Stigma, coping strategies, and their impact on treatment and health outcomes among young men living with HIV in Vietnam: A qualitative study.
Stigma, coping strategies, and their impact on treatment and health outcomes among young men living with HIV in Vietnam: A qualitative study.
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DOI：
10.1371/journal.pgph.0000669
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发表时间：
2022
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污名化以多种方式影响艾滋病毒感染者，包括心理健康、坚持抗逆转录病毒疗法和继续接受护理，并可能表现在人际和个人层面。青年人特别脆弱;弱势群体中的青年人可能会遭受多重耻辱。在越南，年轻男性中新感染艾滋病毒的人数正在上升。为了更好地了解越南感染艾滋病毒的年轻男性所经历的耻辱的各个方面，我们对年轻人和临床医生进行了定性研究。我们对河内的10名青年和2名临床医生进行了深入访谈，询问了个人间和个人内的耻辱感、应对策略和披露的经历。作为进一步研究的框架，我们根据我们的研究结果和已发表的证据基础开发了一个概念模型，该模型描述了艾滋病毒相关污名，应对策略和ART依从性，护理参与和健康结果之间的相互作用。从与青年的访谈中出现的共同主题包括广泛的内化/自我耻辱和感知的耻辱，但有限的经验，由于不披露和回避的应对策略的人际耻辱。在不同类型的关系或背景下，青年使用不同的策略。不向家人、朋友、工作场所/学校透露，回避浪漫关系和医疗保健是常见的。心理健康和社会支持似乎是应对策略和健康结果之间的中介因素。要验证成见对青年的影响机制的这一模型，需要进行更大样本的进一步研究。与此同时，应在越南开展提高公众对艾滋病毒认识的公共运动。对青年及其心理健康的关键支持应涉及适合个人的方法，同时考虑到背景和个人能力，包括有足够的时间为披露做好心理准备。最后提出了一些安全有效的信息披露策略。
Stigma affects persons living with HIV in myriad ways, including mental health, adherence to antiretroviral therapy, and retention in care, and may manifest at inter- and intra-personal levels. Youth are particularly vulnerable; those in vulnerable groups may experience multiple stigmas. In Vietnam, new HIV infections are rising among men in young age groups. To better understand the facets of stigma experienced by young men living with HIV in Vietnam, we conducted a qualitative study with youth and clinicians. We conducted in-depth interviews with ten youth and two clinicians in Hanoi, querying experiences of inter- and intra-personal stigma, coping strategies, and disclosure. As a framework for further research, we developed a conceptual model based on our findings and the published evidence base which portrays interactions among HIV-related stigma, coping strategies, and ART adherence, care engagement, and health outcomes. Common themes that emerged from interviews with youth included extensive internalized/self-stigma and perceived stigma, yet limited experienced interpersonal stigma due to non-disclosure and avoidant coping strategies. Within different types of relationships or contexts, youth used different strategies. Non-disclosure with family, friends, and workplaces/school, and avoidance of romantic relationships and health care were common. Mental health and social support appeared to be mediating factors between coping strategies and health outcomes. Validation of this model of mechanisms of the impact of stigma for youth will require further research with larger samples. In the meantime, public campaigns to increase public awareness related to HIV should be implemented in Vietnam. Critical support for youth and their mental health should involve approaches tailored to the individual, taking into account context and personal capacity, including adequate time to prepare psychologically for disclosure. Some strategies for safe and effective disclosure are suggested.