Winskell Kate, Sabben Gaëlle, Singleton Robyn, Bednarczyk Robert A, Tiendrébéogo Georges, Nkambule-Vilakati Siphiwe, Dia Fatim Louise, Mbakwem Benjamin, Stephenson Rob
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Laafi Consulting, Ouagadougou 01, Burkina Faso.
SSM Popul Health. 2020 Apr 14;11:100586. doi: 10.1016/j.ssmph.2020.100586. eCollection 2020 Aug.
Little is known about how young Africans have made sense of the dramatic ways in which the HIV epidemic has evolved, and how that sense-making varies across countries with different epidemiological and sociocultural profiles. Symbolic representations of HIV and people living with HIV influence prevention, stigma, treatment-seeking, and illness experience. We compared social representations of HIV among young people from Senegal, Burkina Faso, Nigeria (South-East), Kenya, and Swaziland between 1997 and 2014. From a pool of 32,759 HIV-themed creative narratives contributed by 10-24 year-olds to scriptwriting competitions at eight time points (1997, 2000, 2002, 2005, 2008, 2011, 2013, and 2014), we randomly sampled 1937 narratives, stratified by author's sex, age, and rural/urban residence. We quantified components of each narrative and calculated descriptive statistics and adjusted odds ratios, controlling for year, country, and author demographics. From 2005 onwards, representations of death, treatment access, and hopefulness improved significantly. Representations of death reached their lowest point in 2013, while biomedical treatment and hope peaked in 2011 and 2008, respectively, then declined. Narratives increasingly focused on female protagonists. Nigerian texts had significantly higher odds of death and blame, and lower odds of hope. A focus on life post-infection and representations of support for characters living with HIV increased with country HIV prevalence. Narratives by older authors were less blaming and more hopeful, supportive, and prevention-focused. While aggregate social representations in the narratives from 2005 to 2008-11 reflect increased optimism fostered by access to antiretroviral therapy (ART), positive developments are not sustained at this level. Stigmatizing representations persist, particularly in Nigeria. The hope-promoting and stigma-reducing influence of the advent of ART access may have partially run its course by 2011/2013. However, significant temporal and cross-national differences point to opportunities to reframe HIV in more constructive ways and contribute to improved education, communication, and stigma-reduction efforts.
对于非洲年轻人如何理解艾滋病毒疫情演变的剧烈方式，以及这种理解在具有不同流行病学和社会文化特征的国家之间如何变化，我们知之甚少。艾滋病毒及艾滋病毒感染者的象征表征会影响预防、污名化、寻求治疗以及患病体验。我们比较了1997年至2014年间来自塞内加尔、布基纳法索、尼日利亚（东南部）、肯尼亚和斯威士兰的年轻人对艾滋病毒的社会表征。在八个时间点（1997年、2000年、2002年、2005年、2008年、2011年、2013年和2014年），10至24岁的年轻人向剧本创作比赛提交了32759篇以艾滋病毒为主题的创意故事，我们从这些故事中，按照作者的性别、年龄和农村/城市居住情况进行分层，随机抽取了1937篇故事。我们对每篇故事的内容进行量化，并计算描述性统计数据和调整后的比值比，同时控制年份、国家和作者人口统计学特征。从2005年起，关于死亡、获得治疗和希望的表征有了显著改善。死亡表征在2013年达到最低点，而生物医学治疗和希望的表征分别在2011年和2008年达到峰值，随后下降。故事越来越多地聚焦于女性主角。尼日利亚的文本出现死亡和指责的几率显著更高，而出现希望的几率更低。随着国家艾滋病毒流行率的上升，对感染后生活的关注以及对艾滋病毒感染者角色支持的表征也有所增加。年长作者所写的故事指责较少，更充满希望、支持性更强且更注重预防。虽然2005年至2008 - 2011年故事中的总体社会表征反映了获得抗逆转录病毒疗法（ART）所带来的乐观情绪增加，但积极进展并未在这一水平上持续。污名化表征依然存在，尤其是在尼日利亚。到2011/2013年，获得抗逆转录病毒疗法所带来的促进希望和减少污名的影响可能已部分消退。然而，显著的时间和跨国差异表明，有机会以更具建设性的方式重新构建对艾滋病毒的认知，并有助于改进教育、宣传和减少污名的工作。
