HIV Stigma as a Barrier to Retention in HIV Care at a General Hospital in Lima, Peru: A Case–Control Study

Abstract

HIV stigma as a barrier to retention in HIV care has not been well-studied outside the United States. We conducted a case-control study in Lima, Peru to examine this issue. Cases were out-of-care for ≥12 months (n=66) and controls were recruited from patients in active care presenting for a clinic visit (n=110). A previously validated HIV stigma scale with four domains was used. Associations between being out-of-care and each stigma domain were assessed using multivariable logistic regression. Stigma scores were highest for disclosure concerns. Modest associations were found for greater disclosure concerns (OR=1.16; 95% CI: 0.99, 1.36) and concerns with public attitudes (OR=1.20; 95% CI: 1.03, 1.40). Enacted stigma and negative self-image showed non-linear associations with being out-of-care that plateaued or declined, respectively, at higher levels of stigma. The threshold effect for enacted stigma warrants further exploration, while disclosure concerns may be especially amenable to intervention in this population.

Experienced HIV-Related Stigma and Psychological Distress in Peruvian Sexual and Gender Minorities: A Longitudinal Study to Explore Mediating Roles of Internalized HIV-Related Stigma and Coping Styles

“…Importantly, during the first year after diagnosis, 37% of PLWH experience depressive symptoms and 54% report HIV-related psychological distress (7–13). A major contributing factor to mental health outcomes is HIV-related stigma (14–23). HIV-related stigma is generally understood within Goffman’s seminal work (24), wherein stigma is defined as “an attribute that is significantly discrediting” to societies.…”

Discontinuation from Antiretroviral Therapy: A Continuing Challenge among Adults in HIV Care in Ethiopia: A Systematic Review and Meta-Analysis

“…Several studies have suggested that improving knowledge of HIV care as an intervention could influence the retention of HIV positive people[51,52]. Furthermore, according to the seek-test-treat-succeed model, literate HIV infected people[53] have the capacity to provide almost 40% of HIV service-related tasks[54] and could lead to retention and re-engagement into care[47].…”

A Framework for Health Communication Across the HIV Treatment Continuum

“…Barriers at the community level include stigma and discrimination, 16,74–76,81,89,94–97 limited ART knowledge within the community, lack of community involvement in program planning, and lack of community mobilization around ART. 74,78,94,96 Inequitable gender norms, including community stereotypes of masculinity and femininity are key determinants of delayed linkage to care and treatment.…”

“…16,25,81,87,89,97,105–110 Interventions engaging traditional practitioners and faith healers yielded mixed results. Although 1 study 111 demonstrated that training traditional healers led to increased referral rates in Mozambique, others 112–114 did not find such an effect.…”