Building a Conceptual Framework to Study the Effect of HIV Stigma-Reduction Intervention Strategies on HIV Test Uptake: A Scoping Review

Thapa, Subash; Hannes, Karin; Cargo, Margaret; Buvé, Anne; Aro, Arja R.; Matheï, Catharina

doi:10.1016/j.jana.2017.04.004

Cited by 15 publications

(19 citation statements)

References 38 publications

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“…Appropriately powered studies specifically tailored for transgender women in sub-Saharan Africa would facilitate the robust analyses needed to fill gaps in knowledge of diverse transgender populations and to identify which transgender populations may be most vulnerable to HIV. Knowing that stigma drives both depression [ 61 ] and vulnerability to HIV infection, funders and national governments should invest in routine stigma surveillance [ 62 ] and the scale-up of effective transgender-inclusive stigma-reduction interventions [ 63 , 64 ] as key components of their HIV strategies. Transgender populations are emerging across sub-Saharan Africa: the data presented here suggest the need to understand the HIV epidemiology and specific HIV prevention and treatment needs of transgender populations in this region.…”

Section: Discussionmentioning

confidence: 99%

HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis

et al. 2017

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IntroductionSub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries.Methods and findingsRespondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January–August 2013), Côte d’Ivoire (March 2015–February 2016), The Gambia (July–December 2011), Lesotho (February–September 2014), Malawi (July 2011–March 2012), Senegal (February–November 2015), Swaziland (August–December 2011), and Togo (January–June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42–2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63–2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12–1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05–2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49–2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65–2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments.ConclusionsIn this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs.

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Section: Discussionmentioning

confidence: 99%

HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis

et al. 2017

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“…This realist review was informed by a scoping review of empirical and grey literature on stigma reduction interventions to develop a preliminary programme theory (see Figure 1 ), which has been published elsewhere [ 8 ]. The scoping review resulted in an initial programme theory consisting of 4 types of intervention strategies (i.e., awareness creation, influencing normative behaviour, providing support, and developing regulatory laws), three proximal outcomes (i.e., improvement of knowledge, change of attitude and behaviour) and one distal outcome (i.e., HIV test uptake).…”

Section: Methodsmentioning

confidence: 99%

“…Several interventions to reduce HIV stigma have been developed and evaluated for their impacts on HIV test uptake. Some interventions have context-specific effects [ 8 ]. For example, interventions to increase access to HIV testing through a home-based testing approach in Kenya [ 9 ] and Zambia [ 10 ] were noted to reduce HIV stigma and increase HIV test uptake.…”

Section: Introductionmentioning

confidence: 99%

“…This review aims to address whether and how HIV stigma can be reduced to maximize public health benefits via increasing HIV test uptake in LMICs. Especially in LMICs, low income along with illiteracy and traditional beliefs may influence the association between stigma reduction and HIV test uptake [ 8 ]. Moreover, there is heterogeneity in the ways in which HIV stigma is experienced across different communities, and it is likely that the interventions and mechanisms that work to reduce HIV stigma and increase HIV testing may also vary between communities and individuals.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, there is heterogeneity in the ways in which HIV stigma is experienced across different communities, and it is likely that the interventions and mechanisms that work to reduce HIV stigma and increase HIV testing may also vary between communities and individuals. The potential different pathways leading people to or pulling them away from HIV testing, thus, need to be unpacked [ 8 ]. Therefore, we conducted this realist review to understand how stigma is reduced in relation to HIV test uptake in LMICs.…”

Section: Introductionmentioning

confidence: 99%

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Stigma reduction in relation to HIV test uptake in low- and middle-income countries: a realist review

Thapa

Hannes²,

Cargo

et al. 2018

BMC Public Health

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BackgroundThis realist review was conducted to understand how stigma is reduced in relation to HIV test uptake in low- and middle-income countries (LMICs).MethodsA systematic search of eight databases resulted in 34 articles considered for synthesis. Data synthesis was guided by a preliminary programme theory and included coding the meaning units to develop themes or intervention pathways that corresponded to context-mechanism-outcome configurations.ResultsWe found that the interventions produced an effect through two pathways: (a) knowledge leads to changes in stigmatizing attitudes and increases in HIV test uptake and (b) knowledge and attitudes lead to changes in stigmatizing behaviours and lead to HIV test uptake. We also found one competing pathway that illustrated the direct impact of knowledge on HIV test uptake without changing stigmatizing attitudes and behaviour. The identified pathways were found to be influenced by some structural factors (e.g., anti-homosexuality laws, country-specific HIV testing programmes and policies), community factors (e.g., traditional beliefs and practices, sexual taboos and prevalence of intimate partner violence) and target-population characteristics (e.g., age, income and urban-rural residence).ConclusionsThe pathways and underlying mechanisms support the adaptation of intervention strategies in terms of social context and the target population in LMICs.

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Pathways for reduction of HIV‐related stigma: a model derived from longitudinal qualitative research in Kenya and Uganda

Camlin

Charlebois

Getahun

et al. 2020

J. Intern. AIDS Soc.

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Introduction The rollout of antiretroviral therapy (ART) has been associated with reductions in HIV‐related stigma, but pathways through which this reduction occurs are poorly understood. In the newer context of universal test and treat (UTT) interventions, where rapid diffusion of ART uptake takes place, there is an opportunity to understand the processes through which HIV‐related stigma can decline, and how UTT strategies may precipitate more rapid and widespread changes in stigma. This qualitative study sought to evaluate how a UTT intervention influenced changes in beliefs, attitudes and behaviours related to HIV. Methods Longitudinal qualitative in‐depth semi‐structured interview data were collected within a community‐cluster randomized UTT trial, the Sustainable East Africa Research in Community Health (SEARCH) study, annually over three rounds (2014 to 2016) from two cohorts of adults (n = 32 community leaders, and n = 112 community members) in eight rural communities in Uganda and Kenya. Data were inductively analysed to develop new theory for understanding the pathways of stigma decline. Results We present an emergent theoretical model of pathways through which HIV‐related stigma may decline: internalized stigma may be reduced by two processes accelerated through the uptake and successful usage of ART: first, a reduced fear of dying and increased optimism for prolonged and healthy years of life; second, a restoration of perceived social value and fulfilment of subjective role expectations via restored physical strength and productivity. Anticipated stigma may be reduced in response to widespread engagement in HIV testing, leading to an increasing number of HIV status disclosures in a community, “normalizing” disclosure and reducing fears. Improvements in the perceived quality of HIV care lead to people living with HIV (PLHIV) seeking care in nearby facilities, seeing other known community members living with HIV, reducing isolation and facilitating opportunities for social support and “solidarity.” Finally, enacted stigma may be reduced in response to the community viewing the healthy bodies of PLHIV successfully engaged in treatment, which lessens the fears that trigger enacted stigma; it becomes no longer socially normative to stigmatize PLHIV. This process may be reinforced through public health messaging and anti‐discrimination laws. Conclusions Declines in HIV‐related stigma appear to underway and explained by social processes accelerated by UTT efforts. Widespread implementation of UTT shows promise for reducing multiple dimensions of stigma, which is critical for improving health outcomes among PLHIV.

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Building a Conceptual Framework to Study the Effect of HIV Stigma-Reduction Intervention Strategies on HIV Test Uptake: A Scoping Review

Cited by 15 publications

References 38 publications

HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis

HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis

Stigma reduction in relation to HIV test uptake in low- and middle-income countries: a realist review

Pathways for reduction of HIV‐related stigma: a model derived from longitudinal qualitative research in Kenya and Uganda

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