HIV Stigma Toward People Living With HIV and Health Providers Associated With Their Care: Qualitative Interviews With Community Members in Egypt

Lohiniva, Anna-Leena; Kamal, Walid; Benkirane, Manal; Numair, Tarek; Abdelrahman, Mahdy; Saleh, Hanan; Zahran, Amin; Talaat, Maha; Kandeel, Amr

doi:10.1016/j.jana.2015.11.007

Cited by 15 publications

(13 citation statements)

References 28 publications

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“…Lastly, we found no interventions with a specific focus on health workers living with a stigmatized disease, and addressing any stigma they may experience from co-workers or through the facility structures. Research has shown that stigma affects healthcare workers, either because of their own health status or as a result of working with stigmatized individuals [100, 101]. The HaTSaH study, an ongoing study in Free State province, South Africa, is addressing this gap through a combination intervention approach that focuses on reducing HIV and TB stigma among health workers towards colleague health workers living with HIV and TB through clinical, structural, and sociobehavioral factors [102].…”

Section: Discussionmentioning

confidence: 99%

Stigma in health facilities: why it matters and how we can change it

Nyblade

Stockton²,

Giger

et al. 2019

BMC Med

510

436

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Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge—both approaches and methods—regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development’s Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described. The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

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Section: Discussionmentioning

confidence: 99%

Stigma in health facilities: why it matters and how we can change it

Nyblade

Stockton²,

Giger

et al. 2019

BMC Med

510

436

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“…PLWH experiences of enacted healthcare stigma are widely documented across the globe. [17][18][19] Large-scale stigma reduction efforts will need to be a cornerstone of planned global efforts to end the AIDS epidemic by 2030 [20].…”

Section: Introductionmentioning

confidence: 99%

Combating HIV stigma in low‐ and middle‐income healthcare settings: a scoping review

Smith

Hunt

et al. 2020

J Intern AIDS Soc

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Introduction Nearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low‐ and middle‐income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research. Methods We conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews. Results and discussion Our search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings. Conclusions Combating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self‐reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.

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“…Engaging in this kind of behavior could be attributed to the lack of HIV-related knowledge, especially regarding modes of transmission, among HCPs causing subsequent fear of acquiring the infection while treating PLHIV. Furthermore, the fear of being stigmatized by their families and communities and concerns about losing their HIV-free patients are primary factors that contribute to providers being reluctant to treat HIV-positive individuals 15,16. Based on the findings of a cross-sectional study in Egypt, out of 529 men and women living with HIV who were interviewed on their experiences with HIV-related S&D, 40% asserted that on attending health care facilities, including dental settings, they do not inform HCPs about their HIV status whereas >50% stated that they were denied service upon revealing they had the infection 17…”

Section: Introductionmentioning

confidence: 99%

<p>Assessing the levels of HIV-related knowledge and attitudes toward HIV-infected patients among undergraduate dental students: a cross-sectional study</p>

Fadl¹,

Abdelmoety²,

Farahat³

et al. 2019

HIV

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Purpose Worldwide, in the last decade, the numbers of new HIV infections and AIDS-related deaths have drastically decreased. Despite that, around 18 million infected individuals receive antiretroviral therapy and thus tend to live longer. This cross-sectional study was conducted to assess the level of HIV-related knowledge among undergraduate dental students at Ain Shams University (ASU) in Cairo, Egypt and to determine their attitudes toward treating HIV-positive patients. Methods The study sample included 247 undergraduate dental students of third, fourth, and fifth academic years at the Faculty of Dentistry, ASU who were randomly selected to participate in this survey. Data were collected using a self-administrated anonymous questionnaire. Chi square and ANOVA tests were used to measure differences in the level of knowledge and attitudes among students of the 3 years. Multiple linear regression analysis was performed with 95% confidence interval. Results Within the students’ population, around 94% incorrectly considered dentists to be at high risk of acquiring HIV infection and 47% believed that saliva is a vehicle for its transmission. Moreover, the majority of students were unaware of the association between HIV and common oral manifestations such as oral candida, Kaposi sarcoma, and leukoplakia. Although 69% of the students were willing to deliver oral care to people living with HIV (PLHIV), only 33% perceived themselves knowledgeable enough to do so. Conclusion Dental students were not adequately prepared to recognize and manage HIV-positive individuals. Thus, better education and training are required to raise their levels of HIV-related knowledge and enhance their capabilities to treat PLHIV.

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HIV Stigma Toward People Living With HIV and Health Providers Associated With Their Care: Qualitative Interviews With Community Members in Egypt

Cited by 15 publications

References 28 publications

Stigma in health facilities: why it matters and how we can change it

Stigma in health facilities: why it matters and how we can change it

Combating HIV stigma in low‐ and middle‐income healthcare settings: a scoping review

<p>Assessing the levels of HIV-related knowledge and attitudes toward HIV-infected patients among undergraduate dental students: a cross-sectional study</p>

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