Stigma, Cohesion and HIV Outcomes Among Vulnerable Women Across Epidemic Settings

流行病环境下弱势妇女的耻辱、凝聚力和艾滋病毒结果

• 批准号: 9892029
• 负责人: DEANNA L KERRIGAN
• 金额: $ 20.55万
• 依托单位: AMERICAN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-15 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9892029
• 关键词: Address; Africa South of the Sahara; Attention; Behavior; Biological; Biological Markers; Blood; Caring; Communities; Community Workers; Complex; Country; Data; Data Analyses; Development; Dominican Republic; Drops; Effectiveness; Elements; Epidemic; Equation; Funding; Gender; General Population; Geography; HIV; Health; Health Services Accessibility; Incidence; Interruption; Interview; Longitudinal Studies; Measurement; Measures; Mediating; Meta-Analysis; Methodology; Modeling; National Institute of Mental Health; Occupations; Outcome; Participant; Pathway interactions; Prevention; Preventive Intervention; Principal Investigator; Qualitative Methods; Research; Research Infrastructure; Risk; Role; Services; Social Environment; Socioeconomic Status; Structure; Subgroup; Tanzania; Time; Treatment outcome; USAID; Variant; Viral; Woman; Work; antiretroviral therapy; base; care systems; cognitive interview; cohesion; cohort; condoms; consistent condom use; empowerment; experience; female sex worker; improved; individualized medicine; mathematical model; novel; primary outcome; programs; protective behavior; public health relevance; response; sex; social; social cohesion; social determinants; social stigma; social structure; solidarity; structured data; systematic review; theories; therapy adherence; transmission process; treatment services

 DESCRIPTION (provided by applicant): Stigma, cohesion and HIV outcomes among vulnerable women across epidemic settings Female sex workers (FSW) are at significantly heightened risk for HIV. Globally, FSW have a 13.5 times greater odds of being HIV-infected compared to women who are not sex workers. Despite this burden, less than half of FSW have access to antiretroviral therapy (ART). HIV stigma is a critical social determinant known to negatively influence HIV outcomes including access to treatment and ART adherence. For FSW living with HIV, the impact of HIV stigma may be further compounded by other forms of stigma related to their occupation, gender, and/or socioeconomic position. In response to such stigmas, FSW in many settings have come together in solidarity to address the socio-structural context of their HIV-related risk. Social cohesion within the sex worker community has been a central element of community-based responses to HIV and is significantly associated with protective behaviors. However, the role of social cohesion, and its potential mediating influence on HIV and sex work stigma, has yet to be explored in relation to HIV treatment outcomes. While significant attention has been paid to the measurement of HIV stigma in past studies, much less emphasis has been placed on other intersecting social stigmas, including the measurement of sex work stigma. Utilizing the existing research infrastructure of two ongoing cohorts located within distinct social and epidemic settings, we propose to longitudinally examine the role of HIV and sex work stigma and social cohesion as key social determinants of HIV outcomes among FSW living with HIV in Tanzania and the DR. Our specific aims are to: (1) Develop a valid and reliable aggregate measure of sex work-related stigma tailored to the realities of FSW living with HIV in distinct social and epidemic contexts; (2) Determine the roles of HIV and sex work stigma and social cohesion as predictors of biologic HIV outcomes (e.g. ART in the blood, viral suppression) across settings; and (3) Qualitatively explore the dynamic context of HIV and sex work- related stigma and social cohesion among FSW in relation to HIV services and outcomes. For Aim 1 we will use qualitative methods to inform measurement development including both in-depth and cognitive interviews (n=40). We will then employ IRT and factor and reliability analysis to establish shared and distinct items related to the domain of sex work stigma per context. In Aim 2, we will conduct longitudinal structural equation modeling to examine predictors and pathways between HIV and sex work stigma, social cohesion and viral suppression in the context of other known correlates of viral suppression among cohorts of FSW living with HIV in Tanzania and the DR (n=400). In Aim 3 will explore the dynamic social context of HIV and sex work stigma and social cohesion through longitudinal qualitative in-depth interviews among a subset of cohort participants in each country (n=40). Findings will inform tailored treatment as prevention interventions among FSW across geographic and epidemic settings.

 描述（由申请人提供）：耻辱，凝聚力和艾滋病毒的结果在整个流行病环境中的弱势妇女女性性工作者（FSW）的艾滋病毒的风险显着增加。在全球范围内，性工作者感染艾滋病毒的几率是非性工作者的13.5倍。尽管有这种负担，但只有不到一半的家庭成员能够获得抗逆转录病毒疗法。艾滋病毒污名化是一个关键的社会决定因素，已知会对艾滋病毒结果产生负面影响，包括获得治疗和坚持抗逆转录病毒疗法。对于感染艾滋病毒的女性工作者来说，艾滋病毒污名化的影响可能会因与其职业、性别和/或社会经济地位有关的其他形式的污名化而进一步加剧。为了应对这种耻辱，FSW在许多情况下团结一致，解决其艾滋病毒相关风险的社会结构背景。性工作者社区内的社会凝聚力一直是以社区为基础的艾滋病毒应对措施的核心要素，并与保护行为密切相关。然而，社会凝聚力的作用及其对艾滋病毒和性工作污名化的潜在中介影响，尚未在艾滋病毒治疗结果方面加以探讨。 虽然在过去的研究中对艾滋病毒污名化的衡量给予了极大的关注，但对其他交叉的社会污名化，包括性工作污名化的衡量，却重视得少。利用现有的研究基础设施，两个正在进行的队列位于不同的社会和流行病的设置，我们建议纵向研究艾滋病毒和性工作的耻辱和社会凝聚力的作用，作为艾滋病毒的结果之间的关键社会决定因素FSW艾滋病毒感染者在坦桑尼亚和DR。（1）针对感染艾滋病毒的女性性工作者在不同的社会和流行病背景下的实际情况，制定一项有效和可靠的与性工作有关的污名化综合衡量标准;（2）确定艾滋病毒和性工作耻辱和社会凝聚力作为艾滋病毒生物学结果预测因素的作用（如血液中的抗逆转录病毒疗法、病毒抑制）;和（3）定性研究探讨艾滋病毒和性工作的动态背景-在艾滋病毒服务和成果方面，FSW之间存在相关的耻辱感和社会凝聚力。 对于目标1，我们将使用定性方法来告知测量开发，包括深度和认知访谈（n=40）。然后，我们将采用IRT和因素和可靠性分析，以建立共享和不同的项目有关的领域的性工作耻辱的每一个上下文。在目标2中，我们将进行纵向结构方程建模，以检查艾滋病毒和性工作耻辱，社会凝聚力和病毒抑制之间的预测因子和途径，在坦桑尼亚和DR（n=400）的FSW感染艾滋病毒的队列中，其他已知的病毒抑制相关因素。在目标3中，将通过对每个国家（n=40）的一部分队列参与者进行纵向定性深入访谈，探讨艾滋病毒和性工作耻辱感和社会凝聚力的动态社会背景。调查结果将告知量身定制的治疗作为预防干预措施之间的FSW跨地理和流行病的设置。