Perceived HIV stigma and HIV testing among men and women in rural Uganda: a population-based study

Kalichman, Seth C.; Shkembi, Bruno; Wanyenze, Rhoda K.; Naigino, Rose; Bateganya, Moses; Menzies, Nicholas; Lin, Chii‐Dean; Lule, Haruna; Kiene, Susan M.

doi:10.1016/s2352-3018(20)30198-3

Cited by 27 publications

(21 citation statements)

References 32 publications

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“…We additionally identified characteristics associated with higher COVID-19 stigma, including female gender and higher levels of HIV stigma prior to the COVID-19 pandemic, and found a negative association between television as a source of information on COVID-19 and stigma. An association between gender and health-related stigma has been noted previously, demonstrating more perceived HIV stigma among women than men [56] and differential influences of HIV stigma on care-seeking behavior for men and women [57,58]. The association of higher HIV stigma at baseline with higher COVID-19 stigma supports the notion that health-related stigma is not an isolated phenomenon specific to a single condition, but rather reflects the intersectionality of multiple health-related stigmas [19,22] and suggests that structural determinants, such as poverty and systemic racism, may be contributing to multiple healthrelated stigmas for the same individual or group of people.…”

Section: Discussionmentioning

confidence: 56%

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

et al. 2021

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We evaluated COVID-19 stigma and medical mistrust among people living with HIV in South Africa. We conducted telephone interviews with participants in a prospective study of a decentralized antiretroviral therapy program. Scales assessing medical mistrust, conspiracy beliefs, anticipated and internalized stigma, and stereotypes specific to COVID-19 were adapted primarily from the HIV literature, with higher scores indicating more stigma or mistrust. Among 303 participants, the median stigma summary score was 4 [interquartile range (IQR) 0–8; possible range 0–24] and 6 (IQR 2–9) for mistrust (possible range 0–28). A substantial proportion of participants agreed or strongly agreed with at least one item assessing stigma (54%) or mistrust (43%). Higher COVID-19 stigma was associated with female gender and antecedent HIV stigma, and lower stigma with reporting television as a source of information on COVID-19. Further efforts should focus on effects of stigma and mistrust on protective health behaviors and vaccine hesitancy.

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Section: Discussionmentioning

confidence: 56%

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

et al. 2021

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“…42 While our findings provide a strong framework for supporting a healer-delivered intervention, we-and many othersrecognize that stigma remains a significant barrier to any effective HIV testing program. 43,44 Many have noted the prevalence of stigmatizing attitudes among health care workers toward people living with HIV, and called for targeted stigmareduction interventions in health care settings. 45,46 We believe that such efforts should be inclusive of informal providers such as traditional healers, whose stigmatizing attitudes may also negatively impact health care engagement among clients.…”

Section: Discussionmentioning

confidence: 99%

Shortening “the Road” to Improve Engagement with HIV Testing Resources: A Qualitative Study Among Stakeholders in Rural Uganda

Broderick

Ponticiello

Nabukalu

et al. 2021

AIDS Patient Care and STDs

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In HIV-endemic areas, traditional healers are frequently used with, or instead of, biomedical resources for health care needs. Studies show healers are interested in and capable of supporting patients in the HIV care cascade. However, adults who receive care from healers have low engagement with HIV services. To achieve epidemic control, we must understand gaps between the needs of HIV-endemic communities and the potential for healers to improve HIV service uptake. This study's objective was to characterize stakeholder perspectives on barriers to HIV testing and approaches to mitigate barriers in a medically pluralistic, HIV-endemic region. This study was conducted in Mbarara District, a rural area of southwestern Uganda with high HIV prevalence. Participants included HIV clinical staff, traditional healers, and adults receiving care from healers. Fifty-six participants [ N = 30 females (52%), median age 40 years (interquartile range, 32–51.5)] were recruited across three stakeholder groups for minimally structured interviews. Themes were identified using an inductive, grounded theory approach and linked together to create a framework explaining stakeholder perspectives on HIV testing. Stakeholders described the “road” to HIV testing as time-consuming, expensive, and stigmatizing. All agreed healers could mitigate barriers by delivering HIV testing at their practices. Collaborations between biomedical and traditional providers were considered essential to a successful healer-delivered HIV testing program. This work describes a novel approach to “shorten the road” to HIV testing, suggesting that traditional healer-delivered HIV testing holds promise to expand uptake of testing among communities with limited access to existing programs.

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“…For persons with HIV, who have the stigmatized attribute in question, subjective awareness of the norm has a personalized and negative valence, and is therefore sometimes also referred to as felt stigma [ 17 , 63 ], felt normative stigma [ 68 ], or anticipated stigma. When elicited from persons in the general population (presumed to lack the stigmatized attribute in question), this construct is typically referred to as “perceived stigma” [ 22 , 34 ]. However, whether or not one has the stigmatized status in question, measurement of perceived or anticipated stigma proceeds in the same fashion: by eliciting perceptions of normative attitudes and behaviors.…”

Section: Methodsmentioning

confidence: 99%

“…A critical dimension of the stigma attached to HIV is perceived or anticipated stigma, which occurs when one expects, based on subjective awareness of prevailing social norms, that persons with HIV will be devalued and discriminated against [ 14 ]. Numerous studies have examined the health and behavioral impacts of perceived or anticipated stigma [ 15 - 22 ]. In general, these adverse effects are expected to operate whether the stigmatized condition is visible (eg, race/ethnicity) or concealable (eg, asymptomatic HIV) [ 23 , 24 ].…”

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confidence: 99%

Normative vs personal attitudes toward persons with HIV, and the mediating role of perceived HIV stigma in rural Uganda

et al. 2021

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Background HIV stigma has well-documented negative impacts on HIV testing, transmission risk behavior, initiation of and adherence to antiretroviral therapy, and retention in care. We sought to assess the extent to which anticipated HIV stigma is based on misperceptions of normative attitudes toward persons with HIV, and to determine whether persons with HIV have stronger misperceptions compared with HIV-negative persons or persons of unknown serostatus. We also sought to estimate the association between normative attitudes about persons with HIV and personal attitudes about persons with HIV, and to determine the extent to which anticipated stigma mediates this association. Methods We conducted a whole-population survey of 1776 persons living in 8 rural villages in southwestern Uganda. Negative attitudes toward persons with HIV, and anticipated stigma, were measured using a newly validated 15-item scale measuring multiple dimensions of HIV stigma, including social distance, blaming attitudes, and concerns about reciprocity. We used multivariable regression to estimate the association between normative attitudes about persons with HIV and personal attitudes toward persons with HIV, and to determine the extent to which perceptions of normative attitudes (anticipated stigma) mediated this association. Results Study participants believed that negative attitudes toward persons with HIV were more pervasive than they actually are. Perceptions of the extent to which these negative attitudes are normative mediated more than one-third of the association between normative attitudes and their personal attitudes. In contrast to what we originally hypothesized, persons with HIV were less likely to misperceive these norms and perceived normative attitudes to be less stigmatizing than did others in the general population. Conclusions Interventions designed to accurately describe normative attitudes toward persons with HIV may reduce HIV stigma without directly focusing on the educational components that are typically embedded in anti-stigma interventions.

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Perceived HIV stigma and HIV testing among men and women in rural Uganda: a population-based study

Cited by 27 publications

References 32 publications

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

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

Shortening “the Road” to Improve Engagement with HIV Testing Resources: A Qualitative Study Among Stakeholders in Rural Uganda

Normative vs personal attitudes toward persons with HIV, and the mediating role of perceived HIV stigma in rural Uganda

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