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: 8820903
• 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/8820903
• 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; 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; 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.

描述(由申请人提供)：向国家药物滥用研究所(NIDA)提出的K02独立科学家奖申请是我对旨在解决拉美裔人口，特别是波多黎各人中艾滋病毒/艾滋病污名问题研究的持续承诺的延伸。波多黎各是与美国相连的加勒比海岛屿，那里的艾滋病毒感染率估计为1%(超过35000例报告病例)。该岛的流行主要是由注射毒品使用的不清洁针头共用造成的，并植根于艾滋病毒/艾滋病发病率世界第二高的加勒比地区。因此，对无污名医疗服务的需求与日俱增。我的研究生涯的特点是不断致力于解决污名化在艾滋病毒/艾滋病患者(PWHA)获得优质医疗服务方面的作用。在我之前由国立卫生研究院资助的研究中，我把重点放在确定和减少卫生专业人员对艾滋病毒/艾滋病污名的态度上。拟议的K02将使我能够扩展这项研究议程，以解决在临床互动中表现出来的艾滋病毒/艾滋病污名的行为成分。我的长期职业目标包括：1)促进对波多黎各卫生专业人员表现出的艾滋病毒/艾滋病污名态度和行为(即口头和非语言)之间相互关系的了解；2)记录波多黎各环境中艾滋病毒/艾滋病污名态度和行为的潜在预测因素和文化相关性；3)开发经过科学测试的污名测量指南和干预措施，以减少这一人群中的艾滋病毒/艾滋病污名态度和行为。作为建议的K02申请的一部分，我提出了几个职业发展战略，以帮助我实现长期的职业目标。其中包括：1)通过与波多黎各大学标准化患者计划的广泛接触，获得与使用标准化患者模拟技术进行研究相关的新技能；以及2)与罗切斯特大学、佛罗里达国际大学和加州大学旧金山分校的视觉方法学和观察性数据分析领域的专家合作。有了这些技能 通过这些互动，我将更好地实施拟议的研究计划，在该计划中，我建议通过使用波多黎各标准化患者(SP)计划对模拟互动进行观察性研究，研究可能导致PWHA污名化的医生/患者互动的动态。拟议的研究有以下目的：目的1--记录波多黎各医疗居民在医生/患者互动期间艾滋病毒/艾滋病污名的态度及其对污名行为表现的作用；目标2--记录向不同艾滋病毒传播方式的客户提供服务时，医生/患者互动期间艾滋病毒/艾滋病污名行为的变化；以及目标3--确定文化因素(即传统性别角色、宗教信仰、同性恋恐惧症和对吸毒者的污名)对波多黎各医疗居民艾滋病毒/艾滋病污名的态度和行为表现的作用。为了实现这些目标，我提出了一种使用混合方法的实验设计(结构化观察、定量问卷调查和SP模拟)。这项研究将通过波多黎各大学医学校园的SP项目进行。我将在波多黎各招募154名住院医师参加一项包含在他们正在进行的SP培训中的实验，并分配他们从事以下所有患者情况，按随机顺序排列：1)通过静脉吸毒感染艾滋病毒，2)通过无保护的异性关系感染艾滋病毒，3)通过无保护的同性恋关系感染艾滋病毒，4)通过无保护的异性关系或静脉吸毒感染艾滋病毒，5)通过无保护的同性恋关系或静脉吸毒感染艾滋病毒，6)通过无保护的同性恋或异性关系感染艾滋病毒，以及7)将普通感冒作为无耻辱的对照。互动将被录像，并随后使用我的NIH资助的研究中初步开发和试点测试的测量方法，对耻辱的行为表达进行编码。在参与模拟后，所有参与者将完成关于艾滋病毒/艾滋病污名态度和遵守波多黎各环境中重要文化因素的量化问卷。这项研究将首次记录波多黎各医疗居民中艾滋病毒/艾滋病污名的行为表现，从而扩大几乎只关注他们污名态度的科学文献。此外，这将是第一次研究文化因素对波多黎各这一人群中艾滋病毒/艾滋病污名表现的作用以及与感染手段有关的变化。这项研究的发现有可能为制定针对这一人群的污名测量和减少污名干预的指南提供参考，同时考虑到污名的态度和行为表现，以及当地文化对这些指标的作用。