HIV-Related Stigma Reduction in the Era of Undetectable Equals Untransmittable: The South Korean Perspective

Choi, Jeongyong; Seo, Bo Kyeong

doi:10.3947/ic.2021.0127

Cited by 10 publications

(5 citation statements)

References 42 publications

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“…The promotion of the undetectable = untransmittable (U = U) message is key to tackling HIV stigma in local communities in CEE, and it needs to be disseminated through multiple modalities. Stigma has been impeding the communication of the U = U message from HCPs to patients and its acceptance by the public [ 52 , 53 ], but an evidence-based U = U message can lower stigmatized attitudes [ 54 ]. U = U awareness will also likely reduce anticipated HIV stigma relating to dating and sex [ 55 ], improving the quality of life (QoL) of PLWH.…”

Section: Discussionmentioning

confidence: 99%

Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe

Schweitzer,

Dišković,

Krongauz

et al. 2023

AIDS Res Ther

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Introduction Surging HIV prevalence across countries of Central and Eastern Europe (CEE) is largely a result of poor HIV care engagement and a lack of comprehensive support for key populations. This is fostered by widespread stigma across healthcare, community, and legislative settings. Discussion Throughout CEE, HIV stigma and intersectional stigma are serious obstacles to providing adequate medical care to people living with HIV. Anticipated and enacted (experienced) stigma from healthcare professionals, and fears of breaches in confidentiality, deter individuals from having an HIV test and engaging in HIV care. Furthermore, negative connotations surrounding HIV infection can lead to discrimination from family, friends, colleagues, and the public, leading to internalized stigma and depression. Key populations that have higher HIV prevalence, such as men who have sex with men, people who inject drugs, transgender individuals, and sex workers, experience additional stigma and discrimination based on their behaviour and identities. This contributes to the concentrated HIV epidemics seen in these populations in many CEE countries. The stigma is exacerbated by punitive legislation that criminalizes HIV transmission and penalizes sexual orientation, drug use, gender identities, and sex work. Despite high levels of HIV stigma and intersectional stigma, there are many evidence-based interventions that have reduced stigma in other parts of the world. Here, we discuss the interventions that are currently being enacted in various countries of CEE, and we suggest additional effective, evidence-based interventions that will tackle stigma and lead to increased HIV care engagement and higher rates of viral suppression. We cover the promotion of the undetectable = untransmittable (U = U) message, stigma-reduction education and training for healthcare professionals, patient-centric approaches for testing and treatment, and advocacy for non-discriminatory legislation, policies, and practices. We also consider targeted stigma-reduction interventions that acknowledge the wider challenges faced by marginalized populations. Conclusions HIV stigma and intersectional stigma in CEE drive poor engagement with HIV testing services and care. Widespread adoption of evidence-based interventions to tackle stigma highlighted in this review will improve the quality of life of people living with HIV, improve HIV care engagement, and ultimately slow the surging HIV prevalence and concentrated epidemics occurring throughout CEE.

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Section: Discussionmentioning

confidence: 99%

Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe

Schweitzer,

Dišković,

Krongauz

et al. 2023

AIDS Res Ther

View full text Add to dashboard Cite

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“…Therefore, it is necessary to explore measures to promote patient autonomy in patient-centered care. The Counseling Project must advance beyond controlling biomedical indices, namely drug adherence, suppressing HIV viral loads, and preventing its transmission, and instead transition to a sustainable project that improves patients’ health and quality of life throughout the patient care continuum [ 3 5 43 44 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…As a result of an inaccurate public perception of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and the consequent prejudice and stigma, people living with HIV (PLWH) face an array of physical, psychological, and social hardships [ 1 2 3 ]. Providing psychological support, counseling, and medical education is crucial for promoting self-care among PLWH and controlling infectious diseases in society.…”

Section: Introductionmentioning

confidence: 99%

The Story and Implications of the Korean Health Care Facility Counseling Project on People Living with HIV

Choi,

Lee,

et al. 2023

Infect Chemother

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In 2005, the Korea Disease Control and Prevention Agency (KDCA) launched “Health Care Facility Counseling Project on People Living with human immunodeficiency virus (HIV)” funded by the private-subsidy project for the prevention of acquired immune deficiency syndrome (AIDS) and sexually transmitted diseases to provide people living with HIV (PLWH) psychological support and counsel them about the disease and antiretroviral therapy (ART). Currently, 38 counseling nurse specialists work at 28 healthcare facilities for patient care. Of all PLWH in Korea, 71.9% received benefits from the Counseling Project. Adherence to ART medication (>95.0%), level of depression or anxiety, counseling coverage, and viral load status were monitored as common project indicators. Various specialized programs have been implemented in diverse facilities. This project has played a pivotal role in HIV care continuum and viral suppression policies, resulting in 95.9% of PLWH maintaining undetectable status (<40 copies/ml) in 2021. In this review, we present the chronology and fulfillment of this project, which will be an essential step for future planning in the context of aging and the chronic comorbid nature of HIV/AIDS.

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“…Additionally, depression is associated with increased odds of dropping out of HIV care, a primary cause for treatment failure, and along with stigma, lowers the self-reported quality of life [ 5 6 ]. Also, stigma is a significant hurdle to linkage to care, especially in Korea [ 7 ]. In addition, although adherence to ART has improved due to many efforts, such as UNAIDS' '90-90-90' goal and ‘undetectable = untransmittable’ message, some PLWH still report difficulties in taking ART [ 8 9 10 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Nurse-Delivered Cognitive Behavioral Therapy for Adherence and Depression of People Living with HIV in Korea

Kim

Ye³

et al. 2022

Infect Chemother

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Background Cognitive behavioral therapy for adherence and depression (CBT-AD) performed by clinical psychologists is an effective treatment for improving the depression in people living with HIV (PLWH). However, because access to clinical psychologists is limited in most clinics, CBT-AD is rarely performed for PLWH in Korea. This pilot study evaluates whether CBT-AD can be effectively performed by a nurse trained and supervised by a clinical psychologist, with a view to the wider provision of CBT-AD. Materials and Methods One clinical psychologist developed manuals, educated and supervised one nurse. PLWH with depression or adherence to self-reported antiretroviral therapy <90% were enrolled, and CBT-AD was conducted once weekly for 12 sessions. PLWH were assessed for adherence by visual analog scale, Beck depression inventory (BDI) for depression, PozQoL for quality of life, and Berger’s 40-item stigma scale for stigma at baseline, after the 6th, 12th session, at 4-, and 8-months after CBT-AD. Acceptability for PLWH and feasibility for providers were evaluated through surveys. Results Five male PLWH have completed the study protocols (mean age 29.2 years). All study participants showed improving depression (mean BDI at baseline 33.0 ± 7.0, and after the 12th session 13.4 ± 3.5), and the effect was maintained at the 8-month follow-up (BDI 15.4 ± 6.4). Quality of life showed a tendency to improve (mean PozQoL at baseline 28.0 ± 7.7, after 12th session 36.8 ± 4.4, and at the 8-month follow-up 38.2 ± 7.9), but stigma did not show clear improvement (Berger’s 40-item stigma scale at baseline 121.0 ± 3.9, after 12th session 107.6 ± 8.8. and at the 8-month follow-up 107.6 ± 5.0). All study participants received great help from CBT-AD and expressed their desire to continue. All providers agreed that nurse-delivered CBT-AD could be implemented in routine clinical practice. Conclusion Our findings suggest that a nurse-delivered CBT-AD could be feasible and acceptable for PLWH through structured interventions. It has been shown to have the potential to help PLWH, especially for their depression and quality of life. Trial Registration ClinicalTrials.gov Identifier: NCT03823261

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HIV-Related Stigma Reduction in the Era of Undetectable Equals Untransmittable: The South Korean Perspective

Cited by 10 publications

References 42 publications

Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe

Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe

The Story and Implications of the Korean Health Care Facility Counseling Project on People Living with HIV

Implementation of a Nurse-Delivered Cognitive Behavioral Therapy for Adherence and Depression of People Living with HIV in Korea

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