Tuberculosis and human immunodeficiency virus: exploring stigma in a community in western Uganda
Tuberculosis and human immunodeficiency virus: exploring stigma in a community in western Uganda
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DOI：
10.1080/09540121.2014.882488
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发表时间：
2014-08-03
影响因子：
1.7
通讯作者：
Kipp, Walter
中科院分区：
文献类型：
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作者：
Wynne, Ashley;Richter, Solina;Kipp, Walter
不能脱离艾滋病毒/艾滋病流行病孤立地看待乌干达的结核病威胁。污名化导致结核病和艾滋病毒患者寻求治疗的延误和坚持治疗的情况不佳。本研究旨在评估和描述乌干达西部人口中与结核病和艾滋病毒相关的耻辱感和耻辱感的预测因素。这是一项横断面混合方法研究。对从乌干达西部一个地区随机选出的360人进行了调查。根据调查问题的加权分数，将参与者分为低/高耻辱。Logistic回归分析用于确定高耻辱感的显著预测因素。进行了六个焦点小组的调查结果，使用内容分析开发的主题。调查发现，26%的受访者对艾滋病毒持轻蔑态度，47%的受访者对结核病持轻蔑态度。多因素Logistic回归模型包括年龄、性别、婚姻状况、教育程度、居住地和是否有朋友感染HIV/TB。那些有一个HIV阳性朋友的人不太可能有高的HIV耻辱感（OR：0.41，95%CI：0.23-0.72）。具有中学或以上教育程度的人有高结核病耻辱感的可能性为一半（OR：0.50，95%CI：0.27-0.91）。焦点小组的参与者认为，艾滋病毒的“正常化”有助于减少艾滋病毒的耻辱，但仍然存在被艾滋病毒诊所承认的恐惧。结核病的耻辱感导致患者保持沉默，而不是寻求治疗。对结核病的恐惧是由于“结核病意味着艾滋病毒”的假设。艾滋病毒污名化的减少令人鼓舞，但需要作出更多努力来提高保密性。结核病的耻辱感很高，可能会影响就医行为;结核病宣传运动应成为优先事项，并强调结核病的可治疗性和可治愈性，无论艾滋病毒状况如何。
The threat of tuberculosis (TB) in Uganda cannot be considered in isolation from the HIV/AIDS epidemic. Stigma contributes to delays in seeking treatment and poor adherence for both TB and HIV patients. This study aims to assess and describe stigma and predictors of stigma related to TB and HIV in the population of western Uganda. This was a cross-sectional mixed methods study. A survey was administered to 360 individuals, randomly selected from one district in western Uganda. Participants were classified as low/high stigma based on weighted scores built from survey questions. Logistic regression was used to determine significant predictors for high stigma. Six focus groups were conducted to inform survey findings; themes were developed using content analysis. Twenty-six per cent of respondents were found to have stigmatising attitudes towards HIV and 47% towards TB. Multivariate logistic regression models included age, sex, marital status, education, residence and having a friend with HIV/TB. Those who had an HIV-positive friend were less likely to have high HIV stigma (OR: 0.41, 95% CI: 0.23-0.72). Those with secondary education or more were half as likely to have high TB stigma (OR: 0.50, 95% CI: 0.27-0.91). Focus group participants felt that "normalisation" of HIV has contributed to reduced HIV stigma, but there is still a fear of being recognised at the HIV clinic. TB stigma causes patients to remain silent instead of seeking care. Fear of TB is driven by the assumption that "TB means HIV". Declining HIV stigma is encouraging but more effort needs to be made to improve confidentiality. TB stigma is high and is likely affecting care seeking behaviour; TB awareness campaigns should be a priority and emphasise the treatability and curability of TB, regardless of HIV status.