Colombini Manuela, Mutemwa Richard, Kivunaga Jackie, Stackpool Moore Lucy, Mayhew Susannah H
London School of Hygiene and Tropical Medicine, London, UK.
BMC Health Serv Res. 2014 Sep 20;14:412. doi: 10.1186/1472-6963-14-412.
Researchers have widely documented the pervasiveness of HIV stigma and discrimination, and its impact on people living with HIV. Only a few studies, however, have analysed the perceptions of women living with HIV accessing sexual and reproductive health (SRH) services. This study explores the experiences of stigma of HIV-positive clients attending family planning and post-natal services and implications for service use and antiretroviral therapy (ART) adherence. Our aim was to gain a better understanding of the impact of various dimensions of stigma on service use and ART adherence among HIV clients in order to inform the response of integrated SRH services.
In-depth interviews were conducted with 48 women living with HIV attending SRH services in two districts in Kenya. Data were coded using Nvivo 8 and analysed using a thematic analysis approach.
Findings show that many women living with HIV report high levels of anticipated stigma, resulting in a desire to hide their status from family and friends for fear of being discriminated against. Many women feared desertion following disclosure of their positive status to partners. Consequently some women preferred to hide their status and adhere to HIV treatment in secret. However, the majority of study participants attending postnatal care (PNC) services also revealed that anticipated stigma does not adversely affect their HIV drug uptake and ART adherence, as their drive to live outweighs their fear of stigma. Our findings also seem to suggest a preference for specialist HIV services by some family planning (FP) clients because of better confidentiality and reduced opportunities for unwanted disclosure that could lead to stigma.
The findings highlight that anticipated stigma leading to low disclosure is widespread and sometimes reinforced by health providers' actions and facility layout (contributing to enacted stigma). However, the motivation to stay healthy and look after the children appears in many cases to override fears of stigma related to ART adherence in our client-based sample.
研究人员已广泛记录了艾滋病毒污名和歧视的普遍性及其对艾滋病毒感染者的影响。然而，只有少数研究分析了接受性健康和生殖健康（SRH）服务的艾滋病毒感染女性的看法。本研究探讨了参加计划生育和产后服务的艾滋病毒阳性服务对象的污名经历以及对服务利用和抗逆转录病毒疗法（ART）依从性的影响。我们的目的是更好地了解污名的各个层面对艾滋病毒感染者的服务利用和ART依从性的影响，以便为综合性SRH服务的应对措施提供依据。
对肯尼亚两个地区参加SRH服务的48名艾滋病毒感染女性进行了深入访谈。使用Nvivo 8对数据进行编码，并采用主题分析方法进行分析。
研究结果表明，许多艾滋病毒感染女性报告称预期污名程度很高，这导致她们因担心被歧视而希望向家人和朋友隐瞒自己的感染状况。许多女性担心向伴侣披露自己的阳性状况后会被抛弃。因此，一些女性宁愿隐瞒自己的状况并秘密坚持接受艾滋病毒治疗。然而，大多数参加产后护理（PNC）服务的研究参与者也表示，预期污名并不会对她们的艾滋病毒药物服用和ART依从性产生不利影响，因为她们对生存的渴望超过了对污名的恐惧。我们的研究结果似乎还表明，一些计划生育（FP）服务对象更倾向于选择专门的艾滋病毒服务，因为其保密性更好，且意外披露导致污名的机会减少。
研究结果突出表明，导致低暴露率（low disclosure）的预期污名很普遍，有时还会因医疗服务提供者的行为和机构布局而加剧（导致实际污名）。然而，在我们以服务对象为基础的样本中，保持健康和照顾孩子的动机在许多情况下似乎压倒了对与ART依从性相关污名的恐惧。
