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Barth SK, Monroe AK, Houston P, Benator D, Horberg M, Castel AD. COVID-19 Incidence, Risk Factors, Impact, and Related Stigma Among a Cohort of Persons With HIV in Washington, DC. J Acquir Immune Defic Syndr 2024; 96:429-438. [PMID: 38985440 DOI: 10.1097/qai.0000000000003447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/09/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Studies on the incidence of COVID-19 among persons with HIV (PWHs) present varied results. Few studies have investigated the impact of COVID-19 infection on health and socioeconomic factors or COVID-19 stigma. We sought to measure the incidence and severity of COVID-19 infection among a cohort of PWHs, characterize associated risk factors and impact, and document perceptions of COVID-19-related stigma. METHODS Data for this cross-sectional study come from the COVID-19 survey of participants in the DC Cohort longitudinal study from October 30, 2020, through December 31, 2022. Survey results were linked to electronic health records, including HIV laboratory test results and COVID test results. We conducted analyses comparing demographic, socioeconomic, HIV measures, and stigma among those with and without self-reported COVID-19. RESULTS Of 1972 survey respondents, 17% self-reported COVID-19 infection, with the greatest incidence in the Omicron wave of the pandemic. We found statistically significant differences by age, employment status, essential worker status, education, and household income. Longer duration of HIV diagnosis was associated with greater incidence of COVID-19. PWHs who were overweight or obese had a greater incidence of COVID-19 compared with those who were not. Over 40% of PWHs with COVID-19 reported experiencing at least 1 form of COVID-19-related stigma. CONCLUSION We observed a high incidence of COVID-19 infection among PWHs in DC. Furthermore, a substantial proportion of PWHs with COVID-19 reported experiencing COVID-19-related stigma. These findings add to the existing literature on COVID-19 coinfection among PWHs and highlight the need for awareness and support for those experiencing COVID-19 stigma.
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Affiliation(s)
- Shannon K Barth
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Anne K Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Patricia Houston
- Howard University Department of Pediatrics and Child Health, Washington, DC
| | - Debra Benator
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC; and
| | | | - Amanda D Castel
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC
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2
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West NS, Nakubulwa R, Murray SM, Ddaaki W, Mayambala D, Nakyanjo N, Nalugoda F, Hutton HE, Surkan PJ, Kennedy CE. Okweraliikirira and Okwenyamira: Idioms of Psychological Distress Among People Living with HIV in Rakai, Uganda. RESEARCH SQUARE 2024:rs.3.rs-4656465. [PMID: 39011105 PMCID: PMC11247927 DOI: 10.21203/rs.3.rs-4656465/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Introduction Health and illness experiences are positioned within social and cultural contexts. Understanding the mental health and psychological distress of people living with HIV in highly affected communities is critical to addressing their needs and to ensure programming and interventions are targeted and appropriate. Methods Grounded in the ethnomedical theoretical perspective, we conducted qualitative interviews to understand the experience and expression of psychological distress by people living with HIV in Rakai, Uganda. Participants included adults living with HIV (n=20), health workers (counselors, peer health workers, nurses, n=10), and key informants (n=12). Interviews were audio recorded, transcribed/translated, coded, and analyzed using thematic analysis. Results Two idioms of distress, okweraliikirira (worry/apprehension) and okwenyamira (deep/manythoughts/lots of thoughts) were described as impacting people living with HIV. Both idioms were said to be alleviated by social support or counseling, but if left unaddressed could lead to more severe mental health problems and poor ART adherence. Conclusion People living with HIV understand their psychological distress through culturally specific idioms; such distress can have deleterious impacts on well-being. Incorporating idioms of distress into screening and treatment for people living with HIV may improve identification of individuals in need and overall health services to address this need.
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Affiliation(s)
- Nora S West
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine
| | | | - Sarah M Murray
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health
| | | | | | | | | | - Heidi E Hutton
- Johns Hopkins School of Medicine, Division of Psychiatry and Behavioral Sciences
| | - Pamela J Surkan
- Johns Hopkins Bloomberg School of Public Health, Department of International Health
| | - Caitlin E Kennedy
- Johns Hopkins Bloomberg School of Public Health, Department of International Health
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3
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Janek SE, Knippler ET, Saslafsky AT, Mulawa MI. A Scoping Review of Approaches to Reduce Stigma and Discrimination Against People with HIV in Health-Care Settings in the United States: Few Recent Interventions Identified. Nurs Clin North Am 2024; 59:235-252. [PMID: 38670692 PMCID: PMC11055979 DOI: 10.1016/j.cnur.2023.12.002] [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: 04/28/2024]
Abstract
This scoping review identified contemporary stigma-reduction studies across US health-care settings. Despite the significance of this problem, only 3 intervention studies were identified in the past 5 years. These studies highlight the value of intervening during formative training experiences and the importance of including interprofessional health-care providers in interventions. The findings relate to the novel approaches (eg, virtual patient simulations) that are used in interventions. The importance of using a participatory approach to intervention design is noted. Critical gaps in human immunodeficiency virus (HIV) stigma measurement and the lack of interventions are identified, laying a foundation for future programs and research.
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Affiliation(s)
- Sarah E Janek
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA.
| | | | - Ali T Saslafsky
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
| | - Marta I Mulawa
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
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4
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McGee KS. Overview of the US National HIV Strategy and Ending the HIV Epidemic Initiative. Nurs Clin North Am 2024; 59:297-308. [PMID: 38670696 DOI: 10.1016/j.cnur.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The US National HIV/AIDS Strategy (NHAS) is a comprehensive plan that outlines specific goals for Ending the HIV Epidemic in the United States (EHE) by 2025. The strategy also provides specific strategies to prevent new HIV infections and improve health outcomes for people with HIV. The EHE is a companion document which focuses on achieving the goals of the NHAS in specific US jurisdictions where the HIV epidemic is concentrated. This article provides an overview of the NHAS and EHE and provides examples of programs and strategies that can be used to end the HIV epidemic in the United States.
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Affiliation(s)
- Kara S McGee
- MSN Program, Division of Infectious Diseases, Duke University School of Nursing, Duke University School of Medicine, 307 Trent Drive, Box 3322, Durham, NC 27710, USA.
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5
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Hafez S, Ismail SA, Zibwowa Z, Alhamshary N, Elsayed R, Dhaliwal M, Samuels F, Fakoya A. Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002758. [PMID: 38709792 PMCID: PMC11073720 DOI: 10.1371/journal.pgph.0002758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/06/2024] [Indexed: 05/08/2024]
Abstract
Community action is broadly recognised as central to comprehensive and effective system responses to pandemics. However, there is uncertainty about how and where communities can be best supported to bolster long-term resilience and preparedness. We applied a typology of community interventions (Community Informing, Consulting, Involving, Collaborating or Empowering-or CICICE) to cover the diverse range of interventions identified across the literature and used this to structure a scoping review addressing three linked topics: (i) how CICICE interventions have been understood and applied in the literature on epidemic and pandemic preparedness; (ii) the spectrum of interventions that have been implemented to strengthen CICICE and (iii) what evidence is available on their effectiveness in influencing preparedness for current and future emergencies. We drew on peer-reviewed and grey literature from the HIV (from 2000) and COVID-19 pandemics and recent public health emergencies of international concern (from 2008), identified through systematic searches in MEDLINE, Scopus, the Cochrane Collaboration database, supplemented by keyword-structured searches in GoogleScholar and websites of relevant global health organisations. Following screening and extraction, key themes were identified using a combined inductive/deductive approach. 130 papers met the criteria for inclusion. Interventions for preparedness were identified across the spectrum of CICICE. Most work on COVID-19 focused on informing and consulting rather than capacity building and empowerment. The literature on HIV was more likely to report interventions emphasising human rights perspectives and empowerment. There was little robust evidence on the role of CICICE interventions in building preparedness. Evidence of effect was most robust for multi-component interventions for HIV prevention and control. Much of the reporting focused on intermediate outcomes, including measures of health service utilisation. We put forward a series of recommendations to help address evidence shortfalls, including clarifying definitions, organising and stratifying interventions by several parameters and strengthening evaluation methods for CICICE.
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Affiliation(s)
- Sali Hafez
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sharif A. Ismail
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zandile Zibwowa
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nadin Alhamshary
- The Nuffield Centre for International Health and Development, School of Medicine, The University of Leeds, Leeds, United Kingdom
| | - Reem Elsayed
- The University of Western Cape, Cape Town, South Africa
| | - Mandeep Dhaliwal
- HIV and Health Group, United Nations Development Program, New York, United States of America
| | - Fiona Samuels
- Centre for Public Health and Policy, Queen Mary University of London, London, United Kingdom
| | - Ade Fakoya
- Institute for Global Health, University College London, London, United Kingdom
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Gruszczyńska E, Rzeszutek M. Daily stigma and daily emotional well-being among people living with HIV: Testing a buffering hypothesis of social support during the COVID-19 pandemic. Appl Psychol Health Well Being 2024; 16:477-496. [PMID: 37852623 DOI: 10.1111/aphw.12500] [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: 04/27/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023]
Abstract
This study examined the relationship between daily perceived stigma and daily emotional well-being among people living with HIV/AIDS during the COVID-19 pandemic. Additionally, a buffering effect of perceived emotional support on this relationship was verified. The participants were 133 patients with a medically confirmed diagnosis of HIV infection. Data were collected using online diaries completed every evening for five consecutive weekdays in three bursts separated by 6 months. Dynamic multilevel analyses showed a significant positive autoregressive effect for daily stigma in each burst. Additionally, increased stigma predicts increased negative affect and decreased positive affect the next day. However, these effects differed across bursts. Thus, to some extent, daily HIV/AIDS stigma was found to predict a decrease in affective well-being the next day. The buffering effect of perceived emotional support reduced this decline but was also time-limited, probably because of the later established direction in these relationships at the individual level and/or because of changes in the course of the pandemic. The results provide insights on the role of daily stigma in shaping affective well-being, suggesting that it may be a significant source of short-term negative emotional consequences for PWLH.
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Affiliation(s)
- Ewa Gruszczyńska
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
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Gilles I, Jackson-Perry D, Le Saux C, Storari C, Cart-Richter E, Keserue Pittet O, Darling KEA. Navigating HIV-Related Stigma in Switzerland: A Qualitative Study. Int J Public Health 2024; 69:1606333. [PMID: 38737988 PMCID: PMC11082645 DOI: 10.3389/ijph.2024.1606333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Objectives: This study sought to understand how people living with HIV experience, perceive, and navigate stigma in their everyday life and in care settings in an urban French-speaking area in Switzerland. Methods: Semi-structured interviews were carried out with 19 people living with HIV in Lausanne concerning their experience of HIV-related stigma in both everyday life and in healthcare settings. Content analysis was performed to identify main and sub-themes. Results: "Living with HIV" posed little or no difficulty for participants. However, the burden of anticipated and internalized HIV-related stigma played a disproportionately large role in their lives. Participants considered the general population's low level of knowledge about HIV as problematic in this regard. While participants reported few examples of enacted stigma generally, healthcare environments were sometimes experienced as sites of prejudice and discrimination. However, some healthcare professionals were also sources of information and knowledge, contributing to participants' "journeys of self-acceptance." Conclusion: Even in an urban environment in a country with ready access to healthcare and education, HIV-related stigma remains a concern for people living with HIV.
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Affiliation(s)
- Ingrid Gilles
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Clara Le Saux
- University Center of General Medicine and Public Health, Lausanne, Vaud, Switzerland
| | - Chiara Storari
- University Center of General Medicine and Public Health, Lausanne, Vaud, Switzerland
| | - Ellen Cart-Richter
- University Center of General Medicine and Public Health, Lausanne, Vaud, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Oriana Keserue Pittet
- University Center of General Medicine and Public Health, Lausanne, Vaud, Switzerland
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8
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Dai Z, Wu Y, Liu X, Fu J, Si M, Chen X, Wang H, Xiao W, Huang Y, Yu F, Mi G, Su X. Characteristics and influencing factors of anticipated HIV stigma among HIV-negative/unknown MSM in China: A regression mixture model. Brain Behav 2024; 14:e3472. [PMID: 38549560 PMCID: PMC10979188 DOI: 10.1002/brb3.3472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Anticipated HIV stigma among men who have sex with men's (MSM) has a severe negative effect on their physical and mental health wellbeing and hence requires specific attention. The current study aims to identify the characteristics and the psychosocial influencing factors of anticipated HIV stigma in MSM using regression mixture model (RMM) and to determine the cut-off point of the seven-item Anticipated HIV Stigma Questionnaire (AHSQ) using the receiver operating characteristic (ROC) analysis. METHODS A cross-sectional study was conducted among HIV-negative/unknown MSM from Blued online platform in China from December 16th, 2020 to March 1st, 2021, enrolling 1394 participants. Data were collected on demographic characteristics, perceived social support, anticipated HIV stigma, depressive symptoms, and HIV knowledge. Latent profile analysis was performed to identify different profiles of anticipated HIV stigma level. Chi-square test, analysis of variance, and RMM analysis were conducted to explore the influencing factors in different profiles. ROC analyses were carried out to identify the cut-off value of anticipated stigma. RESULTS Among the participants, three profiles of anticipated stigma were identified: "low anticipated HIV stigma" (12.0%), "moderate anticipated HIV stigma" (52.1%), and "severe anticipated HIV stigma" (35.9%). RMM analysis showed that higher income and higher levels of knowledge were positively associated with moderate anticipated HIV stigma, whereas full-time job and social support were negatively associated with moderate anticipated HIV stigma; higher income, depressive symptoms, and knowledge were positively associated with severe anticipated HIV stigma, whereas minor ethnicity and social support were negatively associated with severe anticipated HIV stigma. ROC curve of the AHSQ showed that the optimal cut-off value of ≥16 could indicate positive anticipated HIV stigma. CONCLUSION The study focuses on the level of anticipated HIV stigma and its psycho-socio influencing factors among HIV-negative/unknown MSM. It provides evidence for implementing relevant psychological interventions to HIV-negative/unknown MSM.
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Affiliation(s)
- Zhenwei Dai
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yijin Wu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xin Liu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Jiaqi Fu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Mingyu Si
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xu Chen
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Hao Wang
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Weijun Xiao
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yiman Huang
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Fei Yu
- Danlan Public WelfareBeijingChina
| | | | - Xiaoyou Su
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
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Ebrahimi H, Atashzadeh Shoorideh F, Reza Sohrabi M, Ebrahimi M, Hosseini M. An Analysis of Approaches to Reduction of HIV Stigma across the World through educational interventions: A Scoping Review. INVESTIGACION Y EDUCACION EN ENFERMERIA 2024; 42:e06. [PMID: 39083818 PMCID: PMC11290898 DOI: 10.17533/udea.iee.v42n1e06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/05/2023] [Indexed: 08/02/2024]
Abstract
Objective To determinate the educational interventions for reducing the stigma caused by HIV worldwide. Methods This scoping review study analyzed all papers published from early 2000 to the end of 2022 by searching all the scientific databases, Scopus, Web of Science, PubMed, Cochrane, Embase and CINHAL. The quality assessment of the papers was done using the ROBIS tool checklist. Results 31papers were admitted to the scoping review process. Stigma reduction intervention was founded on three parts: Society, health and therapeutic services providers, and the patients who had HIV and their families. The interventions included education on the reduction of fear, and shame, observation of protective standards, conducting tests and treatment at the above levels, as well as the support provided by the society, policymakers, religious leaders and families of patients in economic, psychological and cultural terms, together with the establishment of social centres and organization of campaigns. Conclusion The stigma associated with HIV is a significant obstacle before treatment, life expectancy and living quality of patients. Therefore, the stigma associated with this disease can be reduced, and the living quality of patients can be raised using approaches such as education of healthcare service providers and afflicted people, as well as economic, social, cultural, and psychological support.
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Affiliation(s)
- Hamideh Ebrahimi
- 1 Ph.D. Candidate, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Foroozan Atashzadeh Shoorideh
- 2 Ph.D. Professor, Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Sohrabi
- 3 Ph.D. Professor, Department of Community Medicine, Social Determinants of Health Research Center, Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Masoumeh Ebrahimi
- 4 M.Sc. Clinical Research Development Unit of Pirooz Hospital, Guilan University of Medical Sciences, Rasht, Guilan.
| | - Meimanat Hosseini
- 5 Ph.D. Associate Professor, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Nyman F. Reshaping the narrative: Tracing the historical trajectory of HIV/AIDS, gay men, and public health in Sweden. PLoS One 2024; 19:e0298630. [PMID: 38386666 PMCID: PMC10883528 DOI: 10.1371/journal.pone.0298630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
The human immunodeficiency virus (HIV) emerged as an endemic health crisis in the United States during the early 1980s. Initially labelled a "gay disease" due to its prevalence among gay men, the spread of HIV led to widespread fear and moral panic, as there was limited medical knowledge on preventing its transmission. While HIV is often associated with Sub-Saharan Africa, this article focuses on Sweden, a pioneering nation that became the first to achieve the remarkable Joint UNAIDS/WHO 90-90-90 continuum in addressing the epidemic. However, despite this significant milestone, the punitive legislation and attitudes prevalent in Sweden have had a counterproductive effect on curbing the virus's spread. Drawing upon a comprehensive triangulation of various data and sources on the evolution of public policy in Sweden, this article argues for the urgent need to reduce stigma surrounding HIV and AIDS. By undertaking further measures to combat stigmatisation, we not only have the potential to prevent the spread of HIV but also significantly enhance the quality of life for individuals living with the virus. An essential step in this journey is to eliminate the legally-enforced mandatory disclosure of one's HIV status, which would mark a tremendous victory for all those affected. With limited evidence to support the effectiveness of criminalisation and penal laws, no longer being viewed as criminals for non-disclosure would be a monumental achievement, positively transforming the lives of people living with HIV and fostering a more inclusive and supportive society.
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Affiliation(s)
- Fredrik Nyman
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Jämtland, Sweden
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Yang M, Zhang L, Jiang Y, Liu P, Liu W, Cao X, Luo Q, Fu C, He L. An adapted white-coat and warm-heart intervention on nurses' knowledge, general stigmatizing attitudes, and work avoidance behaviors towards HIV: a quasi-experimental study. J Occup Health 2024; 66:uiae041. [PMID: 39038083 DOI: 10.1093/joccuh/uiae041] [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: 04/16/2024] [Revised: 07/04/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVES To determine the effect of an adapted white-coat and warm-heart intervention (AWWI) among nurses. BACKGROUND HIV discrimination among medical staff hinders progress in HIV prevention. METHODS A total of 779 nurses were randomized into intervention and control groups. The intervention group was provided with AWWI training. The control group did not receive AWWI training. HIV-related knowledge, attitudes, and behaviors of participants were assessed. RESULTS Participants in the intervention group had better HIV-related knowledge and less stigmatizing attitudes and work avoidance behavior levels than participants in the control group after the 1-, 3-, and 6-month interventions (P < .05). The main effects of group and time factors were highly significant in the intervention group. There were significant interaction effects in group and time factors. CONCLUSIONS AWWI effectively improved the level of HIV-related knowledge and reduced general stigmatizing attitudes and work avoidance behaviors among nurses based on self-reported data in a tertiary hospital in China during a 6-month period.
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Affiliation(s)
- Ming Yang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha 410008, China
| | - Ling Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha 410008, China
| | - Ying Jiang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha 410008, China
| | - Peng Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha 410008, China
| | - Wanli Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha 410008, China
| | - Xiaoxia Cao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha 410008, China
| | - Qin Luo
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha 410008, China
| | - Cangmei Fu
- Department of Oncology, the Second Xiangya Hospital of Central South University, Changsha 410012, China
| | - Lianxiang He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha 410008, China
- Department of Nursing, Xiangya Changde Hospital, Changde 415009, China
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12
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Schweitzer AM, Dišković A, Krongauz V, Newman J, Tomažič J, Yancheva N. Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe. AIDS Res Ther 2023; 20:87. [PMID: 38082352 PMCID: PMC10714556 DOI: 10.1186/s12981-023-00585-1] [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] [Received: 08/08/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Surging HIV prevalence across countries of Central and Eastern Europe (CEE) is largely a result of poor HIV care engagement and a lack of comprehensive support for key populations. This is fostered by widespread stigma across healthcare, community, and legislative settings. DISCUSSION Throughout CEE, HIV stigma and intersectional stigma are serious obstacles to providing adequate medical care to people living with HIV. Anticipated and enacted (experienced) stigma from healthcare professionals, and fears of breaches in confidentiality, deter individuals from having an HIV test and engaging in HIV care. Furthermore, negative connotations surrounding HIV infection can lead to discrimination from family, friends, colleagues, and the public, leading to internalized stigma and depression. Key populations that have higher HIV prevalence, such as men who have sex with men, people who inject drugs, transgender individuals, and sex workers, experience additional stigma and discrimination based on their behaviour and identities. This contributes to the concentrated HIV epidemics seen in these populations in many CEE countries. The stigma is exacerbated by punitive legislation that criminalizes HIV transmission and penalizes sexual orientation, drug use, gender identities, and sex work. Despite high levels of HIV stigma and intersectional stigma, there are many evidence-based interventions that have reduced stigma in other parts of the world. Here, we discuss the interventions that are currently being enacted in various countries of CEE, and we suggest additional effective, evidence-based interventions that will tackle stigma and lead to increased HIV care engagement and higher rates of viral suppression. We cover the promotion of the undetectable = untransmittable (U = U) message, stigma-reduction education and training for healthcare professionals, patient-centric approaches for testing and treatment, and advocacy for non-discriminatory legislation, policies, and practices. We also consider targeted stigma-reduction interventions that acknowledge the wider challenges faced by marginalized populations. CONCLUSIONS HIV stigma and intersectional stigma in CEE drive poor engagement with HIV testing services and care. Widespread adoption of evidence-based interventions to tackle stigma highlighted in this review will improve the quality of life of people living with HIV, improve HIV care engagement, and ultimately slow the surging HIV prevalence and concentrated epidemics occurring throughout CEE.
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Affiliation(s)
| | - Arian Dišković
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | - Veronica Krongauz
- European Distributor Markets, Medical Department, Gilead Sciences, Uxbridge, UK
| | - Julie Newman
- HIV Strategic Implementation & Franchise, Global Medical Affairs, Gilead Sciences, Melbourne, Australia
| | - Janez Tomažič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
- Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
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SoleimanvandiAzar N, Karimi SE, Ahmadi S, Irandoost SF, Amirkafi A, Azimi A. Exploring the determinants of health service utilization among people living with HIV: a qualitative study in Iran. BMC Health Serv Res 2023; 23:1351. [PMID: 38049768 PMCID: PMC10694986 DOI: 10.1186/s12913-023-10321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Health service utilization among people living with HIV is vital for their survival and quality of life. This study aims to exploring the determinants influencing health service utilization among people living with HIV. METHODS We conducted a qualitative study involving 16 men and women aged 18-64 living with HIV in Tehran. Data were collected between September and December 2021 through semi-structured interviews conducted via telephone and online platforms, utilizing the purposeful sampling method. Data were analyzed by MAXQDA-2018 software using conventional content analysis approaches and the Granheim and Landman method. RESULTS Two main themes, seven categories, and 21 subcategories were obtained from the interviews. The main themes included facilitators of health service utilization (positive personality traits, social factors, and structural-behavioral determinants) and inhibitors of health service utilization (personal conditions, insufficient knowledge and understanding of the disease, negative consequences of disease disclosure, and difficult access to services). CONCLUSION This study underscores the need to invest and expand specialized services for people living with HIV by policy makers, while simultaneously increasing public awareness to reduce the social stigma.
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Affiliation(s)
- Neda SoleimanvandiAzar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Ahmadi
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Seyed Fahim Irandoost
- Department of Community Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Amirkafi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Azimi
- Department of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Douglass CH, Win TM, Goutzamanis S, Lim MSC, Block K, Onsando G, Hellard M, Higgs P, Livingstone C, Horyniak D. Stigma Associated with Alcohol and Other Drug Use Among People from Migrant and Ethnic Minority Groups: Results from a Systematic Review of Qualitative Studies. J Immigr Minor Health 2023; 25:1402-1425. [PMID: 36976449 PMCID: PMC10632266 DOI: 10.1007/s10903-023-01468-3] [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] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among migrant and ethnic minority groups. Qualitative studies published in English were identified using six databases. Two reviewers screened and critically appraised articles using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies. Data were synthesised using best fit framework synthesis. Twenty-three studies were included. Stigma drivers and facilitators included stereotypes, socio-cultural norms, legal responses and precarious lived experiences. Stigma intersected with gender, citizenship, race and ethnicity and manifested though shame, exclusion, secondary stigma and discrimination in treatment. Outcomes and impacts included avoidance of services, emotional distress, isolation and loneliness. This review identified similar stigma experiences to other populations, however outcomes were complicated by precarious lived experiences and multiple stigmatised identities. Multi-level interventions are required to reduce AOD-related stigma for migrant and ethnic minority groups.
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Affiliation(s)
- Caitlin H Douglass
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Thin Mar Win
- Burnet Institute Myanmar, 226 Wizaya Plaza, U Wisara Road, Yangon, Myanmar
| | | | - Megan S C Lim
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Karen Block
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Gerald Onsando
- Melbourne School of Social and Political Sciences, University of Melbourne, 420 John Medley Building, Parkville, VIC, 3010, Australia
| | - Margaret Hellard
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Peter Higgs
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Public Health Department, La Trobe University, Plenty Road, Bundoora, VIC, 3086, Australia
| | - Charles Livingstone
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Danielle Horyniak
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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15
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Ferguson L, Gruskin S, Bolshakova M, Rozelle M, Yagyu S, Kasoka K, Oraro-Lawrence T, Motala A, Stackpool-Moore L, Hempel S. Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination. AIDS 2023; 37:1919-1939. [PMID: 37352492 PMCID: PMC10552822 DOI: 10.1097/qad.0000000000003628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023]
Abstract
A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been tried. Using a PICOTS framework and applying the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, we undertook a systematic review to determine the success of interventions aiming to address internalized stigma, stigma and discrimination in healthcare, and at the legal or policy level, and to identify their critical success factors. Random effects meta-analyses summarized results wherever possible. We carried out a component analysis to identify and characterize successful interventions. Internalized stigma interventions were diverse: across all studies, we found a reduction of stigma but it was not statistically significant [standardized mean difference (SMD) 0.56; confidence interval (CI) 0.31-1.02; 17 studies). For interventions to address stigma and discrimination in healthcare settings, effect estimates varied considerably but most studies showed positive effects (SMD 0.71; CI 0.60-0.84, 8 studies). Boosted regression analyses found that a combined approach comprising education, counseling, community participation, support person, and access to a HIV specialist often yielded success. Studies of efforts to address stigma and discrimination through law and policy documented, mostly qualitatively, the effect of court cases and directives. Across a range of settings and populations, promising interventions have been identified that, through diverse pathways, have positively impacted the types of stigma and discrimination studied. This evidence base must be built upon and brought to scale to help reach global HIV-related targets and, most importantly, improve the health and quality of life of people with HIV.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California
| | - Maria Bolshakova
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Mary Rozelle
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | - Aneesa Motala
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | - Susanne Hempel
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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16
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Restall G, Ukoli P, Mehta P, Hydesmith E, Payne M. Resisting and disrupting HIV-related stigma: a photovoice study. BMC Public Health 2023; 23:2062. [PMID: 37864144 PMCID: PMC10590010 DOI: 10.1186/s12889-023-16741-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/12/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The stigma associated with human immunodeficiency virus (HIV) is a significant global public health concern. Health care providers and policy makers continue to struggle with understanding and implementing strategies to reduce HIV-related stigma in particular contexts and at the intersections of additional oppressions. Perspectives and direction from people living with HIV are imperative. METHODS In this project we amplified the voices of people living with HIV about their experiences of HIV-related stigma in Manitoba, Canada. We used an arts-based qualitative case study research design using photovoice and narrative interviews. Adults living with HIV participated by taking pictures that represented their stigma experiences. The photos were a catalyst for conversations about HIV and stigma during follow-up individual narrative interviews. Journaling provided opportunities for participants to reflect on their experiences of, and resistance to, stigma. Interviews were audio recorded and transcribed. Photos, journals, and transcribed interviews were analyzed using inductive qualitative methods RESULTS: Through pictures and dialogue, participants (N = 11; 64% women) expressed the emotional and social impacts of stigmas that were created and supported by oppressive structures and interpersonal attitudes and behaviours. These experiences were compounded by intersecting forms of oppression including racism, sexism, and homophobia. Participants also relayed stories of their personal strategies and transitions toward confronting stigma. Strategies were themed as caring for oneself, caring for children and pets, reconstituting social support networks, and resisting and disrupting stigma. Participants made important recommendations for system and policy change. CONCLUSIONS These stories of oppression and resistance can inspire action to reduce HIV-related stigma. People living with HIV can consider the strategies to confront stigma that were shared in these stories. Health care providers and policy makers can take concerted actions to support peoples' transitions to resisting stigmas. They can facilitate supportive and anti-oppressive health and social service systems that address medical care as well as basic needs for food, shelter, income, and positive social and community connections.
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Affiliation(s)
- Gayle Restall
- Department of Occupational Therapy, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada.
| | - Patricia Ukoli
- Faculty of Social Work, University of Manitoba, Winnipeg, MB, Canada
| | - Punam Mehta
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Elizabeth Hydesmith
- Department of Anthropology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Mike Payne
- Nine Circles Community Health Centre, Winnipeg, MB, Canada
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17
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Rzeszutek M, Gruszczyńska E. Depression during the COVID-19 pandemic among people living with HIV: Are low HIV/AIDS stigma and high perceived emotional support protective resources? Stress Health 2023; 39:884-893. [PMID: 36716041 DOI: 10.1002/smi.3231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/13/2023] [Accepted: 01/21/2023] [Indexed: 01/31/2023]
Abstract
This study has two objectives: first, to examine changes in depressive symptoms among people living with HIV (PLWH) during the COVID-19 pandemic and, second, to verify the role of HIV/AIDS stigma and perceived emotional support (PES) in the heterogeneity of these changes. The participants were 392 people with a medical diagnosis of HIV who have undergone antiretroviral therapy. Depression was measured at three time points with 6-month intervals using the Centre for Epidemiological Studies Depression Scale (CES-D). PES was evaluated with the Berlin Social Support Scales, and HIV/AIDS-related stigma was assessed with the Berger HIV Stigma Scale. Latent growth class modelling identified four trajectories of depression over the study period: three stable (very high, high, and very low) and one increasing. Both the very high and high stable trajectories had baseline values above the CES-D cut-off point for depression, suggesting that 57.6% of the sample was likely to be diagnosed with depression. After controlling for sociodemographic and clinical variables, stigma and PES were found to be significant covariates of the obtained trajectories; however, they did not protect against an increase in depression symptoms. There was no overall increase in depression symptoms among the PLWH participants during the pandemic, but this change in depression symptoms was heterogeneous. We observed the potential development of depression in initially well-functioning individuals despite their personal resources differing only slightly from those who remained resilient.
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Affiliation(s)
| | - Ewa Gruszczyńska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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18
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Kutner BA, Vaughn MP, Giguere R, Rodriguez-Hart C, McKinnon K, Kaighobadi F, Felix B, Akakpo A, Cournos F, Mikaelian M, Knox J, Boccher-Lattimore D, Mack KA, LaForest M, Sandfort TGM. A Systematic Review of Intervention Studies That Address HIV-Related Stigmas Among US Healthcare Workers and Health Systems: Applying a Theory-Based Ontology to Link Intervention Types, Techniques, and Mechanisms of Action to Potential Effectiveness. Ann Behav Med 2023; 57:801-816. [PMID: 37318287 PMCID: PMC10498821 DOI: 10.1093/abm/kaad022] [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: 06/16/2023] Open
Abstract
BACKGROUND To end the HIV epidemic, we need to better understand how to address HIV-related stigmas in healthcare settings, specifically the common theoretical bases across interventions so that we can generalize about their potential effectiveness. PURPOSE We describe theory-based components of stigma interventions by identifying their functions/types, techniques, and purported mechanisms of change. METHODS This systematic review examined studies published by April 2021. We applied a transtheoretical ontology developed by the Human Behaviour Change Project, consisting of 9 intervention types (ITs), 93 behavior change techniques (BCTs), and 26 mechanisms of action (MOAs). We coded the frequency and calculated the potential effectiveness of each IT, BCT, and MOA. We evaluated study quality with a 10-item adapted tool. RESULTS Among the nine highest quality studies, indicated by the use of an experimental design, the highest potentially effective IT was "Persuasion" (i.e. using communication to induce emotions and/or stimulate action; 66.7%, 4/6 studies). The highest potentially effective BCTs were "Behavioral practice/rehearsal" (i.e. to increase habit and skill) and "Salience of consequences" (i.e. to make consequences of behavior more memorable; each 100%, 3/3 studies). The highest potentially effective MOAs were "Knowledge" (i.e. awareness) and "Beliefs about capabilities" (i.e. self-efficacy; each 67%, 2/3 studies). CONCLUSIONS By applying a behavior change ontology across studies, we synthesized theory-based findings on stigma interventions. Interventions typically combined more than one IT, BCT, and MOA. Practitioners and researchers can use our findings to better understand and select theory-based components of interventions, including areas for further evaluation, to expedite ending the HIV epidemic.
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Affiliation(s)
- Bryan A Kutner
- Psychiatry Research Institute at Montefiore Einstein (PRIME), Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael P Vaughn
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristina Rodriguez-Hart
- Division of Disease Control (DIS), New York City Department of Health and Mental Hygiene (DOHMH), New York, NY, USA
| | - Karen McKinnon
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, New York, NY, USA
| | - Farnaz Kaighobadi
- Department of Social Sciences, Bronx Community College, City University New York, Bronx, NY, USA
| | - Bimbla Felix
- Adult Comprehensive Services, Jacobi Medical Center, New York, NY, USA
| | - Attisso Akakpo
- New York State Department of Health, AIDS Institute, New York, NY, USA
| | - Francine Cournos
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, New York, NY, USA
| | - Matt Mikaelian
- The Mental Health Association of Westchester, Tarrytown, NY, USA
| | - Justin Knox
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daria Boccher-Lattimore
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, New York, NY, USA
| | - Kimbirly A Mack
- Division of Disease Control (DIS), New York City Department of Health and Mental Hygiene (DOHMH), New York, NY, USA
| | - Marian LaForest
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, New York, NY, USA
| | - Theodorus G M Sandfort
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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19
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Smith MK, Luo D, Meng S, Fei Y, Zhang W, Tucker J, Wei C, Tang W, Yang L, Joyner BL, Huang S, Wang C, Yang B, Sylvia SY. An Incognito Standardized Patient Approach for Measuring and Reducing Intersectional Healthcare Stigma. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.21.23294305. [PMID: 37662413 PMCID: PMC10473797 DOI: 10.1101/2023.08.21.23294305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background Consistent evidence highlights the role of stigma in impairing healthcare access in people living with HIV (PLWH), men who have sex with men (MSM), and people with both identities. We developed an incognito standardized patient (SP) approach to obtain observations of providers to inform a tailored, relevant, and culturally appropriate stigma reduction training. Our pilot cluster randomized control trial assessed the feasibility, acceptability, and preliminary effects of an intervention to reduce HIV stigma, anti-gay stigma, and intersectional stigma. Methods Design of the intervention was informed by the results of a baseline round of incognito visits in which SPs presented standardized cases to consenting doctors. The HIV status and sexual orientation of each case was randomly varied, and stigma was quantified as differences in care across scenarios. Care quality was measured in terms of diagnostic testing, diagnostic effort, and patient-centered care. Impact of the training, which consisted of didactic, experiential, and discussion-based modules, was assessed by analyzing results of a follow-up round of SP visits using linear fixed effects regression models. Results Feasibility and acceptability among the 55 provider participants was high. We had a 87.3% recruitment rate and 74.5% completion rate of planned visits (N=238) with no adverse events. Every participant found the training content "highly useful" or "useful." Preliminary effects suggest that, relative to the referent case (HIV negative straight man), the intervention positively impacted testing for HIV negative MSM (0.05 percentage points [PP], 95% CI,-0.24, 0.33) and diagnostic effort in HIV positive MSM (0.23 standard deviation [SD] improvement, 95% CI, -0.92, 1.37). Patient-centered care only improved for HIV positive straight cases post-training relative to the referent group (SD, 0.57; 95% CI, -0.39, 1.53). All estimates lacked statistical precision, an expected outcome of a pilot RCT. Conclusions Our pilot RCT demonstrated high feasibility, acceptability, and several areas of impact for an intervention to reduce enacted healthcare stigma in a low-/middle-income country setting. The relatively lower impact of our intervention on care outcomes for PLWH suggests that future trainings should include more clinical content to boost provider confidence in the safe and respectful management of patients with HIV.
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Elgalib A, Shah S, Al-Habsi Z, Al-Fouri M, Lau R, Al-Rawahi B, Al-Abri S. Recent Increase in HIV cases in Oman. Sultan Qaboos Univ Med J 2023; 23:285-287. [PMID: 37655092 PMCID: PMC10467547 DOI: 10.18295/squmj.3.2023.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Affiliation(s)
- Ali Elgalib
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Samir Shah
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Zeyana Al-Habsi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Maha Al-Fouri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Richard Lau
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Bader Al-Rawahi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
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Hicks S, Abuna F, Odhiambo B, Dettinger JC, Sila J, Oketch G, Sifuna E, Ngumbau N, Gómez L, John-Stewart GC, Kinuthia J, Wagner AD. Integrating PrEP in maternal and child health clinics in Kenya: analysis of a service availability and readiness assessment (SARA) survey. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1206150. [PMID: 37484872 PMCID: PMC10359145 DOI: 10.3389/frph.2023.1206150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023] Open
Abstract
Background Risk of HIV acquisition is high during pregnancy and postpartum, and pre-exposure prophylaxis (PrEP) is recommended for peripartum populations. Integrating PrEP into maternal and child health (MCH) clinics is feasible and acceptable. Understanding clinics' service availability and readiness is essential for effective scale up. Methods The PrEP in Pregnancy, Accelerating Reach and Efficiency study (PrEPARE; NCT04712994) engaged PrEP-experienced facilities previously linked to a programmatic or research study in Western Kenya to document available services and commodities via a modified service availability and readiness assessment (SARA) survey with 20 PrEP tracer items covering: staffing/guidelines, services/equipment, and medicines/commodities. Facilities' prior study engagement occurred between 2017 and 2019; SARA survey data was collected between April 2020 and June 2021. Descriptive statistics were stratified by prior study engagement. ANOVA tests assessed associations between facility characteristics and gaps. Fisher's tests assessed differences in commodity availability and stockouts. Results Of the 55 facilities surveyed, 60% had received PrEP training in the last two years, 95% offered PrEP integrated into MCH, and 64% and 78% had both auditory and visual privacy in PrEP and HIV testing service (HTS) delivery spaces, respectively. Supervision frequency was heterogeneous, but 82% had received a supervision visit within 3 months. Availability of commodities was variable and the most commonly unavailable commodities were PrEP in MCH (71% available) and risk assessment screening tool (RAST) and PrEP cards (60% and 75% available, respectively). The number of service and commodity gaps per facility ranged from zero to eight (median: 3; IQR: 2, 5). The most frequent gaps were: PrEP training and risk assessment cards (40% each), lack of privacy in PrEP (36%) and HIV testing services (31%) spaces, PrEP pills in MCH (29%), and PrEP cards (25%). There were no differences in mean number of gaps by county, previous study engagement, or public vs. private status. Level 4 facilities had fewer gaps (mean 2.2) than level 2, 3, and 5 facilities (mean 5.7, 4.5, and 5.3 respectively; p < 0.001). Conclusions PrEP service availability and readiness was generally high across MCH facilities. However, there is a need for increased frequency of provider training and supportive supervision focused on fidelity. To address key commodity stockouts such as PrEP pills, implementation of electronic logistics management information systems may be needed. Targeting these gaps is essential to effectively scale up integrated PrEP delivery, especially among facilities with limited infrastructure.
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Affiliation(s)
- Sarah Hicks
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Felix Abuna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Ben Odhiambo
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Julia C. Dettinger
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Joseph Sila
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - George Oketch
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Enock Sifuna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Ngumbau
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Laurén Gómez
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Grace C. John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Departments of Medicine, University of Washington, Seattle, WA, United States
- Departments of Pediatrics, University of Washington, Seattle WA, United States
| | - John Kinuthia
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
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22
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Gruszczyńska E, Rzeszutek M. HIV/AIDS stigma accumulation among people living with HIV: a role of general and relative minority status. Sci Rep 2023; 13:10709. [PMID: 37400505 DOI: 10.1038/s41598-023-37948-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/30/2023] [Indexed: 07/05/2023] Open
Abstract
The main objective of the study was to investigate the relationship between selected sociodemographic factors (i.e. sexual orientation, gender and AIDS status), and the level of HIV/AIDS stigma among people living with HIV (PLWH). The participants were 663 adults with a medically confirmed diagnosis of HIV infection, undergoing antiretroviral treatment. Their level of HIV/AIDS stigma was assessed with the Berger HIV Stigma Scale, and relevant sociodemographic and clinical data were obtained using a self-report survey. The main effect was revealed only for sexual orientation and total stigma; those with heterosexual orientation declared higher levels of total stigma than those with other sexual orientations. For the subscales, significant results were obtained only for disclosure concerns. Namely, for the interaction of gender and sexual orientation, the highest level of disclosure stigma was declared by heterosexual women, while there was no such relationship for men. This result was further modified when AIDS diagnosis was added to the interaction. There is a cumulative effect of PLWH minority statuses, rather than main effects of each status individually. Thus, each minority status should be analysed from at least two perspectives, general (i.e., compared to the general population) and relative (i.e., compared to the population in question).
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Affiliation(s)
- Ewa Gruszczyńska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska 19/31, 03-815, Warsaw, Poland.
| | - Marcin Rzeszutek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
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23
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Okpua NC, Godwin C A. Healthcare providers in Nigerian hospitals and HIV-related stigma: a systematic review. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:170-179. [PMID: 37401878 DOI: 10.1080/17538068.2022.2121596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Elimination of barriers to identification of new HIV infections, treatment adherence and retention in care of people living with HIV/AIDS is vital to the attainment of WHO's ambitious vision 2030 of 90:90:90 for HIV/AIDS. However, HIV-related stigma, especially among health workers, has been widely documented as a serious threat to this project. This study explored the factors associated with the stigmatization of people living with HIV among healthcare workers in Nigerian hospitals. METHOD Electronic literature search was conducted on eight databases using keywords and MeSH guidelines. Using the PRISMA protocol, studies published from 2003 to 2022 were retrieved and analyzed. RESULT Of the 1481 articles identified, 9 met the inclusion criteria. All the included studies were conducted across 10 of the 36 states in Nigeria, with every geo-political zone in Nigeria represented by at least two studies. The overarching themes identified were attitude and beliefs (n = 7), knowledge of HIV/AIDS (n = 3), quality of care (n = 4), education and in-service training (n = 4), and health facility policies and procedures (n = 3). Factors associated with HIV-related stigma among healthcare workers varied by gender, healthcare settings, specialties of health workers, and the presence of institutional stigma reinforcements. Healthcare workers without recent in-service training on HIV/AIDS and those who work in hospitals without anti-HIV/AIDS stigma policies exhibited more HIV-related stigmatizing attitudes. CONCLUSION Continuous in-service training of healthcare workers and the development of comprehensive stigma reduction interventions that will be reinforced with anti-HIV stigma policies in clinical settings may facilitate the attainment of national HIV prevention goals.
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Affiliation(s)
- Nelson C Okpua
- Department of Community and Public Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Pinang, Malaysia
- Department of Nursing Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Awo Godwin C
- Department of Nursing Sciences, Ebonyi State University, Abakaliki, Nigeria
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Lohiniva AL, Isosomppi S, Pasanen S, Sutinen J. A qualitative study to identify thematic areas for HIV related patient-reported outcome measures (PROM) and patient-reported experience measures (PREM). J Patient Rep Outcomes 2023; 7:41. [PMID: 37126134 PMCID: PMC10151440 DOI: 10.1186/s41687-023-00582-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND The use of patient-reported outcome measures (PROM) and patient-reported experience measures (PREM) provide health providers with valuable feedback on how to improve clinical care and patient outcomes. This paper describes a qualitative study that was conducted to learn about factors influencing the well-being of people living with HIV (PLHIV) in Finland. The findings will be used to develop themes for HIV-specific PROM and PREM questions. METHODS PROMs and PREMs were developed by the Finnish Institute for Health (THL) as a part of a project to develop a national quality-of-care registry for HIV. The study aimed to identify issues and concerns among people living with HIV (PLHIV) that influence their well-being (PROMs) and their experiences in the healthcare system (PREMs). The data were collected through face-to-face in-depth interviews and focus group discussions based on open-ended and semi-structured questions. The data were analyzed using thematic analysis. RESULTS The assessment identified the following PROMs of concern: psychological well-being, concerns about stigma, physical health, social well-being, sexual well-being, medication uptake, managing other medications with antiretrovirals (ARVs), and growing old. The assessment identified the following PREMs: helping patients understand their own health status, proving an opportunity for patients to discuss physical health, psychological and sexual well-being, supporting the uptake of ARVs, assisting patients with medication use, showing compassion towards patients, and empowering patients against stigma. CONCLUSION These findings of the study can be used to develop domain-specific PROM and PREM questions for the national HIV quality care register.
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Affiliation(s)
| | | | - Sini Pasanen
- HivFinland (patient organization), Helsinki, Finland
| | - Jussi Sutinen
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Ninnoni JP, Agyemang SO, Bennin L, Agyare E, Gyimah L, Senya K, Baddoo NA, Annor F, Obiri-Yeboah D. Coping with loneliness and stigma associated with HIV in a resource-limited setting, making a case for mental health interventions; a sequential mixed methods study. BMC Psychiatry 2023; 23:163. [PMID: 36918875 PMCID: PMC10013231 DOI: 10.1186/s12888-023-04643-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/28/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Challenges such as stigma and loneliness may increase vulnerability to Human Immunodeficiency Virus (HIV) infection and negatively affect the quality of life of people living with HIV (PLHIV) despite the massive investment in access to antiretroviral therapy. This study aims to determine the level of loneliness and stigma and explore the coping resources employed by PLHIV in a resource-constrained setting. METHODS This was a sequential mixed methods study conducted at the Cape Coast Teaching Hospital (CCTH) in Ghana between May and December 2021. A total of 395 adults were selected using a simple random sampling technique. HIV Stigma Scale and UCLA Loneliness Scale were used to collect quantitative data. A purposive sampling technique was applied to recruit 18 participants to saturation using a semi-structured interview guide. SPSS version 21 was used for the statistical analysis of the quantitative data. HIV-related loneliness and stigma levels were estimated, and bivariate and multivariable logistic regression were used to evaluate associated factors using a statistical significance of p-value (p < .05). In general, the thematic analysis approach by Braun and Clark was employed to analyse the qualitative data. Findings were then triangulated. RESULTS The mean age was 46.79 years (± 12.53), 75.4% of the participants were female, with a prevalence of stigma of 99.0% (95%CI = 97.4-99.7) and loneliness of 30.1% (95%CI = 25.6-34.9). Tertiary-level education and instrumental support were associated with lower levels of loneliness. In contrast, comorbidity, personalised stigma, negative self-image, and self-blame were positively related to loneliness. Thematic analyses of the qualitative data produced a range of themes that showed that people living with HIV rely on personal resources, social support networks, and behaviour modification strategies to manage their condition. In particular, some of these strategies include; religiosity and spirituality, family and friends, medication and professional support systems. CONCLUSION The results suggest that PLHIV in the developing world face enormous challenges, socially, psychologically and financially. Although there have been global efforts to make HIV services accessible, the findings suggest a need for integrating mental health services contextually to reduce loneliness and HIV-related stigma to improve quality of life.
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Affiliation(s)
- Jerry Paul Ninnoni
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana.
- Department of Mental Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Sampson Opoku Agyemang
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Lydia Bennin
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Agyare
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Leveana Gyimah
- Communicable and Non-Communicable Diseases cluster, World Health Organisation Country Office, Accra, Ghana
| | - Kafui Senya
- Communicable and Non-Communicable Diseases cluster, World Health Organisation Country Office, Accra, Ghana
| | - Nyonuku Akosua Baddoo
- National AIDS/STIs Control Programme, Accra, Ghana
- Department of Community Health, the University of Ghana Medical School, Accra, Ghana
| | - Francis Annor
- Direcctorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | - Dorcas Obiri-Yeboah
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Lazarus JV, Wohl DA, Cascio M, Guaraldi G, Rockstroh J, Hodson M, Richman B, Brown G, Anderson J, Fuster-RuizdeApodaca MJ. Long-term success for people living with HIV: A framework to guide practice. HIV Med 2023; 24 Suppl 2:8-19. [PMID: 36920412 DOI: 10.1111/hiv.13460] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/16/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES In recent decades, the needs of people living with HIV have evolved as life expectancy has greatly improved. Now, a new definition of long-term success (LTS) is necessary to help address the multifaceted needs of all people living with HIV. METHODS We conducted a two-phase research programme to delineate the range of experiences of people living with HIV. The insights garnered from these research phases were explored in a series of expert-led workshops, which led to the development and refinement of the LTS framework. RESULTS The insights generated from the research phases identified a series of themes that form a part of LTS. These themes were subsequently incorporated into the LTS framework, which includes five outcome pillars: sustained undetectable viral load, minimal impact of treatment and clinical monitoring, optimized health-related quality of life, lifelong integration of healthcare, and freedom from stigma and discrimination. A series of supporting statements were also developed by the expert panel to help in the achievement of each of the LTS pillars. CONCLUSIONS The LTS framework offers a comprehensive and person-centric approach that, if achieved, could help improve the long-term well-being of people living with HIV and support the LTS vision of 'every person living with HIV being able to live their best life'.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute of Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA
| | - David A Wohl
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mario Cascio
- European AIDS Treatment Group (EATG), Palermo, Italy
| | | | - Jürgen Rockstroh
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | | | | | - Gina Brown
- Southern AIDS Coalition, Chalmette, Louisiana, USA
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Maria J Fuster-RuizdeApodaca
- SEISIDA, Spanish AIDS Interdisciplinary Society, Madrid, Spain.,Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Walsh JL, John SA, Quinn KG, Hirshfield S, O’Neil A, Petroll AE. Factors associated with quality of life, depressive symptoms, and perceived stress among rural older adults living with HIV in the United States. J Rural Health 2023; 39:488-498. [PMID: 36510755 PMCID: PMC10038895 DOI: 10.1111/jrh.12730] [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: 12/14/2022]
Abstract
PURPOSE Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions. METHODS Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (Mage = 56, 67% male, 67% White, and 23% Black). Associations between social support, HIV stigma, satisfaction with medical care, discrimination in health care settings, and structural barriers and health-related QOL, depressive symptoms, and perceived stress were assessed using multiple linear regressions. FINDINGS Controlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress. CONCLUSIONS In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.
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Affiliation(s)
- Jennifer L. Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Andrew O’Neil
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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van Stekelenburg BCA, De Cauwer H, Barten DG, Mortelmans LJ. Attacks on Health Care Workers in Historical Pandemics and COVID-19. Disaster Med Public Health Prep 2022; 17:e309. [PMID: 36474406 PMCID: PMC9947042 DOI: 10.1017/dmp.2022.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Previous pandemics have been (mis)used for (geo)political reasons, for terrorism purposes, and in times of conflict. Coronavirus disease (COVID-19) has been no exception with populist politicians challenging the relations with China, calling it the "Chinese virus," certain state actors setting up cyberterrorist actions against health care organizations in the United States and Europe, and a reported increase of violent acts against health care workers.Aside from state-driven factors, both left- and right-wing activists and anti-vaccination activists adhering to conspiracy theories are a threat for health care organizations. Furthermore, socioeconomic, religious, and cultural factors play a role in why health care is a possible target of violence. Fear of viral pathogens, fury about financial losses due to the pandemic and governmental measures such as lockdowns, anger because of mandatory quarantines, and the disruption of burial rituals are among the reasons for people to revolt against health care providers.Here, we provide a narrative review of the impact of violence against health care workers during the COVID-19 pandemic and earlier pandemics, and suggest preventive strategies.
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Affiliation(s)
| | - Harald De Cauwer
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Corresponding author: Harald De Cauwer,
| | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Luc J. Mortelmans
- ZNA, Camp Stuivenberg, Antwerp, Belgium
- Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium
- Research Group on Emergency and Disaster Medicine (ReGEDiM), VUB, Brussels, Belgium
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Pelletier J, Bergeron D, Rouleau G, Guillaumie L. Nurses' clinical practices reducing the impact of HIV-related stigmatisation in non-HIV-specialised healthcare settings: a protocol for a realist synthesis. BMJ Open 2022; 12:e062569. [PMID: 36385029 PMCID: PMC9670922 DOI: 10.1136/bmjopen-2022-062569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite tremendous progress in care, people living with HIV (PLHIV) continue to experience HIV-related stigmatisation by nurses in non-HIV-specialised healthcare settings. This has consequences for the health of PLHIV and the spread of the virus. In the province of Quebec (Canada), only four interventions aimed at reducing the impact of HIV-related stigmatisation by nurses have been implemented since the beginning of the HIV pandemic. While mentoring and persuasion could be promising strategies, expression of fears of HIV could have deleterious effects on nurses' attitudes towards PLHIV. In literature reviews on stigma reduction interventions, the contextual elements in which these interventions have been implemented is not considered. In order to develop new interventions, we need to understand how the mechanisms (M) by which interventions (I) interact with contexts (C) produce their outcomes (O). METHODS AND ANALYSIS Realist synthesis (RS) was selected to formulate a programme theory that will rely on CIMO configuration to describe (1) nursing practices that may influence stigmatisation experiences by PLHIV in non-HIV-specialised healthcare settings, and (2) interventions that may promote the adoption of such practices by nurses. The RS will draw on the steps recommended by Pawson: clarify the scope of the review; search for evidence; appraise primary studies and extract data; synthesise evidence and draw conclusions. To allow an acute interpretation of the disparities between HIV-related stigmatisation experiences depending on people's serological status, an initial version of the programme theory will be formulated from data gathered from scientific and grey literature, and then consolidated through realist interviews with various stakeholders (PLHIV, nurses, community workers and researchers). ETHICS AND DISSEMINATION Ethical approval for realist interviews will be sought following the initial programme theory design. We intend to share the final programme theory with intervention developers via scientific publications and recommendations to community organisations that counter HIV-related stigmatisation.
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Affiliation(s)
- Jérôme Pelletier
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
- Faculty of Nursing Sciences, Université Laval, Quebec, Quebec, Canada
| | - Dave Bergeron
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Geneviève Rouleau
- Women's College Hospital, Toronto, Ontario, Canada
- Research Chair in Innovative Nursing Practices, Centre de recherche du CHUM, Montréal, Quebec, Canada
| | - Laurence Guillaumie
- Faculty of Nursing Sciences, Université Laval, Quebec, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
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Horwitz R, Brener L, Marshall AD, Caruana T, Newman CE. Optimising community health services in Australia for populations affected by stigmatised infections: What do service users want? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3686-e3695. [PMID: 36181284 PMCID: PMC10092471 DOI: 10.1111/hsc.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/05/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Stigma in health services undermines diagnosis, treatment and successful health outcomes for all communities, but especially for those affected by blood-borne viruses and sexually transmitted infections (STIs). This study sought to examine experiences in accessing and receiving health services, including what characteristics promoted better health, safety and well-being for people with blood-borne viruses or STIss. It conducted 46 in-depth interviews with people who inject drugs, gay men and other men who have sex with men, sex workers, people in custodial settings, culturally and linguistically diverse people, Indigenous Australians and young people in one Australian urban community setting. Findings reveal that stigma persists in the provision of healthcare services, and that previous experiences of discrimination or fear of mistreatment may result in a reluctance to continue to access services. On-going staff training and education are important to ensure healthcare environments are welcoming and inclusive. Specialised services and services that employed peers were seen as favourable. Attending different services for different health needs created particular access challenges and undermined participant ability to engage in more holistic healthcare. The fragmented structure of health services was thus seen as a barrier to accessing health services, and stronger collaboration between health services is recommended.
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Affiliation(s)
- Robyn Horwitz
- Centre for Social ResearchUniversity of New South WalesSydneyNew South WalesAustralia
| | - Loren Brener
- Centre for Social ResearchUniversity of New South WalesSydneyNew South WalesAustralia
| | - Alison D. Marshall
- Centre for Social ResearchUniversity of New South WalesSydneyNew South WalesAustralia
- The Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Theresa Caruana
- Centre for Social ResearchUniversity of New South WalesSydneyNew South WalesAustralia
| | - Christy E. Newman
- Centre for Social ResearchUniversity of New South WalesSydneyNew South WalesAustralia
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Atwijukiire H, Jemba Nalubega H, Byaruhanga V, Atwiine P, Muhame K, Mpumwire P, Bukombi Muhindi E, Niyonzima V. Stigma and Discrimination of HIV/AIDs Recipients of Care in Western Uganda: Experiences and Roles of Expert Clients. HIV/AIDS - RESEARCH AND PALLIATIVE CARE 2022; 14:517-527. [DOI: 10.2147/hiv.s387599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
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Meek C, Mulenga DM, Edwards P, Inambwae S, Chelwa N, Mbizvo MT, Roberts ST, Subramanian S, Nyblade L. Health worker perceptions of stigma towards Zambian adolescent girls and young women: a qualitative study. BMC Health Serv Res 2022; 22:1253. [PMID: 36253747 PMCID: PMC9575270 DOI: 10.1186/s12913-022-08636-5] [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: 05/03/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background The high prevalence of HIV among adolescent girls and young women aged 15–24 in Eastern and Southern Africa indicates a substantial need for accessible HIV prevention and treatment services in this population. Amidst this need, Zambia has yet to meet global testing and treatment targets among adolescent girls and young women living with HIV. Increasing access to timely, high-quality HIV services in this population requires addressing the intensified anticipated and experienced stigma that adolescent girls and young women often face when seeking HIV care, particularly stigma in the health facility setting. To better understand the multi-level drivers and manifestations of health facility stigma, we explored health workers’ perceptions of clinic- and community-level stigma against adolescent girls and young women seeking sexual and reproductive health, including HIV, services in Lusaka, Zambia. Methods We conducted 18 in-depth interviews in August 2020 with clinical and non-clinical health workers across six health facilities in urban and peri-urban Lusaka. Data were coded in Dedoose and thematically analyzed. Results Health workers reported observing manifestations of stigma driven by attitudes, awareness, and institutional environment. Clinic-level stigma often mirrored community-level stigma. Health workers clearly described the negative impacts of stigma for adolescent girls and young women and seemed to generally express a desire to avoid stigmatization. Despite this lack of intent to stigmatize, results suggest that community influence perpetuates a lingering presence of stigma, although often unrecognized and unintended, in health workers and clinics. Conclusions These findings demonstrate the overlap in health workers’ clinic and community roles and suggest the need for multi-level stigma-reduction approaches that address the influence of community norms on health facility stigma. Stigma-reduction interventions should aim to move beyond fostering basic knowledge about stigma to encouraging critical thinking about internal beliefs and community influence and how these may manifest, often unconsciously, in service delivery to adolescent girls and young women. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08636-5.
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Affiliation(s)
- Caroline Meek
- Center for Health Analytics, Media, and Policy, RTI International, Washington, DC, USA. .,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Patrick Edwards
- Health Care Financing and Payment Program, RTI International, Research Triangle Park, NC, USA
| | | | | | | | - Sarah T Roberts
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Sujha Subramanian
- Public Health Research Division, RTI International, Waltham, MA, USA
| | - Laura Nyblade
- Global Health Division, RTI International, Washington, DC, USA
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Feijoo-Cid M, García-Sierra R, García García R, Ponce Luz H, Fernández-Cano MI, Portell M. Transformative learning experience among nursing students with patients acting as teachers: Mixed methods, non-randomized, single-arm study. J Adv Nurs 2022; 78:3444-3456. [PMID: 35841333 PMCID: PMC9540309 DOI: 10.1111/jan.15364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/26/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022]
Abstract
AIM To examine the effects of expert HIV patients acting as teachers to Spanish nursing students both on their HIV-related knowledge, attitudes and practices and on their approach to the care model as well as to explore their learning experience. DESIGN Non-randomized, single-arm study with quantitative before and after measurements and qualitative data. METHODS The intervention consisted of five 90-min workshops led by two women living with HIV. Thirty-four nursing students participated, and quantitative and qualitative data were gathered from February to June 2018. We used the Patient-Practitioner Orientation Scale (PPOS) and the KAP questionnaire on HIV/AIDS to collect quantitative data. RESULTS Statistically significant differences were found in the global score for care orientation and its two dimensions, caring and sharing. About the changes resulting from the workshops, the quantitative results-more patient-centred care perception and better attitudes towards people living with HIV-match the qualitative findings in all the aspects studied, except in sharing. CONCLUSION Incorporating expert patients as teachers in the nursing bachelor's degree resulted in more patient-centred care and improved knowledge, attitudes and practices. The workshops conducted by qualified expert patients showed transformative learning power, as the participants improved professional and personal aspects.
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Affiliation(s)
- Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine Universitat Autònoma de Barcelona, Campus Bellaterra, Barcelona, Spain.,Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), Barcelona, Spain
| | - Rosa García-Sierra
- Department of Nursing, Faculty of Medicine Universitat Autònoma de Barcelona, Campus Bellaterra, Barcelona, Spain.,Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), Barcelona, Spain.,Research Support Unit Metropolitana Nord, Primary Care Research Institute Jordi Gol (IDIAPJGol), Mataró, Spain
| | - Rubén García García
- Anaesthesia, Resuscitation and Pain Management Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Helena Ponce Luz
- Emergency Unit, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Maria Isabel Fernández-Cano
- Department of Nursing, Faculty of Medicine Universitat Autònoma de Barcelona, Campus Bellaterra, Barcelona, Spain.,Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), Barcelona, Spain
| | - Mariona Portell
- Departament of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Campus Bellaterra, Barcelona, Spain.,Grup de Recerca i Innovació en Dissenys (GRID) (2017 SGR 1405)
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Treloar C, Cama E, Lancaster K, Brener L, Broady TR, Cogle A, O'Donnell D. A universal precautions approach to reducing stigma in health care: getting beyond HIV-specific stigma. Harm Reduct J 2022; 19:74. [PMID: 35799296 PMCID: PMC9264680 DOI: 10.1186/s12954-022-00658-w] [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: 02/15/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Delivery of effective health care is hampered by stigma, the social processes that attach negative judgement and response to some attributes, conditions, practices and identities. Experiencing or anticipating stigma can lead to a range of practical impacts, including avoidance of health care. While we are concerned about the stigma that is attached to HIV, this commentary makes the argument that the health system is burdened by stigma of many origins. Main body Reducing stigma is a key issue in improving quality of health care. Our focus on HIV is about providing better care in a non-judgemental, respectful and dignified manner which enhances the health and well-being of individuals as well as delivering benefit to society at large through better population health outcomes. However, the same could be said for the numerous possible attributes, conditions, practices and identities that attract stigma. It is unrealistic to expect health systems to respond to siloed appeals for change and action. A unifying logic is needed to propel concerns about stigma to the front of the queue for action by health systems. Conclusion This commentary suggests the need for a universal precautions approach to stigma in health care, that focuses on recognising that all people may experience stigma and discrimination targeted at one or more aspects of their identities, attributes, practices and health conditions. Drawing on health system precepts of equity, access and quality of care, we argue that a universal precautions approach to reducing stigma of all origins can effect everyday aspects of policy, procedure and practice to improve outcomes for individuals and for population health.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kari Lancaster
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Aaron Cogle
- National Association of People With HIV Australia (NAPWHA), Sydney, Australia
| | - Darryl O'Donnell
- Australian Federation of AIDS Organisations (AFAO), Sydney, Australia
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Pollack TM, Duong HT, Nhat Vinh DT, Phuong DT, Thuy DH, Nhung VTT, Uyen NK, Linh VT, Van Truong N, Le Ai KA, Ninh NT, Nguyen A, Canh HD, Cosimi LA. A pretest-posttest design to assess the effectiveness of an intervention to reduce HIV-related stigma and discrimination in healthcare settings in Vietnam. J Int AIDS Soc 2022; 25 Suppl 1:e25932. [PMID: 35818864 PMCID: PMC9274370 DOI: 10.1002/jia2.25932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Stigma and discrimination are important barriers to HIV epidemic control. We implemented a multi‐pronged facility‐level intervention to reduce stigma and discrimination at health facilities across three high‐burden provinces. Key components of the intervention included measurement of stigma, data review and use, participatory training of healthcare workers (HCWs), and engagement of people living with HIV and key populations in all stigma reduction activities. Methods From July 2018 to July 2019, we assessed HIV‐related stigma and discrimination among patients and HCWs at 10 facilities at baseline and 9 months following an intervention. A repeated measures design was used to assess the change in stigma and discrimination among HCWs and a repeated cross‐sectional design assessed the change in stigma and discrimination experienced by PLHIV. HCWs at target facilities were invited at random and PLHIV were recruited when presenting for care during the two assessment periods. McNemar's test was used to compare paired proportions among HCWs, and chi‐square test was used to compare proportions among PLHIV. Mixed models were used to compare outcomes before and after the intervention. Results Semi‐structured interviews were conducted with 649 and 652 PLHIV prior to and following the intervention, respectively. At baseline, over the previous 12 months, 21% reported experiencing discrimination, 16% reported self‐stigma, 14% reported HIV disclosure without consent and 7% had received discriminatory reproductive health advice. Nine months after the intervention, there was a decrease in reported stigma and discrimination across all domains to 15%, 11%, 7% and 3.5%, respectively (all p‐values <0.05). Among HCWs, 672 completed the pre‐ and post‐intervention assessment. At baseline, 81% reported fear of HIV infection, 69% reported using unnecessary precautions when caring for PLHIV, 44% reported having observed other staff discriminate against PLHIV, 54% reported negative attitudes towards PLHIV and 41% felt uncomfortable working with colleagues living with HIV. The proportions decreased after the intervention to 52%, 34%, 32%, 35% and 24%, respectively (all p‐values <0.05). Conclusions A multi‐pronged facility‐level intervention was successful at reducing healthcare‐associated HIV‐related stigma in Vietnam. The findings support the scale‐up of this intervention in Vietnam and highlight key components potentially applicable in other settings.
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Affiliation(s)
- Todd M Pollack
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Hao Thi Duong
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam.,Baylor College of Medicine, Houston, Texas, USA
| | | | - Do Thi Phuong
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam
| | - Do Huu Thuy
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | | | | | - Vuong The Linh
- Binh Duong Center for Disease Control, Binh Duong, Vietnam
| | | | - Kim Anh Le Ai
- Thai Nguyen Center for Disease Control, Thai Nguyen, Vietnam
| | | | - Asia Nguyen
- Division of Global HIV and TB, Center for Global Health, United States Centers for Disease Control and Prevention Vietnam, Hanoi, Vietnam
| | - Hoang Dinh Canh
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Lisa A Cosimi
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Dey AK, Ennis N, Cheng DM, Blokhina E, Raj A, Quinn E, Bendiks S, Palfai T, Dunne EM, Cook RL, Krupitsky E, Samet JH. Impulsivity and linkage to HIV Care among People living with HIV in St. Petersburg, Russia. AIDS Behav 2022; 26:4126-4134. [PMID: 35708831 DOI: 10.1007/s10461-022-03738-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/25/2022]
Abstract
This study evaluated the association between impulsivity and linkage to HIV care among Russians living with HIV recruited from an inpatient narcology hospital. Linking Infectious and Narcology Care (LINC) study participants who completed the Barratt Impulsiveness Scale (BIS) were included in these analyses. The primary independent variable was impulsivity score which was categorized as high impulsivity (BIS score > 71) vs. low impulsivity (BIS score < = 71). The primary outcome, linkage to care post recruitment, was defined as one or more HIV medical care visits at 12-month follow-up. Multiple logistic regression models were used to evaluate the association between high impulsivity and linkage to HIV care controlling for potential confounders. Participants (N = 227) were adults with a mean age of 34 years (SD = 5), and the majority were male (74%). We did not detect a significant association between impulsivity and linkage to HIV care after adjusting for respondents' age, gender, CD4 cell count, and depression score. We also found that substance use and hazardous drinking did not appear to confound the relationship. Although our study was unable to detect an association between impulsivity and linkage to HIV care, it may provide direction for future research exploring the associations between impulsivity and HIV care.
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Affiliation(s)
- Arnab K Dey
- Division of Global Public Health, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, 92093, San Diego, CA, USA.
| | | | | | - Elena Blokhina
- First St. Petersburg Pavlov State Medical University, St. Petersburg, Russia
| | - Anita Raj
- Division of Global Public Health, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, 92093, San Diego, CA, USA
| | | | | | | | | | | | - Evgeny Krupitsky
- First St. Petersburg Pavlov State Medical University, St. Petersburg, Russia.,V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Jeffrey H Samet
- Boston University, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA
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Altmiller G, Jimenez F, Wharton J, Wilson C, Wright N. HIV and Contact Tracing: Impact of a Virtual Patient Simulation Activity. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fernandez R, Raj TDS, Heylen E, Nyblade L, Devadass D, Srinivasan K, Ekstrand ML. Awareness of the Use of Standard Precautions during Care of People Living with HIV by Ward Attendants in Indian Hospitals. Indian J Community Med 2022; 47:142-146. [PMID: 35368470 PMCID: PMC8971887 DOI: 10.4103/ijcm.ijcm_1339_21] [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: 10/28/2021] [Accepted: 02/12/2022] [Indexed: 11/04/2022] Open
Abstract
Context: Standard precautions (SP) are infection prevention practices universally used during patient care to lower infection transmission. Aims: The aim of the study was to (1) assess Indian ward attendants' (WAs) knowledge, perceived efficacy, and self-efficacy regarding SP and (2) examine correlates of SP self-efficacy and intent to use unnecessary precautions during care of people living with HIV. Subjects and Methods: Data are sourced from a face-to-face baseline survey of a stigma-reduction trial among 1859 WAs from Indian hospitals. Percentages were used to describe categorical variables means and standard deviations for continuous variables. Multiple regressions examined associations between measures. Results: WAs who had heard of SP had 44% higher odds of confidently using SP than those who had not heard of them. Those aware of universal SP use were 43% more likely to feel confident in using SP but also reported greater intent to use unnecessary precautions. Conclusions: Hospitals could implement SP training for WAs, as their knowledge of universal use was lacking.
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Affiliation(s)
- Ryan Fernandez
- Division of Medical Informatics, St. John's Research Institute, St. John's Medical College, Bengaluru, India
| | - Tony D S Raj
- Division of Medical Informatics, St. John's Research Institute, St. John's Medical College, Bengaluru, India
| | - Elsa Heylen
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Laura Nyblade
- Global Health Division, International Development Group, RTI International, Washington, DC, USA
| | - Dhinagaran Devadass
- Division of Medical Informatics, St. John's Research Institute, St. John's Medical College, Bengaluru, India
| | - Krishnamachari Srinivasan
- Division of Mental Health and Neurosciences, St. John's Research Institute, St. John's Medical College, Bengaluru, India
| | - Maria L Ekstrand
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA.,Division of Mental Health and Neurosciences, St. John's Research Institute, St. John's Medical College, Bengaluru, India
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Chimoyi L, Chikovore J, Musenge E, Mabuto T, Chetty-Makkan CM, Munyai R, Nchachi T, Charalambous S, Setswe G. Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: A qualitative study from South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000132. [PMID: 36962320 PMCID: PMC10021737 DOI: 10.1371/journal.pgph.0000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
Despite advances made in HIV prevention and treatment interventions in South Africa, barriers to their utilization continue to exist. Understanding perspectives from patients and providers of healthcare can shed light on the necessary strategies to enhance uptake of HIV services. A cross-sectional qualitative study was conducted in July 2020 in Ekurhuleni District. Based on HIV prevalence estimates from a national survey, male condom use coverage and antiretroviral treatment (ART) initiation rates from routinely collected clinical data for 2012, we selected facilities from geographical areas with varying HIV prevalence and uptake of HIV services. In-depth interviews were conducted with adult (≥18 years) patients and healthcare workers in selected primary healthcare facilities. Thematic analysis was performed following a framework built around the social cognitive theory to describe behavioural, personal, and social/environmental factors influencing utilization of HIV services. Behavioural factors facilitating uptake of HIV services included awareness of the protective value of condoms, and the benefits of ART in suppressing viral load and preventing mother-to-child HIV transmission which was evident across geographical areas. Barriers in high prevalence areas included suboptimal condom use, fears of a positive HIV result, and anticipated HIV-related stigma while seeking healthcare services. Across the geographical areas, personal factors included ability to correctly use available services enhanced by knowledge acquired during counselling sessions and community-based health promotion activities. Further, social support from family reinforced engagement in care. Compared to low uptake areas, clinics in high uptake areas used care-facilitators, outreach teams and decanting programs to address the environmental barriers including staff shortages and long queues. Barriers at multiple levels prevent optimal utilization of HIV services, calling for strategies that target and address the different levels and tailored to needs of specific settings. Overall, improved delivery of HIV prevention or treatment interventions can be achieved through strengthening training of healthcare providers in facilities and communities and addressing negative sequelae from utilising services in low uptake areas.
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Affiliation(s)
- Lucy Chimoyi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremiah Chikovore
- Human and Social Capabilities Research Division, Human Sciences Research Council, Durban, South Africa
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tonderai Mabuto
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Candice M Chetty-Makkan
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Reuben Munyai
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Tshegang Nchachi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Geoffrey Setswe
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Conocimientos y percepción de estudiantes de psicología sobre el trabajo profesional en personas con VIH. REVISTA DIGITAL INTERNACIONAL DE PSICOLOGÍA Y CIENCIA SOCIAL 2022. [DOI: 10.22402/j.rdipycs.unam.e.8.01.2022.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Los psicólogos que se dedican a la atención de personas diagnosticadas con VIH es necesario que cuenten con una actitud favorable hacia el trabajo profesional que impacte en una mejor atención; además es necesario que como profesionales de la salud, también tengan un comportamiento sexual saludable, de tal manera que haya congruencia entre lo que hace y lo que transmite como profesional. Con base en lo anterior, se tienen dos objetivos: (1) conocer el nivel de conocimientos sobre VIH/SIDA, creencias y uso del condón en relaciones sexuales estudiantes de psicología; y (2) conocer su percepción sobre VIH y del trabajo profesional con personas diagnosticadas con VIH. Se evaluó a 439 estudiantes de psicología, en términos generales se encontró que tienen un nivel aceptable de conocimientos sobre VIH, pero no sobre el uso del condón; tienen creencias favorables hacia su uso, pero no implica que sean consistentes en su uso; también se encontró una valoración positiva hacia la atención de personas con VIH. Se discute en términos de la importancia de formar a los estudiantes sobre la importancia de su salud sexual y en cómo trabajar con personas con VIH.
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Bohren MA, Vazquez Corona M, Odiase OJ, Wilson AN, Sudhinaraset M, Diamond-Smith N, Berryman J, Tunçalp Ö, Afulani PA. Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000582. [PMID: 36962453 PMCID: PMC10021469 DOI: 10.1371/journal.pgph.0000582] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
Stigma and discrimination are fundamental causes of health inequities, and reflect privilege, power, and disadvantage within society. Experiences and impacts of stigma and discrimination are well-documented, but a critical gap remains on effective strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We aimed to address this gap by conducting a mixed-methods systematic review and narrative synthesis to describe strategy types and characteristics, assess effectiveness, and synthesize key stakeholder experiences. We searched MEDLINE, CINAHL, Global Health, and grey literature. We included quantitative and qualitative studies evaluating strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We used an implementation-focused narrative synthesis approach, with four steps: 1) preliminary descriptive synthesis, 2) exploration of relationships between and across studies, 3) thematic analysis of qualitative evidence, and 4) model creation to map strategy aims and outcomes. Of 8,262 articles screened, we included 12 articles from 10 studies. Nine articles contributed quantitative data, and all measured health worker-reported outcomes, typically about awareness of stigma or if they acted in a stigmatizing way. Six articles contributed qualitative data, five were health worker perspectives post-implementation and showed favorable experiences of strategies and beliefs that strategies encouraged introspection and cultural humility. We mapped studies to levels where stigma can exist and be confronted and identified critical differences between levels of stigma strategies aimed to intervene on and evaluation approaches used. Important foundational work has described stigma and discrimination in sexual and reproductive healthcare settings, but limited interventional work has been conducted. Healthcare and policy interventions aiming to improve equity should consider intervening on and measuring stigma and discrimination-related outcomes. Efforts to address mistreatment will not be effective when stigma and discrimination persist. Our analysis and recommendations can inform future intervention design and implementation research to promote respectful, person-centered care for all.
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Affiliation(s)
- Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Martha Vazquez Corona
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Osamuedeme J Odiase
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Nossal Institute, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Nadia Diamond-Smith
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Jim Berryman
- Brownless Biomedical Library, University of Melbourne, Melbourne, Victoria, Australia
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Patience A Afulani
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Ruiz-Robledillo N, Clement-Carbonell V, Ferrer-Cascales R, Portilla-Tamarit I, Alcocer-Bruno C, Gabaldón-Bravo E. Cognitive Functioning and Its Relationship with Self-Stigma in Men with HIV Who Have Sex with Men: The Mediating Role of Health-Related Quality of Life. Psychol Res Behav Manag 2021; 14:2103-2114. [PMID: 34938135 PMCID: PMC8687686 DOI: 10.2147/prbm.s332494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction The human immunodeficiency virus (HIV) stills remains a serious public health problem. HIV acquisition has several negative health consequences, such as a cognitive deterioration or health-related quality of life (HRQoL) impairment. Although these negative consequences could be directly related to a significant increase in self-stigma in this population, few previous studies have analysed the possible associations between these variables. This is especially the case in specific groups of people living with HIV, such as men who have sex with men who could be at a greater risk of stigmatisation. The main aim of the present study was to evaluate the association between cognitive functioning, HRQoL and self-stigma in a group of men with HIV who have sex with men. Methods The present study was conducted in the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). The final sample was composed of 70 participants who passed the inclusion and exclusion criteria. All were men with HIV who had sex with men and the sample’s mean age was 45 years. Each participant completed questionnaires on HRQoL and HIV self-stigma. Moreover, they completed an online cognitive assessment through the previously validated platform for cognitive evaluation CogniFit, Inc. Results The obtained results showed a significant association between memory functioning impairment, lower levels of HRQoL and higher HIV self-stigma scores. Hence, HRQoL, in the mental summary domain, was shown to be a significant mediator in the relationship between low memory performance and higher HIV self-stigma. Discussion Neurocognitive impairment could decrease HRQoL in men with HIV who have sex with men, and hence, reinforce the idea widespread in society that having HIV holds serious consequences. This fact, together with the reduced cognitive abilities to fight against their own self-stigma could represent plausible explanations of the obtained results. In this sense, intervention strategies, oriented towards reducing cognitive impairment, such as those based on cognitive training, and other psychological interventions to promote HRQoL could be effective approaches to prevent the negative effects of HIV self-stigma in this population.
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Affiliation(s)
- Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | | | - Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Irene Portilla-Tamarit
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Cristian Alcocer-Bruno
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Eva Gabaldón-Bravo
- Department of Nursing, Faculty of Health Science, University of Alicante, Alicante, Spain
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Aziz MM, Badahdah AM, Mohammed HM. Cross-Cultural Adaptation and Psychometric Assessment of an Arabic Version of the Health Care Provider HIV/AIDS Stigma Scale. J Int Assoc Provid AIDS Care 2021; 20:23259582211066402. [PMID: 34913384 PMCID: PMC8689598 DOI: 10.1177/23259582211066402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
HIV stigma among health care providers in the Arab world is understudied due to a lack of valid and reliable measures. Data from 352 Egyptian physicians was used to validate an Arabic version of the Health Care Provider HIV/AIDS Stigma Scale (HPASS). Exploratory factor analysis (n = 1 9 4) suggested a 3 -factor structure. Confirmatory factor analysis (n = 1 5 8) validated the three-factor solution with 18 items, which explained 5 3 .3 6% of the variance. All items loaded on their designated constructs, which ranged from 0 .58 to 0 .82 (prejudice) to 0 .58 to 0 .66 (stereotypes) and 0 .52 to 0 .91 (discrimination). The prejudice, stereotypes, and discrimination subscales consisted of seven, five, and six items, respectively. The internal consistency (α = 0 .9 0) and the test-retest reliability demonstrated (r = 0 .9 5) were excellent. The cultural adaptation of the Arabic version of HPASS suggests that it is a suitable scale for assessing HIV stigma among Arab health care providers.
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Affiliation(s)
- Mirette M Aziz
- Department of Public Health & Community Medicine, 68796Assiut University, Egypt
| | - Abdallah M Badahdah
- School of Psychology, Sociology and Rural Studies, 2019South Dakota State University, Brookings, SD
| | - Heba M Mohammed
- Department of Public Health & Community Medicine, 68796Assiut University, Egypt
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Hempel S, Ferguson L, Bolshakova M, Yagyu S, Fu N, Motala A, Gruskin S. Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol. BMJ Open 2021; 11:e053608. [PMID: 34887280 PMCID: PMC8663079 DOI: 10.1136/bmjopen-2021-053608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive. METHODS AND ANALYSIS Building on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common 'critical factors for success or failure' can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma. PROSPERO REGISTRATION NUMBER CRD42021249348.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- Department of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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Mohammadifirouzeh M, Oh KM, Tanner S. HIV stigma reduction interventions among health care providers and students in different countries: a systematic review. Curr HIV Res 2021; 20:20-31. [PMID: 34872477 DOI: 10.2174/1570162x19666211206094709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/21/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Health care providers' stigmatizing attitudes are obstacles to patients' well-being and quality of life. Dealing with HIV-related stigma and understanding the impact of feasible interventions on reducing stigmatizing attitudes among health care providers are considered important strategies to improve the quality of HIV care, patient-provider relationships, and provide supportive and safe care services. OBJECTIVES The aim of this study was to systematically review interventions to reduce HIV-related stigma among health care providers. METHODS This systematic review was performed using Medline, CINAHL, ERIC, and APA PsycInfo, Health Source: Nursing/Academic Edition to search for quasi-experimental studies and randomized controlled trials (RCTs) designed to reduce HIV stigma among health care providers. The quality of eligible research studies was independently appraised by two reviewers. RESULTS A total of 774 studies were screened, 100 articles were assessed for the eligibility, and 10 studies met the inclusion criteria. All interventions effectively reduced HIV-related stigma. Elements of successful interventions including knowledge modules, peer education, patients' testimonials, Photovoice-informed stigma reduction training, stigma-free space intervention, and popular opinion leaders. Interventions were assessed and compared in terms of contents, delivery modes, HIV stigma measurements, follow-up, and limitations. CONCLUSIONS This systematic review supports the effectiveness of in-person educational interventions at reducing HIV-related stigma among health care providers across countries. Comparisons of delivery modes of interventions indicated that educational interventions delivered by patients' testimonials and peer education strategies are more promising than lecture-based teaching methods. Further studies are needed to assess long-term effects of interventions on clinical behaviors and practices.
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Affiliation(s)
- Mona Mohammadifirouzeh
- George Mason University, School of Nursing 4400 University Dr, Fairfax,VA 22030. United States
| | - Kyeung Mi Oh
- George Mason University, School of Nursing 4400 University Dr, Fairfax,VA 22030. United States
| | - Susan Tanner
- George Mason University, School of Nursing 4400 University Dr, Fairfax,VA 22030. United States
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Li Y, Guo Y, Hong YA, Zeng C, Zeng Y, Zhang H, Zhu M, Qiao J, Cai W, Li L, Liu C. Mediating Effects of Stigma and Depressive Symptoms in a Social Media-Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial. J Med Internet Res 2021; 23:e27897. [PMID: 34751654 PMCID: PMC8663519 DOI: 10.2196/27897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/09/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions. OBJECTIVE This study aims to explore the intervention mechanisms of a social media-based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period. METHODS We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants' QOL. RESULTS About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported. CONCLUSIONS These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media-based interventions that can address HIV-related stigma and alleviate depressive symptoms. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019.
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Affiliation(s)
- Yiran Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Global Health, Guangzhou, China
| | - Y Alicia Hong
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Yu Zeng
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hanxi Zhang
- National Center of AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mengting Zhu
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiaying Qiao
- Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Weiping Cai
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Cong Liu
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
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Bhwana D, Das L, Siewe Fodjo JN, Francis F, Challe DP, Makunde HW, Mmbando BP, Colebunders R. A peer support group intervention to decrease epilepsy-related stigma in an onchocerciasis-endemic area in Mahenge, Tanzania: A pilot study. Epilepsy Behav 2021; 124:108372. [PMID: 34757262 DOI: 10.1016/j.yebeh.2021.108372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
A high burden of epilepsy has been reported in sub-Saharan Africa (SSA) particularly in onchocerciasis endemic areas. To improve the quality of life of persons with epilepsy (PWE) in Mahenge, an onchocerciasis-endemic area in Tanzania, we established peer support groups (PSG) in two out of four rural villages (Mdindo, Msogezi, Mzelezi and Sali). One year later (between February and July 2020), we carried out a cross-sectional survey among PWE and their caregivers in the four rural villages with the aim of comparing perceived stigma among PWE in study sites with and without PSG. Perceived stigma was measured using the validated Kilifi stigma scale of epilepsy (KSSE), whose total score ranges from 0-30. A generalized linear mixed regression model was used to identify factors associated with high stigma scores. A total of 161 PWE participated in the study; 76 (47.2%) resided in villages where a PSG intervention was implemented. The overall mean stigma score was 3.7 ± 4.6, with no significant difference between villages with and without PSG (p = 0.537). Only one PWE (0.6%) scored above 20 (very high perceived stigma). Experiencing more seizures during the past week (Coef = 1.013 [0.568, 1.457]), having attended school (Coef = 1.821 0.345, 3.297], and a history of physical abuse (Coef = 3.200 [0.574, 5.827]) were associated with higher stigma scores. Perceived stigma in rural villages in Mahenge is a major public health problem. A follow-up study is needed to determine the medium- to long-term effect of the PSG intervention on perceived epilepsy-related stigma.
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Affiliation(s)
- Dan Bhwana
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania; Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Lies Das
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | - Filbert Francis
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Daniel P Challe
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Holmes W Makunde
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Bruno P Mmbando
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
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Attal BA, Al-Rowaishan KM, Akeel AA, AlAmmar FK. HIV stigma in the teaching hospitals in Sana'a, Yemen: a conflict and low-resource setting. BMC Public Health 2021; 21:1793. [PMID: 34610815 PMCID: PMC8493713 DOI: 10.1186/s12889-021-11845-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV stigma undermines a person's wellbeing and quality of life and hinders HIV control efforts. This study examined the extent and drivers of HIV stigma in the teaching hospitals in Sana'a City, Yemen. The country has low HIV prevalence (4000 (2000-11,000) per 100,000) and limited HIV control funds, worsened by a long conflict and an economic crisis. METHODS We conducted a cross-sectional study of 320 Yemeni health professionals in all the four teaching hospitals in Sana'a City. Data were collected anonymously, using an adapted self-completed Arabic version of the Health Policy Project HIV Stigma tool. The questionnaire covered the respondents' background, the stigmatising practices, and potential personal and professional drivers of stigma. RESULTS The majority of the participants were: females (68%), 20-39 years old (85%), nurses (84%), and holding a nursing diploma (69%) or a bachelor's degree (27%). None of the hospitals had institutional policies against HIV stigma, and 93% of the participants believed the current infection control measures were inadequate. Less than half of the participants provided care for people living with HIV (PLHIV) (45%), had received HIV training (33%), and were confident that their HIV knowledge was adequate (23%). The majority indicated a preference to test patients for HIV prior to surgical procedures (77%) and disclose positive HIV results to others (99%) without prior knowledge or consent. All the participants had exhibited a form of HIV-related stigmatization, such as avoiding physical contact with PLHIV (87%) or wearing gloves throughout the consultation (96.5%). These practices were significantly correlated with the fear of infection, high perceived risk of infection, and poor work environment (p < 0.05). CONCLUSION PLHIV face widespread stigmatizing behaviour in the teaching hospitals in Sana'a City, consistent with the higher level of stigma in low HIV prevalence countries and its links to the fear of infection, poor HIV knowledge, and limited funding for HIV control. Stigma reduction interventions are required at institutional and individual levels. In addition, anti-discrimination policies and structural adjustments are needed, in combination with training on HIV and universal precautions, and action to tackle negative attitudes towards PLHIV and key populations.
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Affiliation(s)
- Bothaina Ahmed Attal
- Faculty of Medicine and Health Sciences, Sana'a University, The Sixty St., Sana'a, Yemen. .,Affiliated researcher at the Centre for Business Research, Cambridge Judge Business School, Cambridge, UK.
| | | | | | - Fawziah Kassim AlAmmar
- Educational and Psychological Sciences Department, Faculty of Education, Art and Applied Sciences, Amran University, Amran, Yemen
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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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Njejimana N, Gómez-Tatay L, Hernández-Andreu JM. HIV-AIDS Stigma in Burundi: A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179300. [PMID: 34501890 PMCID: PMC8431207 DOI: 10.3390/ijerph18179300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
HIV/AIDS stigma is a global issue and a serious problem in African countries. Although prevalence remains high in this region, no detailed study has yet been carried out to determine and characterize this problem in Burundi. Using a qualitative analysis based on an extensive series of 114 interviews, we describe the main characteristics of HIV stigma in the country. The results of our study indicate that the problem of HIV/AIDS stigma is widespread in Burundian society, as all participants in the research reported having experienced some kind of HIV stigma. The seven dimensions of stigma identified in people living with HIV/AIDS (PLWHA) in Burundi are physical violence, verbal violence, marginalization, discrimination, self-stigma, fear and insecurity, and healthcare provider stigma. These dimensions of stigma can be experienced through different manifestations, which have been characterized in this study, revealing that the problem of stigma in PLWHA is still an important issue in Burundi.
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Affiliation(s)
- Néstor Njejimana
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Lucía Gómez-Tatay
- Institute of Life Sciences, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
- Grupo de Medicina Molecular y Mitocondrial, Facultad de Ciencias de la Salud, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
- Correspondence:
| | - José Miguel Hernández-Andreu
- Institute of Life Sciences, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
- Grupo de Medicina Molecular y Mitocondrial, Facultad de Ciencias de la Salud, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
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