"I was scared dating… who would take me with my status?"-Living with HIV in the era of UTT and U = U: A qualitative study in Johannesburg, South Africa.
"I was scared dating… who would take me with my status?"-Living with HIV in the era of UTT and U = U: A qualitative study in Johannesburg, South Africa.
复制标题
“我害怕约会……谁会带我身份？” - 在南非约翰内斯堡的UTT和U = U时代与HIV一起生活。
DOI：
10.1371/journal.pgph.0000829
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
南非于2016年推出了通用测试和治疗（UTT），将治疗资格扩展到所有艾滋病毒感染者（PLHIV）。我们试图了解南非约翰内斯堡的艾滋病毒感染者如何解释和体验他们的艾滋病毒状况，进入UTT时代五年。于2021年5月，我们在三间城郊基层医疗诊所对经艾滋病顾问转介的成人（≥18岁）艾滋病毒感染者进行了深入访谈（IDI）（N = 27）。我们还进行了三个焦点小组讨论（FGD）（N = 27）与成人PLHIV招募从诊所或民间社会组织通过滚雪球抽样。对29名IDI和FGD参与者进行了后续访谈。参与者被要求反思他们的艾滋病毒诊断，他们的艾滋病毒状况对他们意味着什么，以及艾滋病毒阳性如何影响他们的生活。访谈和焦点小组讨论录音，转录，翻译成英文，并使用扎根理论的方法进行分析。与会者认为，艾滋病毒是常见的，艾滋病毒感染者可以过上正常的生活与抗逆转录病毒治疗（ART），ART是广泛的。然而，艾滋病毒作为一种性传播疾病，会引起罪恶感和羞耻感。与会者在讨论艾滋病毒传播时使用了“责备”的语言，引用了自己的鲁莽行为或指责伴侣感染了他们。与会者担心将艾滋病毒传染给他人，并认为有责任避免传播。为了控制传播焦虑，参与者避免性关系，选择HIV阳性的伴侣，和/或坚持使用避孕套。许多参与者担心或以前经历过由于他们的艾滋病毒状况而被伴侣拒绝，并报告隐藏他们的药物，避免披露，或完全避免关系。大多数参与者不知道检测不到的艾滋病毒是不可传播的（U = U）。知道U = U的参与者对将艾滋病毒传播给他人的焦虑程度较低，对建立关系的信心更大。尽管艾滋病毒被视为一种可控制的慢性病，但艾滋病毒感染者仍然面临传播焦虑和害怕被其伴侣拒绝的问题。传播关于U = U的信息可以减轻艾滋病毒感染者的心理负担，鼓励与合作伙伴进行公开交流，并消除艾滋病毒检测和治疗依从性的障碍。
South Africa rolled out Universal Test-and-Treat (UTT) in 2016, extending treatment eligibility to all persons living with HIV (PLHIV). We sought to understand how PLHIV in Johannesburg, South Africa, interpret and experience their HIV status, five years into the UTT era. In May 2021, we conducted in-depth interviews (IDI) (N = 27) with adult (≥18 years) PLHIV referred by HIV counsellors at three peri-urban primary healthcare clinics. We also conducted three focus group discussions (FGDs) (N = 27) with adult PLHIV recruited from clinics or from civil society organisations through snowball sampling. Follow-up interviews were conducted with 29 IDI and FGD participants. Participants were asked to reflect on their HIV diagnosis, what their HIV status meant to them and how, if at all, being HIV-positive affected their lives. Interviews and focus group discussions were audio-recorded, transcribed, translated to English, and analysed using a grounded theory approach. Participants perceived that HIV was common, that PLHIV could live a normal life with antiretroviral therapy (ART), and that ART was widely accessible. However, HIV elicited feelings of guilt and shame as a sexually transmitted disease. Participants used the language of “blame” in discussing HIV transmission, citing their own reckless behaviour or blaming their partner for infecting them. Participants feared transmitting HIV to others and felt responsible for avoiding transmission. To manage transmission anxiety, participants avoided sexual relationships, chose HIV-positive partners, and/or insisted on using condoms. Many participants feared–or had previously experienced–rejection by partners due to their HIV status and reported hiding their medication, avoiding disclosure, or avoiding relationships altogether. Most participants were not aware that undetectable HIV is untransmittable (U = U). Participants who were aware of U = U expressed less anxiety about transmitting HIV to others and greater confidence in having relationships. Despite perceiving HIV as a manageable chronic condition, PLHIV still faced transmission anxiety and fears of rejection by their partners. Disseminating information on U = U could reduce the psychosocial burdens of living with HIV, encourage open communication with partners, and remove barriers to HIV testing and treatment adherence.