HIV/AIDS Stigma Behaviors in Clinical Encounters

描述（由申请人提供）：向国家药物滥用研究所（NIDA）提出的K02独立科学家奖申请是我一直致力于研究的延伸，旨在解决拉丁裔人口，特别是波多黎各人对艾滋病毒/艾滋病的耻辱感。波多黎各是一个与美国相连的加勒比岛屿，艾滋病毒感染率估计为1%（报告病例超过3.5万例）。该岛的流行病主要是由于共用不干净的注射毒品针头造成的，它位于世界上艾滋病毒/艾滋病发病率第二高的加勒比区域。因此，对无耻辱感的卫生服务的需求日益增长。我的研究生涯的特点是持续致力于解决在这种情况下对艾滋病毒/艾滋病患者（PWHA）获得高质量卫生服务的污名化的作用。在我之前的NIH资助的研究中，我专注于识别和减少卫生专业人员对艾滋病毒/艾滋病的污名态度。拟议的K02将允许我扩展这一研究议程，以解决在临床相互作用中表现出来的艾滋病毒/艾滋病耻辱的行为组成部分。我的长期职业目标包括：1)增进对波多黎各卫生专业人员所表现的艾滋病毒/艾滋病污名态度和行为（即言语和非言语）之间相互关系的理解；2)记录波多黎各环境中艾滋病毒/艾滋病污名态度和行为的潜在预测因素和文化相关性；3)制定经过科学检验的污名测量指南和干预措施，以减少该人群中的艾滋病毒/艾滋病污名态度和行为。作为拟议的K02申请的一部分，我提出了几个职业发展战略，以促进我的长期职业目标。这些包括：1)通过与波多黎各大学的标准化患者计划的扩展接触，获得与使用标准化患者模拟技术相关的新技能，用于研究；2)与罗切斯特大学、佛罗里达国际大学和加州大学旧金山分校的视觉方法和观察数据分析领域的专家合作。有了技能

DESCRIPTION (provided by applicant): The proposed K02 Independent Scientist Award application to the National Institute on Drug Abuse (NIDA) is an extension of my ongoing commitment to research aiming to address HIV/AIDS stigma among Latino populations, specifically Puerto Ricans. Puerto Rico is a Caribbean Island linked to the United States, where HIV infection prevalence has been estimated at 1% (more than 35,000 reported cases). The Island's epidemic is mainly driven by unclean needle sharing for injected drug use (IDU) and is embedded in the Caribbean region which has the second highest rates of HIV/AIDS in the world. Therefore, the need for stigma- free health services is ever-growing. My research career has been characterized by an ongoing commitment to addressing the role of stigmatization on access to quality health services for people with HIV/AIDS (PWHA) in this setting. In my previous NIH funded studies I have focused on the identification and reduction of HIV/AIDS stigma attitudes among health professionals. The proposed K02 will allow me to extend this research agenda to address the behavioral components of HIV/AIDS stigma as manifested in clinical interactions. My long-term career goals include: 1) advancing the understanding of the interrelation between HIV/AIDS stigma attitudes and behaviors (i.e. verbal and non-verbal) manifested by health professionals in Puerto Rico, 2) documenting the underlying predictors and cultural correlates of HIV/AIDS stigma attitudes and behaviors in the Puerto Rican setting, and 3) developing scientifically tested stigma measurement guidelines and interventions to reduce both HIV/AIDS stigma attitudes and behaviors among this population. As part of the proposed K02 application I propose several career development strategies to foster my long-term career goals. These include: 1) the acquisition of new skills related to the use of Standardized Patient Simulation Technology for use in research via extended contact with the University of Puerto Rico's Standardized Patient Program, and 2) collaborations with experts in the field of visual methodologies and observational data analysis at the University of Rochester, Florida International University and the University of California at San Francisco. With the skills acquired through these interactions, I will be better positioned to implement the proposed research plan in which I propose to study the dynamics of physician/patient interaction that may contribute to stigmatization of PWHA, through an observational study of simulated interactions using a standardized patient (SP) program in Puerto Rico. The proposed study has the following aims: Aim 1 - To document HIV/AIDS stigma attitudes and their role on behavioral manifestations of stigma during physician/patient interactions in a sample of medical residents in Puerto Rico; Aim 2 - To document variations of HIV/AIDS stigma behaviors during physician/patient interactions when providing services to clients with different modes of HIV transmission; and Aim 3 - To determine the role of cultural factors (i.e., traditional gender roles religiosity, homophobia, and stigmatization of drug users) on attitudinal and behavioral manifestations of HIV/AIDS stigma among medical residents in Puerto Rico. To achieve these aims I propose an experimental design using mixed method techniques (structured observations, quantitative questionnaires, and SP simulations). The study will be conducted through the SP program at the University of Puerto Rico's Medical Sciences Campus. I will recruit a sample of 154 medical residents in Puerto Rico to participate in an experiment embedded within their ongoing SP training, and assign them to engage in all of the following patient conditions, with randomized order of presentation: 1) HIV-infected through intravenous drug use, 2) HIV-infected through unprotected heterosexual relations, 3) HIV-infected through unprotected homosexual relations, 4) HIV-infected through unprotected heterosexual relations or intravenous drug use, 5) HIV-infected through unprotected homosexual relations or intravenous drug use, 6) HIV-infected through unprotected homosexual or heterosexual relations, and 7) the common cold as a stigma- free comparison control. Interactions will be video-recorded and subsequently coded for behavioral expressions of stigma using a preliminary developed and pilot-tested measure from my NIH funded studies. After participation in the simulation, all participants will complete quantitative questionnaires addressing HIV/AIDS stigma attitudes and adherence to cultural factors of importance in the Puerto Rican setting. The study will be the first to document behavioral manifestations of HIV/AIDS stigma among medical residents in Puerto Rico, thereby extending the scientific literature that has focused almost exclusively on their stigmatizing attitudes. Furthermore, it will be the first study to address the role of cultural factors on the manifestations of HIV/AIDS stigma among this population in Puerto Rico and variations related to means of infection. The findings from the study have the potential to inform the development of guidelines for stigma measurement and stigma reduction interventions for this population, taking into consideration both attitudinal and behavioral manifestations of stigma, and the role of local culture on these indicators.