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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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Badacho AS, Mahomed OH. Lived experiences of people living with HIV and hypertension or diabetes access to care in Ethiopia: a phenomenological study. BMJ Open 2024; 14:e078036. [PMID: 38417958 PMCID: PMC10900422 DOI: 10.1136/bmjopen-2023-078036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND People living with HIV (PLWH) are more likely to develop hypertension and diabetes than people without HIV. Previous studies have shown that HIV stigma, discrimination and exclusion make it difficult for PLWH to access care for hypertension and diabetes. OBJECTIVES This study aimed to explore the lived experiences of PLWH with comorbid hypertension or diabetes to access hypertension and diabetes care in southern Ethiopia. DESIGN We conducted a qualitative study using a semistructured interview guide for an in-depth, in-person interview. SETTINGS From 5 August to 25 September 2022, PLWH with comorbid hypertension or diabetes were purposefully selected from five primary healthcare (PHC) facilities in the Wolaita zone of southern Ethiopia. PARTICIPANTS A total of 14 PLWH with comorbid hypertension or diabetes who were receiving antiretroviral therapy from PHC were interviewed. Among them, 10 were women, and 4 were men. METHODS In-person, in-depth interviews were conducted. Qualitative data analysis software (NVivo V.12) was used to assist with the data organisation, and Colaizzi's (1978) inductive thematic analyses were conducted to explore key concepts. RESULT This study yielded two main themes: Theme 1: barriers to accessing care as individual barriers to access (low awareness of non-communicable diseases, misperceptions, lack of health insurance and cost of treatment); healthcare system barriers (shortage of supplies, drugs and equipment; long wait times; lack of integrated services; absence of routine screening and lack of respect from providers); community barriers (lack of support from families, friends and the community) and stigma and discrimination access to hypertension and diabetes. Theme 2: accessibility facilitators (support from family, friends and organisations; health insurance coverage). CONCLUSION PLWH recommended that access to services can be improved by service integration, awareness-raising activities, no user fee charges for hypertension and diabetes care and routine screening.
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Affiliation(s)
- Abebe Sorsa Badacho
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Ozayr Haroon Mahomed
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Dasman Diabetes Institute, Kuwait City, Kuwait
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Adekoya P, Lannap FD, Ajonye FA, Amadiegwu S, Okereke I, Elochukwu C, Aruku CA, Oluwaseyi A, Kumolu G, Ejeh M, Olutola AO, Magaji D. Experiences of Stigmatization and Discrimination in Accessing Health Care Services Among People Living with HIV (PLHIV) in Akwa Ibom State, Nigeria. HIV AIDS (Auckl) 2024; 16:45-58. [PMID: 38406768 PMCID: PMC10891273 DOI: 10.2147/hiv.s447551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/01/2024] [Indexed: 02/27/2024] Open
Abstract
Background Recent advances in care and treatment have turned HIV into a "chronic but manageable condition". Despite this, some people living with HIV (PLHIV) continue to suffer from stigma and discrimination in accessing health care services. This study examined the experience of stigma and discrimination and access to health care services among PLHIV in Akwa Ibom State. Methods The Center for Clinical Care and Clinical Research (CCCRN), implementing a USAID-funded Integrated Child Health and Social Services Award (ICHSSA 1) project, conducted a community-based cross-sectional survey in 12 randomly selected local government areas in Akwa Ibom State, Nigeria. A structured quantitative questionnaire was used for data collection. In total, 425 randomly selected PLHIV were interviewed after providing informed consent. Descriptive statistics and bivariate analyses were conducted using the data analytical application Stata 14. Results The study revealed that 215 PLHIV (50.4%) had been denied access to health care services, including dental care, because of their HIV status in Akwa Ibom State. Respondents reported being afraid of: gossip (78%), being verbally abused (17%), or being physically harassed or assaulted because of their positive status (13%). Self-stigmatization was also evident; respondents reported being ashamed because of their positive HIV status (29%), exhibiting self-guilt (16%), having low self-esteem (38%), and experiencing self-isolation (36%). Women, rural residents, PLHIV with no education, unemployed, single, young people aged between 19 and 29 years, and older adults were more likely to experience HIV-related stigmatization. Conclusion Data from the study revealed that the percentage of PLHIV who experience health-related stigmatization because of their HIV status is high in Akwa Ibom State. This finding calls for the prioritization of interventions to reduce stigma, enhance self-esteem, and promote empathy and compassion for PLHIV. It also highlights the need for HIV education for family and community members and health care providers, to enhance the knowledge of HIV and improve acceptance of PLHIV within families, communities, and health care settings.
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Affiliation(s)
- Peters Adekoya
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | - Faith D Lannap
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | | | | | | | | | | | | | - Grace Kumolu
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | - Michael Ejeh
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | | | - Doreen Magaji
- United States Agency for International Development, Abuja, Nigeria
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Armstrong-Mensah E, Ofori E, Alema-Mensah E, Agyarko-Poku T. HIV destigmatization: perspectives of people living with HIV in the Kumasi Metropolis in Ghana. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1169216. [PMID: 37799493 PMCID: PMC10548132 DOI: 10.3389/frph.2023.1169216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
Background Human immunodeficiency virus (HIV)-related stigma has been identified as one of the principal factors that undermines HIV prevention efforts and the quality of life of people living with HIV (PLWH) in many developing countries including Ghana. While studies have been conducted on HIV-related stigma reduction, very few have sought the views of PLWH on how this might be done. The purpose of the study was to (i) identify factors that cause HIV-related stigma in Ghana from the perspective of PLWH, (ii) identify challenges that HIV-related stigma poses to the treatment and care of PLWH, and (iii) to obtain recommendations from PLWH on what they think various groups (community members, health care providers, and adolescents) including themselves should do to help reduce HIV-related stigma in Ghana. Methods A mixed methods cross-sectional study design was used to collect data from 404 PLWH at the Suntreso Government Hospital in the Kumasi Metropolis of Ghana across six domains using Qualtrics from November 1-30, 2022. Quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS) version 26 and the Statistical Analysis System (SAS) version 9.4. Qualitative data was analyzed using a thematic approach. Results Most of the study participants (70.5%) said HIV-related stigma in Ghana is due to ignorance. Of this population, 90.6% indicated that they had experienced stigma because they have HIV, causing them to feel depressed (2.5%), ashamed (2.2%), and hurt (3.0%). Study participants (92.8%) indicated that the challenges associated with HIV-related stigma has affected their treatment and care-seeking behaviors. Recommendations provided by study participants for HIV destigmatization include the need for PLWH not to disclose their status (cited 94 times), community members to educate themselves about HIV (96.5%), health care providers to identify their stigmatizing behaviors (95.3%), health care providers to avoid discriminating against PLWH (96.0%), and the need for adolescents to be educated on HIV and how it is transmitted (97.0%). Conclusion It is important for the government and HIV prevention agencies in Ghana to target and address co-occurring HIV-related stigma sources at various levels of intersection simultaneously This will help to shift harmful attitudes and behaviors that compromise the health and wellbeing of PLWH effectively.
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Affiliation(s)
- Elizabeth Armstrong-Mensah
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Emmanuel Ofori
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Morton J, Vignato J, Anbari AB. Stigma Experienced by Perinatal Women with Opioid Dependency in the United States: A Qualitative Meta-Synthesis. West J Nurs Res 2023; 45:843-853. [PMID: 37382361 DOI: 10.1177/01939459231182495] [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] [Indexed: 06/30/2023]
Abstract
Stigma is a barrier to accessing care and treatment for perinatal women with pain and opioid dependency, resulting in increased maternal/neonatal morbidity and mortality, prolonged neonatal hospitalizations, and increased healthcare-related costs. This theory-generating qualitative meta-synthesis includes 18 qualitative research reports and describes the stigma-related experiences of perinatal women with opioid dependency. A model emerged consisting of cyclical yet pivotal care points, facilitators/deterrents of stigma, and stigma experiences including infant-associative stigma. Findings of this qualitative meta-synthesis include the following: (a) Perinatal stigma experiences may prevent women from accessing care; (b) Infant-associative stigma may influence the woman to deflect stigma from her infant onto herself; and (c) There is the risk of mothers withdrawing their infants from healthcare to protect from future anticipated stigma. Implications reveal ideal time points to enact healthcare interventions to reduce perinatal stigma experiences and its consequences on maternal/child health and wellness.
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Affiliation(s)
| | | | - Allison B Anbari
- University of Missouri Sinclair School of Nursing, Columbia, Missouri, 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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Iskakova B, Nugmanova Z, Murat Yucel R, Gamarel KE, King EJ. Re-validation and cultural adaptation of the brief, standardized assessment tool for measuring HIV-related stigma in healthcare settings in Almaty, Kazakhstan. PLoS One 2022; 17:e0276770. [PMID: 36322554 PMCID: PMC9629601 DOI: 10.1371/journal.pone.0276770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
The HIV epidemic continues to grow in Kazakhstan and HIV stigma remains a major barrier to HIV prevention and treatment in the country. HIV stigma in healthcare setting may also discourage people living with HIV (PLHIV) from getting the care needed. Therefore, studying the attitudes of healthcare workers towards PLHIV is important and requires well-constructed measurement tools adapted to the specific cultural context. In our study, we aimed to adapt and re-validate a brief questionnaire on HIV stigma among healthcare workers in Almaty, Kazakhstan. We held focus group discussions to obtain input on an existing questionnaire and surveyed 448 primary healthcare providers to psychometrically evaluate the scale. The final HIV-stigma scale consisted of 15 items, 6 of them measuring negative opinions about PLHIV and the rest assessing stigmatizing health facility policies towards PLHIV. Both HIV-stigma subscales demons6trated adequate psychometric properties (with Cronbach's alpha α = 0.57 for the first and α = 0.86 for the second subscale, and with factor loadings >0.35 within each subscale). High numbers of respondents holding negative attitudes towards PLHIV, detected in this sample (87%; n = 380), may suggest the need for immediate actions addressing HIV stigma in healthcare in Kazakhstan.
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Affiliation(s)
- Balnur Iskakova
- Department of Epidemiology, School of Public Health, Kazakh National Medical University Named After S.D. Asfendiyarov, Almaty, Kazakhstan
| | - Zhamilya Nugmanova
- Department of Epidemiology, School of Public Health, Kazakh National Medical University Named After S.D. Asfendiyarov, Almaty, Kazakhstan
| | - Recai Murat Yucel
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, Pennsylvania, United States of America
| | - Kristi E. Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Elizabeth J. King
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
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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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Sexual Prejudice and Comfort to Provide Services to Men Who Have Sex with Men Among HIV Healthcare Workers in Western Kenya: Role of Interpersonal Contact. AIDS Behav 2022; 26:805-813. [PMID: 34406550 DOI: 10.1007/s10461-021-03440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
Sexual minority men living in Africa, where many countries criminalize same-sex behavior, are vulnerable to HIV and experience significant barriers to HIV care. Sexual prejudice in healthcare settings is a key contributor to these barriers. Building on social psychological models of prejudice and interpersonal contact at the clinic, we examined the associations between healthcare workers' sexual prejudice and their comfort to provide care to MSM, and assessed the moderating role of workers' prior interpersonal contact with MSM. A cross-sectional survey of 147 healthcare workers varying in level of training and expertise working in HIV care organizations was conducted in western Kenya. Sexual prejudice was negatively associated with comfort to provide care to MSM. Prior interpersonal contact with MSM moderated the association between sexual prejudice and comfort to provide care to MSM among nurses/counselors, such that those with low prior contact and high sexual prejudice were the most uncomfortable providing care to MSM. Interventions are needed to address sexual prejudice and encourage positive forms of interpersonal contact with MSM, especially with nurses and counselors who might have more and varied patient interactions, to improve access to the continuum of HIV prevention and care for MSM in Kenya.
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Prevalence and Correlates of HIV Stigma Among Women Living with HIV in Metro Vancouver, Canada. AIDS Behav 2021; 25:1688-1698. [PMID: 33389325 DOI: 10.1007/s10461-020-03084-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/22/2022]
Abstract
This study elucidated the prevalence and correlates of four types of HIV stigma among women living with HIV (WLWH). Data were drawn from 2 years (September 1/15 to August 31/17) of follow-up from a longitudinal community-based open cohort of 215 cisgender or transgender WLWH who lived and/or accessed care in Metro Vancouver, Canada (2014-present). Bivariate and multivariable cumulative logistic regression using generalized estimating equations for repeated measures were used to examine correlates of HIV stigma, including: (1) anticipated; (2) enacted; (3) internalized; and (4) perceived stigma. In multivariable analysis, disclosure of HIV status without consent was significantly associated with heightened: anticipated; enacted; and perceived stigma. Verbal and/or physical violence related to HIV status was significantly associated with heightened enacted, internalized and perceived stigma. Negative physical effects/symptoms of HIV was significantly associated with all stigma outcomes. Results suggest a need to support safe disclosure of HIV status and address social and structural violence against WLWH.
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Srinivasan K, Heylen E, Raj T, Nyblade L, Devadass D, Pereira M, Ekstrand ML. Reduction in Stigma Drivers Partially Mediates the Effect of a Stigma Reduction Intervention Among Nursing Students in India: The DriSti Cluster Randomized Controlled Trial. J Acquir Immune Defic Syndr 2021; 86:182-190. [PMID: 33105394 PMCID: PMC7884286 DOI: 10.1097/qai.0000000000002543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV stigma in health care settings acts as a significant barrier to health care. Stigma drivers among health professionals include transmission fears and misconceptions and pre-existing negative attitudes toward marginalized groups vulnerable to HIV. The DriSti intervention, consisted of 2 sessions with videos and interactive exercises on a computer tablet and one interactive face-to-face group session, mostly tablet administered, was designed to target key stigma drivers that included instrumental stigma, symbolic stigma, transmission misconceptions and blame to reduce HIV stigma, and discrimination among nursing students (NS) and ward staff and tested in a cluster randomized trial. SETTING This report focuses on second and third year NS recruited from a range of nursing schools that included private, nonprofit, and government-run nursing schools in south India. RESULTS Six hundred seventy-nine NS received intervention and 813 NS were in the wait-list control group. Twelve months outcome analyses showed significant reduction among intervention participants in endorsement of coercive policies (P < 0.001) and in the number of situations in which NS intended to discriminate against PLWH (P < 0.001). Mediation analysis revealed that the effects of intervention on endorsement of coercive policies and intent to discriminate against PLWH were partially mediated by reductions in key stigma drivers. CONCLUSIONS This brief scalable stigma reduction intervention targeting key stigma drivers fills a critical gap in identifying the mechanistic pathways that aid in stigma reduction among health professionals.
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Affiliation(s)
- Krishnamachari Srinivasan
- Division of Mental Health and Neurosciences, St John's Research Institute and St. John's Medical College, Bangalore, India
| | - Elsa Heylen
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA
| | - Tony Raj
- Division of Medical Informatics, St John's Research Institute, and St. John's Medical College, Bangalore, India; and
| | - Laura Nyblade
- Global Health Division, International Development Group, RTI International, Washington, DC
| | - Dhinagaran Devadass
- Division of Medical Informatics, St John's Research Institute, and St. John's Medical College, Bangalore, India; and
| | - Matilda Pereira
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA
| | - Maria L Ekstrand
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA
- Division of Medical Informatics, St John's Research Institute, and St. John's Medical College, Bangalore, India; and
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Mostafa A, Sabry W, Mostafa NS. COVID-19-related stigmatization among a sample of Egyptian healthcare workers. PLoS One 2020; 15:e0244172. [PMID: 33338064 PMCID: PMC7748273 DOI: 10.1371/journal.pone.0244172] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/06/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To explore coronavirus disease 2019 (COVID-19)-related stigma and its associated factors among Egyptian physicians. METHODS A cross-sectional study using an anonymous online questionnaire was conducted from 7 to 21 June 2020. The survey was distributed via social media and email to physicians working in Egypt through convenience sampling. RESULTS 509 physicians participated in the study (mean age: 41.5±10.2). 138 (27.1%) participants were directly involved in the care of COVID-19 patients. 159 (31.2%) participants reported severe level of COVID-19-related stigma. Participants' mean overall COVID-19-related stigma score was 40.6±8.0. The mean subscale scores were: personalized stigma 26.0±5.7, disclosure concerns 9.3±2.2, negative self-image 6.9±1.6, and concern with public attitudes 24.4±4.9. In the multivariable regression analyses, the overall COVID-19-related stigma score was higher in participants with lower qualifications (β = -0.19, 95% CI: 2.32, -0.64, p = 0.001), and in those working in a quarantine hospital (β = 0.08, 95% CI: 0.01, 7.14, p = 0.050). CONCLUSIONS A considerable proportion of Egyptian physicians in this exploratory study experienced COVID-19-related stigmatization. These preliminary findings highlight the need for specific research and targeted interventions particularly addressing COVID-19-related stigmatization among healthcare workers.
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Affiliation(s)
- Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Walaa Sabry
- Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nayera S. Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Yigit I, Bayramoglu Y, Weiser SD, Johnson MO, Mugavero MJ, Turan JM, Turan B. Changes in Internalized Stigma and HIV Health Outcomes in Individuals New to HIV Care: The Mediating Roles of Depression and Treatment Self-Efficacy. AIDS Patient Care STDS 2020; 34:491-497. [PMID: 33147084 DOI: 10.1089/apc.2020.0114] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
There is limited research on the effects of stigma on health outcomes among new-to-HIV care individuals. We examined the effect of changes in internalized stigma over time on health behaviors and outcomes such as viral suppression, antiretroviral therapy (ART) adherence, and visit adherence among new-to-HIV care individuals. We also analyzed the mediating effects of adherence self-efficacy and depressive symptoms in these associations. Participants were 186 persons living with HIV who initiated care at four HIV clinical sites in the United States and had diverse geographical and ethnic backgrounds. Baseline and 48-week follow-up assessments included measures of internalized stigma, ART adherence, depressive symptoms, and adherence self-efficacy. HIV visit adherence and viral load data were extracted from clinic records. Age, race, gender, insurance status, and site were controlled in all analyses. Logistic regression analyses were used to examine predictors of adherence and viral suppression. Change (decrease) in internalized stigma was calculated by subtracting follow-up internalized stigma scores from baseline scores and served as the main predictor. Mediation analyses included calculation of 95% confidence intervals for the indirect effects using bootstrapping. Decreases in internalized stigma over time were positively associated with viral suppression, ART adherence, and visit adherence. Adherence self-efficacy significantly mediated these effects of decrease in internalized stigma on all outcomes. Depressive symptoms only mediated the association between decrease in internalized stigma and ART adherence. Interventions that address internalized stigma and depressive symptoms, as well as adherence self-efficacy, may significantly improve adherence and viral suppression outcomes for individuals new to HIV care.
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Affiliation(s)
- Ibrahim Yigit
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yunus Bayramoglu
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sheri D. Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michael J. Mugavero
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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14
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Liu Y, Finch BK, Brenneke SG, Thomas K, Le PD. Perceived Discrimination and Mental Distress Amid the COVID-19 Pandemic: Evidence From the Understanding America Study. Am J Prev Med 2020; 59:481-492. [PMID: 32829968 PMCID: PMC7336127 DOI: 10.1016/j.amepre.2020.06.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/09/2020] [Accepted: 06/21/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION This study examines COVID-19-associated discrimination regardless of infection status. It evaluates the contribution of various risk factors (e.g., race/ethnicity and wearing a face mask) and the relationship with mental distress among U.S. adults in March and April 2020, when the pandemic escalated across the country. METHODS Participants consisted of a probability-based, nationally representative sample of U.S. residents aged ≥18 years who completed COVID-19-related surveys online in March and April (n=3,665). Multivariable logistic regression was used to predict the probability of a person perceiving COVID-19-associated discrimination. Linear regression was used to analyze the association between discrimination and mental distress. Analyses were conducted in May 2020. RESULTS Perception of COVID-19-associated discrimination increased from March (4%) to April (10%). Non-Hispanic Black (absolute risk from 0.09 to 0.15 across months) and Asians (absolute risk from 0.11 to 0.17) were more likely to perceive discrimination than other racial/ethnic groups (absolute risk from 0.03 to 0.11). Individuals who wore face masks (absolute risk from 0.11 to 0.14) also perceived more discrimination than those who did not (absolute risk from 0.04 to 0.11). Perceiving discrimination was subsequently associated with increased mental distress (from 0.77 to 1.01 points on the 4-item Patient Health Questionnaire score). CONCLUSIONS Perception of COVID-19-associated discrimination was relatively low but increased with time. Perceived discrimination was associated with race/ethnicity and wearing face masks and may contribute to greater mental distress during early stages of the pandemic. The long-term implications of this novel form of discrimination should be monitored.
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Affiliation(s)
- Ying Liu
- Center for Economic and Social Research, University of Southern California, Los Angeles, California.
| | - Brian Karl Finch
- Center for Economic and Social Research, University of Southern California, Los Angeles, California; Department of Sociology and Spatial Sciences, University of Southern California, Los Angeles, California
| | - Savannah G Brenneke
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kyla Thomas
- Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | - PhuongThao D Le
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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15
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Sedney CL, Dekeseredy P, Haggerty T. Stigmatizing Diagnoses in Neurosurgery: A Narrative Review. World Neurosurg 2020; 145:25-34. [PMID: 32889195 DOI: 10.1016/j.wneu.2020.08.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022]
Abstract
Stigma is defined as a social process resulting in labeling, stereotyping, and separation that cause status loss, disapproval, rejection, exclusion, and discrimination of the labeled individuals. Stigma can be experienced by individuals or groups, can be real or perceived, and can include a wide array of characteristics (e.g., race/ethnicity, gender, and health conditions). It is well documented that stigma for health conditions is a barrier to treatment and leads to worse outcomes for vulnerable people. The purpose of this study is to examine the increasingly mature field of stigma theory and research, and how this relates to the practice of neurosurgery. This review provides an overview of stigma and its application in a neurosurgical setting, including diagnoses treated by neurosurgeons as well as diagnoses with impact on neurosurgical outcomes. Examples of stigmatizing diagnoses of relevance to neurosurgical practice include epilepsy, pain, smoking, obesity, and substance use disorder. This information is useful for the practicing neurosurgeon to understand the origins and higher-order effects of societal perceptions surrounding certain diagnoses, and the subsequent effects on health that those perceptions can create on a systemic level.
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Affiliation(s)
- Cara L Sedney
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
| | - Patricia Dekeseredy
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
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16
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James P, Hayfron-Benjamine A, Abdulai M, Lasim O, Yvonne N, Obiri-Yeboah D. Predictors of HIV stigma among health workers in the Cape Coast metropolis, Ghana. J Public Health Afr 2020; 11:1020. [PMID: 33209227 PMCID: PMC7649736 DOI: 10.4081/jphia.2020.1020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/01/2019] [Indexed: 01/26/2023] Open
Abstract
Stigma against people living with HIV (PLHIV) among health workers remains a barrier to the provision of needed care to HIV patients worldwide. We sought to investigate predictors of HIV stigma among health workers in Cape Coast, Ghana. This was a cross sectional study conducted in three hospitals from November 2016 to February 2017. The study made use of a pre-existing self-administered questionnaire. Multiple regression analysis and Pearson’s coefficient tests were performed to determine the relationship between the dependent variable, i.e. the stigmatized attitudes of health workers, and some independent variables, and to determine which of the independent variables predict stigma amongst health care workers. A total of 331 health workers of different categories participated. Respondents’ personal opinions on HIV, fears/worries of getting infected and category of staff {F(3,327)= 23.934 P<0.00}, R2 = 0.180) significantly predicted their stigmatizing behaviour. Compared to other health workers, nurses had higher scores for stigmatizing behaviour. The study found evidence of discriminatory and stigmatizing behaviour towards PLHIV by health workers. Stigma reduction programmes aimed at health workers should be strengthened at all health facilities that provide care to PLHIV.
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Affiliation(s)
- Prah James
- University Hospital of Cape Coast, University of Cape Coast
| | - Anna Hayfron-Benjamine
- Department of Nursing, School of Nursing and Midwifery, College of Health & Allied Sciences, University of Cape Coast
| | | | - Obed Lasim
- Department of Health Information Management, College of Health & Allied Sciences, University of Cape Coast
| | - Nartey Yvonne
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health & Allied Sciences, University of Cape Coast, Ghana
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17
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Rasoolinejad M, Abedinia N, Noorbala AA, Mohraz M, McMillan I, Moradmand B, Gilkison JH. Stigma and Dissatisfaction of Health Care Personnel in HIV Response in Iran: A Qualitative Study. J Int Assoc Provid AIDS Care 2020; 18:2325958219829606. [PMID: 30782052 PMCID: PMC6748510 DOI: 10.1177/2325958219829606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: With regard to the disease pandemics of HIV/AIDS, it is clear that there is need for
prevention, treatment, care, and support of HIV positive patients in the health care
system. In order to achieve these goals, job satisfaction should be a priority for
health care staff. This study examined the problems of health care personnel and the
behavior of patients undergoing HIV/AIDS counseling at Imam Khomeini Hospital in Tehran,
Iran. Methods: Interviews were conducted individually with 5 health care personnel who participated in
this study. Participants had 30 to 45 minutes each per session at the clinic, during
which they were able to discuss the problems they faced in their careers. All
conversations were officially recorded. Results: The most common problems mentioned by these health care workers included the lack of
safety and standardization of work conditions, the lack of appropriate equipment,
limited space, high numbers of patients, low staffing levels and financial and morale
problems compounded by the lack of support by hospital authorities. Conclusion: The authorities need to allocate more funds to provide facilities and appropriate
working conditions for health care staff in order to increase job satisfaction and
enable staff to provide the best services and care to HIV positive patients.
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Affiliation(s)
- Mehrnaz Rasoolinejad
- 1 Department of Infections, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran (TUMS)
| | - Nasrin Abedinia
- 1 Department of Infections, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran (TUMS)
| | - Ahmad Ali Noorbala
- 2 Department Psychiatric, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran (TUMS)
| | - Minoo Mohraz
- 1 Department of Infections, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran (TUMS)
| | | | - Banafsheh Moradmand
- 4 Department of Public Health, Faculty of Public Health, Flinders University, Flinders, Australia
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18
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Ekstrand ML, Raj T, Heylen E, Nyblade L, Devdass D, Pereira M, Mazur A, Srinivasan K. Reducing HIV stigma among healthcare providers in India using a partly tablet-administered intervention: the DriSti trial. AIDS Care 2020; 32:14-22. [PMID: 32151146 DOI: 10.1080/09540121.2020.1739221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HIV stigma has long been recognized as a significant barrier in the worldwide fight against HIV. Across cultures, stigma has been shown to cause psychological distress and act as a barrier to engagement in care. Health professionals can serve as a crucial source of HIV stigma, with drivers that include fears and transmission misconceptions and pre-existing negative attitudes towards marginalized groups. To increase their impact, stigma reduction interventions need to be scalable and sustainable as well as adaptable to different cultural contexts. The DriSti intervention was designed to meet these needs through an easily adaptable, mostly tablet-administered, interactive intervention delivered to ward staff (n = 1,557) and nursing students (n = 1,625) in 62 Indian institutions, using a cRCT design, with wait-list controls. Six-month outcome analyses, showed significant reductions in misconceptions (p < .001) and worry about acquiring HIV at work (p < .001). Intervention participants also reported significantly greater reductions in endorsement of coercive policies (p < .001) and in the number of situations in which they intended to discriminate against PLWH (p < .001) than control participants. This brief, scaleable intervention could be adapted for similar populations in the region, using different mHealth platforms and thus has important implications for current global stigma reduction initiatives and training curricula.
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Affiliation(s)
- Maria L Ekstrand
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA, USA.,Division of Medical Informatics, St. John's Research Institute, Bangalore, India
| | - Tony Raj
- Division of Medical Informatics, St. John's Research Institute, Bangalore, India
| | - Elsa Heylen
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA, USA
| | - Laura Nyblade
- Global Health Division, International Development Group, RTI International, USA
| | - Dhinagaran Devdass
- Division of Medical Informatics, St. John's Research Institute, Bangalore, India
| | - Matilda Pereira
- Division of Medical Informatics, St. John's Research Institute, Bangalore, India
| | - Amanda Mazur
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA, USA
| | - Krishnamachari Srinivasan
- Division of Mental Health and Neurosciences, Department of Psychiatry, St. John's Research Institute, Bangalore, India
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Stangl AL, Earnshaw VA, Logie CH, van Brakel W, C Simbayi L, Barré I, Dovidio JF. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med 2019; 17:31. [PMID: 30764826 PMCID: PMC6376797 DOI: 10.1186/s12916-019-1271-3] [Citation(s) in RCA: 537] [Impact Index Per Article: 107.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.
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Affiliation(s)
- Anne L Stangl
- International Center for Research on Women, 1120 20th St. NW, Suite 500N, Washington, DC, 20036, USA.
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Leickness C Simbayi
- Human Sciences Research Council & Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Iman Barré
- International Center for Research on Women, 1120 20th St. NW, Suite 500N, Washington, DC, 20036, USA
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20
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Rau A, Wouters E, Engelbrecht M, Masquillier C, Uebel K, Kigozi G, Sommerland N, Janse van Rensburg A. Towards a health-enabling working environment - developing and testing interventions to decrease HIV and TB stigma among healthcare workers in the Free State, South Africa: study protocol for a randomised controlled trial. Trials 2018; 19:351. [PMID: 29973259 PMCID: PMC6031140 DOI: 10.1186/s13063-018-2713-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background Occupational exposure to tuberculosis (TB) constitutes a major health risk for healthcare workers (HCWs). The HIV epidemic equally affects the workforce because of the mutually reinforcing epidemiology of HIV and TB. Stigmas associated with HIV and TB have become so intricately entangled that they stop some HCWs from seeking care in a context where serious shortages in human resources for health besiege public health facilities. It is thus imperative to research, as well as attempt to tackle, HIV and TB stigma among HCWs. But little has been done internationally—and nationally, only our own exploratory studies. Our project aims to address this by (1) scientifically assessing the extent and sources of HIV and TB-related stigma among HCWs and (2) developing and testing evidence-based, stigma-reduction interventions in public hospitals in the Free State Province of South Africa. Methods/design The research follows a stratified cluster randomised controlled trial (RCT) design. Pre intervention, a self-administered questionnaire with the pilot study’s validated stigma scales is used to measure stigma and other key variables among randomly selected HCWs in eight hospitals—stratified by size and district and then randomly allocated to four intervention and four control sites. Interventions comprise HIV- and TB-stigma reduction activities—mainly Social and Behavioural Change Communication (SBCC) interventions—at three social-ecology levels (individual, community, and socio-structural). An outside assessor will appraise the trial mid-way through implementation. Post intervention, all baseline respondents will be followed up to complete the baseline questionnaire with additional items on interventions. Qualitative data will be collected to better understand HIV and TB stigma and explore if, and how, interventions impact stigma levels in the workplace. Discussion The study regards as HCWs all staff, working in all different types of jobs, at all levels in the hospitals. Thus, the research addresses HIV and TB stigma across the whole workforce and the entire workplace. In doing so it will (1) generate essential information on stigma among HCWs and (2) implement stigma-reduction interventions that are innovative yet replicable, and potentially beneficial in addressing a pernicious human-rights-based issue. Trial registration South African National Clinical Trials Register, registration ID: DOH-27-1115-5204. Prospectively registered on 26 August 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2713-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Asta Rau
- University of the Free State (UFS), Centre for Health Systems Research & Development (CHSR&D), Faculty of the Humanities, PO Box 339, Bloemfontein, 9300, South Africa.
| | - Edwin Wouters
- University of the Free State (UFS), Centre for Health Systems Research & Development (CHSR&D), Faculty of the Humanities, PO Box 339, Bloemfontein, 9300, South Africa.,Department of Sociology, University of Antwerp (AU), Research Centre for Longitudinal & Life Course Studies (CELLO), Faculty of Political and Social Sciences, Sint-Jacobstraat 2, BE-2000, Antwerp, Belgium
| | - Michelle Engelbrecht
- University of the Free State (UFS), Centre for Health Systems Research & Development (CHSR&D), Faculty of the Humanities, PO Box 339, Bloemfontein, 9300, South Africa
| | - Caroline Masquillier
- Department of Sociology, University of Antwerp (AU), Research Centre for Longitudinal & Life Course Studies (CELLO), Faculty of Political and Social Sciences, Sint-Jacobstraat 2, BE-2000, Antwerp, Belgium
| | - Kerry Uebel
- University of the Free State (UFS), Centre for Health Systems Research & Development (CHSR&D), Faculty of the Humanities, PO Box 339, Bloemfontein, 9300, South Africa.,Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of the Free State (UFS), PO Box 339, Bloemfontein, 9300, South Africa
| | - Gladys Kigozi
- University of the Free State (UFS), Centre for Health Systems Research & Development (CHSR&D), Faculty of the Humanities, PO Box 339, Bloemfontein, 9300, South Africa
| | - Nina Sommerland
- Department of Sociology, University of Antwerp (AU), Research Centre for Longitudinal & Life Course Studies (CELLO), Faculty of Political and Social Sciences, Sint-Jacobstraat 2, BE-2000, Antwerp, Belgium
| | - André Janse van Rensburg
- University of the Free State (UFS), Centre for Health Systems Research & Development (CHSR&D), Faculty of the Humanities, PO Box 339, Bloemfontein, 9300, South Africa
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21
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Quantification and factors associated with HIV-related stigma among persons living with HIV/AIDS on antiretroviral therapy at the HIV-day care unit of the Bamenda Regional Hospital, North West Region of Cameroon. Global Health 2018; 14:56. [PMID: 29866206 PMCID: PMC5987427 DOI: 10.1186/s12992-018-0374-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/21/2018] [Indexed: 11/22/2022] Open
Abstract
Background The Human Immunodeficiency Virus /Acquired Immune Deficiency Syndrome (HIV/AIDS) is not just a medical problem but its social impact is increasingly affecting its effective management. The fear of HIV-stigma constitutes a major barrier to HIV testing, prevention, uptake and adherence to antiretroviral therapy (ART). We aimed to quantify HIV-related stigma, and identify the factors associated with high HIV-related stigma among persons living with HIV and AIDS (PLHIVA) and on ART. Methods A hospital-based cross sectional analytic survey targeting PLHIVA on ART at the HIV-day care unit of the Bamenda Regional Hospital of Cameroon was conducted from February to April 2016. A total of 308 eligible and willing participants were consecutively included in the survey. Data were collected using a pretested questionnaire designed from the Berger HIV stigma scale and analyzed using Epi info 3.5.4. Results The mean age of the 308 participants was 40.1±10.2 years. The mean overall HIV/AIDS related stigma score was 88.3 ± 18.80 which corresponds to a moderate level of stigma according to the Berger stigma scale. Further analysis revealed that most participants suffered from moderate forms of the different subtypes of stigma including: personalized (49.8%), disclosure (66.4%), negative self-image (50.0%) and public attitude (52.1%) stigmatization. It was estimated that 62.7% (95% confidence interval [CI] = 57.8–68.9%) of the participants lived with high levels of HIV-related stigma. After controlling for gender, religion, age and occupation, level of education below tertiary (Adjusted Odds Ratio [AOR] = 0.70 [95% CI = 0.44–0.91]; p = 0.036) and a duration from diagnosis below 5 years (AOR = 1.74 [95% CI = 1.01–3.00]; p = 0.046) were significantly associated with high HIV-related stigma. Conclusion About three out of every five PLHIVA receiving ART in Bamenda Regional Hospital still experience high levels of HIV-related stigma. This occurs more frequently in participants with low educational status, and who may have known their HIV status for less than 5 years. Anti-HIV-stigma programs in the North West Region need strengthening with intensified psychosocial follow-up of newly diagnosed cases. Electronic supplementary material The online version of this article (10.1186/s12992-018-0374-5) contains supplementary material, which is available to authorized users.
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22
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Reinius M, Rao D, Manhart LE, Wiklander M, Svedhem V, Pryor J, Mayer R, Gaddist B, Kumar S, Mohanraj R, Jeyaseelan L, Wettergren L, Eriksson LE. Differential item functioning for items in Berger's HIV Stigma Scale: an analysis of cohorts from the Indian, Swedish, and US contexts. Qual Life Res 2018; 27:1647-1659. [PMID: 29574526 PMCID: PMC5951887 DOI: 10.1007/s11136-018-1841-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To examine whether items in Berger's HIV Stigma Scale function differently with persons of different age, gender, and cultural backgrounds. METHODS Secondary data from cohorts, collected in South India (n = 250), Sweden (n = 193), and the US (n = 603) were reanalyzed to evaluate DIF within, between, and across these cohorts. All participants had answered the revised version of the HIV stigma scale consisting of 32 items forming the subscales Personalized stigma, Disclosure concerns, Concerns about public attitudes, and Negative self-image. Differential Item Functioning (DIF) for these items was assessed using hybrid ordinal regression-IRT technique. When DIF was detected, the cumulative impact of DIF on individual subscale scores was evaluated. RESULTS DIF was detected for 9 items within, between, or across cohorts, but the DIF was negligible in general. Detected DIF between the Swedish and Indian cohorts had a cumulative salient impact on individual scores for the subscale Disclosure Concerns; Disclosure concerns were overestimated in the Swedish cohort and both over- and underestimated in the Indian cohort. CONCLUSIONS The items in the 32-item version of the HIV stigma scale did not seem to be particularly prone to present DIF. The DIF between the Indian and Swedish cohort for items in the subscale Disclosure Concerns could, however, result in both type I and type II errors if scores should be compared between the Indian and Swedish cohort.
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Affiliation(s)
- Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Solna, Sweden.
| | - Deepa Rao
- Department of Global Health and Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, 325 9th Ave, UW Campus Mailbox Number 359931, Seattle, WA, 98104, USA
| | - Lisa E Manhart
- Department of Epidemiology, Harborview Medical Center, University of Washington, 325 9th Ave, UW Campus Mailbox Number 35993, Seattle, WA, 98104, USA
| | - Maria Wiklander
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, SE-141 86, Huddinge, Sweden
- Department of Medicine, Huddinge, Unit of Infectious Diseases, Karolinska Institutet, 141 86, Huddinge, Sweden
| | - John Pryor
- Department of Psychology, Illinois State University, Normal, IL, USA
| | - Randall Mayer
- Iowa Department of Public Health, 321 E. 12th St, Des Moines, IA, 50319-0075, USA
| | - Bambi Gaddist
- Joseph H. Neal Wellness Center Dba SC HIV Council, 1813 Laurel Street, Columbia, SC, 29201, USA
| | - Shuba Kumar
- Department of Social Sciences, Samarth, Chennai, India
| | - Rani Mohanraj
- Department of Social Sciences, Samarth, Chennai, India
| | | | - Lena Wettergren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Solna, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, SE-141 86, Huddinge, Sweden
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
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23
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Eaton LA, Earnshaw VA, Maksut JL, Thorson KR, Watson RJ, Bauermeister JA. Experiences of stigma and health care engagement among Black MSM newly diagnosed with HIV/STI. J Behav Med 2018; 41:458-466. [PMID: 29626312 DOI: 10.1007/s10865-018-9922-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/03/2018] [Indexed: 12/23/2022]
Abstract
Rates of HIV/STI transmission among Black men who have sex with men (BMSM) are alarmingly high and demand urgent public health attention. Stigma related concerns are a key barrier to accessing health care and prevention tools, yet limited research has been focused in this area. Experiences of stigma related to health care were evaluated among 151 BMSM residing in the Atlanta, GA area, both prior to and post HIV or STI diagnosis in a longitudinal study (data collected from 2014 to 2016). Findings demonstrated that inadequate health care engagement is associated with post-diagnosis anticipated stigma (b = - 0.38, SE = 0.17 p ≤ .05). Pre-diagnosis prejudice is a predictor of post-diagnosis enacted (b = 0.39, SE = 0.14, p < .01), anticipated (b = .28, SE = 0.14, p < .05), and internalized (b = .22, SE = 0.06, p < .001) stigmas. This study is the first of its kind to assess experiences of stigma among BMSM during a critical time (i.e., before and after diagnosis) for HIV/STI prevention and treatment. Results provide a novel understanding of how stigma unfolds over-time and provide direction for stigma intervention development.
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Affiliation(s)
- Lisa A Eaton
- Department of Human Development and Family Studies, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA.
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Jessica L Maksut
- Department of Human Development and Family Studies, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA
| | | | - Ryan J Watson
- Department of Human Development and Family Studies, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA
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Individual and community-level risk factors for HIV stigma in 21 Zambian and South African communities: analysis of data from the HPTN071 (PopART) study. AIDS 2018; 32:783-793. [PMID: 29369164 PMCID: PMC5854764 DOI: 10.1097/qad.0000000000001757] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Supplemental Digital Content is available in the text Objective: To describe the prevalence and determinants of HIV stigma in 21 communities in Zambia and South Africa. Design: Analysis of baseline data from the HPTN 071 (PopART) cluster-randomized trial. HIV stigma data came from a random sample of 3859 people living with HIV. Community-level exposures reflecting HIV fears and judgements and perceptions of HIV stigma came from a random sample of community members not living with HIV (n = 5088), and from health workers (HW) (n = 851). Methods: We calculated the prevalence of internalized stigma, and stigma experienced in the community or in a healthcare setting in the past year. We conducted risk-factor analyses using logistic regression, adjusting for clustering. Results: Internalized stigma (868/3859, prevalence 22.5%) was not associated with sociodemographic characteristics but was less common among those with a longer period since diagnosis (P = 0.043). Stigma experienced in the community (853/3859, 22.1%) was more common among women (P = 0.016), older (P = 0.011) and unmarried (P = 0.009) individuals, those who had disclosed to others (P < 0.001), and those with more lifetime sexual partners (P < 0.001). Stigma experienced in a healthcare setting (280/3859, 7.3%) was more common among women (P = 0.019) and those reporting more lifetime sexual partners (P = 0.001) and higher wealth (P = 0.003). Experienced stigma was more common in clusters wherever community members perceived higher levels of stigma, but was not associated with the beliefs of community members or HW. Conclusion: HIV stigma remains unacceptably high in South Africa and Zambia and may act as barrier to HIV prevention and treatment. Further research is needed to understand its determinants.
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Adjobimey M, Hinson V, Ade S, Békou W, Ayélo P, Agodokpessi G, Fayomi B, Gninafon M. Tuberculose pulmonaire : connaissances et attitudes des collègues de travail des patients diagnostiqués à Cotonou, Bénin. ARCH MAL PROF ENVIRO 2017. [DOI: 10.1016/j.admp.2017.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wouters E, Rau A, Engelbrecht M, Uebel K, Siegel J, Masquillier C, Kigozi G, Sommerland N, Yassi A. The Development and Piloting of Parallel Scales Measuring External and Internal HIV and Tuberculosis Stigma Among Healthcare Workers in the Free State Province, South Africa. Clin Infect Dis 2017; 62 Suppl 3:S244-54. [PMID: 27118854 DOI: 10.1093/cid/civ1185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The dual burden of tuberculosis and human immunodeficiency virus (HIV) is severely impacting the South African healthcare workforce. However, the use of on-site occupational health services is hampered by stigma among the healthcare workforce. The success of stigma-reduction interventions is difficult to evaluate because of a dearth of appropriate scientific tools to measure stigma in this specific professional setting. METHODS The current pilot study aimed to develop and test a range of scales measuring different aspects of stigma-internal and external stigma toward tuberculosis as well as HIV-in a South African healthcare setting. The study employed data of a sample of 200 staff members of a large hospital in Bloemfontein, South Africa. RESULTS Confirmatory factor analysis produced 7 scales, displaying internal construct validity: (1) colleagues' external HIV stigma, (2) colleagues' actions against external HIV stigma, (3) respondent's external HIV stigma, (4) respondent's internal HIV stigma, (5) colleagues' external tuberculosis stigma, (6) respondent's external tuberculosis stigma, and (7) respondent's internal tuberculosis stigma. Subsequent analyses (reliability analysis, structural equation modeling) demonstrated that the scales displayed good psychometric properties in terms of reliability and external construct validity. CONCLUSIONS The study outcomes support the use of the developed scales as a valid and reliable means to measure levels of tuberculosis- and HIV-related stigma among the healthcare workforce in a resource-limited context. Future studies should build on these findings to fine-tune the instruments and apply them to larger study populations across a range of different resource-limited healthcare settings with high HIV and tuberculosis prevalence.
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Affiliation(s)
- Edwin Wouters
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Asta Rau
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Kerry Uebel
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Jacob Siegel
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Caroline Masquillier
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium
| | - Gladys Kigozi
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Nina Sommerland
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Defo D, Kouotou EA, Nansseu JR. Failure to return to receive HIV-test results: the Cameroon experience. BMC Res Notes 2017; 10:309. [PMID: 28738886 PMCID: PMC5525219 DOI: 10.1186/s13104-017-2632-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background To be acquainted of one’s HIV serological status is an important strategy for the fight against HIV/AIDS, but many patients still miss the appointment to receive their HIV-test result. The aim of this study was to determine the epidemiological and serological profiles of patients not coming back to collect their HIV-test result in a tertiary health care facility in Yaoundé, Cameroon. Methods We undertook a retrospective analysis of data of patients who visited the HIV-day care unit of the Yaoundé Central Hospital (Yaoundé, Cameroon) from January to December 2009 in order to be screened for HIV, and who did not come back to retrieve their result. Results Of the 3990 patients who visited the unit during the study period, 396 (9.92%) did not come back to collect their HIV-test result, of whom 21% were aged 26–30 years representing the most encountered age group. Females (57.8%) were significantly more present than males (p = 0.023). More than half of these patients (54.9%) visited the unit for a voluntary HIV testing. Two hundred and three patients (51.3%) had a positive HIV-test result, of whom 63.5% were females. The most HIV-infected group was the one coming for a voluntary screening (36.5%). Women not returning to receive their results were more likely to be tested HIV-positive (odds ratio = 1.62, 95% confidence interval: 1.08–2.42; p < 0.05). Conclusions Almost 10% of patients screened for HIV infection did not come back to collect their result. More strategies should be implemented to reduce this rate, especially targeting young adults (20–35 years) and women. The delay in delivering patients’ results should be shortened. Concurrently, there is need to increase voluntary HIV-testing in our settings.
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Affiliation(s)
- Defo Defo
- Yaoundé Central Hospital, Yaoundé, Cameroon.,Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Emmanuel Armand Kouotou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Jobert Richie Nansseu
- Sickle Cell Disease Unit, Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon. .,Department of Disease, Epidemics and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon. .,Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaoundé, Cameroon.
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Fc O, Tg T, Ak T, Am A, Jn E. ATTITUDES OF FEMALE STREET VENDORS TOWARDS HIV/AIDS IN VHEMBE DISTRICT OF SOUTH AFRICA. Afr J Infect Dis 2017; 11:17-23. [PMID: 28670636 PMCID: PMC5476809 DOI: 10.21010/ajid.v11i2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are still global health problems. This study was conducted to describe the attitudes of female street vendors (FSV) in Thohoyandou, Vhembe district, towards HIV/AIDS and those infected with the virus. Materials and Methods: A quantitative, cross-sectional survey design was adopted. Data were collected by means of a structured, self-administered questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: Majority (85.0%) of the participants had completed secondary education, 46.7% were single and 41.5% were aged 40 and above. Most of them (90.5%) indicated that they would accept to do a voluntary HIV test. Fear of stigmatization ranked highest among the reasons given by those not in favour of testing. Whilst 91.0% of the participants reported that they can stay in the same house with a person who is HIV positive and 88.5% said they would not have sex in exchange for money, only 57.5% indicated that they would agree to take antiretroviral drugs if they tested positive in pregnancy. The level of education was found to be significantly associated (p-value = 0.000) with the type of attitude shown towards HIV and those infected. Conclusion: It is recommended that HIV information providers and health workers in South Africa pay more attention to enlightening women about the importance of taking antiretroviral drugs in pregnancy to reduce the incidence of mother-to-child transmission of HIV.
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Affiliation(s)
- Olaniyi Fc
- Department of Public Health, School of Health Sciences, University of Venda
| | - Tshitangano Tg
- Department of Public Health, School of Health Sciences, University of Venda
| | - Tugli Ak
- Department of Public Health, School of Health Sciences, University of Venda
| | - Amosu Am
- Department of Public Health, School of Public and Allied Health, Babcock University, Nigeria
| | - Edokpayi Jn
- Department of Hydrology and Water Resources, School of Environmental Sciences, University of Venda
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Confronting Challenges in Monitoring and Evaluation: Innovation in the Context of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive. J Acquir Immune Defic Syndr 2017; 75 Suppl 1:S66-S75. [PMID: 28398999 DOI: 10.1097/qai.0000000000001313] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), which was launched in 2011, set a series of ambitious targets, including a reduction of new HIV infections among children by 90% by 2015 (from a baseline year of 2009) and AIDS-related maternal mortality by 50% by 2015. To reach these targets, the Global Plan called for unprecedented investments in the prevention of mother-to-child transmission of HIV (PMTCT), innovative new approaches to service delivery, immense collective effort on the programmatic and policy fronts, and importantly, a renewed focus on data collection and use. We provide an overview of major achievements in monitoring and evaluation across Global Plan countries and highlight key challenges and innovative country-driven solutions using PMTCT program data. Specifically, we describe the following: (1) Uganda's development and use of a weekly reporting system for PMTCT using short message service technology that facilitates real-time monitoring and programmatic adjustments throughout the transition to a "treat all" approach for pregnant and breastfeeding women living with HIV (Option B+); (2) Uganda's work to eliminate parallel reporting systems while strengthening the national electronic district health information system; and (3) how routine PMTCT program data in Nigeria can be used to estimate HIV prevalence at the local level and address a critical gap in local descriptive epidemiologic data to better target limited resources. We also identify several ongoing challenges in data collection, analysis, and use, and we suggest potential solutions.
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Nyblade L, Reddy A, Mbote D, Kraemer J, Stockton M, Kemunto C, Krotki K, Morla J, Njuguna S, Dutta A, Barker C. The relationship between health worker stigma and uptake of HIV counseling and testing and utilization of non-HIV health services: the experience of male and female sex workers in Kenya. AIDS Care 2017; 29:1364-1372. [PMID: 28325068 DOI: 10.1080/09540121.2017.1307922] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The barrier HIV-stigma presents to the HIV treatment cascade is increasingly documented; however less is known about female and male sex worker engagement in and the influence of sex-work stigma on the HIV care continuum. While stigma occurs in all spheres of life, stigma within health services may be particularly detrimental to health seeking behaviors. Therefore, we present levels of sex-work stigma from healthcare workers (HCW) among male and female sex workers in Kenya, and explore the relationship between sex-work stigma and HIV counseling and testing. We also examine the relationship between sex-work stigma and utilization of non-HIV health services. A snowball sample of 497 female sex workers (FSW) and 232 male sex workers (MSW) across four sites was recruited through a modified respondent-driven sampling process. About 50% of both male and female sex workers reported anticipating verbal stigma from HCW while 72% of FSW and 54% of MSW reported experiencing at least one of seven measured forms of stigma from HCW. In general, stigma led to higher odds of reporting delay or avoidance of counseling and testing, as well as non-HIV specific services. Statistical significance of relationships varied across type of health service, type of stigma and gender. For example, anticipated stigma was not a significant predictor of delay or avoidance of health services for MSW; however, FSW who anticipated HCW stigma had significantly higher odds of avoiding (OR = 2.11) non-HIV services, compared to FSW who did not. This paper adds to the growing evidence of stigma as a roadblock in the HIV treatment cascade, as well as its undermining of the human right to health. While more attention is being paid to addressing HIV-stigma, it is equally important to address the key population stigma that often intersects with HIV-stigma.
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Affiliation(s)
- Laura Nyblade
- a Global Health Division, International Development Group , RTI International , Washington , USA
| | - Aditi Reddy
- a Global Health Division, International Development Group , RTI International , Washington , USA
| | | | - John Kraemer
- a Global Health Division, International Development Group , RTI International , Washington , USA.,c Department of Health Systems Administration , Georgetown University , Washington , USA
| | - Melissa Stockton
- a Global Health Division, International Development Group , RTI International , Washington , USA
| | | | - Karol Krotki
- a Global Health Division, International Development Group , RTI International , Washington , USA
| | - Javier Morla
- a Global Health Division, International Development Group , RTI International , Washington , USA
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Rukundo GZ, Mishara BL, Kinyanda E. Burden of Suicidal Ideation and Attempt among Persons Living with HIV and AIDS in Semiurban Uganda. AIDS Res Treat 2016; 2016:3015468. [PMID: 27073694 PMCID: PMC4814631 DOI: 10.1155/2016/3015468] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/07/2016] [Accepted: 02/16/2016] [Indexed: 11/18/2022] Open
Abstract
Although the impact of HIV/AIDS has changed globally, it still causes considerable morbidity and mortality, including suicidality, in countries like Uganda. This paper describes the burden and risk factors for suicidal ideation and attempt among 543 HIV-positive attending two HIV specialized clinics in Mbarara municipality, Uganda. The rate of suicidal ideation was 8.8% (n = 48; 95% CI: 6.70-11.50) and suicidal attempt was 3.1% (17, 95% CI 2.00-5.00). The factors associated with increased risk for suicidal ideation and attempts were state anger (OR = 1.06, 95% CI: 1.03-1.09; p = 0.001); trait anger (OR 1.10, 95% CI 1.04-1.16, p = 0.002); depression (OR 1.13, 95% CI 1.07-1.20, p = 0.001); hopelessness (OR 1.12, 95% CI 1.02-1.23, p = 0.024); anxiety (OR 1.06, 95% CI 1.03-1.09); low social support (OR 0.19, 95% CI 0.07-0.47, p = 0.001); inability to provide for others (OR 0.19, 95% CI 0.07-0.47, p = 0.001); and stigma (OR 2.48, 95% CI 1.11-5.54, p = 0.027). At multivariate analysis, only state anger remained statistically significant. HIV/AIDS is associated with several clinical, psychological, and social factors which increase vulnerability to suicidal ideation and attempts. Making suicide risk assessment and management an integral part of HIV care is warranted.
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Affiliation(s)
- Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Leslie Mishara
- Centre for Research and Intervention on Suicide and Euthanasia and Psychology Department, Université du Québec à Montréal, Montréal, QC, Canada H3C 3P8
| | - Eugene Kinyanda
- Uganda Medical Research Council, Entebbe and Department of Psychiatry, Makerere College of Health Sciences, Kampala, Uganda
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HIV Stigma Toward People Living With HIV and Health Providers Associated With Their Care: Qualitative Interviews With Community Members in Egypt. J Assoc Nurses AIDS Care 2015; 27:188-98. [PMID: 26718817 DOI: 10.1016/j.jana.2015.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 11/16/2015] [Indexed: 11/23/2022]
Abstract
We explored perceived HIV stigma by community members in a low-HIV-prevalence setting toward people living with HIV (PLWH) and physicians associated with HIV in order to develop operational stigma reduction recommendations for HIV referral hospitals. In-depth interviews (N = 30) were conducted with educated and less-educated men and women in Egypt. Thematic analysis was applied to identify drivers, manifestations, and outcomes of stigma. Stigma toward PLWH was rooted in values and fears, manifesting in reluctance to use the same health facilities as PLWH. Stigma toward physicians providing care for PLWH was caused by fear of infection and developed into unwillingness to use those physicians' services. Stigma toward physicians who refused to provide care was linked to perceptions of unethical behavior. HIV referral hospitals in low HIV prevalence settings could benefit from stigma reduction interventions with a special focus on addressing moral-based stigma and fear of casual transmission.
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Abubakar A. Biomedical risk, psychosocial influences, and developmental outcomes: lessons from the pediatric HIV population in Africa. New Dir Child Adolesc Dev 2015; 2014:23-41. [PMID: 25512044 DOI: 10.1002/cad.20071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sub-Saharan Africa is home to millions of HIV-affected children. These children are likely to experience multiple developmental delays. In this chapter, I present data highlighting compromised neurobehavioral, mental health, and scholastic outcomes for children affected by HIV. Furthermore, I discuss biomedical factors (e.g., disease severity and nutritional status) that may exacerbate the adverse effects of HIV on childhood outcomes. I also present evidence on how psychosocial risk factors such as poor maternal mental health, orphanhood, and poverty may aggravate the effects of HIV. The concluding section of the chapter highlights conceptual and methodological refinements in research on the impact of HIV on child development in Sub-Saharan Africa.
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Affiliation(s)
- Amina Abubakar
- Centre for Geographic Medicine Research-Coast, KEMRI/Wellcome Trust Research Progamme, Kilifi, Kenya
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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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Colombini M, Mutemwa R, Kivunaga J, Stackpool Moore L, Mayhew SH. Experiences of stigma among women living with HIV attending sexual and reproductive health services in Kenya: a qualitative study. BMC Health Serv Res 2014; 14:412. [PMID: 25239309 PMCID: PMC4261560 DOI: 10.1186/1472-6963-14-412] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Researchers have widely documented the pervasiveness of HIV stigma and discrimination, and its impact on people living with HIV. Only a few studies, however, have analysed the perceptions of women living with HIV accessing sexual and reproductive health (SRH) services. This study explores the experiences of stigma of HIV-positive clients attending family planning and post-natal services and implications for service use and antiretroviral therapy (ART) adherence. Our aim was to gain a better understanding of the impact of various dimensions of stigma on service use and ART adherence among HIV clients in order to inform the response of integrated SRH services. Methods In-depth interviews were conducted with 48 women living with HIV attending SRH services in two districts in Kenya. Data were coded using Nvivo 8 and analysed using a thematic analysis approach. Results Findings show that many women living with HIV report high levels of anticipated stigma, resulting in a desire to hide their status from family and friends for fear of being discriminated against. Many women feared desertion following disclosure of their positive status to partners. Consequently some women preferred to hide their status and adhere to HIV treatment in secret. However, the majority of study participants attending postnatal care (PNC) services also revealed that anticipated stigma does not adversely affect their HIV drug uptake and ART adherence, as their drive to live outweighs their fear of stigma. Our findings also seem to suggest a preference for specialist HIV services by some family planning (FP) clients because of better confidentiality and reduced opportunities for unwanted disclosure that could lead to stigma. Conclusions The findings highlight that anticipated stigma leading to low disclosure is widespread and sometimes reinforced by health providers’ actions and facility layout (contributing to enacted stigma). However, the motivation to stay healthy and look after the children appears in many cases to override fears of stigma related to ART adherence in our client-based sample.
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Marsicano E, Dray-Spira R, Lert F, Aubrière C, Spire B, Hamelin C. Multiple discriminations experienced by people living with HIV in France: results from the ANRS-Vespa2 study. AIDS Care 2014; 26 Suppl 1:S97-S106. [PMID: 24738926 DOI: 10.1080/09540121.2014.907385] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Since the advent of AIDS, discrimination has remained at the core of the experience of people living with HIV (PLHIV). PLHIV who belong to minority groups are exposed to discrimination not only on the grounds of their HIV infection but also because of rejecting attitudes towards drug users, homosexuals and black people. This article aimed to measure the frequency of discrimination and assess its correlates among PLHIV in France. We used data from a national representative survey, the ANRS-Vespa2 study, conducted in France in 2011 among 3022 male and female HIV-positive patients followed at hospitals. Respondents answered a face-to-face questionnaire documenting their health status and living conditions. Discrimination was documented during the previous two years on the grounds of HIV infection, gender, country of birth, skin colour, sexual orientation, place of residence, and substance abuse in a variety of contexts. For each context, we performed logistic regressions on discrimination, controlling for socio-epidemiological group, age, education level and employment status. Discrimination is frequently experienced by PLHIV in France (26%), particularly when applying for a job (24%), interacting with family (11%) or seeking health services (8%). Women from sub-Saharan Africa reported the highest levels of discrimination, whereas heterosexual non-African men reported the lowest. Men who have sex with men experienced levels of discrimination that fell between those of these two groups. The major perceived reason for discrimination was HIV status (13%). Nationality, skin colour and sexual orientation were cited by 5% each, whereas gender was cited by 1% of respondents. Our analyses show that discrimination is a frequent and cross-cutting experience with differences across the various contexts and among the diverse subpopulations. The intertwining of HIV-related stigma with sexism, racism and homophobia needs to be addressed to understand why discrimination against PLHIV persists when the disease itself has greatly evolved.
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Affiliation(s)
- Elise Marsicano
- a INSERM U1018, Centre de Recherche en Epidémiologie et Santé des populations , Villejuif , France
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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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Abstract
HIV/AIDS stigmatizing attitudes and their consequences on preventative behaviors are among the most poorly understood aspects of the AIDS epidemic. This paper analyzes the socioeconomic determinants of discriminating attitudes toward people living with HIV and their implications on the likelihood of HIV testing. These effects are tested using the 2004 and 2009 Demographic and Health Surveys conducted in Lesotho, where HIV/AIDS is a pervasive problem. We find that HIV/AIDS stigmatizing attitudes are negatively associated with education and wealth and positively correlated with Catholic religion for women and traditional circumcision for men. The analysis also shows a negative association between stigmatizing beliefs and the probability of being tested for HIV.
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Affiliation(s)
- Lucia Corno
- Centre for Research and Analysis of Migration (CReAM), Department of Economics, University College London, London, UK
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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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Wang G, Wada K, Hoshi K, Sasaki N, Ezoe S, Satoh T. Association of knowledge of HIV and other factors with individuals' attitudes toward HIV infection: a national cross-sectional survey among the Japanese non-medical working population. PLoS One 2013; 8:e68495. [PMID: 23874644 PMCID: PMC3713032 DOI: 10.1371/journal.pone.0068495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 05/29/2013] [Indexed: 11/23/2022] Open
Abstract
Background The stigma of and discrimination because of HIV has been described as the most important obstacle to prevention and treatment efforts. The purpose of this study was to investigate negative attitudes and prejudice toward HIV among the Japanese non-medical working population and to explore contributing factors. Methods An online anonymous nationwide survey involving approximately 3,000 individuals was conducted in Japan. Questions ranged from background information and HIV knowledge to individuals’ attitudes towards HIV infection in the workplace. Descriptive statistics and logistic regression were applied for analysis. Results Thirty-three percent of participants feared transmission of HIV from infected colleagues, 34% tended to avoid contact with them and 40% had prejudiced opinions about HIV infection. Despite a relatively high level of knowledge of HIV/AIDS overall (11.9±3.3 from 15 points), only 50% of individuals were aware of some issues. Greater knowledge was associated with less negative attitudes towards HIV infection (OR 0.39, 95% CI 0.31–0.48 for prejudiced opinion, high compared with low level of knowledge), whereas greater health consciousness was inversely related to attitude (OR 1.97, 95% CI 1.50–2.58 for prejudiced opinion, high compared with low health consciousness). Conclusion Knowledge neutralizes peoples’ negative attitudes towards HIV infection, whereas greater health consciousness may worsen them. Educational programs should balance knowledge with health consciousness to improve the efficacy of HIV interventions.
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Affiliation(s)
- Guoqin Wang
- Kitasato Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
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Assessing HIV/AIDS stigma in south India: validation and abridgement of the Berger HIV Stigma scale. AIDS Behav 2013; 17:434-43. [PMID: 22246514 DOI: 10.1007/s10461-011-0128-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
HIV-related stigma has been associated with depression, poor adherence, and nondisclosure of HIV-positive status, all of which can lead to increased transmission of HIV and poorer health outcomes for HIV-infected individuals. The Berger HIV Stigma scale has been used in multiple settings but never adapted and validated in India, home to the world's second largest HIV-infected population. We assessed the reliability and validity of a Tamil translation of the original 40-item scale, and conducted confirmatory and exploratory factor analyses to assess cultural appropriateness and abbreviate the scale. Reliability and validity were high (alpha = 0.91; test-retest reliability ICC = 0.89). Exploratory and confirmatory factor analysis resulted in an abridged 25-item version of the scale that possessed better psychometric properties than the 40-item version. This culturally validated, abridged HIV-Stigma scale can be used in busy clinical settings to identify individuals in need of psychosocial support and assess post-intervention changes in stigma in Southern India.
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MacPherson P, Webb EL, Choko AT, Desmond N, Chavula K, Napierala Mavedzenge S, Makombe SD, Chunda T, Squire SB, Corbett EL. Stigmatising attitudes among people offered home-based HIV testing and counselling in Blantyre, Malawi: construction and analysis of a stigma scale. PLoS One 2011; 6:e26814. [PMID: 22046367 PMCID: PMC3202579 DOI: 10.1371/journal.pone.0026814] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 10/04/2011] [Indexed: 11/18/2022] Open
Abstract
Background HIV/AIDS related stigma is a major barrier to uptake of HIV testing and counselling (HTC). We assessed the extent of stigmatising attitudes expressed by participants offered community-based HTC, and their anticipated stigma from others to assess relationship with HIV test uptake. From these data, we constructed a brief stigma scale for use around the time of HIV testing. Methods and Findings Adult members of 60 households in urban Blantyre, Malawi, were selected using population-weighted random cluster sampling and offered HTC with the option to self-test before confirmatory HTC. Prior to HTC a 15-item HIV stigma questionnaire was administered. We used association testing and principal components analysis (PCA) to construct a scale measure of stigma. Of 226 adults invited to participate, 216 (95.6%) completed questionnaires and 198/216 (91.7%) opted to undergo HTC (all self-tested). Stigmatising attitudes were uncommon, but anticipated stigma was common, especially fearing verbal abuse (22%) or being abandoned by their partner (11%). Three questions showed little association or consistency with the remaining 12 stigma questions and were not included in the final scale. For the 12-question final scale, Cronbach's alpha was 0.75. Level of stigma was not associated with previously having tested for HIV (p = 0.318) or agreeing to HTC (p = 0.379), but was associated with expressed worry about being or becoming HIV infected (p = 0.003). Conclusions Anticipated stigma prior to HTC was common among both men and women. However, the high uptake of HTC suggests that this did not translate into reluctance to accept community-based testing. We constructed a brief scale to measure stigma at the time of HIV testing that could rapidly identify individuals requiring additional support following diagnosis and monitor the impact of increasing availability of community-based HTC on prevalence of stigma.
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Affiliation(s)
- Peter MacPherson
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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Winskell K, Hill E, Obyerodhyambo O. Comparing HIV-related symbolic stigma in six African countries: social representations in young people's narratives. Soc Sci Med 2011; 73:1257-65. [PMID: 21864965 PMCID: PMC3358781 DOI: 10.1016/j.socscimed.2011.07.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 06/30/2011] [Accepted: 07/01/2011] [Indexed: 11/17/2022]
Abstract
HIV-related symbolic stigma arises from moralistic value judgements attached to people living with HIV and has negative consequences from both public health and human rights perspectives. Relatively little is known about cross-national variation in symbolic stigma. With the purpose of informing stigma reduction efforts within and across settings, we compared social representations of HIV in six African countries with estimated adult HIV prevalence rates ranging from 1 to 33%. Our study used a unique data source, namely a stratified random sample (n = 586, ∼5%) from 11,354 creative ideas contributed from six countries to a continent-wide HIV-related scriptwriting contest held between February and April 2005. The narratives were written by equal numbers of males and females aged 10-24 in urban and rural areas of Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso and Senegal. We combined three analytical approaches: descriptive statistics on certain quantifiable characteristics of the narratives, thematic data analysis, and a narrative-based approach. The association of HIV with outsiders ("othering") and preoccupation with the circumstances of infection are more common in lower prevalence countries but vary substantially in tone depending on the sociocultural context. The highest proportion both of moralising narratives and of narratives with pessimistic outcomes come from South-East Nigeria and, to a lesser extent, from Kenya, countries with prevalence levels of 3.9 and 6.1% respectively, in which evangelical Christian movements, including Pentecostalism, have sizeable followings. The data provide a rare cross-cultural overview of symbolic stigma, identify country-specific needs, and point to strategies for future programming. Social representations from the highest prevalence countries, Swaziland and Namibia, and from lower prevalence Burkina Faso offer potential models for the framing of HIV in ways that serve to increase social proximity and counteract symbolic stigma.
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Affiliation(s)
- Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Ziraba AK, Madise NJ, Kimani JK, Oti S, Mgomella G, Matilu M, Ezeh A. Determinants for HIV testing and counselling in Nairobi urban informal settlements. BMC Public Health 2011; 11:663. [PMID: 21861898 PMCID: PMC3179452 DOI: 10.1186/1471-2458-11-663] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 08/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Counselling and testing is important in HIV prevention and care. Majority of people in sub-Saharan Africa do not know their HIV status and are therefore unable to take steps to prevent infection or take up life prolonging anti-retroviral drugs in time if infected. This study aimed at exploring determinants of HIV testing and counselling in two Nairobi informal settlements. METHODS Data are derived from a cross-sectional survey nested in an ongoing demographic surveillance system. A total of 3,162 individuals responded to the interview and out of these, 82% provided a blood sample which was tested using rapid test kits. The outcome of interest in this paper was HIV testing status in the past categorised as "never tested"; "client-initiated testing and counselling (CITC)" and provider-initiated testing and counselling (PITC). Multinomial logistic regression was used to identify determinants of HIV testing. RESULTS Approximately 31% of all respondents had ever been tested for HIV through CITC, 22% through PITC and 42% had never been tested but indicated willingness to test. Overall, 62% of females and 38% of males had ever been tested for HIV. Males were less likely to have had CITC (OR = 0.47; p value < 0.001) and also less likely to have had PITC (OR = 0.16; p value < 0.001) compared to females. Individuals aged 20-24 years were more likely to have had either CITC or PITC compared to the other age groups. The divorced/separated/widowed were more likely (OR = 1.65; p value < 0.01) to have had CITC than their married counterparts, while the never married were less likely to have had either CITC or PITC. HIV positive individuals (OR = 1.60; p value < 0.01) and those who refused testing in the survey (OR = 1.39; p value < 0.05) were more likely to have had CITC compared to their HIV negative counterparts. CONCLUSION Although the proportion of individuals ever tested in the informal settlements is similar to the national average, it remains low compared to that of Nairobi province especially among men. Key determinants of HIV testing and counselling include; gender, age, education level, HIV status and marital status. These factors need to be considered in efforts aimed at increasing participation in HIV testing.
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Affiliation(s)
- Abdhalah K Ziraba
- African Population and Health Research Center, Kirawa Road, off Peponi Road P O Box 10787, 00100, Nairobi, Kenya.
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Pearson CR, Cassels S, Kurth AE, Montoya P, Micek MA, Gloyd SS. Change in sexual activity 12 months after ART initiation among HIV-positive Mozambicans. AIDS Behav 2011; 15:778-87. [PMID: 21082338 PMCID: PMC3357499 DOI: 10.1007/s10461-010-9852-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We assessed sexual behaviors before and 12-months after ART initiation among 277 Mozambicans attending an HIV clinic. Measured behaviors included the number of sexual partners, condom use, concurrent relationships, disclosure of HIV status, alcohol use, and partners' serostatus. Compared to before ART initiation, increases were seen 12 months after ART in the proportion of participants who were sexually active (48% vs. 64% respondents, P < 0.001) and the proportion of participants with HIV-negative or unknown serostatus partners (45% vs. 80%, P < 0.001). Almost all (96%) concurrent partnerships reported at 12 months formed after ART initiation. Although reported correct and consist condom use increased, the number of unprotected sexual relationships remained the same (n = 45). Non-disclosure of HIV-serostatus to sexual partners was the only significant predictor of practicing unprotected sex with partners of HIV-negative or unknown serostatus. Sexual activity among HIV-positive persons on ART increased 12 months after ART initiation. Ongoing secondary transmission prevention programs addressing sexual activity with multiple partners, disclosure to partners and consistent condom use with serodisconcordant partners must be incorporated throughout HIV care programs.
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Affiliation(s)
- Cynthia R Pearson
- School of Social Work, Indigenous Wellness and Research Institute, University of Washington, Seattle, WA 98195-1525, USA.
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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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