Brown University School of Public Health, Providence, RI, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
AIDS Behav. 2019 Feb;23(2):395-405. doi: 10.1007/s10461-018-2265-4.
The disproportionate burden of HIV among women in sub-Saharan Africa reflects underlying gender inequities, which also impact patient-provider relationships, a key component to retention in HIV care. This study explored how gender shaped the patient-provider relationship and consequently, retention in HIV care in western Kenya. We recruited and consented 60 HIV care providers from three facilities in western Kenya affiliated with the Academic Model Providing Access to Healthcare (AMPATH). Trained research assistants conducted and audio recorded 1-h interviews in English or Swahili. Data were transcribed and analyzed in NVivo using inductive thematic analysis. Gender constructs, as culturally defined, emerged as an important barrier negatively impacting the patient-provider relationship through three main domains: (1) challenges establishing clear roles and sharing power due to conflicting gender versus patient/provider identities, (2) provider frustration over suboptimal patient adherence resulting from gender-influenced contextual barriers, and (3) negative provider perceptions shaped by differing male and female approaches to communication. Programmatic components addressing gender inequities in the health care setting are urgently needed to effectively leverage the patient-provider relationship and fully promote long-term adherence and retention in HIV care.
撒哈拉以南非洲国家的女性感染艾滋病的比例过高，这反映出存在深层次的性别不平等问题，这也影响了医患关系，而后者是艾滋病患者接受护理的关键因素。本研究探讨了在肯尼亚西部，性别如何影响医患关系，并由此影响艾滋病患者接受护理的情况。我们在肯尼亚西部的三个与学术模式提供医疗保健（AMPATH）相关的机构招募了 60 名艾滋病毒护理提供者，并获得了他们的同意。经过培训的研究助理以英语或斯瓦希里语进行了 1 小时的访谈，并对访谈进行了录音。研究人员使用 NVivo 软件对数据进行了转录和分析，并采用归纳主题分析法进行分析。文化定义的性别结构成为一个重要的障碍，通过三个主要方面对医患关系产生负面影响：（1）由于患者和医护人员的身份与性别之间存在冲突，导致角色和权力分配不明确；（2）医护人员对因性别影响的环境障碍导致的患者不遵医嘱感到沮丧；（3）不同的男性和女性的沟通方式导致医护人员对患者产生负面看法。迫切需要在医疗保健环境中解决性别不平等问题，以有效地利用医患关系，并充分促进长期坚持和接受艾滋病护理。
