A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States

Rice, Whitney S.; Turan, Bülent; Fletcher, Faith E.; Nápoles, Tessa M.; Walcott, Melonie; Batchelder, Abigail; Kempf, Mirjam-Colette; Konkle‐Parker, Deborah; Wilson, Tracey E.; Tien, Phyllis C.; Wingood, Gina M.; Neilands, Torsten B.; Johnson, Mallory O.; Weiser, Sheri D.; Turan, Janet M.

doi:10.1089/apc.2018.0282

Cited by 64 publications

(51 citation statements)

References 53 publications

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“…The prevalence [37‐39], forms [38‐43] and consequences [4,7‐9,12‐13,33] of health facility HIV stigma are well documented across the globe, as are key drivers of that stigma, including fear of contracting HIV in the workplace, lack of awareness and understanding of stigma, attitudes and the health facility institutional environment [4,37,40‐41,44‐49]. Yet despite this evidence and global recognition of the need to tackle stigma – especially in health facilities – there is little concrete evidence of concerted efforts by countries and donors to scale‐up stigma‐reduction interventions in health facilities within national HIV responses.…”

Section: Introductionmentioning

confidence: 99%

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

Nyblade

Addo²,

Atuahene

et al. 2020

J Intern AIDS Soc

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Introduction: Stigma undermines all aspects of a comprehensive HIV response, as reflected in recent global initiatives for stigma-reduction. Yet a commensurate response to systematically tackle stigma within country responses has not yet occurred, which may be due to the lack of sufficient evidence documenting evaluated stigma-reduction interventions. With stigma present in all life spheres, health facilities offer a logical starting point for developing and expanding stigma reduction interventions. This study evaluates the impact of a "total facility" stigma-reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff in Ghana. Methods: We evaluated the impact of a total facility stigma-reduction intervention by comparing five intervention to five comparable non-intervention health facilities in Ghana. Interventions began in September 2017. Data collection was in June 2017 and April 2018. The primary outcomes were composite indicators for three stigma drivers, self-reported stigmatizing avoidance behaviour, and observed discrimination. The principal intervention variable was whether the respondent worked at an intervention or comparison facility. We estimated intervention effects as differences-in-differences in each outcome, further adjusted using inverse probability of treatment weighting (IPTW). Results: We observed favourable intervention effects for all outcome domains except for stigmatizing attitudes. Preferring not to provide services to people living with HIV (PLHIV) or a key population member improved 11.1% more in intervention than comparison facility respondents (95% CI 3.2 to 19.0). Other significant improvements included knowledge of policies to protect against discrimination (difference-in-differences = 20.4%; 95% CI 12.7 to 28.0); belief that discrimination would be punished (11.2%; 95% CI 0.2 to 22.3); and knowledge of and belief in the adequacy of infection control policies (17.6%; 95% CI 8.3 to 26.9). Reported observation of stigma and discrimination incidents fell by 7.4 percentage points more among intervention than comparison facility respondents, though only marginally significant in the IPTW-adjusted model (p = 0.06). Respondents at intervention facilities were 19.0% (95% CI 12.2 to 25.8) more likely to report that staff behaviour towards PLHIV had improved over the last year than those at comparison facilities. Conclusions: These results provide a foundation for scaling up health facility stigma-reduction within national HIV responses, though they should be accompanied by rigorous implementation science to ensure ongoing learning and adaptation for maximum effectiveness and long-term impact.

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Section: Introductionmentioning

confidence: 99%

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

Nyblade

Addo²,

Atuahene

et al. 2020

J Intern AIDS Soc

View full text Add to dashboard Cite

show abstract

“…[26][27][28] Research has also shown that personal values held by providers may interfere with discussing sexual behaviors with their patients, 25 and patient anticipated stigma in health care settings has been correlated with lower adherence to ART. 29 This underscores that targeted educational and stigma reduction efforts with providers in the southern United States, like those who participated in this study, are warranted.…”

Section: Geographic Information System Results/analysismentioning

confidence: 93%

Perceptions of Patient HIV Risk by Primary Care Providers in High-HIV Prevalence Areas in the Southern United States

Drumhiller

Geter

Elmore

et al. 2020

AIDS Patient Care and STDs

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The southern United States accounted for 52% of new HIV diagnoses in 2015. Visits to primary care providers (PCPs) offer opportunities for routine HIV screening. However, of at-risk persons in the United States who visited a health care provider within the previous year, >75% were not offered a test for HIV. Perceptions of patient population risk by PCPs could offer insight into these missed opportunities, and inform development of HIV testing interventions for PCPs to increase routine screening. During April-October 2017, we conducted online surveys regarding PCP's perceptions of patient HIV risk in six areas of the South with high-HIV prevalence. Surveys queried HIV-related knowledge, beliefs, attitudes, and practices. Free-text responses to the question ''Are there any unique or special risk factors relating to HIV infection in your patient population?'' were analyzed using NVivo for applied thematic analysis. Of 526 respondents, the mean age was 47 years with 65% white, 13% Asian/other, 13% black, 6% Hispanic/Latino; 71% female; 93% straight/heterosexual; and 35% offered HIV screening correctly based on standard of care. Main themes revealed were as follows: (1) provider perceptions of patient risk factors (e.g., ''injection drug use is rampant''), (2) provider perceptions of patient barriers to access and care (e.g., ''concern for parental notification and cost for treatment''), and (3) provider misconceptions of HIV risk and patient stigmatization (e.g., ''I have a low-risk population''). Our findings suggest that PCPs in the South may warrant education regarding local HIV prevalence and routine HIV screening and prevention practices.

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“…That is, it is the duty of health care providers to make efforts to include members of racial and ethnic minorities in all HIV studies so the trials more closely represent the population of people living with HIV. Current studies continue to show the stigma experienced or anticipated by minorities and women with HIV in the health care system, 79 illustrating the need for designing studies to increase participant in clinical trials that address this stigma. Polanco et al 80 suggest that building interdisciplinary teams that include researchers with racial and ethnic diversity can help build an infrastructure that makes it easier to not only recruit these populations but to have them agree to participate.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Engagement of Racial and Ethnic Minorities in HIV Treatment and Vaccine Clinical Trials: A Scoping Review of Literature and Implications for Future Research

Bass

DʼAvanzo

Mohammed

et al. 2020

AIDS Patient Care and STDs

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HIV disproportionately impacts US racial and ethnic minorities but they participate in treatment and vaccine clinical trials at a lower rate than whites. To summarize barriers and facilitators to this participation we conducted a scoping review of the literature guided by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies published from January 2007 and September 2019 were reviewed. Thirty-one articles were identified from an initial pool of 325 records using three coders. All records were then assessed for barriers and facilitators and summarized. Results indicate that while racial and ethnic minority participation in these trials has increased over the past 10 years, rates still do not proportionately reflect their burden of HIV infection. While many of the barriers mirror those found in other disease clinical trials (e.g., cancer), HIV stigma is a unique and important barrier to participating in HIV clinical trials. Recommendations to improve recruitment and retention of racial and ethnic minorities include training health care providers on the importance of recruiting diverse participants, creating interdisciplinary research teams that better represent who is being recruited, and providing culturally competent trial designs. Despite the knowledge of how to better recruit racial and ethnic minorities, few interventions have been documented using these strategies. Based on the findings of this review, we recommend that future clinical trials engage community stakeholders in all stages of the research process through community-based participatory research approaches and promote culturally and linguistically appropriate recruitment and retention strategies for marginalized populations overly impacted by HIV.

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A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States

Cited by 64 publications

References 53 publications

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

Perceptions of Patient HIV Risk by Primary Care Providers in High-HIV Prevalence Areas in the Southern United States

Exploring the Engagement of Racial and Ethnic Minorities in HIV Treatment and Vaccine Clinical Trials: A Scoping Review of Literature and Implications for Future Research

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