University of Sussex, Brighton and Sussex Medical School, Brighton, UK.
University of Oxford, Department of Social Policy and Intervention, Oxford, UK.
J Int AIDS Soc. 2020 May;23(5):e25488. doi: 10.1002/jia2.25488.
INTRODUCTION: Efficacious antiretroviral treatment (ART) enables people to live long and healthy lives with HIV but young people are dying from AIDS-related causes more than ever before. Qualitative evidence suggest that various forms of HIV-related discrimination and resulting shame act as profound barriers to young people's engagement with HIV services. However, the impact of these risks on adolescent retention in HIV care has not been quantified. This study has two aims: (1) to examine whether and how different types of discrimination compromise retention in care among adolescents living with HIV in South Africa; and (2) to test whether internalized stigma mediates these relationships. METHODS: Between 2014 and 2017, adolescents living with HIV (aged 10 to 19) from 53 health facilities in the Eastern Cape, South Africa, were interviewed at baseline (n = 1059) and 18-month follow-up (n = 979, 92.4%), with responses linked to medical records. Data were analysed through multiple regression and mediation models. RESULTS: About 37.9% of adolescents reported full retention in care over the 2-year period, which was associated with reduced odds of viral failure (OR: 0.371; 95% CI: .224, .614). At baseline, 6.9% of adolescents reported discrimination due to their HIV status; 14.9% reported discrimination due to HIV in their families and 19.1% reported discrimination in healthcare settings. Healthcare discrimination was associated with reduced retention in care both directly (effect: -0.120; CI: -0.190, -0.049) and indirectly through heightened internalized stigma (effect: 0.329; 95% CI: 0.129, 0.531). Discrimination due to family HIV was associated with reduced retention in care both directly (effect: -0.074, CI: -0.146, -0.002) and indirectly through heightened internalized stigma (effect: 0.816, CI: 0.494, 1.140). Discrimination due to adolescent HIV was associated with reduced retention in care only indirectly, through increased internalized stigma (effect: 0.408; CI: 0.102, 0.715). CONCLUSIONS: Less than half of adolescents reported 2-year retention in HIV care. Multiple forms of discrimination and the resultant internalized stigma contributed to this problem. More intervention research is urgently needed to design and test adolescent-centred interventions so that young people living with HIV can live long and healthy lives in the era of efficacious anti-retroviral treatment.
简介：有效的抗逆转录病毒治疗（ART）使人们能够长期健康地生活，但现在年轻人死于艾滋病相关原因的比例比以往任何时候都高。定性证据表明，各种形式的与艾滋病相关的歧视以及由此产生的耻辱感，是年轻人与艾滋病服务机构接触的严重障碍。然而，这些风险对青少年在艾滋病护理中的保留率的影响尚未量化。本研究有两个目的：（1）研究不同类型的歧视是否以及如何影响南非感染艾滋病毒的青少年的护理保留率；（2）测试内化耻辱感是否会影响这些关系。 方法：2014 年至 2017 年间，从南非东开普省 53 个卫生机构招募了 1059 名年龄在 10 至 19 岁之间的艾滋病毒感染者青少年，进行了基线（n=1059）和 18 个月随访（n=979，92.4%），用医疗记录对这些受访者的回答进行了关联。通过多元回归和中介模型对数据进行了分析。 结果：约 37.9%的青少年在两年内保持了全面的护理保留率，这与病毒失败的几率降低有关（比值比：0.371；95%可信区间：0.224，0.614）。在基线时，6.9%的青少年报告了因艾滋病状况而受到歧视；14.9%的青少年报告了因家庭成员感染艾滋病而受到歧视，19.1%的青少年报告了在医疗保健环境中受到歧视。医疗保健歧视既直接（效果：-0.120；置信区间：-0.190，-0.049），也通过增强内化耻辱感（效果：0.329；95%置信区间：0.129，0.051）间接影响了护理保留率。因家庭艾滋病毒而受到歧视，既直接（效果：-0.074，置信区间：-0.146，-0.002），也通过增强内化耻辱感（效果：0.816，置信区间：0.494，1.140）影响了护理保留率。因青少年艾滋病而受到歧视，仅通过增强内化耻辱感间接影响护理保留率（效果：0.408；置信区间：0.102，0.715）。 结论：不到一半的青少年报告了两年的艾滋病毒护理保留率。多种形式的歧视和由此产生的内化耻辱感是造成这一问题的原因。迫切需要更多的干预研究来设计和测试以青少年为中心的干预措施，以便在有效的抗逆转录病毒治疗时代，艾滋病毒感染者青少年能够长期健康地生活。
BMC Glob Public Health. 2024-7-1
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