*Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Center for Public Health and Human Rights; ‡Joint United Nations Programme on HIV/AIDS (UNAIDS), Mbabane, Swaziland; and §Department of Epidemiology, Center for Public Health and Human Rights.
J Acquir Immune Defic Syndr. 2015 Mar 1;68 Suppl 2:S146-53. doi: 10.1097/QAI.0000000000000453.
The HIV epidemic in the Gambia is concentrated among stigmatized key populations. This study explores the relationship between 3 types of HIV-related stigma and 3 health outcomes among people living with HIV (PLHIV) in the Gambia.
Three hundred seventeen PLHIV from PLHIV support groups in the Gambia were surveyed using the PLHIV Stigma Index.
Enacted stigma in health care settings was significantly associated with avoiding or delaying seeking care [adjusted odds ratio (aOR) = 3.03, 95% confidence interval (CI) = 1.24 to 7.89]; enacted stigma in the household or community (aOR = 1.21, 95% CI = 0.98 to 1.49) and internal stigma (aOR = 1.47, 95% CI = 0.96 to 2.22) were marginally associated. Enacted stigma in health care settings was significantly associated with non-use of antiretroviral therapy (aOR = 0.52, 95% CI = 0.31 to 0.88), whereas internal stigma and enacted stigma in the household or community were not. Enacted stigma in the household or community (aOR = 0.75, 95% CI = 0.64 to 0.87) and internal stigma (aOR = 0.69, 95% CI = 0.50 to 0.93) were significantly associated with poorer self-reported health status, whereas enacted stigma in health care settings was not.
PLHIV in the Gambia face stigma regardless of identity as members of key populations, who may face dual stigma. Stigma mitigation represents a potentially important component of a comprehensive package of services to improve the HIV care continuum in the Gambia. Targeted interventions that address stigma with health care workers could facilitate antiretroviral therapy use and timely care seeking for PLHIV. Interventions to address internal stigma and enacted stigma in the household and community may yield additional dividends for the overall health of PLHIV. Examining only 1 domain of stigma may not be sufficient to understand the effect of stigma on a specific health outcome.
冈比亚的艾滋病毒疫情集中在受污名化的关键人群中。本研究探讨了冈比亚艾滋病毒感染者（PLHIV）中 3 种与艾滋病毒相关的污名与 3 种健康结果之间的关系。
对来自冈比亚 PLHIV 支持小组的 317 名 PLHIV 进行了调查，使用了 PLHIV 污名指数。
医疗保健环境中的实际污名与避免或延迟寻求医疗保健显著相关（调整后的优势比[OR] = 3.03，95%置信区间[CI] = 1.24 至 7.89）；家庭或社区中的实际污名（OR = 1.21，95%CI = 0.98 至 1.49）和内在污名（OR = 1.47，95%CI = 0.96 至 2.22）呈边缘相关。医疗保健环境中的实际污名与未使用抗逆转录病毒疗法显著相关（OR = 0.52，95%CI = 0.31 至 0.88），而内在污名和家庭或社区中的实际污名则没有。家庭或社区中的实际污名（OR = 0.75，95%CI = 0.64 至 0.87）和内在污名（OR = 0.69，95%CI = 0.50 至 0.93）与较差的自我报告健康状况显著相关，而医疗保健环境中的实际污名则没有。
无论是否属于关键人群成员，冈比亚的 PLHIV 都面临污名，他们可能面临双重污名。减少污名是改善冈比亚艾滋病毒护理连续体的综合服务套餐的一个潜在重要组成部分。针对卫生保健工作者的污名干预措施可以促进 PLHIV 使用抗逆转录病毒疗法并及时寻求治疗。针对家庭和社区中的内在污名和实际污名的干预措施可能会为 PLHIV 的整体健康带来额外收益。仅检查污名的 1 个领域可能不足以了解污名对特定健康结果的影响。
