Patient and Provider Perspectives on HIV Stigma in Healthcare Settings in Underserved Areas of the US South: A Mixed Methods Study

Crockett, Kaylee B.; Turan, Bülent; Whitfield, Samantha; Kay, Emma Sophia; Budhwani, Henna; Fifolt, Matthew; Hauenstein, Kris; Ladner, Murray D.; Sewell, Joshua; Payne-Foster, Pamela; Nyblade, Laura; Batey, D. Scott; Turan, Janet M.

doi:10.1007/s10461-021-03470-y

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…These findings are consistent with Rice and colleagues’ study [ 38 ], which found that enacted and anticipated HIV-related stigma in healthcare settings were associated with poor ART adherence. Consistent evidence corroborates that anticipation and enacted stigma in healthcare settings inhibits engagement along the continuum of HIV prevention and care [ 38 – 40 ]. The stigma anticipated and experienced in clinical sites and with other PLWH may be shaping the stigma anticipated in HIV interventions.…”

Section: Discussionmentioning

confidence: 70%

The association of HIV-related stigma and psychosocial factors and HIV treatment outcomes among people living with HIV in the Volta region of Ghana: A mixed-methods study

Nutor,

Gyamerah,

Duah

et al. 2024

PLOS Glob Public Health

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Stigma and discrimination have been identified as significant barriers to HIV treatment among people living with HIV (PLWH). HIV stigma affects decision to seek HIV testing and early treatment. Evidence shows that HIV stigma undermines antiretroviral therapy (ART) adherence by affecting the psychological process such as adjusting and coping with social support. In Ghana, stigma toward PLWH occurs in many ways including rejection by their communities and family members, ostracism, and refusal to engage in social interactions such as eating, sharing a bed, or shaking hands. Therefore. we examined PLWH’s experiences with different forms of HIV-related stigma and the impact on HIV treatment outcome in the Volta region of Ghana. We employed a convergent mixed-method approach consisting of a survey with 181 PLWH, four focus group discussions with 24 survey respondents, and in-depth interviews with six providers. We performed independent samples t-test, ANOVA, and chi-square test to test associations in bivariate analysis and analyzed qualitative data using thematic analysis. In all, 49% of survey respondents reported experiencing high internalized stigma, which was associated with high social support and depression (p<0.001). In qualitative interviews, anticipated stigma was the most salient concern of PLWH, followed by internalized and enacted stigma, which all negatively impacted HIV treatment and care. Stigma was experienced on multiple levels and affected psychosocial and treatment outcomes. Findings suggest urgent need for HIV-stigma reduction intervention among PLWH and their family, providers, and community members.

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Section: Discussionmentioning

confidence: 70%

The association of HIV-related stigma and psychosocial factors and HIV treatment outcomes among people living with HIV in the Volta region of Ghana: A mixed-methods study

Nutor,

Gyamerah,

Duah

et al. 2024

PLOS Glob Public Health

View full text Add to dashboard Cite

show abstract

“…This kind of discrimination may include denial of services, dehumanizing treatment, or violation of confidentiality, which is facilitated by drivers such as lack of knowledge of the pathology, its mode of transmission and treatment, as well as fear of contagion [50][51][52][53][54]. In the quantitative studies included in this review, it was observed that the behaviors perceived by PLWH, coming from healthcare workers, were mainly negative labels, cynical questions, delay in care, refusal of care, and dissemination of serological status without authorization [21,22]. However, health professionals also documented negative attitudes and stigma, either because they expressed them themselves or because they identified them in colleagues.…”

Section: N Discussionmentioning

confidence: 99%

“…The study by Crockett et al described that, in general, the care environments for PLWH were spaces free of prejudice; however, 51% of PLWH reported experiencing HIV-related discrimination, and 60% reported experiencing more than one experience of discrimination [21]. Stigma enacted in healthcare settings was significantly associated with suboptimal ART adherence among people with HIV (OR=1.38, 95% CI: 1.03-1.84; p=0.028).…”

Section: Stigma On the Part Of Healthcare Professionalsmentioning

confidence: 99%

Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review

2024

Infez Med

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The aim of the present study was to explore the stigma and fear of getting sick in health professionals who treat people living with HIV. An exploratory systematic review was conducted. The search was limited to the presence of stigma and fear of getting sick on the part of healthcare workers who treat people living with HIV, documented by the health workers or patients themselves. No language restriction was made and systematic reviews, comments or communications were excluded. The sources of information were Scopus, PubMed/MEDLINE, Science Direct, and the CEN-TRAL Registry, from the last 5 years. The quality of the evidence was assessed with an adapted tool and the synthesis of the results was carried out using a narrative synthesis approach. Twenty-three articles were included, which related structural stigma, stigma by health professionals and fear of getting sick. Among the findings, data stood out such as that more than 50% of patients reported having experienced discrimination due to HIV and even accumulated stigma for other additional causes. Stigma enacted in healthcare settings was related to suboptimal adherence to treatment (OR 1.38; 95% CI: 1.03-1.84; p=0.028). Stigma is a structural barrier in the care of people living with HIV and generates a psychological, physical, and social health impact for these people. Some limitations of the present study are that, despite searching the major databases, important manuscripts may have been left out. Additionally, there are regions that are not represented in this review because no manuscripts from those areas were found.

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“… 70 , 71 Interestingly, further intersectional stigma regarding HIV was not a theme identified within the interviews, despite HIV stigma being well documented as intersecting with other forms of stigma in communities disproportionately impacted by HIV. 72 For example, in our prior mixed-methods research with young gay males of color we uncovered themes related to HIV stigma as a barrier to seeking out or participating in an online HIV prevention program (i.e., not even wanting to search for the word “HIV” online or of fear someone will see their search and assume they have HIV). 33 Future qualitative studies with NHOPI gay males should explore experiences of intersectional stigma further.…”

Section: Discussionmentioning

confidence: 99%

“I don’t see myself represented:” Strategies and considerations for engaging gay male Native Hawaiian and Other Pacific Islander teens in research and HIV prevention services

et al. 2022

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Significant efforts have been applied to the development of sexual health programs for minority young gay males. Given the absence of research with Native Hawaiian and other Pacific Islander (NHOPI) gay teen males, this study was done to assess how to reach them. Interviews were conducted with 20 NHOPI gay males ages 19–24 as near peers that can inform reaching teens. Data was analyzed using the Reflexive Thematic Analysis method. Three themes were identified: (1) Culture is a crucial factor for recruitment and engagement—whether participants realized it or not; (2) Confidentiality is key in recruitment to provide a safe space for NHOPI gay teen male research participation; and (3) NHOPI gay teen males experience multiple identity conflicts that must be considered for recruitment and engagement initiatives. Online recruitment efforts are optimal and should reflect distinct NHOPI cultures. More research is needed when it comes to understanding the cultural acceptance and understanding of homosexuality in NHOPI communities and how to integrate cultural education into recruitment methods and interventions.

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Patient and Provider Perspectives on HIV Stigma in Healthcare Settings in Underserved Areas of the US South: A Mixed Methods Study

Cited by 11 publications

References 31 publications

The association of HIV-related stigma and psychosocial factors and HIV treatment outcomes among people living with HIV in the Volta region of Ghana: A mixed-methods study

The association of HIV-related stigma and psychosocial factors and HIV treatment outcomes among people living with HIV in the Volta region of Ghana: A mixed-methods study

Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review

“I don’t see myself represented:” Strategies and considerations for engaging gay male Native Hawaiian and Other Pacific Islander teens in research and HIV prevention services

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