Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery, 4Th Floor, Columbia, SC, 29208, USA.
Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
AIDS Behav. 2024 Nov;28(11):3758-3767. doi: 10.1007/s10461-024-04445-5. Epub 2024 Aug 2.
Experiencing adverse childhood experiences (ACEs) may impact personal opinions, attitudes, and judgments, which can further result in HIV-related stigma. HIV-related stigma consequentially may impact HIV preventive measures such as HIV testing, pre-exposure prophylaxis uptake, and condom use. The extent to which ACEs influence HIV-related stigma perception has not been well studied. Therefore, the study aimed to examine the association between ACEs and perceived and interpersonal HIV-related stigma among Tanzanian HIV-negative men. Quantitative survey data were obtained from the Tanzania STEP (Self-Testing Education and Promotion) project established in four wards: Mabibo, Manzese, Tandale, and Mwanyanamala. A total of 507 men responded to the ACEs and HIV-related stigma questionnaires. ACEs were operationalized as types of ACEs (environmental, physical/psychological, sexual abuse) and ACE score (0 (reference) vs. 1, 2, 3, ≥ 4). Perceived HIV-related stigma was analyzed both as a binary (HIV stigma vs. no HIV stigma) and a continuous variable. Unadjusted and adjusted multinomial logistic and linear regression models were used to assess the associations between ACEs and HIV-related stigma. ACE types were associated with HIV stigma (b = 0.237, 95% CI [0.122-0.352], p = < .0001). Findings of the adjusted multinomial logistic regression model show that experiencing one ACE (aOR = 1.9; p-value = 0.023), two ACEs (aOR = 1.8; p-value = 0.044), four or more ACEs (aOR = 4.1; p-value = < 0.0001) were associated with greater perceived HIV-related stigma. Moreover, experiencing environmental (aOR = 8.6; p-value = 0.005), physical/psychological (aOR = 2.5; p-value = 0.004), and sexual abuse (aOR = 3.4; p-value = < 0.0001) were associated with higher odds of HIV-related stigma. Our study findings suggest that those who experience childhood trauma are more likely to have a higher perception of HIV-related stigma. Intervention programs targeting HIV stigma should consider addressing ACEs entailing the behavioral and psychological impact of childhood trauma.
经历不良的童年经历（ACEs）可能会影响个人的意见、态度和判断，进而导致与 HIV 相关的污名化。与 HIV 相关的污名继而可能会影响 HIV 预防措施，如 HIV 检测、暴露前预防的接受和使用避孕套。 ACEs 对与 HIV 相关的污名感知的影响程度尚未得到充分研究。因此，本研究旨在检验坦桑尼亚 HIV 阴性男性中 ACEs 与感知和人际间与 HIV 相关的污名之间的关联。定量调查数据来自于在四个病房（Mabibo、Manzese、Tandale 和 Mwanyanamala）建立的坦桑尼亚 STEP（自我检测教育和促进）项目。共有 507 名男性对 ACEs 和与 HIV 相关的污名问卷做出了回应。 ACEs 被操作化为 ACE 类型（环境、身体/心理、性虐待）和 ACE 评分（0（参考）与 1、2、3、≥4）。感知的与 HIV 相关的污名被分析为二进制（HIV 污名与无 HIV 污名）和连续变量。使用未调整和调整的多项逻辑回归和线性回归模型来评估 ACEs 与与 HIV 相关的污名之间的关联。 ACE 类型与 HIV 污名相关（b=0.237，95%CI [0.122-0.352]，p<0.0001）。调整后的多项逻辑回归模型的结果表明，经历一种 ACE（aOR=1.9；p 值=0.023）、两种 ACE（aOR=1.8；p 值=0.044）、四种或更多 ACE（aOR=4.1；p 值= <0.0001）与更大的感知与 HIV 相关的污名有关。此外，经历环境（aOR=8.6；p 值=0.005）、身体/心理（aOR=2.5；p 值=0.004）和性虐待（aOR=3.4；p 值= <0.0001）与更高的与 HIV 相关的污名的可能性相关。我们的研究结果表明，那些经历过童年创伤的人更有可能对与 HIV 相关的污名有更高的认知。针对与 HIV 相关的污名的干预计划应考虑解决 ACEs，包括童年创伤的行为和心理影响。
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