Exploring Stigmas and HIV Diagnosis Delay, Linkage and Retention for MSM in Ghana

探索加纳 MSM 的耻辱感和 HIV 诊断延迟、关联和保留

• 批准号: 9063191
• 负责人: LaRon Earnest Nelson
• 金额: $ 28.13万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-23 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9063191
• 关键词: Acquired Immunodeficiency Syndrome; Address; Affect; Anti-Retroviral Agents; Appearance; Applications Grants; Area; Attention; Belief; Blood specimen; Caring; Cities; Clinic; Clinical; Communities; Continuity of Patient Care; Country; Critical Care; Data; Detection; Development; Diagnosis; Discrimination; Disease; Distress; Effectiveness; Elements; Epidemic; Ethnography; Factor Analysis; Fright; Future; Gender; General Population; Ghana; HIV; HIV Seropositivity; HIV diagnosis; Health Services Accessibility; Individual; Infection; Intervention; Intervention Studies; Interview; Investigation; Knowledge; Lead; Link; Masculine; Measurement; Mediating; Mediator of activation protein; Mentors; Methods; Modeling; Morphologic artifacts; Outcome; Pathway interactions; Prevalence; Process; Public Health; Punishment; Qualitative Methods; Qualitative Research; Recruitment Activity; Reporting; Research; Risk; Role; Same-sex; Sampling; Scientific Advances and Accomplishments; Seeds; Shapes; Stress; Structure; Surveys; Symptoms; Testing; Time; United States National Institutes of Health; Venipunctures; Viral; Viral Load result; antiretroviral therapy; base; design; digital; experience; improved; innovation; insight; maltreatment; men; men who have sex with men; mortality; outreach; peer; peer support; programs; public health relevance; same sex behavior; social; social stigma; symptom management; symptomatic improvement

 DESCRIPTION (provided by applicant): This application addresses PA-13-246. HIV prevalence among men who have sex with men (MSM) in Ghana is 17.5%, which is 15 times higher than that of the general population. Stigma against same-sex behaviors and identities are common in Ghana and often intertwined with symbolic HIV-related stigma beliefs, perpetuating the notion that infection is divine punishment for MSM. MSM who do not conform to local masculine gender norms are especially vulnerable to stigma. These stigmas can be major contributors to disengagement from HIV care for fear of ridicule and mistreatment. Linkage to and retention in HIV care are critical for achieving viral suppression, improving symptom management, and reducing risk of mortality. Disengagement can lead to decreased access to antiretroviral therapy and concomitant increases in HIV viral load, HIV symptoms and HIV symptom distress. Nonetheless, despite the extremely high HIV prevalence in MSM in Ghana, there are gaps in scientific knowledge regarding how intersecting HIV, same-sex, and gender nonconformity stigmas are associated with HIV care linkage and retention, HIV viral load and HIV symptom distress. Further, it is unknown if associations between stigmas and clinical outcomes are mediated by decreased linkage and retention in HIV care. We propose three aims to narrow these knowledge gaps and support future intervention research. In Aim 1 we will recruit venue-based (n=150) and peer-driven (n=75) samples of HIV positive MSM from four Ghanaian cities with the highest HIV prevalence in MSM, and compare the two strategies for which one produces the greatest yield of MSM that are disengaged from care. We will also conduct brief interviews with a subset of recruiters from the peer-driven sample to explore what challenges (including stigmas) were encountered during recruitment. In Aim 2 we will use structured survey data to test potential mediators (i.e., HIV care linkage and retention) that may explain associations between stigmas and clinical outcomes in the combined venue-based and peer-driven samples (N=225). The survey will include psychometrically validated scales for HIV, same-sex, and gender non-conformity stigmas and HIV symptom distress. HIV viral load will be quantified from venipuncture blood samples. In Aim 3 we will conduct an interpretive ethnography using qualitative interviews from MSM purposively selected from the combined sample because they were diagnosed with HIV late in the course of the disease (n=10) or because they have high HIV symptom distress scores, but are not linked to care (n=10) or were previously linked to HIV care but are not currently engaged (n=10). Interview data will be triangulated with other data collected throughout our time in the field, including unobtrusive observations, field notes, and digital photographs (artifacts) that document elements of the social and cultural contexts of the MSM. Findings from this study will lay the groundwork for the design of a field- based HIV care coordination intervention that integrates peer-outreach to identify MSM not currently in care and peer-support/mentoring strategies to help mitigate the impacts of stigmas on linkage and retention in care.

 描述（由申请人提供）：本申请涉及PA-13-246。加纳男男性行为者的艾滋病毒感染率为17.5%，比一般人口高15倍。对同性行为和身份的污名化在加纳很常见，往往与象征性的艾滋病毒相关污名化信念交织在一起，使感染是对男男性行为者的神圣惩罚的观念永久化。不符合当地男性规范的男男性行为者特别容易受到歧视。这些耻辱感可能是由于害怕嘲笑和虐待而脱离艾滋病毒护理的主要原因。与艾滋病毒护理的联系和保留对于实现病毒抑制、改善症状管理和降低死亡风险至关重要。脱离接触可能导致获得抗逆转录病毒治疗的机会减少，同时增加艾滋病毒载量、艾滋病毒症状和艾滋病毒症状困扰。尽管如此，尽管加纳男男性行为者的艾滋病毒感染率极高，但关于艾滋病毒、同性和性别不一致的耻辱如何与艾滋病毒护理联系和保留、艾滋病毒病毒载量和艾滋病毒症状困扰相关的科学知识仍存在差距。此外，它是未知的，如果耻辱和临床结果之间的关联介导的减少联系和保留在艾滋病毒护理。我们提出了三个目标，以缩小这些知识差距，并支持未来的干预研究。在目标1中，我们将招募场地为基础的（n=150）和同行驱动（n=75）样本的艾滋病毒阳性男同性恋者从加纳的四个城市的艾滋病毒感染率最高的男同性恋者，并比较两种策略，其中一个产生的最大收益率的男同性恋者脱离护理。我们还将对来自同行驱动样本的招聘人员进行简短访谈，以探讨在招聘过程中遇到的挑战（包括耻辱）。在目标2中，我们将使用结构化调查数据来测试潜在的中介者（即，艾滋病毒护理联系和保留），这可能解释之间的关联耻辱和临床结果的组合场地为基础的和同行驱动的样本（N=225）。该调查将包括心理测量验证的艾滋病毒，同性和性别不一致的耻辱和艾滋病毒症状困扰的规模。将从静脉穿刺血样中定量HIV病毒载量。在目标3中，我们将使用从合并样本中有目的地选择的MSM的定性访谈进行解释性民族志研究，因为他们在疾病过程中被诊断为HIV（n=10）或因为他们具有高HIV症状困扰评分，但与护理无关（n=10）或以前与HIV护理有关，但目前没有参与（n=10）。访谈数据将与我们在现场收集的其他数据进行三角测量，包括不引人注目的观察，现场笔记和数码照片（文物），记录MSM的社会和文化背景的元素。这项研究的结果将奠定基础，设计一个基于现场的艾滋病毒护理协调干预措施，整合同侪宣传，以确定目前没有照顾和同侪支持/指导战略，以帮助减轻联系和保持照顾的耻辱的影响。