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
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).
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.
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).
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）。
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.