Management of conflicts arising from disclosure of HIV status among married women in southwest Nigeria

Community Health Workers Improve HIV Disclosure Among HIV-Affected Sexual Partners in Rural Uganda: A Quasi-Experimental Study

BACKGROUND

We evaluated the efficacy of a community health worker (CHW)-led intervention in supporting disclosure among adults living with HIV in heterosexual relationships.

METHODS

We conducted a quasi-experimental study with 2 arms allocated by geographically determined clusters and adjusted for between-group differences among adults living with HIV in the greater Luwero region of Uganda who had never disclosed their status to their current primary sexual partners. Clusters were allocated to either a CHW-led intervention or a control arm. In both arms, participants were consecutively recruited. As opposed to receiving routine care for the control arm, participants in the intervention arm received additional CHW disclosure support. The overall follow-up was 6 months, and the primary outcome was disclosure to the sexual partner. Data were analyzed using a clustered modified Poisson regression model with robust standard errors to determine independent factors associated with disclosure.

RESULTS

Of the 245 participants who enrolled, 230 (93.9%) completed the study, and 112 (48.7%) of those were in the intervention arm. The median age was 30 (interquartile range=25-37) years, the majority were women (76.5%), and most (80%) did not know their partners' HIV status at study entry. At the end of follow-up, the overall disclosure prevalence was 74.4% (95% confidence interval [CI]=68.2, 79.9) and participants in the intervention arm were 51% more likely to disclose compared to those in the control (adjusted relative ratio [aRR]=1.51; 95% CI=1.28, 1.77). Men were 24% (aRR=1.24; 95% CI=1.07, 1.44) more likely to disclose compared to women, and membership in an HIV/AIDS association increased disclosure by 18% (aRR=1.18; 95% CI=1.01, 1.39).

CONCLUSION

CHW support improved disclosure among adults living with HIV in heterosexual relationships when compared to routine care. Therefore, CHW-led mechanisms may be utilized in increasing disclosure among adults living with HIV in heterosexual relationships in rural settings.

Perceived risk of COVID-19 diagnosis and stigma among Nigerians

The World Health Organization (WHO) classified Nigeria as one of the 13 African countries with a higher risk of spreading COVID-19. Although the Nigerian government and its health agencies set directives in place to help curb the spread of COVID-19, there are instances of unconcerned attitudes and adherence to false and superstitious beliefs surrounding COVID-19 among Nigerians. The current study examined the general perception of COVID-19 risk among Nigerians. Additionally, it examined the fear of possible stigmatization if an individual is diagnosed with COVID-19. A cross-section of 332 Nigerian men and women responded to measures on perceived vulnerability to diseases, perception of risk of being infected with COVID-19, COVID-19 stigma, and social and demographic characteristics. The findings show that respondents with a higher perception of vulnerability to diseases reported higher COVID-19 risk and perception of COVID-19-related stigma. Further, we found that gender, age, and education impacted COVID-19 risk and perception of COVID-19-related stigma. Our findings suggest that risk perceptions and attitudes towards COVID-19 can impact the level of preparedness against a pandemic. Also, the findings could inform strategies for the proper implementation of health protective measures at national, state, and local government levels during a viral outbreak.

Depressive symptoms among older adults with HIV in Namibia: the role of social support and spirituality

Background: More than 60% of older adults living with HIV reside in sub-Saharan Africa. Namibia has one of the highest HIV/AIDS prevalence rates. This study examined the association between social support, spirituality and depressive symptoms.Method and results: The sample consisted of 147 Oshiwambo-speaking older adults (mean age = 61 years, SD = 6.92 years) with HIV in Namibia. By utilising a hierarchical multivariate regression method, this study found that social support from friends and spirituality showed a significant negative relationship to depressive symptoms. In addition, self-rated health status and alcohol use were significant sociodemographic predicitive factors of depressive symptoms.Conclusion: This study suggests the need to develop interventions and support programmes that incorporate peer support and spiritual practice to promote health and well-being among older persons living with HIV in Namibia.

HIV-Related Stigma Among Black Mothers in Two North American and One African Cities

HIV-related stigma is a negative attitude or behaviour towards persons living with HIV, and is detrimental to effective care, management, and treatment of HIV. Using a revised 10-item stigma scale, we compared levels of HIV-related stigma and its correlates among Black women living with HIV in Ottawa, Canada, and Miami, FL, USA, with those in Port Harcourt, Nigeria. HIV-related stigma scores were calculated, with a maximum score of 10 and averaged 4.71 in Ottawa, 5.06 in Miami, and 3.78 in Port Harcourt. No significant difference in HIV-related stigma scores between Ottawa and Miami. HIV-related stigma was significantly (p < 0.05) higher among women in the North American cities compared with women in the African city. Hierarchical linear modelling shows that psychosocial variables contributed to variations in HIV-related stigma in Ottawa (22.3%), Miami (36.3%), and Port Harcourt (14.1%). At p < 0.05, discrimination was a significant predictor of increased HIV-related stigma in Ottawa (β = 0.077), Miami (β = 0.092), and Port Harcourt (β = 0.068). Functional social support had a significant diminishing effect on HIV-related stigma in Miami (β = - 0.108) and Port Harcourt (β = - 0.035). Tackling HIV-related sigma requires sociocultural considerations within specific regional and national contexts.

Vidas nuas: mulheres com HIV/aids em situação de violência de gênero

Resumo Em sociedades patriarcais de países periféricos, as mulheres sofrem os efeitos da exclusão social e de gênero, que as expõe à aquisição do HIV e que permanecem após o adoecimento. O objetivo deste estudo foi explorar as experiências de violência de gênero na trajetória de mulheres que vivem com HIV. É um estudo qualitativo em que foram entrevistadas 61 mulheres vítimas de violência de gênero cadastradas em um Serviço Especializado em HIV/aids de um município do interior do Rio Grande do Sul. Foi realizada análise crítica do discurso das narrativas produzidas por essas mulheres. Todas as entrevistadas relataram ter sofrido violações de direitos ao longo da vida, devido a processos históricos de exclusão, limitações no acesso à escola, ao trabalho, a serviços de saúde e à segurança. Nos serviços de saúde, o cuidado prestado pauta-se no modelo médico biopolítico capaz de postergar a morte, mas não de atendê-las com integralidade. Denominamos as trajetórias dessas mulheres de vidas nuas, conceito do filósofo Giorgio Agamben, tendo em vista que são consideradas desvalorizadas e supérfluas na sociedade, marcadas pelas violências e pelo HIV.

Disclosure of stuttering and quality of life in people who stutter

PURPOSE

This study investigated the disclosure practices of people who stutter, and the relationship between disclosure of stuttering and quality of life.

METHOD

Participants were 322 adults who stutter recruited from speech-language pathologists and support group leaders. Participants completed a survey that contained items measuring level of disclosure of stuttering, as well as a global measure of self-rated quality of life. Participants were grouped into low, average, and high quality of life subgroups. Analysis of variance tests compared disclosure levels among these subgroups.

RESULTS

The low quality of life subgroup reported significantly lower levels of disclosure compared to both the average and high quality of life subgroups. Participants with self-help/support group experience for stuttering demonstrated significantly higher levels of disclosure of stuttering compared to individuals without such experience. In addition, a substantial number of participants in the overall sample reported that they more than rarely feel the need to conceal stuttering from others (40%), and that no one knows that they stutter in many areas of life (37%).

CONCLUSIONS

Attempts to conceal stuttering in at least some life situations are not uncommon among adults who stutter. However, being involved in self-help support groups may be a helpful way of increasing disclosure of stuttering. Speech-language pathologists should become aware of the positive relationship between disclosure of stuttering and quality of life and its relevance in assessment and treatment when working with people who stutter.

HIV-Stigma in Nigeria: Review of Research Studies, Policies, and Programmes

Nigeria has about 3.8 million people living with HIV, the second largest globally. Stigma and discrimination are major barriers to testing, treatment uptake, and adherence. In this review, we synthesized information on research studies, policies, and programmes related to HIV-stigma in Nigeria. This was with a view to identify critical areas that research and programmes must address in order to accelerate the progress towards zero (new infections, discrimination, and death) target by year 2030. Existing studies were mostly devoted to stigma assessment using varieties of measures. Research, policies, and programmes in the past two decades have made very useful contributions to stigma reduction. We identified the need for a consistent, valid, and objective measure of stigma at different levels of the HIV response. Nigeria does not lack relevant policies; what needs to be strengthened are design, planning, implementation, monitoring, and evaluation of context-specific stigma reduction programmes.

Iniquidades de gênero: mulheres com HIV/Aids em situação de violência

Resumo Este estudo tem como objetivo visibilizar as iniquidades de gênero presentes na vida de mulheres com HIV/aids em situação de violência. Estudo qualitativo que utilizou narrativas de 61 mulheres cadastradas no Serviço de Assistência Especializada em HIV/aids de um município de médio porte do interior do Rio Grande do Sul, sendo utilizada a técnica de análise de narrativa para a compreensão dos dados. Foi construída uma narrativa única a partir da percepção dos pesquisadores e das trajetórias de vida das entrevistadas, contemplando aspectos vivenciados pela maioria delas. A maior parte das mulheres era jovem, pobre, ocupava empregos precários e muitas exerceram a prostituição ao longo da vida. As mulheres se constituem como figuras do sofrimento e são tratadas pela sociedade como promíscuas, infratoras e “putas”. Houve relatos de violências, abusos, preconceitos, estigmas, infrações de direitos e sofrimentos. As desigualdades de raça, classe social e gênero são situações geradoras de vulnerabilidades, violências e iniquidades na vida de mulheres com HIV/aids.

Taking into Account the Quality of the Relationship in HIV Disclosure

Despite growing interest in HIV disclosure, most theoretical frameworks and empirical studies focus on individual and social factors affecting the process, leaving the contribution of interpersonal factors relatively unexplored. HIV transmission and disclosure often occur within a couple however, and this is where disclosure has the most scope as a HIV transmission intervention. With this in mind, this study explores whether perceived relationship quality influences HIV disclosure outcomes. Ninety-five UK individuals with HIV participated in a cross-sectional survey. Retrospective data were collected on their perceived relationship quality prior to disclosing their HIV positive status, and on disclosure outcomes. Perceived relationship quality was found to significantly affect disclosure outcomes. Positive qualities in the relationship were associated with positive outcomes, whereas negative qualities were associated with negative outcomes. Results further confirmed that this association was not merely correlational, but demonstrated predictive power. Relationship quality might act as either a risk or a resilience factor in the disclosure process, and thus warrants greater attention in future research.

Development of internalized and personal stigma among patients with and without HIV infection and occupational stigma among health care providers in Southern China

BACKGROUND

HIV/AIDS-related stigma is a major barrier of access to care for those infected with HIV. The aim of this study was to examine, validate, and adapt measuring scales of internalized, personal, and occupational stigma developed in Africa into a Chinese context.

METHODS

A cross-sectional study was conducted from January to September 2015 in Kunming, People's Republic of China. Various scales were constructed on the basis of the previous studies with modifications by experts using exploratory and confirmatory factor analyses (EFA + CFA). Validation of the new scales was done using multiple linear regression models and hypothesis testing of the factorial structure invariance.

RESULTS

The numbers of subjects recruited for the development/validation samples were 696/667 HIV-positive patients, 699/667 non-HIV patients, and 157/155 health care providers. EFA revealed a two-factor solution for internalized and personal stigma scales (guilt/blaming and being refused/refusing service), which were confirmed by CFA with reliability coefficients (r) of 0.869 and 0.853, respectively. The occupational stigma scale was found to have a three-factor structure (blaming, professionalism, and egalitarianism) with a reliability coefficient (r) of 0.839. Higher correlations of factors in the HIV patients (r=0.537) and non-HIV patients (r=0.703) were observed in contrast to low-level correlations (r=0.231, 0.286, and 0.266) among factors from health care providers.

CONCLUSION

The new stigma scales are valid and should be used to monitor HIV/AIDS stigma in different groups of Chinese people in health care settings.

A Review of Recent Literature on Trauma Among Individuals Living with HIV

Persons living with HIV (PLWH) report disproportionately high levels of exposure to traumatic events in childhood and adulthood. Traumatic experiences are associated with negative health and behavioral outcomes. Current research in this area seeks to further explicate the myriad health effects of trauma on PLWH and the pathways through which trauma operates. In this paper, we review articles published in English between January 2014 and June 2015 that examine traumatic experiences among PLWH, including intimate partner violence (IPV), domestic abuse, child abuse, and other forms of violence. A selection of studies examining trauma among PLWH and its associations with mental health, antiretroviral medication adherence, clinical outcomes, HIV disclosure, and sexual risk behaviors were included. Studies describing trauma coping strategies and interventions were also included. We conclude with recommendations for care of trauma-exposed PLWH and directions for future research.

Correlates of the Quality of life of Adolescents in families affected by HIV/AIDS in Benue State, Nigeria

It was estimated that over 260,000 children are living with HIV/AIDS while close to 2 million are directly or indirectly affected by the disease in Nigeria. Improvements in treatments for infected children have been documented in the literature but there is a gross knowledge gap on the impact of HIV/AIDS on the quality of life and psychosocial functioning (PSF) of affected children in Nigeria. We comparatively explored the association of quality of life with PSF and other factors among adolescents in families affected by HIV/AIDS (FAHA) and in families not affected by HIV/AIDS (FNAHA). Data was extracted for 960 adolescents from a State wide cross-sectional study in which participants were selected through multistage sampling techniques. Data was collected using questionnaires consisting of demographic information, adapted WHO-QOL BREF and the Strength & Difficulty Questionnaire (SDQ). The quality of life scores were categorized into Poor, Moderate and High based on the amount of standard deviation away from the mean while the SDQ scores were categorized into normal, borderline and abnormal based on the SDQ scoring systems. Chi-square test and independent t-test were used for bivariate analyses while logistic regression was used for multivariate analyses at 5% level of significance. Proportion with poor quality of life (27.0%) was significantly higher among adolescents in FAHA than in FNAHA (p=0.0001). Adolescents in FAHA (OR:2.32; 95%CI:1.67-4.09) were twice more likely to have poor quality of life than those in FNAHA. In FAHA, adolescents on the borderline of PSF (OR:2.19; 95%CI:1.23-3.89) were twice more likely to have poor quality of life than those with normal PSF. Adolescents in FAHA have poorer quality of life than those in FNAHA and also face additional burdens of psychosocial dysfunctions. Interventions focusing on functional social support and economic empowerment will benefit adolescents in FAHA in the studied location.