Adams Alfred K, Zamberia Agostino M
a Amsterdam Institute of Social Science Research , University of Amsterdam , Amsterdam , the Netherlands.
b Department of Sociology and Social Work , University of Swaziland , Kwaluseni , Swaziland.
Afr J AIDS Res. 2017 Dec;16(4):295-303. doi: 10.2989/16085906.2017.1362015.
Swaziland has the highest HIV prevalence in the world. To mitigate the spread and devastation caused by HIV and to improve the wellbeing of people living with HIV, the country has adopted the latest available HIV prevention campaigns, including "Test and Start". Because evidence from randomised controlled trials has demonstrated a significant risk reduction in HIV transmission when HIV-positive people start antiretroviral therapy (ART) early, Swaziland aims to find these people and link them to treatment. This study presents findings regarding the perceptions of this promising HIV-prevention intervention among men aged 17-69 years. A combination of qualitative methods including focus group discussions (12), in-depth interviews (17), informal conversations and participant observation (21) were used to collect data in two peri-urban communities in 2013-2014. Findings illustrate that men still fear taking an HIV test because of a relatively high probability of a positive test which some still interpret as a death sentence. Other potential barriers to the effectiveness of Test and Start programmes include lack of hospitality in hospitals, fear of starting treatment early related to side effects of ART, poverty, and lack of trust in the financial stability of the Swazi government. We argue that several social factors need to be considered for the Test and Start programme to be more effective.
斯威士兰是全球艾滋病病毒感染率最高的国家。为减缓艾滋病病毒的传播及危害，并改善艾滋病病毒感染者的健康状况，该国采用了最新的艾滋病预防活动，包括“检测即治疗”。由于随机对照试验的证据表明，艾滋病病毒呈阳性者尽早开始抗逆转录病毒治疗（ART）可显著降低艾滋病病毒传播风险，斯威士兰旨在找到这些人并为其提供治疗。本研究呈现了17至69岁男性对这一前景良好的艾滋病预防干预措施的看法。2013年至2014年期间，采用焦点小组讨论（12次）、深度访谈（17次）、非正式交谈及参与观察（21次）等定性方法组合，在两个城郊社区收集数据。研究结果表明，男性仍因检测结果呈阳性的可能性相对较高而害怕接受艾滋病病毒检测，有些人仍将此视为死刑宣判。“检测即治疗”项目有效性的其他潜在障碍包括医院缺乏热情接待、因抗逆转录病毒治疗的副作用而害怕过早开始治疗、贫困以及对斯威士兰政府财政稳定性缺乏信任。我们认为，要使“检测即治疗”项目更有效，需要考虑若干社会因素。
