Aransiola Joshua, Imoyera Winifred, Olowookere Samuel, Zarowsky Christina
1.Sociology and Anthropology, Faculty of Social Sciences, Obafemi Awolowo University, Nigeria.
Glob Health Promot. 2014 Mar;21(1):13-22. doi: 10.1177/1757975913507297. Epub 2014 Feb 25.
Thirty years into the HIV pandemic, the interactions of stigma, social and economic survival, and clinical interventions continue to be key to understanding and managing HIV at both personal and societal levels. With antiretroviral therapy, HIV is increasingly a chronic condition requiring lifelong treatment, near-perfect adherence, and support from both social networks and formal services. This study asked: is stigma still a significant problem for people living with HIV (PLHIV) who have secured access to antiretrovirals (ARVs)? How do PLHIV accessing ARVs in Nigeria experience the social, economic and health service supports intended to address their needs? What are the concerns and challenges of PLHIV and health workers regarding these supports? What are the implications for approaches to stigma and discrimination? This qualitative study at the Antiretroviral (ART) Clinic of the Osogbo State Hospital, Osun State, Nigeria involved in-depth interviews with 15 PLHIV who have been attending the clinic for at least one year, and three health workers. The results reveal both the diversity among even a small number of patients, and persistent cross-cutting themes of stigma, discrimination, poverty, and the psychological impacts of insecure livelihoods and well-intentioned but ultimately stigmatizing supports such as selective food parcels. Both population-based interventions against stigma and poverty, as well as micro-level, contextualized attention to patients', families' and health workers' fear of social exclusion and infection at a clinic and community level are needed if patients - and society - are to live well with HIV in Nigeria.
在艾滋病流行30年后，耻辱感、社会和经济生存以及临床干预措施之间的相互作用，仍然是在个人和社会层面理解与管理艾滋病的关键。随着抗逆转录病毒疗法的出现，艾滋病越来越成为一种需要终身治疗、近乎完美的依从性以及社会网络和正规服务支持的慢性病。本研究提出了以下问题：对于已获得抗逆转录病毒药物（ARV）的艾滋病病毒感染者（PLHIV）来说，耻辱感仍然是一个严重问题吗？在尼日利亚，获得抗逆转录病毒药物的艾滋病病毒感染者如何体验旨在满足其需求的社会、经济和卫生服务支持？艾滋病病毒感染者和卫生工作者对这些支持有哪些担忧和挑战？这对消除耻辱感和歧视的方法有何影响？这项在尼日利亚奥孙州奥索博州立医院抗逆转录病毒治疗（ART）诊所开展的定性研究，对15名在该诊所就诊至少一年的艾滋病病毒感染者以及3名卫生工作者进行了深入访谈。结果揭示了即使是少数患者之间的多样性，以及耻辱感、歧视、贫困，以及不安全生计和诸如选择性食品包裹等善意但最终带有耻辱性的支持所带来的心理影响等持续存在的共同主题。如果尼日利亚的患者以及社会要与艾滋病和谐共处，就需要开展基于人群的消除耻辱感和贫困的干预措施，以及在诊所和社区层面针对患者、家庭和卫生工作者对社会排斥和感染的恐惧进行微观层面的情境化关注。
