Articles tagged as "Eliminate stigma and discrimination"

Role for cognitive-behavioural interventions to reduce common mental disorders among HIV-positive adults

Cognitive-behavioural interventions for mood and anxiety disorders in HIV: a systematic review.

Spies G, Asmal L, Seedat S. J Affect Disord. 2013 Sep 5;150(2):171-80. doi:10.1016/j.jad.2013.04. 018. Epub 2013 May 17.

Background: Mood and anxiety disorders are highly prevalent and comorbid with HIV/AIDS. However, there is a paucity of research on the effectiveness of cognitive-behavioural interventions (CBI) for common mental disorders in HIV-infected adults. The present study sought to review the existing literature on the use of CBI for depression and anxiety in HIV-positive adults and to assess the effect size of these interventions.

Methods: We did duplicate searches of databases (from inception to 17-22 May 2012). The following online databases were searched: PubMed, The Cochrane Central Register of Controlled Trials and PsychArticles.

Results: We identified 20 studies suitable for inclusion. A total of 2 886 participants were enrolled in these studies, of which 2 173 participants completed treatment. The present review of the literature suggests that CBI may be effective in the treatment of depression and anxiety in individuals living with HIV/AIDS. Significant reductions in depression and anxiety were reported in intervention studies that directly and indirectly targeted depression and/or anxiety. Effect sizes ranged from 0.02 to 1.02 for depression and 0.04 to 0.70 for anxiety.

Limitations: Some trials included an immediate post intervention assessment but no follow-up assessments of outcome. This omission makes it difficult to determine whether the intervention effects are sustainable over time.

Conclusion: The present review of the literature suggests that CBI may have a positive impact on the treatment of depression and anxiety in adults living with HIV/AIDS.

Abstract access 

Editor’s notes: Common mental disorders (depression and anxiety) are common in people living with HIV (PLHIV) but are under-diagnosed and under-treated in many HIV care settings. Untreated, those conditions can decrease adherence to antiretroviral therapy and worsen HIV-related outcomes. This systematic review identified 20 randomized controlled trials of cognitive behavioural interventions (CBI) among PLHIV and found a consistent trend for CBI to reduce depression and anxiety symptoms. Notably, the studies used a wide variety of CBI delivery formats and outcome measurements, thus offering ample choice for intervention developers. This review supports several additions to the research agenda, including assessment of whether CBI: 1) has sustained impact, 2) is effective in low-income settings and 3) is able to improve HIV treatment outcomes.

  • share
0 comments.

Combination HIV prevention for MSM needed urgently

The global HIV epidemics in MSM: time to act.

Beyrer C, Sullivan P, Sanchez J, Baral SD, Collins C, Wirtz AL, Altman D, Trapence G, Mayer K. AIDS. 2013 Aug6. [Epub ahead of print]

Epidemics of HIV in MSM continue to expand in most low, middle, and upper income countries in 2013 and rates of new infection have been consistently high among young MSM. Current prevention and treatment strategies are insufficient for this next wave of HIV spread. We conducted a series of comprehensive reviews of HIV prevalence and incidence, risks for HIV, prevention and care, stigma and discrimination, and policy and advocacy options. The high per act transmission probability of receptive anal intercourse, sex role versatility among MSM, network level effects, and social and structural determinants play central roles in disproportionate disease burdens. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiologic data show marked clustering of HIV in MSM networks and high proportions of infections due to transmission from recent infections. Prevention strategies that lower biological risks, including those using antiretrovirals, offer promise for epidemic control, but are limited by structural factors including, discrimination, criminalization, and barriers to healthcare. Sub-epidemics, including among racial and ethnic minority MSM in the United States and UK, are particularly severe and will require culturally tailored efforts. For the promise of new and combined bio-behavioral interventions to be realized, clinically competent healthcare is necessary and community leadership, engagement, and empowerment are likely to be key. Addressing the expanding epidemics of HIV in MSM will require continued research, increased resources, political will, policy change, structural reform, community engagement, and strategic planning and programming, but it can and must be done.

Abstract access

Editor’s notes: This paper provides a useful summary of HIV epidemics among men who have sex with men, highlighting that infection levels continue to rise in most countries – both industrialized and developing, and including countries where HIV treatment is widely available. Drawing upon the findings from a range of comprehensive reviews, the paper presents important summary data on the prevalence of HIV among MSM.  It paints a global picture of the very high prevalence burdens found in the United States, the Caribbean, Peru, multiple African countries, Thailand, Myanmar, and parts of China, with the highest rates among the youngest age groups. The paper discusses options for prevention and treatment, arguing that much more needs to be done. The authors suggest that antiretrovirals – including both early treatment and PrEP, could be important additions for prevention.  However, these interventions will only be effective if strategies address structural barriers, including violence, stigmatization and criminalization. The authors argue that interventions and services need to be better equipped to respond to sub-epidemics in particularly marginalized MSM populations; and that an effective response will only be achieved through political will, community engagement and structural change.

  • share
0 comments.

HIV prevention laws based on moralistic judgements of lawmakers may increase stigma

'The intention may not be cruel... but the impact may be': understanding legislators' motives and wider public attitudes to a draft HIV Bill in Malawi.

Stackpool-Moore, L. Sex Transm Infect. 2013. June 89 (4)

Objectives: The law in relation to HIV has prominence in the formation and regulation of moral norms in regard to human rights, and in regard to criminalisation, the policing of sexuality and intimate behaviours, and the production of stigma. The research focuses on the potential and impotence of the law to govern for, and enable, the human right to health in the context of HIV in Malawi.

Methods: This one-country qualitative case study (Malawi) action research involved data collection during a 6-month period (October 2010-March 2011). Datasets include interviews with law commissioners (n=10), opinion leaders (n=22), life story participants who were people living with and closely affected by HIV (n=20), reflections of the action research team (n=6), and a review of the proposed HIV and AIDS (Prevention and Management) Bill, legal and policy documents.

Results: The analysis of the perspectives of the law commissioners, who formed the Special Law Commission and drafted the Bill, revealed that stigma was consciously invoked to delineate social norms and guide governance of notions of personal responsibility. The analysis of the perspectives of the life story participants, whose lives would be most directly impacted if these provisions came into force, reveals the extent to which the stigma associating criminality and HIV is falling on fertile ground through its engagement and generation of internalised stigma; unearthing an uneasy link between stigma and the law in response to HIV in Malawi.

Discussion: The results indicated that the proposed HIV Bill in Malawi manifests a tension between intention and impact. By incorporating criminal sanctions as part of the proposed HIV Bill, the lawmakers actively seek to use stigma to shape social attitudes and attempt to guide normative behaviour.

Abstract access 

Editor’s notes: This paper presents research that examines the impact of criminal law in relation to HIV on stigma in Malawi. Through interviews with lawmakers and life story interviews with people living with and closely affected by HIV, the author examined how participants understand the proposed draft HIV and AIDS (Prevention and Management) Bill. The legal initiative for the bill, whilst based on principles of non-discrimination, includes provision to imprison a person who knows that he (sic) is HIV positive and does not refrain from an act which is likely to infect another person or who deliberately infects another person. Of great concern, the interviews revealed that whilst participants stated a support for non-discrimination of people living with HIV, many supported criminalisation of HIV transmission. The lawmakers were almost unanimously in favour of criminalising HIV transmission as a way to seek retribution and justice rather than for prevention of HIV transmission. The author noted that the lawmakers were particularly judgemental and moralistic about the issue. The people living with or affected by HIV were less certain and provided arguments for and against criminalisation, especially in relation to deliberate transmission of HIV where knowledge of status is not known. They were particularly worried that this law may dissuade people from testing. This paper provides an important understanding of the tension between political level intent to reduce stigma around HIV and the moralizing position taken by law- and policy makers. More worryingly, the author suggests that the perpetuation of stigma through such means as this law could be used to maintain or establish social control. 

Africa
Malawi
  • share
0 comments.

Social support, safer sex lives and developing a post diagnosis identity

Living with HIV post diagnosis: a qualitative study of the experiences of Nairobi slum residents.

Wekesa E, Coast E. BMJ Open. 2013 May 3;3(5)

Objectives: To characterise the experiences of heterosexual men and women living with HIV post diagnosis and explain these experiences in relation to their identity and sexuality.

Design: Qualitative study using in-depth interviews and a theoretically informed biographic disruption theory.

Setting: Interviews were conducted in two Nairobi slums (Kenya).

Participants: 41 HIV-infected heterosexual men and women aged 18 years or older

Results: People living with HIV have divergent experiences surrounding HIV diagnosis. Post diagnosis, there are multiple phases of identity transition, including status (non-) disclosure, and attempts at identity repair and normalcy. For some people, this process involves a transition to a new self-identity, incorporating both HIV and antiretroviral treatment (ART) into their lives. For others, it involves a partial transition, with some aspects of their pre diagnosis identity persisting, and for others it involves a rejection of HIV identity. Those people who were able to incorporate HIV/AIDS in their identity, without it being disruptive to their biography, were pursuing safer sexual and reproductive lives. By contrast, those people with a more continuous biography continued to reflect their pre diagnosis identity and sexual behaviour.

Conclusions: People living with HIV/AIDS (PLWHA) had to rework their sense of identity following diagnosis in the context of living in a slum setting. Men and women living with HIV in slums are poorly supported by health systems and services as they attempt to cope with a diagnosis of HIV. Given the availability of ART, health services and professionals need to support the rights of PLWHA to be sexually active if they want to and achieve their fertility goals, while minimising HIV transmission risk.

Abstract Full-text [free] access

Editor’s notes: There is a need to understand the sexual health rights and needs of people living with HIV, especially in urban areas in sub-Saharan Africa where 72% of the population live in slums with poor access to services. In particular there are issues about stigma and disclosure post-diagnosis as well as concerns about risky sexually behaviour for those who are on ART. In the light of this the authors conducted qualitative research to understand the post-diagnosis experiences of slum dwellers in Nairobi. The authors used a theoretical concept of biographical disruption to understand how HIV acts as a disruptive experience on an individual’s life, social relations, and identity. This theory entails three components: disruption of an individual’s former behaviour and assumptions; changes in an individual’s perception of self, and attempts to repair or change one’s biography. To explore this, the authors conducted 41 in-depth interviews. For the paper they presented detailed analyses of three case studies to represent the wider sample of 41 participants. The findings revealed that reactions to HIV diagnosis represented a disruption of each individual’s biography either experienced as shock, distress, or denial, or for one case study, relief.  This reaction and their HIV status disclosure to others affected the incorporation of the new HIV positive identity. Assimilation and resources for identity normalisation depended to a large extent on their access to social capital, through social support groups, community health workers or faith groups. It was also affected by taking up ART and pursuing a healthy role in society. However, the uptake of ARTs is dependent on people’s hopes or uncertainties that the drugs will either make them well or more sick. Those that are able to assimilate HIV/AIDS in their identity without it being disruptive to their biography were pursuing safer sexual and reproductive lives. The authors suggest that because the process of incorporating an HIV positive identity is not predictable it is important that reaction to diagnosis, disclosure, social support, and uptake of ARTs for a healthy sexual life are discussed at diagnosis, and psychological support provided where an individual is unable to cope with their diagnosis.

Africa
Kenya
  • share
0 comments.

Despite high STI vulnerability among sex workers in Kigali, Rwanda, stigma remains a barrier to service use

Prevalence of sexually transmitted infections, genital symptoms and health-care seeking behaviour among HIV-negative female sex workers in Kigali, Rwanda

N J Veldhuijzen MDPhD, M van Steijn BSc, J Nyinawabega BSc, E Kestelyn MSc, M Uwineza BSc, J Vyankandondera MD and J H H M van de Wijgert PhD. Int J STD AIDS. 2013 Mar 20. [Epub ahead of print]

Timely diagnosis and treatment of sexually transmitted infections (STIs) is often hampered by the lack of symptoms, inadequate diagnostics and/or poor availability, accessibility and quality of treatment in resource-limited settings. Female sex workers (FSW) are highly vulnerable for HIV and key transmitters of STIs. Among FSW (n = 400) participating in a prospective HIV incidence study in Kigali, Rwanda, only 15% (17/116) of women with laboratory-diagnosed non-ulcerative STIs at baseline reported symptoms. Only 27% (20/74) of women self-reporting genital symptoms sought care at enrolment, and 39% (46/117) of women with self-reported genital symptoms during follow-up. During focus group discussions, FSW considered treatment-seeking and partner notification important. Shame and feeling disrespected by doctors or other health-care workers were identified as barriers to seeking health care. A comprehensive STI control programme targeting both symptomatic and asymptomatic FSW should be considered in this setting.

Abstract access

Editor’s notes: STI control is an important component of HIV prevention programmes and includes syndromic STI management, health education, condom promotion, and partner notification and treatment. Timely diagnosis and treatment of STIs is often hampered by the lack of symptoms, inadequate diagnostics and/or poor availability, accessibility and quality of treatment. Many women (and to a lesser extent men) are asymptomatic and not all symptomatic patients will seek care. Some may not recognize the symptoms, be unaware of the risks involved, delay seeking care or consult unqualified sources. Sex workers are vulnerable to STI and HIV infection. Women commonly are not aware of infection, making service access difficult. This cohort study shows that most sex workers in Rwanda with laboratory diagnosed STI infections do not have symptoms. Even women with symptoms were unlikely to seek treatment upon enrolment in the trial. Shame and anticipated stigma remained a barrier to women using services. This paper highlights the need to eliminate stigma and discrimination, alongside the ongoing importance of the provision of effective STI treatment services.  

Africa
Rwanda
  • share
0 comments.

Bisexuality in men who have sex with men

Prevalence of bisexual behaviour among bridge population of men who have sex with men in China: a meta-analysis of observational studies

Yun K, Xu JJ, Reilly KH, Zhang J, Jiang YJ, Wang N, Shang H Sex Transm Infect. 2011; 87: 563-570

Yun and colleagues aimed to integrate empirical estimates of bisexual behaviour among the bridge population of men who have sex with men in China and their HIV and syphilis prevalences stratified by sexual behaviour. Pubmed, Chinese Biomedical, Chinese National Knowledge Infrastructure, VIP, Wanfang and Google Scholar databases were searched to January 2011 to identify relevant articles. Data for eligible citations were extracted by two reviewers. All analyses were performed using Stata 10.0. Forty-nine articles (including 28 739 study subjects who were men who had sex with men) met the selection criteria. Aggregated findings indicated that the estimated prevalence of bisexual behaviour among men who have sex with men in China is 31.2% (95% CI 28.1% to 34.5%). HIV and syphilis prevalences were 5.4% and 11.4%, respectively, among men who have sex with men engaging in bisexual behaviour and 3.8% and 9.3% among those who were only having sex with men. HIV prevalence among men who have sex with men engaging in sex with both men and women was significantly higher than in those who were only having sex with men (OR 1.30; 95% CI 1.04 to 1.62; p=0.02). There is a high prevalence of bisexual behaviour among men who have sex with men in China and bisexual behaviour is significantly associated with increased HIV infection risk. The results of this meta-analysis highlight a critical pattern of HIV transmission among men who have sex with men in China and indicate that targeted interventions aimed at encouraging safe sex practices and promoting societal and family acceptance of men who have sex with men are urgently needed.

For abstract access click here

Editor’s note: In mainland China, the proportion of HIV infections attributed to sexual transmission between men rose from 12% in 2007 to 35% in 2009. This first-ever meta-analysis of bisexual behaviour among Chinese men was based on 49 articles (from 53 unique studies) that met the selection criteria. About 30% of men who had sex with men also reported sex with a woman in the previous 12 months. These men were 30% more likely to have HIV infection than those who did not report sex with a woman. This finding is somewhat counter-intuitive for those who use terms like ‘bridge population’ to suggest that higher HIV prevalence in one key population can place the so-called ‘general population’ at risk. In this case, the bridge is from where to where? With homosexuality still highly stigmatised in a cultural context that emphasises social standing, it is unclear how meeting family expectations to marry women could increase HIV risk for men who have sex with men. The value of this study is that it is hypothesis-generating. It spotlights the need for ethnographic and other qualitative studies to explore the factors that place bisexual men at higher risk of HIV than their ‘men only’ counterparts. Engaging these men to learn more about their experiences and using their voices to inform HIV prevention programming could help prevent HIV from spreading further among men who have sex with men and their female partners in China.

  • share
0 comments.

Bisexuality in men who have sex with men

HIV risk and associations of HIV Infection among men who have sex with men in peri-urban Cape Town, South Africa

Baral S, Burrell E, Scheibe A, Brown B, Beyrer C, Bekker LG, BMC Public Health. 2011 Oct 5;11:766

The HIV epidemic in sub Saharan Africa has been traditionally assumed to be driven by high-risk heterosexual and vertical transmission. However, there is an increasing body of data highlighting the disproportionate burden of HIV infection among men who have sex with men in the generalized HIV epidemics across of southern Africa. In South Africa specifically, there has been an increase in attention focused on the risk status and preventive needs of men who have sex with men both in urban centers and peri-urban townships. The study presented here represents the first evaluation of HIV prevalence and associations of HIV infection among men who have sex with men in the peri-urban townships of Cape Town. The study consisted of an anonymous probe of 200 men, reporting ever having had sex with another man, recruited through venue-base sampling from January to February, 2009. Overall, HIV prevalence was 25.5% (n = 51/200). Of these prevalent HIV infections, only 6% of men who have sex with men who were found to be of HIV-1 positive were aware of their HIV status (3/50). 0% of men reported always having safe sex as defined by always wearing condoms during sex and using water-based lubricants. Independent associations with HIV infection included inconsistent condom use with male partners (aOR 2.3, 95% CI 1.0-5.4), having been blackmailed (aOR 4.4, 95% CI 1.6-20.2), age over 26 years (aOR 4.2, 95% CI 1.6-10.6), being unemployed (aOR 3.7, 95% CI 1.5-9.3), and rural origin (aOR 6.0, 95% CI 2.2-16.7). Bisexual activity was reported by 17.1% (34/199), and a total of 8% (16/200) reported having a regular female partner. Human rights violations were common with 10.5% (n = 21/200) reporting having been blackmailed and 21.0% (n = 42/200) reporting being afraid to seek health care. The conclusions from this study include that a there is a high risk and underserved population of men who have sex with men in the townships surrounding Cape Town. The high HIV prevalence and high risk sexual practices suggest that prevalence will continue to increase among these men in the context of an otherwise slowing epidemic. These data further highlight the need to better characterize risk factors for HIV prevention and appropriate targeted combination packages of HIV interventions including biomedical, behavioural, and structural approaches to mitigate HIV risk among these men.

For abstract access click here

Editor’s note: HIV prevalence studies among men who have sex with men have been conducted in many countries in eastern and southern Africa, mostly in major urban centres. This study recruited a convenience sample of men who have sex with men, rather than a probability-based sample, in relatively clandestine gay venues in the townships around Cape Town. This limits the generalizability of the findings but they are nonetheless valuable for planning combination prevention programmes for this population. Levels of active bisexuality (past 6 months=17%) and bisexual concurrency (stable relationships with both a man and a woman=3%) were lower than those reported in other SADC (Southern African Development Community) countries, possibly due to the better social and legal contexts for gay men in South Africa. However, HIV prevalence was double that of men who have sex with men in urban Cape Town. A disconnect between constitutional protections and daily life in these townships was evident with 24% of participants reporting at least one human rights violation (e.g. denial of housing or healthcare, having been blackmailed, having been beaten by police or a government official based on their sexuality). Clearly, structural interventions to build social capital and address human rights violations, particularly those perpetrated by police, health care workers, and officials, must accompany behavioural and biomedical interventions for men who have sex with men in these townships. 

  • share
0 comments.

Stigma

Measuring stigma among health care and social service providers: The HIV/AIDS provider stigma inventory

Rutledge SE, Whyte J, Abell N, Brown KM, Cesnales NI, AIDS Patient Care STDS. 2011 Nov;25(11):673-82. Epub 2011 Oct 3

Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV (PLHIV). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labelling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHIV that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients α for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed.

For abstract access click here

Editor’s note: Current concepts of HIV-related stigma often categorise stigma as instrumental stigma (fear of physical contagion), symbolic stigma (morality- or values-based judgement), felt, perceived, or internalised stigma (experiences of prejudice and discrimination), courtesy stigma (felt by health care providers caring for people living with HIV or by their families), and enacted stigma (discriminatory actions). Research on the measurement of stigma has focused primarily on the general public and the lived experiences of people living with HIV, with only a few studies having developed scales to assess stigma in health care settings. These researchers developed an instrument that assists providers in assessing their own awareness of negative attitudes, in accepting that there are potential consequences to carrying these views into interactions with patients living with HIV, and in acting intentionally to prevent their prejudice from provoking enacted discrimination. It uses a mindfulness approach, drawn from ancient philosophical traditions of Asia, to promote thoughtful rather than automatic reactions through reflection about troubling situations and their meaning. This tool, once further validated, could be used during training or in continuing education as part of professional socialisation focused on interpersonal skills.

  • share
0 comments.

Stigma

Community patterns of stigma towards persons living with HIV: A population-based latent class analysis from rural Vietnam

Pharris A, Hoa NP, Tishelman C, Marrone G, Kim Chuc NT, Brugha R, Thorson A, BMC Public Health. 2011 Sep 18;11:705

The negative effects of stigma on persons living with HIV (PLHIV) have been documented in many settings and it is thought that stigma against PLHIV leads to more difficulties for those who need to access HIV testing, treatment and care, as well as to limited community uptake of HIV prevention and testing messages. In order to understand and prevent stigma towards PLHIV, it is important to be able to measure stigma within communities and to understand which factors are associated with higher stigma. To analyze patterns of community stigma and determinants to stigma toward PLHIV, Pharris and colleagues performed an exploratory population-based survey with 1874 randomly sampled adults within a demographic surveillance site (DSS) in rural Vietnam. Participants were interviewed regarding knowledge of HIV and attitudes towards persons living with HIV. Data were linked to socioeconomic and migration data from the DSS and latent class analysis and multinomial logistic regression were conducted to examine stigma group sub-types and factors associated with stigma group membership. They found unexpectedly high and complex patterns of stigma against PLHIV in this rural setting. Women had the greatest odds of belong to the highest stigma group (OR 1.84, 95% CI 1.42-2.37), while those with more education had lower odds of highest stigma group membership (OR 0.45, 95% CI 0.32-0.62 for secondary education; OR 0.19, 95% CI 0.10-0.35 for tertiary education). Long-term migration out of the district (OR 0.61, 95% CI 0.4-0.91), feeling at-risk for HIV (OR 0.42, 95% CI 0.27-0.66), having heard of HIV from more sources (OR 0.44, 95% CI 0.3-0.66), and knowing someone with HIV (OR 0.76, 95% CI 0.58-0.99) were all associated with lower odds of highest stigma group membership. Nearly 20% of the population was highly unsure of their attitudes towards PLHIV and persons in this group had significantly lower odds of feeling at-risk for HIV (OR 0.54, 95% CI 0.33-0.90) or of knowing someone with HIV (OR 0.32, 95% CI 0.22-0.46). Stigma towards PLHIV is high generally, and very high in some sub-groups, in this community setting. Future stigma prevention efforts could be enhanced by analysing community stigma sub-groups and tailoring intervention messages to community patterns of stigma.

For abstract access click here

Editor’s note: In 2006, Vietnam strengthened legislation and extended protection for people living with HIV by prohibiting HIV-related stigma and discrimination and by promoting their rights to confidentiality, medical care, and community integration. Despite this existing legal framework and a focus on stigma reduction in government education programmes, this study in a rural population found high levels of stigma and identified three classes of people: less stigmatising, ambivalent, and highly stigmatising, using a latent class analysis approach. This approach, which has been used to tailor marketing campaigns to specific segments of the population, grouped people according to their responses to 8 HIV-related stigma statements. The statements themselves were based on the stigma concepts of labelling, stereotyping, separation, status loss, and discrimination. Those with the most stigmatising attitudes were less likely to know someone with HIV, did not judge themselves to be at risk, and had heard of HIV from fewer sources. In a society in which many perceive HIV to be associated with social evils, putting a human face on HIV would be one approach that could help reduce stigma. More broadly, analysis of community patterns of stigma using latent class analysis can inform effective programming, focused on reducing the stigma that influences people not to come forward to learn their HIV serostatus and that undermines adherence to treatment and access to social support for those who know they are living with HIV.

  • share
0 comments.