乌干达农村地区男女性人群对艾滋病污名和艾滋病检测的认知：一项基于人群的研究。
Perceived HIV stigma and HIV testing among men and women in rural Uganda: a population-based study.
机构信息
Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA.
Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
出版信息
Lancet HIV. 2020 Dec;7(12):e817-e824. doi: 10.1016/S2352-3018(20)30198-3. Epub 2020 Sep 7.
BACKGROUND
Stigma is a formidable social structural barrier to HIV testing, and yet the effect of stigma on HIV testing is rarely examined at the community level. We aimed to examine the geospatial relationships of perceived HIV stigma and HIV testing among men and women living in rural Uganda.
METHODS
Women and men (aged ≥18 years or emancipated minor) residing in rural areas of Uganda who self-identified as HIV negative completed interviews that included measures of HIV testing history and how participants perceived HIV stigma. We used geospatial cluster analyses to identify areas of higher perceived stigma and lower perceived stigma and the geographical dispersion of these areas. We used Poisson regression models stratified by gender to test individual-level and community-level perceived stigma in relation to frequency of HIV testing in the previous 2 years.
FINDINGS
Between Nov 25, 2015, and May 26, 2017, we interviewed 9740 participants (4359 [45%] men and 5381 [55%] women]), among whom 940 (9%) had never been tested for HIV, and among those who had been tested, 1131 (12%) had not been tested in the previous 2 years. Men (3134 [72%] of 4359) were less likely to have been tested in the past 2 years than women (4535 [84%] of 5381) were (p<0·001). We used Poisson regression models, reporting B coefficients, to test study hypotheses regarding the effects of individual-level and community-level stigma on HIV testing frequency counts. Multilevel modelling showed that women showed significant individual-level (B=-0·173, p<0·001) and community-level (B=-0·223, p<0·001) associations between lower stigma predicting higher rates of HIV testing. For men, lower individual-level perceived stigma was also associated with higher testing frequency (B=-0·030, p=0·018), whereas higher community-level perceived stigma was associated with higher testing frequency (B=0·077, p=0·008).
INTERPRETATION
Our results suggest that perceived HIV stigma at the community level exerts a differential influence on testing for women and men. HIV testing campaigns that are targeted to men and women in rural Uganda will require gender tailoring to fit local contexts.
FUNDING
US National Institute of Mental Health.
背景
污名是艾滋病毒检测的一个强大的社会结构性障碍，但污名对艾滋病毒检测的影响很少在社区层面上进行研究。我们旨在研究在乌干达农村地区居住的男性和女性中，对艾滋病毒的污名感知与艾滋病毒检测之间的地理空间关系。
方法
在乌干达农村地区居住的年龄在 18 岁或以上或已成年的自我认定为艾滋病毒阴性的女性和男性完成了访谈，其中包括艾滋病毒检测史以及参与者对艾滋病毒污名的看法。我们使用地理空间聚类分析来确定感知污名程度较高和较低的地区以及这些地区的地理分布情况。我们使用按性别分层的泊松回归模型，检验个体和社区层面的污名感知与过去 2 年内艾滋病毒检测频率之间的关系。
结果
2015 年 11 月 25 日至 2017 年 5 月 26 日期间，我们共采访了 9740 名参与者（4359 名男性[45%]和 5381 名女性[55%]），其中 940 名（9%）从未接受过艾滋病毒检测，在接受过检测的参与者中，有 1131 名（12%）在过去 2 年内未接受过检测。与女性（5381 名中的 4535 名[84%]）相比，男性（4359 名中的 3134 名[72%]）在过去 2 年内接受检测的可能性较低（p<0·001）。我们使用泊松回归模型，报告 B 系数，以检验关于个体和社区层面污名对艾滋病毒检测频率计数的影响的研究假设。多水平模型显示，女性的个体层面（B=-0·173，p<0·001）和社区层面（B=-0·223，p<0·001）污名感知与更高的艾滋病毒检测率呈显著正相关。对于男性，较低的个体层面感知污名也与更高的检测频率相关（B=-0·030，p=0·018），而较高的社区层面感知污名与更高的检测频率相关（B=0·077，p=0·008）。
解释
我们的结果表明，社区层面的艾滋病毒污名感知对女性和男性的检测产生了不同的影响。针对乌干达农村地区男性和女性的艾滋病毒检测宣传活动需要根据当地情况进行性别调整。
资助
美国国家心理健康研究所。
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