旋转的盘子：在 HPTN 071（PopART）研究期间，赞比亚一个城市社区中的生计流动、家庭责任和抗逆转录病毒治疗。
Spinning plates: livelihood mobility, household responsibility and anti-retroviral treatment in an urban Zambian community during the HPTN 071 (PopART) study.
机构信息
Zambart, School of Medicine, University of Zambia, Lusaka, Zambia.
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
出版信息
J Int AIDS Soc. 2018 Jul;21 Suppl 4(Suppl Suppl 4):e25117. doi: 10.1002/jia2.25117.
INTRODUCTION
Qualitative data are lacking on the impact of mobility among people living with HIV (PLHIV) and their decision-making around anti-retroviral treatment (ART). We describe challenges of juggling household responsibility, livelihood mobility and HIV management for six PLHIV in urban Zambia.
METHODS
Six PLHIV (three men and three women, aged 21 to 44) were recruited from different geographic zones in one urban community drawn from a qualitative cohort in a social science component of a cluster-randomized trial (HPTN071 PopART). Participants were on ART (n = 2), not on ART (n = 2) and had started and stopped ART (n = 2). At least two in-depth interviews and participant observations, and three drop-in household visits with each were carried out between February and August 2017. Themed and comparative analysis was conducted.
RESULTS
The six participants relied on the informal economy to meet basic household needs. Routine livelihood mobility, either within the community and to a nearby town centre, or further afield for longer periods of time, was essential to get by. Although aware of ART benefits, only one of the six participants managed to successfully access and sustain treatment. The other five struggled to find time to access ART alongside other priorities, routine mobility and when daily routines were more chaotic. Difficulty in accessing ART was exacerbated by local health facility factors (congestion, a culture of reprimanding PLHIV who miss appointments, sporadic rationed drug supply), stigma and more limited social capital.
CONCLUSIONS
Using a time-space framework illustrated how household responsibility, livelihood mobility and HIV management every day were like spinning plates, each liable to topple and demanding constant attention. If universal lifelong ART is to be delivered, the current service model needs to adjust the limited time that some PLHIV have to access ART because of household responsibilities and the need to earn a living moving around, often away from home. Practical strategies that could facilitate ART access in the context of livelihood mobility include challenging the practice of reprimand, improving drug supply, having ART services more widely distributed, mapped and available at night and weekends, and an effective centralized client health information system.
引言
关于艾滋病毒感染者（PLHIV）的流动性及其对抗逆转录病毒治疗（ART）的决策的影响，缺乏定性数据。我们描述了在赞比亚一个城市中，六名 PLHIV 在兼顾家庭责任、生计流动和 HIV 管理方面所面临的挑战。
方法
从一项社会科学部分的集群随机试验（HPTN071 PopART）的定性队列中，从一个城市社区的不同地理区域招募了六名 PLHIV（3 名男性和 3 名女性，年龄在 21 至 44 岁之间）。参与者分为正在接受 ART 治疗（n=2）、未接受 ART 治疗（n=2）和开始接受 ART 治疗后停药（n=2）。在 2017 年 2 月至 8 月期间，对他们进行了至少两次深入访谈和参与者观察，并对每个参与者进行了三次不定期的家访。进行了主题和比较分析。
结果
六名参与者依靠非正规经济来满足基本的家庭需求。在社区内以及附近的城镇中心，或者更远的地方进行常规的生计流动，是维持生计的必要条件。尽管六名参与者中的一名意识到了 ART 的好处，但只有他成功地获得并维持了治疗。其他五名参与者在日常事务更混乱时，在其他优先事项、日常流动和获得 ART 治疗之间寻找时间时，都难以获得 ART 治疗。当地卫生机构因素（拥挤、谴责错过预约的 PLHIV 的文化、间歇性配给药物供应）、耻辱感和有限的社会资本加剧了获得 ART 治疗的困难。
结论
使用时空框架说明了家庭责任、生计流动和 HIV 管理每天都像旋转的盘子一样，每个盘子都有可能翻倒，需要不断关注。如果要实现普及终生 ART 治疗，目前的服务模式需要调整一些 PLHIV 用于获得 ART 治疗的有限时间，因为他们有家庭责任，并且需要四处谋生，经常离家。在生计流动的背景下促进 ART 治疗的可实施策略包括挑战谴责的做法、改善药物供应、更广泛地分布 ART 服务、将其映射并在夜间和周末提供、以及有效的集中客户健康信息系统。
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