社会生态学分析影响巴布亚新几内亚关键人群中艾滋病毒治疗开始和坚持的因素。
A socio-ecological analysis of factors influencing HIV treatment initiation and adherence among key populations in Papua New Guinea.
机构信息
The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia.
Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
出版信息
BMC Public Health. 2021 Nov 4;21(1):2003. doi: 10.1186/s12889-021-12077-w.
BACKGROUND
In Papua New Guinea (PNG) members of key populations, including female sex workers (FSW), men who have sex with men (MSM) and transgender women (TGW), have higher rates of HIV compared to the general adult population and low engagement in HIV care. This paper examines the socio-ecological factors that encourage or hinder HIV treatment initiation and adherence among HIV positive members of key populations in PNG.
METHODS
As part of a larger biobehavioural survey of key populations in PNG, 111 semi-structured interviews were conducted with FSW, MSM and TGW, of whom 28 identified as living with HIV. Interviews from 28 HIV positive participants are used in this analysis of the influences that enabled or inhibited HIV treatment initiation and treatment adherence.
RESULTS
Enablers included awareness of the biomedical benefits of treatment; experiences of the social, familial and health benefits of early treatment initiation and adherence; support provided by family and friends; and non-judgmental and supportive HIV service provision. Factors that inhibited treatment initiation and adherence included perception of good health and denial of HIV diagnosis; poor family support following positive diagnosis; and anonymity and stigma concerns in HIV care services.
CONCLUSION
Exploring health promotion messages that highlight the positive health impacts of early treatment initiation and adherence; providing client-friendly services and community-based treatment initiation and supply; and rolling out HIV viral load testing across the country could improve health outcomes for these key populations.
背景
在巴布亚新几内亚（PNG），包括性工作者（FSW）、男男性行为者（MSM）和跨性别女性（TGW）在内的关键人群成员的 HIV 感染率高于普通成年人群，且参与 HIV 护理的比例较低。本文研究了鼓励或阻碍 PNG 关键人群中 HIV 阳性成员启动和坚持 HIV 治疗的社会生态因素。
方法
作为对 PNG 关键人群进行的更大规模的生物行为学调查的一部分，对 111 名性工作者、男男性行为者和跨性别女性进行了半结构化访谈，其中 28 人被确认为 HIV 阳性。本分析使用了 28 名 HIV 阳性参与者的访谈，以研究促进或阻碍 HIV 治疗启动和治疗依从性的影响因素。
结果
促进因素包括对治疗的生物医学益处的认识；早期治疗启动和依从的社会、家庭和健康益处的经验；来自家人和朋友的支持；以及非评判性和支持性的 HIV 服务提供。阻碍治疗启动和依从的因素包括对良好健康状况的认知和对 HIV 诊断的否认；阳性诊断后家庭支持不足；以及在 HIV 护理服务中对匿名性和耻辱感的担忧。
结论
探索强调早期治疗启动和依从对健康的积极影响的健康促进信息；提供对客户友好的服务和社区启动及供应治疗；并在全国范围内推出 HIV 病毒载量检测，可以改善这些关键人群的健康结果。
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