Using a Multi-level Framework to Test Empirical Relationships Among HIV/AIDS-Related Stigma, Health Service Barriers, and HIV Outcomes in KwaZulu-Natal, South Africa.
Using a Multi-level Framework to Test Empirical Relationships Among HIV/AIDS-Related Stigma, Health Service Barriers, and HIV Outcomes in KwaZulu-Natal, South Africa.
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使用多层次框架来测试南非夸祖鲁-纳塔尔省与艾滋病毒/艾滋病相关的耻辱、卫生服务障碍和艾滋病毒结果之间的实证关系。
DOI：
10.1007/s10461-019-02439-2
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发表时间：
2020
影响因子：
4.4
通讯作者：
SIZEResearchGroup
中科院分区：
文献类型：
--
作者：
Williams,LeslieD;Aber,JLawrence;SIZEResearchGroup
艾滋病毒/艾滋病相关(HAR)污名在撒哈拉以南非洲是一个持续存在的问题，被认为阻碍了艾滋病毒的预防和治疗干预。本文使用一个嵌套在近邻集群(第二层)和社区(第三层)内的家庭(第一层)的系统样本来检验南非夸祖鲁-纳塔尔的HAR污名与卫生服务障碍(HSB)和艾滋病毒结果的多层次关系，从而解决从这一背景下的文献中的方法和概念空白。研究结果表明，在检验污名的两个不同维度时，水平1的预测模式不同：更高的污名化态度预示着更多的家庭卫生服务障碍；以及对社区标准HAR污名水平更高的看法预测更高的家庭艾滋病毒比率。2级的研究结果在维度上也有类似的差异。跨水平分析发现，近邻群组水平(设定水平)对(标准差)和(平均)社区标准HAR污名水平的共识显著预测家庭水平的HSBS和HIV比率，控制了家庭水平的社区标准HAR污名。这些不同的预测模式表明，Har耻辱是一个多层次的结构，具有多个维度，在多个生态水平内和跨多个生态水平与重要结果有不同的关系。这对未来的研究和开发解决污名的环境水平差异的干预措施具有重要的意义。
HIV/AIDS-related (HAR) stigma is an ongoing problem in Sub-Saharan Africa that is thought to impede HIV preventive and treatment interventions. This paper uses a systematic sample of households (Level 1) nested within near-neighbor clusters (Level 2) and communities (Level 3) to examine multilevel relationships of HAR stigma to health service barriers (HSBs) and HIV outcomes in KwaZulu-Natal, South Africa, thereby addressing methodological and conceptual gaps in the literature from this context. Findings suggest differential patterns of prediction at Level 1 when examining two different dimensions of stigma: more highly stigmatizing attitudes predicted more household health service barriers; and perceptions of greater levels of community normative HAR stigma predicted higher household HIV ratios. Level 2 findings were similarly dimension-differentiated. Cross-level analyses found that near-neighbor cluster-level (setting level) consensus about (standard deviation) and level of (mean) community normative HAR stigma significantly predicted household-level HSBs and HIV ratio, controlling for household-level community normative HAR stigma. These differential patterns of prediction suggest that HAR stigma is a multi-level construct with multiple dimensions that relate to important outcomes differently within and across multiple ecological levels. This has important implications for future research, and for developing interventions that address setting-level variation in stigma.