Population Council, Washington, District of Columbia, USA.
Red Dominicana de Personas que Viven con VIH/SIDA.
AIDS. 2020 Sep 1;34 Suppl 1:S43-S51. doi: 10.1097/QAD.0000000000002642.
OBJECTIVE(S): To describe stigma among seropositive MSM, female sex workers (FSWs), and Haitian-descent individuals in the Dominican Republic, and to assess whether stigma is associated with HIV treatment outcomes.
Cross-sectional survey using Stigma Index 2.0.
People living with HIV (PLHIV) interviewed seropositive adult MSM, FSWs, Haitian-descent persons, and other PLHIV who did not identify with these communities about experiences of social exclusion, harassment, stigma in healthcare settings, and internalized stigma. Bivariate analyses were conducted to compare experiences between FSWs and other women; MSM and other men; and Haitian-descent participants and non-Haitian PLHIV. Within each community, separate multivariate logistic regression analyses were conducted to examine the association between stigma experiences with viral suppression and with missed antiretroviral doses.
The 891 participants consisted of 154 MSM, 216 FSWs, 90 Haitian-descent persons, and 447 who did not identify with any of these three communities. Compared with other women, FSWs reported significantly higher levels of harassment due to their HIV status, and those of Haitian descent reported significantly lower levels of social exclusion compared with non-Haitian PLHIV. In adjusted analyses, MSM who experienced more stigma in HIV-specific services had a significantly lower odds of knowing they had undetectable viral load (adjusted odds ratio 0.37, P < 0.05). Higher internalized stigma scores were significantly associated with missing an antiretroviral treatment dose among FSWs (adjusted odds ratio 1.26, P < 0.05).
For FSWs and MSM, efforts to mitigate HIV-related stigma are necessary to improve treatment adherence and viral suppression. For Haitian-descent PLHIV, interventions must address not only their HIV-specific needs, but also the broader social and legal barriers to care.
描述多米尼加共和国血清阳性男男性行为者（MSM）、性工作者（FSW）和海地裔个体中的耻辱感，并评估耻辱感是否与 HIV 治疗结局相关。
使用耻辱感指数 2.0 进行横断面调查。
对 HIV 感染者（PLHIV）进行访谈，询问他们与血清阳性成年 MSM、FSW、海地裔个体以及其他不认同这些群体的 PLHIV 有关社会排斥、骚扰、医疗环境中的耻辱感和内化耻辱感的经历。进行了单变量分析，以比较 FSW 与其他女性之间、MSM 与其他男性之间以及海地裔参与者与非海地裔 PLHIV 之间的经历。在每个群体中，分别进行了多变量逻辑回归分析，以检验耻辱感经历与病毒抑制和抗逆转录病毒剂量漏服之间的关联。
891 名参与者包括 154 名 MSM、216 名 FSW、90 名海地裔个体和 447 名不认同这三个群体的人。与其他女性相比，FSW 报告因 HIV 状况而受到的骚扰显著更高，海地裔个体报告的社会排斥显著低于非海地裔 PLHIV。在调整分析中，在 HIV 特定服务中经历更多耻辱感的 MSM 知晓自己病毒载量不可检测的可能性显著降低（调整后的优势比 0.37，P<0.05）。较高的内化耻辱感评分与 FSW 漏服抗逆转录病毒治疗剂量显著相关（调整后的优势比 1.26，P<0.05）。
对于 FSW 和 MSM，必须努力减轻与 HIV 相关的耻辱感，以提高治疗依从性和病毒抑制率。对于海地裔 PLHIV，干预措施不仅必须满足他们的 HIV 特定需求，还必须解决更广泛的社会和法律障碍。
