Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa.
Soc Sci Med. 2020 May;253:112940. doi: 10.1016/j.socscimed.2020.112940. Epub 2020 Mar 19.
Stigma can exacerbate negative health outcomes in people living with HIV (PLWH). This longitudinal, cluster randomized controlled trial in rural Mpumalanga, South Africa, examined the interdependence of HIV-related stigma among pregnant couples living with HIV, and the potential impact of a lay health worker delivered intervention, Protect Your Family, on changes in stigma over time across couples, controlling for physical intimate partner violence (IPV), verbal IPV, gender, HIV knowledge, and months since HIV diagnosis. Using a form of the Actor-Partner Interdependence model, changes in stigma over time were also examined within each dyad of seroconcordant participants with HIV.
Antenatal clinics were randomized to experimental or control conditions, and participants completed baseline antenatal and 12-month postpartum assessments. Both women and male partners participated in intervention sessions in gender concordant groups and couple or individual sessions.
Multilevel models (N = 1475) revealed stigma was related to condition and verbal intimate partner violence, but not time. Using an Actor-Partner Interdependence cross-lagged path model to examine within dyad changes in stigma for seroconcordant couples (n = 201), intervention condition participants' stigma levels were not interdependent over time. Women's 12-month stigma was related to their partners' stigma at baseline in the control condition, but not in the intervention condition.
Compared to women in the control condition, postpartum stigma among women in the intervention condition was not related to their male partners' stigma, suggesting that women's perception of stigma became uncoupled from that of their partners. The intervention may have promoted female empowerment to shape their own beliefs and attitudes towards what it means to be infected with HIV, and express their own agency in responding to how others treat them and they treat themselves.
污名可能会加剧感染艾滋病毒的人（PLWH）的负面健康结果。这项在南非姆普马兰加省农村地区进行的纵向、集群随机对照试验，研究了感染艾滋病毒的夫妇之间与艾滋病毒相关的污名相互依赖的情况，以及由非专业卫生工作者提供的干预措施“保护您的家庭”对夫妇之间随时间变化的污名变化的潜在影响，控制了身体上的亲密伴侣暴力（IPV）、言语 IPV、性别、艾滋病毒知识和艾滋病毒诊断后月份。使用演员-伙伴相互依赖模型的一种形式，还在每个 HIV 血清学一致的参与者对之间检查了随时间变化的污名变化。
产前诊所被随机分配到实验组或对照组，参与者完成了基线产前和 12 个月产后评估。女性和男性伴侣都参加了性别一致组的干预会议以及夫妻或个人会议。
多层次模型（N=1475）显示，污名与条件和言语亲密伴侣暴力有关，但与时间无关。使用演员-伙伴相互依赖交叉滞后路径模型来检查血清学一致的夫妇之间污名的变化（n=201），干预条件下参与者的污名水平随时间没有相互依赖。在对照组中，女性的 12 个月污名与伴侣的基线污名有关，但在干预组中则没有。
与对照组中的女性相比，干预组中女性的产后污名与男性伴侣的污名无关，这表明女性对污名的看法与伴侣的污名不再相关。该干预措施可能促进了女性赋权，以塑造她们自己对感染艾滋病毒意味着什么的信念和态度，并在回应他人如何对待她们以及她们如何对待自己时表达自己的代理权。
