Understanding Stigma as a barrier to cancer prevention and treatment in Uganda and Zambia

项目概要/摘要 本申请是为了响应被标识为“NOT-CA-”的特别利益通知（NOSI）而提交的。 23-025“支持全球癌症污名研究的行政补充。癌症导致超过一半的人死亡 每年有100万非洲人，由于人口等因素， 生长和衰老，由于对癌症的认识有限而导致的诊断延迟，缺乏生物医学治疗， 和耻辱感传统上，在整个非洲诊断出的大多数癌症都是与以下疾病有关的类型： 病毒感染，特别是“艾滋病定义的恶性肿瘤”，使艾滋病毒感染者（PLWH）处于 被诊断出患有癌症和死于癌症的风险比那些没有被诊断出患有癌症和死于癌症的风险高得多 艾滋病毒携带者增加癌症风险的健康行为，如烟草使用，也更加普遍 在PLWH中，它可以进一步增加几种非艾滋病定义癌症（NADC）的死亡率。广泛 对艾滋病毒污名化作为艾滋病毒预防、检测和护理的障碍所产生的影响进行了研究。 在我们的父母项目中进行的形成性研究还表明，患者对艾滋病毒的恐惧- 相关健康中心提供癌症预防和筛查服务，包括戒烟 干预措施，将揭示他们的艾滋病毒状况。很少有研究关注PLWH中的癌症耻辱 社区.癌症耻辱感可能源于文化上的刻板印象，即癌症是一种致命的疾病， 传染性，或者是对不道德行为的惩罚。与癌症相关的耻辱可能导致延迟 在生物医学治疗中，由癌症诊断引起的羞耻可能会阻止生物医学筛查的使用， 导致治疗延迟。对癌症污名的程度和影响进行更多的研究对于 制定对文化敏感的干预措施，以扩大教育信息的覆盖面， 坚持预防和治疗。我们通过一项为期一年的研究来探讨这一差距， 癌症污名的流行及其对获得和利用癌症预防、筛查和 在乌干达和赞比亚的艾滋病毒/艾滋病感染者中提供保健服务。癌症污名研究对于 制定文化敏感的干预措施，对医疗保健提供者具有重要意义， 在乌干达的艾滋病毒携带者和艾滋病患者中， 赞比亚和其他中低收入国家。这项研究的主要合作伙伴包括美国烟草控制中心， 马凯雷雷大学公共卫生学院和南加州大学凯克医学院的非洲研究所。

Project Summary/Abstract This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA- 23-025” Administrative Supplement to Support Global Cancer Stigma Research. Cancer kills more than a half a million Africans each year with rates expected to rise over the next decade due to factors such as population growth and aging, delayed diagnosis resulting from limited knowledge of cancer, lack of biomedical treatment, and stigma. Traditionally, the majority of cancers diagnosed throughout Africa have been types associated with viral infection, particularly ‘AIDS-defining malignancies’ which place people living with HIV (PLWH) at a substantially higher risk of being diagnosed with cancer and dying of cancer compared to those who are not living with HIV. Health behaviors that increase cancer risk, such as tobacco use, are also more prevalent among PLWH and can further increase mortality from several Non-Aids defining Cancers (NADCs). Extensive research has been carried out on the impact of HIV stigma as a barrier to HIV prevention, testing, and care. Formative research carried out in our Parent Project also revealed that patient’s feared utilization of HIV- related health centers for cancer prevention and screening services, including tobacco use cessation interventions, would reveal their HIV status. Far less research has focused on cancer stigma within PLWH communities. Cancer stigma may originate from cultural stereotypes that cancer is a fatal disease, is contagious, or is a punishment for immoral behavior. Stigma associated with cancer likely contributes to delays in biomedical treatment and shame resulting from a cancer diagnosis may deter use of biomedical screening, resulting in treatment delays. Additional research on the extent and effects of cancer stigma is essential for the development of culturally sensitive interventions that enhance the reach of educational messages and increase adherence with preventive and curative treatments. We approach this gap with a one-year study examining the prevalence of cancer stigma and its impact on access to, and utilization of, cancer prevention, screening, and care services among PLWH populations in Uganda and Zambia. Cancer stigma research is essential for the development of culturally sensitive interventions and has important implications for healthcare providers, policymakers, and public health practitioners working to prevent and control cancer within PLWH in Uganda and Zambia, and other LMICs. The primary partners in the study include the Center for Tobacco Control in Africa at the Makerere University School of Public Health, and the Keck School of Medicine of USC.