Stigma among key populations living with HIV in the Dominican Republic: experiences of people of Haitian descent, MSM, and female sex workers

Abstract

Objective(s): To describe stigma among seropositive MSM, female sex workers (FSWs), and Haitian-descent individuals in the Dominican Republic, and to assess whether stigma is associated with HIV treatment outcomes. Design: Cross-sectional survey using Stigma Index 2.0. Methods: People living with HIV (PLHIV) interviewed seropositive adult MSM, FSWs, Haitian-descent persons, and other PLHIV who did not identify with these communities about experiences of social exclusion, harassment, stigma in healthcare settings, and internalized stigma. Bivariate analyses were conducted to compare experiences between FSWs and other women; MSM and other men; and Haitian-descent participants and non-Haitian PLHIV. Within each community, separate multivariate logistic regression analyses were conducted to examine the association between stigma experiences with viral suppression and with missed antiretroviral doses. Results: The 891 participants consisted of 154 MSM, 216 FSWs, 90 Haitian-descent persons, and 447 who did not identify with any of these three communities. Compared with other women, FSWs reported significantly higher levels of harassment due to their HIV status, and those of Haitian descent reported significantly lower levels of social exclusion compared with non-Haitian PLHIV. In adjusted analyses, MSM who experienced more stigma in HIV-specific services had a significantly lower odds of knowing they had undetectable viral load (adjusted odds ratio 0.37, P < 0.05). Higher internalized stigma scores were significantly associated with missing an antiretroviral treatment dose among FSWs (adjusted odds ratio 1.26, P < 0.05). Conclusion: For FSWs and MSM, efforts to mitigate HIV-related stigma are necessary to improve treatment adherence and viral suppression. For Haitian-descent PLHIV, interventions must address not only their HIV-specific needs, but also the broader social and legal barriers to care.

Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter

“…Among study participants in the current study, Haitian-Americans endorsed the highest level of stigma, followed by Hispanic-Americans; African-Americans endorsed the lowest level ( p < 0.05). Our findings were similar to a study conducted in the Dominican Republic, where persons of Haitian descent, who are immigrants and have a history of discrimination in the Dominican Republic endorsed higher levels of stigma ( 36 ). In southern Florida, Hispanics are a minority-majority; Haitians are a minority.…”

“…Our findings are also consistent with what has been reported in the state of Florida, regarding significant correlations between HIV-related stigma (by healthcare workers) and ARV adherence (34), and HIV-related stigma and depression (35), although this is specific to a population of majority non-Hispanic Black men and women with HIV. Outside of the US, the relationship between HIV-related stigma and adherence has also been established among marginalized populations in the Dominican Republic, including men and women of Haitian descent (36). We did not find similar US-based studies, disaggregated by ethnicity, for comparison with other cohorts of Haitian women living in the US.…”

Exploring peer navigation and support in the quality of HIV care experiences of female sex workers in the Dominican Republic

“…FSWs often experience stigma and discrimination from the community and healthcare professionals [20,24,30], in addition, to experiencing their own self-stigmatizing views, which is often inundated with feelings of shame [20]. Among FSWs living with HIV, internalized stigma has been associated with missing ART treatment doses [31], while experiences of discrimination within healthcare structures, including harsh treatment, has been associated with healthcare avoidance [32]. Peer navigation and support could be a mechanism for combating these experiences and addressing the healthcare barriers that lead to suboptimal HIV outcomes among this population.…”

Global assessment of existing HIV and key population stigma indicators: A data mapping exercise to inform country-level stigma measurement

“…However, the stated goal for 2020 was to reduce new infections to 500,000, which was not achieved due in part to limited progress in reducing stigma affecting people at risk for and living with HIV [2]. Stigma has been identified as a social determinant of health and a key barrier to improving health outcomes among people living with HIV [3][4][5][6][7][8].…”

“…However, the stated goal for 2020 was to reduce new infections to 500,000, which was not achieved due in part to limited progress in reducing stigma affecting people at risk for and living with HIV [ 2 ]. Stigma has been identified as a social determinant of health and a key barrier to improving health outcomes among people living with HIV [ 3 – 8 ]. As such, stigma continues to present barriers to achieving the HIV prevention and treatment targets by interfering with the provision and uptake of prevention, diagnostic, and treatment services.…”