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佛罗里达州艾滋病毒感染者抗逆转录病毒治疗依从性和病毒抑制与医疗特定制定艾滋病污名的关系

Health Care-Specific Enacted HIV-Related Stigma's Association with Antiretroviral Therapy Adherence and Viral Suppression Among People Living with HIV in Florida.

机构信息

Department of Epidemiology, Florida International University, Miami, Florida, USA.

Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), and Florida International University, Miami, Florida, USA.

出版信息

AIDS Patient Care STDS. 2020 Jul;34(7):316-326. doi: 10.1089/apc.2020.0031.


DOI:10.1089/apc.2020.0031
PMID:32639208
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7370977/
Abstract

Among people living with HIV (PLWH) in Florida, <2/3 are virally suppressed (viral load <200 copies/mL). Previous theoretical frameworks have pointed to HIV-related stigma as an important factor for viral suppression; an important outcome related to the HIV continuum of care. This study aims to analyze the association between enacted HIV-related stigma and antiretroviral therapy (ART) adherence and viral suppression among a sample of PLWH in Florida. The overall sample ( = 932) was male (66.0%), majority greater than 45 years of age (63.5%), black (58.1%), and non-Hispanic (79.7%). Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were estimated using logistic regression models. The odds of nonadherence to ART was not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 1.30, CI: (0.87-1.95),  = 0.198; AOR = 1.17, CI: (0.65-2.11),  = 0.600, respectively]. Moreover, the odds of nonviral suppression were not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 0.92, CI: (0.60-1.42),  = 0.702; AOR = 1.16, CI: (0.64-2.13),  = 0.622, respectively]. However, ever experiencing health care-specific enacted HIV-related stigma was associated with both nonadherence [AOR = 2.29, CI: (1.25-4.20),  = 0.008] and nonsuppression [AOR = 2.16, CI: (1.19-3.92),  = 0.011]. Despite limitations, the results suggest that the perpetuation of stigma by health care workers may have a larger impact on continuum of care outcomes of PLWH than other sources of enacted stigma. Based on the results, there is a need to develop and evaluate interventions for health care workers intended to reduce experienced stigma among PLWH and improve health outcomes.

摘要

在佛罗里达州的 HIV 感染者(PLWH)中,不到 2/3 的人病毒得到抑制(病毒载量<200 拷贝/毫升)。以前的理论框架指出,HIV 相关耻辱感是病毒抑制的一个重要因素;这是与 HIV 护理连续体相关的一个重要结果。本研究旨在分析佛罗里达州 PLWH 样本中实施的 HIV 相关耻辱感与抗逆转录病毒治疗(ART)依从性和病毒抑制之间的关联。总体样本(n=932)中,男性占 66.0%,年龄大于 45 岁的占 63.5%,黑人占 58.1%,非西班牙裔占 79.7%。使用逻辑回归模型估计调整后的优势比(AOR)和 95%置信区间(CI)。报告低度/中度或高度普遍实施的 HIV 相关耻辱感(与无耻辱感相比)的个体,ART 不依从的可能性没有显著增加(AOR=1.30,CI:(0.87-1.95),p=0.198;AOR=1.17,CI:(0.65-2.11),p=0.600)。此外,报告低度/中度或高度普遍实施的 HIV 相关耻辱感(与无耻辱感相比)的个体,病毒未抑制的可能性没有显著增加(AOR=0.92,CI:(0.60-1.42),p=0.702;AOR=1.16,CI:(0.64-2.13),p=0.622)。然而,曾经经历过医疗保健特定的实施性 HIV 相关耻辱感与不依从(AOR=2.29,CI:(1.25-4.20),p=0.008)和未抑制(AOR=2.16,CI:(1.19-3.92),p=0.011)均相关。尽管存在局限性,但结果表明,医疗保健工作者实施的耻辱感可能比其他来源的耻辱感对 PLWH 的护理连续体结果产生更大的影响。基于结果,需要为医疗保健工作者制定和评估旨在减少 PLWH 经历的耻辱感并改善健康结果的干预措施。

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本文引用的文献

[1]
The Florida Cohort study: methodology, initial findings and lessons learned from a multisite cohort of people living with HIV in Florida.

AIDS Care. 2021-4

[2]
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J Gay Lesbian Soc Serv. 2019

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AIDS Behav. 2020-4

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Age, Sex, Race, Ethnicity, Sexual Orientation: Intersectionality of Marginalized-Group Identities and Enacted HIV-Related Stigma Among People Living with HIV in Florida.

AIDS Behav. 2019-11

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AIDS. 2019-7-15

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AIDS Patient Care STDS. 2019-4

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AIDS Patient Care STDS. 2018-10

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AIDS Patient Care STDS. 2018-9

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AIDS Patient Care STDS. 2018-4

[10]
HIV Care Continuum Disparities Among Black Bisexual Men and the Mediating Effect of Psychosocial Comorbidities.

J Acquir Immune Defic Syndr. 2018-4-15

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