Individual and community-level risk factors for HIV stigma in 21 Zambian and South African communities: analysis of data from the HPTN071 (PopART) study.
Individual and community-level risk factors for HIV stigma in 21 Zambian and South African communities: analysis of data from the HPTN071 (PopART) study.
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DOI：
10.1097/qad.0000000000001757
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发表时间：
2018-03-27
期刊：
影响因子：
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通讯作者：
HPTN 071 (PopART) Study Team
中科院分区：
文献类型：
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作者：
Hargreaves JR;Krishnaratne S;Mathema H;Lilleston PS;Sievwright K;Mandla N;Mainga T;Vermaak R;Piwowar-Manning E;Schaap A;Donnell D;Ayles H;Hayes RJ;Hoddinott G;Bond V;Stangl A;HPTN 071 (PopART) Study Team
本文提供补充数字内容，描述了赞比亚和南非21个社区中艾滋病毒耻辱的流行情况和决定因素。HPTN 071 （PopART）集群随机试验的基线数据分析。艾滋病毒污名数据来自3859名艾滋病毒感染者的随机样本。反映艾滋病毒恐惧以及对艾滋病毒污名的判断和看法的社区水平暴露来自非艾滋病毒感染者社区成员（n = 5088）和卫生工作者（n = 851）的随机样本。我们计算了在过去的一年中，在社区或医疗保健机构中，内化耻辱和耻辱的患病率。我们使用逻辑回归进行风险因素分析，调整聚类。内化病耻感（868/3859，患病率22.5%）与社会人口学特征无关，但在确诊时间较长的人群中较少见（P = 0.043）。女性（P = 0.016）、老年（P = 0.011）、未婚（P = 0.009）、曾向他人披露过（P < 0.001）、终生性伴侣较多（P < 0.001）者在社区中有耻辱感（853/3859,22.1%）。在医疗机构中经历的耻辱感（280/3859,7.3%）在女性（P = 0.019）和报告终生性伴侣较多（P = 0.001）和较高财富（P = 0.003）中更为常见。在社区成员感知到较高程度的耻辱的集群中，经历过的耻辱更为常见，但与社区成员或HW的信仰无关。在南非和赞比亚，对艾滋病毒的耻辱感仍然高得令人无法接受，并可能成为艾滋病毒预防和治疗的障碍。需要进一步的研究来了解其决定因素。
Supplemental Digital Content is available in the text To describe the prevalence and determinants of HIV stigma in 21 communities in Zambia and South Africa. Analysis of baseline data from the HPTN 071 (PopART) cluster-randomized trial. HIV stigma data came from a random sample of 3859 people living with HIV. Community-level exposures reflecting HIV fears and judgements and perceptions of HIV stigma came from a random sample of community members not living with HIV (n = 5088), and from health workers (HW) (n = 851). We calculated the prevalence of internalized stigma, and stigma experienced in the community or in a healthcare setting in the past year. We conducted risk-factor analyses using logistic regression, adjusting for clustering. Internalized stigma (868/3859, prevalence 22.5%) was not associated with sociodemographic characteristics but was less common among those with a longer period since diagnosis (P = 0.043). Stigma experienced in the community (853/3859, 22.1%) was more common among women (P = 0.016), older (P = 0.011) and unmarried (P = 0.009) individuals, those who had disclosed to others (P < 0.001), and those with more lifetime sexual partners (P < 0.001). Stigma experienced in a healthcare setting (280/3859, 7.3%) was more common among women (P = 0.019) and those reporting more lifetime sexual partners (P = 0.001) and higher wealth (P = 0.003). Experienced stigma was more common in clusters wherever community members perceived higher levels of stigma, but was not associated with the beliefs of community members or HW. HIV stigma remains unacceptably high in South Africa and Zambia and may act as barrier to HIV prevention and treatment. Further research is needed to understand its determinants.