Gordon Janna R, Barve Apurva, Chaudhari Vipul, Kosambiya Jayendrakumar K, Kumar Ambuj, Gamit Sukesha, Wells Kristen J
a San Diego Joint Doctoral Program in Clinical Psychology , San Diego State University/University of California , San Diego , CA , USA.
b Department of Community Health Sciences, Fielding School of Public Health , University of California, Los Angeles , Los Angeles , CA , USA.
Women Health. 2019 Aug;59(7):801-814. doi: 10.1080/03630242.2019.1565903. Epub 2019 Feb 4.
Women living with HIV (WLWH) are at high risk for cervical cancer (CC); however, many WLWH in India do not obtain regular CC screening. Little is known about facilitators and barriers of CC screening in this population. This qualitative study examined the relation of HIV-related stigma to obtaining CC screening among women in Surat, India. Semi-structured individual in-depth interviews were conducted between April 2015 and July 2015 with 25 WLWH at the New Civil Hospital Anti-Retroviral Centre and 15 stakeholders providing health care to WLWH. HIV-related stigma emerged as a considerable barrier to gynecologic care and CC screening among WLWH. Two major subthemes were identified: (1) perceptions of HIV-related normative stigma and enacted discrimination; and (2) HIV status disclosure in the context of health care and CC screening. Stakeholders described a general awareness of HIV-related stigma as a barrier to care for WLWH, while WLWH focused on experiences of enacted discrimination. Both patients and stakeholders described that concerns about disclosure and fear of stigma hinder WLWH in India from obtaining health care and CC screening. Findings suggest that interventions to increase cancer screening among WLWH in India should address the role of HIV-related stigma to be maximally effective.
感染艾滋病毒的女性（WLWH）患宫颈癌（CC）的风险很高；然而，印度许多感染艾滋病毒的女性没有定期进行宫颈癌筛查。对于这一人群宫颈癌筛查的促进因素和障碍知之甚少。这项定性研究调查了印度苏拉特女性中与艾滋病毒相关的耻辱感与进行宫颈癌筛查之间的关系。2015年4月至2015年7月期间，在新公民医院抗逆转录病毒中心对25名感染艾滋病毒的女性以及15名向感染艾滋病毒的女性提供医疗服务的利益相关者进行了半结构化的个人深入访谈。与艾滋病毒相关的耻辱感成为感染艾滋病毒的女性接受妇科护理和宫颈癌筛查的一个重大障碍。确定了两个主要子主题：（1）对与艾滋病毒相关的规范性耻辱感和实际歧视的认知；（2）在医疗保健和宫颈癌筛查背景下披露艾滋病毒感染状况。利益相关者将对与艾滋病毒相关的耻辱感的普遍认知描述为感染艾滋病毒的女性获得护理的障碍，而感染艾滋病毒的女性则关注实际歧视的经历。患者和利益相关者都表示，对披露信息的担忧和对耻辱感的恐惧阻碍了印度感染艾滋病毒的女性获得医疗保健和宫颈癌筛查。研究结果表明，在印度，为提高感染艾滋病毒的女性的癌症筛查率而采取的干预措施应解决与艾滋病毒相关的耻辱感所起的作用，才能取得最大成效。
