Xie Yufan, Gao Shuang, Wang Qian, Cai Min, Feng Shuaixin, Huang Zhaoqian, Huang Ying, Hong Yeting, Tan Xiaoxia, Li Jinbin, Yuan Li, Liu Fenghua, Jiang Hongbo
Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Haizhu District, No. 283 Jianghai Road, Guangzhou, 510310, China.
Guangdong Women and Children Hospital, Guangzhou, 511400, China.
Arch Public Health. 2024 Sep 18;82(1):160. doi: 10.1186/s13690-024-01382-6.
HIV-related stigma continues to hinder optimal HIV care, and its determinants should be understood at multiple levels. Based on the social-ecological model, this study aimed to explore factors associated with HIV-related stigma among women living with HIV in Guangdong Province, China.
A cross-sectional study was conducted from July to August 2022 to recruit newly reported women living with HIV with a history of pregnancy or current pregnancy in 2021 in 21 cities in Guangdong Province. HIV-related stigma was assessed using an abbreviated Chinese version of Berger's HIV Stigma Scale. Univariate and multivariable hierarchical regression analyses based on the social-ecological model were conducted to explore factors associated with HIV-related stigma and its four dimensions (personalized stigma, disclosure concerns, negative self-image and concerns about public attitudes) at the community/hospital, interpersonal, and individual levels.
A moderate level of HIV-related stigma was found among the 360 participants included, with a mean score of 45.26. Multivariable hierarchical regression analysis showed that at the community/hospital-level, individuals were more likely to experience high levels of HIV-related stigma if they had experienced the discriminatory behaviors from health care workers (aOR = 2.34, 95%CI: 1.48-3.70) and if they rated serostatus disclosure services as less helpful (aOR = 0.69, 95%CI: 0.48-0.98). At the interpersonal-level, individuals with an HIV-positive partner (aOR = 1.71, 95%CI: 1.01-2.90) were more likely to experience high levels of HIV-related stigma than those with an HIV-negative or unknown partner. Individuals with high resilience (aOR = 0.22, 95%CI: 0.13-0.35) had lower levels of HIV-related stigma at the individual-level. In addition, ever experiencing discriminatory behaviors from health care workers, thinking serostatus disclosure services helpful, having ever seen publicity about personal interest protection services and complaint channels for people living with HIV(PLHIV), knowing about care and support services for PLHIV from social organizations at the community/hospital-level, partner notification and support at the interpersonal-level, and violations of personal interests, resilience at the individual-level were also associated with different dimensions of HIV-related stigma.
HIV-related stigma was moderate among women living with HIV. The social-ecological model can facilitate a better understanding of factors associated with HIV-related stigma. Multilevel intervention strategies need to be tailored to reduce HIV-related stigma.
与艾滋病病毒相关的耻辱感继续阻碍着最佳的艾滋病病毒治疗，其决定因素应在多个层面上加以理解。基于社会生态模型，本研究旨在探讨中国广东省感染艾滋病病毒的女性中与艾滋病病毒相关耻辱感的影响因素。
于2022年7月至8月进行了一项横断面研究，招募2021年在广东省21个城市新报告的有妊娠史或当前正在怀孕的感染艾滋病病毒的女性。使用Berger艾滋病病毒耻辱感量表的简化中文版评估与艾滋病病毒相关的耻辱感。基于社会生态模型进行单变量和多变量分层回归分析，以探讨在社区/医院、人际和个体层面上与艾滋病病毒相关耻辱感及其四个维度（个性化耻辱感、披露担忧、负面自我形象和对公众态度的担忧）相关的因素。
在纳入的360名参与者中发现了中等程度的与艾滋病病毒相关的耻辱感，平均得分为45.26。多变量分层回归分析表明，在社区/医院层面，如果个体经历过医护人员的歧视行为（调整后比值比[aOR]=2.34，95%置信区间[CI]：1.48-3.70），以及如果他们认为血清学状态披露服务帮助不大（aOR=0.69，95%CI：0.48-0.98），则更有可能经历高水平的与艾滋病病毒相关的耻辱感。在人际层面，与艾滋病病毒阴性或情况不明的伴侣相比，有艾滋病病毒阳性伴侣的个体（aOR=1.71，95%CI：1.01-2.90）更有可能经历高水平的与艾滋病病毒相关的耻辱感。在个体层面，心理弹性高的个体（aOR=0.22，95%CI：0.13-0.35）与艾滋病病毒相关的耻辱感水平较低。此外，在社区/医院层面，曾经经历过医护人员的歧视行为、认为血清学状态披露服务有帮助、曾经看到过关于艾滋病病毒感染者个人利益保护服务和投诉渠道的宣传、了解社区社会组织为艾滋病病毒感染者提供的护理和支持服务，在人际层面的伴侣通知和支持，以及在个体层面的个人利益受到侵犯、心理弹性，也与艾滋病病毒相关耻辱感的不同维度相关。
感染艾滋病病毒的女性中与艾滋病病毒相关的耻辱感处于中等水平。社会生态模型有助于更好地理解与艾滋病病毒相关耻辱感的影响因素。需要制定多层次的干预策略以减少与艾滋病病毒相关的耻辱感。
