HIV-related stigma and uptake of antiretroviral treatment among incarcerated individuals living with HIV/AIDS in South African correctional settings: A mixed methods analysis

Accessing HIV care services by key populations - An Ubuntu philosophy reflection

BACKGROUND

 Key populations are disproportionately affected by HIV despite the significant decrease in new HIV infections in Africa. They experience challenges like stigma and discrimination as they interface with the healthcare system. This results in reduced access to HIV care services for key populations. Therefore, the attainment of HIV epidemic control may not be easily realised if these gaps are not addressed.

OBJECTIVES

 To explore and synthesise factors associated with accessing HIV care services by key populations, as well as make a reflection of this process using Ubuntu philosophy.

METHOD

 An integrative literature review was conducted on studies published between 2014 and 2024. An electronic search was performed on several databases. Examples of key phrases that were utilised for the search included Africa, HIV care services, key populations and Ubuntu. The studies included were qualitative and quantitative from peer-reviewed journals and restricted to Africa.

RESULTS

 The following themes emerged: non-inclusive healthcare environment, attitudes of healthcare workers and stigma and discrimination. These findings illustrate the challenges and barriers affecting access to HIV care services for key populations.

CONCLUSION

 The insights from this review call for a paradigm shift in the training programmes of healthcare providers in Southern Africa.Contribution: Given the challenges that affect key populations as they access HIV care services, in-service and pre-service training of healthcare providers should incorporate the humane values of Ubuntu.

"Don't Tell Nobody Nothing": A Phenomenological Study on Fear of HIV Disclosure Among Older African Americans During Incarceration Living in Kentucky, USA

ABSTRACT

The intersections of HIV with aging, incarceration, and racial disparities have been well studied, but little is known about the lived incarceration experiences of older African American persons living with HIV. This phenomenological study examined the fear of HIV disclosure among older African Americans living in Kentucky who have experienced incarceration. Based on the interviews analyzed, five main themes were identified: experiences with fear, experiences pertaining to confidentiality, experiences with disclosure, experiences with stigma, and the desire to be accepted. These themes demonstrate HIV disclosure fear within incarceration settings and the desire for support and services. Findings suggest that there should be more efforts to increase HIV knowledge and awareness within incarceration settings. Participants shared that having a support network alleviates isolation. We recommend that correctional settings implement policies to protect confidentiality violations and facilitate groups to help foster a more supportive environment for individuals living with HIV.

Intersectional HIV stigma in Sub-Saharan Africa, Latin America and the Caribbean: Insights and pathways forward - A scoping review

Research has recently surged on intersectional HIV stigma, including how intersecting stigmatized identities and socio-structural conditions influence HIV prevention and treatment outcomes. However, most of this work has been concentrated in high-income settings. This scoping review aimed to provide an overview of research on intersectional HIV stigma in Sub-Saharan Africa, Latin America and the Caribbean. A search was conducted using five databases for articles published between January 2008 and April 2023. Two reviewers independently screened all identified studies, sorted the included studies, and conducted descriptive analyses. Of 1907 retrieved studies, 73 met inclusion criteria, of which 16% were intervention studies and 84% were non-intervention studies. Stigma was propagated through structural factors (e.g., anti-sexual and gender minority laws), institutional factors, and socio-demographic factors. Moreover, place-based differences emerged. Findings of the scoping review were discussed and interpreted by a community advisory board composed of activists and researchers from Sub-Saharan Africa, Latin America, and the Caribbean, which provided recommendations on the pathways forward in research for intersectional HIV stigma. Future research on intersectional stigma should encompass social marketing studies for promoting inclusive HIV services, strategies to transform the narrative in media, and investigations into the impact of laws against sexual and gender minority (SGM) individuals on HIV service participation, all approached from the perspective of those affected by the intersectional stigma.

Correction: Correction: HIV-related stigma and uptake of antiretroviral treatment among incarcerated individuals living with HIV/AIDS in South African correctional settings: A mixed methods analysis

[This corrects the article DOI: 10.1371/journal.pone.0259616.].

Reaching for 90:90:90 in Correctional Facilities in South Africa and Zambia: Virtual Cross-Section of Coverage of HIV Testing and Antiretroviral Therapy During Universal Test and Treat Implementation

BACKGROUND

People in correctional settings are a key population for HIV epidemic control. We sought to demonstrate scale-up of universal test and treat in correctional facilities in South Africa and Zambia through a virtual cross-sectional analysis.

METHODS

We used routine data on 2 dates: At the start of universal test and treat implementation (time 1, T1) and 1 year later (time 2, T2). We obtained correctional facility census lists for the selected dates and matched HIV testing and treatment data to generate virtual cross-sections of HIV care continuum indicators.

RESULTS

In the South African site, there were 4193 and 3868 people in the facility at times T1 and T2; 43% and 36% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 1803 (43%) and 1386 (36%) had known HIV status, 804 (19%) and 845 (21%) were known to be living with HIV, and 60% and 56% of those with known HIV were receiving antiretroviral therapy (ART). In the Zambian site, there were 1467 and 1366 people in the facility at times T1 and T2; 58% and 92% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 857 (59%) and 1263 (92%) had known HIV status, 277 (19%) and 647 (47%) were known to be living with HIV, and 68% and 68% of those with known HIV were receiving ART.

CONCLUSIONS

This virtual cross-sectional analysis identified gaps in HIV testing coverage, and ART initiation that was not clearly demonstrated by prior cohort-based studies.

COVID-19-related stigma within a rural South African community: A mixed methods analysis

BACKGROUND

Infectious disease-related stigma is a pervasive global issue that impedes disease control efforts by increasing reluctance to seek treatment or engagement in prevention behaviors for fear of ostracism. Despite this, there is limited research on COVID-19 stigma in Africa, specifically rural South Africa, which has faced infectious disease-related stigma throughout the HIV epidemic.

METHODS

Population-based surveys were conducted among 1,662 adults living in the Agincourt Health and Socio-Demographic Surveillance System (AHDSS) area in Mpumalanga, South Africa, in August-October 2020 and August-October 2021. Surveys measured anticipated COVID-19-related stigma from low to high levels. Changes in stigma between surveys were compared using Wilcoxon ranked sign tests, and log-binomial models estimated the association between socio-demographic factors and anticipated stigma at both intervals. Qualitative interviews were conducted in 2022 among 31 adults who completed the original surveys, and the data were analyzed thematically to describe anticipated, perceived, and enacted stigma.

RESULTS

Anticipated stigma significantly decreased from the first to the second survey (p-value:<0.0001). Stigma was significantly higher among older age groups. In 2020, those less knowledgeable about COVID-19 were 2.24 times as likely to have higher levels of anticipated stigma compared to those who were more knowledgeable (RR:2.24, 95% CI: 1.90,2.64). Fear of being stigmatized influenced willingness to disclose infection. Participants perceived COVID-19 stigma as similar to HIV/AIDS stigma, but concern and fear reduced over time, with differences observed across generations and sexes. For some, fear of death and mistrust of others endorsed enacting stigma toward others.

CONCLUSION

While COVID-19 stigma decreased over time in rural South Africa, different forms of stigma persisted and influenced participants' willingness to reveal their COVID-19 infection status. Given South Africa's history with infectious disease-related stigma hindering public health efforts, it is crucial that government bodies prioritize strategies to mitigate stigma in rural communities.

Ubuntu Is a Critical Component in the Fight against Human Immunodeficiency Virus and Tuberculosis Stigma: Nursing Students' Perceptions

Stigma is one of the documented barriers to achieving universal access to human immunodeficiency virus (HIV) and tuberculosis (TB) prevention, treatment, care, and support programs. The lack of African social theories to emphasize these issues may be the cause of the continent's failure to reduce stigma. We can use Ubuntu, an African philosophy that emphasizes sociability and ethics, to deepen our understanding of how to reduce HIV- and TB-related stigma in South Africa. In many African regions, Ubuntu values and principles were found to assist in reducing problems related to HIV. Ubuntu is a comprehensive phrase used by Africans to signify the characteristics that incorporate the core human virtues of compassion and humanity. We explored the perceptions of nursing students regarding the use of Ubuntu in the fight against HIV and TB stigma. Qualitative participatory research was used to engage all first- and second-level nursing students enrolled for the 2023 academic year at the selected university in South Africa. Purposive sampling was used to recruit the participants. An interactive workshop was used to gather data. The data from the recordings and flip charts were analysed together. Throughout the study, trustworthiness and ethical principles were upheld. Two primary themes emerged as expressions of Ubuntu in relation to a reduction in HIV and TB stigma and recognition of Ubuntu as a tool to combat stigma associated with HIV and TB. This confirms that within Ubuntu, there are elements that might be applied to reduce stigma attached to HIV and TB.

Human immunodeficiency virus care and management in incarcerated populations in Sub-Saharan Africa between 2010 and 2022: A narrative review

BACKGROUND

Different countries in sub-Saharan Africa (SSA) have established guidelines to reduce HIV transmission and improve its management in prisons. This narrative review aimed to examine established literature on HIV care and management among incarcerated persons in SSA to identify successful interventions that could inform improved guidelines, policies, and practices related to the clinical care of this population.

METHODS

We searched PubMed, Scopus, Web of Science, Embase, and TRIP Medical Databases in August 2022 for articles published between 1st January 2010 and 30th June 2022. We identified 27 eligible articles based on the Population/Concept/Context framework.

RESULTS

HIV screening primarily involved mass campaigns rather than formal prison programmes, with limited implementation of universal testing and treatment. Although a few studies reported on access to antiretrovirals (ARVs), prisoners in urban areas and females had disproportionate access. Barriers identified include poor living conditions, high levels of stigma, and resource constraints. Inter-prison transfers, release from prison, and lack of established programmes hindered follow-up and linkage to care.

CONCLUSIONS

The implementation of strategies such as universal testing and treatment, human resource strengthening, financing plans for testing, ARV care, and frequent assessment of risk could improve HIV care and management in prisons in SSA.

Stigmatisation and resistance processes: Reflections on the field of HIV research and an agenda for contemporary stigma studies

Stigmatisation processes constitute key barriers to effectively addressing the HIV pandemic. In this article, we provide a critical overview of this field's current state of the art, highlighting some key emerging issues that merit greater research attention in the future to ensure that contemporary research on stigmatisation and resistance processes continues to engage with changing social and political circumstances. We look at how resistance to stigma has developed in the context of HIV and highlight some of the most important programmatic strategies that have emerged over the history of the pandemic. We present the key concepts of 'moral panics' and 'necropolitics', and we articulate them in relation to new global phenomena that deepen the processes of stigmatisation. Moreover, we identify an agenda for investigation which merits greater attention in future research, intervention, and advocacy: 1) changing political environments, neoliberalism, growing political polarisation, and the rise of political extremism; 2) the rise of the information age, technological change, and social media; and 3) rebuilding civil society and governmental responses to stigma.

The Relationship Between Intersectional Drug Use and HIV Stigma and HIV Care Engagement Among Women Living with HIV in Ukraine

This study used an intersectional approach to explore the association between enacted and internalized drug use and HIV stigma on HIV care outcomes among HIV-positive women who inject drugs in Ukraine. Surveys were conducted in Kyiv in 2019-2020. Among the 306 respondents, 55% were engaged in HIV care. More than half (52%) of participants not engaged in care reported internalized stigma related to both drug use and HIV status (i.e., intersectional stigma), compared to only 35% of those who were engaged in HIV care. Among those engaged in care, 36% reported intersectional enacted stigma compared to 44% of those not engaged in care; however, this difference was not statistically significant in the univariable analysis (p = 0.06). In the univariable analysis, participants who reported intersectional internalized stigma had 62% lower odds of being engaged in HIV care (OR 0.38, 95% CI 0.22, 0.65, p < 0.001). In the adjusted model, reported intersectional internalized stigma (aOR 0.52, 95% CI 0.30, 0.92, p = 0.026), reported intersectional enacted stigma (aOR 0.47, 95% CI 0.23, 0.95, p = 0.036), and knowing their HIV status for more than 5-years (aOR 2.29, 95% CI 1.35, 3.87, p = 0.002) were significant predictors of HIV care engagement. These findings indicate that interventions to improve HIV care engagement must address women's experiences of both HIV and drug use stigma and the different mechanisms through which stigma operates.

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

Background: With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular.

Methods: Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis.

Results: Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention.

Conclusion: Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.