School of Public Health, The University of Queensland, Brisbane, Australia.
College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
BMC Public Health. 2024 Jul 8;24(1):1815. doi: 10.1186/s12889-024-19329-5.
BACKGROUND: Equitable service provision and coverage are important responses to end the threat of the HIV/AIDS pandemic. Understanding inequity supports policies and programmes to deliver tailored interventions. There is continuous evidence generation on inequity in HIV/AIDS services. However, there was a lack of evidence on the global picture of inequity in behavioural and biomedical services related to HIV/AIDS. This systematic review assessed inequities in knowledge, attitude, HIV testing, and ART coverage across individual-level social groups and multiple (dis)advantage categories. METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, with a PROSPERO registration number CRD42024521247. The risk of bias was assessed by using Hoy et al's and Joanna Brigg's quality appraisal checklists for cross-sectional quantitative and qualitative studies, respectively. The search date was from inception to the final database search date (May 29, 2023). The included articles were either quantitative or qualitative studies. We used mixed-methods approach to analyse the data from the review articles. Quantitative descriptive analysis was conducted to estimate frequency of articles published from different countries around the world. Qualitative content analysis of the findings from the original studies was conducted using the PROGRESS plus framework which stands for: place of residence, occupation or employment status, gender, religion, education status, socioeconomic status, and social capital. RESULTS: Out of 6,029 articles that were accessed and screened, only 72 articles met the inclusion criteria. More articles on HIV-related equity in knowledge, attitude, testing, and ART were published in developed countries than in developing countries. Individuals from higher-income households had better knowledge about HIV/AIDS. Unfavourable attitudes towards people living with HIV and HIV/AIDS-associated stigma were common among women. HIV/AIDS service coverage (HIV testing or ART coverage) was higher among richer and urban residents. HIV/AIDS-associated stigma and lower levels of knowledge about HIV/AIDS were observed among multiple disadvantageous groups due to the intersection of two or more identities. CONCLUSIONS: The current review revealed that there have been disparities in HIV/AIDS services between social classes. Ending service disparity towards the global threat of HIV/AIDS demands tailored interventions based on socially disadvantaged groups (e.g., poor, rural dwellers, and women) and intersectional determinants. There is a need to understand the deep-rooted causes of inequity and the challenges that an equity-oriented system faces over time. More studies on inequity are needed, including intersectional inequity, which has been rarely studied in developing countries.
背景:公平提供服务和覆盖范围是应对艾滋病大流行威胁的重要措施。了解不平等现象有助于制定政策和方案,提供有针对性的干预措施。有关艾滋病服务不平等的证据不断涌现。然而,关于与艾滋病相关的行为和生物医学服务的全球不平等情况,尚缺乏证据。本系统评价评估了个体社会群体和多个(不利)类别中与艾滋病相关的知识、态度、HIV 检测和 ART 覆盖率方面的不平等现象。
方法:本研究遵循系统评价和荟萃分析的首选报告项目 (PRISMA) 指南,并在 PROSPERO 注册了编号 CRD42024521247。使用 Hoy 等人和 Joanna Brigg 的质量评估清单分别评估横断面定量和定性研究的偏倚风险。检索日期为从创建到最终数据库检索日期(2023 年 5 月 29 日)。纳入的文章为定量或定性研究。我们使用混合方法分析综述文章的数据。对来自世界各地不同国家的文章发表频率进行定量描述性分析。使用 PROGRESS plus 框架(代表居住地、职业或就业状况、性别、宗教、教育程度、社会经济地位和社会资本)对原始研究结果进行定性内容分析。
结果:在检索和筛选的 6029 篇文章中,只有 72 篇符合纳入标准。有关艾滋病相关公平知识、态度、检测和 ART 的文章在发达国家发表的数量多于发展中国家。来自高收入家庭的个体对艾滋病/艾滋病的了解更好。对艾滋病毒感染者和艾滋病毒相关耻辱的不利态度在女性中很常见。在较富裕和城市居民中,艾滋病毒/艾滋病服务覆盖率(HIV 检测或 ART 覆盖率)更高。由于两个或多个身份的交叉,多个弱势群体(如贫困、农村居民和妇女)由于艾滋病毒/艾滋病相关耻辱和对艾滋病毒/艾滋病知识水平较低,观察到艾滋病毒/艾滋病服务不平等。
结论:本综述显示,艾滋病服务在社会阶层之间存在差异。要应对艾滋病这一全球性威胁,必须采取有针对性的干预措施,针对社会弱势群体(如贫困人口、农村居民和妇女)和交叉决定因素。需要了解不平等现象的深层次原因以及随着时间的推移,面向公平的系统所面临的挑战。需要进行更多有关不平等现象的研究,包括在发展中国家很少研究的交叉不平等现象。
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