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

Hempel, Susanne; Ferguson, Laura; Bolshakova, Maria; Yagyu, Sachi; Fu, Ning; Gruskin, Sofia

doi:10.1136/bmjopen-2021-053608

Cited by 5 publications

(4 citation statements)

References 199 publications

(23 reference statements)

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“…Global data covering stigma among people living with HIV indicate that resiliencebuilding activities should target the individual (people living with HIV and their family members) and structural (health care workers and policy-makers) levels. 53,54 One example of an intervention-building resilience at the individual level is the resilience, strength, and ethnicity (RiSE) programcomprising group discussions around racial oppression and gender discrimination, and teaching skills to cope with both. The RiSE intervention improved adaptive coping skills and reduce stress among 40 Black women at risk of cardiovascular disease enrolled in a randomized clinical trial in the United States.…”

Section: Discussionmentioning

confidence: 99%

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings

Malama,

Logie,

Sokolovic

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: HIV-related stigma, gender discrimination, and racial discrimination harm mental health and hamper HIV treatment access for women living with HIV. Maladaptive coping strategies, such as substance use, can further worsen HIV treatment outcomes, whereas resilience can improve HIV outcomes. We examined resilience and depression as mediators of the relationship between multiple stigmas and HIV treatment outcomes among women living with HIV. Setting: Ontario, British Columbia, and Quebec, Canada. Methods: We conducted a longitudinal study with 3 waves at 18-month intervals. We used structural equation modeling to test the associations of multiple stigmas (HIV-related stigma, racial discrimination, and gender discrimination) or an intersectional construct of all 3 stigmas at wave 1 on self-reported HIV treatment cascade outcomes (≥95% antiretroviral treatment [ART] adherence, undetectable viral load) at wave 3. We tested depression and resilience at wave 2 as potential mediators and adjusted for sociodemographic factors. Results: There were 1422 participants at wave 1, half of whom were Black (29%) or Indigenous (20%). Most participants reported high ART adherence (74%) and viral suppression (93%). Racial discrimination was directly associated with having a detectable viral load, while intersectional stigma was directly associated with lower ART adherence. Resilience mediated associations between individual and intersectional stigmas and HIV treatment cascade outcomes, but depression did not. Racial discrimination was associated with increased resilience, while intersectional and other individual stigmas were associated with reduced resilience. Conclusion: Race, gender and HIV-related stigma reduction interventions are required to address intersectional stigma among women living with HIV. Including resilience-building activities in these interventions may improve HIV treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings

Malama,

Logie,

Sokolovic

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…The systematic review followed a detailed protocol, is registered in PROSPERO (CRD42021249348), and the reporting follows the PRISMA guidelines [6][7][8].…”

Section: Methods and Analysismentioning

confidence: 99%

“…The systematic review followed a detailed protocol, is registered in PROSPERO (CRD42021249348), and the reporting follows the PRISMA guidelines [ 6 – 8 ]. It followed a transparent and rigorous procedure to minimize review selection and reporting bias.…”

Section: Methods and Analysismentioning

confidence: 99%

Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination

Ferguson

Gruskin

Bolshakova

et al. 2023

Aids

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A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been tried. Using a PICOTS framework and applying the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, we undertook a systematic review to determine the success of interventions aiming to address internalized stigma, stigma and discrimination in healthcare, and at the legal or policy level, and to identify their critical success factors. Random effects meta-analyses summarized results wherever possible. We carried out a component analysis to identify and characterize successful interventions. Internalized stigma interventions were diverse: across all studies, we found a reduction of stigma but it was not statistically significant [standardized mean difference (SMD) 0.56; confidence interval (CI) 0.31-1.02; 17 studies). For interventions to address stigma and discrimination in healthcare settings, effect estimates varied considerably but most studies showed positive effects (SMD 0.71; CI 0.60-0.84, 8 studies). Boosted regression analyses found that a combined approach comprising education, counseling, community participation, support person, and access to a HIV specialist often yielded success. Studies of efforts to address stigma and discrimination through law and policy documented, mostly qualitatively, the effect of court cases and directives. Across a range of settings and populations, promising interventions have been identified that, through diverse pathways, have positively impacted the types of stigma and discrimination studied. This evidence base must be built upon and brought to scale to help reach global HIV-related targets and, most importantly, improve the health and quality of life of people with HIV.

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“…The systematic review followed a detailed protocol (CRD42021249348) [11]. Part of a larger project undertaken by the IAS-International AIDS Society, this systematic review is accompanied by four national efforts exploring stigma and discrimination in Kenya, Malawi, South Africa and Zambia.…”

Section: E T H O D Smentioning

confidence: 99%

Frameworks and measures for HIV‐related internalized stigma, stigma and discrimination in healthcare and in laws and policies: a systematic review

et al. 2022

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Introduction There is strong global commitment to eliminate HIV‐related stigma, and work in this area continues to evolve. Wide variation exists in frameworks and measures used. Methods Building on the existing knowledge syntheses, we carried out a systematic review to identify frameworks and measures aiming to understand or assess internalized stigma, stigma and discrimination in healthcare, and in law and policy. The review addressed two questions: Which conceptual frameworks have been proposed to assess internalized stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? Which measures of these different types of stigma and discrimination have been proposed and what are their descriptive properties? Searches, completed on 6 May 2021, cover publications from 2008 onwards. The review is registered in PROSPERO (CRD42021249348), the protocol incorporated stakeholder input, and the data are available in the Systematic Review Data Repository. Results and discussion Sixty‐nine frameworks and 50 measures met the inclusion criteria. Critical appraisal figures and detailed evidence tables summarize these resources. We established a compendium of frameworks and a catalogue of measures of HIV‐related stigma and discrimination. Seventeen frameworks and 10 measures addressed at least two of our focus domains, with least attention to stigma and discrimination in law and policy. The lack of common definitions and variability in scope and structure of HIV‐related frameworks and measures creates challenges in understanding what is being addressed and measured, both in relation to stigma and efforts to mitigate or reduce its harmful effects. Having comparable data is essential for tracking change over time within and between interventions. Conclusions This systematic review provides an evidence base of current understandings of HIV‐related stigma and discrimination and how further conceptual clarification and increased adaptation of existing tools might help overcome challenges across the HIV care continuum. With people living with HIV at the centre, experts from different stakeholder groups could usefully collaborate to guide a more streamlined approach for the field. This can help to achieve global targets and understand, measure and help mitigate the impact of different types of HIV‐related stigma on people's health and quality of life.

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

Cited by 5 publications

References 199 publications

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings

Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination

Frameworks and measures for HIV‐related internalized stigma, stigma and discrimination in healthcare and in laws and policies: a systematic review

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