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Jordans CCE, Vliegenthart-Jongbloed KJ, van Bruggen AW, van Holten N, van Beek JEA, Vriesde M, van der Sluis D, Verbon A, Roukens AHE, Stutterheim SE, Rokx C. Unmasking Individual and Institutional HIV Stigma in Hospitals: Perspectives of Dutch Healthcare Providers. AIDS Behav 2024; 28:3184-3195. [PMID: 38869755 PMCID: PMC11390866 DOI: 10.1007/s10461-024-04404-0] [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: 05/29/2024] [Indexed: 06/14/2024]
Abstract
People with HIV continue to experience HIV stigma. Quantitative data on HIV stigma perpetrated by healthcare providers of hospitals providing HIV care in high-income countries are limited. The aim of this study is to investigate factors associated with HIV stigma in Dutch healthcare settings from the healthcare providers' perspective. We conducted a cross-sectional study using the questionnaire 'Measuring HIV Stigma and Discrimination Among Health Facility Staff - Monitoring Tool for Global Indicators' to assess HIV stigma among healthcare providers (n = 405) in two academic hospitals. Healthcare providers licensed to provide medical care were eligible for inclusion. The primary outcome was the self-reported prevalence of at least one manifestation of HIV stigma measured by six stigma indicators (four individual, two institutional). Secondary outcomes were the prevalence of HIV stigma per indicator, per occupation, per department, and factors associated with individual stigma indicators. HIV stigma was prevalent among 88.1% (95%CI 84.5% - 91.2%) of participants. Stigma was mostly driven by negative attitudes towards people with HIV and worry to acquire HIV. Multivariate analysis showed that several factors were associated with HIV stigma, including younger age, male sex, working at one of the surgical departments, and working as a nurse. Having received any training on HIV stigma and/or discrimination was associated with less HIV stigma among all indicators. In conclusion, HIV stigma is highly prevalent among Dutch healthcare providers. Targeted approaches, including training on HIV stigma and discrimination, are needed to reduce HIV stigma in healthcare and should, among others, focus on younger healthcare providers.
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Affiliation(s)
- C C E Jordans
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3015 CN, The Netherlands
| | - K J Vliegenthart-Jongbloed
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands
| | - A W van Bruggen
- Master student Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N van Holten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - J E A van Beek
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands
| | - M Vriesde
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands
| | - D van der Sluis
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - A Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3015 CN, The Netherlands
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A H E Roukens
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - S E Stutterheim
- Department of Health Promotion & Care and Public Health Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands
| | - C Rokx
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3015 CN, The Netherlands.
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands.
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Liu T, Pang PCI, Lam CK. Public health education using social learning theory: a systematic scoping review. BMC Public Health 2024; 24:1906. [PMID: 39014365 PMCID: PMC11253563 DOI: 10.1186/s12889-024-19333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Public health education (PHE) in social environments plays a crucial role in mitigating the impact of public health events, especially with the recent surge in global incidents. Social learning theory (SLT) provides a strong theoretical foundation for implementing PHE. The objective of this study is to conduct a systematic scoping review of PHE using SLT, synthesizing the target populations, types of research, main findings, and future directions. METHODS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelines. We conducted a comprehensive search of five electronic databases (Web of Science, Scopus, PubMed, ProQuest, and APA PsycInfo) for English articles related to PHE using SLT. Two reviewers independently screened the titles and abstracts. Descriptive statistics were utilized to analyze the characteristics of the articles included in the study, followed by a comprehensive narrative analysis of the results. RESULTS Research on PHE using SLT mainly focuses on adolescents, students, special patients, and vulnerable populations. The study sample includes seven research types and nine commonly used experimental methods. Four modes of PHE using SLT are identified, along with four types of summarized research results. CONCLUSION PHE research based on SLT can be prioritized for preventing widespread infectious diseases, spreading fundamental public health information, and assisting patients with particular illnesses. To enhance the implementation of PHE, researchers and policymakers should integrate online and offline health education resources, ensure the accessibility of up-to-date information, and leverage digital technologies in PHE. More highly interactive and participatory health education courses will be established in social learning environments to encourage public participation in PHE.
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Affiliation(s)
- Ting Liu
- Faculty of Applied Sciences, Macao Polytechnic University, Macao, China
| | | | - Chi-Kin Lam
- Faculty of Applied Sciences, Macao Polytechnic University, Macao, China
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Steinhaus MC, Nicholson TJ, Pliakas T, Harper A, Lilleston P, Mainga T, Milimo D, Jennings K, Grobbelaar N, Louis F, Liebenberg H, Hayes RJ, Fidler S, Ayles H, Bock P, Hoddinott G, Hargreaves JR, Bond V, Stangl AL. Prevalence and risk of burnout among HIV service providers in South Africa and Zambia: findings from the HPTN 071 (PopART) trial. HUMAN RESOURCES FOR HEALTH 2024; 22:50. [PMID: 38978065 PMCID: PMC11229271 DOI: 10.1186/s12960-024-00934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND In the high disease burden and resource-constrained contexts of sub-Saharan Africa (SSA), health workers experience a range of psychosocial stressors that leave them vulnerable to developing burnout, which can reduce service quality and negatively impact their own health and wellbeing. As universal testing and treatment (UTT) for HIV scales up across SSA, we sought to understand the implications of this human resource-intensive approach to HIV prevention to inform decision-making about health workforce staffing and support needs. METHODS Using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), we assessed the prevalence of three domains of burnout-emotional exhaustion, depersonalization, and personal accomplishment-among three cadres of health workers delivering health services in areas receiving a UTT intervention in Zambia and South Africa. These cadres included health facility workers (n = 478), community health workers (n = 159), and a study-specific cadre of community HIV care providers (n = 529). We used linear regression to assess risk factors associated with emotional exhaustion, the only domain with sufficient variation in our sample. RESULTS The MBI-HSS was completed by 1499/2153 eligible participants (69.6% response rate). Less than 1% of health workers met Maslach's definition for burnout. All groups of health workers reported lower levels of emotional exhaustion than found in previous studies of this type (mean score scores ranged from 10.7 to 15.4 out of 54 across health cadres). Higher emotional exhaustion was associated with higher educational attainment (βadj = 2.24, 95% CI 0.76 to 3.72), greater years providing HIV services (βadj = 0.20, 95% CI 0.03 to 0.36), and testing negative for HIV at last HIV test (βadj = - 3.88 - 95% CI 5.69 to - 2.07). Working as a CHW was significantly associated with lower emotional exhaustion (βadj = - 2.52, 95% CI - 4.69 to - 0.35). Among all health workers, irrespective of HIV status, witnessing stigmatizing behaviors towards people living with HIV among their co-workers was associated with significantly increased emotional exhaustion (βadj = 3.38, 95% CI 1.99 to 4.76). CONCLUSIONS The low level of burnout detected among health workers is reassuring. However, it remains important to assess how UTT may affect levels of emotional exhaustion among health workers over time, particularly in the context of emerging global pandemics, as burnout may impact the quality of HIV services they provide and their own mental health and wellbeing. Interventions to reduce HIV stigma in health facilities may protect against emotional exhaustion among health workers, as well as interventions to increase mindfulness and resilience among health workers at risk of burnout. Trial registration ClinicalTrials.gov number: NCT01900977.
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Affiliation(s)
- Mara C Steinhaus
- International Center for Research On Women, Washington, DC, USA
- WomenStrong International, Washington, DC, USA
| | - Tamaryn J Nicholson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Triantafyllos Pliakas
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Impact Epilysis, Thessaloniki, Greece
- GSK Vaccines, Wavre, Belgium
| | - Abigail Harper
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Tila Mainga
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Deborah Milimo
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Karen Jennings
- Department of Health, City of Cape Town, HIV/AIDS, STIs, and TB, Cape Town, South Africa
| | | | | | | | - Richard J Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Helen Ayles
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - James R Hargreaves
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Virginia Bond
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne L Stangl
- International Center for Research On Women, Washington, DC, USA.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Ngaledzani RI, Ndou-Mammbona AA, Mavhandu-Mudzusi AH. Perioperative care to patients living with HIV by theatre nurses at a South African tertiary hospital. F1000Res 2024; 11:1299. [PMID: 38510266 PMCID: PMC10951563 DOI: 10.12688/f1000research.125582.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
Background Human Immunodeficiency Virus (HIV) is one of the leading health challenges worldwide that influences the provision of quality patient care. Stigma and discrimination around this condition and the health care needs affect the health care provision. This study aimed to gain an in-depth understanding of theatre nurses' experiences in providing perioperative care to patients living with HIV at a tertiary hospital in South Africa. Methods This study was conducted at a tertiary hospital in Tshwane district, South Africa. The study was underpinned by an interpretative phenomenological analysis design. Data were collected from 10 criterion purposively selected theatre nurses using in-depth individual interviews. Data were thematically analyzed and guided by an interpretive phenomenological analysis framework for data analysis. Results The study revealed that theatre nurses work in an under-resourced environment. The resources highlighted are human, materials, including personal protective equipment and life support. The situation negatively affects the perioperative care of HIV-positive patients, who are always prone to perioperative complications, such as profuse bleeding, and even death. The situation increases the occupational risk to the nurses. Conclusions The researchers proposed several recommendations targeted at improving the resources needed by theatre nurses when caring for people living with HIV perioperatively at South African tertiary hospitals. Findings will add to the body of knowledge of the Nursing profession about offering perioperative care to persons living with HIV.
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Affiliation(s)
- Rudzani Ifodia Ngaledzani
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, 0003, South Africa
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Tembo TA, Mollan K, Simon K, Rutstein S, Chitani MJ, Saha PT, Mbeya-Munkhondya T, Jean-Baptiste M, Meek C, Mwapasa V, Go V, Bekker LG, Kim MH, Rosenberg NE. Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial. BMJ Open 2024; 14:e077706. [PMID: 38253452 PMCID: PMC10806658 DOI: 10.1136/bmjopen-2023-077706] [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: 07/12/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Index case testing (ICT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention services. In Malawi, delivery of ICT has faced challenges due to limited technical capacity of healthcare workers (HCWs) and clinical coordination. Digitisation of training and quality improvement processes presents an opportunity to address these challenges. We developed an implementation package that combines digital and face-to-face modalities (blended learning) to strengthen HCWs ICT skills and enhance quality improvement mechanisms. This cluster randomised controlled trial will assess the impact of the blended learning implementation package compared with the standard of care (SOC) on implementation, effectiveness and cost-effectiveness outcomes. METHODS AND ANALYSIS The study was conducted in 33 clusters in Machinga and Balaka districts, in Southern Malawi from November 2021 to November 2023. Clusters are randomised in a 2:1 ratio to the SOC versus blended learning implementation package. The SOC is composed of: brief face-to-face HCW ICT training and routine face-to-face facility mentorship for HCWs. The blended learning implementation package consists of blended teaching, role-modelling, practising, and providing feedback, and blended quality improvement processes. The primary implementation outcome is HCW fidelity to ICT over 1 year of follow-up. Primary service uptake outcomes include (a) index clients who participate in ICT, (b) contacts elicited, (c) HIV self-test kits provided for secondary distribution, (d) contacts tested and (e) contacts identified as HIV-positive. Service uptake analyses will use a negative binomial mixed-effects model to account for repeated measures within each cluster. Cost-effectiveness will be assessed through incremental cost-effectiveness ratios examining the incremental cost of each person tested. ETHICS AND DISSEMINATION The Malawi National Health Science Research Committee, the University of North Carolina and the Baylor College of Medicine Institutional Review Boards approved the trial. Study findings will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT05343390.
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Affiliation(s)
- Tapiwa A Tembo
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Katie Mollan
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Katherine Simon
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah Rutstein
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Mike Jones Chitani
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Pooja T Saha
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Milenka Jean-Baptiste
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Caroline Meek
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | | | - Vivian Go
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Linda Gail Bekker
- Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Maria H Kim
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nora E Rosenberg
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Lee JJ, Li Verdugo J, Xiao AY, Vo K. Digital Interventions to Enhance PrEP Uptake and Adherence Through Stigma Reduction. Curr HIV/AIDS Rep 2023; 20:458-469. [PMID: 38057685 DOI: 10.1007/s11904-023-00685-7] [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: 11/21/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW Although pre-exposure prophylaxis (PrEP) is effective for reducing risk of HIV transmission, stigma persists as a barrier to HIV prevention. Digital technologies present opportunities to access hard-to-reach populations and increase the efficiency of established interventions. This review examines current digital interventions addressing stigma to improve PrEP-related outcomes. RECENT FINDINGS Digital technologies are increasingly used for HIV prevention and include a wide range of formats. Recent interventions focused on stigma and PrEP tend to engage mobile phone-related technology and focus on younger populations with particular attention to men who have sex with men and transgender women. Digital interventions that address stigma are promising for improving PrEP-related outcomes. No single technology currently demonstrates consistent superiority. Limited access to PrEP and heightened stigma in under-resourced countries present challenges for interventions supporting diverse communities. Further research should examine how digital interventions can reduce stigma beyond the individual level to enhance PrEP use and explore opportunities to improve and integrate approaches to stigma measurement.
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Affiliation(s)
- Jane J Lee
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA.
| | - Juliann Li Verdugo
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA
| | | | - Katie Vo
- School of Public Health, University of Washington, Seattle, WA, USA
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Hidayat J, Chen MY, Maulina R, Nurbaya S. Factors Associated With HIV-Related Stigma Among Indonesian Healthcare Workers: A Cross-Sectional Online Survey. J Nurs Res 2023; 31:e295. [PMID: 37668415 DOI: 10.1097/jnr.0000000000000573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Despite worldwide advances in HIV care and growing scientific knowledge about HIV, stigma and prejudice continue to hinder people living with HIV/AIDS (PLWHA) from seeking treatment and care. HIV-related stigma among healthcare workers in Indonesia has been investigated and measured in only a few empirical studies. PURPOSE This study was developed to identify factors related to holding stigmatizing attitudes toward PLWHA among professional healthcare providers in Indonesia. METHODS A cross-sectional survey approach using convenience and snowball sampling techniques was used. Data were collected in February and March 2022. All of the participants were healthcare workers in Indonesia who had completed an online survey that collected demographic data and measured HIV-related stigma, fear of HIV transmission, and HIV-related knowledge. Bivariate analysis and multiple linear regression were used to investigate the association between the independent and dependent variables. RESULTS The study enrolled 252 participants, including eight physicians (3.2%), 200 nurses (79.4%), and 44 midwives (17.5%). Over two thirds of the participants (65.1%) had no formal HIV training. Stigmatizing attitudes were associated with lower levels of HIV knowledge ( B = -0.480, p < .01), fear of becoming infected with the HIV virus ( B = 0.354, p < .05), and type of HIV care setting ( B = -2.913, p < .05). Of the three participant categories, physicians had the highest levels of both HIV knowledge and PLWHA-related stigma. CONCLUSIONS The findings indicate many healthcare workers in Indonesia receive limited formal training on HIV, have low levels of HIV knowledge, and fear HIV transmission. Therefore, providing comprehensive and up-to-date education about HIV for health workers and proper personal protective equipment should be incorporated into programs aimed at reducing stigmatizing attitudes against patients with HIV among healthcare workers in Indonesia.
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Affiliation(s)
- Jufri Hidayat
- MSN, RN, Doctoral Student, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Miao-Yen Chen
- PhD, RN, Associate Professor, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Rufidah Maulina
- MS, Lecturer, Midwifery Department, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Sitti Nurbaya
- MS, Lecturer, Faculty of Nursing, Stikes Nani Hasanuddin Makassar, Indonesia
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Steward WT, Srinivasan K, Raj T, Heylen E, Nyblade L, Mazur A, Devadass D, Pereira M, Ekstrand ML. The Influence of Transmission-Based and Moral-Based HIV Stigma Beliefs on Intentions to Discriminate Among Ward Staff in South Indian Health Care Settings. AIDS Behav 2023; 27:189-197. [PMID: 35776252 PMCID: PMC9805471 DOI: 10.1007/s10461-022-03755-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 01/24/2023]
Abstract
HIV stigma is comprised of several beliefs, including transmission fears and moral judgments against affected communities. We examined the relationships among HIV-related stigma beliefs, endorsement of coercive measures for people living with HIV (PLWH), and intentions to discriminate. We sought to understand to what degree the different stigma beliefs shape support for restrictive policies and discriminatory intentions. Data were drawn from the baseline assessment of DriSti, a cluster randomized controlled trial of an HIV stigma reduction intervention in Indian healthcare settings (NCT02101697). Participants completed measures assessing transmission fears and moral judgments of HIV, endorsement of coercive measures against PLWH (public disclosure of HIV status, refusal of healthcare services, marriage and family restrictions, required testing, and sharing of HIV information in a clinic), and intentions to discriminate against PLWH in professional and personal settings. We utilized multivariate regression modeling with backward elimination to identify the coercive measures and behavioral intentions most strongly associated with moral judgments. 1540 ward staff members completed the assessment. Participants had relatively high perceptions of transmission fears (M = 1.92, SD = 0.79) and moral judgments (M = 1.69, SD = 0.83); endorsed more intentions to discriminate in professional (M = 6.54, SD = 2.28) than personal settings (M = 2.07, SD = 1.49), and endorsed approximately half of all coercive measures (M = 9.47, SD = 2.68). After controlling for transmission fears, perceptions of stronger moral judgments against PLWH were significantly associated with higher endorsement of coercive measures related to refusing services (β = 0.10, t = 4.14, p < 0.001) and sharing patients' HIV status in clinics (β = 0.07, t = 3.04, p = 0.002), as well as with stronger behavioral intentions to discriminate in professional settings (β = 0.05, t = 2.20, p = 0.022). HIV stigma interventions for hospital-based ward staff in India need to focus on both transmission fears and moral judgments that underlie prejudicial beliefs. While the moral judgments are not technically related to risk in a hospital setting, our findings suggest that personnel will continue to discriminate in their professional work so long as these beliefs bear on their decisions and actions.
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Affiliation(s)
- Wayne T Steward
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Tony Raj
- St. Johns Research Institute, Bangalore, India
| | - Elsa Heylen
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laura Nyblade
- International Development Group, Global Health Division, RTI International, DC, Washington, USA
| | - Amanda Mazur
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Maria L Ekstrand
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- St. Johns Research Institute, Bangalore, India.
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94143, USA.
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Devadass D, Fernandez R, Raj TD, Heylen E, Nyblade L, Srinivasan K, Ekstrand ML. Standard Precautions are for everyone: The role of HIV stigma and implications for nursing education in India. JOURNAL OF NURSING EDUCATION AND PRACTICE 2022; 12:69-76. [PMID: 36579144 PMCID: PMC9793881 DOI: 10.5430/jnep.v12n12p69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background and objective Standard Precautions (SP) are infection control procedures universally applicable to every patient. Though SP reduces disease transmission, their implementation is dependent on the knowledge and skills of healthcare workers (HCWs). Poor knowledge regarding the appropriate use of SP can cause fear among HCWs, leading to stigma and discrimination while treating people living with HIV (PLWH). Stigma and discrimination are known barriers for PLWH to access HIV care services. The aim of the study was to assess nursing student knowledge of SP, SP self-efficacy and SP perceived efficacy of nursing students, and (2) to assess the association between SP knowledge, perceived efficacy, and intention to utilize unwarranted precautions, like using double gloves while treating PLWH. Methods This paper analyzes baseline (non-randomized) data of a cluster randomized controlled trial amongst 1868 Indian nursing students. Data was collected using computer-administered structured questionnaire. The associations between the measures were done using multiple, logistic and poisson regression models. Results Although 97% nursing students could identify SP, only 35.5% understood that they need to be used with all patients. Awareness of the importance of using SP with all patients was positively associated with self-efficacy. Students performing high-risk tasks frequently were significantly more likely to be confident in their ability to correctly use SP, but also had higher intention to use unwarranted precautions. Conclusions Existing teaching and training programs for HCWs need to provide clear guidelines and emphasize on the correct use of SP with all patients. This will increase both skills and confidence in their abilities (self-efficacy).
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Affiliation(s)
- Dhinagaran Devadass
- Division of Medical Informatics, St. John’s Research Institute, St. John’s Medical College, Bengaluru, India,Correspondence: Dhinagaran Devadass; ; Address: Division of Medical Informatics, St. John’s Research Institute, St. John’s Medical College, Bengaluru, India
| | - 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, USA
| | - Laura Nyblade
- Global Health Division, International Development Group, RTI International, USA
| | - 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, USA,Division of Mental Health and Neurosciences, St. John’s Research Institute, St. John’s Medical College, Bengaluru, India
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10
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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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11
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Nyblade L, Ndirangu JW, Speizer IS, Browne FA, Bonner CP, Minnis A, Kline TL, Ahmed K, Howard BN, Cox EN, Rinderle A, Wechsberg WM. Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women: conflicting perspectives in South Africa. BMC Public Health 2022; 22:1916. [PMID: 36242000 PMCID: PMC9563466 DOI: 10.1186/s12889-022-14236-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/02/2022] [Accepted: 09/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Globally, an urgent need exists to expand access to HIV prevention among adolescent girls and young women (AGYW), but the need is particularly acute in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) offers an effective HIV prevention method. In many countries, however, accessing PrEP necessitates that AGYW visit their local health clinic, where they may face access challenges. Some countries have implemented youth-friendly services to reduce certain challenges in local health clinics, but barriers to access persist, including clinic stigma. However, evidence of clinic stigma toward AGYW, particularly with respect to PrEP service delivery, is still limited. This mixed methods study explores stigma toward AGYW seeking clinic services, in particular PrEP, from the perspective of both clinic staff (clinical and nonclinical) and AGYW who seek services at clinic sites in Tshwane province, South Africa. METHODS Six focus group discussions were conducted with AGYW (43 total participants) and four with clinic staff (42 total participants) and triangulated with survey data with AGYW (n = 449) and clinic staff (n = 130). Thematic analysis was applied to the qualitative data and descriptive statistics were conducted with the survey data. RESULTS Four common themes emerged across the qualitative and quantitative data and with both AGYW and clinic staff, although with varying degrees of resonance between these two groups. These themes included (1) clinic manifestations of stigma toward AGYW, (2) concerns about providing PrEP services for AGYW, (3) healthcare providers' identity as mothers, and (4) privacy and breaches of confidentiality. An additional theme identified mainly in the AGYW data pertained to stigma and access to healthcare. CONCLUSION Evidence is needed to inform strategies for addressing clinic stigma toward AGYW, with the goal of removing barriers to PrEP services for this group. While awareness has increased and progress has been achieved around the provision of comprehensive, youth-friendly sexual and reproductive health services, these programs need to be adapted for the specific concerns of young people seeking PrEP services. Our findings point to the four key areas noted above where programs seeking to address stigma toward AGYW in clinics can tailor their programming.
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Affiliation(s)
- Laura Nyblade
- Global Health Division, RTI International, Washington, DC USA
| | - Jacqueline W. Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
| | - Ilene S. Speizer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Felicia A. Browne
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Courtney Peasant Bonner
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Alexandra Minnis
- Women’s Global Health Imperative, RTI International, Berkeley, CA USA
- School of Public Health, University of California, Berkeley, CA USA
| | - Tracy L. Kline
- Social Statistics Program, RTI International, Research Triangle Park, NC USA
| | - Khatija Ahmed
- Setshaba Research Centre, Tshwane, South Africa
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Brittni N. Howard
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
| | - Erin N. Cox
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
| | - Abigail Rinderle
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Wendee M. Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Department of Psychology, North Carolina State University, Raleigh, NC USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
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12
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Magnolini R, Senkoro E, Kalinjuma AV, Kitau O, Kivuma B, Samson L, Eichenberger A, Mollel GJ, Krinke E, Okuma J, Ndege R, Glass T, Mapesi H, Vanobberghen F, Battegay M, Weisser M. Stigma-directed services (Stig2Health) to improve 'linkage to care' for people living with HIV in rural Tanzania: study protocol for a nested pre-post implementation study within the Kilombero and Ulanga Antiretroviral Cohort. AAS Open Res 2022; 5:14. [PMID: 36420449 PMCID: PMC9648364 DOI: 10.12688/aasopenres.13353.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 12/01/2022] Open
Abstract
Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1 st February 2020 to 31 st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1 st July 2017 to 1 st February 2019). The primary outcome is 'linkage to care'. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31 st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa.
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Affiliation(s)
- Raphael Magnolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Elizabeth Senkoro
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Aneth Vedastus Kalinjuma
- Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Bernard Kivuma
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Leila Samson
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Anna Eichenberger
- Ifakara Health Institute, Ifakara, Tanzania
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Getrud Joseph Mollel
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Eileen Krinke
- University Psychiatric Clinics Basel, Basel, Switzerland
- University of Zurich, Zurich, Switzerland
| | - James Okuma
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Ndege
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Tracy Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Herry Mapesi
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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13
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He Y, Zhu J, Chen X, Mu Y. Trait Empathy Modulates Patterns of Personal and Social Emotions During the COVID-19 Pandemic. Front Psychol 2022; 13:893328. [PMID: 35756252 PMCID: PMC9231589 DOI: 10.3389/fpsyg.2022.893328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic has caused profound consequences on people's personal and social feelings worldwide. However, little is known about whether individual differences in empathy, a prosocial trait, may affect the emotional feelings under such threat. To address this, we measured 345 Chinese participants' personal emotions (e.g., active, nervous), social emotions (i.e., fearful and empathetic feelings about various social groups), and their empathy traits during the COVID-19 pandemic. Using the representational similarity analysis (RSA), we calculated the pattern similarity of personal emotions and found the similarity between the positive and negative emotions was less in the high vs. low empathy groups. In addition, people with high (vs. low) empathy traits were more likely to have fearful and sympathetic feelings about the disease-related people (i.e., depression patients, suspected COVID-19 patients, COVID-19 patients, flu patients, SARS patients, AIDS patients, schizophrenic patients) and showed more pattern dissimilarity in the two social feelings toward the disease-related people. These findings suggest a prominent role of trait empathy in modulating emotions across different domains, strengthening the polarization of personal emotions as well as enlarging social feelings toward a set of stigmatized groups when facing a pandemic threat.
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Affiliation(s)
- Yaji He
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jiajia Zhu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xuhai Chen
- Key Laboratory of Behavior and Cognitive Psychology in Shaanxi Province, School of Psychology, Shaanxi Normal University, Xi’an, China
| | - Yan Mu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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14
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Zhao Y, Li Z, Sheng Y. Timely linkage to care among men who have sex with men newly diagnosed with HIV: A structural equation model integrated HIV-related stigma framework. Nurs Health Sci 2022; 24:643-651. [PMID: 35633137 DOI: 10.1111/nhs.12960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/27/2022]
Abstract
HIV prevalence among men who have sex with men in China has increased dramatically, and timely linkage to care after being diagnosed with HIV is important to treatment success. This cross-sectional study aims to utilize structural equation modeling to test a hypothesized model of timely linkage to care adapted from the HIV-related stigma framework. Data were collected from 257 men who have sex with men living with HIV. The proportion of participants with timely linkage to care within one month was 63.42%. The model result showed a good fit. Higher HIV-related stigma was significantly associated with a lower level of social support, mental health, maladaptive coping (three mechanism variables), and attitude toward linkage to care. Higher CD4+ T-cell count, disclosure of HIV positivity to sexual partners, and greater convenience of accessing care were related to timely linkage to care (p< 0.05). These model results suggest that enhancing attention to family reactions and social support are needed for further research and interventions to accelerate newly diagnosed people's access to HIV care in China.
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Affiliation(s)
- Yafang Zhao
- Nursing Department, Chinese Academy of Medical Sciences Peking Union Medical College Hospital, Beijing, China
| | - Zhen Li
- Department of ICU, Chinese Academy of Medical Sciences Peking Union Medical College Hospital, Beijing, China
| | - Yu Sheng
- School of Nursing, Peking Union Medical College, Beijing, China
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15
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Zhu J, Yan L, Mu Y. Comparisons Between COVID-19 Stigma and Other Stigmas: Distinct in Explicit Attitudes and Similar in Implicit Process. Front Psychol 2022; 13:848993. [PMID: 35558720 PMCID: PMC9087195 DOI: 10.3389/fpsyg.2022.848993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/18/2022] [Indexed: 01/09/2023] Open
Abstract
Since the outbreak of COVID-19, the public stigma associated with COVID-19 has emerged. To better understand the COVID-19 stigma, the present research conducted three studies on 1,493 Chinese participants from the outbreak to the recovery period of the COVID-19 pandemic to examine the psychological mechanisms of COVID-19 stigma by comparing it with other disease-related stigmas in terms of their explicit and implicit processes. Study 1 and Study 2 jointly demonstrated that the public endorsed more stigma toward the COVID-19 related people (i.e., the COVID-19 patients) relative to the other disease-related people (i.e., the SARS patients, people with flu) in multiple explicit aspects, including emotional, motivational, cognitive, and social processing. Using the implicit association test (IAT), Study 3 found no significant difference in the implicit measures of the COVID-19 vs. the SARS groups, which further revealed that the pandemic stigmas (i.e., COVID-19 and SARS) were similar at the implicit level. These findings suggest common (implicit level) but distinct (explicit level) psychological processes of the pandemic-related stigmas, which provide reference to policymakers in formulating suitable interventions to deal with COVID-19 stigma and a newly generated potential stigma and provide psychological support for the public in the future.
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Affiliation(s)
- Jiajia Zhu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Lihua Yan
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Yan Mu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China,*Correspondence: Yan Mu,
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16
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Rosenberg NE, Tembo TA, Simon KR, Mollan K, Rutstein SE, Mwapasa V, Masiano S, Huffstetler HE, Go V, Kim MH. Development of a Blended Learning Approach to Delivering HIV-Assisted Contact Tracing in Malawi: Applied Theory and Formative Research. JMIR Form Res 2022; 6:e32899. [PMID: 35438644 PMCID: PMC9066333 DOI: 10.2196/32899] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/29/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite progress toward the Joint United Nations Programme on HIV/AIDS "95-95-95" targets (95% of HIV-positive persons tested, 95% of tested persons on treatment, and 95% of treated persons virally suppressed), a gap remains in achieving the first 95% target. Assisted contact tracing (ACT), in which health workers support HIV-positive index clients to recruit their contacts (sexual partners and children) for HIV testing, efficiently identifies HIV-positive persons in need of treatment. Although many countries, including Malawi, began implementing ACT, testing outcomes in routine settings have been worse than those in trial settings. OBJECTIVE The aim of this paper is to use formative research and frameworks to develop and digitize an implementation package to bridge the gap between ACT research and practice. METHODS Semistructured qualitative research was conducted in 2019 in Malawi with key informants. Barriers and facilitators to intervention delivery were identified using the Consolidated Framework for Implementation Research. Approaches to digitization were examined using human-centered design principles. RESULTS Limited clinic coordination and health worker capacity to address the complexities of ACT were identified as barriers. Ongoing individual training consisting of learning, observing, practicing, and receiving feedback, as well as group problem-solving were identified as facilitators. Important features of digitization included (1) culturally relevant visual content, (2) capability of offline use, and (3) simple designs and basic editing to keep costs low. CONCLUSIONS Formative research and frameworks played a key role in designing and digitizing an implementation package for ACT delivery in a low-income setting such as Malawi.
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Affiliation(s)
| | - Tapiwa A Tembo
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Katherine R Simon
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
- Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, United States
| | - Katie Mollan
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sarah E Rutstein
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Steven Masiano
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | | | - Vivian Go
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maria H Kim
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
- Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, United States
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17
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Magnolini R, Senkoro E, Kalinjuma AV, Kitau O, Kivuma B, Samson L, Eichenberger A, Mollel GJ, Krinke E, Okuma J, Ndege R, Glass T, Mapesi H, Vanobberghen F, Battegay M, Weisser M. Stigma-directed services (Stig2Health) to improve 'linkage to care' for people living with HIV in rural Tanzania: study protocol for a nested pre-post implementation study within the Kilombero and Ulanga Antiretroviral Cohort. AAS Open Res 2022; 5:14. [PMID: 36420449 PMCID: PMC9648364 DOI: 10.12688/aasopenres.13353.1] [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: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1 st February 2020 to 31 st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1 st July 2017 to 1 st February 2019). The primary outcome is 'linkage to care'. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31 st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa.
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Affiliation(s)
- Raphael Magnolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Elizabeth Senkoro
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Aneth Vedastus Kalinjuma
- Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Bernard Kivuma
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Leila Samson
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Anna Eichenberger
- Ifakara Health Institute, Ifakara, Tanzania
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Getrud Joseph Mollel
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Eileen Krinke
- University Psychiatric Clinics Basel, Basel, Switzerland
- University of Zurich, Zurich, Switzerland
| | - James Okuma
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Ndege
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Tracy Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Herry Mapesi
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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18
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Langi GG, Rahadi A, Praptoraharjo I, Ahmad RA. HIV-related stigma and discrimination among health care workers during early program decentralization in rural district Gunungkidul, Indonesia: a cross-sectional study. BMC Health Serv Res 2022; 22:356. [PMID: 35300667 PMCID: PMC8932246 DOI: 10.1186/s12913-022-07751-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Expanding HIV services by decentralizing provision to primary care raises a possible concern of HIV-related stigma and discrimination (SAD) from health care workers (HCWs) as new service points gain experience in HIV care delivery during early implementation. We surveyed indicators and examined the correlates of HIV-related SAD among HCWs in a decentralizing district of rural Gunungkidul, Indonesia. METHODS We conducted a cross-sectional survey on a random stratified sample of 234 HCWs in 14 public health facilities (one district hospital, 13 primary health centers [PHC]) during the second year of decentralization roll-out in the district. We computed the prevalence of SAD indicators and used multivariable logistic regression to identify the correlates of these SAD indicators. RESULTS The prevalence of SAD among HCWs was similarly high between hospital and PHC HCWs for fear of HIV transmission (~71%) and perceived negative image of PHIV (~75%). Hospital HCWs exhibited somewhat lower avoidance of service duties (52.6% vs. 63.7%; p = 0.088) with weak evidence of a difference and significantly higher levels of discriminatory practice (96.1% vs. 85.6%; p = 0.009) than those working in PHCs. Recent interactions with PLHIV and receipt of training lowered the odds of fear of HIV transmission (p <0.021). However, the odds of avoiding care duties increased with receipt of training (p =0.003) and decreased for hospital HCWs (p = 0.030). HIV knowledge lowered the odds of discriminatory practice (p = 0.002), but hospital facility and nurse/midwife cadres were associated with increased odds of discriminatory practices (p <0.021). No significant correlate was found for perceived negative image of PLHIV. CONCLUSION HIV-related SAD among HCWs can be prevalent during early decentralization, highlighting the need for timely or preparatory interventions with a focus on building the capacity of hospital and non-physician workforce for positive patient-provider interactions when delivering HIV care.
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Affiliation(s)
- Gaby G Langi
- University Center of Excellence, AIDS Research Center, Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, DKI Jakarta, 12930, Indonesia.
- Field Epidemiology Training Program (FETP), Department of Biostatistics Epidemiology and Population Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
| | - Arie Rahadi
- University Center of Excellence, AIDS Research Center, Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, DKI Jakarta, 12930, Indonesia.
| | - Ignatius Praptoraharjo
- University Center of Excellence, AIDS Research Center, Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, DKI Jakarta, 12930, Indonesia
- Center for Health Policy and Management, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Riris A Ahmad
- Field Epidemiology Training Program (FETP), Department of Biostatistics Epidemiology and Population Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
- Center for Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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19
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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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20
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Lacombe-Duncan A, Berringer KR, Green J, Jacobs A, Hamdi A. “I do the she and her”: A qualitative exploration of HIV care providers’ considerations of trans women in gender-specific HIV care. WOMEN'S HEALTH 2022; 18:17455057221083809. [PMID: 35311400 PMCID: PMC8935587 DOI: 10.1177/17455057221083809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives: Women of all genders, including cisgender (cis) and transgender (trans) women, experience social and structural drivers of HIV inequities and pervasive barriers to HIV care. Yet, little is known about how HIV care providers address gender diversity in health care. Through a critical feminist lens informed by intersectionality theory, medical anthropology, and critical sociology, we explored (1) how do HIV care providers describe women living with HIV’s care needs and barriers; (2) what are their perspectives on optimal HIV care for women; and (3) to what extent do these conceptualizations include/exclude trans women. Methods: Utilizing a community-based exploratory qualitative study design, we conducted 60–90 minute semi-structured individual interviews from March 2019–April 2020 with eight HIV care providers (n = 4 social service providers; n = 4 physicians) practicing across seven counties representative of rural, suburban, and urban Michigan, United States. Data were analyzed utilizing a reflexive thematic approach. Results: Three overarching themes emerged: (1) Emphasis on (different) clinical needs: key considerations in cis and trans women’s HIV care; (2) Recognition of the structural: barriers to HIV care affecting women of all genders; and (3) Proposed solutions: piecing together individual, social, and organizational interventions to increase access to HIV care that may benefit women living with HIV of all genders but are disproportionately framed as being for cis women. While HIV care providers recognized both cis and trans women living with HIV’s clinical care needs and structural barriers to care, they rarely envisioned optimal HIV care inclusive of gender affirmation and structural interventions. Conclusions: Findings suggest that HIV care providers can avoid reducing gender to biology and making assumptions about reproductive care needs, endocrinological care needs, caregiving responsibilities, and other life circumstances; provide gender-affirming medical care; and address structural barriers to HIV care to enhance intersectional and structurally focused gender-affirming—that is, trans-inclusive—women-centered HIV care.
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Affiliation(s)
| | - Kathryn R Berringer
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
- Department of Anthropology, University of Michigan, Ann Arbor, MI, USA
| | | | - Amy Jacobs
- Michigan HIV/AIDS Treatment Program, Michigan Medicine, Ann Arbor, MI, USA
| | - Amy Hamdi
- Michigan HIV/AIDS Council (MHAC), Lansing, MI, USA
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21
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Handayani S, Alimin Maidin M, Birawida AB, Ansariadi, Indriasari R. Combination model in reducing HIV-related stigma: A systematic review. GACETA SANITARIA 2021; 35 Suppl 2:S337-S339. [PMID: 34929847 DOI: 10.1016/j.gaceta.2021.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This article identifies and explains the various research models related to HIV stigma. METHODS This systematic review is done using the PRISMA 2015 guidelines. Source of this review uses 3 online journal databases which are Pubmed, Scinapse, Elsevier. Search criteria include articles published this past 10 years between 2010 and 2020. RESULT 4146 articles were obtained and 9 articles which are suited with the inclusion criteria and were chosen in the literature review. It was discovered that stigmatization is a cultural construct and its experiences varies between countries and communities. Models which differentiate are interpersonal and intrapersonal process in handling the stigma. CONCLUSION Stigmas are still an important issues because often times it became an obstacle in the effort to reduce the prevalence of HIV/AIDS. Therefore there needs to be a gold standard scenario in reducing HIV related stigma, one of them being cultural in source.
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Affiliation(s)
- Sri Handayani
- Tamalatea College of Health Sciences, Makassar 90245, Indonesia; Faculty of Public Health, Hasanuddin University, Makassar 90245, Indonesia.
| | - M Alimin Maidin
- Faculty of Public Health, Hasanuddin University, Makassar 90245, Indonesia
| | | | - Ansariadi
- Faculty of Public Health, Hasanuddin University, Makassar 90245, Indonesia
| | - Rahayu Indriasari
- Faculty of Public Health, Hasanuddin University, Makassar 90245, Indonesia
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22
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Lacombe-Duncan A, Logie CH, Persad Y, Leblanc G, Nation K, Kia H, Scheim AI, Lyons T, Horemans C, Olawale R, Loutfy M. Implementation and evaluation of the 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)' provider education pilot. BMC MEDICAL EDUCATION 2021; 21:561. [PMID: 34732178 PMCID: PMC8566115 DOI: 10.1186/s12909-021-02991-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/21/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Transgender (trans) women face constrained access to gender-affirming HIV prevention and care. This is fueled in part by the convergence of limited trans knowledge and competency with anti-trans and HIV-related stigmas among social and healthcare providers. To advance gender-affirming HIV service delivery we implemented and evaluated 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)'. This theoretically-informed community-developed intervention aimed to increase providers' gender-affirming HIV prevention and care knowledge and competency and reduce negative attitudes and biases among providers towards trans women living with and/or affected by HIV. METHODS Healthcare and social service providers and providers in-training (e.g., physicians, nurses, social workers) working with trans women living with and/or affected by HIV (n = 78) participated in a non-randomized multi-site pilot study evaluating TEACHH with a pre-post-test design. Pre- and post-intervention surveys assessed participant characteristics, intervention feasibility (e.g., workshop completion rate) and acceptability (e.g., willingness to attend another training). Paired sample t-tests were conducted to assess pre-post intervention differences in perceived competency, attitudes/biases, and knowledge to provide gender-affirming HIV care to trans women living with HIV and trans persons. RESULTS The intervention was feasible (100% workshop completion) and acceptable (91.9% indicated interest in future gender-affirming HIV care trainings). Post-intervention scores indicated significant improvement in: 1) knowledge, attitudes/biases and perceived competency in gender-affirming HIV care (score mean difference (MD) 8.49 (95% CI of MD: 6.12-10.86, p < 0.001, possible score range: 16-96), and 2) knowledge, attitudes/biases and perceived competency in gender-affirming healthcare (MD = 3.21; 95% CI of MD: 1.90-4.90, p < 0.001, possible score range: 9-63). Greater change in outcome measures from pre- to post-intervention was experienced by those with fewer trans and transfeminine clients served in the past year, in indirect service roles, and having received less prior training. CONCLUSIONS This brief healthcare and social service provider intervention showed promise in improving gender-affirming provider knowledge, perceived competency, and attitudes/biases, particularly among those with less trans and HIV experience. Scale-up of TEACHH may increase access to gender-affirming health services and HIV prevention and care, increase healthcare access, and reduce HIV disparities among trans women. TRIAL REGISTRATION ClinicalTrials.gov ( NCT04096053 ).
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Affiliation(s)
- Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109-1106, USA.
- Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109-5482, USA.
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada.
| | - Carmen H Logie
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, M5S 1V4, Canada
- Center for Gender & Sexual Health Equity (CGSHE), 1190 Hornby Street, Vancouver, V6Z 2K5, Canada
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
| | - Gabrielle Leblanc
- Action Santé Travesti(e)s & Transsexuel(le)s du Québec (ASTT(E)Q), 1300 Sanguinet, Montréal, H2X 3E7, Canada
| | - Kelendria Nation
- Prism Education Series, Vancouver Coastal Health, 1128 Hornby Street, Vancouver, V6Z 2L4, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, 2080 West Mall, Vancouver, V6T 1Z2, Canada
| | - Ayden I Scheim
- Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Tara Lyons
- Center for Gender & Sexual Health Equity (CGSHE), 1190 Hornby Street, Vancouver, V6Z 2K5, Canada
- Department of Criminology, Kwantlen Polytechnic University, 12666 72 Avenue, Surrey, V3W 2M8, Canada
| | - Chavisa Horemans
- CIHR Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
| | - Ronke Olawale
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109-1106, USA
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
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23
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Handayani S, Maidin A, Birawida AB, Suriah S, Ansariadi A, Indriasari R, Stang S. Determinants Model in Reducing HIV-Related Stigma in Health care Workers: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The stigma accepted by people living with HIV (PLWHA) is a major obstacle in HIV prevention, especially from health workers.
Aims: This study aims to determine the factors associated with HIV stigma among health workers.
Methods: This systematic review was conducted using the 2015 PRISMA guidelines. All publications by reading the title and abstract. In the final screening stage, the authors read the full text of the remainder of the article and held back studies that were consistent with inclusion criteria, focusing on HIV-related stigma determinants published in 2010-2020.
Results: The stigma that comes from health workers to PLWHA can come from personal beliefs or a lack of personal confidence, which can be derived from self-confidence, self-confidence, knowledge, working time, and institutional support or policies from the workplace that create discriminatory behavior when dealing with PLWHA. The created stigma can reduce social interactions and the quality of life of PLWHA.
Conclusion: It is important to find determinants to formulate appropriate intervention plans in reducing HIV-related stigma, especially among health workers.
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24
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Use of eHealth for HIV Medical Education: a Narrative Review. Curr HIV/AIDS Rep 2021; 18:247-260. [PMID: 33817768 DOI: 10.1007/s11904-021-00553-2] [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: 03/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW The complexity of HIV care and its expanding clinical workforce has created a need for new distance learning models to deliver medical education. We conducted a narrative review to assess the acceptability and effectiveness of recent eHealth HIV education interventions supporting HIV healthcare providers. RECENT FINDINGS Evidence from 24 articles revealed that synchronous (real time), asynchronous (any time), and hybrid (combination) models of eHealth education are feasible and acceptable. Only two interventions (one asynchronous, one hybrid) of 19 included in the review utilized a randomized controlled design. Some studies showed improvement in confidence and perceived quality of case management, but few studies were designed to demonstrate impact. Successful eHealth education interventions require a thorough understanding of the target community's capacity and needs. Both synchronous and asynchronous strategies appear acceptable and potentially effective, but more studies are needed to assess impact on knowledge and practices to determine the most effective delivery models.
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25
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Nyblade L, Srinivasan K, Raj T, Oga EA, Heylen E, Mazur A, Devadass D, Steward WT, Pereira M, Ekstrand ML. HIV Transmission Worry Predicts Discrimination Intentions Among Nursing Students and Ward Staff in India. AIDS Behav 2021; 25:389-396. [PMID: 32804318 PMCID: PMC7855682 DOI: 10.1007/s10461-020-03001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Health facility stigma impedes HIV care and treatment. Worry of contracting HIV while caring for people living with HIV is a key driver of health facility stigma, however evidence for this relationship is largely cross-sectional. This study evaluates this relationship longitudinally amongst nursing students and ward staff in India. Worry of contracting HIV and other known predictors of intent to discriminate were collected at baseline and 6 months in 916 nursing students and 747 ward staff. Using fixed effects regression models, we assessed the effect of key predictors on intent to discriminate over a 6-month period. Worry of contracting HIV predicted intent to discriminate for nursing students and ward staff in care situations with low and high-risk for bodily fluid exposure, confirming prior cross-sectional study results and underscoring the importance of addressing worry of contracting HIV as part of health facility HIV stigma-reduction interventions.
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Affiliation(s)
- Laura Nyblade
- Global Health Division, International Development Group, RTI International, 13th St., NW, Suite 750, Washington, DC, 20005, USA.
| | - Krishnamachari Srinivasan
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Tony Raj
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Emmanuel A Oga
- Center for Applied Public Health Research, RTI International, Rockville, MD, USA
| | - Elsa Heylen
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Amanda Mazur
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Dhinagaran Devadass
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Wayne T Steward
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Matilda Pereira
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Maria L Ekstrand
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
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26
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Srinivasan K, Heylen E, Raj T, Nyblade L, Devadass D, Pereira M, Ekstrand ML. Reduction in Stigma Drivers Partially Mediates the Effect of a Stigma Reduction Intervention Among Nursing Students in India: The DriSti Cluster Randomized Controlled Trial. J Acquir Immune Defic Syndr 2021; 86:182-190. [PMID: 33105394 PMCID: PMC7884286 DOI: 10.1097/qai.0000000000002543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV stigma in health care settings acts as a significant barrier to health care. Stigma drivers among health professionals include transmission fears and misconceptions and pre-existing negative attitudes toward marginalized groups vulnerable to HIV. The DriSti intervention, consisted of 2 sessions with videos and interactive exercises on a computer tablet and one interactive face-to-face group session, mostly tablet administered, was designed to target key stigma drivers that included instrumental stigma, symbolic stigma, transmission misconceptions and blame to reduce HIV stigma, and discrimination among nursing students (NS) and ward staff and tested in a cluster randomized trial. SETTING This report focuses on second and third year NS recruited from a range of nursing schools that included private, nonprofit, and government-run nursing schools in south India. RESULTS Six hundred seventy-nine NS received intervention and 813 NS were in the wait-list control group. Twelve months outcome analyses showed significant reduction among intervention participants in endorsement of coercive policies (P < 0.001) and in the number of situations in which NS intended to discriminate against PLWH (P < 0.001). Mediation analysis revealed that the effects of intervention on endorsement of coercive policies and intent to discriminate against PLWH were partially mediated by reductions in key stigma drivers. CONCLUSIONS This brief scalable stigma reduction intervention targeting key stigma drivers fills a critical gap in identifying the mechanistic pathways that aid in stigma reduction among health professionals.
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Affiliation(s)
- Krishnamachari Srinivasan
- Division of Mental Health and Neurosciences, St John's Research Institute and St. John's Medical College, Bangalore, India
| | - Elsa Heylen
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA
| | - Tony Raj
- Division of Medical Informatics, St John's Research Institute, and St. John's Medical College, Bangalore, India; and
| | - Laura Nyblade
- Global Health Division, International Development Group, RTI International, Washington, DC
| | - Dhinagaran Devadass
- Division of Medical Informatics, St John's Research Institute, and St. John's Medical College, Bangalore, India; and
| | - Matilda Pereira
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA
| | - Maria L Ekstrand
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA
- Division of Medical Informatics, St John's Research Institute, and St. John's Medical College, Bangalore, India; and
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Leyva-Moral JM, Dominguez-Cancino KA, Edwards JE, Moriña-Soler D, Cesario SK, Guevara-Vasquez GM, Feijoo-Cid M, Palmieri PA. Attitudes Toward Caring for People Living with HIV/AIDS: A Cross-Sectional Study of Nursing Faculty in Six Countries. Open AIDS J 2020. [DOI: 10.2174/1874613602014010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Since the earliest study about nursing faculty and student attitudes about caring for people living with HIV/AIDS (PLHIV) in 1992, there have been less than 20 additional studies reported in the literature. Yet, PLHIV continues to report stigma and experience discrimination. Nursing faculty attitudes are part of the informal curriculum. Negativity about caring for PLHIV can adversely impact student perceptions as well as their care. Current research in this area is essentially non-existent.
Objective:
To describe the attitudes of the university nursing faculty toward caring for PLHIV; and to identify the relationship between faculty attitudes and explanatory factors such as age, education, religion, nationality, teaching in a clinical setting, years of experience, and university attributes.
Methods:
This was a multicenter cross-sectional study with nonrandomized electronic purposeful sampling. The Healthcare Provider HIV/AIDS Stigma Scale (HPASS) is a 30-item scale with three subscales: Prejudice, stereotype, and discrimination. The English and Spanish versions of the HPASS exhibit stable psychometric properties for cross-cultural research. The HPASS was delivered to university nursing faculty in six countries across three continents.
Results:
A sample of 368 nursing faculty completed the HPASS. The mean composite score was 2.41 (SD = 0.69), six-point scale with lower scores indicating more positive attitudes, with subscale scores: Stereotypes 2.55 (SD = 0.84), discrimination 2.28 (SD = 0.74), and prejudices 2.41 (SD = 0.63). Peruvian faculty had the highest scores while Canadian had the lowest. Significant correlations were observed between attitudes and the three subscales, and between the three subscales and the composite score.
Conclusion:
Attitudes of the nursing faculty toward caring for PLHIV were slightly positive to slightly negative depending on the region and country. Knowledge deficiencies about HIV persist, incorrect beliefs are common, and attitudes appear to be influenced by culture. The correlation between subscales justifies continued research to implement targeted interventions. Education about HIV/AIDS can address knowledge deficits while structured interactions with PLHIV can facilitate experiential learning.
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28
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Wechsberg WM, Browne FA, Ndirangu J, Bonner CP, Minnis AM, Nyblade L, Speizer IS, Howard BN, Myers B, Ahmed K. The PrEPARE Pretoria Project: protocol for a cluster-randomized factorial-design trial to prevent HIV with PrEP among adolescent girls and young women in Tshwane, South Africa. BMC Public Health 2020; 20:1403. [PMID: 32933510 PMCID: PMC7490774 DOI: 10.1186/s12889-020-09458-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/27/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Despite increased prevention efforts, HIV remains the leading cause of death among adolescent girls and young women in South Africa. Although research indicates important determinants of HIV acquisition at the individual and interpersonal levels, structural-level stigma and discrimination continue to be critical barriers to reaching and retaining this key population for HIV prevention and sexual and reproductive health services. Innovative and multilevel interventions are needed that can address the intersectional structural and gender issues that young women face, including stigma, alcohol and drug use, gender-based violence, and other risk factors when seeking health services. Oral pre-exposure prophylaxis (PrEP) taken daily has been found to be an effective biomedical HIV prevention tool. Testing a comprehensive gender-focused biobehavioral HIV prevention intervention that is inclusive of social ecological determinants, such as stigma and discrimination reduction in clinics, is critical for reducing HIV among adolescent girls and young women. METHODS This project involves both a Community Collaborative Board and a Youth Advisory Board in helping to adapt the Young Women's Health CoOp intervention and the Health Policy Project (HPP) Stigma and Discrimination (S&D) reduction training curriculum to the setting and population. This study uses a two-by-two factorial design with stratified randomization of 12 clinics, each with distinct catchment areas. The Young Women's Health CoOp addresses substance use, sexual risk, violence prevention and sexual negotiation, condom demonstration, and problem solving with the following additions: knowledge of PrEP, the importance of PrEP adherence, and sexual and reproductive health. Adolescent girls and young women will be assessed with behavioral and biological measures at baseline, 3-, 6- and 9-month follow-up. The S&D reduction training is provided for all staff in the clinics randomized to this condition. Clinic staff will be surveyed at baseline, 4- and 8-month follow-up. We will recruit 900 AGYW from communities in the 12 clinic catchment areas. DISCUSSION The study findings, if efficacious across the outcomes, will be incorporated into the gender-focused HIV prevention intervention toolkit and disseminated to inform multilevel prevention approaches. TRIAL REGISTRATION ClinicalTrials.gov. Identifier: NCT04048551 (Recruiting). Registered: August 7, 2019 (Retrospectively registered).
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Affiliation(s)
- Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA. .,Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA. .,Department of Psychology, North Carolina State University, 640 Poe Hall, Campus Box 7650, Raleigh, NC, 27695, USA. .,Psychiatry and Behavioral Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Felicia A Browne
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.,Health Behavior, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Jacqueline Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Courtney Peasant Bonner
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Alexandra M Minnis
- Center for Global Health, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA.,Epidemiology Division, Berkeley School of Public Health, University of California, 2121 Berkeley Way, Room 5302, Berkeley, CA, 94720, USA
| | - Laura Nyblade
- International Global Health Division, International Development Group, RTI International, 701 13th Street NW #750, Washington, DC, 20005, USA
| | - Ilene S Speizer
- Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Brittni N Howard
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Bronwyn Myers
- Alcohol and Drug Abuse Research Unit, Medical Research Council Francie van Zijl Drive, Parow Valley, Cape Town, South Africa
| | - Khatija Ahmed
- Setshaba Research Centre, 2088 Block H, Soshanguve, 0152, South Africa
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29
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A total facility approach to reducing HIV stigma in health facilities: implementation process and lessons learned. AIDS 2020; 34 Suppl 1:S93-S102. [PMID: 32881798 DOI: 10.1097/qad.0000000000002585] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To describe development and implementation of a three-stage 'total facility' approach to reducing health facility HIV stigma in Ghana and Tanzania, to facilitate replication. DESIGN HIV stigma in healthcare settings hinders the HIV response and can occur during any interaction between client and staff, between staff, and within institutional processes and structures. Therefore, the design focuses on multiple socioecological levels within a health facility and targets all levels of staff (clinical and nonclinical). METHODS The approach is grounded in social cognitive theory principles and interpersonal or intergroup contact theory that works to combat stigma by creating space for interpersonal interactions, fostering empathy, and building efficacy for stigma reduction through awareness, skills, and knowledge building as well as through joint action planning for changes needed in the facility environment. The approach targets actionable drivers of stigma among health facility staff: fear of HIV transmission, awareness of stigma, attitudes, and health facility environment. RESULTS The results are the three-stage process of formative research, capacity building, and integration into facility structures and processes. Key implementation lessons learned included the importance of formative data to catalyze action and shape intervention activities, using participatory training methodologies, involving facility management throughout, having staff, and clients living with HIV facilitate trainings, involving a substantial proportion of staff, mixing staff cadres and departments in training groups, and integrating stigma-reduction into existing structures and processes. CONCLUSION Addressing stigma in health facilities is critical and this approach offers a feasible, well accepted method of doing so.
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Stangl AL, Sebany M, Kapungu C, Jessee C, Ricker CL, Chard E. Is HIV index testing and partner notification safe for adolescent girls and young women in low- and middle-income countries? J Int AIDS Soc 2020; 23 Suppl 5:e25562. [PMID: 32869478 PMCID: PMC7459168 DOI: 10.1002/jia2.25562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/22/2020] [Accepted: 06/05/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION While HIV index testing and partner notification (PN) services have the potential to reach adolescent girls and young women (AGYW) aged 15 to 24 and their sexual partners in need of HIV testing services, the potential social harms have not yet been studied. This commentary highlights the risks of this approach, including intimate partner violence (IPV), stigma and discrimination, and outlines an urgent research agenda to fully understand the potential harms of PN for AGYW, calling for the development of mitigation strategies. DISCUSSION A substantial evidence base exists demonstrating the feasibility, acceptability and effectiveness of index testing and partner notification for adults aged 18 years and older in low- and middle-income countries (LMICs), particularly for men, and for adults who are married/cohabiting and referring a current sexual partner. AGYW who are most vulnerable to HIV infection in LMICs do not reflect these demographics. Instead, they are often in age-disparate partnerships, have limited negotiating power within relationships, experience high rates of violence and face economic challenges that necessitate transactional sex. PN services may be particularly difficult for adolescent girls under 18 who face restrictions on their decision making and are at increased risk of rape. Adolescent girls may also face coercion to notify partners due to unequal power dynamics in the provider-adolescent client relationship, as well as judgemental attitudes towards adolescent sexual activity among providers. CONCLUSIONS As index testing and PN with AGYW is already being rolled out in some LMICs, research is urgently needed to assess its feasibility and acceptability. Implementation science studies should assess the availability, accessibility, acceptability and quality of HIV PN services for AGYW. Qualitative studies and routine monitoring with age-disaggregated data are critical to capture potential social harms, PN preferences and support needs for AGYW aged 15 to 17, 18 to 20 and 21 to 24. To mitigate potential harms, PN methods should prioritize confidentiality and avoidance of adverse outcomes. Healthcare providers should be trained to conduct routine enquiry for IPV and provide first-line support. Support services for AGYW living with HIV and survivors of violence should be implemented alongside HIV PN.
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Affiliation(s)
- Anne L Stangl
- International Center for Research on WomenWashingtonDCUSA
- Hera SolutionsBaltimoreMDUSA
| | - Meroji Sebany
- International Center for Research on WomenWashingtonDCUSA
| | | | - Cassandra Jessee
- International Center for Research on WomenWashingtonDCUSA
- Making Cents InternationalWashingtonDCUSA
| | - Chelsea L Ricker
- International Center for Research on WomenWashingtonDCUSA
- Independent ConsultantWashingtonDCUSA
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Abstract
Stigma has negatively influenced the lives of people living with HIV since the beginning of the epidemic. It affects every facet of their lives and can cause mental health problems, loss of human rights, and barriers to care. Studies in developing countries have shown a high prevalence of HIV stigma among health care workers. Few studies have been conducted in the United States. We used a validated instrument to survey 330 health care workers in Washington, DC, a high HIV prevalence area. The goal was to obtain data to assess the severity of the problem. We found that stigmatizing beliefs and attitudes were prevalent as reflected in responses from 66% of the participants. Of clinicians surveyed, 31% reported using double gloves. Participants with stigma training had lower stigma levels, whereas older individuals and support staff were more stigmatizing. Negative attitudes affect access to care and have major public health implications.
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Nyblade L, Addo NA, Atuahene K, Alsoufi N, Gyamera E, Jacinthe S, Leonard M, Mingkwan P, Stewart C, Vormawor R, Kraemer JD. Results from a difference-in-differences evaluation of health facility HIV and key population stigma-reduction interventions in Ghana. J Int AIDS Soc 2020; 23:e25483. [PMID: 32329153 PMCID: PMC7180216 DOI: 10.1002/jia2.25483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/07/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Stigma undermines all aspects of a comprehensive HIV response, as reflected in recent global initiatives for stigma-reduction. Yet a commensurate response to systematically tackle stigma within country responses has not yet occurred, which may be due to the lack of sufficient evidence documenting evaluated stigma-reduction interventions. With stigma present in all life spheres, health facilities offer a logical starting point for developing and expanding stigma reduction interventions. This study evaluates the impact of a "total facility" stigma-reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff in Ghana. METHODS We evaluated the impact of a total facility stigma-reduction intervention by comparing five intervention to five comparable non-intervention health facilities in Ghana. Interventions began in September 2017. Data collection was in June 2017 and April 2018. The primary outcomes were composite indicators for three stigma drivers, self-reported stigmatizing avoidance behaviour, and observed discrimination. The principal intervention variable was whether the respondent worked at an intervention or comparison facility. We estimated intervention effects as differences-in-differences in each outcome, further adjusted using inverse probability of treatment weighting (IPTW). RESULTS We observed favourable intervention effects for all outcome domains except for stigmatizing attitudes. Preferring not to provide services to people living with HIV (PLHIV) or a key population member improved 11.1% more in intervention than comparison facility respondents (95% CI 3.2 to 19.0). Other significant improvements included knowledge of policies to protect against discrimination (difference-in-differences = 20.4%; 95% CI 12.7 to 28.0); belief that discrimination would be punished (11.2%; 95% CI 0.2 to 22.3); and knowledge of and belief in the adequacy of infection control policies (17.6%; 95% CI 8.3 to 26.9). Reported observation of stigma and discrimination incidents fell by 7.4 percentage points more among intervention than comparison facility respondents, though only marginally significant in the IPTW-adjusted model (p = 0.06). Respondents at intervention facilities were 19.0% (95% CI 12.2 to 25.8) more likely to report that staff behaviour towards PLHIV had improved over the last year than those at comparison facilities. CONCLUSIONS These results provide a foundation for scaling up health facility stigma-reduction within national HIV responses, though they should be accompanied by rigorous implementation science to ensure ongoing learning and adaptation for maximum effectiveness and long-term impact.
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Affiliation(s)
- Laura Nyblade
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | - Nii A Addo
- Educational Assessment Research Centre (EARC)AccraGhana
| | | | | | - Emma Gyamera
- Educational Assessment Research Centre (EARC)AccraGhana
| | | | - Madeline Leonard
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Department of Health Systems AdministrationGeorgetown UniversityWashingtonDCUSA
| | - Pia Mingkwan
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | - Christin Stewart
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | | | - John D Kraemer
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Department of Health Systems AdministrationGeorgetown UniversityWashingtonDCUSA
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Ekstrand ML, Raj T, Heylen E, Nyblade L, Devdass D, Pereira M, Mazur A, Srinivasan K. Reducing HIV stigma among healthcare providers in India using a partly tablet-administered intervention: the DriSti trial. AIDS Care 2020; 32:14-22. [PMID: 32151146 DOI: 10.1080/09540121.2020.1739221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HIV stigma has long been recognized as a significant barrier in the worldwide fight against HIV. Across cultures, stigma has been shown to cause psychological distress and act as a barrier to engagement in care. Health professionals can serve as a crucial source of HIV stigma, with drivers that include fears and transmission misconceptions and pre-existing negative attitudes towards marginalized groups. To increase their impact, stigma reduction interventions need to be scalable and sustainable as well as adaptable to different cultural contexts. The DriSti intervention was designed to meet these needs through an easily adaptable, mostly tablet-administered, interactive intervention delivered to ward staff (n = 1,557) and nursing students (n = 1,625) in 62 Indian institutions, using a cRCT design, with wait-list controls. Six-month outcome analyses, showed significant reductions in misconceptions (p < .001) and worry about acquiring HIV at work (p < .001). Intervention participants also reported significantly greater reductions in endorsement of coercive policies (p < .001) and in the number of situations in which they intended to discriminate against PLWH (p < .001) than control participants. This brief, scaleable intervention could be adapted for similar populations in the region, using different mHealth platforms and thus has important implications for current global stigma reduction initiatives and training curricula.
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Affiliation(s)
- Maria L Ekstrand
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA, USA.,Division of Medical Informatics, St. John's Research Institute, Bangalore, India
| | - Tony Raj
- Division of Medical Informatics, St. John's Research Institute, Bangalore, India
| | - Elsa Heylen
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA, USA
| | - Laura Nyblade
- Global Health Division, International Development Group, RTI International, USA
| | - Dhinagaran Devdass
- Division of Medical Informatics, St. John's Research Institute, Bangalore, India
| | - Matilda Pereira
- Division of Medical Informatics, St. John's Research Institute, Bangalore, India
| | - Amanda Mazur
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, CA, USA
| | - Krishnamachari Srinivasan
- Division of Mental Health and Neurosciences, Department of Psychiatry, St. John's Research Institute, Bangalore, India
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Ebrahimi F, Sindarreh S, Nasirian M. Attitudes and Practice of Health Care Workers about Human Immunodeficiency Virus in Isfahan, Iran. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:111-116. [PMID: 32195155 PMCID: PMC7055188 DOI: 10.4103/ijnmr.ijnmr_67_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/02/2019] [Accepted: 12/30/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health Care Workers (HCWs) play a key role in the Human Immunodeficiency Virus (HIV) prevention program, care and treat People Living with HIV (PLHIV). The evaluation of the attitude and performance among HCWs is regarded as one effective method for preventing the (HIV) spreading. This study was aimed to assess the attitude and practice of HCWs about HIV in Isfahan. MATERIALS AND METHODS In a cross-sectional study, we recruited 350 eligible participants from five academic hospitals, three academics dental clinics and six health centers by the convenience multistage sampling. A standard questionnaire was used to evaluate HIV attitudes among the HCWs in Isfahan. The variables were compared between males and females by Chi-square and t-test. In addition, linear and logistic regression was utilized to investigate the factors affecting attitude. RESULTS Respondents had a moderate level of attitude toward PLHIV About 2.00% of the respondents had a good attitude. Marital status (β=-11.79, p = 0.048) was associated with attitude. Among women, wearing gloves was associated with attitude (β=5.96, p = 0.041). CONCLUSIONS HIV attitude was not satisfactory among the HCWs in Isfahan. Therefore, the necessary measures and training are needed to improve the attitudes of health personnel and reduce stigma and discrimination toward PLHIV in health systems. Also, it is recommended to strongly monitor HIV infection control guidelines and instruction.
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Affiliation(s)
- Fatemeh Ebrahimi
- Department of Epidemiology and Biostatistics, Health School, and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Setayesh Sindarreh
- Department of Epidemiology and Biostatistics, Health School, and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Nasirian
- Department of Epidemiology and Biostatistics, Health School, and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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HIV Stigma and Moral Judgement: Qualitative Exploration of the Experiences of HIV Stigma and Discrimination among Married Men Living with HIV in Yogyakarta. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020636. [PMID: 31963807 PMCID: PMC7013688 DOI: 10.3390/ijerph17020636] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/14/2022]
Abstract
It is well acknowledged that human immunodeficiency virus stigma (HIV stigma) challenges people living with HIV globally. There is a scarcity of information about determinants of HIV stigma and discrimination among married men in the Indonesian context. This study aimed to explore factors that contribute to stigma and discrimination against HIV-positive men married to women in Yogyakarta, Indonesia. Face-to-face in-depth interviews were conducted to collect data from participants using a snowball sampling technique. A framework analysis was used to guide the analysis of the data. HIV stigma framework was also applied in the conceptualisation and the discussion of the findings. The findings indicate that participants experienced external stigma within healthcare facilities, communities and families. This external stigma was expressed in various discriminatory attitudes and behaviours by healthcare professionals and community and family members. Similarly, participants experienced anticipated stigma as a result of HIV stigma and discrimination experienced by other people living with HIV. Individual moral judgement associating HIV status with amoral behaviours and participants' negative self-judgement were determinants of perceived stigma. The current findings indicate the need for training programs about HIV stigma issues for healthcare professionals. There is also a need to disseminate HIV information and to improve HIV stigma knowledge among families and communities.
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Krishnaratne S, Bond V, Stangl A, Pliakas T, Mathema H, Lilleston P, Hoddinott G, Bock P, Ayles H, Fidler S, Hargreaves JR. Stigma and Judgment Toward People Living with HIV and Key Population Groups Among Three Cadres of Health Workers in South Africa and Zambia: Analysis of Data from the HPTN 071 (PopART) Trial. AIDS Patient Care STDS 2020; 34:38-50. [PMID: 31944852 DOI: 10.1089/apc.2019.0131] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Stigma and judgment by health workers toward people living with HIV (PLHIV) and key populations can undermine the uptake of HIV services. In 2014, we recruited health workers delivering HIV services from 21 urban communities in South Africa and Zambia participating in the first year of the HPTN 071 (PopART) cluster-randomized trial. We analyzed self-reported levels of stigma and judgment toward (1) PLHIV, (2) women who sell sex, (3) men who have sex with men (MSM), and (4) young women who become pregnant before marriage. Using logistic regression, we compared responses between three health worker cadres and explored risk factors for stigmatizing attitudes. Highest levels of stigma and judgment were in relation to women who sell sex and MSM, especially in Zambia. Heath workers did not generally think that clients should be denied services, although this was reported slightly more commonly by community health workers. Higher education levels were associated with lower judgmental beliefs, whereas higher perceptions of coworker stigmatizing behaviors toward PLHIV and each key population were associated with holding judgmental beliefs. Training experience was not associated with judgmental attitudes for any of the key populations. Our findings confirm a high prevalence of judgmental attitudes toward key population groups but lower levels in relation to PLHIV, among all cadres of health workers in both countries. Planning and implementing targeted stigma reduction interventions within health settings are critical to meet the needs of vulnerable populations that face more stigmatizing attitudes from health workers.
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Affiliation(s)
- Shari Krishnaratne
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Virginia Bond
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, The School of Medicine, University of Zambia, Lusaka, Zambia
| | - Anne Stangl
- International Centre for Research on Women, Washington, District of Columbia
| | - Triantafyllos Pliakas
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hlengani Mathema
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Pamela Lilleston
- International Centre for Research on Women, Washington, District of Columbia
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Helen Ayles
- Zambart, The School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, United Kingdom
| | - James R. Hargreaves
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Goshin LS, Sissoko DRG, Stringer KL, Sufrin C, Byrnes L. Stigma and US Nurses' Intentions to Provide the Standard of Maternal Care to Incarcerated Women, 2017. Am J Public Health 2020; 110:S93-S99. [PMID: 31967890 PMCID: PMC6987942 DOI: 10.2105/ajph.2019.305408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To examine relationships among actionable drivers and facilitators of stigma and nurses' intentions to provide the standard of maternal care recommended by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) for incarcerated women.Methods. We conducted a Web-based survey of perinatal nurses in the United States (n = 665; participation rate 98.0%; completion rate 95.3%) in July through September 2017. We used multivariable logistic regression to predict higher than median intentions to provide the standard of care.Results. Lower stigmatizing individual attitudes and institutional norms and higher perceived autonomy when caring for an incarcerated woman were significantly associated with higher care intentions. Knowledge of the AWHONN position statement on the standard of care or their own state's shackling laws was not associated with higher care intentions.Conclusions. We documented significant associations among actionable drivers and facilitators of stigma and the intentions of a key health care provider group to deliver the standard of maternal care to incarcerated women. Individual- and institutional-level stigma-reduction interventions may increase the quality of maternal care and improve perinatal outcomes for women who give birth while incarcerated.
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Affiliation(s)
- Lorie S Goshin
- Lorie S. Goshin, D. R. Gina Sissoko, and Lorraine Byrnes are with the Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York. Kristi L. Stringer is with the Social Intervention Group, Columbia University School of Social Work, Columbia University, New York, NY. Carolyn Sufrin is with the Department of Gynecology and Obstetrics and the Department of Health, Behavior and Society, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D R Gina Sissoko
- Lorie S. Goshin, D. R. Gina Sissoko, and Lorraine Byrnes are with the Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York. Kristi L. Stringer is with the Social Intervention Group, Columbia University School of Social Work, Columbia University, New York, NY. Carolyn Sufrin is with the Department of Gynecology and Obstetrics and the Department of Health, Behavior and Society, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kristi L Stringer
- Lorie S. Goshin, D. R. Gina Sissoko, and Lorraine Byrnes are with the Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York. Kristi L. Stringer is with the Social Intervention Group, Columbia University School of Social Work, Columbia University, New York, NY. Carolyn Sufrin is with the Department of Gynecology and Obstetrics and the Department of Health, Behavior and Society, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carolyn Sufrin
- Lorie S. Goshin, D. R. Gina Sissoko, and Lorraine Byrnes are with the Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York. Kristi L. Stringer is with the Social Intervention Group, Columbia University School of Social Work, Columbia University, New York, NY. Carolyn Sufrin is with the Department of Gynecology and Obstetrics and the Department of Health, Behavior and Society, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lorraine Byrnes
- Lorie S. Goshin, D. R. Gina Sissoko, and Lorraine Byrnes are with the Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York. Kristi L. Stringer is with the Social Intervention Group, Columbia University School of Social Work, Columbia University, New York, NY. Carolyn Sufrin is with the Department of Gynecology and Obstetrics and the Department of Health, Behavior and Society, Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
HIV stigma is a harmful social phenomenon present in United States (US)-based health care settings. This study assessed the efficacy of a participatory PhotoVoice-informed stigma reduction training program focusing on people living with HIV (PLWH) and targeting health care workers. Seventy-three (N = 73) participants were assessed at baseline (T1), within approximately a week of the training (T2), and at a 3-month follow-up (T3) regarding their HIV/AIDS knowledge, attitudes towards PLWH, and observations of enacted HIV stigma. Findings indicated that the training increased knowledge and improved attitudes (β = 0.56, p < 0.01; β = 0.58, p < 0.01, respectively) at T2, but these effects diminished at T3 (β = - 0.03, p > 0.05; β = - 0.29, p > 0.05, respectively). The training did not, however, have an impact on observations of enacted stigma at T2 (β = 0.10, p > 0.05) or at T3 (β = 0.02, p > 0.05). Additional participatory stigma reduction programs that involve diverse groups of health care workers, offer salient study incentives, include time-saving training methods, and comprise a variety of stigma measures, may be particularly beneficial.
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Hartog K, Hubbard CD, Krouwer AF, Thornicroft G, Kohrt BA, Jordans MJD. Stigma reduction interventions for children and adolescents in low- and middle-income countries: Systematic review of intervention strategies. Soc Sci Med 2019; 246:112749. [PMID: 31978636 DOI: 10.1016/j.socscimed.2019.112749] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022]
Abstract
Stigmatisation and discrimination are common worldwide, and have profound negative impacts on health and quality of life. Research, albeit limited, has focused predominantly on adults. There is a paucity of literature about stigma reduction strategies concerning children and adolescents, with evidence especially sparse for low- and middle-income countries (LMIC). This systematic review synthesised child-focused stigma reduction strategies in LMIC, and compared these to adult-focused interventions. Relevant publications were systematically searched in July and August 2018 in the following databases; Cochrane, Embase, Global Health, HMIC, Medline, PsycINFO, PubMed and WorldWideScience.org, and through Google Custom Search. Included studies and identified reviews were cross-referenced. Three categories of search terms were used: (i) stigma, (ii) intervention, and (iii) LMIC settings. Data on study design, participants and intervention details including strategies and implementation factors were extracted. Within 61 unique publications describing 79 interventions, utilising 14 unique stigma reduction strategies, 14 papers discussed 21 interventions and 10 unique strategies involving children. Most studies targeted HIV/AIDS (50% for children, 38% for adults) or mental illness (14% vs 34%) stigma. Community education (47%), individual empowerment (15%) and social contact (12%) were most employed in child-focused interventions. Most interventions were implemented at one socio-ecological level; child-focused interventions mostly employed community-level strategies (88%). Intervention duration was mostly short; between half a day and a week. Printed or movie-based material was key to deliver child-focused interventions (37%), while professionals most commonly implemented adult-focused interventions (53%). Ten unique, child-focused strategies were all evaluated positively, using a diverse set of scales. Children and adolescents are under-represented in stigma reduction in LMIC. More stigma reduction interventions in LMIC, addressing a wider variety of stigmas, with children as direct and indirect target group, are needed. This systematic review is registered under International Prospective Register of Systematic Reviews PROSPERO, reference number #CRD42018094700.
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Affiliation(s)
- Kim Hartog
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Postbus 15718, 1001, NE, Amsterdam, the Netherlands.
| | - Carly D Hubbard
- London School of Hygiene and Tropical Medicine, Keppel St., Bloomsbury, London, WC1E, 7HT, United Kingdom.
| | - Angelica F Krouwer
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands.
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute for Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, United Kingdom.
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA.
| | - Mark J D Jordans
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Postbus 15718, 1001, NE, Amsterdam, the Netherlands.
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Ikeda DJ, Nyblade L, Srithanaviboonchai K, Agins BD. A quality improvement approach to the reduction of HIV-related stigma and discrimination in healthcare settings. BMJ Glob Health 2019; 4:e001587. [PMID: 31297246 PMCID: PMC6590995 DOI: 10.1136/bmjgh-2019-001587] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/16/2019] [Accepted: 05/25/2019] [Indexed: 01/20/2023] Open
Abstract
HIV-related stigma and discrimination (S&D) in healthcare settings represents a potent barrier to achieving global aims to end the HIV epidemic, particularly in Southeast Asia (Cambodia, Lao People’s Democratic Republic, Thailand and Vietnam). Evidence-based approaches for measuring and reducing S&D in healthcare settings exist, but their incorporation into routine practice remains limited, in part due to a lack of attention to how unique organisational practices—beyond the knowledge and attitudes of individuals—may abet and reinforce S&D. Application of a quality improvement (QI) approach in which facilities leverage routine measurement of S&D among healthcare workers and people living with HIV, team-based learning, root cause analysis, and tests of change offers a novel means through which to address S&D in local contexts and develop interventions to address individual-level and organisation-level drivers of S&D. To support the adoption of a QI approach to S&D reduction, the Southeast Asia Stigma Reduction QI Learning Network was launched with Ministries of Health from Cambodia, Lao PDR, Thailand and Vietnam, to co-develop strategies for implementing QI activities in participating facilities. Since the inception of Network activities in 2017, Ministry-led QI activities to address S&D have been implemented in 83 facilities and 29 provinces across participating countries. Moreover, 27 strategies and interventions have been tested to date and are being evaluated for scale up by participating facilities, spanning multiple drivers and organisational domains. Lessons learned through Network activities offer national-level and facility-level HIV programmes best practices for implementing a QI approach to S&D reduction.
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Affiliation(s)
- Daniel J Ikeda
- HEALTHQUAL, Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Laura Nyblade
- Research Triangle Institute, Washington, District of Columbia, USA
| | - Kriengkrai Srithanaviboonchai
- Dept of Community Medicine, Faculty of Medicine, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Bruce D Agins
- HEALTHQUAL, Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA.,Department of Epidemiology and BIostatistics, University of California San Francisco, San Francisco, California, USA
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Nyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, Lean RM, Mitchell EMH, Nelson LRE, Sapag JC, Siraprapasiri T, Turan J, Wouters E. Stigma in health facilities: why it matters and how we can change it. BMC Med 2019; 17:25. [PMID: 30764806 PMCID: PMC6376713 DOI: 10.1186/s12916-019-1256-2] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.
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Affiliation(s)
- Laura Nyblade
- RTI International, 701 13th ST NW, Suite 750, Washington, DC, USA
| | - Melissa A. Stockton
- Epidemiology Department, UNC Gillings School of Global Public Health, 2103 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599 USA
| | - Kayla Giger
- RTI International, 701 13th ST NW, Suite 750, Washington, DC, USA
| | - Virginia Bond
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, Zambart, P.O. Box 50697, Lusaka, Zambia
| | - Maria L. Ekstrand
- Division of Prevention Science, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549 USA
- St John’s Research Institute, St John’s National Academy of Health Sciences, Bengaluru, India
| | - Roger Mc Lean
- Health Economics Unit, Centre for Health Economics, Faculty of Social Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Ellen M. H. Mitchell
- International Institute for Social Studies, Erasmus University, Kortenaerkade 12, 2518 AX The Hague, Netherlands
| | - La Ron E. Nelson
- University of Rochester School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642 USA
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, M5T 1B8 Canada
| | - Jaime C. Sapag
- Departments of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Office of Transformative Global Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Ontario, Canada
| | - Taweesap Siraprapasiri
- Department of Disease Control, Ministry of Public Health of the Government of Thailand, Tivanond Road, Nonthaburi, 11000 Thailand
| | - Janet Turan
- Department of Health Care Organization and Policy, Maternal and Child Health Concentration, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
- Behavioral and Community Sciences Core, UAB Center for AIDS Research (CFAR), Birmingham, USA
| | - Edwin Wouters
- Centre for Longitudinal & Life Course Studies, University of Antwerp, Sint-Jacobstraat 2, B-2000 Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, PO Box 399, Bloemfontein, 9300 South Africa
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"Being seen" at the clinic: Zambian and South African health worker reflections on the relationship between health facility spatial organisation and items and HIV stigma in 21 health facilities, the HPTN 071 (PopART) study. Health Place 2018; 55:87-99. [PMID: 30528346 PMCID: PMC6358039 DOI: 10.1016/j.healthplace.2018.11.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022]
Abstract
Health workers in 21 government health facilities in Zambia and South Africa linked spatial organisation of HIV services and material items signifying HIV-status (for example, coloured client cards) to the risk of People Living with HIV (PLHIV) ‘being seen’ or identified by others. Demarcated HIV services, distinctive client flow and associated-items were considered especially distinguishing. Strategies to circumvent any resulting stigma mostly involved PLHIV avoiding and/or reducing contact with services and health workers reducing visibility of PLHIV through alterations to structures, items and systems. HIV spatial organisation and item adjustments, enacting PLHIV-friendly policies and wider stigma reduction initiatives could combined reduce risks of identification and enhance the privacy of health facility space and diminish stigma. Spatial dimensions of stigma are linked to accessing HIV treatment in clinics.
Distinct demarcation and client flow trigger visibility of People Living with HIV.
Approaching HIV services carries a social risk of unwanted disclosure for PLHIV.
Thoughtful spatial organisation and labelling reduces the chance of “being seen”.
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Idemudia ES, Olasupo MO, Modibo MW. Stigma and chronic illness: A comparative study of people living with HIV and/or AIDS and people living with hypertension in Limpopo Province, South Africa. Curationis 2018; 41:e1-e5. [PMID: 30456983 PMCID: PMC6244151 DOI: 10.4102/curationis.v41i1.1879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 01/15/2023] Open
Abstract
Background Stigma among people with chronic illnesses exists, preventing many sufferers from presenting for treatment especially in South Africa. Objectives This study compared stigma experiences of people living with human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV and/or AIDS) (PLWHA) and people living with hypertension (PLWHPT) in Limpopo Province of South Africa. Method Using a cross-sectional design, 600 participants (300 PLWHA with mean age of 31 years, standard deviation of 8.2; and 300 PLWHPT with age of 55 years, standard deviation of 8.1) were purposefully sampled at HIV and/or AIDS and hypertension outpatient clinics. The perceived stigma of AIDS scale was used to assess stigma in the HIV and/or AIDS sample while the adapted version was used to assess stigma in PLWHPT. Data were analysed using independent t-test. Results Results indicated that PLWHA experienced significantly higher enacted stigma (t(598) = −11.79, p < 0.001) as compared to PLWHPT. However, PLWHPT experienced significantly higher internalised stigma (t(598) = 37.56, p < 0.001) and perceived stigma (t(598) = 41.71, p < 0.001) than PLWHA. Conclusion Stigma among people with chronic illnesses is existent. The stigma type is, however, dependent on the nature of the illness. Stigma reduction interventions among these populations are indicated.
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Affiliation(s)
- Erhabor S Idemudia
- Population and Health Research Entity, Faculty of Humanities, North-West University.
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Ekstrand ML, Bharat S, Srinivasan K. HIV stigma is a barrier to achieving 90-90-90 in India. Lancet HIV 2018; 5:e543-e545. [PMID: 30319116 DOI: 10.1016/s2352-3018(18)30246-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Maria L Ekstrand
- University of California San Francisco, San Francisco, CA 94158, USA; St. John's Research Institute, Bangalore, India.
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