Faculty of Social Sciences, Chiang Mai University, Chiang Mai, Thailand.
Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
PLoS One. 2019 May 2;14(5):e0216382. doi: 10.1371/journal.pone.0216382. eCollection 2019.
Disclosure of HIV status is a critical gateway to HIV prevention. Despite many studies on this topic, there is a gap in knowledge regarding HIV status disclosure and risky sexual behavior in HIV-infected female migrant workers. The current study addressed this research gap, and focused on HIV-infected Shan female migrant workers in Northern Thailand.
This study conducted in-depth interviews with 18 HIV-infected Shan female migrants (aged between 23-54 years old) and 29 healthcare workers in district hospitals in Chiang Mai. Content analysis was employed to identify particular themes related to HIV status disclosure, sexual risk behavior, and ART adherence.
We found that non-disclosure to husbands/partners was mostly related to fear of marital conflict and of losing social and financial support. Non-disclosure prevented Shan female migrant workers from negotiating condom use with their partners. Reasons for not disclosing to friends, family and other community members were mostly related to feared rejection and discrimination due to HIV-related stigma. Accounts of condomless sex in the context of HIV status disclosure suggest that gender norms and male dominance over women influenced decision-making for safe sex. Lastly, some female migrant workers perceived low risk of HIV transmission with good adherence to the ART.
This study highlighted the complex challenges of HIV status disclosure among HIV-positive Shan female migrant workers and the link between disclosure/non-disclosure and condom use. There is a pressing need to create realistic disclosure mechanisms that take into account the socio-cultural barriers to disclosure including marital conflicts, stigma, and gender norms. Messages to encourage condom use should be delivered carefully so that knowledge of the HIV transmission reduction qualities of good ART adherence does not serve as a barrier to condom use.
艾滋病病毒（HIV）状况的披露是预防 HIV 的关键环节。尽管针对这一主题进行了许多研究，但对于感染 HIV 的女性移民工人中 HIV 状况披露和危险性行为的认识仍存在差距。本研究针对这一研究空白，关注泰国北部感染 HIV 的掸族女性移民工人。
本研究对 18 名感染 HIV 的掸族女性移民工人（年龄在 23-54 岁之间）和清迈地区医院的 29 名医护人员进行了深入访谈。采用内容分析法确定与 HIV 状况披露、性风险行为和抗逆转录病毒治疗（ART）依从性相关的特定主题。
我们发现，向丈夫/伴侣隐瞒病情主要与担心婚姻冲突和失去社会及经济支持有关。对伴侣隐瞒病情使掸族女性移民工人无法就使用安全套进行协商。对朋友、家人和其他社区成员隐瞒病情的原因主要与 HIV 相关耻辱感导致的被拒绝和歧视有关。在披露 HIV 状况的背景下发生无保护性行为的描述表明，性别规范和男性对女性的支配地位影响了安全性行为的决策。最后，一些女性移民工人认为只要坚持 ART 治疗，感染 HIV 的风险就很低。
本研究强调了 HIV 阳性掸族女性移民工人披露 HIV 状况所面临的复杂挑战，以及披露/不披露状况与使用安全套之间的联系。迫切需要建立现实的披露机制，考虑到包括婚姻冲突、耻辱感和性别规范在内的披露障碍的社会文化因素。鼓励使用安全套的信息应谨慎传递，以免对良好的 ART 依从性降低 HIV 传播风险的认识成为使用安全套的障碍。
