Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Biomed Res Int. 2019 Jan 21;2019:4208638. doi: 10.1155/2019/4208638. eCollection 2019.
Stigmatization against HIV/AIDS greatly hinders efforts to increase the accessibility and utilization of HIV/AIDS services to meet the 90-90-90 goal. This study assessed the stigmatization and discrimination experienced by people living with HIV (PLWH) across multiple social settings such as family, community, and healthcare facilities in Vietnam. A total of 1,016 patients (63.8% males, mean age = 35.4) participated in a cross-sectional study using a culturally tailored HIV stigma measure in three HIV-epidemic-concentrated cities in Vietnam. Zero-inflated Poisson models were used to examine factors associated with the number of types of stigma that patients experienced. 86.2% PLWH reported experiencing stigma against HIV/AIDS, more frequently from their community (62.8%) and family (30.2%) than from health care facilities (8%). The level of stigma from community reported by PLWH is associated with socioeconomic status (e.g., income, occupation). The poor and middle economic classes and unemployed patients reported more stigmatization and discrimination from the community. Across all settings, PLWH experienced fewer stigmatization over the course of ART indicating the benefits of rapidly expanded ART programs. PLWH reported more stigmatization and discrimination at the provincial level of the health administration. Those with the history of drug injection reported significantly less stigmatization from healthcare setting. More culturally tailored interventions to reduce stigmatization overall to improve the quality of life and health outcomes of PLWH should be warranted to achieve the 90-90-90 goal. Improving HIV-related knowledge of the general population and providing opportunities for PLWH to be reintegrated into should be considered. Using mass media with positive messages and images would also foster positive attitudes towards HIV/AIDS among the population and could potentially change social values. Continuous training of health staffs' attitude could minimize the occurrence of stigmatization and discrimination at healthcare facilities.
艾滋病污名化极大地阻碍了提高艾滋病服务可及性和利用率以实现 90-90-90 目标的努力。本研究评估了越南多个社会环境（如家庭、社区和医疗机构）中艾滋病毒感染者（PLWH）所经历的污名化和歧视。共有 1016 名患者（63.8%为男性，平均年龄=35.4）参加了一项横断面研究，该研究使用了一种文化适应性艾滋病毒污名测量方法，在越南三个艾滋病毒流行集中的城市进行。零膨胀泊松模型用于检查与患者经历的污名类型数量相关的因素。86.2%的 PLWH 报告称经历过艾滋病毒/艾滋病污名，来自社区（62.8%）和家庭（30.2%）的污名比来自医疗保健机构（8%）更为常见。社区报告的 PLWH 污名程度与社会经济地位（如收入、职业）相关。贫穷和中等经济阶层和失业患者报告称，社区的污名化和歧视更多。在所有环境中，PLWH 在接受抗逆转录病毒治疗（ART）的过程中经历的污名化和歧视较少，表明快速扩大 ART 计划带来了好处。PLWH 在省级卫生行政部门报告了更多的污名化和歧视。有注射毒品史的患者报告称，来自医疗保健机构的污名化明显减少。需要采取更多有针对性的文化干预措施，减少总体污名化，以改善 PLWH 的生活质量和健康结果，从而实现 90-90-90 目标。应该考虑提高普通人群对艾滋病毒的认识，并为 PLWH 提供重新融入社会的机会。利用带有积极信息和形象的大众媒体也会在民众中培养对艾滋病毒/艾滋病的积极态度，并可能改变社会价值观。对卫生工作人员的态度进行持续培训，可以最大限度地减少医疗保健机构中污名化和歧视的发生。
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