How Does Antiretroviral Treatment Attenuate the Stigma of HIV? Evidence from a Cohort Study in Rural Uganda

Abstract

Program implementers and qualitative researchers have described how increasing availability of HIV antiretroviral therapy (ART) is associated with improvements in psychosocial health and internalized stigma. To determine whether, and through what channels, ART reduces internalized stigma, we analyzed data from 262 HIV-infected, treatment-naïve persons in rural Uganda followed from ART initiation over a median of 3.4 years. We fitted Poisson regression models with cluster-correlated robust estimates of variance, specifying internalized stigma as the dependent variable, adjusting for time on treatment as well as socio-demographic, clinical, and psychosocial variables. Over time on treatment, internalized stigma declined steadily, with the largest decline observed during the first two years of treatment. This trend remained statistically significant after multivariable adjustment (χ2=28.3; p=0.03), and appeared to be driven by ART-induced improvements in HIV symptom burden, physical and psychological wellbeing, and depression symptom severity.

Types and predictors of partner reactions to HIV status disclosure among HIVinfected adult Nigerians in a tertiary hospital in the Niger Delta

“…Antiretroviral drugs improve general well-being and physical health of HIV-infected patients and the use of ART is known to reduce HIV-related stigma. 22 In one study, stigma and discrimination was eliminated after initiating of ART with some participants reporting about friends and families "returning to them" and "apologizing for abandoning" them once they started "looking well." 23 In studies conducted mainly in developed countries, negative outcome to disclosure was commonest among unmarried sexual partners, sero-discordant couples, and patients with low economic status, especially Africa Americans.…”

Predictors of internalised HIV-related stigma: a systematic review of studies in sub-Saharan Africa

“…Six articles reported on prospective cohort data (Cuca et al, 2012;Makoae et al, 2009;Peltzer, 2012;Tsai, Bangsberg, Bwana, et al, 2013;Wagner, Ghosh-Dastidar, Garnett, Kityo, & Mugyenyi, 2013) and one reported on both prospective cohort data and cross-sectional data (Pearson et al, 2009). …”

“…Within facilities, five studies used total or random sampling of participants (Cuca et al, 2012;Pearson et al, 2009;Takada et al, 2014;Tsai, Bangsberg, Bwana, et al, 2013;Wagner et al, 2013); one used purposive sampling (Cloete et al, 2008); and five used convenience sampling (Kalichman et al, 2009;Neuman & Obermeyer, 2013;Sorsdahl et al, 2011;Visser et al, 2008;Visser & Sipsma, 2013). The remaining six articles did not report methods used to sample participants within facilities.…”

“…The most common measurement used in seven included articles was the Internalized AIDSrelated Stigma Scale (IA-RSS), developed by Kalichman and colleagues (2009) (Cloete et al, 2008;Kalichman et al, 2009;Peltzer, 2012;Simbayi et al, 2007b;Takada et al, 2014;Tsai et al, 2012;Tsai, Bangsberg, Bwana, et al, 2013). Five articles (Cuca et al, 2012;Holzemer et al, 2007;Makoae et al, 2009;Nattabi et al, 2011;Sorsdahl et al, 2011) reported use of the negative self-perception subscale of the HIV/AIDS Stigma Instrument-PLWA (HASI-P).…”

“…Five articles reported a response or retention rate ≥70% (Nattabi et al, 2011;Pearson et al, 2009;Simbayi et al, 2007b;Tsai, Bangsberg, Bwana, et al, 2013;Wagner et al, 2013). Three studies (Cuca et al, 2012;Makoae et al, 2009;Peltzer, 2012) reported response or retention rates below 70%.…”