School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, 47, Remera, Kigali, Rwanda.
School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, 47, Remera, Kigali, Rwanda; University Teaching Hospital of Kigali, KN 4 Ave, Kigali, Rwanda.
Int J Nurs Stud. 2022 Nov;135:104339. doi: 10.1016/j.ijnurstu.2022.104339. Epub 2022 Aug 9.
Stigma is an underlying cause of health inequities, and a major barrier to HIV prevention, care, and treatment. Experiences of HIV stigma have been shown to reduce engagement in care across the HIV care continuum, from testing and diagnosis to long-term retention in care and anti-retroviral therapy adherence. In Rwanda, approximately 130,000 women are living with HIV, representing a prevalence rate (3.7%) which is substantially higher than Rwandan men (2.2%). Both the national Rwanda and City of Kigali HIV and AIDS strategic plans identify stigma as a key concern for reducing the burden of HIV.
The first objective of this study was to understand the sources of HIV-related stigma among women living with HIV in Rwanda. The second objective was to understand the cultural, linguistic, and contextual context of HIV-related stigma and the intersection of HIV-related stigma to the HIV care continuum (engagement in care, medication/treatment adherence) among women with HIV in Rwanda.
This study used a cross-sectional, qualitative design.
Three-three women from urban and rural settings in Rwanda were recruited from public HIV treatment and care centers to participate in this study.
Focus groups discussions, guided by a structured interview guide, were used to collect qualitative data. Framework analysis was used to analyze the data, which was collected during July 2018.
The participants in this study highlighted that Rwandan women with HIV experience all forms of stigma - enacted, anticipated, perceived, and internalized - associated with HIV as well as structural stigma. Further, three major themes - dehumanizing language, importance of motherhood in the context of HIV, and overcoming HIV stigma - emerged from the data.
The results of this study are among the few to give voice and perspective to the stigma experiences of Rwandan women with HIV. The women with HIV participating in this study shed light on the pervasive and culturally constructed effects of stigma that continue to exist. Further, the findings from this study highlighted the significant intersection of the role dehumanizing language experienced by Rwandan women with HIV. Additionally, the intersectional identities of being a woman with HIV and a mother and their relationship to societal and cultural norms and expectations must be considered concurrently. Finally, the beneficial effects of support groups was identified as key in helping Rwandan women with HIV to accept self.
污名是造成健康不平等的一个潜在原因，也是艾滋病毒预防、护理和治疗的主要障碍。艾滋病毒污名的经历已被证明会降低艾滋病毒感染者在整个艾滋病毒护理连续体中的参与度，从检测和诊断到长期护理和抗逆转录病毒治疗的依从性。在卢旺达，约有 13 万名妇女携带艾滋病毒，这一流行率（3.7%）明显高于卢旺达男性（2.2%）。卢旺达国家和基加利市艾滋病毒和艾滋病战略计划都将污名视为减少艾滋病毒负担的一个关键问题。
本研究的第一个目标是了解卢旺达感染艾滋病毒的妇女所经历的与艾滋病毒相关的污名的来源。第二个目标是了解与艾滋病毒相关的污名的文化、语言和背景以及艾滋病毒相关污名与卢旺达艾滋病毒感染者的艾滋病毒护理连续体（参与护理、药物/治疗依从性）的交叉点。
本研究采用了横断面、定性设计。
从卢旺达城市和农村的公共艾滋病毒治疗和护理中心招募了 33 名妇女参加这项研究。
采用焦点小组讨论，以结构化访谈指南为指导，收集定性数据。在 2018 年 7 月期间收集数据后，使用框架分析对数据进行了分析。
本研究的参与者强调，卢旺达感染艾滋病毒的妇女经历了所有形式的污名——实施污名、预期污名、感知污名和内化污名——以及结构性污名。此外，从数据中还出现了三个主要主题——贬低性语言、艾滋病毒背景下母亲的重要性以及克服艾滋病毒污名。
本研究的结果是少数几篇赋予卢旺达感染艾滋病毒的妇女的污名经历发言权和观点的研究之一。参与这项研究的艾滋病毒妇女揭示了污名持续存在的普遍的和文化构建的影响。此外，这项研究的结果强调了卢旺达感染艾滋病毒的妇女所经历的贬低性语言的显著交叉点。此外，必须同时考虑到妇女作为艾滋病毒感染者和母亲的交叉身份以及她们与社会和文化规范和期望的关系。最后，确定支持小组的有益影响是帮助卢旺达感染艾滋病毒的妇女接受自我的关键。
