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Lau LHW, Lee MP, Wong BCK, Kwong TS, Hui WM, Chan JMC, Lee SS. HIV-related public stigma in the era of "Undetectable = Untransmittable": a population-based study in Hong Kong. BMC Public Health 2024; 24:1517. [PMID: 38844889 PMCID: PMC11155177 DOI: 10.1186/s12889-024-18974-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND While global efforts are increasingly relying upon biomedical advancements such as antiretroviral therapy and pre-exposure prophylaxis (PrEP) to end the HIV epidemic, HIV-related stigma remains a concern. This study aimed to assess the general public's awareness and perception of "Undetectable = Untransmittable" (U = U) and PrEP, and the patterns of public stigma towards people living with HIV (PLWH) and their determinants in an Asian Pacific city. METHODS A population-based, self-administrated online survey was conducted between 10-20 March 2023. All adults aged ≥ 18 years and currently living in Hong Kong were eligible. Participants' socio-demographic characteristics, awareness and perception of U = U and PrEP, as well as HIV-related stigma drivers, experience and practices were collected. Latent class analysis was used to delineate population subgroups based on their stigma profiles as reflected by 1.) fear of infection, 2.) concern about socioeconomic ramification of the disease, 3.) social norm enforcement, 4.) perceived stigma in the community, and 5.) stigmatising behaviours and discriminatory attitudes. Memberships of identified subgroups were then correlated with sociodemographic factors, awareness and perception of U = U and PrEP, using multinominal logistic regression. RESULTS Responses from a total of 3070 participants (55% male; 79% aged 18-54) were analysed. A majority, 69% and 81%, indicated that they had never heard of U = U and PrEP respectively, and only 39-40% of participants perceived these to be effective in protection from HIV. Four distinct subgroups were identified, namely "Low stigma" (37%), "Modest stigma" (24%), "Moderate stigma" (24%), and "High stigma" (15%). Compared with "Low stigma", lack of awareness of and/or negative perceptions towards U = U and/or PrEP, not knowing any PLWH were associated with increased odds of higher stigma group membership. Lower educational level and not in employment were associated with increased odds of membership in "Moderate stigma" and "High stigma". While older people were more likely to belong to "High stigma", female were more likely to belong to "Moderate stigma". "Modest stigma" included more younger people who were economically active. CONCLUSION Two-thirds of participants endorsed modest-to-high HIV-related stigma, suggesting the prevalence of HIV-related stigma was high among the general population in Hong Kong. Tailored interventions targeting specific stigma drivers and manifestations of individuals as reflected from the stigma profiles of distinct subgroups could form an important strategy for stigma reduction.
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Affiliation(s)
| | - Man-Po Lee
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - Bonnie Chun-Kwan Wong
- Department of Health, Centre for Health Protection, Hong Kong Special Administrative Region Government, Hong Kong, China
| | - Tsz-Shan Kwong
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - Wai-Man Hui
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Jacky Man-Chun Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Shui-Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
- Postgraduate Education Centre, Stanley Ho Centre for Emerging Infectious Diseases, Prince of Wales Hospital, Hong Kong, China.
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Stigmatizing Attitudes toward People Living with HIV among Young Women Migrant Workers in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116366. [PMID: 35681951 PMCID: PMC9180544 DOI: 10.3390/ijerph19116366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 01/19/2023]
Abstract
Despite intensive HIV education and prevention efforts in the past few years, stigmatizing attitudes toward people living with HIV (PLWH) remain a major barrier to HIV prevention and treatment efforts in Vietnam. The purpose of this study was to examine the prevalence of stigmatizing attitudes regarding HIV and identify correlative factors that impact the perceptions of PLWH among a heretofore overlooked demographic in Vietnamese society: women who are migrant workers in designated industrial zones (IZs). A cross-sectional study was conducted among 1061 women migrant workers aged 18 to 29 from January 2020 to November 2020 in Hanoi, Vietnam. Stigmatizing attitudes toward PLWH were measured using a four-item scale. Multiple logistic regression was conducted to examine the factors associated with stigmatizing attitudes. Our findings indicate both substantial levels of stigma persisting among this demographic group as well as the influence of important mitigating factors on the expression of HIV-related stigma. Over seventy-six percent (76.2%) of the participants reported having at least one of the four stigmatizing attitudes. Greater levels of stigmatizing attitudes toward PLWH were significantly associated with lower HIV knowledge, lower levels of education, and identifying as Kinh (the ethnic majority in Vietnam). Additionally, this study found that questions framing HIV infection through a familial lens were significantly associated with lower rates of stigmatizing responses. The high overall levels of stigmatizing attitudes toward PLWH among the study participants suggests that there is an urgent need for the development of culturally appropriate interventions and outreach education activities to reduce stigmatizing attitudes toward PLWH among women who are migrant workers working in the IZs in Vietnam. This study adds to both the existing literature and current efforts and policies around HIV in Vietnam by empirically suggesting that familial-based messaging may be a powerful potential narrative for interventions addressing HIV-related issues such as stigma.
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Ismail R, Voss JG, Yona S, Nurachmah E, Boutain D, Lowe C, John-Stewart G, Woods NF. Classifying stigma experience of women living with HIV in Indonesia through the social ecological model. Health Care Women Int 2021; 43:345-366. [PMID: 34379051 DOI: 10.1080/07399332.2021.1929989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Little is known how stigma theories apply to women living with HIV (WLWH). To apply stigma theories to WLWH, and locate within the dimensions of the Social-Ecological Model (SEM). Using a literature review and a theoretical subtraction to apply stigma forms to the SEM dimensions. WLWH begin to self-stigmatize, receive stigma based on fear from the family and community. Healthcare providers and society stigmatize WLWH by ascribing character flaws to them. The SEM allowed us to locate the dimensions of stigma and identify areas for future interventions for WLWH in Indonesia and other countries.
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Affiliation(s)
- Rita Ismail
- Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Joachim G Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sri Yona
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Elly Nurachmah
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Doris Boutain
- Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Celia Lowe
- Department of Anthropology, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nancy Fugate Woods
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, Washington, USA
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Leyton A. A latent class analysis to identify how patterns of Intimate Partner Violence influence Early Childhood Development outcomes in Honduras. CHILD ABUSE & NEGLECT 2020; 107:104609. [PMID: 32629290 DOI: 10.1016/j.chiabu.2020.104609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/05/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Intimate Partner Violence (IPV) against women is a complex phenomenon with long-term consequences for victims and their families. OBJECTIVE The goals of this study are two-fold: to identify common patterns of co-occurring and/or successive experiences with IPV; and to study the association between these IPV patterns and outcomes of Early Childhood Development (ECD) among the victim's children. DATA AND PARTICIPANTS Data was obtained from the 2011-12 Honduras Demographic Health Survey (DHS). METHODS A Latent Class Analysis (LCA) was conducted to define homogeneous patterns of experiences with IPV in terms of the type, severity, timing of the last event, and perpetrator of the violence. Outcomes of interest were binary variables indicating if a child is developmentally on track according to the ECD index and its four domains. LCA with distal outcomes and multivariate logistic regressions were used to measure the association between IPV patterns and ECD outcomes. RESULTS Five patterns of lifetime experiences with IPV were identified: (1)"no violence"; (2)"physical and sexual violence by an ex-partner"; (3)"current emotional violence"; (4)"current controlling, emotional and physical violence"; and (5)"past controlling, emotional and physical violence". Multivariate results show that children were less likely to be developmentally on track if their mothers were exposed to patterns of "physical and sexual violence by an ex-partner" or "current controlling, emotional and physical violence", relative to children whose mothers had not experienced violence. Further analysis of specific ECDI domains suggested that IPV hampers children's socioemotional development, but it is not associated with other domains of ECD. CONCLUSION Experiencing a pattern of co-occurrent forms of IPV negatively influences ECD and the socio-emotional development of the victim's children in low and middle-income countries. This study provides initial evidence about the complexity of this phenomenon and its long-lasting sequels.
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Affiliation(s)
- Alejandra Leyton
- Department of Global Community Health and Behavioral Sciences, Tulane University, School of Public Health and Tropical Medicine, 1440 Canal Street, Ste 2200-11, New Orleans, LA, 70112, United States.
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Abstract
Stigma has negatively influenced the lives of people living with HIV since the beginning of the epidemic. It affects every facet of their lives and can cause mental health problems, loss of human rights, and barriers to care. Studies in developing countries have shown a high prevalence of HIV stigma among health care workers. Few studies have been conducted in the United States. We used a validated instrument to survey 330 health care workers in Washington, DC, a high HIV prevalence area. The goal was to obtain data to assess the severity of the problem. We found that stigmatizing beliefs and attitudes were prevalent as reflected in responses from 66% of the participants. Of clinicians surveyed, 31% reported using double gloves. Participants with stigma training had lower stigma levels, whereas older individuals and support staff were more stigmatizing. Negative attitudes affect access to care and have major public health implications.
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Yu MH, Guo CM, Gong H, Li Y, Li CP, Liu Y, Guo M, Zhao YQ, Xu J, Li Z, Gao YJ, Yang J, Cui Z. Using latent class analysis to identify money boys at highest risk of HIV infection. Public Health 2019; 177:57-65. [PMID: 31536863 DOI: 10.1016/j.puhe.2019.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/04/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Limited research has been conducted to investigate the characteristics of money boys (MBs) in China. This study was aimed to identify the subgroups of MBs based on sexual behaviors, Net-based venue sex-seeking, and substance abuse. STUDY DESIGN Cross-sectional study. METHODS Convenience sampling was used to recruit MBs from December 2014 to June 2015 in Tianjin, China. Face-to-face interviews were conducted for 330 MBs, and trained interviewers collected data. RESULTS The laboratory-confirmed human immunodeficiency virus (HIV)-positive rate was 11.52% among 330 MBs. Four classes were identified through latent class analysis (LCA) method: 'relatively safe behavior' group, 'higher sexual risk' group, 'multiple sexual-partners' group, and 'unprotected sex and substance abuse' group, and there is a significant difference based on the HIV status. Significant differences were found in original residence, monthly income, duration in sex trade, employment, history of sexually transmitted infection (STI), HIV testing, knowledge of free antiviral treatment policy, and awareness of free AIDS testing between the four latent classes (P < 0.05). MBs who used Net-based venues to seek sexual partners; who have inconsistent condom use, substance abuse, a longer duration in sex trade, multiple sexual clients, and multiple anal sex; and who were full-time employed had the highest risk of HIV infection. CONCLUSIONS The utility of LCA to identify subgroups based on risky behaviors attributes to formulating targeted intervention strategy.
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Affiliation(s)
- M-H Yu
- Section of STD & AIDS Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, China
| | - C-M Guo
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
| | - H Gong
- Section of STD & AIDS Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, China
| | - Y Li
- Section of STD & AIDS Control and Prevention, Tianjin Nankai District Center for Disease Control and Prevention, Tianjin, China
| | - C-P Li
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
| | - Y Liu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
| | - M Guo
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
| | - Y-Q Zhao
- Department of Medical English and Health Communication, Tianjin Medical University, Tianjin, China
| | - J Xu
- National Center for AIDS/STD Control and Prevention, Beijing, China
| | - Z Li
- GAP Program Office of U.S CDC, Atlanta, USA
| | - Y-J Gao
- Section of STD & AIDS Control and Prevention, Tianjin HongQiao District Center for Disease Prevention and Control, Tianjin, China
| | - J Yang
- Tianjin Shen-Lan Public Health Counseling Service Center, Tianjin, China
| | - Z Cui
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China.
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Picco L, Chang S, Abdin E, Chua BY, Yuan Q, Vaingankar JA, Ong S, Yow KL, Chua HC, Chong SA, Subramaniam M. Associative stigma among mental health professionals in Singapore: a cross-sectional study. BMJ Open 2019; 9:e028179. [PMID: 31300500 PMCID: PMC6629392 DOI: 10.1136/bmjopen-2018-028179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES (1) Investigate and explore whether different classes of associative stigma (the process by which a person experiences stigmatisation as a result of an association with another stigmatised person) could be identified using latent class analysis; (2) determine the sociodemographic and employment-related correlates of associative stigma and (3) examine the relationship between associative stigma and job satisfaction, among mental health professionals. DESIGN Cross-sectional online survey. PARTICIPANTS Doctors, nurses and allied health staff, working in Singapore. METHODS Staff (n=462) completed an online survey, which comprised 11 associative stigma items and also captured sociodemographic and job satisfaction-related information. Latent class analysis was used to classify associative stigma on patterns of observed categorical variables. Multinomial logistic regression was used to examine associations between sociodemographic and employment-related factors and the different classes, while multiple linear regression analyses were used to examine the relationship between associative stigma and job satisfaction. RESULTS The latent class analysis revealed that items formed a three-class model where the classes were classified as 'no/low associative stigma', 'moderate associative stigma' and 'high associative stigma'. 48.7%, 40.5% and 10.8% of the population comprised no/low, moderate and high associative stigma classes, respectively. Multinomial logistic regression showed that years of service and occupation were significantly associated with moderate associative stigma, while factors associated with high associative stigma were education, ethnicity and occupation. Multiple linear regression analyses revealed that high associative stigma was significantly associated with lower job satisfaction scores. CONCLUSION Associative stigma was not uncommon among mental health professionals and was associated with sociodemographic factors and poorer job satisfaction. Associative stigma has received comparatively little attention from empirical researchers and continued efforts to address this understudied yet important construct in conjunction with future efforts to dispel misconceptions related to mental illnesses are needed.
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Samantha Ong
- Nursing, Institute of Mental Health, Singapore, Singapore
| | - Kah Lai Yow
- Allied Health, Institute of Mental Health, Singapore, Singapore
| | - Hong Choon Chua
- Chief Executive Office, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Smith MK, Stein G, Cheng W, Miller WC, Tucker JD. Identifying high risk subgroups of MSM: a latent class analysis using two samples. BMC Infect Dis 2019; 19:213. [PMID: 30832592 PMCID: PMC6399860 DOI: 10.1186/s12879-019-3700-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/09/2019] [Indexed: 01/08/2023] Open
Abstract
Background Latent class analyses (LCA) are increasingly being used to target specialized HIV interventions, but generalizability of emergent population structures across settings has yet to be considered. We compare LCA performed on two online samples of HIV negative Chinese men who have sex with men (MSM) to detect more generalizable latent class structures and to assess the extent to which sampling considerations impact the validity of LCA results. Methods LCAs were performed on an 1) nationwide online survey which involved no in-person contact with study staff and a 2) sentinel surveillance survey in which participants underwent HIV and syphilis testing in the city of Guangzhou, both conducted in 2014. Models for each sample were informed by risk factors for HIV acquisition in MSM that were common to both datasets. Results An LCA of the Guangzhou sentinel surveillance data indicated the presence of two relatively similar classes, differing only by the greater tendency of one to report group sex. In contrast an LCA of the nationwide survey identified three classes, two of which shared many of the same features as those identified in the Guangzhou survey, including the fact that they were mainly distinguished by group sex behaviors. The final latent class in the nationwide survey was composed of members with notably few risk behaviors. Conclusions Comparisons of the latent class structures of each sample lead us to conclude that the nationwide online sample captured a larger, possibly more representative group of Chinese MSM comprised of a larger, higher risk group and a small yet distinct lower group with few reported behaviors. The absence of a lower risk group in the Guangzhou sentinel surveillance dataset suggests that MSM recruited into studies involving free HIV/STI testing may oversample MSM with higher risk behaviors and therefore greater risk perception. Lastly, two types of higher risk MSM were emergent across both samples distinguished largely by their recent group sex behaviors. Higher odds not only of self-reported HIV infection but also of closeted tendencies and gender fluid identities in this highest risk group suggest that interacting factors drive individual and structural facets of HIV risk.
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Affiliation(s)
- M Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota Twin Cities, 1300 South 2nd Street, Minneapolis, MN, 55454, USA.
| | - Gabriella Stein
- Department of Biostatistics, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC, 27599, USA
| | - Weibin Cheng
- Guangzhou Center for Disease Control and Prevention, Department of AIDS/STD Control and Prevention, 1 Jiaochang E Rd, Guangzhou Shi, 510000, Guangdong Sheng, China
| | - William C Miller
- Division of Epidemiology, The Ohio State University, College of Public Health, 1841 Neal Ave., 302 Cunz Hall, Columbus, OH, 43210, USA
| | - Joseph D Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC, 27599, USA
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Than PQT, Tran BX, Nguyen CT, Truong NT, Thai TPT, Latkin CA, Ho CSH, Ho RCM. Stigma against patients with HIV/AIDS in the rapid expansion of antiretroviral treatment in large drug injection-driven HIV epidemics of Vietnam. Harm Reduct J 2019; 16:6. [PMID: 30654814 PMCID: PMC6337792 DOI: 10.1186/s12954-019-0277-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 01/04/2019] [Indexed: 02/01/2023] Open
Abstract
Background Despite existing efforts to provide antiretroviral treatment (ART) for all HIV-diagnosed people, stigma deprives them of the highest attainable health status and challenges the effectiveness of ART program in Vietnam. This study aimed to assess five dimensions of HIV-related stigma and explore its associated factors among ART patients in a multisite survey. Implications of this study support the development of HIV policies to improve patients’ access, utilization, and outcomes of ART program toward the 90-90-90 goal in Vietnam. Methods A total of 1133 ART patients who were recruited by convenience sampling method from 8 ART clinics in Hanoi and Nam Dinh in a cross-sectional study from January to August 2013. Multivariate logistic regression was employed to identify factors associated with stigmatization. Results The majority of participants reported experiencing stigmatization due to shame (36.9%), blame/judge (21.6%), and discrimination (23.4%). Further, 91.5% of participants disclosed their HIV status with others. The likelihood of experiencing stigmatization did not only associate with the patients’ socioeconomic status (e.g., age, occupation, education) and HIV status disclosure, but also their health problems. Those with anxiety or depression and perceived lower quality of life were more likely to experience stigma. Conclusions To maximize the efficiency of the ART program, it is essential to develop interventions that reduce stigma involving individuals, families, and communities, and recognize and address complex health problems especially those patients showing depressive symptoms. Increasing quality of life of HIV-positive patients by providing vocational training, financial, family, and peer support will reduce the likelihood of experiencing stigma.
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Affiliation(s)
- Phung Quoc Tat Than
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
| | - Nu Thi Truong
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Thao Phuong Thi Thai
- Department of General Planning and Department of Cardiology, Friendship Hospital, Hanoi, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Thapa S, Hannes K, Buve A, Bhattarai S, Mathei C. Theorizing the complexity of HIV disclosure in vulnerable populations: a grounded theory study. BMC Public Health 2018; 18:162. [PMID: 29351785 PMCID: PMC5775526 DOI: 10.1186/s12889-018-5073-x] [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: 05/23/2017] [Accepted: 01/11/2018] [Indexed: 12/04/2022] Open
Abstract
Background HIV disclosure is an important step in delivering the right care to people. However, many people with an HIV positive status choose not to disclose. This considerably complicates the delivery of adequate health care. Methods We conducted a grounded theory study to develop a theoretical model explaining how local contexts impact on HIV disclosure and what the mechanisms are that determine whether people choose to disclose or not. We conducted in-depth interviews among 23 people living with HIV, 8 health workers and 5 family and community members, and 1 community development worker in Achham, Nepal. Data were analysed using constant-comparative method, performing three levels of open, axial, and selective coding. Results Our theoretical model illustrates how two dominant systems to control HIV, namely a community self-coping and a public health system, independently or jointly, shape contexts, mechanisms and outcomes for HIV disclosure. Conclusion This theoretical model can be used in understanding processes of HIV disclosure in a community where HIV is concentrated in vulnerable populations and is highly stigmatized, and in determining how public health approaches would lead to reduced stigma levels and increased HIV disclosure rates.
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Affiliation(s)
- Subash Thapa
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. .,Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Karin Hannes
- Centre for Sociological Research, Faculty of Social Sciences, KU Leuven, Parkstraat 45, 3000, Leuven, Belgium
| | - Anne Buve
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Shivani Bhattarai
- Department of Public Health, Nobel College Pokhara University, Kathmandu, 44601, Nepal
| | - Catharina Mathei
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
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Alcohol and tobacco use among methadone maintenance patients in Vietnamese rural mountainside areas. Addict Behav Rep 2017; 7:19-25. [PMID: 29450252 PMCID: PMC5805500 DOI: 10.1016/j.abrep.2017.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction The expansion of methadone maintenance treatment (MMT) program requires more data about the factors affecting the effectiveness of treatment, especially behavioral data such as smoking and alcohol use among patients. This study aimed to examine the prevalence of tobacco and alcohol consumption and identify related factors among MMT patients in the Vietnamese rural mountainside. Methods We interviewed 241 MMT patients in two clinics in Tuyen Quang, a mountainous province in Vietnam. Patients were asked to report the smoking status (current smoker or not), nicotine dependence (by Fagerström test for nicotine dependence - FTND) and alcohol use (by using the Alcohol Use Disorders Identification Test – AUDIT-C). EuroQol-5 dimensions-5 levels (EQ-5D-5L) and EQ-Visual analogue scale (EQ-VAS) were employed to measure health-related quality of life. Multivariate logistic and Tobit regressions were used to identify the associated factors. Results The majority of respondents were current smokers (75.7%) and a low proportion were hazardous drinkers (18.3%). People receiving treatment in a rural clinic (OR = 0.45; 95%CI = 0.22–0.92) and had problems in usual activities (OR = 0.20; 95%CI = 0.06–0.70) were less likely to be smokers. Q-VAS score (Coef. = 0.03; 95%CI = 0.02–0.05) and having problems in mobility (Coef. = 0.72; 95%CI = 0.03–1.42) was found to be associated with the increase of nicotine dependence. In terms of alcohol drinking, people with other jobs were more likely to drink hazardously compared to unemployed patients (OR = 2.86; 95%CI = 1.20–6.82). Similarly, patients having higher duration of MMT had higher likelihood of being hazardous drinkers (OR = 1.07; 95%CI = 1.01–1.13). Conclusions This study highlights the low rate of alcohol abusers but a considerably high proportion of current smokers among MMT patients in the rural mountainside area. Alcohol and tobacco counseling programs combined with social and family support also play an essential role in alcohol and tobacco control. In addition, implementing mass community-based behavioral change campaigns to reduce drug addiction-related stigmatization should also be prioritized. Rates of tobacco and alcohol use were high among MMT patients in the rural mountainside area. The bi-directional association existed between being at risk of hazardous drinking and MMT duration. A comprehensive MMT approach is needed to improve both physical and mental health outcome, which facilitates MMT patients to quit smoking and alcohol use. Alcohol and tobacco counseling programs combined with social and family support are necessary.
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Ishimaru T, Wada K, Hoang HTX, Bui ATM, Nguyen HD, Le H, Smith DR. Nurses' willingness to care for patients infected with HIV or Hepatitis B / C in Vietnam. Environ Health Prev Med 2017; 22:9. [PMID: 29165125 PMCID: PMC5664450 DOI: 10.1186/s12199-017-0614-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 03/04/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study examined the factors associated with nurses' willingness to care for patients infected with human immunodeficiency virus (HIV) or hepatitis B or C virus (HBV/HCV) in Vietnam. METHODS A cross-section of 400 Vietnamese nurses from two hospitals were selected using stratified random sampling, to whom a self-administered questionnaire was administered which included demographic items, previous experience with patients infected with HIV or HBV/HCV, and their attitudes toward these patients. Data was analyzed using descriptive statistics and multiple logistic regression. RESULTS The lifetime prevalence of needlestick or sharps injury whilst caring for a patient infected with HIV or HBV/HCV was 9 and 15.8%, respectively. The majority of participants expressed a willingness to care for patients infected with HIV (55.8%) or HBV/HCV (73.3%). Willingness to care for HIV-infected patients was positively associated with being 40-49 years of age and confidence in protecting themselves against infection. Regarding HBV/HCV infection, willingness to care was positively associated with individual confidence in protecting themselves against infection. CONCLUSIONS This study revealed that Vietnamese nurses were somewhat willing to care for patients infected with HIV or HBV/HCV, and this was associated with individual confidence in protecting themselves against infection and with negative attitudes towards HIV and HBV/HCV. Establishing a positive safety culture and providing appropriate professional education to help reduce the stigma towards infected patients offers an effective way forwards to improve quality of care in Vietnam, as elsewhere.
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Affiliation(s)
- Tomohiro Ishimaru
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand.,Occupational Health Training Center, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koji Wada
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Huong Thi Xuan Hoang
- Department of Infection Control, Faculty of Nursing, Thanh Tay University, Hanoi, Vietnam
| | - Anh Thi My Bui
- Department of Hospital Management, Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Hung Le
- Dong Da Hospital, Hanoi, Vietnam
| | - Derek R Smith
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Prinsloo CD, Greeff M, Kruger A, Ellis S. Psychosocial well-being of people living with HIV and the community before and after a HIV stigma-reduction community "hub" network intervention. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:261-71. [PMID: 27681150 DOI: 10.2989/16085906.2016.1200640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of the research was to determine whether an HIV stigma-reduction community "hub" network intervention in a South African urban area would bring about a difference in the psychosocial well-being of people living with HIV (PLWH), as well as their community (living in the same municipal ward). A single case pre-test post-test design was implemented. The sample for this study included 62 PLWH who were selected through accessibility sampling and 570 community members who were selected through random voluntary sampling. Participants completed the Patient Health Questionnaire (PHQ-9) and the Mental Health Continuum-Short Form (MHC-SF) before and after the intervention. A dependent t-test as well as Cohen's d-values were used to calculate the differences between the pre- and post-test results for depression and well-being. Levels of languishing, moderate mental health and flourishing before and after the intervention were determined. Although the focus of the HIV stigma-reduction community "hub" intervention that was followed in this study was on the involvement of PLWH and people living close to them (PLC) to share their knowledge as community mobilisers and to mobilise and empower their own community to reduce HIV stigma, it can be concluded that a secondary gain was the effect it had on both depression and mental health of the PLWH as well as the community. Of interest is how these effects differed for PLWH and the community. It is thus recommended that future interventions should give special attention to aspects of depression and well-being.
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Affiliation(s)
- Catharina D Prinsloo
- a Africa Unit for Transdisciplinary Health Research (AUTHeR), Faculty of Health Sciences , North-West University , Potchefstroom , South Africa
| | - Minrie Greeff
- a Africa Unit for Transdisciplinary Health Research (AUTHeR), Faculty of Health Sciences , North-West University , Potchefstroom , South Africa
| | - Annamarie Kruger
- a Africa Unit for Transdisciplinary Health Research (AUTHeR), Faculty of Health Sciences , North-West University , Potchefstroom , South Africa
| | - Suria Ellis
- b Unit for Business Mathematics and Informatics , North-West University , Potchefstroom , South Africa
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14
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Costa D, Mendes A, Abreu W. Health and mood among HIV-positive outpatients attending an ART Clinic of a University Hospital. J Clin Nurs 2016; 25:3209-3218. [PMID: 27523649 DOI: 10.1111/jocn.13342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To evaluate how individuals at different stages of infection with HIV perceive their health status and its association with mood states. BACKGROUND With the introduction of Highly Active Antiretroviral Therapy in 1996, the quality of life of people living with HIV has improved. However, the literature emphasises the negative effects of the disease on the mental health of individuals suffering from this condition and the high incidence of depression among infected individuals. Although people diagnosed and living with HIV are overwhelmed by emotions, we found that various emotional manifestations are understudied within this group of patients. DESIGN A cross-sectional study was conducted in an outpatient unit of a University Hospital (antiretroviral therapy clinic), with a consecutive sample composed of 152 patients. METHODS Data were collected through a questionnaire used to assess the sociodemographic and clinical characteristics, the Short Form (36) Health Survey, and the Profile of Mood States scale. RESULTS AND CONCLUSIONS The health status negatively affects the role at the emotional and mental health dimensions. The participants showing a worse health condition than in the previous year had higher levels of tension/anxiety, depression/dejection, fatigue/inertia and confusion/bewilderment. The stage of disease and the profile of mood state emerged as independent phenomena. RELEVANCE TO CLINICAL PRACTICE The results of this study indicate that nurses worldwide should be aware of the emotional aspects (negative emotions strongly impact health) related to the subjective perception of a worsening health status, regardless of the stage of the disease.
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Affiliation(s)
| | - Aida Mendes
- Nursing School of Coimbra, Coimbra, Portugal
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15
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Tran BX, Vu PB, Nguyen LH, Latkin SK, Nguyen CT, Phan HTT, Latkin CA. Drug addiction stigma in relation to methadone maintenance treatment by different service delivery models in Vietnam. BMC Public Health 2016; 16:238. [PMID: 26956741 PMCID: PMC4784456 DOI: 10.1186/s12889-016-2897-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/19/2016] [Indexed: 11/24/2022] Open
Abstract
Background The rapid expansion of methadone maintenance treatment (MMT) services has significantly improved health status and quality of life of patients. However, little is known about its impacts on addiction-related stigma and associated factors. Methods A cross-sectional survey was conducted in 2013 in Vietnam’s capital, Hanoi, and Nam Dinh province among 1016 methadone maintenance patients; 26.6 % at provincial AIDS centers (PAC) and 73.4 % at district health centers (DHC), respectively. Drug addiction history and related stigma, health status, MMT-related covariates, and sociodemographic characteristics were interviewed. Results More than one-sixth of the sample reported experiencing felt or enacted stigma, including Blame or Judgement (17.2 %), Shame (19.9 %), or Others’ fear of HIV transmission (17.1 %). These proportions were higher in PACs than in DHCs, which are integrated with other HIV or general health care services. Very few patients reported being discriminated at the workplace (2.5 %) or at health care services (1.7 %); however, 15.6 % of patients at PACs and 10.6 % of patients at DHCs reported discrimination in their communities. Drug users taking MMT for longer periods were less likely to report felt stigma. Other factors associated with stigma against MMT patients included the lack of comprehensive services, higher education, presence of pain/discomfort, and anxiety/depression, self-reported HIV positive, and number of previous drug rehabilitation episodes. Conclusion The study shows a high level of stigma against MMT patients and emphasizes the necessity to integrate MMT with comprehensive health and support services. Mass communication campaigns to reduce stigma against people with drug addiction and HIV/AIDS, as well as vocational trainings and jobs referrals for MMT patients, are needed to maximize the benefits of MMT programs in Vietnam.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, vietnam. .,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Phuong Bich Vu
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, vietnam
| | - Long Hoang Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, vietnam.,School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | | | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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Phylogenetic Investigation of a Statewide HIV-1 Epidemic Reveals Ongoing and Active Transmission Networks Among Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2016; 70:428-35. [PMID: 26258569 DOI: 10.1097/qai.0000000000000786] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Molecular epidemiological evaluation of HIV-1 transmission networks can elucidate behavioral components of transmission that can be targets for intervention. METHODS We combined phylogenetic and statistical approaches using pol sequences from patients diagnosed between 2004 and 2011 at a large HIV center in Rhode Island, following 75% of the state's HIV population. Phylogenetic trees were constructed using maximum likelihood, and putative transmission clusters were evaluated using latent class analyses to determine association of cluster size with underlying demographic/behavioral characteristics. A logistic growth model was used to assess intracluster dynamics over time and predict "active" clusters that were more likely to harbor undiagnosed infections. RESULTS Of the 1166 HIV-1 subtype B sequences, 31% were distributed among 114 statistically supported, monophyletic clusters (range: 2-15 sequences/cluster). Sequences from men who have sex with men (MSM) formed 52% of clusters. Latent class analyses demonstrated that sequences from recently diagnosed (2008-2011) MSM with primary HIV infection (PHI) and other sexually transmitted infections (STIs) were more likely to form larger clusters (odds ratio: 1.62-11.25, P < 0.01). MSM in clusters were more likely to have anonymous partners and meet partners at sex clubs and pornographic stores. Four large clusters with 38 sequences (100% male, 89% MSM) had a high probability of harboring undiagnosed infections and included younger MSM with PHI and STIs. CONCLUSIONS In this first large-scale molecular epidemiological investigation of HIV-1 transmission in New England, sexual networks among recently diagnosed MSM with PHI and concomitant STIs contributed to the ongoing transmission. Characterization of transmission dynamics revealed actively growing clusters, which may be targets for intervention.
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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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18
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Chan PA, Rose J, Maher J, Benben S, Pfeiffer K, Almonte A, Poceta J, Oldenburg CE, Parker S, Marshall BDL, Lally M, Mayer K, Mena L, Patel R, Nunn AS. A Latent Class Analysis of Risk Factors for Acquiring HIV Among Men Who Have Sex with Men: Implications for Implementing Pre-Exposure Prophylaxis Programs. AIDS Patient Care STDS 2015; 29:597-605. [PMID: 26389735 DOI: 10.1089/apc.2015.0113] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Current Centers for Disease Control and Prevention (CDC) guidelines for prescribing pre-exposure prophylaxis (PrEP) to prevent HIV transmission are broad. In order to better characterize groups who may benefit most from PrEP, we reviewed demographics, behaviors, and clinical outcomes for individuals presenting to a publicly-funded sexually transmitted diseases (STD) clinic in Providence, Rhode Island, from 2012 to 2014. Latent class analysis (LCA) was used to identify subgroups of men who have sex with men (MSM) at highest risk for contracting HIV. A total of 1723 individuals presented for testing (75% male; 31% MSM). MSM were more likely to test HIV positive than heterosexual men or women. Among 538 MSM, we identified four latent classes. Class 1 had the highest rates of incarceration (33%), forced sex (24%), but had no HIV infections. Class 2 had <5 anal sex partners in the previous 12 months, the lowest rates of drug/alcohol use during sex and lower HIV prevalence (3%). Class 3 had the highest prevalence of HIV (7%) and other STDs (16%), > 10 anal sex partners in the previous 12 months (69%), anonymous partners (100%), drug/alcohol use during sex (76%), and prior STDs (40%). Class 4 had similar characteristics and HIV prevalence as Class 2. In this population, MSM who may benefit most from PrEP include those who have >10 sexual partners per year, anonymous partners, drug/alcohol use during sex and prior STDs. LCA is a useful tool for identifying clusters of characteristics that may place individuals at higher risk for HIV infection and who may benefit most from PrEP in clinical practice.
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Affiliation(s)
- Philip A. Chan
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer Rose
- Department of Psychology, Wesleyan University, Middletown, Connecticut
| | - Justine Maher
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stacey Benben
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kristen Pfeiffer
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alexi Almonte
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joanna Poceta
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Catherine E. Oldenburg
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts
| | - Sharon Parker
- Department of Social Work, North Carolina Agricultural and Technical State University, Greensboro, North Carolina
| | - Brandon DL Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Mickey Lally
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kenneth Mayer
- Fenway Health, The Fenway Institute, Boston, Massachusetts
| | - Leandro Mena
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Rupa Patel
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
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19
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Lee SJ, Li L, Lin C, Tuan LA. Challenges facing HIV-positive persons who use drugs and their families in Vietnam. AIDS Care 2014; 27:283-7. [PMID: 25285396 DOI: 10.1080/09540121.2014.963015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It is hypothesized that persons who use drugs (PWUD) in Vietnam who are also HIV-positive may face additional challenges in psychosocial outcomes, and these challenges may extend to their family members. In this study, we examined depressive symptoms, stigma, social support, and caregiver burden of HIV-positive PWUD and their family members, compared to the outcomes of HIV-negative PWUD and their family members. Baseline, 3-month, and 6-month assessment data were gathered from 83 PWUD and 83 family members recruited from four communes in Phú Thọ Province, Vietnam. For PWUD, although we observed a general decline in overall stigma over time for both groups, HIV-positive PWUD consistently reported significantly higher overall stigma for all three periods. Depressive symptoms among family members in both groups declined over time; however, family members of HIV-positive PWUD reported higher depressive symptoms across all three periods. In addition, family members of HIV-positive PWUD reported lower levels of tangible support across all three periods. Caregiver burden among family members of HIV-positive PWUD increased significantly over time, whereas the reported burden among family members of HIV-negative PWUD remained relatively unchanged. The findings highlight the need for future interventions for PWUD and family members, with targeted and culturally specific strategies to focus on the importance of addressing additional stigma experienced by PWUD who are HIV-positive. Such challenges may have direct negative impact on their family members' depressive symptoms, tangible support, and caregiver burden.
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Affiliation(s)
- Sung-Jae Lee
- a Semel Institute for Neuroscience and Human Behavior, Center for Community Health , University of California , Los Angeles , CA , USA
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20
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Kuteesa MO, Wright S, Seeley J, Mugisha J, Kinyanda E, Kakembo F, Mwesigwa R, Scholten F. Experiences of HIV-related stigma among HIV-positive older persons in Uganda--a mixed methods analysis. SAHARA J 2014; 11:126-37. [PMID: 25053275 PMCID: PMC4272102 DOI: 10.1080/17290376.2014.938103] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
There is limited data on stigma among older HIV-infected adults in sub-Saharan Africa. We describe the experiences of stigma and disclosure in a cohort of HIV-positive older people in Uganda. Using data from the Wellbeing of Older Peoples' Study of Kalungu (rural site) and Wakiso district (peri-urban site) residents, we measured self-reported stigma levels for 183 respondents (94 on antiretroviral therapy (ART); 88, not on ART) using a stigma score generated using three questions on stigma perceptions where 0 meant no stigma at all and 100 was maximum stigma. Based on two questions on disclosure, an overall score was computed. High disclosure was assigned to those who often or very often disclosed to the family and were never or seldom afraid to disclose elsewhere. We examined the experiences of HIV stigma of 25 adults (52% females) using semi-structured, open-ended interviews and monthly oral diaries over one year. Mean age of the respondents was 70 years (range 60-80 years) and 80% of all respondents were enrolled in ART. Interview transcripts were analysed using thematic content analysis. Overall, 55% of respondents had a high disclosure score, meaning they disclosed easily, and 47% had a high stigma score. The stigma scores were similar among those with high and low disclosure scores. In multivariate analyses with disclosure and stigma scores as dependent variables none of the respondents' characteristics had a significant effect at the 5% level. Qualitative data revealed that stigma ranges from: (1) perceptions (relatively passive, but leading to behaviour such as gossip, especially if not intended maliciously); to (2) discriminatory behaviour (active or enacted stigma; from malicious gossip to outright discrimination). Despite the relatively high levels of disclosure, older people suffer from high levels of stigma of various forms apart from HIV-related stigma. Efforts to assess for different forms of stigma at an individual level deserve greater attention from service providers and researchers, and must be context specific.
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Affiliation(s)
- Monica O. Kuteesa
- MD, MPH, is affiliated to MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- is an Alumnus at BIARI, Providence, RI, USA
| | - Stuart Wright
- MA, is a Doctoral Student at the School of East Asian Studies, University of Sheffield, Sheffield, UK
| | - Janet Seeley
- PhD, is affiliated to MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Joseph Mugisha
- PhD, is affiliated to MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- PhD, is a Professor at the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Eugene Kinyanda
- PhD, is affiliated to MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Frederick Kakembo
- PhD, is an Alumnus at BIARI, Providence, RI, USA
- is an Associate Dean in the Department of Research and Post Graduate Studies, Uganda Christian University, Mukono, Uganda
| | - Richard Mwesigwa
- is an alumnus to BIARI, Providence, RI, USA
- is a Project Leader for the Expanded Kibaale, Kiboga Program at Infectious Disease Institute, Kampala, Uganda
| | - Francis Scholten
- MSc, is affiliated to MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
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Tran DA, Shakeshaft A, Ngo AD, Mallitt KA, Wilson D, Doran C, Zhang L. Determinants of antiretroviral therapy initiation and treatment outcomes for people living with HIV in Vietnam. HIV CLINICAL TRIALS 2014; 14:21-33. [PMID: 23372112 DOI: 10.1310/hct1401-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study explores patient characteristics that are significantly associated with very late combination antiretroviral therapy (cART) initiation (CD4 count ≤100 cells/mm³) and examines the association between patient characteristics and treatment outcomes, CD4 recovery, and mortality. DESIGN Data were obtained from the clinical records of 2,198 HIV/AIDS patients in 13 outpatient clinics across 6 provinces in Vietnam. METHODS Multivariate logistic regression and Cox proportional hazards regression were used to identify patient characteristics that are significantly associated with very late cART initiation and to measure relationships between patient characteristics and treatment outcomes. RESULTS Very late cART initiation was significantly associated with being male compared with female (odds ratio [OR], 0.36; 95% CI, 0.23-0.58), becoming HIV infected through injecting drugs (OR, 2.13; 95% CI, 1.09-4.14), and having opportunistic infections at cART initiation (OR, 1.69; 95% CI, 1.02-2.86). Being male (female vs male: hazard ratio [HR], 0.45; 95% CI, 0.20-0.98), very late cART initiation (timely vs late: HR, 0.18; 95% CI, 0.04-0.72), low baseline body mass index (BMI) (HR, 0.95; 95% CI, 0.92-0.98), and later baseline WHO clinical stage (WHO clinical stage IV vs combined group of stage I and II: HR, 5.70; 95% CI, 3.90-7.80) were significantly associated with death, whereas being female compared with male (HR, 1.51; 95% CI, 1.14-1.99) and timely cART initiation (HR, 35.45; 95% CI, 13.67-91.91) were significant predictors of CD4 recovery. CONCLUSIONS Timely testing of patients for HIV, increasing use of CD4 count testing services, and starting cART earlier are essential to reduce mortality and improve treatment outcomes.
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Affiliation(s)
- Dam Anh Tran
- National Drug Alcohol Research Centre, The University of New South Wales, Sydney, Australia Kirby Institute, Sydney, Australia. d.tran@
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Ayiga N, Nambooze H, Nalugo S, Kaye D, Katamba A. The impact of HIV/AIDS stigma on HIV counseling and testing in a high HIV prevalence population in Uganda. Afr Health Sci 2013; 13:278-86. [PMID: 24235925 DOI: 10.4314/ahs.v13i2.12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite its importance in HIV/AIDS prevention and treatment, HIV/AIDS Counseling and Testing (HCT) is low in sub-Saharan Africa, where the disease continues to be a serious public health problem. This has in part been attributed to HIV/AIDS related stigma. OBJECTIVE To assess the level of HIV/AIDS related stigma and its impact on uptake of HCT in a high HIV prevalence population in Uganda. METHODS The paper used cross-sectional data on 135 men and 185 women in reproductive ages. Data were analyzed using the Pearson's chi-square statistic and the random intercept binary logistic regression model to identify significant predictors of uptake of HCT. RESULTS The result shows that only 18.4% of the respondents, most of them men expressed highly stigmatizing attitudes against PLHA and 59%, men and women alike, received HCT. Uptake of HCT was higher among men (OR=1.89, p<0.01) and women (OR=4.48, p <0.001) who expressed least stigmatizing attitudes. Secondary/higher education, work in the informal sector and being ever married were significant predictors of uptake of HCT. Compared to men, women aged 25-34, 35+ and with one sexual partner were more likely to have received HCT. CONCLUSIONS The low level of stigma, older age, higher level of education, being ever married and monogamous sexual relationships are significant predictors of increased uptake of HCT.
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Farid-ul-Hasnain S, Johansson E, Gulzar S, Krantz G. Need for multilevel strategies and enhanced acceptance of contraceptive use in order to combat the spread of HIV/AIDS in a Muslim society: a qualitative study of young adults in urban Karachi, Pakistan. Glob J Health Sci 2013; 5:57-66. [PMID: 23985107 PMCID: PMC4776849 DOI: 10.5539/gjhs.v5n5p57] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/12/2013] [Indexed: 11/22/2022] Open
Abstract
This qualitative study explored knowledge, attitudes, beliefs and perceptions of sexual and reproductive health, focusing specifically on contraceptive use and HIV prevention among young unmarried men and women, 17-21 years, in urban Karachi, Pakistan. The main theme, identified as underlying meaning in the focus group discussions was “Societal norms and perceptions create barriers to knowledge and awareness about sexual and reproductive health matters among young adults”. A knowledge gap was revealed concerning HIV/AIDS and contraceptive use among young males and females, who have to rely on media and peers for information seeking. Study participants perceived that HIV/AIDS is incurable and carries a social stigma. It was further revealed, that there is an opposition towards contraceptive use from religious leaders. Young adults in Pakistan are in need of improved knowledge about HIV/AIDS and contraceptive use. Youth clinics and schools/colleges may play a significant role in this regard. The religious leaders need to be informed about the beneficial effects of contraceptives and they should be part of any family planning/contraceptive use program to ensure better community acceptance. At the structural level there is an urgent need for policies targeting the issue of sexual and reproductive health, particularly HIV/AIDS information and contraceptive use to target the young population. The health care services should be able to respond by offering relevant services.
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Ugarte WJ, Högberg U, Valladares EC, Essén B. Measuring HIV- and AIDS-related stigma and discrimination in Nicaragua: results from a community-based study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2013; 25:164-178. [PMID: 23514083 DOI: 10.1521/aeap.2013.25.2.164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Psychometric properties of external HIV-related stigma and discrimination scales and their predictors were investigated. A cross-sectional community-based study was carried out among 520 participants using an ongoing health and demographic surveillance system in León, Nicaragua. Participants completed an 18-item HIV stigma scale and 19 HIV and AIDS discrimination-related statements. A factor analysis found that 15 of the 18 items in the stigma scale and 18 of the 19 items in the discrimination scale loaded clearly into five- and four-factor structures, respectively. Overall Cronbach's alpha of .81 for the HIV stigma scale and .91 for the HIV discrimination scale provided evidence of internal consistency. Hierarchical multiple linear regression analysis identified that females, rural residents, people with insufficient HIV-related transmission knowledge, those not tested for HIV, those reporting an elevated self-perception of HIV risk, and those unwilling to disclose their HIV status were associated with higher stigmatizing attitudes and higher discriminatory actions towards HIV-positive people. This is the first community-based study in Nicaragua that demonstrates that overall HIV stigma and discrimination scales were reliable and valid in a community-based sample comprised of men and women of reproductive age. Stigma and discrimination were reported high in the general population, especially among sub-groups. The findings in the current study suggest community-based strategies, including the monitoring of stigma and discrimination, and designing and implementing stigma reduction interventions, are greatly needed to reduce inequities and increase acceptance of persons with HIV.
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Affiliation(s)
- William J Ugarte
- Center for Demography and Health Research, Nicaraguan National Autonomous University, León, Nicaragua.
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25
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Jürgensen M, Sandøy IF, Michelo C, Fylkesnes K. Effects of home-based voluntary counselling and testing on HIV-related stigma: findings from a cluster-randomized trial in Zambia. Soc Sci Med 2013; 81:18-25. [PMID: 23422056 DOI: 10.1016/j.socscimed.2013.01.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 11/14/2012] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
Abstract
HIV-related stigma continues to be a prominent barrier to testing, treatment and care. However, few studies have investigated changes in stigma over time and the factors contributing to these changes, and there is no evidence of the impact of HIV testing and counselling on stigma. This study was nested within a pair-matched cluster-randomized trial on the acceptance of home-based voluntary HIV counselling and testing conducted in a rural district in Zambia between 2009 and 2011, and investigated changes in stigma over time and the impact of HIV testing and counselling on stigma. Data from a baseline survey (n = 1500) and a follow-up survey (n = 1107) were used to evaluate changes in stigma. There was an overall reduction of seven per cent in stigma from baseline to follow-up. This was mainly due to a reduction in individual stigmatizing attitudes but not in perceived stigma. The reduction did not differ between the trial arms (β = -0.22, p = 0.423). Being tested for HIV was associated with a reduction in stigma (β = -0.57, p = 0.030), and there was a trend towards home-based Voluntary Counselling and Testing having a larger impact on stigma than other testing approaches (β = -0.78, p = 0.080 vs. β = -0.37, p = 0.551), possibly explained by a strong focus on counselling and the safe environment of the home. The reduction observed in both arms may give reason to be optimistic as it may have consequences for disclosure, treatment access and adherence. Yet, the change in stigma may have been affected by social desirability bias, as extensive community mobilization was carried out in both arms. The study underscores the challenges in measuring and monitoring HIV-related stigma. Adjustment for social desirability bias and inclusion of qualitative methods are recommended for further studies on the impact of HIV testing on stigma.
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Affiliation(s)
- Marte Jürgensen
- Centre for International Health, University of Bergen, Postbox 7804, N-5009 Bergen, Norway.
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26
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Agnarson AM, Levira F, Masanja H, Ekström AM, Thorson A. Antiretroviral treatment knowledge and stigma--implications for programs and HIV treatment interventions in rural Tanzanian populations. PLoS One 2013; 8:e53993. [PMID: 23342056 PMCID: PMC3546967 DOI: 10.1371/journal.pone.0053993] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 12/07/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyse antiretroviral treatment (ART) knowledge and HIV- and ART-related stigma among the adult population in a rural Tanzanian community. DESIGN Population-based cross-sectional survey of 694 adults (15-49 years of age). METHODS Latent class analysis (LCA) categorized respondents' levels of ART knowledge and of ART-related stigma. Multinomial logistic regression assessed the association between the levels of ART knowledge and HIV- and ART-related stigma, while controlling for the effects of age, gender, education, marital status and occupation. RESULTS More than one-third of men and women in the study reported that they had never heard of ART. Among those who had heard of ART, 24% were east informed about ART, 8% moderately informed, and 68% highly informed. Regarding ART-related stigma, 28% were least stigmatizing, 41% moderately stigmatizing, and 31% highly stigmatizing toward persons taking ART. Respondents that had at least primary education were more likely to have high levels of knowledge about ART (OR 3.09, 95% CI 1.61-5.94). Participants highly informed about ART held less HIV- and ART-related stigma towards ART patients (OR 0.26, 95% CI 0.09-0.74). CONCLUSION The lack of ART knowledge is broad, and there is a strong association between ART knowledge and individual education level. These are relevant findings for both HIV prevention and HIV treatment program interventions that address ART-related stigma across the entire spectrum of the community.
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Affiliation(s)
- Abela Mpobela Agnarson
- Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
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27
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Tran DA, Shakeshaft A, Ngo AD, Rule J, Wilson DP, Zhang L, Doran C. Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics. PLoS One 2012; 7:e51289. [PMID: 23240013 PMCID: PMC3519823 DOI: 10.1371/journal.pone.0051289] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/01/2012] [Indexed: 11/18/2022] Open
Abstract
In Vietnam, premature mortality due to AIDS-related conditions is commonly associated with late initiation to antiretroviral therapy (ART). This study explores reasons for late ART initiation among people living with HIV (PLHIV) from the perspectives of health care providers and PLHIV. The study was undertaken in six clinics from five provinces in Vietnam. Baseline CD4 counts were collected from patient records and grouped into three categories: very late initiators (≤100 cells/mm(3) CD4), late initiators (100-200 cells/mm(3)) and timely initiators (200-350 cells/mm(3)). Thirty in-depth interviews with patients who started ART and 15 focus group discussions with HIV service providers were conducted and thematic analysis of the content performed. Of 934 patients, 62% started ART very late and 11% initiated timely treatment. The proportion of patients for whom a CD4 count was obtained within six months of their HIV diagnosis ranged from 22% to 72%. The proportion of patients referred to ART clinics by voluntary testing and counselling centres ranged from 1% to 35%. Structural barriers to timely ART initiation were poor linkage between HIV testing and HIV care and treatment services, lack of patient confidentiality and a shortage of HIV/AIDS specialists. If Vietnam's treatment practice is to align with WHO recommendations then the connection between voluntary counselling and testing service and ART clinics must be improved. Expansion and decentralization of HIV/AIDS services to allow implementation at the community level increased task sharing between doctors and nurses to overcome limited human resources, and improved patient confidentiality are likely to increase timely access to HIV treatment services for more patients.
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Affiliation(s)
- Dam Anh Tran
- National Drug and Alcohol Research Centre, the University of New South Wales, Sydney, Australia
- Kirby Institute, the University of New South Wales, Sydney, Australia
- * E-mail: (DAT); (LZ)
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, the University of New South Wales, Sydney, Australia
| | - Anh Duc Ngo
- School of Population Health, the University of South Australia, Adelaide, Australia
| | - John Rule
- School of Public Health, the University of New South Wales, Sydney, Australia
| | - David P. Wilson
- Kirby Institute, the University of New South Wales, Sydney, Australia
| | - Lei Zhang
- Kirby Institute, the University of New South Wales, Sydney, Australia
- * E-mail: (DAT); (LZ)
| | - Christopher Doran
- The University of Newcastle, Hunter Medical Research Institute, New South Wales, Australia
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Messersmith LJ, Semrau K, Hammett TM, Phong NT, Tung ND, Nguyen H, Glandon D, Huong NM, Anh HT. 'Many people know the law, but also many people violate it': discrimination experienced by people living with HIV/AIDS in Vietnam--results of a national study. Glob Public Health 2012; 8 Suppl 1:S30-45. [PMID: 22974225 DOI: 10.1080/17441692.2012.721893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In Vietnam, discrimination against people living with HIV/AIDS (PLHIV) is defined within and prohibited by the 2007 national HIV/AIDS law. Despite the law, PLHIV face discrimination in health care, employment, education and other spheres. This study presents the first national estimates of the levels and types of discrimination that are defined in Vietnamese law and experienced by PLHIV in Vietnam. A nationally representative sample of 1200 PLHIV was surveyed, and 129 PLHIV participated in focus group discussions (FGDs). In the last 12 months, nearly half of the survey population experienced at least one form of discrimination and many experienced up to six different types of discrimination. The most common forms of discrimination included disclosure of HIV status without consent; denial of access to education for children; loss of employment; advice, primarily from health care providers, to abstain from sex; and physical and emotional harm. In logistic regression analysis, the experience of discrimination differed by gender, region of residence and membership status in a PLHIV support group. The logistic regression and FGD results indicate that disclosure of HIV status without consent was associated with experiencing other forms of discrimination. Key programme and policy recommendations are discussed.
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Affiliation(s)
- Lisa J Messersmith
- Department of International Health, Boston University School of Public Health, Boston, MA, USA.
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