Stigma trajectories among people living with HIV (PLHIV) embarking on a life time journey with antiretroviral drugs in Jinja, Uganda
Stigma trajectories among people living with HIV (PLHIV) embarking on a life time journey with antiretroviral drugs in Jinja, Uganda
复制标题
DOI：
10.1186/1471-2458-13-804
复制
发表时间：
2013-09-05
影响因子：
4.5
通讯作者：
Jaffar, Shabbar
中科院分区：
文献类型：
--
作者：
Mbonye, Martin;Nakamanya, Sarah;Jaffar, Shabbar
背景：耻辱是艾滋病毒预防和治疗的障碍。对于艾滋病毒感染者 (PLHIV) 接受抗逆转录病毒治疗 (ART) 所面临的耻辱类型，人们的了解有限。我们描述了感染者从开始 ART 起 5 年期间的耻辱轨迹。 方法：2005 年至 2008 年，对乌干达金贾的艾滋病支持组织 (TASO) 的 41 名成员进行了纵向定性深入访谈，他们是一项实用整群随机试验的一部分，该试验比较了两种不同的 ART 交付模式（设施和家庭）。参与者按性别、ART 实施方式和 HIV 分期（早期或晚期）进行分层，并在 ART 入组时以及 3、6、18 和 30 个月后接受采访。采访的重点是耻辱和艺术经历。 2011年，对24名可追踪的参与者进行了后续访谈。对转录文本进行翻译、编码和主题分析。 结果：据报道，在开始 ART 之前，耻辱感非常高，这是由长期疾病的明显迹象以及歧视和虐待经历来解释的。早期的应对策略包括：退出公共生活、因健康状况不佳而离开工作以及搬去与亲戚同住。开始抗逆转录病毒疗法导致耻辱感稳步下降，并使参与者能够控制自己的疾病并管理自己的社交生活。健康状况的改善导致工作和性行为的恢复，但也减少了向雇主、同事和新性伴侣披露的情况。一些参与者提到了血清分类，以避免有关艾滋病毒血清状态的问题。在 18 个月和 30 个月的访谈中，耻辱程度的上升可能与披露的减少有关。到 2011 年，与 ART 相关的耻辱感更加明显，特别是在那些已经开始新的性关系、找到工作以及因 ART 副作用而出现身体症状的人中。 结论：这项研究表明，虽然 ART 具有健康益处，可以帮助个人摆脱以前耻辱的明显迹象，但在接受 ART 大约五年后，可能会注意到耻辱感的增加，从而导致披露减少。 ART 依从性咨询应反映随着时间的推移不断变化的耻辱原因和表现。
Background: Stigma is a barrier to HIV prevention and treatment. There is a limited understanding of the types of stigma facing people living with HIV (PLHIV) on antiretroviral therapy (ART). We describe the stigma trajectories of PLHIV over a 5-year period from the time they started ART.Methods: Longitudinal qualitative in-depth interviews were conducted with 41 members of The AIDS Support Organisation (TASO) from 2005 to 2008 in Jinja, Uganda, who were part of a pragmatic cluster-randomised trial comparing two different modes of ART delivery (facility and home). Participants were stratified by gender, ART delivery arm and HIV stage (early or advanced) and interviewed at enrolment on to ART and then after 3, 6, 18 and 30 months. Interviews focused on stigma and ART experiences. In 2011, follow-up interviews were conducted with 24 of the participants who could be traced. Transcribed texts were translated, coded and analyzed thematically.Results: Stigma was reported to be very high prior to starting ART, explained by visible signs of long-term illnesses and experiences of discrimination and abuse. Early coping strategies included: withdrawal from public life, leaving work due to ill health and moving in with relatives. Starting ART led to a steady decline in stigma and allowed the participants to take control of their illness and manage their social lives. Better health led to resumption of work and having sex but led to reduced disclosure to employers, colleagues and new sexual partners. Some participants mentioned sero-sorting in order to avoid questions around HIV sero-status. A rise in stigma levels during the 18 and 30 month interviews may be correlated with decreased disclosure. By 2011, ART-related stigma was even more pronounced particularly among those who had started new sexual relationships, gained employment and those who had bodily signs from ART side-effects.Conclusion: This study has shown that while ART comes with health benefits which help individuals to get rid of previously stigmatising visible signs, an increase in stigma may be noticed after about five years on ART, leading to reduced disclosure. ART adherence counselling should reflect changing causes and manifestations of stigma over time.