Effectiveness of HIV Stigma Interventions for Men who have Sex with Men (MSM) With and Without HIV in the United States: A Systematic Review and Meta-Analyses

Gunn, Jayleen K. L.; Rooks-Peck, Cherie; Wichser, Megan E; Denard, Christa L.; McCree, Donna Hubbard; Jeffries, William L.; DeLuca, Julia B; Ross, Leslie W; Herron, Adrienne R.; Barham, Terrika; Flores, Stephen A.; Higa, Darrel H.

doi:10.1007/s10461-021-03358-x

Cited by 14 publications

(8 citation statements)

References 77 publications

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“…Stigma and discrimination appeared to be the most general barrier to ART adherence and maintenance of care. Also, Other studies in America (Earnshaw et al, 2013;Darlington and Hutson, 2017;Gunn et al, 2021;Yabes et al, 2021), Middle East (Aghaei et al, 2020;Ballouz et al, 2020;Moradzadeh and Zamanian, 2021), Asia (Ekstrand et al, 2018;Ekstrand et al, 2020;Stephens and Surjan, 2020), Sub Saharan Africa (Jones et al, 2020;Chimoyi et al, 2021;MacLean and Wetherall, 2021;Madiba et al, 2021), and Europe (Vaughan et al, 2020;Hedge et al, 2021) have found stigma to be a significant contributor to non-adherence. In Pakistan, the stigma of HIV/AIDS is enormous (Ahmed et al, 2019;Ahmed et al, 2021a;Ahmed et al, 2021d).…”

Section: Discussionmentioning

confidence: 95%

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

et al. 2022

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Background: With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular.Methods: Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis.Results: Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention.Conclusion: Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.

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Section: Discussionmentioning

confidence: 95%

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

et al. 2022

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“…Reviews of USA-based studies corroborate the role of multilevel stigma and minority stress as determinants of HIV and mental health in MSM. 32,[47][48][49] For example, self-stigma among MSM in the USA has been associated with emotional distress and HIV testing and diagnosis. 47,50 A study of MSM in 28 European countries found that structural stigma (eg, discriminatory policies and laws) was associated with pressures to conceal one's identity and with lower life satisfaction, 51 and a related study of MSM from 38 European countries found that structural stigma was associated with lower use of HIV-prevention services and higher HIV risk behaviours.…”

Section: Evidence Of Multilevel Determinants Of Hiv and Mental Health...mentioning

confidence: 99%

Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men

et al. 2022

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“…A systematic review by Ferguson et al [56] found that there was a lack of common definitions of HIV internalized stigma in healthcare settings, laws and policies. Furthermore, a systematic review and meta-analysis of stigmareduction interventions in the United States for GBMSM by Gunn et al [57] found that out of 29 studies that were included, only four assessed stigma before and after an intervention. Furthermore, these outcomes varied in terms of the types of stigmas (e.g.…”

Section: Conclusion: Implications For Future Directions On Hiv Servic...mentioning

confidence: 99%

“…Furthermore, a systematic review and meta-analysis of stigma-reduction interventions in the United States for GBMSM by Gunn et al . [57] found that out of 29 studies that were included, only four assessed stigma before and after an intervention. Furthermore, these outcomes varied in terms of the types of stigmas (e.g.…”

Section: Conclusion: Implications For Future Directions On Hiv Servic...mentioning

confidence: 99%

Public health services and intersectional stigma: a social sciences perspective with implications for HIV service design and delivery

Tan

Tang

Tucker

2022

Current Opinion in HIV and AIDS

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Purpose of reviewUnderstanding stigma is important for improving HIV care services and gaps in HIV service delivery have been attributed to stigma. This review article synthesizes recent evidence on stigma and its implications for HIV service design and delivery. Given the intersectional nature of stigma, we will focus on HIV stigma as well as related forms of stigma based on one's race, sexual identity, gender identity and other identities.Recent findingsStigma remains a barrier to achieving equity in HIV services. Individualistic measures of stigma remain influential and are associated with barriers to accessing HIV health services. Recent work also highlights stigma measured at a structural level and its impact on HIV services contexts. Individuals situated at intersections of marginalized identities continue to face greatest injustices, and although intersectional approaches have been adapted to design services at a micro level, few focus on structural change. Recent evidence for mitigating stigma indicates some success for psychosocial interventions that target internalized stigma. Furthermore, community-led approaches show promise in addressing stigma that manifests in HIV health services settings.SummaryInterventions that address individual-level stigma and structural stigma are needed. Theoretical and applied antistigma research is needed to make HIV services more equitable.

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Effectiveness of HIV Stigma Interventions for Men who have Sex with Men (MSM) With and Without HIV in the United States: A Systematic Review and Meta-Analyses

Cited by 14 publications

References 77 publications

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men

Public health services and intersectional stigma: a social sciences perspective with implications for HIV service design and delivery

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