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Article(id=1241102732044596138, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401399, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1706025600000, receivedDateStr=2024-01-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831549893, onlineDateStr=2026-03-18, pubDate=1721836800000, pubDateStr=2024-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831549893, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831549893, creator=13701087609, updateTime=1773831549893, updator=13701087609, issue=Issue{id=1241102730337505325, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831549486, creator=13701087609, updateTime=1773831697291, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103350322745680, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103350322745681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2513, endPage=2516, ext={EN=ArticleExt(id=1241102732350780336, articleId=1241102732044596138, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=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, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
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.

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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。

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杨淑娟，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=4UHP8ND60b0bJqS+vbDhiw==, magXml=yt9vKUvwPyX/4bmq9WOVwQ==, pdfUrl=null, pdf=ZD6m42X+6JHhQUv+b0Ar9g==, pdfFileSize=499638, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=JoGm8QDzMyUq+DS2hSkSJA==, mapNumber=null, authorCompany=null, fund=null, authors=

陈慧（1966—），女，本科，主任护师，研究方向：艾滋病治疗管理

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陈慧（1966—），女，本科，主任护师，研究方向：艾滋病治疗管理

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陈慧（1966—），女，本科，主任护师，研究方向：艾滋病治疗管理

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Journal of Affective Disorders, 2020, 265: 538-544., articleTitle=Prospective relationships of mentally passive sedentary behaviors with depression: Mediation by sleep problems, refAbstract=null)], funds=[Fund(id=1241102740147990830, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, awardId=81703279, language=CN, fundingSource=国家自然科学基金(81703279), fundOrder=null, country=null), Fund(id=1241102740261237046, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, awardId=SWFZ23-Y-19, language=CN, fundingSource=四川省基层卫生事业发展研究中心科研课题(SWFZ23-Y-19), fundOrder=null, country=null), Fund(id=1241102740332540220, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, awardId=2022ZC02, language=CN, fundingSource=中央财政重大传染病防治项目(2022ZC02), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241102732925400009, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, xref=1., ext=[AuthorCompanyExt(id=1241102732933788618, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, companyId=1241102732925400009, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Mianyang 404 Hospital, Mianyang, Sichuan 621000, China), AuthorCompanyExt(id=1241102732942177228, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, companyId=1241102732925400009, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川绵阳四○四医院，四川 绵阳 621000)]), AuthorCompany(id=1241102733076394959, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, xref=2., ext=[AuthorCompanyExt(id=1241102733084783567, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, companyId=1241102733076394959, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学-香港理工大学灾后重建与管理学院)]), AuthorCompany(id=1241102733164475346, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, xref=3., ext=[AuthorCompanyExt(id=1241102733177058261, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, companyId=1241102733164475346, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.四川大学华西公共卫生学院/华西第四医院)])], figs=[ArticleFig(id=1241102739548205304, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, language=EN, label=Table 1, caption=

Demographic characteristics of HIV/AIDS patients

, figureFileSmall=null, figureFileBig=null, tableContent=
项目占比依从性不好依从性好χ2P
性别1.4760.224
男271（67.6）87（71.9）184（65.7）
女130（32.4）34（28.1）96（34.3）
年龄（岁）0.1470.986
50~60225（56.1）69（57.0）156（55.7）
61~70111（27.7）33（27.3）78（27.9）
71~8056（14.0）16（13.2）40（14.3）
81~909（2.2）3（2.5）6（2.1）
婚姻状况2.3350.506
未婚16（4.0）7（5.8）9（3.2）
已婚/同居250（62.3）70（57.9）180（64.3）
离婚/分居89（22.1)29（24.0）60（21.4）
丧偶46（11.5）15（12.4）31(11.1)
病毒载量（cells/ml）3.9430.139
≤20234（58.4）79（65.3）155（55.4）
>2083（20.7）23（19.0）60（20.1）
无记录84（20.9）19（15.7）65（23.2）
CD4个数（个/uL）3.8080.283
0~20044（11.0）16（13.2）28（10.0）
201~500173（43.1）52（43.0）121（43.2）
≥501107（26.7）36（29.8）71（25.4）
无记录77（19.2）17（14.0）60（21.4）
现在/既往吸烟5.0040.025
是115（28.7）44（36.4）71（25.4）
否286（71.3）77（63.4）209（74.6）
现在/既往饮酒5.0740.017
是95（23.7）38（31.4）57（20.4）
否306（76.3）83（68.6）223（79.6）
抗病毒治疗方案4.1990.122
三联343（85.5）110（90.9）233（83.2）
二联30（7.4）55（4.1）25（8.9）
单片28（6.9）6（5.0）22（7.9）121.979<0.001
个人及家庭支持
≤26224（55.9）118（97.5）106（37.9）
>26177（44.1）3（2.5）174（62.1）
社区及社会支持7.0960.008
≤14242（60.3）85（70.2）157（56.1）
>14159（39.7）36（29.8）123（43.9）
), ArticleFig(id=1241102739640479999, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, language=CN, label=表1, caption=

HIV/AIDS人口学特征

, figureFileSmall=null, figureFileBig=null, tableContent=
项目占比依从性不好依从性好χ2P
性别1.4760.224
男271（67.6）87（71.9）184（65.7）
女130（32.4）34（28.1）96（34.3）
年龄（岁）0.1470.986
50~60225（56.1）69（57.0）156（55.7）
61~70111（27.7）33（27.3）78（27.9）
71~8056（14.0）16（13.2）40（14.3）
81~909（2.2）3（2.5）6（2.1）
婚姻状况2.3350.506
未婚16（4.0）7（5.8）9（3.2）
已婚/同居250（62.3）70（57.9）180（64.3）
离婚/分居89（22.1)29（24.0）60（21.4）
丧偶46（11.5）15（12.4）31(11.1)
病毒载量（cells/ml）3.9430.139
≤20234（58.4）79（65.3）155（55.4）
>2083（20.7）23（19.0）60（20.1）
无记录84（20.9）19（15.7）65（23.2）
CD4个数（个/uL）3.8080.283
0~20044（11.0）16（13.2）28（10.0）
201~500173（43.1）52（43.0）121（43.2）
≥501107（26.7）36（29.8）71（25.4）
无记录77（19.2）17（14.0）60（21.4）
现在/既往吸烟5.0040.025
是115（28.7）44（36.4）71（25.4）
否286（71.3）77（63.4）209（74.6）
现在/既往饮酒5.0740.017
是95（23.7）38（31.4）57（20.4）
否306（76.3）83（68.6）223（79.6）
抗病毒治疗方案4.1990.122
三联343（85.5）110（90.9）233（83.2）
二联30（7.4）55（4.1）25（8.9）
单片28（6.9）6（5.0）22（7.9）121.979<0.001
个人及家庭支持
≤26224（55.9）118（97.5）106（37.9）
>26177（44.1）3（2.5）174（62.1）
社区及社会支持7.0960.008
≤14242（60.3）85（70.2）157（56.1）
>14159（39.7）36（29.8）123（43.9）
), ArticleFig(id=1241102739745337608, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, language=EN, label=Table 2, caption=

Regression analysis of the association between compliance and perception of discrimination in HIV/AIDS patients with antiviral therapy

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素OR（95%CI）SEWalsP
担心公开1.116（1.023~1.217）0.0446.1320.013
公众歧视1.105（1.008~1.211）0.0474.5090.034
内在羞耻1.119（1.022~1.225）0.0465.9080.015
), ArticleFig(id=1241102739820835088, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, language=CN, label=表2, caption=

HIV/AIDS抗病毒治疗依从性与歧视感知的回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素OR（95%CI）SEWalsP
担心公开1.116（1.023~1.217）0.0446.1320.013
公众歧视1.105（1.008~1.211）0.0474.5090.034
内在羞耻1.119（1.022~1.225）0.0465.9080.015
), ArticleFig(id=1241102739904721170, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, language=EN, label=Table 3, caption=

Regression analysis oftheassociation between HIV/AIDS discrimination perception and adherence to antiviral therapy in different social support groups

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素OR（95%CI）SEWalsP
个人及家庭支持
≤26
担心公开1.159（1.034~1.299）0.0586.4380.011
公众歧视1.128（1.004~1.267）0.0594.1000.043
内在羞耻1.150（1.021~1.297）0.0615.2550.022
>26
担心公开1.079（0.676~1.721）0.2380.1010.750
公众歧视1.039（0.558~1.935）0.3170.0140.905
内在羞耻0.804（0.469~1.380）0.2750.6240.430
社会及社区支持
≤14
担心公开1.067（0.948~1.202）0.0611.1640.281
公众歧视1.057（0.929~1.203）0.0660.7130.398
内在羞耻1.085（0.953~1.235）0.0661.5330.216
>14
担心公开1.134（0.966~1.330）0.0812.3710.124
公众歧视1.048（0.877~1.251）0.0910.2650.607
内在羞耻1.092（0.924~1.289）0.0851.0660.302
), ArticleFig(id=1241102740001190173, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102732044596138, language=CN, label=表3, caption=

不同社会支持分组分层中HIV/AIDS歧视感知对抗病毒治疗依从性的回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素OR（95%CI）SEWalsP
个人及家庭支持
≤26
担心公开1.159（1.034~1.299）0.0586.4380.011
公众歧视1.128（1.004~1.267）0.0594.1000.043
内在羞耻1.150（1.021~1.297）0.0615.2550.022
>26
担心公开1.079（0.676~1.721）0.2380.1010.750
公众歧视1.039（0.558~1.935）0.3170.0140.905
内在羞耻0.804（0.469~1.380）0.2750.6240.430
社会及社区支持
≤14
担心公开1.067（0.948~1.202）0.0611.1640.281
公众歧视1.057（0.929~1.203）0.0660.7130.398
内在羞耻1.085（0.953~1.235）0.0661.5330.216
>14
担心公开1.134（0.966~1.330）0.0812.3710.124
公众歧视1.048（0.877~1.251）0.0910.2650.607
内在羞耻1.092（0.924~1.289）0.0851.0660.302
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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
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陈慧 1 , 贾文君 1 , 王莉鸿 1 , 王瑶 1 , 王岚 1 , 刘佳 1 , 余彬 2, 3 , 杨淑娟 3
现代预防医学 | 流行病与统计方法 2024,51(14): 2513-2516
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现代预防医学 | 流行病与统计方法 2024, 51(14): 2513-2516
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
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陈慧1, 贾文君1, 王莉鸿1, 王瑶1, 王岚1, 刘佳1, 余彬2, 3, 杨淑娟3
作者信息
  • 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

    • 陈慧（1966—），女，本科，主任护师，研究方向：艾滋病治疗管理

通讯作者:

杨淑娟，E-mail：
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
Hui CHEN1, Wen-jun JIA1, Li-hong WANG1, Yao WANG1, Lan WANG1, Jia LIU1, Bin YU2, 3, Shu-juan YANG3
Affiliations
  • Mianyang 404 Hospital, Mianyang, Sichuan 621000, China
出版时间: 2024-07-25 doi: 10.20043/j.cnki.MPM.202401399
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摘要
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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。

艾滋病  /  社会支持  /  歧视感知  /  抗病毒治疗依从性  /  影响因素
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.

HIV/AIDS  /  Social support  /  Discrimination perception  /  Adherence to antiretroviral therapy  /  Influencing factors
陈慧, 贾文君, 王莉鸿, 王瑶, 王岚, 刘佳, 余彬, 杨淑娟. 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. 现代预防医学, 2024 , 51 (14) : 2513 -2516 . DOI: 10.20043/j.cnki.MPM.202401399
Hui CHEN, Wen-jun JIA, Li-hong WANG, Yao WANG, Lan WANG, Jia LIU, Bin YU, Shu-juan YANG. 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[J]. Modern Preventive Medicine, 2024 , 51 (14) : 2513 -2516 . DOI: 10.20043/j.cnki.MPM.202401399
正文
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由于艾滋病(AIDS)是由艾滋病病毒(HIV)引起的一种严重危害人类健康的致死性慢性传染病[1]。近年来，新发现的50岁及以上艾滋病病毒感染者和艾滋病病人(HIV/AIDS)数量逐年上升，2017年中老年HIV/AIDS新发人数占新发病例的14.7%[2]，该人群逐渐成为艾滋病防治工作的重点人群。与年轻人相比，老年HIV/AIDS的服药依从性更低[3]，这对HIV/AIDS的预防和治疗提出了更高的要求。因为HIV感染途径的特殊性，人们对艾滋病感染者存在恐惧、排斥和歧视。研究发现[4-5]，影响HIV/AIDS接受抗病毒治疗的重要因素是HIV相关歧视与羞辱，特别是50岁及以上中老年HIV/AIDS人群。既往研究提示，对于社会支持高的人群，其心理健康问题会达到缓解[6]，社会支持由此起到一定的修饰效应。虽然艾滋病病毒感染者和艾滋病病人(HIV/AIDS)在医疗机构的获得一定支持，但社会支持整体水平偏低[7-8]。社会支持水平较低的中老年HIV/AIDS，艾滋病相关歧视感知对服药依从性的不利影响可能更为凸显，而相关研究证据不足。本文旨为了解艾滋病相关歧视感知对中老年HIV/AIDS抗病毒治疗（antiretroviral therapy，ART）依从性的影响，并分析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。
1　对象与方法
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1.1　研究对象
本研究采取整群随机抽样方法，于2022年11月至2023年4月期间抽取绵阳市5个主城区作为研究区域所有在治的50岁以上的HIV/AIDS，421人纳入，401人接受调查，接受调查率95.25%（401/421）。纳入标准为：（1）年龄为 50 岁及以上中老年HIV/AIDS；（2）正在服用抗病毒治疗药物；（3）在知情同意原则下自愿参加基线和随访调查。排除标准：（1）调查期间不在本地者；（2）存在认知功能障碍或精神疾病的感染者。本研究通过四川大学华西第四医院/华西公共卫生学院伦理委员会的审核 (批号：Gwll2021060)。
1.2　研究方法
自行设计调查问卷，统一培训调查人员，在患者知情同意情况下，面对面对调查对象进行调查。调查内容包括一般人口学资料、社会支持、歧视感知和抗病毒治疗依从性等。调查所用量表包括：
（1）社会支持量表[9]：含18个条目5个维度，分别为社会支持、社区支持、社团支持、家庭支持和个人支持，量表总分15～74分，前3个维度分值均为2～10分，后两个维度分值分别为5～24分、4～20分，分值越高社会支持越高。该量表Conbachα系数为0.67，信度良好。
（2）HIV相关歧视感知量表[10]：该量表包含12个条目4个维度，分别为担心公开、公众歧视、家庭歧视、内在羞辱，量表总分12～48分，4个维度分值均为3～12分，分值越高歧视感知的水平越高。
（3）服药依从性[11]：ART服药依从性根据调查者最近一次漏服药物的情况来判断，漏服药物发生在：①过去的一周内；②1~2周前；③3-4周前；④1-3个月前；均判断为漏服，即依从性差。漏服药物发生在:超过3 个月之前或从未漏服过均判断为未漏服，即依从性好。
1.3　统计分析
采用SPSS 23.0进行统计分析。计量资料采用均数±标准差、计数资料采用频数和构成比描述分析，采用t检验和χ2检验/方差分析。根据t检验和χ2检验/方差分析结果，将服药依从性作为因变量，进行logistic回归分析，P<0.05 表示差异具有统计学意义。
2　结果
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2.1　患者基本情况　本次研究共纳入绵阳市401名50岁及以上中老年HIV/AIDS 患者，其中男性271人（占67.9%），50~60岁者225人（占56.1%），已婚或同居有配偶者250人（占62.31%），吸烟者115人（占28.7%），饮酒者95人（占23.7%），抗病毒药三联方案343人（占85.5%）。患者人口学特征见表1。
2.2　服药依从性情况　将服药依从性作为因变量，一般人口社会学作为自变量，进行单因素分析发现个人及家庭支持、社会及社区支持、病毒载量、抗病毒药物方案、吸烟、饮酒对服药依从性影响有统计学意义（P<0.05），详见表1。
2.3　歧视感知与治疗依从性情况　将歧视感知和单因素中P<0.05的变量纳入到回归模型，分析发现担心公开（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）对服药依从性影响有统计学意义(P值<0.05)，但家庭歧视对服药依从性的作用差异无统计学意义(P值均>0.05)，见表2。
2.4　社会支持对歧视感知的影响按照个人及家庭支持得分中位数（26分）分层分析发现，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）是个人及家庭支持得分≤26组中服药依从性的影响因素（P值均<0.05）；按照社会及社区支持得分中位数（14分）分层分析发现，歧视感知对服药依从性作用无统计学意义P>0.05），见表3。
3　讨论
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本研究发现歧视感知、病毒载量、抗病毒药物方案、吸烟、饮酒对服药依从性影响均有统计学意义（P值均<0.05）；分层分析发现，在个人及家庭支持中担心公开、公众歧视、内在羞耻是服药依从性的影响因素（P<0.05）。
HIV/AIDS广泛受到来自社会、家庭的歧视，包括对获得 ART、坚持ART 及其依从性、心理健康和生活质量等方面的影响[12-13]。本研究发现歧视感知中担心公开、公众歧视和内在羞耻是治疗依从性的重要影响因素。这提示艾滋病治疗工作者在工作中要强化减少对HIV/AIDS的羞辱和歧视方面的工作。鼓励HIV/AIDS在知晓自己病情时主动告知或者在知情同意下由医务人员告知家人和配偶，加强艾滋病相关知识的健康教育，提高其知晓率，降低恐惧感，从而能够给HIV/AIDS提供心理及情感上的支持，进一步提高ART治疗依从性。
社会支持是来自他人的对个体精神和物质上的关心、支持和帮助[14]。得到社会支持让人们有积极的生活态度及更好的生活体验，可以对抗负性心理作用，获得良好的生活质量和情绪体验[15]。HIV感染者需要终身服药，长期抗病毒治疗使患者面临生理、心理、社会层面的巨大压力。近年来，HIV感染者心理健康问题受到广泛关注，但是整个社会层面的支持仍比较薄弱。本研究结果显示，个人及家庭支持中担心公开、公众歧视、内在羞耻对HIV/AIDS患者ART治疗依从性影响具有统计学意义。患者在家人的理解支持和主动关心帮助下，一方面可以缓解他们所面临的压力与负性心理，另一方面HIV/AIDS在得知自己感染艾滋病病毒或确诊为艾滋病后，为了避免把病毒传染给家人的风险，他们能够积极治疗[16]，主动配合，养成好的服药依从性。这提示艾滋病治疗工作者要加强社会支持工作，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， 主动教育鼓励HIV/AIDS家人参与治疗活动，提高随访依从性，确保ART治疗成功率，保证社会支持作用的充分发挥。
本研究存在不足。首先，横断面设计无法判断歧视感知与治疗依从性之间的因果顺序，仅能得出两者的相关关系；其次，仅采用歧视感知量表来衡量≧50岁HIV感染者的歧视感知水平，可能会导致对该人群歧视感知水平的低估。
综上所述，个人及家庭支持、抗病毒治疗方案和病毒载量是影响HIV/AIDS中老年患者抗病毒治疗依从性的重要因素，为提高ART治疗依从性和成功率，艾滋病治疗管理工作人员要注重社会支持对HIV/AIDS歧视感知的影响，提高社会支持特别是个人及家庭支持力度，对HIV/AIDS及家属加大宣传教育力度，尽可能减少对HIV/AIDS的歧视羞辱，充分发挥家庭和社会的作用，提高社会支持水平。同时，开展治疗前、治疗中病毒载量的检测，根据药物副反应、病毒载量及耐药情况，及时调整个性化的治疗方案。
基金
收起
  • 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)
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参考文献 引证文献
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2024年第51卷第14期
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doi: 10.20043/j.cnki.MPM.202401399
  • 接收时间：2024-01-24
  • 首发时间：2026-03-18
  • 出版时间：2024-07-25
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  • 收稿日期：2024-01-24
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)
作者信息
    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

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2种不同金属材料的力学参数
科
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Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
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Genus		 种数
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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