“他们看你的样子，就好像你被污染了一样”：在加拿大的环境下，与 HIV 相关的耻辱感如何影响感染 HIV 的被监禁女性获得护理的机会。
"They look at you like you're contaminated": how HIV-related stigma shapes access to care for incarcerated women living with HIV in a Canadian setting.
机构信息
Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
出版信息
Can J Public Health. 2022 Apr;113(2):282-292. doi: 10.17269/s41997-021-00562-z. Epub 2021 Sep 1.
OBJECTIVES
Given the gender disparities in HIV outcomes for women living with HIV (WLWH) who experience incarceration, and the impact of HIV-related stigma on HIV care, this qualitative study investigated how HIV-related stigma within prison settings shapes HIV care for WLWH.
METHODS
Drawing from SHAWNA (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment), a community-based research project with cisgender and transgender WLWH in Metro Vancouver, peer and community interviewers conducted 19 qualitative interviews (May 2017-February 2018) with recently incarcerated WLWH focused on factors that shape incarceration trajectories. Drawing on socio-ecological frameworks and using participatory analysis, this analysis sought to characterize how HIV-related stigma shapes experiences and access to care for incarcerated WLWH.
RESULTS
Participants' responses focused predominately on experiences in provincial correctional facilities and the ways through which HIV-related stigma within correctional settings was linked to access to HIV care. Experiences of HIV-related stigma within prisons led to isolation and discrimination for WLWH which was reinforced through institutional processes, compromised privacy, and uncertainty about confidentiality. Experiences of HIV-related stigma informed decisions for some participants to withhold HIV status from healthcare staff, compromising access to HIV treatment during incarceration.
CONCLUSION
Amid ongoing efforts to improve healthcare delivery within Canadian correctional facilities, these findings have important implications for the provision of HIV care for incarcerated WLWH. Culturally safe, trauma-informed programming focused on reducing HIV-related stigma, improved communication regarding medical privacy, and interventions to change processes that compromise privacy is critical to improve healthcare access in correctional facilities.
目的
鉴于感染艾滋病毒的女性囚犯（WLWH）在监禁期间存在艾滋病毒结局的性别差异，以及艾滋病毒相关耻辱感对艾滋病毒护理的影响，本定性研究调查了监狱环境中的艾滋病毒相关耻辱感如何影响 WLWH 的艾滋病毒护理。
方法
本研究借鉴了 SHAWNA（性健康和艾滋病毒/艾滋病：女性纵向需求评估），这是一个与温哥华大都市区跨性别和跨性别 WLWH 合作的基于社区的研究项目，同伴和社区访谈员对最近被监禁的 WLWH 进行了 19 次定性访谈（2017 年 5 月至 2018 年 2 月），重点关注影响监禁轨迹的因素。本研究采用社会生态框架并使用参与式分析，旨在描述艾滋病毒相关耻辱感如何影响监禁的 WLWH 的经历和获得护理的机会。
结果
参与者的回应主要集中在省级惩教设施的经历，以及艾滋病毒相关耻辱感在惩教环境中与获得艾滋病毒护理之间的联系方式。监狱内艾滋病毒相关耻辱感导致 WLWH 被隔离和歧视，这种歧视通过机构程序、侵犯隐私和对保密性的不确定性得到加强。艾滋病毒相关耻辱感的经历促使一些参与者向医疗保健人员隐瞒艾滋病毒状况，从而在监禁期间无法获得艾滋病毒治疗。
结论
在加拿大惩教机构内不断努力改善医疗服务的背景下，这些发现对为被监禁的 WLWH 提供艾滋病毒护理具有重要意义。文化安全、以创伤为中心的方案侧重于减少艾滋病毒相关耻辱感、改善有关医疗隐私的沟通，以及干预措施改变侵犯隐私的程序，对于改善惩教设施中的医疗保健机会至关重要。
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