Estigmas que se entrecruzan con la adherencia al tratamiento antirretroviral en poblaciones clave jóvenes que viven con VIH en Zambia
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Introducción: Existe poca investigación sobre las experiencias de adherencia al tratamiento antirretroviral (TAR) entre hombres jóvenes que viven con VIH y que tienen sexo con hombres (HSH) y mujeres transgénero (MT) en Zambia. Este estudio tuvo como objetivo abordar esta brecha de evidencia mediante la elucidación de las manifestaciones del estigma que se entrecruzan con la adherencia al tratamiento antirretroviral en poblaciones clave jóvenes que viven con VIH en Zambia.
Métodos: Este estudio utilizó un diseño de métodos mixtos. Se realizaron entrevistas en profundidad para recoger datos cualitativos y se aplicó un cuestionario para recoger datos cuantitativos. Para el análisis de los datos cualitativos se utilizó un análisis temático. Los datos cuantitativos se analizaron de forma descriptiva utilizando Stata. La adherencia al TAR se definió como haber omitido alguna vez una dosis (sí/no). Se generaron frecuencias y porcentajes de adherencia al TAR según características sociodemográficas e indicadores de estigma.
Resultados: Se reclutaron 56 participantes en tres sitios: los distritos de Lusaka, Chipata y Solwezi. La edad media de los participantes fue de 23 años. La mitad de los participantes reportó haber omitido alguna vez una dosis de TAR, con proporciones iguales entre HSH (50%) y MT (50%). Las dosis omitidas fueron más frecuentes entre los participantes que experimentaron estigma relacionado con el VIH (59,4%) en comparación con aquellos que no lo experimentaron (37,5%). La omisión de dosis fue más prevalente entre quienes vivían con su familia (88,9%) en comparación con quienes no vivían con ella. El estigma relacionado con la orientación sexual o la identidad de género (OSIG) mostró patrones mixtos, sin diferencias consistentes en la omisión de dosis. Se observaron variaciones en la adherencia según edad, educación, empleo, arreglos de vivienda y entornos de atención, aunque no emergieron patrones claros debido al pequeño tamaño de la muestra. Los temas emergentes fueron: estigma basado en la orientación sexual e identidad de género; negociación de la identidad personal en contextos de incertidumbre; experiencias de estigma en la familia y adherencia al TAR; orientación sexual, adherencia al TAR y desafíos en la revelación del estado serológico; así como el reinicio del TAR.
Conclusión: El estudio aporta evidencia sobre cómo los distintos tipos de estigma se entrecruzan con la terapia antirretroviral en poblaciones clave jóvenes. La mayor parte del estigma que afectó la adherencia al TAR estuvo relacionada con el VIH. Apoyar la adherencia al TAR entre adolescentes y jóvenes, incluidos los grupos de minorías sexuales, puede requerir enfoques adaptados que aborden sus experiencias vividas.
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