Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, USA.
BMC Public Health. 2013 Dec 10;13:1155. doi: 10.1186/1471-2458-13-1155.
Some aspects of HIV-related stigma have been shown to be a barrier to HIV services uptake and adherence to antiretroviral treatment (ART). Distinguishing which domains of stigma impact HIV services uptake can enhance the efficacy and efficiency of stigma-reduction interventions.
The relationships between use of voluntary counseling and testing (VCT) services and two domains of community stigma identified through factor analysis, negative labeling/devaluation and social exclusion, were investigated among 3749 female heads of household. Data were from a general household survey conducted in rural Mozambique. Multivariable logistic regression outcomes were: lifetime VCT use, past-6-months VCT use and VCT endorsement.
Thirteen percent (13%) of the participants reported lifetime VCT use, 10% reported past-6-months VCT use and 63% endorsed VCT. A 25-point decrease (from 50 to 25) in the score for negative labeling and devaluation stigma was associated with increased lifetime VCT use (adjusted OR: 1.6, 95% CI: 1.1-2.3) and past-6-months VCT use (adjusted OR: 1.6, 95% CI: 1.1-2.4). A decrease from 50 to 25-points in the score for social exclusion stigma was associated with 1.5 and 1.3-fold increase in odds for past-6-months VCT use and endorsing VCT use, respectively (p < 0.001 for both). Compared with never-testers, considerably high endorsement of VCT use was observed among testers who did not receive HIV test results (adjusted OR: 2.7, 95% CI: 1.6-4.6) and much higher among testers who received results (adjusted OR: 7.3, 95% CI: 4.9-11.0). Distance from health facilities was associated with lower VCT use, but not lower endorsement of VCT.
VCT use and endorsement might differ by domains of stigma held by individuals in the community. Greater uptake and favorable disposition towards use of VCT services in rural settings might be achieved by addressing stigma via domain-specific interventions and by improving the proximity of services and the dissemination of HIV test results.
一些与艾滋病相关的耻辱感方面被证明是艾滋病服务利用和抗逆转录病毒治疗（ART）依从性的障碍。区分哪些耻辱感领域会影响艾滋病服务的利用，可以提高减少耻辱感干预的效果和效率。
通过因子分析确定了社区耻辱感的两个领域，即负面标记/贬低和社会排斥，在 3749 名女性户主中调查了这两个领域与自愿咨询和检测（VCT）服务利用之间的关系。数据来自莫桑比克农村地区进行的一项一般家庭调查。多变量逻辑回归结果为：终身 VCT 使用率、过去 6 个月 VCT 使用率和 VCT 支持率。
13%的参与者报告了终身 VCT 使用率，10%报告了过去 6 个月 VCT 使用率，63%的人支持 VCT。负面标记和贬低耻辱感的评分从 50 分下降到 25 分，与终身 VCT 使用率（调整后的 OR：1.6，95%CI：1.1-2.3）和过去 6 个月 VCT 使用率（调整后的 OR：1.6，95%CI：1.1-2.4）增加有关。社会排斥耻辱感评分从 50 分下降到 25 分，与过去 6 个月 VCT 使用率和支持 VCT 使用率的几率分别增加 1.5 倍和 1.3 倍（两者均<0.001）有关。与从未接受过检测的人相比，没有获得 HIV 检测结果的检测者中 VCT 使用率的高认可度（调整后的 OR：2.7，95%CI：1.6-4.6），以及获得结果的检测者中更高的认可度（调整后的 OR：7.3，95%CI：4.9-11.0）。与 VCT 使用率相比，距离卫生设施的远近与 VCT 认可度的相关性较低。
社区中个人持有的耻辱感领域可能会导致 VCT 的使用和认可度不同。通过针对特定领域的干预措施解决耻辱感问题，并改善服务的接近度和 HIV 检测结果的传播，可以在农村地区实现更大的 VCT 服务利用和对 VCT 的有利倾向。
