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

Abstract

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 and mental health challenges among adolescents living with HIV in selected adolescent-specific antiretroviral therapy clinics in Zomba District, Malawi

“…These findings highlight the crucial need to develop culturally relevant context specific mental health interventions aimed at helping ALHIV to cope with these diverse challenges. A critical next step is to develop a grant proposal to pilot test a tailored, appropriate evidence-informed group-therapy interventions [ 26 ] that can be integrated into the routine care of ALHIV in ART clinics, but also at family and community levels to reduce the stressors; support them moving forward with fewer mental health symptoms, improved relationships, and better medication adherence [ 59 ].…”

The Perceptions of Older People Living With HIV/AIDS Towards Physical Activity and Exercise

“…Our participants cited internalized stigma as a major barrier to engaging in some form of physical activity or exercise, especially in a group setting. Akatukwasa et al (2021) also advocate for the further exploration of the connection between levels of internalized stigma and physical activity behavior in PLHIV, in order to better inform physical activity interventions for this population (42). Developing and implementing physical activity programmes for OPLWH should include factors to mitigate against such stigma in the community.…”

Uptake and provision of self-care interventions for sexual and reproductive health: findings from a global values and preferences survey

“…Sexual practices, and SRH care in general, are often stigmatised across diverse contexts and populations and this leads to constrained access to information and SRH services. 5 , 6 For instance, stigma toward HIV persists and presents barriers to HIV testing, prevention, and treatment engagement across low- and middle-income contexts 7 as well as high-income contexts. 8 There is also stigma toward sexually transmitted infections (STI) that presents related barriers to testing and treatment.…”