艾滋病患者的歧视知觉与社会支持:HIV感染结果告知的中介作用

Self-stigma and Perceived Social Support among HIV/AIDS Patients: The Mediating Role of HIV Notification

目的 调查艾滋病患者HIV感染结果告知现状,并分析HIV感染结果告知在患者歧视知觉、社会支持间的中介作用,为今后艾滋病患者疾病告知干预提供依据。方法 于2020年6—12月对某省会城市1 276名艾滋病患者进行匿名问卷调查,调查艾滋病患者HIV感染结果告知现状、社会支持与歧视知觉水平,采用二分类非条件Logistic回归模型及有序Logistic回归模型分析HIV感染结果告知、歧视知觉与社会支持的相关性,采用逐步检验对HIV感染结果告知在歧视知觉与社会支持间的中介效应进行检验。结果 (1)HIV阳性确诊至今,艾滋病患者家人、朋友及伴侣告知率分别为52.6%(671/1 276)、49.3%(629/1 276)、39.3%(502/1 276)。(2)多因素分析结果显示,歧视知觉与家人告知(OR=0.48,P=0.003)、朋友告知(OR=0.48,P=0.003)/(OR=0.69,P=0.003)、伴侣告知(OR=0.46,P=0.001)/(OR=0.71,P=0.007)呈负相关;社会支持与歧视知觉(OR=0.34,P<0.001)/(OR=0.68,P=0.006)呈负相关,与家人告知(OR=1.39,P=0.022)、朋友告知(OR=1.44,P=0.011)呈正相关,与伴侣告知不相关(P>0.05)。(3)家人告知(中介效应占总效应的比例为20.3%)、朋友告知(中介效应占总效应的比例为28.9%)在艾滋病患者的歧视知觉与社会支持间起部分中介作用。结论 歧视知觉直接影响艾滋病患者的社会支持,亦可通过家人告知和朋友告知间接影响其社会支持。在协助和促进艾滋病患者实现HIV感染结果告知的干预工作中,还应特别关注患者的伴侣告知。

Objective To investigate disease notification of HIV/AIDS patients and analyze the relationship between HIV notification, self-stigma and perceived social support, in order to provide a basis for future HIV/AIDS patients’ disease notification and intervention.Methods A self-administered questionnaire survey was conducted anonymously among 1 276 HIV/AIDS patients in a provincial capital city from June to December 2020,and used to investigate patients’ disease notification, perceived discrimination and social support.Two-class unconditional Logistic regression model and ordinal Logistic regression model were used to analyze the mediating role of HIV notification between them.Step-by-step testing was used to test the mediating effect of HIV infection result notification between perceived discrimination and social support.Results (1)Since the diagnosis of HIV/AIDS,the proportions of HIV/AIDS patients who informed their families, friends and partners were 52.6%(671/1 276),49.3%(629/1 276),and 39.3%(502/1 276)respectively.(2)Multivariate logistic regression analysis showed discrimination perception was related to family notification(OR=0.48,P=0.003),friend notification(OR=0.48,P=0.003)/(OR=0.69,P=0.003),partner notification(OR=0.46,P=0.001)/(OR=0.71,P=0.007)was negatively correlated;social support and self-stigma(OR=0.34,P<0.001)/(OR=0.68,P=0.006)was negatively correlated, social support and family members informed(OR=1.39,P=0.022),friends informed(OR=1.44,P=0.011)was positively correlated;social support was not correlated with partner notification(P>0.05).(3)Family notification(mediating effect accounted for 20.3% of the total effect)and friend notification(mediating effect accounted for 28.9% of the total effect)played a part of the mediating role between AIDS patients’ discrimination perception and social support.Conclusion The self-stigma directly affects the social support of AIDS patients, and can also indirectly affect their social support through the notification of family members and friends.In the intervention work that assists and promotes AIDS patients to realize disease notification, special attention should be paid to the patient’s partner notification.