Perceived Stigma as a Contextual Barrier to Early Uptake of HIV Testing, Treatment Initiation, and Disclosure; The Case of Patients Admitted with AIDS-Related Illness in a Rural Hospital in South Africa

We explored the extent to which perceived HIV-related stigma influences the disclosure and concealment of HIV status to family among adult patients hospitalised for AIDS-related illness, and described reports of negative responses and enacted stigma following disclosure. We conducted interviews with a purposeful sample of 28 adult patients in a rural South African hospital. Data analysis was deductive and inductive and followed the thematic approach. We found evidence of delayed HIV diagnosis and initiation of treatment. There was delayed and selective disclosure as well as concealment of the HIV-positive status. The disclosure was delayed for months or even years. During that time, there was active concealment of the HIV status to avoid stigma from family, friends, and community. When disclosure occurred, there was selective disclosure to close family members who would keep the secret and respond favorably. Although the participants disclosed mostly to close family, some of their post-disclosure experiences included incidents of enacted stigma and discrimination. The fear of perceived stigma and self-stigma influenced the active concealment of their HIV status from others. Continuous concealment of one’s HIV status and delayed disclosure limit the opportunities for support and care. There is a need to take into consideration the interaction between HIV-related stigma and disclosure to develop disclosure-counselling strategies in primary health care settings.

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Assessment of HIV-related stigma and determinants among people living with HIV/AIDS in Abeokuta, Nigeria: A cross-sectional study

SAGE Open Medicine ◽

10.1177/2050312119869109 ◽

2019 ◽

Vol 7 ◽

pp. 205031211986910

Author(s):

Olaide Olutoyin Oke ◽

Adeolu Oladayo Akinboro ◽

Fatai Olatunde Olanrewaju ◽

Olatunbosun Ayokunle Oke ◽

Ayanfe Samuel Omololu

Keyword(s):

Hiv Stigma ◽

People Living With Hiv ◽

Perceived Stigma ◽

Cross Sectional ◽

Stigma Score ◽

Low Education ◽

Related Stigma ◽

Enacted Stigma ◽

Living With Hiv ◽

Hiv Aids

Introduction: HIV/AIDS-related stigma remains an essential barrier to the formulated care delivery and improved quality of life of people living with HIV/AIDS in sub-Saharan Africa. Only a few studies have evaluated stigma and its determinants as concerns people living with HIV/AIDS in Nigeria. Methods: A cross-sectional design study recruited 386 people living with HIV/AIDS attending the government clinic, Federal Medical Centre, Abeokuta, Nigeria, for the assessment of stigma using Berger’s HIV stigma scale and United States Agency International Development-recommended indicators and questions on HIV-related stigma among people living with HIV/AIDS. Data were analyzed using SPSS 21. Results: Of the 386 people living with HIV/AIDS, 322 (83.4%) were females and 64 (16.6%) were males, and 96.9% had disclosed their HIV status. Overall, mean perceived stigma score was moderately high at 95.74 (standard deviation = ±16.04). Majority (77.2%) of the participants experienced moderately perceived stigma. Among the subscales, disclosure concerns contributed the most to stigma score at 68.9%. Enacted stigma in the last 12 months was documented in 35.8% (138). There was no association observed between age, gender, marital status and HIV-related stigma. However, low education was associated with higher negative self-image perception (31.83 ± 5.81 vs 29.76 ± 5.74, p < 0.001). Furthermore, higher perceived stigma score was associated with abandonment by spouses (p < 0.001), isolation from household members (p < 0.001) and social exclusion (p < 0.001). We demonstrated a correlation between the domains of enacted stigma and Berger HIV stigma scales except for the loss of resources. Conclusion: Perceived HIV-related stigma is moderately high among people living with HIV/AIDS. Low education, disclosure concerns, spousal or household abandonment and social exclusion are the significant contributors. HIV-related stigma preventive interventions at different levels of care are advocated.

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Stigma mastery in people living with HIV: gender similarities and theory

Journal of Public Health ◽

10.1007/s10389-021-01480-7 ◽

2021 ◽

Author(s):

Charles Patrick Namisi ◽

John C. Munene ◽

Rhoda K. Wanyenze ◽

Anne R. Katahoire ◽

Rosalinda M. Parkes-Ratanshi ◽

...

Keyword(s):

Older Women ◽

Social Exclusion ◽

Theoretical Framework ◽

People Living With Hiv ◽

Negative Effects ◽

Hiv Diagnosis ◽

Cross Sectional ◽

Age Related ◽

Related Stigma ◽

Living With Hiv

Abstract Aims This study aimed to determine the prevalence of, factors associated with, and to build a theoretical framework for understanding Internalsed HIV-related Stigma Mastery (IHSM). Methods A cross-sectional study nested within a 2014 Stigma Reduction Cohort in Uganda was used. The PLHIV Stigma Index version 2008, was used to collect data from a random sample of 666 people living with HIV (PLHIV) stratified by gender and age. SPSS24 with Amos27 softwares were used to build a sequential-mediation model. Results The majority of participants were women (65%), aged ≥ 40 years (57%). Overall, IHSM was 45.5% among PLHIV, that increased with age. Specifically, higher IHSM correlated with men and older women “masculine identities” self-disclosure of HIV-diagnosis to family, sharing experiences with peers. However, lower IHSM correlated with feminine gender, the experience of social exclusion stress, fear of future rejection, and fear of social intimacy. Thus, IHSM social exclusion with its negative effects and age-related cognition are integrated into a multidimensional IHSM theoretical framework with a good model-to-data fit. Conclusion Internalised HIV-related Stigma Mastery is common among men and older women. Specificially, “masculine identities” self-disclose their own HIV-positive diagnosis to their family, share experiences with peers to create good relationships for actualising or empowerment in stigma mastery. However, social exclusion exacerbates series of negative effects that finally undermine stigma mastery by young feminine identities. Thus, stigma mastery is best explained by an integrated empowerment framework, that has implications for future practice, policy, and stigma-related research that we discuss.

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Instruments to Measure Perceptions in the Emergency Department Provider-Patient with Sickle Cell Disease Interaction: Findings of an Integrative Review from a Ph.D. Project

The Open Nursing Journal ◽

10.2174/1874434602014010263 ◽

2020 ◽

Vol 14 (1) ◽

pp. 263-284

Author(s):

Aindrea B. Maddray ◽

Shannon M. Phillips

Keyword(s):

Emergency Department ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Reliability And Validity ◽

Adult Patients ◽

Integrative Review ◽

Cell Disease ◽

Related Stigma ◽

Health Related ◽

Adequate Reliability

Background & Purpose: The purpose of this review is to examine instruments that measure providers' perceptions of adult patients with Sickle Cell Disease (SCD), examine instruments that measure adult patients with SCD perceptions of providers' behaviors, and determine optimal instruments to use in evaluating the perceptions of Emergency Department (ED) providers and adult patients with SCD of one another's behaviors after an interaction in the ED. Methods: An integrative review was conducted searching EBSCOhost and PubMed databases using the keywords: measure [OR] measure* [OR] assess* [OR] scale [OR] survey [OR] tool [AND] stigma* [OR] stereotype [OR] prejudice [OR] bias [OR] perception [OR] attitude [OR] discrimination [OR] racism [OR] behavior [AND] interaction [OR] relationship [OR] communication [AND] sickle cell. Initial search located 256 articles, but only 15 articles were included in the final review. Results: Fifteen articles reporting six instruments were reviewed. Four instruments evaluated a provider’s perceptions of patients with SCD behaviors, and two instruments evaluated how patients with SCD perceived provider behaviors. The two patient-focused instruments and three provider-focused instruments were found to be adequately reliable and valid according to the Psychometric Grading Framework (PGF). Conclusions: The findings suggest that the General Perceptions About Sickle Cell Disease Patients Scale would be an optimal instrument to evaluate ED providers' perceptions of adult patients with SCD behaviors. One patient-focused instrument, The Sickle Cell Health-Related Stigma Scale (SCD-HRSS), reported adequate reliability and validity but was not specific to measuring the patient's perceptions of ED providers' behaviors, nor was it administered in the ED environment. The SCD-HRSS Doctors subscale has potential adaptability for use in measuring patients with SCD perceptions of ED provider behaviors in the ED environment.

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Prevalence and socio-demographic correlates of HIV among Tuberculosis patients of DOTS centre in Delhi

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i1.12744 ◽

2015 ◽

Vol 7 (1) ◽

pp. 53-58 ◽

Cited By ~ 1

Author(s):

Vishal C Soyam ◽

Jyoti Das ◽

Rajeeva TC ◽

Pallavi Boro ◽

Charu Kohli

Keyword(s):

Cross Sectional Study ◽

Point Of View ◽

Hiv Care ◽

Hiv Status ◽

Medical Sciences ◽

Hiv Diagnosis ◽

Cross Sectional ◽

Continuation Phase ◽

Tb Treatment ◽

Demographic Correlates

Background: Knowledge of HIV status of a TB patient is critical from both patient and public health point of view. Early HIV diagnosis among TB patients could serve as an entry point for HIV care and treatment. Surveillance of HIV among TB patients has been recognized to be important as the HIV epidemic continues to fuel TB epidemics. Hence, this study was conducted with an objective to assess the socio-demographic profile and the prevalence of HIV among TB patients.Methodology: Cross sectional study was carried out in eight DOTS cum DMCs of Delhi. Data was collected from January 2012 to December 2012. Registered TB patients (new and retreatment) were interviewed on a predesigned questionnaire at the end of five months of treatment.Results: In 2012, out of the total 552 TB patients interviewed, 524 (94.9%) had been tested for HIV by the end of fifth month of their TB treatment. In them, 13 patients (2.4%) were HIV positive. All of them had been initiated on ART and CPT during continuation phase of TB treatment. In present study no variable was found to be significantly associated with HIV status except number family member and patients on retreatment category.Conclusions: The prevalence of HIV infection in TB patients in current study was (2.4%) substantially lower than reported in studies from other states. If HIV testing done by all TB patients then routine reporting of HIV status for all TB patients would provide even better information on which to base future planning.Asian Journal of Medical Sciences Vol.7(1) 2015 53-58

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Treatment outcome of tuberculosis at Dilla Referral Hospital, Gedeo Zone, southern Ethiopia: A retrospective study

PLoS ONE ◽

10.1371/journal.pone.0249369 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249369

Author(s):

Endrias Markos Woldesemayat ◽

Zewtir Azeze

Keyword(s):

Risk Factors ◽

Treatment Outcome ◽

Success Rate ◽

Treatment Success ◽

Referral Hospital ◽

Treatment Success Rate ◽

Southern Ethiopia ◽

Hiv Status ◽

Hospital Data ◽

Tb Treatment

Background Tuberculosis (TB) is one of the major public health problems in Ethiopia. Determining treatment outcome of TB cases could help to understand the effectiveness of TB control efforts. The objective of this study was to assess TB treatment outcome and associated factors and determine the risk factors of death among TB cases who were on Directly Observed Treatment Short course (DOTS). Methodology We analyzed a retrospective data for TB cases who were on DOTS at Dilla Referral Hospital from July 2011- June 2016. The study population was TB cases with known HIV status and whose treatment outcome was evaluated at the Hospital. Data were entered, cleaned and analyzed using statistical package SPSS for windows, version 20. Result Out of 899 registered TB cases, 731 included in this analysis. Of these cases, 424 (58.0%) were male and 334 (45.7%) were in the age group of below 25 years. Treatment success rate of TB was 675 (92.3%) and death rate was 18 (2.5%). Treatment outcome showed statistically significant variation by HIV status (P < 0.001). HIV status of the TB cases and pretreatment weight were associated with TB treatment outcome. HIV status of the TB cases was associated with death of the TB cases (Adjusted Odds Ratio (AOR) 5.0; CI 95%: 1.8–13.5). Conclusion TB treatment success rate found in this study was high. Patient’s weight and HIV status were associated with treatment outcome. Moreover, HIV status predicted death of TB cases. Cautious treatment follow-up and defaulter tracing mechanisms for TB cases with these risk factors were suggested.

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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 ◽

10.1371/journal.pone.0249462 ◽

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.

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Barriers and facilitators of completing the steps in the PMTCT cascade at Midwife Obstetric Units in Gauteng - Healthcare Provider and Patient's views

10.21203/rs.3.rs-24824/v1 ◽

2020 ◽

Author(s):

Constance Mongwenyana ◽

Nelly Jinga ◽

Given Mohomi ◽

Sindisiwe Buthelezi ◽

Nancy Nkopane ◽

...

Keyword(s):

Primary Healthcare ◽

Healthcare Providers ◽

Turnaround Time ◽

Postpartum Care ◽

Barriers And Facilitators ◽

Hiv Status ◽

Hiv Diagnosis ◽

Hiv Test ◽

Increase Risk ◽

Pmtct Cascade

Abstract Background: The implementation of Prevention of Mother to Child Transmission (PMTCT) programmes at midwifes obstetric units (MOU) involves the confirmation of HIV diagnosis during labour, early infant HIV diagnosis (EID), initiation/continuation of antiretroviral therapy (ART) for mother and baby as appropriate and counselling for postpartum care. Objectives: The aim of this study was to explore the barriers and facilitators to completing the steps in the PMTCT cascade at MOUs as defined by healthcare providers and recently postpartum women. Methods: We conducted 10 in-depth interviews with healthcare providers, and 24 HIV positive and HIV negative women at the four MOUs and Primary Healthcare Centres (PHC’s) in Gauteng South Africa (SA). Results: The implementation of PMTCT at MOU is impeded by maternal denial of HIV status (both new diagnoses and ANC diagnoses). Challenges with acceptance and disclosure of HIV status were thought to compromise patient commitment to EID tests and postpartum adherence to infant ART. Newly diagnosed (during labour) patients have limited time to process new HIV diagnosis and clinics have limited nurse/counsellor capacity for further one on one counselling. Additional challenges include communication challenges with foreign women and turnaround time for birth HIV tests. Results are often not available at postnatal visit and unclear processes for referral to Primary Healthcare Centre (PHC) for postpartum care increase risk of postpartum loss to follow up. Conclusion: We need to strengthen MOU capacity to prepare women for postpartum PMTCT requirements and facilitate access to EID results. Patient referral processes, including communication of infant HIV test results to the referral PHC, needs improvement.

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Psychosocial symptomatology, personal growth, and development among young adult patients following the diagnosis of leukemia or lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.4.613 ◽

1988 ◽

Vol 6 (4) ◽

pp. 613-617 ◽

Cited By ~ 21

Author(s):

S Daiter ◽

R A Larson ◽

W W Weddington ◽

J E Ultmann

Keyword(s):

Young Adult ◽

Young Adulthood ◽

Personal Growth ◽

Psychosocial Stress ◽

Critical Period ◽

Social Supports ◽

Adult Patients ◽

Life Goals ◽

Self Image ◽

Close Family

Leukemias and lymphomas, especially Hodgkin's disease, are common cancers in young adults. Young adulthood is also a critical period for psychological and social development. The occurrence of cancer can interfere with the development of independence, self-image, and life goals of young adult patients. Young adult patients with leukemia or lymphoma, especially those with less favorable prognoses, experience areas of significant personal growth and maturation during their illness and treatment. Close family and social supports report as much psychosocial stress, and in many cases more stress, than the patients themselves, but similar patterns of personal growth are rarely seen.

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Navigating Life with HIV as an Older Adult in South African Communities: A Phenomenological Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165797 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5797 ◽

Cited By ~ 1

Author(s):

Naomi Hlongwane ◽

Sphiwe Madiba

Keyword(s):

Older Adults ◽

South African ◽

Phenomenological Study ◽

Support Network ◽

Hiv Status ◽

Hiv Diagnosis ◽

Gauteng Province ◽

Descriptive Phenomenology ◽

Hiv Test ◽

Fear Of Rejection

The study explored how older adults experience an HIV diagnosis, deal with issues of stigma and disclosure, and navigate the healthcare system. Descriptive phenomenology was used to collect data from 20 older adults receiving antiretroviral treatment in health facilities in Gauteng Province, South Africa. Data analysis was inductive and followed the thematic approach. After diagnosis with HIV, the older adults experienced shock and disbelief, internalized their new reality of being HIV-positive, and found it difficult to disclose their HIV status. Stigma was embedded in their patterns of disclosure, and they chose not to disclose in order to manage stigma, protect their status, and maintain their privacy. Moreover, nondisclosure allowed them to achieve some normality in their lives without the fear of rejection. The older adults adopted various survival skills that aided them to accept their HIV status. Self-acceptance was important for the older adults who did not want to feel cheated out of life by the HIV diagnosis. The positive supportive attitudes of the healthcare professionals provided the much-needed support network for the older adults immediately after they had received their HIV test results. This was instrumental in their acceptance of their HIV status, their adherence to clinic visits, and their ability to live a healthy, positive life.

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