University of North Carolina Project-China, Guangzhou, Guangdong, China.
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
Curr Opin HIV AIDS. 2023 Jan 1;18(1):18-26. doi: 10.1097/COH.0000000000000769. Epub 2022 Nov 29.
Understanding stigma is important for improving HIV care services and gaps in HIV service delivery have been attributed to stigma. This review article synthesizes recent evidence on stigma and its implications for HIV service design and delivery. Given the intersectional nature of stigma, we will focus on HIV stigma as well as related forms of stigma based on one's race, sexual identity, gender identity and other identities.
Stigma remains a barrier to achieving equity in HIV services. Individualistic measures of stigma remain influential and are associated with barriers to accessing HIV health services. Recent work also highlights stigma measured at a structural level and its impact on HIV services contexts. Individuals situated at intersections of marginalized identities continue to face greatest injustices, and although intersectional approaches have been adapted to design services at a micro level, few focus on structural change. Recent evidence for mitigating stigma indicates some success for psychosocial interventions that target internalized stigma. Furthermore, community-led approaches show promise in addressing stigma that manifests in HIV health services settings.
Interventions that address individual-level stigma and structural stigma are needed. Theoretical and applied antistigma research is needed to make HIV services more equitable.
了解污名对于改善艾滋病护理服务很重要，艾滋病服务提供方面的差距被归因于污名。本文综述了最近关于污名及其对艾滋病服务设计和提供影响的证据。鉴于污名的交叉性质，我们将重点关注艾滋病污名以及基于种族、性身份、性别认同和其他身份的相关污名形式。
污名仍然是实现艾滋病服务公平的障碍。污名的个人主义衡量标准仍然具有影响力，并与获得艾滋病健康服务的障碍有关。最近的工作还强调了在结构层面上衡量污名及其对艾滋病服务环境的影响。处于边缘化身份交叉点的个人继续面临最大的不公正，尽管交叉方法已被改编用于微观层面的服务设计，但很少关注结构性变革。减轻污名的最新证据表明，针对内在污名的心理社会干预措施取得了一些成功。此外，以社区为导向的方法在解决艾滋病健康服务环境中表现出的污名方面显示出了希望。
需要采取干预措施来解决个人层面的污名和结构性污名。需要进行理论和应用抗污名研究，以使艾滋病服务更加公平。
