Centre for International Health, University of Bergen, Bergen, Norway.
BMC Health Serv Res. 2012 Jan 5;12:2. doi: 10.1186/1472-6963-12-2.
Client-initiated HIV counselling and testing has been scaled up in many African countries, in the form of voluntary counselling and testing (VCT). Test rates have remained low, with HIV-related stigma being an important barrier to HIV testing. This study explored HIV testing decisions in one rural and one urban district in Zambia with high HIV prevalence and available antiretroviral treatment.
Data were collected through 17 in-depth interviews and two focus group discussions with individuals and 10 in-depth interviews with counsellors. Interpretive description methodology was employed to analyse the data.
'To know your status' was found to be a highly charged concept yielding strong barriers against HIV testing. VCT was perceived as a diagnostic device and a gateway to treatment for the severely ill. Known benefits of prevention and early treatment were outweighed by a perceived burden of knowing your HIV status related to stigma and fear. The manner in which the VCT services were organised added to this burden.
This study draws on social stigma theory to enhance the understanding of the continuity of HIV related stigma in the presence of ART, and argues that the burden of knowing an HIV status and the related reluctance to get HIV tested can be understood both as a form of label-avoidance and as strong expressions of the still powerful embodied memories of suffering and death among non-curable AIDS patients over the last decades. Hope lies in the emerging signs of a reduction in HIV related stigma experienced by those who had been tested for HIV. Further research into innovative HIV testing service designs that do not add to the burden of knowing is needed.
在许多非洲国家，以自愿咨询检测（VCT）的形式，已经扩大了以客户为导向的艾滋病毒咨询和检测。检测率仍然很低，与艾滋病毒相关的耻辱感是艾滋病毒检测的一个重要障碍。本研究探讨了赞比亚两个农村和一个城市地区的艾滋病毒检测决策，这些地区艾滋病毒流行率高，并且有抗逆转录病毒治疗。
通过与个人进行的 17 次深入访谈和两次焦点小组讨论以及与咨询者进行的 10 次深入访谈收集了数据。采用解释性描述方法对数据进行了分析。
“了解你的状况”被认为是一个充满矛盾的概念，对艾滋病毒检测构成了强烈的障碍。VCT 被视为一种诊断工具，也是治疗重病患者的途径。预防和早期治疗的已知益处被认为是了解 HIV 状况相关耻辱和恐惧的负担所抵消。VCT 服务的组织方式增加了这种负担。
本研究借鉴社会耻辱理论，加深了对在 ART 存在的情况下与艾滋病毒相关耻辱感的连续性的理解，并认为了解 HIV 状况的负担以及相关的不愿接受 HIV 检测的情况，可以理解为一种避免标签的形式，也是对过去几十年中非绝症艾滋病患者所遭受的痛苦和死亡的强烈表达，这种强烈的表达仍然具有强大的身体记忆。希望在于那些已经接受过 HIV 检测的人身上，出现了与艾滋病毒相关的耻辱感减少的迹象。需要进一步研究不增加了解负担的创新 HIV 检测服务设计。
