Falling Short of the First 90: HIV Stigma and HIV Testing Research in the 90–90–90 Era

Sullivan, Matthew C.; Rosen, Aviana O; Allen, Aerielle; Benbella, Diane; Camacho, Gabriel; Cortopassi, Andrew C.; Driver, Redd; Ssenyonjo, Jude; Eaton, Lisa A.; Kalichman, Seth C.

doi:10.1007/s10461-019-02771-7

Cited by 56 publications

(46 citation statements)

References 56 publications

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“…It increases the risk of mental health problems (33)(34)(35). It also hinders utilization of different HIV/AIDS related services (31,(36)(37)(38).…”

Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Predictors of Discrimination Towards People Living With HIV/ AIDS Among People Aged 15–49 Years in Ethiopia: A Multilevel Analysis

Arefaynie

Damtie

Kefale

et al. 2020

Preprint

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BackgroundThere is limited national representative evidence on determinants of discrimination towards people living with HIV/AIDS especially, community level factors are not investigated in Ethiopia. Thus, this study aimed to assess individual and community level factors associated with discrimination towards people living with HIV/AIDS among 15 to 49 age people in Ethiopia.MethodA secondary data analysis was done on the 2016 Ethiopian Demographic and Health Survey dataset which were collected cross-sectional. A total of 25,927 15 to 49 age people were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA version 14.0 to identify individual and community-level factors. Adjusted odds ratio with 95% confidence interval was used to show the strength and direction of association and statistical significance was declared at P value less than 0.05.Resultfrom individual variables, female [AOR=1.47, 95% CI= (1.18, 1.83)], rural dwellers [AOR=1.65, 95% CI= ( 1.23, 2.21)], not attend education[AOR=5.88,95% CI= (4.50, 7.67)], attending primary education [AOR=3.03, 95% CI= (2.40, 3.81)] and attending secondary education [AOR=1.48, 95% CI= ( 1.19, 1.82)] have discrimination attitude towards people living with HIV/AIDS. From community level factors, live in low proportion of educated communities [AOR=1.33, 95% CI= (1.01, 1.65)], live in low proportion of HIV tested communities [AOR=1.61, 95% CI= (1.33, 1.93)] were significantly associated with people living with HIV/AIDS.Conclusionsex of the respondent, religion, educational status, house hold wealth index, marital status, media exposure, internet use, HIV test status, region, residence, community level of education and community level of HIV test status have significant association with HIV related stigma in Ethiopia. Improving educational coverage, improving community level HIV/AIDS test coverage are important interventions to reduce discrimination towards people living with HIV/AIDS in the country.

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“…It increases the risk of mental health problems (33)(34)(35). It also hinders utilization of different HIV/AIDS related services (31,(36)(37)(38).…”

Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Predictors of Discrimination Towards People Living With HIV/ AIDS Among People Aged 15–49 Years in Ethiopia: A Multilevel Analysis

Arefaynie

Damtie

Kefale

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…HIV testing is a crucial entry point to other services such as HIV prevention, treatment, care and support; and early diagnosis can reduce transmission and improve health outcomes (Armstrong et al, 2013;Janssen et al, 2019). Despite progress in increasing access to antiretrovirals (ARVs), without testing and diagnosing, efforts to achieve the 90-90-90 goals will be thwarted (Sullivan et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…Prior research has reported on the inconsistency between willingness to be tested and testing uptake due to barriers such as fear, stigma, perceived lack of confidentiality, and embarrassment (Mohlabane et al, 2016;Strauss et al, 2015). The social context of persistent HIV stigma and discrimination makes the prospect of receiving a positive result a daunting one (Sullivan et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

“There is no fear in me … well, that little fear is there”: dualistic views towards HIV testing among South African adolescent girls and young women

Duby

Jonas

Appollis

et al. 2020

African Journal of AIDS Research

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Adolescents and young people in South Africa As of 2017, the HIV prevalence rate amongst young people aged 15-24 years in South Africa was 8% (Simbayi et al., 2019). Efforts to curb the HIV epidemic continue to be thwarted by low rates of HIV diagnosis and treatment initiation among adolescents in South Africa (Armstrong et al., 2013; Asaolu et al., 2016; Wong et al., 2017). Testing rates among those in the age group 15-19 are the lowest for any age group in South Africa (Maskew et al., 2019; Simbayi et al., 2019). In order to achieve the UNAIDS fast-track 90-90-90 and 95-95-95 targets, there is a need to target adolescents and young people for testing and treatment (Abuelezam et al., 2019). Adolescent girls and young women in South Africa The disproportionate burden of HIV amongst adolescent girls and young women (AGYW) in South Africa is evident, both in the 15-19 age group (4.7% in males vs 5.8% in females), and even more pronounced in the 20-24 age group (4.8% in males vs 15.6% in females) (George et al., 2020). Rates of HIV-incidence in South Africa are highest amongst AGYW aged 15-24 years (1.5% compared to 0.5% in young males of the same age (George et al., 2020). In spite of the high HIV burden and high prevalence and incidence of HIV infection among AGYW, uptake of HIV testing in this population falls short of the 90-90-90 targets (Maskew et al., 2019). A nationally representative survey conducted in South Africa in 2017 reported that 32% of females aged 15-24 years had never tested for HIV (50%

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“…There is, however, counter-evidence that HIV stigma persists in many settings, even in contexts of the ART rollout [6,7]; and, results from a five-country study were equivocal, suggesting that although increased access to ART may lower HIV stigma, stigma was found to have declined in only two of the five sites in which ART was scaled-up [8]. A recent review of research on HIV stigma and HIV testing in the 90-90-90 era highlighted the role of persistent stigma in shortfalls towards achieving testing targets (the "first 90") across sub-Saharan Africa [9].…”

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confidence: 99%

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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Falling Short of the First 90: HIV Stigma and HIV Testing Research in the 90–90–90 Era

Cited by 56 publications

References 56 publications

WITHDRAWN: Predictors of Discrimination Towards People Living With HIV/ AIDS Among People Aged 15–49 Years in Ethiopia: A Multilevel Analysis

WITHDRAWN: Predictors of Discrimination Towards People Living With HIV/ AIDS Among People Aged 15–49 Years in Ethiopia: A Multilevel Analysis

“There is no fear in me … well, that little fear is there”: dualistic views towards HIV testing among South African adolescent girls and young women

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

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