“我认为他们受到感染是因为无知和缺乏责任感”：哈萨克斯坦医疗系统中与艾滋病相关耻辱感的混合方法研究

"I think they are infected because of their ignorance and lack of responsibility": A mixed-methods study on HIV-related stigma in the healthcare system in Kazakhstan.

作者信息

Iskakova Balnur, King Elizabeth J, Yucel Recai Murat, DeHovitz Jack, Nugmanova Zhamilya

机构信息

Department of Epidemiology, School of Public Health, Kazakh National Medical University named after S.D, Asfendiyarov, Almaty, Kazakhstan.

Department of Health Behavior and Health Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.

出版信息

PLoS One. 2025 Sep 2;20(9):e0331201. doi: 10.1371/journal.pone.0331201. eCollection 2025.

DOI:10.1371/journal.pone.0331201

PMID:40892800

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12404490/

Abstract

BACKGROUND

HIV-related stigma among healthcare providers remains a significant barrier to effective HIV care and treatment. This study aimed to assess HIV-related stigma and associated factors among healthcare providers in primary healthcare clinics (PHCs) in Almaty, Kazakhstan.

METHODS

A mixed-methods design was employed, involving quantitative surveys and qualitative in-depth interviews. Eight PHCs were randomly selected, and 448 healthcare providers participated in the survey. The cross-sectional surveys took place at the PHCs between May 2, 2019, and July 2, 2019. The sample size was predetermined statistically with a 2.5% precision using a 95% confidence level. For the qualitative component, 10 participants were chosen for in-depth interviews. Descriptive statistics, bivariate analysis, and multivariable logistic regression models were performed for quantitative data analysis. Qualitative data were analyzed through manual thematic analysis.

RESULTS

The study revealed high levels of HIV-related stigma, with 87% of respondents agreeing with at least one stigmatizing statement about people living with HIV (PLHIV). Fear of HIV infection was also prevalent, with 85% of healthcare providers expressing some level of concern about contracting HIV during medical procedures. Logistic regression analysis indicated that longer years of work in healthcare were protective against stigmatizing opinions (Adjusted Odds Ratio (AOR)=0.25; 95% Confidence Interval (95%CI)=0.09,0.67; p = 0.006), while not having seen a patient living with HIV in the last 12 months was associated with higher stigma (AOR = 3.31; 95%CI = 1.73, 6.31; p < 0.001). Qualitative interviews corroborated these findings and highlighted differential attitudes towards PLHIV based on modes of transmission, with particularly negative views towards sex workers and individuals with non-traditional sexual orientations.

CONCLUSIONS

The study demonstrates significant HIV-related stigma among healthcare providers in Almaty PHCs, influenced by a lack of exposure to PLHIV and specific socio-demographic factors. These findings underscore the need for targeted interventions to reduce stigma and enhance HIV care in Kazakhstan.

摘要

背景

医疗服务提供者中与艾滋病相关的耻辱感仍然是有效开展艾滋病护理和治疗的重大障碍。本研究旨在评估哈萨克斯坦阿拉木图初级保健诊所（PHC）医疗服务提供者中与艾滋病相关的耻辱感及相关因素。

方法

采用混合方法设计，包括定量调查和定性深入访谈。随机选择了8家初级保健诊所，448名医疗服务提供者参与了调查。横断面调查于2019年5月2日至2019年7月2日在初级保健诊所进行。使用95%的置信水平，以2.5%的精度预先统计确定样本量。对于定性部分，选择了10名参与者进行深入访谈。对定量数据分析进行描述性统计、双变量分析和多变量逻辑回归模型分析。定性数据通过手动主题分析进行分析。

结果

研究显示与艾滋病相关的耻辱感水平较高，87%的受访者至少同意一条关于艾滋病病毒感染者（PLHIV）的污名化表述。对感染艾滋病的恐惧也很普遍，85%的医疗服务提供者表示在医疗程序中对感染艾滋病有一定程度的担忧。逻辑回归分析表明，在医疗领域工作年限较长可预防污名化观点（调整后的优势比（AOR）=0.25；95%置信区间（95%CI）=0.09，0.67；p = 0.006），而在过去12个月内未见过艾滋病病毒感染者与更高的耻辱感相关（AOR = 3.31；95%CI = 1.73，6.31；p < 0.001）。定性访谈证实了这些发现，并强调了基于传播方式对艾滋病病毒感染者的不同态度，对性工作者和具有非传统性取向的人看法尤为负面。