Stigma and Judgment Toward People Living with HIV and Key Population Groups Among Three Cadres of Health Workers in South Africa and Zambia: Analysis of Data from the HPTN 071 (PopART) Trial

Krishnaratne, Shari; Bond, Virginia; Stangl, Anne; Pliakas, Triantafyllos; Mathema, Hlengani; Lilleston, Pamela; Hoddinott, Graeme; Böck, Peter; Ayles, Helen; Fidler, Sarah; Hargreaves, James

doi:10.1089/apc.2019.0131

Cited by 33 publications

(46 citation statements)

References 40 publications

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“… 43 , 44 Many have noted the prevalence of stigmatizing attitudes among health care workers toward people living with HIV, and called for targeted stigma-reduction 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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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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“…Treatment refusal despite eligibility has also been documented [ 8 , 9 ]. Meanwhile, HIV remains heavily stigmatized throughout sub-Saharan Africa [ 10 - 12 ]. In some countries such as Uganda, certain stigmas have actually intensified over the past decade [ 13 ].…”

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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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“…where the uptake of CHW-led HIV services was low due to a variety of reasons including the health system related barriers that CHW were faced with, HIV stigma, community and political contexts [26,[28][29][30][31] .…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Perceptions of People Living With HIV Regarding The HIV Services That Are Offered By The Community Health Workers in KwaZulu-Natal, South Africa

Khumalo¹,

Segobe²,

Lutge³

et al. 2021

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Background: KwaZulu-Natal (KZN) is the province with the highest HIV prevalence in South Africa (SA). Community Health Workers (CHWs) are key to delivery of HIV services at community level. Evidence on knowledge and perceptions of people living with HIV (PLWH) regarding the HIV services that are offered by the CHWs is limited. Therefore, this study seeks to determine knowledge and perceptions of PLWH regarding the HIV services that are offered by the CHWs in KZN.Methods: The study design was a quantitative survey using an administrator-administered questionnaire. A total of 303 PLWH from 3 selected KZN clinics were interviewed to determine their knowledge and perceptions of HIV services offered by the CHWs. Statistical Package for Social Sciences (SPSS) version 27 was used to describe the population and testing for associations between variables. The significant level was set at a p value ≤ 0.05 and at 95% confidence internal.Results: Among the 303 PLWH surveyed, 24 (8%), knew about the HIV services offered by the CHWs and of the 89 (29%) participants that were visited by CHWs, 73 (82%) had a positive perception about these services. Participants who were visited by a CHW were more likely (OR=1.57, 95% CI: 0.57-4.35) to know about the HIV services. Knowledge of HIV services was significantly associated with the positive perception of the HIV services (p<0.05). Knowledge and perception of the HIV services was not associated with age, gender, level of education or duration of visiting the clinic.Conclusion: The majority of PLWH in KZN have poor knowledge of HIV services offered by the CHWs and most of them have never been visited by a CHW in their homes. Those that were visited by CHWs were more likely to have positive perceptions regarding their HIV services. The findings of the study should trigger the scaling up of HIV community targeted initiatives that are delivered by CHWs in order to curb the HIV epidemic in the province.

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Stigma and Judgment Toward People Living with HIV and Key Population Groups Among Three Cadres of Health Workers in South Africa and Zambia: Analysis of Data from the HPTN 071 (PopART) Trial

Cited by 33 publications

References 40 publications

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

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

Knowledge and Perceptions of People Living With HIV Regarding The HIV Services That Are Offered By The Community Health Workers in KwaZulu-Natal, South Africa

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