The relationship between health worker stigma and uptake of HIV counseling and testing and utilization of non-HIV health services: the experience of male and female sex workers in Kenya
The relationship between health worker stigma and uptake of HIV counseling and testing and utilization of non-HIV health services: the experience of male and female sex workers in Kenya
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DOI：
10.1080/09540121.2017.1307922
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发表时间：
2017-01-01
影响因子：
1.7
通讯作者：
Barker, Catherine
中科院分区：
文献类型：
--
作者：
Nyblade, Laura;Reddy, Aditi;Barker, Catherine
艾滋病毒-耻辱对艾滋病毒治疗级联的障碍越来越多地被记录在案；然而，关于男女性工作者参与艾滋病毒护理连续体系以及性工作耻辱对艾滋病毒护理连续体的影响的了解较少。虽然耻辱发生在生活的各个领域，但卫生服务中的耻辱可能对寻求健康的行为特别有害。因此，我们展示了肯尼亚男性和女性性工作者中医护人员(HCW)性工作污名的水平，并探索性工作污名与艾滋病毒咨询和检测之间的关系。我们还检验性工作污名与非艾滋病毒健康服务利用之间的关系。通过改进的受访者驱动的抽样程序，在四个地点招募了497名女性性工作者(FSW)和232名男性性工作者(MSW)的滚雪球样本。大约50%的男性性工作者和女性性工作者都报告预期会受到HCW的口头污名，而72%的FSW和54%的MSW报告至少经历了HCW所测量的七种污名中的一种。一般来说，耻辱导致报告延迟或避免咨询和检测以及非艾滋病毒特定服务的几率更高。关系的统计意义因卫生服务类型、污名类型和性别而异。例如，预期的污名并不是延迟或回避MSW卫生服务的重要预测因素；然而，与不预期的FSW相比，预期到HCW污名的FSW回避非HIV服务的几率显著更高(OR=2.11)。这篇论文增加了越来越多的证据，表明耻辱是艾滋病毒治疗级联中的一个障碍，以及它对人权健康权的破坏。在对艾滋病毒污名问题给予更多关注的同时，同样重要的是要解决经常与艾滋病毒污名相交的关键人群污名问题。
The barrier HIV-stigma presents to the HIV treatment cascade is increasingly documented; however less is known about female and male sex worker engagement in and the influence of sex-work stigma on the HIV care continuum. While stigma occurs in all spheres of life, stigma within health services may be particularly detrimental to health seeking behaviors. Therefore, we present levels of sex-work stigma from healthcare workers (HCW) among male and female sex workers in Kenya, and explore the relationship between sex-work stigma and HIV counseling and testing. We also examine the relationship between sex-work stigma and utilization of non-HIV health services. A snowball sample of 497 female sex workers (FSW) and 232 male sex workers (MSW) across four sites was recruited through a modified respondent-driven sampling process. About 50% of both male and female sex workers reported anticipating verbal stigma from HCW while 72% of FSW and 54% of MSW reported experiencing at least one of seven measured forms of stigma from HCW. In general, stigma led to higher odds of reporting delay or avoidance of counseling and testing, as well as non-HIV specific services. Statistical significance of relationships varied across type of health service, type of stigma and gender. For example, anticipated stigma was not a significant predictor of delay or avoidance of health services for MSW; however, FSW who anticipated HCW stigma had significantly higher odds of avoiding (OR=2.11) non-HIV services, compared to FSW who did not. This paper adds to the growing evidence of stigma as a roadblock in the HIV treatment cascade, as well as its undermining of the human right to health. While more attention is being paid to addressing HIV-stigma, it is equally important to address the key population stigma that often intersects with HIV-stigma.