Albert Einstein College of Medicine, Montefiore Health System Bronx, NY, USA.
Centre for Sexuality and Health Research and Policy (C-SHaRP), C-ShaRP, Chennai, India Chennai, India.
J Int Assoc Provid AIDS Care. 2023 Jan-Dec;22:23259582231199398. doi: 10.1177/23259582231199398.
In India and other low-and-middle-income countries, little is known about how intersectional stigma affects MSM engagement in ART. Informed by the Health Stigma and Discrimination Framework, we qualitatively examined how multiple stigmas influence ART engagement among Indian MSM. We conducted 3 focus groups (N = 22) with MSM living with HIV, aged 21-58 years, in Delhi and Hyderabad to identify potential intervention targets and solutions to improve treatment outcomes. Framework analysis and techniques were used to code and analyze translated audio-recordings. Findings revealed enacted stigma, associated with HIV and MSM identity, manifested as familial shame and healthcare discrimination, inhibiting access to support, and decreasing HIV care engagement. Anticipated stigma led to worry about disclosure and societal repercussions. Community-Based-Organizations, ART centers, and family members were primary sources of support, leading to increased ART initiation and retention. Potential solutions included using MSM peer-counselors, increasing social support, and providing HIV education to the general community.
在印度和其他中低收入国家，人们对交叉污名如何影响男男性接触者（MSM）参与抗逆转录病毒治疗（ART）知之甚少。本研究以健康污名和歧视框架为指导，定性研究了多种污名如何影响印度 MSM 参与 ART。我们在德里和海得拉巴对 21-58 岁的 HIV 感染者 MSM 进行了 3 次焦点小组（N=22），以确定潜在的干预目标和解决方案，以改善治疗结果。使用框架分析和技术对翻译后的音频记录进行编码和分析。研究结果显示，与 HIV 和 MSM 身份相关的实施污名表现为家庭羞耻感和医疗保健歧视，阻碍了获得支持的机会，并降低了 HIV 护理参与度。预期污名导致了对披露和社会后果的担忧。社区组织、ART 中心和家庭成员是主要的支持来源，这导致了更多的人开始接受 ART 治疗并坚持治疗。潜在的解决方案包括使用男男性接触者同伴辅导员、增加社会支持以及向普通社区提供 HIV 教育。
