Suubi4Stigma: Addressing HIV-Associated Stigma Among Adolescents

撒哈拉以南非洲(SSA)艾滋病毒负担沉重，85%的新感染病例发生在青少年和 该区域正在发生全球性的青年问题。最近的统计数据表明，艾滋病毒在青少年中的流行率和 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使用降低了儿童死亡率，但它 增加了一些携带艾滋病毒的儿童( CLWH )将过渡到成年期，与 艾滋病毒是一种被高度污名化的慢性疾病。不幸的是，这一群体经历的耻辱导致了 生活质量较低。耻辱，一种常见的经历，其特征是公众指责、道德谴责和 歧视已被证明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永久化，并阻止个人进行测试和寻求医疗保健。 研究表明，艾滋病毒/艾滋病相关的耻辱预示着抑郁和创伤后应激障碍，糟糕的治疗和 坚持、孤独和社会孤立、艾滋病毒相关的身体健康以及艾滋病毒的性行为风险。它是 艾滋病毒干预措施的关键是针对耻辱，以减少艾滋病毒的传播。然而， 减少耻辱的干预措施 在南非，几乎不存在以艾滋病毒/艾滋病患者为目标的儿童和青少年。因此，有必要 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 AS 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， 一种创新的团体认知行为疗法(G-CBT)的可接受性和初步影响 家庭小组(MFG)减少艾滋病毒/艾滋病相关耻辱的干预措施及其对目标人群的影响 参与者结果(耻辱、创伤后症状、抑郁、性危险行为、家庭/社会支持、 和坚持服药)相比：1a)常规护理与G-CBT；1b)常规护理与MFG；1c)G-CBT VS MFG。目标2：定性检查参与者和主持人的干预经验，并确定 个人、家庭和机构一级的促进者和实施G-CBT和MFG干预措施的障碍 和参与度。这项研究将在9家保健诊所(n=90名10-14岁的儿童)和他们的 Masaka的照顾者(总共90名儿童照顾者二人)。诊所将随机分配到三个研究小组中的一个 (n=3个诊所；每臂30名儿童照顾者)：1)常规护理，接受目前实施的常规护理 解决与艾滋病毒/艾滋病有关的污名问题(乌干达卫生部编写的教材)； 2)G-CBT干预+常规护理；3)MFG干预+常规护理。参与者将被跟踪超过一年 6个月期间，数据按基线收集 ，3个月 并在干预开始后6个月评估 可行性、可接受性和初步影响。拟议研究的长期目标是发展 在文化上适当、可行、可接受和有效的应对艾滋病毒/艾滋病相关问题的干预措施 耻辱及其对人的影响 CLWH 在SSA的幸福和他们的家人。

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.