Rutledge Scott Edward, Abell Neil, Padmore Jacqueline, McCann Theresa J
School of Social Administration, Temple University, Philadelphia, PA 19122, USA.
Sociol Health Illn. 2009 Jan;31(1):17-34. doi: 10.1111/j.1467-9566.2008.01133.x. Epub 2008 Oct 2.
Stigma obstructs HIV/AIDS prevention and care worldwide, including in the Caribbean, where the prevalence of AIDS is second only to sub-Saharan Africa. To contextualise the experience of AIDS stigma in health services in Grenada and Trinidad and Tobago, we conducted eight focus groups with 51 people living with HIV/AIDS (PLHA), families, and service providers. Quasi-deductive content analysis revealed consonance with Western and Northern conceptualisations of AIDS stigma wherein stigma is enacted upon marginalized populations and reinforced through psycho-sociological processes comparing 'in' and 'out' groups. Socially constructed to be physically contagious and socially deviant, PLHA are scorned by some service providers, especially when they are perceived to be gay or bisexual. PLHA and providers identified passive neglect and active refusal by hospital and clinic staff to provide care to PLHA. Institutional practices for safeguarding patient confidentiality are perceived as marginally enforced. Interventions are needed to reduce provider stigma so the public will access HIV testing and PLHA will seek treatment.
耻辱感阻碍了全球范围内的艾滋病毒/艾滋病预防和护理工作，在加勒比地区亦是如此，该地区的艾滋病患病率仅次于撒哈拉以南非洲。为了解格林纳达以及特立尼达和多巴哥卫生服务中艾滋病耻辱感的情况，我们与51名艾滋病毒/艾滋病感染者、其家人以及服务提供者进行了八次焦点小组讨论。准演绎性内容分析显示，其与西方和北方对艾滋病耻辱感的概念化认识一致，即耻辱感施加于边缘化人群，并通过比较“圈内”和“圈外”群体的心理社会学过程得以强化。艾滋病毒/艾滋病感染者在社会观念中被认为具有身体传染性且行为偏离社会规范，遭到一些服务提供者的蔑视，尤其是当他们被认为是同性恋或双性恋者时。艾滋病毒/艾滋病感染者及其家人指出，医院和诊所工作人员对他们存在消极忽视和主动拒绝提供护理的情况。人们认为保护患者隐私的机构措施执行力度微弱。需要采取干预措施以减少服务提供者的耻辱感，这样公众才会接受艾滋病毒检测，艾滋病毒/艾滋病感染者才会寻求治疗。
