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Zhang Y, Yang X, Chai X, Han S, Zhang L, Shao Y, Ma J, Li K, Wang Z. Psychometric properties of stigma and discrimination measurement tools for persons living with HIV: a systematic review using the COSMIN methodology. Syst Rev 2024; 13:115. [PMID: 38678285 PMCID: PMC11055308 DOI: 10.1186/s13643-024-02535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
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.
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Affiliation(s)
- Yizhu Zhang
- School of Nursing, Peking University, Beijing, 100191, China
| | - Xianxia Yang
- School of Public Health, Wuhan University, Wuhan, China
| | - Xinru Chai
- School of Nursing, Peking University, Beijing, 100191, China
| | - Shuyu Han
- School of Nursing, Peking University, Beijing, 100191, China.
| | - Lili Zhang
- Department of Nursing, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, 100069, China
| | - Ying Shao
- Department of Infection, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, 100069, China
| | - Jianhong Ma
- Department of Infection, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, 100069, China
| | - Ke Li
- Department of Emergency, Peking University First Hospital, Beijing, 100034, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, 100191, China
- Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, 100191, China
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Smart BTH, Combrink HMV. The ontology of epidemics-A value-dependent realist account of epidemics. J Eval Clin Pract 2022. [PMID: 36412041 DOI: 10.1111/jep.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 10/21/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Abstract
RATIONALE Charters and Heitman have recently argued that epidemic status is lost once the disease becomes 'accepted into people's daily lives and routines, becoming endemic-domesticated-and accepted'. This is a normativist, subjectivist approach to epidemic classification; that is, it is both value-laden, and dependent on the attitudes of the population. In this article, we argue for an alternative approach: a value-dependent realist account of epidemic-status. AIMS AND OBJECTIVES We aim to provide an ontological account of epidemics, with a particular focus on their endings. We do not attempt to present a historical account of previous epidemics, or why their endings were declared, but rather consider the theoretical underpinnings of such declarations. Further, our account is meant to be more prescriptive than descriptive; that is to say, even if public health does not currently view epidemics in the manner we advocate, the metaphysic of epidemics we advocate is, we believe, that which public health should ultimately endorse. METHOD The methodologies employed in this article are primarily those common to the philosophy of public health, philosophy of medicine and metaphysics; namely, conceptual analysis grounded by practical considerations. RESULTS Charters and Heitman have recently argued that epidemic status is lost once the disease becomes 'accepted into people's daily lives and routines, becoming endemic-domesticated-and accepted'. This is a normativist, subjectivist approach to epidemic classification; that is, it is both value-laden, and dependent on the attitudes of the population. In this article, we argue for an alternative approach: a value-dependent realist account of epidemic-status. CONCLUSION To frame the argument we draw from complexity theory, arguing that human populations can be viewed as complex systems, and epidemic-status as an emergent property of a complex system. We propose aggregating the normative standards relevant to labeling a disease as an epidemic, and use this as our indicator for both the beginning, and the end of epidemics. An epidemic ends, we argue, once the burden of disease drops below an objective but distinctly normative 'epidemic threshold'.
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Affiliation(s)
- Benjamin T H Smart
- The Centre for Philosophy of Epidemiology, Medicine, and Public Health, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Herkulaas M V Combrink
- Office of the Dean, Economics and Management Sciences, Top Management, University of the Free State, Bloemfontein, South Africa
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Surratt HL, Otachi J, McLouth C, Vundi N. Healthcare stigma and HIV risk among rural people who inject drugs. Drug Alcohol Depend 2021; 226:108878. [PMID: 34214880 PMCID: PMC8355211 DOI: 10.1016/j.drugalcdep.2021.108878] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The HIV epidemic is increasingly penetrating rural areas of the U.S. due to evolving epidemics of injection drug use. Many rural areas experience deficits in availability of HIV prevention, testing and harm reduction services, and confront significant stigma that inhibits care seeking. This paper examines enacted stigma in healthcare settings among rural people who inject drugs (PWID) and explores associations of stigma with continuing high-risk behaviors for HIV. METHODS PWID participants (n = 324) were recruited into the study in three county health department syringe service programs (SSPs), as well as in local community-based organizations. Trained interviewers completed a standardized baseline interview lasting approximately 40 min. Bivariate logistic regression models examined the associations between enacted healthcare stigma, health conditions, and injection risk behaviors, and a mediation analysis was conducted. RESULTS Stigmatizing health conditions were common in this sample of PWID, and 201 (62.0 %) reported experiencing stigma from healthcare providers. Injection risk behaviors were uniformly associated with higher odds of enacted healthcare stigma, including sharing injection equipment at most recent injection (OR = 2.76; CI 1.55, 4.91), and lifetime receptive needle sharing (OR = 2.27; CI 1.42, 3.63). Enacted healthcare stigma partially mediated the relationship between having a stigmatizing health condition and engagement in high-risk injection behaviors. DISCUSSION Rural PWID are vulnerable to stigma in healthcare settings, which contributes to high-risk injection behaviors for HIV. These findings have critical public health implications, including the importance of tailored interventions to decrease enacted stigma in care settings, and structural changes to expand the provision of healthcare services within SSP settings.
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Affiliation(s)
| | | | - Chris McLouth
- University of Kentucky, Department of Behavioral Science
| | - Nikita Vundi
- University of Kentucky, Center for Health Services Research
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Sahoo SS, Khanna P, Verma R, Verma M, Mahapatra S, Parija PP, Panda UK. Social stigma and its determinants among people living with HIV/AIDS: A cross-sectional study at ART center in North India. J Family Med Prim Care 2021; 9:5646-5651. [PMID: 33532408 PMCID: PMC7842445 DOI: 10.4103/jfmpc.jfmpc_981_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/31/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: HIV/AIDS-related stigma and discrimination together have long been recognized as one of the main obstacles in the prevention, care, and treatment of HIV and AIDS. Yet, little has been done on a large scale to combat them. Stigma still precludes many in need of treatment and care for people living with HIV/AIDS (PLHIV). The purpose of this study was to assess the social stigma among PLHIV and the factors influencing it. Material and Methods: This hospital-based cross-sectional study was conducted among four hundred PLHIV attending the antiretroviral therapy (ART) center of a tertiary care institute of Haryana, India, using a semi-structured questionnaire and Berger Stigma Scale. Data analysis was performed using SPSS version 20.0 software to explore the relationship between a dependent (social stigma score) and other independent variables. Results: The overall mean stigma score in our study was found to be 110.96 ± 17.05. The stigma score in the male PLHIV was higher than in females. Male gender, younger age group (18–25 years), nuclear family, and rural residents PLHIV experienced more stigma as showed by the logistic regression analysis. Conclusion: Stigma and discrimination are a continuous deterrent for program implementation or successful outcomes. Education, behavior change strategies, and building supportive environments to the targeted population (young, single, and rural residents) can provide a roadmap in ending stigma and discrimination.
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Affiliation(s)
- Soumya S Sahoo
- Department of Community and Family Medicine, AIIMS, Bathinda, Punjab, India
| | - Pardeep Khanna
- Department of Community Medicine, Post Graduate Institute of Medical Studies (PGIMS), Rohtak, Haryana, India
| | - Ramesh Verma
- Department of Community Medicine, Post Graduate Institute of Medical Studies (PGIMS), Rohtak, Haryana, India
| | - Madhur Verma
- Department of Community and Family Medicine, AIIMS, Bathinda, Punjab, India
| | - Sandeep Mahapatra
- Associate Epidemiologist, Decision Resources Group (DRG), Bengaluru, Karnataka, India
| | - Pragyan P Parija
- Department of Community and Family Medicine, AIIMS, Raipur, Chhattisgarh, India
| | - Udit K Panda
- Post Doctoral Fellow, Addiction Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Mennechet FJD, Dzomo GRT. Coping with COVID-19 in Sub-Saharan Africa: What Might the Future Hold? Virol Sin 2020; 35:875-884. [PMID: 32870452 PMCID: PMC7459943 DOI: 10.1007/s12250-020-00279-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/24/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Franck J D Mennechet
- Institute of Molecular Genetic of Montpellier, CNRS, University of Montpellier, Montpellier, 34090, France.
| | - Guy R Takoudjou Dzomo
- University Hospital Complex the "Bon Samaritain", N'Djamena, BP 456, Republic of Chad.
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Sudharshan S, Nair N, Curi A, Banker A, Kempen JH. Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy - An update. Indian J Ophthalmol 2020; 68:1787-1798. [PMID: 32823395 PMCID: PMC7690468 DOI: 10.4103/ijo.ijo_1248_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/13/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
Intraocular inflammation in patients with human immunodeficiency virus (HIV) infection is commonly due to infectious uveitis. Ocular lesions due to opportunistic infections (OI) are the most common and have been described extensively in the pre highly active antiretroviral therapy (HAART) era. Many eye lesions were classified as acquired immunodeficiency syndrome (AIDS) defining illnesses. HAART-associated improvement in immunity of the individual has changed the pattern of incidence of these hitherto reported known lesions leading to a marked reduction in the occurrence of ocular OI. Newer ocular lesions and newer ocular manifestations of known agents have been noted. Immune recovery uveitis (IRU), the new menace, which occurs as part of immune recovery inflammatory syndrome (IRIS) in the eye, can present with significant ocular inflammation and can pose a diagnostic and therapeutic challenge. Balancing the treatment of inflammation with the risk of reactivation of OI is a task by itself. Ocular involvement in the HAART era can be due to the adverse effects of some systemic drugs used in the management of HIV/AIDS. Drug-associated retinal toxicity and other ocular side effects are being increasingly reported. In this review, we discuss the ocular manifestations in HIV patients and its varied presentations following the introduction of HAART, drug-associated lesions, and the current treatment guidelines.
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Affiliation(s)
| | - Nivedita Nair
- Department of Uveitis, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Andre Curi
- André Luiz Land Curi, National Institute of Infectious Diseases - INI/ Fiocruz, Brazil
- Clinical Research Laboratory of Infectious, Diseases in Ophthalmology - INI / Fiocruz, Brazil
| | - Alay Banker
- Banker's Retina Clinic and Laser Centre, Ahmedabad, Gujarat, India
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, Ethiopia
- Schepens Eye Research Institute, Boston, Massachusetts, USA
- MCM Eye Unit, MyungSung Christian Medical Center (MCM) General Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
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Husbands W, Nakamwa J, Tharao W, Greenspan N, Calzavara L, Sathiyamoorthy T, Muchenje-Marisa M, Arnold K, Browne O, Kerr J. Love, Judgement and HIV: Congregants' Perspectives on an Intervention for Black Churches to Promote Critical Awareness of HIV Affecting Black Canadians. J Racial Ethn Health Disparities 2020; 8:507-518. [PMID: 32656731 DOI: 10.1007/s40615-020-00808-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/25/2022]
Abstract
We assess participants' experience of Black Pastors Raising Awareness and Insight of Stigma through Engagement (Black PRAISE), an intervention for Black churches to promote critical awareness of HIV affecting Black Canadian communities. We used a community-based participatory approach to implement Black PRAISE among six churches in the Greater Toronto Area and Ottawa, in October-November 2016. For the intervention, congregants received a booklet with validated HIV-related information, attended a sermon on compassion and justice, viewed a short film on HIV-related stigma, and completed baseline and follow-up surveys to evaluate the effectiveness of the intervention. We then conducted in-depth interviews with 18 pastors and congregants from the six churches to explore how they experienced the intervention. Three major themes emerged from an iterative exploration of the thematic content of the interviews: the beneficial impact of the intervention; reconciling the moral and theological issues of their faith with the social reality of HIV and stigma; and perspectives on future stigma reduction efforts. Participants spoke approvingly about Black PRAISE and supported stigma reduction but acknowledged uncertainties about their capacity to actualise their commitment. The main overarching lessons from Black PRAISE are as follows: first, our results support a community-based participatory approach to productively engaging Black congregations in stigma reduction and health promotion; second, promising or successful interventions incorporate multiple components to promote critical awareness about the specific health issue for Black life and wellbeing; and third, interventions are more likely to succeed if they support critical reflection on the underlying conceptual issues, implicit assumptions and belief systems among the professional and lay stakeholders.
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Affiliation(s)
- Winston Husbands
- Ontario HIV Treatment Network, Toronto, ON, M4T 1X3, Canada.
- University of Toronto, Toronto, ON, M5T 3M7, Canada.
| | | | - Wangari Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, ON, M5B 1J3, Canada
| | | | | | | | | | - Keresa Arnold
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, ON, M5C 2N8, Canada
| | | | - Jelani Kerr
- University of Louisville, Louisville, KY 40292, USA
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Bashir F, Ba Wazir M, Schumann B, Lindvall K. The realities of HIV prevention. A closer look at facilitators and challenges faced by HIV prevention programmes in Sudan and Yemen. Glob Health Action 2020; 12:1659098. [PMID: 31496422 PMCID: PMC6746302 DOI: 10.1080/16549716.2019.1659098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: HIV/AIDS prevention has historically encountered many obstacles. Understanding the factors affecting HIV/AIDS prevention is central to designing and implementing suitable context-specific interventions. Research relating to HIV prevention in the Middle East and North African region is required to address the gradually increasing HIV epidemic. Objective: This study aimed to explore the perspectives of employees/health care professionals who are working or have worked within HIV prevention in Sudan and Yemen on the challenges and facilitating factors facing HIV prevention. Methods: A qualitative approach was employed using an open-ended questionnaire. Sixteen stakeholders from governmental and non-governmental agencies participated in the study. The questionnaire focused on the various challenges and facilitating factors facing HIV prevention as well as proposed possible solutions from the perspectives of the participants. The data were analysed using thematic analysis. Results: The study illustrated the similarities in context and HIV prevention systems between Sudan and Yemen. Thematic analysis resulted in three main themes: I) much is achieved despite difficulties; II) a programme left to be paralysed; this theme addressed the main obstacles facing HIV prevention in Sudan and Yemen generating a total of six sub-themes; III) comprehensive change is needed. The participants drew focus and attention to vital changes required to improve the delivery of HIV prevention services. Conclusion: Increased financial support for HIV prevention in Sudan and Yemen is urgently needed. De-stigmatisation and increased political support, advocacy and improved legislation for people living with HIV (PLHIV) are required for the sustainability and effectiveness of HIV prevention programmes in Sudan and Yemen. Civil society organisations must be aided and supported in their role in engaging key populations.
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Affiliation(s)
- Fatima Bashir
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Maha Ba Wazir
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Barbara Schumann
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Kristina Lindvall
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
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Pell C, Reis R, Dlamini N, Moyer E, Vernooij E. 'Then her neighbour will not know her status': how health providers advocate antiretroviral therapy under universal test and treat. Int Health 2019; 11:36-41. [PMID: 30137387 DOI: 10.1093/inthealth/ihy058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/10/2018] [Indexed: 11/14/2022] Open
Abstract
Introduction Universal test and treat (UTT)-antiretroviral therapy (ART) for all HIV-positive individuals regardless of CD4 count-is the WHO's recommended treatment guideline. UTT has implications for health providers' workload in areas of high HIV prevalence and for understandings of ART and HIV. This article explores health providers' experiences of implementing UTT in Hhohho Region, Eswatini. Methods Between March 2015 and October 2016, in-depth interviews were conducted with health providers implementing UTT. Interviews were transcribed verbatim and translated into English for qualitative content analysis. Results Twenty-five providers from eight facilities were interviewed. Respondents encouraged early ART by promoting its overall health benefits, and the possibility of avoiding disclosure and HIV-related stigma in the community. Some health providers downplayed UTT's preventive benefits to avoid discouraging condom use. Respondents suggested that initiating ART immediately after testing could improve linkage-to-care, but recognized that overly hasty initiation might affect adherence. Viral load testing was seen as a potentially useful tool to monitor clients' response to ART. Conclusions Health providers appropriated stigma to encourage early ART. This suggests an attentiveness to the social burden of HIV/AIDS, but potentially exacerbates discrimination and conflicts with efforts to reduce HIV-related stigma.
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Affiliation(s)
- Christopher Pell
- Amsterdam Institute for Social Science Research, University of Amsterdam, Nieuwe Achtergracht 166, WV, Amsterdam, the Netherlands.,Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Tower C4, Paasheuvelweg 25, BP, Amsterdam, the Netherlands
| | - Ria Reis
- Amsterdam Institute for Social Science Research, University of Amsterdam, Nieuwe Achtergracht 166, WV, Amsterdam, the Netherlands.,The Children's Institute, School of Child and Adolescent Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa.,Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 ZD, Leiden, the Netherlands
| | - Njabuliso Dlamini
- Amsterdam Institute for Social Science Research, University of Amsterdam, Nieuwe Achtergracht 166, WV, Amsterdam, the Netherlands.,Clinton Health Access Initiative, 4th Floor, Lilunga House, Somhlolo Road, Mbabane, Eswatini
| | - Eileen Moyer
- Amsterdam Institute for Social Science Research, University of Amsterdam, Nieuwe Achtergracht 166, WV, Amsterdam, the Netherlands
| | - Eva Vernooij
- Amsterdam Institute for Social Science Research, University of Amsterdam, Nieuwe Achtergracht 166, WV, Amsterdam, the Netherlands.,Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
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Ekstrand ML, Heylen E, Mazur A, Steward WT, Carpenter C, Yadav K, Sinha S, Nyamathi A. The Role of HIV Stigma in ART Adherence and Quality of Life Among Rural Women Living with HIV in India. AIDS Behav 2018; 22:3859-3868. [PMID: 29789984 DOI: 10.1007/s10461-018-2157-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
HIV stigma continues to be a barrier to physical and mental health among people living with HIV globally, especially in vulnerable populations. We examined how stigma is associated with health outcomes and quality of life among rural women living with HIV in South India (N = 600). Interviewer-administered measures assessed multiple dimensions of stigma, as well as loneliness, social support, ART adherence, time since diagnosis, and quality of life. Internalized stigma and a lack of social support were associated with a lower quality of life, while the association between internalized stigma and adherence was mediated by the use of stigma-avoidant coping strategies, suggesting that keeping one's diagnosis a secret may make it more difficult to take one's medications. These findings suggest that these women constitute a vulnerable population who need additional services to optimize their health and who might benefit from peer support interventions and stigma-reduction programs for family and community members.
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Affiliation(s)
- Maria L Ekstrand
- University of California, San Francisco, 550 16th St, 3rd floor, San Francisco, CA, 94158, USA.
- St John's Research Institute, Bangalore, India.
| | - Elsa Heylen
- University of California, San Francisco, 550 16th St, 3rd floor, San Francisco, CA, 94158, USA
| | - Amanda Mazur
- University of California, San Francisco, 550 16th St, 3rd floor, San Francisco, CA, 94158, USA
| | - Wayne T Steward
- University of California, San Francisco, 550 16th St, 3rd floor, San Francisco, CA, 94158, USA
| | | | | | - Sanjeev Sinha
- All India Institute of Medical Sciences, New Delhi, India
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Thapa S, Hannes K, Cargo M, Buve A, Peters S, Dauphin S, Mathei C. Stigma reduction in relation to HIV test uptake in low- and middle-income countries: a realist review. BMC Public Health 2018; 18:1277. [PMID: 30453923 PMCID: PMC6245520 DOI: 10.1186/s12889-018-6156-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 10/26/2018] [Indexed: 11/20/2022] Open
Abstract
Background This realist review was conducted to understand how stigma is reduced in relation to HIV test uptake in low- and middle-income countries (LMICs). Methods A systematic search of eight databases resulted in 34 articles considered for synthesis. Data synthesis was guided by a preliminary programme theory and included coding the meaning units to develop themes or intervention pathways that corresponded to context-mechanism-outcome configurations. Results We found that the interventions produced an effect through two pathways: (a) knowledge leads to changes in stigmatizing attitudes and increases in HIV test uptake and (b) knowledge and attitudes lead to changes in stigmatizing behaviours and lead to HIV test uptake. We also found one competing pathway that illustrated the direct impact of knowledge on HIV test uptake without changing stigmatizing attitudes and behaviour. The identified pathways were found to be influenced by some structural factors (e.g., anti-homosexuality laws, country-specific HIV testing programmes and policies), community factors (e.g., traditional beliefs and practices, sexual taboos and prevalence of intimate partner violence) and target-population characteristics (e.g., age, income and urban-rural residence). Conclusions The pathways and underlying mechanisms support the adaptation of intervention strategies in terms of social context and the target population in LMICs.
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Affiliation(s)
- Subash Thapa
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, 5000, Denmark.
| | - Karin Hannes
- Social Research Methodology Group, Faculty of Social Sciences, KU Leuven, Parkstraat 45, 3000, Leuven, Belgium
| | - Margaret Cargo
- Health Research Institute, University of Canberra, University Drive, 22-B17, Bruce, ACT, 2601, Australia
| | - Anne Buve
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Sanne Peters
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Stephanie Dauphin
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Catharina Mathei
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
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Gwadz M, Leonard NR, Honig S, Freeman R, Kutnick A, Ritchie AS. Doing battle with "the monster:" how high-risk heterosexuals experience and successfully manage HIV stigma as a barrier to HIV testing. Int J Equity Health 2018; 17:46. [PMID: 29678188 PMCID: PMC5910579 DOI: 10.1186/s12939-018-0761-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/10/2018] [Indexed: 12/22/2022] Open
Abstract
Background Annual HIV testing is recommended for populations at-risk for HIV in the United States, including heterosexuals geographically connected to urban high-risk areas (HRA) with elevated rates of HIV prevalence and poverty, who are primarily African American/Black or Hispanic. Yet this subpopulation of “individuals residing in HRA” (IR-HRA) evidence low rates of regular HIV testing. HIV stigma is a recognized primary barrier to testing, in part due to its interaction with other stigmatized social identities. Guided by social-cognitive and intersectionality theories, this qualitative descriptive study explored stigma as a barrier to HIV testing and identified ways IR-HRA manage stigma. Methods In 2012-2014, we conducted in-depth qualitative interviews with 31 adult IR-HRA (74% male, 84% African American/Black) with unknown or negative HIV status, purposively sampled from a larger study for maximum variation on HIV testing experiences. Interviews were audio-recorded and professionally transcribed verbatim. Data were analyzed using a systematic content analysis approach that was both theory-driven and inductive. Results Stigma was a primary barrier to HIV testing among IR-HRA. In the context of an under-resourced community, HIV stigma was experienced as emerging from, and being perpetuated by, health care organizations and educational institutions, as well as community members. Participants noted it was “better not to know” one’s HIV status, to avoid experiencing HIV-related stigma, which could interact with other stigmatized social identities and threaten vital social relationships, life chances, and resources. Yet most had tested for HIV previously. Factors facilitating testing included health education to boost knowledge of effective treatments for HIV; understanding HIV does not necessitate ending social relationships; and tapping into altruism. Conclusions In the context of economic and social inequality, HIV stigma operates on multiple, intersecting layers. IR-HRA struggle with an aversion to HIV testing, because adopting another stigmatized status is dangerous. They also find ways to manage stigma to engage in testing, even if not at recommended levels. Findings highlight strategies to reduce HIV stigma at the levels of communities, institutions, and individuals to improve rates of annual HIV testing necessary to eliminate HIV transmission and reduce HIV-related racial and ethnic health disparities among IR-HRA.
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Affiliation(s)
- Marya Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA.
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Sylvie Honig
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Robert Freeman
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Alexandra Kutnick
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
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13
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Ngangue P, Gagnon MP, Bedard E. Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:9. [PMID: 28390398 PMCID: PMC5385024 DOI: 10.1186/s12914-017-0118-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/29/2017] [Indexed: 11/12/2022]
Abstract
Background The Cameroon government has made HIV testing and counselling (HTC) a priority in its HIV/AIDS strategic plan. However, there is a dearth of literature on the perspectives of providers on the quality of HTC services. The aim of this study was to explore challenges in the provision of HTC services and their implications on quality of HTC services in Douala’s district hospitals. Methods Two primary data collection methods supported by the Donabedian’s model of healthcare were used to explain the challenges in the provision of HTC services and their implications on quality of HTC services. This consisted of semi-structured individual interviews with 6 nurses and 16 lay counsellors and a non-participant observation of the physical environment for HTC by site. The study sites were the prevention and voluntary testing and counselling centre (PVTCC) of the six district hospitals of the city of Douala. Results The study reveals concerns about confidentiality and privacy during the counselling sessions due to inadequate and limited space. An absence of consent, even verbal, was reported in one PVTCC. There is no specific accredited training curriculum that leads to a formal registration as a PVTCC staff, and some lay counsellors work without training. Lay counsellors carry the burden of HIV counselling, but the majority of them work for many years without remuneration and recognition. Another quality challenge is the high workload in the district hospitals’ lab, which leads to long waiting times for HIV test results, thus contributing to failure to return for results. Conclusion The findings of this study highlighted some issues such as lack of adequate space and equipment for HIV testing and counselling that hinder the quality of HTC services and should challenge the health authorities of Cameroon on the need to reorganize HTC services and create a national HIV quality assurance program. Electronic supplementary material The online version of this article (doi:10.1186/s12914-017-0118-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrice Ngangue
- Faculty of Nursing Sciences, Laval University, 1050, avenue de la medicine, Pavillon Vandry, Québec, Québec, G1V0A6, Canada. .,Population Health and Optimal Health Practices, CHU de Québec Research Center, 10, Rue de l'Espinay, D6, Québec, Québec, G1L 3L5, Canada.
| | - Marie-Pierre Gagnon
- Faculty of Nursing Sciences, Laval University, 1050, avenue de la medicine, Pavillon Vandry, Québec, Québec, G1V0A6, Canada.,Population Health and Optimal Health Practices, CHU de Québec Research Center, 10, Rue de l'Espinay, D6, Québec, Québec, G1L 3L5, Canada
| | - Emmanuelle Bedard
- Université du Québec à Rimouski (UQAR), 1595 Boul. Alphonse-Desjardins, UQAR, Campus de Lévis, Lévis, Québec, Canada
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Pierre S, Riviera V, Jean CP, Louis MJJ, Reif LK, Severe P, Rouzier V, Johnson WD, Pape JW, Fitzgerald DW, McNairy ML, Boutin-Foster C. Live with the Disease Like You Used to Before You Knew You Were Infected: A Qualitative Study Among 10-Year Survivors Living with HIV in Haiti. AIDS Patient Care STDS 2017; 31:145-151. [PMID: 28282245 DOI: 10.1089/apc.2016.0192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 2003, the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), a nonprofit organization, began administering antiretroviral therapy (ART) to its patients. This practice transformed HIV from a fatal disease to a more manageable chronic condition. However, relatively few studies focus on the experiences of survivors. This study provided a unique opportunity to interview patients who survived at least 10 years after being treated with ART at GHESKIO. The goal of the study was to elicit from patients their perspectives on what enabled them to survive with AIDS. Grounded Theory, a qualitative research method was used to guide data collection, coding, and analysis. Individual interviews were conducted, audio-taped, transcribed and analyzed in Creole, and translated into English. Data saturation was reached at 25 participants. Of which, 64% were women, the mean age was 49, range of 43-55 years, 24% were married, 44% had not completed elementary school, and 72% had no income, the remaining participants had incomes ranging from $1000 to $5000 annually. Qualitative analysis resulted in 681 codes, which were grouped into six categories: being spiritually grounded, having supportive interactions with providers, caring for children, setting personal goals, persevering and living life as usual, and maintaining strict medication adherence practices. The overarching theory was that having a reason to live despite one's circumstances and living life as usual enabled one to survive. Having a strong spiritual foundation coupled with supportive family and providers motivated participants to live and adhere to their ART. As the number of patients who are living longer with HIV in Haiti increases, results from this study will be important in helping tailor interventions that enhance their overall quality of life.
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Affiliation(s)
- Samuel Pierre
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Vanessa Riviera
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Circee Phara Jean
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Marie Jude Jean Louis
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Lindsey K. Reif
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Patrice Severe
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Warren D. Johnson
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Jean W. Pape
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | | | - Margaret L. McNairy
- Center for Global Health, Weill Cornell Medical College, New York, New York
- Division of General Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Carla Boutin-Foster
- Brooklyn Health Disparities Center, SUNY Downstate Medical Center, New York, New York
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Abou-El-Enein M, Bauer G, Reinke P. Gene therapy: a possible future standard for HIV care. Trends Biotechnol 2016; 33:374-6. [PMID: 26088914 DOI: 10.1016/j.tibtech.2015.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/09/2015] [Accepted: 03/20/2015] [Indexed: 11/28/2022]
Abstract
Despite undeniable accomplishments in developing cell and gene therapeutic strategies to combat HIV infection, key social, economic, and policy-related challenges still need to be overcome for any future commercialization efforts of these novel therapies to be successful. Here, we address these challenges and structure a framework for eradicating HIV/AIDS using gene therapy.
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Affiliation(s)
- Mohamed Abou-El-Enein
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Campus Virchow, Berlin, Germany; Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany.
| | - Gerhard Bauer
- University of California Davis, Institute For Regenerative Cures (IRC) Sacramento, CA, USA
| | - Petra Reinke
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Campus Virchow, Berlin, Germany; Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
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HIV/AIDS Related Stigma and Discrimination against PLWHA in Nigerian Population. PLoS One 2015; 10:e0143749. [PMID: 26658767 PMCID: PMC4675522 DOI: 10.1371/journal.pone.0143749] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 11/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV/AIDS remain a major public health concern in Nigeria. People living with HIV/AIDS (PLWHA) face not only personal medical problems but also social problems associated with the disease such as stigma and discriminatory attitudes. This study provides an insight into HIV/AIDS related stigma and discrimination against PLWHA in Nigeria. METHODS The data for this study was extracted from the 2013 Nigeria Demographic and Health Survey conducted by the National Population Commission. All men and women aged 15-49 years, permanent residents and visitors of the households were eligible for the interview. Several questionnaires were used in the survey, some covering questions on HIV/AIDS. RESULTS A total of 56 307 men and women aged 15-49 years participated in this national survey. About half of the population in Nigeria have HIV stigma. Younger persons, men, those without formal education and those within poor wealth index are more likely to have stigma towards PLWHA. In addition, married people are more likely to have stigma on PLWHA and are more likely to blame PLWHA for bringing the disease to the community. Also about half of the population discriminates against PLWHA. However, those with higher levels of education and those from higher wealth index seem to be more compassionate towards PLWHA. About 70% in the population are willing to care for relative with AIDS, even more so among those with higher level of education. CONCLUSION There is a high level of HIV stigma and discrimination against PLWHA in the Nigerian population. Education seems to play a major role in the society with respect to HIV stigma and discrimination against PLWHA. Educating the population with factual information on HIV/AIDS is needed to reduce stigma and discrimination towards PLWHA in the community.
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Associations of stigma with negative health outcomes for people living with HIV in the Gambia: implications for key populations. J Acquir Immune Defic Syndr 2015; 68 Suppl 2:S146-53. [PMID: 25723979 DOI: 10.1097/qai.0000000000000453] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The HIV epidemic in the Gambia is concentrated among stigmatized key populations. This study explores the relationship between 3 types of HIV-related stigma and 3 health outcomes among people living with HIV (PLHIV) in the Gambia. METHODS Three hundred seventeen PLHIV from PLHIV support groups in the Gambia were surveyed using the PLHIV Stigma Index. RESULTS Enacted stigma in health care settings was significantly associated with avoiding or delaying seeking care [adjusted odds ratio (aOR) = 3.03, 95% confidence interval (CI) = 1.24 to 7.89]; enacted stigma in the household or community (aOR = 1.21, 95% CI = 0.98 to 1.49) and internal stigma (aOR = 1.47, 95% CI = 0.96 to 2.22) were marginally associated. Enacted stigma in health care settings was significantly associated with non-use of antiretroviral therapy (aOR = 0.52, 95% CI = 0.31 to 0.88), whereas internal stigma and enacted stigma in the household or community were not. Enacted stigma in the household or community (aOR = 0.75, 95% CI = 0.64 to 0.87) and internal stigma (aOR = 0.69, 95% CI = 0.50 to 0.93) were significantly associated with poorer self-reported health status, whereas enacted stigma in health care settings was not. CONCLUSIONS PLHIV in the Gambia face stigma regardless of identity as members of key populations, who may face dual stigma. Stigma mitigation represents a potentially important component of a comprehensive package of services to improve the HIV care continuum in the Gambia. Targeted interventions that address stigma with health care workers could facilitate antiretroviral therapy use and timely care seeking for PLHIV. Interventions to address internal stigma and enacted stigma in the household and community may yield additional dividends for the overall health of PLHIV. Examining only 1 domain of stigma may not be sufficient to understand the effect of stigma on a specific health outcome.
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