scholarly journals Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0249462
Author(s):  
Cecilia Akatukwasa ◽  
Monica Getahun ◽  
Alison M. El Ayadi ◽  
Judith Namanya ◽  
Irene Maeri ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Physical Violence ◽  
Marital Dissolution ◽  
Care Seeking ◽  
Internalized Stigma ◽  
Test And Treat ◽  
Hiv Test ◽  
Related Stigma ◽  
Enacted Stigma ◽  
Anticipated Stigma

HIV-related stigma is a frequently cited barrier to HIV testing and care engagement. A nuanced understanding of HIV-related stigma is critical for developing stigma-reduction interventions to optimize HIV-related outcomes. This qualitative study documented HIV-related stigma across eight communities in east Africa during the baseline year of a large HIV test-and-treat trial (SEARCH, NCT: 01864603), prior to implementation of widespread community HIV testing campaigns and efforts to link individuals with HIV to care and treatment. Findings revealed experiences of enacted, internalized and anticipated stigma that were highly gendered, and more pronounced in communities with lower HIV prevalence; women, overwhelmingly, both held and were targets of stigmatizing attitudes about HIV. Past experiences with enacted stigma included acts of segregation, verbal discrimination, physical violence, humiliation and rejection. Narratives among women, in particular, revealed acute internalized stigma including feelings of worthlessness, shame, embarrassment, and these resulted in anxiety and depression, including suicidality among a small number of women. Anticipated stigma included fears of marital dissolution, verbal and physical abuse, gossip and public ridicule. Anticipated stigma was especially salient for women who held internalized stigma and who had experienced enacted stigma from their partners. Anticipated stigma led to care avoidance, care-seeking at remote facilities, and hiding of HIV medications. Interventions aimed at reducing individual and community-level forms of stigma may be needed to improve the lives of PLHIV and fully realize the promise of test-and-treat strategies.

Stigma, sexual risk and desire for HIV tests in Ghana

Sexual Health ◽  
2011 ◽  
Vol 8 (1) ◽  
pp. 110 ◽  
Author(s):  
Emmanuel F. Koku
Keyword(s):  
Hiv Prevention ◽  
Hiv Testing ◽  
Treatment Programs ◽  
Negative Interaction ◽  
Sexual Behaviours ◽  
Hiv Test ◽  
Related Stigma ◽  
Risky Sexual Behaviours ◽  
Positive Effect

Background: Although various HIV prevention and treatment programs have been implemented in Ghana since 2003, desire for and uptake of HIV testing is still low, owing largely to HIV-related stigma. This study examined the effect of stigma on desire for HIV testing, while controlling for socio-demographic and other influences. Method: The study used data from the 2003 Ghana Demographic and Health Survey to regress desire for an HIV test on levels of stigma while controlling for selected socio-demographic, socio-cognitive and socio-behavioural covariates. Results: The study revealed significant associations between several socio-demographic and socio-cognitive variables and the desire for an HIV test. For example, both male (adjusted odds ratio (AOR) = 0.41; 95% confidence interval (CI) = 0.24–0.72) and female (AOR = 0.62; 95% CI = 0.41–0.93) respondents in the wealthiest households, and those who know someone infected with HIV (AOR = 0.65; 95% CI = 0.43–1.00) have lower odds of desiring an HIV test. The study showed a significant but negative interaction between risky sexual behaviours and community stigma (AOR = 0.44; 95% CI = 0.19–0.67), indicating that the positive effect of risky sex on HIV testing is attenuated among females who live in communities with high levels of stigma. Conclusion: Since community-level education and risk reduction programs have demonstrable influences on reducing HIV stigma, it is imperative that the Ghana government’s ongoing anti-stigma campaigns and other HIV prevention programs recognise the role of community stigma in influencing HIV testing decisions, especially in the context of risky sexual behaviours.

Barriers to contraception among HIV-positive women in a periurban district of Uganda

2012 ◽  
Vol 23 (9) ◽  
pp. 661-666 ◽  
Author(s):  
A K Mbonye ◽  
K S Hansen ◽  
F Wamono ◽  
P Magnussen
Keyword(s):  
Hiv Testing ◽  
Household Survey ◽  
Hiv Positive ◽  
Care Seeking ◽  
Test Results ◽  
Group Discussions ◽  
Effective Interventions ◽  
Hiv Positive Women ◽  
Hiv Test ◽  
Negative Perceptions

This study explored perceptions and care-seeking practices for HIV testing and contraception in order to obtain data for designing effective interventions to increase contraception among HIV-positive women. A triangulation of methods (household survey, focus group discussions and key informant interviews) were conducted in Wakiso district, central Uganda from January to April 2009. Results show that a majority of women, 2062/2896 (71.2%) would like to have an HIV test, while access to antiretroviral therapy (ART) was low at 237/879 (27%). Of the women who were on ART, 133/266 (50.0%) could not use contraception due to negative perceptions that a combination of ART and contraceptives would weaken them, as these drugs were perceived to be ‘strong’. Fear of side-effects for contraceptives and resistance from spouses were other main reasons. Constraints to HIV testing included fear of clients knowing their own HIV status and fear of their spouses’ reactions to the test results. Private midwives were identified as a potential outlet for delivering contraception to HIV-positive women.

scholarly journals BARRIERS TO PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV SERVICES IN UGANDA

2009 ◽  
Vol 42 (2) ◽  
pp. 271-283 ◽  
Author(s):  
A. K. MBONYE ◽  
K. S. HANSEN ◽  
F. WAMONO ◽  
P. MAGNUSSEN
Keyword(s):  
Family Planning ◽  
Hiv Testing ◽  
Age Groups ◽  
Wealth Quintile ◽  
Care Seeking ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Health Seeking ◽  
Hiv Test ◽  
Mother To Child

SummaryUnderstanding care-seeking practices and barriers to prevention of mother-to-child transmission (PMTCT) of HIV is necessary in designing effective programmes to address the high disease burden due to HIV/AIDS in Uganda. This study explored perceptions, care-seeking practices and barriers to PMTCT among young and HIV-positive women. A household survey (10,706 women aged 14–49 years), twelve focus group discussions and 66 key informant interviews were carried out between January and April 2009 in Wakiso district, central Uganda. Results show that access to PMTCT services (family planning, HIV counselling and testing and delivery at health units) was poor. Decision making was an important factor in accessing PMTCT services. Socioeconomic factors (wealth quintile, age, education level) and institutional practices also influenced access to PMTCT. Overall, having had an HIV test was highest when both men and women made decisions together or when women were empowered to make their own decisions. This was significant across wealth quintiles (p=0.0001), age groups (p=0.0001) and education levels (p=0.0001). The least level of HIV testing was when men made decisions for their spouses; and this was the case with family planning and deliveries at health units. Other barriers to PMTCT were fear of women and male spouses to have an HIV test and the perception that HIV testing is compulsory in antenatal clinics. In conclusion, to increase access to PMTCT among women, especially the young, poor and least educated, there is a need to empower them to make decisions on health seeking, and also to empower men to support their spouses to make good decisions. Other barriers like fear of having an HIV test should be addressed through appropriate counselling of clients.

scholarly journals Associations of internalized and anticipated HIV stigma with returning to work for persons living with HIV

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252783
Author(s):  
Joseph S. Lightner ◽  
Serena Rajabiun ◽  
Howard J. Cabral ◽  
Jessica Flaherty ◽  
Jamie Shank ◽  
...  
Keyword(s):  
The United States ◽  
Hiv Stigma ◽  
Internalized Stigma ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Employment Barriers ◽  
Persons Living With Hiv ◽  
Related Stigma ◽  
Anticipated Stigma ◽  
Living With Hiv

Introduction Employment is particularly beneficial for persons living with HIV (PLWH). However, PLWH experiencing internalized stigma or anticipating that they may experience stigma may be less likely to seek employment due to additional barriers associated with HIV. The purpose of this study was to understand the associations between internalized and anticipated stigma and employment barriers for PLWH. Methods Participants (N = 712) from 12 sites across the United States were recruited and interviewed about barriers to employment, HIV stigma, and several other factors related to health. A series of unadjusted and adjusted linear regression models were conducted using cross-sectional data. Results Adjusted models suggest that greater anticipated stigma was related to increased employment barriers (β = 0.12, p = 0.04). Mental and physical health functioning also positively predicted employment barriers (β = -0.18, p <0.001; β = -0.40, p <0.001, respectively). Discussion Employment among PLWH has beneficial impacts on HIV-related health outcomes. This study suggests that anticipated stigma may limit and individual’s willingness to seek out employment, or may cause them to leave employment. Internalized stigma may not play as large of a role in employment as anticipated stigma for PLWH. HIV-related stigma reduction interventions focused on community-level and employers are essential to improve employment opportunities for PLWH.

Stigma and Its Implications for Health: Introduction and Overview

2017 ◽  
Author(s):  
Brenda Major ◽  
John F. Dovidio ◽  
Bruce G. Link ◽  
Sarah K. Calabrese
Keyword(s):  
Health Disparities ◽  
Physiological Responses ◽  
Future Research ◽  
Internalized Stigma ◽  
Negative Consequences ◽  
Individual Level ◽  
Marginalized Groups ◽  
Enacted Stigma ◽  
Domains Of Life ◽  
Anticipated Stigma

There is growing recognition that stigma plays an important role in producing health disparities between members of socially advantaged and disadvantaged (marginalized) groups. This chapter defines stigma, describes differences among stigmatized marks, and discusses the functions that stigma may serve for individuals, groups, and societies. It also provides a conceptual model of the pathways by which stigma relates to health. This model posits that socially conferred marks that are devalued in society are the basis for four key stigma processes: enacted stigma, felt stigma, internalized stigma, and anticipated stigma. These stigma processes lead to stress and accompanying individual-level affective, cognitive, behavioral, and physiological responses, as well as to social and community-level exclusion from important domains of life that collectively have downstream negative consequences for health. This chapter provides an integrative overview of the chapters in the current volume and concludes with suggestions for future research on stigma and health.

scholarly journals INDIVIDUAL- AND COMMUNITY-LEVEL DETERMINANTS OF ANTENATAL HIV TESTING IN ZIMBABWE

2018 ◽  
Vol 51 (2) ◽  
pp. 203-224 ◽  
Author(s):  
Martin Marufu Gazimbi ◽  
Monica Akinyi Magadi
Keyword(s):  
Socioeconomic Status ◽  
Hiv Testing ◽  
Community Level ◽  
Demographic And Health Surveys ◽  
Hiv Status ◽  
Individual Level ◽  
Hiv Test ◽  
Wide Range ◽  
Related Stigma ◽  
Hiv Awareness

SummaryThis study contributes to the dialogue on the prevention of mother-to-child HIV transmission (PMTCT) through the use of HIV and antenatal care (ANC) integrated services. The determinants of antenatal HIV testing in Zimbabwe were explored. Multilevel logistic regression models were applied to data for 8471 women from 406 clusters who gave birth in the 5 years preceding Zimbabwe Demographic and Health Surveys conducted in 2005/6 and 2010/11. The uptake of antenatal HIV testing was found to be determined by a wide range of individual-level factors relating to women’s economic and demographic status, as well as HIV-related factors, including HIV awareness and stigma within the community. Important individual-level enabling and perceived need factors included high socioeconomic status, not having observed HIV-related stigma and knowledge of HIV status (based on a previous HIV test), such that these groups of individuals had a significantly higher likelihood of being tested for HIV during pregnancy than their counterparts of lower socioeconomic status, and who had observed HIV-related stigma or did not know their HIV status. The results further revealed that community HIV awareness is important for improving antenatal HIV testing, while stigma is associated with reduced testing uptake. Most contextual community-level factors were not found to have much effect on the uptake of antenatal HIV testing. Therefore, policies should focus on individual-level predisposing and enabling factors to improve the uptake of antenatal HIV testing in Zimbabwe.

Access to contraception and HIV testing among young women in a peri-urban district of Uganda

2012 ◽  
Vol 24 (4) ◽  
pp. 301-306 ◽  
Author(s):  
Anthony K. Mbonye ◽  
Felix Wamono
Keyword(s):  
Hiv Testing ◽  
Older Women ◽  
Young Women ◽  
Age Groups ◽  
Reproductive Age ◽  
Human Immune Deficiency Virus ◽  
Care Seeking ◽  
Urban District ◽  
Hiv Test ◽  
Hiv Testing Services

Abstract Objective: The purpose of the study was to assess care-seeking practices for contraception and human immune deficiency virus (HIV) testing services among young women (14–24 years) in a peri-urban district of Uganda. Methods: A formative study assessed care-seeking practices among women in Wakiso district, Central Uganda. A survey was carried out in 11 randomly selected parish clusters targeting women in the reproductive age group. Data on current use of contraception, information from women who had been tested for HIV, future desire for an HIV test, and choice of care were captured. Results: A total of 10,993 women were interviewed of whom young women were 5384 (49.0%). The proportion of young women using a method of contraception was less, 2446 (45.8%), compared with 2832 (54.3%) for older women, p=0.0001. Few adolescents (14–19 years), 850 (45.3%), had tested for HIV compared with older women, p=0.0001, whereas majority of the young women, 1321 (75.5%), wished to have an HIV test compared with older women, 742 (66.0%), p=0.0001. Fear for an HIV test was common among women of both age groups, p=0.9. Data further show that young women were less likely to deliver at hospitals, 1582 (50.8%), compared with older women, 2586 (53.3%), p=0.0001. Similarly, a lesser proportion of young women, 845 (50.4%), sought contraception at hospitals compared with older women, 1432 (54.4%), p=0.004. The factors that most influenced access to services were age, educational level, source of care, marital status, and future intention to use a particular service. Conclusions: Young women are less likely to access contraception and HIV testing services in this district. These results will be useful in designing and evaluating future interventions targeting young women.

scholarly journals Qualitative Exploration of Experiences and Consequences of Health-related Stigma among Indonesians with HIV, Leprosy, Schizophrenia and Diabetes

2020 ◽  
Vol 15 (1) ◽  
pp. 7
Author(s):  
Sarju Sing Rai ◽  
Irwanto Irwanto ◽  
Ruth M.H. Peters ◽  
Elena V. Syurina ◽  
Annisa Ika Putri ◽  
...  
Keyword(s):  
Social Interactions ◽  
Negative Impact ◽  
Health Conditions ◽  
Public Health Programs ◽  
Individual Level ◽  
Related Stigma ◽  
Health Related ◽  
Enacted Stigma ◽  
Anticipated Stigma ◽  
Qualitative Exploration

Health-related stigma causes a negative impact on the lives of affected people and undermines the effectiveness of public health programs. This study aimedto explore experiences and consequences of stigma among people affected by four health conditions relevant in Indonesia– HIV (Human ImmunodeficiencyVirus), leprosy, schizophrenia and diabetes. In this qualitative study 40 people affected by the four health conditions in Jakarta and West Java, Indonesia–,were interviewed between March and June 2018. Data were analyzed thematically by following an integrative inductive-deductive approach. The experiencesand consequences of people with stigma were similar, but such experience were more severe among people affected by HIV, leprosy, and schizophrenia.Those with diabetes either experienced no or less severe stigma. The participants revealed that they experienced enacted stigma in healthcare, employment,and social interactions in the structural and interpersonal levels. They also experience the stigma in the form of internalized and anticipated stigma at an individual level. Incidences of human rights violations were evident. Social, behavioral, psychological, and medical consequences were also reported.

scholarly journals Women’s experiences of fistula-related stigma in Uganda: application of a conceptual framework to inform stigma-reduction interventions

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Alison Elayadi
Keyword(s):  
Conceptual Framework ◽  
Poor Mental Health ◽  
Mulago Hospital ◽  
Internalized Stigma ◽  
Stigma Reduction ◽  
Community Activities ◽  
Self Worth ◽  
Related Stigma ◽  
Enacted Stigma ◽  
Stigma Experiences

Aims: To understand women’s fistula-related stigma experiences using a conceptual framework. Methods: In-depth interviews and focus groups discussion including 33 women who underwent fistula surgery 6-24 months prior at Mulago Hospital in Kampala, Uganda in May-July 2014.Coded transcripts were analyzed thematically for experiences and consequences of enacted, anticipated, and internalized stigma. Results: Narratives of enacted stigma experiences included verbal abuse, relationship dissolution, and exclusion from household, family and community activities. Women’s stigma anticipations reflected fears of enacted stigma. Internalized stigma reports revealed pervasive shame and low self-esteem: reduction in self-worth, disgrace, and envisioning no future. Consequences of fistula-related stigma described by women included self-imposed social isolation, changes to normal household activities, non-disclosure of fistula, and poor mental health. Conclusions: Refining stigma theory to specific conditions has resulted in nuanced understanding of stigma dimensions, manifestations, mechanisms, and consequences, permitting comparison across contexts and populations, and development and evaluation of stigma-reduction interventions. These lessons should be applied to fistula, acknowledging its unique features: concealability, management needs, lack of community awareness, and links with infertility and stillbirth. Reducing fistula-related stigma requires timely access to surgical and supportive care, developing and evaluating evidence and theory-based interventions for social reintegration and stigma reduction, and addressing the complex societal structures perpetuating this condition.

Perceived barriers and facilitators to HIV testing in South African communities

2016 ◽  
Vol 23 (12) ◽  
pp. 1635-1645 ◽  
Author(s):  
Henri De Wet ◽  
Ashraf Kagee
Keyword(s):  
Hiv Testing ◽  
South African ◽  
Unprotected Sex ◽  
Perceived Barriers ◽  
Hiv Positive ◽  
South Africans ◽  
Hiv Test ◽  
Related Stigma ◽  
The Media

We interviewed 15 South Africans seeking HIV testing to understand the factors that influenced their seeking an HIV test. Reasons in favour of testing included having had unprotected sex, availability of social support if testing HIV positive and modelling test-seeking behaviour to others. Reasons against seeking testing included fear testing HIV positive, the possibility of receiving treatment too late, HIV-related stigma and long distances to testing sites. Participants also discussed ways to increase the uptake of HIV testing, such as workplace testing, the role of the media and the role of cultural rituals such as male circumcision.

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