Abstract
IntroductionContrary to assertions that stigma may no longer be experienced due to substantial advancement in antiretroviral access and treatment, self-stigma still exists among people living with HIV/AIDS (PLWHA) in Nigeria. The use of peer health workers to improve care in underserviced settings has been implemented by a number of programs, but its effect has not been extensively assessed. This study compared the level of self-stigma among PLWHA in peer support and non-support groups in Enugu State Nigeria.MethodsA cross-sectional study using quantitative and qualitative instruments was conducted among PLWHA attending ARV clinics. Quantitative data was assessed using pre-tested structured interviewer-administered questionnaires. Chi-square test of statistical significance was used in the analysis. Four focus group discussions and eight key informant interviews were conducted among PLWHA and healthcare workers respectively. Manual content analysis was used to analyse the qualitative data.ResultsComparable proportions of respondents in peer support (31.4%) and non-peer support groups (30.2%) had self-stigma (p=0.709). Disclosure was higher among respondents in non-peer support groups (96%) against 94.5% in peer support groups (p=0.331). Health workers interviewed were of the opinion that self-stigma cuts across members of both groups. Participants in the FGD reported that the media and economic empowerment have helped reduce self-stigma among PLWHA.ConclusionThough peer support groups may be a starting place for the development of social support interventions for PLWHA, it might not be sufficient to combat self-stigma. Interventions aimed at economic empowerment of PLWHA and public enlightenment are essential for effective mitigation against self-stigma.
Highlights
The World Health Organisation (WHO) cites fear of stigma as the main reason why people are reluctant to get tested, disclose their HIV status, take antiretroviral (ARV) drugs and access other antiretroviral therapy (ART) services [1,2]
Quantitative findings: a total of 840 people living with HIV/AIDS (PLWHA) participated in this study
A significantly higher proportion of respondents in the non-peer support group who were in the low socio-economic status were selfstigmatized when compared with those who were in the high socioeconomic status, (Χ2=4.421, p=0.035) (Table 4)
Summary
The World Health Organisation (WHO) cites fear of stigma as the main reason why people are reluctant to get tested, disclose their HIV status, take antiretroviral (ARV) drugs and access other antiretroviral therapy (ART) services [1,2]. PLWHA may lose employment, financial resources, and even family and friends as major sources of support and in some cases, suffer abandonment [4,5] This may be due to the fact that HIV is primarily transmitted through sexual intercourse and people sometimes erroneously link HIV infection with promiscuity and infidelity [6]. Prevalence of self-stigma ranged from 9.6% in Malawi to 45.0% in Burkina Faso and 33% to 66% among men and 23% to 61% among women in South Africa [10] This has accounted for the emotional reactions and distress experienced by PLWHA resulting to self-condemnation, social drift and unwillingness to seek help or access available resources [3,4]. There remains a gap in the knowledge; whether participation in peer support group activities reduces self-stigma among PLWHA in Nigeria
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