中老年HIV/AIDS歧视感知对抗病毒治疗依从性的作用及社会支持的修饰效应分析  

Modification effect of social support level on the perception of discrimination against HIV and adherence to antiviral therapy among middle-aged and elderly people living with HIV

作　　者：陈慧[1] 贾文君[1] 王莉鸿 王瑶 王岚 刘佳 余彬 杨淑娟 CHEN Hui;JIA Wen-jun;WANG Li-hong;WANG Yao;WANG Lan;LIU Jia;YU Bin;YANG Shu-juan(Mianyang 404 Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]四川绵阳四○四医院,四川绵阳621000 [2]四川大学-香港理工大学灾后重建与管理学院 [3]四川大学华西公共卫生学院/华西第四医院

出　　处：《现代预防医学》2024年第14期2513-2516,2580,共5页Modern Preventive Medicine

基　　金：国家自然科学基金(81703279);四川省基层卫生事业发展研究中心科研课题(SWFZ23-Y-19);中央财政重大传染病防治项目(2022ZC02)。

摘　　要：目的探讨艾滋病相关歧视感知对中老年艾滋病病毒感染者和艾滋病病人(HIV/AIDS)抗病毒治疗(antiretroviral therapy,ART)依从性的影响及社会支持的修饰效应,为进一步提高ART治疗成功率提供指导依据。方法采取整群随机抽样方法,对绵阳市现存活中老年HIV/AIDS进行问卷调查,了解其社会人口学特征、社会支持、歧视感知及治疗依从性情况,运用logistic回归模型分析上述因素与HIV/AIDS治疗依从性间的关系。结果本研究共调查401例正在接受ART治疗的中老年HIV/AIDS,治疗依从性好占69.82%,依从性不好占30.18%,治疗成功率为93.06%。单因素分析显示,病毒有效抑制患者(病毒载量≤20)相对治疗失败患者(>20)依从性更好,单片和二联抗病毒药方案服药依从性更好。Logistic回归结果显示,担心公开(OR=1.116,95%CI:1.023~1.217)、公众歧视(OR=1.105,95%CI:1.008~1.211)、内在羞耻(OR=1.119,95%CI:1.022~1.225)是治疗依从性重要影响因素。分层分析发现,个人及家庭支持中担心公开(OR=1.159,95%CI:1.034~1.299)、公众歧视(OR=1.128,95%CI:1.004~1.267)、内在羞耻(OR=1.150,95%CI:1.021~1.297)是治疗依从性的影响因素。结论个人及家庭支持中担心公开、公众歧视、内在羞耻、抗病毒治疗方案和病毒载量会影响HIV/AIDS治疗依从性,故应加强社会支持力度,特别要提高个人及家庭的支持,增强其对歧视感知的修饰效应,同时对HIV/AIDS及家人宣传教育,增加支持,减少歧视,加强病毒载量检测并及时调整个性化的治疗方案。Objective To explore the impact of perceived HIV-related discrimination on antiretroviral therapy(ART)adherence among middle-aged and elderly individuals living with HIV/AIDS and the modifying effect of social support,so as to provide guidance for improving ART treatment success rates.Methods By using cluster random sampling method,a questionnaire survey was conducted among middle-aged and elderly HIV/AIDS patients in the city of Mianyang.The survey assessed their sociodemographic characteristics,social support,perceived discrimination,and treatment adherence.Logistic regression models were used to analyze the relationship between these factors and ART adherence.Results The study included 401 middle-aged and elderly HIV/AIDS patients receiving ART.Good adherence was observed in 69.82%of participants,while 30.18%had poor adherence.Univariate analysis revealed that patients with effective viral suppression(viral load≤20)demonstrated better adherence compared to treatment failure patients(viral load>20).Adherence was also higher among those following single or dual antiretroviral drug regimens.Logistic regression results indicated that fear of disclosure(OR=1.116,95%CI:1.023–1.217),public discrimination(OR=1.105,95%CI:1.008–1.211),and internal shame(OR=1.119,95%CI:1.022–1.225)significantly influenced treatment adherence.Stratified analysis further revealed that fear of disclosure(OR=1.159,95%CI:1.034–1.299),public discrimination(OR=1.128,95%CI:1.004–1.267),and internal shame(OR=1.150,95%CI:1.021–1.297)were associated with adherence.Conclusion Enhancing social support,particularly at the individual and family levels,is crucial to mitigate the impact of fear of disclosure,public discrimination,internal shame,and treatment regimens on HIV/AIDS treatment adherence.Public education and support programs should aim to reduce discrimination,strengthen viral load monitoring,and adjust personalized treatment plans promptly.

关 键 词：艾滋病 社会支持 歧视感知 抗病毒治疗依从性 影响因素 

分 类 号：R512.91[医药卫生—内科学]