P4.125 Structural Interventions to Reduce Stigmatization and Increase Uptake of HIV Treatment Services

Nwuba, C; Omoloja, Abiodun Aderogba

doi:10.1136/sextrans-2013-051184.1022

Cited by 1 publication

(13 citation statements)

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“…Most of the studies were published as full articles in peer reviewed journals [44][45][46][47][48][49][50][51][52][53][54][55][56][57], with the remainder published as conference abstracts [58][59][60] or public reports [61][62][63] (Table 1). According to the World Bank geoscheme [89], a third of studies were located in sub-Saharan Africa [45,48,57,59,61,63,83] followed by South Asia [44,54,55,58,60,62]. Among the 10 studies located in East Asia and the Pacific, six took place in China and India which account for over half of people living with HIV in the region [50][51][52]75].…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, two studies had sites in multiple countries, most of which were collectively located in sub-Saharan Africa [47], but one of which also had a single site in Latin American and the Caribbean [56]. The most common study design was a single group pre/post-test comparison [44,45,47,51,52,54,57,59,60,62,63] followed by pre/post-test comparisons with a control group [46,49,55,56,58,61,63] (including one that used a comparative effectiveness trial design [49]) and RCTs [48,50,75].…”

Section: Resultsmentioning

confidence: 99%

“…Interventions conducted by every study in this review focused on the individual-level changes which included strategies such as improvement of HIV knowledge or reduction in discriminatory attitudes. Among these, six studies [44,50,59,60,62,63] additionally included strategies focused on institutional-level change, such as implementation of universal precautions, provision of preventive medical equipment like gloves or sharps containers and reversal of discriminatory clinical practices such as marking patient medical records to signal their HIV status to colleagues.…”

Section: Intervention Strategies and Impactmentioning

confidence: 99%

“…Using the classification strategy introduced by Brown et al, every study in this review was found to have employed at least two strategies as part of the intervention, with some using three [53,54,75] or at most four [59,62] approaches in the same study. Information-based training was included in every study, an approach most commonly deployed through didactic lectures or group discussion.…”

Section: Intervention Strategies and Impactmentioning

confidence: 99%

“…Skills-building was used in all but three of the studies [47,55,60] and involved techniques such as role playing, group brainstorming or sharing of personal experiences. Contact with affected groups was used in less than half [47,[53][54][55]58,59,62,75] of studies, and institutional changes such as desegregation of patients living with HIV from other patients or implementation of universal precautions was used in five studies [44,50,59,60,62]. Physicians and nurses made up the intervention target population of every studyincluding students still in training for medicine and nursingamong which half [44,46,48,49,51,57,59,[61][62][63]75] also included nonclinical staff such as laboratory technicians or administrative staff in their intervention activities.…”

Section: Intervention Strategies and Impactmentioning

confidence: 99%

See 4 more Smart Citations

Combating HIV stigma in low‐ and middle‐income healthcare settings: a scoping review

Smith

Hunt

et al. 2020

J Intern AIDS Soc

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Introduction Nearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low‐ and middle‐income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research. Methods We conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews. Results and discussion Our search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings. Conclusions Combating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self‐reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.

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