"We don't exist": a qualitative study of marginalization experienced by HIV-positive lesbian, bisexual, queer and transgender women in Toronto, Canada
"We don't exist": a qualitative study of marginalization experienced by HIV-positive lesbian, bisexual, queer and transgender women in Toronto, Canada
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DOI：
10.7448/ias.15.2.17392
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发表时间：
2012-09-07
影响因子：
6
通讯作者：
Loutfy, Mona R.
中科院分区：
文献类型：
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作者：
Logie, Carmen H.;James, LLana;Loutfy, Mona R.
背景：女同性恋、双性恋、酷儿和变性人（LBQT）感染艾滋病毒的女性一直被描述为隐形的和未被充分研究的。然而，暴力和歧视的社会和结构背景加剧了LBQT妇女感染艾滋病毒的风险。研究目的是探讨加拿大多伦多HIV阳性LBQT妇女在日常生活中的挑战和获得HIV服务的经历。方法：在交叉理论框架的指导下，我们采用基于社区的定性方法。我们安排了两个焦点小组；一组是hiv阳性的女同性恋、双性恋和酷儿女性（n = 7），另一组是hiv阳性的跨性别女性（n = 16）。参与者是通过有目的的抽样来招募的。对焦点小组进行了数字记录，并逐字抄写。专题分析用于分析数据，以加强对影响艾滋病毒阳性LBQT妇女健康的因素的理解。结果：参与者的叙述揭示了边缘化的轨迹。社会排斥和暴力等结构性因素增加了感染艾滋病毒的风险；艾滋病毒预防信息不足加剧了这一风险。与会者描述了艾滋病毒护理和支助方面的多重障碍，包括普遍存在的与艾滋病毒有关的污名、艾滋病毒阳性妇女服务中的异性规范假设以及卫生专业人员的歧视性和不称职治疗。LBQT妇女在艾滋病毒研究中的代表性不足进一步加剧了边缘化和排斥。与会者表示愿意参与将转化为行动的艾滋病毒研究。结论：结构性因素增加了LBQT妇女的艾滋病毒风险，限制了获得艾滋病毒预防的机会，并存在艾滋病毒护理和支持的障碍。本研究对边缘化轨迹的概念化丰富了对与LBQT女性健康相关的结构性因素的讨论，并强调了解决LBQT女性在艾滋病预防、护理和研究方面需求的必要性。需要采取干预措施，解决社区和社会规范、艾滋病毒规划和研究中相互交叉的边缘化形式（例如性耻辱、变性恐惧症、与艾滋病毒有关的耻辱），以促进LBQT妇女的健康平等。
Background: Lesbian, bisexual, queer and transgender (LBQT) women living with HIV have been described as invisible and understudied. Yet, social and structural contexts of violence and discrimination exacerbate the risk of HIV infection among LBQT women. The study objective was to explore challenges in daily life and experiences of accessing HIV services among HIV-positive LBQT women in Toronto, Canada.Methods: We used a community-based qualitative approach guided by an intersectional theoretical framework. We conducted two focus groups; one focus group was conducted with HIV-positive lesbian, bisexual and queer women (n = 7) and the second with HIV-positive transgender women (n = 16). Participants were recruited using purposive sampling. Focus groups were digitally recorded and transcribed verbatim. Thematic analysis was used for analyzing data to enhance understanding of factors that influence the wellbeing of HIV-positive LBQT women.Results: Participant narratives revealed a trajectory of marginalization. Structural factors such as social exclusion and violence elevated the risk for HIV infection; this risk was exacerbated by inadequate HIV prevention information. Participants described multiple barriers to HIV care and support, including pervasive HIV-related stigma, heteronormative assumptions in HIV-positive women's services and discriminatory and incompetent treatment by health professionals. Underrepresentation of LBQT women in HIV research further contributed to marginalization and exclusion. Participants expressed a willingness to participate in HIV research that would be translated into action.Conclusions: Structural factors elevate HIV risk among LBQT women, limit access to HIV prevention and present barriers to HIV care and support. This study's conceptualization of a trajectory of marginalization enriches the discussion of structural factors implicated in the wellbeing of LBQT women and highlights the necessity of addressing LBQT women's needs in HIV prevention, care and research. Interventions that address intersecting forms of marginalization (e. g. sexual stigma, transphobia, HIV-related stigma) in community and social norms, HIV programming and research are required to promote health equity among LBQT women.