Ukrainian Institute on Public Health Policy Consultant, Kyiv, Ukraine.
Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
J Int AIDS Soc. 2020 May;23(5):e25492. doi: 10.1002/jia2.25492.
INTRODUCTION: Co-located treatment for HIV and opioid use disorder has been shown to improve care outcomes for HIV-positive people who inject drugs (PWID) in Ukraine. However, patients continue to be stigmatized for both HIV and substance use. This study aimed to assess whether co-located care for HIV-positive PWID receiving opioid agonist treatment (OAT) services in Ukraine is associated with less stigma and better perceived quality of HIV services. METHODS: This cross-sectional study enrolled 191 HIV-positive PWID who received OAT services at three healthcare facilities providing substance use treatment (OAT only) and at four facilities that provided co-located care (both OAT and HIV treatment) in six regions in Ukraine during July-September, 2017. Primary outcomes were HIV stigma (Berger scale), substance use stigma (Substance Abuse Stigma Scale) and intersectional stigma (both stigma forms above 75th percentile). Secondary outcome was quality of HIV care, a composite score based on a package of received services. Linear and ordinal regressions were used to assess the predictors of selected outcomes. RESULTS: Study participants were 75% male, mean age 40 ± 7 years; 47% received co-located care, and 10.5% had both high HIV and substance use stigma. Co-located care was neither associated with HIV nor substance use stigma but it was linked to better quality of HIV care (adjusted odds ratio: 4.13; 95% CI: 2.31, 7.54). HIV stigma was associated with suicide attempts (adjusted beta (aβ): 5.90; 95% CI: 2.05, 9.75), and substance use stigma was linked to poor mental health (aβ: -0.26; 95% CI: -0.44, -0.08) and lower likelihood of receipt of services from non-governmental organization (NGO; aβ: -6.40; 95% CI: -10.23, -2.57). CONCLUSION: One in ten people with HIV in this cohort who received OAT services experienced high levels of both HIV and substance use stigma, which was associated with poorer mental health and less NGO support. Co-located HIV and OAT services were linked to better perceived quality of HIV care, but did not seem to reduce stigma for this key population. Stigma interventions for PWID, possibly delivered involving NGOs, may be an approach to mitigate this challenge.
介绍：在乌克兰，为同时患有 HIV 和阿片类药物使用障碍的患者提供联合治疗，已被证实能够改善接受阿片类激动剂治疗（OAT）的 HIV 阳性吸毒者（PWID）的治疗效果。然而，这些患者仍因 HIV 和药物滥用而受到污名化。本研究旨在评估乌克兰接受 OAT 服务的 HIV 阳性 PWID 接受联合治疗（同时提供 OAT 和 HIV 治疗）与接受单独 OAT 治疗相比，其 HIV 相关污名和对 HIV 服务质量的感知是否存在差异。
方法：本横断面研究共纳入了 191 名在乌克兰六个地区的三家提供药物滥用治疗服务（仅 OAT）的医疗机构和四家提供联合治疗服务（同时提供 OAT 和 HIV 治疗）的医疗机构接受 OAT 服务的 HIV 阳性 PWID。主要结局为 HIV 污名（Berger 量表）、物质使用污名（物质滥用污名量表）和交叉污名（两个污名量表的第 75 百分位数以上）。次要结局是 HIV 护理质量，这是根据一整套服务包来衡量的综合得分。线性和有序回归用于评估所选结局的预测因素。
结果：研究参与者中 75%为男性，平均年龄为 40 ± 7 岁；47%的人接受了联合治疗，10.5%的人同时存在 HIV 和物质使用污名。联合治疗既与 HIV 污名也与物质使用污名无关，但与更好的 HIV 护理质量相关（调整后的比值比：4.13；95%置信区间：2.31，7.54）。HIV 污名与自杀未遂相关（调整后的β值（aβ）：5.90；95%置信区间：2.05，9.75），物质使用污名与心理健康较差相关（aβ：-0.26；95%置信区间：-0.44，-0.08），且不太可能从非政府组织（NGO）获得服务（aβ：-6.40；95%置信区间：-10.23，-2.57）。
结论：在本队列中，每 10 名接受 OAT 服务的 HIV 阳性患者中就有 1 人同时存在 HIV 和物质使用污名，这与较差的心理健康和 NGO 支持减少有关。接受联合的 HIV 和 OAT 服务与对 HIV 护理质量的更好感知有关，但似乎并未减少这一关键人群的污名。针对 PWID 的污名干预措施，可能通过非政府组织来实施，可能是减轻这一挑战的一种方法。
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