HİV/AİDS İLE YAŞAYAN KİŞİLERE YÖNELİK DAMGALAMA VE AYRIMCILIK: NİTEL BİR ARAŞTIRMA, İSTANBUL/TÜRKİYE

Öz

Amaç: İnsan immün yetmezlik virüsü, dünyadaki en önemli halk sağlığı sorunlarından biri olmaya devam etmektedir. Ruh ve beden sağlığı ile sosyal yaşam üzerinde önemli bir etkiye sahiptir. Hastalığın HİV'den AİDS'e ilerlemesinde erken tanı, düzenli muayene, takip ve antiretroviral tedavi önleyicidir. Bununla birlikte, damgalama ve ayrımcılık, HİV ve HİV ile ilgili komplikasyonlarla başa çıkmada başlıca engellerdir. Bu nedenle, ailelerde, sağlık bakım ortamlarında, topluluklarda ve işyerlerinde HİV pozitiflere yönelik damgalama ve ayrımcılık algısını anlamak çok önemlidir.
Yöntem: Veri analizi için kuram temelli nitel analiz kullanılmıştır. Verilerin toplanmasında yarı yapılandırılmış bir anket ile amaçlı ve kartopu örnekleme yöntemi kullanılmıştır. Yöntem ve sonuçları raporlamak için Niteliksel Araştırma Raporlama için Konsolide Kriterler (COREQ) ilkeleri formu kullanılmıştır. Veri analizi için MAXQDA21 nitel programı kullanılmıştır.
Bulgular: Araştırma, yaşları 23 ile 66 arasında değişen toplam 20 erkek ve 3 kadın katılımcıdan oluşmaktadır. Katılımcıların çoğunluğu homoseksüel erkeklerden oluşmaktadır (%69,5; n:16). Katılımcılardan biri hariç hepsinin cinsel ilişki yoluyla HIV'e yakalandığı görülmüştür. Katılımcıların neredeyse yarısı üniversite mezunudur; %13'ten biraz fazlası (n:3) iş güvencesine sahiptir. Veri analizi sonucunda damgalama ve ayrımcılık, ruhsal sağlık sorunlarını da kapsayan sonuçlar olmak üzere iki tema ve beş kategori ortaya çıkmıştır.
Sonuç: Bu çalışmaya katılanların neredeyse tamamının yaşamın her seviyesinde damgalanma ve ayrımcılığa maruz kaldığı görülmüştür. Başa çıkma stratejileri ve HIV/AIDS ile ilgili yorumları farklılık göstermektedir. Damgalama ve ayrımcılığa maruz kalmanın ruh sağlığı üzerinde önemli etkisi olduğu anlaşılmıştır. Damgalama ve ayrımcılıkla mücadele için halkın katılımını sağlamak, toplumsal farkındalık ve bilincin arttırılması önemli olabilir. Bunun için sosyal medya, okullar, üniversiteler ve resmi ve özel iletişim kaynakları ile işbirliği yapılabilir. Toplum sağlığı açısından önemli bir kronik enfeksiyon hastalığı olan HIV'in özellikle sağlık bölümlerinin eğitim müfredatına dahil edilmesi önerilebilir.

Anahtar Kelimeler

• HIV/AIDS
• damgalama
• ayrımcılık
• ART uyumu
• gömülü teori
• depresyon
• intihar düşüncesi
• sosyal önyargı

STIGMA AND DISCRIMINATION TOWARDS PEOPLE LIVING WITH HIV/AIDS: A QUALITATIVE STUDY, ISTANBUL/TURKEY

Öz

Objective: The human immunodeficiency virus remains one of the most important public health problems across the world. It has an important influence on mental and physical health, and social life. Early detection, regular examination, follow-ups, and antiretroviral therapy are preventive in progressing the disease from HIV to AIDS. However, stigma and discrimination are major impediments to cope with HIV and HIV related complications. Thus, it is crucial to understand the perception of stigma and discrimination towards HIV-positive within families, health care settings, communities and workplaces.
Method: A grounded theory-based qualitative analysis was used for data analysis. Purposive and snowball sampling method was used with a semi-structured questionnaire for data collection. The principles of the Consolidated Criteria for Reporting Qualitative Research (COREQ) were applied to report the methods and results. MAXQDA21 qualitative program was used for data analysis.
Results: The study consisted of 20 male and 3 female participants aged between 23 and 66 years old. Majority of them were men who have sex with men (69.5%; n:16). All of them, except one, contracted HIV by sexual intercourse. Almost half of them were university graduates; just over 13%(n:3) of them had job security. Two themes and five categories emerged from the codes defined by the data analysis. These themes were as follows: stigma and discrimination; and outcomes including mental health problems.
Conclusions: Almost all participants in this study experienced stigma and discrimination at all levels of life. Their coping strategies and interpretations of HIV/AIDS varied. Mental health problems were main outcome. Providing public engagement and increasing awareness/knowledge through social media, schools, universities, and formal and private communication resources may help them tackle negative life experiences, such as stigma and discrimination. It can be suggested that HIV, which is an important chronic infectious disease in terms of public health, should be included in the education curriculum of health departments.

Anahtar Kelimeler

• HIV/AIDS
• stigma
• discrimination
• ART adherence
• grounded theory
• depression
• suicide ideation
• social prejudice

Kaynakça

1. 1. Ghiasvand H, Higgs P, Noroozi M, Ghaedamini G, Hemmat M, Ahounbar E, et al. Social and demographical determinants of quality of life in people who live with HIV / AIDS infection : evidence from a meta-analysis. Biodemography Soc Biol. 2020;65(1):57–72.
2. 2. Wagener MN, Roelofs PDDM, Miedema HS, Dees PM, Dahmen R, Gorp ECM Van, et al. The development of a multidisciplinary , evidence- based guideline for “ HIV and employment .” AIDS Care. 2015;27(2):133–41.
3. 3. Ornek OK, Ardic A. Evaluation of Nursing Practice in Patients With HIV/AIDS with the Omaha System Electronic-Based Information Program: A Retrospective Study. CIN Comput Informatics, Nurs. 2019;37(9):482–90.
4. 4. Carlander C, Wagner P, Yilmaz A, Sparén P, Svedhem V. Employment by HIV status, mode of HIV transmission and migrant status: a nation-wide population-based study. AIDS. 2021;35(1):115–23.
5. 5. Republic of Turkey Ministry of Health. Turkey HIV/AIDS Control Program 2019-2024/Türkiye HIV / AIDS Kontrol Programı 2019-2024. Irmak H, Yardım N, Keklik K, Keklik F, editors. Saglık Bakanlıgı yayın no:1131, Ankara: Artı6 Medya Tanıtım Matba Ltd. Şti; 2019.
6. 6. Mete B, Gunduz A, Bolukcu S, Karaosmanoglu HK, Yildiz D, Koç MM, et al. HIV care in Istanbul, Turkey: How far is it from the UNAIDS 90–90–90 targets? Int J STD AIDS. 2019;30(13):1298–303.
7. 7. Gokengin D, Calik Ş, Oktem P. Türkiye ’ de HIV ’ le İlgili Damgalama ve Ayrımcılığın Analizi : HIV ’ le Yaşayan Kişiler İçin Damgalanma Göstergesi Sonuçları. Klimik J / Klimik Derg. 2017;30(1):15–21.
8. 8. Ornek OK, Tabak F, Mete B. Stigma in Hospital : an examination of beliefs and attitudes towards HIV / AIDS patients , Istanbul. AIDS Care. 2020;0(0):1–7.

9. 9. Öktem P. Türkiye’de HIV/AIDS ile Yaşayanların Çalışma Hakkı İhlalleri: Yasal Çerçeve ve Alandan Örnekler. In: VI Sosyal İnsan Hakları Ulusal Sempozyumu. Eskişehir/Turkey; 2014.
10. 10. Zhao M, Liu B, Zheng T, Xu J, Hao Y, Wang J, et al. Factors associated with hostility among people living with HIV / AIDS in Northeast China : a cross-sectional study. BMC Public Health. 2019;19(1189).
11. 11. Bader A, Kremer H, Erlich-trungenberger I, Rojas R, Lohmann M, Deobald O, et al. An adherence typology : Coping , quality of life , and physical symptoms of people living with HIV / AIDS and their adherence to antiretroviral treatment. Med Sci Monit. 2006;12(12):493–501.
12. 12. Oran NT, Şenuzun F. A loop to be broken in a society: HIV/AIDS stigma and coping strategies. J Hum Sci. 2008;5(1).
13. 13. Gesesew HA, Gebremedhin AT, Demissie TD, Kerie MW, Sudhakar M, Mwanri L. Significant association between perceived HIV related stigma and late presentation for HIV / AIDS care in low and middle-income countries : A systematic review and meta- analysis. PLoS One. 2017;12(3):e0173928.
14. 14. Bezabhe WM, Chalmers L, Bereznicki LR, Peterson GM, Bimirew MA, Kassie DM. Barriers and Facilitators of Adherence to Antiretroviral Drug Therapy and Retention in Care among Adult HIV- Positive Patients : A Qualitative Study from Ethiopia. PLoS One. 2014;9(5).
15. 15. Yathiraj AB, Unnikrishnan B, Ramapuram JT, Kumar N, Mithra P, Thapar R, et al. HIV-related stigma experienced by people living with HIV / AIDS in coastal South India. HIV &AIDS Rev Int J HIV-Related Probl. 2018;17(1):30–5.
16. 16. Eshun-wilson I, Rohwer A, Hendricks L, Oliver S, Garner P. Being HIV positive and staying on antiretroviral therapy in Africa : A qualitative systematic review and theoretical model. PLoS One. 2019;14(1):e0210408.
17. 17. Monroe-wise A, Maingi Mutiti P, Kimani H, Moraa H, Bukusi DE, Farquar C. Assisted partner notification services for patients receiving HIV care and treatment in an HIV clinic in Nairobi , Kenya : a qualitative assessment of barriers and opportunities for scale-up. J Int AIDS Soc. 2019;22(S3):e25315.
18. 18. Brion JM, Leary MR, Drabkin AS. Self-compassion and reactions to serious illness : The case of HIV. HHS Public Access. 2015;19(2):218–29.
19. 19. Naidoo P, Premdutt R. Do challenges still exist amongst HIV / AIDS patients in managing their condition ? A cross-sectional study of 297 participants in the Ethekwini Metro of Do challenges still exist amongst HIV / AIDS patients in managing their. African J AIDS Res. 2019;18(3):198–204.
20. 20. Boucher LM, Brien KKO, Baxter LN, Fitzgerald ML, Liddy CE, Kendall CE. Patient Education and Counseling Healthy aging with HIV : The role of self-management support. Patient Educ Couns. 2019;102(8):1565–9.
21. 21. Glaser B, Strauss AL. The discovery of grounded theory: Strategies for qualitative research. 1967. 139 p.
22. 22. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research ( COREQ ): a 32-item checklist for interviews and focus groups. Int J Qual Heal Care. 2007;19(6):349–57. 23. Corbin, Juliet M.; Strauss A. Grounded theory research: Procedures, canons, and evaluative criteria. Qual Sociol. 1990;13(1):3–21.
23. 24. Li X, Yuan L, Li X, Shi J, Jiang L, Zhang C, et al. Factors associated with stigma attitude towards people living with HIV among general individuals in Heilongjiang , Northeast China. BMC Infect Dis. 2017;17(154):1–7.
24. 25. Care P, Tesemma AL, Abate MG, Abebo ZH, Madebo WE. Determinants of Poor Quality of Life Among Adults Living with HIV and Enrolled in Highly Active Anti-Retroviral Therapy at Public Health Facilities of Arba Minch Town Administration in Southern Ethiopia. AIDS Care - Res Palliat Care. 2019;11:387–94.
25. 26. Kontomanolis EN, Michalopoulos S, Gkasdaris G, Fasoulakis Z. The social stigma of HIV – AIDS : society ’ s role. HIV/AIDS - Res Palliat Care. 2017;9:111–8.
26. 27. Abedinia N, Rasoolinajad M, Noorbala A, Badie BM. I am HIV-positive , but I am a human being : qualitative study on experiences of stigma in health care centres in the Islamic Republic of Iran. East Mediterr Heal J. 2019;25(10):669–76.
27. 28. Ali H, Zakar R, Junaid K, Khan A, Fischer F. Frequency and reasons for delayed treatment initiation after HIV diagnosis: cross-sectional study in Lahore, Pakistan. BMC Public Health. 2021;21(1):1–12.
28. 29. Soffer M. HIV/AIDS-related beliefs among Israeli Arab-Palestinian women. Heal Soc Care Community. 2020;28(1):216–24.
29. 30. Gh.Barkish F, Jalali R, Jalali A. Experiences of patients with primary HIV diagnosis in Kermanshah-Iran regarding the nature of HIV / AIDS : A qualitative study. Heliyon. 2019;5(August):e02278.
30. 31. Wong LP. Multi-ethnic perspective of uptake of HIV testing and HIV-related stigma: A cross-sectional population-based study. AIDS Care. 2013;25(11):1356–1369.
31. 32. Özdemir HÖ, Tosun S, Özdemir D, Korkmaz E. The determinants of employability of people living with HIV / AIDS in Turkey. Am J Ind Med. 2020;63:92–8.
32. 33. Oliva J. Health economics letters labour participation of people living with HIV / AIDS in Spain. Health Econ. 2010;500(April 2009):491–500.
33. 34. Platten M, Pham HN, Nguyen H V. Knowledge of HIV and factors associated with attitudes towards HIV among final-year medical students at Hanoi medical university in Vietnam.[Erratum appears in BMC Public Health. 2014;14:576 Note: Nguyen, Nhu T [added]; Le, Giang M [added]]. BMC Public Health. 2014;14:265.