Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses.
Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses.
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DOI：
10.1136/bmjopen-2016-011453
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发表时间：
2016-07-13
期刊：
影响因子：
2.9
通讯作者：
Rourke SB
中科院分区：
文献类型：
--
作者：
Rueda S;Mitra S;Chen S;Gogolishvili D;Globerman J;Chambers L;Wilson M;Logie CH;Shi Q;Morassaei S;Rourke SB
对艾滋病毒相关耻辱与艾滋病毒感染者健康之间的关联进行系统性审查和一系列荟萃分析。对6个电子数据库进行了结构化检索，以获取1996年至2013年期间发表的报告艾滋病毒相关污名与健康相关结果之间关联的期刊文章。考虑纳入对艾滋病毒感染者的对照研究、队列研究、病例对照研究和横断面研究。心理健康（抑郁症状、情绪和精神困扰、焦虑）、生活质量、身体健康、社会支持、坚持抗逆转录病毒疗法、获得和使用保健/社会服务以及危险行为。我们的荟萃分析纳入了64项研究。我们发现，与艾滋病毒有关的耻辱感与抑郁症发病率较高、社会支持较低、抗逆转录病毒药物依从性较低以及获得和使用卫生和社会服务的机会较低之间存在显著关联。与艾滋病毒有关的耻辱和焦虑，生活质量，身体健康，情绪和精神困扰和性风险的做法之间的关系较弱。虽然偏倚风险评估显示，在纳入的研究中，与如何测量艾滋病毒污名和健康结局相关的总体质量良好，但在对潜在混杂因素进行适当控制方面，观察到个体研究中偏倚风险较高。更多的研究应侧重于阐明污名化与健康之间的负面关系背后的机制，以便更好地为干预措施提供信息，减少污名化对艾滋病毒感染者健康和福祉的影响。这项系统性综述和一系列荟萃分析支持这样一种观点，即与艾滋病毒有关的耻辱感对艾滋病毒感染者的各种健康相关结果具有不利影响。这一审查可以为制定多方面的部门间干预措施提供信息，以减少与艾滋病毒有关的污名对艾滋病毒感染者的健康和福祉的影响。
To conduct a systematic review and series of meta-analyses on the association between HIV-related stigma and health among people living with HIV. A structured search was conducted on 6 electronic databases for journal articles reporting associations between HIV-related stigma and health-related outcomes published between 1996 and 2013. Controlled studies, cohort studies, case-control studies and cross-sectional studies in people living with HIV were considered for inclusion. Mental health (depressive symptoms, emotional and mental distress, anxiety), quality of life, physical health, social support, adherence to antiretroviral therapy, access to and usage of health/social services and risk behaviours. 64 studies were included in our meta-analyses. We found significant associations between HIV-related stigma and higher rates of depression, lower social support and lower levels of adherence to antiretroviral medications and access to and usage of health and social services. Weaker relationships were observed between HIV-related stigma and anxiety, quality of life, physical health, emotional and mental distress and sexual risk practices. While risk of bias assessments revealed overall good quality related to how HIV stigma and health outcomes were measured on the included studies, high risk of bias among individual studies was observed in terms of appropriate control for potential confounders. Additional research should focus on elucidating the mechanisms behind the negative relationship between stigma and health to better inform interventions to reduce the impact of stigma on the health and well-being of people with HIV. This systematic review and series of meta-analyses support the notion that HIV-related stigma has a detrimental impact on a variety of health-related outcomes in people with HIV. This review can inform the development of multifaceted, intersectoral interventions to reduce the impact of HIV-related stigma on the health and well-being of people living with HIV.