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Gázquez-López M, Álvarez-Serrano MA, Martín-Salvador A, Pérez-Morente MÁ, García-García I, González-García A, Martínez-García E. Attitudes towards people living with HIV/AIDS through the EAPVVS-E: A descriptive analysis in nursing students. NURSE EDUCATION TODAY 2024; 144:106418. [PMID: 39316862 DOI: 10.1016/j.nedt.2024.106418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 09/09/2024] [Accepted: 09/16/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Despite advances in antiretroviral treatment, stigma towards people with HIV/AIDS continues to exist. Nursing students, as future key players in health care, must advocate for the elimination of stigma through education, empathy and the creation of a supportive environment. This holistic approach is crucial to improving their quality of life and moving towards the eradication of HIV/AIDS. AIM To identify nursing students' attitudes towards people living with HIV or AIDS and their relationship with sociodemographic and academic-cultural variables of the participants. DESIGN A cross-sectional study was performed. SETTINGS The research was carried out in the Nursing Degree of the Faculty of Health Sciences of the Ceuta Campus of the University of Granada. PARTICIPANTS Convenience sampling was used to recruit 284 students of the degree in Nursing. METHODS Data were collected voluntarily and on an anonymous basis, using the "Attitudes Towards People Living with HIV/AIDS Scale in Nursing Students". Bivariate and multivariate analyses were performed. RESULTS Factors 1 (Professional Practice), 2 (Social Integration) and 3 (Partner and Family) exhibited mean scores considered to be favourable attitudes (>4 points). In contrast, Factor 4, called Benevolent Stigma, had a mean score of 3.68 ± 0.97. Religious beliefs, academic year, sexual orientation, academic practices and age are considered influential variables in the different factors. CONCLUSIONS Nursing students present attitudes with favourable scores. However, these results highlight the importance of influencing the different factors, especially in the second year of the Bachelor's Degree in Nursing in our sample. Thus, an educational intervention in this area would be necessary to reinforce the values of humanised care.
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Affiliation(s)
- María Gázquez-López
- Department of Nursing, Faculty of Health Sciences, University of Granada, 51001 Ceuta, Spain
| | | | - Adelina Martín-Salvador
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | | | - Alberto González-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Encarnación Martínez-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; Virgen de las Nieves University Hospital, 18014 Granada, Spain
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Denardo D, Cort DA. Temporal changes in HIV-related stigma and sexual behaviours: An examination of 22 African countries. Glob Public Health 2024; 19:2405019. [PMID: 39324704 DOI: 10.1080/17441692.2024.2405019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 09/10/2024] [Indexed: 09/27/2024]
Abstract
ABSTRACTDespite non-trivial success against the HIV epidemic, health experts in Sub-Saharan Africa (SSA) remain concerned about new infections, stigma attitudes, and increasing rates of higher-risk sexual behaviours (HRSBs). Although this concern has produced voluminous scholarship on the behavioural consequences of belonging to stigmatised populations, scholars have only recently examined the behavioural consequences of holding stigmatising attitudes. Existing work generally finds a positive relationship between stigmatising beliefs and the practice of HRSBs. Yet, it is unknown whether this relationship has changed for countries over the past two decades. We fill this gap using Demographic and Health Survey data from 22 SSA countries. We first find that in most countries, the practice of HRSBs has increased, while stigma beliefs have become more tolerant. Second, the relationship between stigma beliefs and HRSBs changed in only six countries: Nigeria, Kenya, Mozambique, Sierra Leone, Ethiopia, and Lesotho. It changed from non-existent or negative to positive in Nigeria, Kenya, Mozambique, and Ethiopia, but non-existent to negative in Sierra Leone. In Lesotho, the positive association weakened over time. These findings highlight the importance of social and epidemic contexts when considering how stigma impacts sexual behaviours and HIV rates in SSA.
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Affiliation(s)
- Danielle Denardo
- Social and Behavioral Sciences, Soka University of America, Aliso Viejo, CA, USA
| | - David A Cort
- Department of Sociology, University of Massachusetts, Boston, MA, USA
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Yendewa GA, Kpaka RA, Sellu E, Yendewa SA, Massaquoi SPE, Cummings PE, Ghazzawi M, Barrie U, Dubé K, Lakoh S, James PB, Salata RA, Babawo LS. Perceived and Enacted HIV-Related Stigma in Eastern and Southern Sierra Leone: A Psychometric Study of an HIV Stigma Scale. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.07.23292152. [PMID: 37503110 PMCID: PMC10370221 DOI: 10.1101/2023.07.07.23292152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background HIV stigma continues to hinder the care of people with HIV (PWH), especially in low-resource settings. We aimed to adapt and validate a concise HIV stigma scale for perceived HIV stigma in Sierra Leone. Methods We enrolled participants in two HIV clinics in Eastern and Southern Sierra Leone in 2022. We assessed perceived stigma using a 12-item adaptation of Berger's HIV Stigma Scale and enacted stigma using select USAID indicators. We used ordinal logistic regression to identify predictors of perceived stigma and Pearson's correlation to examine associations between perceived and enacted stigma. Results 624 PWH were enrolled. The final adapted 6-item HIV stigma scale demonstrated acceptable internal consistency (Cronbach's α = 0.72) and a four-factor solution accounting for 84.8% of variance: concern about public attitude (2 items), personalized stigma (2 items), negative self-image (1 item), and disclosure concerns (1 item). The prevalence of perceived HIV stigma was 68.6%, with disclosure concerns as the most prominent contributor. Enacted HIV stigma was reported by only 6.7% of participants, with partner/spousal abandonment and workplace stigma being the most common discriminatory experiences. Employment (β = 0.525, p <0.001), residence in Eastern Sierra Leone (β = 3.215, p < 0.001), and experiencing enacted stigma (β = 0.804, p < 0.001) were significantly associated with perceived stigma. Having a family member or friend with HIV (β = -0.499, p < 0.001), and HIV disclosure (β = -0.710, p < 0.001) were protective against perceived stigma. Enacted stigma strongly correlated with partner abandonment and family isolation (r = 0.223, p < 0.001). Conclusion We found high levels of perceived HIV stigma, underscoring the need for targeted interventions to combat stigma and promote inclusivity for PWH in Sierra Leone.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Edmond Sellu
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Sahr A Yendewa
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | | | - Umaru Barrie
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Peter B James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lawrence S Babawo
- Eastern Technical University, Kenema, Sierra Leone
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
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Ghazzawi M, Yendewa SA, James PB, Massaquoi SP, Babawo LS, Sahr F, Deen GF, Kabba M, Ocama P, Lakoh S, Salata RA, Yendewa GA. Assessment of Knowledge, Stigmatizing Attitudes and Health-Seeking Behaviors Regarding Hepatitis B Virus Infection in a Pharmacy and Community Setting in Sierra Leone: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11020177. [PMID: 36673546 PMCID: PMC9859485 DOI: 10.3390/healthcare11020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Hepatitis B virus (HBV) is a major global health challenge. Emerging evidence suggests that poor knowledge and stigma are impacting HBV control efforts in sub-Saharan Africa (SSA), but their role is not well understood. We conducted a cross-sectional study of adults aged ≥18 years in a community and pharmacy setting in Freetown, Sierra Leone. A structured questionnaire was used to assess knowledge, stigmatizing attitudes and health-seeking behaviors regarding HBV. Logistic regression was used to identify predictors of HBV knowledge and related stigma. A total of 306 adult participants were enrolled (50.7% male, 7.5% HBV positive and 11.7% vaccinated). Overall, 52.2% had good HBV knowledge and 49.3% expressed a stigmatizing attitude towards people with HBV. Notwithstanding, 72.2% stated they would receive the HBV vaccine if offered, 80.4% would take anti-HBV medication and 78.8% would be willing to attend clinic regularly. Good HBV knowledge was associated with HBV positive status (aOR 4.41; p = 0.029) and being vaccinated against HBV (aOR 3.30; p = 0.034). HBV-related stigma was associated with secondary or higher level of education (aOR 2.36; p < 0.001), good HBV knowledge (aOR 2.05; p = 0.006) and pharmacy setting (aOR 1.74, p = 0.037). These findings suggest that education and stigma reduction may benefit HBV elimination efforts in SSA.
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Affiliation(s)
| | | | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia
| | | | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F. Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-2168441988
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Hargreaves JR, Pliakas T, Hoddinott G, Mainga T, Mubekapi‐Musadaidzwa C, Donnell D, Wilson E, Piwowar‐Manning E, Agyei Y, Bell‐Mandla NF, Dunbar R, Schaap A, Macleod D, Floyd S, Bock P, Fidler S, Seeley J, Stangl A, Bond V, Ayles H, Hayes RJ. The association between HIV stigma and HIV incidence in the context of universal testing and treatment: analysis of data from the HPTN 071 (PopART) trial in Zambia and South Africa. J Int AIDS Soc 2022; 25 Suppl 1:e25931. [PMID: 35818869 PMCID: PMC9274206 DOI: 10.1002/jia2.25931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/03/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION To investigate the association between individual and community-level measures of HIV stigma and HIV incidence within the 21 communities participating in the HPTN (071) PopART trial in Zambia and South Africa. METHODS Secondary analysis of data from a population-based cohort followed-up over 36 months between 2013 and 2018. The outcome was rate of incident HIV infection among individuals who were HIV negative at cohort entry. Individual-level exposures, measured in a random sample of all participants, were: (1) perception of stigma in the community, (2) perception of stigma in health settings and (3) fear and judgement towards people living with HIV. Individual-level analyses were conducted with adjusted, individual-level Poisson regression. Community-level HIV stigma exposures drew on data reported by people living with HIV, health workers and community members. We used linear regression to explore the association between HIV stigma and community-level HIV incidence. RESULTS Among 8172 individuals who were HIV negative and answered individual-level stigma questions at enrolment to the cohort, there was no evidence of a statistically significant association between any domain of HIV stigma and risk of incident HIV infection. Among the full cohort of 26,110 individuals among whom HIV incidence was measured, there was no evidence that community-level HIV incidence was associated with any domain of HIV stigma. CONCLUSIONS HIV stigma is often cited as a barrier to the effectiveness of HIV prevention programming. However, in the setting for the HPTN 071 "PopART trial," measured stigma alone was not associated with the risk of HIV infection.
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Affiliation(s)
- James R. Hargreaves
- Department of Public Health, Environments and Society, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Tila Mainga
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
| | - Constance Mubekapi‐Musadaidzwa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | | | - Ethan Wilson
- Fred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | | | - Yaw Agyei
- Johns Hopkins UniversitySchool of MedicineBaltimoreMarylandUSA
| | - Nomtha F. Bell‐Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Ab Schaap
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
| | - David Macleod
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Sarah Fidler
- Department of Medicine, Imperial College NIHR BRCImperial College LondonLondonUK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Anne Stangl
- International Center for Research on WomenWashingtonDCUSA
- Hera SolutionsBaltimoreMarylandUSA
| | - Virginia Bond
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
- Department of Global Health and Development, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Helen Ayles
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
- Department of Clinical Research, Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - Richard J. Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
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Ndirangu JW, Gichane MW, Browne FA, Bonner CP, Zule WA, Cox EN, Smith KM, Carney T, Wechsberg WM. ‘We have goals but [it is difficult]’. Barriers to antiretroviral therapy adherence among women using alcohol and other drugs living with HIV in South Africa. Health Expect 2022; 25:754-763. [PMID: 35060260 PMCID: PMC8957738 DOI: 10.1111/hex.13422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/03/2021] [Accepted: 12/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Methods Results Conclusion Patient or Public Contribution
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Affiliation(s)
- Jacqueline W. Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Margaret W. Gichane
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Felicia A. Browne
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Courtney P. Bonner
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - William A. Zule
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Erin N. Cox
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Kevin M. Smith
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit South African Medical Research Council Tygerberg South Africa
- Department of Psychiatry and Mental Health University of Cape Town Rondebosch Cape Town South Africa
| | - Wendee M. Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
- Department of Psychology North Carolina State University Raleigh North Carolina USA
- Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
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Kawuki J, Kamara K, Sserwanja Q. Prevalence of risk factors for human immunodeficiency virus among women of reproductive age in Sierra Leone: a 2019 nationwide survey. BMC Infect Dis 2022; 22:60. [PMID: 35039011 PMCID: PMC8764866 DOI: 10.1186/s12879-022-07037-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background and aim For over 40 years of the HIV/AIDS global epidemic, no effective cure nor vaccine is yet available, making the current control strategies focused on curbing new infections through risk reduction. The study aimed to determine the prevalence of HIV risk factors and their associated socio-demographics among women of reproductive age in Sierra Leone. Methods We used weighted data from the Sierra Leone Demographic and Health Survey (SLDHS) of 2019 for 12,005 women aged 15–49 years. Multistage sampling was used to select study participants. Exposure to HIV risk factors was considered if a woman reported at least one of the following; having multiple sexual partners, transactional sex, non-condom use for the unmarried, and having other sexually transmitted infections (STIs). We, then, conducted multivariable logistic regression to explore the associated socio-demographics. All the analyses were done using SPSS (version 25). Results Of the 12,005 women, 38.1% (4577/12005) (95% confidence interval (CI) 37.3–39.0) had at least one of the four risk factors. Women of 15 to 19 years (adjusted odds ratio (AOR) = 1.34, 95% CI 1.00–1.80) and 20 to 34 years (AOR = 1.25, 95% CI 1.05–1.49) had more odds of having HIV risk factors compared to those of 35 to 49 years. Urban residents (AOR = 1.49, 95% CI 1.17–1.89) and those from the Northwestern region (AOR = 1.81, 95% CI 1.26–2.60) were also more likely to encounter HIV risk factors compared to their respective counterparts. Moreover, unmarried women (AOR = 111.17, 95% CI 87.55–141.18) and those working (AOR = 1.38, 95% CI 1.14–1.67) also had higher odds of having HIV risk factors, compared to their respective counterparts. Sex of household head and parity were also significant associates. Conclusions More than a third of women in Sierra Leone had encountered at least one HIV risk factor, and this was associated with age, place of residence, region, marital status, working status, household head and parity. There is a need for strengthening HIV/AIDS education programs, laws and policies targeting the young, working, unmarried and urban-resident women. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07037-7.
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Affiliation(s)
- Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kassim Kamara
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Sierra Leone, Freetown, Sierra Leone
| | - Quraish Sserwanja
- Programmes Department, GOAL, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
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Levy B, Correia HE, Chirove F, Ronoh M, Abebe A, Kgosimore M, Chimbola O, Machingauta MH, Lenhart S, White KAJ. Modeling the Effect of HIV/AIDS Stigma on HIV Infection Dynamics in Kenya. Bull Math Biol 2021; 83:55. [PMID: 33818710 PMCID: PMC8021528 DOI: 10.1007/s11538-021-00891-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022]
Abstract
Stigma toward people living with HIV/AIDS (PLWHA) has impeded the response to the disease across the world. Widespread stigma leads to poor adherence of preventative measures while also causing PLWHA to avoid testing and care, delaying important treatment. Stigma is clearly a hugely complex construct. However, it can be broken down into components which include internalized stigma (how people with the trait feel about themselves) and enacted stigma (how a community reacts to an individual with the trait). Levels of HIV/AIDS-related stigma are particularly high in sub-Saharan Africa, which contributed to a surge in cases in Kenya during the late twentieth century. Since the early twenty-first century, the United Nations and governments around the world have worked to eliminate stigma from society and resulting public health education campaigns have improved the perception of PLWHA over time, but HIV/AIDS remains a significant problem, particularly in Kenya. We take a data-driven approach to create a time-dependent stigma function that captures both the level of internalized and enacted stigma in the population. We embed this within a compartmental model for HIV dynamics. Since 2000, the population in Kenya has been growing almost exponentially and so we rescale our model system to create a coupled system for HIV prevalence and fraction of individuals that are infected that seek treatment. This allows us to estimate model parameters from published data. We use the model to explore a range of scenarios in which either internalized or enacted stigma levels vary from those predicted by the data. This analysis allows us to understand the potential impact of different public health interventions on key HIV metrics such as prevalence and disease-related death and to see how close Kenya will get to achieving UN goals for these HIV and stigma metrics by 2030.
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Affiliation(s)
- Ben Levy
- Department of Mathematics, Fitchburg State University, Fitchburg, MA, USA
| | - Hannah E Correia
- Harvard Data Science Initiative, Harvard University, Cambridge, MA, USA.,Department of Biostatistics, Harvard University, Boston, MA, USA
| | - Faraimunashe Chirove
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg, South Africa
| | - Marilyn Ronoh
- School of Mathematics, University of Nairobi, Nairobi, Kenya
| | - Ash Abebe
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg, South Africa
| | - Moatlhodi Kgosimore
- Department of Biometry and Mathematics, Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - Obias Chimbola
- Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Palapye, Botswana
| | - M Hellen Machingauta
- Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Palapye, Botswana
| | - Suzanne Lenhart
- Mathematics Department, University of Tennessee, Knoxville, TN, USA
| | - K A Jane White
- Department of Mathematical Sciences, University of Bath, Bath, UK.
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Nabifo SC, Tsai AC, Bajunirwe F. HIV-related stigma and its association with HIV transmission risk behaviors among boda boda motorcyclists in Mbarara Municipality, southwestern Uganda. Int J STD AIDS 2021; 32:791-798. [PMID: 33769905 DOI: 10.1177/0956462420987760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Key populations have a disproportionate burden of HIV compared with the general population. HIV-related stigma has been recognized as a major barrier to HIV prevention and treatment efforts. It remains unclear whether HIV-related stigma is a significant driver of HIV transmission risk behavior among boda boda (motorcycle taxi) riders, a key population in Uganda. Methods: We conducted a cross-sectional study among boda boda motorcyclists in Mbarara Municipality of southwestern Uganda. Using multistage sampling, we recruited participants aged 18-59 years who had been riding for at least 6 months. The primary explanatory variable of interest was HIV-related stigma, measured using the 7-item STRIVE scale and dichotomized at "no stigma" versus "any stigma." Self-reported HIV transmission risk behaviors included: condomless sexual intercourse, sexual intercourse under the influence of alcohol, having non-primary sexual partners, and sexual intercourse with a commercial sex worker. We used multivariable logistic regression to estimate the association between HIV-related stigma and HIV transmission risk behavior. Results: We enrolled 401 boda boda motorcyclists. All were men. Most [330 (82%)] were classified as having HIV-related stigma, particularly among younger men aged 18-29 years. One hundred and thirty-two (34%) participants reported their last sexual encounter was with a non-primary partner, 153 (39%) did not know the serostatus of their last sexual partner, and 138 (36%) reported sexual intercourse with a sex worker in the past 6 months. In multivariable logistic regression, HIV-related stigma (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.06-3.34) had a statistically significant association with any HIV transmission risk behavior. Men who reported either minimal alcohol use (aOR = 1.81, 95% CI: 1.07-2.95) or harmful alcohol use (aOR = 3.5, 95% CI: 1.92-6.54), compared with men who reported no alcohol use, also reported greater odds of HIV transmission risk behavior. Conclusions: HIV transmission risk behavior is common among boda boda motorcyclists in the municipality and is associated with both HIV-related stigma and alcohol use. Interventions aimed at reducing HIV-related stigma and alcohol use may potentially reduce the high rates of HIV transmission risk behavior in this key population.
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Affiliation(s)
- Stella C Nabifo
- Department of Community Health, 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Francis Bajunirwe
- Department of Community Health, 108123Mbarara University of Science and Technology, Mbarara, Uganda
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Olamijuwon E, Odimegwu C, Chemhaka G. Involuntary Childlessness and Marital Infidelity Among Women in Sub-Saharan African Countries: An Assessment of the Moderating Role of Women's Education. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:601-614. [PMID: 32621140 DOI: 10.1007/s10508-020-01770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
A considerable number of married women in sub-Saharan African countries are childless and may be likely to engage in marital infidelity to avoid social stigma, economic insecurities, and other debilitating experience associated with being involuntarily childless. This study sought to investigate the relationship between involuntary childlessness and marital infidelity and how it may be moderated by women's educational attainment. Data were obtained from 23,847 women in their first union for at least 2 years and participated in the demographic and health surveys of five sub-Saharan African countries comprising Cameroon, Gabon, Lesotho, Liberia, and Sierra Leone. Data were analyzed using multivariate logistic regression, adjusted for socioeconomic, union, and partner characteristics. Involuntarily childless women in Cameroon (AOR: 2.34, 95% CI 1.62-3.39) and Sierra Leone (AOR: 2.22, 95% CI 1.42-3.49) were about two times more likely to engage in marital infidelity compared to non-childless married women. In Gabon, Lesotho, and Liberia, the odds of marital infidelity did not significantly differ between involuntarily childless and non-childless married women. Although involuntarily childless women with secondary or higher education reported higher levels of marital infidelity than non-childless women with a similar level of education, we found no statistical evidence in all the countries that the relationship between involuntary childlessness and marital infidelity was moderated by women's educational attainment. These findings suggest that involuntary childlessness is a critical factor potentially related to marital infidelity and may be an important target for intervention and prevention, particularly in settings with high levels of sexually transmitted infections.
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Affiliation(s)
- Emmanuel Olamijuwon
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa.
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Kwaluseni Campus, Kwaluseni, Eswatini.
| | - Clifford Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa
| | - Garikayi Chemhaka
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Kwaluseni Campus, Kwaluseni, Eswatini
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11
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Lakoh S, Jiba DF, Vandy AO, Poveda E, Adekanmbi O, Murray MJS, Deen GF, Sahr F, Hoffmann CJ, Jacobson JM, Salata RA, Yendewa GA. Assessing eligibility for differentiated service delivery, HIV services utilization and virologic outcomes of adult HIV-infected patients in Sierra Leone: a pre-implementation analysis. Glob Health Action 2021; 14:1947566. [PMID: 34404330 PMCID: PMC8381912 DOI: 10.1080/16549716.2021.1947566] [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: 11/05/2022] Open
Abstract
Background There are limited data to help guide implementation of differentiated HIV service delivery (DSD) in resource-limited settings in sub-Saharan Africa. Objectives This pre-implementation study sought to assess the proportion of patients eligible for DSD and HIV services utilization, as well as risk factor analysis of virologic failure in Sierra Leone. Methods We conducted a retrospective study of adult HIV-infected patients aged 18 years and older receiving care at the largest HIV treatment center in Sierra Leone 2019–2020. Multiple logistic regression was used to identify predictors of virologic failure. Results Of 586 unique patients reviewed, 210 (35.8%) qualified as ‘stable’ for antiretroviral therapy (ART) delivery. There was high utilization of certain HIV service programs (e.g. HIV status disclosure to partners (83%) and treatment ‘buddy’ program participation (62.8%)), while other service programs (e.g. partner testing and community HIV support group participation) had low utilization (<50%). Of 429 patients with available viral load, 277 (64.6%) were virologically suppressed. In the multivariate logistic regression analysis of risk factors of virologic failure, CD4 < 350 cells/mm3 (p = 0.009), atazanavir-based ART (p = 0.032), once monthly versus once two- or three-monthly ART dispensing (p = 0.028), history of ART switching (p = 0.02), poor adherence (p = 0.001) and not having received adherence support (p < 0.001) were independent predictors of virologic failure. Conclusion Approximately one in three HIV-infected patients on ART were eligible for DSD. We identified gaps in HIV care (i.e. low partner testing, treatment ‘buddy’, program participation and a substantially high rate of virologic failure) that need to be addressed in preparation for full implementation of DSD in Sierra Leone.
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Affiliation(s)
- Sulaiman Lakoh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Alren O Vandy
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario De Vigo, SERGAS-UVigo, Spain
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Gibrilla F Deen
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Sahr
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Christopher J Hoffmann
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Jeffrey M Jacobson
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Milic M, Gazibara T, Stevanovic J, Parlic M, Nicholson D, Mitic K, Lazic D, Dotlic J. Patterns of condom use in a university student population residing in a high-risk area for HIV infection. EUR J CONTRACEP REPR 2020; 25:269-278. [PMID: 32436747 DOI: 10.1080/13625187.2020.1766674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The study objective was to investigate factors associated with condom use among university students. METHODS During the 2013-2014 academic year, 1017 first and fourth year students from the University of Pristina temporarily seated in Kosovska Mitrovica, northern Kosovo, completed a questionnaire on sociodemographic data, HIV-related knowledge, attitudes and risky behaviours. RESULTS Condom use during the most recent sexual encounter and with casual partners was reported by just over half of participants. Factors associated with condom use during the most recent sexual encounter were: being male (35.1%), using medical sources of information about HIV (35.7%), having a positive approach to HIV testing (40.1%) and a positive attitude towards sex workers (17.7%), as well as not having had a sexually transmitted infection in the past year (54.2%). Factors associated with more frequent condom use with casual partners were: being single (28.9%), not living in a rented apartment or own home (32.1%), frequenting night clubs at the weekend (35.3%), not using drugs/opioids (54.1%), not being sure whether to keep a contact after learning of their HIV-positive status (10.1%), and having stronger opinions (either positive or negative) on homosexual individuals (15.5% and 32.1%, respectively), sex workers (18.7% and 23.9%, respectively) and drug users (13.2% and 36.5%, respectively). CONCLUSION Condom use among students in northern Kosovo was low. Strategies for HIV prevention should be focussed on promoting healthy behaviours, especially among female students and students who live alone while at university. Moreover, sexuality education should be carried out in schools and primary health care centres to provide support and enable young people to negotiate safe sex.
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Affiliation(s)
- Marija Milic
- Department of Epidemiology, Faculty of Medicine, University of Pristina temporarily seated in Kosovska Mitrovica, Kosovska Mitrovica, Kosovo, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jasmina Stevanovic
- Department of Epidemiology, Faculty of Medicine, University of Pristina temporarily seated in Kosovska Mitrovica, Kosovska Mitrovica, Kosovo, Serbia
| | - Milan Parlic
- Department of Epidemiology, Faculty of Medicine, University of Pristina temporarily seated in Kosovska Mitrovica, Kosovska Mitrovica, Kosovo, Serbia
| | - Desmond Nicholson
- Department of Regional Health Services Region Five, Ministry of Public Health, Georgetown, Guyana
| | - Katarina Mitic
- Programme Coordinator of the Emergency Relief Project 'Solidarity', SOS Children's Villages, Belgrade, Serbia
| | - Dragoslav Lazic
- Department of Dentistry, Faculty of Medicine, University of Pristina temporarily seated in Kosovska Mitrovica, Kosovska Mitrovica, Kosovo, Serbia
| | - Jelena Dotlic
- Clinic of Gynaecology and Obstetrics, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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The Impact of Perceptions of Community Stigma on Utilization of HIV Care Services. J Racial Ethn Health Disparities 2019; 7:383-391. [PMID: 31808137 DOI: 10.1007/s40615-019-00667-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
The relationship between perceived community stigma and treatment adherence has been established in previous literature. Yet, less is known about explicit circumstances in which perceived community stigma deters people living with HIV (PLWH) from maintaining care. This research examines the impact of perceived community stigma against PLWH on self-reported barriers and supports to remain in HIV care services. We used survey data from a 3-year study of the HIV test and treat (T&T) continuum of services in Hartford, CT, surveying 200 PLWH. Logistic regression was used to determine if perceived community stigma had a statistically significant effect on the willingness of PLWH to utilize HIV care services. Results revealed that an increase in perceived stigma predicted willingness to see a doctor in 6 months for those who 'had a fear of poor treatment' (χ2(6) = 21.995, p < 0.001) and 'were concerned about privacy' (χ2(6) = 16.670, p < 0.01). An increase in perceived stigma was also a significant factor in the belief that supportive case managers helped with accessing HIV care services (χ2(1) = 6.817, p < 0.01). Our findings suggest that having a high degree of perceived community stigma is impactful in instances where individuals anticipate stigma or discrimination.
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14
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Finkelstein-Fox L, Park CL, Kalichman SC. Health benefits of positive reappraisal coping among people living with HIV/AIDS: A systematic review. Health Psychol Rev 2019; 14:394-426. [PMID: 31284849 DOI: 10.1080/17437199.2019.1641424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
People living with HIV/AIDS (PLWHA) often face significant stress, ranging from perceiving identity changes to encountering barriers to daily health behavior engagement. To manage these experiences, many people use positive reappraisal coping (including benefit finding and perceiving growth). Effective coping is highly important for PLWHA; stress reduction has salutary effects on multiple indicators of health. The present systematic review, conducted in PubMed, PsycINFO, and CINAHL, synthesises findings from 33 studies of PLWHA, addressing effects of positive reappraisal on health-related outcomes for adults living with HIV as a chronic illness. Studies were evaluated based on methodological considerations, measurement of key variables, and implications for specific aspects of health. Results suggest that positive reappraisal is often beneficial when dealing with the implications of a potentially traumatic HIV diagnosis on one's identity, although effects may be contextually bound. Implications of these findings are reviewed, emphasizing the importance of positive reappraisal for enhancing health promotion and self-management of HIV. Although the present review is limited by inclusion of multiple disparate outcomes and exclusion of non-English-language articles, these findings inform a comprehensive model of direct and indirect effects of positive reappraisal on emotional, functional, physiological, and behavioural aspects of health useful for guiding future research.
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Affiliation(s)
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
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15
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The social network context of HIV stigma: Population-based, sociocentric network study in rural Uganda. Soc Sci Med 2019; 233:229-236. [PMID: 31229909 DOI: 10.1016/j.socscimed.2019.05.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 04/25/2019] [Accepted: 05/11/2019] [Indexed: 02/06/2023]
Abstract
RATIONALE HIV-related stigma profoundly affects the physical and social wellbeing of people living with HIV, as well as the community's engagement with testing, treatment, and prevention. Based on theories of stigma elaborating how it arises from the relationships between the stigmatized and the stigmatizer as well as within the general community, we hypothesized that social networks can shape HIV-related stigma. OBJECTIVE To estimate social network correlates of HIV-related stigma. METHODS During 2011-2012, we collected complete social network data from a community of 1669 adults ("egos") in Mbarara, Uganda using six culturally-adapted name generators to elicit different types of social ties ("alters"). We measured HIV-related stigma using the 9-item AIDS-Related Stigma Scale. HIV serostatus was based on self-report. We fitted linear regression models that account for network autocorrelation to estimate the association between egos' HIV-related stigma, alters' HIV-related stigma and alters' self-reported HIV serostatus, while adjusting for egos' HIV serostatus, network centrality, village size, perceived HIV prevalence, and sociodemographic characteristics. RESULTS The average AIDS-Related Stigma Score was 0.79 (Standard Deviation = 0.50). In the population 116 (7%) egos reported being HIV-positive, and 757 (46%) reported an HIV-positive alter. In the multivariable model, we found that egos' own HIV-related stigma was positively correlated with their alters' average stigma score (b=0.53; 95% confidence interval [CI] 0.42-0.63) and negatively correlated with having one or more HIV-positive alters (b=-0.05; 95% CI -0.10 to -0.003). CONCLUSION Stigma-reduction interventions should be targeted not only at the level of the individual but also at the level of the network. Directed and meaningful contact with people living with HIV may also reduce HIV-related stigma.
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Evaluation of a community-based ART programme after tapering home visits in rural Sierra Leone: a 24-month retrospective study. SAHARA J 2018; 15:138-145. [PMID: 30257611 PMCID: PMC6161614 DOI: 10.1080/17290376.2018.1527244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Evaluations of community-based antiretroviral therapy (ART) programmes have demonstrated positive outcomes, but little is known about the impact of tapering community-based ART. The objective of this study was to assess 24-month HIV retention outcomes of a community-based ART programme and its tapered visit frequency in Koidu City, Sierra Leone. This retrospective, quasi-experimental study compared outcomes of 52 HIV-infected persons initiated on community-based ART against 91 HIV-infected persons receiving the standard of care from November 2009 to February 2013. The community-based ART pilot programme was designed to strengthen the standard of care through a comprehensive, patient-centred case management strategy. The strategy included medical, educational, psychological, social, and economic support. Starting in October 2011, the frequency of home visits was tapered from twice daily every day per week to once daily three days per week. Outcomes were retention in care at 12 and 24 months and adherence to ART over a three-month time period. Participants who received community-based ART had significantly higher retention than those receiving standard of care. At 12 months, retention rates for community-based ART and standard of care were 61.5% and 31.9%, respectively (p < .01). At 24 months, retention rates for community-based ART and standard of care were 73.1% and 44.0%, respectively (p < .01). Significant differences in levels of adherence were observed when comparing community-based ART against persons receiving standard of care (p < .05). No differences in adherence levels were observed between groups of people receiving various frequencies of home visits. Our pilot programme in Koidu City provides new evidence that community-based ART has the potential to improve retention and adherence outcomes for HIV-infected persons, regardless of the frequency of home visits. Overcoming the barriers to HIV care requires a comprehensive, patient-centred approach that may include clinic-based and community-based interventions.
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Kufa T, Maseko VD, Nhlapo D, Radebe F, Puren A, Kularatne RS. Knowledge of HIV status and antiretroviral therapy use among sexually transmitted infections service attendees and the case for improving the integration of services in South Africa: A cross sectional study. Medicine (Baltimore) 2018; 97:e12575. [PMID: 30278565 PMCID: PMC6181585 DOI: 10.1097/md.0000000000012575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We describe knowledge of human immunodeficiency virus (HIV) status, correct report of HIV status and antiretroviral therapy (ART) use among sexually transmitted infection (STI) service attendees in South Africa.An anonymous questionnaire was administered and serological HIV testing done. Proportions of attendees reporting knowledge of HIV status and HIV status consistent with laboratory results and ART use (among HIV positives) were determined as were factors associated with knowledge and inconsistent report of HIV status.Of 1054 attendees, 288 (27.3%) were HIV positive and 830 (78.8%) self-reported knowledge of HIV status. Not knowing one's HIV status was associated with male gender [adjusted Odds Ratio (aOR) 2.66 (95% confidence interval (CI) 1.70-4.18] medical circumcision [aOR 0.48 (95% CI 0.24-0.95)] and site [Gauteng Province (GP)-aOR 6.20 (95% CI 3.51-10.95), Eastern Cape (EC)-aOR 17.29 (95% CI 10.08- 29.66) versus Free State (FS)/Western Cape (WC) sites]. Of 219 HIV positive attendees with knowledge of HIV status, 136 (62.1%) self-reported being HIV positive, of whom 80 (58.8%) reported taking ARVs in the preceding 3 days. Inconsistent report of status was associated with males [aOR 2.26 (95%CI 1.05-4.87)], prior STI treatment [aOR 0.33 (95% CI 0.16-0.69)], recent HIV testing (6months) [aOR 3.20 (95% CI 1.62-6.36)] and site [GP-aOR 6.89 (95% 3.21-14.82), EC-aOR 5.08 (95% CI 2.15-11.64) versus FS/WC sites]. Knowledge of HIV status was lower than targeted. HIV testing and linkage to care services are essential in STI-related care and validation of self-reported indicators in this population maybe necessary.
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Affiliation(s)
- Tendesayi Kufa
- Centre for HIV and STIs, National Institute for Communicable Diseases
- The School of Public Health
| | - Venessa D. Maseko
- Centre for HIV and STIs, National Institute for Communicable Diseases
| | - Duduzile Nhlapo
- Centre for HIV and STIs, National Institute for Communicable Diseases
| | - Frans Radebe
- Centre for HIV and STIs, National Institute for Communicable Diseases
| | - Adrian Puren
- Centre for HIV and STIs, National Institute for Communicable Diseases
- Division of Virology, School of Pathology
| | - Ranmini S. Kularatne
- Centre for HIV and STIs, National Institute for Communicable Diseases
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kadengye DT, Dalal S. Social intolerance, risky sexual behaviors and their association with HIV knowledge among Ugandan adults: results from a national survey. AIDS Care 2018; 31:250-254. [PMID: 29911430 DOI: 10.1080/09540121.2018.1488028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Understanding the link between HIV knowledge, risky sexual behaviors, and social intolerance such as stigma and discrimination is important for HIV prevention and treatment program planning. We investigated whether intolerant attitudes and practices among Ugandan adults were associated with HIV-transmission knowledge. We analyzed data from a nationally representative population-based household survey, the 2011 Uganda AIDS Indicator Survey. A total of 15,526 participants who responded to questions on HIV knowledge, social intolerance and risky sexual behavior were included in this analysis. Results show that 34.8% of respondents reported having fear of casual contact with people living with HIV (PLWA), 21% blame PLWAs for their disease, 62% would not want HIV infection in their family disclosed, while 25% reported engaging in risky sexual behaviors. After adjusting for age, sex, residence, and level of education, people with low HIV-transmission knowledge had almost three-fold higher odds of fear of casual contact with a PLWA (aOR = 2.70, 95%CI = 2.33-3.13), and had 30% higher odds of HIV-related stigmatizing attitudes (aOR = 1.29, 95%CI = 1.07-1.54). Further, they had 47% higher odds of having sex under the influence of alcohol (aOR = 1.47, 95%CI = 1.25-1.73) and 40% higher odds of having unprotected sex with any of their last three sex partners (aOR = 1.39, 95%CI = 1.06-1.89). Our findings show that intolerant attitudes such as stigma still persist, particularly among people with low HIV-transmission knowledge. Improving knowledge about HIV/AIDS can foster positive attitudes and building safe practices among populations, and is critical for improving prevention and treatment programs.
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Affiliation(s)
- Damazo T Kadengye
- a School of Statistics and Planning , Makerere University , Kampala , Uganda
| | - Shona Dalal
- b Independent consultant , Geneva , Switzerland
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