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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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Tuan Abdullah TN, Mat Min R, Hossain M, Abdullah SS. Relationship and career challenges faced by people infected with HIV in Malaysia. F1000Res 2019; 8:1994. [PMID: 33214871 PMCID: PMC7649721 DOI: 10.12688/f1000research.21079.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/04/2022] Open
Abstract
Background: In Malaysia, there are still lack of studies related to the challenges of people infected with HIV (PIWH). Therefore, this study was conducted to explore the experiences of PIWH and how they cope with HIV. Methods: This qualitative study was based on a social constructivist and grounded theory approach. A total of 12 PIWH were selected by purposive sampling, all of whom participated in semi-structured and audio-recorded interviews, which were supported with non-participant observations and diary entries on three occasions for each participant. The interviews and diaries were transcribed and analysed using the grounded theory approach, which was assisted by utilizing NVIVO-8 to identify the themes related to the experiences of the participants. Results: PIWH experienced challenges related to their career and relationships with family and others. These challenges led to difficulties in gaining employment and career development, as well as feelings of denial, being uncomfortable, rejection, and labelling. They found that their lives were totally and dramatically changed after being tested positive for HIV. Conclusions: Among PIWH, HIV impacted relationships with significant others and career development. The absence of support and acceptance from significant others affected the ability of PIWH to cope with their daily challenges. The results of this study have implications for policymakers in terms of gaining sufficient knowledge and awareness to provide prevention programmes for HIV/AIDS.
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Affiliation(s)
- Tuan Norbalkish Tuan Abdullah
- Faculty of Business, Economic and Social Development, Universiti Malaysia Terengganu, Kuala Terengganu, Terengganu, 21030, Malaysia
| | - Ruhani Mat Min
- Faculty of Business, Economic and Social Development, Universiti Malaysia Terengganu, Kuala Terengganu, Terengganu, 21030, Malaysia
| | - Mosharaf Hossain
- Faculty of Business, Economic and Social Development, Universiti Malaysia Terengganu, Kuala Terengganu, Terengganu, 21030, Malaysia
| | - Siti Salina Abdullah
- Faculty of Business, Economic and Social Development, Universiti Malaysia Terengganu, Kuala Terengganu, Terengganu, 21030, Malaysia
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Tuan Abdullah TN, Mat Min R, Hossain M, Abdullah SS. Relationship and career challenges faced by people infected with HIV in Malaysia. F1000Res 2019; 8:1994. [PMID: 33214871 PMCID: PMC7649721 DOI: 10.12688/f1000research.21079.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 08/08/2023] Open
Abstract
Background: In Malaysia, there are still lack of studies related to the challenges of people infected with HIV (PIWH). Therefore, this study was conducted to explore the experiences of PIWH and how they cope with HIV. Methods: This qualitative study was based on a social constructivist and grounded theory approach. A total of 12 PIWH were selected by purposive sampling, all of whom participated in semi-structured and audio-recorded interviews, which were supported with non-participant observations and diary entries on three occasions for each participant. The interviews and diaries were transcribed and analysed using the grounded theory approach, which was assisted by utilizing NVIVO-8 to identify the themes related to the experiences of the participants. Results: PIWH experienced challenges related to their career and relationships with family and others. These challenges led to difficulties in gaining employment and career development, as well as feelings of denial, being uncomfortable, rejection, and labelling. They found that their lives were totally and dramatically changed after being tested positive for HIV. Conclusions: Among PIWH, HIV impacted relationships with significant others and career development. The absence of support and acceptance from significant others affected the ability of PIWH to cope with their daily challenges. The results of this study have implications for policymakers in terms of gaining sufficient knowledge and awareness to provide prevention programmes for HIV/AIDS.
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Affiliation(s)
- Tuan Norbalkish Tuan Abdullah
- Faculty of Business, Economic and Social Development, Universiti Malaysia Terengganu, Kuala Terengganu, Terengganu, 21030, Malaysia
| | - Ruhani Mat Min
- Faculty of Business, Economic and Social Development, Universiti Malaysia Terengganu, Kuala Terengganu, Terengganu, 21030, Malaysia
| | - Mosharaf Hossain
- Faculty of Business, Economic and Social Development, Universiti Malaysia Terengganu, Kuala Terengganu, Terengganu, 21030, Malaysia
| | - Siti Salina Abdullah
- Faculty of Business, Economic and Social Development, Universiti Malaysia Terengganu, Kuala Terengganu, Terengganu, 21030, Malaysia
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Diedricks T, Myburgh C, Poggenpoel M. Promoting mental health of students living with HIV using appreciative inquiry. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 17:163-174. [PMID: 30003845 DOI: 10.2989/16085906.2018.1478312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Living with HIV poses many challenges. This is especially true for students living with HIV (SLHIV) within a university setting. The challenges faced by SLHIV makes it difficult for them to see new possibilities in living with the virus. The purpose of the study was to describe the experiences of being a student living with HIV and being a practitioner caring for them by using Appreciative Inquiry which incorporated individual interviews. A qualitative, exploratory, descriptive and contextual research design was applied in this study. Purposeful sampling was utilised to select participants in accordance with specific criteria. Individual interviews using the 4-D model of Appreciative Inquiry, were conducted with SLHIV and practitioners caring for them. The individual interviews were transcribed verbatim and analysed into themes and categories which were verified separately by an independent coder, who is experienced in qualitative research, and further confirmed by research participants through member checking. Themes and categories derived from the data were discussed, and the findings were positioned in terms of relevant literature and the results of similar studies. The study concluded that when SLHIV and practitioners caring for them, embarked on a journey of discovering their strengths in living with HIV and dealing with SLHIV respectively, they start to see new possibilities and potential to effect change to help students manage their HIV infection more effectively.
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Affiliation(s)
- Teolene Diedricks
- a Department of Educational Psychology , University of Johannesburg , Johannesburg , South Africa
| | - Christoffel Myburgh
- a Department of Educational Psychology , University of Johannesburg , Johannesburg , South Africa
| | - Marie Poggenpoel
- a Department of Educational Psychology , University of Johannesburg , Johannesburg , South Africa
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Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, Wilson M, Logie CH, Shi Q, Morassaei S, Rourke SB. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open 2016; 6:e011453. [PMID: 27412106 PMCID: PMC4947735 DOI: 10.1136/bmjopen-2016-011453] [Citation(s) in RCA: 506] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To conduct a systematic review and series of meta-analyses on the association between HIV-related stigma and health among people living with HIV. DATA SOURCES A structured search was conducted on 6 electronic databases for journal articles reporting associations between HIV-related stigma and health-related outcomes published between 1996 and 2013. STUDY ELIGIBILITY CRITERIA Controlled studies, cohort studies, case-control studies and cross-sectional studies in people living with HIV were considered for inclusion. OUTCOME MEASURES Mental health (depressive symptoms, emotional and mental distress, anxiety), quality of life, physical health, social support, adherence to antiretroviral therapy, access to and usage of health/social services and risk behaviours. RESULTS 64 studies were included in our meta-analyses. We found significant associations between HIV-related stigma and higher rates of depression, lower social support and lower levels of adherence to antiretroviral medications and access to and usage of health and social services. Weaker relationships were observed between HIV-related stigma and anxiety, quality of life, physical health, emotional and mental distress and sexual risk practices. While risk of bias assessments revealed overall good quality related to how HIV stigma and health outcomes were measured on the included studies, high risk of bias among individual studies was observed in terms of appropriate control for potential confounders. Additional research should focus on elucidating the mechanisms behind the negative relationship between stigma and health to better inform interventions to reduce the impact of stigma on the health and well-being of people with HIV. CONCLUSIONS This systematic review and series of meta-analyses support the notion that HIV-related stigma has a detrimental impact on a variety of health-related outcomes in people with HIV. This review can inform the development of multifaceted, intersectoral interventions to reduce the impact of HIV-related stigma on the health and well-being of people living with HIV.
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Affiliation(s)
- Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Sanjana Mitra
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Shiyi Chen
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | | | | | - Lori Chambers
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Mike Wilson
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Qiyun Shi
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | | | - Sean B Rourke
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Centre for Research on Inner City Health, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Moshabela M, Zuma T, Orne-Gliemann J, Iwuji C, Larmarange J, McGrath N. "It is better to die": experiences of traditional health practitioners within the HIV treatment as prevention trial communities in rural South Africa (ANRS 12249 TasP trial). AIDS Care 2016; 28 Suppl 3:24-32. [PMID: 27421049 PMCID: PMC5096678 DOI: 10.1080/09540121.2016.1181296] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The ANRS 12249 Treatment-as-Prevention (TasP) cluster-randomized trial in rural South Africa uses a "test and treat" approach. Home-based testing services and antiretroviral treatment initiation satellite clinics were implemented in every cluster as part of the trial. A social science research agenda was nested within TasP with the aim of understanding the social, economic and contextual factors that affect individuals, households, communities and health systems with respect to TasP. Considering the rural nature of the trial setting, we sought to understand community perceptions and experiences of the TasP Trial interventions as seen through the eyes of traditional health practitioners (THPs). A qualitative study design was adopted using four repeat focus group discussions conducted with nine THPs, combined with community walks and photo-voice techniques, over a period of 18 months. A descriptive, interpretive and explanatory approach to analysis was adopted. Findings indicate that THPs engaged with the home-based testing services and HIV clinics established for TasP. Specifically, home-based testing services were perceived as relatively successful in increasing access to HIV testing. A major gap observed by THPs was linkage to HIV clinics. Most of their clients, and some of the THPs themselves, found it difficult to use HIV clinics due to fear of labelling, stigma and discrimination, and the ensuing personal implications of unsolicited disclosure. On the one hand, a growing number of patients diagnosed with HIV have found sanctuary with THPs as alternatives to clinics. On the other hand, THPs in turn have been struggling to channel patients suspected of HIV into clinics through referrals. Therefore, acceptability of the TasP test and treat approach by THPs is a major boost to the intervention, but further success can be achieved through strengthened ties with communities to combat stigma and effectively link patients into HIV care, including partnerships with THPs themselves.
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Affiliation(s)
- Mosa Moshabela
- a Africa Centre for Population Health , University of KwaZulu-Natal , Mtubatuba , South Africa
- b School of Nursing and Public Health , University of KwaZulu-Natal , Durban , South Africa
| | - Thembelihle Zuma
- a Africa Centre for Population Health , University of KwaZulu-Natal , Mtubatuba , South Africa
| | - Joanna Orne-Gliemann
- c INSERM U1219 - Centre Inserm Bordeaux Population Health , Université de Bordeaux , Bordeaux , France
- d Université de Bordeaux, ISPED , Centre INSERM U1219-Bordeaux Population Health , Bordeaux , France
| | - Collins Iwuji
- a Africa Centre for Population Health , University of KwaZulu-Natal , Mtubatuba , South Africa
- e Research Department of Infection and Population Health , University College London , London , UK
| | - Joseph Larmarange
- a Africa Centre for Population Health , University of KwaZulu-Natal , Mtubatuba , South Africa
- f Centre Population & Développement (Ceped UMR 196 UPD IRD) , Institut de Recherche pour le Développement , Paris , France
| | - Nuala McGrath
- a Africa Centre for Population Health , University of KwaZulu-Natal , Mtubatuba , South Africa
- e Research Department of Infection and Population Health , University College London , London , UK
- f Centre Population & Développement (Ceped UMR 196 UPD IRD) , Institut de Recherche pour le Développement , Paris , France
- g Faculty of Medicine and Faculty of Social, Human and Mathematical Sciences , University of Southampton , Southampton , UK
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