Identity management in the face of HIV and intersecting stigmas: A metasynthesis of qualitative reports from sub-Saharan Africa.
Identity management in the face of HIV and intersecting stigmas: A metasynthesis of qualitative reports from sub-Saharan Africa.
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DOI：
10.1371/journal.pgph.0000706
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发表时间：
2023
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虽然艾滋病毒感染者（PLWH）所经历的耻辱有很好的记录，但交叉耻辱和额外的耻辱身份并未受到类似的关注。本综合研究的目的是确定撒哈拉以南非洲地区PLWH中显著的污名化交叉点及其对健康结果的影响。使用Sandelowski和Barroso的元合成方法，我们在四个数据库中搜索同行评议的定性文献。纳入研究(1)探讨交叉柱头的个人经历，(2)包括≥1个传染病柱头因素，(3)在撒哈拉以南非洲进行。我们的跨国团队提取、汇总、解释并综合了这些发现。从454篇筛选摘要中，纳入本综合研究的34项研究报告了至少1258名参与者（282名男性，557名女性，109名未指明性别）和关键信息提供者的观点。从这些研究中，性别和艾滋病毒是最显著的耻辱交叉点，逃避艾滋病毒检测和否认艾滋病毒状态似乎在男性中更常见，以保持传统的男性身份。艾滋病毒并没有以同样的方式威胁到女性的身份，因为女性更愿意接受艾滋病毒检测，但有被遗弃和撤回经济支持的风险。为了防止地位的丧失，男性和女性都使用表现性行为来突出积极的品质，或尽量减少消极的品质。这些身份管理实践最终塑造了健康行为和结果。从这一综合出发，设计了耻辱感认同框架，以框架身份和耻辱感管理，重点关注角色期望和实现。该框架说明了PLWH如何创建、最小化或强调其他身份特征，以防止地位丧失和歧视。提供者必须认识到，污名化如何破坏了PLWH适应社会模式的能力，以及如何根据个人独特的交叉身份定制护理。在妇女艾滋病毒护理中应考虑经济安全和安全，同时强调抗逆转录病毒药物在保持力量和男子气概方面的作用可能会改善男性的护理参与。
While stigma experienced by people living with HIV (PLWH) is well documented, intersectional stigma and additional stigmatized identities have not received similar attention. The purpose of this metasynthesis is to identify salient stigmatized intersections and their impact on health outcomes in PLWH in sub-Saharan Africa. Using Sandelowski and Barroso’s metasynthesis method, we searched four databases for peer-reviewed qualitative literature. Included studies (1) explored personal experiences with intersecting stigmas, (2) included ≥1 element of infectious disease stigma, and (3) were conducted in sub-Saharan Africa. Our multinational team extracted, aggregated, interpreted, and synthesized the findings. From 454 screened abstracts, the 34 studies included in this metasynthesis reported perspectives of at least 1258 participants (282 men, 557 women, and 109 unspecified gender) and key informants. From these studies, gender and HIV was the most salient stigmatized intersection, with HIV testing avoidance and HIV-status denial seemingly more common among men to preserve traditional masculine identity. HIV did not threaten female identity in the same way with women more willing to test for HIV, but at the risk of abandonment and withdrawal of financial support. To guard against status loss, men and women used performative behaviors to highlight positive qualities or minimize perceived negative attributes. These identity management practices ultimately shaped health behaviors and outcomes. From this metasynthesis, the Stigma Identity Framework was devised for framing identity and stigma management, focusing on role expectation and fulfillment. This framework illustrates how PLWH create, minimize, or emphasize other identity traits to safeguard against status loss and discrimination. Providers must acknowledge how stigmatization disrupts PLWH’s ability to fit into social schemas and tailor care to individuals’ unique intersecting identities. Economic security and safety should be considered in women’s HIV care, while highlighting antiretrovirals’ role in preserving strength and virility may improve care engagement among men.