俄罗斯圣彼得堡有艾滋病毒和非法药物使用史的人群中的污名和抗逆转录病毒治疗启动-一项前瞻性队列分析。
Stigma and ART initiation among people with HIV and a lifetime history of illicit drug use in Saint-Petersburg, Russia-A prospective cohort analysis.
机构信息
First Pavlov State Medical University of Saint Petersburg, 6-8 Lev Tolstoy Street, St. Petersburg, 197022, Russia.
Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
出版信息
Int J Drug Policy. 2022 Apr;102:103600. doi: 10.1016/j.drugpo.2022.103600. Epub 2022 Feb 5.
BACKGROUND
HIV-positive people who inject drugs (PWID) are stigmatized and face more challenges in accessing ART. The natural course of stigma and its role on ART initiation in this population is unclear. We examined 1] whether HIV stigma changes over time and 2] whether HIV and substance use stigma are associated with ART initiation in a prospective cohort of HIV-positive PWID in St. Petersburg, Russia.
METHODS
We used data from 165 HIV-positive PWID who were ART-naïve at enrollment andgeneralized estimating equations to assess changes in HIV stigma between baseline, 12- and 24-month study visits. Logistic regression estimated associations of HIV stigma and substance use stigma with ART initiation. All models were adjusted for gender, age, CD4 count, duration of HIV diagnosis, recent (past 30-day) drug use and depressive symptoms.
RESULTS
Participants characteristics were the following: median age of 34 (Q1; Q3: 30; 37) years; 30% female; 28% with CD4 count <350; 44% reported recent drug use. During the study period, 31% initiated ART and the median time between HIV diagnosis and ART initiation was 8.5 years (Q1; Q3: 4.68; 13.61). HIV stigma scores decreased yearly by 0.57 (95% CI -1.36, 0.22). More than half (27/47 [57.4%]) of participants who were eligible for ART initiation per local ART guidelines did not initiate therapy. Total HIV stigma and substance use stigma scores were not associated with ART initiation (AOR 0.99, 95%CI 0.94-1.04; AOR 1.01, 95%CI 0.96-1.05, respectively).
CONCLUSION
In this Russian cohort of HIV-positive, ART-naïve PWID, stigma did not change over time and was not associated with ART initiation. Addressing stigma alone is unlikely to increase ART initiation rates in this population. Reducing further existing structural barriers, e.g., by promoting equal access to ART and the value of substance-use treatment for ART treatment success should complement stigma-reduction approaches.
背景
感染 HIV 的吸毒者（吸毒者）受到污名化，在获得抗逆转录病毒治疗 (ART) 方面面临更多挑战。污名的自然发展及其对该人群中开始接受 ART 的影响尚不清楚。我们研究了 1] HIV 污名是否随时间而变化，以及 2] HIV 和物质使用污名是否与俄罗斯圣彼得堡 HIV 阳性吸毒者的 ART 起始相关。
方法
我们使用了 165 名在入组时为 ART 初治的 HIV 阳性吸毒者的数据，并使用广义估计方程来评估 HIV 污名在基线、12 个月和 24 个月研究访视之间的变化。Logistic 回归估计了 HIV 污名和物质使用污名与 ART 起始的关联。所有模型均调整了性别、年龄、CD4 计数、HIV 诊断持续时间、近期（过去 30 天）药物使用和抑郁症状。
结果
参与者的特征如下：中位年龄为 34 岁（Q1；Q3：30；37）；30%为女性；28%的 CD4 计数<350；44%报告了最近的药物使用。在研究期间，有 31%的人开始接受 ART，从 HIV 诊断到开始 ART 的中位时间为 8.5 年（Q1；Q3：4.68；13.61）。HIV 污名评分每年下降 0.57（95%CI -1.36，0.22）。超过一半（27/47 [57.4%]）符合当地 ART 指南的开始 ART 治疗的参与者未开始治疗。总的 HIV 污名和物质使用污名评分与 ART 起始无关（AOR 0.99，95%CI 0.94-1.04；AOR 1.01，95%CI 0.96-1.05）。
结论
在这项俄罗斯的 HIV 阳性、ART 初治吸毒者队列中，污名并没有随时间而变化，也与 ART 起始无关。仅解决污名问题不太可能提高该人群的 ART 起始率。减少现有的结构性障碍，例如，通过促进平等获得 ART 和物质使用治疗对 ART 治疗成功的价值，应补充减少污名的方法。
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