Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America.
Department of Health, Society and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, United States of America.
PLoS One. 2023 Aug 24;18(8):e0290228. doi: 10.1371/journal.pone.0290228. eCollection 2023.
HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men's experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women's experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to "move on" and "look ahead." Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.
HIV 相关污名可能会影响应对能力和社会支持，从而影响健康。污名体验和社会支持方面的性别差异尚未得到充分探索，尤其是在加勒比地区。我们在多米尼加共和国的两家 HIV 诊所对 32 名患者进行了半结构化访谈。使用定性内容分析（演绎和归纳方法）对访谈记录进行编码，以确定有关污名体验和社会支持的主题，然后在男性和女性参与者之间进行比较，以确定性别差异。虽然男性和女性都描述了经历过污名化，包括言语虐待，但男性的污名化体验更为微妙，而女性则描述了直接拒绝和身体暴力的情况，包括亲密伴侣暴力。男性和女性都描述了工作歧视，但女性描述了严重的无力感，以及收入和/或就业的永久性丧失，而男性则描述了就业的暂时变化和/或收入减少。男性和女性都描述了由于预期的污名而改变行为，但只有女性讨论了孤立自己和在他人面前服用 HIV 药物时的不适。关于内化污名，男性和女性都描述了对 HIV 状况感到羞耻、内疚和抑郁，但这些经历在女性中更为常见。女性的经历阻碍了她们寻求医疗保健，包括自杀倾向，而男性有时会将 HIV 归咎于女性，并表示希望“向前看”和“向前看”。男性和女性都描述了从家人和朋友那里获得经济支持，从邻居那里获得社区支持，从政府那里获得支持，以及从其他 HIV 感染者那里获得支持。女性最常讨论从家人和朋友那里获得支持，并利用宗教信仰来应对，而男性则提到一般的家庭支持和政府福利，对个人关系和社交网络不太愿意提及，通常不会向他人透露 HIV 状况。与 HIV 相关的污名的社会背景对女性和男性的影响不同，对身心健康都有影响，可能需要采取不同的缓解措施。
