Background

Stigma is an underlying cause of health inequities, and a major barrier to HIV prevention, care, and treatment. Experiences of HIV stigma have been shown to reduce engagement in care across the HIV care continuum, from testing and diagnosis to long-term retention in care and anti-retroviral therapy adherence. In Rwanda, approximately 130,000 women are living with HIV, representing a prevalence rate (3.7%) which is substantially higher than Rwandan men (2.2%). Both the national Rwanda and City of Kigali HIV and AIDS strategic plans identify stigma as a key concern for reducing the burden of HIV.

Objectives

The first objective of this study was to understand the sources of HIV-related stigma among women living with HIV in Rwanda. The second objective was to understand the cultural, linguistic, and contextual context of HIV-related stigma and the intersection of HIV-related stigma to the HIV care continuum (engagement in care, medication/treatment adherence) among women with HIV in Rwanda.

Design

This study used a cross-sectional, qualitative design.

Setting and participants

Three-three women from urban and rural settings in Rwanda were recruited from public HIV treatment and care centers to participate in this study.

Method

Focus groups discussions, guided by a structured interview guide, were used to collect qualitative data. Framework analysis was used to analyze the data, which was collected during July 2018.

Results

The participants in this study highlighted that Rwandan women with HIV experience all forms of stigma – enacted, anticipated, perceived, and internalized – associated with HIV as well as structural stigma. Further, three major themes – dehumanizing language, importance of motherhood in the context of HIV, and overcoming HIV stigma – emerged from the data.

Conclusion

The results of this study are among the few to give voice and perspective to the stigma experiences of Rwandan women with HIV.

The women with HIV participating in this study shed light on the pervasive and culturally constructed effects of stigma that continue to exist. Further, the findings from this study highlighted the significant intersection of the role dehumanizing language experienced by Rwandan women with HIV. Additionally, the intersectional identities of being a woman with HIV and a mother and their relationship to societal and cultural norms and expectations must be considered concurrently. Finally, the beneficial effects of support groups was identified as key in helping Rwandan women with HIV to accept self.

中文翻译：

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非人化的语言、艾滋病毒背景下的母性以及克服艾滋病毒耻辱——感染艾滋病毒的卢旺达妇女的声音：焦点小组研究

 背景

耻辱是健康不平等的根本原因，也是艾滋病毒预防、护理和治疗的主要障碍。事实证明，艾滋病毒耻辱经历会减少整个艾滋病毒护理连续过程中的护理参与度，从检测和诊断到长期保留护理和抗逆转录病毒治疗依从性。在卢旺达，大约有 130,000 名妇女感染艾滋病毒，其患病率 (3.7%) 远高于卢旺达男性 (2.2%)。卢旺达国家和基加利市的艾滋病毒和艾滋病战略计划都将耻辱视为减轻艾滋病毒负担的一个关键问题。

 目标

这项研究的第一个目标是了解卢旺达艾滋病毒感染妇女中与艾滋病毒相关的耻辱的根源。第二个目标是了解卢旺达艾滋病毒感染妇女中艾滋病毒相关耻辱的文化、语言和背景，以及艾滋病毒相关耻辱与艾滋病毒护理连续体（参与护理、药物/治疗依从性）的交叉点。

 设计

本研究采用横断面定性设计。

 背景及参与者

从卢旺达公共艾滋病毒治疗和护理中心招募了来自卢旺达城市和农村地区的三三名妇女参加这项研究。

 方法

在结构化访谈指南的指导下进行焦点小组讨论，用于收集定性数据。使用框架分析来分析 2018 年 7 月收集的数据。

 结果

这项研究的参与者强调，感染艾滋病毒的卢旺达妇女经历了与艾滋病毒相关的各种形式的耻辱——制定的、预期的、感知的和内化的——以及结构性耻辱。此外，数据中还出现了三个主要主题——非人性化的语言、艾滋病毒背景下母性的重要性以及克服艾滋病毒耻辱。

 结论

这项研究的结果是为数不多的为卢旺达艾滋病毒感染者的耻辱经历提供声音和视角的研究结果之一。

参与这项研究的艾滋病毒携带者女性揭示了持续存在的耻辱的普遍影响和文化建构的影响。此外，这项研究的结果强调了感染艾滋病毒的卢旺达妇女所经历的非人性语言角色的重大交叉。此外，必须同时考虑感染艾滋病毒的妇女和母亲的交叉身份及其与社会和文化规范和期望的关系。最后，支持小组的有益作用被认为是帮助感染艾滋病毒的卢旺达妇女接受自我的关键。