Faculty of Health Sciences, University of Ottawa School of Nursing, 451 chemin Smyth Road, Ottawa, ON K1H 8M5, Canada.
BMC Public Health. 2013 Aug 8;13:736. doi: 10.1186/1471-2458-13-736.
Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one's life chances and overcome life's challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH.
We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations.
Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence.
Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society's most vulnerable populations.
全球范围内，采用人权方法来管理艾滋病毒以及努力使艾滋病毒暴露/传播非刑事化，为艾滋病毒感染者（PLWH）带来了希望。然而，在 PLWH 的弱势群体中，必须解决实质性的人权和结构性挑战（由于一个善意的自由社会的日常实践而导致的劣势和不公正）。这些挑战跨越了所有生态社会环境层面，在北美（加拿大和美国），可能包括对艾滋病毒未披露和艾滋病毒暴露/传播的起诉。我们的目的是：1）确定社会结构因素——艾滋病毒暴露/传播的刑事定罪、个人因素——感知社会资本（支持个人生活机会和克服生活挑战的资源）与 PLWH 的艾滋病毒抗逆转录病毒治疗（ART）依从性之间是否存在关联；2）描述社会结构因素——艾滋病毒暴露/传播的刑事定罪、个人因素——感知社会资本与 PLWH 的艾滋病毒 ART 依从性之间关联的性质。
我们使用生态社会理论和社会流行病学来指导我们的研究。艾滋病毒相关刑法数据来自已发表的文献。感知社会资本和艾滋病毒 ART 依从性数据来自成年 PLWH。我们使用相关性和逻辑回归来识别和描述观察到的关联。
在成年 PLWH 样本（n=1873）中，感知社会资本、法律要求的艾滋病毒披露与自我报告的艾滋病毒 ART 依从性之间存在显著正相关。我们发现，感知社会资本水平较高且法律要求披露艾滋病毒的 PLWH 报告的平均依从性更好。相比之下，生活在艾滋病毒传播/暴露为犯罪的地区的 PLWH 报告的 30 天药物依从性较低。在我们的北美参与者中，年龄较大、具有白种人或西班牙裔血统以及感知社会资本较高，是更好的 HIV ART 依从性的显著预测因素。
治疗方法在控制 HIV 和减少人群层面的 HIV 传播方面具有明显优势。然而，如果不解决允许 HIV 在社会最弱势群体中继续传播的社会和结构性挑战，这些优势对治疗依从性的益处将有限。
