Global Health Division, International Development Group, RTI International, Washington, DC, United States of America.
PLoS One. 2018 Jun 21;13(6):e0199602. doi: 10.1371/journal.pone.0199602. eCollection 2018.
People living with HIV are increasingly burdened by noncommunicable diseases (NCDs) as a result of the NCD susceptibility that accompanies increased life expectancy and the rising global prevalence of NCDs. Health systems are being strengthened and programs are being developed to address this burden, often building on HIV care strategies and infrastructure or through integrated care models. HIV remains a stigmatized condition and the role of HIV stigma in the provision of NCD care is not well understood.
We conducted a scoping literature review of both peer reviewed and grey literature to identify evidence of the role of HIV stigma in the NCD-care continuum (prevention, diagnosis, care seeking, retention in care, and adherence to treatment of NCDs). We searched PsychInfo and Pubmed and conducted additional searches of programmatic reports and conference abstracts. Included studies were published in English within the past decade and examined HIV-related stigma as it relates to NCD-care or to integrated NCD-and HIV-care programs.
Sixteen articles met the inclusion criteria. Findings suggest: fear of disclosure, internalized shame and embarrassment, and negative past experiences with or negative perceptions of health care providers negatively influence engagement with NCD care; HIV stigma can adversely affect not only people living with HIV in need of NCD care, but all NCD patients; some NCDs are stigmatized in their own right or because of their association with HIV; integrating NCD and HIV care can both reduce stigma for people living with HIV and a present a barrier to access for NCD care.
Due to the dearth of available research and the variability in initial findings, further research on the role of HIV stigma in the NCD-care continuum for people living with HIV is necessary. Lessons from the field of HIV-stigma research can serve as a guide for these efforts.
随着预期寿命的延长和全球非传染性疾病（NCD）患病率的上升，艾滋病毒感染者越来越多地受到 NCD 的影响。卫生系统正在得到加强，各项方案正在制定，以应对这一负担，这些方案往往是在艾滋病毒护理战略和基础设施的基础上制定的，或者通过综合护理模式制定的。艾滋病毒仍然是一种受污名化的疾病，艾滋病毒污名在 NCD 护理中的作用尚未得到很好的理解。
我们对同行评议文献和灰色文献进行了广泛的文献回顾，以确定艾滋病毒污名在 NCD 护理连续体（预防、诊断、寻求护理、护理保留和 NCD 治疗的坚持）中的作用的证据。我们在 PsychInfo 和 Pubmed 上进行了搜索，并对方案报告和会议摘要进行了额外的搜索。纳入的研究在过去十年中以英文发表，研究了与 NCD 护理或综合 NCD 和 HIV 护理方案相关的艾滋病毒相关污名。
16 篇文章符合纳入标准。研究结果表明：对披露的恐惧、内化的羞耻和尴尬，以及对卫生保健提供者的负面过去经历或负面看法，会对参与 NCD 护理产生负面影响；艾滋病毒污名不仅会对需要 NCD 护理的艾滋病毒感染者产生不利影响，而且会对所有 NCD 患者产生不利影响；一些 NCD 本身就带有污名，或者因为与艾滋病毒有关而带有污名；综合 NCD 和 HIV 护理既能减少艾滋病毒感染者的污名，也能为 NCD 护理带来障碍。
由于可用研究的缺乏和初步研究结果的差异，有必要对艾滋病毒感染者的 NCD 护理连续体中的艾滋病毒污名的作用进行进一步的研究。艾滋病毒污名研究领域的经验可以为这些努力提供指导。
