Maman Suzanne, Abler Laurie, Parker Lisa, Lane Tim, Chirowodza Admire, Ntogwisangu Jacob, Srirak Namtip, Modiba Precious, Murima Oliver, Fritz Katherine
Department of Health Behavior and Health Education, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Soc Sci Med. 2009 Jun;68(12):2271-8. doi: 10.1016/j.socscimed.2009.04.002. Epub 2009 Apr 23.
What accounts for differences in HIV stigma across different high prevalence settings? This study was designed to examine HIV stigma and discrimination in five high prevalence settings. Qualitative data were collected as part of the U.S. National Institute of Mental Health (NIMH) Project Accept, a multi-site community randomized trial of community-based HIV voluntary counseling and testing. In-depth interviews were conducted with 655 participants in five sites, four in Sub-Saharan Africa and one in Southeast Asia. Interviews were conducted in the local languages by trained research staff. Data were audiotaped, transcribed, translated, coded and computerized for thematic data analysis. Participants described the stigmatizing attitudes and behaviors perpetuated against people living with HIV/AIDS (PLWHA). The factors that contribute to HIV stigma and discrimination include fear of transmission, fear of suffering and death, and the burden of caring for PLWHA. The family, access to antiretrovirals and other resources, and self-protective behaviors of PLWHA protected against HIV stigma and discrimination. Variation in the availability of health and socioeconomic resources designed to mitigate the impact of HIV/AIDS helps explain differences in HIV stigma and discrimination across the settings. Increasing access to treatment and care resources may function to lower HIV stigma, however, providing services is not enough. We need effective strategies to reduce HIV stigma as treatment and care resources are scaled up in the settings that are most heavily impacted by the HIV epidemic.
不同高流行地区的艾滋病耻辱感差异是由什么造成的？本研究旨在调查五个高流行地区的艾滋病耻辱感和歧视情况。定性数据是作为美国国立精神卫生研究所（NIMH）的“接受项目”的一部分收集的，该项目是一项基于社区的艾滋病自愿咨询和检测的多地点社区随机试验。对五个地点的655名参与者进行了深入访谈，其中四个地点在撒哈拉以南非洲，一个地点在东南亚。访谈由经过培训的研究人员用当地语言进行。数据被录音、转录、翻译、编码并计算机化以进行主题数据分析。参与者描述了针对艾滋病毒/艾滋病感染者（PLWHA）持续存在的污名化态度和行为。导致艾滋病耻辱感和歧视的因素包括对传播的恐惧、对痛苦和死亡的恐惧以及照顾艾滋病毒/艾滋病感染者的负担。艾滋病毒/艾滋病感染者的家庭、获得抗逆转录病毒药物和其他资源的情况以及自我保护行为能防止艾滋病耻辱感和歧视。旨在减轻艾滋病毒/艾滋病影响的卫生和社会经济资源的可获得性差异有助于解释不同地区艾滋病耻辱感和歧视的差异。增加获得治疗和护理资源的机会可能会降低艾滋病耻辱感，然而，仅仅提供服务是不够的。在受艾滋病疫情影响最严重的地区扩大治疗和护理资源规模时，我们需要有效的策略来减少艾滋病耻辱感。
