Stigma and Discrimination towards People Living with HIV in the Context of Families, Communities, and Healthcare Settings: A Qualitative Study in Indonesia

Factors associated with internalized HIV-related stigma among people living with HIV in Thailand

Internalized HIV-related stigma (IHS) among people living with HIV (PLHIV) has been documented as one of the factors contributing to the ongoing AIDS epidemic. The purpose of this study, which was conducted from September 2021 to January 2022, was to measure prevalence and identify factors associated with IHS among research participants who were living with HIV recruited from a research clinic in Chiang Mai, Northern Thailand. Participants were considered to have IHS if they agreed to at least one of the 8 items of the newly developed Thai Internalized HIV-related Stigma Scale (Thai-IHSS). Of the 104 participants, 65.4% were female. The median age was 51.5 years and the duration of known HIV infection was 19.0 years. Fifty-three percent of the participants had IHS as defined by the study. Reduced probability of having IHS was independently associated with certain levels of education (middle or high school education compared with no or primary school) (AOR = 0.30; 95% CI: 0.12-0.77) and increased mental health-related quality of life (AOR = 0.39; 95% CI: 0.18-0.86). The prevalence of IHS among PLHIV in Chiang Mai was high. These findings highlight the requirement for comprehensive mental health care programs for PLHIV to improve their quality of life.

Intimate partner violence and factors influencing HIV status disclosure among women living with HIV in Indonesia: a cross-sectional study

The disclosure of HIV status poses challenges, and women living with HIV often face intimate partner violence as a result of revealing their HIV status. This study aims to investigate the prevalence of intimate partner violence and HIV status disclosure among women living with HIV in Indonesia, as well as the factors associated with disclosure. A total of 283 women with HIV participated in an online survey, and descriptive and logistic regression analyses were performed. The findings revealed that women reported experiencing physical (9.54%), sexual (6.01%), mental (23.67%), and economic (14.49%) abuse. HIV status disclosure varied among different individuals, with higher rates observed for partners (71.2%), other family members (65.02%), close friends (37.10%), and lower rates for health workers (1.77%). Factors such as employment status and partner's HIV status influenced disclosure to partners, while the duration of knowing one's HIV status, experiences of intimate partner violence, and perceived barriers influenced disclosure to both family and non-family members. To mitigate the negative consequences of HIV status disclosure, targeted health promotion efforts should prioritize partners, family members, and non-family members, focusing on enhancing knowledge and awareness about HIV, including the impact of violence.

Bridge Nodes Linking Depression and Medication Taking Self-Efficacy Dimensions Among Persons With HIV: A Secondary Data Analysis

Depression and low medication taking self-efficacy are among the most important mechanisms contributing to poor adherence to treatment and care for persons with HIV (PWH). While the overall negative relationship between depression and medication taking self-efficacy has been well established, little is known on the precise pathways linking depression and medication taking self-efficacy. Thus, it is critical to identify a specific item of depression and medication taking self-efficacy that derives the overall negative relationship. The current study is a secondary data analysis using the baseline data from a randomized controlled trial that aims to support PWH to self-manage antiretroviral therapy regimens via mHealth technology and community health workers to monitor their adherence using a self-management app. A total of 282 participants were included. The machine-learning based network analysis was conducted to explore the structure of the depression and medication taking self-efficacy network and to identify bridge nodes between depression and medication taking self-efficacy. Our study identified difficulty concentrating on things and confidence to stick to treatment schedule when not feeling well are important bridge nodes connecting the network of depression and medication taking self-efficacy. Future studies should focus on developing interventions that would target the bridge pathway and examine their effectiveness in reducing depression and increasing medication taking self-efficacy.

Client-reported challenges and opportunities for improved antiretroviral therapy services uptake at a secondary health facility in Ghana

Antiretroviral therapy (ART) regimens in African countries, including Ghana, are often faced with the challenge of treatment default. To maximize ART utilization and efficiency among people living with HIV (PLHIV), it is pertinent to ensure that ART-related challenges that clients encounter are identified and addressed holistically. A phenomenological qualitative study of thirty participants recruited through the purposive sampling technique was conducted using in-depth interviews from June to July 2021. Independent coding was done using Atlas ti. Sub-themes were developed from the codes, using the most expressive phrases, and grouped under two broad themes, challenges, and opportunities to maximise ART uptake. Ten different challenges, grouped into the health system and individual constraints were reported. Health system constraints included stigmatisation and discrimination by healthcare workers, queuing outside while waiting to be served, long waiting periods, non-communication of laboratory test results to clients, lack of proper education on side effects associated with ART, and language barrier. Individual constraints included financial constraints, perceived non-improvement in health outcomes, food insecurity, and forgetfulness. Opportunities identified for improved ART uptake were assuring ART clients of improved health outcomes, leveraging the good rapport between ART clients and healthcare providers, leveraging the better counselling services offered to PLHIV at the ART clinic, provision of varied ART treatment regimens to clients, routine communication of laboratory test results to clients, and leveraging clients' satisfaction with ART services at ART clinic. We recommend health system reforms targeting healthcare service delivery to PLHIV to encourage linkage, continuity, and retention in care and augmenting ART regimes with financial and nutritional support while encouraging status disclosure to a trusted family member.

A qualitative exploration of the impact of the COVID-19 pandemic on gender-based violence against women living with HIV or tuberculosis in Timor Leste

Violence against women or gender-based violence (GBV) is a significant public health issue facing women and girls in different settings. It is reported to have worsened globally during the COVID-19 pandemic. Despite the impact of the COVID-19 pandemic on increased violence against women in general, which has been reported in many settings globally, there is a paucity of evidence of its impact on violence against highly vulnerable women living with HIV or tuberculosis (TB). Using a qualitative design, this study aimed to explore the views and experiences of women living with HIV (n = 19) or TB (n = 23) in Timor Leste regarding the GBV they faced during the COVID-19 pandemic. They were recruited using the snowballing sampling technique. Data were collected using one-on-one, in-depth interviews and focus group discussions. The five steps of qualitative data analysis suggested in Ritchie and Spencer's analysis framework were employed to guide the analysis of the findings. Findings indicated that women in this study experienced intensified physical, verbal, sexual and psychological violence by their partners, spouses, in-laws, and parents or other family members during the COVID-19 pandemic. Several prominent risk factors that worsened violence against women during the pandemic were (i) HIV or TB-positive status, (ii) traditional gender roles or responsibilities and expectations, (iii) economic and financial difficulties reflected in the loss of jobs and incomes due to the pandemic, and (iv) individual factors such as jealousy and increased alcohol drinking developed during the lockdowns. The women's experience of GBV during the pandemic also led to various negative psychological impacts. The findings underscore the urgent need for multifaceted interventions to address GBV, which should encompass challenging traditional gender norms, addressing economic inequalities, and targeting individual-level risk factors. The findings also indicate the need for the development of robust monitoring and evaluation systems to assess the effectiveness of policies and interventions addressing GBV where the results can inform future improvement. The findings also indicate the need to include GBV in the protocol or guidelines for HIV and TB management. Future large-scale quantitative studies to capture the magnitude and specific drivers of GBV against women living with HIV and TB during the pandemic are recommended.

Sexual health behaviours and partner notification practices related to sexually transmitted infections in young adults in Ireland

BACKGROUND

Sexually transmitted infections (STIs) impose burdens on individuals and communities, while their prevalence in young people has risen continually in recent years. Partner notification is an effective public health strategy which can limit STI transmission.

AIMS

This study aimed to explore young adults' sexual health behaviours, attitudes toward STI testing, and feelings toward visiting a sexual health clinic. It also aimed to investigate preferences for partner notification and the role of self-efficacy in people's intentions to notify a partner for STIs including the human immunodeficiency virus (HIV).

METHODS

A quantitative, cross-sectional design was applied. Participants were 400 adults aged 18-34 years (M = 23 years; SD = 4.27), recruited from the Republic of Ireland.

RESULTS

Over half of the participants reported never being tested for STIs. These young people placed less importance on undergoing regular STI testing and testing after unprotected sex than their counterparts who had been tested for STIs. Self-efficacy was significantly associated with intentions to notify partner(s) for STIs including HIV.

CONCLUSIONS

As STIs are becoming increasingly prevalent in young adults, it is important to gain a deeper understanding of the interventions used to break the transmission chain and how different beliefs and attitudes may affect them. Self-efficacy was a key component in PN intentions, suggesting that the belief in someone's ability or skillset to perform a sexual health behaviour is positively related to their intention to perform the behaviour.

Yasin M, Mat Nasir N, Mohamad M. The association between HIV-related stigma, HIV knowledge and HIV late presenters among people living with HIV (PLHIV) attending public primary care clinic settings in Selangor

INTRODUCTION

HIV late presenters were defined as individuals presenting with a CD4 count below 350 cells/μL or with an AIDS-defining event, according to the European Late Presenter Consensus working group. Early diagnosis and treatment of HIV have proven beneficial for people living with HIV (PLHIV), reducing the burden on healthcare systems, and contributing to ending the HIV/AIDS epidemic. However, in Malaysia, over 50% of newly diagnosed HIV patients present late, leading to increased morbidity and premature mortality. This study aims to determine the prevalence of late HIV presenters and its association with HIV-related stigma and HIV knowledge among PLHIV attending public primary care clinics in Selangor.

METHODS

A cross-sectional study was conducted at selected public health clinics in Selangor, involving PLHIV aged 18 years and older, who were diagnosed since 2019. HIV-related stigma was measured using the Malay version of Berger's HIV Stigma Scale, and HIV knowledge was assessed using the Malay version of Brief HIV-KQ-18. Univariate and multivariate logistic regression analyses were performed to identify factors associated with late HIV presentation.

RESULTS

A total of 400 participants were included in the study, with 60.0% (n = 240, 95% CI: 55.0-65.0) classified as late presenters. The participants had a mean age of 30.29 (±7.77) years. The risk factors for late presenters were high levels of HIV-related stigma (aOR = 1.049, 95% CI: 1.034-1.063, p-value <0.001), low levels of HIV knowledge (aOR = 0.709, 95% CI: 0.646-0.778, p-value <0.001), tertiary education background (aOR = 15.962, 95% CI: 1.898-134.235, p-value = 0.011), and being single (aOR = 3.582, 95% CI: 1.393-9.208, p-value = 0.008).

CONCLUSION

This study highlights the association between high levels of HIV-related stigma, low levels of HIV knowledge, and late HIV presentation. Interventions targeting stigma reduction and HIV education can promote early testing and prompt access to care, improving health outcomes for PLHIV.

Capturing the HIV-related social exclusion practices experienced by key populations through photovoice: an interpretative phenomenological study

BACKGROUND

Key populations are defined as groups that are susceptible to HIV, including Men Sex with Men (MSM), Transgender (TG), Persons who Inject Drug (PID), and Female Sex Worker (FSW). These key populations groups are among the fastest-growing populations in Indonesia. These vulnerable groups are ostracized by society and health services, which makes it difficult to get treatment. This project was carried out to investigate the different experiences and perspectives of these key populations in facing and addressing social and spiritual exclusion.

METHODS

A qualitative phenomenological study using photovoice was carried out from July to December 2022. Key populations comprising MSM, TG, PID, and FSW were recruited from community-based peer groups in West Bandung Regency using snowball sampling. This was followed by the Photovoice stages, from workshops to focus group discussions and interviews with audio recordings. Furthermore, thematic data analysis was carried out by interpretative participant narratives and photographs supported by Atlas.ti software.

RESULT

Eighteen participants comprising four MSM, five TG, four PIDs, and five FSWs participated in this research. Among these eighteen participants, six were HIV-negative, including 3 PIDs and 3 FSWs, while the remaining were positive. The analysis of the collected data identified four main themes: 1) limited access like unequal treatment, disadvantage, and harassment, 2) social and spiritual impact, 3) coping mechanisms, and 4) self-reflection through photovoice. These results showed that social exclusion occurred in an environment where community values, beliefs, and norms dehumanised these key populations, and where removal of support and care was prominent. Despite these challenges, participant resilience was evidenced by using internal resources and peer support as coping mechanisms. The participants considered photovoice as a tool to foster self-confidence and self-awareness through a reflective process.

CONCLUSIONS

The findings of this study highlight the emphasis on participants' openness in sharing their experiences, which can build empathy and promote a more inclusive community in HIV prevention efforts. This research findings can be used to inform HIV policy and practice and inclusion of these key populations in the community. We advocate making the photovoice efforts accessible to a wider audience through exhibitions and various media.

The Effect of Stigma and Social Networks on Role Expectations among African Immigrants Living with HIV

This paper examines how African immigrants living with HIV negotiate and reconstruct their productive (i.e., educational and career opportunities), sexual, and reproductive identities. We used data from a mixed-methods study to explore how stigma and social networks in which participants were embedded shaped how they understood and negotiated their role expectations and responsibilities. Participants revealed how HIV not only changed their identities and limited their sex life, partner choices, and fundamental decisions about fertility and reproduction, but also presented them with the opportunity to reinvent/reshape their lives. Our analysis revealed that the cultural discourses about illness and HIV in participant's countries of origin, the acculturative and migratory stressors, and the competing influences and expectations from family and friends in their home and host countries shape their illness experience, and how they adjust to life with HIV. This paper builds on sociological understanding of illness experience as a social construct that shapes the ill person's identity, role, and function in society. Specifically, the paper contributes to discourses on how (i) participants' social location and identity (as transnational migrants adjusting to acculturative stressors associated with resettlement into a new country), (ii) cultural discourses about illness and HIV in their countries of origin, and (iii) embeddedness in transnational social networks influence health outcomes, including lived experiences with chronic illnesses and stigmatized conditions such as HIV.

Specialty Care Referral for Underrepresented Minorities Living with HIV in the United States: Experiences, Barriers, and Facilitators

The increased incidence of chronic diseases among people with HIV (PWH) is poised to increase the need for specialty care outside of HIV treatment settings. To reduce outcome disparities for HIV-associated comorbidities in the United States, it is critical to optimize access to and the quality of specialty care for underrepresented racial and ethnic minority (URM) individuals with HIV. We explored the experiences of URM individuals with HIV and other comorbidities in the specialty care setting during their initial and follow-up appointments. We conducted qualitative interviews with participants at three large academic medical centers in the United States with comprehensive health care delivery systems between November 2019 and March 2020. The data were analyzed using applied thematic analysis. A total of 27 URM individuals with HIV were interviewed. The majority were Black or African American and were referred to cardiology specialty care. Most of the participants had positive experiences in the specialty care setting. Facilitators of the referral process included their motivation to stay healthy, referral assistance from HIV providers, access to reliable transportation, and proximity to the specialty care health center. Few participants faced individual, interpersonal, and structural barriers, including the perception of individual and facility stigma toward PWH, a lack of transportation, and a lack of rapport with providers. Future case studies are needed for those URM individuals with HIV who face barriers and negative experiences. Interventions that involve PWH and health care providers in specialty care settings with a focus on individual- and structural-level stigma can support the optimal use of specialty care.

Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review

The aim of the present study was to explore the stigma and fear of getting sick in health professionals who treat people living with HIV. An exploratory systematic review was conducted. The search was limited to the presence of stigma and fear of getting sick on the part of healthcare workers who treat people living with HIV, documented by the health workers or patients themselves. No language restriction was made and systematic reviews, comments or communications were excluded. The sources of information were Scopus, PubMed/MEDLINE, Science Direct, and the CENTRAL Registry, from the last 5 years. The quality of the evidence was assessed with an adapted tool and the synthesis of the results was carried out using a narrative synthesis approach. Twenty-three articles were included, which related structural stigma, stigma by health professionals and fear of getting sick. Among the findings, data stood out such as that more than 50% of patients reported having experienced discrimination due to HIV and even accumulated stigma for other additional causes. Stigma enacted in healthcare settings was related to suboptimal adherence to treatment (OR 1.38; 95% CI: 1.03-1.84; p=0.028). Stigma is a structural barrier in the care of people living with HIV and generates a psychological, physical, and social health impact for these people. Some limitations of the present study are that, despite searching the major databases, important manuscripts may have been left out. Additionally, there are regions that are not represented in this review because no manuscripts from those areas were found.

An exploration of multi-level factors affecting routine linkage to HIV care in Zambia's PEPFAR-supported treatment program in the treat all era

Multiple steps from HIV diagnosis to treatment initiation and confirmed engagement with the health system are required for people living with HIV to establish full linkage to care in the modern treat all era. We undertook a qualitative study to gain an in-depth understanding of the impeding and enabling factors at each step of this linkage pathway. In-depth interviews were conducted with fifty-eight people living with HIV recruited from ten routine HIV care settings supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) in Lusaka, Zambia. Using a semi-structured interview guide informed by an established conceptual framework for linkage to care, questions explored the reasons behind late, missed, and early linkage into HIV treatment, as well as factors influencing the decision to silently transfer to a different clinic after an HIV diagnosis. We identified previously established and intersecting barriers of internal and external HIV-related stigma, concerns about ART side effects, substance use, uncertainties for the future, and a perceived lack of partner and social support that impeded linkage to care at every step of the linkage pathway. However, we also uncovered newer themes specific to the current test and treat era related to the rapidity of ART initiation and insufficient patient-centered post-test counseling that appeared to exacerbate these well-known barriers, including callous health workers and limited time to process a new HIV diagnosis before treatment. Long travel distance to the clinic where they were diagnosed was the most common reason for silently transferring to another clinic for treatment. On the other hand, individual resilience, quality counseling, patient-centered health workers, and a supportive and empathetic social network mitigated these barriers. These findings highlight potential areas for strengthening linkage to care and addressing early treatment interruption and silent transfer in the test and treat era in Zambia.

Empowering people living with HIV (PLHIV): unveiling care gaps and identifying opportunities for improving care for PLHIV in Singapore and Hong Kong

INTRODUCTION

This study explored the behaviours of people living with HIV in Singapore and Hong Kong in terms of achieving and maintaining their physical and psychological wellbeing in relation to HIV, to identify the challenges and support needed in HIV care.

METHODS

This qualitative study involved 90-minute interviews among Singapore and Hong Kong people living with HIV aged ≥18 years to explore health-related quality of life perceptions and gaps in patient empowerment in HIV care during February-May 2022. The COM-B (C: Capability; O: Opportunity; M: Motivation; B: Behaviour) framework was used during data analysis to identify behaviour facilitators and barriers for people living with HIV to achieve and maintain their wellbeing. Detailed accounts of respondents' experience of living with and managing HIV, that is what worked well, unmet needs and perceived significance of wellbeing indicators, were analysed qualitatively via a combination of inductive content and deductive frameworks.

RESULTS

A total of 30 and 28 respondents were recruited from Singapore (SG) and Hong Kong (HK), respectively. Most respondents were aged 20-49 years (SG: 83.3%; HK: 64.3%), males (SG: 96.7%; HK: 92.9%), men who have sex with men (SG: 93.3%; HK: 71.4%), had university or higher education (SG: 73.3%; HK: 50.0%) and were fully employed (SG: 73.3%; HK: 57.1%). In both Singapore and Hong Kong, physical health was considered a key focus of overall wellbeing, albeit attention to long-term health associated with cardiovascular and renal health was less salient. The impact of symptoms, side effects of treatment, mood and sleep were among the top wellbeing indicators of importance. Respondents felt that insufficient information was provided by physicians, citing consultation time and resource constraints impeding further expression of concerns to their physicians during consultation. Respondents prioritized functional wellness and delegated psychosocial health to supportive care professionals, patient groups, families and/or friends.

CONCLUSIONS

There is a need in Singapore and Hong Kong to empower people living with HIV to establish better communications with their physicians and be more involved in their treatment journey and equally prioritize their psychosocial wellbeing.

Psychometric properties of stigma and discrimination measurement tools for persons living with HIV: a systematic review using the COSMIN methodology

BACKGROUND

The development of antiretroviral therapy broadly extends the life expectancy of persons living with HIV (PLHIV). However, stigma and discrimination are still great threat to these individuals and the world's public health care system. Accurate and reproducible measures are prerequisites for robust results. Therefore, it is essential to choose an acceptable measure with satisfactory psychometric properties to assess stigma and discrimination. There has been no systematic review of different stigma and discrimination tools in the field of HIV care. Researchers and clinical practitioners do not have a solid reference for selecting stigma and discrimination measurement tools.

METHODS

We systematically searched English and Chinese databases, including PubMed, EMBASE, CINAHL, Web of Science, PsycINFO, ProQuest Dissertations and Theses, The Cochrane Library, CNKI,, and Wanfang, to obtain literature about stigma and discrimination measurement tools that have been developed and applied in the field of HIV. The search period was from 1st January, 1996 to 22nd November 2021. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline (2018 version) was applied to assess the risk of bias for each involved study and summarize the psychometric properties of each tool. The modified version of the Grading of Recommendations Assessment, Development, and, Evaluation (GRADE) method was used to grade the evidence and develop recommendations.

RESULTS

We included 45 studies and 19 PROMs for HIV/AIDS-related stigma and discrimination among PLHIV. All studies had sufficient methodological quality in content validity, structural validity, internal consistency, and the hypothesis testing of structural validity. Limited evidence was found for cross-cultural validity, stability, and criterion validity. No relevant evidence was found concerning measurement error and responsiveness. The Internalized AIDS-related Stigma Scale (IARSS), Internalized HIV Stigma Scale (IHSS), and Wright's HIV stigma scale (WHSS) are recommended for use.

CONCLUSIONS

This study recommends three PROMs for different stigma and discrimination scenarios, including IARSS for its good quality and convenience, IHSS for its broader range of items, higher sensitivity, and greater precision, and WHSS for its comprehensive and quick screening. Researchers should also consider the relevance and feasibility of the measurements before putting them into practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022308579.

Acceptability of a pilot motivational interviewing intervention at public health facilities to improve the HIV treatment cascade among people who inject drugs in Indonesia

BACKGROUND

HIV-positive people who inject drugs (PWID) experience challenges in initiating and adhering to antiretroviral treatment (ART). Counselling using motivational interviewing (MI) techniques may help them formulate individualised strategies, and execute actions to address these challenges collaboratively with their providers. We evaluated the acceptability of MI from a pilot implementation at three public health facilities in Indonesia.

METHODS

Adapting the acceptability constructs developed by Sekhon (2017) we assessed the acceptability to HIV-positive PWID clients (n = 12) and providers (n = 10) in four synthesised constructs: motivation (attributes that inspire engagement); cost consideration (sacrifices made to engage in MI); learned understanding (mechanism of action); and outcomes (ability to effect change with engagement). We included all providers and clients who completed ≥ 2 MI encounters. Qualitative analysis with an interpretive paradigm was used to extract and categorise themes by these constructs.

RESULTS

In motivation, clients valued the open communication style of MI, while providers appreciated its novelty in offering coherent structure with clear boundaries. In cost consideration, both groups faced a challenge in meeting MI encounters due to access or engagement in other health care areas. In learned understanding, clients understood that MI worked to identify problematic areas of life amenable to change to support long-term ART, with reconciliation in family life being the most targeted change. By contrast, providers preferred targeting tangible health outcomes to such behavioural proxies. In outcomes, clients were confident in their ability to develop behaviours to sustain ART uptakes, whereas providers doubted the outcome of MI on younger PWID or those with severe dependence.

CONCLUSIONS

There is broad acceptability of MI in motivating engagement for both actors. Relative to providers, clients were more acceptable in its mechanism and had greater confidence to perform behaviours conducive to ART engagement. Design innovations to improve the acceptability of MI for both actors are needed.

The lived experiences of HIV-positive women in rural Zimbabwe: A qualitative focus group study

BACKGROUND

 The study explored and described the meaning attached to the lived experiences of women living with human immunodeficiency virus (HIV) in the rural context of Zimbabwe. Stigma and discrimination negatively impact one's ability to perform the expected social roles, the quality of life, and the efforts to prevent the spread of HIV and acquired immunodeficiency syndrome (AIDS) and reduce HIV-related mortality. Thus, the study aims to understand the meaning attached to the lived experiences of HIV-positive women living in rural areas or villages of Matabeleland South province in Zimbabwe.

METHODS

 The study used a qualitative, descriptive, and exploratory design. Four focus group discussions were conducted with 24 HIV-positive rural women living in Matabeleland South province, Zimbabwe. An Interpretative Phenomenological Analysis (IPA) was adopted to explore and describe the meaning attached to the lived experiences of women living with HIV.

RESULTS

 Two interconnected themes were identified in the analysis with their sub-themes. These were: (1) struggle for social belonging, with subthemes - loss of social belonging and reduced access to community-based empowerment opportunities and (2) struggle for maintaining the quality of life with subthemes - lack of need-based community healthcare and food insecurity.

CONCLUSION

 Being a woman living with HIV in rural Zimbabwe means a perpetual struggle to maintain one's humanness and quality of life.Contribution: This study's results will support the efforts of the Zimbabwean government to improve the quality of life of HIV-positive women living in rural areas.

Association of coping mechanisms with medication adherence among young People living with HIV (PLHIV) in Klang Valley

Background

As young People Living with HIV (PLHIV) will need to take antiretroviral therapy (ART) for life, there is a need to understand their coping mechanisms in living with the disease. Lack of coping mechanisms leads to poor medication adherence and hospital follow-up, poor health outcomes and shortened life expectancy.

Objectives

This study aimed to determine the pattern of coping mechanisms in young PLHIV and its association with medication adherence.

Methods

This study was a cross-sectional study amongst young PLHIV patients (aged 20-39 years old) attending two HIV clinics in Klang Valley. Data was collected between February to August 2022. The pattern of coping strategies was assessed using the 28-item Brief Coping Orientation to Problems Experienced (COPE) questionnaire in English and Malay language, which was validated and found to have good internal consistency. Self-reported medication adherence was measured using the one-item Medical Outcomes Study (MOS) Specific Adherence Scale. Statistical analysis included descriptive statistics, single and multiple logistic regression.

Results

A total of 395 respondents were recruited for the study. The mean scores for each coping mechanism were: 1) problem-focused coping 2.98 (SD 0.62), 2) emotion-focused coping 2.40 (SD 0.48), 3) dysfunctional coping 1.84 (SD 0.44) and 4) religion/spirituality coping 3.07 (SD 0.97). The majority of the respondents (66.8%) were adherent to their ART. Respondents who had a longer duration of medication [OR:1.014 (95% CI: 1.002,1.026)] and those who adopted less religion/spirituality coping mechanisms [OR: 0.495 (95% CI:0.246, 0.997)] were found to be significantly associated with medication adherence.

Conclusion

This study revealed an overall medication adherence rate of 66.8%. Patients with longer ART duration and who adopted less religion or spirituality coping had better medication adherence. These study findings provide input into the design of intervention by clinicians and healthcare policy makers for young PLHIV in clinical practice.

Disclosure Concerns and the Correlation Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV Receiving Antiretroviral Therapy in Taiwan

Gay, bisexual, and other men who have sex with men (GBMSM) are associated with the widespread human immunodeficiency virus (HIV) transmission in Taiwan. Additionally, little is known about disclosure patterns and rates, as well as factors influencing disclosure, among GBMSM living with HIV in the country. HIV prevention for GBMSM is effective when HIV status is disclosed. For instance, GBMSM disclosing their HIV status can result in early pre-exposure prophylaxis with a serodiscordant partner. In this cross-sectional study of 200 GBMSM living with HIV conducted from June to November 2020, we assessed internalized homophobia (IHP Scale) and social support (Multidimensional Scale of Perceived Social Support), as well as self-reported disclosure and non-disclosure. Among the participants, 75.5% revealed their HIV status within 3 months of diagnosis. Younger age, occupation type, and number of sexual partners were some factors associated with disclosure. Those receiving more social support and who experienced less IHP were more likely to reveal their HIV status. On the contrary, older GBMSM and GBMSM living with HIV who worked in educational enterprises still experienced severe IHP. Policymakers and healthcare practitioners should be aware of the problems faced by GBMSM living with HIV and offer practical assistance to improve their mental health.

An adapted white-coat and warm-heart intervention on nurses' knowledge, general stigmatizing attitudes, and work avoidance behaviors towards HIV: a quasi-experimental study

OBJECTIVES

To determine the effect of an adapted white-coat and warm-heart intervention (AWWI) among nurses.

BACKGROUND

HIV discrimination among medical staff hinders progress in HIV prevention.

METHODS

A total of 779 nurses were randomized into intervention and control groups. The intervention group was provided with AWWI training. The control group did not receive AWWI training. HIV-related knowledge, attitudes, and behaviors of participants were assessed.

RESULTS

Participants in the intervention group had better HIV-related knowledge and less stigmatizing attitudes and work avoidance behavior levels than participants in the control group after the 1-, 3-, and 6-month interventions (P < .05). The main effects of group and time factors were highly significant in the intervention group. There were significant interaction effects in group and time factors.

CONCLUSIONS

AWWI effectively improved the level of HIV-related knowledge and reduced general stigmatizing attitudes and work avoidance behaviors among nurses based on self-reported data in a tertiary hospital in China during a 6-month period.

Overcoming Stigma: The Human Side of Monkeypox Virus

Monkeypox (Mpox) virus is a zoonotic disease that was recently declared a public health emergency of international concern (PHEIC) by the World Health Organization (WHO). Symptoms of Mpox include fever, headache, muscle pain, and a rash which starts on the face and spreads to the rest of the body. The stigma surrounding the Mpox virus has been one of the greatest challenges in dealing with the disease. People with Mpox have been often shunned by their communities, and many are afraid to seek medical care for fear of ostracism. For those affected by the virus, this stigma can significantly impact their mental health and quality of life. It is further fueled by misinformation and societal norms. Hence, a multifaceted approach that includes education, awareness campaigns, and community engagement is needed to overcome the stigma associated with Mpox. Effective communication strategies are critical to the dispelling of rumors and the reduction of fear. Interventional measures need to be shaped according to the needs of those affected.

Disclosure of HIV Status in Healthcare Settings: Practices and Considerations among Women Living with HIV/AIDS in Vietnam

OBJECTIVE

This study investigated women living with HIV/AIDS (WLHA)'s practices and decision-making regarding disclosure of HIV status in healthcare settings in Vietnam. Introduction: Disclosure of HIV status in healthcare settings is under-studied.

METHODS

We conducted in-depth interviews with 30 WLHA in Hanoi, Vietnam. Thematic analysis was conducted to investigate the patterns, considerations, and consequences of HIV disclosure. Results: Most participants chose a selective disclosure strategy based on the type of procedure and healthcare setting. They considered several factors: concerns about stigma/discrimination, risks of confidentiality breach, relevance to healthcare provision, and altruism towards protecting providers and other patients. Selective disclosure or non-disclosure often prevented participants from accessing comprehensive care. Conclusion: The study underscores the need to prepare WLHA to make informed decisions regarding disclosure and provide them with service navigations and support. It also highlights the necessity of reducing stigma and enhancing confidentiality protection to ensure safe disclosure in healthcare settings.

The relationship between HIV-related stigma and quality of life among HIV infected outpatients: A cross-sectional study in Vietnam

Background

The impact of stigma on individuals with HIV remains a significant challenge, causing feelings of worthlessness, shame, and emotional distress. This study aimed to examine the relationship between HIV-related stigma and quality of life (QOL) among HIV-infected outpatients initiating antiretroviral therapy (ART) in Vietnam.

Design and methods

This was a cross-sectional study which conducted at Vinh General Hospital, Nghe An Province, involved 323 HIV-infected outpatients. Participants were surveyed between October 2020 and October 2021. The study collected data through structured interviews, assessing socio-demographic factors, HIV stigma, and QOL.

Results

The result showed that HIV-infected outpatients experiencing higher stigma showed poorer QOL across various domains. The negative impact of stigma was particularly evident in domains related to physical health, psychological well-being, and spirituality. Participants who were married, had children, consumed alcohol, had comorbidities (particularly hepatitis B/C), and lacked a history of drug use reported varying levels of correlation with QOL domains and stigma.

Conclusions

By identifying the intricate connections between stigma and QOL, the study provides valuable insights for designing comprehensive interventions that prioritize the well-being of HIV infected outpatients.

"I Was Very Shocked, I Wanted It to Be Over": A Qualitative Exploration of Suicidal Ideation and Attempts among Women Living with HIV in Indonesia

HIV diagnosis and poor HIV management have various detrimental impacts on the lives of people living with HIV (PLHIV). As a part of a large qualitative study investigating HIV risk factors and impacts, of which the topic of suicide is not a focus, this paper describes the factors contributing to suicidal ideation and attempts that arose naturally in the stories of women living with HIV (WLHIV; n = 52) in Yogyakarta and Belu districts, Indonesia. The participants were recruited using the snowball sampling technique. Guided by a qualitative data analysis framework, the data were thematically analysed. The findings were grouped into four main themes: (i) the women experienced immense psychological challenges due to the infection, spousal transmission, fear of mother-to-child transmission, and losing a child due to AIDS, which triggered suicidal ideation and attempts; (ii) the lack of awareness of HIV management strategies resulted in them feeling trapped and overwhelmed, and the associated negative thoughts and the anticipation and experience of HIV stigma influenced their thoughts of suicide; (iii) the lack of social support from family and friends during the early stages of HIV diagnosis, compounded with pre-existing financial difficulties, lack of income, unemployment, and feeling overburdened, also triggered the women's thoughts of suicide; and (iv) family breakdown following HIV diagnosis, concern about future relationships, and fear of being rejected or abandoned by their partner were also influencing factors for suicidal ideation and attempts among the women. The findings indicate the need for a nuanced approach to counselling within HIV care interventions for couples to support the acceptance of each other's HIV status whilst maintaining psychological wellbeing. Additionally, the findings indicate the importance of HIV education and awareness among community members for the de-stigmatisation of HIV and to increase the acceptance of PLHIV by their families and communities.

The Effect on Theatre Nurses for Rendering Perioperative Care to Patients Living with HIV in a South African Tertiary Hospital

Purpose

The study aimed to gain an in-depth understanding of how theatre nurses are being affected when they render perioperative care to patients living with HIV in a South African tertiary hospital.

Background

There is a scarcity of studies that focus solely on the wellbeing of theatre nurses who render perioperative care to HIV patient due to the ramifications of the nurses' fear of contracting HIV. Patients living with HIV often receive substandard care.

Objectives

To establish how theatre nurses are being impacted when rendering perioperative care to patient living with HIV, the study followed a qualitative approach using an interpretative phenomenological analysis design. Data were collected through in-depth individual interviews from ten theatre nurses who were purposively selected according to specific criteria. They voluntarily agreed to participate. An interpretive phenomenological analysis framework was used to analyse the data. Two main themes emerged from the data analysis, namely, the negative effect on nurses' wellbeing and the impact that it had on them professionally.

Results

The study revealed that the perioperative care of patients living with HIV had a negative impact on physical, mental, and social wellbeing of theatre nurses. Their compromised wellbeing in turn led to poor patient care, which put nurses at risk of losing their jobs and even potentially having to face litigation. The study further indicated that nurses did not receive psychological support from the management which further affected their health and professional performance.

Conclusion

The study proposes that theatre nurses rendering perioperative care to people living with HIV should receive proper training and support; staff shortages should also be addressed. There is also an urgent need for appropriate and sufficient protective equipment. Such changes will be essential in order to mitigate the negative impact that their jobs have on their wellbeing and on them in their professional capacity.

Community stigma and discrimination against the incidence of HIV and AIDS

The problem of human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome (AIDS) is increasingly complex, including not only health-related concerns problems but also rampant stigma and discrimination, further exacerbating the health and social conditions of the affected individuals. This study aimed to examine the triggers of stigma and discrimination among individuals with HIV/AIDS in Wakatobi, Southeast Sulawesi. We employed a quasi-qualitative design with a case study approach involving data reduction, presentation, and drawing conclusions. Triggers of stigma and discrimination experienced by individuals living with HIV/AIDS encompassed a range of factors. Stigma was rooted in various causes, including fear, perceptions of unattractiveness, anxiety, associations with the disease, and lack of confidentiality. Discrimination, on the other hand, was caused by disappointment, feelings of insecurity, diminished self-esteem, and factors like competition and exploitation. The forms of stigma for people living with HIV/AIDS were public stigma, self-stigma, verbal discrimination, and avoidance. Meanwhile, the impact of stigma and discrimination on individuals living with HIV and AIDS is substantial. They encounter difficulties in finding help, restoring their lives, and discrimination. Stigmatizing attitudes and discriminatory acts of people living with HIV/AIDS worsen the quality of life of people living with HIV/AIDS, which can potentially cause new infections. Therefore, the government should undertake extensive educational initiatives regarding HIV and AIDS. By enhancing public knowledge and awareness, society can work towards eradicating stigma and discrimination from social interactions.

Validation of the attitudes towards people living with HIV/AIDS scale in nursing students

BACKGROUND

One of the environments where people living with HIV/AIDS should feel safer is in the health care setting; however, scientific evidence has identified discriminatory behaviour on the part of health care professionals towards these people. The reduction or abolition of discriminatory practices requires, first of all, to know the attitudes of nursing students towards AIDS with tools appropriate to the socio-cultural context of the disease. The objectives of this study are to update the AIDS Attitudes Scale for Nursing Students (EASE) by adapting it to the sociocultural landscape and to analyse the reliability and structural validity of the new scale.

METHODS

The results of the questionnaires answered by 213 undergraduate nursing students from the Faculty of Health Sciences of Ceuta (University of Granada) were analysed. Reliability (test-retest, n = 33) and validity (n = 180) tests were carried out.

RESULTS

An exploratory and confirmatory factor analysis indicated that a four-factor model was the most parsimonious solution. Items were examined for their underlying relationships and labelled: professional practice, social integration, partner and family, and benevolent stigma. The new scale yielded a McDonald's Omega coefficient (ω) of 0.893. Convergent validity was established for average variance extracted per factor greater than 0.5 and divergent validity when the variance retained by each factor is greater than the variance shared between them (average variance extracted per factor > ϕ2).

CONCLUSIONS

The new scale is a psychometrically sound instrument for assessing attitudes towards people living with HIV/AIDS in nursing students.

Understanding the quality of life of people living with HIV in rural and urban areas in Indonesia

Human Immunodeficiency Virus (HIV) is a major global public health issue that affects the quality of life (QoL) of people living with HIV (PLHIV) globally and in Indonesia. As a part of a large-scale qualitative study investigating HIV risk factors and impacts on PLHIV and facilitators of and barriers to their access to HIV care services in Yogyakarta and Belu, Indonesia, this paper describes their in-depth views and experiences of the influence of HIV on their QoL. Ninety-two participants were recruited using the snowball sampling technique. Data were collected using in-depth interviews. In addition, the World Health Organisation Quality of Life questionnaire (WHOQOL-HIV BREF) was also distributed to each of them to fill out prior to the interviews. Chi-Square analysis was used to analyse data from the survey and a framework analysis was applied to guide qualitative data analysis. The findings reported several factors affecting the QoL of the participants. These included (i) environmental factors, such as living in rural areas, the unavailability of HIV care services and public transport, and long-distance travel to healthcare facilities; (ii) personal beliefs associated with HIV; (iii) sexual and social relationships and their influence of the QoL of participants; and (iv) level of independence and physical health condition following HIV diagnosis. The findings indicate the need for intervention programs that address the availability and accessibility of HIV care services to PLHIV within rural communities and support various physical, psychological, and financial needs of PLHIV. These can be implemented by providing supplements and nutritious food, HIV counselling and door-to-door/community-based ART service delivery to PLHIV, which may increase their engagement in and adherence to the treatment and improve their physical and psychological condition and QoL.

[Stigmatization of people living with HIV in health care services in Togo]

Introduction

The elimination of AIDS as a threat to public health implies comprehensive care for those tested in all health facilities and without discrimination/stigmatization. The aim of this study is to evaluate the problems of stigmatization and discrimination of people living with HIV (PLHIV) in health care facilities and their implications for access to care for PLHIV.

Methodology

This is a descriptive cross-sectional study in the 6 health regions of Togo targeting people aged 18 years and over, living with HIV. A hybrid sampling method combining a limited chain referral and a sampling based on the mapping of meeting places/activities was used. Data were collected using the digitized version 2.0 of the PLHIV Stigma Index questionnaire.

Results

A total of 1 119 PLHIV with a mean age of 39 years were included. The sex-ratio was 0.5, and 43.4% had known their HIV status for 1 to 4 years. In the last 12 months, the experiences of stigmatization reported by the PLHIV from health personnel were: gossip (13%), disclosure of status without consent (10%) or avoidance of physical contact (2.6%). In terms of reproductive health, 2.1% of respondents had been advised not to become fathers/mothers and 1.4% had their access to antiretroviral drugs (ARV) conditioned by the use of a contraceptive method. 28.4% of those on ARV had missed one dose of treatment in the last 12 months for fear that someone would find out they were HIV positive. Also, 39.5% of the respondents who were not on ARV justified this by the fear that health workers would treat them badly or reveal their HIV status without their consent.

Conclusion

In health care settings, this phenomenon of HIV-related stigma is multifaceted and deserves to be documented so that it can be taken into account in order to improve the quality of services offered to beneficiary populations.

“A frightening experience, especially at our age”: Examining the neglect and abuse of older persons in HIV prevention and care programs

Background

As the global population ages and the HIV pandemic matures, a growing number of older persons aged ≥50 years are becoming increasingly vulnerable to acquiring HIV. Unfortunately, older persons are often neglected and left out of sexual health programs and services. This study explored the experiences of older persons living with and without HIV in accessing prevention and care services and how those experiences translate into the neglect and abuse of older persons. The study also explored older people's perspectives on community responses to HIV in older people.

Methods

This qualitative analysis used data from 37 individuals who participated in focus group discussions conducted in 2017/2018 across two communities in Durban, South Africa. Using an interview guide and thematic content analysis, salient themes regarding attitudes to HIV in older persons and factors of access to HIV prevention and cares services for older persons were analyzed.

Results

The study participant's mean age was 59.6 years. Major themes emerging from the data included factors impacting HIV prevention and transmission in older people; community responses to HIV contributing to the abuse of older people, and structural drivers of abuse in older people living with HIV (OPLHIV). Knowledge about HIV and how to protect themselves from HIV was limited among participants. Older persons were frightened to acquire HIV at an older age as they feared judgment and discrimination for getting HIV at that age. OPLHIV reported frequently experiencing community stigma and poor staff attitudes and practices at health facilities, such as a triage health delivery system that fueled community stigma. Participants also experienced neglect, verbal and emotional abuse at healthcare facilities.

Conclusion

Although there were no reports of physical and sexual abuse of older persons in this study, this study shows that despite decades of HIV programs in the country, HIV-related stigma, discrimination, and disrespect of older persons remain pervasive in the community and at health facilities. As an increasing number of people age and live longer with HIV, the neglect and outright abuse of older persons need urgent policy and program interventions.

Barriers and Facilitators to HIV Treatment Adherence in Indonesia: Perspectives of People Living with HIV and HIV Service Providers

HIV treatment adherence in Indonesia is a major challenge. Although previous studies have demonstrated several barriers and facilitators to adherence, studies providing a comprehensive analysis from both PLHIV and HIV service providers' perspectives are limited, especially in Indonesia. In this qualitative study with 30 people living with HIV on treatment (PLHIV-OT) and 20 HIV service providers (HSPs), we explored, via online interviews, the barriers and facilitators to antiretroviral therapy (ART) adherence using a socioecological approach. Both PLHIV-OT and HSPs reported stigma as a major barrier at each socioecological level, including public stigma at the societal level, stigma in healthcare settings, and self-stigma at the intrapersonal level. Stigma reduction must therefore be prioritized. PLHIV-OT and HSPs also reported support from significant others and HSPs as the foremost facilitators to ART adherence. The enablement of support networks is thus an important key to improved ART adherence. Overall, the societal level and health system barriers to ART adherence should be addressed in order to remove barriers and enhance the facilitators at the subordinate socioecological levels.

Advanced HIV disease and health-related suffering-exploring the unmet need of palliative care

With more than 38 million people living with HIV worldwide, the scale-up of antiretroviral therapy ensures nearly 28 million of them receive regular treatment. However, a substantial number of deaths still occur every year from AIDS-related complications, with approximately 680 000 deaths in 2021. Of the estimated 56·8 million people globally in need of palliative care in 2020, only 7 million can access services. Providing palliative care services can help alleviate health-related suffering, such as pain and disease-related symptoms, and improve wellbeing. This Viewpoint discusses the unrealised potential of palliative care in individuals with advanced HIV disease. Key areas of training for health-care workers include appropriate sensitisation, training in palliative care, and effective communication. Advance care planning supports both the individual and their family and is therefore of crucial importance. Integration of palliative care in HIV programmes is needed to address health-related suffering, particularly for advanced HIV disease.

Experiences of Caring for Adolescents Living with HIV (ALHIV): A Qualitative Interview with Caregivers

Purpose

This study aims at exploring experiences of people caring for adolescents living with HIV, also known as caregivers. By 2021, 150,000 adolescents were living with HIV and 32,000 adolescents were dying of AIDS related causes. HIV/AIDS remains one of the most serious public health problems, especially among the adolescents. This has placed a heavy burden on many caregivers, yet they are essential in caring for ALHIV. However, focus of all interventions has excluded caregivers of ALHIV. Thus, this is the reason why this study is being conducted to find out caregivers' experience in caring for ALHIV.

Participants and Methods

A phenomenological study was carried out. Purposive sampling was used to select a total of 15 caregivers to participate in the study. These participants were subjected to in-depth semi-structured interviews. Their responses were recorded, transcribed and translated for thematic analysis.

Results

While analyzing the results, six themes emerged. They include: diagnosis and reaction to diagnosis, experiences on adolescent's HIV serostatus disclosure, stigma and discrimination, care disengagement, and lastly, challenges during care and coping strategies. Caregivers experienced feelings of fear, Guilt, suicidal thoughts after diagnosis. Stigma and discrimination of adolescents living with HIV which was common at school and from the neighbors and the adolescent stage were some of the challenges experienced by the caregivers and it makes it hard to retain ALHIV in care.

Conclusion

Families are the main source of caregiving to the adolescents living with HIV (ALHIV). The study's findings indicate that caregivers in the families experience challenges related to family needs, and psychological challenges resulting from the adolescence stage. So, families should not be left to shoulder the burden of caring for ALHIV. As a way forward, social network and financial support should also be strengthened for most caregivers as a coping strategy.

The Medication Experience of TB/HIV Coinfected Patients: Qualitative Study

Tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy and the stigma related to both diseases are complex. The patients' subjective experiences with diseases and medications are of utmost importance in pharmaceutical care practice. This study aimed to understand the subjective medication experience of TB and HIV/AIDS coinfected patients. The study was based on descriptive research of a qualitative and quantitative nature using data collected during pharmaceutical care appointments and from medical records from September 2015 to December 2016 at a tertiary infectious diseases referral hospital in Southeastern Brazil. Data from 81 patients were analyzed. Regarding patient subjective medication experience, the following responses to the quantitative questionnaire were most frequent: preference for a route of administration (12.4%) and for non-pharmacological therapy (50.6%); concerns about price (11.1%) and adverse effects (18.5%); and association of a worsening of their health status with a change in medication dosage (23.5%). In the thematic analysis, adversity and socially constructed aspects were more prominent. Resolvability, associated with the patient's understanding of relief from signs and symptoms and health recovery, was observed; however, feelings of ambivalence permeated the other aspects, hence leading to treatment abandonment. The evaluation of patient medication experience can be a path to understanding and intervening in the phenomenon of treatment abandonment among TB and HIV/AIDS coinfected individuals.

Men's late presentation for HIV care in Eastern Uganda: The role of masculinity norms

INTRODUCTION

In Uganda, adult men living with HIV are more likely to present late for care; with a CD4 cell count below 350 cells/μl compared to women. Understanding why adult men present late for HIV care is important in improving early linkage to care. Studies across countries in Sub-Saharan Africa emphasize the role of masculinity norms; defined as social expectations about appropriate roles and behavior for men, in men's health behaviours particularly, in HIV care engagement. This study therefore explored how masculinity norms influence men's late presentation for HIV care.

METHODS

This was a qualitative study undertaken in Jinja District, Eastern Uganda between October and November 2020. We conducted 20 In-Depth Interviews (IDIs) with men living with HIV who had presented late for care at Family Hope Centre. We also conducted four Focus Group Discussions (FGDs) with HIV negative men and women in selected communities of Katende and Walukuba. Conventional content analysis approach was used to identify themes across the collected data.

RESULTS

A total of 20 men participated in the In-depth Interviews (IDIs), with majority being married 15/20 (75%) and primary level holders 7/15 (46.7%). Nineteen (19) women participated in two FGDs, with a mean age of 29.5 years. Nineteen (19) men also participated in other two FGDs, with a mean age of 28.2 years. Conventional content analysis results indicated that men's late presentation for HIV care in Jinja district is greatly related to their concerns of loss of respect and the need to preserve their reputation and maintain a sense of normality in their families and society as proposed by Wilson's (1969) respectability-reputation theoretical model. Respectability was endorsed by 'the wider society', while reputation was endorsed almost entirely by men and some women.

CONCLUSION

Findings show that the explanations for men's late presentation arise from the masculinity norms in Jinja District, Eastern Uganda.

Barriers to Accessing HIV Care Services in Host Low and Middle Income Countries: Views and Experiences of Indonesian Male Ex-Migrant Workers Living with HIV

Migrant populations are one of the vulnerable groups to HIV transmission and its consequences. They are also reported to experience delayed entry or linkage into HIV services and have poorer HIV-related health outcomes. This study aimed to understand barriers to accessing HIV care services in host countries among Indonesian, male, former (returned) migrant workers living with HIV. The study was carried out from December 2020 to February 2021. It utilised a qualitative design employing in-depth interviews to collect data from twenty-two returned migrant workers from Eastern Indonesia, recruited using the snowball sampling technique. A qualitative data analysis framework was used to guide a step-by-step analysis of the findings. Findings demonstrated that limited host-country language proficiency, lack of knowledge regarding healthcare systems in host countries and having 'undocumented' worker status were barriers to accessing HIV care services. Data also revealed the unavailability of HIV care services nearby migrants' work locations, long-distance travel to healthcare facilities, and challenges in accessing public transportation as barriers that impeded their access to the services. Other factors limiting the participants' access to HIV services were identified as the transient and mobile nature of migrant work requiring frequent relocation and disrupting work-life stability. Additionally, in lieu of formal HIV services, many participants self-medicated by using over-the-counter herbal or 'traditional' medicines, often because of peer or social group influence regarding the selection of informal treatment options. Recommendations arising from this study demonstrate the need to improve pre-departure information for migrant workers regarding the healthcare system and access procedures in potential host countries. Data from this study also indicate that social services should be available to assist potential migrants to access legal channels for migrant work overseas, to ensure that Indonesian migrants can safely access healthcare services in the countries for which they are providing migrant labour. Future studies to understand barriers to accessing HIV care services among various migrant groups living with HIV are warranted to build evidence for potential social policy change.

Personal experiences following acquiring HIV infection while volunteering in Phase I/II HIV vaccine trials: A qualitative study from Tanzania

BACKGROUND

Participation in HIV vaccine trials is an essential step towards development of an effective preventive vaccine. A Phase I/II HIV vaccine trial enrolls volunteers at low risk of acquiring HIV infection, however a few may still become infected. Understanding the experiences of volunteers who acquired HIV infection while participating in such trials is essential for future research. Here, we describe experiences of HIV infected volunteers in Phase I/II HIV vaccine trials conducted in urban Tanzania.

MATERIALS AND METHODS

We used a case study design. In-depth interviews were conducted with four participants who became HIV infected during long follow-up visits after completion of vaccination schedules in a Phase I/II trial. Between 3 and 8 years after HIV positive diagnosis, each participant was interviewed at three time points within a two-year interval so as to allow for accumulation of experiences and cross-checking the emerging constructs. Data was analyzed using a qualitative data analysis framework.

RESULTS

Analysis revealed that participation in HIV vaccine trials involves balancing controversies and the spirit of informed decision. The participants declared that they did not acquire HIV from the experimental vaccine. Disclosure of HIV status within the family was gender specific. Men were hesitant to disclose their HIV status to their sexual partners fearing for the consequences. Women's attempt to disclose their HIV status yielded negative reactions from the sexual partners. The acquired knowledge from the HIV vaccine research enabled the participants to cope with the uncertainties and their health status.

CONCLUSIONS

The knowledge acquired during the Phase I/II HIV vaccine trial appears to be an essential resource to cope with uncertainties post research. The HIV vaccine trial implementers need to understand the challenges the volunteers may confront after the trial while coping with their health status. Longitudinal studies are essential to trace the effects of uncertainties to the individual participants.

Spatiotemporal Clusters and Trends of Pneumocystis Pneumonia in Korea

This study determined the recent status and trend of Pneumocystis jirovecii pneumonia (PcP) in the non-human immunodeficiency virus (HIV) (non-HIV-PcP) and HIV (HIV-PcP) infected populations using data from the Health Insurance Review & Assessment Service (HIRA) and the Korea Disease Control and Prevention Agency (KDCA). SaTScan and Joinpoint were used for statistical analyses. Non-HIV-PcP cases showed an upward trend during the study period from 2010 to 2021, with the largest number in 2021 (551 cases). The upward trend was similar until 2020 after adjusting for the population. Seoul had the highest number of cases (1,597) in the non-HIV-PcP group, which was the same after adjusting for the population (162 cases/1,000,000). It was followed by Jeju-do (89 cases/1,000,000). The most likely cluster (MLC) for the non-HIV-PCP group was Seoul (Relative Risk (RR)=4.59, Log Likelihood Ratio (LLR)=825.531), followed by Jeju-do (RR=1.59, LLR=5.431). An upward trend was observed among the non-HIV-PcP group in the Jeju-do/Jeollanam-do/Jeollabuk-do/Gyeongsangnam-do/Busan/Daejeon/Daegu/Ulsan joint cluster (29.02%, LLR=11.638, P<0.001) located in the southern part of Korea. Both women and men in the non-HIV groups showed an overall upward trend of PcP during the study period. Men in the 60-69 age group had the highest annual percentage change (APC 41.8) during 2014-2019. In contrast, the HIV groups showed a falling trend of PcP recently. Men in the 60-69 age group had the most decrease (APC -17.6) during 2018-2021. This study provides an analytic basis for health measures and a nationwide epidemiological surveillance system for the management of PcP.

Investigation of discriminatory attitude toward people living with HIV in the family context using socio-economic factors and information sources: A nationwide study in Indonesia

Background

The well-being of people living with HIV (PLHIV) remains a concern. In addition to facing discrimination in their communities, many PLHIV have family members who have a discriminatory attitude. This study analyzes the discriminatory attitude toward PLHIV in the family context using socio-economic factors and information sources in Indonesia.

Methods

A cross-sectional study design was adopted using secondary data from the 2017 Indonesian Demographic Health Survey (IDHS). A total sample of 28,879 respondents was selected using two-stage stratified cluster sampling. The study variables are information sources, sex, age, education, residence, earnings, and familial discriminatory attitude. We used the STATA 16.1 software to analyze Chi-square and binary logistics with a 95% confident interval (CI) with a significance of 5% (p-value < 0.05).

Results

In Indonesia, familial discriminatory attitude has a prevalence of 72.10%. In the survey, the respondents with access to some information about HIV (AOR: 0.794; 95% CI [0.722-0.873]), women (AOR: 0.768; 95% CI [0.718-0.820]), and those living in rural areas (AOR: 0.880; 95% CI [0.834-0.929]) were the least likely to have a familial discriminatory attitude. Meanwhile, the respondents aged 15-24 years (AOR: 1.329; 95% CI [1.118-1.581]) and those with a secondary level of education (AOR: 1.070; 95% CI [1.004-1.142]) were the most likely to have a familial discriminatory attitude.

Conclusion

In the study, we found that, the younger the age and the lower the educational level of the respondent, the more likely they were to have a familial discriminatory attitude. The government may consider these factors when designing policies to tackle familial discrimination faced by PLHIV; in particular, education on HIV and AIDS should be promoted.

Mental Health Challenges and the Associated Factors in Women Living with HIV Who Have Children Living with HIV in Indonesia: A Qualitative Study

Women living with HIV (WLHIV) are vulnerable to various mental health challenges. However, there is a paucity of studies globally and in the Indonesian context that have specifically explored mental health challenges among mothers living with HIV who also have children living with HIV (CLHIV). This qualitative study explored mental health challenges and the associated factors in mothers living with HIV who have CLHIV in Yogyakarta, Indonesia. In-depth interviews were employed to collect data from the participants (N = 23) who were recruited using the snowball sampling technique. A qualitative data analysis framework was used to guide the analysis of the findings. The findings showed that the mothers experienced a range of mental health issues due to their own, and their child’s diagnoses of stress, depression, anxiety, fear, sadness, and guilt. Lack of knowledge about HIV, fear of death, shame, not knowing whom to talk with and what to do after their own HIV diagnosis, and the HIV diagnosis of their children were factors that challenged their mental health. Difficulties in dealing with daily life or social activities of their CLHIV, dilemmas in addressing questions and complaints of their CLHIV about HIV treatment, and concerns about the health condition of their CLHIV and how their children cope with any potential negative social impacts also impacted the mothers’ mental health. Social factors such as unsympathetic expressions from friends towards them and their CLHIV and negatively worded religious-related advice from parents and relatives also contributed to their poor mental health. Our findings indicate the need for intervention programs that support mothers living with HIV and their CLHIV. Future large-scale studies involving mothers living with HIV who have CLHIV in Indonesia and other settings globally are needed to obtain a comprehensive understanding of mental health challenges and the associated factors they face.

Psychological and Social Impact of HIV on Women Living with HIV and Their Families in Low- and Middle-Income Asian Countries: A Systematic Search and Critical Review

Human Immunodeficiency Virus (HIV) infection adds a significant burden to women in Low- and Middle-Income Countries (LMICs), often leading to severe detrimental impact, not only on themselves, but also on their families and communities. Given that more than half of all people living with HIV globally are females (53%), this review seeks to understand the psychological and social impact of HIV infection on Women Living with HIV (WLHIV) and their families in LMICs in Asia, and the interrelationships between one impact and another. A systematic review was conducted to find literature using the following databases: Medline, PsycINFO, CINAL, Emcare, Scopus and ProQuest. Research articles included in this review were selected based on the following inclusion criteria: conducted in LMICs in Asia, published in English language between 1 January 2004 and 31 December 2021, had full text available, involved WLHIV (married and unmarried) and explored the psychological and social impacts of HIV on these women and their families. Critical appraisal tools developed by Joanna Briggs Institute (JBI) were used to assess the methodological quality of the studies, and thematic narrative synthesis was used to analyse the findings. A total of 17 articles met the inclusion criteria. The review showed that HIV has a range of negative psychological consequences on WLHIV, such as stress, fear, worry, anxiety and depression, as well as social impacts on the women and their families, including stigma, discrimination and family separation. The findings indicate the need for targeted interventions-specific to WLHIV-that address the psychological challenges, stigma and discrimination these women and their families face. These interventions should also incorporate education and sustainable support structures for WLHIV and their families.

Stigma and mental health challenges among adolescents living with HIV in selected adolescent-specific antiretroviral therapy clinics in Zomba District, Malawi

BACKGROUND

Of the 1.8 million adolescents between the ages of 10 and 19 living with HIV globally in 2020; approximately 1.5 million of these live in sub-Saharan Africa. These adolescents living with HIV (ALHIV) are at higher risk of experiencing mental health problems than those without; in Malawi, 18.9% have a depressive disorder. ALHIV can face numerous psychosocial challenges, but little is known about how ALHIV in Malawi perceive these stressors. Understanding psychosocial challenges of ALHIV is a key step in ensuring good mental health care. The aim of this study was to assess the psychosocial challenges faced by ALHIV attending adolescent-specific ART program in Zomba, Malawi.

METHODS

Between April and May 2019, we engaged a purposive sample of ALHIV ages 12-18 (n = 80) in a series of eight focus groups drawing from four Teen Clubs linked to an adolescent-specific ART program. Data were analyzed inductively and deductively to identify themes related to ALHIV psychosocial experiences.

RESULTS

Two themes that emerged from the study include: 1) stigma and discrimination within communities and families; 2) non-adherence to medications. HIV-related stigma was associated with increased psychological distress; physical and emotional/verbal abuse; low social support, isolation, and a feeling of rejection; and risky health behaviors such as medication hiding and non-adherence to ART. Discriminatory actions were manifested in a form of being given separate utensils for their meals and mistreatment at school. Furthermore, some parents did not allow their children to play with the participants out of fear that HIV transmission.

CONCLUSIONS

Stigma and discrimination are overlooked potential barriers to HIV treatment and care. If HIV services are to effectively meet ALHIVs' needs, mental health interventions are needed to prevent and manage depression and improve adherence to ART. These findings highlight the crucial need to develop culturally relevant mental interventions aimed at helping ALHIV to cope with these diverse challenges.

Association between Internalized Stigma and Depression among People Living with HIV in Thailand

Internalized stigma and depression are among the most common mental health problems in people living with HIV (PLHIV). This study aimed to examine the association between depression and overall internalized stigma, as well as different aspects of internalized stigma in PLHIV. The study included 400 PLHIV receiving care in Bangkok and Chiang Mai, Thailand. Data were analyzed using descriptive statistics, Mann-Whitney U test, and Spearman correlation coefficients. The results indicated the PLHIV with mild depression had lower median scores for the social relationship internalized stigma subscale than PLHIV with major depressive disorder (p = 0.009). Total HIV internalized stigma scores were significantly correlated with PHQ-9 scores in the mild depression group (r = 0.327, p = 0.004). Depression and internalized stigma were prevalent and associated, especially in the area of social relationships. Health personnel should be aware of possible depression in PLHIV who have internalized stigma. Intervention to promote understanding and social support for PLHIV is warranted.

Prevalence and Factors Affecting Discrimination Towards People Living With HIV/AIDS in Indonesia

Objectives

This study aimed to identify the behaviors associated with discrimination towards people living with HIV/AIDS (PLHA) in Indonesia and to determine the factors affecting discrimination.

Methods

Secondary data from the 2017 Indonesia Demographic and Health Survey were analyzed using a cross-sectional design. Discrimination was assessed based on the questions (1) “Should children infected with HIV/AIDS be allowed to attend school with non-infected children?” and (2) “Would you buy fresh vegetables from a farmer or shopkeeper known to be infected with HIV/AIDS?” Multivariable logistic regression was used to determine the factors affecting discrimination, with adjusted odds ratio (aOR) and 95% confidence interval (CIs) used to show the strength, direction, and significance of the associations among factors.

Results

In total, 68.9% of 21 838 individuals showed discrimination towards PLHA. The odds of discrimination were lower among women (aOR, 0.63; 95% CI, 0.55 to 0.71), rural dwellers (aOR, 0.81; 95% CI, 0.75 to 0.89), those who understood how HIV is transmitted from mother to child (aOR, 0.81; 95% CI, 0.73 to 0.89), and those who felt ashamed of their own family’s HIV status (aOR, 0.56; 95% CI, 0.52 to 0.61). The odds were higher among individuals who knew how to reduce the risk of getting HIV/AIDS (aOR, 1.27; 95% CI, 1.15 to 1.39), how HIV/AIDS is transmitted (aOR, 3.49; 95% CI, 3.09 to 3.95), and were willing to care for an infected relative (aOR, 2.78; 95% CI, 2.47 to 3.13). A model consisting of those variables explained 69% of the variance in discrimination.

Conclusions

Gender, residence, knowledge, and attitudes related to HIV/AIDS were explanatory factors for discrimination against PLHA. Improvements in HIV/AIDS education programs are needed to prevent discrimination.

Behavioral Changes, Adaptation, and Supports among Indonesian Female Sex Workers Facing Dual Risk of COVID-19 and HIV in a Pandemic

The objective of this study is to explore the impacts of COVID-19 and changes taking place among the Indonesian female sex worker (FSW) community during the COVID-19 pandemic and the predictors of these changes. We conducted a cross-sectional online survey and selected the participants using a purposive snowball sampling technique. Incentives were provided to participants in the form of a 5 USD e-wallet balance. Variables of interest included adaptation to online sex work, adherence to COVID-19 prevention measures during sex work, number of clients, income reduction, social support, condom access, and condom use frequency. Sociodemographic data and COVID-19 fear index values were also collected. Final analysis included 951 FSWs, of whom 36.4% of had adapted to online sex work and 48.6% had practiced COVID-19 prevention measures. Major reductions in client frequency and income were reported by 67.8% and 71.1% of respondents, respectively. However, only 36.3% of FSWs reported they had ever received any form of social support from any parties, public or private. Meanwhile, 16.7% encountered difficulties in accessing condoms and 12.5% reported less frequent condom use during the pandemic. Easy access to condoms was the main factor influencing the frequency of condom use. As expected, staying in employment protected FSWs from major income loss, while education and younger age predicted adaptive behavioral changes, such as taking up online sex work. The COVID-19 pandemic has disrupted access to socioeconomic support systems and HIV prevention services among FSWs and has further exposed them to the dual jeopardy of HIV and COVID-19 infections.

Stigma, coping strategies, and their impact on treatment and health outcomes among young men living with HIV in Vietnam: A qualitative study

BACKGROUND

Stigma affects persons living with HIV in myriad ways, including mental health, adherence to antiretroviral therapy, and retention in care, and may manifest at inter- and intra-personal levels. Youth are particularly vulnerable; those in vulnerable groups may experience multiple stigmas. In Vietnam, new HIV infections are rising among men in young age groups. To better understand the facets of stigma experienced by young men living with HIV in Vietnam, we conducted a qualitative study with youth and clinicians.

METHODS

We conducted in-depth interviews with ten youth and two clinicians in Hanoi, querying experiences of inter- and intra-personal stigma, coping strategies, and disclosure. As a framework for further research, we developed a conceptual model based on our findings and the published evidence base which portrays interactions among HIV-related stigma, coping strategies, and ART adherence, care engagement, and health outcomes.

RESULTS

Common themes that emerged from interviews with youth included extensive internalized/self-stigma and perceived stigma, yet limited experienced interpersonal stigma due to non-disclosure and avoidant coping strategies. Within different types of relationships or contexts, youth used different strategies. Non-disclosure with family, friends, and workplaces/school, and avoidance of romantic relationships and health care were common. Mental health and social support appeared to be mediating factors between coping strategies and health outcomes.

CONCLUSIONS

Validation of this model of mechanisms of the impact of stigma for youth will require further research with larger samples. In the meantime, public campaigns to increase public awareness related to HIV should be implemented in Vietnam. Critical support for youth and their mental health should involve approaches tailored to the individual, taking into account context and personal capacity, including adequate time to prepare psychologically for disclosure. Some strategies for safe and effective disclosure are suggested.

Misconceptions and stigma against people living with HIV/AIDS: a cross-sectional study from 2017 Indonesia Demographic and Health Survey

OBJECTIVES

Data are not available in Indonesia to measure the main indicators of zero new infections, zero acquired immune deficiency syndrome (AIDS)-related deaths and zero discrimination. This study aimed to determine factors related to misconceptions about human immunodeficiency virus (HIV) transmission and the stigma against people living with HIV/AIDS (PLWHA) in Indonesia

METHODS

This cross-sectional study used secondary data from the 2017 Indonesia Demographic and Health Survey (IDHS). The sample was women and men aged 17–45 years and married (n=3,023).

RESULTS

Education and wealth index quintile were significantly related to misconceptions about HIV transmission. Respondents with low levels of education were more likely to have misconceptions about HIV transmission. Respondents who were in the poorest, poorer, middle, and richer quintiles of the wealth index were more likely to have misconceptions about HIV transmission than those in the richest quintile. Educational level, employment status, and wealth index quintile were predictors of stigma against PLWHA.

CONCLUSIONS

There are still many Indonesian people with misconceptions about HIV transmission and stigma against PLWHA. Future studies should focus on educational programs or interventions aimed at increasing public knowledge and awareness, promoting compassion towards PLWHA, and emphasizing respect for the rights of PLWHA. These interventions are particularly important for populations who are uneducated and living in poverty.

Stigma Mechanisms and Outcomes among Sub-Saharan African Descendants in Belgium-Contextualizing the HIV Stigma Framework

HIV-related stigma and discrimination are recognized barriers to HIV prevention, testing and treatment among people of Sub-Saharan African descent (SSA) origin living in Belgium, but insights into HIV related-stigma mechanisms and outcomes are lacking for this population with high HIV prevalence. Guided by Earnshaw and Chaudoir’s stigma framework (2009), we conducted this qualitative study using 10 focus-groups with 76 SSA community members and 20 in-depth interviews with SSA descendants living with HIV to explore specific HIV-stigma mechanisms and outcomes and underlying drivers. Inductive and deductive thematic analysis showed high degrees of stigma among SSA communities driven by fear of HIV acquisition and misconceptions in a migration context, negatively affecting SSA descendants living with HIV. The results allowed for contextualization of the framework: At the community level, prejudices and stereotypes were major stigma mechanisms, while physical distancing, gossips, sexual rejection, violence and increased HIV prevalence emerged as stigma outcomes. Among SSA descendants living with HIV, enacted, anticipated and internalized stigmas were validated as stigma mechanisms, with witnessed stigma as an additional mechanism. Self-isolation, community avoidance and low utilization of non-HIV specialized healthcare were additional outcomes. These results are relevant for tailoring interventions to reduce HIV-related stigma.