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Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial

HIV-related stigma is a frequently cited barrier to HIV testing and care engagement. A nuanced understanding of HIV-related stigma is critical for developing stigma-reduction interventions to optimize HIV-related outcomes. This qualitative study documented HIV-related stigma across eight communities...

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Autores principales: Akatukwasa, Cecilia, Getahun, Monica, El Ayadi, Alison M., Namanya, Judith, Maeri, Irene, Itiakorit, Harriet, Owino, Lawrence, Sanyu, Naomi, Kabami, Jane, Ssemmondo, Emmanuel, Sang, Norton, Kwarisiima, Dalsone, Petersen, Maya L., Charlebois, Edwin D., Chamie, Gabriel, Clark, Tamara D., Cohen, Craig R., Kamya, Moses R., Bukusi, Elizabeth A., Havlir, Diane V., Camlin, Carol S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128261/
https://www.ncbi.nlm.nih.gov/pubmed/33999961
http://dx.doi.org/10.1371/journal.pone.0249462
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author Akatukwasa, Cecilia
Getahun, Monica
El Ayadi, Alison M.
Namanya, Judith
Maeri, Irene
Itiakorit, Harriet
Owino, Lawrence
Sanyu, Naomi
Kabami, Jane
Ssemmondo, Emmanuel
Sang, Norton
Kwarisiima, Dalsone
Petersen, Maya L.
Charlebois, Edwin D.
Chamie, Gabriel
Clark, Tamara D.
Cohen, Craig R.
Kamya, Moses R.
Bukusi, Elizabeth A.
Havlir, Diane V.
Camlin, Carol S.
author_facet Akatukwasa, Cecilia
Getahun, Monica
El Ayadi, Alison M.
Namanya, Judith
Maeri, Irene
Itiakorit, Harriet
Owino, Lawrence
Sanyu, Naomi
Kabami, Jane
Ssemmondo, Emmanuel
Sang, Norton
Kwarisiima, Dalsone
Petersen, Maya L.
Charlebois, Edwin D.
Chamie, Gabriel
Clark, Tamara D.
Cohen, Craig R.
Kamya, Moses R.
Bukusi, Elizabeth A.
Havlir, Diane V.
Camlin, Carol S.
author_sort Akatukwasa, Cecilia
collection PubMed
description HIV-related stigma is a frequently cited barrier to HIV testing and care engagement. A nuanced understanding of HIV-related stigma is critical for developing stigma-reduction interventions to optimize HIV-related outcomes. This qualitative study documented HIV-related stigma across eight communities in east Africa during the baseline year of a large HIV test-and-treat trial (SEARCH, NCT: 01864603), prior to implementation of widespread community HIV testing campaigns and efforts to link individuals with HIV to care and treatment. Findings revealed experiences of enacted, internalized and anticipated stigma that were highly gendered, and more pronounced in communities with lower HIV prevalence; women, overwhelmingly, both held and were targets of stigmatizing attitudes about HIV. Past experiences with enacted stigma included acts of segregation, verbal discrimination, physical violence, humiliation and rejection. Narratives among women, in particular, revealed acute internalized stigma including feelings of worthlessness, shame, embarrassment, and these resulted in anxiety and depression, including suicidality among a small number of women. Anticipated stigma included fears of marital dissolution, verbal and physical abuse, gossip and public ridicule. Anticipated stigma was especially salient for women who held internalized stigma and who had experienced enacted stigma from their partners. Anticipated stigma led to care avoidance, care-seeking at remote facilities, and hiding of HIV medications. Interventions aimed at reducing individual and community-level forms of stigma may be needed to improve the lives of PLHIV and fully realize the promise of test-and-treat strategies.
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spelling pubmed-81282612021-05-27 Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial Akatukwasa, Cecilia Getahun, Monica El Ayadi, Alison M. Namanya, Judith Maeri, Irene Itiakorit, Harriet Owino, Lawrence Sanyu, Naomi Kabami, Jane Ssemmondo, Emmanuel Sang, Norton Kwarisiima, Dalsone Petersen, Maya L. Charlebois, Edwin D. Chamie, Gabriel Clark, Tamara D. Cohen, Craig R. Kamya, Moses R. Bukusi, Elizabeth A. Havlir, Diane V. Camlin, Carol S. PLoS One Research Article HIV-related stigma is a frequently cited barrier to HIV testing and care engagement. A nuanced understanding of HIV-related stigma is critical for developing stigma-reduction interventions to optimize HIV-related outcomes. This qualitative study documented HIV-related stigma across eight communities in east Africa during the baseline year of a large HIV test-and-treat trial (SEARCH, NCT: 01864603), prior to implementation of widespread community HIV testing campaigns and efforts to link individuals with HIV to care and treatment. Findings revealed experiences of enacted, internalized and anticipated stigma that were highly gendered, and more pronounced in communities with lower HIV prevalence; women, overwhelmingly, both held and were targets of stigmatizing attitudes about HIV. Past experiences with enacted stigma included acts of segregation, verbal discrimination, physical violence, humiliation and rejection. Narratives among women, in particular, revealed acute internalized stigma including feelings of worthlessness, shame, embarrassment, and these resulted in anxiety and depression, including suicidality among a small number of women. Anticipated stigma included fears of marital dissolution, verbal and physical abuse, gossip and public ridicule. Anticipated stigma was especially salient for women who held internalized stigma and who had experienced enacted stigma from their partners. Anticipated stigma led to care avoidance, care-seeking at remote facilities, and hiding of HIV medications. Interventions aimed at reducing individual and community-level forms of stigma may be needed to improve the lives of PLHIV and fully realize the promise of test-and-treat strategies. Public Library of Science 2021-05-17 /pmc/articles/PMC8128261/ /pubmed/33999961 http://dx.doi.org/10.1371/journal.pone.0249462 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Akatukwasa, Cecilia
Getahun, Monica
El Ayadi, Alison M.
Namanya, Judith
Maeri, Irene
Itiakorit, Harriet
Owino, Lawrence
Sanyu, Naomi
Kabami, Jane
Ssemmondo, Emmanuel
Sang, Norton
Kwarisiima, Dalsone
Petersen, Maya L.
Charlebois, Edwin D.
Chamie, Gabriel
Clark, Tamara D.
Cohen, Craig R.
Kamya, Moses R.
Bukusi, Elizabeth A.
Havlir, Diane V.
Camlin, Carol S.
Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial
title Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial
title_full Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial
title_fullStr Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial
title_full_unstemmed Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial
title_short Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial
title_sort dimensions of hiv-related stigma in rural communities in kenya and uganda at the start of a large hiv ‘test and treat’ trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128261/
https://www.ncbi.nlm.nih.gov/pubmed/33999961
http://dx.doi.org/10.1371/journal.pone.0249462
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