HIV Community-Level Stigmatizing Attitudes in Tanzania: Perspectives from Antenatal Care

Patient experiences and contextual appropriateness of universal screening for depression and suicide risk in HIV care: a qualitative study in Tanzania

Introduction

Depression and suicidal thoughts and behaviour are remarkably common among people living with HIV worldwide, leading to a higher burden of disease, poor HIV care engagement, and death. Suicidal behaviour is criminalized in 20 countries worldwide, including Tanzania, where context-appropriate interventions are lacking.

Methods

We describe the experiences of patients who were screened for depression and suicidal ideation by HIV clinic nurses, and how the socio-cultural context influences these experiences. This screening was the initial procedure in a randomized controlled clinical trial and parent study aimed at reducing suicide and depression and improving HIV care engagement in Kilimanjaro, Tanzania. We conducted in-depth interviews (IDIs) with 20 people living with HIV. Interviews were held 3 months post-enrollment of participants. Data was collected from July to November 2023. We referred to a brief screener developed for the trial, combining the PHQ-2 for depression and one question on suicidal ideation. IDIs focused on the experiences and appropriateness of being screened for depression and suicidal ideation, factors influencing these challenges, and opinions on the illegality of suicidal behaviour in Tanzania. Data was analyzed using Nvivo 14. Thematic analysis approach was utilized to identify, review and, label codes. Differences were resolved by the first three and final authors.

Results

Our findings revealed high appreciation for the screening and occasional initial discomfort. Stigma, misinformation, and poverty contributed to mental health challenges. Patients favoured abolishment of laws against suicide due to their hindering support-seeking and impracticality for individuals in mental health crises.

Discussion

In a mental health resource-limited setting, these findings highlight the need for targeted and integrated non-specialist screenings and interventions and outsourcing HIV and mental health support beyond healthcare facilities. Further research is needed to assess the sustainability of screening.

Understanding male involvement in antenatal care in the Kilimanjaro region of Tanzania: Barriers, facilitators, and opportunities for engagement

BACKGROUND

Male engagement in antenatal care (ANC) has been recommended by the World Health Organization to improve maternal and newborn health outcomes, but implementation challenges remain. This study explored barriers, facilitators, and opportunities to improve male attendance and engagement in ANC.

METHODS

In-depth interviews were conducted individually with pregnant women and male partners attending a first ANC visit at two public health facilities in Moshi, Tanzania. Interviews examined factors influencing male ANC attendance and male experiences during the clinic visit. Interviews were recorded, transcribed verbatim, and translated from Swahili into English. Transcripts were coded thematically in NVivo.

MAIN FINDINGS

Constructions of masculinity both positively and negatively influenced male involvement in ANC. Individual-level barriers included a fear of HIV testing, perceptions of pregnancy as the woman's responsibility, and discomfort with ANC as a predominantly female space. Structural barriers included inability to take time off from work and long clinic wait times. The primary facilitator to male involvement was the preferential care given in the ANC clinic to women who present with a male partner. Additionally, some men desired to learn about their family's health status and felt that attending ANC was a sign of respect and love for their partner.

CONCLUSIONS

Opportunities exist to improve male involvement in ANC, namely training providers to engage men beyond HIV testing and counseling. Peer programs that promote men's engagement in pregnancy could prove useful to reduce apprehension around HIV testing and dispel conceptions of ANC as only a women's healthcare space.

The Development and Psychometric Evaluation of the HIV Stigmatizing Attitudes Scale (HSAS) in Tanzania

HIV stigmatizing attitudes are embedded in social context, making it important to develop culturally specific tools for accurate measurement. The goal of this study was to develop and evaluate the psychometric properties of the HIV Stigmatizing Attitudes Scale (HSAS) in Moshi, Tanzania. Items were adapted based on a scale developed by Visser et al. which was one of the first to measure HIV stigmatizing attitudes in the general population (i.e., people not living with HIV). Items were translated into Swahili and modified with iterative feedback. The HSAS was administered to participants (N = 1494) in an HIV stigma reduction intervention study at two antenatal care clinics in Moshi, Tanzania. The HSAS was found to have strong domain coherence and high reliability based on Cronbach’s alpha, Omega 6 coefficient values, and the composite reliability coefficient, and high validity based on content-oriented evidence, relations to other variables, and response process. Factor analysis revealed a two-factor structure (Moral Judgment and Interpersonal Distancing), consistent with the original Visser scale. The HSAS provides a robust way to measure HIV stigma in the Tanzanian context and can be culturally adapted to other settings.