Suubi4Stigma: Addressing HIV-Associated Stigma Among Adolescents

撒哈拉以南非洲（SSA）艾滋病毒负担沉重，85%的新感染发生在青少年中， 在全球范围内发生的年轻人。最近的统计数字表明，青少年和 乌干达的年轻人正在崛起。虽然免费抗逆转录病毒疗法的提供和获得降低了儿童死亡率， 增加了一些感染艾滋病毒的儿童（ CLWH ）将过渡到成年期， 艾滋病毒是一种慢性的、备受指责的疾病。不幸的是，这个群体所经历的耻辱导致了许多 生活质量较低。污名，一种以公众指责、道德谴责和 据记载，歧视是减缓艾滋病毒和艾滋病传播的最大挑战之一。 它使沉默和恐惧的文化长期存在，并阻止个人进行检测和寻求保健。 研究表明，与艾滋病毒/艾滋病相关的耻辱感预示着抑郁症和创伤后应激障碍，治疗不当， 坚持，孤独和社会隔离，艾滋病毒相关的身体健康和艾滋病毒性风险行为。是 艾滋病毒干预措施必须针对污名化，以减少艾滋病毒的传播。然而， 减少耻辱的干预措施 在撒哈拉以南非洲，针对感染艾滋病毒/艾滋病的儿童和青少年的培训几乎不存在。因此需要 研究将产生知识，以解决艾滋病毒/艾滋病相关的耻辱，特别是在 CLWH 作为 他们会过渡到青春期拟议的探索性研究（R21）将：目标1：初步测试可行性， 可接受性，以及创新的群体认知行为疗法（G-CBT）和多重 家庭小组为减少与艾滋病毒/艾滋病有关的耻辱感而采取的干预措施及其对目标群体的影响 参与者结果（耻辱，创伤后症状，抑郁，性风险行为，家庭/社会支持， 和药物依从性）与：1a）常规护理与G-CBT; 1b）家庭护理与MFG; 1c）G-CBT vs. Mfg.目标2：Qualitiment检查参与者和辅导员的干预经验， 个人、家庭和机构一级的促进因素和实施性别-CBT和MFG干预措施的障碍 和参与。本研究将在9家诊所（n = 90名儿童，年龄10-14岁）进行， 照顾者（共90名儿童-照顾者二人组）在马萨卡。诊所将被随机分配至三个研究组之一 （n=3个诊所;每组30名儿童护理者）：1）接受目前实施的常规护理的儿童护理 解决与艾滋病毒/艾滋病有关的耻辱问题（乌干达卫生部编写的教育材料）; 2)G-CBT干预+常规护理; 3）MFG干预+常规护理。与会者将被跟踪一个 6-月期间，在基线时收集数据 3个月 干预开始后6个月， 可行性、可接受性和初步影响。拟议研究的长期目标是开发 文化上适当、可行、可接受和有效的干预措施， 污名化及其对 CLWH 的幸福和他们的家人在SSA。

Sub-Saharan Africa (SSA) is heavily burdened by HIV, with 85% of new infections among adolescents and youth globally happening in the region. Recent statistics indicate that HIV prevalence among adolescents and young people is rising in Uganda. While availability and access to free ART has decreased child mortality, it has increased the likelihood that a number of children living with HIV ( CLWH ) will transition into adulthood, with HIV as a chronic, highly stigmatized illness. Unfortunately, the stigma this group experiences results in much lower quality of life. Stigma, a common experience characterized by public blame, moral condemnation and discrimination, has been documented to be one of the greatest challenges to slowing the spread of HIV&AIDS. It perpetuates the culture of silence and fear and prevents individuals from testing and seeking health care. Research has shown that HIV/AIDS-associated stigma predicts depression and PTSD, poor treatment and adherence, loneliness and social isolation, HIV-related physical health, and HIV sexual risk behavior. It is critical for HIV interventions to target stigma in order to reduce HIV spread. Yet, stigma-reduction interventions targeting children and adolescents living with HIV/AIDS in SSA are almost non-existent. Thus, there is a need for research that will generate knowledge to address HIV/AIDS-associated stigma, especially among CLWH as they transition to adolescence. The proposed exploratory study (R21) will: Aim 1: Pilot test the feasibility, acceptability, and preliminary impact of an innovative Group Cognitive Behavior Therapy (G-CBT) and Multiple Family Group (MFG) interventions on reducing HIV/AIDS-associated stigma and its impact on targeted participant outcomes (stigma, post-trauma symptoms, depression, sexual risk behavior, family/social support, and adherence to medication) in comparison to: 1a) usual care vs G-CBT; 1b) Usual care vs MFG; 1c) G-CBT vs. MFG. Aim 2: Qualitatively examine participants' and facilitators' intervention experiences and identify individual, family and institutional-level facilitators and barriers to G-CBT and MFG intervention implementation and participation. The study will be conducted in 9 health clinics (n = 90 children, ages 10-14) and their caregivers (total 90 child- caregiver dyads) in Masaka. Clinics will be randomized to one of three study arms (n=3 clinics; 30 child-caregiver dyads each arm): 1) Usual care to receive the currently implemented usual care addressing HIV/AIDS-associated stigma (educational materials developed by the Ugandan Ministry of Health); 2) G-CBT intervention + usual care; and 3) MFG intervention + usual care. Participants will be followed over a 6-month period, with data collected at baseline , 3 months and 6 months post intervention initiation to assess feasibility, acceptability, and preliminary impact. The long-term goal of the proposed research is to develop culturally appropriate, feasible, acceptable and effective interventions that address HIV/AIDS-associated stigma and its impact on CLWH 's wellbeing and their families in SSA.