Treves-Kagan Sarah, El Ayadi Alison M, Pettifor Audrey, MacPhail Catherine, Twine Rhian, Maman Suzanne, Peacock Dean, Kahn Kathleen, Lippman Sheri A
Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA.
Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
AIDS Behav. 2017 Sep;21(9):2579-2588. doi: 10.1007/s10461-016-1671-8.
Stigma remains a significant barrier to HIV testing in South Africa. Despite being a social construct, most HIV-stigma research focuses on individuals; further the intersection of gender, testing and stigma is yet to be fully explored. We examined the relationship between anticipated stigma at individual and community levels and recent testing using a population-based sample (n = 1126) in Mpumalanga, South Africa. We used multi-level regression to estimate the potential effect of reducing community-level stigma on testing uptake using the g-computation algorithm. Men tested less frequently (OR 0.22, 95% CI 0.14-0.33) and reported more anticipated stigma (OR 5.1, 95% CI 2.6-10.1) than women. For men only, testing was higher among those reporting no stigma versus some (OR 1.40, 95% CI 0.97-2.03; p = 0.07). For women only, each percentage point reduction in community-level stigma, the likelihood of testing increased by 3% (p < 0.01). Programming should consider stigma reduction in the context of social norms and gender to tailor activities appropriately.
在南非，耻辱感仍然是艾滋病毒检测的一个重大障碍。尽管耻辱感是一种社会建构，但大多数关于艾滋病毒耻辱感的研究都集中在个体层面；此外，性别、检测与耻辱感之间的交叉关系尚未得到充分探讨。我们使用南非姆普马兰加省的一个基于人群的样本（n = 1126），研究了个体和社区层面预期的耻辱感与近期检测之间的关系。我们使用多层次回归，通过g计算算法估计减少社区层面耻辱感对检测接受率的潜在影响。男性的检测频率低于女性（比值比0.22，95%置信区间0.14 - 0.33），且报告的预期耻辱感更多（比值比5.1，95%置信区间2.6 - 10.1）。仅对于男性而言，报告无耻辱感者的检测率高于报告有一定耻辱感者（比值比1.40，95%置信区间0.97 - 2.03；p = 0.07）。仅对于女性而言，社区层面耻辱感每降低一个百分点，检测的可能性就增加3%（p < 0.01）。项目规划应在社会规范和性别的背景下考虑减少耻辱感，以便适当地调整活动。
