Estigma em pessoas com HIV/Aids e implicações na adesão ao tratamento: um estudo de base comunitária

Abstract

The stigma associated with the human immunodeficiency virus (HIV) has been differentially associated with quality of life, with psychological impacts, access to care services, as well as lower adherence to treatment. This dissertation analyses the relationships between different forms of stigma experienced by people with HIV/AIDS with health outcomes, especially regarding adherence to HIV treatment. This is a community-based study, whose sample was composed of 1,784 people, aged between 18 and 76 years (µ = 40.14±12.95) and living with HIV by, approximately, ten years (µ = 10.61±8.76). Participants answered to a series of questions from the project Stigma Index Brazil, including measures of stigma and discrimination, internalized stigma, adherence to HIV/AIDS treatment, among others. Data were analysed descriptively (means, standard deviations) and by using inferential techniques (association tests, comparisons between groups, and regression models). In descriptive terms, it was noted that the majority of the sample (n = 1125; 63.84%) reported the male gender identity, followed by female (n = 566; 32.12%) and transsexual/non-binary individuals (n = 71; 4,02%). In addition, there was a greater representation of blacks, browns, yellows and indigenous people (n = 1239; 69.68%). The prevalence of individuals reporting missing one or more doses of antiretroviral therapy (ART) due to concerns of having their HIV diagnosis exposed was 25.45% (95%CI: 23.43–27.55%). Factors independently associated with ART non-adherence included lower age (OR=.982; 95%CI: .966–.998), internalized (OR=1.334; 95%CI: 1.214–1.467), and general HIV-related stigma (OR=1.049; 95%CI: 1.004–1.097). PLHA between 1 to 5 and 6 to 9 years were more likely to miss ART doses due to stigma-related concerns (OR=1.854;95%CI: 1.094– 3.140; OR= 1.889; 95%CI: 1.078–3.309, respectively). Individuals reporting fair health were more likely to miss a dose compared to those with good self-reported health (OR=1.636; 95%CI: 1.140–2.347). Finally, those who delayed starting medication were significantly more likely to miss doses in the last year (OR=1.940; 95%CI: 1.190–3.162) compared to those who started treatment immediately. In summary, this study showed that the risk of missing ART medication is influenced by several demographic, clinical, and psychosocial factors, and the results can be useful for HIV services and policies in a myriad of ways.