为男同性恋者、双性恋者、双性人及其他与男性发生性行为的男性提供在线性健康外展服务时出现的伦理问题：在线外展工作者的观点
The emergence of ethical issues in the provision of online sexual health outreach for gay, bisexual, two-spirit and other men who have sex with men: perspectives of online outreach workers.
作者信息
Fantus Sophia, Souleymanov Rusty, Lachowsky Nathan J, Brennan David J
机构信息
Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada.
出版信息
BMC Med Ethics. 2017 Nov 3;18(1):59. doi: 10.1186/s12910-017-0216-7.
BACKGROUND
Mobile applications and socio-sexual networking websites are used by outreach workers to respond synchronously to questions and provide information, resources, and referrals on sexual health and STI/HIV prevention, testing, and care to gay, bisexual and other men who have sex with men (GB2M). This exploratory study examined ethical issues identified by online outreach workers who conduct online sexual health outreach for GB2M.
METHODS
Semi-structured individual interviews were conducted between November 2013 and April 2014 with online providers and managers (n = 22) to explore the benefits, challenges, and ethical implications of delivering online outreach services in Ontario, Canada. Interviews were digitally recorded and transcribed verbatim. Thematic analyses were conducted, and member-checking, analyses by multiple coders, and peer debriefing supported validity and reliability.
RESULTS
Four themes emerged on the ethical queries of providing online sexual health outreach for GB2M: (a) managing personal and professional boundaries with clients; (b) disclosing personal or identifiable information to clients; (c) maintaining client confidentiality and anonymity; and (d) security and data storage measures of online information. Participants illustrated familiarity with potential ethical challenges, and discussed ways in which they seek to mitigate and prevent ethical conflict.
CONCLUSIONS
Implications of this analysis for outreach workers, researchers, bioethicists, and policy-makers are to: (1) understand ethical complexities associated with online HIV prevention and outreach for GB2M; (2) foster dialogue to recognize and address potential ethical conflict; and (3) identify competencies and skills to mitigate risk and promote responsive and accessible online HIV outreach.
背景
外展工作者利用移动应用程序和社交性网络网站，同步回应问题，并就性健康以及性传播感染/艾滋病毒的预防、检测和护理，为男同性恋者、双性恋者及其他与男性发生性行为的男性（GB2M）提供信息、资源和转介服务。本探索性研究调查了为GB2M开展在线性健康外展服务的在线外展工作者所确定的伦理问题。
方法
2013年11月至2014年4月期间，对在线服务提供者和管理人员（n = 22）进行了半结构化个人访谈，以探讨在加拿大安大略省提供在线外展服务的益处、挑战及伦理影响。访谈进行了数字录音并逐字转录。进行了主题分析，成员核对、多名编码员分析及同行汇报支持了有效性和可靠性。
结果
在为GB2M提供在线性健康外展服务的伦理问题上出现了四个主题：（a）管理与客户的个人和职业界限；（b）向客户披露个人或可识别信息；（c）维护客户的保密性和匿名性；（d）在线信息的安全和数据存储措施。参与者表明熟悉潜在的伦理挑战，并讨论了他们试图减轻和预防伦理冲突的方式。
结论
该分析对外展工作者、研究人员、生物伦理学家和政策制定者的启示是：（1）了解与GB2M在线艾滋病毒预防和外展相关的伦理复杂性；（2）促进对话以识别和解决潜在的伦理冲突；（3）确定减轻风险并促进响应性和可及性在线艾滋病毒外展的能力和技能。
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