Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV 'test and treat' trial.
Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV 'test and treat' trial.
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大型艾滋病毒“测试和治疗”试验开始时，肯尼亚农村社区和乌干达的艾滋病毒相关污名的维度。
DOI：
10.1371/journal.pone.0249462
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Camlin CS
中科院分区：
文献类型：
--
作者：
Akatukwasa C;Getahun M;El Ayadi AM;Namanya J;Maeri I;Itiakorit H;Owino L;Sanyu N;Kabami J;Ssemmondo E;Sang N;Kwarisiima D;Petersen ML;Charlebois ED;Chamie G;Clark TD;Cohen CR;Kamya MR;Bukusi EA;Havlir DV;Camlin CS
与艾滋病毒有关的耻辱是艾滋病毒检测和护理参与的一个经常被提及的障碍。细致入微地了解艾滋病毒相关的耻辱感对于制定减少耻辱感的干预措施以优化艾滋病毒相关的结果至关重要。在大规模艾滋病毒检测和治疗试验（SEARCH, NCT: 01864603）的基准年期间，在广泛的社区艾滋病毒检测运动和将艾滋病毒感染者与护理和治疗联系起来的努力实施之前，这项定性研究记录了东非八个社区中与艾滋病毒相关的耻辱感。调查结果揭示了制定的、内化的和预期的耻辱经历，这些经历高度性别化，在艾滋病毒流行率较低的社区更为明显；女性，绝大多数，都持有并成为对艾滋病污名化态度的目标。过去的污名化经历包括种族隔离、语言歧视、身体暴力、羞辱和拒绝。预期的耻辱尤其突出的妇女谁持有内化的耻辱和谁经历了从他们的伴侣制定的耻辱。预期的耻辱导致逃避护理，在偏远设施寻求护理，以及隐藏艾滋病毒药物。可能需要采取干预措施，减少个人和社区层面的耻辱感，以改善艾滋病毒感染者的生活，并充分实现检测和治疗战略的承诺。
HIV-related stigma is a frequently cited barrier to HIV testing and care engagement. A nuanced understanding of HIV-related stigma is critical for developing stigma-reduction interventions to optimize HIV-related outcomes. This qualitative study documented HIV-related stigma across eight communities in east Africa during the baseline year of a large HIV test-and-treat trial (SEARCH, NCT: 01864603), prior to implementation of widespread community HIV testing campaigns and efforts to link individuals with HIV to care and treatment. Findings revealed experiences of enacted, internalized and anticipated stigma that were highly gendered, and more pronounced in communities with lower HIV prevalence; women, overwhelmingly, both held and were targets of stigmatizing attitudes about HIV. Past experiences with enacted stigma included acts of segregation, verbal discrimination, physical violence, humiliation and rejection. Narratives among women, in particular, revealed acute internalized stigma including feelings of worthlessness, shame, embarrassment, and these resulted in anxiety and depression, including suicidality among a small number of women. Anticipated stigma included fears of marital dissolution, verbal and physical abuse, gossip and public ridicule. Anticipated stigma was especially salient for women who held internalized stigma and who had experienced enacted stigma from their partners. Anticipated stigma led to care avoidance, care-seeking at remote facilities, and hiding of HIV medications. Interventions aimed at reducing individual and community-level forms of stigma may be needed to improve the lives of PLHIV and fully realize the promise of test-and-treat strategies.
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