在越南大规模药物注射驱动的 HIV 流行中,抗逆转录病毒治疗的快速扩张导致对 HIV/AIDS 患者的污名化。
Stigma against patients with HIV/AIDS in the rapid expansion of antiretroviral treatment in large drug injection-driven HIV epidemics of Vietnam.
机构信息
Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.
Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
出版信息
Harm Reduct J. 2019 Jan 17;16(1):6. doi: 10.1186/s12954-019-0277-7.
BACKGROUND
Despite existing efforts to provide antiretroviral treatment (ART) for all HIV-diagnosed people, stigma deprives them of the highest attainable health status and challenges the effectiveness of ART program in Vietnam. This study aimed to assess five dimensions of HIV-related stigma and explore its associated factors among ART patients in a multisite survey. Implications of this study support the development of HIV policies to improve patients' access, utilization, and outcomes of ART program toward the 90-90-90 goal in Vietnam.
METHODS
A total of 1133 ART patients who were recruited by convenience sampling method from 8 ART clinics in Hanoi and Nam Dinh in a cross-sectional study from January to August 2013. Multivariate logistic regression was employed to identify factors associated with stigmatization.
RESULTS
The majority of participants reported experiencing stigmatization due to shame (36.9%), blame/judge (21.6%), and discrimination (23.4%). Further, 91.5% of participants disclosed their HIV status with others. The likelihood of experiencing stigmatization did not only associate with the patients' socioeconomic status (e.g., age, occupation, education) and HIV status disclosure, but also their health problems. Those with anxiety or depression and perceived lower quality of life were more likely to experience stigma.
CONCLUSIONS
To maximize the efficiency of the ART program, it is essential to develop interventions that reduce stigma involving individuals, families, and communities, and recognize and address complex health problems especially those patients showing depressive symptoms. Increasing quality of life of HIV-positive patients by providing vocational training, financial, family, and peer support will reduce the likelihood of experiencing stigma.
背景
尽管为所有 HIV 确诊者提供抗逆转录病毒治疗(ART)的努力一直在进行,但耻辱感剥夺了他们获得最佳健康状态的机会,并对越南的 ART 项目的效果提出了挑战。本研究旨在评估与 HIV 相关的耻辱感的五个维度,并在多地点调查中探索其与 ART 患者的关联因素。本研究的意义在于支持制定 HIV 政策,以改善患者获得、利用和 ART 项目效果的机会,从而实现越南的 90-90-90 目标。
方法
本研究采用便利抽样法,于 2013 年 1 月至 8 月从河内和南定的 8 个 ART 诊所招募了 1133 名 ART 患者,进行了一项横断面研究。采用多变量逻辑回归分析确定与耻辱感相关的因素。
结果
大多数参与者报告因羞耻感(36.9%)、指责/评判(21.6%)和歧视(23.4%)而经历了耻辱感。此外,91.5%的参与者向他人透露了自己的 HIV 状况。经历耻辱感的可能性不仅与患者的社会经济地位(如年龄、职业、教育)和 HIV 状况的披露有关,还与他们的健康问题有关。那些有焦虑或抑郁且自感生活质量较低的患者更有可能经历耻辱感。
结论
为了使 ART 项目的效率最大化,必须制定涉及个人、家庭和社区的减少耻辱感的干预措施,并认识和解决复杂的健康问题,特别是那些表现出抑郁症状的患者。通过提供职业培训、经济、家庭和同伴支持来提高 HIV 阳性患者的生活质量,将降低其经历耻辱感的可能性。
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