背景:对表格进行了有限的研究,在赞比亚,与男性(MSM)和变性女性(TGW)的年轻HIV阳性男性之间的交叉污名的表现和影响。在这项研究中,我们旨在通过在一小群年轻人中阐明这些经历来解决这一差距,赞比亚的HIV+MSM和TGW。
方法:我们采用了混合方法设计。数据收集时间为2022年1月至2022年5月。定性数据是通过深入访谈收集的,而定量数据是通过问卷调查收集的。使用主题分析对定性转录本进行编码,同时将纸质问卷数据输入KoboConnect。描述性统计,使用卡方检验使用Excel计算。在本文中,我们提供了样本的描述性概况,然后专注于交叉污名的定性发现,抑郁症,和自杀的沉思。
结果:我们从三个地点招募了56名参与者:卢萨卡,奇帕塔,和Solwezi区。参与者的平均年龄为23岁。研究发现,所有参与者中有36%有中度到显著的抑郁症状,7%有严重抑郁症,30%有中度焦虑的迹象,11%的人有高度焦虑的迹象,4%的人有很高的焦虑迹象,36%的人至少考虑过一次自杀。与MSM相比,TGW的中度至重度抑郁症状(40%)或重度抑郁症(10%)的比例更高,33%和6%,分别(X2=0.65;p=0.42)。同样,TGW(55%)比MSM同行(36%,X2=1.87;p=0.17)。在定性数据中,关于形式的四个紧急主题,表现,交叉污名的影响是(1)艾滋病毒,性取向,和性别认同披露;(2)双重身份;(3)寻找和维持性伴侣的挑战;(4)应对和复原力。总的来说,不得不隐藏一个人的性行为和艾滋病毒状况产生了复合效应,并被描述为“一个私人谎言”。\"
结论:要有效解决年轻HIV阳性MSM和TGW中的污名和不良心理健康结果,需要采用一种侧重于结构性干预的社会生态方法,为感染艾滋病毒的年轻人提供更多的创伤知情和身份支持护理,以及加强真正的社区知情公共卫生工作。
BACKGROUND: Limited research has been conducted on the forms, manifestations and effects of intersectional stigma among young HIV-positive men who have sex with men (MSM) and transgender women (TGW) in Zambia. In this study, we aimed to address this gap by elucidating the experiences of these in a small group of young, HIV + MSM and TGW in Zambia.
METHODS: We applied a mixed-methods design. Data were collected from January 2022 to May 2022. Qualitative data were collected using in-depth interviews while quantitative data were collected using a questionnaire. Qualitative transcripts were coded using thematic analysis while paper-based questionnaire data were entered into Kobo Connect. Descriptive statistics, using chi-squared tests were calculated using Excel. In this paper, we provide a descriptive profile of the sample and then focus on the qualitative findings on intersectional stigma, depression, and contemplation of suicide.
RESULTS: We recruited 56 participants from three sites: Lusaka, Chipata, and Solwezi districts. Participants\' mean age was 23 years. The study found that 36% of all participants had moderate to significant symptoms of depression, 7% had major depression, 30% had moderate signs of anxiety, 11% had high signs of anxiety, 4% had very high signs of anxiety and 36% had contemplated suicide at least once. A greater proportion of TGW had moderate to significant symptoms of depression (40%) or major depression (10%) compared to MSM, at 33% and 6%, respectively (X2 = 0.65; p = 0.42). Similarly, more TGW (55%) had contemplated suicide than MSM peers (36%, X2=1.87; p = 0.17). In the qualitative data, four emergent themes about the forms, manifestations, and effects of intersectional stigma were (1) HIV, sexual orientation, and gender identity disclosure; (2) Dual identity; (3) Challenges of finding and maintaining sexual partners; (4) Coping and resilience. Overall, having to hide both one\'s sexuality and HIV status had a compounding effect and was described as living \"a private lie.\"
CONCLUSIONS: Effectively addressing stigmas and poor mental health outcomes among young HIV-positive MSM and TGW will require adopting a socio-ecological approach that focuses on structural interventions, more trauma-informed and identity-supportive care for young people with HIV, as well as strengthening of authentic community-informed public health efforts.