Human Immunodeficiency Virus Stigma Research Articles

Health literacy of people living with HIV in a rural area in Indonesia: A cross-sectional study.

Indonesia, the fourth most populated country in the world, has experienced a fivefold increase in Human Immunodeficiency Virus (HIV)‐infected individuals since 2001. Little is known about health literacy in people living with HIV (PLHIV) in Indonesia. This study aimed to determine the level of health literacy among PLHIV in Indonesia and assess associations between sociodemographic variables, beliefs about medicines, stigma and health literacy. We conducted a cross‐sectional study using questionnaires in PLHIV in Papua, Indonesia. The short version of the Test of Functional Health Literacy in Adults (S‐TOFHLA), Beliefs about Medicines Questionnaire (BMQ) and HIV stigma scale as well as questions on demographic information were completed by the participants from two hospitals in Papua, Indonesia. In a multivariate logistic regression analysis, we assessed the association between sociodemographic variables, stigma, beliefs about medicine and low health literacy. Overall, 331 participants were included, 62.0% female, 67.0% Papuans. A total of 38.5% of participants had low health literacy. PLHIV with multi‐dose regimen were less likely to have low health literacy than those taking a fixed‐dose combination (OR = 0.51; 95%CI = 0.32–0.82). PLHIV who had social support in medicine‐taking were more likely to have low health literacy (OR = 1.78; 95%CI = 1.07–2.97). More awareness about medication overuse (OR = 1.17; 95%CI = 1.06–1.29) and medication harm (OR = 1.10; 95%CI = 1.01–1.20) were also associated with having low health literacy. Overall, interventions targeting health literacy may be a promising strategy to improve self‐management.

Human immunodeficiency virus (HIV) stigma among general population in Isfahan metropolis in Central Iran

Background This study was aimed to evaluate stigma-related to HIV infection among the general population in Isfahan as a representative of Iran. Methods In order to conduct the cross-sectional study, 800 people with an age range of 18–73 years from 14 municipal regions of Isfahan were selected based on a multistage sampling. A standard questionnaire was used to evaluate HIV stigma in the general population in December 2017. Results The mean score (SD) of stigma toward PLHIV was 45.49 (9.17) out of 90. The prevalence of stigmatized attitudes was 18.97% among participants. Stigma’s score was correlated with the score of HIV knowledge, gender, and age. Conclusion The level of stigmatized attitude toward PLHIV was low among the general population in Isfahan. Given that there is still a stigma toward PLHIV in Isfahan as the representative of Iranian population, it is recommended to implement the population-based educational programs for decreasing HIV stigma.

A realist systematic review of stigma reduction interventions for HIV prevention and care continuum outcomes among men who have sex with men.

While stigma associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is well recognized, there remains relatively limited intervention data on effective stigma reduction strategies. This systematic review was conducted to highlight the mechanisms through which sexual and HIV stigma is reduced in relation to HIV prevention and care engagement. Search of PubMed and Scopus resulted in 11 tested interventions to include in our preliminary model constructed from programme frameworks and recommendations. We refined the preliminary programme theory to identify whether, why, or how mitigation strategies produce observed outcomes. Our review showed that the interventions produced stigma reduction through three groups of mechanisms: (1) Self-acceptance, leadership, and motivational activation for behaviour change from intrapersonal strategies, such as education and mobile health strategies, which intervene on internalized and anticipated stigma; (2) socialization, knowledge sharing, and social empowerment from interpersonal strategies, such as peer support and training for care providers; and (3) community introspection, self-reflection, and humanistic activation from structural strategies such as community leaders' sensitization, which intervene on both anticipated and enacted stigma. Interventions mechanisms act complementarily and can be activated in different contexts in which MSM exposed to and infected with HIV are living.

Integrating the prevention of mother-to-child transmission of HIV into primary healthcare services after AIDS denialism in South Africa: perspectives of experts and health care workers - a qualitative study

BackgroundIntegrating Prevention of Mother-to-Child Transmission (PMTCT) programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of PMTCT in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing primary health care (PHC) services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. This study explored the perspectives of both experts or key informants and frontline health workers (FHCWs) in South Africa on PMTCT integration into PHC in the context of post-AIDS denialism using a Complex Adaptive Systems framework.MethodsA total of 20 in-depth semi-structured interviews were conducted; 10 with experts including national and international health systems and HIV/PMTCT policy makers and researchers, and 10 FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed. Three investigators collaborated in coding transcripts and used an iterative approach for thematic analysis.ResultsExperts and FHCWs agreed on the importance of integrated PMTCT services. Experts reported a slow and partial integration of PMTCT programmes into PHC following its initial rollout as a stand-alone programme in the aftermath of the AIDS denialism period. Experts and FHCWs diverged on the challenges associated with integration of PMTCT. Experts highlighted bureaucracy, HIV stigma and discrimination and a shortage of training for staff as major barriers to PMTCT integration. In comparison, FHCWs emphasized high workloads, staff turnover and infrastructural issues (e.g., lack of rooms, small spaces) as their main challenges to integration. Both experts and FHCWs suggested that working with community health workers, particularly in the post-partum period, helped to address cases of loss to follow-up of women and their babies and to improve linkages to polymerase-chain reaction (PCR) testing and immunisation.ConclusionsDespite organised efforts in South Africa, experts and FHCWs reported multiple barriers for the full integration of PMTCT in PHC, especially postpartum. The results suggest opportunities to address operational challenges towards more integrated PMTCT and other health services in order to improve maternal and child health.

Determinants of stigma among patients with hepatitis C virus infection.

Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV treatment and elimination. The determinants of HCV-related stigma, including the impacts of stage of HCV treatment (ie spontaneously cleared; diagnosed, untreated; previously treated, not cured; currently being treated; and treated, cured) and coinfection with human immunodeficiency virus (HIV), remain unknown. To address these gaps, we conducted a cross-sectional study among patients with a history of HCV infection (n=270) at outpatient clinics in Philadelphia from July 2018 to May 2019. We evaluated stigma using the validated HCV Stigma Scale, adapted from the Berger HIV Stigma Scale. Associations among HCV-related stigma and hypothesized demographic, behavioural, and clinical risk factors were evaluated by multivariable linear regression. Most participants (95.5%) experienced HCV-related stigma. Mean stigma scores did not differ significantly between HCV-monoinfected and HIV/HCV-coinfected participants (P=.574). However, we observed significant interactions between HIV status and multiple determinants; therefore, we stratified analyses by HIV status. Among HIV/HCV-coinfected participants, previous HCV treatment without cure, female gender, Hispanic/Latinx ethnicity and some college education were significantly associated with higher HCV-stigma scores. An annual income of $10000-$40000 was associated with significantly lower stigma scores. No significant associations were observed among HCV-monoinfected participants. We found that most participants experienced stigma associated with HCV diagnosis. While stigma scores were similar between HCV-monoinfected and HIV/HCV-coinfected participants, the determinants associated with HCV stigma differed by HIV status. Understanding how experiences of stigma differ between HCV-monoinfected and HIV/HCV-coinfected patients may aid in the development of targeted interventions to address the HCV epidemic.

Personal dispositions as predictors of student nurses' prejudice, stereotyping, and discrimination against human immunodeficiency virus-infected persons in Osun State, Nigeria

Background: Human immunodeficiency virus (HIV)/AIDS is a disease that is stigmatized as a result of its origin and outcome. HIV stigma may occur in the form of prejudice, stereotyping, and discrimination, collectively called HIV stigma mechanism. While studies have shown that student nurses are among persons who stigmatize, little is known about the role of their personal dispositions in the stigma process. Objective: This study aimed to examine the role of personal dispositions on their HIV stigma mechanism against HIV-infected persons. Methods: We employed a cross-sectional descriptive design involving 395 students across Osun State, Nigeria, using a modified Health Care Provider HIV/AIDS Stigma Scale instrument. Four personal dispositions (age, study level, HIV knowledge, and perception) serving as the independent variable, were of interest as well as the HIV stigma mechanism (prejudice, stereotyping, and discrimination) serving as the dependent variable in this study. Data were analyzed using mean and multiple linear regression analysis. Results: The mean scores of the categorical variables of knowledge about AIDS and perception of HIV-infected persons, measured on scales of 0–9 and 0–15, revealed moderate knowledge about HIV (5.90 ± 1.26) and negative perception (10.61 ± 2.47). For the dependent variables, the mean scores were 17.97 ± 4.07 for prejudice, 13.84 ± 3.34 for stereotyping, and 10.47 ± 3.22 for discrimination, which indicated that student nurses stigmatized HIV-infected patients. However, the core finding of this study revealed that, of all the predictors of HIV stigma mechanism, perception was the most significant. Conclusions: Personal dispositions are contributory factors to the enactment of HIV stigma mechanism. Future planning for intervention studies to reduce HIV stigma among health profession students should take cognizance of this.

HIV Stigma and Moral Judgement: Qualitative Exploration of the Experiences of HIV Stigma and Discrimination among Married Men Living with HIV in Yogyakarta.

It is well acknowledged that human immunodeficiency virus stigma (HIV stigma) challenges people living with HIV globally. There is a scarcity of information about determinants of HIV stigma and discrimination among married men in the Indonesian context. This study aimed to explore factors that contribute to stigma and discrimination against HIV-positive men married to women in Yogyakarta, Indonesia. Face-to-face in-depth interviews were conducted to collect data from participants using a snowball sampling technique. A framework analysis was used to guide the analysis of the data. HIV stigma framework was also applied in the conceptualisation and the discussion of the findings. The findings indicate that participants experienced external stigma within healthcare facilities, communities and families. This external stigma was expressed in various discriminatory attitudes and behaviours by healthcare professionals and community and family members. Similarly, participants experienced anticipated stigma as a result of HIV stigma and discrimination experienced by other people living with HIV. Individual moral judgement associating HIV status with amoral behaviours and participants’ negative self-judgement were determinants of perceived stigma. The current findings indicate the need for training programs about HIV stigma issues for healthcare professionals. There is also a need to disseminate HIV information and to improve HIV stigma knowledge among families and communities.

Understanding Global HIV Stigma and Discrimination: Are Contextual Factors Sufficiently Studied? (GAPRESEARCH).

Stigma and discrimination are among the greatest challenges that people living with human immunodeficiency virus (HIV) face, and both are known to negatively affect quality of life as well as treatment outcomes. We analyzed the growing research and current understanding of HIV-related stigma and contextual factors in HIV/AIDS (human Immunodeficiency virus/ acquired immunodeficiency syndrome) bibliography. A total of 5984 publications published from 1991 to 2017 were retrieved from the Web of Science database. The number of papers and their impacts have been considerably grown in recent years. Research landscapes related to stigma and discrimination include clinical, physical and mental health outcomes, risk behaviors of most-at-risk populations, and HIV-related services. We found a lack of empirical studies not only on social, cultural and economic contexts, but also on specific interventions for particular settings and sub-populations. This study highlights certain gaps and provides a basis for future studies and interventions on this critical issue given the changing drivers of HIV epidemics.

Older people living with human immunodeficiency virus/acquired immune deficiency syndrome in Chinese rural areas: perceived stigma and associated factors.

Perceived stigma is a common problem among people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLWHA). In recent years, the number of older adults with HIV/AIDS has rapidly increased in China. However, HIV/AIDS-related perceived stigma and associated factors in older PLWHA remain unknown. A cross-sectional study was conducted in Yongzhou. Participants were recruited via the Hunan HIV/AIDS Registry system. All participants were ≥50 y of age at the time of their HIV diagnosis. Sowell's HIV Stigma Scale was used to measure perceived stigma. A total of 193 participants were interviewed, of which 132 (68.4%) were male. The ages of the participants ranged from 50 to 82 y and the average age was 61.1±5.95 y. Eighteen (9.3%) subjects were ethnic minorities. Older PLWHA reported a relatively high level of perceived stigma, especially individuals of Han ethnicity having high annual incomes. The individuals who had disclosed their HIV-positive status to all their family had higher scores on the dimension related to blame. Regression analysis showed that ethnicity, annual income, living arrangement and disclosure patterns were the main associated factors of perceived stigma. Perceived stigma is common in older Chinese PLWHA. Individuals of ethnic minorities or with higher economic status have higher levels of stigma. Family relationships have a deep influence on perceived stigma.

A preliminary analysis of the association between perceived stigma and HIV-related pain in South Africans living with HIV.

BackgroundStigma related to the human immunodeficiency virus (HIV) remains common and has been associated with severity of HIV-related symptoms. Associations between HIV stigma and HIV-related pain, one of the most common symptoms in HIV, have however not been investigated. Data from low back pain populations suggest that stigma is associated with worse pain intensity and so we hypothesised that the same would be the case in HIV.AimThe goal of this study was to assess the association between HIV stigma and pain intensity in people living with HIV (PLWH) with chronic pain whilst controlling for depression, a well-established correlate of pain.SettingThe study took place at an HIV clinic in Johannesburg, South Africa.MethodsMediation analysis was used to assess the effect of depression on the relationship between stigma and pain intensity in a cross-sectional cohort of 50 PLWH and chronic pain (pain most days of the week for > 3 months). All participants were assessed using the HIV/AIDS Stigma Instrument – PLWA, an 11-point numerical pain rating scale and the Beck Depression Inventory II.ResultsIn all, 88% (44/50) of participants reported experiencing some form of HIV stigma (HIV stigma scale score ≥ 1). Worst pain intensity and depressive symptoms individually correlated with total stigma score (Spearman’s r = 0.33, p = 0.02 for both). The mediation analysis highlighted that mediation of the relationship by depression was equivocal (b = -0.002, bootstrapped confidence interval -0.02 to 0.00).ConclusionWhilst these preliminary data are marginal, they do suggest that associations between HIV stigma and HIV-related pain warrant further investigation. Future study should also include potential mechanisms, which may include mediation through depression.

The association between ethnicity, stigma, beliefs about medicines and adherence in people living with HIV in a rural area in Indonesia

BackgroundIndonesia is one of Asia’s countries with the fastest growing rate of human immunodeficiency virus (HIV) infections according to the World Health Organization (WHO). The prevalence of HIV infections in the province of Papua is 2.4% which is 24 times higher than the national rate in Indonesia. This study aimed to investigate the association between stigma, beliefs about medicines, sociodemographic characteristics including ethnicity and adherence in People living with HIV (PLHIV) in Papua, Indonesia.MethodsWe conducted a cross-sectional study using questionnaires. We included participants from two hospital-outpatient clinics who were on antiretroviral treatment (ART) for more than 6 months, were at least 18 years old, and signed informed consent. Participants completed the Medication Adherence Rating Scale (MARS), Beliefs about Medicines Questionnaire (BMQ), an HIV stigma scale and questions on demographic information. Data on antiretroviral medications were collected from medical records. The outcome was self-reported adherence as measured by the MARS using an 80% cut-off score. Multivariate logistic regression was used to analyse the data.ResultsOverall, 331 out of 363 eligible participants were included with a mean age of 33.3 (± 9.4) years, 61.6% were female, 67.1% were Papuan. A total of 65.9% of participants were adherent. Being Papuan decreased the likelihood of adherence (odds ratio (OR) = 0.53; 95% confidence interval (CI) = 0.32–0.89). Feeling more distant, a stigma type, also decreased the likelihood of adherence (OR = 0.93; 95% CI = 0.88–0.99).ConclusionThe ethnicity of being Papuan and taking a distance to others were associated with non–adherence. Targeted interventions should be developed to improve adherence in this group.

Behavioral and Clinical Characteristics of American Indian/Alaska Native Adults in HIV Care - Medical Monitoring Project, United States, 2011-2015.

The rate of diagnosis of human immunodeficiency virus (HIV) infection among American Indians and Alaska Natives (AI/ANs) in 2016 (10.2 per 100,000 population) was the fourth highest among seven racial/ethnic groups in the United States (1); the number of diagnoses of HIV infection among AI/AN persons increased by 70%, from 143 in 2011 to 243 in 2016 (1). However, little has been published about the sociodemographic, behavioral, and clinical characteristics of AI/AN patients with HIV infection in care because small sample sizes have led to infrequent analysis of AI/AN-specific estimates (2) and because of underestimation of AI/AN race/ethnicity in surveillance and other data sources (3). CDC analyzed data from the Medical Monitoring Project (MMP), a surveillance system that collects information about the experiences and needs of persons with diagnosed HIV infection, collected during 2011-2015 among AI/AN adults receiving HIV medical care. The results indicated that 64% of AI/AN patients with HIV infection in care achieved sustained viral suppression, and 76% achieved viral suppression at their most recent viral load test within the past 12 months, which is below the national HIV prevention goal of 80%, but comparable to or better than some other racial/ethnic groups (4). Based on self-report, 51% of AI/AN patients with HIV infection had incomes at or below the U.S. Department of Health and Human Services' (HHS) annual poverty limit, 27% had symptoms of depression, 78% reported internalized HIV-related stigma, and 20% reported binge drinking in the past 30 days. To improve the health of AI/AN patients with HIV infection, it is important that health care providers, tribal organizations, and state and local health departments consider the sociodemographic and behavioral barriers to AI/AN patients with HIV infection achieving viral suppression and design care plans that seek to eliminate those barriers.

Prevalence of Depressive Symptoms and Associated Factors among HIV-Positive Youth Attending ART Follow-Up in Addis Ababa, Ethiopia

Depression is most frequently and highly occurring common mental disorder in HIV/AIDS patients especially youth living with HIV/AIDS. This study aimed to assess the prevalence and associated factors of depressive symptoms among youth living with Human Immunodeficiency Virus (HIV) attending Antiretroviral Therapy (ART) follow-up at public hospitals in Addis Ababa, Ethiopia. Objective. To assess the prevalence and associated factors of depressive symptoms among youth living with Human Immunodeficiency Virus (HIV) attending Antiretroviral Therapy (ART) follow-up at public hospitals Addis Ababa, Ethiopia, 2016. Method. In a cross sectional study, 507 HIV-positive young people from public health hospitals were recruited by systematic random sampling technique. Beck Depression Inventory-II was used to assess depressive symptoms. Morisky medication adherence rating scale, social support rating scale, and HIV stigma scale were the instruments used to assess the associated factors. Results. Prevalence of depressive symptoms among HIV-positive youth was 35.5% (95% CI:31.3, 39.6). In multivariate analysis, age range between 20 and 24 years with (AOR=2.22, 95% CI: 1.33,3.62), history of opportunistic infection (AOR=1.94, 95% CI:1.15,3.27), poor medication adherence (AOR=1.73, 95%CI:1.13,2.64, low social support (AOR=2.74, 95%CI:1.13,2.64), moderate social support (AOR=1.75 95% CI: 1.03,2.98), and stigma (AOR=2.06, 95% CI: 1.35,3.14) were associated with depressive symptoms. The results suggest that prevalence of depressive symptoms among HIV-positive youth was high. Prevention of opportunistic infection, stigma, and counseling for good medication adherence are necessary among HIV-positive youth.

Development of an 18-item abbreviated Chinese version of Berger's HIV Stigma Scale.

Human immunodeficiency virus (HIV) stigma in people living with HIV is associated with depression and poor treatment adherence. The current literature lacks a Chinese instrument to measure HIV stigma in Taiwan. Thus, the purpose of this study was to develop an abbreviated Chinese translation version of Berger's HIV Stigma Scale. The instrument development process was guided by Brislin's Translation Model of establishment of construct validity and convergent validity and verification of reliability. This study recruited 540 HIV-infected adults (January-November 2015). Data analysis using confirmatory factor analysis resulted in an 18-item abbreviated Chinese version of Berger's HIV Stigma Scale, consisting with four factors: personalized stigma (seven items), disclosure concerns (three items), negative self-image (four items), and concerns with public attitudes toward people with HIV (four items). The final model demonstrated a good fit. A positive correlation between HIV stigma and depression was found. The Cronbach α for internal consistency was 0.92. The 18-item abbreviated Chinese version of Berger's HIV Stigma Scale demonstrated adequate reliability and validity to assess HIV stigma among Chinese people living with HIV. It is a feasible tool that allows for rapid assessment of HIV-related stigma.

HIV Stigma and Discrimination Management in Pokhara, Nepal

Stigma and discrimination attached to Human Immuno-deficiency Virus (HIV) and Acquired Immuno-deficiency Syndrome (AIDS) are not new issues in Nepal where the issues are often considered to be the outcomes of either extra-marital sexual activities or sharing needles for drug use withpeople living with HIV (PLHIV). These activities are considered to be outside norms and values of Nepalese societies. Consequently, PLHIV are stigmatized and discriminated against in family and society. There are number of studies on stigma and discrimination attached to HIV and AIDS. However, there are very limited studies on management of HIV stigma and discrimination in Nepal. Therefore, this paper aims to look at HIV stigma and discrimination in general with a view to contextualize these issues, and to examine management of HIV stigma and discrimination in particular after being HIV diagnosed. This study follows qualitative research approach, face to face in-depth interview with 16 PLHIV in Pokhara during the period February-March 2017. This study investigates ways the participants have been able to manage their HIV stigma and discrimination in a greater extent at present with their own individual rigorous efforts, and supports made by local body and organizations/hospitals working in the field of HIV and AIDS as well. This paper has important policy implications, especially in the management of HIV stigma and discrimination in Nepal and other countries with similar socio-cultural contexts.Janapriya Journal of Interdisciplinary Studies, Vol. 6 (December 2017), page: 97-109

Authorship Correction: Sampling Key Populations for HIV Surveillance: Results From Eight Cross-Sectional Studies Using Respondent-Driven Sampling and Venue-Based Snowball Sampling.

[This corrects the article DOI: 10.2196/publichealth.8116.].

Marginalization and Community Perception of HIV Care, Treatment, and Support on Mfangano Island, Kenya.

In rural sub-Saharan Africa (SSA), the human immunodeficiency virus (HIV)/AIDS pandemic has exerted effects on nearly every aspect of life. Yet despite the pandemic's near ubiquitous impacts, major barriers to HIV care, treatment, and support persist. Compounding the barriers to care is the incredible complexity and diversity of experience across different sociocultural contexts. This exploratory community-based participatory study aimed to generate an explanatory model about how geographic and socioeconomic marginalization shape community perception of HIV care, treatment, and support among rural communities of Mfangano Island, Kenya. Twelve focus groups with a total of 105 participants were conducted as a part of a mixed-methods cross-sectional health study. Study findings are organized within an ecological framework with the following themes: readiness at the individual level, social capital at the household level, and collective efficacy at the community level. Potential solutions were also described within this framework; enabling encouragement at the individual level, enhancing productivity at the household level, and addressing underlying socioeconomic inequities at the community level. HIV-related consequences at the individual, household, and community levels have adversely affected how Mfangano communities respond to the HIV/AIDS epidemic. Community-based strategies are needed to address interrelated inequities at multiple levels. Changing community perception may overcome HIV stigma to enable individual readiness to seek care. Access to care and treatment enhances productivity and hence social capital in HIV-affected households. Addressing socioeconomic inequities at the community level increases access to social and instrumental support and, thus, may decrease risk and vulnerability for HIV/AIDS.

Self-Perceived Stigma and its Effect on Quality of Life among Malaysians Living with Human Immunodeficiency Virus

Human Immunodeficiency Virus (HIV) epidemic remains a significant burden in Malaysia. Stigma related to HIV and its effect on the quality of life (QOL) of persons living with HIV (PLHIV) remains under-reported. The aim of the present study was to assess self-perceived stigma amongst PLHIV attending an urban community clinic and its influence on their QOL. Data was collected using HIV Stigma Scale and WHO-QOL HIV BREF Scale. The overall stigma experienced by PLHIV in this community was higher than previous studies (mean ± SD; 103.37 ±18.14). Majority participants had fear disclosing their disease status, while personalized stigma or the experience of prejudice and rejection was the least experienced. The overall QOL was low and was significantly impaired in social relationship domain (mean ± SD; 12.72 ± 3.59). However, their ability to perform daily activities was not affected by the illness (mean ± SD; 14.48 ± 2.91). PLHIV with higher spiritual values demonstrate lower perception of negative self-image and inferiority (r= -0.54). This finding was unique to PLHIV in this study and suggested the importance of spirituality and personal beliefs on their self-esteem. In conclusion, stigma remains as a significant problem among PLHIV in this community. Primary care offers the best platform to promote a holistic management of PLHIV, where the integration between counselors, religious experts, family and non-governmental associations could come together. The management of PLHIV is unique in every community, hence individualized approach based on cultural norms and beliefs could assist in the overall management of PLHIV.

Measuring HIV- and TB-related stigma among health care workers in South Africa: a validation and reliability study.

Recent evidence indicates that human immunodeficiency virus (HIV) and tuberculosis (TB) related stigma act as a key barrier to the utilisation of associated occupational health services by South African health care workers (HCWs). It also highlights a dearth of appropriate tools to measure HIV and TB stigma among HCWs. To test four scales measuring different aspects of stigma: respondent's external stigma (RES) and others' external stigma (OES) towards TB as well as HIV across different professional categories of HCWs. The current study employs data from a study on HIV and TB stigma among HCWs, a cluster randomised controlled trial for the collection of data among 882 HCWs in the Free State Province of South Africa. Confirmatory factor analyses and structural equation modelling were used to assess the validity and reliability of the scales. All four scales displayed adequate internal construct validity. Subsequent analysis demonstrated that all four scales were metric-invariant, and that the OES scales were even scalar-invariant across patient and support staff groups. The scales displayed good reliability and external construct validity. Our results support the use of the scales developed to measure TB and HIV stigma among HCWs. Further research is, however, needed to fine tune the instruments and test them across different resource-limited countries.

Using 15 DHS surveys to study epidemiological correlates of TB courtesy stigma and health-seeking behaviour.

Tuberculosis (TB) stigma is thought to delay or prevent the decision to seek health care, but the strength of this association and the prevalence of anticipated TB stigma in the general population in most countries is unknown. To examine epidemiological, cultural and sociodemographic factors associated with TB courtesy stigma in 15 surveys across 13 countries, and its link to health seeking for cough in children under five. A multilevel survey weighted logistic regression model was used to analyse how individual characteristics and social contexts affect the occurrence of TB courtesy stigma. The same modelling approach was used to analyse associations between TB courtesy stigma and individual-level predictors of health-seeking behaviour of mothers for children with cough. TB courtesy stigma varies greatly among countries. TB courtesy stigma was negatively correlated with knowledge of TB's curability (adjusted OR [aOR] 0.82; 95%CI 0.78-0.86) and human immunodeficiency virus (HIV) accepting attitudes (proxy for HIV stigma) (aOR 0.15, 95%CI 0.15-0.16). Mothers' health-seeking behaviour for children under five with cough was found to be positively correlated with HIV accepting attitudes (OR 1.16, 95%CI 1.08-1.25), but was marginally affected by TB courtesy stigma (OR 0.99, 95%CI 0.98-1.00). Improving the general awareness of the effectiveness of anti-tuberculosis treatment will help to diminish TB courtesy stigma, and should be prioritised over expanding knowledge of mode of transmission. Efforts to reduce HIV and TB stigma may increase care seeking for childhood TB symptoms.