Lacombe-Duncan Ashley, Logie Carmen H, Newman Peter A, Bauer Greta R, Kazemi Mina
School of Social Work, University of Michigan, Ann Arbor, MI, USA.
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
AIDS Care. 2020 Aug;32(8):1008-1013. doi: 10.1080/09540121.2020.1728212. Epub 2020 Feb 18.
Stigma in healthcare is a pervasive adversity experienced by transgender (trans) women living with HIV (WLWH). Resilience is described as individual and collective processes of navigating and overcoming adversity. This qualitative study sought to explore resilience exhibited by trans WLWH in response to stigma in healthcare. Semi-structured, individual interviews were conducted in 2017-2018 with a purposive sample of trans WLWH ( = 11) participating in a community-based cohort study. Framework analysis was used to identify key themes, patterns within themes between participants, and patterns across themes among participants. Three overarching themes were identified. (1) . Participants exhibited resilient personality traits and processes of resistance and transformation in response to stigma. (2) . Participants experienced self and altruistic driven motivations. Benefits included increased self-worth, economic resources, and leverage for better healthcare treatment, and reduced internalized stigma and isolation. Negative consequences included defensive provider reactions, being further stereotyped, and decreased physical and mental health. (3) . Participants recommended trans inclusion in service delivery, development, and management, as well as increased provider education. Providers can leverage trans WLWH's personal and collective strengths while working in solidarity to reduce stigma in healthcare settings.
医疗保健中的污名化是感染艾滋病毒的跨性别女性（trans WLWH）普遍面临的困境。复原力被描述为应对和克服逆境的个人及集体过程。这项定性研究旨在探索trans WLWH在应对医疗保健污名化时所展现出的复原力。2017年至2018年，对参与一项基于社区的队列研究的11名trans WLWH进行了半结构化的个人访谈。采用框架分析法来确定关键主题、参与者之间主题内的模式以及参与者之间主题间的模式。确定了三个总体主题。（1）参与者在应对污名化时展现出坚韧的人格特质以及抵抗和转变的过程。（2）参与者经历了自我驱动和利他驱动的动机。益处包括自我价值感增强、经济资源增加以及获得更好医疗保健待遇的影响力，同时减少内化污名和孤独感。负面后果包括医疗服务提供者的防御性反应、被进一步刻板化以及身心健康下降。（3）参与者建议在服务提供、发展和管理中纳入跨性别者，同时加强医疗服务提供者的教育。医疗服务提供者在共同努力减少医疗保健环境中的污名化时，可以利用trans WLWH的个人和集体优势。
