Factors associated with discriminatory attitudes towards people living with HIV among adult population in Ethiopia: analysis on Ethiopian demographic and health survey

Exploring how stay-at-home orders during the COVID-19 pandemic impedes engagement along the HIV/AIDS care continuum in public hospitals of Southwest Ethiopia: a qualitative study

Introduction

COVID-19 has rapidly spread across the world. In March 2020, shortly after the first confirmed case of COVID-19 in Ethiopia in March 2020, the government of Ethiopia took several measures.

Purpose

This study aims to explore how stay-at-home orders during the COVID-19 pandemic hinder engagement with HIV/AIDS care in public hospitals in Southwest Ethiopia. Additionally, we aim to explore the psychosocial challenges faced in accessing services during stay-at-home orders.

Methods

A descriptive qualitative study was conducted from 20 May to 3 June 2020, using semi-structured, in-depth interviews. In total, 27 study participants were recruited from purposively selected people living with HIV/AIDS (PLWHA) who had experienced delays, declines, or discontinuation of care after COVID-19 was confirmed in Ethiopia on 13 March 2020. The participants were interviewed over the phone and their responses were audio-recorded. Data were transcribed verbatim, translated, and analyzed using inductive thematic analysis in the Atlas ti.7.1 software package.

Results

The main themes and sub-themes that emerged were psychosocial issues (such as depression, hopelessness, and fear), risk perception (including high risk, susceptibility, and severity), forceful enforcement of stay-at-home orders (such as police beatings, community leaders disgracing, and influence of families and relatives), socioeconomic factors (such as stigma, religion, and transportation costs), misinformation about COVID-19 (such as lockdowns and ART stock-outs), and healthcare factors (such as inadequate health information and long distances to healthcare facilities).

Conclusion

Overall, these findings were similar to the challenges experienced by PLWHA in adhering to the recommended continuum of care. However, there are additional factors due to COVID-19, such as misinformation and the forceful implementation of the stay-at-home-orders, that impede the continuum of care. Therefore, it is important to strengthen information, education, and communication.

Individual and community level factors associated with discriminatory attitudes against people living with HIV/AIDS among women of reproductive age in three sub-Saharan African countries: evidence from the most recent demographic and health survey (2021/22)

INTRODUCTION

HIV-related stigma and discrimination significantly affects health, and well-being, willingness to be tested for HIV, initiation and adherence to antiretroviral therapy, and quality of life. However, the findings of the prior studies revealed that the prevalence of discrimination against people living with HIV is high. Thus, we aimed to assess the magnitude of discriminatory attitudes against people living with HIV/AIDS and associated factors in three sub-Saharan African countries.

METHODS

The appended and most recent Demographic and Health Survey dataset of three sub-Saharan African countries from 2021 to 2022 was used for data analysis. A total of 56,690 women aged 15-49 years were included in this study as a weighted sample. The determinants of discriminatory attitudes against people living with HIV/AIDS were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with discriminatory attitudes against people living with HIV/AIDS in the multilevel mixed-effect logistic regression model were declared significant at p-values < 0.05. The adjusted odds ratio (AOR) and confidence interval (CI) were used to interpret the results.

RESULT

The overall prevalence of discriminatory attitudes against people living with HIV/AIDS was 28.19% (95% CI: 27.74%, 28.64%). In the multivariable analysis, individual level (being young, being an internet user, being tested for HIV, and having comprehensive knowledge about HIV) and community level (being a rural dweller) were factors associated with discriminatory attitudes against people living with HIV/AIDS.

CONCLUSION

The prevalence of discriminatory attitudes against people living with HIV/AIDS in three sub-Saharan African countries was high. Individual and community-level variables were associated with discriminatory attitudes against people living with HIV/AIDS. Therefore, special consideration should be given to rural dwellers and young adults. In addition, better to strengthen the accessibility of Internet and HIV testing services, and improve HIV-related education to reduce the magnitude of discriminatory attitudes against people living with HIV/AIDS.

Multilevel analysis of discrimination of people living with HIV/AIDS and associated factors in Ghana: demographic health survey of 2022 Ghana data

Introduction

The negative effects of stigma and discrimination in communities and families include medication non-adherence, heightened psychological distress, verbal and physical abuse, a lack of social support, isolation, and dangerous health behaviors such as hiding prescriptions. Despite the huge burden of HIV/AIDS discriminatory attitudes, limited studies were conducted in Ghana. Therefore, this study examines the burden of discriminatory attitudes and their determinant factors on people who are living with HIV/AIDS in Ghana.

Objective

This study aimed to determine the prevalence of discriminatory attitudes and associated factors among people who are living with HIV/AIDS in Ghana based on recent DHS data.

Method

Secondary data analysis was used for this multilevel logistic regression analysis based on the Ghana Demographic Health Survey of 2022. Data extraction, cleaning, and analysis were conducted using Stata version 14. The community of Ghana, from the 15 to 49 age group, was used for this study, with a final sample size of 22,058 participants. Four separate models were fitted, incorporating individual and community levels. Multilevel logistic regression models were calibrated to determine the associated factors at the individual and community level with discriminatory attitudes, with a 95% CI and AOR.

Results

The prevalence of discriminatory attitudes toward people living with HIV/AIDS was 60.92%, with a 95% CI (60.13, 61.70) among Ghana DHS. Lower wealth status, having no comprehensive knowledge of HIV, low educational status at the individual level, and low wealth status at the community level, poorest and poorer [AOR =2.03; 95% CI: (1.04, 3.94)] and [AOR = 2.09; 95% CI: (1.84, 8.65)], respectively, no comprehensive knowledge [AOR = 3.42; 95% CI: (1.74, 6.73)], no and primary education [AOR = 3.18; 95% CI: (2.48, 5.51)] and [AOR = 3.78; 95% CI: (2.68, 5.92)], respectively, at the individual level and low wealth status [AOR = 1.58; 95% CI: (1.00, 2.46)] community level were the associated factors.

Conclusion

The prevalence of discriminatory attitudes toward people living with HIV/AIDS was high (60.92%) in Ghana's DHS. The associated factors for this study were lower wealth status, having no comprehensive knowledge of HIV, and low educational status at the individual level.

Experiences of Stigmatization and Discrimination in Accessing Health Care Services Among People Living with HIV (PLHIV) in Akwa Ibom State, Nigeria

Background

Recent advances in care and treatment have turned HIV into a "chronic but manageable condition". Despite this, some people living with HIV (PLHIV) continue to suffer from stigma and discrimination in accessing health care services. This study examined the experience of stigma and discrimination and access to health care services among PLHIV in Akwa Ibom State.

Methods

The Center for Clinical Care and Clinical Research (CCCRN), implementing a USAID-funded Integrated Child Health and Social Services Award (ICHSSA 1) project, conducted a community-based cross-sectional survey in 12 randomly selected local government areas in Akwa Ibom State, Nigeria. A structured quantitative questionnaire was used for data collection. In total, 425 randomly selected PLHIV were interviewed after providing informed consent. Descriptive statistics and bivariate analyses were conducted using the data analytical application Stata 14.

Results

The study revealed that 215 PLHIV (50.4%) had been denied access to health care services, including dental care, because of their HIV status in Akwa Ibom State. Respondents reported being afraid of: gossip (78%), being verbally abused (17%), or being physically harassed or assaulted because of their positive status (13%). Self-stigmatization was also evident; respondents reported being ashamed because of their positive HIV status (29%), exhibiting self-guilt (16%), having low self-esteem (38%), and experiencing self-isolation (36%). Women, rural residents, PLHIV with no education, unemployed, single, young people aged between 19 and 29 years, and older adults were more likely to experience HIV-related stigmatization.

Conclusion

Data from the study revealed that the percentage of PLHIV who experience health-related stigmatization because of their HIV status is high in Akwa Ibom State. This finding calls for the prioritization of interventions to reduce stigma, enhance self-esteem, and promote empathy and compassion for PLHIV. It also highlights the need for HIV education for family and community members and health care providers, to enhance the knowledge of HIV and improve acceptance of PLHIV within families, communities, and health care settings.

Discrimination against HIV/AIDS patients and associated factors among women in East African countries: using the most recent DHS data (2015-2022)

INTRODUCTION

The biggest health problem in East Africa is the human immunodeficiency virus (HIV). Combating stigma and discrimination related to HIV/AIDS is a key goal of many international organizations in their efforts to ensure universal access to HIV/AIDS prevention, treatment, care, and support programs. However, previous studies in various regions of Africa have shown that the prevalence of discriminatory attitudes related to HIV/AIDS is particularly high. Furthermore, there is a current evidence gap in the region. Therefore, the aim of this study was to determine the prevalence of discriminatory attitude toward HIV/AIDS patients, and its associated factors among women in East African countries.

METHODS

The data we utilized were gathered from the most recent Demographic and Health Surveys (DHS), which were carried out in east African nations between 2016 and 2022. We integrated DHS data from ten countries into our investigation. For our analysis, a weighted sample of 139,812 women overall was employed. The analysis used multiple logistic regressions. The adjusted odds ratio and its 95% confidence interval were then shown, and components with binary logistic regression p values of less than or equal to 0.2 and < 0.05 were regarded as significant predictors of discrimination against HIV/AIDS patients.

RESULTS

In this study, 32.73% (95% CI 34.48-32.97) of respondents had a discriminatory attitude toward HIV/AIDS patients. In the multiple logistic regression analysis, being in the older age groups, having a better education level, being from a wealthy household, having employment status, having ANC follow-up, institutional delivery, mass media exposure, and having female household heads were associated with higher odds of not having a discriminatory attitude toward HIV/AIDS patients. However, being unmarried and living far from the health facilities were associated with higher odds of discriminatory attitudes toward HIV/AIDS patients.

CONCLUSION

This study concluded that women in East Africa still had a very discriminatory attitude toward HIV/AIDS patients. The good news for East Africa is that prevalence has decreased when compared to earlier findings. Improving women's empowerment, maternal health services, and health facilities' accessibility are crucial.

Community Perceptions of HIV Stigma, Discriminatory Attitudes, and Disclosure Concerns: A Health Facility-Based Study in Selected Health Districts of South Africa

Research data about HIV stigma perceptions and discriminatory attitudes among the general population are limited. Furthermore, the willingness of HIV-negative individuals to engage with HIV prevention and disclosure interventions has not been established in South Africa. The study investigated community perceptions of stigma as well as discriminatory attitudes towards HIV disclosure to understand if and how these perceptions might influence the uptake of disclosure interventions. This facility-based study used a validated questionnaire to measure the four constructs of HIV stigma among 670 adults recruited from health districts of two provinces of South Africa. Of these, 72% were female, 87% had ever been tested for HIV, and 31% knew someone who has HIV. Stigma towards people living with HIV (PLHIV) is widespread in the general population. A high proportion (75%) endorsed disclosure concerns, 75% perceived stigma to be common, and 56% endorsed negative statements indicating perceived stigma in communities. Fear, moral and social judgement, and rejection underlined their perceptions about PLHIV. Almost half (45.7%) were unwilling to care for family members sick with AIDS, suggesting negative distancing reactions and discriminatory attitudes towards PLHIV. The widespread discriminatory attitudes and the perceived stigma that is evident in the general population might heighten the disclosure concerns endorsed, promote non-disclosure, and increase HIV transmission. To design interventions, it is crucial to be cognisant of disclosure concerns, discriminatory attitudes, and perceived stigma evident in communities. Thus, the findings underscore the need to increase efforts to challenge and reduce community drivers of negative discriminatory attitudes and perceived stigma.

Stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among general adult population: the results from the 6th Thai National Health Examination Survey (NHES VI)

Background

Thailand has an ongoing action plan to reduce human immunodeficiency virus (HIV) discrimination and stigma. We aimed to monitor the level of stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among the general adult population and to investigate its related factors.

Methods

This study was based on data from the 6^th Thai National Health Examination Survey, a large-scale country-wide survey in 2019-2020. We used a multistage sampling technique and included 11 843 adults aged 20 to 59. We collected data through face-to-face interviews which included six items related to HIV stigma domains. We weighted all analyses to account for the probability of sampling the Thai population aged 20 to 59 years.

Results

We found that anticipated stigma had the highest percentage of negative stigmatizing attitude responses (78.5%), followed by perceived stigma (66.6%), fear of HIV infection (54.4%), and social judgment (28.2%). Regarding the UNAIDS global indicator for discriminatory attitude, 48.6% of respondents had negative perceptions to questions about experienced stigma or discrimination. Multiple logistic regression showed that factors associated with discriminatory attitudes toward PLWHA were being aged 20-39 (adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.18-1.47) or 50-59 (aOR = 1.23, 95% CI = 1.09-1.40) compared to being aged 40-49, being Muslim compared to Buddhist (aOR = 1.73, 95% CI = 1.46-2.06), being married compared to being single (aOR = 1.15, 95% CI = 1.04-1.28), holding certificate degree or higher compared to not studying or studying at a primary level (aOR = 0.81, 95% CI = 0.68-0.97), living in the Northeast (aOR = 1.27, 95% CI = 1.12-1.45) and Bangkok (aOR = 1.30, 95% CI = 1.12-1.51) compared to living in the North, having no HIV/AIDS infected relative or acquaintance compared to having an HIV/AIDS infected relative or acquaintance (aOR = 1.56, 95% CI = 1.41-1.73), and not obtaining an HIV test compared to obtaining it (aOR = 1.10, 95% CI = 1.02-1.19).

Conclusions

We found that HIV stigmatizing and discriminatory attitudes toward PLWHA decreased, but remained concerning among Thai adult people. A public education and awareness campaign, as well as an intervention to reduce HIV-related stigma and discrimination in the country's health care facilities, must still be maintained.

'I am struggling to survive' - limited living conditions increase the burden of HIV: A qualitative study

The human immunodeficiency virus (HIV) continues to have life-limiting health consequences for many individuals and remains a significant threat to global public health. This qualitative study explores the experiences of people living with HIV in Sidama, Ethiopia. Interviews with 19 adults recruited from an HIV outpatient clinic were conducted using a semi-structured interview guide. The analysis method used was systematic text condensation. The results reveal that an HIV diagnosis triggered strong emotions. Economic concerns, stigma, and discrimination also increased the burden of a diagnosis, which could lead to a loss of income or housing. Consequently, informants' ability to maintain a regular life and receive social and psychological support was reduced. Religious faith provided strength to informants, though they stated that some religious leaders do not support antiretroviral therapy. Understanding the everyday challenges of people living with HIV is crucial for health professionals and health programme developers working to promote health and enable people to follow their recommended course of treatment. Person-centred care is recommended. In particular, the poorest should receive attention. It is also crucial to reduce stigma and discriminatory attitudes towards people living with HIV and to motivate faith leaders to prevent HIV stigma and support antiretroviral therapy.

A three-year randomized community trial of community support workers in rural Ethiopia to promote retention in HIV care

Retention in care is a major challenge for global AIDS control, including sub-Saharan Africa. In a large Ethiopian region, we evaluated an intervention where HIV positive community support workers (CSWs) provided HIV health education, personal counseling and social support for HIV patients new to care. We enrolled 1,799 patients recently entering care from 32 hospitals and health centers, randomized to intervention or control sites. Dates of all clinic visits, plus deaths or transfers were abstracted from HIV medical records. Primary outcomes were gap in clinical care (>90 days from a missed clinical or drug pickup appointment) and death. For 36 months of follow-up, and for the first 12 months after enrollment, weighted risk differences [RD] between treatment arms were modest and non-significant for gap in clinical care, death or either outcome. Through 36 months, 624 of 980 controls and 469 of 819 intervention participants had gaps in clinical care (RD = -5.5%, 95% confidence interval [CI] = -17.9%, 7.0%); 79 controls and 82 intervention participants died (RD = 2.5% 95% CI = -1.7%, 6.8%). Factors including HIV stigma and a volatile political climate may have attenuated the advantages we anticipated, demonstrating how benefits of CSW interventions may depend upon psychosocial, clinical and structural factors particular to specific community settings.

Hotspots and determinants of women's discriminatory attitude towards people living with HIV; evidence from ethiopian demographic and health survey data

Background

Human Immunodeficiency Virus (HIV) is the major public health concern in Ethiopia with more profound effect on women. Discriminatory attitude towards people living with HIV (PLWH) impose a significant impact on patient outcomes and related issues. Hence, this study aimed to investigate the hotspot areas and determinant factors of women’s discriminatory attitude towards people living with HIV.

Methods

An in-depth secondary data analysis was conducted based on Ethiopian demographic and health survey (EDHS) 2016. A total of weighed 13,822 reproductive-age women were included in the analysis. The non-spatial analysis was conducted using Stata 16. A mixed effect multi-level logistic regression model was fitted to identify determinant factors of discriminatory attitude towards PLWH. A p-value < 0.2 and 0.05 were used as a cut-off point to declare statistical significance for the bi- and multi-variable regression models, respectively. Four separate models i.e. the null, individual, community level model, and a fourth combined model were fitted. Model comparison was done using deviance. Random effect parameters such as correlation coefficient, median odds ratio, and proportional change in variance were used to explain the variation between and within clusters. Global and local level spatial analyses were conducted using Global Moran’s index, GetisOrd Gi* statistics, and Spatial scan statistics were conducted.

Results

The magnitude of women’s discriminatory attitude towards PLWH was 62.66% (95%CI: 60.12, 65.10). The discriminatory attitude of women towards PLWH was spatially clustered (Moran’s index = 0.41, P < 0.01). The hotspots of discriminatory attitude towards PLWH were detected in most parts of the Tigray region; Northern, and southeast borders of the Amhara region; Addis Ababa city; Central, Southern, and western Oromiya region; and East, south, and northeastern parts of South Nations, Nationalities and Peoples Region (SNNPR). Being rural resident, and having no media exposure were positively associated while better educational statuses, better wealth index, unmarried, having comprehensive HIV knowledge, Orthodox religion fellow, and ever being tested for HIV were negatively associated with women’s discriminatory attitude towards people living with HIV.

Conclusion

Discriminatory attitude of women towards PLWH was high in Ethiopia. Hotspots were detected in Amhara, Oromiya, SNNPR, Tigray regions, and Addis Ababa city. Socio-demographic, socio-economic, and HIV knowledge-related factors determine the women’s discriminatory attitude towards PLWH.

Discriminatory attitude towards people living with HIV/AIDS and its associated factors among adult population in 15 sub-Saharan African nations

Background

Discrimination of people living with HIV/AIDS is one of the reported obstacles to the achievement of universal access to HIV/AIDS prevention, treatment, care, and support programs. Many international agencies have made combating HIV/AIDS stigma and discrimination a top priority. However, previous evidence in different parts of Africa revealed that the magnitude of HIV/AIDS-related discriminatory attitude is significantly high.

Objective

To assess discriminatory attitude towards people living with HIV/AIDS and its associated factors among the adult population in 15 sub-Saharan African nations.

Methods

We have used the 15 Demographic and Health Survey data that were conducted in sub-Saharan Africa (SSA) from 2015 to 2019/20. Each country’s data was appended and a total weighted sample of 318,186 (unweighted sample = 315,448) adults who had ever heard of AIDS was used for the final analysis. The two discriminatory attitude questions were used to get the outcome variable and those who answered “Yes” or “don’t know” for both questions were counted as if they had no discriminatory attitude towards people living with HIV/AIDS. To assess the factors associated with discriminatory attitude towards people living with HIV/AIDS, we have fitted a multilevel binary logistic regression model. Bivariable analysis was done to select eligible variables for the multivariable analysis. Finally, variables with p<0.05, in the multivariable analysis, were considered as significant predictors of discriminatory attitude towards people living with HIV/AIDS.

Results

The prevalence of discriminatory attitude towards HIV/AIDS in the 15 sub-Saharan African nations was 47.08% (95% CI: 47.08, 47.42), which ranges from 17.64% (95% CI: 17.22, 18.07) in Malawi to 79.75% (95% CI: 79.02, 80.45) in Guinea. In the multivariable analysis, both individual level and community level variables were significantly associated with discriminatory attitude towards people living with HIV/AIDS. Being younger age, no formal education, never married, low socioeconomic status, male-headed household, non-contraceptive use, no mass media exposure, and incorrect comprehensive knowledge towards HIV/AIDS were among the individual-level factors that were associated with higher odds of discriminatory attitude towards people living with HIV/AIDS. While being from urban residence and the western SSA region were among the community-level factors that were significantly associated with higher odds discriminatory attitude towards people living with HIV/AIDS.

Conclusion

The prevalence of discriminatory attitude towards people living with HIV/AIDS in 15 sub-Saharan African nations was high. Both individual and community-level factors were associated with discriminatory attitude towards people living with HIV/AIDS. Therefore, special attention should be given to those who are poor, uneducated, and younger adults. In addition, it is better to strengthen the accessibilities of different media for adult populations to create an appropriate attitude towards people with HIV/AIDS.

Individual-, household-, and community-level factors associated with pregnant married women's discriminatory attitude towards people living with HIV in sub-Saharan Africa: A multicountry cross-sectional study

BACKGROUND AND AIMS

Discriminatory attitude towards people living with human immunodeficiency virus (HIV) remains a major problem in the prevention and treatment of HIV in sub-Sahara Africa (SSA). Understanding the multiple factors linked to discriminatory attitude towards people living with HIV/AIDS (PLWHA) in SSA is necessary for developing appropriate interventions. This study aimed at investigating the individual, household, and community-level factors associated with pregnant married women's discriminatory attitude towards people living with HIV/AIDS.

METHODS

We used data from the Demographic and Health Surveys of 12 sub-Saharan African countries conducted between 2015 and 2019. Data on 17 065 pregnant married women were analyzed. Bivariate (chi-squared test) and multivariable multilevel logistic regression analyses were applied to investigate the factors associated with discriminatory attitude towards PLWHA. The results were reported as adjusted odds ratio (aOR) at 95% confidence interval (CI).

RESULTS

The mean age of participants was 31.2 ± 8.5. The prevalence of discriminatory attitude towards PLWHA was 36.2% (95% CI: 33.4%-39.1%). Individual/household-level factors associated with discriminatory attitude towards PLWHA were women's educational level (secondary school-aOR = 0.49, 95% CI: 0.26-0.93), husband's educational level (higher education-aOR = 0.35, 95% CI: 0.16-0.76), decision-making power (yes-aOR = 0.51, 95% CI: 0.38-0.69), wife-beating attitude (disagreement with wife beating-aOR = 0.58, 95% CI: 0.43-0.79), and religion (Muslim-aOR = 1.92, 95% CI: 1.22-3.04). Community socioeconomic status (medium-aOR = 0.61, 95% CI: 0.41-0.93) was the only community-level factor associated with discriminatory attitude towards PLWHA.

CONCLUSION

More than one-third of pregnant married women in SSA had discriminatory attitude towards PLWHA. Women's educational level, husband's educational level, decision-making power, wife-beating attitude, religion, and community socio-economic status were associated with discriminatory attitude towards PLWHA. To lessen the prevalence of discriminatory attitude towards PLWHA, considering these significant factors is needed. Therefore, governments and other stakeholders in the respective countries need to increase education coverage. Moreover, empowering women through education and economy is crucial. Finally, working with religious leaders to increase awareness about HIV and discriminatory attitude towards PLWHA should also be a priority in SSA.

Misconceptions and stigma against people living with HIV/AIDS: a cross-sectional study from 2017 Indonesia Demographic and Health Survey

OBJECTIVES

Data are not available in Indonesia to measure the main indicators of zero new infections, zero acquired immune deficiency syndrome (AIDS)-related deaths and zero discrimination. This study aimed to determine factors related to misconceptions about human immunodeficiency virus (HIV) transmission and the stigma against people living with HIV/AIDS (PLWHA) in Indonesia

METHODS

This cross-sectional study used secondary data from the 2017 Indonesia Demographic and Health Survey (IDHS). The sample was women and men aged 17–45 years and married (n=3,023).

RESULTS

Education and wealth index quintile were significantly related to misconceptions about HIV transmission. Respondents with low levels of education were more likely to have misconceptions about HIV transmission. Respondents who were in the poorest, poorer, middle, and richer quintiles of the wealth index were more likely to have misconceptions about HIV transmission than those in the richest quintile. Educational level, employment status, and wealth index quintile were predictors of stigma against PLWHA.

CONCLUSIONS

There are still many Indonesian people with misconceptions about HIV transmission and stigma against PLWHA. Future studies should focus on educational programs or interventions aimed at increasing public knowledge and awareness, promoting compassion towards PLWHA, and emphasizing respect for the rights of PLWHA. These interventions are particularly important for populations who are uneducated and living in poverty.