Persistent HIV-related stigma in rural Uganda during a period of increasing HIV incidence despite treatment expansion

被引：60

作者：

Chan, Brian T. ^{[1
,2
,3
]}

Weiser, Sheri D. ^{[4
,5
]}

Boum, Yap ^{[6
]}

Siedner, Mark J. ^{[1
,3
,7
]}

Mocello, A. Rain ^{[8
]}

Haberer, Jessica E. ^{[3
,7
]}

Hunt, Peter W. ^{[4
]}

Martin, Jeffrey N. ^{[8
]}

Mayer, Kenneth H. ^{[3
,9
,10
]}

Bangsberg, David R. ^{[3
,7
,11
]}

Tsai, Alexander C. ^{[3
,7
,12
]}

机构：

[1] Massachusetts Gen Hosp, Div Infect Dis, Boston, MA 02114 USA

[2] Brigham & Womens Hosp, Div Infect Dis, Boston, MA 02115 USA

[3] Harvard Univ, Sch Med, Boston, MA USA

[4] Univ Calif San Francisco, San Francisco Gen Hosp, Div HIV AIDS, San Francisco, CA USA

[5] Univ Calif San Francisco, Ctr AIDS Prevent Studies, San Francisco, CA 94143 USA

[6] Epicentre, Mbarara, Uganda

[7] Massachusetts Gen Hosp, Ctr Global Hlth, Boston, MA 02114 USA

[8] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA

[9] Beth Israel Deaconess Med Ctr, Div Infect Dis, Boston, MA 02215 USA

[10] Fenway Hlth, Boston, MA USA

[11] Mbarara Univ Sci & Technol, Mbarara, Uganda

[12] Massachusetts Gen Hosp, Chester M Pierce MD Div Global Psychiat, Boston, MA 02114 USA

来源：

AIDS | 2015年 / 29卷 / 01期

基金：

美国国家卫生研究院;

关键词：

HIV; incidence; stigma; trends; Uganda; AIDS-RELATED STIGMA; ANTIRETROVIRAL THERAPY; CAPE-TOWN; INTERNALIZED STIGMA; TESTING SERVICES; HIV/AIDS; PEOPLE; DEPRESSION; IMPACT; RELIABILITY;

D O I：

10.1097/QAD.0000000000000495

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Objective: Programme implementers have argued that the increasing availability of antiretroviral therapy (ART) will reduce the stigma of HIV. We analyzed data from Uganda to assess how HIV-related stigma has changed during a period of ART expansion. Design: Serial cross-sectional surveys. Methods: We analyzed data from the Uganda AIDS Rural Treatment Outcomes study during 2007-2012 to estimate trends in internalized stigma among people living with HIV (PLHIV) at the time of treatment initiation. We analyzed data from the Uganda Demographic and Health Surveys from 2006 to 2011 to estimate trends in stigmatizing attitudes and anticipated stigma in the general population. We fitted regression models adjusted for sociodemographic characteristics, with year of data collection as the primary explanatory variable. Results: We estimated an upward trend in internalized stigma among PLHIV presenting for treatment initiation [adjusted b = 0.18; 95% confidence interval (CI), 0.06-0.30]. In the general population, the odds of reporting anticipated stigma were greater in 2011 compared with 2006 [adjusted odds ratio (OR) = 1.80; 95% CI, 1.51-2.13], despite an apparent decline in stigmatizing attitudes (adjusted OR = 0.62; 95% CI, 0.52-0.74). Conclusion: Internalized stigma has increased over time among PLHIV in the setting of worsening anticipated stigma in the general population. Further study is needed to better understand the reasons for increasing HIV-related stigma in Uganda and its impact on HIV prevention efforts. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

引用

页码：83 / 90

页数：8

共 55 条

[1] Challenges to ART scale-up in a rural district in Tanzania: stigma and distrust among Tanzanian health care workers, people living with HIV and community members [J].