Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA.
Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA.
J Int AIDS Soc. 2022 Jul;25 Suppl 1(Suppl 1):e25915. doi: 10.1002/jia2.25915.
INTRODUCTION: There is strong global commitment to eliminate HIV-related stigma, and work in this area continues to evolve. Wide variation exists in frameworks and measures used. METHODS: Building on the existing knowledge syntheses, we carried out a systematic review to identify frameworks and measures aiming to understand or assess internalized stigma, stigma and discrimination in healthcare, and in law and policy. The review addressed two questions: Which conceptual frameworks have been proposed to assess internalized stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? Which measures of these different types of stigma and discrimination have been proposed and what are their descriptive properties? Searches, completed on 6 May 2021, cover publications from 2008 onwards. The review is registered in PROSPERO (CRD42021249348), the protocol incorporated stakeholder input, and the data are available in the Systematic Review Data Repository. RESULTS AND DISCUSSION: Sixty-nine frameworks and 50 measures met the inclusion criteria. Critical appraisal figures and detailed evidence tables summarize these resources. We established a compendium of frameworks and a catalogue of measures of HIV-related stigma and discrimination. Seventeen frameworks and 10 measures addressed at least two of our focus domains, with least attention to stigma and discrimination in law and policy. The lack of common definitions and variability in scope and structure of HIV-related frameworks and measures creates challenges in understanding what is being addressed and measured, both in relation to stigma and efforts to mitigate or reduce its harmful effects. Having comparable data is essential for tracking change over time within and between interventions. CONCLUSIONS: This systematic review provides an evidence base of current understandings of HIV-related stigma and discrimination and how further conceptual clarification and increased adaptation of existing tools might help overcome challenges across the HIV care continuum. With people living with HIV at the centre, experts from different stakeholder groups could usefully collaborate to guide a more streamlined approach for the field. This can help to achieve global targets and understand, measure and help mitigate the impact of different types of HIV-related stigma on people's health and quality of life.
简介:全球致力于消除与艾滋病相关的耻辱感,这方面的工作仍在不断发展。所使用的框架和措施存在广泛差异。
方法:在现有知识综合的基础上,我们进行了系统评价,以确定旨在了解或评估内在耻辱感、医疗保健中的耻辱感和歧视以及法律和政策中根深蒂固的耻辱感和歧视的框架和措施。该审查提出了两个问题: 哪些概念框架已被提出用于评估医疗环境中的内在耻辱感、耻辱感和歧视,以及法律和政策中根深蒂固的耻辱感和歧视? 已提出哪些不同类型的耻辱感和歧视的衡量标准,其描述性特征是什么? 搜索于 2021 年 5 月 6 日完成,涵盖了 2008 年以后发表的出版物。该审查在 PROSPERO(CRD42021249348)中注册,该方案纳入了利益相关者的意见,数据可在系统评价数据存储库中获得。
结果与讨论:69 个框架和 50 个措施符合纳入标准。批判性评价数据和详细的证据表总结了这些资源。我们建立了一个包含艾滋病相关耻辱感和歧视的框架汇编和一个措施目录。17 个框架和 10 个措施至少涉及我们关注的两个领域,而对法律和政策中的耻辱感和歧视关注最少。艾滋病相关框架和措施在定义、范围和结构上缺乏共同性,这给理解所涉及的内容和衡量标准带来了挑战,包括耻辱感以及减轻或减少其有害影响的努力。拥有可比数据对于跟踪干预措施在时间和干预措施之间的变化至关重要。
结论:本系统评价提供了当前对艾滋病相关耻辱感和歧视的理解的证据基础,以及进一步明确概念和更多地改编现有工具如何帮助克服整个艾滋病护理连续体中的挑战。以艾滋病毒感染者为中心,来自不同利益相关者群体的专家可以进行有益的合作,为该领域提供更精简的方法。这有助于实现全球目标,了解、衡量和帮助减轻不同类型的艾滋病相关耻辱感对人们健康和生活质量的影响。
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