干预工作确定优先事项，目的是改善：(1)医生对变性人健康问题的了解；(2)医生实施变性人适当护理的能力；(3)医生提供优质服务的意愿；(4)波多黎各医生对MTF-TG的态度。为了实现这些目标，我们将实施混合方法设计，使用定性的深度访谈、焦点小组和通过iPad技术管理的定量问卷。对于目标1，我们将对在波多黎各艾滋病毒相关临床环境中工作的医生进行(N=30)深入访谈。定性信息将用于开发一种 对感兴趣的因素(即知识、能力、治疗意愿和态度)有意义的了解。对于目标2，我们将利用定性数据来适应文化，并试行TET量化措施来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，其中包括从事艾滋病毒相关服务提供工作的医生和不从事艾滋病毒相关服务工作的医生。目标3将利用焦点小组的数据，这些小组有来自医学院和医疗组织的30名关键人员，以及我们团队的变性人社区咨询委员会招聘的15名MTF-TG，以确定减少耻辱、改善获得和护理质量的关键干预目标和战略。收集到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MTF-TG获得高质量的艾滋病毒预防和保健服务。