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评估社区卫生工作者干预措施对减少美国西南部服务不足的拉丁裔人群中艾滋病毒/艾滋病污名化现象及增加艾滋病毒检测率的影响

Evaluation of a Community Health Worker Intervention to Reduce HIV/AIDS Stigma and Increase HIV Testing Among Underserved Latinos in the Southwestern U.S.

作者信息

Rios-Ellis Britt, Becker Davida, Espinoza Lilia, Nguyen-Rodriguez Selena, Diaz Gaby, Carricchi Ana, Galvez Gino, Garcia Melawhy

机构信息

California State University, Monterey Bay, College of Health Sciences and Human Services, Seaside, CA ; National Council of La Raza/California State University, Long Beach Center for Latino Community Health, Evaluation and Leadership Training, Long Beach, CA.

Kaiser Permanente, Pasadena, CA.

出版信息

Public Health Rep. 2015 Sep-Oct;130(5):458-67. doi: 10.1177/003335491513000509.

Abstract

OBJECTIVES

Latinos are at an elevated risk for HIV infection. Continued HIV/AIDS stigma presents barriers to HIV testing and affects the quality of life of HIV-positive individuals, yet few interventions addressing HIV/AIDS stigma have been developed for Latinos.

METHODS

An intervention led by community health workers (promotores de salud, or promotores) targeting underserved Latinos in three southwestern U.S. communities was developed to decrease HIV/AIDS stigma and increase HIV knowledge and perception of risk. The intervention was led by HIV-positive and HIV-affected (i.e., those who have, or have had, a close family member or friend with HIV/AIDS) promotores, who delivered interactive group-based educational sessions to groups of Latinos in Spanish and English. To decrease stigma and motivate behavioral and attitudinal change, the educational sessions emphasized positive Latino cultural values and community assets. The participant pool comprised 579 Latino adults recruited in El Paso, Texas (n=204); San Ysidro, California (n=175); and Los Angeles, California (n=200).

RESULTS

From pretest to posttest, HIV/AIDS stigma scores decreased significantly (p<0.001). Significant increases were observed in HIV/AIDS knowledge (p<0.001), willingness to discuss HIV/AIDS with one's sexual partner (p<0.001), and HIV risk perception (p=0.006). Willingness to test for HIV in the three months following the intervention did not increase. Women demonstrated a greater reduction in HIV/AIDS stigma scores when compared with their male counterparts, which may have been related to a greater increase in HIV/AIDS knowledge scores (p=0.016 and p=0.007, respectively).

CONCLUSION

Promotores interventions to reduce HIV/AIDS stigma and increase HIV-related knowledge, perception of risk, and willingness to discuss sexual risk with partners show promise in reaching underserved Latino communities.

摘要

目的

拉丁裔感染艾滋病毒的风险较高。对艾滋病毒/艾滋病的持续污名化给艾滋病毒检测带来了障碍,并影响艾滋病毒呈阳性者的生活质量,然而针对拉丁裔的解决艾滋病毒/艾滋病污名化问题的干预措施却很少。

方法

开发了一种由社区卫生工作者(健康促进员,即promotores)主导的干预措施,目标是美国西南部三个社区中未得到充分服务的拉丁裔,以减少对艾滋病毒/艾滋病的污名化,并增加艾滋病毒知识和风险认知。该干预措施由艾滋病毒呈阳性者和受艾滋病毒影响者(即那些自己患有或曾有近亲或朋友患有艾滋病毒/艾滋病的人)担任健康促进员,他们用西班牙语和英语为拉丁裔群体开展基于小组的互动式教育课程。为了减少污名化并促进行为和态度的改变,教育课程强调了积极的拉丁裔文化价值观和社区资产。参与对象包括在得克萨斯州埃尔帕索招募的579名拉丁裔成年人(n = 204);加利福尼亚州圣伊西德罗(n = 175);以及加利福尼亚州洛杉矶(n = 200)。

结果

从前测到后测,艾滋病毒/艾滋病污名化得分显著降低(p < 0.001)。艾滋病毒/艾滋病知识(p < 0.001)、与性伴侣讨论艾滋病毒/艾滋病的意愿(p < 0.001)以及艾滋病毒风险认知(p = 0.006)均有显著提高。干预后三个月内进行艾滋病毒检测的意愿没有增加。与男性相比,女性的艾滋病毒/艾滋病污名化得分降低幅度更大,这可能与艾滋病毒/艾滋病知识得分的更大幅度增加有关(分别为p = 0.016和p = 0.007)。

结论

由健康促进员主导的干预措施,旨在减少艾滋病毒/艾滋病污名化,并增加与艾滋病毒相关的知识、风险认知以及与伴侣讨论性风险的意愿,在覆盖未得到充分服务的拉丁裔社区方面显示出前景。

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