Human Immunodeficiency Virus Stigma Research Articles

Legal guardians understand how children with the human immunodeficiency virus perceive quality of life and stigma.

AimThis aim of this study was to describe how legal guardians assessed health‐related quality of life and HIV‐related stigma in children with the human immunodeficiency virus (HIV) compared to the children's own ratings.MethodsA cross‐sectional nationwide study was performed to compare how 37 children aged from eight to 16 years of age with perinatal HIV, and their legal guardians, assessed the children's health‐related quality of life and HIV‐related stigma. Data were collected using the 37‐item DISABKIDS Chronic Generic Module and a short eight‐item version of the HIV stigma scale.ResultsIntraclass correlations indicated concordance between the legal guardians' ratings and the children's own ratings of the child's health‐related quality of life and HIV‐related stigma. There were no statistically significant differences between the ratings of the two groups and gender did not have any impact on the results. Both groups indicated that the children had concerns about being open about their HIV status.ConclusionThe results of this study indicated that legal guardians understood how their children perceived their health‐related quality of life and HIV‐related stigma. The results also indicated the need for interventions to support both the children and legal guardians when it came to disclosing the child's HIV status.

Should HIV and AIDS workplace programmes still be advocated in the automotive industry?

Orientation: In light of the human immunodeficiency virus (HIV) pandemic, and in order to improve competitiveness in the South African private sector, many structures have implemented subsidised workplace programmes.Research purpose: The aim of this study was to collect baseline data regarding the knowledge, attitudes, practices and belief (KAPB) of employees in the automotive industry in relation to HIV and AIDS, in order to assess the need for HIV and AIDS workplace programmes.Motivation for the study: Given the abundance of HIV and AIDS information, the question is whether these workplace programmes’ efforts are still relevant.Research design, approach and method: A quantitative descriptive study design was used using a self-administered questionnaire covering questions about KAPB with regard to HIV and AIDS. The data collection took place in seven automotive supplier companies in South Africa (n = 733) who were going to implement HIV and AIDS workplace programmes with the support of the Automotive Industry Development Centre in the Eastern Cape.Main findings: High-risk behaviour, as indicated by sexual relations with more than one partner in the last 12 months, occurred in between 12% (management) and 42% (cleaners) of employees. All risk behaviour indicators showed significant differences (p < 0.05) between management and administrative staff on the one hand and technicians, operators and cleaners on the other. Despite being aware of an HIV policy, more than 50% of employees indicated that they would not be willing to disclose their status.Practical/managerial implications: As HIV and AIDS risk behaviour and stigma remain a problem, HIV infection with associated health problems may threaten productivity in the automotive industry if no measures are taken to address the impact on employees and the company.Contribution: This study strongly supports the conclusion that KAPB studies can still provide important information to tailor HIV workplace programmes according to employee needs.

HIV stigma and disclosure experiences of people living with HIV in an urban and a rural setting

Human immunodeficiency virus (HIV) remains a highly stigmatised condition for people living with HIV (PLWH) and people living close to them (PLC) globally. The research objectives for this study were to explore and describe how HIV stigma and disclosure experiences impact the lives of PLWH and to explore whether there are differences between experiences in urban and rural settings. A qualitative approach was followed and participants were selected through purposive voluntary sampling. Data collection took place using in-depth interviews with 23 PLWH, 11 of whom resided in an urban setting in North-West, South Africa, and 12 resided in a rural setting in the same province. The data were manually analysed through open coding. The HIV stigma experiences expressed by PLWH depicted negative behavioural patterns and attitudes towards them, fear from the community of being infected by PLWH and lastly negative self-judgement by PLWH themselves. During disclosure, PLWH were unsure and they described it as a stressful event. They cautiously considered to whom to disclose their condition and what benefits disclosure will hold. They further had to handle forced disclosure due to being identifiable in health-care settings. HIV stigma and related disclosure practices remained a problem, which detrimentally affected treatment and support efforts. Recommendations focused on HIV stigma reduction in the community that needed to involve PLWH and PLC.

Re-Validation of the Van Rie HIV/AIDS-Related Stigma Scale for Use with People Living with HIV in the United States

There is little consensus about which of the many validated human immunodeficiency virus (HIV) stigma scales should be regularly used, with few being re-validated in different contexts or evaluated for how they compare to other, existing HIV stigma scales. The purpose of this exploratory study was to re-validate the Van Rie HIV/AIDS-Related Stigma Scale, originally validated in Thailand and using a third-person wording structure, for use with people living with HIV in the United States. Adult HIV clinic patients completed a survey including the Berger and Van Rie scales, and measures of social support and depression. Eighty-five of 211 (40%) eligible participants provided data for both stigma scales. Exploratory factor analyses identified three factors to the Van Rie scale: Loss of Social Relationships (new subscale), Managing HIV Concealment (new subscale), and Perceived Community Stigma (original subscale). These subscales were moderately inter-related (r = 0.51 to 0.58) with acceptable to excellent reliability (Cronbach’s alpha = 0.69 to 0.90). The Van Rie subscales were also moderately inter-correlated with the Berger subscales (r = 0.44 to 0.76), had similar construct validity, and tended to have higher mean stigma scores when compared with Berger subscales that were conceptually most similar. The revised Van Rie HIV-related Stigma Scale demonstrates good validity and internal consistency, offering a valid measure of HIV stigma with a three-factor structure. The third-person wording may be particularly suitable for measuring stigmatizing attitudes during an individual’s transition from at-risk and undergoing HIV testing to newly diagnosed, a time when experiences of discrimination and processing issues of disclosure have not yet occurred. The stigma mechanisms for individuals making this transition have not been well explored. These scenarios, combined with the observed non-response to the Berger Enacted Stigma subscale items (a surprise finding), highlight gaps in our understanding of HIV stigma and how best to measure it.

Knowledge and Attitude on Prevention of Mother to Child Transmission of HIV among Pregnant Women Attending Antenatal Clinic at Kisii Level Five Hospital in Kisii County, Kenya

Introduction: The acquired immunodeficiency syndrome (AIDS) epidemic is the greatest challenge to human kind in the 21 century. Over 35.5 million people are infected with Human immunodeficiency virus (HIV) worldwide and the majority of these infections are in the reproductive age group. Mother to Child Transmission (MTCT) of HIV infections is high especially in subSaharan Africa despite improvements in PMTCT services over the years. In 2006 there were 2.3 million children under 15 years living with HIV, and approximately 530,000 children were newly infected with HIV through mother to child transmission of the virus. A child dies of AIDS nearly Original Research Article Kei et al.; IJTDH, 6(2): 44-51, 2015; Article no.IJTDH.2015.037 45 every minute of every day. Objective: To assess knowledge and attitude on prevention of mother to child transmission of HIV among pregnant women attending antenatal clinic in Kisii general hospital. Methodology: An institution-based cross-sectional study was conducted among pregnant mothers attending antenatal care clinic at Kisii general hospital from February to April, 2014. A systematic random sampling technique was used to select the 328 respondents. Data were collected through structured pre-tested questionnaire. The data were then summarized into SPSS version 20.0, for windows and analyzed. Chi-square was used to calculate the association between, education, Occupation and age against knowledge on prevention of mother to child transmission. Findings: The findings from the study showed that there was an association between the knowledge on PMTCT and Occupation (P = 0.05). A big number (52%) of the mothers did not know about PMTCT services which were being offered in the hospital. The study showed that the knowledge on PMTCT was associated to the age (P = 0.02). It was noted that respondents who had little or no knowledge of the services were mostly below 25 years of age and those with low education levels (P = 0,01). On the attitude towards PMTCT services it was found that threequarters (77%) reported that it is good to take on PMTCT services if reactive and quarter (23%) of respondents reported that PMTCT services are wastage of time because AIDS has no cure. Challenges that affect the PMTCT program include stigma still surrounding HIV and AIDS as a disease, which has led to 210 (64%) of the mothers not willing to know their status. Conclusion: The utilization of the PMTCT services were affected by the low levels of HIV testing. The insufficient knowledge on PMTCT coupled with the negative attitude towards HIV testing, fear and stigma towards HIV and AIDS contributed to the low utilization of PMTCT services in Kisii level 5 Hospital in Kisii County. Recommendation: The study recommends working in collaboration with all stakeholders to improve and increase on the sensitization and awareness to the communities on what PMTCT program is all about and what it entails. There is need to do a qualitative study to find out if the information given during counseling is enough and useful to pregnant women and to see if more counseling session are needed for pregnant women during antenatal visits.

Assessment of stigma associated with tuberculosis in Mexico.

Stigma is a major barrier to health care access and impacts the quality of life for individuals affected by tuberculosis (TB). Assessing TB stigma is essential to addressing health disparities. However, no such instrument was available in Mexico at the time of our study. This study examined the adaptability of the TB and human immunodeficiency virus (HIV) stigma scales previously used in Thailand. The original scale, developed in English, was linguistically adapted to Spanish and administered to 217 individuals affected by TB in five states in Mexico. The TB-HIV stigma subscales were designed to assess individual and community perspectives. Additional data collected included general information and socio-demographics. Assessment of psychometric properties included basic statistical tests, evaluation of Cronbach's alpha and factor analysis. We found no significant statistical differences associated with higher stigma scores by location, age, marital status, education and stigma scores. Factor analysis did not create any new factors. Internal consistency reliability coefficients were satisfactory (Cronbach α = 0.876-0.912). The use of the stigma scales has implications for 1) health improvements, 2) research on stigma and health disparities, and 3) TB and HIV stigma interventions. Further research is needed to examine transferability among larger and randomly selected Spanish-speaking populations.

Acceptability of a nipple shield delivery system administering antiviral agents to prevent mother-to-child transmission of HIV through breastfeeding.

Breastfeeding is a route of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV). The World Health Organization recommends antiretroviral (ARV) prophylaxis as the best method to prevent mother-to-child transmission of HIV (PMTCT) during breastfeeding. The nipple shield delivery system (NSDS) is being developed as an accessible method to deliver ARVs to infants and PMTCT during breastfeeding. The NSDS can potentially circumvent hygiene and storage issues in delivering drugs to infants in low-resource settings. The primary objective was to determine acceptability of the NSDS for PMTCT in Kenya. Secondary objectives included assessing mothers' understanding of MTCT and identifying cultural and implementation issues that might affect NSDS acceptability. Eleven focus group discussions were conducted, each group consisting of 7 to 12 participants. Seven focus group discussions consisted of HIV-positive mothers, 2 included grandmothers/mothers-in-law, and 2 included fathers/husbands. Ten in-depth interviews were also conducted with individual maternal/child health care providers. Topics included infant feeding and HIV stigma, as well as safety, effectiveness, and feasibility of the NSDS. Device prototypes were used in discussions. Participants felt that the NSDS could be trusted if validated scientifically and promoted by health care professionals. HIV-related stigma, access, efficacy, and hygiene were identified as important considerations for acceptance. The NSDS is a potentially acceptable method of PMTCT during breastfeeding. Further studies are needed to confirm acceptability, safety, and efficacy. For NSDS adoption to PMTCT, strategies will need to be developed to minimize HIV-related stigma and to ensure that continuous hygiene of the device is maintained.

Investigation of perceived stigma among people living with human immunodeficiency virus/acquired immune deficiency syndrome in Henan Province, China

PurposeTo investigate the level of and factors influencing perceived stigma and discrimination among people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (PLWHA) in Henan Province. MethodsIn total, 161 PLWHA from Zhengzhou and Zhenping were investigated using the Berger HIV stigma scale. ResultsThe mean Berger stigma scale score was 105.70 ± 15.20, indicating a middle stigma level. Among the four subscales of the Berger stigma scale, the disclosure concerns score was highest, while the negative self-image score was lowest. Multivariate analyses showed that factors influencing perceived HIV stigma included the level of education and route of infection. ConclusionThe level of perceived HIV stigma and discrimination among PLWHA in Henan Province is moderate and was affected by the level of education and route of infection. Special intervention should be established to address this problem.

African-American and Hispanic Perceptions of HIV Vaccine Clinical Research: A Qualitative Study

To examine perceptions of phase-I human immunodeficiency virus (HIV) vaccine trial participation among African-Americans and Hispanics in San Francisco, California. Qualitative, semistructured interviews. San Francisco Department of Health. Thirty-six African-American and Hispanic men and women, 18 to 50 years of age, residing in the San Francisco Bay Area. Purposive sampling using advertisements, community-based organization rosters, and snowball referrals. Thematic analysis of transcripts identified salient themes and patterns. Participants viewed participation in HIV research as important; however, they held that HIV was not a health priority given limited awareness about HIV research or beliefs that only infected or high-risk persons were eligible for participation. Altruism and personal gain, trustworthy trial staff, convenient schedules and facilities, and involvement of trusted community groups in recruitment were perceived to motivate participants. Concerns about the social consequences of participating in HIV research and product-related side effects were seen as discouraging participation. Limitations include the possibility that participants in interview research have more favorable views of biomedical research than those who refuse to participate. Historically, African-Americans and Hispanics in the United States have had limited participation in HIV trials. Understanding their perceptions of HIV biomedical research, identifying facilitators and barriers to participation, addressing misinformation about HIV, distorted risk perceptions, HIV stigma, and providing accessible opportunities to participate are imperative to ensure health equity and generalizability of findings.

Personal meaning, social support, and perceived stigma in individuals receiving HIV mental health services.

Human immunodeficiency virus (HIV) stigma represents a significant source of stress among individuals living with HIV disease, prompting interest in research to identify factors that may help to ameliorate the stress burden associated with HIV stigma. Consistent with this research line, the current study was conducted as a cross-sectional investigation examining associations between positive global personal meaning, social support, and perceived HIV stigma. Global personal meaning refers to beliefs and aspirations through which one ascribes value and purpose in living. The study sample was comprised of individuals living with HIV disease who presented for an initial visit in a specialty HIV mental health services program. In bivariate analyses, social support was negatively correlated with multidimensional aspects of HIV stigma that included distancing, blaming, and discrimination stigma, whereas personal meaning was negatively associated only with blaming stigma. In further analyses using structural equation modeling, social support significantly mediated the association between personal meaning and both distancing and blaming stigma. Interactions between positive personal meaning and social support may be useful to consider in future research on psychological resource factors and HIV stigma. Understanding these interactions may also inform clinical efforts to address HIV stigma concerns.

Internalized HIV-Stigma, Mental Health, Coping and Perceived Social Support among People Living with HIV/AIDS in Aizawl District—A Pilot Study

AIDS is a global pandemic, and persons with HIV/AIDS are stigmatized throughout the world in varying degrees. The current study is a pilot study for a further in-depth study to understand the psychological implications of living with Human Immunodeficiency Virus (HIV). The study employed a quantitative approach with an aim to find out the level and prevalence of Internalized HIV Stigma (IHS) and to examine the mental health, coping strategies and perceived social support in a sample of 31 People Living with HIV/AIDS (PLWHA). Two-way classification of “Gender” (male and female) and three-way classification of “Level of IHS” (High IHS, Moderate IHS and Low IHS) on the dependent variables was employed, to elucidate the relationships between Internalized Stigma, Mental Health, Coping and perceived social support. The overall analysis revealed moderate levels of IHS (64.5%), depression (35.5%), and perceived social support (54.8%), and low level of anxiety (54.8%). It was also seen that majority (54.84%) employed emotion-oriented coping strategy. No significant gender differences were found in IHS. However, significant gender differences were found in levels of depression (p < 0.05) and Emotion-oriented coping (p < 0.05). Further analysis revealed that the two subscales of the IHS measure i.e. Stereotypes of HIV and Social Relationships stigma were significantly and positively correlated with anxiety (p < 0.05 and p < 0.01 respectively).

Consensus on context-specific strategies for reducing the stigma of human immunodeficiency virus/acquired immunodeficiency syndrome in Zambézia Province, Mozambique

Stigma has been implicated in poor outcomes of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) care. Reducing stigma is important for HIV prevention and long-term treatment success. Although stigma reduction interventions are conducted in Mozambique, little is known about the current nature of stigma and the efficacy and effectiveness of stigma reduction initiatives. We describe action research to generate consensus on critical characteristics of HIV stigma and anti-stigma interventions in Zambézia Province, Mozambique. Qualitative data gathering methods, including in-depth key-informant interviews, community interviews and consensus group sessions, were utilized. Delphi methods and the strategic options development analysis technique were used to synthesize qualitative data. Key findings are that stigma enacted by the general public might be declining in tandem with the HIV/AIDS epidemic in Mozambique, but there is likely excessive residual fear of HIV disease and community attitudes that sustain high levels of perceived stigma. HIV-positive women accessing maternal and child health services appear to shoulder a disproportionate burden of stigma. Unintentional biases among healthcare providers are currently the critical frontier of stigmatization, but there are few interventions designed to address them. Culturally sensitive psychotherapies are needed to address psychological distress associated with internalized stigma and these interventions should complement current supports for voluntary counseling and testing. While advantageous for defining stakeholder priorities for stigma reduction efforts, confirmatory quantitative studies of these consensus positions are needed before the launch of specific interventions.

Negative labeling and social exclusion of people living with human immunodeficiency virus/acquired immune deficiency syndrome in the antiretroviral therapy era: insight from attitudes and behavioral intentions of female heads of households in Zambézia Province, Mozambique

In the age of antiretroviral therapy (ART), unraveling specific aspects of stigma that impede uptake and adherence to human immunodeficiency virus (HIV) services and the complex intersections among them might enhance the efficacy of stigma-reduction interventions targeted at the general public. Few studies have described community stigma in high HIV prevalence regions of Mozambique where program scale-up has been concentrated, but fear of stigma persists as a barrier to HIV service uptake. Principal components analysis of attitudinal data from 3749 female heads of households surveyed in Zambézia Province was used to examine patterns of agreement with stigmatizing attitudes and behavior toward people living with HIV. Inferences were based on comparison of factor loadings and commonality estimates. Construct validity was established through correlations with levels of knowledge about HIV transmission and consistency with the labeling theory of stigma. Two unique domains of community stigma were observed: negative labeling and devaluation (NLD, α = 0.74) and social exclusion (SoE, α = 0.73). NLD is primarily an attitudinal construct, while SoE captures behavioral intent. About one-third of the respondents scored in the upper tertile of the NLD stigma scale (scale: 0–100 stigma points) and the equivalent was 41.3% in the SoE stigma scale. Consistent with literature, NLD and SoE stigma scores were inversely correlated with HIV transmission route knowledge. In item level analysis, fear of being labeled a prostitute/immoral and of negative family affect defined the nature of stigma in this sample. Thus, despite ART scale-up and community education about HIV/acquired immune deficiency syndrome (AIDS), NLD and SoE characterized the community stigma of HIV in this setting. Follow-up studies could compare the impact of these stigma domains on HIV services uptake, in order to inform domain-focused stigma-reduction interventions.

Condom use, risk perception, and HIV knowledge: a comparison across sexes in Nigeria

BackgroundThis paper analyzes how different types of Human immunodeficiency virus (HIV) knowledge influences condom use across the sexes.MethodsThe empirical work was based on a household survey conducted among 1979 households of a representative group of stallholders in Lagos, Nigeria in 2008. Condom use during last sexual intercourse was analyzed using a multivariate model corrected for clustering effects. The data included questions on socioeconomic characteristics, knowledge of the existence of HIV, HIV prevention, HIV stigma, intended pregnancy, and risk perceptions of engaging in unprotected sex.ResultsA large HIV knowledge gap between males and females was observed. Across the sexes, different types of knowledge are important in condom use. Low-risk perceptions of engaging in unprotected sex and not knowing that condoms prevent HIV infection appear to be the best predictors for risky sexual behavior among men. For females, stigma leads to lower condom use. Obviously, lack of knowledge on where condoms are available (9.4% and 29.1% of male and female respondents, respectively) reduced condom use in both males and females.ConclusionThe results call for programmatic approaches to differentiate between males and females in the focus of HIV prevention campaigns. Moreover, the high predictive power of high-risk perceptions of engaging in unprotected sex (while correcting for other HIV knowledge indicators) calls for further exploration on how to influence these risk perceptions in HIV prevention programs.

The health-care needs of the older gay man living with HIV

Human immunodeficiency virus (HIV) was once thought of as a condition predominately affecting the young. However, HIV among the older population is increasing. Older gay male adults living with HIV have received little attention from those who provide and commission services. However, with effective treatment those gay men aged over 50 are the fastest growing group of people with HIV in the U.K. Nurses will be required to offer care in a number of ways to this cohort of patients. In so doing, nurses will need to develop innovative and effective ways of supporting this growing group of people. This article provides an overview of the issues that can impact on the health and wellbeing of the older gay man living with HIV. The article discusses the epidemiology, the issue of HIV stigma, comorbidities and mental health and wellbeing needs.

The interpersonally sensitive disposition and health: An integrative review.

This article reviews studies that have examined the association between constructs related to interpersonal sensitivity (IS) and morbidity and mortality from major medical illnesses. We define IS as a stable trait characterized by ongoing concerns about negative social evaluation. This disposition makes people vigilant for as well as sensitive to others' evaluations of them. To avoid negative social evaluation, they adopt defensive behaviors such as submission and inhibition. Aspects of IS are captured by various constructs, including introversion, rejection sensitivity, social inhibition, social anxiety, and submissiveness. The review includes 76 long-term prospective studies across 4 outcome categories, namely, infectious disease, cancer, cardiovascular disease (CVD), and all-cause mortality. Three general conclusions are established. First, IS individuals are at increased risk of infectious diseases and possibly CVD, but not cancer and not all-cause mortality. Second, the positive studies provide evidence that IS temporally precedes disease, and go a long way toward ruling out the most plausible alternative explanations based on confounders, supporting a tentative causal interpretation of the data. However, unmeasured potential confounders make it impossible to be certain about whether IS drives the effects on mortality and morbidity. Third, the effects of introversion are accentuated and may only become apparent in contexts that activate social-evaluative concerns (e.g., exposure to early life residential mobility, living with the stigma of human immunodeficiency virus). Findings are discussed in regard to potential psychosocial and psychobiological mechanisms as well as implications for future work concerning IS and health.

Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings.

The rollout of antiretroviral therapy (ART) significantly reduced human immunodeficiency virus (HIV)-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home- and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a compelling case for more data to guide strategies to improve access and adherence to treatment in resource-limited settings.

Frequent Emergency Department Use Among Released Prisoners With Human Immunodeficiency Virus: Characterization Including a Novel Multimorbidity Index

The objective was to characterize the medical, social, and psychiatric correlates of frequent emergency department (ED) use among released prisoners with human immunodeficiency virus (HIV). Data on all ED visits by 151 released prisoners with HIV on antiretroviral therapy (ART) were prospectively collected for 12 months. Correlates of frequent ED use, defined as having two or more ED visits postrelease, were described using univariate and multivariate models and generated medical, psychiatric, and social multimorbidity indices. Forty-four (29%) of the 151 participants were defined as frequent ED users, accounting for 81% of the 227 ED visits. Frequent ED users were more likely than infrequent or nonusers to be female; have chronic medical illnesses that included seizures, asthma, and migraines; and have worse physical health-related quality of life (HRQoL). In multivariate Poisson regression models, frequent ED use was associated with lower physical HRQoL (odds ratio [OR] = 0.95, p = 0.02) and having not had prerelease discharge planning (OR = 3.16, p = 0.04). Frequent ED use was positively correlated with increasing psychiatric multimorbidity index values. Among released prisoners with HIV, frequent ED use is driven primarily by extensive comorbid medical and psychiatric illness. Frequent ED users were also less likely to have received prerelease discharge planning, suggesting missed opportunities for seamless linkages to care.

Human Immunodeficiency Virus (HIV) Prevention Education in Singapore: Challenges for the Future

We reviewed the current human immunodeficiency virus (HIV) prevention education programmes in Singapore, discussed the challenges faced and proposed prevention education interventions for the future. Education programmes on HIV prevention have shown some success as seen by reduced visits to sex workers among the general adult population and a marked increase in condom use among brothel-based sex workers. However, we still face many challenges such as low awareness of HIV preventive strategies and high prevalence of HIV stigma in the general population. Voluntary HIV testing and condom use remain low among the priority groups such as men who have sex with men (MSM) and heterosexual men who buy sex. Casual sex has increased markedly from 1.1% in 1989 to 17.4% in 2007 among heterosexuals in Singapore, with the majority (84%) practising unprotected sex. Sex workers have moved from brothels to entertainment venues where sex work is mostly hidden with lack of access to sexually transmitted infections (STIs)/ HIV prevention education and treatment programmes. Education programmes promoting early voluntary testing is hampered because of poor access, high cost and stigma towards people living with HIV. It remains a challenge to promote abstinence and consistent condom use in casual and steady sexual relationships among heterosexuals and MSM. New ways to promote condom use by using a positive appeal about its pleasure enhancing effects rather than the traditional disease-oriented approach should be explored. Education programmes promoting early voluntary testing and acceptance of HIV-infected persons should be scaled up and integrated into the general preventive health services.

Measuring stigma: are we looking in the right places? [Correspondence

Measuring stigma: are we looking in the right places? [Correspondence