PDF(Pubmed)
Abstract：
Adherence to antiretroviral therapy (ART) is a complex and multi-determined process that is influenced by psychosocial variables. Although international studies have pointed to the adverse impact of HIV stigma, sexual stigma, and depression on ART adherence among men who have sex with men (MSM) with HIV, less is known about this association among Brazilians. We aimed to (a) evaluate indicators of depression, stigma related to HIV and homosexuality, and adherence to ART in a sample of Brazilian MSM living with HIV; (b) assess possible correlations between the variables analyzed, and (c) assess the impact of HIV and sexual stigma and depression on ART adherence. This cross-sectional study comprised 138 Brazilian MSM living with HIV as participants. Scales used included: a sociodemographic/clinical questionnaire, the questionnaire for assessment of adherence to antiretroviral therapy (CEAT-HIV), the Beck depression inventory (BDI-II), the internalized homophobia scale, and the HIV stigmatization scale. The mean adherence score was relatively high (78.83, within a range of 17-89 points). However, we observed inadequate ART adherence (CEAT-HIV < 75) in 28 (20.2%) respondents. Participants reported high scores for internalized sexual stigma, perceived sexual stigma in the community, and HIV stigma. Symptoms of depression were identified in 48.47% of participants. We found negative correlations between depression, HIV stigma, and treatment adherence, but not between sexual stigma and ART adherence. HIV-related stigma and sexual stigma were positively correlated with depression. Our regression analysis indicated that each year of age at diagnosis of HIV increased adherence by 0.22 points, on average. Each additional BDI-II score reduced adherence to ART by 0.20 points. The high prevalence of depression, HIV stigma, and sexual stigma, and their adverse effects on ART adherence and mental health, point to the need to implement evidence-based interventions to reduce sexual and serological stigma in the general population, as well as to mitigate the negative impacts of stigma on MSM living in HIV in Brazil. They also highlight the importance of periodically screening for these variables among MSM treated in Brazilian public health services, especially among those with inadequate adherence to ART.
摘要：
坚持抗逆转录病毒疗法（ART）是一个复杂而多方面的过程，受社会心理变量的影响。尽管国际研究指出了艾滋病毒耻辱的不利影响，性污名,与HIV发生性关系的男性（MSM）对ART依从性的抑郁，巴西人对这种联系知之甚少。我们的目标是(A)评估抑郁的指标，与艾滋病毒和同性恋有关的耻辱，和坚持ART在巴西MSM的样本与艾滋病毒；（b）评估可能的相关性之间的变量分析，（c）评估艾滋病毒和性污名和抑郁对ART依从性的影响。这项横断面研究包括138名感染艾滋病毒的巴西MSM作为参与者。使用的量表包括：社会人口统计学/临床问卷，抗逆转录病毒治疗依从性评估问卷（CEAT-HIV），贝克抑郁症清单(BDI-II)，内化的同性恋恐惧症量表，和艾滋病毒污名化量表。平均依从性得分相对较高（78.83，在17-89分范围内）。然而,我们观察到28名(20.2%)受访者的ART依从性不足(CEAT-HIV<75).参与者报告说，内化的性耻辱得分很高，在社区中感知到的性污名，和艾滋病毒的耻辱。在48.47％的参与者中发现了抑郁症状。我们发现抑郁症之间存在负相关，艾滋病毒的耻辱，和治疗依从性，但不是在性污名和ART依从性之间。与HIV相关的污名和性污名与抑郁呈正相关。我们的回归分析表明，诊断为HIV的年龄每年增加0.22分的依从性，平均而言。每增加一次BDI-II评分，对ART的依从性就会降低0.20分。抑郁症的高患病率，艾滋病毒的耻辱，和性耻辱，以及它们对ART依从性和心理健康的不利影响，指出有必要实施基于证据的干预措施，以减少普通人群的性和血清学污名，以及减轻污名对巴西艾滋病毒携带者的负面影响。他们还强调了在巴西公共卫生服务机构接受治疗的MSM中定期筛查这些变量的重要性，尤其是那些对ART依从性不足的人。
