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不让任何人掉队?通过关注多样性来解决艾滋病毒不平等问题:一项探索津巴布韦感染艾滋病毒的 LGBTQI+ 年轻人需求的定性研究。

Leaving no one behind? Addressing inequitable HIV outcomes by attending to diversity: A qualitative study exploring the needs of LGBTQI+ young people living with HIV in Zimbabwe.

作者信息

Lariat Joni, Mavhu Webster, Mudhumo Thandiwe, Shaba Pueshpa, Sibanda Sharon, Mbundure Rufaro, Wogrin Carol, Mutsinze Abigail, Willis Nicola, Bernays Sarah

机构信息

School of Public Health, University of Sydney, Sydney, Australia.

Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe.

出版信息

PLOS Glob Public Health. 2024 Jan 25;4(1):e0002442. doi: 10.1371/journal.pgph.0002442. eCollection 2024.

Abstract

Leaving nobody behind in the fight to end the HIV epidemic as a public health threat depends on addressing inequities in optimal HIV outcomes. Consistently overlooked in research, policy and programming are young lesbian, gay, bisexual, transgender, queer/questioning and intersex (LGBTQI+) people who are living with HIV. This study engaged young LGBTQI+ people in Zimbabwe to better understand their experiences of living with HIV and the support they need. Between September 2022 and February 2023, we conducted qualitative research with 14 LGBTQI+ young people (18-24 years), (two focus group discussions and in-depth interviews with 5/14). All 14 participants were accessing a LGBTQI+ HIV support group at Zvandiri ('As I Am'), a well-established community-based HIV program. We conducted thematic analysis and key findings informed the collaborative development of internal activities to further enhance inclusivity of LGBTQI+ young people within Zvandiri's programs. There was consensus among participants that being LGBTQI+ and living with HIV leads to "double stigma and double trouble", involving physical and verbal harassment, social exclusion and family rejection. Participants concealed their LGBTQI+ identity and HIV status in most situations, and many withheld their HIV status in LGBTQI+ social spaces, including community-led LGBTQI+ services. This negatively impacted their psychosocial well-being and social connectedness. Participants described positive experiences of Zvandiri. Interacting with others living with HIV in a destigmatising environment promoted self-acceptance. However, reflecting their prevailing experiences, participants were cautious about revealing their sexuality and/or gender identity at Zvandiri outside of their support group. Ensuring equitable access to HIV care, including mental health support, relies on understanding the challenges experienced by those most marginalised. Critically important is understanding the impact of intersectional stigma on LGBTQI+ young peoples' social lives, and their access to services. Community-based HIV support programs are well-positioned to support and advance this group's health rights.

摘要

在消除作为公共卫生威胁的艾滋病毒流行的斗争中不让任何人掉队,这取决于解决在实现最佳艾滋病毒防治成果方面存在的不平等问题。感染艾滋病毒的年轻女同性恋、男同性恋、双性恋、跨性别、酷儿/疑问和双性人(LGBTQI+)群体在研究、政策和项目规划中一直被忽视。本研究让津巴布韦的年轻LGBTQI+群体参与进来,以更好地了解他们感染艾滋病毒后的经历以及他们所需的支持。在2022年9月至2023年2月期间,我们对14名LGBTQI+年轻人(18至24岁)进行了定性研究(两次焦点小组讨论以及对14人中的5人进行深入访谈)。所有14名参与者都加入了位于Zvandiri(“真我”)的一个LGBTQI+艾滋病毒支持小组,Zvandiri是一个成熟的基于社区的艾滋病毒项目。我们进行了主题分析,关键发现为内部活动的协同开展提供了参考,以进一步提高Zvandiri项目中LGBTQI+年轻人的包容性。参与者们一致认为,身为LGBTQI+且感染艾滋病毒会导致“双重耻辱和双重麻烦”,包括身体和言语上的骚扰、社会排斥以及家庭抛弃。参与者在大多数情况下都隐瞒自己的LGBTQI+身份和艾滋病毒感染状况,许多人在LGBTQI+社交场合,包括社区主导的LGBTQI+服务中隐瞒自己的艾滋病毒感染状况。这对他们的心理社会福祉和社会联系产生了负面影响。参与者描述了在Zvandiri的积极经历。在一个消除耻辱的环境中与其他艾滋病毒感染者互动促进了自我接纳。然而,反映他们普遍的经历,参与者在Zvandiri的支持小组之外对透露自己的性取向和/或性别认同持谨慎态度。确保公平获得艾滋病毒护理,包括心理健康支持,依赖于了解最边缘化人群所面临的挑战。至关重要的是要了解交叉耻辱对LGBTQI+年轻人社会生活及其获得服务的影响。基于社区的艾滋病毒支持项目有能力支持并推进该群体的健康权利。

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