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Muiruri C, Dombeck C, Swezey T, Gonzales S, Lima M, Gray S, Vicini J, Pettit AC, Longenecker CT, Meissner EG, Okeke NL, Bloomfield GS, Corneli A. Specialty Care Referral for Underrepresented Minorities Living with HIV in the United States: Experiences, Barriers, and Facilitators. AIDS Patient Care STDS 2024; 38:259-266. [PMID: 38868933 DOI: 10.1089/apc.2024.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
The increased incidence of chronic diseases among people with HIV (PWH) is poised to increase the need for specialty care outside of HIV treatment settings. To reduce outcome disparities for HIV-associated comorbidities in the United States, it is critical to optimize access to and the quality of specialty care for underrepresented racial and ethnic minority (URM) individuals with HIV. We explored the experiences of URM individuals with HIV and other comorbidities in the specialty care setting during their initial and follow-up appointments. We conducted qualitative interviews with participants at three large academic medical centers in the United States with comprehensive health care delivery systems between November 2019 and March 2020. The data were analyzed using applied thematic analysis. A total of 27 URM individuals with HIV were interviewed. The majority were Black or African American and were referred to cardiology specialty care. Most of the participants had positive experiences in the specialty care setting. Facilitators of the referral process included their motivation to stay healthy, referral assistance from HIV providers, access to reliable transportation, and proximity to the specialty care health center. Few participants faced individual, interpersonal, and structural barriers, including the perception of individual and facility stigma toward PWH, a lack of transportation, and a lack of rapport with providers. Future case studies are needed for those URM individuals with HIV who face barriers and negative experiences. Interventions that involve PWH and health care providers in specialty care settings with a focus on individual- and structural-level stigma can support the optimal use of specialty care.
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Affiliation(s)
- Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Carrie Dombeck
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Teresa Swezey
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Morgan Lima
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shamea Gray
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joseph Vicini
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - April C Pettit
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chris T Longenecker
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Eric G Meissner
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nwora Lance Okeke
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gerald S Bloomfield
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
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Berrezouga L, Kooli I, Marrakchi W, Harzallah G, Chakroun M. Quality of Life of People Living with HIV on Antiretroviral Therapy: A Cross-Sectional Study in Monastir, Tunisia. HIV AIDS (Auckl) 2023; 15:671-682. [PMID: 38028190 PMCID: PMC10644839 DOI: 10.2147/hiv.s430376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Despite the benefits of an efficient antiretroviral therapy (ART), HIV/AIDS epidemic still represents the most seriousaffection worldwide that negatively impacts people's quality of life (QoL). As no studies exist on QoL in Tunisia, the aim of the present work was i: to assess, based on WHOQOL-HIV BREF tool, the perception of QoL of people living with HIV (PLHIV) receiving ART and ii: to investigate the relationship between socio-demographic features, disease-related variables and QoL domains' mean scores. Methods This cross-sectional study was conducted at the department of infectious diseases of F. Bourguiba Teaching Hospital in Monastir, Tunisia. One hundred and five participants receiving ART were involved. QoL assessment was based on the WHOQOL-HIV Bref including six domains with 29 items with scores ranged from the lowest (4) to the highest (20). Results were reported as frequencies and means (±SD). The Student's t-test for independent samples and the one-way ANOVA were performed to assess differences in QoL mean scores. Linear regression analysis was used to investigate predictors of QoL. The confidence interval was set at 95%. Results Clients' mean age was 39.20±10.18 years old with a male to female sex ratio of 3.12. Low mean scores were seen with the environment (12.34±2.90), social relations (12.58±3.94) and psychological domains (12.76±3.31), and moderate mean scores were noted for the physical (14.11±3.52), the spiritual (14.05±3.78) and the level of independence (13.98±3.57) domains. Regression analysis showed that health status and feeling healthy were related to all QoL domains and that profession, marital status and the presence of a confident person were related to environment and spiritual domains. Conclusion QoL of PLHIV on ART is affected. Concrete measures and strategies should be undertaken by healthcare stakeholders to improve QoL determinants.
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Affiliation(s)
- Latifa Berrezouga
- Department of Microbiology and Immunology, University of Monastir, Faculty of Dental Medicine, Monastir, Tunisia
- Department of Endodontics, University of Monastir, Dental Clinic, Monastir, Tunisia
- Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology and Mycology LR12ES09, University of Monastir, Monastir, Tunisia
| | - Ikbel Kooli
- Department of Infectious Diseases, University of Monastir, F. Bourguiba Teaching Hospital, Monastir, Tunisia
| | - Wafa Marrakchi
- Department of Infectious Diseases, University of Monastir, F. Bourguiba Teaching Hospital, Monastir, Tunisia
| | - Ghaya Harzallah
- Department of Infectious Diseases, University of Monastir, F. Bourguiba Teaching Hospital, Monastir, Tunisia
| | - Mohamed Chakroun
- Department of Infectious Diseases, University of Monastir, F. Bourguiba Teaching Hospital, Monastir, Tunisia
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Sharafi M, Mirahmadizadeh A, Hassanzadeh J, Seif M, Heiran A. Duration of delayed diagnosis in HIV/AIDS patients in Iran: a CD4 depletion model analysis. Front Public Health 2023; 11:1029608. [PMID: 37139388 PMCID: PMC10149797 DOI: 10.3389/fpubh.2023.1029608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Objective Delayed diagnosis of HIV can lead to an inappropriate response to antiretroviral therapy (ART), rapid progression of the disease, and death. It can also carry harmful effects on public health due to the increment of transmission. This study aimed to estimate the duration of delayed diagnosis (DDD) in HIV patients in Iran. Methods This hybrid cross-sectional cohort study was conducted on the national HIV surveillance system database (HSSD). Linear mixed effect models with random intercept, random slope, and both were used to estimate the parameters required for the CD4 depletion model to determine the best-fitted model for DDD, stratified by the route of transmission, gender, and age group. Results The DDD was estimated in 11,373 patients including 4,762 (41.87%) injection drug users (IDUs), 512 (4.5%) men who had sexual contact with men (MSM), 3,762 (33.08%) patients with heterosexual contacts, and 2,337 (20.55%) patients who were infected through other routes of HIV transmission. The total mean DDD was 8.41 ± 5.97 years. The mean DDD was 7.24 ± 0.08 and 9.43 ± 6.83 years in male and female IDUs, respectively. In the heterosexual contact group, DDD was obtained as 8.60 ± 6.43 years in male patients and 9.49 ± 7.17 years in female patients. It was also estimated as 9.37 ± 7.30 years in the MSM group. Furthermore, patients infected through other transmission routes were found with a DDD of 7.90 ± 6.74 years for male patients and a DDD of 7.87 ± 5.87 years for female patients. Conclusion A simple CD4 depletion model analysis is represented, which incorporates a pre-estimation step to determine the best-fitted linear mixed model for calculating the parameters required for the CD4 depletion model. Considering such a noticeably high HIV diagnostic delay, especially in older adults, MSM, and heterosexual contact groups, regular periodic screening is required to reduce the DDD.
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Affiliation(s)
- Mehdi Sharafi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- *Correspondence: Alireza Mirahmadizadeh
| | - Jafar Hassanzadeh
- Department of Epidemiology, School of Health, Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Non-communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Heiran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Alenezi A. Stigmatization and discrimination towards human immunodeficiency virus seropositive patients in psychiatric and mental health facilities. Int J Ment Health Nurs 2022; 31:1198-1212. [PMID: 35678330 DOI: 10.1111/inm.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
Stigmatization and discriminatory attitudes of nurses towards human immunodeficiency (HIV) patients have been reported in many countries. The current study was undertaken to assess the knowledge, attitudes and factors associated with stigmatizing attitudes and discrimination among psychiatric and mental health nurses and nurse interns towards patients diagnosed with the human immunodeficiency virus; utilizing a single-centre hospital-based survey design. Primary data were collected using a previously validated questionnaire in a large mental health care hospital in Riyadh, Saudi Arabia. Knowledge, attitudes, acts of discrimination and associated factors on the part of mental health nurses towards those diagnosed with the HIV were identified. The study described herein is in accordance with the STROBE guideline. A total of 241 psychiatric and mental health nurses completed the questionnaire, yielding a completion rate of 74.4%. Overall, more than half of the nurses demonstrated gaps in knowledge and reported higher stigmatizing attitudes and acts of discrimination. Factors associated with stigmatization and/or discrimination include higher exposure to seropositive patients, no formal HIV training, lower religiousness, lower awareness of HIV testing policy and lower level of knowledge about HIV infection. There is an urgent need to implement a training program that will help to reduce stigma among nurses caring for people diagnosed with this illness.
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Affiliation(s)
- Atallah Alenezi
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
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Quality of Life and Its Association With HIV-Related Stigma Among People Living With HIV in Kerman, Iran: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2022; 33:605-612. [PMID: 36170123 DOI: 10.1097/jnc.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study aimed to evaluate the quality of life (QoL) and its association with HIV-related stigma among people living with HIV (PLHIV) in Kerman province, southeast Iran. A convenience sample of 104 PLHIV was recruited. Data on QoL were collected using the HIV/AIDS-Targeted QoL instrument. Internal and external stigma were measured using an instrument developed by UNAIDS. The average QoL score was 52.5 (SD =13.9). In multivariable model, PLHIV who experienced higher external stigma score (B = -1.9; 95% confidence interval [CI]: -2.6 to -1.1) and higher internal stigma score (B = -1.1; 95% CI: -1.5 to -0.6) had lower level of QoL. The low level of QoL among PLHIV in Iran indicates the need for initiatives to increase QoL among this population. Our data suggest that QoL in PLHIV could be improved by interventions aimed at reducing stigma in both community and health care settings.
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Pashaei Z, Oskouie F, Moradi-Lakeh M, Jahanfar S, Haghani S. HIV serostatus disclosure to sexual partner: a survey among women in Tehran, Iran. Eur J Med Res 2022; 27:56. [PMID: 35395935 PMCID: PMC8994217 DOI: 10.1186/s40001-022-00663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disclosure of HIV-positive status in women is associated with many factors. Consequently, status disclosure remains a challenge for Iranian women living with HIV. This study aimed to assess the prevalence, related factors, and reflections of HIV-positive status disclosure to a sexual partner(s) among Iranian women living with HIV. METHODS A cross-sectional study was conducted on 170 HIV-seropositive women. Participants were selected from patients registered in the largest HIV clinic and HIV-positive club of Iran. The "HIV disclosure" questionnaire had 38-items and all the interviews were administered by the researcher. Data were analyzed using SPSS version 21.0 software. We used a logistic regression method to calculate the crude odds ratio (COR) and the adjusted odds ratio (AOR) for self-disclosure as the independent predictor variable and the dependent variable, respectively. RESULTS One hundred and seventy HIV-positive women were enrolled. Most of them had disclosed their HIV status to at least one person (94.1%) and their sexual partners (86.5%). In the univariate analysis, being married (COR = 18.66, 95% CI 5.63-61.87), living with a sexual partner (COR = 4.72, 95% CI 1.92-11.62), being aware of sexual partners' HIV status (COR = 6.20, 95% CI 1.79-21.49), and gaining the support of sexual partner (COR = 9.08, 95% CI 3.48-23.64) were associated with higher odds of HIV status disclosure. In the multivariate analysis, being aware of sexual partners' HIV status, and gaining the support of sexual partners remained associated with HIV status disclosure. Most women reported a positive reflection from their sexual partners after disclosure, however, negative reflections from society were more common compared to sexual partners and family members. CONCLUSION This study shows high overall HIV disclosure proportions. It should be noted that a large number of women were infected by their sexual partners, especially by their spouses. The high rate of transmission in married people indicates an urgent need for more emphasis on appropriate prevention behaviors by infected partners.
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Affiliation(s)
- Zahra Pashaei
- Department of Community Health Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.,Iranian Research Center for HIV/AIDS (IRCHA), Iran Nursing Care, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Oskouie
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran. .,Department of Community Health Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA
| | - Shima Haghani
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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Baldwin A, Sileo KM, Huynh TA, Olfers A, Woo CJ, Greene SL, Casillas GL, Taylor BS. Applying the Health Stigma and Discrimination Framework to Assess HIV Stigma among Health Care Professionals: A Mixed Methods, Community-Based Participatory Research Study. J Health Care Poor Underserved 2022; 33:950-972. [PMID: 35574887 PMCID: PMC9680822 DOI: 10.1353/hpu.2022.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
HIV stigma in health care disrupts the care continuum and negatively affects health outcomes among people living with HIV. Few studies explore HIV stigma from the perspective of health care providers, which was the aim of this mixed-methods, community-based participatory research study. Guided by the Health Stigma Discrimination Framework, we conducted an online survey and focus group interviews with 88 and 18 participants. Data were mixed during interpretation and reporting results. Stigma was low overall and participants reported more stigma among their colleagues. The main drivers of stigma included lack of knowledge and fear. Workplace policies and culture were key stigma facilitators. Stigma manifested highest through the endorsement of stereotypes and in the use of unnecessary precautions when treating people with HIV. This study adds to our understanding of HIV stigma within health care settings, with implications for the development of multi-level interventions to reduce HIV stigma among health care professionals.
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Affiliation(s)
| | | | | | | | | | | | | | - Barbara S. Taylor
- Joe R. and Teresa Lozano Long School of Medicine, UT Health
San Antonio
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8
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Increased Work Experience Associated with Less Stigmatizing Attitudes towards People Living with HIV among Thai Healthcare Personnel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189830. [PMID: 34574754 PMCID: PMC8465955 DOI: 10.3390/ijerph18189830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
Abstract
HIV-related stigma in health facilities has been suggested as a primary target for HIV-related stigma reduction. The objective of this study was to describe negative attitudes among Thai healthcare personnel (HCP) toward PLHIV. This nationwide probability sampled survey was conducted in 2019 in 12 provinces in Thailand and Bangkok, the capital. Participants were considered to have stigmatizing attitudes toward PLHIV if they had a stigmatizing view in response to at least one of the four questions. Eighty-two percent of the 3056 respondents had at least one stigmatizing attitude. Younger HCP, ages < 30 (AOR = 1.60; 95%CI: 1.18–2.18) and 30–39 (AOR = 1.60; 95%CI: 1.21–2.12) were more likely to have stigmatizing attitudes towards PLHIV compared to those aged 50 and older. Being support staff, support-clinical (AOR = 1.89; 95%CI: 1.44–2.49) and support-nonclinical (AOR = 1.71; 95%CI: 1.24–2.36) as opposed to professional staff also increased the likelihood of having stigmatizing attitudes. Stigma was also more likely to be present in HCPs who did not work at HIV-focused clinics (AOR = 1.97; 95%CI: 1.57–2.48). HCP who had more work experience, especially related to PLHIV care, were less likely to have stigmatizing attitudes. These personnel could be good peer educators or role models for a stigma reduction campaign within their healthcare facilities.
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Moradzadeh R, Zamanian M. HIV-Related Stigma Among People Living With HIV in Iran: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2021; 32:610-618. [PMID: 33782241 DOI: 10.1097/jnc.0000000000000251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT HIV is perceived as a taboo topic in Iranian culture. This study examined HIV-related stigma among Iranian people living with HIV (PLWH). This cross-sectional study was conducted among 123 PLWH in 2019. HIV-related stigma was assessed by a standardized questionnaire adapted into Persian for this study. The range of the stigma scores for each of the subscales (personalized stigma, negative self-image, disclosure concerns, and concerns about public attitudes) was 3-12, whereas the range for the total stigma score was 12-48. The highest and lowest mean scores were observed in concerns about public attitudes (10.07) and negative self-image (7.39). The total mean stigma score was 37.03, indicating a high level of stigma. The most important factors determining HIV-related stigma were socioeconomic status, transmission method, duration of disease, and education level. This study suggests the need for more effective interventions to reduce HIV-related stigma among Iranian PLWH.
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Affiliation(s)
- Rahmatollah Moradzadeh
- Rahmatollah Moradzadeh, PhD, is an Associate Professor of Epidemiology, Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran. Maryam Zamanian, PhD, is an Assistant Professor of Epidemiology, Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
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10
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Predictive Factors for Positive HIV Test Results in a Hospital Setting. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Hospital admission for any reason provides the situation for voluntary HIV testing and consultation. Identifying the predictors of positivity may lead to a cost-effective method while enhancing professionalism. Objectives: To find the predictors of HIV-positive test result in a general hospital in Shiraz compared to a control group. Methods: In this case-control study, the records of all patients who received HIV testing upon their hospitalization in a general hospital in Shiraz, south of Iran, from January 2017 to the end of December 2017 were reviewed. For each HIV-positive case, at least one control from the same ward in the hospital with negative HIV test result was randomly selected. Based on the best-fitted model of logistic regression, the probability of positive HIV test results was estimated for each participant according to the risk factors, and a receiver operating characteristic (ROC) curve was drawn. Results: Out of 7333 persons who accepted to be tested, 77 patients tested positive for HIV, of whom 55 (71.4%) were male with the mean age of 41.5 ± 9.5 years. None of the HIV-positive patients were intravenous drug users, nor had they a history of imprisonment. The odds ratio (OR) was 21 for hepatitis-positive patients (hepatitis B and/or C) compared to negative ones, which was seven times higher in opium addicts than non-opium addicts. We developed a model using age, sex, opium addiction, and HBV and HCV status to predict the probability of being positive for HIV with an AUC of 0.853 (95% confidence interval 0.797 to 0.909). Conclusions: Hospital admission could be an appropriate momentum for providing voluntary counseling and testing. Infection with HBV and HCV are important risk factors for HIV infection, and additional testing should be offered, especially to these patients.
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Mokhtarabadi S, Sharifi H, Rad AAR, Iranpour A, Dehghan M. Development and Validation of HIV/AIDS Stigma and Discrimination Scale in Southeast Iran: The General Population Viewpoint. J Int Assoc Provid AIDS Care 2021; 19:2325958220963601. [PMID: 33063601 PMCID: PMC7580148 DOI: 10.1177/2325958220963601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Stigma and discrimination are one of the important challenges in coping with HIV infection. Stigma and discrimination are universal phenomenon for the epidemic of HIV and exposure to people with HIV. The present study aimed to develop and measure psychometrically the HIV/AIDS Stigma and discrimination scale from the general population viewpoint in southeast Iran. Data collection lasted from May to September 2016. The results showed that the "HIV/AIDS Stigma and discrimination scale" had an acceptable internal consistency and stability (Cronbach's alpha coefficient = 0.69, omega coefficient = 0.7, and r = 0.57, p = 0.001). The scale had acceptable content and face validities. The Principal Axis Factoring (PAF) with varimax rotation analysis shows that the scale has 4 dimensions: "patient social position" (5 items), "social support" (4 items), "social disease perspective" (7 items), and "social harassment" (2 items). In general, the psychometric properties of "HIV/AIDS Stigma and discrimination scale" are acceptable, and this scale can be used in studies.
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Affiliation(s)
- Sima Mokhtarabadi
- Shafa Hospital, 48463Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, 48463Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Ahmad Rafiei Rad
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, 48463Kerman University of Medical Sciences, Kerman, Iran
| | - Abedin Iranpour
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, 48463Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Nursing Research Center, 48463Kerman University of Medical Sciences, Kerman, Iran
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12
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Missel M, Bernild C, Westh Christensen S, Dagyaran I, Kikkenborg Berg S. The marked body - a qualitative study on survivors embodied experiences of a COVID-19 illness trajectory. Scand J Caring Sci 2021; 36:183-191. [PMID: 33734468 PMCID: PMC8251171 DOI: 10.1111/scs.12975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/02/2020] [Accepted: 01/31/2021] [Indexed: 01/08/2023]
Abstract
Background Research on COVID‐19 has reported data on epidemiology and pathophysiology but less about what it means to be a person living through this illness. Research involving the patients’ perspectives may help to improve healthcare professionals' understanding of ways to support patients. Aims To gain in‐depth understanding of the meaning of a COVID‐19 illness trajectory from the patients’ perspective. Methods Fifteen participants who had undergone an illness trajectory due to confirmed COVID‐19 infection participated in individual qualitative interviews. Data collection, analysis and interpretation were inspired by Ricoeur’s philosophy and Merleau‐Ponty’s phenomenology of perception and embodiment has been applied as a theoretical frame. Findings Being infected with coronavirus is expressed as an experience in which the participants oscillate between relief, security, imprisonment and raw fear. A predominant focus on the physical dimensions of the diseased body was found in the encounters between patient and healthcare system, and distance may furthermore be a consequence of use of protective equipment. Stigma and fear of infection were also expressed. After COVID‐19, an overwhelming feeling of a door opening to freedom is perceived. However, the body is marked, and bears witness to decay from this insidious and frightening virus. The responsibility for assessing their bodily symptoms is placed with the individual patients themselves, who feel lonely and fearful and this keeps them indoors. Conclusions During a COVID‐19 illness, trajectory concerns about the unknown course of this disease are highlighted. Isolation is confrontational; however, a companionship between patients might emerge. The study shed light on an unavoidable gap between the patients and healthcare professionals due to the use protective equipment. After COVID‐19, the body is labelled as something others fear and become a symbol of awe and alienation for others.
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Affiliation(s)
- Malene Missel
- Department of Cardiothoracic Surgery, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Camilla Bernild
- 2Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Westh Christensen
- 2Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ilkay Dagyaran
- Department of Infectious Diseases, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- 2Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Nyblade L, Srinivasan K, Raj T, Oga EA, Heylen E, Mazur A, Devadass D, Steward WT, Pereira M, Ekstrand ML. HIV Transmission Worry Predicts Discrimination Intentions Among Nursing Students and Ward Staff in India. AIDS Behav 2021; 25:389-396. [PMID: 32804318 PMCID: PMC7855682 DOI: 10.1007/s10461-020-03001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Health facility stigma impedes HIV care and treatment. Worry of contracting HIV while caring for people living with HIV is a key driver of health facility stigma, however evidence for this relationship is largely cross-sectional. This study evaluates this relationship longitudinally amongst nursing students and ward staff in India. Worry of contracting HIV and other known predictors of intent to discriminate were collected at baseline and 6 months in 916 nursing students and 747 ward staff. Using fixed effects regression models, we assessed the effect of key predictors on intent to discriminate over a 6-month period. Worry of contracting HIV predicted intent to discriminate for nursing students and ward staff in care situations with low and high-risk for bodily fluid exposure, confirming prior cross-sectional study results and underscoring the importance of addressing worry of contracting HIV as part of health facility HIV stigma-reduction interventions.
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Affiliation(s)
- Laura Nyblade
- Global Health Division, International Development Group, RTI International, 13th St., NW, Suite 750, Washington, DC, 20005, USA.
| | - Krishnamachari Srinivasan
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Tony Raj
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Emmanuel A Oga
- Center for Applied Public Health Research, RTI International, Rockville, MD, USA
| | - Elsa Heylen
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Amanda Mazur
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Dhinagaran Devadass
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Wayne T Steward
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Matilda Pereira
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Maria L Ekstrand
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
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14
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Adane B, Yalew M, Damtie Y, Kefale B. Perceived Stigma and Associated Factors Among People Living with HIV Attending ART Clinics in Public Health Facilities of Dessie City, Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:551-557. [PMID: 33116917 PMCID: PMC7549310 DOI: 10.2147/hiv.s274019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022]
Abstract
Introduction Despite the fact that responses to epidemics of human immune-deficiency virus (HIV) have gradually improved; it remains one of the world's public health challenges, particularly in low- and middle-income countries. Evidence is still limited in this area and this study aimed to assess the magnitude of perceived stigma and associated factors among people living with HIV (PLWH) in public health facilities of Dessie city, Ethiopia. Methods A health facility-based cross-sectional study was conducted among a total of 422 PLWH from September 1 to October 30, 2019 in Dessie city. A pretested structured interviewer-administered questionnaire was used to collect the data and it was analyzed using Stata/SE 14. Multivariable binary logistic regression analysis was used to identify factors associated with perceived stigma. The adjusted odds ratio (AOR) along with 95% confidence interval (CI) was estimated to measure the strength and direction of the association. Statistical significance was declared at P value less than 0.05. Results The overall magnitude of perceived stigma among people living with HIV in public health facilities of Dessie city was 41.93% [95% CI: (37.25, 46.75)]. Perceived stigma was positively associated with being female [AOR=2.08, 95% CI: (1.26, 3.46)], living in rural areas [AOR=1.80, 95% CI: (1.10, 2.94)] and not disclosing HIV status [AOR=2.36, 95% CI: (1.19, 4.66)]. Conclusion In this study, the magnitude of perceived stigma was high as compared to UNAIDS standard, and sex, place of residence, and disclosure of HIV serostatus were significantly associated with perceived stigma. The findings suggested that special emphasis should be placed on rural residents in order to reduce perceived stigma. Moreover, counseling should focus on disclosing HIV serostatus to anyone else interested to disclose particularly for females.
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Affiliation(s)
- Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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15
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Gangi MF, Karamouzian M, Nedjat S, Rahimi-Movaghar A, Yazdani K, Shokoohi M, Mirzazadeh A. HIV prevention cascades for injection and sexual risk behaviors among HIV-negative people who inject drug in Iran. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102868. [PMID: 32717706 PMCID: PMC7738401 DOI: 10.1016/j.drugpo.2020.102868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The HIV prevention cascade complements the HIV treatment cascade and helps evaluate the access to and use of harm reduction programs among HIV-negative individuals at risk for HIV, including people who inject drugs (PWID). This study aimed to estimate the HIV prevention cascades among PWID in Iran. METHODS Using data from the 2014 national bio-behavioral surveillance survey, 2,391 PWID were recruited from 31 harm reduction facilities and through outreach efforts across 10 major cities. PWID aged ≥18 years who reported drug injection in the past year were interviewed, and information regarding their demographic characteristics, sexual and drug injection practices, and access to services were gathered. PWID were also tested for HIV infection. We examined the prevention cascade framework among HIV-negative PWID. RESULTS The majority of PWID were male (97.6%) and more than half aged ≥ 35 years old (55.5%). Overall, 2,092 (92.5% [95% CI: 90.8, 93.9]) were HIV-negative; 93% of whom knew illicit drug injection could increase the risk of HIV transmission, 54% had access to free-of-charge sterile needles and syringes, 51% used sterile needles and syringes in their last injection practice, and 33% used sterile needles and syringes in all injection practices in the past month. Also, 87.8% (95% CI: 85.1, 90.0) of HIV-negative PWID had sex with any partner in the past year; 88% of whom knew using condoms could reduce the risk of HIV transmission, 35% had access to free-of-charge condoms, 32% used condoms in their last sexual practice, and 18% used condoms in all of their sexual practices in the past month. CONCLUSION The majority of HIV-negative PWID in Iran were at risk for HIV acquisition through unsafe drug injection or sexual practices. Harm reduction programs should improve access to free sterile needles, syringes, and condoms for PWID.
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Affiliation(s)
- Monireh Faghir Gangi
- Department of Epidemiology and Biostatistics, School of public health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Karamouzian
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
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16
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Najafi Z, Taj L, Dadras O, Ghadimi F, Moradmand B, SeyedAlinaghi S. Epidemiology of HIV in Iran. Curr HIV Res 2020; 18:228-236. [PMID: 32503409 DOI: 10.2174/1570162x18666200605152317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 05/06/2020] [Indexed: 02/08/2023]
Abstract
:
Iran has been one of the active countries fighting against HIV/AIDS in the Middle East
during the last decades. Moreover, there is a strong push to strengthen the national health management
system concerning HIV prevention and control. In Iran, HIV disease has its unique features,
from changes in modes of transmission to improvement in treatment and care programs, which can
make it a good case for closer scrutiny. The present review describes the HIV epidemic in Iran from
the first case diagnosed until prevention among different groups at risk and co-infections. Not only
we addressed the key populations and community-based attempts to overcome HIV-related issues in
clinics, but we also elaborated on the efforts and trends in society and the actual behaviors related to
HIV/AIDS. Being located in the Middle East and North Africa (MENA) region, given the countryspecific
characteristics, and despite all the national efforts along with other countries in this region,
Iran still needs to take extra measures to reduce HIV transmission, especially in health education.
Although Iran is one of the pioneers in implementing applicable and appropriate policies in the
MENA region, including harm reduction services to reduce HIV incidence, people with substance
use disorder continue to be the majority of those living with HIV in the country. Similar to other
countries in this region, the HIV prevention and control programs aim at 90-90-90 targets to eliminate
HIV infection and reduce the transmission, especially the mother-to-child transmission and
among other key populations.
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Affiliation(s)
- Zeinab Najafi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Taj
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Dadras
- Department of Health Informatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fatemeh Ghadimi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | | | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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17
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A total facility approach to reducing HIV stigma in health facilities: implementation process and lessons learned. AIDS 2020; 34 Suppl 1:S93-S102. [PMID: 32881798 DOI: 10.1097/qad.0000000000002585] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To describe development and implementation of a three-stage 'total facility' approach to reducing health facility HIV stigma in Ghana and Tanzania, to facilitate replication. DESIGN HIV stigma in healthcare settings hinders the HIV response and can occur during any interaction between client and staff, between staff, and within institutional processes and structures. Therefore, the design focuses on multiple socioecological levels within a health facility and targets all levels of staff (clinical and nonclinical). METHODS The approach is grounded in social cognitive theory principles and interpersonal or intergroup contact theory that works to combat stigma by creating space for interpersonal interactions, fostering empathy, and building efficacy for stigma reduction through awareness, skills, and knowledge building as well as through joint action planning for changes needed in the facility environment. The approach targets actionable drivers of stigma among health facility staff: fear of HIV transmission, awareness of stigma, attitudes, and health facility environment. RESULTS The results are the three-stage process of formative research, capacity building, and integration into facility structures and processes. Key implementation lessons learned included the importance of formative data to catalyze action and shape intervention activities, using participatory training methodologies, involving facility management throughout, having staff, and clients living with HIV facilitate trainings, involving a substantial proportion of staff, mixing staff cadres and departments in training groups, and integrating stigma-reduction into existing structures and processes. CONCLUSION Addressing stigma in health facilities is critical and this approach offers a feasible, well accepted method of doing so.
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18
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HIV-Related Knowledge and Stigma Among the General Population in the Southeast of Iran. SHIRAZ E-MEDICAL JOURNAL 2020. [DOI: 10.5812/semj.96311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: HIV-related stigma is a barrier to effective HIV responses among people living with HIV (PLHIV). Objectives: The current study aimed at measuring HIV-related stigma, and its associated factors among the general population in the Southeast of Iran. Methods: The current cross-sectional study was conducted on a convenience sample of 900 individuals in Kerman, Southeast of Iran, from July to September 2016. Data was collected using a self-administered questionnaire, including (I) demographic and background characteristics; (II) HIV-related stigma; and (III) HIV-related knowledge. Data were analyzed with SPSS version 20 using descriptive statistics, as well as bivariable and multivariable linear regressions. Results: Low, moderate, and high levels of stigmatizing attitudes toward PLHIV were reported by 39.1%, 57.8%, and 3.1% of the participants, respectively. Female sex(beta = 0.33, P value = 0.01) and those not having a history of HIV testing (beta = 0.45, P value < 0.001) had, on average, higher levels of stigmatizing attitudes, while those with a higher level of education (beta = -0.97, P value < 0.001) had, on average, lower levels of stigmatizing attitudes. Conclusions: Gender-sensitive educational interventions need to be developed to reduce the negative attitude towards PLHIV in Iran.
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19
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Akbari H, Safari S. Conditions of experienced stigma in people living with HIV in Iran: a qualitative comparative analysis. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1060-1076. [PMID: 32162344 DOI: 10.1111/1467-9566.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Stigma against people living with HIV (PLWH) seriously affects their quality of life. Moreover it can lead them to hide their HIV status from others, which in turn endangers public health. Many studies dealing with HIV-related stigma focus on the consequences of this phenomenon and pay less attention to the social conditions which affect different types of HIV-related stigma (anticipated, internalized and enacted stigma [ES]). Therefore, in this study, we tried to achieve more understanding about effective causal conditions of various types of experienced stigma. First of all, data were collected from 19 PLWH, using semi-structured interviews from those who had visited the Counseling Center for Behavioral Diseases in Mashhad. Secondly, the data were analyzed by applying a mixture of two methods: thematic analysis and qualitative comparative analysis (Boolean Algebra). The analysis of the data reveals that a combination of informing family members about HIV status, lack of family support, and medical support lead to anticipated stigma; a combination of religious beliefs and poor self-esteem results in internalized stigma and a combination of lack of family support, mistreatment by community, poor self-esteem, poverty and no religious beliefs lead to ES.
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Affiliation(s)
- Hossein Akbari
- Department of Social Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Saeid Safari
- Department of Sociology, Tarbiat Modares University, Tehran, Iran
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20
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Tavakoli F, Karamouzian M, Rafiei-Rad AA, Iranpour A, Farrokhnia M, Noroozi M, Sharifi A, Marshall BDL, Shokoohi M, Sharifi H. HIV-Related Stigma Among Healthcare Providers in Different Healthcare Settings: A Cross-Sectional Study in Kerman, Iran. Int J Health Policy Manag 2020; 9:163-169. [PMID: 32331496 PMCID: PMC7182146 DOI: 10.15171/ijhpm.2019.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/14/2019] [Indexed: 11/22/2022] Open
Abstract
Background: Stigmatizing attitudes among healthcare providers are an important barrier to accessing services among people living with HIV (PLHIV). This cross-sectional study aimed to assess the status and correlates of HIV-related stigma among healthcare providers in Kerman, Iran.
Methods: Using a validated and pilot-tested stigma scale questionnaire, we measured HIV-related stigma among 400 healthcare providers recruited from three teaching hospitals (n=363), private sectors (n=28), and the only voluntary counseling and testing (VCT) center (n=9) in Kerman city. Data were gathered using self-administered questionnaires at participants’ workplace during Fall 2016. To examine the correlates of stigmatizing attitudes, we constructed bivariable and multivariable linear regression models.
Results: The mean ± standard deviation (SD) of stigma score was 25.95 ± 7.20 out of the possible 50, with higher scores reflecting more stigmatizing attitudes. Paramedics, nurses’ aides, and housekeeping staff had the highest, and VCT personnel had the lowest average stigma scores, respectively. Multivariable regression analyses showed that prior experience of working with PLHIV (β=-2.48; P=.03), exposure to HIV-related educational courses (β=-2.03; P=.02), and <10 years of work experience (β=-2.70; P<.001) were associated with lower stigma scores.
Conclusion: Our findings highlight the need for health managers to provide training opportunities for healthcare providers, including programs that focus on improving HIV-related knowledge for healthcare providers. Enforcing policies that aim to reduce HIV-related stigma and discrimination among healthcare providers in Iran are urgently needed.
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Affiliation(s)
- Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Ahmad Rafiei-Rad
- Department of Sociology, Allameh Tabatabai University, Tehran, Iran.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abedin Iranpour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehrdad Farrokhnia
- Department of Internal Medicine, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Noroozi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Sharifi
- Department of Ophthalmology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Mostafa Shokoohi
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, ON, Canada.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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21
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Nyblade L, Addo NA, Atuahene K, Alsoufi N, Gyamera E, Jacinthe S, Leonard M, Mingkwan P, Stewart C, Vormawor R, Kraemer JD. Results from a difference-in-differences evaluation of health facility HIV and key population stigma-reduction interventions in Ghana. J Int AIDS Soc 2020; 23:e25483. [PMID: 32329153 PMCID: PMC7180216 DOI: 10.1002/jia2.25483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/07/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Stigma undermines all aspects of a comprehensive HIV response, as reflected in recent global initiatives for stigma-reduction. Yet a commensurate response to systematically tackle stigma within country responses has not yet occurred, which may be due to the lack of sufficient evidence documenting evaluated stigma-reduction interventions. With stigma present in all life spheres, health facilities offer a logical starting point for developing and expanding stigma reduction interventions. This study evaluates the impact of a "total facility" stigma-reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff in Ghana. METHODS We evaluated the impact of a total facility stigma-reduction intervention by comparing five intervention to five comparable non-intervention health facilities in Ghana. Interventions began in September 2017. Data collection was in June 2017 and April 2018. The primary outcomes were composite indicators for three stigma drivers, self-reported stigmatizing avoidance behaviour, and observed discrimination. The principal intervention variable was whether the respondent worked at an intervention or comparison facility. We estimated intervention effects as differences-in-differences in each outcome, further adjusted using inverse probability of treatment weighting (IPTW). RESULTS We observed favourable intervention effects for all outcome domains except for stigmatizing attitudes. Preferring not to provide services to people living with HIV (PLHIV) or a key population member improved 11.1% more in intervention than comparison facility respondents (95% CI 3.2 to 19.0). Other significant improvements included knowledge of policies to protect against discrimination (difference-in-differences = 20.4%; 95% CI 12.7 to 28.0); belief that discrimination would be punished (11.2%; 95% CI 0.2 to 22.3); and knowledge of and belief in the adequacy of infection control policies (17.6%; 95% CI 8.3 to 26.9). Reported observation of stigma and discrimination incidents fell by 7.4 percentage points more among intervention than comparison facility respondents, though only marginally significant in the IPTW-adjusted model (p = 0.06). Respondents at intervention facilities were 19.0% (95% CI 12.2 to 25.8) more likely to report that staff behaviour towards PLHIV had improved over the last year than those at comparison facilities. CONCLUSIONS These results provide a foundation for scaling up health facility stigma-reduction within national HIV responses, though they should be accompanied by rigorous implementation science to ensure ongoing learning and adaptation for maximum effectiveness and long-term impact.
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Affiliation(s)
- Laura Nyblade
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | - Nii A Addo
- Educational Assessment Research Centre (EARC)AccraGhana
| | | | | | - Emma Gyamera
- Educational Assessment Research Centre (EARC)AccraGhana
| | | | - Madeline Leonard
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Department of Health Systems AdministrationGeorgetown UniversityWashingtonDCUSA
| | - Pia Mingkwan
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | - Christin Stewart
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | | | - John D Kraemer
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Department of Health Systems AdministrationGeorgetown UniversityWashingtonDCUSA
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22
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Juliastuti D, Dean J, Fitzgerald L. Sexual and reproductive health of women living with HIV in Muslim-majority countries: a systematic mixed studies review. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:5. [PMID: 32160885 PMCID: PMC7066758 DOI: 10.1186/s12914-020-00225-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 02/28/2020] [Indexed: 01/07/2023]
Abstract
Background The number of women living with the human immunodeficiency virus (WLHIV) in Muslim-majority countries has increased significantly in the last decade. These women are often marginalized and face insecure sexual and reproductive health (SRH) needs and rights. However, little is known about the multi-faceted factors influencing these women’s fertility, contraceptive, and perinatal decisions and sexual life. This systematic mixed studies review aimed to synthesize the empirical evidence on social, cultural, and structural factors influencing the SRH of WLHIV in Muslim-majority countries. Methods This review provides a synthesis of quantitative, qualitative and mixed-method research findings searched from PubMed, EMBASE, Scopus, CINAHL and Cochrane databases. We screened 3452 SRH studies involving WLHIV. The studies, published in English between 2008 and 2017, were from 20 Muslim-majority countries with increased numbers of WLHIV. The quality of eligible studies was appraised using a mixed-methods appraisal tool (MMAT) version 2011. Findings were thematically analysed by a hybrid deductive-inductive approach. Two independent reviewers were involved in the study selection, data extraction, quality appraisal, and data synthesis. Results We included 13 SRH-related studies involving 1748 WLHIV in eight Muslim-majority countries. Most of these studies explored fertility desire and sexual health, while only a small proportion related to contraceptive use and the perinatal-care experience. We identified that WLHIV faced neglect of their SRH rights. These rights were predominantly affected by the socio-cultural, religious and health-services context of the women’s lives, which directed them to unsafe sex practices and stressful perinatal experiences. Conclusions This study points to the need for SRH laws, policies, and interventions which stop WLHIV experiencing SRH discrimination violence and achieving their SRH rights.
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Affiliation(s)
- Dyah Juliastuti
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia. .,Ichsan Medical Centre Bintaro Health College, South Tangerang, Indonesia. .,School of Public Health room 111, Faculty of Medicine, The University of Queensland, 288 Herston, Road, QLD 4006, Brisbane, Australia.
| | - Judith Dean
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,School of Public Health room 025, Faculty of Medicine, The University of Queensland, 288 Herston, Road, QLD 4006, Brisbane, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,School of Public Health room 021, Faculty of Medicine, The University of Queensland, 288 Herston, Road, QLD 4006, Brisbane, Australia
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23
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Ebrahimi F, Sindarreh S, Nasirian M. Attitudes and Practice of Health Care Workers about Human Immunodeficiency Virus in Isfahan, Iran. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:111-116. [PMID: 32195155 PMCID: PMC7055188 DOI: 10.4103/ijnmr.ijnmr_67_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/02/2019] [Accepted: 12/30/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health Care Workers (HCWs) play a key role in the Human Immunodeficiency Virus (HIV) prevention program, care and treat People Living with HIV (PLHIV). The evaluation of the attitude and performance among HCWs is regarded as one effective method for preventing the (HIV) spreading. This study was aimed to assess the attitude and practice of HCWs about HIV in Isfahan. MATERIALS AND METHODS In a cross-sectional study, we recruited 350 eligible participants from five academic hospitals, three academics dental clinics and six health centers by the convenience multistage sampling. A standard questionnaire was used to evaluate HIV attitudes among the HCWs in Isfahan. The variables were compared between males and females by Chi-square and t-test. In addition, linear and logistic regression was utilized to investigate the factors affecting attitude. RESULTS Respondents had a moderate level of attitude toward PLHIV About 2.00% of the respondents had a good attitude. Marital status (β=-11.79, p = 0.048) was associated with attitude. Among women, wearing gloves was associated with attitude (β=5.96, p = 0.041). CONCLUSIONS HIV attitude was not satisfactory among the HCWs in Isfahan. Therefore, the necessary measures and training are needed to improve the attitudes of health personnel and reduce stigma and discrimination toward PLHIV in health systems. Also, it is recommended to strongly monitor HIV infection control guidelines and instruction.
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Affiliation(s)
- Fatemeh Ebrahimi
- Department of Epidemiology and Biostatistics, Health School, and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Setayesh Sindarreh
- Department of Epidemiology and Biostatistics, Health School, and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Nasirian
- Department of Epidemiology and Biostatistics, Health School, and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Rashidian M, Minichiello V, Knutsen S, Ghamsary M. Western, Asian, and Middle Eastern Societies’ Cultural Attitudes and Barriers Impacting the Management of Sexual Health Care. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-36222-5_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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25
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HIV-related stigma among health-care workers in the MENA region. Lancet HIV 2020; 7:e311-e313. [PMID: 31928930 DOI: 10.1016/s2352-3018(19)30401-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 11/21/2022]
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26
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Aghaei A, Mohraz M, Shamshirband S. Effects of media, interpersonal communication and religious attitudes on HIV-related stigma in Tehran, Iran. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Alinaghi SAS, Rasoolinejad M, Najafi Z, Dadras O, Malekianzadeh E, Mirzazadeh A. Drug resistance patterns in HIV patients with virologic failure in Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019; 14:e96531. [PMID: 32266317 PMCID: PMC7138207 DOI: 10.5812/archcid.96531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We reviewed the medical charts of 1,700 patients diagnosed with HIV who referred to a central HIV clinic in Tehran between 2004 and 2017. Participants who had a viral load of > 200 copies/mL after six months or more on antiretroviral therapy (ART) were grouped as virologic failure (VF). We assessed the demographic characteristics, diagnosis date, first ART regimen, and resistance to various ART drugs. Out of 1,700 patients, 72 (4.2%) had a treatment failure. Among those with treatment failure, 51.3% were on zidovudine + lamivudine + efavirenz, 13.9% were on tenofovir + lamivudine + lopinavir/ritonavir, and 12.5% were on tenofovir + emtricitabine + efavirenz. In patients with treatment failure, the highest resistance was to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) combination (44.4%). In these patients, resistance to tenofovir (one of the NRTIs) was 29.1%. The highest treatment failure was observed among patients treated with nevirapine (NVP) and efavirenz (EFV)-based regimen. Our findings suggest that protease inhibitors should be considered as first-line drugs in ART regimens in VF patients in Iran.
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Affiliation(s)
- Seyed Ahmad Seyed Alinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Rasoolinejad
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Najafi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Dadras
- Department of Global Health and Socioepidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, CA, USA
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Ma H, Loke AY. A qualitative study into female sex workers' experience of stigma in the health care setting in Hong Kong. Int J Equity Health 2019; 18:175. [PMID: 31727157 PMCID: PMC6857210 DOI: 10.1186/s12939-019-1084-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background Hong Kong has gained a good reputation for its quality public health care services. However, there is a growing recognition that social stigma is a potential obstacle when female sex workers (FSWs) access health care services. There are a lack of studies focusing on how FSWs experience and cope with stigma when accessing health care services in Hong Kong. Objective This study aims to explore how FSWs experience stigma and develop coping strategies when accessing health care services in Hong Kong. Methods This is a qualitative interview study. Staff of non-governmental organizations (NGOs) that serve sex workers in Hong Kong facilitated the process of recruiting the participants. In-depth individual interviews were conducted with 22 FSWs, focusing on their experiences of stigma and coping strategies when accessing health care services. A directed content analysis approach was adopted to analyze the data. Results The interview data can be grouped into three themes: experience of stigma in the health care setting; coping with the stigma of sex work; and the call for non-judgmental holistic health care. Conclusion This study contributes to an understanding of the experience of stigma and stigma coping strategies of FSWs when accessing health care services in Hong Kong. stigma remains an important issue for a large proportion of FSWs when they seek timely professional help, openly disclose their sex work identity, and receive comprehensive health care services. The study also highlights the need to address multiple healthcare needs of FSWs beyond STDs. Moreover, the study contributes to increasing awareness of, and respect for, the human right of FSWs to receive non-discriminatory health services.
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Affiliation(s)
- Haixia Ma
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, GH 525, Hong Kong, China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, GH 525, Hong Kong, China.
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Ebrahimi Kalan M, Han J, Ben Taleb Z, Fennie KP, Asghari Jafarabadi M, Dastoorpoor M, Hajhashemi N, Naseh M, Rimaz S. Quality Of Life And Stigma Among People Living With HIV/AIDS In Iran. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:287-298. [PMID: 31814774 PMCID: PMC6858798 DOI: 10.2147/hiv.s221512] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/23/2019] [Indexed: 01/10/2023]
Abstract
Background Stigma against HIV profoundly affects the quality of life (QOL) of people living with HIV/AIDS (PLWHA). We aimed to assess the factors associated with QOL in PLWHA in Iran, specifically HIV-related stigma, sociodemographic and clinical characteristics. Methods Two hundred PLWHA participated in this cross-sectional study. Data were collected using sociodemographic, stigma, and WHO-QOL-BREF questionnaires. Correlations, ANOVAs, and Student’s t-distribution tests were performed as bivariate analyses. We employed stepwise multiple linear regression analysis to explore the main factors associated with QOL domains. Results Six domains of QOL were negatively correlated with three domains of stigma (p<0.001 for all). Stepwise multiple linear regression revealed that, after adjusting for confounders, lack of healthcare insurance, having no basic knowledge of HIV/AIDs prior to diagnosis, low monthly income of participants and family, and stigma (blaming and distancing, discrimination, and fear) were associated with low mean score of different domains of QOL. Conclusion Our findings indicated that increasing HIV/AIDS-related stigma decreases QOL in PLWHA in Iran. Attention toward decreasing stigma, improving healthcare plan, and cultivating economic condition should be given high priority to ensure improvement in total QOL and corresponding domains in PLWHA’s life.
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Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Jian Han
- Department of Biology, North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Dastoorpoor
- Department of Biostatistics and Epidemiology, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nima Hajhashemi
- Department of Biology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Mitra Naseh
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Shahnaz Rimaz
- Radiation Biology Research Center, Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Experiences of patients with primary HIV diagnosis in Kermanshah-Iran regarding the nature of HIV/AIDS: A qualitative study. Heliyon 2019; 5:e02278. [PMID: 31517089 PMCID: PMC6728303 DOI: 10.1016/j.heliyon.2019.e02278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/14/2019] [Accepted: 08/07/2019] [Indexed: 11/25/2022] Open
Abstract
Background A diagnosis of HIV (human immunodeficiency virus) infection causes a wide range of mental challenges regarding the meaning and understanding of such a diagnosis because of the specific nature of HIV and its social consequences. AIDS patients perceived their disease as multidimensional Stigma and rejection and even discrimination and insult in receiving health services. Therefore, a deep awareness and understanding of an individual's meaning and interpretation of a HIV-positive diagnosis and their relevant experiences are essential for providing better care. Objective This study aimed to examine the attitude, understanding, and interpretation of a positive diagnosis of HIV. Methods The present qualitative study was based on the descriptive phenomenological method. Participants included 13 HIV-positive patients who had been referred to the Kermanshah Counseling Center for Behavioral Diseases in Iran and diagnosed at most 6 months before being interviewed. The data were collected via semi-structured in-depth interviews. Results The continuous analyses of the data and the interview notes resulted in the identification of five main themes: contagious disease with two subthemes Illness and Harm to others, new self with a Crisis of identity subtheme, disappointment with the life ending and impending death subtheme, unmentionable disease with two subthemes secretive and horrifying diseases, and loss with Frustration subtheme. Conclusion Because the attitudes and behaviors of other people, such as relatives and people in society had a negative impact on the participants' mental status, as well as on their perceptions and understanding about the positive diagnosis, the focus of care for people with HIV/AIDS should shift from therapeutic issues to socio-cultural ones. These issues play a major role in forming an individual's understanding of HIV and can be a vital factor in improving their activities and adaptations to a positive diagnosis.
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Parisey M, Louni F, Bouvet E, Landman R, Charpentier C, Lariven S, Joly V, Villemant A, Mackoumbou-Nkouka C, Yazdanpanah Y, Burdet C. HIV Infection in North African Patients. AIDS Res Hum Retroviruses 2019; 35:628-633. [PMID: 31099259 DOI: 10.1089/aid.2018.0292] [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: 11/12/2022] Open
Abstract
North Africa is one of the rare regions where the HIV epidemic is growing. In France, 5% of the migrants discovering their HIV infection are from North Africa. The objective of this study was to compare the sociodemographic characteristics and outcomes of North African and French HIV-infected patients. This study was conducted in the HIV clinic of Bichat Hospital (Paris, France). The North African HIV-infected patients were born in Algeria, Tunisia, or Morocco or had lived there for more than 6 months. They were matched for age and gender (1:2) to patients born in France who had never lived outside France for more than 6 months. Sociodemographic, clinical, and immunovirological characteristics of North African and French patients were compared using conditional logistic regression. Among 4,738 eligible patients, 285 North Africans were identified. CD4 levels at HIV diagnosis were not significantly different between North African and French patients, but were more frequently <200/mm3 in the former than the latter at treatment initiation (p = .02). CDC stage 3 disease occurred more frequently in the first 3 years of care in our center in North African patients than in French patients (p = .01), and control of the HIV viral load over the 12 months preceding inclusion was better in French patients (p = .0001). There was no difference regarding loss to care. These results highlight possible issues in adherence to antiretroviral treatment in North African patients, which may be related to differences in the acceptability of the disease.
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Affiliation(s)
- Marion Parisey
- Department of Infectious Diseases, Bichat Hospital, AP-HP, Paris, France
| | | | - Elisabeth Bouvet
- Department of Infectious Diseases, Bichat Hospital, AP-HP, Paris, France
| | - Roland Landman
- Department of Infectious Diseases, Bichat Hospital, AP-HP, Paris, France
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Charlotte Charpentier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Virology Laboratory, Bichat Hospital, AP-HP, Paris, France
| | - Sylvie Lariven
- Department of Infectious Diseases, Bichat Hospital, AP-HP, Paris, France
| | - Véronique Joly
- Department of Infectious Diseases, Bichat Hospital, AP-HP, Paris, France
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Agnès Villemant
- Department of Internal Medicine, Beaujon Hospital, AP-HP, Clichy, France
| | | | - Yazdan Yazdanpanah
- Department of Infectious Diseases, Bichat Hospital, AP-HP, Paris, France
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Charles Burdet
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Department of Epidemiology, Biostatistic and Clinical Research, Bichat Hospital, AP-HP, Paris, France
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Abstract
This study explores the lived experience of domestic violence in HIV-infected women in Iran using a qualitative phenomenological approach. Data were collected in 2014 through in-depth interview of twelve HIV-infected women purposefully selected from a counselling centre in Tehran. The qualitative data were analysed using a thematic analysis approach. The main theme that emerged was 'the sunset of life' - an emotional numbing and fragile marital relationship resulting from the violence suffered by the women. From this, three sub-themes expressing women's feelings of hopelessness were extracted: 'the destroyed life', 'being in the destiny prison' and 'living on the edge of annihilation'. The results revealed that although the experience of domestic violence had devastating effects on women's lives, HIV infection was the factor that forced them to remain trapped in violent relationships. The findings emphasize the importance of designing comprehensive violence prevention strategies tailored to meeting the needs of HIV-infected women in Iran.
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Hosseinzadeh H, Dadich A. Cross-cultural integration affects attitudes towards people with HIV/AIDS in Australia. Sex Health 2018; 13:182-9. [PMID: 26841318 DOI: 10.1071/sh15199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/18/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The stigma associated with HIV/AIDS represents a significant issue. It can hinder help-seeking behaviours, fracture relationships, conceal prevalence rates and curtail public health initiatives to reduce HIV/AIDS. Culture is known to shape this stigma - it influences how individuals and the communities they represent understand the causes of HIV/AIDS, how it can and should be treated, and how people living with HIV/AIDS (PLWHA) should be regarded. Following recent increases in both HIV/AIDS and cross-cultural migration, this study determines the effect of cross-cultural integration on the tendency to stigmatise PLWHA. METHODS This was achieved by surveying adults who are at the nexus of two dissimilar cultures - adults from the Australian-Iranian community (n=236). While the Iranian culture is largely collectivistic, the Australian culture is largely individualistic. RESULTS Survey results indicated the respondents represented a collectivistic (44.1%), transitional (33.5%) or an individualistic (22.4%) culture. Those within the collectivistic culture held the most stigmatising views about PLWHA, supporting coercive policies and reporting they would avoid PLWHA. Those within the individualistic culture held the most positive attitudes. Furthermore, regression analysis indicated that movement from a collectivistic to an individualistic culture significantly reduced stigmatising attitudes towards PLWHA. CONCLUSIONS This study is the first to demonstrate the benefits afforded by an individualist culture, particularly for PLWHA. The article concludes with a discussion on the implications associated with these findings, particularly for researchers and practitioners within the health promotion field.
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Affiliation(s)
- Hassan Hosseinzadeh
- School of Public Health and Community Medicine, Faculty of Medicine, Room 222, Level 2, Samuels Building, University of New South Wales, UNSW, Sydney, NSW 2052, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Nyblade L, Srinivasan K, Mazur A, Raj T, Patil DS, Devadass D, Radhakrishna K, Ekstrand ML. HIV Stigma Reduction for Health Facility Staff: Development of a Blended- Learning Intervention. Front Public Health 2018; 6:165. [PMID: 29977887 PMCID: PMC6021510 DOI: 10.3389/fpubh.2018.00165] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction: The effect of stigma on health and health inequity is increasingly recognized. While many medical conditions trigger stigmatization, the negative effects of HIV stigma are particularly well documented. HIV stigma undermines access, uptake, and adherence to both HIV prevention and treatment. People living with HIV face stigma in all aspects of their daily lives; however, stigma in the health system is particularly detrimental. A key component for health facility stigma-reduction interventions is participatory training of staff, often through several days of in-person training. Though this approach shows promise, it is time intensive and poses challenges for busy health facilities. In response, the DriSti study has developed a brief blended-learning approach to stigma reduction in Karnataka State, India. This paper describes the process and final content of the intervention development. The intervention is currently being tested. Final evaluation results will be published upon study completion. Methods: Grounded in behavior change strategies based on social cognitive theory principles that stress the importance of combining interpersonal interactions with specific strategies that promote behavior change, we used a three-phase approach to intervention development: (1) content planning—review of existing participatory stigma-reduction training activities; (2) story boarding—script development and tablet content production; and (3) pilot testing of tablet and in-person session materials. Results: The final intervention curriculum consists of three sessions. Two initial self-administered tablet sessions focus on stigma awareness, attitudes, fears of HIV transmission, and use of standard precautions. The third small group session covers the same material but includes skill building through role-play and testimony by a person living with HIV. A study team member administers the tablet sessions, explains the process, and is present throughout to answer questions. Conclusion: This paper describes the theoretical underpinning and process of developing the blended-learning curriculum content, and practical lessons learned.The approach covers three key drivers of HIV stigma—stigma awareness, fear of HIV transmission, and attitudes. Developing video content for the self-directed learning is complex, requires a diverse set of people and skills, and presents unexpected opportunities for stigma reduction. Co-facilitation of the in-person session by someone living with HIV is a critical component.
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Affiliation(s)
- Laura Nyblade
- Global Health Division, International Development Group, RTI International, Washington, DC, United States
| | | | - Amanda Mazur
- Department of Medicine, Center for AIDS Prevention Studies, San Francisco, CA, United States
| | - Tony Raj
- St. Johns Research Institute, Bangalore, India
| | | | | | | | - Maria L Ekstrand
- St. Johns Research Institute, Bangalore, India.,Department of Medicine, Center for AIDS Prevention Studies, San Francisco, CA, United States
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Maimaiti R, Yuexin Z, Kejun P, Wubili M, Lalanne C, Duracinsky M, Andersson R. Assessment of Health-Related Quality of Life among People Living with HIV in Xinjiang, West China. J Int Assoc Provid AIDS Care 2017; 16:588-594. [PMID: 28874069 DOI: 10.1177/2325957417729752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In total, 679 HIV-positive patients from 4 clinics in Urumqi city were given structured questionnaires by the doctors or nurses treating them. Health-related quality of life (HRQL) was assessed using the Chinese Patient-Reported Outcome Quality of Life-HIV questionnaire versions in Mandarin and Uyghur. This tool has been used in other parts of China and several countries. Compared to France, Australia, United States, Brazil, Thailand, Cambodia, Senegal, and Central-Southern China (CS China), the HRQL was significantly lower among HIV-positive patients in Xinjiang, with regard to the dimension of treatment impact and general health score. The health concern was similar to Brazil and Cambodia but lower than other countries and CS China. Our findings showed high stigmatization: 86% of the patients were afraid to tell others they were HIV positive and 69% often felt or always felt depressed. Only 1% of the patients were on antidepressant treatment.
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Affiliation(s)
- Rena Maimaiti
- 1 Department of Prevention and Health Care, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, PR China
| | - Zhang Yuexin
- 2 Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, PR China
| | - Pan Kejun
- 2 Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, PR China
| | - Maimaitaili Wubili
- 2 Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, PR China
| | - Christophe Lalanne
- 3 REMES-Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société (ED 393), Unité de Méthodologie des critères d'évaluation (Patient-Reported Outcomes), Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.,4 URC ECO/DRCD (Département de la Recherche Clinique et du Développement)-AP-HP Hôpital Fernand-Widal, Batiment Antoine Dubois, Porte 7bis 200 rue du faubourg Saint-Denis, AP-HP, Paris, France
| | - Martin Duracinsky
- 3 REMES-Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société (ED 393), Unité de Méthodologie des critères d'évaluation (Patient-Reported Outcomes), Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.,4 URC ECO/DRCD (Département de la Recherche Clinique et du Développement)-AP-HP Hôpital Fernand-Widal, Batiment Antoine Dubois, Porte 7bis 200 rue du faubourg Saint-Denis, AP-HP, Paris, France.,5 Service de Médecine Interne et de Maladies Infectieuses (Pr Delfraissy), Assistance Publique-Hopitaux de Paris (AP-HP) Hopital Bicetre, Leclerc, Le Kremlin-Bicetre Cedex, France
| | - Rune Andersson
- 6 Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden
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Oskouie F, Kashefi F, Rafii F, Gouya MM. Qualitative study of HIV related stigma and discrimination: What women say in Iran. Electron Physician 2017; 9:4718-4724. [PMID: 28894526 PMCID: PMC5586984 DOI: 10.19082/4718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/10/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction HIV-related stigma is a major social problem of people living with HIV. Stigma against these people, especially women, interferes with the prevention, diagnosis and treatment of HIV. This study examined the experiences of HIV infected women who were stigmatized, as well as the strategies used to tackle the issue. Methods Twenty-five women living with HIV were examined using in-depth, semi-structured interviews. The data obtained was analyzed using content analysis method in MAXQDA10. Results The finding of this study was classified into four themes: fear, shame, rejection by family or friends and feelings of frustration. The participant strategies adopted to the perceived stigma and discrimination included isolation, nondisclosure, and loss of follow-up. Conclusions HIV in women has different social interposition. It is necessary to intervene, so as to alleviate the effect of stigma on HIV infected women, in order that they gain the ability to accomplish wellness, increase life span and improve quality of life. Nurses, midwives and other professionals need to be involved to ensure public policy in providing supportive environments, and decrease stigma.
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Affiliation(s)
- Fatemeh Oskouie
- Ph.D., Professor, Nursing Care Research Center and School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Kashefi
- Ph.D. Student, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Forough Rafii
- Ph.D., Professor, Nursing Care Research Center and School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Gouya
- MD, Director General (DG), Iranian Center for Communicable Disease Control (CDC), Ministry of Health and Medical Education (MOHME), Tehran, Iran.,Associate Professor, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Rashidian M, Minichiello V, Knutsen SF, Ghamsary M. Effect of attitudes towards patients on sexual history taking: a survey of Iranian-American physicians in California, USA. Sex Health 2017; 14:514-522. [PMID: 28618248 DOI: 10.1071/sh17016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/22/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although obtaining sexual history from patients is essential, the attitudes of physicians can become a barrier to sexual health care. Iranian-American physicians may face particular challenges because talking about sexuality is considered a taboo within their culture. Our study examined these physicians' attitudes when taking a sexual history from their patients. METHODS In 2013, a self-administrated questionnaire was sent to 1550 Iranian-American physicians in California, USA. Using factor analysis, the principal components approach with a Varimax rotation was used on a set of 12-item questions (five-point Likert scales) to detect latent factors that explain attitudes affecting sexual history taking. Scores are generated to determine physicians' attitudes towards sexual history taking. RESULTS In total, 354 questionnaires were returned (23% response rate). Three factors were identified as internally consistent (Cronbach's α=0.84 - 0.94): (1) attitude towards various patients; (2) female sexuality; and (3) age and marriage. Significant association were found between these three factors and some variables such as physicians' gender, country of medical graduation, religion, birthplace and age. CONCLUSIONS Results revealed that cultural attitudes are important factors affecting physicians' involvement in sexual history taking. Additional studies from this population and other subpopulations of US physicians are needed. New strategies that reflect on physicians' attitude on sexual healthcare delivery is needed. If confirmed in other studies, our findings could have implications for the training of medical graduates globally.
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Affiliation(s)
- Mitra Rashidian
- Collaborative Research Network, University of New England, School of Health, Armidale, NSW 2351, Australia
| | - Victor Minichiello
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Synnove F Knutsen
- Department of Biostatistics and Epidemiology, Loma Linda University, School of Public Health, Loma Linda, California, 92350, USA
| | - Mark Ghamsary
- Department of Biostatistics and Epidemiology, Loma Linda University, School of Public Health, Loma Linda, California, 92350, USA (Retired)
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Ishimaru T, Wada K, Smith DR. A consensus for occupational health management of healthcare workers infected with human immunodeficiency virus, hepatitis B virus, and / or hepatitis C virus. J Occup Health 2017; 59:304-308. [PMID: 28381816 PMCID: PMC5478506 DOI: 10.1539/joh.16-0275-op] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Occupational health management plays an important role in the prevention of provider-to-patient transmission in healthcare workers infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and/or hepatitis C virus (HCV). Therefore, the Japan Society for Occupational Health's Research Group on Occupational Health for Health Care Workers has proposed a consensus for the management of healthcare workers infected with HIV, HBV, and/or HCV based on recent evidence for each concerned group. The consensus recommends that: (1) employers in medical institutions should establish a policy of respecting the human rights of healthcare workers, management strategies for occupational blood exposure, and occupational health consultation; (2) occupational health staff should appropriately assess the risk of provider-to-patient transmission of HIV, HBV, and/or HCV infection and rearrange their tasks if necessary. When conducting risk assessment, occupational health staff should obtain informed consent and then cooperate with the physician in charge as well as infection control experts in the workplace; (3) healthcare workers infected with HIV, HBV, and/or HCV should disclose their employment to their treating physician and consult with their doctor regarding the need for special considerations at work; and (4) supervisors and colleagues in medical institutions should correctly understand the risks of HIV, HBV, and HCV infection and should not engage in any behavior that leads to discrimination against colleagues infected with HIV, HBV, and/or HCV.
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Affiliation(s)
- Tomohiro Ishimaru
- Department of Health Management, Nishinihon Occupational Health Service Center.,Occupational Health Training Center, University of Occupational and Environmental Health.,The Research Group on Occupational Health for Health Care Workers, Japan Society for Occupational Health
| | - Koji Wada
- The Research Group on Occupational Health for Health Care Workers, Japan Society for Occupational Health.,Bureau of International Health Cooperation, National Center for Global Health and Medicine
| | - Derek R Smith
- College of Public Health, Medical and Veterinary Sciences, James Cook University
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Nikus Fido N, Aman M, Brihnu Z. HIV stigma and associated factors among antiretroviral treatment clients in Jimma town, Southwest Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2016; 8:183-193. [PMID: 27920581 PMCID: PMC5126004 DOI: 10.2147/hiv.s114177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND HIV stigma has an important role in the spread of the AIDS epidemic. It profoundly affects the lives of individuals living with HIV/AIDS. Fear of being identified as having HIV may discourage a person from getting tested, accessing medical services, and obtaining medications. Thus, this study was aimed at assessing HIV-related stigma and associated factors among antiretroviral treatment (ART) clients in Jimma town, Oromia region, Southwest Ethiopia. METHODS A facility-based cross-sectional study was conducted from March 11 to April 26, 2015, in ART clinics in Jimma town. Consecutively identified sample was obtained from ART clients who voluntarily participated in the survey after signing written consent. A structured interviewer-administered questionnaire was used to collect the data. Multiple linear regressions were conducted to assess the factors associated with various stigma domains. RESULTS Out of 349 clients requested, 318 (91.1%) respondents voluntarily participated in the study; among them, 204 (64.2%) respondents were females and the mean age of the respondents was 32.9 years. The mean score (and possible range) of experienced HIV stigma was 41.5±12.6 (20.0-86.7), internalized stigma was 50.5±16.4 (20-96.5), and perceived stigma was 56.2±19.2 (20-100). CONCLUSION The study revealed that duration of ART use and provider-initiated and forced HIV testing were significantly associated with the three HIV stigma domains. Despite the lower experienced HIV stigma, there were higher internalized and perceived stigmas. Therefore, HIV counseling services should be strengthened for new ART beginners, including pretest counseling.
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Affiliation(s)
- Neno Nikus Fido
- Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Mamusha Aman
- Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Zewdie Brihnu
- Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
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Gökengin D, Doroudi F, Tohme J, Collins B, Madani N. HIV/AIDS: trends in the Middle East and North Africa region. Int J Infect Dis 2016; 44:66-73. [PMID: 26948920 DOI: 10.1016/j.ijid.2015.11.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To give an overview of the HIV epidemic in the Middle East and North Africa (MENA) region. METHODS Articles on the MENA region were reviewed. RESULTS The MENA region comprises a geographically defined group of countries including both high-income, well-developed nations and low- and middle-income countries. While the annual number of new HIV infections in Sub-Saharan Africa has declined by 33% since 2005, new HIV infections in the MENA region have increased by 31% since 2001, which is the highest increase among all regions in the world. Moreover, the number of AIDS-related deaths in 2013 was estimated to be 15000, representing a 66% increase since 2005. However, the current prevalence of 0.1% is still among the lowest rates globally. There is substantial heterogeneity in HIV epidemic dynamics across MENA, and different risk contexts are present throughout the region. Despite unfavorable conditions, many countries in the region have put significant effort into scaling up their response to this growing epidemic, while in others the response to HIV is proving slower due to denial, stigma, and reluctance to address sensitive issues. CONCLUSIONS The HIV epidemic in the MENA region is still at a controllable level, and this opportunity should not be missed.
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Affiliation(s)
- Deniz Gökengin
- Department of Clinical Microbiology and Infectious Diseases, Medical Faculty, Ege University, Bornova, Izmir, Turkey.
| | - Fardad Doroudi
- UNAIDS - The Joint United Nations Programme on HIV/AIDS (UNAIDS), Islamic Republic of Iran.
| | - Johnny Tohme
- M-Coalition, Yazbeck Center, Achrafieh, Beirut, Lebanon.
| | | | - Navid Madani
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
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Samiei M, Moradi A, Noori R, Aryanfard S, Rafiey H, Naranjiha H. Persian At-Risk Women and Barriers to Receiving HIV Services in Drug Treatment: First Report From Iran. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 5:e27488. [PMID: 27622170 PMCID: PMC5002316 DOI: 10.5812/ijhrba.27488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/26/2015] [Accepted: 04/14/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND As the most populated Persian Gulf country, in Iran, engagement with drug injection and unsafe sex are the main routes of HIV transmission among some drug-dependent women. OBJECTIVES The current study explored the barriers that a group of drug-dependent women reported in accessing and adhering to HIV services in drug use treatment. PATIENTS AND METHODS Qualitative interviews were conducted with 47 Persian women at five outpatient drug treatment centers between January and December 2011. Five focus group interviews were conducted with ten key informants (KI). The interviews made use of a semi-structured interview guide, which facilitated discussion regarding the barriers. The interview transcripts were analyzed thematically using Atlas-ti software. RESULTS The interview accounts highlighted a number of barriers, including stigmatization, a considerable lack of knowledge about free HIV centers in the community, previous traumatic events, misconceptions about the quality of HIV services, and a poor supportive referral system among drug treatment and HIV centers. CONCLUSIONS The findings highlight a need for removing stigma and providing high quality women-only HIV services. Increasing trust and knowledge of available HIV services are needed for this group of women. Increasing staff knowledge is a priority. An integrated supportive network among drug treatment and HIV centers is suggested in Iran.
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Affiliation(s)
- Mercedeh Samiei
- Division of Psychiatry, Razi Psychiatric Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Afsaneh Moradi
- Department of Psychology, Faculty of Psychology and Educational Sciences, Al-Zahra University, Tehran, IR Iran
| | - Roya Noori
- Substance Abuse and Dependence Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
- Corresponding author: Roya Noori, Substance Abuse and Dependence Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran. Tel/Fax: +98-2122180095, E-mail:
| | - Sepideh Aryanfard
- Department of Social Welfare, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Hassan Rafiey
- Department of Social Welfare, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
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Rashidian M, Minichiello V, Knutsen SF, Ghamsary M. Barriers to sexual health care: a survey of Iranian-American physicians in California, USA. BMC Health Serv Res 2016; 16:263. [PMID: 27416727 PMCID: PMC4946137 DOI: 10.1186/s12913-016-1481-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 06/21/2016] [Indexed: 11/17/2022] Open
Abstract
Background Despite increasing numbers of Iranian-American physicians practicing in the United States, little is known about the barriers that may impact them as providers of sexual health care. This is an important topic as discussions of sexual topics are generally considered a taboo among Iranians. We aimed to identify barriers experienced by Iranian-American physicians that inhibit their willingness to engage in discussions of sexual health care with patients. Methods In 2013, a self-administrated questionnaire was sent to 1,550 Iranian-American physicians in California. Questions included demographics of the physicians as well as their perception of challenges in discussing various sexual health topics with their patients. Factor analysis: Principal components approach with a Varimax rotation was used to detect latent factors within the data that may help explain possible barriers to discussion of sexual health among physicians. The analysis was performed on 11 items, specifically focused on possible barriers, to detect a possible relationship between correlated variables within the data to produce a set of uncorrelated variables (factors). Results The overall response rate was 23 %. Data revealed specific barriers regarding sexual history taking, discussing STIs and sexual dysfunctions with patients based on their gender, and age. Three factors were identified as internally consistent (Cronbach’s alpha = 0.82 to 0.91): (i) embarrassment, (ii) cultural and religious, (iii) lack of time and financial constraint. Significant associations were found between these 3 factors and some variables such as: country of medical graduation, religious affiliation, birthplace, age, and gender. Conclusions Our findings are the first to identify possible barriers among Iranian-American physicians in delivering effective sexual health care to patients. Additional studies from Iranian-American physicians as well as from other foreign-born/subpopulation of US physicians populations and mainstream US physicians are needed to assess the extent of such barriers, and changes over time. Effective strategies to better engage such physicians in these studies are needed. If confirmed from other studies, our findings could have implications for the training of US medical graduates. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1481-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mitra Rashidian
- Collaborative Research Network, University of New England, School of Health, Armidale, Australia.
| | - Victor Minichiello
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,University of New England, Armidale, Australia
| | - Synnove F Knutsen
- Department of Biostatistics and Epidemiology, Loma Linda University, School of Public Health, Loma Linda, USA
| | - Mark Ghamsary
- Department of Biostatistics and Epidemiology, Loma Linda University, School of Public Health, Loma Linda, USA
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Abstract
Stigma is one of the main problems of patients suffering from cirrhosis, and it causes many challenges for the patients and their treatment. The present study aimed to discover and define the perceived stigma by cirrhotic patients. This qualitative study was conducted through a content analysis approach. The participants were 15 patients suffering from cirrhosis. Data were collected via semistructured, in-depth interviews and analyzed on the basis of methods described by Granheme and Landman. During data analysis, stigma was categorized into four categories and 13 subcategories: external representation of social stigma (others' avoidance behaviors, inadmissible tag, discriminative behaviors of treatment personnel, blaming behaviors), internal representation of social stigma (social ostracism, social isolation, curiosity to perceive people's perceptions), external representation of self-stigma (fear of disclosure of illness, threatening situation, difficult emotional relationships), and internal representation of self-stigma (condemned to suffer, self-punishment, self-alienation). Experiencing stigma is common among cirrhotic patients and may affect patients' coping with the illness and treatment. Thus, it is specifically important that treatment personnel know patients' perception, provide comprehensive support for these patients, and plan to enhance public awareness about the disease recommended.
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Ishimaru T, Wada K, Arphorn S, Smith DR. Barriers to the acceptance of work colleagues infected with Hepatitis B and Hepatitis C in Japan. J Occup Health 2016; 58:269-75. [PMID: 27108645 PMCID: PMC5356951 DOI: 10.1539/joh.15-0288-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Healthcare workers infected with Hepatitis B (HBV) or Hepatitis C virus (HCV) may undertake patient care activities if provider-to-patient transmission risks have been assessed in terms of viral load and clinical procedures. The present study investigated potential barriers to the acceptance of colleagues infected with HBV/HCV in healthcare settings after appropriate risk assessment. Methods: We conducted an anonymous, internet-based survey of Japanese nurses. Multivariate logistic analysis was used to assess factors associated with willingness to accept colleagues infected with HBV/HCV after risk assessment. Results: In total, 992 nurses responded to the survey, with 16% indicating that colleagues infected with HBV/HCV should not have patient contact after risk assessment. Willingness to accept HBV/HCV-infected colleagues was negatively associated with attitudes regarding the avoidance of contact with HBV/HCV-infected colleagues (OR: 0.49; 95% CI: 0.28-0.85). Previous professional contact with HBV/HCV patients (OR: 1.73; 95% CI: 1.36-2.12), experience of accidental injection from or personal exposure to HBV/HCV patients (OR: 2.00; 95% CI: 1.42-2.61), knowledge of HBV/HCV (OR: 2.00; 95% CI: 1.52-2.49), and female sex (OR: 1.60; 95% CI: 1.17-2.09) were positively associated with a willingness to accept HBV/HCV-infected colleagues. Conclusions: This study suggests that attitudes regarding the avoidance of contact with HBV/HCV-infected colleagues may be barriers to accepting these colleagues even after risk assessment has been performed. To protect the employment of nurses infected with HBV/HCV, employers should provide comprehensive education for nurses to reduce stigma and improve understanding about the management of staff infected with infectious diseases, such as HBV or HCV.
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Affiliation(s)
- Tomohiro Ishimaru
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University
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Davtyan M, Farmer S, Brown B, Sami M, Frederick T. Women of Color Reflect on HIV-Related Stigma through PhotoVoice. J Assoc Nurses AIDS Care 2016; 27:404-18. [PMID: 27085253 DOI: 10.1016/j.jana.2016.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
HIV-related stigma affects people living with HIV (PLWH), especially in communities of color. In our study, African American and Latina/Hispanic women living with HIV (WLWH) described experiences of stigma through PhotoVoice, a community-based participatory method of documentary photography. Ten WLWH from Los Angeles documented stigma experiences through photographs for up to 5 weeks and discussed their images during a focus group or semi-structured individual interview. Qualitative interpretive phenomenological analysis of participant narratives and photographs revealed lack of education and cultural myths as the main triggers of the stigma our participants faced. Stigma was experienced in health care settings, and participants identified depression, fear of intimate relationships, and nondisclosure of HIV status as its consequences. Social support and faith were noted as key coping mechanisms. WLWH recommended involving PLWH and public health officials in stigma reduction campaigns and youth education. PhotoVoice was perceived as a useful tool for education and self-improvement.
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Lohiniva AL, Benkirane M, Numair T, Mahdy A, Saleh H, Zahran A, Okasha O, Talaat M, Kamal W. HIV stigma intervention in a low-HIV prevalence setting: a pilot study in an Egyptian healthcare facility. AIDS Care 2015; 28:644-52. [PMID: 26717980 DOI: 10.1080/09540121.2015.1124974] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This pilot study is the first to evaluate stigma-reduction intervention in a healthcare setting in Egypt and in the Middle East and North Africa region. It also contributes to knowledge on how to address stigma in low-HIV prevalence settings. A quasi-experimental study design was used to evaluate the effect of anti-HIV stigma intervention in one hospital in Egypt. A control hospital was selected and matched to the intervention hospital by type, size and location. The intervention focused on HIV-related stigma, infection control and medical ethics. Stigma was measured at baseline and at three months post-intervention. A standardized, 10-point scale was developed to measure stigmatizing attitudes and fear-based stigma among participants. Comparisons of overall and job-stratified stigma scores were made across the intervention and control hospitals, before and after the intervention, using two-sample t-test and multivariate regression analysis. Mean stigma scores did not reveal significant differences between the intervention and control hospitals at baseline. After intervention, the overall value-based and fear-based stigma scores were significantly lower in the intervention hospital compared to the control hospital (2.1 and 1.1 compared to 3.8 and 3.2, respectively; p < .001). Context-specific and culturally appropriate HIV stigma-reduction interventions in low-HIV prevalence settings can reduce fear-based and value-based stigma among physicians and nurses.
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Affiliation(s)
- Anna-Leena Lohiniva
- a Global Disease Detection and Response Program , US Naval Medical Research Unit No 3 , Cairo , Egypt
| | - Manal Benkirane
- a Global Disease Detection and Response Program , US Naval Medical Research Unit No 3 , Cairo , Egypt
| | - Tarek Numair
- b National AIDS Program , Ministry of Health in Egypt , Cairo , Egypt
| | - Abdelrahman Mahdy
- c Oum El Masreyn General Hospital , Ministry of Health in Egypt , Giza , Egypt
| | - Hanan Saleh
- c Oum El Masreyn General Hospital , Ministry of Health in Egypt , Giza , Egypt
| | - Amin Zahran
- c Oum El Masreyn General Hospital , Ministry of Health in Egypt , Giza , Egypt
| | - Omar Okasha
- a Global Disease Detection and Response Program , US Naval Medical Research Unit No 3 , Cairo , Egypt
| | - Maha Talaat
- a Global Disease Detection and Response Program , US Naval Medical Research Unit No 3 , Cairo , Egypt
| | - Walid Kamal
- b National AIDS Program , Ministry of Health in Egypt , Cairo , Egypt
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Varas-Díaz N, Neilands TB, Rodríguez-Madera SL, Padilla M. The role of emotions in the reduction of HIV/AIDS stigma among physicians in training. AIDS Care 2015; 28:376-83. [PMID: 26444133 DOI: 10.1080/09540121.2015.1090537] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Scientific literature has systematically documented the negative effects of social stigma for people living with HIV/AIDS (PLWHA). HIV/AIDS stigma has the potential to negatively impact self-care strategies for those already affected, and simultaneously hinder prevention efforts to deter the emergence of new infections. When health professionals manifest these negative attitudes access to quality health-care and prevention strategies can be seriously affected. Scientifically tested interventions to reduce HIV/AIDS stigma among health professionals are still scarce. Although the number of tested interventions has increased over the past decade, few of them target Latino health professionals or Spanish-speaking populations. Furthermore, although some of those interventions have been reported as effective for stigma reduction, more work is needed to better understand the underlying variables that account for the reduction of stigma attitudes in those efforts. The SPACES intervention has been documented as an effective HIV/AIDS stigma-reduction intervention focusing on health-care professionals in training. The intervention, which is delivered in Spanish, has been previously tested with medical students in Puerto Rico and shown significant results in addressing negative attitudes toward PLWHA. The main objective of this study was to document the underlying variables that fostered reduction of HIV/AIDS stigma due to participation in the SPACES intervention. Results evidence that health professionals in training who participated in the intervention (n = 507) had less stigmatizing attitudes toward PLWHA due to an increase in their positive emotions toward this population. In light of these results, we discuss the importance of engaging health professionals in HIV/AIDS stigma-reduction interventions that go beyond the provision of information and skills for interacting with PLWHA, and address the emotional component of HIV/AIDS stigma.
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Affiliation(s)
- Nelson Varas-Díaz
- a Institute for Psychological Research (IPSI), University of Puerto Rico , San Juan , Puerto Rico
| | | | | | - Mark Padilla
- d Global and Sociocultural Studies , Florida International University , Miami , FL , USA
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Orisakwe E, Ochiogu S, Ocholla P. Perceptions of the HIV counselling and testing programme by patients in a rural regional hospital in South Africa. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2015.1080979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Faraji E, Sardashti S, Firouzeh MM, Aminabad FJ, Alinaghi SAS, Hajiabdolbaghi M. Perceived social support affects disease coping among people living with HIV: a study in Tehran, Iran. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(14)60806-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mohammadi N, Kochak HE, Gharacheh M. The Lived Experience of Domestic Violence in Iranian HIV-Infected Women. Glob J Health Sci 2015; 7:43-50. [PMID: 26156897 PMCID: PMC4803845 DOI: 10.5539/gjhs.v7n5p43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/04/2014] [Indexed: 11/12/2022] Open
Abstract
Domestic violence is one of the most prevalent problems linked to HIV. Domestic violence in HIV-infected women has not been sufficiently explored, particularly in developing countries including Iran. This study aimed to explore the lived experience of domestic violence in Iranian HIV-infected women. A qualitative approach was used to conduct the study. Data were collected through semi-structured, in-depth interviews with ten HIV-infected women and were analyzed using content analysis. During the data analysis, four main themes emerged including, "regretful past", "disappointing future", "loneliness", and "no other option", which refer to the condition that the participants experienced in their lives due to challenges that mainly stem from the experience of HIV-related domestic violence. HIV infection can be a risk factor for domestic violence. Health care providers need to address domestic violence during the assessment of HIV-infected women and make appropriate referrals for abused women.
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