Health worker perceptions of stigma towards Zambian adolescent girls and young women: a qualitative study.
Health worker perceptions of stigma towards Zambian adolescent girls and young women: a qualitative study.
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DOI：
10.1186/s12913-022-08636-5
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发表时间：
2022-10-17
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
--
作者：
东部和南部非洲15至24岁少女和年轻妇女艾滋病毒感染率很高，这表明这一人群非常需要获得艾滋病毒预防和治疗服务，但赞比亚尚未实现感染艾滋病毒的少女和年轻妇女的全球检测和治疗目标。要增加这一人群获得及时、高质量艾滋病毒服务的机会，就必须解决少女和年轻妇女在寻求艾滋病毒护理时经常面临的预期和经历过的更严重的耻辱问题，特别是在卫生设施环境中的耻辱问题。为了更好地了解卫生设施污名化的多层次驱动因素和表现形式，我们探讨了赞比亚卢萨卡卫生工作者对寻求性健康和生殖健康（包括艾滋病毒）服务的少女和年轻妇女在诊所和社区一级污名化的看法。我们于2020年8月对卢萨卡城市和城郊的六家卫生设施的临床和非临床卫生工作者进行了18次深入访谈。数据在Dedoose中编码并进行主题分析。卫生工作者报告说，他们观察到了由态度、认识和体制环境驱动的污名化表现。诊所一级的耻辱往往反映了社区一级的耻辱。卫生工作者清楚地描述了污名化对少女和年轻妇女的负面影响，似乎普遍表示希望避免污名化。尽管这种缺乏意图的污名化，结果表明，社区的影响延续了挥之不去的存在的耻辱，虽然往往是不承认的和无意的，在卫生工作者和诊所。这些研究结果表明，重叠的卫生工作者的诊所和社区的作用，并建议需要多层次的污名减少的方法，解决社区规范对卫生设施的耻辱的影响。减少污名化的干预措施应力求超越培养关于污名化的基本知识，鼓励对内部信念和社区影响进行批判性思考，并思考这些信念和社区影响如何在向少女和年轻妇女提供服务的过程中表现出来，而且往往是无意识地表现出来。在线版本包含补充材料，可通过10.1186/s12913-022-08636-5获得。
The high prevalence of HIV among adolescent girls and young women aged 15–24 in Eastern and Southern Africa indicates a substantial need for accessible HIV prevention and treatment services in this population. Amidst this need, Zambia has yet to meet global testing and treatment targets among adolescent girls and young women living with HIV. Increasing access to timely, high-quality HIV services in this population requires addressing the intensified anticipated and experienced stigma that adolescent girls and young women often face when seeking HIV care, particularly stigma in the health facility setting. To better understand the multi-level drivers and manifestations of health facility stigma, we explored health workers’ perceptions of clinic- and community-level stigma against adolescent girls and young women seeking sexual and reproductive health, including HIV, services in Lusaka, Zambia. We conducted 18 in-depth interviews in August 2020 with clinical and non-clinical health workers across six health facilities in urban and peri-urban Lusaka. Data were coded in Dedoose and thematically analyzed. Health workers reported observing manifestations of stigma driven by attitudes, awareness, and institutional environment. Clinic-level stigma often mirrored community-level stigma. Health workers clearly described the negative impacts of stigma for adolescent girls and young women and seemed to generally express a desire to avoid stigmatization. Despite this lack of intent to stigmatize, results suggest that community influence perpetuates a lingering presence of stigma, although often unrecognized and unintended, in health workers and clinics. These findings demonstrate the overlap in health workers’ clinic and community roles and suggest the need for multi-level stigma-reduction approaches that address the influence of community norms on health facility stigma. Stigma-reduction interventions should aim to move beyond fostering basic knowledge about stigma to encouraging critical thinking about internal beliefs and community influence and how these may manifest, often unconsciously, in service delivery to adolescent girls and young women. The online version contains supplementary material available at 10.1186/s12913-022-08636-5.
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影响因子：
33.9
作者：
Brown, Kristin;Williams, Daniel B.;Voetsch, Andrew C.
通讯作者：
Voetsch, Andrew C.
影响因子：
3.8
作者：
Nyblade, Laura;Mbuya-Brown, Rebecca J.;Kraemer, John D.
通讯作者：
Kraemer, John D.
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
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Kipenda CU
影响因子：
16.1
作者：
Andersson, Galit Zeluf;Reinius, Maria;Ekstrom, Anna Mia
通讯作者：
Ekstrom, Anna Mia
影响因子：
5.2
作者：
Nyblade L;Srinivasan K;Mazur A;Raj T;Patil DS;Devadass D;Radhakrishna K;Ekstrand ML
通讯作者：
Ekstrand ML