Department of Africana Studies, SUNY Binghamton, 4400 Vestal Parkway East, Binghamton, New York 13902-6000, USA.
AIDS Patient Care STDS. 2013 Jan;27(1):55-64. doi: 10.1089/apc.2012.0150.
This study explored the cultural context of HIV stigma on antiretroviral therapy adherence among people living with HIV/AIDS (PLWHA) in southwest Nigeria. Using purposive sampling, participants were recruited through a community-based organization. Consenting PLWHA participated in in-depth interviews and focus group discussions that were audio-taped. Using Deacon's conceptual framework of stigma, four opinion guides facilitated the interviews and discussions. Interviews and discussions were conducted in three languages, and lasted from 45 min to 2 h. A total of 35 women and men participated in the study. Participants ranged in age from 22 to 58 years, with an average of 4 years since clinical diagnosis of HIV/AIDS. All participants were receiving ART, and self-reported high adherence level. Using thematic analysis, three themes emerged: life before ART, life after ART, and strategies used in ART adherence. In describing their lives before ART, participants reported experiencing self, anticipated and enacted stigmas due to their sickly appearance from HIV-related complications. After initiating ART, participants talked about friends and families "returning to them" and "apologizing for abandoning" them once they started "looking well." In response to anticipated stigma, many reported sticking to their medications. Drawing from the cultural milieu as part of their strategies, participants discussed the use of plastic bags for medications and àkònpó, as ways of diverting attention from their use of many medications. Implications for ART program policies and stigma interventions were discussed, along with limitation of a short-term ART study on stigma since long-term use of ART can contribute to stigma by way of lipoatrophy as PLWHA age.
这项研究探讨了在尼日利亚西南部，艾滋病毒感染者和艾滋病患者（PLWHA）接受抗逆转录病毒治疗时，艾滋病毒耻辱感的文化背景。研究人员采用目的性抽样，通过一个社区组织招募参与者。同意参与的 PLWHA 参加了深入访谈和焦点小组讨论，这些讨论都进行了录音。研究人员使用迪肯的耻辱感概念框架，通过四个意见指南来辅助访谈和讨论。访谈和讨论以三种语言进行，持续时间从 45 分钟到 2 小时不等。共有 35 名男女参加了这项研究。参与者的年龄从 22 岁到 58 岁不等，平均有 4 年的 HIV/AIDS 临床诊断史。所有参与者都在接受抗逆转录病毒治疗，并且自我报告的治疗依从性水平较高。通过主题分析，出现了三个主题：接受抗逆转录病毒治疗前的生活、接受抗逆转录病毒治疗后的生活和接受抗逆转录病毒治疗时采用的策略。在描述接受抗逆转录病毒治疗前的生活时，参与者报告说，由于 HIV 相关并发症导致身体虚弱，他们经历了自我、预期和实际的耻辱。接受抗逆转录病毒治疗后，参与者谈到了朋友和家人“回到他们身边”，以及“为抛弃他们而道歉”，因为他们开始“看起来好多了”。为了应对预期的耻辱，许多人表示坚持服药。作为他们策略的一部分，参与者从文化环境中汲取灵感，讨论了使用塑料袋和 àkònpó 来存放药物，以转移人们对他们使用多种药物的注意力。讨论了抗逆转录病毒治疗方案政策和耻辱感干预措施的影响，同时还讨论了由于长期使用抗逆转录病毒治疗可能会导致脂肪萎缩，从而增加 PLWHA 的耻辱感，因此对短期抗逆转录病毒治疗研究的局限性。
