The impact of taking or not taking ARVs on HIV stigma as reported by persons living with HIV infection in five African countries

Abstract

Aim This study examined the impact of taking or not taking antiretroviral (ARV) medications on stigma, as reported by people living with HIV infection in five African countries. Design A two group (taking or not taking ARVs) by three (time) repeated measures analysis of variance examined change in reported stigma in a cohort sample of 1,454 persons living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Participants self-reported taking ARV medications and completed a standardized stigma scale validated in the African context. Data were collected at three points in time, from January 2006 to March 2007. Participants taking ARV medications self-reported a mean CD4 count of 273 and those not taking ARV self-reported a mean CD4 count of 418. Results Both groups reported significant decreases in total HIV stigma over time; however, people taking ARVs reported significantly higher stigma at Time 3 compared to those not taking ARVs. Discussion This study documents that this sample of 1,454 HIV infected persons in five countries in Africa reported significantly less HIV stigma over time. In addition, those participants taking ARV medications experienced significantly higher HIV stigma over time compared to those not taking ARVs. This finding contradicts some authors’ opinions that when clients enroll in ARV medication treatment it signifies that they are experiencing less stigma. This work provides caution to health care providers to alert clients new to ARV treatment that they may experience more stigma from their families and communities when they learn they are taking ARV medications.

To tell or not to tell: Negotiating disclosure for people living with HIV on antiretroviral treatment in a South African setting

“…This was because it is more difficult to hide one's status when taking ARV treatment, due to regular clinical visits to the clinic, having one's blood drawn frequently, and having to take medication at specific times, twice daily for the rest of one's life. Thus, to avoid disclosure and keep their social support within the household, and social ties with friends and acquaintances, PLHIV will either delay or stop taking their ARVs (Makoae et al 2009;Waddell & Messeri 2006). To the contrary, Stirratt, Remien, Smith, Copeland, Dolezal, Krieger, et al (2006) found that individuals who disclosed had higher rates of adherence than those who had not.…”

“…Whilst stigma and discrimination have generally lessened over time, Makoae et al (2009) show that those on treatment experienced higher levels of discrimination over time than those who were not on treatment. This was because it is more difficult to hide one's status when taking ARV treatment, due to regular clinical visits to the clinic, having one's blood drawn frequently, and having to take medication at specific times, twice daily for the rest of one's life.…”

“…Studies by Herek and Capitanio (1993) and Herek, Capitanio and Widaman (2002) have described the pervasive and persistent nature of HIV/ AIDS-related stigma in the USA over almost two decades, including after antiretroviral (ARV) treatment was available. Stigma and discrimination inhibit access to prevention, care and treatment services (Makoae, Portillo, Uys, Dlamini, Greeff, Chirwa, et al 2009;Weiss & Ramakrishna 2001in Campbell, Foulis, Maimane & Sibiya 2005. A study by Genberg, Hlavka, Konda, Maman, Chariyalertsak, Chingono, et al (2009) showed that people who did not know about HIV or AIDS, had never been tested for HIV and thus did not know their status, or who did not know about the existence or availability of ARVs, blamed PLHIV for their infection and isolated them.…”

Factors Associated With Perceived Stigma Among People Living With HIV/AIDS in Post-Conflict Northern Uganda

“…Received stigma is further divided into five dimensions: fear of contagion (six items), health care neglect (seven items), social isolation (five items), verbal abuse (eight items), and workplace stigma (two items). Cronbach's alpha reliability coefficients for the stigma scale range from .76 to .90 (Makoae et al, 2009). The HASI-P tool, the definitions of the dimensions and detailed items for each dimension are described in Holzemer et al (2007).…”

“…However, not all studies have documented a reduction in stigmatization of PL-HIV as a result of the roll out of HAART. A year-long longitudinal study comparing patients on and off HAART found that although stigma reduced over time in both groups, those on HAART had higher levels of stigma (Makoae et al, 2009). Verbal abuse, negative self-perception, and social isolation were the factors significantly associated with HAART.…”