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Cohen SR, Marchand V, Calkins K, Stephens MJ, Barabara ML, Minja LM, Olomi GA, Mlay J, Mlay PS, Hanson OR, Mmbaga BT, Watt MH. Participatory simulation training design: The MAMA interprofessional team-training program for obstetric care of pregnant individuals living with HIV in Tanzania. EVALUATION AND PROGRAM PLANNING 2025; 110:102550. [PMID: 39914273 PMCID: PMC12005675 DOI: 10.1016/j.evalprogplan.2025.102550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/15/2025] [Accepted: 01/26/2025] [Indexed: 03/05/2025]
Abstract
INTRODUCTION Stigma towards women living with HIV (WLHIV) during childbirth can lead to suboptimal care and clinical outcomes. In this paper we describe the design of MAMA, a simulation team-training curriculum for labor and delivery (L&D) providers to reduce HIV stigma, provide more respectful maternity care (RMC), and improve clinical empathy. METHODS In order to adapt the PRONTO model of simulation training, we integrated and applied the ADAPT-ITT framework for systematic adaptation of evidence-based interventions (EBI) and participatory design principles to create a responsive and innovative program. This process ensured we met local needs through continuous and iterative input from stakeholders, enabling those who would benefit from the intervention to drive its creation. RESULTS The final intervention is a 2.5 days workshop, followed by a 2-hour in-situ refresher in the providers' clinical setting. The training centers simulation scenarios, teamwork and communication activities, and interactive lessons on principles of RMC, HIV stigma, prevention of mother-to-child transmission, implicit bias, teamwork, clinical empathy, and coping with burnout. CONCLUSION The ADAPT-ITT model, augmented by participatory design strategies, provides a systematic yet flexible process to adapt and contextualize EBIs. The use of these complementary approaches resulted in a locally grounded intervention to build provider confidence and skills caring for WLHIV giving birth and to improve RMC in facilities in Tanzania. TRIAL REGISTRATION NCT03600142.
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Affiliation(s)
- Susanna R Cohen
- LIFT Simulation Design Lab, ASCENT Center, Obstetrics and Gynecology, University of Utah, 30 N 1900 E # 2B200 SOM, Salt Lake City, UT 84132, United States.
| | - Virginie Marchand
- Duke University School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC 27710, United States.
| | - Kimberly Calkins
- PRONTO International, 316 Lake Washington Blvd S, Seattle, WA 98144, United States.
| | - Maya J Stephens
- Department of Population Health Sciences, School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT 84108, United States.
| | - Mariam L Barabara
- Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Kilimanjaro, Tanzania.
| | - Linda M Minja
- Kilimanjaro Clinical Research Institute, PO Box 2236, Moshi, Kilimanjaro, Tanzania.
| | - Gaudensia A Olomi
- Kilimanjaro Regional Secretary's Office, Health Management Department, Moshi, Tanzania
| | - Janeth Mlay
- Kilimanjaro Clinical Research Institute, PO Box 2236, Moshi, Kilimanjaro, Tanzania
| | - Pendo S Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, PO Box 3010, Moshi, Kilimanjaro, Tanzania
| | - Olivia R Hanson
- Department of Population Health Sciences, School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT 84108, United States.
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, PO Box 2236, Moshi, Kilimanjaro, Tanzania.
| | - Melissa H Watt
- Department of Population Health Sciences, School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT 84108, United States.
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Maulana S, Ibrahim K, Pramukti I, Amirah S, Hartantri Y. Retention in HIV care among Southeast Asian people living with HIV: A systematic review and meta-analysis. BELITUNG NURSING JOURNAL 2025; 11:264-277. [PMID: 40438660 PMCID: PMC12117377 DOI: 10.33546/bnj.3719] [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] [Received: 11/06/2024] [Revised: 12/10/2024] [Accepted: 04/12/2025] [Indexed: 06/01/2025] Open
Abstract
Background Despite the effectiveness of antiretroviral therapy (ART) in reducing HIV-related morbidity and mortality, the retention of HIV care remains suboptimal in Southeast Asia. Objective This systematic review and meta-analysis aimed to investigate the coverage of retention in care and the likelihood factors for retention in HIV care among Southeast Asian people living with HIV, to inform targeted interventions and policy improvements. Methods Following the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) guidelines, this study included observational studies reporting factors associated with retention in HIV care among Southeast Asian adults, with searches conducted in PubMed, Scopus, Cochrane Library, and CINAHL up to July 15, 2024. Demographic and clinical factors were analyzed using a random-effects model with the generalized linear mixed-effect model (GLLM) to estimate proportion and the DerSimonian-Laird method to estimate odds ratios (OR) with 95% confidence intervals (CI), assessing heterogeneity using the I² statistic. Results Among the eleven studies with 46,480 pooled participants analyzed, the coverage of retention in care revealed a pooled proportion of 75.2% (95% CI: 66.7-82.1). Significant clinical factors associated with a higher likelihood of retention included high CD4 count (≥200 cells/mm³) (OR 2.17 (95%CI: 1.19-3.97, p = 0.01), WHO stage 3-4 (OR 2.06, 95%CI: 1.09-3.87, p = 0.02), not being on ART (OR 6.88, 95%CI: 1.89-25.06, p = 0.001), hemoglobin levels ≥10 g/dL (OR 0.50, 95% CI: 0.25-0.99, p = 0.04), and demographic factors of employment (OR 1.18, 95% CI: 1.02-1.38; p = 0.03). Other clinical factors, such as HIV stage, TB co-infection, drug abuse/substance use, and hemoglobin levels, did not significantly affect the likelihood of retention. Similarly, demographic factors such as age, gender, education, marital status, and geographic setting also showed no significant impact on likelihood retention. Conclusion Retention in care among Southeast Asian people living with HIV was still below 95%. Clinical factors, particularly high CD4 counts, WHO stage, and the absence of ART, were likelihood factors for retention in HIV care, whereas other clinical and demographic factors studied did not show a significant impact. A universal test and treatment strategy is required to improve retention in care.
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Affiliation(s)
- Sidik Maulana
- Postgraduate Program of Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Kusman Ibrahim
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Iqbal Pramukti
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Shakira Amirah
- Clinical Clerkship Program, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Central Jakarta, Indonesia
| | - Yovita Hartantri
- Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
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Gillette E, Nyandiko W, Chory A, Scanlon M, Aluoch J, Koros H, Ashimosi C, Biegon W, Munyoro D, Lidweye J, Nyagaya J, DeLong A, Kantor R, Vreeman R, Naanyu V. Risks and benefits of engaging youth living with HIV in research: perspectives from Kenyan Youth, caregivers, and subject matter experts. BMC Med Ethics 2025; 26:63. [PMID: 40375234 DOI: 10.1186/s12910-025-01225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/07/2025] [Indexed: 05/18/2025] Open
Abstract
BACKGROUND Involving children and adolescents (youth) living with HIV (YLWH) in research is critical for developing appropriate HIV care services and interventions. However, this vulnerable population may not adequately weigh risks against benefits when participating in research, forming an ethical concern, yet little is known about how YLWH perceive these risks and benefits. To inform research-related policies and procedures, we sought perspectives of Kenyan YLWH, their caregivers and subject matter experts (SMEs) on risks and benefits of participation in research in a setting with a high burden of youth HIV infection. METHODS We conducted a qualitative inquiry on identifying, enrolling, and protecting YLWH (age 10-24 years) in research using semi-structured interviews with YLWH involved in research, their caregivers, YLWH with no prior research experience, and other SMEs at the AMPATH care and research sites in western Kenya. Transcripts were thematically analyzed and emerging themes derived to characterize perspectives of each group on risks and benefits of engaging YLWH in research. RESULTS Interviews were conducted with 40 YLWH (50% female; median age 17.5 years), 20 caregivers (70% female), and 39 SMEs [healthcare providers (N = 10), community leaders (N = 10) community advisory board members (N = 4), IRB experts (N = 5), clinical researchers (N = 6), social science researchers (N = 4) and laboratory experts (N = 1).] Participants in all groups identified accidental disclosure of HIV status, stigma and discrimination, risks of blood draws, mental health effects, and coercion due to study compensation as risks of research involvement. Benefits fell into 5 categories: clinical, informational, personal, future and community or household benefits. Benefits included access to health care, learning about HIV, gaining hope and community, improving HIV care, and reducing stigma. All participant groups largely held similar views; however, caregivers were the only group to identify misuse of study compensation as a risk, and YLWH less frequently cited clinical benefits. CONCLUSION These findings suggest that participants commonly cite indirect risks and benefits of research participation, yet these are often excluded from institutional guidelines for consent documentation. Researchers should consider including indirect risks and benefits, such as the risk of stigma or the benefit of gaining knowledge and community, to study documentation.
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Affiliation(s)
- Emma Gillette
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Winstone Nyandiko
- College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, IN, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Hillary Koros
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Whitney Biegon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Allison DeLong
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Rami Kantor
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Rachel Vreeman
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Violet Naanyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
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Brink DT, Martin-Hughes R, Bowring AL, Wulan N, Burke K, Tidhar T, Dalal S, Scott N. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries: a modelling study. Lancet HIV 2025; 12:e346-e354. [PMID: 40157378 DOI: 10.1016/s2352-3018(25)00074-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 03/10/2025] [Accepted: 03/11/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND International funding for HIV has been crucial in reducing new HIV transmissions and deaths. Five countries providing over 90% of international HIV funding have announced reductions in international aid of between 8% and 70% between 2025 and 2026, with the US Government pausing aid with immediate effect on Jan 20, 2025. We investigated the potential impact of these funding reductions on HIV incidence and mortality through mathematical modelling. METHODS We used 26 country-validated Optima HIV models (Albania, Armenia, Azerbaijan, Belarus, Bhutan, Cambodia, Colombia, Costa Rica, Côte d'Ivoire, Dominican Republic, Eswatini, Georgia, Kazakhstan, Kenya, Kyrgyzstan, Malawi, Malaysia, Moldova, Mongolia, Mozambique, South Africa, Sri Lanka, Tajikistan, Uganda, Uzbekistan, and Zimbabwe). HIV incidence and mortality were projected across 2025-30 for a status quo scenario (most recent HIV spending continued) and four additional scenarios capturing the effects of anticipated international aid reductions for HIV prevention and testing, plus additional effects on treatment and facility-based testing resulting from immediate discontinuation of President's Emergency Fund for AIDS Relief (PEPFAR) support. Country-specific effects were estimated using sources of country-reported HIV funding. We disaggregated outcomes for children, adults in the general population, and adults in key populations. We extrapolated the scenario outcomes to all low-income and middle-income countries (LMICs) based on the modelled proportion of globally reported international aid by source (the 26 countries representing 49% of overall aid and 54% of PEPFAR aid). Upper and lower bounds reflected different mitigation and absorption assumptions. FINDINGS Across all LMICs, an anticipated 24% weighted average of international aid reductions plus discontinued PEPFAR support could cause an additional 4·43-10·75 million new HIV infections and 0·77-2·93 million HIV-related deaths between 2025 and 2030 compared with the status quo. If PEPFAR support could be reinstated or equivalently recovered, this reduced to 0·07-1·73 million additional new HIV infections and 0·005-0·061 million HIV-related deaths. The effects were greatest in countries with a higher percentage of international funding and in those with increasing incidence of HIV among key populations. INTERPRETATION Unmitigated funding reductions could significantly reverse progress in the HIV response by 2030, disproportionately affecting sub-Saharan African countries and key and vulnerable populations. Sustainable financing mechanisms are crucial to ensure people have continued access to HIV prevention, testing, and treatment programmes, thereby reducing new HIV infections and deaths. FUNDING None.
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Affiliation(s)
| | | | | | | | | | - Tom Tidhar
- Burnet Institute, Melbourne, VIC, Australia
| | - Shona Dalal
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Nick Scott
- Burnet Institute, Melbourne, VIC, Australia
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da Cunha AP, da Mota JC, da Cruz MM, Miranda R, Rosso L, Kruppa M, Santos J, da Silva ASP, Faccin G, Schweitzer C, Zonta R, Cota VL. Factors associated with the interruption of antiretroviral therapy among people living with HIV/AIDS in Brazilian municipalities between 2019 and 2022. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2025; 28:e250015. [PMID: 40197900 PMCID: PMC11980824 DOI: 10.1590/1980-549720250015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 12/27/2024] [Accepted: 01/21/2025] [Indexed: 04/10/2025] Open
Abstract
OBJECTIVE To analyze the factors associated with antiretroviral therapy interruption among people living with the human immunodeficiency virus participating in the A Hora é Agora [The Time is Now] project in the municipalities of Campo Grande, Curitiba, and Florianópolis. METHODS This is a cross-sectional analytical study using data from the Brazilian Medication Logistics Control System, collected between October 2019 and September 2022. Bivariate analyses were performed to assess associations between sex, age group, race/skin color, and level of education, with the outcomes of treatment interruption and the number of times the treatment was interrupted, using the χ2 test with a 5% significance level. RESULTS In Campo Grande, treatment interruption was more frequent among individuals with eight to 11 years of formal education (34.0%). In Curitiba, women (20.4%) showed a higher frequency of treatment interruption, and the age group of 50 years or older had a higher likelihood of treatment interruption (OR: 1.73; 95%CI: 1.12-2.66). In Florianópolis, 31.1% of women experienced treatment interruption, and individuals with up to seven years of formal education had a higher likelihood of treatment interruption (OR: 1.62; 95%CI: 1.15-2.29). CONCLUSIONS The interruption of antiretroviral therapy was significantly associated with sex, level of education, and age group, with distinct patterns across the analyzed territorial contexts. These findings highlight the need for targeted interventions aimed at vulnerable groups, considering regional differences and local challenges to improve treatment adherence.
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Affiliation(s)
- Ana Paula da Cunha
- Fundação Oswaldo Cruz, Sergio Arouca National School of Public Health - Rio de Janeiro (RJ), Brazil
| | - Jurema Corrêa da Mota
- Fundação Oswaldo Cruz, Institute of Scientific and Technological Communication and Information on Health - Rio de Janeiro (RJ), Brazil
| | - Marly Marques da Cruz
- Fundação Oswaldo Cruz, Sergio Arouca National School of Public Health - Rio de Janeiro (RJ), Brazil
| | - Raquel Miranda
- Fundação Oswaldo Cruz, Sergio Arouca National School of Public Health - Rio de Janeiro (RJ), Brazil
| | - Liza Rosso
- Secretaria Municipal da Saúde de Curitiba - Curitiba (PR), Brazil
| | - Mariele Kruppa
- Secretaria Municipal da Saúde de Curitiba - Curitiba (PR), Brazil
| | - Juliane Santos
- Secretaria Municipal da Saúde de Curitiba - Curitiba (PR), Brazil
| | | | - Giordana Faccin
- Secretaria Municipal de Saúde de Campo Grande - Campo Grande (MS), Brazil
| | | | - Ronaldo Zonta
- Secretaria Municipal de Saúde de Florianópolis - Florianópolis (SC), Brazil
| | - Vanda Lúcia Cota
- Fundação Oswaldo Cruz, Sergio Arouca National School of Public Health - Rio de Janeiro (RJ), Brazil
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Davis A, Nyblade L, Sun Y, Balabekova O, Landers SE, Gryazev D, Tucker JD, Gulyaev V, Rosenthal SL, Lunze K, Tang W, Kuskulov A, Terlikbayeva A, Primbetova S, Chang M, Denebayeva AY, Akhmetova AU, Absemetova A, Karzhaubayeva S, Kassymbekova S, Maximova M, Mussina Z, Bekenova G, Nugmanova Z, Kalmatayeva Z, Polyakova L, Zhazykbaeva ZK, Vinogradov V, Shaikezhanov A, Darisheva M, Orynbetova B, Norakidze E, Kozhakhmet M, Tolegenova A, Imadillda A, Satkhozhina D, Kartamyssov A, Kanieva Z, Aleshina A, Makhan O, Muravyova A, Rahimzanova A, Duisenbayev A, Tursynbek Z, Dias N, Beken M, Murzakhan M, Brown ZA, Maitekov D, Li A, Mergen S, Mergenov D, Kuanysh A, Rakhimbekov A, Baisbay Y, Aruzhan A, Kozhambet Z, Grebenchishikov D, Bekker D, Kozhamberdiev S, Salykov D, Sagimbayeva M, Yussupova K, Mergenova G. A digital citizen science intervention to reduce HIV stigma and promote HIV testing: a randomized clinical trial among adolescents and young adults in Kazakhstan. Sex Health 2025; 22:SH24235. [PMID: 40146739 DOI: 10.1071/sh24235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Accepted: 03/04/2025] [Indexed: 03/29/2025]
Abstract
Background Kazakhstan has a high HIV incidence among adolescents and young adults (AYA), and high HIV stigma contributing to low HIV testing uptake. We examined whether an AYA-developed digital crowdsourced intervention reduced HIV stigma compared with conventional public health materials among AYA in Almaty, Kazakhstan. Methods A total of 216 AYA (females:116/males:110) aged 16-24 years were recruited to the online study cohort and randomized 1:1 to the intervention or control arm. AYA were exposed to the crowdsourced intervention or control materials once a week for 5weeks, with equivalent exposures between arms. Outcomes included a total HIV stigma score assessed at baseline, immediately post-intervention and 2months post-intervention from January to August 2023. We conducted multilevel mixed models to compare changes over time by arm and sex. Results AYA in the intervention arm had significantly lower HIV testing stigma 2months post-intervention (adjusted mean change (AMC): -0.73 (-1.07, -0.39)) than AYA in the control arm (AMC: -0.06 (-0.42, 0.30); P =0.032). Female AYA in the intervention arm had significantly lower total HIV stigma immediately post-intervention (AMC: -4.91 (-7.25, -2.58)) and 2months post-intervention (AMC: -5.16 (-7.48, -2.84)) than females in the control arm (immediately post-intervention AMC: -0.03 (-2.63, 2.57) and 2-months post-intervention AMC: -0.07 (-2.70, 2.56); P =0.012, P =0.012). Conclusions The AYA-developed crowdsourced intervention decreased HIV testing stigma, although this effect was moderated by sex, and decreased total HIV stigma among female AYA. Crowdsourced interventions may be a promising way to engage communities to develop interventions to decrease HIV stigma.
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Affiliation(s)
- Alissa Davis
- School of Social Work, Columbia University, New York, NY, USA
| | | | - Yihang Sun
- School of Social Work, Columbia University, New York, NY, USA
| | - Olga Balabekova
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Sara E Landers
- School of Social Work, Columbia University, New York, NY, USA
| | - Denis Gryazev
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA; and Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Valera Gulyaev
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Karsten Lunze
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA; and Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Weiming Tang
- Institute for Global Health and Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Azamat Kuskulov
- School of Social Work, Columbia University, New York, NY, USA
| | - Assel Terlikbayeva
- School of Social Work, Columbia University, New York, NY, USA; and Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Sholpan Primbetova
- School of Social Work, Columbia University, New York, NY, USA; and Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Mingway Chang
- School of Social Work, Columbia University, New York, NY, USA
| | | | | | | | - Sholpan Karzhaubayeva
- Almaty City Center for Human Reproduction, Youth and Family Health Department, Almaty, Kazakhstan
| | | | - Marina Maximova
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, Kazakhstan
| | - Zhannat Mussina
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, Kazakhstan
| | - Gulnar Bekenova
- Kazakhstan Association for Sexual and Reproductive Health, Almaty, Kazakhstan
| | | | | | | | | | | | | | | | | | | | | | | | - Aknur Imadillda
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | | | - Zhamilya Kanieva
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Albina Aleshina
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Olzhas Makhan
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Aida Muravyova
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | | | | | - Nurgazy Dias
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Malika Beken
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Miras Murzakhan
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Daniyal Maitekov
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Artur Li
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Dautali Mergenov
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Amirali Kuanysh
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Yenlik Baisbay
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Alibek Aruzhan
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | | | - Dmitriy Bekker
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Dauren Salykov
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Kamila Yussupova
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
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Nunez A, Curtis M, Wong M, Kosyluk KA, Galea JT, Franke MF, Errea RA. Change targets, messaging, and content delivery for a community-engaged social media campaign addressing HIV-related stigma in Peru: a qualitative study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.02.12.25321801. [PMID: 39990558 PMCID: PMC11844602 DOI: 10.1101/2025.02.12.25321801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
Mitigating HIV-related stigma is critical to improving HIV outcomes and reaching global HIV targets. We conducted formative community-engaged research to identify key characteristics of a social media campaign to address HIV-related stigma among youth in Lima, Peru. Focus groups and in-depth interviews with young people living with HIV (men who have sex with men, transgender women, sex workers, persons with perinatally-acquired HIV, cisgender women, and Venezuelan migrants), HIV advocates, and healthcare providers were carried out from November 2022 to July 2023. Audio recordings were transcribed verbatim and analysed for emergent themes using framework analysis. Two change targets were identified for campaign messaging: 1) changing how HIV and people living with HIV (PLWH) are perceived, and 2) changing attitudes and actions towards PLWH. Messages aligning with the first change target included education to raise awareness that HIV does not discriminate; HIV is a chronic, treatable condition; and "undetectable equals untransmittable" (U=U). Messages aligning with the second target included normalizing open conversations about HIV, encouraging support versus pity for PLWH, fostering unity among HIV-affected communities, and promoting inclusion of PLWH. Participants provided recommendations to achieve these messaging objectives, including how, to whom and by whom messages are delivered.
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Salihu A, Jahun I, Oyedeji DO, Fajemisin W, Idogho O, Shehu S, Yakubu A, Anyanti J. Scaling up access to antiretroviral treatment for HIV: lessons from a key populations program in Nigeria. AIDS Res Ther 2025; 22:10. [PMID: 39893486 PMCID: PMC11787728 DOI: 10.1186/s12981-025-00711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 01/29/2025] [Indexed: 02/04/2025] Open
Abstract
Over the years, Nigeria has recorded significant progress in controlling the HIV epidemic in the country. HIV prevalence has reduced from 4.1% in 2010 to 1.4 in 2019. The number of people acquiring new HIV infections decreased from 120,000 in 2010 to 74,000 in 2021, and HIV-related deaths decreased from 82,000 in 2010 to 51,000 in 2021. However, the country still faces challenges such as high HIV transmission among key populations (KP) who account for 11% of new HIV infections. Over the years, the government and development partners involved in HIV response efforts in Nigeria have been establishing and scaling up access to services to help address the needs of KPs. Initially, services for KPs as with the general population in Nigeria were largely preventive. Treatment of PLHIV in Nigeria commenced in 2002 and has increased from about 15,000 to more than 1.78 million PLHIVs in 2023. Despite this progress in treatment coverage, however, KPs are not equitably covered. To address this gap, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) launched an ambitious initiative-the Key Population Investment Fund (KPIF)-to target the unaddressed HIV-related needs of key populations (KPs) who are disproportionately affected by HIV. The KPIF initiative was implemented through partner organizations such as the Society for Family Health (SFH), a KP-friendly and indigenous non-governmental organization. Earlier, the program implemented by SFH was largely an HIV prevention program. SFH's transformation, transition, and growth to a comprehensive HIV prevention, care, and treatment service provider was necessary to bridge the gap in the needed expansion of HIV services to adequately meet the care needs of KPs and scale up programs. Therefore, this paper's aim is to share experiences in the transformation of SFH into a comprehensive HIV prevention, treatment, and care service provider in the hope that it may serve as a lesson for organizations with similar objectives.
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Affiliation(s)
| | - Ibrahim Jahun
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | | | | | | | | | - Aminu Yakubu
- Center for Bioethics and Research, Ibadan, Nigeria
- Federal Ministry of Health, Abuja, Nigeria
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9
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Phaswana Mafuya RN, Phalane E, Rao A, Willis K, Rucinski K, Voet KA, Abdulrahman A, Siyamayambo C, Sebati B, Seloka M, Jaiteh M, Olifant LL, Journeay K, Sisel H, Li X, Olatosi B, Hikmet N, Duhoon P, Wolmarans F, Shiferaw YA, Motsieloa L, Rampilo M, Baral S. Harnessing Big Heterogeneous Data to Evaluate the Potential Impact of HIV Responses Among Key Populations in Sub-Saharan Africa: Protocol for the Boloka Data Repository Initiative. JMIR Res Protoc 2025; 14:e63583. [PMID: 39841994 PMCID: PMC11799808 DOI: 10.2196/63583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/19/2024] [Accepted: 09/30/2024] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND In South Africa, there is no centralized HIV surveillance system where key populations (KPs) data, including gay men and other men who have sex with men, female sex workers, transgender persons, people who use drugs, and incarcerated persons, are stored in South Africa despite being on higher risk of HIV acquisition and transmission than the general population. Data on KPs are being collected on a smaller scale by numerous stakeholders and managed in silos. There exists an opportunity to harness a variety of data, such as empirical, contextual, observational, and programmatic data, for evaluating the potential impact of HIV responses among KPs in South Africa. OBJECTIVE This study aimed to leverage and harness big heterogeneous data on HIV among KPs and harmonize and analyze it to inform a targeted HIV response for greater impact in Sub-Saharan Africa. METHODS The Boloka data repository initiative has 5 stages. There will be engagement of a wide range of stakeholders to facilitate the acquisition of data (stage 1). Through these engagements, different data types will be collated (stage 2). The data will be filtered and screened to enable high-quality analyses (stage 3). The collated data will be stored in the Boloka data repository (stage 4). The Boloka data repository will be made accessible to stakeholders and authorized users (stage 5). RESULTS The protocol was funded by the South African Medical Research Council following external peer reviews (December 2022). The study received initial ethics approval (May 2022), renewal (June 2023), and amendment (July 2024) from the University of Johannesburg (UJ) Research Ethics Committee. The research team has been recruited, onboarded, and received non-web-based internet ethics training (January 2023). A list of current and potential data partners has been compiled (January 2023 to date). Data sharing or user agreements have been signed with several data partners (August 2023 to date). Survey and routine data have been and are being secured (January 5, 2023). In (September 2024) we received Ghana Men Study data. The data transfer agreement between the Pan African Centre for Epidemics Research and the Perinatal HIV Research Unit was finalized (October 2024), and we are anticipating receiving data by (December 2024). In total, 7 abstracts are underway, with 1 abstract completed the analysis and expected to submit the full article to the peer-reviewed journal in early January 2024. As of March 2025, we expect to submit the remaining 6 full articles. CONCLUSIONS A truly "complete" data infrastructure that systematically and rigorously integrates diverse data for KPs will not only improve our understanding of local epidemics but will also improve HIV interventions and policies. Furthermore, it will inform future research directions and become an incredible institutional mechanism for epidemiological and public health training in South Africa and Sub-Saharan Africa. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/63583.
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Affiliation(s)
- Refilwe Nancy Phaswana Mafuya
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, University of Johannesburg, Johannesburg, South Africa
- Department of Health Services Policy Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Edith Phalane
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, University of Johannesburg, Johannesburg, South Africa
| | - Amrita Rao
- Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Kalai Willis
- Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine Rucinski
- Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - K Alida Voet
- Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Amal Abdulrahman
- Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Claris Siyamayambo
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, University of Johannesburg, Johannesburg, South Africa
| | - Betty Sebati
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, University of Johannesburg, Johannesburg, South Africa
| | - Mohlago Seloka
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, University of Johannesburg, Johannesburg, South Africa
| | - Musa Jaiteh
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, University of Johannesburg, Johannesburg, South Africa
| | - Lerato Lucia Olifant
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, University of Johannesburg, Johannesburg, South Africa
| | - Katharine Journeay
- Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Haley Sisel
- Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Xiaoming Li
- Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Bankole Olatosi
- Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Neset Hikmet
- Engineering and Computing, Integrated Information Technology, University of South Carolina, Columbia, SC, United States
| | - Prashant Duhoon
- Engineering and Computing, Integrated Information Technology, University of South Carolina, Columbia, SC, United States
| | - Francois Wolmarans
- Technology Architecture & Planning, University of Johannesburg, Johannesburg, South Africa
| | - Yegnanew A Shiferaw
- Department of Statistics, Faculty of Science, University of Johannesburg, Johannesburg, South Africa
| | | | | | - Stefan Baral
- Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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10
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Lopez CM, Moreland AD, Amaya S, Bisca E, Mujica C, Wilson T, Baker N, Richey L, Eckard AR, Resick PA, Safren SA, Danielson CK. Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, and Testing (ADAPT-ITT) Framework to Tailor Evidence-Based Posttraumatic Stress Disorder Treatment for People With HIV to Enhance Engagement and Adherence: Qualitative Results from a Feasibility Randomized Controlled Trial. JMIR Form Res 2025; 9:e64258. [PMID: 39819749 PMCID: PMC11783029 DOI: 10.2196/64258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 09/23/2024] [Accepted: 09/27/2024] [Indexed: 01/19/2025] Open
Abstract
BACKGROUND Individuals with co-occurring posttraumatic stress disorder (PTSD) and HIV are at high-risk for negative HIV-related outcomes, including low adherence to antiretroviral therapy, faster disease progression, more hospitalizations, and almost twice the rate of death. Despite high rates of PTSD in persons with HIV (PWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PWH does not exist. OBJECTIVE This study aimed to describe the adaptation and theater testing of an evidence-based intervention designed for people with co-occurring PTSD and HIV. METHODS The Assessment, Decision, Adaptation, Production, Topical experts-integration, Training, and Testing (ADAPT-ITT) framework guided the formative process used to modify an evidence-based PTSD treatment (cognitive processing therapy; CPT) to meet the unique needs of PWH experiencing PTSD. With the integration of Life-Steps for Medication Adherence (Life-Steps), the adapted protocol (CPT-Life-Steps for integration of adherence; CPT-L) targeted HIV-related stigma and HIV medication adherence within a trauma-informed framework. Theater testing was completed with 7 participants to evaluate acceptability of CPT-L for PWH. The qualitative data (N=54 recordings) used to evaluate and adapt CPT-L emerged from individual interviews conducted with participants after each therapy session as well as exit interviews conducted at posttreatment data collection. RESULTS After challenging stigma-related appraisals, participants expressed feeling less constrained by maladaptive thoughts. These shifts translated to increased self-efficacy with both HIV-related care and mental health. CONCLUSIONS These results indicate that trauma-informed work with PWH should consider the impact of HIV on trauma-related stuck points, intersecting identities (including living with HIV), and challenging internalized stigma. Findings provide evidence that CPT-L is acceptable and effective in addressing internalized HIV stigma that impacts PTSD symptom maintenance and HIV treatment engagement. TRIAL REGISTRATION ClinicalTrials.gov; NCT05275842; https://clinicaltrials.gov/study/NCT05275842?id=NCT05275842&rank=1. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.conctc.2023.101150.
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Affiliation(s)
- Cristina M Lopez
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Angela D Moreland
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Stephanie Amaya
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Erin Bisca
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Christin Mujica
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Tayler Wilson
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Nathaniel Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Lauren Richey
- Department of Medicine, Infectious Disease Section, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Allison Ross Eckard
- Department of Infectious Diseases, Medical University of South Carolina, Charleston, SC, United States
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, AL, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Carla Kmett Danielson
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
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11
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Lo Hog Tian JM, Watson JR, Cioppa L, Murphy M, Boni AR, Parsons JA, Maunder RG, Rourke SB. The Role of Dimensions of Social Support in the Relationship Between Stigma and Mental Health: A Moderation Analysis. AIDS Behav 2025; 29:155-165. [PMID: 39325117 DOI: 10.1007/s10461-024-04506-9] [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] [Accepted: 09/07/2024] [Indexed: 09/27/2024]
Abstract
HIV stigma remains a barrier to good health and understanding how social support may reduce the negative impact of stigma on health may help with designing stigma interventions. This study aims to understand how different types of social support may moderate or change the nature of the relationship between stigma and mental health. We recruited 327 participants to complete the People Living with HIV Stigma Index at baseline (t1) between August 2018 and September 2019 and at follow-up (t2) between February 2021 and October 2021. Separate moderation models were created with different types of social support (emotional/informational, tangible, affectionate, positive social interaction) as moderators, baseline stigma (internalized, enacted, anticipated) as the antecedent, and mental health (t2) as the outcome. Emotional/informational support was a significant moderator for the relationship between enacted (b = -2.12, 95% CI: -3.73, -0.51), internalized (b = -1.72, 95% CI: -3.24, -0.20), and anticipated (b = -2.59, 95% CI: -4.59, -0.60) stigma at t1 and mental health at t2. Tangible support was a significant moderator for internalized stigma (b = -1.54, 95% CI: -2.74, -0.35). Lastly, positive social interaction was a significant moderator for internalized (b = -1.38, 95% CI: -2.71, -0.04) and anticipated stigma (b = -2.14, 95% CI: -3.93, -0.36). In general, the relationship between social support and better mental health was stronger for participants with low stigma. Intervention strategies aimed at both stigma reduction and boosting social supports with different functions may be important for improving the mental health of people living with HIV.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Lynne Cioppa
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Michael Murphy
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Anthony R Boni
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Janet A Parsons
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
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12
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Lo Hog Tian JM, Watson JR, Parsons JA, Maunder RG, Murphy M, Cioppa L, McGee A, Bristow W, Boni AR, Ajiboye ME, Rourke SB. The impact of determinants of health on the relationship between stigma and health in people living with HIV. AIDS Care 2024; 36:1902-1911. [PMID: 39285792 DOI: 10.1080/09540121.2024.2401379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 09/02/2024] [Indexed: 11/13/2024]
Abstract
Determinants of health are important drivers of health states, yet there is little work examining their role in the relationship between HIV stigma and health. This study uses moderation analysis to examine how determinants of health affect the relationship between enacted, internalized, and anticipated stigma and mental health. Quantitative data was collected on 337 participants in Ontario, Canada at baseline (t1) between August 2018 and September 2019 and at follow-up (t2) between February 2021 and October 2021. Separate moderation models were created with each determinant of health (age, gender, sexual orientation, ethnicity, geographic region, education, employment, and basic needs) acting as the moderator between types of stigma at t1 and mental health at t2. Age was a significant moderator for the relationship between internalized and enacted stigma at t1 and mental health at t2. Region was a moderator for enacted and anticipated stigma and mental health. Sexual orientation was a moderator for anticipated stigma and mental health. Lastly, having basic needs was a moderator for enacted and anticipated stigma and mental health. Our findings suggest that intervention strategies may be more effective by incorporating supports for these determinants of health in addition to stigma reduction to improve mental health.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Janet A Parsons
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Robert G Maunder
- Sinai Health System, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Michael Murphy
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Lynne Cioppa
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - A McGee
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Wayne Bristow
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Anthony R Boni
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Monisola E Ajiboye
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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13
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Brandelli Costa A, Martins da Silva M, Wiehe Chaves L, Gelain M, Graeff Bins-Ely I, Alckmin-Carvalho F, Wendt GW. General and healthcare-related HIV stigma among cisgender Brazilian women: the role of socioeconomic vulnerability. HIV Res Clin Pract 2024; 25:2361179. [PMID: 38884378 DOI: 10.1080/25787489.2024.2361179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND HIV-related stigma is associated with worse health outcomes and lower adherence to antiretroviral therapy. There is limited data on the stigma faced by Latin American cisgender women, although they are among the populations most affected by HIV. This study aims to provide insight into the Stigma Index Brazil, with the objective of estimating the prevalence of HIV-related stigma among cisgender women in Brazil and to investigate the role of low socioeconomic status in stigma experience. METHODS This is a cross-sectional community-based study. A total of 30 people with HIV were trained to recruit participants from their peer networks; 1,768 people with HIV from all regions of Brazil participated in the study, of which 566 participants were cisgender women. We used the Stigma Index, an instrument that assesses global trends in HIV-related stigma from the perspective of people with HIV. RESULTS Approximately 70% of participants reported some form of HIV-related stigma. The most prevalent forms were discriminatory comments or gossiping (51.26%) and verbal harassment (30.99%). More than 20% experienced any health care related HIV-stigma in the last 12 months, the most frequent being the avoidance of physical contact (10.02%). Women in social vulnerability faced more stigma compared to the group without social vulnerability, both in general contexts (75.79% vs 64.32%; χ2 = 8.67, p < 0.05) and in healthcare contexts (24.12% vs 16.02%; χ2 = 4.06, p < 0.05). CONCLUSION We found a high prevalence of stigma associated with HIV faced by Brazilian women from all regions of the country, both in everyday life and in healthcare contexts. Evidence-based interventions to reduce stigma in the general population, and specific mental health care aimed at women with HIV in Brazil, especially among those with greater socioeconomic vulnerability, are urgent.
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Affiliation(s)
- Angelo Brandelli Costa
- Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Graduate program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Murilo Martins da Silva
- Graduate program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lara Wiehe Chaves
- Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Milena Gelain
- Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Isadora Graeff Bins-Ely
- Graduate program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Alckmin-Carvalho
- Faculty of Social and Human Sciences, Department of Psychology and Education, Postgraduate Program in Clinical and Health Psychology, Beira Interior University, Covilhã, Portugal
| | - Guilherme Welter Wendt
- Graduate Program in Applied Health Sciences, Western Parana State University, Francisco Beltrão, Brazil
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14
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Buccheri R, Miranda C, Almeida-Neto CD, Gonçalez T, Preiss L, Amorim L, Carneiro-Proiett AB, Loureiro P, Sabino EC, Custer B. Perceived levels of social stigma following HIV notification: Insights from Brazilian blood centers. Braz J Infect Dis 2024; 28:104480. [PMID: 39547004 DOI: 10.1016/j.bjid.2024.104480] [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: 06/07/2024] [Revised: 10/14/2024] [Accepted: 11/04/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND HIV/AIDS remains a highly stigmatizing disease worldwide, preventing people with risk or infection from testing to learn their HIV status, accessing supportive services, or taking antiretroviral therapy. Despite many studies of HIV in blood donors, no studies have evaluated the factors that contribute to stigma surrounding this illness following notification process and counseling provided by blood centers. METHODS A cross-sectional questionnaire-based survey was conducted between 2016 and 2017. Persons with HIV were invited to return to the blood center for an audio computer-assisted interview after participation in an HIV risk factor assessment study conducted from 2007 to 2016. The questionnaire was based on HIV risk interviews developed by the US CDC, with modifications appropriate to the Brazilian setting which aimed to evaluate their follow-up activities, perceptions of HIV stigma and discrimination, and the quality of counseling and notification after the donation that tested positive for HIV. Response frequencies and adjusted odds ratios from multivariable logistic regression analyses are reported. RESULTS 268 HIV-positive blood donors agreed to participate in the study. Almost all participants, 262 (97 %), rated as very important or important the blood center counseling experience in their decision to seek health care. One-hundred-five (39 %) participants reported none to low levels of stigma, and 163 (61 %) participants moderate stigma. Individuals reporting heterosexual orientation (OR=2.13, 95 % CI [1.08‒4.22]) and healthcare-seeking behavior (OR=2.46, 95 % CI [1.10‒5.48]) had significantly increased odds of reporting moderate levels of stigma. CONCLUSIONS Our study provides information about perceived stigma and discrimination in the Brazilian blood donor population and reinforces the importance of the counseling process in linkage to care and reducing HIV-related stigma.
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Affiliation(s)
| | | | | | | | - Liliana Preiss
- Research Triangle Institute (RTI) International, Rockville, USA
| | - Luiz Amorim
- Fundação Hemorio, Rio de Janeiro, RJ, Brazil
| | | | - Paula Loureiro
- Fundação Hemope, Recife, PE, Brazil; Faculdade de Medicina da Universidade de Pernambuco, Recife, PE, Brazil
| | - Ester C Sabino
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Brian Custer
- Vitalant Research Institute, San Francisco, USA; University of California San Francisco, San Francisco, USA
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Hickman JH, Swartz A, Sicwebu N, Stek C, Masimini N, Nöstlinger C. Exploring Health-Related Quality of Life (HRQOL) among patients with HIV-associated TB in Khayelitsha, South Africa. PLoS One 2024; 19:e0275554. [PMID: 39495745 PMCID: PMC11534229 DOI: 10.1371/journal.pone.0275554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 08/27/2024] [Indexed: 11/06/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL) is an important and frequently used patient-reported outcome in health research. However, little qualitative research exists in this field in South Africa. This study was set in Khayelitsha, one of the largest informal settlements in South Africa, where the burden of HIV and tuberculosis (TB) co-infection are amongst the highest in the world and significantly affect HRQOL. OBJECTIVE To explore the experience of HRQOL among patients living with HIV-associated TB. METHODS We conducted sixteen interviews with male (n = 10) and female (n = 6) adult participants (ages 24-56; median age 35) to explore their HRQOL living with HIV-associated TB, related treatment and how this impacted on life domains they considered relevant for HRQOL. We used thematic analysis to analyse data, using both an inductive and deductive analysis using an interpretive phenomenological approach (IPA). RESULTS Experiences of HRQOL were identified along the predominantly emerging themes of physical, social, and mental aspects of HRQOL. Identified sub-themes included well-being, loss of strength, and self-care for the physical domain; usual activities and stigma for the social domain; concerns and coping for the mental domain. The findings illustrate that HRQOL domains are interconnected through social experience. The social experience of HRQOL was identified as the common denominator connecting all domains, around which HRQOL revolved for these participants. CONCLUSION HRQOL is experienced socially. The interpersonal connections patients have with significant others present as key to high HRQOL among patients living with HIV-associated TB. This study adds to the existing literature of HRQOL and examines HRQOL using IPA which may help to inform future interventions to improve HRQOL among HIV/TB patients.
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Affiliation(s)
- John-Henry Hickman
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- St George’s School of Health and Medical Sciences, City St George’s University of London, London, United Kingdom
| | - Namhla Sicwebu
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Cari Stek
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Nobom Masimini
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Kampouri E, Damas J, Kusejko K, Ledergerber B, Braun D, Nawej Tshikung O, Hachfeld A, Weisser M, Wissel K, Bernasconi E, Cobos Manuel I, Jackson-Perry D, Eriksson LE, Reinius M, Cavassini M, Darling KE. Prevalence of HIV-related stigma among people with HIV in Switzerland: addressing the elephant in the room. AIDS 2024; 38:1874-1884. [PMID: 39051627 PMCID: PMC11424058 DOI: 10.1097/qad.0000000000003983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/28/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES We aimed to determine the prevalence of HIV-related stigma among people with HIV (PWH) in Switzerland. DESIGN A cross-sectional multicenter study nested within the Swiss HIV Cohort Study (SHCS). METHODS We included adult PWH enrolled in the SHCS, attending follow-up between March 1, 2020, and January 31, 2021. Inability to speak English, French, German, or Italian was the only exclusion criterion. Participants were invited to complete a validated 12-item HIV-stigma questionnaire comprising four stigma subscales (negative self-image, personalized stigma, disclosure concerns, and concerns regarding public attitudes), plus two healthcare-related stigma items. Questionnaire responses were graded using a four-point Likert-type scale, higher scores indicating higher stigma. "Non-applicable," inferring HIV-status non-disclosure, was possible for personalized stigma; stigma scores from participants answering "non-applicable" to at least one item were analyzed separately. Factors associated with HIV-stigma were identified through multivariable linear models. RESULTS Of 9643 PWH with a SHCS visit, 5563 participated in the study: 26% were female, 13% Black, and 37% heterosexual; median age was 53 years (interquartile range 44-59); 2067 participants (37%) gave at least one "non-applicable" response. Disclosure concerns had the highest stigma scores and were reported by 4656/5563 (84%). HIV-stigma was reported across all demographic groups. However, being female, Black, and heterosexual were independently associated with higher scores. Higher education and longer follow-up duration were associated with lower scores. Healthcare-related stigma was reported in 37% of participants. CONCLUSION HIV-stigma was prevalent across all demographic groups. The association with being female and Black suggests that HIV-stigma accentuates preexisting sex and race inequalities.
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Affiliation(s)
- Eleftheria Kampouri
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - José Damas
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich
| | - Dominique Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich
| | | | - Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel
| | - Kerstin Wissel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, Lugano
- University of Geneva, Geneva
- University of Southern Switzerland, Lugano, Switzerland
| | - Isabel Cobos Manuel
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - David Jackson-Perry
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - Lars E. Eriksson
- Karolinska Institutet, Division of Nursing, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Maria Reinius
- Karolinska Institutet, Division for Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden
| | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - Katharine E.A. Darling
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
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Tadesse G, Rtbey G, Andualem F, Takelle GM, Melkam M, Tadesse Abate A, Wassie YA, Tekleslassie Alemayehu T, Geremew GW, Dires EA, Tinsae T, Fentahun S, Nakie G. HIV-related perceived stigma and internalized stigma among people living with HIV/AIDS in Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0309231. [PMID: 39441793 PMCID: PMC11498694 DOI: 10.1371/journal.pone.0309231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/07/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND HIV-related stigma has significant adverse impacts on people living with HIV/AIDS, such as psychological distress, decreased quality of life, a reluctance to get screened and treated, and a reluctance to disclose their status due to fear of stereotypes or rejection. OBJECTIVES To determine the pooled prevalence and factors associated with HIV-related perceived stigma and internalized stigma among people living with HIV/AIDS in Africa. METHODS Articles that assessed the prevalence and associated factors of HIV-related perceived stigma and internalized stigma were reviewed. PubMed, EMBASE, Google Scholar, African Journal Online, CINAHL, and Science Direct were the databases used to search the primary studies. The data was extracted through a Microsoft Excel spreadsheet and exported to STATA version 14 for further analysis. The I2 test was applied to test heterogeneity, whereas Egger's test and funnel plot were used to check publication bias. RESULTS In this study, the total sample size was 28,355 (for perceived stigma) and 22,732 (for internalized stigma). The overall pooled prevalence of HIV-related perceived stigma and internalized stigma was determined to be 41.23% and 35.68%, respectively. Based on the subgroup analysis results, the highest pooled prevalence of perceived stigma was observed in Nigeria (50.04%), followed by Ethiopia (41.72%), while the highest prevalence of internalized stigma was observed in Ethiopia (56.13%), followed by Cameroon (44.66%). Females (OR = 1.63: 1.31, 2.02) and rural dwellers (OR = 1.93: 1.36, 2.74) had more odds of experiencing HIV-related perceived stigma. CONCLUSION AND RECOMMENDATION This study concluded that four in ten and more than one-third of people living with HIV/AIDS suffered from perceived and internalized stigma. Thus, special considerations must be given to women and rural dwellers. It is recommended to implement multi-level interventions and foster empowerment and support for individuals living with HIV.
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Affiliation(s)
- Gebresilassie Tadesse
- Department of Psychiatry, School of Medicine, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Gidey Rtbey
- Department of Psychiatry, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatry, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Asnake Tadesse Abate
- Department of Neonatal Health Nursing, School of nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yilkal Abebaw Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tekletsadik Tekleslassie Alemayehu
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebremariam Wulie Geremew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Techilo Tinsae
- Department of Psychiatry, School of Medicine, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, School of Medicine, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, School of Medicine, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
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Su X, Zhong X, Zhang X, Gao Y, Zou X, Chen X, Wang W, Wang H, Meng J, Yu L, He J, Zhou Y. Unveiling trends in late diagnosis among 22,504 people living with HIV in Hunan, China. Sci Rep 2024; 14:23165. [PMID: 39369087 PMCID: PMC11455870 DOI: 10.1038/s41598-024-73648-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/19/2024] [Indexed: 10/07/2024] Open
Abstract
This study examined the prevalence of HIV late diagnosis (LD) and identified associated factors with LD among people living with HIV (PLWH). We extracted sociodemographic, epidemiological, and immunological information between 2018 and 2021 in Hunan, China from the HIV/AIDS Comprehensive Response Information Management System of China. The chi-squared test and multivariable logistic regression model were used to identify the factors associated with LD. Among 22,504 PLWH, 14,988 (66.6%) were diagnosed late. PLWH aged 50 and older had a higher proportion of LD (71.2%) than the younger group (60.0%). Older age, being male, Han ethnicity, being registered in Western Hunan, being transferred from health facilities, and being infected through heterosexual intercourse were associated with LD. Among PLWH younger than 50 years, apart from the factors mentioned above, individuals who had primary school or lower education, were non-student, and were divorced or widowed were more likely to be diagnosed late. Unlike younger PLWH, these factors were not associated with LD in the older group. But regional disparities in LD were more significant among them. LD in PLWH remains a severe issue, especially among older people. The study findings provided valuable insights into designing programs targeting groups at higher risk of LD to reduce its prevalence.
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Affiliation(s)
- Xinyi Su
- Xiangya Nursing School, Central South University, 172, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Xueyuan Zhong
- Xiangya Nursing School, Central South University, 172, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Xiangjun Zhang
- Center for Community Research and Evaluation, University of Memphis, Memphis, TN, USA
| | - Yanxiao Gao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xiaobai Zou
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Xi Chen
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Honghong Wang
- Xiangya Nursing School, Central South University, 172, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Jingjing Meng
- School of Nursing, Anhui Medical University, Hefei, China
| | - Lu Yu
- Xiangya Nursing School, Central South University, 172, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Jianmei He
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China.
| | - Yaqin Zhou
- Xiangya Nursing School, Central South University, 172, Tongzipo Road, Changsha, 410013, Hunan, China.
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Lin C, Diep NB, Nguyen L, Trang NT, Li L, Le MG. Navigating cultural and gender aspects of stigma among women living with HIV in Vietnam. CULTURE, HEALTH & SEXUALITY 2024; 26:1333-1349. [PMID: 38478464 PMCID: PMC11393182 DOI: 10.1080/13691058.2024.2318428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/09/2024] [Indexed: 04/21/2024]
Abstract
Women living with HIV often face intersecting challenges of stigma and gender inequality. In Vietnam, this issue is potentially exacerbated by the patriarchal culture. From December 2021 to March 2022, we conducted in-depth interviews with 30 women living with HIV in Hanoi to better understand their experiences and the coping mechanisms to navigate HIV stigma, cultural beliefs and gender norms. The interviews explored various topics including women's social and family roles in Vietnam, HIV-related beliefs, stigma and its impact on one's health and coping strategies. Participants reported stereotypes that assumed that women living with HIV had either engaged in sex work or behaved promiscuously. These stereotypes render them vulnerable to judgement and discrimination owing to widespread expectations of female virtue. As a result, women living with HIV often enacted non-disclosure and self-isolation to avoid stigma. This self-stigmatisation negatively impacted their healthcare-seeking, employment opportunities and ability to fulfil traditional family-caring roles. Conversely, many participants exhibited resilience with the support of family and peers. Overall, the complex interplay between gender, culture and HIV stigma underscores the importance of developing culturally appropriate, multifaceted approaches to engaging family and peers, modifying gender-based discriminatory social practices and enhancing women's self-efficacy and empowerment in Vietnam.
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Affiliation(s)
- Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California, Center for Community Health, Los Angeles, CA, USA
| | - Nguyen Bich Diep
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Lynn Nguyen
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nguyen Thu Trang
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Li Li
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California, Center for Community Health, Los Angeles, CA, USA
| | - Minh Giang Le
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Pereira LMS, França EDS, Costa IB, Lima IT, Freire ABC, Ramos FLDP, Monteiro TAF, Macedo O, Sousa RCM, Freitas FB, Costa IB, Vallinoto ACR. Sociobehavioral Risk Factors and Clinical Implications of Late Presentation Among People Living with HIV in the Brazilian Amazon Region. AIDS Behav 2024; 28:3404-3420. [PMID: 38992229 PMCID: PMC11427532 DOI: 10.1007/s10461-024-04437-5] [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] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
This study aimed to analyze the prevalence, sociobehavioral factors and clinical-laboratory consequences of late presentation among people living with HIV (PLHIV) in the Brazilian Amazon region. In total, 402 HIV + individuals treated at reference units in Belém city (Pará, Brazil) between 2018 and 2019 were evaluated. Late presentation was defined as a first-collection LTCD4+ count below 350 cells/µL. Sociodemographic, behavioral and clinical data were obtained from questionnaires or medical records. Th1, Th2 and Th17 cytokine profiles were evaluated by flow cytometry. Longitudinal data on viral load, T lymphocytes, and antiretroviral therapy administration were obtained from control and logistic databases. Approximately 52.73% of the participants were late presenters and sought medical care 7-12 + months after their primary HIV diagnosis. Sociobehavioral factors associated with late presentation included illicit drug use for more than 5 years, polyamory, no alcohol consumption, homosexuality, and sexual inactiveness after HIV diagnosis. Clinically, late presentation was associated with coinfection rate; polysymptomatology; high IFN-ɣ, IL-6 and IL-10 levels; nonresponse to antiretroviral therapy; and virological failure- and tuberculosis coinfection-motivated changes to therapy. In summary, the prevalence of late presentation in Pará in the Brazilian Amazon region is high. Delays in seeking specialized care after a primary HIV diagnosis cause medium/long-term changes in the life expectancy and health of PLHIV.
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Affiliation(s)
| | - Eliane Dos Santos França
- Epstein‒Barr Virus Laboratory, Virology Unit, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Iran Barros Costa
- Epstein‒Barr Virus Laboratory, Virology Unit, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Igor Tenório Lima
- Epstein‒Barr Virus Laboratory, Virology Unit, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | | | | | | | - Olinda Macedo
- Retrovirus Laboratory, Virology Unit, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Rita Catarina Medeiros Sousa
- Epstein‒Barr Virus Laboratory, Virology Unit, Evandro Chagas Institute, Ananindeua, Pará, Brazil
- School of Medicine, Federal University of Pará, Belém, Pará, Brazil
| | - Felipe Bonfim Freitas
- Retrovirus Laboratory, Virology Unit, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Igor Brasil Costa
- Epstein‒Barr Virus Laboratory, Virology Unit, Evandro Chagas Institute, Ananindeua, Pará, Brazil.
- Graduate Program in Virology, Evandro Chagas Institute, Ananindeua, Pará, Brazil.
| | - Antonio Carlos Rosário Vallinoto
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil.
- Graduate Program in Virology, Evandro Chagas Institute, Ananindeua, Pará, Brazil.
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21
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Ljubas D, Škornjak H, Božičević I. Knowledge, attitudes and beliefs regarding HIV among medical students in Zagreb, Croatia. BMC MEDICAL EDUCATION 2024; 24:1004. [PMID: 39272072 PMCID: PMC11401420 DOI: 10.1186/s12909-024-05994-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Medical students, as future health-care providers (HCPs) play a significant role in shaping attitudes towards people living with HIV/AIDS (PLWHA) and should possess adequate knowledge of this infection. The study aim was to assess knowledge about HIV among medical students of the University of Zagreb School of Medicine, and to determine the level of discriminatory attitudes towards PLWHA. METHODS We assessed knowledge about epidemiology, treatment, and prevention of HIV by using closed-ended and multiple-choice questions. Likert-scale questions were employed to determine attitudes towards PLWHA. Bivariate and multivariate ordinal logistic regression was used to assess correlates of certain discriminatory attitudes. RESULTS 561 medical students participated, with 46.7% attending preclinical courses. Overall, 42.1% of students think they received sufficient information on HIV/AIDS during elementary and high school education. Among clinical students, 42.6%, 20.8% and 11.8% estimated accurately transmission risk after a needle injury, unprotected vaginal, and anal intercourse, respectively. 66.8% of clinical students were aware that treatment can prevent AIDS, while 58.7% and 69.8% were familiar with the rationale of using pre-exposure (PrEP) and post-exposure prophylaxis (PEP). In the multivariate analysis, individuals lacking infectology course attendance (aOR = 1.45; CI: 1.00-2.09) and those unaware of transmission routes (aOR = 1.49; CI: 1.06-2.09) showed higher odds of advocating HIV status disclosure compared to those who did not yet attend an infectology course. Students supporting extra protection for handling PLWHA bodily fluids were more likely to support refusal to treat PLWHA (aOR = 1.80; CI: 1.22-2.69) compared to those who did not support that opinion. Males were more inclined to state that they would refuse to treat PLWHA (aOR = 1.66; CI: 1.11-2.50) and disclose their HIV status (aOR = 1.62; CI: 1.17-2.27) than females. Overestimating needle injury transmission risk raised treatment refusal likelihood (aOR = 2.22; CI = 1.29-3.92) compared to those accurately informed of this risk. CONCLUSION Results indicate lack of knowledge of HIV transmission risks after specific exposures and about PrEP, PEP and treatment effectiveness. Gender and knowledge about HIV transmission risks influence students' attitudes towards PLWHA. Medical education should be focused on fostering correct attitudes and addressing stigma, which undermines prevention and treatment outcomes of PLWHA.
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Affiliation(s)
- Dominik Ljubas
- Department for Pediatric Infectious Diseases, University Clinic for Infectious Diseases 'Dr. Fran Mihaljević', Mirogojska 8, Zagreb, 10 000, Croatia.
| | - Hana Škornjak
- Teaching Institute for Public Health 'Dr. Andrija Štampar', Mirogojska 16, Zagreb, 10000, Croatia
| | - Ivana Božičević
- WHO Collaborating Centre for HIV Strategic Information, Andrija Štampar School of Public Health, Rockefeller Street 4, Zagreb, 10 000, Croatia
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, 10000, Croatia
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22
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Filiatreau LM, Ebasone PV, Dzudie A, Wainberg M, Yotebieng M, Anastos K, Parcesepe AM. Intersectional HIV- and Depression-Related Stigma Among People with HIV Entering HIV Care in Cameroon. AIDS Behav 2024; 28:2950-2960. [PMID: 38767726 PMCID: PMC11926849 DOI: 10.1007/s10461-024-04375-2] [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] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Mental health-related stigma is a prominent barrier to improved mental health outcomes globally and may be particularly harmful to populations with other stigmatized identities. We aimed to understand intersectional depression- and HIV-related stigma among people with HIV (PWH) entering HIV care in Cameroon. Using baseline data from a cohort of PWH entering HIV care in Cameroon between 2019 and 2020, we characterized depression- and HIV-related stigma in the population overall and by sociodemographic sub-group. We also explored substantively meaningful variation in stigma endorsement by depressive symptom severity (Patient Health Questionnaire-9 [PHQ-9]) and causal attribution of depression. Among those with elevated depressive symptoms (PHQ-9 scores > 4), we estimated the association between stigma type and depressive symptom severity using binomial regression. Among 398 participants, 49% endorsed low HIV- and depression-related stigma (N = 195), 10% endorsed high HIV- and depression-related stigma (N = 38), 29% endorsed high depression-related stigma only (N = 116), and 12% endorsed high HIV-related stigma only (N = 49). Respondents with and without heightened depressive symptoms commonly believed depressive symptoms were caused by HIV (N = 140; 32.9%). Among those with elevated depressive symptoms, the prevalence of moderate to severe symptoms was higher among those endorsing high HIV-related stigma only (prevalence ratio 1.55; 95% confidence interval: 1.01, 2.37) compared to those reporting low HIV- and depression-related stigma. HIV- and depression-related stigma are both common among PWH entering HIV care in Cameroon. The consistent association between HIV-related stigma and poor psychosocial well-being among people with HIV necessitates the urgent scale-up of evidence-based HIV-related stigma interventions specifically.
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Affiliation(s)
- Lindsey M Filiatreau
- School of Medicine, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bendera A, Baryomuntebe DM, Kevin NU, Nanyingi M, Kinengyere PB, Mujeeb S, Sulle EJ. Determinants of Late HIV Diagnosis and Advanced HIV Disease Among People Living with HIV in Tanzania. HIV AIDS (Auckl) 2024; 16:313-323. [PMID: 39220740 PMCID: PMC11363941 DOI: 10.2147/hiv.s473291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024] Open
Abstract
Background About half of people infected with Human Immunodeficiency Virus (HIV) often present late for care, resulting in higher healthcare costs, undesired treatment outcomes, and ongoing HIV transmission. This study aimed to assess the prevalence and determinants of late HIV diagnosis and advanced HIV disease (AHD) in Tanzania. Methods Data were obtained from the 2016-17 Tanzania HIV impact survey. We included 677 newly diagnosed people living with HIV. Late HIV diagnosis and AHD were defined as having a CD4 cell count below 350 cells/µL or 200 cells/µL at diagnosis, respectively. Bivariate and multivariable logistic regression models were fitted to identify the determinants of late HIV diagnosis or AHD. Results The mean age of the participants was 37.8 years (SD, 12.4). About two-thirds were women (62.6%). The prevalence of late HIV diagnosis was 42.4%, whereas the prevalence of AHD was 17.7%. Factors associated with late HIV diagnosis included age 31-40 years (adjusted odds ratio [aOR] = 1.72, 95% confidence interval [CI]: 1.14-2.60), age ≥41 years (aOR = 1.79, 95% CI: 1.16-2.76), male sex (aOR = 1.88, 95% CI: 1.29-2.73), and active syphilis infection (aOR=2.63, 95% CI: 1.20-5.76). Factors associated with AHD were age 31-40 years (aOR = 2.12, 95% CI: 1.18-3.81), age ≥41 years (aOR = 2.42, 95% CI: 1.32-4.41), male sex (aOR = 1.77, 95% CI: 1.09-2.87), formal education (aOR = 0.49, 95% CI: 0.30-0.81) and active syphilis infection (aOR = 2.49, 95% CI: 1.07-5.77). Conclusion Late HIV diagnosis and AHD are prevalent among newly diagnosed people living with HIV in Tanzania. Specific subgroups are more likely to present late for HIV care, including middle-aged and older adults, men, illiterate individuals, and those with active syphilis and HIV co-infection. Therefore, we recommend expanding HIV testing services and implementing targeted interventions to improve early access and enrollment in HIV care.
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Affiliation(s)
- Anderson Bendera
- Department of Radiology and Medical Imaging, Monduli District Hospital, Arusha, Tanzania
| | | | | | - Miisa Nanyingi
- Department of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | | | - Salaam Mujeeb
- Department of Pathology, Islamic University in Uganda, Kampala, Uganda
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Bin Ahmad MZ, Md. Yasin M, Mat Nasir N, Mohamad M. The association between HIV-related stigma, HIV knowledge and HIV late presenters among people living with HIV (PLHIV) attending public primary care clinic settings in Selangor. PLoS One 2024; 19:e0306904. [PMID: 39037975 PMCID: PMC11262653 DOI: 10.1371/journal.pone.0306904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION HIV late presenters were defined as individuals presenting with a CD4 count below 350 cells/μL or with an AIDS-defining event, according to the European Late Presenter Consensus working group. Early diagnosis and treatment of HIV have proven beneficial for people living with HIV (PLHIV), reducing the burden on healthcare systems, and contributing to ending the HIV/AIDS epidemic. However, in Malaysia, over 50% of newly diagnosed HIV patients present late, leading to increased morbidity and premature mortality. This study aims to determine the prevalence of late HIV presenters and its association with HIV-related stigma and HIV knowledge among PLHIV attending public primary care clinics in Selangor. METHODS A cross-sectional study was conducted at selected public health clinics in Selangor, involving PLHIV aged 18 years and older, who were diagnosed since 2019. HIV-related stigma was measured using the Malay version of Berger's HIV Stigma Scale, and HIV knowledge was assessed using the Malay version of Brief HIV-KQ-18. Univariate and multivariate logistic regression analyses were performed to identify factors associated with late HIV presentation. RESULTS A total of 400 participants were included in the study, with 60.0% (n = 240, 95% CI: 55.0-65.0) classified as late presenters. The participants had a mean age of 30.29 (±7.77) years. The risk factors for late presenters were high levels of HIV-related stigma (aOR = 1.049, 95% CI: 1.034-1.063, p-value <0.001), low levels of HIV knowledge (aOR = 0.709, 95% CI: 0.646-0.778, p-value <0.001), tertiary education background (aOR = 15.962, 95% CI: 1.898-134.235, p-value = 0.011), and being single (aOR = 3.582, 95% CI: 1.393-9.208, p-value = 0.008). CONCLUSION This study highlights the association between high levels of HIV-related stigma, low levels of HIV knowledge, and late HIV presentation. Interventions targeting stigma reduction and HIV education can promote early testing and prompt access to care, improving health outcomes for PLHIV.
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Affiliation(s)
- Mohd Zulfikry Bin Ahmad
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Mazapuspavina Md. Yasin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Nafiza Mat Nasir
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Mariam Mohamad
- Department of Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
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Endalamaw A, Gilks CF, Ambaw F, Shiferaw WS, Assefa Y. Explaining inequity in knowledge, attitude, and services related to HIV/AIDS: a systematic review. BMC Public Health 2024; 24:1815. [PMID: 38978024 PMCID: PMC11229290 DOI: 10.1186/s12889-024-19329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Equitable service provision and coverage are important responses to end the threat of the HIV/AIDS pandemic. Understanding inequity supports policies and programmes to deliver tailored interventions. There is continuous evidence generation on inequity in HIV/AIDS services. However, there was a lack of evidence on the global picture of inequity in behavioural and biomedical services related to HIV/AIDS. This systematic review assessed inequities in knowledge, attitude, HIV testing, and ART coverage across individual-level social groups and multiple (dis)advantage categories. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, with a PROSPERO registration number CRD42024521247. The risk of bias was assessed by using Hoy et al's and Joanna Brigg's quality appraisal checklists for cross-sectional quantitative and qualitative studies, respectively. The search date was from inception to the final database search date (May 29, 2023). The included articles were either quantitative or qualitative studies. We used mixed-methods approach to analyse the data from the review articles. Quantitative descriptive analysis was conducted to estimate frequency of articles published from different countries around the world. Qualitative content analysis of the findings from the original studies was conducted using the PROGRESS plus framework which stands for: place of residence, occupation or employment status, gender, religion, education status, socioeconomic status, and social capital. RESULTS Out of 6,029 articles that were accessed and screened, only 72 articles met the inclusion criteria. More articles on HIV-related equity in knowledge, attitude, testing, and ART were published in developed countries than in developing countries. Individuals from higher-income households had better knowledge about HIV/AIDS. Unfavourable attitudes towards people living with HIV and HIV/AIDS-associated stigma were common among women. HIV/AIDS service coverage (HIV testing or ART coverage) was higher among richer and urban residents. HIV/AIDS-associated stigma and lower levels of knowledge about HIV/AIDS were observed among multiple disadvantageous groups due to the intersection of two or more identities. CONCLUSIONS The current review revealed that there have been disparities in HIV/AIDS services between social classes. Ending service disparity towards the global threat of HIV/AIDS demands tailored interventions based on socially disadvantaged groups (e.g., poor, rural dwellers, and women) and intersectional determinants. There is a need to understand the deep-rooted causes of inequity and the challenges that an equity-oriented system faces over time. More studies on inequity are needed, including intersectional inequity, which has been rarely studied in developing countries.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Charles F Gilks
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Fentie Ambaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- School of Public Health, The University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Davis A, Rosenthal SL, Tucker JD, Balabekova O, Nyblade L, Sun Y, Gryazev D, Lunze K, Landers SE, Tang W, Kuskulov A, Gulyayev V, Terlikbayeva A, Primbetova S, Mergenova G, the JasSpark Study Team. A citizen science approach to develop a digital intervention to reduce HIV stigma and promote HIV self-testing among adolescents and young adults: a mixed methods analysis from Kazakhstan. J Int AIDS Soc 2024; 27 Suppl 3:e26314. [PMID: 39030847 PMCID: PMC11258447 DOI: 10.1002/jia2.26314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/04/2024] [Indexed: 07/22/2024] Open
Abstract
INTRODUCTION Kazakhstan has one of the fastest-growing HIV epidemics in the world, with increasing rates among adolescents and young adults (AYA). Innovative strategies are needed to increase HIV testing uptake and decrease HIV stigma among AYA. Citizen science, defined as the active engagement of the general public in scientific research tasks, promotes and facilitates community engagement throughout the research process. This citizen science study used crowdsourcing to engage AYA in Kazakhstan to develop a digital intervention to reduce HIV stigma and promote HIV self-testing. Our objectives in this paper are to describe the approach used, its feasibility and acceptability, and AYA motivations for and lessons learned collaborating on the study. METHODS From October 2021 to July 2022, in collaboration with a Community Collaborative Research Board and a Youth Advisory Board, we developed an open call requesting multimedia submissions to reduce HIV testing stigma. Eligible submissions were separated by age group (13-19 or 20-29 years) and judged by a panel composed of AYA (n = 23), healthcare professionals (n = 12), and representatives from the local government and non-governmental organizations (n = 17). Each entry was reviewed by at least four judges and ranked on a 5-point scale. The top 20 open call contestants were asked to submit self-recordings sharing their motivation for and experience participating in the contest and lessons learned. Descriptive statistics were calculated for quantitative data. Qualitative data were coded using open coding. RESULTS We received 96 submissions from 77 youth across Kazakhstan. Roughly, three-quarters (n = 75/96) of entries met judging eligibility criteria. Of the eligible entries, over half (n = 39/75) scored 3.5 or higher on a 5-point scale (70.0%). The most frequent types of entries were video (n = 36/96, 37.5%), image (n = 28/96, 29.2%) and text (n = 24/96, 25.0%). AYA's primary motivations for collaborating on the study included a desire to improve society and help youth. The main challenges included creating content to address complex information using simple language, finding reliable information online and technological limitations. CONCLUSIONS Crowdsourcing was feasible and highly acceptable among AYA in Kazakhstan. Citizen science approaches hold great promise for addressing the increasingly complex health and social challenges facing communities today.
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Affiliation(s)
- Alissa Davis
- School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Susan L. Rosenthal
- Department of PediatricsColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
- Department of PsychiatryColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
| | - Joseph D. Tucker
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
- Clinical Research Department, Faculty of Infectious and Tropical DiseasesLondon School of Hygiene & Tropical MedicineLondonUK
| | - Olga Balabekova
- Global Health Research Center of Central AsiaAlmatyKazakhstan
| | - Laura Nyblade
- Research Triangle InstituteResearch Triangle ParkChapel HillNorth CarolinaUSA
| | - Yihang Sun
- School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Denis Gryazev
- Global Health Research Center of Central AsiaAlmatyKazakhstan
| | - Karsten Lunze
- Section of General Internal Medicine, Department of MedicineBoston Medical CenterBostonMassachusettsUSA
- Chobanian and Avedisian School of MedicineBoston UniversityBostonMassachusettsUSA
| | - Sara E. Landers
- School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Weiming Tang
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Azamat Kuskulov
- School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Valera Gulyayev
- Global Health Research Center of Central AsiaAlmatyKazakhstan
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27
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Hall E, Davis K, Ohrnberger J, Pickles M, Gregson S, Thomas R, Hargreaves JR, Pliakas T, Bwalya J, Dunbar R, Mainga T, Shanaube K, Hoddinott G, Bond V, Bock P, Ayles H, Stangl AL, Donnell D, Hayes R, Fidler S, Hauck K. Associations between HIV stigma and health-related quality-of-life among people living with HIV: cross-sectional analysis of data from HPTN 071 (PopART). Sci Rep 2024; 14:12835. [PMID: 38834593 PMCID: PMC11150264 DOI: 10.1038/s41598-024-63216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 05/27/2024] [Indexed: 06/06/2024] Open
Abstract
People living with HIV (PLHIV) report lower health-related quality-of-life (HRQoL) than HIV-negative people. HIV stigma may contribute to this. We explored the association between HIV stigma and HRQoL among PLHIV. We used cross-sectional data from 3991 randomly selected PLHIV who were surveyed in 2017-2018 for HPTN 071 (PopART), a cluster randomised trial in Zambia and South Africa. Participants were 18-44 years, had laboratory-confirmed HIV infection, and knew their status. HRQoL was measured using the EuroQol-5-dimensions-5-levels (EQ-5D-5L) questionnaire. Stigma outcomes included: internalised stigma, stigma experienced in the community, and stigma experienced in healthcare settings. Associations were examined using logistic regression. Participants who had experienced community stigma (n = 693/3991) had higher odds of reporting problems in at least one HRQoL domain, compared to those who had not (adjusted odds ratio, aOR: 1.51, 95% confidence interval, 95% Cl: 1.16-1.98, p = 0.002). Having experienced internalised stigma was also associated with reporting problems in at least one HRQoL domain (n = 552/3991, aOR: 1.98, 95% CI: 1.54-2.54, p < 0.001). However, having experienced stigma in a healthcare setting was less common (n = 158/3991) and not associated with HRQoL (aOR: 1.04, 95% CI: 0.68-1.58, p = 0.850). A stronger focus on interventions for internalised stigma and stigma experienced in the community is required.
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Affiliation(s)
- Emily Hall
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Katherine Davis
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK.
| | - Julius Ohrnberger
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Michael Pickles
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Simon Gregson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Ranjeeta Thomas
- Department of Health Policy, London School of Economics, London, UK
| | - James R Hargreaves
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Justin Bwalya
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Tila Mainga
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kwame Shanaube
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Helen Ayles
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne L Stangl
- Hera Solutions, Baltimore, MD, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Katharina Hauck
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
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Portilla-Tamarit I, Rubio-Aparicio M, Fuster-RuizdeApodaca MJ, Portilla-Tamarit J, Reus S, Portilla J. Health-Related Quality of Life in People with Advanced HIV Disease, from 1996 to 2021: Systematic Review and Meta-analysis. AIDS Behav 2024; 28:1978-1998. [PMID: 38743382 PMCID: PMC11161547 DOI: 10.1007/s10461-024-04298-y] [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] [Accepted: 02/16/2024] [Indexed: 05/16/2024]
Abstract
The purpose of the study was to assess the effects of advanced HIV disease (AHD) on health-related quality of life (HRQoL) in PLHIV, the changes in HRQoL outcomes over the last 25 years, and the differences between countries according to level of economic development. We conducted a systematic review and meta-analysis. The search was conducted in PubMed and Web of Science using the terms: "health-related quality of life", "HQRoL", "HIV", "AIDS", "advanced HIV disease" and "low CD4 cells". Studies inclusion criteria were: adult population; initiated after 1996 and published before July 2021; clinical trials, cross-sectional, cohort, and case-control studies; studies analyzing the relationship between AHD and HRQoL; English or Spanish language. Standardized mean differences (d+) were calculated to estimate the effect size for the meta-analyses. Summary statistics were calculated using a random-effects model, and analyses of effect moderators, using mixed-effects models. The meta-analysis included 38 studies. The results indicated that HRQoL is worse in patients with AHD compared to those without. The main HRQoL domains affected were overall health perception and concern and physical and functional health and symptoms. We found a moderate impact for age and gender on some HRQoL domains. There were no differences in relation to socioeconomic inequities, country of residence, or time period analyzed. In conclusion, advanced HIV disease has a negative impact on health and well-being in PLHIV. Our results show that despite all the advances in antiretroviral treatments over the last 25 years, AHD persists as a source of extreme vulnerability, regardless of where PLHIV live.
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Affiliation(s)
- I Portilla-Tamarit
- Department of Health Psychology, University of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Alicante University General Hospital, Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
| | - M Rubio-Aparicio
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
- Department of Basic Psychology & Methodology, Faculty of Psychology and Speech Therapy, University of Murcia, Avda. Teniente Flomesta, 5, 30003, Murcia, Spain.
| | - M J Fuster-RuizdeApodaca
- Faculty of Psychology, National Distance Learning University (UNED), Madrid, Spain
- Spanish Interdisciplinary AIDS Society (SEISIDA), 28036, Madrid, Spain
| | - J Portilla-Tamarit
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Alicante University General Hospital, Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
| | - S Reus
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Alicante University General Hospital, Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- Department of Clinical Medicine, Miguel Hernandez University, Elche, Alicante, Spain
| | - J Portilla
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Alicante University General Hospital, Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- Department of Clinical Medicine, Miguel Hernandez University, Elche, Alicante, Spain
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Watt MH, Marchand V, Barabara ML, Minja LM, Stephens MJ, Hanson OR, Mlay PS, Olomi GA, Kiwia JF, Mmbaga BT, Cohen SR. Outcomes of the MAMA Training: A Simulation and Experiential Learning Intervention for Labor and Delivery Providers to Improve Respectful Maternity Care for Women Living with HIV in Tanzania. AIDS Behav 2024; 28:1898-1911. [PMID: 38480648 PMCID: PMC11912301 DOI: 10.1007/s10461-024-04283-5] [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] [Accepted: 01/26/2024] [Indexed: 01/24/2025]
Abstract
Respectful maternity care (RMC) for women living with HIV (WLHIV) improves birth outcomes and may influence women's long-term commitment to HIV care. In this study, we evaluated the MAMA training, a team-based simulation training for labor and delivery (L&D) providers to improve RMC and reduce stigma in caring for WLHIV. The study was conducted in six clinical sites in the Kilimanjaro Region of Tanzania. 60 L&D providers participated in the MAMA training, which included a two-and-a-half-day workshop followed by a half-day on-site refresher. We assessed the impact of the MAMA training using a pre-post quasi-experimental design. To assess provider impacts, participants completed assessments at baseline and post-intervention periods, measuring RMC practices, HIV stigma, and self-efficacy to provide care. To evaluate patient impacts, we enrolled birthing women at the study facilities in the pre- (n = 229) and post- (n = 214) intervention periods and assessed self-reported RMC and perceptions of provider HIV stigma. We also collected facility-level data on the proportion of patients who gave birth by cesarean section, disaggregated by HIV status. The intervention had a positive impact on all provider outcomes; providers reported using more RMC practices, lower levels of HIV stigma, and greater self-efficacy to provide care for WLHIV. We did not observe differences in self-reported patient outcomes. In facility-level data, we observed a trend in reduction in cesarean section rates for WLHIV (33.0% vs. 24.1%, p = 0.14). The findings suggest that the MAMA training may improve providers' attitudes and practices in caring for WLHIV giving birth and should be considered for scale-up.
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Affiliation(s)
- Melissa H Watt
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | | | - Mariam L Barabara
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Maya J Stephens
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Olivia R Hanson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Pendo S Mlay
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Gaudensia A Olomi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Regional Secretary of Kilimanjaro - Health Department, Moshi, Tanzania
| | - Janeth F Kiwia
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Susanna R Cohen
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
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Nabunya P, Migadde H, Namuwonge F, Mugisha J, Kirabo W, Ssentumbwe V, Claire N, Raymond A, Bahar OS, Mwebembezi A, McKay MM, Ssewamala FM. Feasibility and Acceptability of Group-Based Stigma Reduction Interventions for Adolescents Living with HIV and Their Caregivers: The Suubi4Stigma Randomized Clinical Trial (2020-2022). AIDS Behav 2024; 28:1630-1641. [PMID: 38308772 PMCID: PMC11070307 DOI: 10.1007/s10461-024-04284-4] [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] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
This study examined the feasibility and acceptability of two group-based interventions: group-cognitive behavioral therapy (G-CBT) and a family-strengthening intervention delivered via multiple family group (MFG-FS), to address HIV stigma among adolescents living with HIV (ALHIV) and their caregivers. A total of 147 adolescent -caregiver dyads from 9 health clinics situated within 7 political districts in Uganda were screened for eligibility. Of these, 89 dyads met the inclusion criteria and provided consent to participate in the study. Participants were randomized, at the clinic level, to one of three study conditions: Usual care, G-CBT or MFG-FS. The interventions were delivered over a 3-month period. While both adolescents and their caregivers attended the MFG-FS sessions, G-CBT sessions were only attended by adolescents. Data were collected at baseline, 3 and 6-months post intervention initiation. The retention rate was 94% over the study period. Across groups, intervention session attendance ranged between 85 and 92%, for all sessions. Fidelity of the intervention was between 85 and 100%, and both children and caregivers rated highly their satisfaction with the intervention sessions. ALHIV in Uganda, and most of sub-Saharan Africa, are still underrepresented in stigma reduction interventions. The Suubi4Stigma study was feasible and acceptable to adolescents and their caregivers -supporting testing the efficacy of the interventions in a larger trial.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA.
| | - Herbert Migadde
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Winnie Kirabo
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - Najjuuko Claire
- Division of Computational & Data Sciences, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, USA
| | - Atwebembere Raymond
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | | | - Mary M McKay
- Office of the Vice Provost, Washington University in St. Louis, St. Louis, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
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Gilles I, Jackson-Perry D, Le Saux C, Storari C, Cart-Richter E, Keserue Pittet O, Darling KEA. Navigating HIV-Related Stigma in Switzerland: A Qualitative Study. Int J Public Health 2024; 69:1606333. [PMID: 38737988 PMCID: PMC11082645 DOI: 10.3389/ijph.2024.1606333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Objectives: This study sought to understand how people living with HIV experience, perceive, and navigate stigma in their everyday life and in care settings in an urban French-speaking area in Switzerland. Methods: Semi-structured interviews were carried out with 19 people living with HIV in Lausanne concerning their experience of HIV-related stigma in both everyday life and in healthcare settings. Content analysis was performed to identify main and sub-themes. Results: "Living with HIV" posed little or no difficulty for participants. However, the burden of anticipated and internalized HIV-related stigma played a disproportionately large role in their lives. Participants considered the general population's low level of knowledge about HIV as problematic in this regard. While participants reported few examples of enacted stigma generally, healthcare environments were sometimes experienced as sites of prejudice and discrimination. However, some healthcare professionals were also sources of information and knowledge, contributing to participants' "journeys of self-acceptance." Conclusion: Even in an urban environment in a country with ready access to healthcare and education, HIV-related stigma remains a concern for people living with HIV.
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Affiliation(s)
- Ingrid Gilles
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Clara Le Saux
- University Center of General Medicine and Public Health, Lausanne, Vaud, Switzerland
| | - Chiara Storari
- University Center of General Medicine and Public Health, Lausanne, Vaud, Switzerland
| | - Ellen Cart-Richter
- University Center of General Medicine and Public Health, Lausanne, Vaud, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Oriana Keserue Pittet
- University Center of General Medicine and Public Health, Lausanne, Vaud, Switzerland
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Alckmin-Carvalho F, Pereira H, Nichiata L. "It's a Lot of Closets to Come Out of in This Life": Experiences of Brazilian Gay Men Living with Human Immunodeficiency Virus at the Time of Diagnosis and Its Biopsychosocial Impacts. Eur J Investig Health Psychol Educ 2024; 14:1068-1085. [PMID: 38667825 PMCID: PMC11049621 DOI: 10.3390/ejihpe14040070] [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: 02/07/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
We investigated the experiences of Brazilian gay men with HIV, focusing on the moment of diagnosis and its potential biopsychosocial impacts. This clinical-qualitative study involved 15 participants interviewed online and synchronously by a clinical psychologist in 2021. Thematic analysis was employed to analyze the data. Interpretations were grounded in Minority Stress Theory. Four thematic axes emerged, including "Diagnostic Revelation", "Social and Internalized Stigma", "Biopsychosocial Effects of Living with HIV", and "Gratitude for Treatment Advances and the Brazilian Health System". The diagnosis was often experienced as traumatic, exacerbated by the absence of empathy and emotional support from healthcare providers. Participants commonly reported guilt, fear upon learning of their HIV status, social isolation, loneliness, lack of social support, and damage to affective-sexual relationships. Many also noted a decline in mental health, even those without HIV-related medical complications. Despite over 40 years since the HIV epidemic began, the prevalence of homophobia and serophobia among gay men remains widespread, including within the multidisciplinary teams of specialized services. This indicates that the stigma associated with homosexuality and HIV persists, despite significant biomedical progress in the diagnosis and treatment of the infection, particularly in Brazil.
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Affiliation(s)
| | - Henrique Pereira
- Department of Psychology and Education, Faculty of Social and Human Sciences, University of Beira Interior, Pólo IV, 6200-209 Covilhã, Portugal;
- Research Centre in Sports Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Lucia Nichiata
- School of Nursing, Universidade de São Paulo, São Paulo 01239-020, Brazil;
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Kennedy CE, Yeh PT, Verster A, Luhmann N, Nguyen VTT, de Mello MB, Baggaley R, Macdonald V. Do Peer Navigators Improve Initiation and Retention in HIV/VH/STI Treatment Programs for People From Key Populations? A Systematic Review of Effectiveness, Values and Preferences, and Cost. J Acquir Immune Defic Syndr 2024; 95:305-312. [PMID: 38416032 PMCID: PMC10896188 DOI: 10.1097/qai.0000000000003364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/15/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Key populations are disproportionately affected by HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) and face barriers to care. Peer navigation programs are widely used, but evidence supporting their use has not been synthesized. SETTING Peer navigation programs for sex workers, men who have sex with men, people who inject drugs, prisoners, and trans and gender diverse people globally. METHODS To inform World Health Organization guidelines, we conducted a systematic review of effectiveness, values and preferences, and cost studies published between January 2010 and May 2021. We searched CINAHL, PsycINFO, PubMed, and EMBASE; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials and comparative observational studies evaluating time to diagnosis or linkage to care, treatment initiation, treatment retention/completion, viral load, cure, or mortality. We assessed risk of bias and summarized findings in GRADE evidence profiles. Values and preferences and cost data were summarized descriptively. RESULTS Four studies evaluated the effectiveness of peer navigators for key populations. All were focused on HIV; none were designed for VH or STIs. These studies showed mixed effects on linkage to care, treatment retention/completion, and viral load; no studies measured treatment initiation, cure, or mortality. Two values and preferences studies with community-based organization staff and health workers suggested peer navigators for key populations were acceptable and valued, although continued challenges remained. No cost studies were identified. CONCLUSIONS Although limited, available studies provide moderate certainty evidence for benefits of HIV/VH/STI peer navigation programs for key populations. Further evaluations are needed.
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Affiliation(s)
- Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Ping T. Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Annette Verster
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Van T. T. Nguyen
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Maeve B. de Mello
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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Chen WT, Huang F, Shiu CS, Lin SH, Tun MS, Nwe TW, Oo YTN, Oo HN. Can social support mediate stigma and perceived stress in people live with human immunodeficiency virus? AIDS Care 2024; 36:255-262. [PMID: 37674375 PMCID: PMC10842375 DOI: 10.1080/09540121.2023.2254545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
Stigma has heavily impacted People Living with HIV (PLWH). Limited studies report on how social support affects HIV-related stigma and perceived stress, especially in Myanmar. During first seven months of 2020, a random sample of 248 eligible PLWH were contacted from a private, closed Facebook group with more than 18,000 Myanmar people, where 90% of the members were PLWH. Variables collected included demographics data, perceived stress, social support, and HIV stigma. After controlling for the effects of demographic variables, the path from HIV stigma to perceived stress (direct effect β = 0.40) and though the mediation of social support was significant (indirect effect β = 0.014). However, the mediating effect of social support was non-significant between HIV stigma and perceived stress. This exploratory study shows that social support did not have the expected effect of decreasing perceived stress in PLWH in Myanmar. Interventions to reduce HIV stigma to decrease perceived stress should consider other strategies, e.g., spirituality-based practice, to reduce perceived stress in Myanmar PLWH.
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Affiliation(s)
- Wei-Ti Chen
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Feifei Huang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Cheng-Shi Shiu
- Department of Social Work, National Taiwan University, Taipei, Taiwan
| | - Sai Htun Lin
- Human Rights & Technical Services Department, Secretariat Office, Myanmar Positive Group (MPG), Yangon, Myanmar
| | - Min San Tun
- Human Rights & Technical Services Department, Secretariat Office, Myanmar Positive Group (MPG), Yangon, Myanmar
| | - Thet Wai Nwe
- National AIDS Program, Department of Public Health, Ministry of Health and Sports, Naypyidaw, Myanmar
| | - Yin Thet Nu Oo
- Health System Research Division, Department of Medical Research, Yangon, Myanmar
| | - Htun Nyunt Oo
- National AIDS Program, Department of Public Health, Ministry of Health and Sports, Naypyidaw, Myanmar
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35
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Schweitzer AM, Dišković A, Krongauz V, Newman J, Tomažič J, Yancheva N. Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe. AIDS Res Ther 2023; 20:87. [PMID: 38082352 PMCID: PMC10714556 DOI: 10.1186/s12981-023-00585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Surging HIV prevalence across countries of Central and Eastern Europe (CEE) is largely a result of poor HIV care engagement and a lack of comprehensive support for key populations. This is fostered by widespread stigma across healthcare, community, and legislative settings. DISCUSSION Throughout CEE, HIV stigma and intersectional stigma are serious obstacles to providing adequate medical care to people living with HIV. Anticipated and enacted (experienced) stigma from healthcare professionals, and fears of breaches in confidentiality, deter individuals from having an HIV test and engaging in HIV care. Furthermore, negative connotations surrounding HIV infection can lead to discrimination from family, friends, colleagues, and the public, leading to internalized stigma and depression. Key populations that have higher HIV prevalence, such as men who have sex with men, people who inject drugs, transgender individuals, and sex workers, experience additional stigma and discrimination based on their behaviour and identities. This contributes to the concentrated HIV epidemics seen in these populations in many CEE countries. The stigma is exacerbated by punitive legislation that criminalizes HIV transmission and penalizes sexual orientation, drug use, gender identities, and sex work. Despite high levels of HIV stigma and intersectional stigma, there are many evidence-based interventions that have reduced stigma in other parts of the world. Here, we discuss the interventions that are currently being enacted in various countries of CEE, and we suggest additional effective, evidence-based interventions that will tackle stigma and lead to increased HIV care engagement and higher rates of viral suppression. We cover the promotion of the undetectable = untransmittable (U = U) message, stigma-reduction education and training for healthcare professionals, patient-centric approaches for testing and treatment, and advocacy for non-discriminatory legislation, policies, and practices. We also consider targeted stigma-reduction interventions that acknowledge the wider challenges faced by marginalized populations. CONCLUSIONS HIV stigma and intersectional stigma in CEE drive poor engagement with HIV testing services and care. Widespread adoption of evidence-based interventions to tackle stigma highlighted in this review will improve the quality of life of people living with HIV, improve HIV care engagement, and ultimately slow the surging HIV prevalence and concentrated epidemics occurring throughout CEE.
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Affiliation(s)
| | - Arian Dišković
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | - Veronica Krongauz
- European Distributor Markets, Medical Department, Gilead Sciences, Uxbridge, UK
| | - Julie Newman
- HIV Strategic Implementation & Franchise, Global Medical Affairs, Gilead Sciences, Melbourne, Australia
| | - Janez Tomažič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
- Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
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Jia DT, Carcamo PM, Diaz MM. Ongoing Healthcare Disparities in neuroHIV: Addressing Gaps in the Care Continuum. Curr HIV/AIDS Rep 2023; 20:368-378. [PMID: 37999827 DOI: 10.1007/s11904-023-00683-9] [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] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW We aim to review the neurological complications of HIV and the social, cultural, and economic inequalities that contribute to disparities in neuroHIV care. RECENT FINDINGS Disparities in diagnostics and care of patients with neurological infections and non-infectious conditions associated with HIV in both high-income and low-to-middle-income countries (LMIC) are common. The COVID-19 pandemic has exacerbated these disparities. Factors, such as HIV-related stigma, may deter people from accessing HIV treatment. First-line recommended treatments for neurological infections are not available in many LMICs, leading to inadequate treatment and exposure to agents with more harmful side effect profiles. Access-related factors, such as lack of transportation, lack of health insurance, and inadequate telehealth access, may increase the risk of HIV-related neurological complications. Further research is needed to increase awareness of neurological complications among providers and PWH, and regional guidelines should be considered to better address these complications.
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Affiliation(s)
- Dan Tong Jia
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Paloma M Carcamo
- Laboratory of Epidemiology and Public Health, Yale School of Public Health, New Haven, CT, USA
- Health Innovation Laboratory, Alexander Von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Monica M Diaz
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
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Simha A, Prasad R, Ahmed S, Dinesh AS, Rao NP. Effect of national cultural dimensions and HIV prevalence rates on stigma towards people living with HIV/AIDS. PSYCHOL HEALTH MED 2023; 28:2908-2914. [PMID: 35361006 DOI: 10.1080/13548506.2022.2057557] [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] [Received: 01/27/2021] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
This paper examines the main and interactive effects of national culture dimensions and HIV prevalence rates on stigma towards people living with HIV/AIDS (PLHIVA). We examined these various relationships using data from a sample of 68,041 individuals from 49 countries, obtained from the World Values Survey. We used Hierarchical Linear Modeling to conduct our cross-level analyses. Our results indicated that collectivistic societies were positively associated while egalitarian and performance-oriented societies were negatively associated with stigma towards PLHIVA. Additionally, HIV prevalence rates interact with several cultural dimensions to worsen stigma towards PLHIVA. Our findings indicate the need to tailor stigma reduction strategies by taking the national culture dimensions of a given society into consideration when designing and implementing programs.
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Affiliation(s)
- Aditya Simha
- Department of Management, University of Wisconsin, Whitewater, WI, USA
| | - Ramakrishna Prasad
- PCMH Restore Health; National Center for Primary Care Research & Policy, Academy of Family Physicians of India (AFPI), Bengaluru, India
| | - Sana Ahmed
- Department of Management, Independent Scholar, United States of America
| | | | - Naren P Rao
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Qiu K, Lu J, Guo H, Du C, Liu J, Li A. Study on Respiratory Function and Hemodynamics of AIDS Patients with Respiratory Failure. Infect Drug Resist 2023; 16:6941-6950. [PMID: 37928608 PMCID: PMC10624180 DOI: 10.2147/idr.s376752] [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: 05/06/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Objective We performed a comparative analysis of respiratory function and hemodynamics among patients with Acquired Immunodeficiency Syndrome (AIDS)-associated respiratory failure and those with non-AIDS-associated respiratory failure. Methods Data were collected from critically ill patients diagnosed with Acquired Immunodeficiency Syndrome who were admitted to the Intensive Care Unit (ICU) of Beijing Ditan Hospital, affiliated with Capital Medical University, between January 1, 2019, and December 31, 2019. We simultaneously gathered data from non-AIDS patients admitted to the ICU of Beijing Liangxiang Hospital within the same timeframe. A comparative study was performed to analyze clinical data from these two patient groups, encompassing parameters related to respiratory mechanics and hemodynamic indicators. Results A total of 12 patients diagnosed with Acquired Immunodeficiency Syndrome (AIDS) and experiencing respiratory failure, along with 23 patients with respiratory failure independent of AIDS, were included in our study. Subsequently, a comparative analysis of clinical information was conducted between the two patient cohorts. Our findings demonstrate non-statistically significant differences between the two patient groups when assessing various indicators, encompassing peak airway pressure, plateau pressure, mean pressure, compliance, oxygenation index, and arterial partial pressure of carbon dioxide (P>0.05). Additionally, the comparison of multiple indicators encompassing mean arterial pressure, central venous pressure, cardiac output index, intrathoracic blood volume index, global end-diastolic volume index, extravascular lung water content, and pulmonary vascular permeability index revealed no statistically significant differences between the two patient groups (P>0.05). Ultimately, the Galileo respiratory system was utilized to assess the pressure-volume (P-V) curve of the experimental cohort, revealing a consistent and seamless trajectory devoid of noticeable points of inflection. Conclusion No statistically significant differences were found in the respiratory function and hemodynamic profiles between patients diagnosed with AIDS presenting respiratory failure and those experiencing respiratory failure unrelated to AIDS. Additionally, the pressure-volume curve of individuals diagnosed with AIDS presenting respiratory failure displayed a seamless and uninterrupted trajectory devoid of discernible points of inflection. Hence, there might be constraints when utilizing P-V curve-based adjustments for positive end-expiratory pressure (PEEP) during mechanical ventilation in individuals diagnosed with AIDS presenting respiratory failure.
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Affiliation(s)
- Kai Qiu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Intensive Care Medicine, Liangxiang Hospital of Beijing Fangshan District, Beijing, People’s Republic of China
| | - Jiaqi Lu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hebing Guo
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chunjing Du
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jingyuan Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ang Li
- Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Fu L, Wang B, Wu K, Yang L, Hong Z, Wang Z, Meng X, Ma P, Qi X, Xu G, Wang F, Zhang W, Huang C, Zhang D, Lin Y, Cao W, Sun P, Wu W, Gao Y, Lv F, Qian J, Lu H, Zou H. Epidemiological characteristics, clinical manifestations, and mental health status of human mpox cases: A multicenter cross-sectional study in China. J Med Virol 2023; 95:e29198. [PMID: 37881113 DOI: 10.1002/jmv.29198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
Human mpox is occurring worldwide, however, evidence from the Asian Pacific Region is limited. In this multicenter cross-sectional study, information of confirmed mpox cases diagnosed between June 1 and July 31, 2023 in China. Information included demographic and epidemiological characteristics, and clinical manifestations, laboratory results, and mental health status of mpox cases. A total of 115 confirmed mpox cases were enrolled. All cases were men. A total of 102 (90.3%) identified as homosexual. The median age was 31.0 years (interquartile range 27.0-36.5). A total of 65 (56.5%) were HIV-positive, of whom 92.3% were receiving antiretroviral therapy (ART). A total of 19/39 (40.4%) had a CD4 cell count <500 cells/μL. Systemic features such as fever (73.0%), lymphadenopathies (49.6%), and myalgia (28.7%) were commonly observed. Skin lesions were present in all participants: 49.6% in the genital area and 27.0% in the perianal area. Vesicular rash (78.3%) and papular rash (44.3%) were the most common lesion morphologies. People living with HIV were more likely to have anxiety than those living without HIV. The majority of mpox cases had primary genital lesions and sexual activities before diagnosis, which supports the likelihood of sexual contact transmission. Guidelines on hospitalization and isolation protocols for mpox patients necessitate further confirmation.
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Affiliation(s)
- Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Ke Wu
- Beijing Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Liuqing Yang
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern, University of Science and Technology, Shenzhen, China
| | - Zhongsi Hong
- Department of Infectious Diseases, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Ziyu Wang
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Xiaojun Meng
- Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Ping Ma
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Xiao Qi
- Beijing Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Guangyong Xu
- Department of Dermatology, Qingdao Sixth People's Hospital, Qingdao, Shandong, China
| | - Fuxiang Wang
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern, University of Science and Technology, Shenzhen, China
| | - Weijie Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Chenming Huang
- Beijing Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Dingyan Zhang
- Beijing Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Yuanlong Lin
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern, University of Science and Technology, Shenzhen, China
| | - Wanxian Cao
- Division of Life Sciences and Medicine, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
| | - Ping Sun
- Department of Infectious Diseases, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Weibo Wu
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern, University of Science and Technology, Shenzhen, China
| | - Yong Gao
- Division of Life Sciences and Medicine, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
| | - Fan Lv
- National Center for AIDS/Sexually Transmitted Disease Control and Prevention, The Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Qian
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hongzhou Lu
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern, University of Science and Technology, Shenzhen, China
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China
- School of Public Health, Southwest Medical University, Luzhou, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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Boesecke C, Schellberg S, Schneider J, Schuettfort G, Stocker H. Prevalence, characteristics and challenges of late HIV diagnosis in Germany: an expert narrative review. Infection 2023; 51:1223-1239. [PMID: 37470977 PMCID: PMC10545628 DOI: 10.1007/s15010-023-02064-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/10/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE We aimed to review the landscape of late HIV diagnosis in Germany and discuss persisting and emerging barriers to earlier diagnosis alongside potential solutions. METHODS We searched PubMed for studies informing the prevalence, trends, and factors associated with late HIV diagnosis in Germany. Author opinions were considered alongside relevant data. RESULTS In Germany, older individuals, heterosexuals, and migrants living with HIV are more likely to be diagnosed late. The rate of late diagnosis in men who have sex with men (MSM), however, continues to decrease. Indicator conditions less often prompt HIV testing in women and non-MSM. During the COVID-19 pandemic, the absolute number of late diagnoses fell in Germany, but the overall proportion increased, probably reflecting lower HIV testing rates. The Ukraine war and subsequent influx of Ukrainians living with HIV may have substantially increased undiagnosed HIV cases in Germany. Improved indicator testing (based on unbiased assessments of patient risk) and universal testing could help reduce late diagnoses. In patients who receive a late HIV diagnosis, rapid treatment initiation with robust ART regimens, and management and prevention of opportunistic infections, are recommended owing to severely compromised immunity and increased risks of morbidity and mortality. CONCLUSION Joint efforts are needed to ensure that UNAIDS 95-95-95 2030 goals are met in Germany. These include greater political will, increased funding of education and testing campaigns (from government institutions and the pharmaceutical industry), continued education about HIV testing by HIV experts, and broad testing support for physicians not routinely involved in HIV care.
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Affiliation(s)
| | | | - Jochen Schneider
- School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gundolf Schuettfort
- Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Hartmut Stocker
- Department of Infectious Diseases, St. Joseph Hospital, Berlin, Germany.
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Hidayat J, Chen MY, Maulina R, Nurbaya S. Factors Associated With HIV-Related Stigma Among Indonesian Healthcare Workers: A Cross-Sectional Online Survey. J Nurs Res 2023; 31:e295. [PMID: 37668415 DOI: 10.1097/jnr.0000000000000573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Despite worldwide advances in HIV care and growing scientific knowledge about HIV, stigma and prejudice continue to hinder people living with HIV/AIDS (PLWHA) from seeking treatment and care. HIV-related stigma among healthcare workers in Indonesia has been investigated and measured in only a few empirical studies. PURPOSE This study was developed to identify factors related to holding stigmatizing attitudes toward PLWHA among professional healthcare providers in Indonesia. METHODS A cross-sectional survey approach using convenience and snowball sampling techniques was used. Data were collected in February and March 2022. All of the participants were healthcare workers in Indonesia who had completed an online survey that collected demographic data and measured HIV-related stigma, fear of HIV transmission, and HIV-related knowledge. Bivariate analysis and multiple linear regression were used to investigate the association between the independent and dependent variables. RESULTS The study enrolled 252 participants, including eight physicians (3.2%), 200 nurses (79.4%), and 44 midwives (17.5%). Over two thirds of the participants (65.1%) had no formal HIV training. Stigmatizing attitudes were associated with lower levels of HIV knowledge ( B = -0.480, p < .01), fear of becoming infected with the HIV virus ( B = 0.354, p < .05), and type of HIV care setting ( B = -2.913, p < .05). Of the three participant categories, physicians had the highest levels of both HIV knowledge and PLWHA-related stigma. CONCLUSIONS The findings indicate many healthcare workers in Indonesia receive limited formal training on HIV, have low levels of HIV knowledge, and fear HIV transmission. Therefore, providing comprehensive and up-to-date education about HIV for health workers and proper personal protective equipment should be incorporated into programs aimed at reducing stigmatizing attitudes against patients with HIV among healthcare workers in Indonesia.
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Affiliation(s)
- Jufri Hidayat
- MSN, RN, Doctoral Student, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Miao-Yen Chen
- PhD, RN, Associate Professor, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Rufidah Maulina
- MS, Lecturer, Midwifery Department, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Sitti Nurbaya
- MS, Lecturer, Faculty of Nursing, Stikes Nani Hasanuddin Makassar, Indonesia
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Almeida A, Ogbonnaya IN, Wanyenze RK, Crockett KS, Ediau M, Naigino R, Lin CD, Kiene SM. A Psychometric Evaluation and a Framework Test of the HIV Stigma Mechanisms Scale Among a Population-Based Sample of Men and Women Living with HIV in Central Uganda. AIDS Behav 2023; 27:3038-3052. [PMID: 36917424 PMCID: PMC10440247 DOI: 10.1007/s10461-023-04026-y] [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] [Accepted: 02/13/2023] [Indexed: 03/15/2023]
Abstract
HIV stigma is a critical barrier to HIV prevention and care. This study evaluates the psychometric properties of the HIV Stigma Mechanisms Scale (HIV-SMS) among people living with HIV (PLHIV) in central Uganda and tests the underlying framework. Using data from the PATH/Ekkubo study, (n = 804 PLHIV), we assessed the HIV-SMS' reliability and validity (face, content, construct, and convergent). We used multiple regression analyses to test the HIV-SMS' association with health and well-being outcomes. Findings revealed a more specific (5-factor) stigma structure than the original model, splitting anticipated and enacted stigmas into two subconstructs: family and healthcare workers (HW). The 5-factor model had high reliability (α = 0.92-0.98) and supported the convergent validity (r = 0.12-0.42, p < 0.01). The expected relationship between HIV stigma mechanisms and health outcomes was particularly strong for internalized stigma. Anticipated-family and enacted-family stigma mechanisms showed partial agreement with the hypothesized health outcomes. Anticipated-HW and enacted-HW mechanisms showed no significant association with health outcomes. The 5-factor HIV-SMS yielded a proper and nuanced measurement of HIV stigma in central Uganda, reflecting the importance of family-related stigma mechanisms and showing associations with health outcomes similar to and beyond the seminal study.
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Affiliation(s)
- Alexandra Almeida
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA, USA
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Ijeoma Nwabuzor Ogbonnaya
- School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Katherine Schmarje Crockett
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Rose Naigino
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Chii-Dean Lin
- Department of Mathematics & Statistics, San Diego State University, La Jolla, CA, USA
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
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Okumu M, Logie CH, Chitwanga AS, Hakiza R, Kyambadde P. A syndemic of inequitable gender norms and intersecting stigmas on condom self-efficacy and practices among displaced youth living in urban slums in Uganda: a community-based cross-sectional study. Confl Health 2023; 17:38. [PMID: 37599369 PMCID: PMC10440931 DOI: 10.1186/s13031-023-00531-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Adverse socio-cultural factors compromise the implementation of HIV prevention strategies among displaced youth. While condoms are an affordable and effective HIV prevention strategy for youth, stigma and inequitable gender norms may constrain condom self-efficacy (i.e., knowledge, intentions, and relationship dynamics that facilitate condom negotiation) and use. Further, knowledge of contextually appropriate HIV prevention approaches are constrained by limited understanding of the socio-cultural conditions that affect condom self-efficacy and use among displaced youth. Guided by syndemics theory, we examine independent and joint effects of adverse socio-cultural factors associated with condom self-efficacy and use among displaced youth living in urban slums in Kampala, Uganda. METHODS We conducted a community-based cross-sectional survey of displaced youth aged 16-24 years living in five slums in Kampala. We used multivariable logistic regression and multivariate linear regression to assess independent and two-way interactions among adverse socio-cultural factors (adolescent sexual and reproductive health-related stigma [A-SRH stigma], perceived HIV-related stigma, and beliefs in harmful inequitable gender norms) on condom self-efficacy and recent consistent condom use. We calculated the prevalence and co-occurrence of adverse socio-cultural factors; conducted regression analyses to create unique profiles of adverse socio-cultural factors; and then assessed joint effects of adverse socio-cultural factors on condom self-efficacy and practices. RESULTS Among participants (mean age: 19.59 years; SD: 2.59; women: n = 333, men: n = 112), 62.5% were sexually active. Of these, only 53.3% reported recent consistent condom use. Overall, 42.73% of participants reported two co-occurring adverse socio-cultural factors, and 16.63% reported three co-occurring exposures. We found a joint effect of beliefs in harmful inequitable gender norms with high A-SRH stigma (β = - 0.20; p < 0.05) and high A-SRH stigma with high perceived HIV stigma (β = - 0.31; p < 0.001) on reduced condom self-efficacy. We found a multiplicative interaction between high A-SRH stigma with high perceived HIV stigma (aOR = 0.52; 95% CI 0.28, 0.96) on recent consistent condom use. Additionally, we found that condom self-efficacy (aOR = 1.01; 95% CI 1.05, 1.16) and safer sexual communication (aOR = 2.12; 95% CI 1.54, 2.91) acted as protective factors on inconsistent condom use. CONCLUSIONS Displaced youth living in urban slums exhibited low consistent condom use. Intersecting stigmas were associated with lower condom self-efficacy-a protective factor linked with increased consistent condom use. Findings highlight the importance of gender transformative and intersectional stigma reduction approaches to increase sexual agency and safer sex practices among Kampala's slum-dwelling displaced youth.
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Affiliation(s)
- Moses Okumu
- School of Social Work, University of Illinois, Urbana-Champaign, 1010 W. Nevada St., Urbana, IL, 61801, USA.
- School of Social Sciences, Uganda Christian University, Mukono, Uganda.
| | - Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
- United Nations University Institute for Water, Environment, and Health (UNU-INWEH), 204-175 Longwood Rd S, Hamilton, ON, L8P 0A1, Canada
| | - Anissa S Chitwanga
- School of Social Work, University of Illinois, Urbana-Champaign, 1010 W. Nevada St., Urbana, IL, 61801, USA
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Nsambya Gogonya, Kampala, Uganda
| | - Peter Kyambadde
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- Most at Risk Population Initiative, Mulago Hospital, Kampala, Uganda
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Abbas Q, Nisa M, Khan MU, Anwar N, Aljhani S, Ramzan Z, Shahzadi M. Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: a randomized control trial. BMC Psychiatry 2023; 23:539. [PMID: 37491185 PMCID: PMC10367308 DOI: 10.1186/s12888-023-05013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE Individuals living with HIV/AIDs are at a high risk of many problems like depression, stigma, quality of life, decreased adherence to treatment, and lack of social support. The present study aimed to investigate the impact of brief-cognitive behavior therapy (B-CBT) on reducing depression and stigma and improving treatment adherence, quality of life, and social support among patients with HIV/AIDS attending antiretroviral therapy (ART). MATERIALS AND METHODS This randomized clinical trial was conducted at ART Clinic in the Tehsil Headquarters Hospital Shahkot Nankana Sahib from July 2021 to October 2021. After baseline screening, 126 patients met the eligibility criteria and 63 were allocated to the experimental group (EXPg = 63) and 63 to waitlist-control group (WLCg = 63). Participants' age range was from 20 to 55 years. Participants who were taking ART treatment were enrolled for the CBT treatment. Before this, all the participants completed a baseline assessment to ensure a level of severity and diagnosis. A total of eight CBT based therapeutic sessions were conducted individually with EXPg. To assess the outcomes among patients receiving ART, we used Demographic form, Patient health questionnaire, HIV stigma scale, General medication adherence scale, Multidimensional scale of perceived social support, and WHOQOL BREF scale. RESULTS Findings suggest that B-CBT significantly reduced the level of depression (i.e. F (1, 78) = 101.38, p < .000, η2 = .599), and social stigma (i.e. F (1, 78) = 208.47, p < .000, η2 = .787) among patients with HIV/AIDS. Furthermore, CBT substantially improved the level of adherence to treatment (i.e. F(1,78) = 24.75, p < .000, η2 = .503), social support (i.e. F (1, 78) = 128.33, p < .000, η2 = .606), and quality of life (i.e. F (1, 78) = 373.39, p < .000, η2 = .837) among patients with HIV/AIDS. Significant mean difference M(SD) on PHQ at post-analysis in the EXPg vs. WLCg was seen 1.22(0.47) vs. 2.30(0.68) and similarly, on MPSS at a post-analysis in the EXPg vs. WLCg 2.85(0.36) vs. 1.70(0.51) which indicates sound therapeutic outcomes. CONCLUSIONS Cognitive behavioral therapy effectively decreases the level of depression and stigma and enhances the level of social support, quality of life, and adherence to treatment among HIV/AIDS patients. It is concluded that cognitive behavior therapy is an effective treatment approach for patients with HIV/AIDS. TRIAL REGISTRATION Thai clinical trial registry (i.e. TCTR = TCTR20210702002 ).
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Affiliation(s)
- Qasir Abbas
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan.
| | - Mehru Nisa
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan
| | - Muhammad Umar Khan
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan
| | - Nida Anwar
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sumayah Aljhani
- Department of Psychiatry, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Zoobia Ramzan
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mafia Shahzadi
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan
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Lo Hog Tian JM, Watson JR, McFarland A, Parsons JA, Maunder RG, McGee A, Boni AR, Cioppa L, Ajiboye ME, Rourke SB. The cost of anticipating stigma: a longitudinal examination of HIV stigma and health. AIDS Care 2023:1-9. [PMID: 36942573 DOI: 10.1080/09540121.2023.2190575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Levels of HIV stigma remain high, however there is a limited understanding around how different types of stigma interact to impact health. This study uses data from two time points to examine how enacted and internalized stigma lead to worse health through anticipated stigma as a mediator. We recruited 341 participants in Ontario, Canada to complete the HIV Stigma Index survey at baseline (t1) from September 2018 to August 2019 and follow up (t2) approximately two years later. Mediation models were created with enacted and internalized stigma at t1 as the antecedents, anticipated stigma at t2 as the mediator, and physical health, mental health, and overall health at t2 as the outcomes. Only the model with internalized stigma (t1) as the antecedent had anticipated stigma (t2) as a significant mediator contributing to both decreased mental and overall health. This highlights the need to address internalized stigma and the potential for anticipated stigma interventions to be effective at improving the health and wellbeing of people living with HIV.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Abbey McFarland
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Janet A Parsons
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Department of Physical Therapy and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - A McGee
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Anthony R Boni
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Lynne Cioppa
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Monisola E Ajiboye
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- International Community of Women Living with HIV, Toronto, Canada
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Watt MH, Minja LM, Barabara M, Mlay P, Stephens MJ, Olomi G, Mlay J, Marchand V, Mmbaga BT, Hanson OR, Cohen SR. A simulation and experiential learning intervention for labor and delivery providers to address HIV stigma during childbirth in Tanzania: study protocol for the evaluation of the MAMA intervention. BMC Pregnancy Childbirth 2023; 23:181. [PMID: 36927460 PMCID: PMC10018883 DOI: 10.1186/s12884-023-05482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The experience of HIV stigma during intrapartum care can impact women's trust in the health care system and undermine their long-term commitment to HIV care engagement. Delivery of respectful maternity care (RMC) to women living with HIV (WLHIV) can improve quality of life and clinical outcomes. The goal of this study is to conduct an evaluation of MAMA (Mradi wa Afya ya Mama Mzazi, Project to Support the Health of Women Giving Birth), a simulation team-training curriculum for labor and delivery providers that addresses providers' instrumental and attitudinal stigma toward WLHIV and promotes the delivery of evidence-based RMC for WLHIV. METHODS The MAMA intervention will be evaluated among healthcare providers across six clinics in the Kilimanjaro Region of Tanzania. To evaluate the impact of MAMA, we will enroll WLHIV who give birth in the facilities before (n = 103 WLHIV) and after (n = 103 WLHIV) the intervention. We will examine differences in the primary outcome (perceptions of RMC) and secondary outcomes (postpartum HIV care engagement; perceptions of HIV stigma in the facility; internal HIV stigma; clinical outcomes and evidence-based practices) between women enrolled in the two time periods. Will also assess participating providers (n = 60) at baseline, immediate post, 1-month post training, and 2-month post training. We will examine longitudinal changes in the primary outcome (practices of RMC) and secondary outcomes (stigma toward WLHIV; self-efficacy in delivery intrapartum care). Quality assurance data will be collected to assess intervention feasibility and acceptability. DISCUSSION The implementation findings will be used to finalize the intervention for a train-the-trainer model that is scalable, and the outcomes data will be used to power a multi-site study to detect significant differences in HIV care engagement. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov, NCT05271903.
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Affiliation(s)
- Melissa H. Watt
- Intermountain Healthcare, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake, UT 84102 USA
| | - Linda M. Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Pendo Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Maya J. Stephens
- Intermountain Healthcare, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake, UT 84102 USA
| | | | - Janeth Mlay
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | - Olivia R. Hanson
- Intermountain Healthcare, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake, UT 84102 USA
| | - Susanna R. Cohen
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT USA
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Chautrakarn S, Ong-Artborirak P, Naksen W, Thongprachum A, Wungrath J, Chariyalertsak S, Stonington S, Taneepanichskul S, Assanangkornchai S, Kessomboon P, Neelapaichit N, Aekplakorn W. Stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among general adult population: the results from the 6 th Thai National Health Examination Survey (NHES VI). J Glob Health 2023; 13:04006. [PMID: 36637802 PMCID: PMC9838688 DOI: 10.7189/jogh.13.04006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Thailand has an ongoing action plan to reduce human immunodeficiency virus (HIV) discrimination and stigma. We aimed to monitor the level of stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among the general adult population and to investigate its related factors. Methods This study was based on data from the 6th Thai National Health Examination Survey, a large-scale country-wide survey in 2019-2020. We used a multistage sampling technique and included 11 843 adults aged 20 to 59. We collected data through face-to-face interviews which included six items related to HIV stigma domains. We weighted all analyses to account for the probability of sampling the Thai population aged 20 to 59 years. Results We found that anticipated stigma had the highest percentage of negative stigmatizing attitude responses (78.5%), followed by perceived stigma (66.6%), fear of HIV infection (54.4%), and social judgment (28.2%). Regarding the UNAIDS global indicator for discriminatory attitude, 48.6% of respondents had negative perceptions to questions about experienced stigma or discrimination. Multiple logistic regression showed that factors associated with discriminatory attitudes toward PLWHA were being aged 20-39 (adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.18-1.47) or 50-59 (aOR = 1.23, 95% CI = 1.09-1.40) compared to being aged 40-49, being Muslim compared to Buddhist (aOR = 1.73, 95% CI = 1.46-2.06), being married compared to being single (aOR = 1.15, 95% CI = 1.04-1.28), holding certificate degree or higher compared to not studying or studying at a primary level (aOR = 0.81, 95% CI = 0.68-0.97), living in the Northeast (aOR = 1.27, 95% CI = 1.12-1.45) and Bangkok (aOR = 1.30, 95% CI = 1.12-1.51) compared to living in the North, having no HIV/AIDS infected relative or acquaintance compared to having an HIV/AIDS infected relative or acquaintance (aOR = 1.56, 95% CI = 1.41-1.73), and not obtaining an HIV test compared to obtaining it (aOR = 1.10, 95% CI = 1.02-1.19). Conclusions We found that HIV stigmatizing and discriminatory attitudes toward PLWHA decreased, but remained concerning among Thai adult people. A public education and awareness campaign, as well as an intervention to reduce HIV-related stigma and discrimination in the country's health care facilities, must still be maintained.
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Affiliation(s)
| | | | - Warangkana Naksen
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jukkrit Wungrath
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | - Scott Stonington
- Departments of Internal Medicine and Anthropology, University of Michigan, Michigan, USA
| | | | | | | | | | - Wichai Aekplakorn
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,National Health Examination Survey Office, Bangkok, Thailand
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Significant Others and Not Family or Friend Support Mediate Between Stigma and Discrimination Among People Living With HIV in Lagos State, Nigeria: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:96-104. [PMID: 36198119 DOI: 10.1097/jnc.0000000000000366] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
ABSTRACT Approximately 70% of the 37.7 million people living with HIV (PLWH) globally reside in sub-Saharan Africa and 10% of the global HIV burden is in Nigeria. PLWH encounter stigma and discrimination. Limited support from family, friends, and significant others increases stigma and discrimination among PLWH. This study sought to understand how support from family, friends, and significant others mediates stigma and discrimination in the Nigerian context. This descriptive cross-sectional study enrolled 396 PLWH from six health facilities between June and July 2021 in Lagos State, Nigeria. Stigma, discrimination, and social support were assessed. On average, participants were 32 years of age and female. Increased social support was associated with reduced stigma and discrimination. Support from participants' significant others was found to mediate the relationship between stigma and discrimination.
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Lofgren SM, Tsui S, Natala N, Nakasujja N, Sebuliba R, Ndyetukira JF, Arinda A, Akinyange V, Hullsiek KH, Nalintya E, Sadiq A, Pastick KA, Stadleman A, Meya D, Boulware DR. Differences in Reasons for Late Presentation to HIV Care in Uganda Among Men and Women. AIDS Behav 2023; 27:303-313. [PMID: 35916948 PMCID: PMC9343575 DOI: 10.1007/s10461-022-03764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Late presentation to HIV care, i.e., presenting with < 200 CD4 cells/mL, is associated with higher mortality and worse outcomes. Despite that, a quarter of people living with HIV in Uganda still present late to care. We surveyed Ugandans living with HIV who enrolled in clinic ≤ 90 days prior. We compared groups who presented 'late' with CD4 < 200 and 'early' with CD4 > 350, stratifying by sex. We found men who presented late had higher externalized stigma than early presenters. Thirty-six percent of the entire cohort were depressed. Social support was stronger in late presenters versus early, although weak overall. Social support was inversely correlated with depression, with social support dropping as depression increased. Interventions to improve clinic privacy, reduce stigma, improve social support, and help women disclose their HIV status to male partners are needed to reduce late presentation to HIV care.
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Affiliation(s)
- Sarah M Lofgren
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, 689 23rd Avenue S.E., Minneapolis, MN, 55455, USA.
- Infectious Diseases Institute, Makerere University, Kampala, Uganda.
| | - Sharon Tsui
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Nakita Natala
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | | | - Raymond Sebuliba
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Anita Arinda
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | | | - Kathy H Hullsiek
- Division of Biostatistics, University of Minnesota, School of Public Health, Minneapolis, MN, USA
| | | | - Alisat Sadiq
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Katelyn A Pastick
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, 689 23rd Avenue S.E., Minneapolis, MN, 55455, USA
| | - Anna Stadleman
- Division of Biostatistics, University of Minnesota, School of Public Health, Minneapolis, MN, USA
| | - David Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, 689 23rd Avenue S.E., Minneapolis, MN, 55455, USA
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50
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Severin S, Delforge M, De Wit S. Epidemiology, comorbidities at diagnosis and outcomes associated with HIV late diagnosis from 2010 to 2019 in a Belgian reference centre: A retrospective study. HIV Med 2022; 23:1184-1194. [PMID: 36356949 DOI: 10.1111/hiv.13440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Our objective was to investigate the demographic factors, comorbidities, and outcomes of patients with a late diagnosis (LD) of HIV in a Belgian HIV reference centre. METHODS All patients with HIV who presented for care between 2010 and 2019 were included. They were excluded if time between diagnosis and presentation or first CD4 count exceeded 6 months or if they had previously received antiretroviral therapy (ART). LD was defined as a CD4 cell count ≤350/mm3 or an AIDS-defining event at diagnosis. Data were retrospectively collected and included data on demographic variables, cardiovascular risk factors, comorbidities at diagnosis, first prescribed ART, and outcomes. Logistic regression was used to determine factors associated with LD. RESULTS Of 1078 patients, 427 (39.6%) were LD. In multivariable analysis, the following factors were associated with LD: non-homosexual transmission route, being born in Sub-Saharan Africa (SSA), and age ≥35 years. Prevalence at diagnosis of malignancies, diabetes, and cardiovascular diseases did not differ between non-LD and LD, whereas renal impairment was more frequent in LD. In univariable analysis, high-density lipoprotein (HDL) cholesterol <40 mg/dL and estimated glomerular filtration rate <60 ml/min were associated with LD; in multivariable analysis, only HDL cholesterol <40 mg/dL was associated. Patients with LD experienced more adverse events leading to a switch in ART, virological failure, and death during follow-up. CONCLUSION LD remains common in our centre, especially in non-homosexual patients and those born in SSA. Although not associated with an important burden of comorbidities at diagnosis, it still results in poorer outcomes, emphasizing the need to expand coverage and access to HIV testing.
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Affiliation(s)
- Simon Severin
- Division of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium
| | - Marc Delforge
- Division of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium
| | - Stéphane De Wit
- Division of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium
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