Kalichman Seth, Katner Harold, Banas Ellen, Kalichman Moira
Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
Mercer University Medical School, Macon, GA, USA.
Prev Sci. 2017 Jul;18(5):517-525. doi: 10.1007/s11121-017-0761-9.
AIDS stigmas delay HIV diagnosis, interfere with health care, and contribute to mental health problems among people living with HIV. While there are few studies of the geographical distribution of AIDS stigma, research suggests that AIDS stigmas are differentially experienced in rural and urban areas. We conducted computerized interviews with 696 men and women living with HIV in 113 different zip code areas that were classified as large-urban, small-urban, and rural areas in a southeast US state with high-HIV prevalence. Analyses conducted at the individual level (N = 696) accounting for clustering at the zip code level showed that internalized AIDS-related stigma (e.g., the sense of being inferior to others because of HIV) was experienced with greater magnitude in less densely populated communities. Multilevel models indicated that after adjusting for potential confounding factors, rural communities reported greater internalized AIDS-related stigma compared to large-urban areas and that small-urban areas indicated greater experiences of enacted stigma (e.g., discrimination) than large-urban areas. The associations between anticipated AIDS-related stigma (e.g., expecting discrimination) and population density at the community-level were not significant. Results suggest that people living in rural and small-urban settings experience greater AIDS-related internalized and enacted stigma than their counterparts living in large-urban centers. Research is needed to determine whether low-density population areas contribute to or are sought out by people who experienced greater AIDS-related stigma. Regardless of causal directions, interventions are needed to address AIDS-related stigma, especially among people in sparsely populated areas with limited resources.
艾滋病污名化会延迟艾滋病毒的诊断、干扰医疗保健，并导致艾滋病毒感染者出现心理健康问题。虽然关于艾滋病污名化地理分布的研究较少，但研究表明，农村和城市地区对艾滋病污名化的感受存在差异。我们在美国东南部艾滋病毒感染率较高的一个州，对113个不同邮政编码区域的696名艾滋病毒感染者进行了计算机辅助访谈，这些区域被划分为大城市、小城市和农村地区。在考虑邮政编码层面聚类的个体层面（N = 696）进行的分析表明，在人口密度较低的社区，内化的与艾滋病相关的污名（例如，因感染艾滋病毒而产生的低人一等的感觉）更为严重。多层次模型表明，在调整潜在混杂因素后，与大城市地区相比，农村社区报告的内化的与艾滋病相关的污名更多，并且小城市地区比大城市地区表现出更多的实际污名化经历（例如，歧视）。社区层面预期的与艾滋病相关的污名（例如，预期会受到歧视）与人口密度之间的关联并不显著。结果表明，生活在农村和小城市地区的人比生活在大城市中心的人经历更多与艾滋病相关的内化和实际污名。需要开展研究来确定低密度人口地区是导致艾滋病相关污名感较强的原因，还是吸引了这类人群。无论因果关系如何，都需要采取干预措施来消除与艾滋病相关的污名，特别是在资源有限的人口稀少地区。
