HIV Stigma and Status Disclosure in Three Municipalities in Ghana

Experiences of Disclosure, Resilience and Viral Suppression among People Living with HIV in Ghana

Support for people living with HIV (PLHIV) as they disclose their HIV status can impact continuity of HIV treatment and adherence to antiretrovirals. In the presence of multi-level adversities, resilience among PLHIV can promote health-seeking behaviors and better health outcomes. However, few studies have examined how disclosure experience and resilience work together to impact HIV treatment outcomes among PLHIV. In this study, we assessed the relationships between HIV disclosure experience, resilience and viral suppression among PLHIV in Ghana. The Stigma Index 2.0 questionnaire was completed by 1827 PLHIV in Ghana in 2021 to assess demographics, experiences of HIV related stigma, resilience-factors, and other self-reported outcomes including viral suppression. Participants were also asked to classify their disclosure experience with friends and family as positive or negative. Multivariable log-binomial models estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the association between disclosure experience and viral suppression. A dichotomized measure of resilience was evaluated as a potential effect measure modifier, and subgroup analyses explored associations by key population. Overall, those with a positive disclosure experience were more likely to have achieved viral suppression than participants with a negative disclosure experience (PR 1.09, 95%CI:1.00-1.19). This association increased among participants with lower resilience scores (PR 1.33, 95%CI:1.11-1.60). Findings suggest the importance of early positive social interactions for sustained engagement in ART, particularly for marginalized populations who face psychosocial and structural stigmas that challenge resilience. Ultimately, optimizing HIV treatment necessitates interventions that mitigate community stigma and promote resilience-building strategies for PLHIV in Ghana.

Healthcare workers' perspective about barriers and facilitators to pediatric HIV status disclosure in eastern Uganda using capability opportunity and motivation of behavior change model

HIV status disclosure by caregivers to children and adolescents living with HIV (CALH) remains a public health concern in countries with a high burden of HIV despite guidelines for healthcare workers (HCWs) to facilitate the process. This study explored barriers and facilitators to HIV disclosure at two referral hospitals in eastern Uganda focusing on the utilization of existing guidelines. In-depth qualitative interviews were conducted among all HCWs involved in the management of CALH at three pediatric HIV clinics. Research assistants collected data using a semi-structured interview guide designed based on the Capability, Opportunity, and Motivation of Behavior change (COM-B) Model. The audio-recorded interviews were transcribed verbatim, analyzed thematically, and categorized based on the COM-B and social-ecological models using the inductive content approach. Sixteen in-depth interviews were conducted among HCWs, including both males and females in equal numbers. The barriers to disclosure involved all five levels of the social-ecological model, while facilitators were at only three levels (individual, interpersonal, and institutional levels). Regarding the capability of HCWs to support disclosure, limited training affected their psychological (knowledge) and physical ability (skills), while awareness of responsibilities enhanced psychological ability. For opportunity, an unstable home environment, limited access to guidelines, and HIV-related stigma were barriers in physical and social environments, while peer support, teamwork, and orphanhood status were facilitators in the social environment. Limited health funding and lack of preparatory procedures affected reflective motivation, while delayed disclosure affected automatic motivation. Conversely, emotional reward and monitoring, checklists, and supervision enhanced the automatic motivation of HCWs toward disclosure. The findings highlighted several potentially modifiable factors that need to be addressed or reinforced to improve HIV disclosure and utilization of existing guidelines. These findings are key in informing stakeholders regarding the development of implementation strategies for improving pediatric HIV disclosure and utilization of existing guidelines in Uganda.

Correlates of HIV testing among men in Ghana: Cross-sectional analysis of the 2022 demographic and health survey

IntroductionNew HIV infections are on the rise in Ghana, with approximately 16,574 new cases reported in 2022 alone. Although HIV prevalence rate is higher among women aged 15-49 years (2.0 [1.7-2.3]) than men aged 15-49 (1.0 [0.8-1.2]) in Ghana, evidence form the country's 2022 Demographic and health Survey suggest that only 12% of men had ever been tested for HIV once in their lifetime relative to 17% of women, and yet more men (35%) than women (23%) reported having sexual intercourse with persons who were neither their wife nor live-in partners. More so, the Ghana National HIV and AIDS Policy has over the years positively influenced the utilization of HIV testing (HIVT) services among women in Ghana through antenatal care visits. While this policy encourages women to undertake testing with their husbands, most men in the Ghanaian Context rarely accompany their spouse to antenatal care due to several reasons including conflicting work schedules, thus limiting their chances of getting tested. Using a nationally representative dataset, this study adds to the broader literature by exploring the factors associated with HIVT among men.MethodsUsing the 2022 Ghana Demographic and Health Survey (N = 7044 males), and employing multiple logistic regression models, this study explored the factors associated with HIVT among men.ResultsMarried men (OR = 1.723; p < .001), the employed, particularly, those paid in cash only (OR = 2.021; p < .001) and those paid both in cash and kind (OR = 1.823; p < .001), those who had knowledge of HIV test kits (OR = 1.708; p < .001), aware and approve to use Pre-Exposure Prophylaxis (PrEP) (OR = 1.1280; p < .001), as well as those who visited a health facility in the past 6 months (OR = 1.615; p < .001), all significantly reported higher odds of testing. Moreover, Educational attainment, age, household wealth, religion, ethnicity, and the region of residence significantly predicted HIVT in the study context.ConclusionSocio-demographic, economic, geographic and health-related factors have significant influence on the uptake of HIVT among men in Ghana, thus underscoring the need for tailored interventions that consider diverse contextual factors in HIV prevention and healthcare delivery.

Can AIDS education reduce HIV stigma? Evidence from Zimbabwe

HIV stigma remains a barrier to HIV prevention, testing, and treatment in sub-Saharan Africa. This study uses Zimbabwe Demographic and Health Survey data to examine how education reduces HIV stigma, focusing on two key initiatives: the 1992 AIDS Action Program, which enhanced HIV awareness, and the 1980 education reform, which expanded schooling access. By addressing gaps in the literature on external HIV stigma, the study highlights education's long-term impact on attitudes toward people living with HIV. Our findings show that the 1980 reform is associated with a 1.19-year increase in educational attainment and a 42.6% rise in secondary school attendance for children aged 2-7 years in 1980 compared to those aged 16 and older. Furthermore, each additional year of schooling after the AIDS Action Program is associated with a 12.1% reduction in the likelihood of stigmatizing people with HIV and a 12.8% increase in HIV knowledge. Stigma reduction is more pronounced among rural residents (13.3%) and women (5.9%) but is insignificant for men and urban dwellers. These results underscore the role of schools in improving public health knowledge and reducing HIV stigma, offering valuable insights for future educational and health strategies.

Adherence, perceptions and knowledge of an HIV PMTCT programme: A mother-baby pair study

Background

Prevention of mother-to-child transmission (PMTCT) programmes are designed to prevent HIV transmission to infants and children. Despite efforts to achieve this goal, several factors continue to pose challenges.

Objectives

To investigate the level of adherence, perceptions, knowledge, and factors associated with adherence to the PMTCT programme in primary healthcare facilities.

Method

A descriptive cross-sectional study design and quantitative research approach was used, and clinical records were reviewed to determine the prevalence of seroconverted babies of mothers enrolled in a PMTCT programme for the past 2 years in the community healthcare centres. Bivariate and multivariate logistic regression analyses were performed.

Results

A total of 341 mother-baby pairs were recruited and took part in the study. Most women (263; 77%), perceived that a pregnant woman living with HIV can transmit the virus to her unborn baby. The following factors were independently associated with non-adherence: being unmarried, the period of maternal HIV diagnosis and initiation on antiretroviral therapy, unsuppressed viral load results, missed clinic appointments, side effects, and getting tired of taking HIV medication.

Conclusion

This study investigated adherence to and perceptions of all components of the PMTCT programme by pregnant and breastfeeding women in primary healthcare facilities. Despite the significant progress made, maternal and paediatric HIV pandemic pose a challenge to the PMTCT services. There is a need for follow-up research to monitor the ongoing adherence to the PMTCT programme and its long-term impact in reducing the rate of transmission of HIV in mothers.

Correlates of internalized stigma and antiretroviral therapy adherence among people living with HIV in the Volta region of Ghana

OBJECTIVE

HIV-related stigma is a major public health concern compromising the rights and health outcomes of many people living with HIV (PLWH). Its reduction is said to be critical in strengthening the continuous efforts targeted at preventing and controlling HIV, as it directly impacts antiretroviral treatment adherence. This study examines the association between HIV-related stigma and adherence to antiretroviral therapy (ART) among PLWH in one of the 16 administrative regions of Ghana, Africa.

METHODS

This descriptive cross-sectional study employed a survey to assess the factors affecting the utilization of ART among PLWH (n = 155) in the Volta region. The Center for Support Evaluation adherence index and internalized stigma of AIDS Tool were used to collect data on medication adherence and stigma, respectively. Data was analyzed using R statistical analysis software. Logistic regression models were performed to ascertain the predictors of ART utilization among PLWH.

RESULTS

A greater proportion (70%) of the study's participants reported adherence to ART. We found a positive association between HIV-related internalized stigma and medication adherence such that reporting high levels of stigma on average was associated with high levels of medication adherence [OR = 1.08, 95% CI:1.01, 1.15]. Older age was related to higher adherence while reporting more depressive symptoms was associated with low medication adherence.

CONCLUSION

Our findings show that stigma may serve as a facilitator instead of a barrier to adhering to antiretroviral medication. Although this contradicts common narratives about stigma's destructive effect, it is possible to promote good health-seeking behavior when the fear component of stigma is considered. To encourage medication adherence towards meeting UNAIDS' 95-95-95 agenda and better understand stigma's role, further research is required.

Understanding depression, anxiety and stress in young people living with HIV in Ghana

Ghanaians with perinatally acquired human immunodeficiency virus (HIV) infection now live into adulthood. It is known that adolescents and young adults living with HIV have a high risk of mental health comorbidity. Despite increasing global attention on HIV-mental health interactions, the field remains understudied in Ghana, with an attendant lack of national integrated care solutions. This study aimed to measure the burden and explore the context of depression, anxiety and stress symptoms among young people living with HIV receiving care at a tertiary care hospital in Ghana. This was an explanatory sequential mixed-methods study. Depression, anxiety and stress symptoms were measured using the Depression, Anxiety and Stress Scale, and their associations with quality of life (QoL), socioeconomic status, internalised stigma, disease stage and HIV-related risk-taking behaviours were explored. After preliminary quantitative data analysis, semi-structured interviews were conducted for those who screened positive for depression and/or anxiety to explore their experience with this comorbidity. This study found a low prevalence of depression and anxiety symptoms, which were associated with higher stigma scores and lower QoL. We believe this low prevalence to be attributable to the effect of several psychosocial interventional programmes, which were previously piloted with the study cohort that have gradually normalised mental health discussions. Participants also showed marked resilience and knowledge about their condition. The results of this study present an opportunity to advocate and scale up effective locally adapted and strength-based solutions to address the mental illness-HIV syndemic in Ghanaian young people living with HIV.

HIV Disclosure and Low HIV Stigma in a Gay Serodiscordant Couple: An Interpretative Phenomenological Case Study of the Discloser-Confidant Dynamics

Introduction HIV stigma levels are high in Greece. HIV stigma hinders testing, healthcare access, and treatment adherence, often leading to non-disclosure. The discloser navigates challenges by balancing the confidant's potential reactions, ranging from rejection and discrimination to the benefits of increased intimacy and liking. However, much research focuses on either the confidant's reactions or the discloser's role, leaving gaps in understanding the full disclosure process. Methods This qualitative case study explores how HIV disclosure, stigma, and trust-building unfold, focusing on the timing, reasons, and impact of disclosing HIV-positive status on the relationship dynamics between the discloser and the confidant. Semi-structured interviews were conducted with a serodiscordant gay couple, recruited from a hospital in Greece. Results Through interpretative phenomenological analysis, we identified a Superordinate Theme: The HIV Disclosure Process with three sub-themes: (1) Navigating HIV Disclosure: Decision Making and the Disclosure Event, (2) HIV Acceptance and Stigma: Pathways to Disclosure, and (3) HIV Disclosure: Building a Foundation of Trust and Navigating Life's Broader Uncertainties. Investigator triangulation was used, enhancing the credibility and reliability of the findings. Conclusion Our case study explores HIV disclosure as a unified process, revealing that both avoidance and approach goals coexist. Avoidance delayed disclosure by withholding emotions in conflicted family relationships, yet led to positive outcomes, while approach goals encouraged earlier, open, and factual disclosure in romantic relationships, resulting in better positive outcomes. Greater HIV knowledge, approach goals, and trust encouraged protective behaviors and advocacy. HIV was normalized within the relationship, allowing the couple to manage it alongside everyday uncertainties.

Perceptions of patients and healthcare providers regarding barriers and enablers of HIV anti-retroviral therapy among women at a regional hospital in Ghana: implications for national HIV/AIDS control

BACKGROUND

The Acquired Immune Deficiency Syndrome (AIDS) pandemic has created a lot of devastation over the last four decades and continues to be a public health threat. Anti-retroviral treatment (ART), a group of medications that people who have been diagnosed with the Human Immunodeficiency Virus (HIV) infection take, has been shown to be efficacious and has significantly improved the fight against the disease. In Ghana, women carry a higher prevalence and incidence of HIV. The study's objectives were to understand the experiences of women living with HIV/AIDS on ART and determine the barriers and enablers for ART uptake from the perspective of both the females living with HIV and their healthcare providers in the Upper East Regional Hospital of Ghana.

METHODS

This was a qualitative study that used interviews to acquire data from women living with HIV on the perceived barriers and enablers for ART. The Upper East Regional Hospital in Ghana was the study site. We used a phenomenological approach to explore the lived experiences, perceptions, and meanings associated with ART among women. We collected data until we reached thematic saturation, interviewing a total of sixteen women living with HIV. We conducted a focus group discussion with nine healthcare workers providing care at the ART clinic. Data were analysed using thematic analysis.

RESULTS

Women living with HIV and their healthcare providers viewed an environment that provided encouragement and support from healthcare workers and patients' relatives, the ability to conceal HIV status, peer counselling, and the perceived benefits of therapy as enablers of ART uptake and medication adherence. The following were barriers to ART uptake and adherence: ill health, forgetfulness, long distances to ART clinics, cultural and spiritual beliefs, and fear of stigma.

CONCLUSIONS

Enablers of ART uptake should be expanded upon and encouraged so that women living with HIV/AIDS can access drugs in a timely and stress-free manner. On the other hand, the barriers identified can be addressed through education, the expansion of healthcare infrastructure, and the economic empowerment of women.

The association of HIV-related stigma and psychosocial factors and HIV treatment outcomes among people living with HIV in the Volta region of Ghana: A mixed-methods study

Stigma and discrimination have been identified as significant barriers to HIV treatment among people living with HIV (PLWH). HIV stigma affects decision to seek HIV testing and early treatment. Evidence shows that HIV stigma undermines antiretroviral therapy (ART) adherence by affecting the psychological process such as adjusting and coping with social support. In Ghana, stigma toward PLWH occurs in many ways including rejection by their communities and family members, ostracism, and refusal to engage in social interactions such as eating, sharing a bed, or shaking hands. Therefore. we examined PLWH's experiences with different forms of HIV-related stigma and the impact on HIV treatment outcome in the Volta region of Ghana. We employed a convergent mixed-method approach consisting of a survey with 181 PLWH, four focus group discussions with 24 survey respondents, and in-depth interviews with six providers. We performed independent samples t-test, ANOVA, and chi-square test to test associations in bivariate analysis and analyzed qualitative data using thematic analysis. In all, 49% of survey respondents reported experiencing high internalized stigma, which was associated with high social support and depression (p<0.001). In qualitative interviews, anticipated stigma was the most salient concern of PLWH, followed by internalized and enacted stigma, which all negatively impacted HIV treatment and care. Stigma was experienced on multiple levels and affected psychosocial and treatment outcomes. Findings suggest urgent need for HIV-stigma reduction intervention among PLWH and their family, providers, and community members.

A critical review and analysis of the context, current burden, and application of policy to improve cancer equity in Ghana

BACKGROUND

Cancer causes a major disease burden worldwide. This is increasingly being realised in low and middle-income countries, which account disproportionately for preventable cancer deaths. Despite the World Health Organization calling for governments to develop policies to address this and alleviate cancer inequality, numerous challenges in executing effective cancer policies remain, which require consideration of the country-specific context. As this has not yet been considered in Ghana, the aim of this review was to bring together and critique the social-environmental, health policy and system factors to identifying opportunities for future health policies to reduce cancer burden in the Ghanian context. A critical policy-focused review was conducted to bring together and critique the current health systems context relating to cancer in Ghana, considering the unmet policy need, health system and social factors contributing to the burden and policy advances related to cancer.

CONCLUSION

The findings highlight the changing burden of cancer in Ghana and the contextual factors within the socio-ecosystem that contribute to this. Policies around expanding access to and coverage of services, as well as the harmonization with medical pluralism have potential to improve outcomes and increase equity but their implementation and robust data to monitor their impact pose significant barriers.

Predictors of HIV status disclosure among people living with HIV (PLHIV) in Ghana: the disclosure conundrum and its policy implications in resource limited settings

BACKGROUND

Globally, over 40 million lives have been claimed by HIV/AIDS. In Ghana, more than 350,000 people are living with HIV. Non-disclosure of HIV status is a major barrier to HIV/AIDS eradication; yet, little is known of the determinants of HIV status disclosure in resource limited settings in Africa like Ghana.

OBJECTIVE

Determine the predictors of HIV status disclosure among people living with HIV (PLHIV) and stimulate policy discourse on support systems for self-disclosure in Africa.

METHODS

This is a descriptive cross-sectional study among PLHIV (n = 181) in sub-Saharan Africa, specifically the Volta region of Ghana. Bivariate probit regression was run to determine factors associated with HIV status disclosure among PLHIV.

RESULTS

HIV status self-disclosure was reported by 50% of the respondents; nearly 65% disclosed their status to non-family members and non-partners. Significant correlates of HIV status disclosure either to partners or non-partners were marital status, monthly income, type of occupation, and being divorced due to HIV status (p < 0.05).

CONCLUSIONS

HIV status disclosure remains low in Ghana like many African countries. There is the need for a renewed policy debate on tailored guidelines for HIV status self-disclosure and targeted support systems for PLHIV to ameliorate their predicaments and promote eradication of the epidemic in Africa.

The role of internalised HIV stigma in disclosure of maternal HIV serostatus to children perinatally HIV-exposed but uninfected: a prospective study in the United States

INTRODUCTION

Decisions to disclose HIV serostatus may be complicated by internalised HIV stigma. We evaluated the association of internalised HIV stigma in biological mothers living with HIV with disclosure of their serostatus to their children perinatally HIV-exposed but uninfected (CHEU).

METHODS

Mothers and their CHEU were enrolled in the United States (U.S.)-based Surveillance Monitoring for Antiretroviral Therapy (ART) Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study (PHACS), a longitudinal study of outcomes related to in utero exposure to HIV and ART among CHEU. Mothers completing at least one stigma and disclosure assessment starting at the child's age 11-, 13-, 15- and/or 17-year study visits between 16 August 2016 and 1 October 2020 were eligible. Stigma was measured with the 28-item Internalised HIV Stigma Scale (IHSS). Mean stigma scores were linearly transformed to a range of 0-100, with higher scores indicating greater levels of stigma. At each visit, mothers were asked if their child was aware of their HIV diagnosis and at what age the child became aware. The Kaplan-Meier estimator evaluated the cumulative probability of disclosure at each child age. Logistic regression models with generalised estimating equations to account for repeated measures were fit to examine the association between stigma and disclosure, controlling for relevant socio-demographic variables.

RESULTS

Included were 438 mothers of 576 children (mean age 41.5 years, 60% U.S.-born, 60% Black/African American and 37% with household income ≤$10,000). The prevalence of disclosure across all visits was 29%. Mothers whose children were aware versus not aware of their serostatus reported lower mean IHSS scores (38.2 vs. 45.6, respectively). The cumulative proportion of disclosure by age 11 was 18.4% (95% CI: 15.5%, 21.8%) and 41% by age 17 (95% CI: 35.2%, 47.4%). At all child ages, disclosure was higher among children of U.S.-born versus non-U.S.-born mothers. After adjusting for age, marital status and years since HIV diagnosis, higher IHSS scores were associated with lower odds of disclosure (OR = 0.985, 95% CI: 0.975, 0.995).

CONCLUSIONS

Providing support to women as they make decisions about serostatus disclosure to their children may entail addressing internalised HIV stigma and consideration of community-level factors, particularly for non-U.S.-born mothers.

Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence

INTRODUCTION

HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health outcomes. Yet few studies have assessed the potential link between HIV stigma, relationship dynamics, and antiretroviral therapy (ART) adherence. Using dyadic data from a cross-sectional study of Malawian couples living with HIV, we tested associations between anticipated stigma and: 1) relationship dynamics (e.g., trust, sexual satisfaction, communication) and partner support; and 2) self-reported ART adherence.

METHODS

Heterosexual couples (211 couples, 422 individuals) with at least one partner on ART were recruited from clinics in Zomba, Malawi. Partners completed separate surveys on anticipated stigma, relationship dynamics, and ART adherence. Linear mixed models evaluated associations between anticipated stigma and relationship dynamics, and whether associations varied by gender. Generalized estimating equation models tested for associations between anticipated stigma and high ART adherence (90-100% vs. < 90%) at the individual level, and whether they were moderated by relationship dynamics at the couple level.

RESULTS

Couples' relationship length averaged 12.5 years, 66.8% were HIV sero-concordant, and 95.6% reported high ART adherence. In multivariable models, sexual satisfaction (β = -0.22, 95%CI = -0.41;-0.03, p = 0.020) and partner social support (β = -0.02, 95%CI = -0.04;-0.01, p < 0.01) were negatively associated with anticipated stigma. Significant interaction effects showed that adherence is moderated in couples with higher partner support and sexual satisfaction such that adherence is lowest when anticipated stigma is high and social support is low, and that adherence is lowest when anticipated stigma is high and sexual satisfaction is low.

CONCLUSIONS

Increased anticipated stigma is most associated with lower ART non-adherence at lower levels of social support and sexual satisfaction. Conversely, supportive and fulfilling relationships may buffer the negative association between stigma and ART adherence. Couples' interventions that focus on improving communication and support systems within couples could reduce the negative impacts of anticipated stigma on couples living with HIV.

HIV destigmatization: perspectives of people living with HIV in the Kumasi Metropolis in Ghana

Background

Human immunodeficiency virus (HIV)-related stigma has been identified as one of the principal factors that undermines HIV prevention efforts and the quality of life of people living with HIV (PLWH) in many developing countries including Ghana. While studies have been conducted on HIV-related stigma reduction, very few have sought the views of PLWH on how this might be done. The purpose of the study was to (i) identify factors that cause HIV-related stigma in Ghana from the perspective of PLWH, (ii) identify challenges that HIV-related stigma poses to the treatment and care of PLWH, and (iii) to obtain recommendations from PLWH on what they think various groups (community members, health care providers, and adolescents) including themselves should do to help reduce HIV-related stigma in Ghana.

Methods

A mixed methods cross-sectional study design was used to collect data from 404 PLWH at the Suntreso Government Hospital in the Kumasi Metropolis of Ghana across six domains using Qualtrics from November 1-30, 2022. Quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS) version 26 and the Statistical Analysis System (SAS) version 9.4. Qualitative data was analyzed using a thematic approach.

Results

Most of the study participants (70.5%) said HIV-related stigma in Ghana is due to ignorance. Of this population, 90.6% indicated that they had experienced stigma because they have HIV, causing them to feel depressed (2.5%), ashamed (2.2%), and hurt (3.0%). Study participants (92.8%) indicated that the challenges associated with HIV-related stigma has affected their treatment and care-seeking behaviors. Recommendations provided by study participants for HIV destigmatization include the need for PLWH not to disclose their status (cited 94 times), community members to educate themselves about HIV (96.5%), health care providers to identify their stigmatizing behaviors (95.3%), health care providers to avoid discriminating against PLWH (96.0%), and the need for adolescents to be educated on HIV and how it is transmitted (97.0%).

Conclusion

It is important for the government and HIV prevention agencies in Ghana to target and address co-occurring HIV-related stigma sources at various levels of intersection simultaneously This will help to shift harmful attitudes and behaviors that compromise the health and wellbeing of PLWH effectively.

Perceived and Enacted HIV-Related Stigma in Eastern and Southern Sierra Leone: A Psychometric Study of an HIV Stigma Scale

Background

HIV stigma continues to hinder the care of people with HIV (PWH), especially in low-resource settings. We aimed to adapt and validate a concise HIV stigma scale for perceived HIV stigma in Sierra Leone.

Methods

We enrolled participants in two HIV clinics in Eastern and Southern Sierra Leone in 2022. We assessed perceived stigma using a 12-item adaptation of Berger's HIV Stigma Scale and enacted stigma using select USAID indicators. We used ordinal logistic regression to identify predictors of perceived stigma and Pearson's correlation to examine associations between perceived and enacted stigma.

Results

624 PWH were enrolled. The final adapted 6-item HIV stigma scale demonstrated acceptable internal consistency (Cronbach's α = 0.72) and a four-factor solution accounting for 84.8% of variance: concern about public attitude (2 items), personalized stigma (2 items), negative self-image (1 item), and disclosure concerns (1 item). The prevalence of perceived HIV stigma was 68.6%, with disclosure concerns as the most prominent contributor. Enacted HIV stigma was reported by only 6.7% of participants, with partner/spousal abandonment and workplace stigma being the most common discriminatory experiences. Employment (β = 0.525, p <0.001), residence in Eastern Sierra Leone (β = 3.215, p < 0.001), and experiencing enacted stigma (β = 0.804, p < 0.001) were significantly associated with perceived stigma. Having a family member or friend with HIV (β = -0.499, p < 0.001), and HIV disclosure (β = -0.710, p < 0.001) were protective against perceived stigma. Enacted stigma strongly correlated with partner abandonment and family isolation (r = 0.223, p < 0.001).

Conclusion

We found high levels of perceived HIV stigma, underscoring the need for targeted interventions to combat stigma and promote inclusivity for PWH in Sierra Leone.

HIV Care Preferences among Young People Living with HIV in Lesotho: A Secondary Data Analysis of the PEBRA Cluster Randomized Trial

Introduction

Sub-Saharan Africa is home to 89% of all young people living with HIV, a key population with specific challenges and needs. In-depth knowledge of service demands is needed to tailor and differentiate service delivery for this group. We evaluated HIV care preferences among young people living with HIV who were part of the PEBRA (Peer Educator Based Refill of ART) cluster-randomized trial.

Methods

The PEBRA trial evaluated a novel model of care at 20 health facilities in Lesotho, Southern Africa. In the PEBRA model, a peer educator regularly assessed participant preferences regarding antiretroviral therapy (ART) refill location, SMS notifications (for adherence, drug refill, viral load), and general care support options and delivered services accordingly over a 12-month period. We present these preferences and their changes over time.

Results

At enrolment, 41 of 123 (33.3%) chose ART refill outside the health facility, compared to 8 of 123 (6.5%) after 12 months. Among those selecting clinic-based ART refill, many preferred collecting ART during the peer educator led Saturday clinic club, 45 of 123 (36.5%) at the beginning and 55 of 123 (44.7%) at the end. SMS reminders for treatment adherence and ART refill visits were chosen by 51 of 123 (41.5%) at enrolment and 54 of 123 (44.7%) at the last assessment. Support by the peer educator was popular at the beginning (110 of 123 (89.4%)) and lower but still high at the end (85 of 123 (69.1%)). Thirteen of 123 (10.6%) participants chose support by the nurse, without the involvement of any peer educator, at the first and 21 of 123 (17.1%) at the last assessment.

Conclusion

Our longitudinal preference assessment among young people living with HIV in Lesotho showed a sustained interest in SMS notifications for adherence and refill visits as well as in additional support by a peer educator. ART refill outside the health facility was not as popular as expected; instead, medication pick-up at the facility, especially during Saturday clinic clubs, was favoured. The PEBRA trial was registered with clinicaltrials.gov (NCT03969030. Registered on 31 May 2019).

Molecular Epidemiology of HIV-1 in Ghana: Subtype Distribution, Drug Resistance and Coreceptor Usage

The greatest HIV-1 genetic diversity is found in West/Central Africa due to the pandemic’s origins in this region, but this diversity remains understudied. We characterized HIV-1 subtype diversity (from both sub-genomic and full-genome viral sequences), drug resistance and coreceptor usage in 103 predominantly (90%) antiretroviral-naive individuals living with HIV-1 in Ghana. Full-genome HIV-1 subtyping confirmed the circulating recombinant form CRF02_AG as the dominant (53.9%) subtype in the region, with the complex recombinant 06_cpx (4%) present as well. Unique recombinants, most of which were mosaics containing CRF02_AG and/or 06_cpx, made up 37% of sequences, while “pure” subtypes were rare (<6%). Pretreatment resistance to at least one drug class was observed in 17% of the cohort, with NNRTI resistance being the most common (12%) and INSTI resistance being relatively rare (2%). CXCR4-using HIV-1 sequences were identified in 23% of participants. Overall, our findings advance our understanding of HIV-1 molecular epidemiology in Ghana. Extensive HIV-1 genetic diversity in the region appears to be fueling the ongoing creation of novel recombinants, the majority CRF02_AG-containing, in the region. The relatively high prevalence of pretreatment NNRTI resistance but low prevalence of INSTI resistance supports the use of INSTI-based first-line regimens in Ghana.

Voluntary Counseling and Testing, Antiretroviral Therapy Access, and HIV-Related Stigma: Global Progress and Challenges

To date, about 37 million people are living with the human immunodeficiency virus (HIV) and an estimated 680,000 people have died from acquired immune deficiency syndrome (AIDS) related illnesses globally. While all countries have been impacted by HIV, some have been significantly more impacted than others, particularly countries in sub-Saharan Africa. The purpose of this paper was to identify progress made in HIV prevention globally, particularly in the areas of voluntary counseling and testing (VCT) uptake, access to antiretroviral therapy (ART), and HIV-related stigma. With the development of ART, a cocktail of medications for the treatment of HIV, VCT uptake increased, as it became apparent that the medication would only be prescribed after an HIV diagnosis through testing. Widely considered a critical gateway to HIV prevention and treatment, VCT is being implemented in many countries, and as a result, about 38 million people living with HIV in 2018 had access to ART. Regardless of this success, major challenges still remain. We did an electronic search of 135 articles in English related to global HIV progress and challenges indexed in PubMed, ResearchGate, Google, and other search engines from 1998 to 2021. Sixty articles met the inclusion criteria for this paper. Data on trends in ART coverage were obtained from the Joint United Nations Programme on HIV/AIDS (UNAIDS) website. These data were used to show ART coverage globally in World Health Organization (WHO) regions. It was found that while global successes have been chalked in the areas of VCT uptake and ART coverage, HIV-related stigma has impeded greater success. This paper summarizes and discusses global successes and challenges in HIV prevention efforts in the past four decades with a focus on VCT, ART, and HIV-related stigma.

Barriers and facilitators of adherence to antiretroviral treatment at a public health facility in Ghana: a mixed method study

BACKGROUND

HIV/AIDS is a disease of global public health concern with high morbidity and mortality rates. Poor adherence to antiretroviral therapy (ART) increases the risk of viral drug resistance and reduces treatment effectiveness towards viral suppression leading to disease progression, greater risk of death and increased risk of viral transmission. The study sought to assess current adherence levels to ART among patients in Ghana, exploring barriers and enablers of adherence to it, to provide future guidance to all key stakeholder groups.

METHOD

A mixed method approach was used comprising of a cross-sectional survey of patients followed by a focused group discussion with patients and an in-depth interview of four key health professionals working in the ART clinic of Atua Government Hospital, a primary care health facility in the Eastern Region of Ghana. A structured questionnaire was used to assess current adherence levels and their determinants among 231 randomly selected patients attending the clinic between July to September, 2019. Quantitative data were analysed using bivariate and multivariate methods while qualitative data were analysed using thematic framework approach.

RESULTS

Adherence levels was found to be 42.9% among our study population. Lower adherence to ART was associated with patients' belief in herbal medicine (aOR =0.34 CI: 0.19-0.61). Other barriers identified from the qualitative analysis included low motivation arising from pill fatigue, forgetfulness, frequent stock out of medicines, long waiting times and worrying side-effects; while enablers, on the other hand, included measures that ensure improved assessment of adherence and health facility-related activities that improve patient satisfaction with ART services. Conclusion: Adherence to ART among patients living with HIV was sub-optimal in our study population. Understanding of the barriers and factors that enable adherence to ART is a key step to developing evidence-based adherence improvement strategies to enhance clinical outcomes.