Jimma University, Department of Health, Behavior and Society, Jimma, Ethiopia.
Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia.
PLoS One. 2019 Jan 25;14(1):e0211298. doi: 10.1371/journal.pone.0211298. eCollection 2019.
Stigma and discrimination (SAD) related to HIV compromise access and adherence to treatment and support programs among people living with HIV (PLHIV). The ambitious goal of ending the epidemic of HIV by 2030 set by the United Nations Joint Program of HIV/AIDS (UNAIDS) will thus only be achieved if HIV-related stigma and discrimination are reduced. The objective of this review was to locate, appraise and describe international literature reporting on interventions that addressed HIV-related SAD in healthcare settings.
The databases searched were: Cumulative Index to Nursing and Allied Health (CINAHL), Excerpta Medica Database from Elsevier (EMBASE), PubMed and Psychological Information (PsycINFO) database. Two individuals independently appraised the quality of the papers using appraisal instruments from the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool from JBI. Quality of evidence for major outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
We retained 14 records reporting on eight studies. Five categories of SAD reduction (information-based, skills building, structural, contact-based and biomedical interventions) were identified. Training popular opinion leaders (POLs) resulted in significantly lower mean avoidance intent scores (MD = -1.87 [95% CI -2.05 to -1.69]), mean prejudicial attitude scores (MD = -3.77 [95% CI -5.4 to -2.09]) and significantly higher scores in mean compliance to universal precaution (MD = 1.65 [95% CI 1.41 to 1.89]) when compared to usual care (moderate quality evidence). The Summary of Findings table (SOF) is shown in Table 1.
Evidence of moderate quality indicates that training popular opinion leaders is effective in reducing avoidance intent and prejudicial attitude and improving compliance to universal precaution. Very low quality evidence indicates that professionally-assisted peer group interventions, modular interactive training, participatory self-guided assessment and intervention, contact strategy combined with information giving and empowerment are effective in reducing HIV-related stigma.Further Randomized Controlled Trials (RCTs) are needed. Future trials need to use up-to-date and validated instruments to measure stigma and discrimination.
与 HIV 相关的污名和歧视（SAD）会影响 HIV 感染者（PLHIV）获得治疗和支持计划的机会，并影响他们对这些计划的依从性。联合国艾滋病规划署（UNAIDS）制定了 2030 年终结艾滋病流行的宏伟目标，因此，只有减少与 HIV 相关的污名和歧视，才能实现这一目标。本综述的目的是查找、评估和描述国际文献中报告的在医疗保健环境中针对与 HIV 相关的 SAD 的干预措施。
检索的数据库包括：护理学和联合健康文献累积索引（CINAHL）、爱思唯尔摘录医学数据库（EMBASE）、PubMed 和心理信息（PsycINFO）数据库。两名研究人员使用 Joanna Briggs 研究所（JBI）的评估工具独立评估论文的质量。使用 JBI 标准化数据提取工具从纳入的综述论文中提取数据。使用 Grading of Recommendations, Assessment, Development and Evaluation（GRADE）评估主要结局的证据质量。
我们保留了 14 份报告 8 项研究的记录。确定了五类 SAD 减少措施（基于信息、技能培养、结构、基于接触和生物医学干预）。培训有影响力的意见领袖（POL）可显著降低平均回避意图评分（MD=-1.87[95%CI-2.05 至-1.69]）、平均偏见态度评分（MD=-3.77[95%CI-5.4 至-2.09]）和显著提高普遍预防措施的平均依从性评分（MD=1.65[95%CI 1.41 至 1.89]），与常规护理相比（中等质量证据）。总结发现表（SOF）见表格 1。
中等质量的证据表明，培训有影响力的意见领袖可有效降低回避意图和偏见态度，提高对普遍预防措施的依从性。非常低质量的证据表明，专业协助的同伴小组干预、模块化互动培训、参与式自我指导评估和干预、结合信息提供和赋权的接触策略可有效减少与 HIV 相关的污名。需要进一步的随机对照试验（RCT）。未来的试验需要使用最新和经过验证的工具来衡量污名和歧视。
