A conceptual model of HIV/AIDS stigma from five African countries

AIM: This paper is a report on the development of a conceptual model delineating contexts and processes of HIV/AIDS stigma as reported by persons living with HIV/AIDS and nurses from African countries. It is part of a larger study to increase understanding of HIV/AIDS stigma. BACKGROUND: Researchers have defined stigma, explored determinants and outcomes of stigma and attempted to measure its multiple dimensions. This literature is difficult to synthesize, and often does not distinguish adequately between experiences of stigma and its causes and outcomes. METHOD: Forty-three focus groups were held with persons living with HIV/AIDS and nurses in five African countries in 2004. Focus group recordings were transcribed and coded. The data were organized into a conceptual model of HIV/AIDS stigma. FINDINGS: Two components were identified in the data: contextual factors--environment, healthcare system, agents--that influence and affect stigma and the stigma process itself. The stigma process included four dimensions: triggers of stigma, stigmatizing behaviours, types of stigma and the outcomes of stigma. CONCLUSION: A conceptual model is presented that delineates the dynamic nature of stigma as reported by study participants. The model may be used to identify areas appropriate for the design and testing of stigma reduction interventions that have a goal of reducing the burden of HIV/AIDS stigma.     

Perspectives of HIV-related stigma in a community in Vietnam: A qualitative study

Background

While HIV/AIDS is increasing in Vietnam, very few published studies focus on HIV-related stigma in Vietnam. This study reports on findings from a community development project to reduce HIV-related stigma within one community in Vietnam.

Objectives and design

The purpose of this qualitative study is to describe HIV-related stigma from the perspective of three groups within one community in Vietnam: people living with HIV, their family members, and community members and leaders, including health care professionals.

Setting, participants and methods

Fifty-eight individuals from a poor, industrial district on the outskirts of a large city participated in the study and were asked to describe HIV-related stigma. Interviews were conducted with 10 people living with HIV, 10 family members of a person living with HIV, and 10 community members and 5 community leaders including health care professionals. We also conducted three focus groups, one with people living with HIV (n = 8), one with family members of people living with HIV (n = 8), and one with community leaders including health care professionals (n = 7).

Findings

Stigma across the three groups is characterized by four dimensions of HIV-related stigma: feeling shamed and scorned, behaving differently, stigma due to association, and fear of transmission. The manifestation of these dimensions differs for each group. Four themes of HIV-related stigma as described by people living with HIV are: being avoided, experiencing anger and rejection, being viewed as a social ill, and hiding the illness. Seven themes of HIV-related stigma as described by family members are: shunned by neighbors, viewed as poor parents, discriminated by health professionals, overhearing discussions about people with HIV, maintaining the secret, financial hardship for family, and fear of contracting HIV. Four themes of HIV-related stigma as described by community members and leaders including health professionals are: stigma as a fair reward, avoidance and shunning by neighbors, ruined family reputation, and fear of contracting HIV.

Conclusions

HIV-related stigma is experienced in a different manner by each of these groups, a finding that should help in developing culturally sensitive strategies to reduce HIV-related stigma in Vietnam.     

HIV infection of women in African countries

BACKGROUND: The increase in human immunodeficiency virus infection among women of childbearing age increases the potential risk for vertical transmission of infection to their newborns. AIM: This paper discusses literature reviewed on human immunodeficiency virus infection of women in Africa with reference to Ghana, West Africa. The paper provides an epidemiological overview of human immunodeficiency virus infection of women in Ghana and Africa and the potential risk for vertical transmission and associated contributing factors. Literature reviewed was retrieved from the Cumulative Index of Nursing and Allied Health Literature and United States National Library of Medicine databases. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Findings from the review of literature suggest that human immunodeficiency virus infection of African women is a major public health problem which must be addressed and considered a priority in the next decade. Leadership in African countries including nurses and policy-makers will have to do more to make a difference to the epidemic. Measures to reduce transmission of human immunodeficiency virus are discussed.     

Profile of physical therapy educators in five countries

Physical therapy educators in Australia, Britain and Ireland, New Zealand, Nigeria, and South Africa were surveyed to develop a profile of physical therapy educators in these countries and to permit comparison with data on US and Canadian educators. Faculty members (N = 154) from 18 programs responded to a questionnaire consisting of 22 items related to education, experience, and professional activities. Most of the respondents (79%) held an entry-level qualification at the diploma or certificate level, and compared with US educators, a much lower percentage held academic degrees of any kind. Similarities between the respondents and US and Canadian educators were found in percentages of women, of those under 40 years of age, of those currently enrolled in academic programs, and of those with tenure; differences were found in hours spent teaching and number of faculty members who had published in the last two years. Understanding these similarities and differences may facilitate international faculty exchange programs and employment.     

Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale.

An instrument to measure the stigma perceived by people with HIV was developed based on the literature on stigma and psychosocial aspects of having HIV. Items surviving two rounds of content review were assembled in a booklet and distributed through HIV-related organizations across the United States. Psychometric analysis was performed on 318 questionnaires returned by people with HIV (19% women, 21% African American, 8% Hispanic). Four factors emerged from exploratory factor analysis: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes toward people with HIV. Extraction of one higher-order factor provided evidence of a single overall construct. Construct validity also was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas between .90 and .93 for the subscales and .96 for the 40-item instrument provided evidence of internal consistency reliability. The HIV Stigma Scale was reliable and valid with a large, diverse sample of people with HIV.     

The relationship between HIV-related knowledge and safe sexual behavior in African American women dwelling in the rural southeast.

There is an epidemiological shift toward increased rates of HIV infection in African American women, despite widely available information regarding HIV prevention. The purpose of this study was to determine the relationship between HIV-related knowledge and high-risk sexual behavior while controlling for related variables. A multivariate regression model was selected to differentiate the effects of these variables. The participants were 75 African American women, aged 18 to 38. The results indicated a positive relationship between HIV-related knowledge and high-risk sexual behaviors using the Pearson's r correlation coefficient (0.411, p < .001). Age of first sexual experience, number of lifetime sexual partners, income, educational level, and level of HIV-related knowledge were then regressed onto level of high risk sexual behavior using a hierarchical techniques. Only total years of education achieved statistical significance (p < .001 on the first step and p < .05 on the second step).