A Systematic Mixed Studies Review of the Intersections of Social–Ecological Factors and HIV Stigma in People Living With HIV in the U.S. South (original) (raw)
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BMJ open, 2016
To conduct a systematic review and series of meta-analyses on the association between HIV-related stigma and health among people living with HIV. 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. Controlled studies, cohort studies, case-control studies and cross-sectional studies in people living with HIV were considered for inclusion. 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. 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 rel...
Journal of acquired immune deficiency syndromes (1999), 2017
There are multiple dimensions of HIV-related stigma that can compromise the mental and physical health of people living with HIV (PLWH). We focused on the dimension of experienced stigma, defined as exposure to acts of discrimination, devaluation, and prejudice, and investigated its relationship with HIV health and psychosocial outcomes. We examined associations between experienced stigma in the community and healthcare settings and psychosocial and health outcomes for PLWH (N=203) receiving care at an urban HIV clinic in the Southeastern United States. We also investigated whether those effects are unique to experienced stigma or are mediated by other dimensions of HIV-related stigma. Experienced stigma was associated with suboptimal clinical outcomes like viral non-suppression, as well as poor affective, cognitive, and mental health outcomes (self-esteem, depressive symptoms, avoidance coping, and blame coping) and interpersonal outcomes like social support and physician trust. Fu...
A Comprehensive HIV Stigma-reduction and Wellness-enhancement Community Intervention: A Case Study
Journal of the Association of Nurses in AIDS Care, 2014
We describe the implementation of a comprehensive HIV stigma-reduction and wellness-enhancement community intervention that focused on people living with HIV (PLWH), as well as people living close to them (PLC) from six designated groups. A holistic multiple case study design was used in urban and rural settings in the North West Province, South Africa. Purposive voluntary sampling was used to recruit the PLWH group; snowball sampling was used for the PLCs. Data were analyzed by means of open coding and text document analysis. The comprehensive nature of the intervention ensured enhancement in relationships in all groups. The increase in knowledge about stigma, coping with it, and improved relationships led to PLWH feeling less stigmatized and more willing to disclose. PLCs became aware of their stigmatizing behaviors and were empowered to lead stigma reduction in their communities. Many community members were reached through these initiatives.
2021
Background Defining HIV-related stigma (HRS) can be problematic due to structural inequalities, cultural differences, discrimination by health care providers and the limitations of tools measuring stigma for people living with HIV (PLWH). This meta-analysis aimed to determine self-reported HRS and its association with socio-demographic and clinical determinants. Methods PubMed, Scopus, Web of Science, PsycInfo, SciELO and Cochrane electronic databases were searched and after reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals. Results Thirty-one studies containing 10,475 participants met the eligibility criteria. Among the potential risk factors: age > 30 years (OR = 0.93, 95%CI = 0.86, 1), living with a spouse (OR = 0.07, 95%CI = 0.02...
Journal of Urban Health, 2019
Evidence suggests that HIV-related stigma is a contributing factor to mental health and substance use problems among people living with HIV (PLWH). Limited research, however, has examined the differential effects that multiple stigma constructs, specifically, anticipated, enacted, and internalized stigma may have on mental health and alcohol use disorders among PLWH. Furthermore, no studies have examined this relationship within the larger context of urban life stressors. The purpose of this study was to examine associations of an overall HIV-related stigma measure and four HIV stigma subscales on depression, anxiety, and hazardous drinking among a sample of 380 PLWH in New Orleans. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by urban life stressors. Overall, higher levels of HIVstigma were associated with depressive symptoms (RR 1.67, 95% CI 1.25, 2.23), anxiety symptoms (RR 1.91, 95% CI 1.17, 3.12), and hazardous drinking (RR 1.45, 95% CI 1.02, 2.05). Internalized HIV-stigma (measured using the negative self-image subscale) was associated with all three outcomes and had the highest magnitude point estimates across the four stigma subscales. Urban life stressors, measured by the Urban Life Stressors Scale (ULSS), modified the association between HIVrelated stigma and mental health and alcohol use disorders (P < 0.2), highlighting the importance for examining the larger urban environmental context. Findings from this study may inform interventions to reduce HIV-related stigma operating at the individual and structural level.
Relationship of health rating and HIV-related stigma among people living with HIV: a community study
Humanities & social sciences communications, 2022
The purpose of this study was to understand the impact of stigma among a geographic population of people living with HIV in Maricopa County, Arizona. People living with HIV who experience stigma have lower medication adherence and fewer kept appointments. The people living with HIV patient survey was administered using both paper and online versions in the beginning months of 2019. A total of 296 respondents completed the survey for this study. Participants were recruited through multiple methods, including online sites, the Phoenix AIDS Walk, health clinics, and the identification of zip codes with high HIV prevalence rates. There was a significant relationship between health status and age, with those who reported a higher health rating, that of excellent or good, more likely to be 45 years of age or older, X2 (1, N = 296) = 4.812, p = 0.028. Researchers and health care providers must be attentive to these variations and intersecting stigmas when providing services across diverse populations, especially when working with a high-stigma population such as people living with HIV. Providers can take a more active role in helping people living with HIV to see how their perceptions and experience of HIV-related stigma may be taking a toll on their perceptions of their health, as well as their approach to treatment, and refer them to support groups or individual counseling. Strategies, policies, and messages should be tailored with cultural, social, and ethnic sensitivities in mind. To address these threats, policies must be created that reduce the impact of HIV-related stigma within various systems, including but not limited to the public health sector.
HIV Stigma: A Clinical Provider Sample in the Southern U.S
Journal of the National Medical Association, 2020
This study examined the prediction of HIV knowledge on multiple dimensions of stigma beliefs. Methods: We assessed clinical staff (N ¼ 153) in rural clinics (2017) HIV stigma beliefs and knowledge. Using multiple regression, we examined the ability of knowledge to predict stigma beliefs organized into meaningful dimensions. Results: There was high variability in HIV knowledge among the medical professionals surveyed with a score of 70/100 (i.e., a 'C'). Of the five stigma factors explored, only two had a score greater than 80 (ie., a 'B' score on the 'test'). Controlling for demographic factors, there was a significant effect of HIV Knowledge on Discrimination (F (4,146) ¼ 2.02, p ¼ 0.03), Prejudice (F (4,146) ¼ 2.13, p ¼ 0.04), Service Provision (F (4,145) ¼ 2.30. p ¼ 0.02), and Perceived Risk in Practice (F (4,91) ¼ 5.75, p < 0.01). Conclusions: The relatively low knowledge score and link between knowledge and stigma beliefs indicated a need for continued basic HIV education. Increased education around HIV risk is critical in the eradication of HIV given the link between high stereotyping beliefs and low testing rate.