Population Council, HIV and AIDS Program, Center for Biomedical Research, New York, New York.
Population Council, HIV and AIDS Program, Washington, District of Columbia, USA.
AIDS. 2020 Sep 1;34 Suppl 1(Suppl 1):S5-S18. doi: 10.1097/QAD.0000000000002602.
OBJECTIVE(S): To describe the process of updating the People Living with HIV (PLHIV) Stigma Index (Stigma Index) to reflect current global treatment guidelines and to better measure intersecting stigmas and resilience.
Through an iterative process driven by PLHIV, the Stigma Index was revised, pretested, and formally evaluated in three cross-sectional studies.
Between March and October 2017, 1153 surveys (n = 377, Cameroon; n = 390, Senegal; n = 391, Uganda) were conducted with PLHIV at least 18 years old who had known their status for at least 1 year. PLHIV interviewers administered the survey on tablet computers or mobile phones to a diverse group of purposively sampled respondents recruited through PLHIV networks, community-based organizations, HIV clinics, and snowball sampling. Sixty respondents participated in cognitive interviews (20 per country) to assess if questions were understood as intended, and eight focus groups (Uganda only) assessed relevance of the survey, overall.
The Stigma Index 2.0 performed well and was relevant to PLHIV in all three countries. HIV-related stigma was experienced by more than one-third of respondents, including in HIV care settings. High rates of stigma experienced by key populations (such as MSM and sex workers) impeded access to HIV services. Many PLHIV also demonstrated resilience per the new PLHIV Resilience Scale.
The Stigma Index 2.0 is now more relevant to the current context of the HIV/AIDS epidemic and response. Results will be critical for addressing gaps in program design and policies that must be overcome to support PLHIV engaging in services, adhering to antiretroviral therapy, being virally suppressed, and leading healthy, stigma-free lives.
描述更新艾滋病毒感染者（PLHIV）耻辱指数（耻辱指数）的过程，以反映当前全球治疗指南，并更好地衡量交叉耻辱和弹性。
通过由 PLHIV 驱动的迭代过程，对耻辱指数进行了修订、预测试，并在三项横断面研究中进行了正式评估。
2017 年 3 月至 10 月期间，对至少 18 岁、已知 HIV 状况至少 1 年的 1153 名 PLHIV 进行了调查（n = 377，喀麦隆；n = 390，塞内加尔；n = 391，乌干达）。PLHIV 访谈员通过 PLHIV 网络、基于社区的组织、HIV 诊所和滚雪球抽样，对多样化的有目的抽样受访者在平板电脑或移动电话上进行了调查。60 名受访者参加了认知访谈（每个国家 20 名），以评估问题是否如预期的那样被理解，8 个焦点小组（仅在乌干达）评估了调查的相关性。
耻辱指数 2.0 在所有三个国家的 PLHIV 中表现良好且相关。超过三分之一的受访者经历了与 HIV 相关的耻辱，包括在 HIV 护理环境中。关键人群（如男男性行为者和性工作者）遭受的高耻辱率阻碍了获得 HIV 服务的机会。许多 PLHIV 还表现出了新的 PLHIV 弹性量表所定义的弹性。
耻辱指数 2.0 现在与 HIV/AIDS 流行和应对的当前背景更加相关。结果对于解决方案设计和政策中的差距至关重要，这些差距必须克服，以支持 PLHIV 参与服务、坚持抗逆转录病毒治疗、实现病毒抑制以及过上健康、无耻辱的生活。
