解析双重污名的动态：艾滋病毒-结核病共同流行如何改变医护人员对结核病的污名及其管理
Unpacking the dynamics of double stigma: how the HIV-TB co-epidemic alters TB stigma and its management among healthcare workers.
机构信息
Department of Sociology and Centre for Population, Family and Health, University of Antwerp, Sint-Jacobstraat 2, BE-2000, Antwerp, Belgium.
Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa.
出版信息
BMC Infect Dis. 2020 Feb 6;20(1):106. doi: 10.1186/s12879-020-4816-3.
BACKGROUND
HIV and tuberculosis (TB) are intricably interlinked in South Africa. The social aspects of this co-epidemic remain relatively unexplored. More specifically, no research has quantitatively explored the double stigma associated with HIV and TB in this context, and more specifically the impact of the co-epidemic on [1] the stigmatisation of TB and [2] the TB stigma mangement strategy of covering (i.e. the use of TB as a cover for having HIV). The current study aims to address this research gap by disentangling the complex mechanisms related to HIV-TB stigma.
METHODS
Using Structural Equation Modelling (SEM), data of 882 health care workers (HCWs) in the Free State province, South Africa, are analysed to investigate the link between the stigmatization of HIV and TB and the stigma management by those affected. The current study focuses on health care workers (HCWs), as both TB and HIV have a severe impact on this professional group.
RESULTS
The results demonstrate that the perceived link between the epidemics is significantly associated with double HIV-TB stigmatization. Furthermore, the link between the illnesses and the double stigma are driving the stigmatization of TB. Finally, the link between HIV and TB as well as the stigmatization of both diseases by colleagues are associated with an increased use of covering as a stigma management strategy.
CONCLUSIONS
This is the first quantitative study disentagling the mediating role of double stigma in the context of the co-epidemic as well as the impact of the co-epidemic on the social connotations of TB. The results stress the need for an integrated approach in the fight against HIV and TB recognizing the intertwined nature of the co-epidemic, not only in medical-clinical terms, but also in its social consequences.
TRIAL REGISTRATION
South African National Clinical Trials Register, registration ID: DOH-27-1115-5204. Prospectively registered on 26 August 2015.
背景
在南非，艾滋病毒和结核病（TB）紧密交织在一起。这一共同流行的社会方面仍未得到充分探索。具体而言，没有研究从定量角度探讨这一背景下与艾滋病毒和结核病相关的双重污名，更具体地说，没有研究探讨共同流行对（1）结核病污名化的影响，以及（2）掩盖（即利用结核病掩盖感染艾滋病毒）这一结核病污名管理策略的影响。本研究旨在通过剖析与艾滋病毒-TB 污名相关的复杂机制来解决这一研究空白。
方法
本研究使用结构方程模型（SEM），对南非自由州省 882 名卫生保健工作者（HCWs）的数据进行分析，以调查 HIV 和 TB 污名化与受感染者污名管理之间的联系。本研究重点关注卫生保健工作者（HCWs），因为结核病和艾滋病毒都对这一专业群体有严重影响。
结果
结果表明，对这两种疾病流行之间关联的感知与双重 HIV-TB 污名化显著相关。此外，疾病之间的联系以及双重污名化导致了结核病污名化。最后，HIV 和 TB 之间的联系以及同事对这两种疾病的污名化与掩盖作为污名管理策略的使用增加有关。
结论
这是第一项在共同流行背景下剖析双重污名的中介作用以及共同流行对结核病社会内涵影响的定量研究。研究结果强调需要采取综合方法来防治艾滋病毒和结核病，既要认识到共同流行在医学临床方面的交织性质，也要认识到其社会后果的交织性质。
试验注册
南非国家临床试验注册中心，注册号：DOH-27-1115-5204。于 2015 年 8 月 26 日前瞻性注册。
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