Examining the impact of HIV-related stigma in people living with HIV: a systematic literature review

Mathew Nyashanu; Florence Tafadzwa Ellah Mushonga; Samuel Oluwasogo Dada; Mandu Stephen Ekpenyong

doi:10.18203/2320-1770.ijrcog20242826

Authors

Mathew Nyashanu Nottingham Trent University, Institute of Health and Allied Professions, Nottingham, United Kingdom
Florence Tafadzwa Ellah Mushonga University Hospitals of Birmingham NHS Department of Sexual Health and HIV Birmingham United Kingdom
Samuel Oluwasogo Dada Nottingham Trent University, Institute of Health and Allied Professions, Nottingham, United Kingdom
Mandu Stephen Ekpenyong Manchester Metropolitan University, Department of Public Health and Nursing, Manchester, United Kingdom

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242826

Keywords:

HIV, Stigma, Anti-retroviral

Abstract

The last 20 years have seen an improvement in access to anti-retroviral (ARVs) drugs for people living with HIV leading to improvement in health outcomes. However, despite achieving this milestone HIV stigma has continued to hamper the health outcomes of people living with HIV. This study aimed to undergo a systematic review exploring the impact of HIV stigma on people living with HIV. A systematic literature review of both quantitative and qualitative studies published between 2017 and 2021 was undertaken using the following databases: CINAHL Plus, Embase, Google Scholar, Medline, and Scopus. Reference lists from relevant studies and websites of relevant sexual health and HIV organisations were also searched. The primary search terms were “HIV and stigma” combined with “impact” or with “discrimination”, “internalised stigma” and “lack of esteem”, or “mental health” or “caused by HIV sigma” in communities, “HIV and discrimination”, “impact of HIV stigma”. Six articles were included for review and analysed using constant comparative analysis. The review identified six broad themes (lack of adherence, internalised HIV stigma, discrimination, lack of self-esteem, public stereotyping, and non-disclosure) factors having a significant influence on people living with HIV. Perceived stigma towards people living with HIV has a negative effect on health outcomes of people living with the condition. The findings of our study highlight that public stereotyping and perceived stigma in the community are the major factors impacting people living with HIV.

Metrics

Metrics Loading ...

References

Oguntibeju OO. Quality of life of people living with HIV and AIDS and antiretroviral therapy. HIV/AIDS (Auckland, NZ). 2012;4:117.

Smith DK, Van Handel M, Huggins R. Estimated coverage to address financial barriers to HIV preexposure prophylaxis among persons with indications for its use, United States, 2015. Journal of Acquired Immune Deficiency Syndromes (1999). 2017;76(5):465.

Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JH, Godbole SV. Prevention of HIV-1 infection with early antiretroviral therapy. New England journal of medicine. 2011;365(6):493-505.

Sweeney SM, Vanable PA. The association of HIV-related stigma to HIV medication adherence: a systematic review and synthesis of the literature. AIDS and Behavior. 2016;20(1):29-50.

Cosponsors UN, Initiative EP, Coalition GH. Towards Universal Access to Prevention, Treatment and Care: Experiences and Challenges from Mbeya Region in Tanzania–A Case Study. Training. 2022;2:12-5.

Levy B, Correia HE, Chirove F, Ronoh M, Abebe A, Kgosimore M, Chimbola O, Machingauta MH, Lenhart S, White KA. Modeling the effect of HIV/AIDS stigma on HIV infection dynamics in Kenya. Bulletin of Mathematical Biology. 2021;83(5):1-25.

Zhang C, Li X, Liu Y, Qiao S, Zhang L, Zhou Y, Tang Z, Shen Z, Chen Y. Stigma against people living with HIV/AIDS in China: does the route of infection matter?. PloS one. 2016;11(3):151078.

Rao D, Feldman BJ, Fredericksen RJ, Crane PK, Simoni JM, Kitahata MM, Crane HM. A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS and Behavior. 2012;16(3):711-6.

Camara A, Sow MS, Touré A, Sako FB, Camara I, Soumaoro K, Delamou A, Doukouré M. Anxiety and depression among HIV patients of the infectious disease department of Conakry University Hospital in 2018. Epidemiology and Infection. 2020;14:8-12.

Goffman E. Stigma englewood cliffs. NJ: Spectrum. 1963;12:6-9.

Turan B, Budhwani H, Fazeli PL, Browning WR, Raper JL, Mugavero MJ, Turan JM. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS and Behaviour. 2017;21(1):283-91.

Ziersch A, Walsh M, Baak M, Rowley G, Oudih E, Mwanri L. “It is not an acceptable disease”: A qualitative study of HIV-related stigma and discrimination and impacts on health and wellbeing for people from ethnically diverse backgrounds in Australia. BMC public health. 2021;21(1):1-5.

Algarin AB, Sheehan DM, Varas-Diaz N, Fennie K, Zhou Z, Spencer EC, Cook CL, Cook RL, Ibanez GE. Enacted HIV-related stigma’s association with anxiety and depression among people living with HIV (PLWH) in Florida. AIDS and Behavior. 2021;25(1):93-103.

Bernier A, Benmoussa A, Hilali MK, Henry E, Otis J, Loukid M, Préau M. Self-Esteem and HIV Infection in Morocco: Associated Factors Among People Living with HIV—Results from a Community-Based Study. Comm Mental Heal J. 2019;55(8):1402-10.

Lewis J, Abramowitz SJ, Koenig L, Chandwani S, Orban L. Negative life events and depression in adolescents with HIV: a stress and coping analysis. AIDS care. 2015;27(10):1265-74.

Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L. Depression in HIV infected patients: a review. Current psychiatry reports. 2015;17(1):1-12.

Rivera AV, DeCuir J, Crawford ND, Amesty S, Harripersaud K, Lewis CF. Factors associated with HIV stigma and the impact of a nonrandomized multi-component video aimed at reducing HIV stigma among a high-risk population in New York City. AIDS care. 2015;27(6):772-6.

Chaudoir SR, Fisher JD, Simoni JM. Understanding HIV disclosure: A review and application of the Disclosure Processes Model. Social science & medicine. 2011;72(10):1618-29.

Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, Wilson M, Logie CH, Shi Q, Morassaei S, Rourke SB. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ open. 2016;6(7):11453.

Chambers LA, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, et al. Stigma, HIV and health: a qualitative synthesis. BMC public health. 2015;15(1):1-7.

Golub SA, Gamarel KE. The impact of anticipated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS patient care and STDs. 2013;27(11):621-7.

Sevelius JM. Gender affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex roles. 2013;68(11):675-89.

Batey DS, Whitfield S, Mulla M, Stringer KL, Durojaiye M, McCormick L, et al. Adaptation and implementation of an intervention to reduce HIV-related stigma among healthcare workers in the United States: piloting of the FRESH workshop. AIDS Patient Care and STDs. 2016;30(11):519-27.

Straetemans M, Bakker MI, Mitchell EM. Correlates of observing and willingness to report stigma towards HIV clients by (TB) health workers in Africa. The International J Tubercul Lung Dis. 2017;21(11):6-18.

Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bangsberg DR, et al. Impact of HIV‐related stigma on treatment adherence: systematic review and meta‐synthesis. J Inter AIDS Society. 2013;16:18640.

Checklist CQ. Critical appraisal skills programme. Retrieved. 2018;16:3-7.

Coughlan M, Cronin P, Ryan F. Step-by-step guide to critiquing research. Part 1: quantitative research. Br J NurS. 2007;16(11):658-63.

Singh J. Critical appraisal skills programme. J Pharmacol Pharmacotherap. 2013;4(1):76.

Mo PK, Ng CT. Stigmatization among people living with HIV in Hong Kong: A qualitative study. Health Expectations. 2017;20(5):943-51.

Hargreaves JR, Pliakas T, Hoddinott G, Mainga T, Mubekapi-Musadaidzwa C, Donnell D, et al. HIV stigma and viral suppression among people living with HIV in the context of universal test and treat: analysis of data from the HPTN 071 (PopART) trial in Zambia and South Africa. J Acq Imm Def Synd. 2020;85(5):561.

Kimera E, Vindevogel S, Reynaert D, Justice KM, Rubaihayo J, De Maeyer J, et al. Experiences and effects of HIV-related stigma among youth living with HIV/AIDS in Western Uganda: a photovoice study. PLoS One. 2020;15(4):232359

Turan B, Budhwani H, Fazeli PL, Browning WR, Raper JL, Mugavero MJ, et al. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS and Behavior. 2017;21(1):283-91.

Moussa AB, Delabre RM, Villes V, Elkhammas M, Bennani A, Ouarsas L, Filali H, Alami K, Karkouri M, Castro DR. Determinants and effects or consequences of internal HIV-related stigma among people living with HIV in Morocco. BMC public health. 2021;21(1):1-1.

Adam A, Fusheini A, Ayanore MA, Amuna N, Agbozo F, Kugbey N, et al. HIV stigma and status disclosure in three municipalities in Ghana. Annals of global health. 2021;87:1.

Young S, Wheeler AC, McCoy SI, Weiser SD. A review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. AIDS and Behavior. 2014;18(5):505-15.

Longo JD, Rasacanu A, Mbopi-Keou FX, Gresenguet G, Belec L. Atypical extensive genital ulcer in full blown aids with slim disease. Afr J Infect Dis. 2016;10(1):29-31.

Zhou G, Li X, Qiao S, Shen Z, Zhou Y. HIV symptom management self-efficacy mediates the relationship of internalized stigma and quality of life among people living with HIV in China. J Heal Psychol. 2020;25(3):311-21.

Hall A, Joseph O, Devlin S, Kerman J, Schmitt J, Ridgway JP, McNulty MC. “That same stigma... that same hatred and negativity:” a qualitative study to understand stigma and medical mistrust experienced by people living with HIV diagnosed with COVID-19. BMC infectious diseases. 2021;21(1):1-8.

Dessalegn NG, Hailemichael RG, Shewa-Amare A, Sawleshwarkar S, Lodebo B, Amberbir A, et al. HIV Disclosure: HIV-positive status disclosure to sexual partners among individuals receiving HIV care in Addis Ababa, Ethiopia. PloS one. 2019 Feb 15;14(2):211967.

Senyurek G, Kavas MV, Ulman YI. Lived experiences of people living with HIV: A descriptive qualitative analysis of their perceptions of themselves, their social spheres, healthcare professionals and the challenges they face daily. BMC Public Health. 2021;21(1):1-5.

Dapaah JM, Senah KA. HIV/AIDS clients, privacy and confidentiality; the case of two health centres in the Ashanti Region of Ghana. BMC medical ethics. 2016;17(1):1-0.

Kawale P, Mindry D, Phoya A, Jansen P, Hoffman RM. Provider attitudes about childbearing and knowledge of safer conception at two HIV clinics in Malawi. Reproductive health. 2015;12(1):1-7.

Velotti P, Garofalo C, Bottazzi F, Caretti V. Faces of shame: Implications for self-esteem, emotion regulation, aggression, and well-being. The Journal of psychology. 2017;151(2):171-84.

Nafradi L, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PloS one. 2017;12(10):186458.

Buscher A, Hartman C, Kallen MA, Giordano TP. Validity of self-report measures in assessing antiretroviral adherence of newly diagnosed, HAART-naive, HIV patients. HIV clinical trials. 2011;12(5):244-54.

Labra O. Social representations of HIV/AIDS in mass media: Some important lessons for caregivers. International Social Work. 2015;58(2):238-48.

Dubov A, Galbo Jr P, Altice FL, Fraenkel L. Stigma and shame experiences by MSM who take PrEP for HIV prevention: a qualitative study. Am J Men's Heal. 2018;12(6):1843-54.

Fazeli PL, Turan JM, Budhwani H, Smith W, Raper JL, Mugavero MJ, et al. Moment-to-moment within-person associations between acts of discrimination and internalized stigma in people living with HIV: An experience sampling study. Stigma and health. 2017;2(3):216.

Earnshaw VA, Smith LR, Chaudoir SR, Lee IC, Copenhaver MM. Stereotypes about people living with HIV: implications for perceptions of HIV risk and testing frequency among at-risk populations. AIDS education and Prevention. 2012;24(6):574-81.

Daskalopoulou M, Lampe FC, Sherr L, Phillips AN, Johnson MA, Gilson R, et al. Non-disclosure of HIV status and associations with psychological factors, ART non-adherence, and viral load non-suppression among people living with HIV in the UK. AIDS and Behavior. 2017;21(1):184-95.

Saggurti N, Raj A, Mahapatra B, Cheng DM, Coleman S, Bridden C, et al. Prevalence and correlates of non-disclosure of HIV serostatus to sex partners among HIV-infected female sex workers and HIV-infected male clients of female sex workers in India. AIDS and Behavior. 2013;17(1):399-406.

Monteiro S, Villela W, Soares P, Pinho A, Fraga L. ‘Protective’silence surrounding AIDS: Reasons and implications of non-disclosure among pregnant women living with HIV in Rio de Janeiro (Brazil). Global public health. 2018;13(1):51-64.

Ismail N, Matillya N, Ratansi R, Mbekenga C. Barriers to timely disclosure of HIV serostatus: A qualitative study at care and treatment centers in Dares Salaam, Tanzania. PloS one. 2021;16(8):256537.