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Williams LD, van Heerden A, Friedman SR, Chibi B, Rodriguez WA, Memela P. Changes in Stigma and Social Support among Participants in a Randomized Trial of a Novel Expanded Social Network-based HIV Testing Intervention in KwaZulu-Natal, South Africa. AIDS Behav 2024:10.1007/s10461-024-04379-y. [PMID: 38833064 DOI: 10.1007/s10461-024-04379-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
HIV-related stigma is a well-documented barrier to HIV testing in South Africa, and may be particularly likely to create reluctance to test among South African men, who have reported feeling blamed for HIV by their partners and communities. The present study presents a novel expanded social network recruitment to HIV testing (E-SNRHT) intervention explicitly designed to reduce stigma as a barrier to testing by asking people to recruit anyone they know to testing, thus allowing them to avoid the potential for increased stigma and/or blame associated with direct risk partner recruitment, and helping to normalize openly discussing HIV among social networks. We examined baseline and 6-10-week follow-up data from a 2022-2023 randomized trial in KwaZulu-Natal, South Africa that recruited 110 individuals who had been newly diagnosed with HIV and randomly assigned them to recruit people to HIV testing either via the E-SNRHT intervention or via risk network recruitment. Participants in the E-SNRHT intervention reported significant decreases in anticipated and enacted HIV-related stigma between baseline and follow-up; and the E-SNRHT intervention was more effective at decreasing enacted HIV-related stigma than was risk network recruitment. Individuals newly diagnosed with HIV by the E-SNRHT intervention reported significant increases in social support between intervention enrollment and follow-up, and all of these individuals reported participating in positive conversations about HIV services with peers in the 6-10 weeks after intervention enrollment. These findings suggest that E-SNRHT is a potentially important strategy to reduce HIV-related stigma as a barrier to HIV testing among peer networks in KwaZulu-Natal.
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Affiliation(s)
- Leslie D Williams
- Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, USA.
| | - Alastair van Heerden
- Sweetwaters Centre for Community Based Research, Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
- SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samuel R Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Buyisile Chibi
- Sweetwaters Centre for Community Based Research, Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | - Wendy Avila Rodriguez
- Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, USA
| | - Phumlani Memela
- Sweetwaters Centre for Community Based Research, Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
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Perkins DD, Sonn CC, Lenzi M, Xu Q, Carolissen R, Portillo N, Serrano-García I. The global development of community psychology as reflected in the American Journal of Community Psychology. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 72:302-316. [PMID: 37526574 DOI: 10.1002/ajcp.12696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/06/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023]
Abstract
This commentary presents a virtual special issue on the global growth of community psychology (CP), particularly, but not exclusively, as reflected in the American Journal of Community Psychology (AJCP). CP exists in at least 50 countries all over the world, in many of those for over 25 years. Yet, aside from several early Israeli articles, AJCP rarely published work from or about countries outside the US and Canada until the early 2000s, when the number of international articles began to rise sharply. The focus of CP developed differently in different continents. CP in Australia and New Zealand initially followed North America's emphasis on improving social service systems, but has since focused more on environmental and indigenous cultural and decolonial issues that are as salient in those countries as in North America, but have drawn much more attention. CP came later to most of Asia, where it also tended to follow the North American path, but starting in Japan, India, and Hong Kong and now in China and elsewhere, it is establishing its own way. The other two global hotspots for CP for over 40 years have been Europe and Latin America. The level and focus of CP in Europe varies in each country, with some focused on applied developmental psychology and/or community services and others advancing critical and liberation psychology. CP in Latin America evolved from social psychology, but like CP in Sub-Saharan Africa, is also more explicitly political due to a history of political oppression, social activism, and the limitations of individualistic psychology to focus on social change, overcoming poverty, and interventions by (not just for) community members. Despite those differences, CP literature over the past 23 years suggests an increasingly common interest in social justice, multinational collaborations, and decoloniality. There is still a need for more truly (bidirectional) cross-cultural, comparative work for mutual learning, sharing of ideas, methods, and intervention practices, and for CP to develop in countries and communities throughout the globe where it could have the greatest impact.
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Affiliation(s)
- Douglas D Perkins
- Human & Organizational Development, Peabody College, Vanderbilt University, Nashville, USA
| | - Christopher C Sonn
- Department of Psychology, College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Michela Lenzi
- Developmental Psychology and Socialisation, University of Padova, Padua, Italy
| | - Qingwen Xu
- Master of Social Work Program, New York University-Shanghai, Shanghai, China
| | - Ronelle Carolissen
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Tempalski B, Williams LD, Kolak M, Ompad DC, Koschinsky J, McLafferty SL. Conceptualizing the Socio-Built Environment: An Expanded Theoretical Framework to Promote a Better Understanding of Risk for Nonmedical Opioid Overdose Outcomes in Urban and Non-Urban Settings. J Urban Health 2022; 99:701-716. [PMID: 35672547 PMCID: PMC9360264 DOI: 10.1007/s11524-022-00645-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 01/31/2023]
Abstract
Nonmedical opioid (NMO) use has been linked to significant increases in rates of NMO morbidity and mortality in non-urban areas. While there has been a great deal of empirical evidence suggesting that physical features of built environments represent strong predictors of drug use and mental health outcomes in urban settings, there is a dearth of research assessing the physical, built environment features of non-urban settings in order to predict risk for NMO overdose outcomes. Likewise, there is strong extant literature suggesting that social characteristics of environments also predict NMO overdoses and other NMO use outcomes, but limited research that considers the combined effects of both physical and social characteristics of environments on NMO outcomes. As a result, important gaps in the scientific literature currently limit our understanding of how both physical and social features of environments shape risk for NMO overdose in rural and suburban settings and therefore limit our ability to intervene effectively. In order to foster a more holistic understanding of environmental features predicting the emerging epidemic of NMO overdose, this article presents a novel, expanded theoretical framework that conceptualizes "socio-built environments" as comprised of (a) environmental characteristics that are applicable to both non-urban and urban settings and (b) not only traditional features of environments as conceptualized by the extant built environment framework, but also social features of environments. This novel framework can help improve our ability to identify settings at highest risk for high rates of NMO overdose, in order to improve resource allocation, targeting, and implementation for interventions such as opioid treatment services, mental health services, and care and harm reduction services for people who use drugs.
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Affiliation(s)
- Barbara Tempalski
- Center for Community-Based Population Health Research, NDRI-USA, Inc., 31 West 34th Street, New York, NY 10001 USA
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, Chicago, IL 60607 USA
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, 1155 East 60th Street, Chicago, IL 60637 USA
| | - Danielle C. Ompad
- Center for Drug Use and HIV/HCV Research, and the Department of Epidemiology, New York University School of Global Public Health, 708 Broadway, New York, NY 10003 USA
| | - Julia Koschinsky
- Center for Spatial Data Science, University of Chicago, 1155 East 60th Street, Chicago, IL 60637 USA
| | - Sara L. McLafferty
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, 1301 W Green Street, Urbana, IL 61801 USA
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Hoke T, Bateganya M, Toyo O, Francis C, Shrestha B, Philakone P, Pandey SR, Persaud N, Cassell MM, Wilcher R, Mahler H. How Home Delivery of Antiretroviral Drugs Ensured Uninterrupted HIV Treatment During COVID-19: Experiences From Indonesia, Laos, Nepal, and Nigeria. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:978-989. [PMID: 34933991 PMCID: PMC8691873 DOI: 10.9745/ghsp-d-21-00168] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/10/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Faced with the coronavirus disease (COVID-19) pandemic, governments worldwide instituted lockdowns to curtail virus spread. Health facility closures and travel restrictions disrupted access to antiretroviral (ARV) therapy for people living with HIV. This report describes how HIV programs in Indonesia, Laos, Nepal, and Nigeria supported treatment continuation by introducing home delivery of ARVs. METHODS Staff supporting the programs provided accounts of when and how decisions were taken to support ARV home delivery. They captured programmatic information about home delivery implementation using an intervention documentation tool. The 4 country experiences revealed lessons learned about factors favoring successful expansion of ARV home delivery. RESULTS Three of the countries relied on existing networks of community health workers for ARV delivery; the fourth country, Indonesia, relied on a private sector courier service. Across the 4 countries, between 19% and 51% of eligible clients were served by home delivery. The experiences showed that ARV home delivery is feasible and acceptable to health service providers, clients, and other stakeholders. Essential to success was rapid mobilization of stakeholders who led the design of the home delivery mechanisms and provided leadership support of the service innovations. Timely service adaptation was made possible by pre-existing differentiated models of care supportive of community-based ARV provision by outreach workers. Home delivery models prioritized protection of client confidentiality and prevention measures for COVID-19. Sustainability of the innovation depends on reinforcement of the commodity management infrastructure and investment in financing mechanisms. CONCLUSION Home delivery of ARVs is a feasible client-centered approach to be included among the options for decentralized drug distribution. It serves as a measure for expanding access to care both when access to health services is disrupted and under routine circumstances.
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Affiliation(s)
| | | | - Otoyo Toyo
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
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Williams LD, Mackesy-Amiti ME, Latkin C, Boodram B. Drug use-related stigma, safer injection norms, and hepatitis C infection among a network-based sample of young people who inject drugs. Drug Alcohol Depend 2021; 221:108626. [PMID: 33689967 PMCID: PMC8041355 DOI: 10.1016/j.drugalcdep.2021.108626] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Identifying risk for hepatitis C (HCV) infection is important for understanding recent increases in HCV incidence among young people who inject drugs (PWID) in suburban and rural areas; and for refining the targeting of effective HCV preventive interventions. Much of the extant research has focused on individual health behaviors (e.g., risky drug injection behaviors) as predictors of HCV infection. The present study examines two social factors (substance use-related stigma and injection-related social norms), and the interaction between these factors, as predictors of HCV infection. METHODS Baseline data were used from an ongoing longitudinal study of young PWID (N = 279; mean age = 30.4 years) from the Chicago suburbs and their injection risk network members. Adjusted logistic regression models were used to examine relationships among substance use-related stigma, safer injection norms, and HCV infection. RESULTS Despite a marginal bivariate association between less safe injection norms and HCV infection (OR = 0.74; 95 % CI[0.39, 1.02]; p = .071), a significant stigma X norms interaction (AOR = 0.68; 95 % CI[0.51, 0.90]) suggested that at high levels of stigma, probability of HCV infection was high regardless of injection norms. CONCLUSIONS Findings suggest that social factors - specifically, substance use-related stigma and injection norms - are important predictors of HCV infection risk. The interaction found between these social factors suggests that intervening only to change injection norms or behaviors is likely insufficient to reduce risk for HCV infection in high-stigma settings or among high-stigma populations. Future research should develop and evaluate stigma-reduction interventions in combination with safer-injection interventions in order to maximize HCV risk reduction.
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Affiliation(s)
- Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL
| | - Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL
| | - Carl Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Basmattee Boodram
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL
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Tesfay F, Javanparast S, Mwanri L, Ziersch A. Stigma and discrimination: barriers to the utilisation of a nutritional program in HIV care services in the Tigray region, Ethiopia. BMC Public Health 2020; 20:904. [PMID: 32522269 PMCID: PMC7288681 DOI: 10.1186/s12889-020-09040-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/03/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In Ethiopia, stigmatising attitudes towards people living with HIV have reduced over time. This is mainly due to improved HIV knowledge and the expansion of access to HIV care and support services. However, HIV stigma and discrimination remain a key challenge and have negative impacts on access to and utilisation of HIV services including nutritional programs in the HIV care setting. A small number of studies have examined the experience of stigma related to nutritional programs, but this is limited. This study explored HIV status disclosure and experience of stigma related to a nutritional program in HIV care settings in Ethiopia and impacts on nutritional program utilisation. METHODS As part of a larger study, qualitative in-depth interviews were conducted with 20 adults living with HIV, 15 caregivers of children living with HIV and 13 program staff working in the nutritional program in three hospitals in the Tigray region of Northern Ethiopia. Framework thematic analysis was employed to analyse the data and NVivo 11 was used to analyse the qualitative interview data. This study is presented based on the consolidated criteria for reporting of qualitative research (COREQ). RESULTS The study found varying levels of positive HIV status disclosure, depending on who the target of disclosure was. Disclosing to family members was reported to be less problematic by most participants. Despite reported benefits of the nutritional program in terms of improving weight and overall health status, adults and caregivers of children living with HIV revealed experiences of stigma and discrimination that were amplified by enrolment to the nutritional program and concerns about unwanted disclosure of positive HIV status. This was due to: a) transporting, consuming and disposing of the nutritional support (Plumpynut/sup) itself, which is associated with HIV in the broader community; b) required increased frequency of visits to HIV services for those enrolled in the nutritional program and associated greater likelihood of being seen there. CONCLUSION There was evidence of concerns about HIV-related stigma and discrimination among individuals enrolled in this program and their family members, which in turn negatively affected the utilisation of the nutritional program and the HIV service more broadly. Stigma and discrimination are a source of health inequity and undermine access to the nutritional program and other HIV services. Nutritional programs in HIV care should include strategies to take these concerns into account by mainstreaming stigma prevention and mitigation activities. Further research should be done to identify innovative ways of facilitating social inclusion to mitigate stigma and improve utilisation.
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Affiliation(s)
- Fisaha Tesfay
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia.
- School of Public Health, Mekelle University, Mekelle, Ethiopia.
- School of Health and Social Development, DeakinUniversity, Melbourne, Australia.
| | - Sara Javanparast
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- The Discipline of General Practice, Flinders University, Adelaide, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
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Williams LD, Aber JL. Using a Multi-level Framework to Test Empirical Relationships Among HIV/AIDS-Related Stigma, Health Service Barriers, and HIV Outcomes in KwaZulu-Natal, South Africa. AIDS Behav 2020; 24:81-94. [PMID: 30798458 PMCID: PMC6707890 DOI: 10.1007/s10461-019-02439-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV/AIDS-related (HAR) stigma is an ongoing problem in Sub-Saharan Africa that is thought to impede HIV preventive and treatment interventions. This paper uses a systematic sample of households (Level 1) nested within near-neighbor clusters (Level 2) and communities (Level 3) to examine multilevel relationships of HAR stigma to health service barriers (HSBs) and HIV outcomes in KwaZulu-Natal, South Africa, thereby addressing methodological and conceptual gaps in the literature from this context. Findings suggest differential patterns of prediction at Level 1 when examining two different dimensions of stigma: more highly stigmatizing attitudes predicted more household health service barriers; and perceptions of greater levels of community normative HAR stigma predicted higher household HIV ratios. Level 2 findings were similarly dimension-differentiated. Cross-level analyses found that near-neighbor cluster-level (setting level) consensus about (standard deviation) and level of (mean) community normative HAR stigma significantly predicted household-level HSBs and HIV ratio, controlling for household-level community normative HAR stigma. These differential patterns of prediction suggest that HAR stigma is a multi-level construct with multiple dimensions that relate to important outcomes differently within and across multiple ecological levels. This has important implications for future research, and for developing interventions that address setting-level variation in stigma.
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Affiliation(s)
- Leslie D Williams
- Steinhardt School of Culture, Education, and Human Development, New York University, 246 Greene Street, 8th Floor, New York, NY, 10003, USA.
- National Development and Research Institutes, New York, NY, USA.
| | - J Lawrence Aber
- Steinhardt School of Culture, Education, and Human Development, New York University, 246 Greene Street, 8th Floor, New York, NY, 10003, USA
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The Impact of Perceptions of Community Stigma on Utilization of HIV Care Services. J Racial Ethn Health Disparities 2019; 7:383-391. [PMID: 31808137 DOI: 10.1007/s40615-019-00667-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
The relationship between perceived community stigma and treatment adherence has been established in previous literature. Yet, less is known about explicit circumstances in which perceived community stigma deters people living with HIV (PLWH) from maintaining care. This research examines the impact of perceived community stigma against PLWH on self-reported barriers and supports to remain in HIV care services. We used survey data from a 3-year study of the HIV test and treat (T&T) continuum of services in Hartford, CT, surveying 200 PLWH. Logistic regression was used to determine if perceived community stigma had a statistically significant effect on the willingness of PLWH to utilize HIV care services. Results revealed that an increase in perceived stigma predicted willingness to see a doctor in 6 months for those who 'had a fear of poor treatment' (χ2(6) = 21.995, p < 0.001) and 'were concerned about privacy' (χ2(6) = 16.670, p < 0.01). An increase in perceived stigma was also a significant factor in the belief that supportive case managers helped with accessing HIV care services (χ2(1) = 6.817, p < 0.01). Our findings suggest that having a high degree of perceived community stigma is impactful in instances where individuals anticipate stigma or discrimination.
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Smyrnov P, Williams LD, Korobchuk A, Sazonova Y, Nikolopoulos GK, Skaathun B, Morgan E, Schneider J, Vasylyeva TI, Friedman SR. Risk network approaches to locating undiagnosed HIV cases in Odessa, Ukraine. J Int AIDS Soc 2019; 21. [PMID: 29356365 PMCID: PMC5810318 DOI: 10.1002/jia2.25040] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 12/08/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Providing HIV healthcare and Treatment as Prevention both depend on diagnosing HIV cases, preferably soon after initial infection. We hypothesized that tracing risk networks recruits higher proportions of undiagnosed positives than outreach-based testing or respondent-driven sampling (RDS) in Odessa, Ukraine. METHODS The Transmission Reduction Intervention Project (TRIP) used risk network tracing to recruit sexual and injection networks of recently-infected and longer-term infected (LTs) seeds (2013 to 2016). Integrated Biobehavioural Surveillance (IBBS) (2013) used RDS to recruit people who inject drugs (PWID). Outreach Testing tested PWID for HIV at community outreach sites (2013 to 2016). Proportions of undiagnosed positives among those tested were compared TRIP versus IBBS; TRIP versus Outreach Testing and between TRIP arms. Costs were compared across the projects. RESULTS TRIP tested 1252 people (21% women) in seeds' risk networks; IBBS tested 400 (18% women); Outreach Testing 13,936 (31% women). TRIP networks included a higher proportion of undiagnosed positives (14.6%) than IBBS (5.0%) or Outreach Testing (2.4%); odds ratio (OR) 3.25 (95% CI 2.07, 5.12) versus IBBS and 7.03 (CI 5.95, 8.31) versus Outreach Testing respectively. Findings remained significant in analyses stratified by sex and when PWID in TRIP networks were compared with Outreach Testing and IBBS. Within TRIP, recently-infected participants' networks contained higher proportions of undiagnosed positives (16.3%) than LTs' networks (12.2%); OR 1.41 (CI 1.01, 1.95). TRIP located undiagnosed positives less expensively than did RDS or Outreach Testing. CONCLUSIONS TRIP's recruiting techniques, including prioritizing networks of the recently infected, find undiagnosed HIV-positive people efficiently. They should be integrated with standard practice to improve case-finding. Research should test these techniques in other socio-epidemiologic contexts. CLINICAL TRIAL REGISTRY Registered ClinicalTrials.gov: NCT01827228.
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Affiliation(s)
| | | | | | | | | | - Britt Skaathun
- University of Chicago, Chicago, IL, USA.,Division of Global Public Health, University of California, San Diego, CA, USA
| | | | - John Schneider
- Department of Medicine and Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | | | - Samuel R Friedman
- National Development and Research Institutes, New York, NY, USA.,Center for Drug Use and HIV Research, New York, NY, USA
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Williams LD, Aber JL. The Multilevel Relationships of HIV-Related Stigma to Child and Caregiver Mental Health among HIV-Affected Households in South Africa. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 63:3-16. [PMID: 30368830 DOI: 10.1002/ajcp.12280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
HIV/AIDS-related (HAR) stigma is still a prevalent problem in Sub-Saharan Africa, and has been found to be related to mental health of HIV-positive individuals. However, no studies in the Sub-Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV-negative, HIV-affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra-individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community-representative sample of 508 HIV-affected households nested within 24 communities in KwaZulu-Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual-level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV-affected adults; and that community-level HAR stigma significantly predicts both individual-level mental health outcomes (anxiety) among HIV-affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV-affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context.
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Affiliation(s)
- Leslie D Williams
- Department of Applied Psychology, New York University, New York, NY, USA
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY, USA
| | - J Lawrence Aber
- Department of Applied Psychology, New York University, New York, NY, USA
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Brief Report: Stigma and HIV Care Continuum Outcomes Among Ethiopian Adults Initiating ART. J Acquir Immune Defic Syndr 2018; 76:382-387. [PMID: 28834799 DOI: 10.1097/qai.0000000000001530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Stigma harms the mental health of HIV-positive individuals and reduces adherence to antiretroviral therapy (ART), but less is known about stigma and other outcomes across the HIV care continuum. METHODS Among 1180 Ethiopian adults initiating ART at 6 urban HIV clinics, we examined the relationship of internalized, anticipated, and enacted stigma to HIV care-related outcomes ascertained by interview (repeat HIV-positive testing, provider vs. self-referred testing, missed clinic visit before ART initiation, eagerness to begin ART), and by abstraction of routinely collected clinical data (late ART initiation, 3-month gap in care following ART initiation). Logistic regression was used to assess the association of each type of stigma with each outcome, adjusting for potential confounders. RESULTS Scoring higher on each stigma domain was associated with 50%-90% higher odds of repeat HIV-positive testing. High internalized stigma was associated with higher odds of provider vs. self-referred test [adjusted odds ratio (aOR)high vs. low: 1.7; 95% confidence interval (CI): 1.3 to 2.2]. Higher anticipated stigma was associated with lower eagerness to begin ART (aORhigh vs. low: 0.55; 0.35-0.87; aORmedium vs. low: 0.45; 95% CI: 0.30 to 0.69). Any enacted stigma was associated with higher odds of a missed visit (aORany vs. none 1.8; 1.2-2.8). Stigma was not associated with late ART-initiation or with a subsequent gap in care. DISCUSSION AND CONCLUSIONS These findings provide further evidence of the importance of measuring and addressing stigma across the entire care continuum. Future work should test hypotheses about specific stigma domains and outcomes in prospective intervention or observational studies.
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Monteiro S, Villela W, Soares P, Pinho A, Fraga L. 'Protective' silence surrounding AIDS: Reasons and implications of non-disclosure among pregnant women living with HIV in Rio de Janeiro (Brazil). Glob Public Health 2016; 13:51-64. [PMID: 27455879 DOI: 10.1080/17441692.2016.1211163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The persistence of stigma surrounding AIDS remains a challenge in the epidemic's fourth decade. Based on qualitative research, this study analyses how pregnant women living with HIV/AIDS (PWLHA) experience and cope with AIDS stigma. A total of 29 semi-structured interviews were conducted with PWLHA focusing on socioeconomic profiles, the contexts in which they discovered HIV infection, experiences with health-care sites and ways of dealing with AIDS-related stigma. We recruited PWLHA at two prevention of mother-to-child transmission sites in Rio de Janeiro, Brazil. The PWLHA's testimony indicates that access to care and treatment has a profound effect on the deconstruction of their understanding of AIDS as a fatal disease. However, fear of AIDS stigma is still predominant. The law guarantees HIV non-disclosure, and women see it as a way to protect themselves from discrimination. We argue, however, that the silence surrounding HIV diagnosis perpetuates the psychosocial and structural mechanisms that reproduce stigma. We conclude that diverse sectors of society, including health-care facilities, must be involved in confronting stigma by demystifying AIDS, improving patients' knowledge of their rights, and increasing their access to material and symbolic goods.
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Affiliation(s)
- Simone Monteiro
- a Laboratory of Environmental and Health Education , Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz) , Rio de Janeiro , Brazil
| | - Wilza Villela
- b Department of Preventive Medicine , Federal University of São Paulo , São Paulo , Brazil
| | - Priscilla Soares
- a Laboratory of Environmental and Health Education , Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz) , Rio de Janeiro , Brazil
| | - Adriana Pinho
- a Laboratory of Environmental and Health Education , Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz) , Rio de Janeiro , Brazil
| | - Livia Fraga
- a Laboratory of Environmental and Health Education , Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz) , Rio de Janeiro , Brazil
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Treves-Kagan S, Steward WT, Ntswane L, Haller R, Gilvydis JM, Gulati H, Barnhart S, Lippman SA. Why increasing availability of ART is not enough: a rapid, community-based study on how HIV-related stigma impacts engagement to care in rural South Africa. BMC Public Health 2016; 16:87. [PMID: 26823077 PMCID: PMC4730651 DOI: 10.1186/s12889-016-2753-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/19/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Stigma is a known barrier to HIV testing and care. Because access to antiretroviral therapy reduces overt illness and mortality, some scholars theorized that HIV-related stigma would decrease as treatment availability increased. However, the association between ART accessibility and stigma has not been as straightforward as originally predicted. METHODS We conducted a "situational analysis"--a rapid, community-based qualitative assessment to inform a combination HIV prevention program in high prevalence communities. In the context of this community-based research, we conducted semi-structured interviews and focus groups with 684 individuals in four low-resource sub-districts in North West Province, South Africa. In addition to using this data to inform programming, we examined the impact of stigma on the uptake of services. RESULTS Findings suggested that anticipated stigma remains a barrier to care. Although participants reported less enacted stigma, or hostility toward people living with HIV, they also felt that HIV remains synonymous with promiscuity and infidelity. Participants described community members taking steps to avoid being identified as HIV-positive, including avoiding healthcare facilities entirely, using traditional healers, or paying for private doctors. Such behaviors led to delays in testing and accessing care, and problems adhering to medications, especially for men and youth with no other health condition that could plausibly account for their utilization of medical services. CONCLUSIONS We conclude that providing access to ART alone will not end HIV-related stigma. Instead, individuals will remain hesitant to seek care as long as they fear that doing so will lead to prejudice and discrimination. It is critical to combat this trend by increasing cultural acceptance of being seropositive, integrating HIV care into general primary care and normalizing men and youths' accessing health care.
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Affiliation(s)
- Sarah Treves-Kagan
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA, USA.
| | - Wayne T Steward
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA, USA.
| | - Lebogang Ntswane
- University of Washington, International Training and Education Center for Health (ITECH) - South Africa, Pretoria, South Africa.
| | - Robin Haller
- University of California, San Francisco, Global Health Sciences, San Francisco, CA, USA.
| | - Jennifer M Gilvydis
- University of Washington, International Training and Education Center for Health (ITECH) - South Africa, Pretoria, South Africa.
| | - Harnik Gulati
- University of Washington, International Training and Education Center for Health, Seattle, WA, USA.
| | - Scott Barnhart
- University of Washington, International Training and Education Center for Health, Seattle, WA, USA.
| | - Sheri A Lippman
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA, USA.
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Collazzoni A, Capanna C, Bustini M, Stratta P, Ragusa M, Marino A, Rossi A. Humiliation and interpersonal sensitivity in depression. J Affect Disord 2015; 167:224-7. [PMID: 24995891 DOI: 10.1016/j.jad.2014.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/05/2014] [Accepted: 06/06/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study is to explore the relationship between humiliation and protective psychosocial factors in a sample of depressed patients. METHOD We assessed humiliation, psychiatric symptoms, negative primary familial environment and resilience in 70 depressed patients, 33 male and 37 female, and analyzed the correlations between these variables. Then to better understand the relations among the assessed variables we controlled for the depression severity and replicated the correlational analyses. RESULTS A pattern of significant correlations among all the constructs emerged. Correlations between humiliation, interpersonal sensitivity, negative primary familial environment and resilience persisted after controlling for depression severity. LIMITATIONS The cross sectional nature of this study; the use of self-report instruments; the lack of personality assessment. CONCLUSIONS This study provides a contribution to the understanding of the relationship between the experience of humiliation and negative primary familial environment, protective factors and clinical interpersonal sensitivity in depressed patients.
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Affiliation(s)
- Alberto Collazzoni
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L׳Aquila, Via Vetoio, Coppito II, 67100 L׳Aquila, Italy.
| | - Cristina Capanna
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L׳Aquila, Via Vetoio, Coppito II, 67100 L׳Aquila, Italy
| | - Massimiliano Bustini
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L׳Aquila, Via Vetoio, Coppito II, 67100 L׳Aquila, Italy
| | - Paolo Stratta
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L׳Aquila, Via Vetoio, Coppito II, 67100 L׳Aquila, Italy; Department of Mental Health, ASL 1, L׳Aquila, Italy; Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
| | - Marzia Ragusa
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L׳Aquila, Via Vetoio, Coppito II, 67100 L׳Aquila, Italy
| | - Antonio Marino
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L׳Aquila, Via Vetoio, Coppito II, 67100 L׳Aquila, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L׳Aquila, Via Vetoio, Coppito II, 67100 L׳Aquila, Italy
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Schwitters A, Lederer P, Zilversmit L, Gudo PS, Ramiro I, Cumba L, Mahagaja E, Jobarteh K. Barriers to health care in rural Mozambique: a rapid ethnographic assessment of planned mobile health clinics for ART. GLOBAL HEALTH, SCIENCE AND PRACTICE 2015; 3:109-16. [PMID: 25745124 PMCID: PMC4356279 DOI: 10.9745/ghsp-d-14-00145] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/29/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND In Mozambique, 1.6 million people are living with HIV, and over 60% of the population lives in rural areas lacking access to health services. Mobile health clinics, implemented in 2013 in 2 provinces, are beginning to offer antiretroviral therapy (ART) and basic primary care services. Prior to introduction of the mobile health clinics in the communities, we performed a rapid ethnographic assessment to understand barriers to accessing HIV care and treatment services and acceptability and potential use of the mobile health clinics as an alternative means of service delivery. METHODS We conducted assessments in Gaza province in January 2013 and in Zambezia Province in April-May 2013 in districts where mobile health clinic implementation was planned. Community leaders served as key informants, and chain-referral sampling was used to recruit participants. Interviews were conducted with community leaders, health care providers, traditional healers, national health system patients, and traditional healer patients. Interviewees were asked about barriers to health services and about mobile health clinic acceptance. RESULTS In-depth interviews were conducted with 117 participants (Gaza province, n = 57; Zambezia Province, n = 60). Barriers to accessing health services included transportation and distance-related issues (reliability, cost, and travel time). Participants reported concurrent use of traditional and national health systems. The decision to use a particular health system depended on illness type, service distance, and lack of confidence in the national health system. Overall, participants were receptive to using mobile health clinics for their health care and ability to increase access to ART. Hesitations concerning mobile health clinics included potentially long wait times due to high patient loads. Participants emphasized the importance of regular and published visit schedules and inclusion of community members in planning mobile health clinic services. CONCLUSION Mobile health clinics can address many barriers to uptake of HIV services, particularly related to transportation issues. Involvement of community leaders, providers, traditional healers, and patients, as well as regularly scheduled mobile clinic visits, are critical to successful service delivery implementation in rural areas.
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Affiliation(s)
- Amee Schwitters
- Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, USA Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA
| | - Philip Lederer
- Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, USA Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA
| | - Leah Zilversmit
- Centers for Disease Control and Prevention, Maputo, Mozambique Association of Schools and Programs of Public Health, Washington, DC, USA
| | - Paula Samo Gudo
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | | | | | | | - Kebba Jobarteh
- Centers for Disease Control and Prevention, Maputo, Mozambique
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