Sineke Tembeka, Onoya Dorina, Mokhele Idah, Cele Refiloe, Sharma Shubhi, Sigasa Patience, Dukashe Mandisa, Hansrod Laila, Inglis Robert, King Rachel, Bor Jacob
Faculty of Health Sciences, Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
PLOS Glob Public Health. 2023 Oct 13;3(10):e0000829. doi: 10.1371/journal.pgph.0000829. eCollection 2023.
South Africa rolled out Universal Test-and-Treat (UTT) in 2016, extending treatment eligibility to all persons living with HIV (PLHIV). We sought to understand how PLHIV in Johannesburg, South Africa, interpret and experience their HIV status, five years into the UTT era. In May 2021, we conducted in-depth interviews (IDI) (N = 27) with adult (≥18 years) PLHIV referred by HIV counsellors at three peri-urban primary healthcare clinics. We also conducted three focus group discussions (FGDs) (N = 27) with adult PLHIV recruited from clinics or from civil society organisations through snowball sampling. Follow-up interviews were conducted with 29 IDI and FGD participants. Participants were asked to reflect on their HIV diagnosis, what their HIV status meant to them and how, if at all, being HIV-positive affected their lives. Interviews and focus group discussions were audio-recorded, transcribed, translated to English, and analysed using a grounded theory approach. Participants perceived that HIV was common, that PLHIV could live a normal life with antiretroviral therapy (ART), and that ART was widely accessible. However, HIV elicited feelings of guilt and shame as a sexually transmitted disease. Participants used the language of "blame" in discussing HIV transmission, citing their own reckless behaviour or blaming their partner for infecting them. Participants feared transmitting HIV to others and felt responsible for avoiding transmission. To manage transmission anxiety, participants avoided sexual relationships, chose HIV-positive partners, and/or insisted on using condoms. Many participants feared-or had previously experienced-rejection by partners due to their HIV status and reported hiding their medication, avoiding disclosure, or avoiding relationships altogether. Most participants were not aware that undetectable HIV is untransmittable (U = U). Participants who were aware of U = U expressed less anxiety about transmitting HIV to others and greater confidence in having relationships. Despite perceiving HIV as a manageable chronic condition, PLHIV still faced transmission anxiety and fears of rejection by their partners. Disseminating information on U = U could reduce the psychosocial burdens of living with HIV, encourage open communication with partners, and remove barriers to HIV testing and treatment adherence.
南非于2016年推出了普遍检测与治疗（UTT）项目，将治疗资格扩大到所有艾滋病毒感染者（PLHIV）。我们试图了解在普遍检测与治疗时代进入五年之际，南非约翰内斯堡的艾滋病毒感染者如何理解和体验他们的艾滋病毒感染状况。2021年5月，我们对来自三个城郊初级保健诊所、由艾滋病毒咨询师转介的成年（≥18岁）艾滋病毒感染者进行了深入访谈（IDI）（N = 27）。我们还通过滚雪球抽样法，对从诊所或民间社会组织招募的成年艾滋病毒感染者进行了三次焦点小组讨论（FGD）（N = 27）。对29名参与深入访谈和焦点小组讨论的人员进行了随访访谈。参与者被要求反思他们的艾滋病毒诊断情况、他们的艾滋病毒感染状况对他们意味着什么，以及艾滋病毒呈阳性在何种程度上（如果有影响的话）影响了他们的生活。访谈和焦点小组讨论进行了录音、转录、翻译成英文，并采用扎根理论方法进行分析。参与者认为艾滋病毒很常见，艾滋病毒感染者通过抗逆转录病毒疗法（ART）可以过上正常生活，而且抗逆转录病毒疗法广泛可得。然而，艾滋病毒作为一种性传播疾病引发了内疚和羞耻感。参与者在讨论艾滋病毒传播时使用了“责备”的措辞，列举自己的鲁莽行为或指责伴侣感染了他们。参与者担心将艾滋病毒传染给他人，并觉得有责任避免传播。为了应对传播焦虑，参与者避免发生性关系、选择艾滋病毒呈阳性的伴侣和/或坚持使用避孕套。许多参与者担心——或者以前经历过——由于他们的艾滋病毒感染状况而被伴侣拒绝，并报告说他们会隐藏药物、避免透露病情或完全避免建立关系。大多数参与者不知道艾滋病毒检测不到就不具有传染性（U=U）。了解到U=U的参与者对将艾滋病毒传染给他人的焦虑较少，对建立关系更有信心。尽管将艾滋病毒视为一种可控制的慢性病，但艾滋病毒感染者仍然面临传播焦虑和对被伴侣拒绝的恐惧。传播关于U=U的信息可以减轻艾滋病毒感染者的心理社会负担，鼓励与伴侣坦诚交流，并消除艾滋病毒检测和治疗依从性的障碍。
