A post-outbreak assessment of exposure proximity and Ebola virus disease-related stigma among community members in Kono District, Sierra Leone: A cross-sectional study.
A post-outbreak assessment of exposure proximity and Ebola virus disease-related stigma among community members in Kono District, Sierra Leone: A cross-sectional study.
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DOI：
10.1016/j.ssmmh.2022.100064
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发表时间：
2022-12-01
期刊：
影响因子：
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通讯作者：
Kelly, J Daniel
中科院分区：
文献类型：
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作者：
Davidson, Michelle C;Lu, Scott;Kelly, J Daniel
背景：根据其他背景的研究结果，根据群体间接触理论，更多的接触与更少的耻辱感相关，我们假设接触埃博拉病毒病（EVD）病例较多的社区成员不太可能报告与EVD幸存者相关的耻辱感。我们评估了个人对埃博拉幸存者的污名化态度，这反映了个人的恐惧和判断，以及对埃博拉幸存者的感知污名化，这反映了个人对社区对污名化群体的态度。方法：2016年9月至2017年7月，我们在塞拉利昂科诺区四个受埃博拉病毒影响的农村社区对未感染埃博拉病毒的个体进行了一项基于社区的埃博拉病毒相关污名的横断面研究。我们从所有被隔离的家庭中确定了个体，并从未暴露的家庭中随机抽取了样本。暴露者或居住在隔离的家庭中，或据报告与埃博拉病毒病病例有过接触。我们的解释变量是在疫情爆发期间接近埃博拉病毒病病例。我们的主要结果是对埃博拉病毒病幸存者的污名，通过赞比亚和南非验证的6项艾滋病毒相关污名指数来衡量，其中1项反映个人污名态度，5项反映感知到的社区污名。6项EVD柱头指数具有良好的内部一致性（Cronbach’s alpha=0.82）。我们使用修正的泊松和负二项回归模型，调整潜在混杂因素，来估计暴露距离与EVD柱头之间的关系。结果：我们采访了538名年龄在12至85岁之间的参与者。大多数（57%）已被隔离。超过三分之一（39%）的人报告有个人污名态度或感觉到社区污名；最常被认可的项目是对埃博拉病毒病幸存者的恐惧和判断。与埃博拉病毒感染者有过接触与感知社区污名的可能性较低（患病率比[PR]， 0.26; 95% CI, 0.13-0.54）和个人污名态度（PR, 0.44; 95% CI, 0.29-0.65）显著相关。相反，被隔离与感知到社区耻辱的可能性较高显著相关（PR, 3.9; 95% CI, 1.5-10.1）。结论：在这项横断面研究中，我们发现了EVD相关的污名与接触EVD病例之间呈反比关系的证据。这一发现证实了群体间接触理论，并可能形成反污名化干预的基础。
Background: Based on findings from other contexts, informed by intergroup contact theory, that more contact is associated with less stigma, we hypothesized that community members with greater exposure to cases of Ebola virus disease (EVD) were less likely to report EVD-related stigma towards EVD survivors. We assessed personal stigmatizing attitudes towards Ebola survivors, which reflects personal fear and judgement, as well as perceived stigma towards EVD survivors, which reflects an individual's perception of the attitudes of the community towards a stigmatized group.Methods: From September 2016 to July 2017, we conducted a cross-sectional, community-based study of EVD-related stigma among individuals who did not contract Ebola in four EVD-affected rural communities of Kono District, Sierra Leone. We identified individuals from all quarantined households and obtained a random sample of those who were unexposed. Exposed individuals either lived in a quarantined household or were reported to have been in contact with an EVD case. Our explanatory variable was proximity to an EVD case during the outbreak. Our primary outcome was stigma towards EVD survivors, measured by a 6-item adapted HIV-related stigma index validated in Zambia and South Africa, with 1 item reflecting personal stigmatizing attitudes and 5 items reflecting perceived community stigma. The 6-item EVD stigma index had good internal consistency (Cronbach's alpha=0.82). We used modified Poisson and negative binomial regression models, adjusting for potential confounders, to estimate the association between exposure proximity and EVD stigma.Results: We interviewed 538 participants aged 12 to 85 years. Most (57%) had been quarantined. Over one-third (39%) reported personal stigmatizing attitudes or perceived community stigma; the most frequently endorsed item was fear and judgment towards EVD survivors. Having contact with someone with EVD was significantly associated with a lower likelihood of perceived community stigma (prevalence ratio [PR], 0.26; 95% CI, 0.13-0.54) and personal stigmatizing attitudes (PR, 0.44; 95% CI, 0.29-0.65). In contrast, being quarantined was significantly associated with a higher likelihood of perceived community stigma (PR, 3.9; 95% CI, 1.5-10.1).Conclusions: In this cross-sectional study, we found evidence of an inverse relationship between EVD-related stigma and contact with an EVD case. This finding substantiates intergroup contact theory and may form the basis for anti-stigma interventions.