种族、教育程度、经济脆弱性和污名化对巴西艾滋病病毒感染者病毒载量可检测性的影响
The Impact of Race, Education, Economic Vulnerability, and Stigma on Viral Load Detectability Among People Living with HIV in Brazil.
作者信息
Brandelli Costa Angelo, Graeff Bins-Ely Isadora, Penzato Valentina, Vaitses Fontanari Anna Martha, Alckmin-Carvalho Felipe, Pereira Henrique, Welter Wendt Guilherme
机构信息
Graduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Department of Psychological and Social Sciences, John Cabot University, Rome, Italy.
出版信息
HIV AIDS (Auckl). 2025 Aug 1;17:241-249. doi: 10.2147/HIV.S534526. eCollection 2025.
BACKGROUND
Understanding barriers to viral undetectability is crucial for developing targeted interventions for populations struggling with treatment adherence. The aim of this study was to investigate the impact of race, education, economic vulnerability and HIV-related stigma on viral load detectability among people living with HIV (PLWHA) in Brazil.
METHODS
This was a cross-sectional, community-based study. The sample consisted of 1767 participants. We used the Brazilian version of the HIV Stigma Index 2.0 questionnaire, the Internalized AIDS-Related Stigma Scale, and a sociodemographic questionnaire. Viral load was self-reported. Data were collected by 30 PLHV themselves in 2019, after receiving training on the Brazilian Stigma Index. Data was analyzed with both descriptive and inferential statistics using SPSS.
RESULTS
Our generalized linear model showed that participants who were non-white, with low education and of lower economic status had a lower likelihood of reporting undetectable viral load (UVL) compared compared to their respective counterparts (white participants, those with higher education, and those of higher economic status). Key population group membership was not significantly associated with UVL. Higher internalized stigma was negatively associated with lower UVL.
CONCLUSION
Our findings highlight the impact of racial, educational and economic disparities and internalized stigma on HIV outcomes and underscore the need for tailored interventions that address the specific challenges faced by different racial/ethnic and more vulnerable groups. These findings challenge the dominant treatment-as-prevention framework that focuses primarily on key populations, suggesting the need to broaden our focus to include other vulnerable populations, such as non-whites and those experiencing economic hardship. Such approach is critical to avoid overlooking situations where community viral load remains high.
背景
了解病毒检测不到的障碍对于为在治疗依从性方面存在困难的人群制定有针对性的干预措施至关重要。本研究的目的是调查种族、教育程度、经济脆弱性和与艾滋病毒相关的耻辱感对巴西艾滋病毒感染者（PLWHA）病毒载量可检测性的影响。
方法
这是一项基于社区的横断面研究。样本包括1767名参与者。我们使用了巴西版的艾滋病毒耻辱感指数2.0问卷、内化艾滋病相关耻辱感量表和一份社会人口学问卷。病毒载量由参与者自行报告。2019年，30名艾滋病毒感染者在接受巴西耻辱感指数培训后自行收集数据。使用SPSS对数据进行描述性和推断性统计分析。
结果
我们的广义线性模型显示，与各自的对应人群（白人参与者、受过高等教育的参与者和经济地位较高的参与者）相比，非白人、教育程度低和经济地位较低的参与者报告病毒载量不可检测（UVL）的可能性较低。关键人群组成员身份与UVL没有显著关联。较高的内化耻辱感与较低的UVL呈负相关。
结论
我们的研究结果突出了种族、教育和经济差异以及内化耻辱感对艾滋病毒感染结果的影响，并强调需要制定针对性的干预措施，以应对不同种族/族裔和更弱势群体面临的具体挑战。这些研究结果挑战了主要关注关键人群的主导的治疗即预防框架，表明有必要扩大我们的关注范围，将其他弱势群体，如非白人和经历经济困难的人包括在内。这种方法对于避免忽视社区病毒载量仍然很高的情况至关重要。
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