School of Nursing, Tung Wah College, Hong Kong, China.
Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China.
BMC Public Health. 2024 Jun 6;24(1):1517. doi: 10.1186/s12889-024-18974-0.
While global efforts are increasingly relying upon biomedical advancements such as antiretroviral therapy and pre-exposure prophylaxis (PrEP) to end the HIV epidemic, HIV-related stigma remains a concern. This study aimed to assess the general public's awareness and perception of "Undetectable = Untransmittable" (U = U) and PrEP, and the patterns of public stigma towards people living with HIV (PLWH) and their determinants in an Asian Pacific city.
A population-based, self-administrated online survey was conducted between 10-20 March 2023. All adults aged ≥ 18 years and currently living in Hong Kong were eligible. Participants' socio-demographic characteristics, awareness and perception of U = U and PrEP, as well as HIV-related stigma drivers, experience and practices were collected. Latent class analysis was used to delineate population subgroups based on their stigma profiles as reflected by 1.) fear of infection, 2.) concern about socioeconomic ramification of the disease, 3.) social norm enforcement, 4.) perceived stigma in the community, and 5.) stigmatising behaviours and discriminatory attitudes. Memberships of identified subgroups were then correlated with sociodemographic factors, awareness and perception of U = U and PrEP, using multinominal logistic regression.
Responses from a total of 3070 participants (55% male; 79% aged 18-54) were analysed. A majority, 69% and 81%, indicated that they had never heard of U = U and PrEP respectively, and only 39-40% of participants perceived these to be effective in protection from HIV. Four distinct subgroups were identified, namely "Low stigma" (37%), "Modest stigma" (24%), "Moderate stigma" (24%), and "High stigma" (15%). Compared with "Low stigma", lack of awareness of and/or negative perceptions towards U = U and/or PrEP, not knowing any PLWH were associated with increased odds of higher stigma group membership. Lower educational level and not in employment were associated with increased odds of membership in "Moderate stigma" and "High stigma". While older people were more likely to belong to "High stigma", female were more likely to belong to "Moderate stigma". "Modest stigma" included more younger people who were economically active.
Two-thirds of participants endorsed modest-to-high HIV-related stigma, suggesting the prevalence of HIV-related stigma was high among the general population in Hong Kong. Tailored interventions targeting specific stigma drivers and manifestations of individuals as reflected from the stigma profiles of distinct subgroups could form an important strategy for stigma reduction.
虽然全球的努力越来越依赖于抗逆转录病毒疗法和暴露前预防（PrEP）等生物医学进展来终结艾滋病毒流行，但与艾滋病毒相关的耻辱感仍然是一个问题。本研究旨在评估亚太地区一个城市的普通公众对“检测不到=不传播”（U=U）和 PrEP 的认识和看法，以及公众对艾滋病毒感染者（PLWH）的污名化模式及其决定因素。
这是一项于 2023 年 3 月 10 日至 20 日进行的基于人群的、自我管理的在线调查。所有年龄在 18 岁及以上、目前居住在香港的成年人都有资格参加。收集了参与者的社会人口特征、对 U=U 和 PrEP 的认识和看法，以及艾滋病毒相关耻辱感驱动因素、经历和做法。采用潜在类别分析根据他们在社区中的污名化特征（1）感染恐惧、（2）对疾病的社会经济影响的关注、（3）社会规范执行、（4）感知到的社区污名化以及（5）污名化行为和歧视态度，将人群分为不同的亚组。然后使用多项逻辑回归将确定的亚组的成员资格与社会人口因素、对 U=U 和 PrEP 的认识和看法相关联。
共分析了 3070 名参与者的回复（55%为男性；79%年龄在 18-54 岁）。大多数参与者（69%）从未听说过 U=U，81%的参与者从未听说过 PrEP，只有 39-40%的参与者认为这些措施能有效预防艾滋病毒。确定了四个不同的亚组，即“低污名”（37%）、“适度污名”（24%）、“中度污名”（24%）和“高污名”（15%）。与“低污名”相比，缺乏对 U=U 和/或 PrEP 的认识和/或负面看法，不认识任何 PLWH，与更高的污名化亚组成员资格相关。教育程度较低和无业与“中度污名”和“高污名”亚组成员资格的增加相关。年龄较大的人更有可能属于“高污名”组，而女性更有可能属于“中度污名”组。“适度污名”包括更多的年轻、经济活跃的人。
三分之二的参与者对艾滋病毒相关耻辱感表示适度至高度，这表明香港普通人群中艾滋病毒相关耻辱感的流行率很高。针对特定耻辱感驱动因素和特定亚组耻辱感特征反映的表现的有针对性的干预措施，可能成为减少耻辱感的重要策略。
