Reducing stigmatizing attitudes and behaviors of nursing students in simulated clinical visits of patients living with HIV in Iran

项目总结/摘要 伊朗是中东地区艾滋病毒感染率最高的国家。然而，只有42%的伊朗艾滋病毒感染者是 28%的患者接受了抗逆转录病毒治疗。艾滋病毒连续护理的最大差距是诊断。由于 社会文化和宗教信仰、与艾滋病毒有关的耻辱感和吸毒耻辱感非常高， 婚外性行为或与另一个男人发生性关系被认为是“罪恶”的行为。这些交叉 污名（对吸毒的污名，性别歧视和同性恋恐惧症）除了艾滋病毒的污名是主要的障碍， 许多有感染艾滋病毒风险或已感染艾滋病毒的人参加艾滋病毒检测或治疗。我们之前的研究发现， 卫生服务提供者与艾滋病毒感染者（PLWH）的临床接触有限，并且没有艾滋病毒污名 训练这种缺乏培训的情况可能导致对艾滋病毒高危人群的轻蔑态度和行为， PLWH。最高的艾滋病毒污名化行为的护士和医生助理。这些数据， 再加上伊朗艾滋病毒高危关键人群的极端边缘化，呼吁发展 培训护士的新方法，以减少临床环境中与艾滋病毒有关的耻辱。我们建议开发， 测试艾滋病毒污名在线培训，包括模拟护士学校学生的艾滋病毒感染者。中 随机对照试验，我们将评估在线艾滋病毒的可行性，可接受性和初步疗效 污名化培训对降低模拟临床访视中护生污名化态度和行为的影响 与艾滋病毒感染者相比，在线艾滋病毒流行病学培训没有关于耻辱的具体内容。 艾滋病污名培训和模拟艾滋病风险患者或艾滋病病毒感染者的成功开发将为 这是一个对护士和其他医疗服务提供者进行更大规模试验的阶段， 可扩展的培训计划，以减少临床环境中与艾滋病毒相关的耻辱感，并提高艾滋病毒检测的参与度 和护理服务。

Project Summary/Abstract Iran has the highest burden of HIV in the Middle East. However, only 42% of Iranians living with HIV are diagnosed and 28% on antiretroviral therapy. The largest gap in the continuum of HIV care is diagnosis. Due to sociocultural and religious beliefs, HIV-associated stigma and drug use stigma are exceedingly high, and sex outside of marriage, or sex of man with another man are considered to be “sinful” behaviors. These intersectional stigmas (stigma towards drug use, sexism, and homophobia) in addition to HIV stigma are major barriers for many people at risk for or living with HIV to engage in HIV testing or treatment. Our prior studies found that health providers have limited clinical encounters with people living with HIV (PLWH) and have no HIV stigma training. This lack of training can lead to stigmatizing attitudes and behaviors towards people at risk for HIV or PLWH. The highest HIV stigmatizing behaviors was reported in nurses and physician assistants. These data, coupled with the extreme marginalization of key populations at high risk for HIV in Iran, call for the development of new ways to train nurses to reduce HIV-related stigma in clinical settings. We propose to develop, and field test an HIV stigma online training including simulated patients living with HIV for nursing school students. In a randomized controlled trial, we will assess the feasibility, acceptability, and preliminary efficacy of the online HIV stigma training in reducing stigmatizing attitudes and behaviors of nursing students in simulated clinical visits of patients living with HIV compared to an online HIV epidemiology training with no specific content on stigma. Successful development of the HIV stigma training and simulated patients at risk for or living with HIV will set the stage for developing a larger trial of nurses and other health providers which can lead to an effective and scalable training program to reduce HIV-related stigma in clinical settings and improve engagement in HIV testing and care services.