HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV

Pantelic, Marija; Boyes, Mark; Cluver, Lucie; Meinck, Franziska

doi:10.7448/ias.20.1.21771

Cited by 85 publications

(108 citation statements)

References 56 publications

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“…Discrimination refers to overt instances of being treated differently from others due to a person’s HIV status [7]. Adolescents living with HIV are subjected to discrimination within their communities and families both because of their own HIV status and, sometimes, because of their caregivers’ HIV status [8‐10]. Adolescents living with HIV also report frequent instances of healthcare providers getting angry and shouting at them, which they experience as discrimination [3].…”

Section: Introductionmentioning

confidence: 99%

“…Being a target of discrimination can lead to internalized stigma [11], which occurs when adolescents internalize stigmatizing characterizations of people living HIV and accept them as applicable to themselves [12]. Internalized stigma evokes feelings of shame, guilt, helplessness and, in some cases, suicidal ideation [10,13‐16]. A national survey of more than 10,000 people living with HIV in South Africa found that 36% reported experiencing discrimination and 43% reported experiencing internalized HIV stigma in the past year.…”

Section: Introductionmentioning

confidence: 99%

“…Qualitative evidence on adolescent HIV and the broader literature on adolescent development suggests that HIV‐related discrimination and internalized shame act as profound barriers to engagement with health services among young people living with HIV [10,15‐16,18,19]. Adolescence is a time when self‐conceptions develop [20].…”

Section: Introductionmentioning

confidence: 99%

“…The lower weight and height‐for‐age experienced by adolescents born with HIV [23] is recognized by young people in high HIV‐prevalence settings to be a marker of HIV [26]. These difficulties make adolescents living with HIV particularly vulnerable to discrimination and the ensuing internalized‐stigma [10].…”

Section: Introductionmentioning

confidence: 99%

“…The effects of discrimination on adolescent long‐term retention in HIV care have not yet been quantified [27]. The link between HIV‐related discrimination and internalized stigma has been quantitatively tested in both adolescent [10] and adult populations [11]. A growing body of adult‐focused evidence suggests that internalized stigma has onward effects on retention in HIV care [15,28,29], suggesting a potential pathway from discrimination to compromised retention in care via internalized stigma.…”

Section: Introductionmentioning

confidence: 99%

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Multiple forms of discrimination and internalized stigma compromise retention in HIV care among adolescents: findings from a South African cohort

et al. 2020

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Introduction Efficacious antiretroviral treatment (ART) enables people to live long and healthy lives with HIV but young people are dying from AIDS‐related causes more than ever before. Qualitative evidence suggest that various forms of HIV‐related discrimination and resulting shame act as profound barriers to young people’s engagement with HIV services. However, the impact of these risks on adolescent retention in HIV care has not been quantified. This study has two aims: (1) to examine whether and how different types of discrimination compromise retention in care among adolescents living with HIV in South Africa; and (2) to test whether internalized stigma mediates these relationships. Methods Between 2014 and 2017, adolescents living with HIV (aged 10 to 19) from 53 health facilities in the Eastern Cape, South Africa, were interviewed at baseline (n = 1059) and 18‐month follow‐up (n = 979, 92.4%), with responses linked to medical records. Data were analysed through multiple regression and mediation models. Results About 37.9% of adolescents reported full retention in care over the 2‐year period, which was associated with reduced odds of viral failure (OR: 0.371; 95% CI: .224, .614). At baseline, 6.9% of adolescents reported discrimination due to their HIV status; 14.9% reported discrimination due to HIV in their families and 19.1% reported discrimination in healthcare settings. Healthcare discrimination was associated with reduced retention in care both directly (effect: −0.120; CI: −0.190, −0.049) and indirectly through heightened internalized stigma (effect: 0.329; 95% CI: 0.129, 0.531). Discrimination due to family HIV was associated with reduced retention in care both directly (effect: −0.074, CI: −0.146, −0.002) and indirectly through heightened internalized stigma (effect: 0.816, CI: 0.494, 1.140). Discrimination due to adolescent HIV was associated with reduced retention in care only indirectly, through increased internalized stigma (effect: 0.408; CI: 0.102, 0.715). Conclusions Less than half of adolescents reported 2‐year retention in HIV care. Multiple forms of discrimination and the resultant internalized stigma contributed to this problem. More intervention research is urgently needed to design and test adolescent‐centred interventions so that young people living with HIV can live long and healthy lives in the era of efficacious anti‐retroviral treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multiple forms of discrimination and internalized stigma compromise retention in HIV care among adolescents: findings from a South African cohort

et al. 2020

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A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

et al. 2019

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Introduction Women living with HIV (WLHIV) experience stigma and elevated exposure to violence in comparison with HIV‐negative women. We examined the mediating role of experiencing recent violence in the relationship between stigma and depression among WLHIV in Canada. Methods We conducted a cohort study with WLHIV in three Canadian provinces. Recent violence was assessed through self‐reported experiences of control, physical, sexual or verbal abuse in the past three months. At Time 1 (2013‐2015) three forms of stigma were assessed (HIV‐related, racial, gender) and at Time 2 (2015‐2017) only HIV‐related stigma was assessed. We conducted structural equation modelling (SEM) using the maximum likelihood estimation method with Time 1 data to identify direct and indirect effects of gender discrimination, racial discrimination and HIV‐related stigma on depression via recent violence. We then conducted mixed effects regression and SEM using Time 1 and Time 2 data to examine associations between HIV‐related stigma, recent violence and depression. Results At Time 1 (n = 1296), the direct path from HIV‐related stigma (direct effect: β = 0.200, p < 0.001; indirect effect: β = 0.014, p < 0.05) to depression was significant; recent violence accounted for 6.5% of the total effect. Gender discrimination had a significant direct and indirect effect on depression (direct effect: β = 0.167, p < 0.001; indirect effect: β = 0.050, p < 0.001); recent violence explained 23.15% of the total effect. Including Time 1 and Time 2 data (n = 1161), mixed‐effects regression results indicate a positive relationship over time between HIV‐related stigma and depression (Acoef: 0.04, 95% CI: 0.03, 0.06, p < 0.001), and recent violence and depression (Acoef: 1.95, 95% CI: 0.29, 4.42, p < 0.05), controlling for socio‐demographics. There was a significant interaction between HIV‐related stigma and recent violence with depression (Acoef: 0.04, 95% CI: 0.01, 0.07, p < 0.05). SEM analyses reveal that HIV‐related stigma had a significant direct and indirect effect on depression over time (direct effect: β = 0.178, p < 0.001; indirect effect: β = 0.040, p < 0.001); recent violence experiences accounted for 51% of the total effect. Conclusions Our findings suggest that HIV‐related stigma is associated with increased experiences of recent violence, and both stigma and violence are associated with increased depression among WLHIV in Canada. There is an urgent need for trauma‐informed stigma interventions to address stigma, discrimination and violence.

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Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa

et al. 2019

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Introduction Adolescent girls and young women aged 15 to 24 years have some of the highest HIV incidence rates globally, with girls two to four times more likely to be living with HIV than their male peers. High levels of intimate partner violence ( IPV ) experienced by this age group is a significant risk factor for HIV acquisition. While behavioural interventions to prevent IPV and HIV in southern Africa have seen some success in reducing self‐reported experiences of IPV , these interventions have largely failed to achieve similar outcomes for young women. Discussion We identify three main reasons for the failure of IPV / HIV interventions for many young women in southern Africa. First, interventions are usually developed without the meaningful involvement of both young women and young men. Youth input into research design is largely focused on user testing or consultation of targeted groups, involving relatively low levels of participation. Second, interventions are focused on addressing individual risk factors rather than broader social and structural contexts of being a young woman. “Risk factor” interventions, rather than supporting women's agency, can pose a major barrier for supporting changes in behaviour among young women because they often fail to dislodge well‐entrenched gender and age‐related inequalities. Third, current intervention models have not adequately accounted for changes in gender norms and relationships across southern Africa. Individuals are getting married later in life (or not at all), new technologies are transforming romantic interactions and opening new opportunities for violence, and discussions about women's rights are both challenging gender inequalities and reinforcing them. Conclusions In order to move beyond the status quo of current approaches, and to support real innovation, IPV / HIV prevention interventions need to be co‐developed with youth as part of a meaningful participatory process of research, intervention design, youth involvement in development and implementation. This process of co‐development needs to be radical and break with the current focus on adapting existing interventions to meet the needs of young people, which are not well understood and often do not directly reflect their priorities. Broader social contexts and compound lenses are needed to avoid narrow approaches and to accommodate evolving norms.

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HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV

Cited by 85 publications

References 56 publications

Multiple forms of discrimination and internalized stigma compromise retention in HIV care among adolescents: findings from a South African cohort

Multiple forms of discrimination and internalized stigma compromise retention in HIV care among adolescents: findings from a South African cohort

A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa

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