PLOS ONE2013-10-15 10:50 PM

Correlates of Social Exclusion and Negative Labeling and Devaluation of People Living with HIV/AIDS in Rural Settings: Evidence from a General Household Survey in Zambézia Province, Mozambique 农村环境中社会性歧视以及对艾滋病人的否定和贬低的相关性研究:以莫桑比克的桑贝利亚省户口普查数据为例

论文摘要 Background Increased HIV/AIDS knowledge and access to antiretroviral treatment (ART) have been hypothesized to decrease HIV stigma. However, stigma persists as a barrier to HIV services uptake. We studied the relationship between stigma, knowledge and attitudes towards HIV and its treatment, and confidence in the legal system (legal rights certitude). 背景 曾经人们以为随着对艾滋病越来越深入的了解以及抗逆转录病毒治疗(ART)成为可能的时候,艾滋病就不再那么耸人听闻了。可事到如今,艾滋病的臭名仍旧阻碍着艾滋病康复服务的进步。我们研究了对艾滋病和艾滋病治疗的偏见、了解和态度,以及对法律体系的信任之间的关系。 Methods We analyzed data from a household survey of 3749 randomly sampled female heads of households in 259 enumeration areas across 14 districts of Zambézia Province, Mozambique. The questionnaire included questions about beliefs, attitudes and behavior towards PLWHA, HIV transmission knowledge, treatment-related beliefs, and legal rights certitude. Factor analysis distinguished two stigma constructs: Negative labeling and devaluation (NLD) and social exclusion (SoE). Multivariable linear regression was used to determine the association between stigma, knowledge of HIV/AIDS, treatment-related beliefs, and legal rights certitude, while controlling for variance in socio-demographics. 方法 我们根据莫桑比克的赞贝利亚省横跨14个区列举出的259个地区的数据随机抽取了3749个女性户主家庭进行分析。问卷内容包括信仰问题、针对艾滋病病毒感染者和艾滋病人的态度和行为、艾滋病传播知识、和治疗相关的信条、自我法律权利意识。这样的原因分析可以区分两种偏见的不同:否定贬低(NLD)和社会性歧视(SoE)。在做社会人口统计方差时,多元线性回归统计用于体现偏见、对艾滋病毒的认识、治疗相关的信条、自我法律权利意识之间的联系。 Results A 4-point increase in knowledge about HIV transmission was associated with more than a 3 unit decrease in NLD and SoE stigma scores (p<0.001). Given HIV transmission knowledge, a 25-point increase in legal rights certitude was associated with a 4.62 unit drop in NLD stigma (p<0.001); we did not detect an association between legal rights certitude and SoE stigma. Knowing at least one HIV positive person was associated with lower SoE (−3.17, 95% CI: −5.78, −0.56); no association with NLD (p = 0.1) was detected. ART efficacy belief was associated with higher NLD and lower SoE (2.90 increase and 6.94 decrease, respectively; p≤0.001). 结果 对艾滋病毒传播知识每增加4个点,NLD现象和SoE的分数就会随之下降3个点还多(P<0.001)。在艾滋病毒传播知识方面,在自我法律权利意识上每上升25个点,NLD现象就会有4.62单位的下降(P<0.001);我们没有考察自我法律权利意识和SoE现象之间的联系。但至少我们得知艾滋病毒携带者会表现出较低的SoE现象 (−3.17, 95% CI: −5.78, −0.56);没有发现艾滋病毒携带者和NLD (p = 0.1)有联系。对抗逆转录病毒治疗(ART)的信心和NLD正相关,和SoE反相关(分别增加2.90,降低6.94,p≤0.001)。 Conclusion Increasing knowledge about HIV transmission and access to ART are likely to reduce stigma, but neither of the two is a panacea. Raising community awareness of the legal rights of PLWHA might improve the efficacy of stigma reduction efforts. Strategies that focus on specific domains of stigma might be more effective than generic stigma reduction strategies. 结论 艾滋病毒传播知识的增加以及抗逆转录病毒治疗(ART)能减少不良现象,但是这两者哪一个都不是万应灵丹。提高艾滋病病毒感染者和艾滋病人群体的自我法律权利意识或许能帮助减少不良现象。对不良现象的特别区块进行针对性研究比总体研究在降低功效方面要更有效率。

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