Viisainen Kirsi, Baumgart Dos Santos Marion, Sunderbrink Ute, Couto Aleny
Department of Global Health and Social Medicine, King's College, London, United Kingdom.
Independent Consultant, Maputo, Mozambique.
PLOS Glob Public Health. 2024 Jul 15;4(7):e0003166. doi: 10.1371/journal.pgph.0003166. eCollection 2024.
Both gender and HIV stigma are known to contribute to poor retention to antiretroviral therapy (ART), but little is known how they interact in decisions about adherence or default by people living with HIV (PLWH). This qualitative study explored HIV stigma and gender interaction in PLWH's care decisions in Mozambique. Transcribed data from semi-structured interviews of 68 men and 71 women living with HIV, were coded and analyzed for themes of HIV stigma, gender norms and treatment continuation and interruption pathways, using both deductive and inductive coding approaches. Stigma experiences were found to be influenced by gender roles. Anticipation of stigma was common across the narratives of PLWH, while women had more experiences of enacted stigma, particularly by their intimate partners. Women's treatment interruptions were influenced by fear of partner's negative reaction. Men's narratives showed internalized stigma and delayed treatment due to anticipated stigma and masculine norm of strength. Severe internalized stigma was found among single mothers, who without economic or moral support defaulted treatment. Women's pathway to adherence was facilitated by their caregiver role and support from partner or kin family. Men's adherence was facilitated by experience of severe symptoms, provider role and by support from their mother or partner. Results indicate that linkage of stigma to gender roles interact in treatment decisions in three main ways. First, HIV stigma and unequal gender norms can work jointly as a barrier to adherence. Secondly, those resisting restrictive gender norms found it easier to manage HIV stigma for the benefit of treatment adherence. Thirdly, some gender norms also facilitated adherence and stigma management. Programs targeted at HIV stigma reduction and improving ART adherence among heterosexual populations should be built on an understanding of the local gender norms and include socially and culturally relevant gender sensitive and transformative activities.
已知性别和艾滋病毒污名化都会导致抗逆转录病毒疗法（ART）的留存率低，但对于它们在艾滋病毒感染者（PLWH）关于坚持治疗或停药的决策中如何相互作用，人们却知之甚少。这项定性研究探讨了莫桑比克艾滋病毒感染者在医疗决策中艾滋病毒污名化与性别的相互作用。对68名感染艾滋病毒的男性和71名感染艾滋病毒的女性进行半结构化访谈的转录数据，采用演绎和归纳编码方法，对艾滋病毒污名化、性别规范以及治疗持续和中断途径等主题进行编码和分析。研究发现，污名化经历受到性别角色的影响。在艾滋病毒感染者的叙述中，普遍存在对污名化的预期，而女性遭受实际污名化的经历更多，尤其是来自亲密伴侣的污名化。女性的治疗中断受到对伴侣负面反应的恐惧的影响。男性的叙述显示出内化污名，以及由于预期污名和男性力量规范而导致的治疗延迟。在单身母亲中发现了严重的内化污名，她们因缺乏经济或道德支持而停药。女性坚持治疗的途径得益于她们的照顾者角色以及伴侣或亲属家庭的支持。男性的坚持治疗则得益于严重症状的经历、提供者角色以及母亲或伴侣的支持。结果表明，污名化与性别角色的联系在治疗决策中主要通过三种方式相互作用。首先，艾滋病毒污名化和不平等的性别规范共同构成坚持治疗的障碍。其次，那些抵制限制性性别规范的人发现，为了坚持治疗，更容易应对艾滋病毒污名化。第三，一些性别规范也有助于坚持治疗和应对污名化。针对减少艾滋病毒污名化和提高异性恋人群抗逆转录病毒疗法依从性的项目，应该建立在对当地性别规范的理解基础上，并包括社会和文化相关的性别敏感及变革性活动。
