The Multilevel Relationships of HIV-Related Stigma to Child and Caregiver Mental Health among HIV-Affected Households in South Africa.
The Multilevel Relationships of HIV-Related Stigma to Child and Caregiver Mental Health among HIV-Affected Households in South Africa.
复制标题
南非艾滋病毒感染家庭中与艾滋病毒相关的耻辱与儿童和看护者心理健康的多层次关系。
DOI：
10.1002/ajcp.12280
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发表时间：
2019
影响因子：
3.1
通讯作者：
SIZEResearchGroup
中科院分区：
文献类型：
--
作者：
Williams,LeslieD;Aber,JLawrence;SIZEResearchGroup
艾滋病毒/艾滋病相关污名(HAR)在撒哈拉以南非洲仍然是一个普遍存在的问题，已被发现与艾滋病毒阳性个人的心理健康有关。然而，在撒哈拉以南非洲的背景下，还没有研究在艾滋病毒阴性、感染艾滋病毒的成年人和家庭中，污名与心理健康之间的关系；在这方面，也没有任何研究将污名作为一种生态结构，通过超个人(背景水平)和个人的影响水平来预测心理健康结果。在南非夸祖鲁-纳塔尔的24个社区中，对508个受艾滋病毒影响的家庭进行了系统的、具有社区代表性的抽样，采用多水平模型来研究HAR耻辱与儿童和照顾者对心理健康之间的多层次生态关系。测量了HAR污名的两个不同维度：个人污名态度和对社区标准污名的看法。研究结果表明，个人层面的HAR耻辱显著预测受艾滋病毒感染的成年人的个人心理健康(抑郁和焦虑)；社区层面的HAR耻辱显著预测受艾滋病毒影响的成年人的个人层面的心理健康结果(焦虑)，以及受艾滋病毒影响的儿童的心理健康结果(创伤后应激障碍和外在行为得分)。使用两种不同的污名测量发现了不同的关系模式。在两个分析水平(个人和社区)利用两种概念上不同的污名测量时确定的独特关系的这些发现表明，在这种情况下，HAR污名应该被概念化为一个多层次、多维度的结构。这些发现对心理健康干预和在这一背景下减少HAR耻辱的干预都有重要的影响。
HIV/AIDS‐related (HAR) stigma is still a prevalent problem in Sub‐Saharan Africa, and has been found to be related to mental health of HIV‐positive individuals. However, no studies in the Sub‐Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV‐negative, HIV‐affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra‐individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community‐representative sample of 508 HIV‐affected households nested within 24 communities in KwaZulu‐Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual‐level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV‐affected adults; and that community‐level HAR stigma significantly predicts both individual‐level mental health outcomes (anxiety) among HIV‐affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV‐affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context.