Institute on Inequalities in Global Health, University of Southern California.
Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA.
AIDS. 2023 Nov 1;37(13):1919-1939. doi: 10.1097/QAD.0000000000003628. Epub 2023 Jun 19.
A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been tried. Using a PICOTS framework and applying the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, we undertook a systematic review to determine the success of interventions aiming to address internalized stigma, stigma and discrimination in healthcare, and at the legal or policy level, and to identify their critical success factors. Random effects meta-analyses summarized results wherever possible. We carried out a component analysis to identify and characterize successful interventions. Internalized stigma interventions were diverse: across all studies, we found a reduction of stigma but it was not statistically significant [standardized mean difference (SMD) 0.56; confidence interval (CI) 0.31-1.02; 17 studies). For interventions to address stigma and discrimination in healthcare settings, effect estimates varied considerably but most studies showed positive effects (SMD 0.71; CI 0.60-0.84, 8 studies). Boosted regression analyses found that a combined approach comprising education, counseling, community participation, support person, and access to a HIV specialist often yielded success. Studies of efforts to address stigma and discrimination through law and policy documented, mostly qualitatively, the effect of court cases and directives. Across a range of settings and populations, promising interventions have been identified that, through diverse pathways, have positively impacted the types of stigma and discrimination studied. This evidence base must be built upon and brought to scale to help reach global HIV-related targets and, most importantly, improve the health and quality of life of people with HIV.
全球消除与艾滋病毒相关的耻辱和歧视的决心非常坚定,并且已经尝试了多种策略来减少或消除耻辱和歧视。我们采用 PICOTS 框架并应用 Grading of Recommendations, Assessment, Development, and Evaluation(GRADE)标准,进行了系统评价,以确定旨在解决内化耻辱感、医疗保健中的耻辱和歧视以及法律或政策层面的干预措施的成功程度,并确定其关键成功因素。只要有可能,我们就进行了随机效应荟萃分析以总结结果。我们进行了成分分析以确定和描述成功的干预措施。内化耻辱感的干预措施多种多样:在所有研究中,我们发现耻辱感有所减轻,但没有统计学意义[标准化均数差(SMD)0.56;置信区间(CI)0.31-1.02;17 项研究]。针对医疗保健环境中耻辱和歧视问题的干预措施,效果估计差异很大,但大多数研究显示出积极的效果[SMD 0.71;CI 0.60-0.84,8 项研究]。提升回归分析发现,一种包含教育、咨询、社区参与、支持人员和获得艾滋病毒专家的综合方法通常会取得成功。通过法律和政策解决耻辱和歧视问题的研究主要以定性方式记录了法庭案件和指令的效果。在各种环境和人群中,已经确定了一些有前途的干预措施,这些措施通过多种途径,对所研究的耻辱和歧视类型产生了积极影响。必须在此基础上进一步建立和推广这一证据基础,以帮助实现全球与艾滋病毒相关的目标,最重要的是,改善艾滋病毒感染者的健康和生活质量。
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