HIV and tuberculosis: The construction and management of double stigma
HIV and tuberculosis: The construction and management of double stigma
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DOI：
10.1016/j.socscimed.2012.01.027
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发表时间：
2012-05-01
影响因子：
5.4
通讯作者：
Daftary, Amrita
中科院分区：
文献类型：
--
作者：
Daftary, Amrita
关键的临床、操作和社会挑战削弱了结核病（TB）和艾滋病毒综合症的缓解，而其中的社会方面却很少被探讨。本文从受影响个体的角度审视了结核病和艾滋病毒的生活经历，分析他们如何看待自己的双重疾病；他们如何理解自己的结核病与艾滋病毒之间的关系，反之亦然；以及他们如何在他们的看法和身份背景下描述他们的（被污名化的）经历。从 2009 年 2 月 8 月起，我们在南非夸祖鲁-纳塔尔省的三个门诊诊所对 40 名患有艾滋病毒和结核病的成年人进行了定性、半结构化访谈。使用修正的扎根理论分析了疾病经历的主观意义。关于疾病认知和披露的新兴主题揭示了患者如何通过道德敏感性和（非）永久性的社会建构构建与结核病和艾滋病毒相关的二分身份。每个身份都与相对不同程度的耻辱有关，这是标签、负面刻板印象和歧视的产物。艾滋病毒具有最不理想的身份，并引起最大的耻辱。然而，两种流行病的融合使结核病成为艾滋病毒的象征和症状，并提高了艾滋病的知名度。因此，双重疾病给患者的身份建构带来了悖论，并产生了独特的、重叠的双重耻辱。这助长了针对结核病的新形式的耻辱，并加剧了针对艾滋病毒的现有耻辱。它还使人们能够了解某些形式的肺外结核病。患者通过新颖的信息共享形式来管理他们的双重耻辱，这种信息共享依赖于隔离他们的双重疾病身份。患者通过艾滋病毒“另类”他们与艾滋病毒感染者的象征性距离，以及“掩盖”他们选择性地披露与结核病有关的疾病（以及与艾滋病毒相关的身份），从而转移了艾滋病毒的主要耻辱感。研究结果呼吁更多地考虑耻辱在提供结核病/艾滋病毒医疗保健中的复杂作用。 (C) 2012 Elsevier Ltd. 保留所有权利。
Mitigation of the tuberculosis (TB) and HIV syndemic is undermined by critical clinical, operational and social challenges of which the social aspects have been least explored. This paper examines the lived experience of TB disease and HIV from the perspective of affected individuals to analyze how they may think about their dual illness; how they understand their illness with TB in relation to HIV, and vice versa; and how they characterize their (stigmatized) experiences in the context of their perceptions and identities. From February August 2009, qualitative, semi-structured interviews were conducted with 40 adults with HIV and TB disease at three ambulatory clinics in KwaZulu-Natal, South Africa. Subjective meanings of illness experience were analyzed using modified grounded-theory. Emergent themes on illness perception and disclosure revealed how patients constructed dichotomous identities associated with TB and HIV through social constructs of moral susceptibility and (im)permanence. Each identity was associated with relatively disparate degrees of stigma as a product of labeling, negative stereotyping and discrimination. HIV bore the least desirable identity and invoked the greatest stigma. However, the confluence of the two epidemics rendered TB symbolic and symptomatic of HIV, and enhanced the visibility of AIDS. Dual illness thus introduced a paradox to patients' identity constructions, and produced a unique, overlapping double stigma. This facilitated new forms of stigma against TB, and aggravated existing stigma against HIV. It also conferred visibility to some forms of extra-pulmonary TB. Patients managed their double stigmas through novel forms of information sharing that relied on segregating their dual illness identities. Patients deflected the dominant stigma of HIV through concurrent processes of HIV 'othering' their symbolic distancing from persons affected by HIV, and 'covering' their selective disclosure of illness (and identity associated) with TB over that of HIV. Findings call for greater consideration to the complex role of stigma in the delivery of TB/HIV healthcare. (C) 2012 Elsevier Ltd. All rights reserved.