'HIV and work don't go together': Employment as a social determinant of HIV outcomes among men who have sex with men and transgender women in the Dominican Republic
'HIV and work don't go together': Employment as a social determinant of HIV outcomes among men who have sex with men and transgender women in the Dominican Republic
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DOI：
10.1080/17441692.2016.1160141
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Kerrigan, Deanna
中科院分区：
文献类型：
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作者：
Barrington, Clare;Acevedo, Ramon;Kerrigan, Deanna
在多米尼加共和国，男男性行为者 (MSM) 和跨性别女性受艾滋病毒影响尤为严重。人们对他们感染艾滋病毒这种慢性疾病的经历知之甚少。我们探讨了就业作为艾滋病毒感染者福祉的社会决定因素。我们对感染艾滋病毒的 MSM (n=16) 和变性女性 (n=5) 进行了 42 次定性深入访谈；每位参与者完成 2 次访谈，以促进深度和迭代分析。我们使用叙述分析和系统编码来确定与就业和艾滋病毒经历相关的显着主题，并开发了艾滋病毒耻辱、失业和艾滋病毒结果之间路径的概念模型。早期的生活经历，包括遭到家庭和学校的拒绝，导致工作机会有限，尤其是跨性别女性。艾滋病毒诊断后，所有社会经济水平的参与者都因非法艾滋病毒检测以及艾滋病毒耻辱和歧视而失业和/或无法找到工作。无法工作会影响心理健康、艾滋病毒护理参与度和整体福祉。我们的结论是，缺乏就业是男男性行为者和感染艾滋病毒的跨性别女性的一个突出问题。迫切需要采取全面、多层次的计划来解决非法艾滋病毒检测和歧视性招聘做法，以促进护理参与和长期福祉。
Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in the Dominican Republic. Little is known about their experiences living with HIV as a chronic condition. We explored employment as a social determinant of well-being with HIV. We conducted 42 qualitative in-depth interviews with MSM (n=16) and transgender women (n=5) living with HIV; each participant completed 2 interviews to facilitate depth and iterative analysis. We used narrative analysis and systematic coding to identify salient themes related to employment and the HIV experience and developed a conceptual model of the pathways between HIV stigma, unemployment, and HIV outcomes. Early life experiences, including rejection from families and school, resulted in limited work opportunities, especially among transgender women. Following HIV diagnosis, participants across all socio-economic levels lost jobs and/or were unable to get jobs due to illegal HIV testing and HIV stigma and discrimination. Not being able to work impacted mental health, engagement in HIV care, and overall well-being. We conclude that lack of employment is a salient concern among MSM and transgender women living with HIV. Holistic, multi-level programmes that address illegal HIV testing and discriminatory hiring practices are urgently needed to facilitate engagement in care and long-term well-being.