Bergman Alanna J, Relf Michael V, Mthinkhulu Nomusa, Ndlouvu Nkateko, Lowensen Kelly, Farley Jason E
University of Virginia, School of Nursing, Charlottesville, VA, USA.
Johns Hopkins University Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA.
AIDS Behav. 2025 Jul 16. doi: 10.1007/s10461-025-04803-x.
For people with HIV and tuberculosis (TB), stigma may change over time. Identifying time points when individuals are most likely to experience HIV or TB related stigma, or when stigma begins to abate, may be useful in tailoring stigma-reduction interventions in resource-limited settings. This study used longitudinal qualitative data to explore if and how HIV and TB stigma change over the course of treatment. People living with HIV and rifampicin-resistant TB were purposively recruited at a district TB hospital in KwaZulu-Natal, South Africa. Participants consented to in-depth interviews throughout TB treatment. The team used reflexive thematic analysis to develop latent themes within the transcripts. This study was designed to identify longitudinal changes stigma over time from the perspective of someone living with HIV and TB. However, participants were more expansive in their conceptualization of evolving stigma. 30 individuals discussed changes in stigma from three distinct perspectives. First was a perspective of lived experience, where participants described changes in experienced, internalized, and anticipated stigma over time beginning with diagnosis. The second was from a shifted perspective, as participants described their diagnosis and movement from status neutral to status positive transitioning from a potential enactor of stigma to someone at risk for experiencing stigma. Finally, participants described changes in stigma from the community perspective whose attitudes towards HIV and TB disease were shaped by time. To strengthen care engagement, we must effectively intervene on disease-related stigma. Appropriate interventions must consider time and shifting social expectations that impact stigma.
对于感染艾滋病毒和结核病的人来说，耻辱感可能会随时间而变化。确定个体最有可能经历与艾滋病毒或结核病相关耻辱感的时间点，或者耻辱感开始减轻的时间点，可能有助于在资源有限的环境中制定减少耻辱感的干预措施。本研究使用纵向定性数据来探讨艾滋病毒和结核病耻辱感在治疗过程中是否以及如何变化。在南非夸祖鲁-纳塔尔省的一家地区结核病医院，有目的地招募了感染艾滋病毒和耐利福平结核病的患者。参与者同意在整个结核病治疗过程中接受深入访谈。研究团队使用反思性主题分析在访谈记录中提炼出潜在主题。本研究旨在从艾滋病毒和结核病患者的角度确定耻辱感随时间的纵向变化。然而，参与者对不断演变的耻辱感的概念化更为宽泛。30名个体从三个不同角度讨论了耻辱感的变化。第一个是生活经历的角度，参与者描述了从诊断开始，随着时间推移，所经历的、内化的和预期的耻辱感的变化。第二个是转变后的角度，参与者描述了他们的诊断以及从无特定身份状态转变为积极身份状态，从潜在的耻辱感施加者转变为有遭受耻辱感风险的人。最后，参与者从社区角度描述了耻辱感的变化，社区对艾滋病毒和结核病的态度受时间影响。为了加强护理参与度，我们必须有效干预与疾病相关的耻辱感。适当的干预措施必须考虑到时间以及影响耻辱感的不断变化的社会期望。
