Background: Tanzania is one of 15 nations that share 75% of the HIV burden in sub-Saharan Africa, with a national prevalence of 5.3% and prevalence rates as high as 30% in special populations. Knowledge about HIV infection, testing, and treatment is low, especially in younger populations, suggesting a need for effective HIV educational programs. We sought to understand the impact of HIV-related stigma and gender roles in HIV education and knowledge in educational programs and explored methodologies that effectively incorporate culturally competent approaches to reduce stigma in HIV education programs.Methods: Literature searches were conducted in multiple databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Complete, and the U.S. National Library of Medicine through the National Institutes of Health (Medline/PubMed). The search terms were structured to include all text of each article rather than restricting the search to titles or keywords. While these search criteria resulted in identification of 45 peer-reviewed articles, the inclusion criteria (HIV prevention, community education, HIV knowledge and stigma) led to the exclusion of all except 20 articles. Their findings are described here.Results: Attitudes of blame, fear of people on antiretroviral therapy spreading the disease, and an acceptance of a positive HIV status as punishment for sin were identified as barriers to testing. Cultural norms/perceptions and gender power dynamics were key components in creating culturally competent models that empower women to be tested and disclose their status. Community-level awareness and increased opportunities to interact with people living with HIV/AIDS were used successfully to reduce stigma among younger populations.Conclusions: Community-based programs partnered with religious organizations were effective in disseminating HIV education and can be used as a strategy for reducing shame-based stigma based upon misconceptions and popular beliefs. Stigma can also be reduced by increasing HIV knowledge with an appropriate sociocultural framework. We propose targeting community and religious leaders using train-the-trainer models as a means to improve HIV education and reduce stigma, especially within high-risk populations.
Background: Approximately 37 million people worldwide are infected with the Human Immunodeficiency Virus (HIV), with the majority located in sub-Saharan Africa. The relationship existing between HIV incidence and socioeconomic inequity confirms the critical need for programs promoting HIV education, prevention and treatment access. This literature review analyzed 36 sources with a specific focus on the Democratic Republic of Congo (DRC), whose critically low socioeconomic status and education rate have resulted in a drastically high HIV rates. Relationships between HIV testing and treatment and barriers to care were explored.Methods: Literature searches were conducted in multiple databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Complete, and the U.S. National Library of Medicine through the National Institutes of Health (Medline/PubMed). The search terms were structured to include all text of each article rather than restricting the search to titles or keywords. While these search criteria resulted in identification of 36 peer-reviewed articles, the inclusion criteria (HIV prevention, community education, HIV knowledge and stigma) led to the exclusion of all except 17 articles. Their findings are described here.Results: Cultural and religious considerations were found to be vital when creating and implementing HIV education and testing programs. Partnerships encouraging active support from community-based spiritual leaders to implement HIV educational programs were also key mechanisms to reach communities and individuals. Gender roles were highlighted as a key component for implementation of effective community trust-building and successful HIV education programs. The efficacy of added support by hospitals and clinics in rural areas to facilitate access to HIV testing and care for people living with HIV/AIDS (PLWHA) was discussed. Conclusions:We highlighted the need for health care providers to provide a network of continued education for PLWHA in clinical settings during disclosure and throughout the course of treatment to increase retention in care and promote medication adherence for viral load suppression. Implementation of culturally-sensitive models that rely on community familiarity with HIV educators such as train-thetrainer were also proposed as efficacious tools for educating rural communities about HIV.
Background: Despite high HIV prevalence in Zambia, which lies within the heart of sub-Saharan Africa, early implementation of public policy and programs to effectively manage the burden of disease has insured consistently high testing rates. Zambian strategies to combat the HIV/AIDS crisis employ governmental support for HIV testing and public education and can serve as models for neighboring countries to advance the development of effective testing and treatment initiatives. Although these testing programs have proven highly successful, stigma and gaps in public knowledge continue to hamper access to treatment. Through this review of the current literature, we sought to better understand HIV-specific educational programs, the impact of HIV-related stigma, and the cultural components that influence patient care. Methods: Literature searches were conducted in multiple databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Complete, and the U.S. National Library of Medicine through the National Institutes of Health (Medline/PubMed). The search terms were structured to include all text of each article rather than restricting the search to titles or keywords. While these search criteria resulted in identification of 38 peer-reviewed articles, the inclusion criteria (HIV prevention, community education, HIV knowledge and stigma) led to the exclusion of all except 22 articles. Their findings are described here. Results: Individuals who reported negative experiences with health workers perceived HIV-related stigma was common. The fear of involuntary status disclosure while filling prescriptions for anti-retroviral medications led to higher levels of perceived stigma and treatment refusal. Observation of stigma and bullying experienced by people living with HIV/AIDS in the educational system increased fear in both teachers and students. Conclusions: Cultural and religious considerations were found to be important in stigma reduction. In sum, collaboration with key community leaders, church elders, and politicians were seen as vital in strengthening HIV programs. We propose using train-the-trainer models to empower teachers, particularly women, to become HIV educators and reduce stigma.
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