云南省澜沧县艾滋病病毒感染者及病人生存质量现状及相关因素研究

目的了解艾滋病病毒感染者及病人生存质量的现状并分析其相关因素。方法应用世界卫生组织生活质量量表(WHOQOL-BREFF)中文版评价艾滋病病毒感染者及病人的生存质量,同时调查可能影响生活质量的人口学特征和HIV感染有关特征。采用t检验、方差分析进行单因素分析,多元线性回归模型分析生理、心理、社会关系及环境4大领域的影响因素。结果 300例艾滋病病毒感染者及病人生存质量4大领域平均得分分别为:生理领域(14.04±1.87)分、心理领域(12.48±1.88)分、社会关系领域(12.78±2.25)分、环境领域(11.87±2.00)分。配偶的文化程度越高其本人的心理、社会关系和环境领域得分越高;静脉注射途径在各领域中得分最低。结论应加强年轻患者、抗病毒治疗患者和静脉注射感染者的心理健康辅导,以提高生存质量。     

艾滋病病毒感染者和病人生存质量调查及相关因素分析

目的调查与评价艾滋病病毒感染者和病人的生存质量,分析影响其生存质量的因素。方法采用世界卫生组织生存质量简表（WHOQOL—BREF中文版）加上艾滋病相关条目。对300例艾滋病病毒感染者和病人与112例健康的配偶／固定性伴及吸毒同伴进行调查。结果艾滋病病毒感染者和病人各方面得分均显著低于健康的配偶／固定性伴及吸毒同伴（P〈0．01）,健康的配偶,固定性伴及吸毒同伴的生存质量的心理领域和社会关系领域显著得分低于全国其他城市常模人群（P〈0．01）。文化程度、CD4细胞计数及家庭年收入与艾滋病病毒感染者和病人生存质量呈正相关,吸毒及HIV检测前及与配偶,固定性伴发生性关系的频次与艾滋病病毒感染者和病人的生存质量呈负相关。结论艾滋病病毒感染者和病人总体生存质量较差,其性伴或吸毒同伴的生存质量的心理领域和社会关系领域得分也低于全国其他城市常模人群。     

安徽省艾滋病病毒感染儿童的生活质量评价

目的用“儿科健康相关生活质量普适性核心量表4.0”评价安徽省儿童艾滋病病毒感染者/病人（简称艾滋病儿童）的生活质量。方法采用普查方法,对安徽省所有艾滋病儿童及其监护人进行问卷调查。结果共调查艾滋病儿童60人,平均年龄（10.23±3.25）岁;男性32人（53.3%）;艾滋病病人48人（80.0%）。大多数艾滋病儿童认为自己的身体较好或一般,近四成的孩子在最近两周内生过病,两周患病率为38.3%。艾滋病儿童的生理、情感、社会和角色功能的得分分别是75.2、85.0、77.6和70.8分;后三项构成心理领域,平均为78.5分;生活质量总平均为77.8分。与一般儿童相比,除情感功能外,艾滋病儿童在各方面得分均较低,且差异具有统计学意义。儿童艾滋病病毒感染者与儿童艾滋病病人相比,生理功能上两组儿童差异有统计学意义;而在其他方面、整个心理领域以及总体得分等指标上,两组儿童差异无统计学意义。艾滋病儿童生理功能同年龄、家庭经济状况和儿童的身体状况有关联关系;社会功能与家庭经济状况和儿童的身体状况有关联关系;心理领域同家庭经济状况有关联关系;生活质量总分同家庭经济状况和儿童的身体状况有关联关系。结论安徽省儿童艾滋病病毒感染者/病人的生活质量受到严重影响,亟需干预措施改善生活质量。     

心理资本在艾滋病病毒感染者/病人社会支持与焦虑关系中的中介作用研究

目的了解艾滋病病毒感染者/病人的心理健康状况,分析影响心理焦虑的因素,为其心理干预提供依据。方法应用Duke-UNC功能性社会支持问卷(functional social support questionnaire)、心理资本(psychological capital)问卷和焦虑自评量表(SAS)对424例艾滋病病毒感染者/病人进行调查分析。结果被调查者焦虑标准分为(48.11±11.31)分,超过中国常模(29.78±0.46)分。心理资本的自我效能维度对社会支持与焦虑起到部分中介作用,使解释的变异量增加了10.1%。结论艾滋病病毒感染者/病人的焦虑症状明显高于一般人群,社会支持以心理资本为中介能够减轻其焦虑症状水平。     

医学应对方式与社会支持对艾滋病病毒感染者/病人生存质量影响的研究

目的探讨社会支持与应对方式对艾滋病病毒感染者/病人生活质量的影响。方法采用Feifel等编制的医学应对问卷、肖水源等编制的社会支持评定量表以及美国波士顿健康研究所编制的健康状况调查问卷对57例艾滋病病毒感染者/病人进行问卷调查。结果艾滋病病毒感染者/病人生存质量在生理职能、躯体疼痛以及情感职能方面的得分低于常模,在精力方面的得分高于常模;社会支持与健康状况、精力、情感职能和社会功能呈明显正相关;艾滋病病毒感染者/病人回避应对方式与屈服应对方式得分高于常模水平;面对应对方式与精神健康和情感职能呈正相关;屈服应对方式与生理机能、健康状况、精力和精神健康呈负相关。结论应该对艾滋病病毒感染者/病人开展心理健康教育,帮助艾滋病病毒感染者/病人充分利用社会支持,提高其生存质量;同时鼓励艾滋病病毒感染者/病人采用更加积极的应对方式来面对疾病带来的痛苦,更好的生活下去。     

SF-36量表测定中国云南农村艾滋病病毒感染者和普通村民生活质量分析

[目的]探讨SF-36量表测定中国云南农村艾滋病病毒感染者与普通村民生活质量的效果。[方法]采用SF-36量表对艾滋病病毒感染者和普通村民进行面对面问卷调查,比较普通村民与感染者、未接受治疗与接受治疗的感染者组间在躯体功能、社会功能等8个维度方面的区别。[结果]①感染者组SF-36量表各维度Cronbach's α系数均大于或接近0.7;普通村民组除活力(VT)和社会功能(SF)维度外,其他维度Cronbach's α系数均大于0.7。②普通村民组躯体功能(PF)、VT、机体疼痛(BP)和总的健康状况(GH)维度得分显著高于未接受抗病毒治疗的感染者组;接受抗病毒治疗的感染者组VT、BP和GH维度得分显著高于未治疗的感染者组。[结论]SF-36测定中国农村艾滋病病毒感染者生活质量时具有较好的信度;在反映生理健康的维度上具有较好的判别效度,在反映心理健康的维度上判别效度不理想。建议开发艾滋病病毒感染者特异性生活质量量表。     

农村接受抗病毒治疗艾滋病病人生活质量评估

目的评价接受抗病毒治疗的艾滋病病人的生活质量,为提高他们的生活质量提供依据。方法对安徽省抗病毒治疗效果评估队列的艾滋病人及其邻居进行问卷调查。问卷包括一般情况和36条目简明量表(SF-36)中文版进行生活质量评价。结果共调查艾滋病病人110人,对照邻居114人。两组人群在年龄、性别、家庭人口数、职业等方面情况类似,但在婚姻状况、文化程度、个人收入、家庭收入、自觉家庭经济状况等方面,艾滋病病人相对较为弱势。在所有的生活治疗的8个领域中,艾滋病病人的得分均显著低于对照邻居。艾滋病病人和对照邻居的生理生活质量得分分别是47.1±18.5和75.9±22.1(t=-10.390,P<0.001),心理生活质量得分分别为51.3±21.7和80.7±19.2(t=-10.484,P<0.001)。多因素逐步回归分析显示,组别、性别和年龄等变量与生理生活质量相关,组别、性别和自评家庭经济状况等变量与心理生活质量相关。而在艾滋病病人中,仅病毒载量分别与生理生活质量和心理生活质量相关。结论艾滋病对个人和家庭的影响显著,尤其是在经济方面;艾滋病病人的生活质量显著降低,艾滋病对生活质量的影响巨大且覆盖了常见危险因素的影响。     

结对健康教育模式对受艾滋病影响儿童生活质量的影响

目的探索结对健康教育与心理辅导模式对受艾滋病影响儿童生活质量的影响。方法在河南省某艾滋病重点村确定60名受艾滋病影响儿童(OVC),同时选择60名一般农村儿童作对照,志愿者与OVC 1∶4结成对子进行健康教育和心理辅导,分别于教育辅导前后调查其艾滋病知识、态度、家庭防护知识及生活质量评分,评价实施效果。结果健教前,2组艾滋病知识、态度、家庭防护知识掌握程度一致。结对健康教育模式实施后,OVC的知识、态度、家庭防护知识得分提高,与对照比较得分均值差异有统计学意义(P<0.05);心理辅导前,OVC与一般农村儿童生活质量总分差异无统计学意义,OVC在生理健康、心理健康2方面与自我满意度3者得分比一般农村儿童低;心理支持后,OVC生活质量社会心理相关维度中师生关系、同伴关系、亲子关系、负性情绪4个维度得分改善(P<0.05),心理健康得分提高(P<0.05)。结论结对展开受艾滋病影响儿童的健康教育与心理支持模式具有一定适用性和有效性。     

受艾滋病影响农村儿童主观生活质量及自尊状况调查

目的了解受艾滋病影响儿童的主观生活质量和自尊现状,为向相关人群提供心理支持提供依据。方法方便选取河南、安徽农村地区194名受艾滋病影响儿童,采用儿少主观生活质量问卷和自尊量表进行一对一问卷调查。结果儿童主观生活质量的认知成分得分为(90.48±14.42)分,其中家庭生活维度相对得分最低,仅为(17.92±3.78)分。与父母生活在一起(父/母/父母/自身为HIV感染者)的儿童主观生活质量均低于普通家庭儿童,接受非政府组织心理干预较少和较多的儿童及"阳光家庭"中的儿童,差异均有统计学意义(P值均0.05)。自尊量表普遍得分较低,初中及以上学生平均得分低于小学生,差异有统计学意义(P0.05)。结论儿童家庭生活满意度及自尊水平较低。需要对受艾滋病影响儿童进行进一步的心理支持,减轻其在家庭生活方面的心理压力,提高自我接纳水平,从而更好地适应社会。     

老年高血压患者生存质量与家庭功能关系

目的 探讨老年高血压患者生存质量与家庭功能的关系.方法 采用世界卫生组织生存质量量表简表(WHOQ0L-BREF)和家庭功能评定量表(FAD)对415名60岁～老年高血压患者进行调查.结果 老年高血压患者生存质量中,生理领域、心理领域、社会关系领域和环境领域等4个维度的平均得分依次为52.46,45.60,50.04,48.97分;家庭功能中,问题解决、沟通、角色、情感反应、情感介入、行为控制和总的功能等7个因子的平均得分依次为2.17,2.28,2.29,2.38,2.39,2.36和2.28分.典则相关分析显示,角色和情感反应、生理领域和心理领域分别是家庭功能和生存质量中起主要作用的因素.生理领域和心理领域分别与家庭功能的各因子得分呈负相关.结论 老年高血压患者家庭功能水平越低,生存质量越差.     

艾滋病毒感染者/艾滋病患者与其家属艾滋病相关羞辱和歧视的研究

目的 了解某农村社区艾滋病毒感染者/艾滋病患者(HIV/AIDS)与其家属遭遇的羞辱和歧视,并分析造成相关羞辱和歧视的原因.方法 采用自制调查问卷,对某农村艾滋病流行区的117例HIV/AIDS及其相应的190名健康家属进行面对面问卷调查.结果 HIV/AIDS与其家属遭受到的羞辱和歧视可分为两类,即内在的羞辱和歧视及外在的羞辱和歧视;这两种羞辱和歧视在HIV/AIDS与其家属之间的差异有统计学意义(t=-12.540,P=0.000);且HIV/AIDS与其家属遭受的内在的羞辱和歧视要高于外在的羞辱和歧视.艾滋病内在的羞辱和歧视与研究对象的自我效能(OR=0.558,P=0.041)、家庭功能(OR=0.650,P=0.027)、是否感染HIV(OR=2.116,P=0.004)等因素有关.艾滋病外在的羞辱和歧视与研究对象的自我效能(OR=0.468,P=0.028)、家庭功能(OR=0.427,P=0.000)、是否感染HIV(OR=3.412,P=0.001)有关.结论 某农村社区HIV/AIDS与其家属在社会环境中均遭受到一定的内在、外在的羞辱和歧视,应采取有针对性的策略和措施,减少并消除这种羞辱和歧视.     

Stigma rises despite antiretroviral roll-out: A longitudinal analysis in South Africa

Stigma is a recognised problem for effective prevention, treatment, and care of HIV/AIDS. However, few studies have measured changes in the magnitude and character of stigma over time. This paper provides the first quantitative evaluation in Africa of the changing nature of stigma and the potential determinants of these changes. More specifically, it evaluates the dynamic relationship between stigma and (1) increased personal contact with people living with HIV/AIDS and (2) knowing people who died of AIDS. Panel survey data collected in Cape town 2003 and 2006 for 1074 young adults aged 14–22 years were used to evaluate changes in three distinct dimensions of stigma: behavioural intentions towards people living with HIV/AIDS; instrumental stigma; and symbolic stigma. Individual fixed effects regression models are used to evaluate factors that influence stigma over time. Each dimension of stigma increased in the population as a whole, and for all racial and gender sub-groups. Symbolic stigma increased the most, followed by instrumental stigma, while negative behavioural intentions showed a modest increase. Knowing someone who died of AIDS was significantly associated with an increase in instrumental stigma and symbolic stigma, while increased personal contact with people living with HIV/AIDS was not significantly associated with any changes in stigma. Despite interventions, such as public-sector provision of antiretroviral treatment (which some hoped would have reduced stigma), stigma increased among a sample highly targeted with HIV-prevention messages. These findings emphasise that changes in stigma are difficult to predict and thus important to monitor. They also indicate the imperative for renewed efforts to reduce stigma, perhaps through interventions to weaken the association between HIV/AIDS and death, to reduce fear of HIV/AIDS, and to recast HIV as a chronic manageable disease.     

HIV感染者与AIDS患者感知歧视与应对方式、希望水平的相关性

目的　了解HIV感染者与AIDS患者感知歧视、应对方式、希望水平的现状和三者的相关性。方法　选取2017年9月至12月在成都市某传染病医院就诊的112例HIV感染者与AIDS患者进行Berger HIV感知歧视量表、医学应对问卷及Herth希望指数量表调查。结果　HIV感染者与AIDS患者感知歧视得分为（113.30±16.11）分,主要表现为担心病情公开;应对方式以屈服应对为主（61例,54.5%）;面对维度得分低于常模,回避和屈服维度得分高于常模,差异均有统计学意义（P＜0.001）。希望得分为（36.24±4.85）分。Pearson相关分析显示,感知歧视总分及各维度得分与屈服维度得分均呈正相关（均P＜0.05）,与面对和回避维度得分均无相关性（均P＞0.05）;除担心公开维度得分与希望得分无相关性（均P＞0.05）外,其余各维度得分及感知歧视总分与希望得分均呈负相关（均P＜0.001）。结论　HIV感染者与AIDS患者存在感知歧视,且与其应对方式和希望水平相关,应采取针对性的干预措施,降低其歧视感。     

Enacted and internalized stigma and quality of life among people with HIV: the role of group identity

Purpose

This study analyzes the mediating role of social identity in the relationship between enacted stigma and internalized stigma and quality of life of people with HIV.

Methods

A total of 557 people with HIV participated in this study. Participants were recruited from hospitals and non-governmental organizations. Questionnaires measuring perceived stigma (Berger’s HIV Stigma Scale), social identity (Cameron’s three factor identity scale), and quality of life (Ruiz and Baca’s Quality of Life Questionnaire) were administered. The instruments were adapted for use with the Spanish population. Structural equation modeling (SEM) was used to test the mediation model, and multigroup SEM was conducted to evaluate its invariance.

Results

Both enacted stigma and internalized stigma had a negative influence on the quality of life of people with HIV, but this influence occurred in different ways. Enacted stigma had a direct negative influence on quality of life. No dimension of group identity protected people with HIV from its negative influence. However, the negative influence of internalized stigma was totally mediated by some dimensions of group identification, mainly through in-group affect.

Conclusions

Group identification not only did not protect people with HIV from the negative effects of stigmatization, but it may even be detrimental in the case of internalized stigma. This suggests that in highly stigmatized groups, the salience of identity is negative and worsens the members’ opinion of their own group. This argues for different kinds of intervention to improve the quality of life of people with HIV.     

‘My biggest fear was that people would reject me once they knew my status…’: stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg,South Africa

Stigma is not a new concept; however, it remains highly significant in the context of HIV/AIDS in South Africa. There is wide consensus that HIV/AIDS‐related stigma compromises the well‐being of people living with the disease. This paper is part of a larger study that seeks to understand the social and cultural complexity related to the provision and outcomes of antiretroviral therapy (ART) in South Africa. It explores and analyses how patients on ART perceived and experienced stigma and how it has shaped their behaviour towards, as well as their understanding of the epidemic. The data have been collected by means of in‐depth face‐to‐face interviews, conducted between June and November 2007, with a sample of 44 patients in an HIV/AIDS clinic in a resource‐limited setting in Johannesburg, South Africa. The findings reveal that the level of felt and anticipated stigma is intense and affects all dimensions of living with HIV/AIDS, particularly disclosure and treatment. Stigma permeates the experience of HIV‐positive people on ART who participated in this study. The intensity of HIV/AIDS‐related stigma can threaten to compromise the value of ART, thus impacting on the daily lives of people living with HIV/AIDS (PLWHA). This study suggests that three decades into the epidemic, stigmatisation remains a core feature of the patient experience of HIV/AIDS. In the clinic in which this research was conducted, HIV/AIDS was regarded as a chronic condition increasingly manageable by ongoing access to ART. However, this approach was not shared by many family members, neighbours and employers who held highly stigmatised views.     

AIDS stigma in health services in the Eastern Caribbean

Stigma obstructs HIV/AIDS prevention and care worldwide, including in the Caribbean, where the prevalence of AIDS is second only to sub-Saharan Africa. To contextualise the experience of AIDS stigma in health services in Grenada and Trinidad and Tobago, we conducted eight focus groups with 51 people living with HIV/AIDS (PLHA), families, and service providers. Quasi-deductive content analysis revealed consonance with Western and Northern conceptualisations of AIDS stigma wherein stigma is enacted upon marginalised populations and reinforced through psycho-sociological processes comparing 'in' and 'out' groups. Socially constructed to be physically contagious and socially deviant, PLHA are scorned by some service providers, especially when they are perceived to be gay or bisexual. PLHA and providers identified passive neglect and active refusal by hospital and clinic staff to provide care to PLHA. Institutional practices for safeguarding patient confidentiality are perceived as marginally enforced. Interventions are needed to reduce provider stigma so the public will access HIV testing and PLHA will seek treatment.     

Homosexuality and HIV/AIDS stigma in Jamaica

This paper reports on a study of the relationship of homophobia to HIV/AIDS‐related stigma in Jamaica. Ethnography, key informant interviews and focus groups were used to gather data from a sample of 33 male and female adults during the summer of 2003. The sample included health and social service providers, HIV positive men and women, and men and women with same sex partners in urban and rural Jamaica. A strong and consistent relationship between homophobia and HIV/AIDS‐related stigma was reported, but the relationship varied according to geographic location, social class, gender, and skin colour (complexion)—to the extent that this coincided with class. Stigma against people living with HIV/AIDS and homosexuality was implicated in low levels of use of HIV testing, treatment and care services and the reluctance of HIV positive people to reveal their serostatus to their sexual partners. Data reveal a pressing need for anti‐stigma measures for both homophobia and HIV/AIDS, and for training for health and human service professionals.     

A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS

HIV/AIDS-related stigma and discrimination have a substantial impact on people living with HIV/AIDS (PLHA). The objectives of this study were: (1) to determine the associations of two constructs of HIV/AIDS-related stigma and discrimination (negative attitudes towards PLHA and perceived acts of discrimination towards PLHA) with previous history of HIV testing, knowledge of antiretroviral therapies (ARVs) and communication regarding HIV/AIDS and (2) to compare these two constructs across the five research sites with respect to differing levels of HIV prevalence and ARV coverage, using data presented from the baseline survey of U.S. National Institute of Mental Health (NIMH) Project Accept, a four-country HIV prevention trial in Sub-Saharan Africa (Tanzania, Zimbabwe and South Africa) and northern Thailand. A household probability sample of 14,203 participants completed a survey including a scale measuring HIV/AIDS-related stigma and discrimination. Logistic regression models determined the associations between negative attitudes and perceived discrimination with individual history of HIV testing, knowledge of ARVs and communication regarding HIV/AIDS. Spearman's correlation coefficients determined the relationships between negative attitudes and perceived discrimination and HIV prevalence and ARV coverage at the site-level. Negative attitudes were related to never having tested for HIV, lacking knowledge of ARVs, and never having discussed HIV/AIDS. More negative attitudes were found in sites with the lowest HIV prevalence (i.e., Tanzania and Thailand) and more perceived discrimination against PLHA was found in sites with the lowest ARV coverage (i.e., Tanzania and Zimbabwe). Programs that promote widespread HIV testing and discussion of HIV/AIDS, as well as education regarding and universal access to ARVs, may reduce HIV/AIDS-related stigma and discrimination.     

Children's attitudes toward people with AIDS in Puerto Rico: exploring stigma through drawings and stories

AIDS stigma refers to prejudice and discrimination directed at people or groups perceived to have HIV/AIDS (Herek, 1999). Although AIDS stigma has been found in adolescent and adult populations, few researchers have explored it among children. Misconceptions about people with AIDS (PWA) might lead to negative attitudes toward PWA and obstruct HIV prevention efforts. The authors assessed 110 Puerto Rican children's attitudes toward PWA using drawings (n=65) and stories (n=45). Although participants held stigmatizing attitudes toward PWA across both methods, the approaches captured different beliefs and attitudes. Drawings depicted PWA as physically deteriorated and performing socially condemned behaviors, whereas stories describing PWA highlighted children's fear of contagion and death. Stigma toward PWA was more pronounced than toward other illnesses (e.g., cancer). The study highlights the importance of assessing children's attitudes through creative data collection procedures.     

Homosexuality and HIV/AIDS stigma in Jamaica

This paper reports on a study of the relationship of homophobia to HIV/AIDS-related stigma in Jamaica. Ethnography, key informant interviews and focus groups were used to gather data from a sample of 33 male and female adults during the summer of 2003. The sample included health and social service providers, HIV positive men and women, and men and women with same sex partners in urban and rural Jamaica. A strong and consistent relationship between homophobia and HIV/AIDS-related stigma was reported, but the relationship varied according to geographic location, social class, gender, and skin colour (complexion)-to the extent that this coincided with class. Stigma against people living with HIV/AIDS and homosexuality was implicated in low levels of use of HIV testing, treatment and care services and the reluctance of HIV positive people to reveal their serostatus to their sexual partners. Data reveal a pressing need for anti-stigma measures for both homophobia and HIV/AIDS, and for training for health and human service professionals.