Implementation Research Division, The Aurum Institute, Johannesburg, South Africa.
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
PLoS One. 2021 Jul 30;16(7):e0254975. doi: 10.1371/journal.pone.0254975. eCollection 2021.
Stigma affects engagement with HIV healthcare services. We investigated the prevalence and experience of stigma among incarcerated people living with HIV (PLHIV) in selected South African correctional settings during roll-out of universal test and treat.
A cross-sectional mixed-methods study design included 219 incarcerated PLHIV and 30 in-depth interviews were conducted with four different types of PLHIV. HIV-related stigma was assessed through survey self-reporting and during the interviews. A descriptive analysis of HIV-related stigma was presented, supplemented with a thematic analysis of the interview transcripts.
ART uptake was high (n = 198, 90.4%) and most reported HIV-related stigma (n = 192, 87.7%). The intersectional stigma occurring due to individual and structural stigma around provision of healthcare in these settings mostly contributed to perceived stigma through involuntary disclosure of HIV status. Interpersonal and intrapersonal factors led to negative coping behaviours. However, positive self-coping strategies and relationships with staff encouraged sustained engagement in care.
We encourage continuous peer support to reduce stigmatization of those infected with HIV and whose status may be disclosed inadvertently in the universal test and treat era.
污名化会影响人们参与艾滋病毒医疗保健服务。在南非选定的惩教机构中开展普遍检测和治疗期间，我们调查了被监禁的艾滋病毒感染者（PLHIV）中污名化的流行程度和经历。
采用横断面混合方法设计，纳入了 219 名被监禁的 PLHIV，并对 4 种不同类型的 PLHIV 进行了 30 次深入访谈。通过问卷调查和访谈评估与 HIV 相关的污名。对 HIV 相关污名进行描述性分析，并对访谈记录进行主题分析。
抗逆转录病毒治疗（ART）的使用率很高（n=198，90.4%），大多数人报告了与 HIV 相关的污名（n=192，87.7%）。由于在这些环境中提供医疗保健的个人和结构性污名的交叉影响，主要导致了因 HIV 状况无意中披露而产生的感知污名。人际和内在因素导致了消极的应对行为。然而，积极的自我应对策略和与工作人员的关系鼓励了持续的护理参与。
我们鼓励持续的同伴支持，以减少在普遍检测和治疗时代感染艾滋病毒和可能无意中披露其状况的人的污名化。
