Developing measurements to evaluate intersectional stigma related to cancer and HIV

项目总结 本申请是对特别利益通知(NOSI)的回应，该通知被确认为 “不是-CA-23-036。”撒哈拉以南非洲(SSA)在全球范围内承受着不成比例的艾滋病毒负担。此外， 这一人群患恶性肿瘤的风险远远超过一般人群，与此相关的发病率和 死亡率。随着艾滋病毒和癌症在全球人口中的双重负担增加，调查其影响 消除对这一人群的耻辱对于改善健康结果至关重要。 耻辱是一个经过充分研究的概念，当个人被识别并被贴上“他者”的标签时，它就会出现 由于各种社会人口、行为或健康相关的特征，并已与贫穷联系在一起 生活质量和与健康相关的结果。尤其是与艾滋病毒和癌症诊断有关的耻辱 与精神健康状况差、治疗依从率低和医疗保健减少有关 订婚。当一个人有多个共同出现的污名化特征时，他们有可能 对于更复杂的污名体验，称为交叉性污名。携带艾滋病毒和癌症的个人 可能由于一种显性的污名化条件而更显著地经历污名，或者可能经历 协同效应或乘性效应。交叉污名是通过已验证的构建量表测量的 例如种族、民族、性别认同和行为，但没有衡量 艾滋病毒和癌症污名。衡量艾滋病毒携带者和癌症患者耻辱经历的能力是 这对于评估其对健康相关行为的影响以及设计更有针对性的干预措施至关重要。 作为U54 CA254571的行政补充，我们的总体目标是启动 该量表有效地衡量同时患有艾滋病毒和癌症诊断的患者的交叉耻辱。 我们的具体目标是：1)开发一个初步的规模问题池，以捕捉艾滋病毒的关键方面 和癌症的交叉耻辱。我们将使用预先存在的和从头开始的定性访谈和 开发这个初始池所需的定量数据。2)让社区利益攸关方和艾滋病毒携带者参与 和癌症，在进一步完善的规模问题池。我们将使用包括成员在内的技术 检查和认知情况汇报。3)完成对患者总体子集的初步条目验证 与艾滋病毒和癌症并存。 为了实现这些目标，我们利用一支由多学科领导者组成的团队，在污名、规模发展、 艾滋病毒相关癌症和流行病学。我们将开发针对艾滋病毒和癌症的跨部门污名量表。 由我们在西部AMPATH网络中现有的艾滋病毒和恶性肿瘤实验室提供支持 肯尼亚，由父母赠款U54 CA254571资助。这项工作的发现预计将导致 开发一种交叉柱头标尺，将有助于更好地表征潜在的共生现象 艾滋病毒和癌症耻辱的协同作用，最终使我们能够制定更知情的卫生干预措施。

PROJECT SUMMARY This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA-23-036.” Sub-Saharan Africa (SSA) bears a disproportional burden of HIV globally. Additionally, the risk for malignancy in this population far exceeds the general population with higher associated morbidity and mortality. As the dual burden of HIV and cancer in the global population increases, investigation of the impact of stigma on this population is crucial for improving health outcomes. Stigma is a well-studied construct that occurs when individuals are recognized and labeled as “other” due to various sociodemographic, behavioral, or health-related characteristics, and has been linked to poor quality of life and health-related outcomes. Stigma associated with HIV and cancer diagnoses in particular have been associated to poor mental health, low treatment adherence rates, and decreased healthcare engagement. When an individual has multiple, co-occurring stigmatizing characteristics, they have the potential for a more complex stigma experience, termed intersectional stigma. Individuals living with HIV and cancer may experience stigma more prominently due to one dominant stigmatizing condition or may experience a synergistic or multiplicative effect. Intersectional stigma has been measured via validated scales for constructs such as race, ethnicity, gender identity, and behavior, but no scale exists to measure the intersectionality of HIV and cancer stigma. The ability to measure the stigma experience in people living with HIV and cancer is crucial for assessing its influence on health-related behaviors and for designing more targeted interventions. As an administrative supplement to U54 CA254571, our overall goal is to initiate the development of a scale that effectively measures intersectional stigma in patients with concurrent HIV and cancer diagnoses. Our specific aims are: 1) To develop a preliminary pool of scale questions that capture key dimension of HIV and cancer intersectional stigma. We will use both pre-existing and de-novo qualitative interviews and quantitative data to develop this initial pool. 2) To involve community stakeholders and participants with HIV and cancer in further refinement of the pool of scale questions. We will use techniques including member checking and cognitive debriefing. 3) To complete preliminary item validation on a population subset of patients living with both HIV and cancer. To achieve these aims, we leverage a multidisciplinary team of leaders in stigma, scale development, HIV-associated cancers, and epidemiology. We will develop an intersectional stigma scale for HIV and cancer supported by our already existing laboratory for HIV and malignancies in the AMPATH network in western Kenya, funded by parent grant U54 CA254571. Findings from this work are expected to lead to the development of an intersectional stigma scale that will help to better characterize co-occuring, potentially synergistic HIV and cancer stigma and ultimately allow us to develop more informed health interventions.