The influence of AIDS stigma and discrimination and social cohesion on HIV testing and willingness to disclose HIV in rural KwaZulu-Natal,South Africa

Abstract

This study aims to understand the influence of AIDS stigma and discrimination, and social cohesion to HIV testing, and willingness to disclose an HIV status. A cross-sectional, interviewer administered survey (N=594) was conducted. Independent sample t-tests explored the mean differences between sex and age groups on stigma, discrimination, and social cohesion measurement. Logistic regression models were fitted with the above independent variables, and the binominal dependent variables: having had a test, willingness to have a test and disclose a positive status. The mean age of participants was 25.3 years and 60% were women. Only 28% had an HIV test, 63% were willing to have a test, and 82% reported a willingness to disclose an HIV status. High levels of stigma and discrimination were anticipated from the community, less so from their partners, and very little from families. Low levels of social distance exist towards people with HIV/AIDS, membership to social networks seems limited, and inadequate social support for people with HIV/AIDS was reported. The analysis indicates that AIDS stigma and discrimination, and inadequate social cohesion, limit access to voluntary counselling and testing (VCT), inhibit disclosure, and are, thus, barriers to care, support and prevention. Interventions need to extend the focus on information and education to strengthen social capital within a participatory and sustainable development framework.     

‘HIV and work don't go together’: Employment as a social determinant of HIV outcomes among men who have sex with men and transgender women in the Dominican Republic

Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in the Dominican Republic. Little is known about their experiences living with HIV as a chronic condition. We explored employment as a social determinant of well-being with HIV. We conducted 42 qualitative in-depth interviews with MSM (n?=?16) and transgender women (n?=?5) living with HIV; each participant completed 2 interviews to facilitate depth and iterative analysis. We used narrative analysis and systematic coding to identify salient themes related to employment and the HIV experience and developed a conceptual model of the pathways between HIV stigma, unemployment, and HIV outcomes. Early life experiences, including rejection from families and school, resulted in limited work opportunities, especially among transgender women. Following HIV diagnosis, participants across all socio-economic levels lost jobs and/or were unable to get jobs due to illegal HIV testing and HIV stigma and discrimination. Not being able to work impacted mental health, engagement in HIV care, and overall well-being. We conclude that lack of employment is a salient concern among MSM and transgender women living with HIV. Holistic, multi-level programmes that address illegal HIV testing and discriminatory hiring practices are urgently needed to facilitate engagement in care and long-term well-being.     

Attitudes towards and perceptions of reproductive health needs of persons living with HIV/AIDS in rural Kilimanjaro,Tanzania

The introduction of antiretroviral treatment has resulted in the resumption of socially productive and sexually active lives of people living with HIV/AIDS, together with the desire for children. However, factors affecting the reproductive health needs of people living with HIV/AIDS are not well understood. With this in mind, the aim of this paper was to investigate factors associated with these health needs using a qualitative approach. Findings indicate that attitudes and perceptions about reproductive health needs are influenced by fertility beliefs, the central role of family, procreation and the perceived social and clinical consequences of pregnancies among people living with HIV/AIDS. While there was mixed opinion about acceptability of people living with HIV/AIDS, having children, marriage and family were institutions important for partnerships maintenance and procreation. These findings suggest that living with HIV in a community with strong pro-life attitudes is challenging for people living with HIV/AIDS who do not have children. Apart from having to grapple with potential stigma of not having children, people living with HIV/AIDS also face social challenges in realising their reproductive choices. Interventions to address stigma, societal changes and the integration of reproductive-health education into HIV care and treatment are needed.     

Stigmatisation of alcohol use among people receiving antiretroviral therapy for HIV infection,Cape Town,South Africa

ABSTRACT

Antiretroviral therapy (ART) effectively treats HIV infection, with improved longevity and quality of life among people living with HIV. Alcohol use, however, remains a robust barrier to ART. This study, for the first time, examined the effects of the stigmatisation of alcohol use on ART adherence. Patients receiving ART in Cape Town, South Africa who currently drink alcohol (N?=?187) and those who do not drink alcohol (N?=?106) completed measures of alcohol use, alcohol-ART adherence, and alcohol-ART stigma. Participants also provided permission to access their most recent HIV viral load from clinic medical records. Results of a mediation model demonstrated significant detrimental effects of alcohol use on ART adherence. In addition, the indirect effects of alcohol use on ART adherence through alcohol-ART stigma was also significant, indicating that alcohol-ART stigma at least in part mediates the association between alcohol use and ART adherence. The same pattern of results was observed in relation to HIV viral load obtained from medical records. Interventions designed to address alcohol use as a barrier to ART adherence should incorporate alcohol-ART stigma as a barrier to adherence as well as a barrier to participating in adherence interventions.     

Changing social and HIV/AIDS risk behaviours: Effects of life skills education among urban street youths

Abstract

The objective of this study was to examine the effect of a life skills education intervention among male and female youth in Ibadan, Nigeria, on knowledge about prevention and safe sexual practices, sexual roles and responsibilities, HIV/AIDS, money management, assertiveness and communication through follow-up interviews four weeks and eight weeks following the intervention. The participants were 98 males and females, and part of an initial survey of social and health problems of street youths in Ibadan, Nigeria. They were locality-separated, with consecutive assignments to two groups of experimental (n?=?54, exposure to a manual driven life skills education) and control (n?=?44, non-exposure to life skills education, but attention given) participants, and evaluated subsequently at four weeks and then at eight-week follow-ups. At the four-week post-intervention assessment, the experimental group showed significantly increased scores in the knowledge of antisocial behaviour prevention (p < 0.01), about HIV/AIDS (p < 0.001), about safe sexual practices (p < 0.001), about social roles and responsibilities and about assertiveness and communication (p < 0.01). At eight-week follow-up assessment, substantial significant reductions in reported antisocial and unsafe sexual behaviours were observed across the experimental group compared with the control group. The results suggest that street youths can be empowered through life skills education but with limitation to safe sexual practices over a sustained period of time in Nigeria.     

Students and their parental attitudes toward the education of children affected by HIV/AIDS: a cross‐sectional study in AIDS prevalent rural areas,China

Objective : To investigate the prevalence and determinants of student and parental attitudes toward the education of children affected by HIV/AIDS in areas of rural China where AIDS is prevalent. Methods : A cross‐sectional study of a random sample of students (n=732) and their parents (n=732) conducted in April 2010, using a questionnaire and in‐depth interview. Results : Twenty‐six per cent of students and 29% of parents had a ‘good’ attitude toward the education of children affected by HIV/AIDS. Following adjustment for sociodemographic characteristics, students’ attitudes were significantly associated with knowledge of HIV/AIDS non‐transmission (adjusted odds ratio [aOR]= 3.13) and their parents’ attitudes (aOR= 2.38), but not with knowledge of HIV/AIDS transmission, prevention or their parents’ knowledge. Parents’ attitudes were significantly associated with knowledge of HIV/AIDS non‐transmission (aOR= 2.12) and their children's attitudes (aOR= 2.52), but not with knowledge of HIV/AIDS transmission, prevention or their children's knowledge. Conclusion : Stigma and discrimination undermine the right to education of HIV/AIDS‐affected children in rural China. Improving non‐transmission knowledge may improve caring attitudes. Implications : HIV/AIDS public health educational campaigns highlighting non‐transmission and extending family education, combined with school education, may help to enhance an environment of non‐discrimination and safeguard public support programs for the right to education of children affected by HIV/AIDS.     

Parental history of moderate to severe infantile malnutrition is associated with cognitive deficits in their adult offspring

Objectives: We compared the IQ and academic achievement of the young adult offspring of parents malnourished in infancy and those of a healthy control group in order to test the hypothesis that the offspring of previously malnourished individuals would show IQ and academic deficits that could be related to reduced parental socioeconomic status.

Methods: We conducted a group comparison study based on a community sample in Barbados (Barbados Nutrition Study). Participants were adult children ≥16 years of age whose parents had been malnourished during the first year of life (n?=?64; Mean age 19.3 years; 42% male) or whose parents were healthy community controls (n?=?50; Mean age 19.7 years; 48% male). The primary outcome was estimated IQ (Wechsler Abbreviated Scale of Intelligence); a secondary outcome was academic achievement (Wide Range Achievement Test – Third Edition). Data were analyzed using PROC MIXED with and without adjusting for parental socioeconomic status (Hollingshead Index of Social Position).

Results: IQ was reduced in the offspring of previously malnourished parents relative to the offspring of controls (9.8 point deficit; P?Discussion: The deleterious impact of infant malnutrition on cognitive function may be transmitted to the next generation; however, this intergenerational effect does not appear to be explained by the reduced socioeconomic status or IQ of the parent generation.     

Children caring for their ill parents with HIV/AIDS

Abstract

Children orphaned by HIV/AIDS experience not only the trauma of a parent's death, but the stress of living with and often caring for an ill and dying parent. We interviewed 50 mothers ill from HIV/AIDS in both Mutare, Zimbabwe and New York, USA, and one child of each aged 8–16 about personal assistive care the child provided; other household responsibilities; hours/day children spent on chores; and parental/child mental health. Children provided substantial amounts of personal care; took responsibility for cooking, cleaning, shopping and other household tasks; and some were their parents' confidants. The amount of care provided was related to maternal disability, not child age, gender, or presence of other adults/siblings. Children reported performing more tasks than their mothers reported. Almost half of New York and 80% of Mutare children said they had too much responsibility, and most reported reduced after-school and peer activities. Both children and parents felt children were more capable because of their responsibilities. Depression rates in New York and Mutare children were high but Mutare children were extremely vulnerable; two-thirds had depression scores in the clinically significant range. However, child caregiving was unrelated to depression. Research to better understand the role of child caregivers is still needed.     

Prevalence and factors associated with HIV/AIDS-related stigma and discriminatory attitudes: A cross-sectional nationwide study

ObjectiveThe prime purpose of this study is to assess HIV/AIDS-related self-stigma and discrimination (S&D) attitudes and associated factors using multivariate analysis of data from the 2010–11 National Survey of Understanding the Root of HIV/AIDS Related Stigma and Discrimination.MethodA national telephone survey was carried out with 2271 of the Malaysian public aged 18–60 years. The sample was contacted by random digit dialing covering the whole of Peninsular Malaysia from December 2010 to May 2011. The HIV-transmission knowledge, HIV-related self-stigma, and public stigma were investigated.ResultsDespite high level of HIV-transmission knowledge [mean (SD) = 10.56 (2.42), mean score at 70th percentile] the respondents in this study had moderate levels (mean scores near midpoints) of self-stigma and public stigma attitudes. HIV-transmission knowledge score was not significantly correlated with self-stigma score, but showed a significantly small positive effect (r < 0.2) for public stigma scores. Ethnicity is the strongest correlate of HIV-transmission knowledge, self-stigma, and public stigma attitudes in the multivariate analyses. Other significant correlates were age, socioeconomic group, and urban–rural setting.ConclusionsThe root causes of HIV stigma and discriminatory attitudes were not associated with knowledge deficiency. Interventions should be oriented towards promoting de-stigmatization of HIV/AIDS, and tailored socio-culturally.     

Can AIDS stigma be reduced to poverty stigma? Exploring Zimbabwean children's representations of poverty and AIDS

Objective We use children's drawings to investigate social stigmatization of AIDS‐affected and poverty‐affected children by their peers, in the light of suggestions that the stigmatization of AIDS‐affected children might derive more from the poverty experienced by these children than from their association with AIDS. Methods A qualitative study, in rural Zimbabwe, used draw‐and‐write techniques to elicit children's (10–12 years) representations of AIDS‐affected children (n= 30) and poverty‐affected children (n= 33) in 2009 and 2010 respectively. Results Representations of children affected by AIDS and by poverty differed significantly. The main problems facing AIDS‐affected children were said to be the psychosocial humiliations of AIDS stigma and children's distress about sick relatives. Contrastingly, poverty‐affected children were depicted as suffering from physical and material neglect and deprivation. Children affected by AIDS were described as caregivers of parents whom illness prevented from working. This translated into admiration and respect for children's active contribution to household survival. Poverty‐affected children were often portrayed as more passive victims of their guardians' inability or unwillingness to work or to prioritize their children's needs, with these children having fewer opportunities to exercise agency in response to their plight. Conclusions The nature of children's stigmatization of their AIDS‐affected peers may often be quite distinct from poverty stigma, in relation to the nature of suffering (primarily psychosocial and material respectively), the opportunities for agency offered by each affliction, and the opportunities each condition offers for affected children to earn the respect of their peers and community. We conclude that the particular nature of AIDS stigma offers greater opportunities for stigma reduction than poverty stigma.     

HIV/AIDS and intersectional stigmas: Examining stigma related behaviours among medical students during service delivery

ABSTRACT

HIV/AIDS stigma remains a major global health issue with detrimental consequences for people with HIV/AIDS (PWHA), especially when manifested by health professionals. Research on HIV/AIDS stigma has documented negative attitudes towards PWHA among health professionals. However, fewer studies have examined how HIV/AIDS stigma is manifested behaviourally during clinical interactions and how it interacts with other stigmas (i.e. drug use, sexism, homophobia). This study aimed to: (1) examine behavioural manifestations of HIV/AIDS stigma among medical students during clinical interactions, and (2) explore HIV/AIDS stigma intersectionality with other stigmas. We implemented an experimental design using Standardised Patient (SP) simulations, observational techniques, and quantitative questionnaires. A total of 237 medical students engaged in SP encounters with three experimental scenarios: (1) PWHA infected via illegal drug use, (2) PWHA infected via unprotected heterosexual relations, (3) PWHA infected via unprotected homosexual relations. They also interacted with a person with common cold (control condition). Results evidenced statistically significant differences between the experimental and control simulation, with higher number of stigma behaviours manifested towards experimental conditions. Results also evidence higher HIV/AIDS stigma towards MSM when compared to the drug user and heterosexual woman SP’s. We discuss the implications of these findings for training of medical students.     

Factors associated with intention to conceive and its communication to providers among HIV clients in Uganda

Persons living with HIV/AIDS (PLHA) must discuss their fertility intentions with healthcare providers to receive the support needed to have children safely and limit transmission risks. However, few quantitative studies have examined correlates of fertility intentions, let alone the communication of such intentions with providers. We examined the prevalence and correlates of intentions to have children, and comfort discussing such plans with one’s providers, in HIV clients at two HIV clinics in Uganda. Cross-sectional self-report data were collected from 233 patients who had primary partners. Bivariate correlates significant at the P < 0.10 level were included in logistic regression analysis. Of the 233 participants, 103 (44%) reported an intention to conceive a child in the near future. In multivariate analysis, younger age of both the patient and their partner, better physical health functioning and higher internalized HIV stigma were associated with having fertility intentions. One-third (35%) of those with fertility intentions expressed having difficulty discussing these intentions with their providers, which was associated with receiving care at the rural clinic and greater internalized HIV stigma. These findings highlight the need for reproductive health services that help clients accept themselves as PLHA and their fertility rights, thus promoting patient-doctor communication needed to promote safe child conception and delivery outcomes.     

The role of secondary school teachers in HIV prevention in Nigeria

Abstract

The purpose of this study was to investigate knowledge about HIV/AIDS among classroom secondary school teachers and document any efforts at educating their pupils about HIV prevention. A self-administered questionnaire addressed issues on demography, knowledge and awareness on HIV/AIDS and their roles in HIV/AIDS prevention. All consenting school teachers in the Irewole local government area of Osun State, Nigeria, participated in this study. The response rate was 91.7% (n?=?180). There were more males (76.4%) than females (23.0%) The mean (± SD) age of the respondents was 41.5 (±15.5) years. More than 90% had adequate knowledge of HIV/AIDS and indicated that it could be prevented. Furthermore, 86.1% wanted HIV/AIDS preventive education to be made compulsory in the secondary school curriculum. There were 131 (n?=?165, 79.4%) teachers who did not teach HIV/AIDS prevention, while 32 (19.4%) teachers believed that the pupils were too young and that the non-availability of guidelines and resources are reasons for not teaching it. One hundred and fifty-three (92.7%) of the respondents would like to attend a course/programme/workshop to update their knowledge and 139 (84.2%) of teachers would like to be part of an HIV/AIDS prevention group for their community. There is a need for school teachers to be trained adequately and provided with a structured educational programme to follow in order to enhance effectiveness in HIV/AIDS preventive education to pupils.     

Alcohol misuse,depressive symptoms,and HIV/STI risks of US Hispanic women

Objectives: Alcohol misuse and depressive symptoms have been linked to HIV/STI risk, but studies have rarely included Hispanic women, who have over four times greater HIV incidence than white, non-Hispanic women. Understanding the connections among alcohol misuse, depressive symptoms, and HIV/STI risks may suggest ways to meet specific needs of Hispanic women. This study’s objective is to examine the relationships among alcohol misuse, depressive symptoms, and seven HIV/STI risk factors.

Design: Five hundred forty-eight US Hispanic women with intake data from a randomized trial were assessed for alcohol misuse (CAGE) and depressive symptoms (CES-D). GZLM and path analyses tested relationships between alcohol misuse or depressive symptoms and HIV/STI risk factors.

Results: Self-efficacy and condom use were not related to alcohol misuse or depressive symptoms, but only 15% of women reported consistent condom use. After controlling for demographics, women with alcohol misuse had significantly more perceived HIV/STI risk (OR?=?2.15) and better HIV/STI knowledge (β?=??.54); and women with depressive symptoms had significantly more perceived HIV/STI risk (OR?=?1.76) and worse HIV/STI knowledge (β?=?.37).

Conclusions: Interventions to increase condom use for Hispanic women are needed, regardless of mental disorders. Working with Hispanic women with alcohol misuse or depressive symptoms presents a need (and opportunity) to address issues directly related to HIV/STI risk. Women’s health practitioners have an excellent opportunity to reach women by implementing regular screening programs in clinics that serve Hispanic women. For women with high depressive symptoms, poor HIV/STI knowledge should also be addressed. Future studies should test whether integrated and tailored risk reduction interventions affect these factors and lower HIV/STI risk for Hispanic women.     

Children's opinions about learning to read

There is plenty of research on teaching reading skills as well as on the prerequisites of literacy, but not so much on children's opinions on learning to read. Few know what a child thinks itself of his/her learning to read and ability to learn to read. The aim of this article is to reveal the children's (n?=?43) opinions on learning to read at the time they start school. A total of 43 children (23 girls and 20 boys), aged six and a half years, were interviewed and their level of literacy was measured before interviews. Children were divided into three groups: the literate ones (n?=?8), the ones who recognise words (n?=?16) and the illiterate ones (n?=?19). Data were analysed with the phenomenographic method. Learning to read appeared as a surprising and pleasant experience, but also demanding. School entrants showed strong belief and trust in their own abilities to learn to read and were careful and realistic when evaluating them. The conclusion of this article is that children with their skills and learning perceptions should be taken into careful consideration when instructing them with new methods and means in order to secure every individual's learning to read.     

Network stigma towards people living with HIV/AIDS and their caregivers: An egocentric network study

HIV stigma occurs among peers in social networks. However, the features of social networks that drive HIV stigma are not well understood. The objective of this study is to investigate anticipated HIV stigma within the social networks of people living with HIV/AIDS (PLWHA) (N = 147) and the social networks of PLWHA's caregivers (N = 148). The egocentric social network data were collected in Guangxi, China. More than half of PLWHA (58%) and their caregivers (53%) anticipated HIV stigma from their network peers. Both PLWHA and their caregivers anticipated that spouses or other family members were less likely to stigmatise them, compared to friend peers or other relationships. Married network peers were believed to stigmatise caregivers more than unmarried peers. The association between frequent contacts and anticipated stigma was negative among caregivers. Being in a close relationship with PLWHA or caregivers (e.g., a spouse or other family member) was associated with less anticipated stigma. Lower network density was associated with higher anticipated stigma among PLWHA's alters, but not among caregivers' alters. Findings may shed light on innovative stigma reduction interventions at the social network level and therefore improve HIV/AIDS treatment utilisation.     

HIV-negative children’s experiences and opinions towards parental HIV disclosure: a qualitative study in China

In HIV/AIDS research, few studies to date have evaluated ways to improve parental HIV disclosure practices using feedback from HIV-negative children who have recently experienced this event. We conducted semi-structured in-depth interviews with 20 children (aged 6–15) who were partially to fully aware of their parents’ HIV status in rural Guangxi, China. Of the 20 children, eight children who were of older age (11.38 years in average) endorsed parental HIV disclosure, five discouraged it and seven expressed uncertainty. Children’s different experiences and attitudes towards disclosure were seen to be associated with their family dynamics (especially the parent–child relationship), social support and care, experiences of stigma and discrimination, psychosocial suffering, comprehension of the disease and the children’s age. Our study contributes to building a child-centered comprehensive understanding for Chinese parental HIV disclosure. It is imperative that counselors and community advocates assess and help parents achieve optimal readiness preceding disclosure of their illness to their HIV-negative children.     

HIV/AIDS stigma attitudes among educators in KwaZulu-Natal, South Africa

BACKGROUND: One hundred and twenty educators from KwaZulu-Natal, South Africa, underwent HIV/AIDS training. The educators were surveyed about their attitudes toward people with HIV. METHODS: The educators completed self-administered survey questionnaires both before and after 2 interventions. Measures included demographic characteristics, teachers' knowledge about HIV/AIDS, self-efficacy in handling HIV/AIDS situations, and attitudes (stigma and otherwise) toward HIV-related issues. The first intervention was a CD-ROM and the second intervention involved educators receiving a 2-day workshop on HIV transmission, risk factors, and actions that educators should know and undertake. The first step entailed testing the stigma instrument for its internal consistency and developing and testing potential subscales from the instrument. The second step entailed testing for the statistical associations between stigma (as measured by the stigma instrument and its subscales) and various demographic and HIV knowledge-related variables. RESULTS: The overall stigma scale had a Cronbach α coefficient of .66. Educators in the workshop generally had lower baseline levels of stigma than those in the CD-ROM intervention. Following both interventions, the stigma levels of both groups of educators were significantly reduced. Improvements in the general knowledge about HIV as a disease and in the specific knowledge about HIV transmission risks were both statistically significantly associated with reductions in stigma attitudes, having controlled for educators' baseline stigma levels and demographic profiles. CONCLUSIONS: The levels of teachers' stigma attitudes were statistically significantly lower after both types of HIV/AIDS training and were also statistically significantly associated with improvements in HIV knowledge.