“他们也是人，他们也是斯威士兰人”：斯威士兰 HIV 阳性男男性行为者所面临的相互交织的污名与积极的健康、尊严和预防需求。
"They are human beings, they are Swazi": intersecting stigmas and the positive health, dignity and prevention needs of HIV-positive men who have sex with men in Swaziland.
机构信息
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;
出版信息
J Int AIDS Soc. 2013 Dec 2;16 Suppl 3(4Suppl 3):18749. doi: 10.7448/IAS.16.4.18749.
INTRODUCTION
Despite the knowledge that men who have sex with men (MSM) are more likely to be infected with HIV across settings, there has been little investigation of the experiences of MSM who are living with HIV in sub-Saharan Africa. Using the framework of positive health, dignity and prevention, we explored the experiences and HIV prevention, care and treatment needs of MSM who are living with HIV in Swaziland.
METHODS
We conducted 40 in-depth interviews with 20 HIV-positive MSM, 16 interviews with key informants and three focus groups with MSM community members. Qualitative analysis was iterative and included debriefing sessions with a study staff, a stakeholders' workshop and coding for key themes using Atlas.ti.
RESULTS
The predominant theme was the significant and multiple forms of stigma and discrimination faced by MSM living with HIV in this setting due to both their sexual identity and HIV status. Dual stigma led to selective disclosure or lack of disclosure of both identities, and consequently a lack of social support for care-seeking and medication adherence. Perceived and experienced stigma from healthcare settings, particularly around sexual identity, also led to delayed care-seeking, travel to more distant clinics and missed opportunities for appropriate services. Participants described experiences of violence and lack of police protection as well as mental health challenges. Key informants, however, reflected on their duty to provide non-discriminatory services to all Swazis regardless of personal beliefs.
CONCLUSIONS
Intersectionality provides a framework for understanding the experiences of dual stigma and discrimination faced by MSM living with HIV in Swaziland and highlights how programmes and policies should consider the specific needs of this population when designing HIV prevention, care and treatment services. In Swaziland, the health sector should consider providing specialized training for healthcare providers, distributing condoms and lubricants and engaging MSM as peer outreach workers or expert clients. Interventions to reduce stigma, discrimination and violence against MSM and people living with HIV are also needed for both healthcare workers and the general population. Finally, research on experiences and needs of MSM living with HIV globally can help inform comprehensive HIV services for this population.
简介
尽管人们知道男男性行为者（MSM）在各种环境中更有可能感染艾滋病毒，但对撒哈拉以南非洲地区感染艾滋病毒的 MSM 的经历却鲜有研究。本研究使用积极健康、尊严和预防框架，探讨了斯威士兰感染艾滋病毒的 MSM 的经历以及他们对艾滋病毒预防、护理和治疗的需求。
方法
我们对 20 名 HIV 阳性 MSM 进行了 40 次深入访谈，对 16 名关键知情人进行了访谈，并与 MSM 社区成员进行了三次焦点小组讨论。定性分析是迭代进行的，包括与研究人员进行情况汇报会议、利益相关者研讨会以及使用 Atlas.ti 对关键主题进行编码。
结果
主要主题是在这种环境下，HIV 阳性 MSM 由于他们的性身份和 HIV 状况而面临着严重的、多种形式的耻辱和歧视。双重耻辱导致他们对两者身份的选择性披露或缺乏披露，从而导致缺乏寻求护理和坚持用药的社会支持。来自医疗保健机构的感知和经历的耻辱，特别是围绕性身份的耻辱，也导致了寻求护理的延迟、前往更远的诊所以及错失适当服务的机会。参与者描述了暴力和缺乏警察保护的经历以及心理健康方面的挑战。然而，关键知情人反思了他们为所有斯威士人提供无歧视服务的责任，无论个人信仰如何。
结论
交叉性为理解斯威士兰感染艾滋病毒的 MSM 所面临的双重耻辱和歧视经历提供了一个框架，并强调了在设计艾滋病毒预防、护理和治疗服务时，方案和政策应考虑到这一人群的具体需求。在斯威士兰，卫生部门应考虑为医疗保健提供者提供专门培训，分发避孕套和润滑剂，并让 MSM 作为同伴外展工作者或专家客户参与。还需要针对医疗保健工作者和一般人群开展减少对 MSM 和艾滋病毒感染者的耻辱、歧视和暴力的干预措施。最后，对全球感染艾滋病毒的 MSM 的经历和需求进行研究，可以为这一人群提供全面的艾滋病毒服务。
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