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Oga EA, Stockton MA, Abu-Ba'are GR, Vormawor R, Mankattah E, Endres-Dighe S, Richmond R, Jeon S, Logie CH, Baning E, Saalim K, Torpey K, Nelson LE, Nyblade L. Measuring intersectional HIV, sexual diversity, and gender non-conformity stigma among healthcare workers in Ghana: scale validation and correlates of stigma. BMC Health Serv Res 2024; 24:647. [PMID: 38773589 PMCID: PMC11110277 DOI: 10.1186/s12913-024-11098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/10/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are at heightened risk for HIV acquisition, yet they may delay or avoid HIV testing due to intersectional stigma experienced at the healthcare facility (HCF). Few validated scales exist to measure intersectional stigma, particularly amongst HCF staff. We developed the Healthcare Facility Staff Intersectional Stigma Scale (HCF-ISS) and assessed factors associated with stigma in Ghana. METHODS We analyzed baseline data from HCF staff involved in a study testing a multi-level intervention to reduce intersectional stigma experienced by MSM. Data are from eight HCFs in Ghana (HCF Staff n = 200). The HCF-ISS assesses attitudes and beliefs towards same-sex relationships, people living with HIV (PLWH) and gender non-conformity. Exploratory factor analysis assessed HCF-ISS construct validity and Cronbach's alphas assessed the reliability of the scale. Multivariable regression analyses assessed factors associated with intersectional stigma. RESULTS Factor analysis suggested an 18-item 3-factor scale including: Comfort with Intersectional Identities in the Workplace (6 items, Cronbach's alpha = 0.71); Beliefs about Gender and Sexuality Norms (7 items, Cronbach's alpha = 0.72); and Beliefs about PLWH (5 items, Cronbach's alpha = 0.68). Having recent clients who engage in same-gender sex was associated with greater comfort with intersectional identities but more stigmatizing beliefs about PLWH. Greater religiosity was associated with stigmatizing beliefs. Infection control training was associated with less stigma towards PLWH and greater comfort with intersectional identities. CONCLUSIONS Achieving the goal of ending AIDS by 2030 requires eliminating barriers that undermine access to HIV prevention and treatment for MSM, including HCF intersectional stigma. The HCF-ISS provides a measurement tool to support intersectional stigma-reduction interventions.
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Affiliation(s)
- Emmanuel A Oga
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | - Melissa A Stockton
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Gamji R Abu-Ba'are
- School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Richard Vormawor
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Emmanuel Mankattah
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Stacy Endres-Dighe
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Ryan Richmond
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Sangchoon Jeon
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, M5S 1V4, Canada
| | - Emma Baning
- Educational Assessment and Research Center, Accra, Ghana
| | - Khalida Saalim
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Kwasi Torpey
- School of Public Health, University of Ghana, Accra, Ghana
| | - Laron E Nelson
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
- School of Nursing, Yale University, New Haven, CT, 06520, USA
| | - Laura Nyblade
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
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Aluah CP, Robillard A, Billings D, Smallwood S. Courtesy Stigma and HIV Professionals: A Brief Review of Implications for Psychosocial and Professional Well-Being. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:368-378. [PMID: 38459705 DOI: 10.1080/19371918.2024.2325566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
The impact of HIV-related stigma on social workers, clinicians, counselors, and advocates working in organizations serving people living with HIV (PLWH), is rarely considered. Professionals experience "courtesy stigma" when working with or on behalf of PLWH, regardless of their personal HIV status. PubMed, Medline, and PsycInfo databases, along with a review of relevant reference lists and referrals, identified 13 studies addressing this phenomenon. Although limited, this brief review suggests that members of the HIV workforce do indeed face challenges that compromise their personal and professional well-being as a result of courtesy stigma. Addressing stigma among professionals is necessary to support the health of those working in the field, and to avoid undermining the efforts of this important workforce. More research is needed to understand the perceptions and experiences of courtesy stigma and how this stigma may adversely impact the psychological well-being, social functioning, and professional practice of HIV professionals.
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Affiliation(s)
- Christopher Peter Aluah
- Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Alyssa Robillard
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Deborah Billings
- Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
- Group Care Global, Philadelphia, PA, USA
| | - Stacy Smallwood
- Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University Statesboro, Statesboro, Georgia, USA
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Huang F, Sun W, Li Y, Zhang L, Chen WT. Modification and validation of the COVID-19 stigma instrument in nurses: A cross-sectional survey. Front Psychol 2023; 14:1084152. [PMID: 37663322 PMCID: PMC10473103 DOI: 10.3389/fpsyg.2023.1084152] [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] [Received: 10/30/2022] [Accepted: 02/17/2023] [Indexed: 09/05/2023] Open
Abstract
Background Nurses taking care of patients with infectious diseases have suffered from noticeable societal stigma, however currently, there is no validated scale to measure such stigma. This study aimed to revise and validate the COVID-19 Stigma Instrument-Nurse-Version 3 (CSI-N-3) by using item response theory (IRT) as well as classical test theory analysis. Methods In phase I, the Chinese CSI-N-3 was modified from the English version of HIV/AIDS Stigma Instrument-Nurse based on standard cross-cultural procedures, including modifications, translation/back translations, pilot testing, and psychometric testing with classical test theory and Rasch analysis. In phase II, a cross-sectional study using cluster sampling was conducted among 249 eligible nurses who worked in a COVID-19-designed hospital in Shanghai, China. The influencing factors of COVID-19-associated stigma were analyzed through regression analysis. Results In phase I, the two-factor structure was verified by confirmatory factor analysis, which indicated a good model fit. The 15-item CSI-N-3 achieved Cronbach's α of 0.71-0.84, and composite reliability of 0.83-0.91. The concurrent validity was established by significant association with self-reported physical, psychological, and social support levels (r = -0.18, -0.20, and -0.21, p < 0.01). In IRT analysis, the CSI-N-3 has ordered response thresholds, with the Item Reliability and Separation Index of 0.95 and 4.15, respectively, and the Person Reliability and Separation Index of 0.20 and 0.50, respectively. The infit and outfit mean squares for each item ranged from 0.39 to 1.57. In phase II, the mean score for the CSI-N-3 in Chinese nurses was 2.80 ± 3.73. Regression analysis showed that social support was the only factor affecting nurses' COVID-19-associated stigma (standardized coefficients β = -0.21, 95% confidence interval: -0.73 ~ -0.19). Conclusion The instrument CSI-N-3 is equipped with rigorous psychometric properties that can be used to measure COVID-19-associated stigma during and after the COVID-19 pandemic among nurses. The use of this instrument may facilitate the evaluation of tailored stigma-reduction interventions.
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Affiliation(s)
- Feifei Huang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Wenxiu Sun
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yonglin Li
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei-Ti Chen
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
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Rusyda MH, Abdul Kadir NB, Ismail WNK, Abdul Jalil SJ, Abdullah NA, Che Kasim A, Hoesni SM, Abdul Manaf MR. Identifying the Psychometric Properties of the Malay Version of the WHOQOL-BREF among Employees with Obesity Problem. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7542. [PMID: 35742790 PMCID: PMC9223816 DOI: 10.3390/ijerph19127542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022]
Abstract
The Malay version of the WHOQOL-BREF was published approximately 15 years ago. Since then, no known research has been conducted to identify the psychometric properties of the scale using confirmatory factor analysis. This study aimed to establish a model by applying a scientific approach to the translation and adaptation method. The back translation technique was used for the translation process. This cross-sectional study involved 282 employees at Universiti Kebangsaan Malaysia. The instrument received satisfactory Cronbach's alpha reliability values. The data were analysed with SEM using AMOS. Results showed that the model produced is parsimonious, with CMIN/df = 0.23, CFI = 0.93, SRMR = 0.08, RMSEA = 0.08 and PCLOSE = 0.07. Adopting the Malay version of the WHOQOL-BREF for future research is highly recommended due to its properties.
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Affiliation(s)
- Mohd Helma Rusyda
- Centre for Research in Psychology and Human Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (N.B.A.K.); (W.N.K.I.); (N.-A.A.); (A.C.K.); (S.M.H.)
| | - Nor Ba’yah Abdul Kadir
- Centre for Research in Psychology and Human Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (N.B.A.K.); (W.N.K.I.); (N.-A.A.); (A.C.K.); (S.M.H.)
| | - Wan Nur Khairunnisa Ismail
- Centre for Research in Psychology and Human Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (N.B.A.K.); (W.N.K.I.); (N.-A.A.); (A.C.K.); (S.M.H.)
| | - Siti Jamiaah Abdul Jalil
- Department of Dakwah and Leadership, Faculty of Islamic Studies, Universiti Kebangsan Malaysia, Bangi 43600, Malaysia;
| | - Nurul-Azza Abdullah
- Centre for Research in Psychology and Human Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (N.B.A.K.); (W.N.K.I.); (N.-A.A.); (A.C.K.); (S.M.H.)
| | - Arena Che Kasim
- Centre for Research in Psychology and Human Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (N.B.A.K.); (W.N.K.I.); (N.-A.A.); (A.C.K.); (S.M.H.)
| | - Suzana Mohd. Hoesni
- Centre for Research in Psychology and Human Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (N.B.A.K.); (W.N.K.I.); (N.-A.A.); (A.C.K.); (S.M.H.)
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia;
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Huang F, Chen WT, Sun W, Lin M, Shiu CS, Zhang L, Lu H. Adaptation and Validation of the COVID-19 Stigma Instrument in Nurses:A Cross-sectional Survey. RESEARCH SQUARE 2022:rs.3.rs-1655493. [PMID: 35665003 PMCID: PMC9164521 DOI: 10.21203/rs.3.rs-1655493/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Stigma is a prominent issue among nurses working with patients with infectious diseases, but the unavailability of validated measures of such stigma. The aim of our study was to adapt, modify, and validate the COVID-19 Stigma Instrument-Nurse -Version 3 (CSI-N-3) with both classical test theory and item response theory (IRT) analysis. Methods: We administered the scale to 249 eligible nurses who worked in a COVID-19 designed hospital in Shanghai, China. Results: The two-factor structure was confirmed by confirmatory factor analysis. The 15-item CSI-N-3 achieved Cronbach's α of 0.64 to 0.84. Convergent validity was also demonstrated. In IRT analysis, the CSI-N-3 has ordered response thresholds, with the appropriate item difficulty and infit and outfit mean squares. Self-reported social support was the only factor influencing nurses' COVID-19 stigma (standardized coefficients β =-0.21). Conclusions: The CSI-N-3 is an instrument with sound psychometric properties that can be used to measure COVID-19 stigma during the COVID-19 outbreak or afterward among nurses.
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Affiliation(s)
- Feifei Huang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | | | - Wenxiu Sun
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Meilian Lin
- Fuqing Health School of Fujian Province, Fuqing, China
| | - Cheng-Shi Shiu
- National Taiwan University, Department of Social Work, Taipei, Taiwan
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Development and psychometric evaluation of the nurse behavior toward confirmed and suspected HIV/AIDS patients (NB-CSHAP) scale. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
There is a scarcity of literature discussing nurses’ behaviors toward caring for suspected or confirmed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. The development of a scale specific to measure nurses’ behaviors will allow health institutions to assess the disposition of their nurses in terms of HIV care. This study aims to present the rigors of developing and validating a reliable instrument to contextualize these nurses’ behaviors. This study utilized a sequential exploratory mixed method design to develop the NB-CSHAP scale. Thematic analysis was done on the qualitative data from the interviews with persons living with HIV/AIDS (PLHA) from which items were selected to be included in the scale. Exploratory factor analysis was utilized to extract the factors and Cronbach's alpha was used to assess the reliability of the instrument. Four factors were extracted and are categorized as either caring or discriminatory behaviors. These include: (1) service-oriented, (2) openhanded, (3) perceptive, and (4) discriminatory. The scale has an internal consistency of 0.73. The scale shows acceptable psychometric properties, hence can be used to assess the nurses’ behaviors in caring for confirmed or suspected HIV clients. The scale may be used by health institutions to determine the quality of the patient care provided by their nurses to clients with confirmed or suspected HIV.
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Lazarus JV, Safreed-Harmon K, Kamarulzaman A, Anderson J, Leite RB, Behrens G, Bekker LG, Bhagani S, Brown D, Brown G, Buchbinder S, Caceres C, Cahn PE, Carrieri P, Caswell G, Cooke GS, Monforte AD, Dedes N, Del Amo J, Elliott R, El-Sadr WM, Fuster-Ruiz de Apodaca MJ, Guaraldi G, Hallett T, Harding R, Hellard M, Jaffar S, Kall M, Klein M, Lewin SR, Mayer K, Pérez-Molina JA, Moraa D, Naniche D, Nash D, Noori T, Pozniak A, Rajasuriar R, Reiss P, Rizk N, Rockstroh J, Romero D, Sabin C, Serwadda D, Waters L. Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV. Nat Commun 2021; 12:4450. [PMID: 34272399 PMCID: PMC8285468 DOI: 10.1038/s41467-021-24673-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
Health systems have improved their abilities to identify, diagnose, treat and, increasingly, achieve viral suppression among people living with HIV (PLHIV). Despite these advances, a higher burden of multimorbidity and poorer health-related quality of life are reported by many PLHIV in comparison to people without HIV. Stigma and discrimination further exacerbate these poor outcomes. A global multidisciplinary group of HIV experts developed a consensus statement identifying key issues that health systems must address in order to move beyond the HIV field's longtime emphasis on viral suppression to instead deliver integrated, person-centered healthcare for PLHIV throughout their lives.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Adeeba Kamarulzaman
- University of Malaya, Kuala Lumpur, Malaysia
- International AIDS Society (IAS), Geneva, Switzerland
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Georg Behrens
- Medizinische Hochschule Hannover (MHH), Hannover, Germany
| | | | - Sanjay Bhagani
- Royal Free London NHS Trust and University College London, London, United Kingdom
| | - Darren Brown
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Graham Brown
- Centre for Social Impact, University of New South Wales, Sydney, Australia
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, United States
| | - Carlos Caceres
- Center for Research in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseilles, France
| | - Georgina Caswell
- Global Network of People Living with HIV (GNP+), Cape Town, South Africa
| | | | | | | | - Julia Del Amo
- National Plan on AIDS, Ministry of Health, Madrid, Spain
| | | | | | | | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Università degli studi di Modena e Reggio Emilia, Modena, Italy
| | - Tim Hallett
- Imperial College London, London, United Kingdom
| | | | | | - Shabbar Jaffar
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Marina Klein
- McGill University Health Centre Research Institute, Montreal, Canada
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Ken Mayer
- Fenway Health and Harvard Medical School, Boston, United States
| | - Jose A Pérez-Molina
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Denise Naniche
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Denis Nash
- City University of New York Graduate School of Public Health and Health Policy, New York City, United States
| | - Teymur Noori
- European Centre for Disease Control and Prevention, Solna, Sweden
| | - Anton Pozniak
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Peter Reiss
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Diana Romero
- City University of New York Graduate School of Public Health and Health Policy, New York City, United States
| | | | - David Serwadda
- Makerere University School of Public Health, Kampala, Uganda
| | - Laura Waters
- Central and North West London NHS Trust, London, United Kingdom
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Relf MV, L Holzemer W, Holt L, Nyblade L, Ellis Caiola C. A Review of the State of the Science of HIV and Stigma: Context, Conceptualization, Measurement, Interventions, Gaps, and Future Priorities. J Assoc Nurses AIDS Care 2021; 32:392-407. [PMID: 33654005 PMCID: PMC9208366 DOI: 10.1097/jnc.0000000000000237] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Stigma is a fundamental cause of health inequities. As such, stigma is a major barrier to HIV prevention, care, and treatment. This review will examine the concept of stigma, explicating the mechanisms of action of HIV-related stigma while also examining intersectional stigma and structural stigma. Instruments to measure HIV-related stigma and its mechanisms of action, as well as stigma enacted and experienced by HIV health care providers, will also be reviewed. This article will conclude with a review of stigma interventions, gaps in the literature, and priorities for future HIV, intersectional, and structural stigma research.
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Affiliation(s)
- Michael V Relf
- Michael V. Relf, PhD, RN, AACRN, ACNS-BC, CNE, ANEF, FAAN, is Associate Dean for Global and Community Health Affairs, Duke University School of Nursing, and Associate Research Professor, Duke Global Health Institute, Durham, North Carolina, USA. William L. Holzemer, PhD, RN, FAAN, is Distinguished Professor and Dean Emeritus, Rutgers University School of Nursing, Newark, New Brunswick, & Blackwood, New Jersey, USA. Lauren Holt, MSN, RN, is a PhD Student, Duke University School of Nursing, Durham, North Carolina, USA. Laura Nyblade, PhD, is Fellow and Senior Technical Advisor, Stigma and Discrimination, Research Triangle International, Washington, DC, USA. Courtney Ellis Caiola, PhD, MPH, RN, CNE, is Assistant Professor, East Carolina University, College of Nursing, Greenville, North Carolina, USA
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Small E, Nikolova SP, Zhou Y, Okumu M. Exploring factors associated with HIV secondary stigma among adolescents and young adults in Uganda: A cross-sectional study. Glob Public Health 2021; 17:526-537. [PMID: 33406003 DOI: 10.1080/17441692.2020.1869286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV stigma is a public health problem. It refers to irrational judgments and attitudes towards people living with or at risk of HIV. Among adolescents and young adults living with HIV, stigma can negatively influence help-seeking decisions and impede HIV prevention efforts. The present study aimed to explore social-ecological factors associated with HIV-related stigma using a cross-sectional study design. Data used were from the 2016 Uganda Demographic and Health Survey [UDHS] of young men (n = 2214) and young women (n = 8058) aged 15-24 years. We conducted a gender disaggregated multivariable logistic regression to understand social-ecological factors associated with HIV secondary stigma. An overwhelming majority of participants (85%) indicated that secondary HIV stigma was associated with factors such as gender, ethnicity, education, wealth, cultural attitudes, and testing experiences. The study concludes that many young people living with HIV experience stigma in Uganda. Therefore, the government of Uganda, health professionals, and researchers should consider developing interventions that address HIV stigma and discrimination. Supportive programmes, such as peer support services and community-based interventions, are needed to help young people living with HIV learn to cope with the illness.
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Affiliation(s)
- Eusebius Small
- School of Social Work, University of Texas, Arlington, TX, USA
| | | | - Yuan Zhou
- Department of Industrial, Manufacturing, & Systems Engineering, University of Texas, Arlington
| | - Moses Okumu
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
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Smith MK, Xu RH, Hunt SL, Wei C, Tucker JD, Tang W, Luo D, Xue H, Wang C, Yang L, Yang B, Li L, Joyner BL, Sylvia SY. Combating HIV stigma in low- and middle-income healthcare settings: a scoping review. J Int AIDS Soc 2020; 23:e25553. [PMID: 32844580 PMCID: PMC7448195 DOI: 10.1002/jia2.25553] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Nearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low- and middle-income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research. METHODS We conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews. RESULTS AND DISCUSSION Our search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings. CONCLUSIONS Combating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self-reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.
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Affiliation(s)
- M. Kumi Smith
- Division of Epidemiology & Community HealthUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Richie H. Xu
- Division of Epidemiology & Community HealthUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Shanda L. Hunt
- Health Sciences LibrariesUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Chongyi Wei
- Department of Health Behavior, Society and PolicyRutgers UniversityNew BrunswickNYUSA
| | - Joseph D. Tucker
- Institute for Global Health and Infectious DiseasesSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
- London School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Institute for Global Health and Infectious DiseasesSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
| | | | - Hao Xue
- Freeman Spogli Institute for International StudiesStanford UniversityStanfordCAUSA
| | - Cheng Wang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Ligang Yang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Bin Yang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Li Li
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCAUSA
| | - Benny L. Joyner
- Division of Pediatric Critical Care MedicineSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
| | - Sean Y. Sylvia
- Department of Health Policy & ManagementUniversity of North CarolinaChapel HillNCUSA
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Krishnaratne S, Bond V, Stangl A, Pliakas T, Mathema H, Lilleston P, Hoddinott G, Bock P, Ayles H, Fidler S, Hargreaves JR. Stigma and Judgment Toward People Living with HIV and Key Population Groups Among Three Cadres of Health Workers in South Africa and Zambia: Analysis of Data from the HPTN 071 (PopART) Trial. AIDS Patient Care STDS 2020; 34:38-50. [PMID: 31944852 DOI: 10.1089/apc.2019.0131] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Stigma and judgment by health workers toward people living with HIV (PLHIV) and key populations can undermine the uptake of HIV services. In 2014, we recruited health workers delivering HIV services from 21 urban communities in South Africa and Zambia participating in the first year of the HPTN 071 (PopART) cluster-randomized trial. We analyzed self-reported levels of stigma and judgment toward (1) PLHIV, (2) women who sell sex, (3) men who have sex with men (MSM), and (4) young women who become pregnant before marriage. Using logistic regression, we compared responses between three health worker cadres and explored risk factors for stigmatizing attitudes. Highest levels of stigma and judgment were in relation to women who sell sex and MSM, especially in Zambia. Heath workers did not generally think that clients should be denied services, although this was reported slightly more commonly by community health workers. Higher education levels were associated with lower judgmental beliefs, whereas higher perceptions of coworker stigmatizing behaviors toward PLHIV and each key population were associated with holding judgmental beliefs. Training experience was not associated with judgmental attitudes for any of the key populations. Our findings confirm a high prevalence of judgmental attitudes toward key population groups but lower levels in relation to PLHIV, among all cadres of health workers in both countries. Planning and implementing targeted stigma reduction interventions within health settings are critical to meet the needs of vulnerable populations that face more stigmatizing attitudes from health workers.
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Affiliation(s)
- Shari Krishnaratne
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Virginia Bond
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, The School of Medicine, University of Zambia, Lusaka, Zambia
| | - Anne Stangl
- International Centre for Research on Women, Washington, District of Columbia
| | - Triantafyllos Pliakas
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hlengani Mathema
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Pamela Lilleston
- International Centre for Research on Women, Washington, District of Columbia
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Helen Ayles
- Zambart, The School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, United Kingdom
| | - James R. Hargreaves
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Stangl AL, Lilleston P, Mathema H, Pliakas T, Krishnaratne S, Sievwright K, Bell‐Mandla N, Vermaak R, Mainga T, Steinhaus M, Donnell D, Schaap A, Bock P, Ayles H, Hayes R, Hoddinott G, Bond V, Hargreaves JR. Development of parallel measures to assess HIV stigma and discrimination among people living with HIV, community members and health workers in the HPTN 071 (PopART) trial in Zambia and South Africa. J Int AIDS Soc 2019; 22:e25421. [PMID: 31840400 PMCID: PMC6912047 DOI: 10.1002/jia2.25421] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Integrating standardized measures of HIV stigma and discrimination into research studies of emerging HIV prevention approaches could enhance uptake and retention of these approaches, and care and treatment for people living with HIV (PLHIV), by informing stigma mitigation strategies. We sought to develop a succinct set of measures to capture key domains of stigma for use in research on HIV prevention technologies. METHODS From 2013 to 2015, we collected baseline data on HIV stigma from three populations (PLHIV (N = 4053), community members (N = 5782) and health workers (N = 1560)) in 21 study communities in South Africa and Zambia participating in the HPTN 071 (PopART) cluster-randomized trial. Forty questions were adapted from a harmonized set of measures developed in a consultative, global process. Informed by theory and factor analysis, we developed seven scales, with values ranging from 0 to 3, based on a 4-point agreement Likert, and calculated means to assess different aspects of stigma. Higher means reflected more stigma. We developed two measures capturing percentages of PLHIV who reported experiencing any stigma in communities or healthcare settings in the past 12 months. We validated our measures by examining reliability using Cronbach's alpha and comparing the distribution of responses across characteristics previously associated with HIV stigma. RESULTS Thirty-five questions ultimately contributed to seven scales and two experience measures. All scales demonstrated acceptable to very good internal consistency. Among PLHIV, a scale captured internalized stigma, and experience measures demonstrated that 22.0% of PLHIV experienced stigma in the community and 7.1% in healthcare settings. Three scales for community members assessed fear and judgement, perceived stigma in the community and perceived stigma in healthcare settings. Similarly, health worker scales assessed fear and judgement, perceived stigma in the community and perceived co-worker stigma in healthcare settings. A higher proportion of community members and health workers reported perceived stigma than the proportion of PLHIV who reported experiences of stigma. CONCLUSIONS We developed novel, valid measures that allowed for triangulation of HIV stigma across three populations in a large-scale study. Such comparisons will illuminate how stigma influences and is influenced by programmatic changes to HIV service delivery over time.
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Affiliation(s)
- Anne L Stangl
- International Center for Research on WomenWashingtonDCUSA
| | | | - Hlengani Mathema
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
- Division of Public Health Surveillance and ResponseNational Institute for Communicable DiseasesNational Health Laboratory ServiceJohannesburgSouth Africa
| | | | | | | | - Nomhle Bell‐Mandla
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Redwaan Vermaak
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Tila Mainga
- ZambartSchool of MedicineUniversity of ZambiaLusakaZambia
| | - Mara Steinhaus
- International Center for Research on WomenWashingtonDCUSA
| | | | - Ab Schaap
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
- ZambartSchool of MedicineUniversity of ZambiaLusakaZambia
| | - Peter Bock
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Helen Ayles
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
- ZambartSchool of MedicineUniversity of ZambiaLusakaZambia
| | - Richard Hayes
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Graeme Hoddinott
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Virginia Bond
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
- ZambartSchool of MedicineUniversity of ZambiaLusakaZambia
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Grosso AL, Ketende SC, Stahlman S, Ky-Zerbo O, Ouedraogo HG, Kouanda S, Samadoulougou C, Lougue M, Tchalla J, Anato S, Dometo S, Nadedjo FD, Pitche V, Baral SD. Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso. BMC Infect Dis 2019; 19:208. [PMID: 30832604 PMCID: PMC6399877 DOI: 10.1186/s12879-019-3693-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa. Methods This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures’ convergent validity, their correlations with expected variables were examined through bivariate logistic regression models. Results One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach’s alpha ranged from 0.71–0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW. Conclusions Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa.
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Affiliation(s)
- Ashley L Grosso
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA. .,Research and Evaluation Unit, Public Health Solutions, 40 Worth Street, 5th Floor, New York, NY, USA.
| | - Sosthenes C Ketende
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
| | - Shauna Stahlman
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
| | - Odette Ky-Zerbo
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023, Avenue du Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Henri Gautier Ouedraogo
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Cesaire Samadoulougou
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Marcel Lougue
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023, Avenue du Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | | | | | | | | | - Vincent Pitche
- Conseil National de Lutte contre le SIDA et les IST, 01 BP 2237, Lomé, 01, Togo
| | - Stefan D Baral
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
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Hewko SJ, Cummings GG, Pietrosanu M, Edwards N. The Impact of Quality Assurance Initiatives and Workplace Policies and Procedures on HIV/AIDS-Related Stigma Experienced by Patients and Nurses in Regions with High Prevalence of HIV/AIDS. AIDS Behav 2018; 22:3836-3846. [PMID: 29476436 PMCID: PMC6208913 DOI: 10.1007/s10461-018-2066-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/AIDS patients. Few intervention studies have explored the impact of workplace policies and/or quality improvement on stigma. We examine the contribution of health care workplace policies, procedures and quality assurance initiatives, and self- and peer-assessed individual nurse practices, to nurse-reported HIV/AIDS-stigma practices toward patients living with HIV/AIDS and nurses in health care settings. Our sample of survey respondents (n = 1157) included managers (n = 392) and registered/enrolled nurses (n = 765) from 29 facilities in 4 countries (South Africa, Uganda, Jamaica, Kenya). This is one of the first studies in LMIC countries to use hierarchical linear modeling to examine the contributions of organizational and individual factors to HIV/AIDS stigma. Based on our results, we argue that organizational interventions explicitly targeting HIV/AIDS stigma are required to reduce the incidence, prevalence and morbidity of HIV/AIDS.
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Mental Health of Nurses Working at a Government-designated Hospital During a MERS-CoV Outbreak: A Cross-sectional Study. Arch Psychiatr Nurs 2018; 32:2-6. [PMID: 29413067 PMCID: PMC7127092 DOI: 10.1016/j.apnu.2017.09.006] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/27/2017] [Accepted: 09/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND During an epidemic of a novel infectious disease, many healthcare workers suffer from mental health problems. OBJECTIVES The aims of this study were to test the following hypotheses: stigma and hardiness exert both direct effects on mental health and also indirect (mediated) effects on mental health through stress in nurses working at a government-designated hospital during a Middle East Respiratory Syndrome coronavirus (MERS-CoV) epidemic. METHODS A total of 187 participants were recruited using a convenience sampling method. The direct and indirect effects related to the study hypotheses were computed using a series of ordinary least-squares regressions and 95% bootstrap confidence intervals with 10,000 bootstrap resamples from the data. DISCUSSIONS The influences of stigma and hardiness on mental health were partially mediated through stress in nurses working at a hospital during a MERS-CoV epidemic. Their mental health was influenced more by direct effects than by indirect effects.
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16
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Roomaney R, Steenkamp J, Kagee A. Predictors of burnout among HIV nurses in the Western Cape. Curationis 2017; 40:e1-e9. [PMID: 28697615 PMCID: PMC6091648 DOI: 10.4102/curationis.v40i1.1695] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 03/06/2017] [Accepted: 04/08/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Burnout has been implicated as one of the reasons for key healthcare personnel, such as nurses, leaving their profession, resulting in insufficient staff to attend to patients. OBJECTIVE We investigated the predictors of three dimensions of burnout, namely emotional exhaustion, depersonalisation and personal accomplishment, among nurses in South Africa attending to patients living with HIV. METHOD Participants were recruited at a large tertiary hospital in the Western Cape region, with the help of the assistant director of nursing at the hospital. They completed the Maslach Burnout Inventory, the Quantitative Workload Inventory, the Interpersonal Conflict at Work Scale, the Organisational Constraints Scale, the Death and Dying subscale of the Nursing Stress Scale, and the HIV and AIDS Stigma Instrument - Nurse. RESULTS We found elevated levels of burnout among the sample. Workload, job status and interpersonal conflict at work significantly explained more than one-third of the variance in emotional exhaustion (R² = 0.39, F(7, 102) = 9.28, p = 0.001). Interpersonal conflict, workload, organisational constraints and HIV stigma significantly explained depersonalisation (R² = 0.33, F(7, 102) = 7.22, p = 0.001). Job status and organisational constraints significantly predicted personal accomplishment (R² = 0.18, F(7, 102) = 3.12, p = 0.001). CONCLUSION Factors such as workload, job status and interpersonal conflict in the work context, organisational constraints and stigma associated with HIV were found to be predictors of burnout in the sample of nurses. Our recommendations include developing and testing interventions aimed at reducing burnout among nurses, including reducing workload and creating conditions for less interpersonal conflict at work.
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Affiliation(s)
| | | | - Ashraf Kagee
- Department of Psychology, Stellenbosch University.
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17
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Radhakrishna K, Dass D, Raj T, Rakesh D, Kishore R, Srinivasan K, Nyblade L, Ekstrand-Abueg M, Ekstrand ML. Development of a Novel Tablet-based Approach to Reduce HIV Stigma among Healthcare Staff in India. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2017; 14:1b. [PMID: 28566985 PMCID: PMC5430130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although stigma is considered to be one of the major barriers to reducing the AIDS epidemic in India, efforts to reduce stigma have not been sufficiently examined. In response, a partially computer-administered three-session stigma reduction intervention was developed and is currently being tested. This paper describes the technological design, development, implementation, and management of these in-person tablet-administered assessment and intervention sessions that are being used to evaluate the efficacy of this innovative stigma reduction intervention among nursing students and ward attendants in India.
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Affiliation(s)
| | | | - Tony Raj
- St. John's Research Institute in Bangalore, India
| | - Divya Rakesh
- St. John's Research Institute in Bangalore, India
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Maluccio JA, Wu F, Rokon RB, Rawat R, Kadiyala S. Assessing the Impact of Food Assistance on Stigma Among People Living with HIV in Uganda Using the HIV/AIDS Stigma Instrument-PLWA (HASI-P). AIDS Behav 2017; 21:766-782. [PMID: 27372803 DOI: 10.1007/s10461-016-1476-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HIV-related stigma among persons living with HIV/AIDS (PLHIV) is prevalent throughout sub-Saharan Africa. There is limited evidence, however, on which interventions are effective in reducing it. We used data from a prospective impact evaluation of a 12-month food assistance intervention among 904 antiretroviral therapy (ART)- naïve PLHIV in Uganda to examine the program impact on stigma. Stigma was measured using the comprehensive HASI-P scale, which demonstrated good internal consistency (Cronbach's alpha = 0.87) and was correlated with several related constructs including physical and mental health-related quality of life, disclosure, and physical health symptoms in the sample. Using quasi-experimental difference-in-difference matching methods to better infer causality, we tested whether the intervention improved the overall stigma scale and its subscales. The food assistance intervention had a significant effect on reported internalized (but not external) stigma of approximately 0.2 SD (p < 0.01). The HASI-P stigma scale is a useful tool for measuring and tracking stigma. Food assistance interventions, embedded in an HIV care program, can reduce internalized stigma.
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Affiliation(s)
- John A Maluccio
- Department of Economics, Middlebury College, 14 Old Chapel Road, Middlebury, VT, 05753, USA.
| | - Fan Wu
- Department of Economics, Middlebury College, 14 Old Chapel Road, Middlebury, VT, 05753, USA
| | - Redwan B Rokon
- Department of Economics, Middlebury College, 14 Old Chapel Road, Middlebury, VT, 05753, USA
| | - Rahul Rawat
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Edwards N, Kaseje D, Kahwa E, Klopper HC, Mill J, Webber J, Roelofs S, Harrowing J. The impact of leadership hubs on the uptake of evidence-informed nursing practices and workplace policies for HIV care: a quasi-experimental study in Jamaica, Kenya, Uganda and South Africa. Implement Sci 2016; 11:110. [PMID: 27488735 PMCID: PMC4973110 DOI: 10.1186/s13012-016-0478-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/25/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The enormous impact of HIV on communities and health services in Sub-Saharan Africa and the Caribbean has especially affected nurses, who comprise the largest proportion of the health workforce in low- and middle-income countries (LMICs). Strengthening action-based leadership for and by nurses is a means to improve the uptake of evidence-informed practices for HIV care. METHODS A prospective quasi-experimental study in Jamaica, Kenya, Uganda and South Africa examined the impact of establishing multi-stakeholder leadership hubs on evidence-informed HIV care practices. Hub members were engaged through a participatory action research (PAR) approach. Three intervention districts were purposefully selected in each country, and three control districts were chosen in Jamaica, Kenya and Uganda. WHO level 3, 4 and 5 health care institutions and their employed nurses were randomly sampled. Self-administered, validated instruments measured clinical practices (reports of self and peers), quality assurance, work place policies and stigma at baseline and follow-up. Standardised average scores ranging from 0 to 1 were computed for clinical practices, quality assurance and work place policies. Stigma scores were summarised as 0 (no reports) versus 1 (one or more reports). Pre-post differences in outcomes between intervention and control groups were compared using the Mantel Haenszel chi-square for dichotomised stigma scores, and independent t tests for other measures. For South Africa, which had no control group, pre-post differences were compared using a Pearson chi-square and independent t test. Multivariate analysis was completed for Jamaica and Kenya. Hub members in all countries self-assessed changes in their capacity at follow-up; these were examined using a paired t test. RESULTS Response rates among health care institutions were 90.2 and 80.4 % at baseline and follow-up, respectively. Results were mixed. There were small but statistically significant pre-post, intervention versus control district improvements in workplace policies and quality assurance in Jamaica, but these were primarily due to a decline in scores in the control group. There were modest improvements in clinical practices, workplace policies and quality assurance in South Africa (pre-post) (clinical practices of self-pre 0.67 (95 % CI, 0.62, 0.72) versus post 0.78 (95 % CI, 0.73-0.82), p = 0.002; workplace policies-pre 0.82 (95 % CI, 0.70, 0.85) versus post 0.87 (95 % CI, 0.84, 0.90), p = 0.001; quality assurance-pre 0.72 (95 % CI, 0.67, 0.77) versus post 0.84 (95 % CI, 0.80, 0.88)). There were statistically significant improvements in scores for nurses stigmatising patients (Jamaica reports of not stigmatising-pre-post intervention 33.9 versus 62.4 %, pre-post control 54.7 versus 64.4 %, p = 0.002-and Kenya pre-post intervention 35 versus 51.6 %, pre-post control 34.2 versus 47.8 %, p = 0.006) and for nurses being stigmatised (Kenya reports of no stigmatisation-pre-post intervention 23 versus 37.3 %, pre-post control 15.4 versus 27 %, p = 0.004). Multivariate results for Kenya and Jamaica were non-significant. Twelve hubs were established; 11 were active at follow-up. Hub members (n = 34) reported significant improvements in their capacity to address care gaps. CONCLUSIONS Leadership hubs, comprising nurses and other stakeholders committed to change and provided with capacity building can collectively identify issues and act on strategies that may improve practice and policy. Overall, hubs did not provide the necessary force to improve the uptake of evidence-informed HIV care in their districts. If hubs are to succeed, they must be integrated within district health authorities and become part of formal, legal organisations that can regularise and sustain them.
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Affiliation(s)
- Nancy Edwards
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Dan Kaseje
- Great Lakes University of Kisumu, Kisumu, Kenya
| | - Eulalia Kahwa
- School of Nursing, University of West Indies, Mona, Kingston Jamaica
| | | | - Judy Mill
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - June Webber
- Coady International Institute, St. Francis Xavier University, Antigonish, Canada
| | - Susan Roelofs
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Jean Harrowing
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Canada
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Ahmadi K, Reidpath DD, Allotey P, Hassali MAA. A latent trait approach to measuring HIV/AIDS related stigma in healthcare professionals: application of mokken scaling technique. BMC MEDICAL EDUCATION 2016; 16:155. [PMID: 27240562 PMCID: PMC4885119 DOI: 10.1186/s12909-016-0676-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/24/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The attitudes of healthcare professionals towards HIV positive patients and high risk groups are central to the quality of care and therefore to the management of HIV/AIDS related stigma in health settings. Extant HIV/AIDS stigma scales that measure stigmatising attitudes towards people living with HIV/AIDS have been developed using scaling techniques such as principal component analysis. This approach has resulted in instruments that are often long. Mokken scale analysis is a nonparametric hierarchical scaling technique that can be used to develop unidimensional cumulative scales. This technique is advantageous over the other approaches; as the scales are usually shorter, while retaining acceptable psychometric properties. Moreover, Mokken scales also make no distributional assumptions about the underlying data, other than that the data are capable of being ordered by item and by person. In this study we aimed at developing a precise and concise measure of HIV/AIDS related stigma among health care professionals, using Mokken scale analysis. METHODS We carried out a cross sectional survey of healthcare students at the Monash University campuses in Malaysia and Australia. The survey consisted of demographic questions and an initial item pool of twenty five potential questions for inclusion in an HIV stigma scale. RESULTS We analysed the data using the mokken package in the R statistical environment providing a 9-item scale with high reliability, validity and acceptable psychometric properties, measuring and ranking the HIV/AIDS related stigmatising attitudes. CONCLUSION Mokken scaling procedure not only produced a comprehensive hierarchical scale that could accurately order a person along HIV/AIDS stigmatising attitude, but also demonstrated a unidimensional and reliable measurement tool which could be used in future studies. The principal component analysis confirmed the accuracy of the Mokken scale analysis in correctly detecting the unidimensionality of this scale. We recommend future works to study the generalisability of this scale in a new population.
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Affiliation(s)
- Keivan Ahmadi
- School of Pharmacy, University of Lincoln, Joseph Banks Laboratories, Lincoln, Lincolnshire, LN6 7DL, United Kingdom.
| | - Daniel D Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Jalan Lagoon Selatan, Bandar Sunway, 46150, Selangor DE, Malaysia
| | - Pascale Allotey
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Jalan Lagoon Selatan, Bandar Sunway, 46150, Selangor DE, Malaysia
| | - Mohamed Azmi Ahmad Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia
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Bowen P, Govender R, Edwards P. Validating survey measurement scales for AIDS-related knowledge and stigma among construction workers in South Africa. BMC Public Health 2016; 16:70. [PMID: 26803294 PMCID: PMC4724124 DOI: 10.1186/s12889-016-2756-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 01/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Construction workers in South Africa are regarded as a high-risk group in the context of HIV/AIDS. HIV testing is pivotal to controlling HIV transmission and providing palliative care and AIDS-related knowledge and stigma are key issues in addressing the likelihood of testing behaviour. In exploring these issues, various studies have employed an 11-item AIDS-related knowledge scale (Kalichman and Simbayi, AIDS Care 16:572-580, 2004) and a 9-item stigma scale (Kalichman et al., AIDS Behav 9:135-143, 2005), but little evidence exists confirming the psychometric properties of these scales. METHODS Using survey data from 512 construction workers in the Western Cape, South Africa, this research examines the validity and reliability of the two scales through exploratory and confirmatory factor analysis and internal consistency tests. RESULTS From confirmatory factor analysis, a revised 10-item knowledge scale was developed (χ2 /df ratio = 1.675, CFI = 0.982, RMSEA = 0.038, and Hoelter (95 %) = 393). A revised 8-item stigma scale was also developed (χ2 /df ratio = 1.929, CFI = 0.974, RMSEA = 0.045, and Hoelter (95 %) = 380). Both revised scales demonstrated good model fit and all factor loadings were significant (p < 0.01). Reliability analysis demonstrated excellent to good internal consistency, with alpha values of 0.80 and 0.74, respectively. Both revised scales also demonstrated satisfactory convergent and divergent validity. Limitations of the original survey from which the data was obtained include the failure to properly account for respondent selection of language for completion of the survey, use of ethnicity as a proxy for identifying the native language of participants, the limited geographical area from which the survey data was collected, and the limitations associated with the convenience sample. A limitation of the validation study was the lack of available data for a more robust examination of reliability beyond internal consistency, such as test-retest reliability. CONCLUSIONS The revised knowledge and stigma scales offered here hold considerable promise as measures of AIDS-related knowledge and stigma among South African construction workers.
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Affiliation(s)
- Paul Bowen
- Department of Construction Economics and Management, University of Cape Town, Private Bag, Rondebosch, 7701, Cape Town, South Africa.
| | - Rajen Govender
- Medical Research Council of South Africa and Department of Sociology, University of Cape Town, Private Bag, Rondebosch, 7701, Cape Town, South Africa
| | - Peter Edwards
- School of Property, Construction and Project Management, RMIT University, Swanston Street, Melbourne, Victoria, Australia
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Prinsloo CD, Greeff M. A Community "Hub" Network Intervention for HIV Stigma Reduction: A Case Study. J Assoc Nurses AIDS Care 2015; 27:166-79. [PMID: 26627447 DOI: 10.1016/j.jana.2015.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/30/2015] [Indexed: 11/16/2022]
Abstract
We describe the implementation of a community "hub" network intervention to reduce HIV stigma in the Tlokwe Municipality, North West Province, South Africa. A holistic case study design was used, focusing on community members with no differentiation by HIV status. Participants were recruited through accessibility sampling. Data analyses used open coding and document analysis. Findings showed that the HIV stigma-reduction community hub network intervention successfully activated mobilizers to initiate change; lessened the stigma experience for people living with HIV; and addressed HIV stigma in a whole community using a combination of strategies including individual and interpersonal levels, social networks, and the public. Further research is recommended to replicate and enhance the intervention. In particular, the hub network system should be extended, the intervention period should be longer, there should be a stronger support system for mobilizers, and the multiple strategy approach should be continued on individual and social levels.
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Mugweni E, Omar M, Pearson S. Understanding barriers to safer sex practice in Zimbabwean marriages: implications for future HIV prevention interventions. HEALTH EDUCATION RESEARCH 2015; 30:388-399. [PMID: 25503579 DOI: 10.1093/her/cyu073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
Against the backdrop of high human immunodeficiency virus (HIV) prevalence in stable relationships in Southern Africa, our study presents sociocultural barriers to safer sex practice in Zimbabwean marriages. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008. Our aim was to identify barriers faced by married women when negotiating for safer sex. Participants identified individual, relational and community-level barriers. Individual level barriers made women voiceless to negotiate for safer sex. Being voiceless emanated from lack sexual decision-making power, economic dependence, low self-efficacy or fear of actual or perceived consequences of negotiating for safer sex. Relational barriers included trust and self-disclosure. At the community level, extended family members and religious leaders were said to explicitly or implicitly discourage women's safer sex negotiation. Given the complexity and multi-levelled nature of barriers affecting sexual behaviour in marriage, our findings suggest that HIV prevention interventions targeted at married women would benefit from empowering individual women, couples and also addressing the wider community.
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Affiliation(s)
- Esther Mugweni
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Mayeh Omar
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Stephen Pearson
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
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Siegel J, Yassi A, Rau A, Buxton JA, Wouters E, Engelbrecht MC, Uebel KE, Nophale LE. Workplace interventions to reduce HIV and TB stigma among health care workers - Where do we go from here? Glob Public Health 2015; 10:995-1007. [PMID: 25769042 DOI: 10.1080/17441692.2015.1021365] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fear of stigma and discrimination among health care workers (HCWs) in South African hospitals is thought to be a major factor in the high rates of HIV and tuberculosis infection experienced in the health care workforce. The aim of the current study is to inform the development of a stigma reduction intervention in the context of a large multicomponent trial. We analysed relevant results of four feasibility studies conducted in the lead up to the trial. Our findings suggest that a stigma reduction campaign must address community and structural level drivers of stigma, in addition to individual level concerns, through a participatory and iterative approach. Importantly, stigma reduction must not only be embedded in the institutional management of HCWs but also be attentive to the localised needs of HCWs themselves.
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Affiliation(s)
- Jacob Siegel
- a School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada
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25
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Mak WWS, Cheng SSY, Law RW, Cheng WWL, Chan F. Reducing HIV-related stigma among health-care professionals: a game-based experiential approach. AIDS Care 2015; 27:855-9. [PMID: 25671591 DOI: 10.1080/09540121.2015.1007113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Stigmatizing attitudes from health professionals toward people living with HIV (PLHIV) constitute a key barrier to HIV care. Despite considerable progress in HIV stigma-reduction research, we are still searching for effective strategies that can be implemented on a larger scale. To narrow this research gap, the present study investigated a novel cost-effective approach to reducing HIV-related stigma among health professionals. Interactive experiential games were used to help participants gain first-hand experience of potential stressors that PLHIV might encounter. The effectiveness of this game-based experiential approach was compared with that of in vivo contact in reducing HIV-related stigma among students in the health-care fields. Eighty-eight students of health-related programs in Hong Kong were randomly assigned to either the game-based or in vivo contact program. They completed measures of stigmatizing attitudes and HIV/AIDS-related knowledge at pre-program, post-program, and one-month follow-up. Findings showed that the effectiveness of the game-based experiential approach in reducing HIV-related stigma was similar to that of in vivo contact both at post-program and one-month follow-up. Further research is needed to explore the potential value of the game-based approach in reducing HIV stigma among health professionals.
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Affiliation(s)
- Winnie W S Mak
- a Department of Psychology , The Chinese University of Hong Kong , Hong Kong , China
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Stigma in HIV-infected health care workers in Kenya: a mixed-method approach. J Assoc Nurses AIDS Care 2014; 26:639-51. [PMID: 25769752 DOI: 10.1016/j.jana.2014.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 12/22/2014] [Indexed: 11/23/2022]
Abstract
HIV-related stigma decreases access to HIV testing, prevention, and treatment services. Our mixed methods study explored stigma as perceived, experienced, and managed in a sample of 76 HIV-infected health care workers in Kisumu, Kenya. Stigma was quantitatively measured using the HIV/AIDS Stigma Instrument for People Living with AIDS (HASI-P). Overall, subjects experienced low stigma levels (mean = 7.88, SD = 12.90; range = 0-61), and none of the sociodemographic variables were predictive of stigma. Transcript analysis of 20 qualitative interviews revealed two negative themes (blame, lack of knowledge) and five positive themes (living positively, optimism, empathy, support, changes over time). Three themes emerged on reducing stigma (normalizing, empowerment, leading by example). Disclosure, access to treatment, stigma reduction training, workplace support groups, and awareness of an HIV workplace policy may have contributed to low stigma scores. Qualitative findings corroborated quantitative findings and corresponded to the six domains of the HASI-P.
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Franke MF, Nelson AK, Muñoz M, Cruz JS, Atwood S, Lecca L, Shin SS. Validation of 2 Spanish-Language Scales to Assess HIV-Related Stigma in Communities. J Int Assoc Provid AIDS Care 2014; 14:527-35. [PMID: 25294853 DOI: 10.1177/2325957414547738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report the psychometric properties of 2 Spanish-language scales designed to measure (1) opinions about HIV in the community and particularly among health care workers and (2) observed acts of stigma toward people living with HIV/AIDS (PLWHA) by health care workers. The Opinions about HIV Scale included 3 components (policy, avoidance, and empathy) and 9 items, while an adapted version of the HIV/AIDS Stigma Instrument-Nurse, designed to capture acts of stigma, included 2 components (discrimination related to clinical care and refusal to share or exchange food/gifts). Scales demonstrated good reliability and construct validity. Relative to community health workers, treatment supporters were more likely to have stigmatizing opinions related to avoidance and empathy. We offer 2 Spanish-language scales that could be used to identify populations with high levels of stigmatizing opinions and behaviors toward PLWHA. Formal training of health care workers, especially treatment supporters, may raise awareness and reduce stigma toward HIV.
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Affiliation(s)
- Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners In Health / Socios En Salud, Lima, Peru
| | - Adrianne K Nelson
- Partners In Health / Socios En Salud, Lima, Peru Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Leonid Lecca
- Partners In Health / Socios En Salud, Lima, Peru
| | - Sonya S Shin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners In Health / Socios En Salud, Lima, Peru Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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Waluyo A, Culbert GJ, Levy J, Norr KF. Understanding HIV-related stigma among Indonesian nurses. J Assoc Nurses AIDS Care 2014; 26:69-80. [PMID: 24759060 DOI: 10.1016/j.jana.2014.03.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/03/2014] [Indexed: 11/16/2022]
Abstract
Evidence indicates widespread stigmatization of persons living with HIV (PLWH) in Indonesia. Such attitudes among health care workers could impede the country's policies for effective diagnosis and medical treatment of PLWH. Nonetheless, research to guide interventions to reduce stigma in health care settings is lacking. Also, the contributions of workplace, religion, and HIV knowledge to nurses' HIV-related stigma are poorly understood. Our cross-sectional study aimed to describe factors associated with nurses' stigmatizing attitudes toward PLWH. Four hundred nurses recruited from four hospitals in Jakarta, Indonesia, were surveyed using the Nurse AIDS Attitude Scale to measure stigma. Stigmatizing attitudes were significantly predicted by education, HIV training, perceived workplace stigma, religiosity, Islamic religious identification, and affiliation with the Islamic hospital. HIV knowledge was not a significant predictor of stigmatizing attitudes. Organization changes fostering workplace diversity are likely to substantially reduce stigmatizing attitudes in nurses.
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Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc 2013; 16:18734. [PMID: 24242268 PMCID: PMC3833106 DOI: 10.7448/ias.16.3.18734] [Citation(s) in RCA: 446] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/23/2013] [Accepted: 08/29/2013] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION HIV-related stigma and discrimination continue to hamper efforts to prevent new infections and engage people in HIV treatment, care and support programmes. The identification of effective interventions to reduce stigma and discrimination that can be integrated into national responses is crucial to the success of the global AIDS response. METHODS We conducted a systematic review of studies and reports that assessed the effectiveness of interventions to reduce HIV stigma and discrimination between 1 January 2002 and 1 March 2013. Databases searched for peer-reviewed articles included PubMed, Scopus, EBSCO Host -CINAHL Plus, Psycinfo, Ovid, Sociofile and Popline. Reports were obtained from the www.HIVAIDSClearinghouse.eu, USAID Development Experience Clearinghouse, UNESCO HIV and AIDS Education Clearinghouse, Google, WHO and UNAIDS. Ancestry searches for articles included in the systematic review were also conducted. Studies of any design that sought to reduce stigma as a primary or secondary objective and included pre- and post-intervention measures of stigma were included. RESULTS Of 2368 peer-reviewed articles and reports identified, 48 were included in our review representing 14 different target populations in 28 countries. The majority of interventions utilized two or more strategies to reduce stigma and discrimination, and ten included structural or biomedical components. However, most interventions targeted a single socio-ecological level and a single domain of stigma. Outcome measures lacked uniformity and validity, making both interpretation and comparison of study results difficult. While the majority of studies were effective at reducing the aspects of stigma they measured, none assessed the influence of stigma or discrimination reduction on HIV-related health outcomes. CONCLUSIONS Our review revealed considerable progress in the stigma-reduction field. However, critical challenges and gaps remain which are impeding the identification of effective stigma-reduction strategies that can be implemented by national governments on a larger scale. The development, validation, and consistent use of globally relevant scales of stigma and discrimination are a critical next step for advancing the field of research in this area. Studies comparing the effectiveness of different stigma-reduction strategies and studies assessing the influence of stigma reduction on key behavioural and biomedical outcomes are also needed to maximize biomedical prevention efforts.
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Affiliation(s)
- Anne L Stangl
- Department of Global Health, International Center for Research on Women, Washington, DC, USA;
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31
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A brief, standardized tool for measuring HIV-related stigma among health facility staff: results of field testing in China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. J Int AIDS Soc 2013; 16:18718. [PMID: 24242266 PMCID: PMC3833189 DOI: 10.7448/ias.16.3.18718] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/16/2013] [Accepted: 08/29/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction Within healthcare settings, HIV-related stigma is a recognized barrier to access of HIV prevention and treatment services and yet, few efforts have been made to scale-up stigma reduction programs in service delivery. This is in part due to the lack of a brief, simple, standardized tool for measuring stigma among all levels of health facility staff that works across diverse HIV prevalence, language and healthcare settings. In response, an international consortium led by the Health Policy Project, has developed and field tested a stigma measurement tool for use with health facility staff. Methods Experts participated in a content-development workshop to review an item pool of existing measures, identify gaps and prioritize questions. The resulting questionnaire was field tested in six diverse sites (China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis). Respondents included clinical and non-clinical staff. Questionnaires were self- or interviewer-administered. Analysis of item performance across sites examined both psychometric properties and contextual issues. Results The key outcome of the process was a substantially reduced questionnaire. Eighteen core questions measure three programmatically actionable drivers of stigma within health facilities (worry about HIV transmission, attitudes towards people living with HIV (PLHIV), and health facility environment, including policies), and enacted stigma. The questionnaire also includes one short scale for attitudes towards PLHIV (5-item scale, α = 0.78). Conclusions Stigma-reduction programmes in healthcare facilities are urgently needed to improve the quality of care provided, uphold the human right to healthcare, increase access to health services, and maximize investments in HIV prevention and treatment. This brief, standardized tool will facilitate inclusion of stigma measurement in research studies and in routine facility data collection, allowing for the monitoring of stigma within healthcare facilities and evaluation of stigma-reduction programmes. There is potential for wide use of the tool either as a stand-alone survey or integrated within other studies of health facility staff.
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Diesel H, Ercole P, Taliaferro D. Knowledge and perceptions of HIV/AIDS among Cameroonian nursing students. Int J Nurs Educ Scholarsh 2013; 10:/j/ijnes.2013.10.issue-1/ijnes-2012-0036/ijnes-2012-0036.xml. [PMID: 24047598 DOI: 10.1515/ijnes-2012-0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The HIV/AIDS pandemic impacts people throughout the world and is complicated by fear, prejudice, and stigma. Nurses play a major role in the health care delivery systems, yet in many parts of the world with high HIV sero-prevalence rates, nurses lack sufficient training and education to provide care to patients with HIV/AIDS. In an effort to build capacity and improve knowledge, attitudes and beliefs regarding care of patients with HIV/AIDS, a 4-day workshop was provided by American nursing students for Cameroonian nursing students. The training program included HIV epidemiology, disease management, and natural course of the disease, testing, legal and ethical issues, and infection control practices. Pre- and post-test scores were calculated using a series of surveys that measured HIV-related knowledge, attitudes, and beliefs. Results indicated that these measures of HIV-related perceptions improved due to the train-the-trainer workshop.
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Affiliation(s)
- Holly Diesel
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO 63110, USA.
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Mill J, Harrowing J, Rae T, Richter S, Minnie K, Mbalinda S, Hepburn-Brown C. Stigma in AIDS nursing care in sub-saharan Africa and the Caribbean. QUALITATIVE HEALTH RESEARCH 2013; 23:1066-1078. [PMID: 23771634 DOI: 10.1177/1049732313494019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Some nurses who provide AIDS care, in addition to experiencing stigma themselves, also exhibit negative attitudes and perpetrate stigma and discrimination toward persons living with HIV (PLWHAs). We used a participatory research approach to explore the nature, context, and influence of stigma on the nursing care provided to PLWHAs in four low- and middle-income countries: Jamaica, Kenya, South Africa, and Uganda. Eighty-four registered nurses, enrolled nurses, and midwives participated in interviews and 79 participated in 11 focus groups. Nurses were very aware of the stigma and discrimination that AIDS evoked, and made adjustments to their care to decrease the manifestation of AIDS stigma. Despite the assurance that PLWHAs were treated equally, and that universal precautions were used consistently, we found that in reality, nurses sometimes made decisions about nursing care that were based on the appearance of the patient or knowledge of his or her status.
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Affiliation(s)
- Judy Mill
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada.
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Abdelrahman I, Lohiniva AL, Kandeel A, Benkirane M, Atta H, Saleh H, El Sayed N, Talaat M. Learning about Barriers to Care for People Living with HIV in Egypt: A Qualitative Exploratory Study. J Int Assoc Provid AIDS Care 2013; 14:141-7. [PMID: 23792709 DOI: 10.1177/2325957413488180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to identify obstacles health care workers face in providing care for people living with HIV and AIDS (PLWHA). Based on these findings, health authorities can design interventions to support health care workers in providing better medical care for PLWHA. Thirty in-depth interviews were conducted with physicians and nurses in one 300-bed tertiary care public hospital in Giza, Egypt. Thematic analysis was conducted by 2 investigators. Five main themes were identified (1) fear of infection; (2) disbelief in effectiveness of infection control measures to protect against HIV; (3) misconceptions regarding medical care for PLWHA; (4) fear of secondary stigma; and (5) moral judgments toward PLWHA and negative connotations related to HIV. Interventions targeting health care workers should be multidimensional, including knowledge and skills building as well as value and attitude change. Reducing stigma among health care workers will improve access to care for PLWHA.
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Affiliation(s)
| | - Anna Leena Lohiniva
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | | | - Manal Benkirane
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Hossam Atta
- Ouem El Masreyn General Hospital, Ministry of Health in Egypt, Cairo, Egypt
| | - Hanan Saleh
- Ouem El Masreyn General Hospital, Ministry of Health in Egypt, Cairo, Egypt
| | | | - Maha Talaat
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
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Liem A, Adiyanti MG. “Bidan cantik”: Psychoeducation on HIV and AIDS to improve the service quality of midwives at Yogyakarta public health center. HIV & AIDS REVIEW 2013. [DOI: 10.1016/j.hivar.2013.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Pham HN, Protsiv M, Larsson M, Ho HT, de Vries DH, Thorson A. Stigma, an important source of dissatisfaction of health workers in HIV response in Vietnam: a qualitative study. BMC Health Serv Res 2012; 12:474. [PMID: 23259923 PMCID: PMC3548727 DOI: 10.1186/1472-6963-12-474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 12/19/2012] [Indexed: 11/16/2022] Open
Abstract
Background Like in many other low- and middle-income countries, the recent development of an HIV epidemic in Vietnam has led to a growing need for prevention, treatment, care, and support services for people living with HIV (PLHIV). This puts greater demands on the national HIV services, primarily on health workers, which increases the importance of their job satisfaction and working conditions. This study describes health worker perceptions and explores the factors that influence job satisfaction and dissatisfaction of health personnel working on the HIV response in Vietnam. Spector’s job satisfaction model was used as the theoretical framework for the study design and analysis. Methods The study employed a qualitative design with 7 focus group discussions and 15 semi-structured interviews with health workers, purposively selected from national and provincial organizations responsible for HIV services in 5 cities and provinces in Vietnam. Data were analyzed using a hybrid approach of theory-driven and data-driven coding and theme development using qualitative analysis software. Results HIV services are perceived by Vietnamese health workers as having both positive and negative aspects. Factors related to job satisfaction included training opportunities, social recognition, and meaningful tasks. Factors related to job dissatisfaction included unsatisfactory compensation, lack of positive feedback and support from supervisors, work-related stress from a heavy workload, fear of infection, and HIV-related stigma because of association with PLHIV. An adjusted Spector’s model of job satisfaction for HIV service health workers was developed from these results. Conclusion This study confirmed the relationship between stigmatization of PLHIV and stigma experienced by staff because of association with PLHIV from families, colleagues, and society. The experiencing stigma results in additional work-related stress, low self-esteem, poor views of their profession, and lower income. The study shows the importance of actions to improve staff job satisfaction such as pay raises, supportive supervision, stress management, stigma reduction and workplace safety. Immediate actions could be the provision of more information; education and communication in mass media to improve the public image of HIV services, as well as improvement of workplace safety, therefore making health workers feel that their work is valued and safe.
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Affiliation(s)
- Ha Nguyen Pham
- Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
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Blythe SL, Jackson D, Halcomb EJ, Wilkes L. The stigma of being a long-term foster carer. JOURNAL OF FAMILY NURSING 2012; 18:234-260. [PMID: 22045043 DOI: 10.1177/1074840711423913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Stigma is a powerful social phenomenon with insidious health implications. Understanding stigma as it applies to various populations is imperative for nurses as it enables nurses to enhance individual patient care and nurses are well positioned to influence both social and health care policies which may exacerbate the experience of stigma. This article is a report of a study to explore the experiences of women who provide long-term foster care. Interviews were conducted with 20 women who provided long-term foster care in Australia. Data were coded according to the components of stigma described by Link and Phelan (2001). Findings reveal participants rejected the label of foster carer to avoid the negative stereotype. When unable to conceal their foster carer label, participants experienced social isolation and status loss. Moreover, participants felt marginalized and disempowered within the governing systems.
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Affiliation(s)
- Stacy L Blythe
- Family & Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia.
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Jones L, Akugizibwe P, Clayton M, Amon JJ, Sabin ML, Bennett R, Stegling C, Baggaley R, Kahn JG, Holmes CB, Garg N, Obermeyer CM, Mack CD, Williams P, Smyth C, Vitoria M, Crowley S, Williams B, McClure C, Granich R, Hirnschall G. Costing human rights and community support interventions as a part of universal access to HIV treatment and care in a Southern African setting. Curr HIV Res 2012; 9:416-28. [PMID: 21999777 PMCID: PMC3531822 DOI: 10.2174/157016211798038614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 12/04/2022]
Abstract
Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, ‘Know Your Rights’ information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes costs. ART programs should consider measuring the cost and impact of human rights and community support interventions as key aspects of successful programme expansion.
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Rosenburg N, Taliaferro D, Ercole P. HIV-Related Stigma Among Nursing Students in Cameroon. J Assoc Nurses AIDS Care 2012; 23:170-6. [DOI: 10.1016/j.jana.2011.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 09/06/2011] [Indexed: 11/30/2022]
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Rutledge SE, Whyte J, Abell N, Brown KM, Cesnales NI. Measuring stigma among health care and social service providers: The HIV/AIDS Provider Stigma Inventory. AIDS Patient Care STDS 2011; 25:673-82. [PMID: 21967495 DOI: 10.1089/apc.2011.0008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV/AIDS (PLHA). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHA that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients α for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed.
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Affiliation(s)
| | - James Whyte
- College of Nursing, Florida State University, Tallahassee, Florida
| | - Neil Abell
- College of Social Work, Florida State University, Tallahassee, Florida
| | - Kristin M. Brown
- College of Social Work, Florida State University, Tallahassee, Florida
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41
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Phillips KD, Moneyham L, Tavakoli A. Development of an instrument to measure internalized stigma in those with HIV/AIDS. Issues Ment Health Nurs 2011; 32:359-66. [PMID: 21692574 DOI: 10.3109/01612840.2011.575533] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Stigma has grave consequences for persons living with HIV/AIDS. Stigma hampers prevention of HIV transmission to sexual partners and to unborn babies, diagnosis, and early treatment, and negatively affects mental and physical health, quality of life, and life satisfaction. Internalized stigma of HIV/AIDS may have even more severe consequences than perceived or enacted stigma. The purpose of this study was to develop an instrument to measure internalized stigma in those with HIV/AIDS. Data were drawn from the Rural Women's Health Project. Research assistants administered structured interviews at baseline, 3 months, and 6 months. Instruments used in these analyses included a demographic data form, the Centers for Epidemiological Studies Depression Scale (CES-D), the Perceived Stigma Scale (PSS), and the Internalized Stigma of AIDS Tool (ISAT). Exploratory factor analysis confirmed that the ten items of the ISAT measure a single factor that explains 88% of the variance in the construct. Internal consistency was demonstrated by a Cronbach's alpha of .91 (Time 1), .92 (Time 2), and .92 (Time 3). Convergent validity was supported with significant positive correlations with the CES-D (rho = 0.33, p < 0.0001) and the PSS (rho = 0.56, < 0.0001). The Internalized Stigma of AIDS Tool appears to be a reliable and valid instrument to measure internalization of the stigma of HIV/AIDS. It may be of value in research and clinical assessment.
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Affiliation(s)
- Kenneth D Phillips
- The University of Tennessee-Knoxville, College of Nursing, Knoxville, Tennessee, USA.
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Kohi TW, Portillo CJ, Durrheim K, Dlamini PS, Makoae LN, Greeff M, Chirwa M, Naidoo J, Uys LR, Holzemer WL. Does perceived HIV stigma contribute to nurses' intent to migrate in five African countries? J Assoc Nurses AIDS Care 2010; 21:134-43. [PMID: 20116298 DOI: 10.1016/j.jana.2009.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 09/16/2009] [Indexed: 11/25/2022]
Abstract
Nurse migration out of low-resource countries has occurred for many years, resulting in workforce shortages, particularly in countries with a high prevalence of HIV. A cross-sectional survey of 1,374 nurses from five African countries (Lesotho, Malawi, South Africa, Swaziland, and Tanzania) was conducted. A logistic regression analysis resulted in a profile of odds ratios predicting increased odds of intent to migrate for nurses who were more experienced and working in urban hospitals. These data provide the first support that HIV stigma experienced by nurses through their association as providers for people living with HIV may also be contributing to their intent to migrate. The study contributes to a greater understanding of the complexity of nurse migration in Africa.
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Affiliation(s)
- Thecla W Kohi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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43
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Uys L, Chirwa M, Kohi T, Greeff M, Naidoo J, Makoae L, Dlamini P, Durrheim K, Cuca Y, Holzemer WL. Evaluation of a health setting-based stigma intervention in five African countries. AIDS Patient Care STDS 2009; 23:1059-66. [PMID: 20025515 DOI: 10.1089/apc.2009.0085] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The study aim is to explore the results of an HIV stigma intervention in five African health care settings. A case study approach was used. The intervention consisted of bringing together a team of approximately 10 nurses and 10 people living with HIV or AIDS (PLHA) in each setting and facilitating a process in which they planned and implemented a stigma reduction intervention, involving both information giving and empowerment. Nurses (n = 134) completed a demographic questionnaire, the HIV/AIDS Stigma Instrument-Nurses (HASI-N), a self-efficacy scale, and a self-esteem scale, both before and after the intervention, and the team completed a similar set of instruments before and after the intervention, with the PLHA completing the HIV/AIDS Stigma Instrument for PLHA (HASI-P). The intervention as implemented in all five countries was inclusive, action-oriented, and well received. It led to understanding and mutual support between nurses and PLHA and created some momentum in all the settings for continued activity. PLHA involved in the intervention teams reported less stigma and increased self-esteem. Nurses in the intervention teams and those in the settings reported no reduction in stigma or increases in self- esteem and self-efficacy, but their HIV testing behavior increased significantly. This pilot study indicates that the stigma experience of PLHA can be decreased, but that the stigma experiences of nurses are less easy to change. Further evaluation research with control groups and larger samples and measuring change over longer periods of time is indicated.
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Affiliation(s)
- Leana Uys
- School of Nursing, University of KwaZulu-Natal, Durban, South Africa
| | - Maureen Chirwa
- College of Medicine, University of Malawi, Lilongwe, Malawi
| | - Thecla Kohi
- College of Health Sciences, Muhimbili University, Dar es Salaam, United Republic of Tanzania
| | - Minrie Greeff
- Department of Nursing, Potchefstroom Campus, North-West University, Potchefstroom, South Africa
| | - Joanne Naidoo
- School of Nursing, University of KwaZulu-Natal, Durban, South Africa
| | - Lucia Makoae
- Department of Nursing, National University of Lesotho, Maseru, Lesotho
| | | | - Kevin Durrheim
- Department of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - Yvette Cuca
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - William L. Holzemer
- School of Nursing, University of California, San Francisco, San Francisco, California
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Greeff M, Uys LR, Wantland D, Makoae L, Chirwa M, Dlamini P, Kohi TW, Mullan J, Naidoo JR, Cuca Y, Holzemer WL. Perceived HIV stigma and life satisfaction among persons living with HIV infection in five African countries: a longitudinal study. Int J Nurs Stud 2009; 47:475-86. [PMID: 19854440 DOI: 10.1016/j.ijnurstu.2009.09.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 09/04/2009] [Accepted: 09/21/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Descriptive literature exists on the effects of HIV-related stigma on the lives of people living with HIV infection but few empirical studies have measured perceived HIV stigma nor explored its potential relationship to quality of life (QoL) over time in people living with HIV infection. AIM A cohort study of a purposive convenient sample of 1457 HIV-positive persons was followed for one year in a longitudinal design that examined the effects of stigma and the life satisfaction dimension of the HIV/AIDS Targeted Quality of Life Instrument (HAT-QOL) over time, as well as the influence of other demographic and assessed social variables. Data were collected three times about six months apart from December 2005 to March 2007. RESULTS The average age in this sample was 36.8 years (SD=8.78, n=1454) and 72.7% (n=1056) were female. The initial sample of participants was balanced among the five countries: Lesotho, Malawi, South Africa, Swaziland, and Tanzania. An attrition analysis demonstrated few demographic differences between those who remained in the study 12 months later compared with those at baseline. However, those who completed the study and who answered the QoL questions had significantly higher life satisfaction scores at baseline than those who left the study. There was a general increase in the report of life satisfaction QoL in all countries over the one-year period. However, as stigma scores increased over time there was a significant decrease in life satisfaction with differing rates of change by country. Certain factors had a positive influence on life satisfaction QoL: positive HIV media reports, taking antiretrovirals, reduced symptom intensity, and disclosure to a friend. CONCLUSION This cohort study is the first to document empirically in a longitudinal sample, that perceived HIV stigma has a significantly negative and constant impact upon life satisfaction QoL for people with HIV infection. In the absence of any intervention to address and reduce stigmatization, individuals will continue to report poorer life satisfaction evidenced by reduced living enjoyment, loss of control in life, decreased social interactivity, and decreased perceived health status.
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Affiliation(s)
- Minrie Greeff
- North-West University, Potchefstroom Campus, South Africa
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Holzemer WL, Makoae LN, Greeff M, Dlamini PS, Kohi TW, Chirwa ML, Naidoo JR, Durrheim K, Cuca Y, Uys YR. Measuring HIV stigma for PLHAs and nurses over time in five African countries. SAHARA J 2009; 6:76-82. [PMID: 19936409 PMCID: PMC3630506 DOI: 10.1080/17290376.2009.9724933] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The aim of this article is to document the levels of HIV stigma reported by persons living with HIV infections and nurses in Lesotho, Malawi, South Africa, Swaziland and Tanzania over a 1-year period. HIV stigma has been shown to negatively affect the quality of life for people living with HIV infection, their adherence to medication, and their access to care. Few studies have documented HIV stigma by association as experienced by nurses or other health care workers who care for people living with HIV infection. This study used standardised scales to measure the level of HIV stigma over time. A repeated measures cohort design was used to follow persons living with HIV infection and nurses involved in their care from five countries over a 1-year period in a three-wave longitudinal design. The average age of people living with HIV/AIDS (PLHAs) (N=948) was 36.15 years (SD=8.69), and 67.1% (N=617) were female. The average age of nurses (N=887) was 38.44 years (SD=9.63), and 88.6% (N=784) were females. Eighty-four per cent of all PLHAs reported one or more HIV-stigma events at baseline. This declined, but was still significant 1 year later, when 64.9% reported experiencing at least one HIV-stigma event. At baseline, 80.3% of the nurses reported experiencing one or more HIV-stigma events and this increased to 83.7% 1 year later. The study documented high levels of HIV stigma as reported by both PLHAs and nurses in all five of these African countries. These results have implications for stigma reduction interventions, particularly focused at health care providers who experience HIV stigma by association.
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Affiliation(s)
- William L Holzemer
- International Programs at the University of California, San Francisco, School of Nursing, USA.
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Dlamini PS, Wantland D, Makoae LN, Chirwa M, Kohi TW, Greeff M, Naidoo J, Mullan J, Uys LR, Holzemer WL. HIV stigma and missed medications in HIV-positive people in five African countries. AIDS Patient Care STDS 2009; 23:377-87. [PMID: 19327098 DOI: 10.1089/apc.2008.0164] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The availability of antiretroviral medications has transformed living with HIV infection into a manageable chronic illness, and high levels of adherence are necessary. Stigma has been identified as one reason for missing medication doses. The objective of this study was to explore the relationship between perceived HIV stigma and self-reported missed doses of antiretroviral medications in a 12-month, repeated measures cohort study conducted in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Data were collected from 1457 HIV-positive individuals at three times between January 2006 and March 2007. Participants completed a series of questionnaires. Of the 1457 participants, 698 were taking ARVs during the study and are included in this analysis. There was a significant relationship between perceived HIV stigma and self-report of missed medications over time (t = 6.04, p </= 0.001). Individuals who reported missing more ARV medications also reported higher levels of perceived HIV stigma. Individuals reporting fewer medication worries reported decreased stigma over the one year period (t = -4.79, p </= 0.001). While those who reported increased symptom intensity also reported increased stigma initially (t = 8.67, p </= 0.001) that remained high over time. This study provides evidence of a significant and stable correlation that documents the relationship between perceived HIV stigma and self-reported reasons for missed medications over time. These findings suggest that part of the reason for poor adherence to ARV medications is linked to the stigma experienced by people living with HIV.
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Affiliation(s)
| | - Dean Wantland
- University of California, San Francisco, San Francisco, California
| | | | | | - Thecla W. Kohi
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Republic of Tanzania
| | - Minrie Greeff
- North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | | | - Joseph Mullan
- University of California, San Francisco, San Francisco, California
| | - Leana R. Uys
- University of KwaZulu-Natal, Durban, South Africa
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47
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HIV stigma and nurse job satisfaction in five African countries. J Assoc Nurses AIDS Care 2009; 20:14-21. [PMID: 19118767 DOI: 10.1016/j.jana.2008.10.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 10/01/2008] [Indexed: 11/22/2022]
Abstract
This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross-sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The Personal Satisfaction subscale was the highest in this sample, as in the other 2. Job satisfaction scores differed significantly among the 5 countries, and these differences were consistent across all subscales. A hierarchical regression showed that mental and physical health, marital status, education level, urban/rural setting, and perceived HIV stigma had significant influence on job satisfaction. Perceived HIV stigma was the strongest predictor of job dissatisfaction. These results provide new areas for intervention strategies that might enhance the work environment for nurses in these countries.
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