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Chory A, Nyandiko W, Gillette E, Scanlon M, Aluoch J, Koros H, Munyoro D, Ashimosi C, Beigon W, Lidweye J, Nyagaya J, DeLong A, Kantor R, Vreeman R, Naanyu V. Ethical Considerations for Engaging Youth Living with HIV in Research: Perspectives from Youth, Their Caregivers and Subject Matter Experts in Kenya. J Empir Res Hum Res Ethics 2023; 18:175-188. [PMID: 37574803 PMCID: PMC11325439 DOI: 10.1177/15562646231193949] [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: 08/15/2023]
Abstract
Introduction: Engaging youth living with HIV (YLWH) in research is critical to improving HIV-related outcomes, but their involvement raises unaddressed bioethical questions. Methods: This study used qualitative inquiry with Kenyan YLWH, caregivers, and subject matter experts (SMEs) to evaluate ethical considerations and strategies for research involving YLWH. Results: Interviews were conducted with 99 participants: 40 YLWH (median age 17.5, 50% female), 20 caregivers (70% female), and 39 SMEs (44% female). All participant groups discussed the need for HIV disclosure status assessment, confidentiality, and engagement of caregivers. Youth participants discussed the importance of clear protocol explanations and developing good rapport. All participant groups perceived youth under 18 to be harder to recruit due to a number of identified barriers. Clinic settings were the most acceptable place for recruitment. Conclusion: Participants provided perspectives on engaging YLWH in research that can be incorporated into protocols and regulatory guidelines.
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Affiliation(s)
- Ashley Chory
- Department of Global Health and Health Systems Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Winstone Nyandiko
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Emma Gillette
- Department of Global Health and Health Systems Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, Indiana, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Hillary Koros
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Whitney Beigon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Allison DeLong
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Rami Kantor
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Rachel Vreeman
- Department of Global Health and Health Systems Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Violet Naanyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University School of Arts and Social Sciences, Eldoret, Kenya
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Njuguna I, Moraa H, Mugo C, Mbwayo A, Nyapara F, Aballa C, Wagner AD, Wamalwa D, John-Stewart G, Inwani I, O’Malley G. 'They should show them love even if their status of being HIV positive is known': Youth and caregiver stigma experience and strategies to end HIV stigma in schools. Trop Med Int Health 2023; 28:466-475. [PMID: 37177902 PMCID: PMC10278085 DOI: 10.1111/tmi.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE HIV stigma and discrimination is widespread in sub-Saharan Africa and is associated with poor clinical outcomes. Schools play a critical role in the life of youth and have been identified as a potentially stigmatising environment. We sought to explore school HIV stigma drivers, facilitators, manifestations and outcomes among youth living with HIV (YLH) as well as potential stigma reduction interventions in Kenya. METHODS Semi-structured in-depth qualitative interviews with 28 school-attending YLH aged 14-19 years and 24 caregivers of YLH were analysed using directed content analysis. Results were summarised using the Health and Stigma Framework. RESULTS Drivers and facilitators of HIV stigma in the school environment included misconceptions about HIV transmission, HIV treatment outcomes and long-term overall health of people living with HIV. HIV stigma manifested largely as gossip, isolation and loss of friendships. Fear of HIV stigma or experienced stigma resulted in poor adherence to antiretroviral treatment-particularly among YLH in boarding schools-and poor mental health. Stigma also impacted school choice (boarding vs. day school) and prevented HIV disclosure to schools which was necessary for optimal support for care. Proposed interventions to address HIV stigma in schools included HIV education, psychosocial support for YLH, support for HIV disclosure to schools while ensuring confidentiality and building YLH resilience. CONCLUSION There is an urgent need to develop interventions to address HIV stigma in schools to ensure optimised health and social outcomes for YLH. Future studies to understand the most effective and efficient interventions are needed.
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Affiliation(s)
- Irene Njuguna
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Hellen Moraa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Florence Nyapara
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Calvins Aballa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anjuli D. Wagner
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Grace John-Stewart
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Epidemiology, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Medicine, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Pediatrics, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Irene Inwani
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Gabrielle O’Malley
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
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Callen G, Chory A, Sang F, Munyoro D, Aluoch J, Scanlon M, Enane L, McHenry M, Wools-Kaloustian K, Apondi E, Vreeman R. A Qualitative Examination of Perceived Stigma and its Sources Among Adolescents Living With HIV in Western Kenya. Glob Pediatr Health 2022; 9:2333794X211065335. [PMID: 35024383 PMCID: PMC8744199 DOI: 10.1177/2333794x211065335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction. Adolescents (10-19 years) living with HIV (ALWH) face unique challenges in controlling HIV long-term, including stigma and perception of stigma within their communities. Methods. We conducted a qualitative investigation of the sources of perceived HIV-related stigma with ALWH in western Kenya. Forty-six ALWH on ART, aware of their status, and engaged in care were enrolled. Interviews explored perceived stigma by probing the individuals and experiences that adolescents identify as causing or perpetuating their ongoing fears. Results. Participants (54% male, mean age 17.4) reported ongoing fears of stigmatization related to friends and peers not living with HIV. They described previous enacted and first-hand observations of stigma, most often occurring in pre-adolescence, by age mates or peers at school as the most common cause for their ongoing fears. Conclusions. Perceived stigma is prevalent among ALWH and develops from experiences in pre-adolescence. Anti-HIV stigma interventions addressing educators and children in school settings to combat perceived stigma at its source should be investigated.
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Affiliation(s)
- Grant Callen
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Ashley Chory
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
- Arnhold Institute for Global Health,
Department of Health Systems Design and Global Health, Icahn School of Medicine at
Mt. Sinai, New York City, NY, USA
| | - Festus Sang
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | | | - Michael Scanlon
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Leslie Enane
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Megan McHenry
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
- Moi Teaching and Referral Hospital,
Eldoret, Kenya
| | - Rachel Vreeman
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
- Arnhold Institute for Global Health,
Department of Health Systems Design and Global Health, Icahn School of Medicine at
Mt. Sinai, New York City, NY, USA
- Moi University, Eldoret, Kenya
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Chory A, Nyandiko W, Ashimosi C, Aluoch J, Martin R, Biegon W, Munyoro D, Apondi E, Vreeman R. Social Stigma Related to COVID-19 Disease Described by Primary and Secondary School Teachers and Adolescents Living With HIV in Western Kenya. Front Public Health 2021; 9:757267. [PMID: 34869172 PMCID: PMC8635633 DOI: 10.3389/fpubh.2021.757267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/13/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Understanding community members' knowledge, attitudes, and beliefs about the novel SARS-CoV-2 virus and the prevalence of associated stigma are critical steps for increasing accurate public health knowledge, encouraging uptake of preventative or mitigating health behaviors, and ultimately bringing the COVID-19 pandemic under control. Methods: We conducted a one-time, phone-based assessment to assess the presence of perceived COVID-19 community stigma reported by Kenyan primary and secondary school teachers, as well as adolescents living with HIV. Participants were previously enrolled in an ongoing, cluster-randomized trial to evaluate the impact of multi-media teacher training on teachers' negative attitudes and beliefs around HIV. The SAFI Stigma Questionnaire, a validated tool to assess HIV-related stigma in this setting, was adapted to ask questions regarding the stigma and discrimination experienced or perceived during the COVID-19 pandemic. Results: We enrolled 330 participants in this study, including 311 primary and secondary teachers (56% female, average age 36 years) and 19 adolescents living with HIV (57.89% female, average age 16.37 years). None of the adolescent participants reported witnessing or experiencing discrimination related to COVID-19, nor did they report losing financial and/or social support. In contrast, the teacher participants reported prominent social stigma experiences of various levels and related to COVID-19. Teachers in the intervention group, who had completed the multi-media training on HIV-related stigma, were significantly less likely to think that the community viewed COVID-19 as a dirty or shameful disease, and less likely to feel it was important to keep their COVID-19 infection a secret, compared to the teacher control group. Conclusion: These findings suggest that COVID-19-related stigma may be prevalent in western Kenya and that interventions to reduce community-level stigma for HIV may also have a protective impact on other stigmatized infectious diseases such as COVID-19.
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Affiliation(s)
- Ashley Chory
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Winstone Nyandiko
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Roxanne Martin
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Whitney Biegon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rachel Vreeman
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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