AIDS Stigma & Gender: Health Consequences in Urban India

描述（由申请人提供）：艾滋病污名化是防治艾滋病毒/艾滋病的主要障碍。它增加了感染者的痛苦，并干扰了寻求艾滋病毒咨询和检测、披露艾滋病毒感染以及寻求治疗艾滋病毒相关问题的决定。边缘化群体的成员往往遭受双重耻辱，迫使他们隐瞒自己的生活方式，使他们更难以获得艾滋病预防方案和治疗。为艾滋病毒阳性患者提供护理的家庭成员和卫生保健工作者也成为艾滋病污名化和歧视的目标。我们的研究表明，这些问题在印度也存在。Bharat先前在印度城市进行的定性工作已经确定了在卫生保健环境和家庭中对艾滋病的耻辱态度和公开歧视。这包括拒绝照顾艾滋病毒感染者，额外的手套、口罩等防护设备的额外费用，房间的熏蒸，以及缺乏保密性。数据还表明，印度城市艾滋病污名化是一种性别现象。关于妇女受到丈夫和姻亲忽视和虐待的报告很常见，而且许多妇女获得治疗的机会少于其丈夫。 虽然许多重要的特定文化的问题，确定在巴拉特的定性研究，现在有必要扩大这项工作，以发展特定文化的量化模型和艾滋病的耻辱及其健康后果的措施，并检查在印度背景下的流行和相关的耻辱。目前的调查旨在满足这一需要。它将建立在巴拉特的定性工作的基础上，通过将文化特定的主题纳入到由Herek在美国开发和管理的定量测量的修改版本中。这项措施将在印度两个艾滋病毒高流行州的大城市的一系列保健机构中实施。具体而言，我们建议： 在接触城市卫生保健系统的人群中，包括a）艾滋病毒/艾滋病感染者（PLWHA），B）PLWHA的家庭，c）卫生保健工作人员，以及d）综合医院门诊病人中，在多个层面上按性别审查艾滋病污名化和歧视的性质、程度和背景。 2.衡量艾滋病污名化和歧视在上述每个层面上对艾滋病污名化实施者和目标造成的潜在健康相关后果。 3.发展a）在印度城市艾滋病耻辱和健康的文化特定的理论理解，以及B）艾滋病耻辱的措施，可用于评估未来的耻辱减少政策和计划，在卫生保健和社区设置之间的受害者和肇事者的耻辱。 4.制定具体的基于数据的方案和政策建议，以减少印度城市卫生保健环境中与艾滋病有关的耻辱和歧视，并在区域利益攸关方中传播这些建议。

DESCRIPTION (provided by applicant): AIDS stigma is a major barrier in the fight against HIV/AIDS. It adds to the suffering of those infected and interferes with decisions to seek HIV counseling and testing, disclosure of HIV infection, and seeking treatment for HIV-related problems. Members of marginalized groups often experience dual stigma, forcing them to conceal their lifestyles and making it more difficult for them to access AIDS prevention programs and treatment. Family members and health care workers who provide care to HIV positive patients also become the target of AIDS stigma and discrimination. Our research suggests that these problems exist in India as well. Previous qualitative work in urban India by Bharat has identified AIDS stigma attitudes and overt discrimination, both in the health care setting and the family. This has included refusal to care for HIV infected individuals, additional charges for protective equipment such as extra gloves, masks, fumigation of rooms, and lack of confidentiality. The data also suggest that AIDS stigma in urban India is a gendered phenomenon. Reports of women being neglected and maltreated by their husbands and in-laws were common, and many women were found to have less access to treatment than their husbands. Although many important culture-specific issues were identified in Bharat's qualitative research, there is now a need to extend this work to develop culture-specific quantitative models and measures of AIDS stigma and its health consequences and to examine the prevalence and correlates of stigma in the Indian context. The current investigation has been designed to meet this need. It will build on the qualitative work by Bharat, by incorporating the culture-specific themes into a modified version of a quantitative measure developed and administered in the U.S. by Herek. This measure will be administered in a range of health care settings in two large Indian cities situated in high HIV prevalence states. Specifically we propose to: Examine the nature, extent, and context of AIDS stigma and discrimination by gender, at multiple levels, among people coming into contact with urban health care systems, including a) People Living with HIV/AIDS (PLWHAs), b) families of PLWHAs, c) healthcare staff; and d) general hospital outpatients. 2. Measure the potential health-relevant consequences of AIDS stigma and discrimination between both perpetrators and targets of stigma at each of the above levels. 3. Develop a) a culture-specific theoretical understanding of AIDS stigma and health in urban India as well as b) measures of AIDS stigma that can be used to evaluate future stigma reduction policies and programs in health care and community settings among both victims and perpetrators of stigma. 4. Develop specific data-based program and policy recommendations to reduce AIDS-related stigma and discrimination in urban Indian health care settings and to disseminate these among regional stakeholders.