Kutner Bryan A, Meyers Kathrine, Wu Yumeng, Lane Benjamin, Yang Gang, Hou Baichun, Balán Iván C
Albert Einstein College of Medicine & Montefiore Medical Center, Psychiatry Research Institute at Montefiore Einstein, 1225 Morris Park Ave., 4A, Bronx, NY, 10461, USA.
Aaron Diamond AIDS Research Center, Columbia University Irving Medical Center, New York, NY, 10032, USA.
AIDS Behav. 2025 Sep 18. doi: 10.1007/s10461-025-04878-6.
Stigma toward anal sex impedes engagement in health services that are vital to Ending the HIV Epidemic. We evaluated a stigma-reduction training to build HIV worker capacity to address anal pleasure and health during HIV service encounters in China. In a sequential explanatory mixed-methods design, we assessed the training's preliminary impact on anal health promotion activities and, based on the Theoretical Domains Framework, mechanisms of action among 51 health workers. We conducted descriptive statistics, bivariate comparisons, and thematic analyses based on pre/post-training online surveys and post-training in-depth interviews. The frequency of anal health promotion activities among the 38 participants who completed pre/post-training surveys increased by 7-8% of the scale range, but not significantly (p-values between 0.06 and 0.08). Mechanisms for discussing anal sex (knowledge, skills, role responsibility, self-efficacy, organizational acceptability, and positive emotions) shifted from baseline (5%-36% range), primarily due to boosts in knowledge and skills (28% and 36%, all p < .05). Additional mechanisms of comfort addressing sexual orientation, anal health, and sex-related concerns also increased (4-14% range, all p < .05). Qualitative analysis revealed mechanistic themes of heightened empathy, weakened stereotypes, and a shift toward accepting role responsibility to discuss anal sex. Gay and bisexual workers reported notable personal growth to optimize their own anal health. Although knowledge and communication skills increased provider confidence, some participants remained hesitant to initiate discussion during HIV service encounters. For most participants the theoretically-informed training activities operated as hypothesized, to enhance mechanisms that could increase provider-initiated discussion of anal pleasure and health.
对肛交的污名化阻碍了人们参与对终结艾滋病流行至关重要的健康服务。我们评估了一项减少污名化培训，以增强中国艾滋病防治工作者在艾滋病服务过程中处理肛门快感和健康问题的能力。在一项序列解释性混合方法设计中，我们评估了该培训对肛门健康促进活动的初步影响，并基于理论领域框架，分析了51名卫生工作者的行动机制。我们根据培训前/后的在线调查以及培训后的深入访谈进行了描述性统计、双变量比较和主题分析。在完成培训前/后调查的38名参与者中，肛门健康促进活动的频率在量表范围内增加了7%-8%，但不显著（p值在0.06至0.08之间）。讨论肛交的机制（知识、技能、角色责任、自我效能感、组织接受度和积极情绪）从基线水平（5%-36%的范围）发生了变化，主要是由于知识和技能的提升（分别为28%和36%，所有p < 0.05）。处理性取向、肛门健康和性相关问题时的舒适度等其他机制也有所增加（4%-14%的范围，所有p < 0.05）。定性分析揭示了增强同理心、弱化刻板印象以及向接受讨论肛交的角色责任转变等机制主题。男同性恋和双性恋工作者报告称在优化自身肛门健康方面有显著的个人成长。尽管知识和沟通技能增强了提供者的信心，但一些参与者在艾滋病服务过程中仍对展开讨论有所犹豫。对于大多数参与者来说，理论指导的培训活动按预期发挥了作用，增强了那些能够增加提供者发起关于肛门快感和健康讨论的机制。
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