A realist systematic review of stigma reduction interventions for HIV prevention and care continuum outcomes among men who have sex with men

Abstract

<jats:p> While stigma associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is well recognized, there remains relatively limited intervention data on effective stigma reduction strategies. This systematic review was conducted to highlight the mechanisms through which sexual and HIV stigma is reduced in relation to HIV prevention and care engagement. Search of PubMed and Scopus resulted in 11 tested interventions to include in our preliminary model constructed from programme frameworks and recommendations. We refined the preliminary programme theory to identify whether, why, or how mitigation strategies produce observed outcomes. Our review showed that the interventions produced stigma reduction through three groups of mechanisms: (1) Self-acceptance, leadership, and motivational activation for behaviour change from intrapersonal strategies, such as education and mobile health strategies, which intervene on internalized and anticipated stigma; (2) socialization, knowledge sharing, and social empowerment from interpersonal strategies, such as peer support and training for care providers; and (3) community introspection, self-reflection, and humanistic activation from structural strategies such as community leaders’ sensitization, which intervene on both anticipated and enacted stigma. Interventions mechanisms act complementarily and can be activated in different contexts in which MSM exposed to and infected with HIV are living. </jats:p>

Exploring the enablers and barriers to social prescribing for people living with long-term neurological conditions: a focus group investigation

“…Research into stigma particularly the impact of living with epilepsy has shown that stigma can result in a perceived reduction in social value and poor quality of life [ 56 ]. Interventions to address stigma with people affected by HIV [ 57 ] and mental health conditions [ 58 ] has been widely published and emphasise the importance of social connection and education. There is little evidence to guide interventions to address stigma with plwLTNCs and is an area that needs greater research attention.…”

Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol

“…To date, a substantial number of systematic reviews has been published that address different aspects of HIV-related stigma and discrimination. These include associations of stigma (covariates, causes or effects), 13–40 access to care, 41–66 HIV testing, 67–91 country-specific explorations of stigma or discrimination, 92–109 the role of stigma and discrimination in treatment adherence, 110–127 HIV experiences of people living with HIV or their care givers, 128–141 stigma/discrimination reduction in the community, 142–153 HIV disclosure considerations, 154–162 stigma/discrimination in healthcare, 163–170 rights and regulations, 171–177 intersectionality, 178–183 measuring stigma, 184–189 HIV prevention, 190–193 stigma reduction in low income countries, 194–197 self-stigma 7 198 199 and other, unique topics. 200 201 We build on these reviews which outline existing research and point to persistent knowledge gaps.…”

Breaking Down Barriers to HIV Care for Gay and Bisexual Men and Transgender Women: The Advocacy and Other Community Tactics (ACT) Project

“…Stigma and discrimination are widely considered primary drivers of the disproportionate global burden of HIV on gay, bisexual, and other men who have sex with men and on transgender women 1 [1][2][3][4][5]. In 2018, UNAIDS estimated gay, bisexual, and other men who have sex with men were at 22 times greater risk of HIV acquisition than members of the general population [6].…”