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Ismail R, Voss JG, Yona S, Nurachmah E, Boutain D, Lowe C, John-Stewart G, Woods NF. Classifying stigma experience of women living with HIV in Indonesia through the social ecological model. Health Care Women Int 2021; 43:345-366. [PMID: 34379051 DOI: 10.1080/07399332.2021.1929989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Little is known how stigma theories apply to women living with HIV (WLWH). To apply stigma theories to WLWH, and locate within the dimensions of the Social-Ecological Model (SEM). Using a literature review and a theoretical subtraction to apply stigma forms to the SEM dimensions. WLWH begin to self-stigmatize, receive stigma based on fear from the family and community. Healthcare providers and society stigmatize WLWH by ascribing character flaws to them. The SEM allowed us to locate the dimensions of stigma and identify areas for future interventions for WLWH in Indonesia and other countries.
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Affiliation(s)
- Rita Ismail
- Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Joachim G Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sri Yona
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Elly Nurachmah
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Doris Boutain
- Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Celia Lowe
- Department of Anthropology, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nancy Fugate Woods
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, Washington, USA
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Wardojo SSI, Huang YL, Chuang KY. Determinants of the quality of life amongst HIV clinic attendees in Malang, Indonesia. BMC Public Health 2021; 21:1272. [PMID: 34193121 PMCID: PMC8243711 DOI: 10.1186/s12889-021-11321-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the number of people living with human immunodeficiency virus (HIV; PLHIV) in Indonesia has increased in recent years, more efforts have been expended to improve their health status. However, in a country where PLHIV are very much stigmatized, there has been little research concerning their quality of life (QoL). Hence, this study aimed to assess the QoL among PLHIV and its associated factors. Findings of this research can contribute to improving the health and wellbeing of PLHIV in Indonesia. METHODS A cross-sectional survey with convenience sampling was conducted from June to September 2018, at four healthcare centers in Malang, Indonesia. PLHIV, aged 18 years or over, were asked if they would like to participate in this study when they came to a health center to receive services. To protect confidentiality, the healthcare staff at the clinics assisted with recruitment and face-to-face interviews with structured questionnaires. Measurements included sociodemographic, medication-related, social support, HIV-stigma, and QoL variables. RESULTS In total, 634 PLHIV agreed to participate in this study. A multivariate linear regression analysis showed that being older, having a job, living in an urban area, having better access to healthcare services, adhering to medication, being in an antiretroviral therapy (ART) program for more than 1 year, experiencing a lower level of stigma, and receiving more social support were associated with a better QoL. The regression model had an adjusted R2 of 0.21. CONCLUSIONS Findings from this research have significant policy implications. Policies focused on reducing social stigma and promoting medication adherence will likely have a positive impact on the QoL of PLHIV. Increasing public awareness and acceptance of PLHIV in Indonesia remains challenging, but would likely have significant impacts. Furthermore, interventions should also focus on reducing disparities in QoL between PLHIV living in rural areas and those in urban areas.
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Affiliation(s)
- Sri Sunaringsih Ika Wardojo
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Faculty of Health Science, University of Muhammadiyah, Malang, Indonesia
| | - Ya-Li Huang
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical Univeristy, Taipei, Taiwan
| | - Kun-Yang Chuang
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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Kusuma MTPL, Kidd T, Muturi N, Procter SB, Yarrow L, Hsu WW. The Symbolic Meaning of HIV: Understanding Lecturers' Ambivalence over Teaching HIV to Dietetic Students. J Int Assoc Provid AIDS Care 2021; 19:2325958220939755. [PMID: 32662324 PMCID: PMC7361481 DOI: 10.1177/2325958220939755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Responding to the increasing reports of health students and professionals demonstrating stigmatized attitudes toward people living with HIV (PLHIV), this article examined the learning process that takes place during their academic training. Using symbolic interactionism as a theoretical framework, we studied the way lecturers in dietetic schools in Indonesia make meaning of their understanding and experience of HIV in relation to their teaching conduct. We found that the current curriculum does not provide adequate opportunities for students to learn and interact with PLHIV. Participants described HIV discussion is mainly limited to the clinical aspects and essential treatment as they were uncomfortable discussing HIV with the students. The ostensible symbolic meaning of HIV among dietetic lecturers in Indonesia was compounded with limitations and restrictions affecting their teaching practices and attitudes to PLHIV. Future intervention is required to help lecturers recognize their degree of awareness and personal values about HIV.
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Affiliation(s)
- Mutiara Tirta Prabandari Lintang Kusuma
- Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.,Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Tandalayo Kidd
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Nancy Muturi
- A.Q. Miller School of Journalism and Mass Communications, College of Arts and Sciences, Kansas State University, Manhattan, KS, USA
| | - Sandra Butin Procter
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Linda Yarrow
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Wei-Wen Hsu
- Department of Statistics, College of Arts and Sciences, Kansas State University, Manhattan, KS, USA
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Raya NAJ, Nilmanat K. Experience and management of stigma among persons living with HIV in Bali, Indonesia: A descriptive study. Jpn J Nurs Sci 2020; 18:e12391. [PMID: 33164323 DOI: 10.1111/jjns.12391] [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: 05/20/2020] [Revised: 09/12/2020] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to describe the level of HIV stigma experience and the HIV stigma management strategies used by persons living with HIV (PLWH) in Bali, Indonesia. METHODS A cross-sectional descriptive study was conducted from March to May 2019. In total, 215 respondents were recruited using purposive sampling from hospitals and HIV private clinic. The research tools consisted of the demographic characteristics form, the 28-Item Internalized HIV Stigma Scale, and the Stigma Management Strategies Checklist. This study used descriptive statistics and non-parametric statistics to analyze the data. RESULTS Overall, the transformed mean score of HIV stigma experience was at a low level (mean = 42.88, SD ± 17.59). There was no statistically significant difference between demographic characteristics and HIV stigma (p > .05). Of the 38 stigma management strategies, prayer (70.7%) was reported as the most common, whereas forgiving one's spouse (4.1%) was the least utilized strategy of the respondents. The most often reported reason to manage stigma was to alleviate and/or avoid stress (68.8%). In addition, the most effective stigma management strategy was prayer (28.8%). Conversely, the least effective was staying alone (21.9%). CONCLUSIONS HIV stigma is present in Bali, Indonesia, and PLWH struggle to accept their HIV status. Furthermore, they use prayer as a stigma management strategy to get closer to God. The findings of this study could serve as evidence to inform HIV stigma reduction programs in the community. In addition, the development of faith-based stigma management interventions is recommended.
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Affiliation(s)
- Nyoman Agus Jagat Raya
- Nursing Study Program, Faculty of Medicine, Udayana University, Denpasar, Indonesia.,Adult and Gerontological Nursing Department, Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand
| | - Kittikorn Nilmanat
- Adult and Gerontological Nursing Department, Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand
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Kusuma MTPL, Kidd T, Muturi N, Procter SB, Yarrow L, Hsu WW. HIV knowledge and stigma among dietetic students in Indonesia: implications for the nutrition education system. BMC Infect Dis 2020; 20:663. [PMID: 32907539 PMCID: PMC7487527 DOI: 10.1186/s12879-020-05379-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have demonstrated that health care students and practitioners are not immune to stigma towards people living with HIV (PLHIV). This attitude could lead to poor quality of care if it remains uncorrected. However, little is known about dietetic students' acceptance of PLHIV despite their substantial role in treatment. This study aimed to measure the extent of knowledge and stigma towards PLHIV among dietetic students and to determine the associated factors using the attribution theory. METHODS Students from three dietetics schools in Indonesia (n = 516) were recruited to participate in this cross-sectional study. Survey questions covered demographic information, interaction with PLHIV, access to information sources, cultural values, and beliefs as predictor variables. The outcome variables were comprehensive knowledge of HIV, HIV and nutrition-specific knowledge, and attitudes. Analyses with linear regression and the stepwise selection were performed to determine factors related to the outcome. RESULTS The levels of HIV comprehensive knowledge and HIV-nutrition specific knowledge among dietetic students were low, as indicated by the average score of 19.9 ± 0.19 (maximum score = 35) and 8.0 ± 0.11 (maximum score = 15), respectively. The level of negative attitudes towards PLHIV was high, with 99.6% of participants reported having a high stigma score. Types of university affiliation (public or private), beliefs and values, exposure to HIV discourse, access to printed media, and years of study were significantly related to HIV comprehensive knowledge (p < 0.05). Nutrition-specific knowledge was also correlated with university affiliation, beliefs and values, participation in HIV discussion, and years of study (p < 0.05). HIV comprehensive knowledge, university affiliation, discussion participation, and ethnicities were associated with attitudes (p < 0.05). CONCLUSIONS Awareness and acceptance of PLHIV must be further improved throughout dietetic training to ensure patients' quality of care since students represent future dietary care providers. Considering the consistent findings that affiliation to education institution correlates with HIV knowledge and attitude, some examinations concerning the curriculum and teaching conduct might be necessary.
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Affiliation(s)
- Mutiara Tirta Prabandari Lintang Kusuma
- Department of Nutrition and Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. .,Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA.
| | - Tandalayo Kidd
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Nancy Muturi
- A.Q. Miller School of Journalism and Mass Communications, College of Arts and Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Sandra B Procter
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Linda Yarrow
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Wei-Wen Hsu
- Department of Statistics, College of Arts and Sciences, Kansas State University, Manhattan, Kansas, USA
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HIV Stigma and Moral Judgement: Qualitative Exploration of the Experiences of HIV Stigma and Discrimination among Married Men Living with HIV in Yogyakarta. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020636. [PMID: 31963807 PMCID: PMC7013688 DOI: 10.3390/ijerph17020636] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/14/2022]
Abstract
It is well acknowledged that human immunodeficiency virus stigma (HIV stigma) challenges people living with HIV globally. There is a scarcity of information about determinants of HIV stigma and discrimination among married men in the Indonesian context. This study aimed to explore factors that contribute to stigma and discrimination against HIV-positive men married to women in Yogyakarta, Indonesia. Face-to-face in-depth interviews were conducted to collect data from participants using a snowball sampling technique. A framework analysis was used to guide the analysis of the data. HIV stigma framework was also applied in the conceptualisation and the discussion of the findings. The findings indicate that participants experienced external stigma within healthcare facilities, communities and families. This external stigma was expressed in various discriminatory attitudes and behaviours by healthcare professionals and community and family members. Similarly, participants experienced anticipated stigma as a result of HIV stigma and discrimination experienced by other people living with HIV. Individual moral judgement associating HIV status with amoral behaviours and participants' negative self-judgement were determinants of perceived stigma. The current findings indicate the need for training programs about HIV stigma issues for healthcare professionals. There is also a need to disseminate HIV information and to improve HIV stigma knowledge among families and communities.
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Lazuardi E, Bell S, Newman CE. A 'scoping review' of qualitative literature about engagement with HIV care in Indonesia. Sex Health 2019; 15:283-291. [PMID: 30021685 DOI: 10.1071/sh17163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/01/2018] [Indexed: 01/19/2023]
Abstract
Background The Indonesian response to HIV has been informed largely by quantitative evidence. This review examines what is known about the Indonesian HIV care cascade from published qualitative research. METHODS A 'scoping review' method was used to synthesise and interpret the findings of 17 eligible peer-reviewed publications. RESULTS Qualitative findings are reported in relation to two themes. Factors influencing successful engagement include a lack of HIV-related knowledge among clients, fear of stigma or lack of privacy/confidentiality at services, limited accessibility and affordability, and poor linkages between services. Factors affecting the broader response include a failure to adapt programs to specific socio-cultural settings, political issues in the distribution of donor funding, distrust and poor communication between service users and providers, the need for cultural privacy in particular community settings, and systemic experiences of gendered stigmatisation. CONCLUSIONS Enhancing understanding of the Indonesian context would benefit from future qualitative research on HIV care in urban settings, describing the experiences of the most at-risk populations, and examining the role of clinics and providers in delivering HIV care in an increasingly decentralised health system.
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Affiliation(s)
- Elan Lazuardi
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Stephen Bell
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
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Wulandari LPL, Lubis DSM, Widarini P, Widyanthini DN, Wirawan IMA, Wirawan DN. HIV testing uptake among pregnant women attending private midwife clinics: challenges of scaling up universal HIV testing at the private sectors in Indonesia. Int J Health Plann Manage 2019; 34:1399-1407. [PMID: 31120151 DOI: 10.1002/hpm.2807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Being ranked seventh among countries with the highest number of new pediatric HIV infection, around 3% of new pediatric HIV infection worldwide occurs in Indonesia. UNAIDS has set a goal of elimination of mother-to-child HIV transmission, and private sector plays a critical role in achieving this goal. More than half of pregnant women in Indonesia seek antenatal care (ANC) services at private sectors, particularly at private midwife clinics. However, no published data is available on the rates of HIV testing uptake among pregnant women at these clinics, reflecting important gap on prevention of mother to child HIV transmission programmatic data. PURPOSE A longitudinal study was conducted to examine the rates of HIV testing uptake among pregnant women attending private midwife clinics in Bali and were referred to Voluntary HIV counselling and testing (VCT) clinics for a HIV test. METHODS Seventy midwives from private clinics were asked to suggest women, who were deemed to be at risk of HIV, to seek HIV testing at the nominated VCT clinics and to provide the women with a referral. Data were then analyzed to identify the percentage of women who took HIV testing at the VCT clinics among those referred by the midwives. RESULTS The midwives referred 619 women to VCT clinics. Of the referred women, only 321 (52%; 95% CI, 47.8%-55.9%) took a HIV test at the appointed clinics. Among these who tested, three (0.9%) were HIV positive. This study identified a challenge in scaling up HIV testing coverage among women seeking ANC services at private sectors. Implications and recommendations are discussed.
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Affiliation(s)
- Luh Putu Lila Wulandari
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia.,Kerti Praja Foundation, Bali, Indonesia
| | - Dinar S M Lubis
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia.,Kerti Praja Foundation, Bali, Indonesia
| | - Putu Widarini
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia.,Kerti Praja Foundation, Bali, Indonesia
| | - Desak Nyoman Widyanthini
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia.,Kerti Praja Foundation, Bali, Indonesia
| | - I Made Ady Wirawan
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia.,Kerti Praja Foundation, Bali, Indonesia
| | - Dewa Nyoman Wirawan
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia.,Kerti Praja Foundation, Bali, Indonesia
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Wulandari LPL, Ruddick A, Guy R, Kaldor J. "Self-testing sounds more private, rather than going to the clinic and everybody will find out": Facilitators and barriers regarding HIV testing among men who purchase sex in Bali, Indonesia. PLoS One 2019; 14:e0214987. [PMID: 30958845 PMCID: PMC6453456 DOI: 10.1371/journal.pone.0214987] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/25/2019] [Indexed: 12/29/2022] Open
Abstract
In many Asian countries, men who purchase sex account for the largest single network of people which often face elevated HIV risk in relation to the general population. However, high proportions of these men have never undertaken HIV testing. We assessed barriers to and facilitators of HIV testing among men who purchase sex in Indonesia, including the acceptability of HIV self-testing. A qualitative study was conducted during December 2016-January 2017 at fourteen sex-work venues and one voluntary HIV counselling and testing (VCT) clinic in Bali. Interviews were conducted with men who purchase sex exploring the men's views on HIV testing. Data were examined using thematic analysis. Twenty-nine men participated in the study. The themes that emerged regarding the barriers to HIV testing included fear of potential shame, embarrassment, and confidentiality breach in accessing HIV testing; fear of social exclusion if the test result was positive; self-treatment and prevention; the distance to a clinic; time constraints; and fear of an invasive testing method. Factors that were seen as facilitating a test were the convenience of time and place; the provision of speedy results; and privacy. Participants expressed interest in HIV self-testing and preferred it to clinic-based testing due to the privacy and confidentiality of the results. The findings support the introduction of an HIV self-testing strategy among this group to improve access to HIV testing.
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Affiliation(s)
- Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
- * E-mail: ,
| | - Abby Ruddick
- Independent Consultant, Denpasar, Bali, Indonesia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Lindayani L, Ibrahim K, Wang JD, Ko NY. Independent and synergistic effects of self- and public stigmas on quality of life of HIV-infected persons. AIDS Care 2017; 30:706-713. [PMID: 29115159 DOI: 10.1080/09540121.2017.1396282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Stigma has a potential impact on the quality of life of HIV-infected individuals over time. There is little empirical evidence regarding the first appearance and dynamic changes among different types of stigma, self-stigma and public-stigma, and their impacts on quality of life over time in HIV-infected persons. The purpose of this study was to assess the dynamic changes in self-stigma and public-stigma along the time course and determined their independent and synergistic impacts on quality of life. A Cross-sectional study was conducted at Two HIV-designed hospitals and two branches of non-government an-AIDS organizations in Wes Java, Indonesia. Persons diagnosed with HIV completed self-report measures of stigma and the questionnaire of World Health Organization Quality of Life (WHOQOL)-HIV brief version. Kernel smoothing method and multivariate linear regression were applied for statistical analysis. Two hundred fifteen adult HIV-infected persons agreed to participate in this study, with a response rate of 85.3%. The kernel smoothing means showed that one-third of subjects developed self-stigma immediately after HIV diagnosis while a higher public-stigma felt 6 months later, and both seemed to last continually. Beginning at about 48 months after diagnosis, participants with stigma showed consistently lower scores for all domains of quality of life. After control of potential confounding through multiple linear regression analyses, we found scores of all four domains and items of mobility, fatigue, activity of daily living, positive feeling, self-esteem, social support, and physical environment of WHOQOL were independently associated with both self-stigma and public-stigma. While self-stigma also affects items related to personal psychological feelings, public stigma alone associates with lower scores of items related to social and environmental domains. Our findings underscore the need to explore and control the complex structure and possible synergistic effects of multiple stigmatizations.
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Affiliation(s)
- Linlin Lindayani
- a Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University , Tainan , Taiwan.,b Sekolah Tinggi Ilmu Keperawatan Persatuan Perawat Nasional Indonesia (PPNI) Jawa Barat , Bandung , Indonesia.,e Department of Nursing , College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Kusman Ibrahim
- c Faculty of Nursing , Univeristas Padjadjaran , Bandung , Indonesia
| | - Jung-Der Wang
- d Department of Public Health , National Cheng Kung University College of Medicine , Tainan , Taiwan
| | - Nai-Ying Ko
- e Department of Nursing , College of Medicine, National Cheng Kung University , Tainan , Taiwan.,f Nursing Department , National Cheng Kung Univeristy Hospital , Tainan , Taiwan
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Hu R, Zhang F, Wang V, Dou Z, Shepard C, Zhao D, Liu X, Mu W, Wu Y, Zhao H, Li H. Comparing Outcomes of HIV-Infected Chinese Adults on Antiretroviral Therapy by CD4 Count at Treatment Initiation: A Nationwide Retrospective Observational Cohort Study, 2012-2014. AIDS Patient Care STDS 2017; 31:413-420. [PMID: 28981337 DOI: 10.1089/apc.2017.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The chief concerns for antiretroviral therapy (ART) programs considering removal of CD4+ cell count thresholds for treatment are the increased incidence of ART-related adverse events. A nationwide observational cohort study was conducted among patients who initiated ART in 2012. We divided the eligible patients into three groups: an early ART group with a baseline CD4+ cell count of 500 cells/μL or greater, a standard ART group with a baseline CD4+ cell count between 350 and 499 cells/μL, and a late ART group with a baseline CD4+ cell count between 200 and 349 cells/μL. These patients were followed up to December 31, 2014 and observed for three outcomes: virological failure, treatment nonretention, or time to death. Patients who met the eligibility criteria numbered at 26,752. Out of all study participants, 20,827 participants were in late ART group, 4336 were in standard ART group, and 1589 were in early ART group. Patients in late ART group were more likely to become virally suppressed 12 and 24 months after treatment initiation than patients in early ART group [adjusted odds ratio (aOR) 0.81; 95% CI, 0.69-0.95 and aOR, 0.78; 95% CI, 0.65-0.94]. Treatment nonretention was also less likely to occur among patients in late ART group than early ART group 12 months after treatment initiation (aOR, 0.85; 95% CI, 0.75-0.96). Compared with early ART group, neither standard ART group nor late ART group had a statistically significant difference in the time-to-death analysis. Late ART initiates were more likely to be virally suppressed and retained on treatment than early ART initiates. The importance of treatment retention and adherence should be emphasized for high CD4+ patients newly initiated to ART therapy through education and counseling programs.
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Affiliation(s)
- Ran Hu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Vania Wang
- Global AIDS Program, US Centres for Disease Control and Prevention, Beijing, China
| | - Zhihui Dou
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Colin Shepard
- Global AIDS Program, US Centres for Disease Control and Prevention, Beijing, China
| | - Decai Zhao
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xia Liu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Weiwei Mu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yasong Wu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxin Zhao
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Huiqin Li
- Yunnan AIDS Care Center, Kunming, China
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12
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Williams K, Haire BG, Nathan S. 'They say God punishes people with HIV': experiences of stigma and discrimination among adults with HIV in Dili, Timor-Leste. CULTURE, HEALTH & SEXUALITY 2017; 19:1108-1121. [PMID: 28276919 DOI: 10.1080/13691058.2017.1293845] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Little is known about the experiences of people with HIV in the small island nation of Timor-Leste. This study explored the HIV-related stigma experiences of adults aged between 18 and 40 living with HIV in Dili, Timor-Leste. Participants were interviewed on topics related to living with HIV, both as key informants describing the experience of others with HIV known to them, and also with respect to their own personal experiences. Findings suggest that people with HIV in Timor-Leste face stigma and discrimination in various contexts. In this predominantly Catholic country, perceptions of HIV and attitudes towards people with HIV appear to be commonly shaped by religious beliefs. In families and communities, participants encountered gossip, social exclusion and threats of violence. In health settings, participants experienced discrimination from health providers in the form of failing to maintain confidentiality and inappropriate treatment. The impact of stigma was profoundly negative and influenced participants' decision to disclose their status to others. Participants attributed stigma to a lack of information about HIV among the general public. Unless stigma reduction interventions also address the Church's role in shaping perceptions of HIV, education campaigns are unlikely to be effective in reducing HIV-related stigma.
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Affiliation(s)
- Kate Williams
- a School of Public Health and Community Medicine , UNSW Sydney , Sydney , Australia
| | - Bridget G Haire
- b Kirby Institute for Infection and Immunity in Society, UNSW , Sydney , Australia
| | - Sally Nathan
- a School of Public Health and Community Medicine , UNSW Sydney , Sydney , Australia
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Culbert GJ, Earnshaw VA, Wulanyani NMS, Wegman MP, Waluyo A, Altice FL. Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis. J Assoc Nurses AIDS Care 2015; 26:743-57. [PMID: 26304049 DOI: 10.1016/j.jana.2015.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022]
Abstract
In Indonesia, the syndemic nature of HIV, drug use, and incarceration may influence experiences of stigma for HIV-infected prisoners. This mixed-method study explores HIV stigma in prisoners living with HIV in Indonesia. Randomly selected male HIV-infected prisoners (n = 102) from two large prisons in Jakarta completed in-depth interviews and a structured HIV stigma survey. Quantitative results found four groups of HIV-infected prisoners with significantly higher HIV stigma levels, including those: (a) with drug-related offenses, (b) seeking help to decrease drug use, (c) diagnosed with HIV before the current incarceration, and (d) who had not disclosed their HIV status to family members or friends. Qualitative results highlighted the prominent role of HIV stigma in decisions to disclose HIV status to family members, partners, and other prisoners. Interventions should address HIV stigma in HIV-infected prisoners in Indonesia to achieve HIV treatment as prevention goals.
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Waluyo A, Culbert GJ, Levy J, Norr KF. Understanding HIV-related stigma among Indonesian nurses. J Assoc Nurses AIDS Care 2014; 26:69-80. [PMID: 24759060 DOI: 10.1016/j.jana.2014.03.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/03/2014] [Indexed: 11/16/2022]
Abstract
Evidence indicates widespread stigmatization of persons living with HIV (PLWH) in Indonesia. Such attitudes among health care workers could impede the country's policies for effective diagnosis and medical treatment of PLWH. Nonetheless, research to guide interventions to reduce stigma in health care settings is lacking. Also, the contributions of workplace, religion, and HIV knowledge to nurses' HIV-related stigma are poorly understood. Our cross-sectional study aimed to describe factors associated with nurses' stigmatizing attitudes toward PLWH. Four hundred nurses recruited from four hospitals in Jakarta, Indonesia, were surveyed using the Nurse AIDS Attitude Scale to measure stigma. Stigmatizing attitudes were significantly predicted by education, HIV training, perceived workplace stigma, religiosity, Islamic religious identification, and affiliation with the Islamic hospital. HIV knowledge was not a significant predictor of stigmatizing attitudes. Organization changes fostering workplace diversity are likely to substantially reduce stigmatizing attitudes in nurses.
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Chan KY, Reidpath DD. Methodological considerations in the measurement of institutional and structural forms of HIV discrimination. AIDS Care 2011; 17 Suppl 2:S205-13. [PMID: 16174630 DOI: 10.1080/09540120500120211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The systematic measurement of HIV/AIDS-related discrimination is imperative within the current rhetoric that holds discrimination as one of the two 'biggest' barriers to HIV/AIDS pandemic intervention. This paper provides a methodological critique of the UNAIDS (2000b) Protocol for the Identification of Discrimination against People Living with HIV (the Protocol). Specifically, the paper focuses on the Protocol's capacity to accurately identify and measure institutional levels of HIV-related discrimination that allows data that are reliable and comparable across time and contexts. Conceptual issues including the Protocol's objective as an indicator versus a direct measure of discrimination and the role of the Protocol as a tool of research versus a tool of advocacy are explored. Design issues such as the operationalization of discrimination, appropriateness of indicator content, sampling and data collection strategies and issues of scoring are also evaluated. It is hoped that the matters outlined will provide readers with ways of critically reflecting and evaluating the findings of the research papers presented in this Special Issue, as well as pointing to ways of improving research design.
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Affiliation(s)
- K Y Chan
- School of Health & Social Development, Deakin University, Burwood, VIC, Australia.
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Ibrahim K, Songwathana P, Boonyasopun U, Francis K. The HIV/AIDS epidemic in Indonesia: does primary health care as a prevention and intervention strategy work? Int J Nurs Pract 2010; 16:87-91. [PMID: 20487052 DOI: 10.1111/j.1440-172x.2010.01816.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The continuing increase in the number of people living with HIV/AIDS (PLWHA) in Indonesia is impacting on society. Various policies and strategies have been adopted and implemented to tackle this epidemic including primary health-care (PHC) initiatives. This paper describes the current HIV/AIDS epidemic in Indonesia and highlights a range of prevention and intervention initiatives introduced to limit the spread and impact of this disease factors, such as the characteristics of high-risk groups, the decentralization policy in the health sector, and the lack of skilled human resources and supplies in health centres have been identified as influencing access to health-care services among high-risk groups. Revitalization of a PHC approach coupled with adequate fiscal, infrastructure and human resources if addressed will increase of PLWHA and other risk groups to health care.
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Affiliation(s)
- Kusman Ibrahim
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand.
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Wisaksana R, Indrati AK, Fibriani A, Rogayah E, Sudjana P, Djajakusumah TS, Sumantri R, Alisjahbana B, van der Ven A, van Crevel R. Response to first-line antiretroviral treatment among human immunodeficiency virus-infected patients with and without a history of injecting drug use in Indonesia. Addiction 2010; 105:1055-61. [PMID: 20331555 DOI: 10.1111/j.1360-0443.2010.02898.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND There is a common belief that injecting drug use (IDU) is associated with lower uptake, retention and success of antiretroviral treatment (ART) in human immunodeficiency virus (HIV)-infected patients. We examined this in an Indonesian setting, where IDU is the main risk factor for HIV infection. METHODS Patient characteristics and response to ART were recorded for all patients diagnosed with HIV infection in the referral hospital for West Java (40 million people). Kaplan-Meier estimates and Cox's regression were used to compare mortality, loss to follow-up and virological failure between patients with and without a history of IDU. RESULT A total of 773 adult HIV patients (81.9% IDUs) presented between January 1996 and April 2008. IDUs had a median CD4 cell count of 33 [interquartile ratio (IQR), 12-111] cells/mm(3) compared to 84 (IQR, 28-224) cells/mm(3) in non-IDUs. Among patients with a history of IDU, 87.7% were coinfected with hepatitis C (HCV). Mortality was associated strongly with CD4 count; after 6 months of ART, 18.3, 20.3, 7.1 and 0.7% of patients with CD4 cell counts <25, 25-99, 100-199, respectively, > or =200/mm(3) had died (P < 0.0001). Mortality [adjusted for CD4; hazard ratio (HR) = 0.65; 95% confidence interval (CI) 0.35-1.23], loss to follow-up (HR = 0.85, 95% CI 0.51-1.41) and virological failure (HR = 0.47, 95% CI 0.19-1.13) were not significantly different in IDUs and non-IDUs. CONCLUSION Intravenous drug users (IDUs) in Indonesia with HIV/acquired immune deficiency syndrome tend to have more advanced disease but respond similarly to non-IDUs to antiretroviral therapy.
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Affiliation(s)
- Rudi Wisaksana
- Department of Internal Medicine, Technical Institute Bandung (ITB), Bandung, Indonesia.
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Reidpath DD, Chan KY. HIV discrimination: integrating the results from a six-country situational analysis in the Asia Pacific. AIDS Care 2006; 17 Suppl 2:S195-204. [PMID: 16174629 DOI: 10.1080/09540120500120278] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The findings of the six independent studies on institutional forms of HIV discrimination in the Asia Pacific presented in this Special Issue of AIDS Care are integrated. At first glance, the general pattern of the results across the study sites suggests that discrimination is most pertinent in the domain of 'practice' rather than in the domains of law or institutional policy. On closer analysis, however, utilising the qualitative data, this conclusion does not take sufficient account of the cultural context within which the interpersonal interaction (practice) between the health carers and people living with HIV/AIDS occurs. Limitations on the use of anti-discrimination legislations and protective written policies for reducing discrimination in these contexts are discussed. The need for alternative approaches to thinking about discrimination intervention is raised and this is done through a consideration of the strategy of universal precautions.
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Affiliation(s)
- D D Reidpath
- School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex, UK.
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Chan KY, Reidpath DD. Future research on structural and institutional forms of HIV discrimination. AIDS Care 2006; 17 Suppl 2:S215-8. [PMID: 16174631 DOI: 10.1080/09540120500120005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is scant research into HIV discrimination, particularly structural and institutional forms of it. This appears, in part, to arise from a prevailing view that the solutions to HIV discrimination are known a priori and in the absence of additional data. The six country studies into HIV discrimination presented in this AIDS Care supplement suggest that this is not the case. There needs to be an acceptance that if the issue of HIV discrimination is to be tackled successfully and based on evidence, then incremental and effortful steps need to be taken to develop that evidence base. This is discussed.
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Affiliation(s)
- K Y Chan
- School of Health & Social Development, Deakin University, Burwood, VIC, Australia.
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