AIDS and Society Research Unit, University of Cape Town, Private Bag, Rondebosch, 7701, Cape Town, South Africa.
Soc Sci Med. 2010 Feb;70(3):368-374. doi: 10.1016/j.socscimed.2009.09.041. Epub 2009 Nov 4.
Stigma is a recognised problem for effective prevention, treatment, and care of HIV/AIDS. However, few studies have measured changes in the magnitude and character of stigma over time. This paper provides the first quantitative evaluation in Africa of the changing nature of stigma and the potential determinants of these changes. More specifically, it evaluates the dynamic relationship between stigma and (1) increased personal contact with people living with HIV/AIDS and (2) knowing people who died of AIDS. Panel survey data collected in Cape town 2003 and 2006 for 1074 young adults aged 14-22 years were used to evaluate changes in three distinct dimensions of stigma: behavioural intentions towards people living with HIV/AIDS; instrumental stigma; and symbolic stigma. Individual fixed effects regression models are used to evaluate factors that influence stigma over time. Each dimension of stigma increased in the population as a whole, and for all racial and gender sub-groups. Symbolic stigma increased the most, followed by instrumental stigma, while negative behavioural intentions showed a modest increase. Knowing someone who died of AIDS was significantly associated with an increase in instrumental stigma and symbolic stigma, while increased personal contact with people living with HIV/AIDS was not significantly associated with any changes in stigma. Despite interventions, such as public-sector provision of antiretroviral treatment (which some hoped would have reduced stigma), stigma increased among a sample highly targeted with HIV-prevention messages. These findings emphasise that changes in stigma are difficult to predict and thus important to monitor. They also indicate the imperative for renewed efforts to reduce stigma, perhaps through interventions to weaken the association between HIV/AIDS and death, to reduce fear of HIV/AIDS, and to recast HIV as a chronic manageable disease.
污名是艾滋病毒/艾滋病有效预防、治疗和护理的公认问题。然而,很少有研究衡量污名的程度和性质随时间的变化。本文提供了在非洲首次对污名变化性质及其变化潜在决定因素的定量评估。更具体地说,它评估了污名与以下两者之间的动态关系:(1) 与艾滋病毒/艾滋病感染者个人接触的增加;(2) 了解死于艾滋病的人。使用了 2003 年和 2006 年在开普敦收集的针对 1074 名 14-22 岁年轻人的面板调查数据,评估了污名的三个不同维度的变化:对艾滋病毒感染者的行为意图;工具性污名;以及象征性污名。个体固定效应回归模型用于评估随时间变化影响污名的因素。污名的所有三个维度在整个人群中都有所增加,并且在所有种族和性别亚组中都有所增加。象征性污名增加最多,其次是工具性污名,而负面行为意图则略有增加。了解死于艾滋病的人,与工具性污名和象征性污名的增加显著相关,而与艾滋病毒感染者的个人接触增加则与污名的任何变化没有显著相关。尽管采取了干预措施,如公共部门提供抗逆转录病毒治疗(一些人希望这会减少污名),但在一个高度针对艾滋病毒预防信息的样本中,污名仍有所增加。这些发现强调,污名的变化难以预测,因此需要进行监测。它们还表明,必须重新努力减少污名,也许可以通过干预措施来削弱艾滋病毒/艾滋病与死亡之间的关联,减少对艾滋病毒/艾滋病的恐惧,并将艾滋病毒重新塑造成一种可以控制的慢性疾病。
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