Impact of a multicomponent navigation strategy on stigma among people living with HIV and Kaposi's sarcoma in Kenya: a qualitative analysis.

Sigrid M Collier, Aggrey Semeere, Linda Chemtai, Helen Byakwaga, Celestine Lagat, Miriam Laker-Oketta, Juliet Bramante, Ann Pacheco, Morvarid Zehtab, Alexis G Strahan, Merridy Grant, Laura M Bogart, Ingrid V Bassett, Naftali Busakhala, Jesse Opakas, Toby Maurer, Jeffrey Martin, Samson Kiprono, Esther E Freeman
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Abstract

Persons with HIV-associated Kaposi's sarcoma (KS) experience three co-existing stigmatizing health conditions: skin disease, HIV, and cancer, which contribute to a complex experience of stigmatization and to delays in diagnosis and treatment. Despite the importance of stigma among these patients, there are few proven stigma-reduction strategies for HIV-associated malignancies. Using qualitative methods, we explore how people with HIV-associated KS in western Kenya between August 2022 and 2023 describe changes in their stigma experience after participation in a multicomponent navigation strategy, which included 1) physical navigation and care coordination, 2) video-based education with motivational survivor stories, 3) travel stipend, 4) health insurance enrollment assistance, 5) health insurance stipend, and 6) peer mentorship. A purposive sample of persons at different stages of chemotherapy treatment were invited to participate. Participants described how a multicomponent navigation strategy contributed to increased knowledge and awareness, a sense of belonging, hope to survive, encouragement, and social support, which served as stigma mitigators, likely counteracting the major drivers of intersectional stigma in HIV-associated KS.

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肯尼亚艾滋病毒感染者和卡波西肉瘤患者对多成分导航战略的污名化影响:定性分析。
与艾滋病病毒相关的卡波西肉瘤(KS)患者同时患有皮肤病、艾滋病病毒(HIV)和癌症这三种令人鄙视的健康问题,这导致了复杂的鄙视体验,并延误了诊断和治疗。尽管污名化在这些患者中非常重要,但很少有针对艾滋病相关恶性肿瘤的行之有效的减少污名化策略。我们采用定性方法,探讨了 2022 年 8 月至 2023 年期间肯尼亚西部的艾滋病相关 KS 患者如何描述他们在参与多成分导航策略(包括 1) 物理导航和护理协调、2) 基于幸存者励志故事的视频教育、3) 旅行津贴、4) 医疗保险注册援助、5) 医疗保险津贴和 6) 同伴指导)后在污名化体验方面的变化。我们邀请了处于不同化疗阶段的患者进行有目的的抽样调查。参与者描述了多成分导航策略如何有助于提高知识和意识、归属感、生存希望、鼓励和社会支持,这些都是减轻污名化的因素,很可能抵消了艾滋病毒相关 KS 中交叉污名化的主要驱动因素。
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