Intersecting stigma and HIV testing practices among urban refugee adolescents and youth in Kampala, Uganda: qualitative findings.
Intersecting stigma and HIV testing practices among urban refugee adolescents and youth in Kampala, Uganda: qualitative findings.
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DOI：
10.1002/jia2.25674
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发表时间：
2021-03
影响因子：
6
通讯作者：
Baral S
中科院分区：
文献类型：
--
作者：
Logie CH;Okumu M;Kibuuka Musoke D;Hakiza R;Mwima S;Kyambadde P;Abela H;Gittings L;Musinguzi J;Mbuagbaw L;Baral S
在人道主义背景下，艾滋病毒相关风险可能会加剧。乌干达收容了130万难民，其中60%年龄在18岁以下。在城市难民青年中，对艾滋病毒检测的促进者和障碍，包括艾滋病毒和相互交叉的耻辱，存在着知识差距。作为回应，我们与乌干达坎帕拉的城市难民青年一起探讨了艾滋病毒检测战略的经验和观点，包括艾滋病毒自我检测。我们对2019年2月至4月居住在坎帕拉非正式定居点的16至24岁的顺性别难民青年进行了定性研究。我们对难民青年进行了五次重点小组讨论，其中两次是男孩和青年男子，两次是女孩和青年妇女，一次是女性性工作者。我们还与政府、非政府和社区难民机构以及艾滋病毒服务提供者进行了五次关键知情人（KI）访谈。我们进行了专题分析，以了解艾滋病毒检测的经验，观点和建议。参与者（n = 49）包括来自刚果民主共和国[刚果民主共和国]（n = 29）、卢旺达（n = 11）、布隆迪（n = 3）和苏丹（n = 1）的年轻男性（n = 17）和年轻女性（n = 27），此外还有5名KI（性别：n = 3名女性，n = 2名男性;原籍国：n = 2名卢旺达人，n = 2名乌干达人，n = 1名刚果民主共和国人）。参与者的叙述显示，污名化的驱动因素包括害怕感染艾滋病毒;错误地认为艾滋病毒是一种“乌干达疾病”;以及对性活动的指责和羞耻。污名化的促成因素包括性工作、同性行为和移民身份方面的法律的不稳定性，以及医疗虐待和保密问题。污名化的经历归因于社会对交叉身份（性工作者、青年、难民、性少数群体、艾滋病毒感染者、妇女）的贬低。与会者对艾滋病毒自我检测表示高度兴趣。他们建议艾滋病毒自我检测实施战略得到同伴的支持，并对伴侣检测中的性暴力和基于性别的暴力表示关切。根植于恐惧、错误信息、指责和羞耻、法律的不稳定性和医疗虐待的相互交织的耻辱感限制了目前对城市难民青年的艾滋病毒检测战略。调查结果与健康污名和歧视框架一致，该框架将贬低交叉健康状况和社会身份的污名驱动因素和促进因素概念化。调查结果可以为多层次战略提供信息，以促进城市难民青年的艾滋病毒检测环境，包括解决交叉污名问题和利用难民青年同伴的支持。
HIV‐related risks may be exacerbated in humanitarian contexts. Uganda hosts 1.3 million refugees, of which 60% are aged under 18. There are knowledge gaps regarding HIV testing facilitators and barriers, including HIV and intersecting stigmas, among urban refugee youth. In response, we explored experiences and perspectives towards HIV testing strategies, including HIV self‐testing, with urban refugee youth in Kampala, Uganda. We implemented a qualitative study with refugee cisgender youth aged 16 to 24 living in Kampala's informal settlements from February‐April 2019. We conducted five focus groups with refugee youth, including two with adolescent boys and young men, two with adolescent girls and young women and one with female sex workers. We also conducted five key informant (KI) interviews with government, non‐government and community refugee agencies and HIV service providers. We conducted thematic analyses to understand HIV testing experiences, perspectives and recommendations. Participants (n = 49) included young men (n = 17) and young women (n = 27) originally from the Democratic Republic of Congo [DRC] (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1), in addition to five KI (gender: n = 3 women, n = 2 men; country of origin: n = 2 Rwanda, n = 2 Uganda, n = 1 DRC). Participant narratives revealed stigma drivers included fear of HIV infection; misinformation that HIV is a “Ugandan disease”; and blame and shame for sexual activity. Stigma facilitators included legal precarity regarding sex work, same‐sex practices and immigration status, alongside healthcare mistreatment and confidentiality concerns. Stigma experiences were attributed to the social devaluation of intersecting identities (sex work, youth, refugees, sexual minorities, people living with HIV, women). Participants expressed high interest in HIV self‐testing. They recommended HIV self‐testing implementation strategies to be peer supported and expressed concerns regarding sexual‐ and gender‐based violence with partner testing. Intersecting stigma rooted in fear, misinformation, blame and shame, legal precarity and healthcare mistreatment constrain current HIV testing strategies with urban refugee youth. Findings align with the Health Stigma and Discrimination Framework that conceptualizes stigma drivers and facilitators that devalue intersecting health conditions and social identities. Findings can inform multi‐level strategies to foster enabling HIV testing environments with urban refugee youth, including tackling intersecting stigma and leveraging refugee youth peer support.
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DOI：
10.1080/13691058.2015.1035751
发表时间：
2015
期刊：
Culture, health & sexuality
影响因子：
--
作者：
Dworkin SL;Fleming PJ;Colvin CJ
通讯作者：
Colvin CJ
影响因子：
3.7
作者：
O'Laughlin KN;Rabideau DJ;Kasozi J;Parker RA;Bustamante ND;Faustin ZM;Greenwald KE;Walensky RP;Bassett IV
通讯作者：
Bassett IV
影响因子：
2.2
作者：
Gibbs, Andrew;Myrttinen, Henri;Jewkes, Rachel
通讯作者：
Jewkes, Rachel
影响因子：
6
作者：
Logie CH;Okumu M;Mwima SP;Kyambadde P;Hakiza R;Kibathi IP;Kironde E;Musinguzi J;Kipenda CU
通讯作者：
Kipenda CU
影响因子：
1.3
作者：
Earnshaw VA;Quinn DM;Park CL
通讯作者：
Park CL