The burden of knowing: balancing benefits and barriers in HIV testing decisions. a qualitative study from Zambia
The burden of knowing: balancing benefits and barriers in HIV testing decisions. a qualitative study from Zambia
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DOI：
10.1186/1472-6963-12-2
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发表时间：
2012-01-05
影响因子：
2.8
通讯作者：
Blystad, Astrid
中科院分区：
文献类型：
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作者：
Juergensen, Marte;Tuba, Mary;Blystad, Astrid
背景：在许多非洲国家，以自愿咨询和检测（VCT）的形式扩大了由客户发起的艾滋病毒咨询和检测。检测率仍然很低，与艾滋病毒有关的耻辱是艾滋病毒检测的一个重要障碍。本研究探讨了赞比亚艾滋病毒高流行率和可获得抗逆转录病毒治疗的一个农村和一个城市地区的艾滋病毒检测决策。方法：通过17次深度访谈和2次个人焦点小组讨论以及10次咨询师深度访谈收集数据。采用解释性描述方法对数据进行分析。结果：“了解自己的状况”被发现是一个高度敏感的概念，对艾滋病毒检测产生了很强的障碍。VCT被认为是一种诊断设备和治疗重症的途径。已知的预防和早期治疗的好处被了解自己的艾滋病毒状况所带来的耻辱和恐惧所抵消。VCT服务的组织方式增加了这一负担。结论：本研究利用社会耻辱感理论来加强对抗逆转录病毒疗法存在下艾滋病相关耻辱感的持续性的理解，并认为了解艾滋病毒状况的负担和相关的不愿接受艾滋病毒检测可以被理解为一种标签回避形式，以及过去几十年来无法治愈的艾滋病患者对痛苦和死亡的强烈记忆的强烈表达。希望在于那些接受艾滋病毒检测的人所经历的与艾滋病毒有关的耻辱减少的新迹象。需要进一步研究不增加知情负担的创新性艾滋病毒检测服务设计。
Background: Client-initiated HIV counselling and testing has been scaled up in many African countries, in the form of voluntary counselling and testing (VCT). Test rates have remained low, with HIV-related stigma being an important barrier to HIV testing. This study explored HIV testing decisions in one rural and one urban district in Zambia with high HIV prevalence and available antiretroviral treatment.Methods: Data were collected through 17 in-depth interviews and two focus group discussions with individuals and 10 in-depth interviews with counsellors. Interpretive description methodology was employed to analyse the data.Results: 'To know your status' was found to be a highly charged concept yielding strong barriers against HIV testing. VCT was perceived as a diagnostic device and a gateway to treatment for the severely ill. Known benefits of prevention and early treatment were outweighed by a perceived burden of knowing your HIV status related to stigma and fear. The manner in which the VCT services were organised added to this burden.Conclusions: This study draws on social stigma theory to enhance the understanding of the continuity of HIV related stigma in the presence of ART, and argues that the burden of knowing an HIV status and the related reluctance to get HIV tested can be understood both as a form of label-avoidance and as strong expressions of the still powerful embodied memories of suffering and death among non-curable AIDS patients over the last decades. Hope lies in the emerging signs of a reduction in HIV related stigma experienced by those who had been tested for HIV. Further research into innovative HIV testing service designs that do not add to the burden of knowing is needed.