Medical Mistrust and Stigma Associated with COVID-19 Among People Living with HIV in South Africa

Jarolimova, Jana; Yan, Joyce; Govere, Sabina; Ngobese, Nompumelelo; Shazi, Zinhle M; Khumalo, Anele; Bunda, Bridget; Wara, Nafisa J.; Zionts, Danielle; Thulare, Hilary; Bogart, Laura M.; Bassett, Ingrid V.

doi:10.1007/s10461-021-03307-8

Cited by 20 publications

(18 citation statements)

References 56 publications

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“…Containment measures of COVID-19 taken in Ethiopia had a significant contribution to halting the spread of COVID-19 in Ethiopia; however, they had their own implications on HIV care and treatment services as the response from the patients with HIV as indicated. Transport disruption, partial lockdown that impaired mobility, and income reduction were significant factors in missing health care visits, which was in agreement with previous studies conducted in Ethiopia ( 13 , 42 ), and elsewhere in the world ( 43 – 50 ) that the COVID-19 containment measure had a significant impact on patients' access to healthcare facilities.…”

Section: Discussionsupporting

confidence: 91%

COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study

2022

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BackgroundThere has been promising progress toward screening, testing, and retaining patients with HIV in care in Ethiopia. Concern exists that possible disruptions in HIV programs due to coronavirus disease 2019 (COVID-19) could result in a more HIV-related mortality and new HIV infections. This study aimed to investigate the real-time burden of COVID-19 on patients with HIV attending antiretroviral therapy.MethodsWe conducted a facility-based, multicenter, and cross-sectional study among patients with HIV attending antiretroviral therapy in 10 healthcare facilities in Addis Ababa, Ethiopia, in the COVID-19 pandemic period. Data were collected using adapted, interviewer-based questionnaires, and entered into EpiInfo version 7 and exported to SPSS version 26 for analysis.ResultA total of 212 patients with HIV were included. The participants who missed visits for refill were 58 (27.4%). When the effects of other independent variables on appointments/visits for refill were controlled, the following characteristics were found to be the most important predictors of missed appointments (p< 0.05): age ≥ 55 [adjusted odds ratio (AOR) = 6.73, 95% CI (1.495–30.310)], fear of COVID-19 [AOR = 24.93, 95% CI (2.798–222.279)], transport disruption [AOR = 4.90, 95% CI (1.031–23.174)], reduced income for traveling to a health facility [AOR = 5.64, 95% CI (1.234-25.812)], limited access to masks [AOR = 7.67, 95% CI (1.303–45.174)], sanitizer [AOR = 0.07, 95% CI (0.007–0.729)], and non-medical support [AOR = 2.32, 95% CI (1.547–12.596)]. The participants were well aware of the COVID-19 preventive measures. The most costly COVID-19 preventive measures that cause financial burden to the patients were the costs for buying face masks (63.7%), disinfectants (55.2%), and soap for handwashing (22.2%). The participants who missed follow-up diagnostic tests were 56 (26.4%). Variables, which were found to be statistically significant, include the following: age ≥ 55 [AOR = 0.22, 95% CI (0.076–0.621)], partial lockdown [AOR = 0.10, 95% CI (0.011–0.833)], limited access to health services [AOR = 0.15, 95% CI (0.045–0.475)], reduced income for traveling to health facility [AOR = 0.18, 95% CI (0.039–0.784)], and unable to get masks [AOR = 0.12, 95% CI (0.026–0.543)]. The participants who missed counseling services were 55 (25.9%). In multivariate logistic regression, the following were statistically significant: age ≥ 55 [AOR = 0.21, 95% CI (0.078–0.570)], fear of COVID-19 [AOR = 0.11, 95% CI (0.013–0.912)], reduced income [AOR = 0.17, 95% CI (0.041–0.699)], unable to get face masks [AOR = 0.19, 95% CI (0.039–0.959)], and partial lockdown [AOR = 0.08, 95% CI (0.008–0.790)].ConclusionsThe COVID-19 had a significant burden on patients with HIV to attend their routine clinical care and treatment, which may lead to treatment failure and drug resistance. The impact was on their appointments for medication refills and clinical and laboratory follow-ups. Targeted initiatives are needed to sustain HIV clinical care and treatment services and improve the well-being of people living with HIV.

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Section: Discussionsupporting

confidence: 91%

COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study

2022

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“…The study’s findings showed that females were more likely to experience stigma than their male counterparts. This finding is consistent with previous studies carried out among patients with infectious diseases, including COVID-19, showing a higher prevalence of stigma among females than males ( Zandifar et al, 2020 ; James et al, 2019 ; Jarolimova et al, 2021 ). Several factors could be attributed to the higher prevalence of stigma in females.…”

Section: Discussionsupporting

confidence: 93%

Stigma and its associated factors among patients with COVID-19 in Dhaka City: evidence from a cross-sectional investigation

Kibria

Islam

et al. 2022

PeerJ

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Background Coronavirus disease 2019 (COVID-19) has become a significant disease pandemic. Dhaka City alone has contributed about one-third to the total COVID-19 cases in Bangladesh. Globally, patients with infectious diseases, including COVID-19, experience stigma. There was no quantitative estimate of stigma experienced by patients with COVID-19 in the country. Therefore, this study aimed to assess the prevalence of stigma and its associated factors among patients with COVID-19 in Dhaka. Methods A cross-sectional study was conducted among 384 respondents aged 18 years or older who had been hospitalized or had stayed at home and were tested negative 15 days to 6 months before the day of data collection. Data collection was done through in-person and telephone interviews using a semi-structured survey questionnaire. A 15-item COVID-19-related stigma scale questionnaire was used to assess stigma. Binary logistic regression analysis was performed to identify the predictors of stigma. Results More than half (53.1%) of the respondents experienced stigma when they were COVID-19 positive. Females were at a 3.24 times higher risk of experiencing stigma than their male counterparts. Respondents from the 60+ age group and 40–59 age group were 63.0% and 48.0% less likely to experience stigma than those from the 18–39 age group. Non-hospitalised patients had 1.67 times higher odds of facing stigma than those hospitalised. Conclusions This study reported a high prevalence of stigma among the patients with COVID-19 in Dhaka City. The current evidence base of stigma experience among patients with COVID-19 offers a solid foundation for creating effective strategies and policies and designing appropriate interventions to counter stigma, which will improve the psychological well-being of patients with COVID-19 in Bangladesh.

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“…Medical disinformation about COVID-19 may have ultimately exacerbated this pre-existing mistrust in healthcare. Understanding the high risk of being stigmatized with COVID-19 among those living with HIV is critical, as the repercussions on health outcomes can be severe [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…After the onset of the pandemic, the stigma of COVID-19 itself heightened other dubious conceptions about PLHIV. A prospective observational cohort study of PLHIV in South Africa reported over half of the participants either agreeing or strongly agreeing with survey questions assessing the stigma and stereotypes of COVID-19, as well as the lack of trust in healthcare providers [ 29 ]. It was determined that the association of stigma between HIV and COVID-19 did not occur during isolation.…”

Section: Discussionmentioning

confidence: 99%

The Social, Behavioral, and Ethical Modalities of COVID-19 on HIV Care in South Africa: A Systematic Review

Roy

Himelfarb

Karrah³

et al. 2022

IJERPH

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The profound public health impact of the novel outbreak of the SARS-CoV-2 virus in 2019 has been unparalleled in the last century. Rapid spread of the disease and a high death toll fueled the development and global rollout of effective vaccines regardless of the massive inequitable access. However, some public health measures intended to control COVID-19 have had collateral effects on the control of other infectious diseases. In this systematic review, we analyze the impact of the COVID-19 pandemic on efforts to control HIV in South Africa, emphasizing the social, ethical, and behavioral ramifications. The SCOPUS, PubMed, Ovid, PsychINFO, and Cochrane Library databases were searched for publications between March 2020 and January 2022. Of the 854 articles identified, 245 were found duplicated, and 609 were screened, 241 of which were potentially eligible, and 15 of which were ultimately included. Although no studies on the ethical implications were eligible for our study criteria due to insufficient primary data to perform an analysis on, we explored this topic in the Discussion section of this paper. We confirm declines in ART, PrEP, and HIV testing during the initial lockdown period, with slight variations across the South African provinces. Protecting routine services and reducing the disease burden on high-risk nations such as South Africa is imperative moving forward with the pandemic.

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Medical Mistrust and Stigma Associated with COVID-19 Among People Living with HIV in South Africa

Cited by 20 publications

References 56 publications

COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study

COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study

Stigma and its associated factors among patients with COVID-19 in Dhaka City: evidence from a cross-sectional investigation

The Social, Behavioral, and Ethical Modalities of COVID-19 on HIV Care in South Africa: A Systematic Review

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