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Tsai AC, Kakuhikire B, Perkins JM, Downey JM, Baguma C, Satinsky EN, Gumisiriza P, Kananura J, Bangsberg DR. Normative vs personal attitudes toward persons with HIV, and the mediating role of perceived HIV stigma in rural Uganda. J Glob Health 2021; 11:04956. [PMID: 34552725 PMCID: PMC8442577 DOI: 10.7189/jogh.11.04056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background HIV stigma has well-documented negative impacts on HIV testing, transmission risk behavior, initiation of and adherence to antiretroviral therapy, and retention in care. We sought to assess the extent to which anticipated HIV stigma is based on misperceptions of normative attitudes toward persons with HIV, and to determine whether persons with HIV have stronger misperceptions compared with HIV-negative persons or persons of unknown serostatus. We also sought to estimate the association between normative attitudes about persons with HIV and personal attitudes about persons with HIV, and to determine the extent to which anticipated stigma mediates this association. Methods We conducted a whole-population survey of 1776 persons living in 8 rural villages in southwestern Uganda. Negative attitudes toward persons with HIV, and anticipated stigma, were measured using a newly validated 15-item scale measuring multiple dimensions of HIV stigma, including social distance, blaming attitudes, and concerns about reciprocity. We used multivariable regression to estimate the association between normative attitudes about persons with HIV and personal attitudes toward persons with HIV, and to determine the extent to which perceptions of normative attitudes (anticipated stigma) mediated this association. Results Study participants believed that negative attitudes toward persons with HIV were more pervasive than they actually are. Perceptions of the extent to which these negative attitudes are normative mediated more than one-third of the association between normative attitudes and their personal attitudes. In contrast to what we originally hypothesized, persons with HIV were less likely to misperceive these norms and perceived normative attitudes to be less stigmatizing than did others in the general population. Conclusions Interventions designed to accurately describe normative attitudes toward persons with HIV may reduce HIV stigma without directly focusing on the educational components that are typically embedded in anti-stigma interventions.
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Affiliation(s)
- Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Justus Kananura
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda.,Oregon Health Sciences University-Portland State University School of Public Health, Portland, Oregon, USA
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Jeulin H, Jeanmaire E, Murray JM, Malve B, André M, Melliez H, Lanoix JP, Hustache-Mathieu L, Partisani M, Goehringer F, May T, Schvoerer E. Treatment as prevention enrolling at least 75% of individuals on ART will be needed to significantly reduce HIV prevalence in a HIV cohort. J Clin Virol 2019; 120:27-32. [PMID: 31541773 DOI: 10.1016/j.jcv.2019.08.010] [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: 04/04/2019] [Revised: 07/01/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND "Treatment as Prevention" (TasP) aims to reduce new HIV infections through higher enrolment on suppressive antiretroviral therapy (ART). OBJECTIVES We studied the current epidemic and possible impact of TasP in a French HIV cohort including MSM and migrant subjects. STUDY DESIGN Socio-demographic, clinical and laboratory variables were collected during the follow-up of 6995 HIV-infected patients. The numbers of individuals living with HIV in each year were estimated from diagnoses up to that year minus recorded deaths. Patients were classified according to gender, transmission mode, country of birth and treatment status. RESULTS The cohort includes 6995 individuals diagnosed from 1985 to 2015, of whom 72% were men. Unprotected sexual intercourse was the main mode of transmission. Women were more likely to be migrants (45% versus 13%), whereas men were more likely to have been born in France (52% versus 27%). Diagnoses were more correlated with untreated than treated prevalence in each group. MSM diagnoses was strongly correlated to untreated prevalence whatever the country of birth (p < 0.0001). However, heterosexual diagnoses were better correlated with prevalence within individual country groups (b = 0.29 female diagnoses/year per untreated male born in France, compared to b = 0.73 for foreigners). Using these transmission rates, mathematical modelling estimated that enrolling 75% of untreated individuals per year would decrease diagnoses ten-fold by 2021. CONCLUSIONS Enrolling at least 75% of individuals on ART is necessary to substantially impact numbers of new HIV infections in this cohort. Treatment as prevention will actually be effective to reduce HIV prevalence.
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Affiliation(s)
- Hélène Jeulin
- Laboratoire de Virologie, Hôpital Brabois, CHRU de Nancy, Vandoeuvre-les-Nancy, France; LCPME (Laboratoire de Chimie Physique et Microbiologie pour les Matériaux et l'Environnement), UMR 7564, Faculté de Pharmacie, Nancy, F-54000, France
| | - Eliette Jeanmaire
- Service de Maladies Infectieuses et Tropicales, Hôpital Brabois, CHRU de Nancy, Vandoeuvre-les-Nancy, France
| | - John M Murray
- School of Mathematics and Statistics, UNSW Sydney, NSW, 2052, Australia; Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, 2021, Australia
| | - Brice Malve
- Laboratoire de Virologie, Hôpital Brabois, CHRU de Nancy, Vandoeuvre-les-Nancy, France
| | - Marie André
- Service de Maladies Infectieuses et Tropicales, Hôpital Brabois, CHRU de Nancy, Vandoeuvre-les-Nancy, France
| | - Hugues Melliez
- Service de Maladies Infectieuses et Tropicales, Hôpital Guy Chatiliez, CH Tourcoing, Tourcoing, France
| | | | | | - Marialuisa Partisani
- HIV Infection care Center, Hôpitaux Universitaires Strasbourg, Strasbourg, France
| | - François Goehringer
- Service de Maladies Infectieuses et Tropicales, Hôpital Brabois, CHRU de Nancy, Vandoeuvre-les-Nancy, France
| | - Thierry May
- Service de Maladies Infectieuses et Tropicales, Hôpital Brabois, CHRU de Nancy, Vandoeuvre-les-Nancy, France
| | - Evelyne Schvoerer
- Laboratoire de Virologie, Hôpital Brabois, CHRU de Nancy, Vandoeuvre-les-Nancy, France; LCPME (Laboratoire de Chimie Physique et Microbiologie pour les Matériaux et l'Environnement), UMR 7564, Faculté de Pharmacie, Nancy, F-54000, France.
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