A model for understanding the relationship between stigma and healthcare-seeking behaviour among people living with HIV/AIDS in sub-Saharan Africa

Abstract

People living with HIV or AIDS (PLHIV) in sub-Saharan Africa sometimes have care-seeking behaviours that result in a suboptimal quality of life. This paper seeks to examine the role of stigma in the care-seeking behaviour of PLHIV. We hypothesise that stigma relates to the behaviour of PLHIV themselves and with societal reactions, including those of healthcare professionals. From a literature review, we identified the following as important correlates of care-seeking behavior: beliefs about pathways of HIV infection and people infected with HIV, social reactions, coping strategies, knowledge of HIV and AIDS, and self-efficacy in finding care and treatment in addition to coping with the disease. Poverty, gender, age, religion and policy were found to be moderating variables. The Precede-Proceed model was adapted to build an explanatory model of healthcare-seeking behaviour among PLHIV and particularly to explore the role of stigma in the non-utilisation of healthcare institutions.

Associates of Comprehensive HIV/AIDS Knowledge and Acceptance Attitude among Male Youth Aged 15-24: Comparison Study among Ivory Coast, Cameroon and Gabon

“…Similar study was found in Botswana, in which Christian youth had more positive attitudes towards PLHA than those who have no religion [28]. In the lives of the sub-Saharan Africans, religion plays a major role and has been recognized as a factor which may alleviate the HIV/AIDS stigma [47]. In a study done in Ethiopia, being religious and religious service attendant was found to be the highest significant factor where respondents who attend the religious service at least once a week were 7 times more likely to have favorable attitude than those who didn't attend the religious service [44].…”

The Experiences and Complexities of Care-Seeking Behavior of People Living with HIV/AIDS: A Qualitative Study in Nigeria

“…The model adapted from the Precede portion of the (Green & Kreuter, 1999) Precede-Proceed model was helpful in understanding HIV-stigma related problems, coping mechanisms and care-seeking behaviors of PLWHA which can affect utilization of health-care institutions (Mbonu et al, 2009). This study shows that certain determining and moderating variables are important for PLWHA, in order for them to cope with HIV/AIDS and to make care choices.…”

“…Following prior research on stigma in relation to HIV/AIDS (Mbonu, Van Den Borne & De Vries, 2009), using an inductive approach from an extensive literature review in SubSaharan Africa, we adapted the Precede portion of the Precede-Proceed model (Green & Kreuter, 1999) as an explanatory model. The PRECEDE-PROCEED model provides a systematic approach for assessing quality-of-life of health and for designing, implementing, and evaluating health education and health promotion programs.…”

“…PROCEED includes an implementation phase, an intervention process evaluation, impact evaluation of changes in behavior or environment, and an outcome evaluation in which the impact on health and quality of life is assessed (Green & Kreuter, 1999). Since models are constantly modified to fit the situation (Chiang et al, 2003), we specified the model to the health care-seeking behaviour among PLWHA and used it to analyse people's coping strategies in dealing with stigma-related problems (Mbonu et al, 2009). The model proposes that a complex health problem, such as careseeking behaviour of PLWHA, is a function of various factors; and these factors have to be considered from a wider perspective of the social structural context.…”

Societal Beliefs and Reactions About People Living with HIV/AIDS

“…(Gari et al, 2010;Anglewicz, et al, 2011;Stutterheim et al, 2011). In a previous study, we reviewed behavioral problems of PLWHA in Sub-Saharan Africa in seeking care, and argued that this is partly due to stigmatizing responses to PLWHA from health care professionals and society at large (Mbonu, Van den Borne, & De Vries, 2009). Given the negative impact of stigma on care seeking and the selective disclosure of a positive HIV-sero-status to close and trusted people, it is important to understand why HIV/AIDS attracts such a degree of negative reaction in society.…”