“你就是想早点死！”：伊朗社会生态环境如何阻碍艾滋病毒感染者接受治疗。

'You just prefer to die early!': how socioecological context impedes treatment for people living with HIV in Iran.

机构信息

Social Policy and Intervention, Oxford University, Oxford, UK

Iranian Research Center for HIV / AIDS, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of).

出版信息

BMJ Glob Health. 2021 Nov;6(11). doi: 10.1136/bmjgh-2021-006088.

DOI:10.1136/bmjgh-2021-006088

PMID:34794955

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8603297/

Abstract

INTRODUCTION

Despite the low prevalence of HIV and broad provision of antiretroviral therapy, the Middle East and North Africa (MENA) remains the only region where new HIV infections and AIDS-related deaths are not declining. There is a dearth of evidence from MENA on antiretroviral therapy engagement. In this qualitative study, we sought to identify the ways in which successful treatment is hindered in Iran, which is home to 24% of HIV infections in MENA.

METHODS

From August 2018 to January 2019, we used purposive sampling and conducted 12 individual interviews and 8 focus group discussions with 27 female and 31 male patients, in addition to 5 individual interviews with HIV care providers and 1 focus group discussion with 8 care providers. Social constructivism augmented with realist-informed thematic analysis was used to understand how the socioecological context triggers cognitive and affective mechanisms that disrupt antiretroviral therapy.

RESULTS

The use of Thematic Network Analysis resulted in the identification of three key cognitive and affective mechanisms that appear to shape treatment experience and are triggered via HIV's socioecological context and changing economic conditions in Iran: denial in response to societal negative perceptions of HIV; fear in response to societal lack of awareness regarding HIV and misinformation; and despair in response to HIV-related stigma and enacted discrimination, economic insecurity and social support.

CONCLUSIONS

To our knowledge, this is the first study within MENA to identify pathways through which successful treatment is hindered. It appears that lack of societal awareness regarding HIV is specific to low prevalence settings, such as MENA countries, where negative perceptions, stigma, discrimination and misinformation regarding HIV and its treatment produce denial, fear and despair, acting as mechanisms that disrupt antiretroviral therapy. The experience of despair, in response to changing economic conditions and social support, further impacts treatment experience.

摘要

简介

尽管 HIV 的发病率较低，且广泛提供了抗逆转录病毒治疗，但中东和北非（MENA）仍然是唯一一个新的 HIV 感染和艾滋病相关死亡人数没有下降的地区。该地区缺乏关于抗逆转录病毒治疗参与情况的证据。在这项定性研究中，我们试图确定在伊朗（MENA 地区 24%的 HIV 感染发生地）成功治疗受到阻碍的原因。

方法

从 2018 年 8 月到 2019 年 1 月，我们使用了目的性抽样，对 27 名女性和 31 名男性患者进行了 12 次个人访谈和 8 次焦点小组讨论，此外还对 5 名 HIV 护理提供者进行了 5 次个人访谈，并对 8 名护理提供者进行了 1 次焦点小组讨论。社会建构主义与现实主义启发的主题分析相结合，用于了解社会生态环境如何触发认知和情感机制，从而破坏抗逆转录病毒治疗。