National Clinician Scholars Program UCLA, Division of General Internal Medicine and Health Services Research, Department of Medicine, Los Angeles, CA, USA; VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA.
Mbarara University of Science & Technology, Mbarara, Uganda.
Soc Sci Med. 2019 Jul;233:229-236. doi: 10.1016/j.socscimed.2019.05.012. Epub 2019 May 20.
HIV-related stigma profoundly affects the physical and social wellbeing of people living with HIV, as well as the community's engagement with testing, treatment, and prevention. Based on theories of stigma elaborating how it arises from the relationships between the stigmatized and the stigmatizer as well as within the general community, we hypothesized that social networks can shape HIV-related stigma.
To estimate social network correlates of HIV-related stigma.
During 2011-2012, we collected complete social network data from a community of 1669 adults ("egos") in Mbarara, Uganda using six culturally-adapted name generators to elicit different types of social ties ("alters"). We measured HIV-related stigma using the 9-item AIDS-Related Stigma Scale. HIV serostatus was based on self-report. We fitted linear regression models that account for network autocorrelation to estimate the association between egos' HIV-related stigma, alters' HIV-related stigma and alters' self-reported HIV serostatus, while adjusting for egos' HIV serostatus, network centrality, village size, perceived HIV prevalence, and sociodemographic characteristics.
The average AIDS-Related Stigma Score was 0.79 (Standard Deviation = 0.50). In the population 116 (7%) egos reported being HIV-positive, and 757 (46%) reported an HIV-positive alter. In the multivariable model, we found that egos' own HIV-related stigma was positively correlated with their alters' average stigma score (b=0.53; 95% confidence interval [CI] 0.42-0.63) and negatively correlated with having one or more HIV-positive alters (b=-0.05; 95% CI -0.10 to -0.003).
Stigma-reduction interventions should be targeted not only at the level of the individual but also at the level of the network. Directed and meaningful contact with people living with HIV may also reduce HIV-related stigma.
艾滋病毒相关耻辱感深刻影响着艾滋病毒感染者的身心健康，以及社区参与检测、治疗和预防的程度。基于耻辱感产生于被污名化者与污名施加者之间的关系以及整个社区内的关系的理论，我们假设社交网络可以影响艾滋病毒相关耻辱感。
估计与艾滋病毒相关耻辱感的社交网络相关性。
在 2011 年至 2012 年期间，我们使用六种文化适应性的名称生成器从乌干达姆巴拉拉的 1669 名成年人（“自我”）社区中收集了完整的社交网络数据，以引出不同类型的社交联系（“他人”）。我们使用 9 项艾滋病相关耻辱量表来衡量与艾滋病毒相关的耻辱感。艾滋病毒血清状况基于自我报告。我们拟合了线性回归模型，这些模型考虑了网络自相关性，以估计自我的与艾滋病毒相关的耻辱感、他人的与艾滋病毒相关的耻辱感以及他人的自我报告的艾滋病毒血清阳性率之间的关联，同时调整了自我的艾滋病毒血清阳性率、网络中心性、村庄规模、感知的艾滋病毒流行率以及社会人口统计学特征。
平均艾滋病相关耻辱量表得分为 0.79（标准差=0.50）。在人群中，有 116 名（7%）自我报告为艾滋病毒阳性，有 757 名（46%）报告了一名或多名艾滋病毒阳性的他人。在多变量模型中，我们发现自我的与艾滋病毒相关的耻辱感与他们的他人的平均耻辱感得分呈正相关（b=0.53；95%置信区间[CI]0.42-0.63），与有一个或多个艾滋病毒阳性的他人呈负相关（b=-0.05；95%CI-0.10 至-0.003）。
减少耻辱感的干预措施不仅应针对个人，还应针对网络。与艾滋病毒感染者进行有针对性和有意义的接触也可能会减少与艾滋病毒相关的耻辱感。
