AIDS Stigma & Gender: Health Consequences in Urban India

描述(申请人提供)：艾滋病污名是抗击艾滋病毒/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、披露艾滋病毒感染情况以及寻求艾滋病毒相关问题治疗的决定。边缘化群体的成员经常遭受双重耻辱，迫使他们隐瞒自己的生活方式，并使他们更难获得艾滋病预防计划和治疗。为艾滋病毒阳性患者提供护理的家庭成员和医护人员也成为艾滋病污名和歧视的目标。我们的研究表明，这些问题在印度也存在。巴拉特之前在印度城市进行的定性工作已经发现了艾滋病污名态度和公开的歧视，无论是在医疗保健环境中还是在家庭中都是如此。这包括拒绝照顾艾滋病毒感染者，额外收取额外手套、口罩等防护设备的费用，对房间进行熏蒸，以及缺乏保密性。数据还表明，印度城市中的艾滋病污名是一种性别现象。妇女被丈夫和姻亲忽视和虐待的报告很常见，许多妇女获得治疗的机会比她们的丈夫少。 尽管在巴拉特的定性研究中发现了许多重要的特定于文化的问题，但现在有必要扩大这项工作，以开发特定于文化的量化模型和措施，研究艾滋病污名及其健康后果，并检查印度背景下污名的流行率和相关性。目前的调查就是为了满足这一需要而设计的。它将以巴拉特的定性工作为基础，将特定于文化的主题纳入由赫里克开发和管理的美国量化测量的修改版本中。这项措施将在印度两个大城市的一系列医疗保健设施中实施，这些城市位于艾滋病毒高发区。具体来说，我们建议： 审查艾滋病污名和性别歧视的性质、程度和背景，在多个层面上，在接触过城市卫生保健系统的人中，包括a)艾滋病毒/艾滋病患者、b)艾滋病患者家属、c)医护人员和d)综合医院门诊患者。 2.在上述各级衡量艾滋病污名和污名者与污名者之间的歧视对健康造成的潜在后果。 3.发展a)对印度城市艾滋病污名和健康的特定文化的理论理解，以及b)艾滋病污名的措施，可用来评估未来在医疗保健和社区环境中针对污名受害者和施害者的减少污名的政策和方案。 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污名和歧视，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.