Social Networks, HIV Stigma, and the HIV Care Cascade in Rural Uganda

乌干达农村地区的社交网络、艾滋病毒耻辱和艾滋病毒护理串联

• 批准号: 9766402
• 负责人: ALEXANDER C TSAI
• 金额: $ 62.67万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9766402
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Adult; Africa South of the Sahara; Alcohol abuse; Attitude; Awareness; Belief; CD4 Positive T Lymphocytes; Caring; Cell Count; Cells; Coitus; Counseling; Data; Dimensions; Disclosure; Disease; Effectiveness; Foundations; HIV; HIV Infections; HIV Seronegativity; HIV antiretroviral; HIV risk; Health; Human immunodeficiency virus test; Intervention; Literature; Mediating; Mediation; Mental Depression; Methods; Migrant; Mission; Participant; Persons; Pilot Projects; Process; Production; Public Health; Research; Research Personnel; Research Priority; Resources; Risk; Rural; Self Efficacy; Social Network; Social support; Source; Stigmatization; Testing; Time; Treatment outcome; Uganda; United States National Institutes of Health; Viral; analytical method; antiretroviral therapy; base; cohort; coping; design; improved; innovation; population based; prevention service; response; seropositive; social; social stigma; therapy adherence; transmission process; uptake

PROJECT SUMMARY Of the 29 million persons living with HIV (PLHIV) in sub-Saharan Africa, only half are aware of their seropositivity, and among these, less than half are on HIV antiretroviral therapy (ART). The average CD4+ T-lymphocyte cell count at ART initiation in sub-Saharan Africa was 140 cells/mm3 as of 2012, demonstrating that late-stage disease at presentation to care and at ART initiation remain the norm. The stigma attached to HIV has been identified as a critical barrier to improving these HIV prevention and treatment outcomes. HIV remains heavily stigmatized throughout sub-Saharan Africa and has only been partially mitigated by current interventions. The scientific objective of this R01 application is to apply social network methods to understand the social production of HIV stigma, its propagation over time through the social network, and its causal effects on HIV prevention and treatment outcomes. Our central hypothesis is that injunctive norms (i.e., the prevailing attitude within the social network about what constitutes approved or disapproved conduct) have a causal effect on one's own beliefs, and that the effect is mediated by anticipated stigma (i.e., what one perceives to be the prevailing attitude). We further hypothesize that injunctive norms, anticipated stigma, and one's own beliefs exert independent causal effects on HIV prevention among those at risk for HIV infection and on HIV treatment outcomes among PLHIV. These hypotheses have been formulated on the basis of our strong preliminary data from rural Uganda showing that injunctive norms are associated with one's own negative attitudes toward PLHIV, and that HIV stigma is associated with a wide range of adverse HIV prevention and treatment outcomes. We recently completed a population-based, sociocentric social network study of N=1,814 adults in rural Uganda. This R01 application will extend our pilot study into a cohort, following these same participants and any new in-migrants over time, so that we can accomplish the following specific aims: (1) Estimate the causal effect of injunctive norms on negative attitudes toward PLHIV; (2) Estimate the causal effects of injunctive norms, anticipated stigma, and negative attitudes toward PLHIV on uptake of voluntary counseling and testing, condomless sexual intercourse, and HIV infection among HIV-negative persons and persons of unknown serostatus; and (3) Estimate the causal effects of injunctive norms, anticipated stigma, and internalized stigma on depression, linkage to care, ART adherence, viral suppression, retention in care, & secondary transmission risk among PLHIV. Our key innovation is that we use photograph-based identity verification to collect longitudinal, sociocentric social network data, and we apply analytic methods designed to identify causal effects and causal mediation effects. The proposed study will have significant public health impact by laying a foundation for developing more effective anti-stigma interventions and by identifying where in the dynamic process of stigma formation these interventions can most strategically be deployed.

项目总结 在撒哈拉以南非洲的2900万艾滋病毒携带者中，只有一半的人知道他们的 其中，不到一半的人正在接受艾滋病毒抗逆转录病毒治疗(ART)。平均CD_4~+ 截至2012年，撒哈拉以南非洲地区启动抗逆转录病毒治疗时的T淋巴细胞计数为140个细胞/mm3，这表明 晚期疾病在呈现到护理和ART开始时仍然是常态。贴在上面的污点 艾滋病毒已被确定为改善这些艾滋病毒预防和治疗成果的关键障碍。艾滋病病毒 在整个撒哈拉以南非洲地区仍然受到严重的耻辱，目前的情况只是部分缓解了这种情况 干预措施。这个R01应用程序的科学目标是应用社交网络方法来理解 艾滋病毒污名的社会产生、其通过社会网络随时间的传播及其因果影响 关于艾滋病毒预防和治疗结果的报告。我们的中心假设是禁制性规范(即普遍存在的 社交网络中关于什么构成批准或不批准的行为的态度)具有因果关系 对自己的信仰的影响，并且这种影响是由预期的污名(即，一个人所感知的)中介的 普遍的态度)。我们进一步假设，禁令规范、预期的耻辱和一个人自己的信仰 对艾滋病毒感染风险人群的艾滋病毒预防和艾滋病毒治疗产生独立的因果关系 艾滋病病毒感染者之间的结果。这些假设是建立在我们强大的初步数据基础上的 来自乌干达农村的研究表明，禁令规范与一个人自己对 艾滋病毒，艾滋病毒污名与一系列不利的艾滋病毒预防和治疗有关 结果。我们最近完成了一项以人口为基础、以社会为中心的社交网络研究，对象为N=1,814名成年人 乌干达农村。这个R01应用程序将我们的试点研究扩展到队列中，跟踪这些参与者 随着时间的推移，任何新的移民，以便我们可以实现以下具体目标：(1)估计 禁令规范对艾滋病病毒感染者消极态度的因果效应；(2)估计艾滋病病毒感染者的因果效应 自愿咨询中的禁止性规范、预期污名和对艾滋病病毒的负面态度 和检测，无避孕套性行为，艾滋病毒阴性者和 未知的血清状态；以及(3)估计强制规范、预期污名和 抑郁症的内在化污名，与护理的联系，抗逆转录病毒疗法的坚持，病毒抑制，护理中的保留，& 艾滋病病毒的二次传播风险。我们的主要创新是我们使用基于照片的身份 验证以收集纵向的、以社会为中心的社交网络数据，并应用旨在 确定因果效应和因果调解效应。这项拟议的研究将对公众健康产生重大影响 通过为制定更有效的反耻辱干预措施奠定基础并确定 在污名形成的动态过程中，这些干预措施可以得到最具战略性的部署。