The Thai Internalized HIV-related Stigma Scale

Stigma and discrimination against adolescents living with perinatal HIV in Thailand: caregivers' perceptions

Background

Thailand has been particularly affected by the HIV epidemic in the middle of the years 1990s. Thousands of children living with perinatal HIV have been exposed to HIV-related stigma/discrimination, but its frequency and expressions have been little studied. Our objectives were to assess, among adolescents living with perinatal HIV, the prevalence of stigma/discrimination, the factors associated with it and its expressions.

Methods

All caregivers of adolescents aged 12-19 years living with perinatal HIV and receiving antiretrovirals in 20 hospitals throughout Thailand were invited to complete a face-to-face questionnaire on their adolescent's life, and to report their adolescents' experiences of stigma/discrimination. Stigma/discrimination as perceived by the caregivers was analyzed using both quantitative and qualitative approaches.

Results

A total of 712 adolescents living with perinatal HIV and their caregivers were interviewed as part of the TEEWA study between March 2010 and November 2012. Of the 572 adolescents living in family settings, 464 had their HIV-status known in the community. Among them, the overall stigma/discrimination prevalence was 46%. The multivariable analysis showed that the risk of being stigmatized was nearly 3 times higher in the northeast region (OR: 2.93, 95%CI: 1.36-6.45) and when having a low intellectual ability (OR: 3.35, 95%CI: 1.66-7.10). It was nearly twice higher in case of conflicts with caregivers (OR: 1.81, 95%CI: 1.17-2.79) and when caregivers were members of a support group (OR: 2.28, 95%CI: 1.48-3.53), while having a BMI >18.5 was associated with a lower risk of stigma/discrimination (OR: 0.61, 95%CI: 0.37-0.98). Expressions of stigma/discrimination included bullying, social isolation, behavioral discrimination and public disclosure. Consequences of stigma/discriminations included voluntary withdrawal from school, painful awareness of HIV status, marginalization from the community, and separation of drinks and food.

Conclusion

We found that the prevalence of stigma/discrimination among adolescents living with perinatal HIV was high. Despite existing policies, stigma eradication remains necessary to normalize their life as they grow into adulthood and may face the consequences of past/current discrimination in terms of access to university studies or occupation, at work, in the community or in their romantic life.

Factors associated with internalized HIV-related stigma among people living with HIV in Thailand

Internalized HIV-related stigma (IHS) among people living with HIV (PLHIV) has been documented as one of the factors contributing to the ongoing AIDS epidemic. The purpose of this study, which was conducted from September 2021 to January 2022, was to measure prevalence and identify factors associated with IHS among research participants who were living with HIV recruited from a research clinic in Chiang Mai, Northern Thailand. Participants were considered to have IHS if they agreed to at least one of the 8 items of the newly developed Thai Internalized HIV-related Stigma Scale (Thai-IHSS). Of the 104 participants, 65.4% were female. The median age was 51.5 years and the duration of known HIV infection was 19.0 years. Fifty-three percent of the participants had IHS as defined by the study. Reduced probability of having IHS was independently associated with certain levels of education (middle or high school education compared with no or primary school) (AOR = 0.30; 95% CI: 0.12-0.77) and increased mental health-related quality of life (AOR = 0.39; 95% CI: 0.18-0.86). The prevalence of IHS among PLHIV in Chiang Mai was high. These findings highlight the requirement for comprehensive mental health care programs for PLHIV to improve their quality of life.