Mitigate the effect of HIV-related stigma through a resilience approach

摘要 与艾滋病毒和艾滋病有关的污名和歧视(“与艾滋病毒有关的污名”)在世界范围内被认定为 艾滋病毒治疗和护理的主要障碍，对艾滋病毒预防工作和提供适当的 护理、支持和治疗。尽管几十年来全球一直在努力解决与艾滋病毒相关的耻辱问题，但之前的 旨在减少耻辱的干预措施在很大程度上无效。面临的知识差距和挑战 与艾滋病毒相关的耻辱作斗争，部分根源于耻辱的复杂性和多样性，部分根源于 当前对减少耻辱努力概念化的局限性。最近的研究，包括我们自己的研究 初步数据显示，注重发展优势的复原力方法前景看好， 艾滋病毒携带者(PLWH)及其亲生或代理的能力、资源和能力 家庭成员和医疗机构，以预防、减少和减轻耻辱的负面影响。然而， 弹性方法虽然是假设的，但尚未在干预试验中得到广泛测试。在当前 应用，我们建议开发、实施和评估一种理论指导的、多级别的多模式弹性- 通过阶梯式楔形随机试验对800名PLWH及其真实或代孕家庭进行干预 会员以及320名广西医疗保健提供者，在中国那里我们建立了强大的研究 自2004年以来，通过美国国立卫生研究院资助的研究开展基础设施和社区合作。主要结果将是 在PLWH中进行病毒抑制，中间成果将包括以下级别的复原力资源 个人、真实或代孕家庭成员、医疗机构以及慢性压力反应 以及坚持治疗和护理。拟议的研究具有创新性，因为它涉及许多知识 基于两种耻辱减少概念化的HIV相关耻辱减少干预研究中的差距 以及干预研究方法的进步(例如，多层次和多成分干预 形态，阶梯式楔形设计，添加生物标记物以评估污名的影响，并以原发为靶点 艾滋病毒的临床结果，如病毒抑制)。拟议的研究具有重要意义，因为它解决了一个关键的 美国和全球的公共卫生问题。拟议的干预方案，如果被证明有效，将具有 有可能在其他低收入和中等收入国家复制，以减轻耻辱对 艾滋病毒治疗和护理的连续体。

ABSTRACT Stigma and discrimination related to HIV and AIDS (“HIV-related stigma”) have been identified worldwide as major barriers to HIV treatment and care, posing challenges to HIV prevention efforts and provision of adequate care, support, and treatment. Despite decades of global efforts to tackle HIV-related stigma, previous interventions designed to reduce stigma have been largely ineffective. The knowledge gaps and challenges for combating HIV-related stigma are partly rooted in the complexity and diversity of the stigma and partly in the limitations in current conceptualization of stigma reduction efforts. Recent research, including our own preliminary data, has shown the promise of resilience approaches that focus on the development of strengths, competencies, resources, and capacities of people living with HIV (PLWH) and those of their real or surrogate family members and healthcare facilities to prevent, reduce, and mitigate the negative effects of stigma. However, the resilience approach, while hypothesized, has not been widely tested in intervention trials. In the current application, we propose to develop, implement, and evaluate a theory-guided, multilevel multimode resilience- based intervention via a stepped wedge randomized trial among 800 PLWH and their real or surrogate family members as well as 320 healthcare providers in Guangxi, China where we have built a strong research infrastructure and community collaboration through NIH-funded research since 2004. The primary outcome will be viral suppression among PLWH, and the intermediate outcomes will include resilience resources at the levels of individuals, the real or surrogate family members, and healthcare facilities as well as chronic stress response and adherence to treatment and care. The proposed study is innovative as it addresses a number of knowledge gaps in HIV-related stigma reduction intervention research based on both a conceptualization of stigma reduction and advancement in intervention research methodology (e.g., multilevel and multi-component intervention modality, a stepped wedge design, addition of biomarkers to assess the effects of stigma, and targeting primary HIV clinical outcomes such as viral suppression). The proposed research is significant as it addresses a critical public health issue in the US and globally. The proposed intervention protocol, if proven efficacious, has the potential to be replicated in other low- and middle-income countries to mitigate the negative impact of stigma on the HIV treatment and care continuum.