南非跨性别和性别多样化女性中的污名和艾滋病毒服务获取 - 来自 HPTN 071（PopART）试验的纵向定性数据分析的叙述分析。
Stigma and HIV service access among transfeminine and gender diverse women in South Africa - a narrative analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial.
机构信息
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch University, K-Floor, Clinical Building, Tygerberg Campus, Francie van Zyl Drive, Tygerberg, Cape Town, 7505, South Africa.
Department of Social and Environmental Health Research, Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK.
出版信息
BMC Public Health. 2020 Dec 10;20(1):1898. doi: 10.1186/s12889-020-09942-5.
BACKGROUND
Transgender women have a disproportionately high HIV prevalence compared to cisgender women and men who have sex with men, which puts them at risk of HIV-related stigma (Baral SD et al., Lancet Infect Dis, 13;3, 2013). People whose gender identities are in tension with dominant social norms (including transgender women) often also experience gender identity-related stigma. There has been increasing attention to transgender people in HIV research and interventions. However, very little research has been done in sub-Saharan African countries.
METHODS
We conducted a qualitative cohort study which included eight transfeminine and/or gender diverse women (four living with HIV) in Western Cape, South Africa, for a follow-up period of 12-18 months. Using a narrative analysis approach, we set out to understand how transfeminine and gender diverse participants in the cohort anticipated, experienced and internalised HIV stigma and gender identity stigma, and how these stigmas affected HIV service access.
RESULT
We found that participants reported anticipated, experienced, and internalised stigma relating both to their gender identity and to living with HIV. Participants reported inconsistent uptake of antiretroviral therapy (ART) services (including ART initiation and adherence) that they linked to stigma. We also found that gender diverse women and transfeminine women are challenged with other stigmatising social identities, like being a sex worker, drug user and/or a man (or assigned male sex at birth) who have sex with men (MSM). We use the terms 'transfeminine' and 'gender diverse' as terms that are inclusive of gender variant people who were all assigned male sex at birth and identify as women in some or all aspects of their lives. The persons in our study also showed gender identifications that were fluid and sometimes varied in different contexts and situations, therefore gender identity and sexual identity were often conflated for these individuals. Participants managed high levels of reported stigma by drawing on social support networks like families, friends and peers.
CONCLUSION
Our study provides exploratory work on how stigma may affect HIV services uptake amongst gender diverse women and transfeminine women in South Africa. We recommend future studies to further explore the unique HIV risks of gender diverse individuals.
TRIAL REGISTRATION
DOH-27-0513-4253 .
背景
与顺性别女性和男男性行为者相比，跨性别女性的 HIV 感染率不成比例地高，这使她们面临与 HIV 相关的污名化风险（Baral SD 等人，柳叶刀传染病，13；3，2013）。那些其性别认同与主流社会规范存在冲突的人（包括跨性别女性）也经常经历与性别认同相关的污名化。人们对 HIV 研究和干预中的跨性别者越来越关注。然而，在撒哈拉以南非洲国家，几乎没有进行过相关研究。
方法
我们在南非西开普省进行了一项定性队列研究，其中包括 8 名跨性别女性和/或性别多样化女性（4 名 HIV 感染者），随访期为 12-18 个月。我们采用叙述性分析方法，旨在了解队列中的跨性别女性和性别多样化参与者如何预期、经历和内化 HIV 污名和性别认同污名，以及这些污名如何影响 HIV 服务的获取。
结果
我们发现，参与者报告了与他们的性别认同和 HIV 感染者身份相关的预期、经历和内化的污名。参与者报告说，他们在获得抗逆转录病毒治疗（ART）服务方面存在不一致的情况（包括开始和坚持使用 ART），他们将这种不一致性与污名联系起来。我们还发现，性别多样化女性和跨性别女性面临着其他污名化的社会身份，例如性工作者、吸毒者和/或男男性行为者（或出生时被指定为男性）。我们使用“跨性别”和“性别多样化”这两个术语，以涵盖所有出生时被指定为男性但在生活的某些或所有方面认同为女性的性别多样化者。我们研究中的人也表现出性别认同的流动性，有时在不同的背景和情况下会有所不同，因此这些人通常会将性别认同和性认同混淆。参与者通过家庭、朋友和同伴等社会支持网络来应对高水平的污名化。
结论
我们的研究提供了关于污名化如何影响南非性别多样化女性和跨性别女性获得 HIV 服务的探索性工作。我们建议未来的研究进一步探索性别多样化个体的独特 HIV 风险。
试验注册
DOH-27-0513-4253。
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