Impact of Internalized Stigma on HIV Prevention Behaviors Among HIV-Infected Individuals Seeking HIV Care in Kenya

Abstract

In general, an initial diagnosis of HIV is likely to be correlated with the onset of HIV stigma. HIV-positive individuals are likely to internalize stigma, may suffer from psychosocial issues, or engage in maladaptive behaviors to cope with the diagnosis. Internalized stigma stems from fear of stigmatization also known as felt stigma. The current study examined the impact of HIV felt stigma on overall health and success of HIV prevention behaviors among 370 participants living with HIV and receiving care at an urban HIV clinic in Kenya. An 18-item instrument was cross culturally adapted to measure felt stigma. Descriptive and logistic regression analyses examined the data. Findings indicate that 25.9% (n = 96) of participants who reported experiencing high levels of felt stigma related to other people's attitudes toward their condition, ostracizing, and a disruption of their personal life, were likely to not adhere to prescribed HIV medication and not disclose their HIV serostatus to one other person. Those who also experienced felt stigma related to a disruption of their personal lives while mediated by depression were likely to report poor overall health. Findings support having HIV clinics and interventions develop relevant HIV prevention strategies that focus on the emerging dimensions of felt stigma which can significantly impact disclosure of serostatus, medication adherence, and overall health.

Shame, Guilt, and Stress: Community Perceptions of Barriers to Engaging in Prevention of Mother to Child Transmission (PMTCT) Programs in Western Kenya

“…26 This theoretical model is supported by literature demonstrating similar findings between shame and other HIV-related health behaviors such as condom use, 27 retention in care, 28,29 and adherence to medication. [30][31][32][33] This also suggests that shame, unlike more culturally or socially rooted values of stigma, is potentially modifiable and should be a target for intervention at the individual level. 34 Discrimination was also highly prevalent in this population.…”

HIV-Positive Men's Experiences with Integrated Family Planning and HIV Services in Western Kenya: Integration Fosters Male Involvement

“…17,18 Given the men's strong preference for HIV clinics as their source of FP services, we argue that integrating FP services into HIV clinics should be kept a priority as this model likely fosters male involvement in FP, which, in turn, may improve contraceptive use. 29 In addition, HIVpositive men in SSA tend to have worse clinical outcomes as compared to women [39][40][41][42][43][44][45] and face unique challenges in accessing and remaining in HIV care and treatment, [46][47][48][49][50] and integrated FP services may serve as one of many tools to attract and retain these men.…”

Providing anti-retroviral therapy in the context of self-perceived stigma: a mixed methods study from Tanzania

“…A previous multi-country study carried out in Lesotho, Malawi, South Africa, Swaziland, and Tanzania indicated the consequences of stigma on medicine intake; stigma increased the frequency of missing medications among HIV positive people (Dlamini et al, 2009). Similarly, in Kenya, patients who reported experiencing stigma were those who related to other people's attitudes towards their HIV status, and these patients were likely to not adhere to the prescribed medicines (Kingori et al, 2012). Although much has been documented to increase community awareness about HIV/AIDS and stigma reduction, evidence suggests that more effort is needed to overcome the impact of stigma among ARTprescribed patients.…”

“…Perceived stigma in the context of ART refers to association of people taking ART with AIDS patients. Previous studies in Africa show that HIV-related stigma hinders access and retention to HIV care services and adherence to ART (Baltazary et al, 2011;Kingori et al, 2012). A multi-site study in five African countries showed that ART-prescribed patients who missed taking their ARV doses had a significant increase in stigma over time (Dlamini et al, 2009).…”

“…A multi-site study in five African countries showed that ART-prescribed patients who missed taking their ARV doses had a significant increase in stigma over time (Dlamini et al, 2009). Although HIV-related stigma may be constructed differently, it is expressed in the same pattern across settings (Baltazary et al, 2011;van Tam et al, 2011;Kingori et al, 2012). Also universally, fear of disclosure of HIV status has been reported to influence adherence to ART.…”