Reducing Stigma to Improve HIV/AIDS Prevention, Treatment, and Care among Adolescents Living with HIV in Botswana

项目总结 对艾滋病毒污名进行了大量研究，记录了其在世界范围内的高流行率。艾滋病病毒 耻辱与艾滋病毒预防、治疗参与、坚持抗逆转录病毒治疗的不良影响有关 治疗(ART)。艾滋病毒污名及其伴随而来的对歧视的恐惧也对病毒载量产生不利影响， 抑郁、自杀、自尊、生活质量和艾滋病毒传播风险。尽管取得了进展，但 记录艾滋病毒污名的流行和负面后果，对最好的方法知之甚少 减少污名的有害影响。因此，这项研究的广泛目标是确定干预措施 在青少年中减少艾滋病毒污名及其对艾滋病毒预防、治疗、护理和健康的影响 博茨瓦纳的艾滋病毒携带者(ALWH)，这是一个撒哈拉以南的非洲国家，艾滋病毒感染率在世界上排名第三 世界。另一个重要目标是提高博茨瓦纳研究人员制定干预措施的能力 改进艾滋病毒预防、治疗和护理。这个项目是一个多学科团队的合作成果， 来自美国和博茨瓦纳的研究人员，他们有合作和 借鉴了博茨瓦纳大学和宾夕法尼亚大学长达十多年的合作伙伴关系。成员： 该团队已经为不同的人群开发了几种有效的艾滋病毒风险降低干预措施 青少年。具体地说，该团队将进行初步的探索性研究，以开发一种基于理论的、 在发展和文化上适宜的艾滋病毒污名减少干预措施，以改善抗逆转录病毒治疗的依从性和 减少艾滋病毒污名对青少年健康的不利影响。这一干预将是对青少年的一种适应 俱乐部，自2005年以来对13至17岁的巴茨瓦纳籍ALWH实施的干预措施 解决艾滋病毒污名问题。干预研究的祸害在于，产生的有效干预措施往往是 没有传播，因为它们在需要它们的环境中是不可持续的。我们试图绕过这一点 问题是在拟议的环境中采用了超过10年的干预措施，导致 干预措施具有很高的可持续性。我们将与ALWH、同行教育者一起开展焦点小组 实施现有计划的人，以及ALWH的父母和其他照顾者，与ALWH一起进行调查 要检查污名的相关因素，请咨询社区咨询委员会，并将我们所学的与 社会认知理论调整干预措施以解决艾滋病毒污名问题，同时确保其具有理论基础 在发展上和文化上都是合适的。我们将进行试点可行性随机对照试验 (RCT)以确定适应性干预的可行性和可接受性。拟议的工作包括 行为改变科学研究员计划，与联合国儿童基金会共同举办一系列研讨会 项目活动，以提高博茨瓦纳研究人员制定干预措施改善艾滋病毒的能力 预防、治疗和护理。在前期研究的基础上，我们将开发一个赠款应用程序来测试 减少污名干预在ALWH患者的全面随机对照试验中的有效性。

PROJECT SUMMARY Considerable research has been conducted on HIV stigma, documenting its high prevalence worldwide. HIV stigma has been tied to adverse effects on HIV prevention, treatment engagement, adherence to antiretroviral therapy (ART). HIV stigma and its accompanying fear of discrimination also adversely affect viral load, depression, suicidality, self-esteem, quality of life, and HIV-transmission risk. Despite the progress in documenting the prevalence and negative consequences of HIV stigma, little is known about the best way to reduce stigma’s deleterious impact. Accordingly, the broad objective of this research is to identify interventions to reduce HIV stigma and its impact on HIV prevention, treatment, and care and health among adolescents living with HIV (ALWH) in Botswana, a sub-Saharan African nation with the third highest HIV prevalence in the world. Another important goal is to improve the capacity of researchers in Botswana to develop interventions to improve HIV prevention, treatment, and care. This project is a collaborative effort of a multidisciplinary team of researchers from the United States and the Republic of Botswana who have a history of collaborating and draws on a more than decade-long University of Botswana-University of Pennsylvania partnership. Members of the team have developed several efficacious HIV risk-reduction interventions for a variety of populations of adolescents. Specifically, the team will conduct preliminary exploratory research to develop a theory-based, developmentally and culturally appropriate HIV stigma-reduction intervention to improve ART adherence and reduce HIV stigma’s adverse impact on adolescents’ health. The intervention will be an adaptation of Teen Club, an intervention implemented with Batswana ALWH ages 13 to 17 years since 2005 that does not address HIV stigma. The bane of intervention research is that resulting efficacious interventions too often are not disseminated because they are not sustainable in the settings that need them. We seek to circumvent this problem by adapting an intervention employed for over 10 years in the proposed setting, resulting in an intervention with a high probability of sustainability. We will conduct focus groups with ALWH, peer educators who implement the existing program, and parents and other caregivers of ALWH, conduct a survey with ALWH to examine correlates of stigma, consult with a Community Advisory Board, and integrate what we learn with Social Cognitive Theory to adapt the intervention to address HIV stigma while ensuring that it is theory-based and developmentally and culturally appropriate. We will conduct a pilot feasibility randomized controlled trial (RCT) to determine the adapted intervention’s feasibility and acceptability. The proposed work includes a Science of Behavior Change Fellows Program with a series of workshops implemented in concert with the project’s activities to improve the capacity of researchers in Botswana to develop interventions to improve HIV prevention, treatment, and care. Based on the preliminary research, we will develop a grant application to test the stigma-reduction intervention’s efficacy in a full-scale RCT with ALWH.