社會支持可以減輕年輕愛滋感染者之恥辱感對自殺的影響

資料來源：Oğuzhan Nuh / 2022 年 8 月 19 日 /aidsmap / 財團法人台灣紅絲帶基金會編譯

圖片：Rodnae Productions/Pexels

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在最近的第 24 屆國際愛滋病大會（AIDS 2022）上，來自南非和美國的兩項獨立研究顯示，與 HIV 相關的恥辱感和心理健康挑戰與年輕 HIV 感染者的自殺傾向相關。南非的研究顯示，社會支持具有保護作用，而美國的研究確定了其他風險因素，包括系統性種族主義、性少數群體地位和懷孕。

在過去的 45 年中，全球自殺率增加了約 60%，其中青少年和年輕人的增幅最大。許多研究發現，在愛滋病毒感染者中，自殺未遂和自殺意念（自殺念頭）的發生率很高，但對這一群體的自殺傾向的影響知之甚少。

來自南非開普敦大學的 Wylene Saal 博士提供了來自 715 名感染愛滋病毒的年輕女性的數據，其中包括 311 名青春期母親。超過一半的參與者最近被診斷出感染了愛滋病毒。在採訪時，平均年齡為 18 歲，23% 的女性居住在農村地區，20% 的女性居住在非正式住房中，76% 的女性至少無法獲得一種基本必需品。

在訪談期間，7% 的女性報告在上個月有自殺念頭或企圖自殺。儘管大多數女性表示她們得到了一些社會支持，但三分之一的女性在照護方面的留存率很差，三分之一的女性表示心理健康狀況不佳。在多變量分析中，照護留存不佳和 HIV 恥辱經歷與較高的自殺機率直接或間接相關（透過不良的心理健康介導）。進一步的分析顯示，社會支持減輕了照護存留率低和社會恥辱經歷的影響，降低了感染愛滋病毒的年輕女性的自殺機率。

Saal 強調，需要將預防和應對自殺納入 HIV 服務，透過減輕照護存留率低和污名化的風險因素。感染 HIV 的年輕女性，尤其是那些努力堅持 HIV 照護或支持網絡有限的女性，應該接受自殺和心理健康不良篩查。此外，同伴支持小組可以加強社會關係，以改善感染愛滋病毒的年輕女性的心理健康並減少自殺率。

來自哥倫比亞大學和紐約州精神病學研究所的 Philip Kreniske 博士介紹了紐約市青少年和年輕人前瞻性世代研究的結果。該研究招募了 206 名出生時感染 HIV 的參與者，以及 134 名在懷孕、分娩或出生後接觸 HIV 但未感染 HIV 的參與者。 2003 年至 2008 年間，該研究的平均加入研究之年齡為 12 歲，目前參與者的平均年齡為 28 歲。一半的參與者是女性，57% 是黑人，57% 是拉丁裔。

感染愛滋病毒的年輕人（27%）比愛滋病毒陰性的年輕人（16%）更頻繁地報告曾企圖自殺。在年齡調整模型中，與 HIV 陰性的人相比，感染 HIV 的年輕人自殺未遂的機率更高。在感染愛滋病毒的年輕人中，與其他性取向相比，那些被認定為異性戀的人自殺未遂的機率較低。對於那些懷孕或有懷孕伴侶的愛滋病毒感染者，企圖自殺的機率要高出兩倍多。 HIV 污名和心理健康問題再次與自殺未遂有關，而作為個人或家庭成員的自我價值感更強的年輕人自殺未遂的機率較低。

Kreniske 還指出，過去一年生活在弱勢社區造成的壓力、消極的生活事件和被捕都與自殺未遂的機率顯著增加有關。在之前的研究中，這些因素與系統性種族主義有關，在為可能面臨系統性障礙的 HIV 感染者提供照護和支持時必須考慮這些因素。

儘管越來越多的證據顯示社會支持對愛滋病毒感染者的心理健康和福祉產生了積極影響，但仍需要更多的研究來檢查影響愛滋病毒感染者或接觸愛滋病毒的青少年和年輕人自殺的因素。此外，現有的臨床和支持服務可能提供介入和解決年輕人自殺問題的機會。

參考文獻

Saal W et al. 社會支持減輕了感染愛滋病毒的南非年輕女性愛滋病毒照護不良和對自殺傾向的恥辱感。第 24 屆國際愛滋病大會，蒙特婁，摘要 OAD0702，2022 年。

Kreniske P et al. 青春期和青年期的愛滋病毒和自殺風險：在受愛滋病毒影響的縱向世代中對企圖自殺的社會人口學、背景和心理社會風險因素的檢查。第 24 屆國際愛滋病大會，蒙特婁，摘要 OAD0705，2022 年。

Social support can buffer the effects of stigma on suicidality among young people living with HIV

Oğuzhan Nuh / 19 August 2022 / aidsmap

圖片：Rodnae Productions/Pexels

HIV-related stigma and mental health challenges were associated with suicidality among young people living with HIV in two separate studies from South Africa and the United States presented at the recent 24th International AIDS Conference (AIDS 2022). The South African study showed that social support was protective, while the US study identified other risk factors, including systemic racism, sexual minority status and pregnancy.

In the last 45 years, suicide rates have increased around 60% globally, with the greatest increase reported among adolescents and young adults. A number of studies have found high rates of attempted suicide and suicidal ideation (thoughts of suicide) among young people living with HIV, but less is known about what shapes suicidality in this group.

Dr Wylene Saal from the University of Cape Town, South Africa presented data from 715 young women living with HIV, including 311 adolescent mothers. More than half of the participants were recently diagnosed with HIV. At the time of the interviews, mean age was 18 years, 23% of women lived in rural areas, 20% lived in informal housing, and 76% had no access to at least one basic necessity.

During the interviews, 7% of women reported suicidal ideation or having attempted suicide in the last month. Although the majority of the women said they received some social support, one third had poor retention in care and one third reported poor mental health. In the multivariate analysis, poor retention in care and experiences of HIV stigma were associated with higher odds of suicidality, directly and indirectly (mediated through poor mental health). Further analysis showed that social support mitigated the effects of poor retention in care and experience of social stigma, reducing the odds of suicidality among young women living with HIV.

Saal emphasised that suicide prevention and response need to be integrated in HIV services, by mitigating the risk factors of poor retention in care and stigma. Young women living with HIV, especially those struggling to stick with HIV care or who have limited support networks, should be screened for suicidality and poor mental health. In addition, peer support groups can strengthen social relationships to improve mental health and reduce suicidality among young women living with HIV.

Dr Philip Kreniske from the University of Columbia and the New York State Psychiatric Institute, presented findings from a prospective cohort study in New York City of adolescents and young adults. The study enrolled 206 participants born with HIV, and 134 participants who were exposed to HIV during pregnancy, delivery or after birth but not living with HIV. The mean enrolment age to the study was 12 years between 2003 and 2008, and the current mean age of participants is 28 years. Half the participants were women, 57% were Black and 57% were Latinx.

Ever having attempted suicide was more frequently reported by young people living with HIV (27%) than HIV-negative young people (16%). In the age-adjusted model, young people living with HIV had higher odds of attempted suicide compared to those who are HIV negative. Among the young people living with HIV, those who identified as heterosexual had lower odds of attempted suicide compared to other sexual orientations. The odds of attempting suicide were more than two times greater for those living with HIV who were pregnant or had a pregnant partner. HIV stigma and mental health issues were again associated with attempted suicide, while young people with a greater sense of self-worth as an individual or as a family member had lower odds of attempted suicide.

Kreniske also pointed out that the stress caused by living in a disadvantaged neighbourhood, negative life events and arrest in the past year were all associated with significantly increased odds of attempted suicide. These factors have been linked to systemic racism in previous research and must be considered when providing care and support to people living with HIV who may be facing systematic barriers.

Although there is growing evidence on positive effects of social support on mental health and wellbeing of people living with HIV, more research is needed to examine the factors affecting suicidality among adolescents and young people living with or exposed to HIV. Furthermore, existing clinical and support services may provide an opportunity to intervene and address suicidality among young people.

References

Saal W et al. Social support attenuates the syndemic of poor HIV care and stigma on suicidal tendencies among South African young women living with HIV. 24th International AIDS Conference, Montreal, abstract OAD0702, 2022.

Kreniske P et al. HIV and suicide risk across adolescence and young adulthood: an examination of sociodemographic, contextual, and psychosocial risk factors for attempted suicide in a longitudinal cohort of youth affected by HIV. 24th International AIDS Conference, Montreal, abstract OAD0705, 2022.