Addressing stigma among persons living with HIV through the Sujaag project in Pakistan: A socioecological analysis

Abstract

HIV-related stigma causes multifaceted problems for people with lived experiences. Stigma leads to feelings of shame and disgrace, and marginalizes persons living with HIV and their caregivers by marring social relationships and impacting health outcomes. In April 2019 Ratodero Tehsil in Larkana District, Pakistan, had an HIV outbreak, where evidence highlighted increase in infection rates among non-high-risk populations, including children. In the aftermath of this outbreak, affected families faced loss of communal ties in part due to stigmatizing attitudes. The Sujaag Project employed Participatory Action Research strategies to address HIV-based stigma and enhance acceptance of people living with HIV in the region. By utilizing a qualitative methodology, this study reports manifestations in changes in HIV stigma at four layers of the Socioecological Model: Individual, Interpersonal, Community and Social, and Macro levels. Findings from focus group discussions and reflective narrative reports gathered at varied points of the project cycle create an understanding of how HIV-related stigma affects wellbeing

External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events

“…Participants explained how long-standing informal relationships among target communities and organizations involved in the intervention engendered trust in new activities or programs facilitating the involvement of hard-to-reach populations, which is broadly consistent with the community engagement literature ( 37 , 69 , 74 – 76 ). Long-term community engagement also contributed to organizational capacity for culturally-appropriate interventions, as well as the recruitment and retention of community staff whose contributions to COVID-19 vaccine events were described as essential factors in the success of the events through cultural congruence which created and reinforced trust among Hispanic and Marshallese individuals who were more comfortable with members of their own community ( 74 , 77 – 79 ).…”

“…Recent calls for IS to focus on health equity and adopt justice-focused approaches requires an increased focus on organizational relationships and community engagement, and implementation researchers could draw on the robust CEnR literature to improve health equity ( 73 , 77 , 80 , 81 ). Addressing structural health inequalities at the intersections of race, gender, sexual orientation, and immigration status will require a greater focus on incorporating interested communities and individuals into the development, implementation, and evaluation of interventions ( 27 , 28 , 32 , 82 , 27 ).…”

On the history and growth of the stigma concept: A reflection on the positioning of social relationships in stigma research

“…Lattaner and Hatzenbuehler (2023) for example trace the impact of structural stigma through to perceptions of structural stigma and its effects on loneliness and perceived lack of support, whereas Khurshid et al. (2023) examine HIV in the cultural and structural context of Pakistan. Other papers address within‐the‐person identity threat (Froelich et al., 2023) or stereotype threat (Turetsky et al., 2023) whereas others focus on interpersonal enactment of stigma (Ballinger et al., 2023; Schmidt et al., 2023; Yampolsky et al., 2023).…”

“…At the same time, while the special issue generated a focus on social relationships it also allowed a broad consideration of many different stigmatizing circumstances. Relationship stigma is considered with respect to gender (Turetsky et al, 2023), low socioeconomic status (Park et al, 2023;Pestnik et al, 2023), mental illness (Ballinger et al, 2023) transgender people (Lewis et al, 2023) racism (Debrosse et al, 2023), same sex couples (Frost & Leblanc, 2023), weight (Schmidt et al, 2023), HIV (Gamarel et al, 2023;Khurshid et al, 2023), immigration status (Froehlich et al, 2023), gay men (Eschliman et al, 2023;Lattanner & Hatzenbuehler, 2023), homelessness (Rea, 2023), and women who earn more than their male partners (Vink et al, 2023). A final paper addressed 23 circumstances to show that mothers who experience stigma report more controlling behaviors with their daughters (Kazmierski et al, 2023. In addition to the breadth of conditions considered, the papers in the special issue span multiple levels.…”

“…A final paper addressed 23 circumstances to show that mothers who experience stigma report more controlling behaviors with their daughters (Kazmierski et al, 2023. In addition to the breadth of conditions considered, the papers in the special issue span multiple levels. Lattaner and Hatzenbuehler (2023) for example trace the impact of structural stigma through to perceptions of structural stigma and its effects on loneliness and perceived lack of support, whereas Khurshid et al (2023) examine HIV in the cultural and structural context of Pakistan. Other papers address within-the-person identity threat (Froelich et al, 2023) or stereotype threat (Turetsky et al, 2023) whereas others focus on interpersonal enactment of stigma (Ballinger et al, 2023;Schmidt et al, 2023;Yampolsky et al, 2023).…”