Perceived stigma among patients receiving antiretroviral treatment: A prospective randomised trial comparing an m-DOT strategy with standard-of- care in Kenya

Abstract

HIV and AIDS remain highly stigmatised. Modified directly observed therapy (m-DOT) supports antiretroviral treatment (ART) adherence but little is known about its association with perceived stigma in resource-constrained settings. In 2003, 234 HIV-infected adults enrolled in a two-arm randomised trial comparing a health centre-based m-DOT strategy with standard self-administration of ART. Data on perceived stigma were collected using Berger's HIV stigma scale prior to starting ART and after 12 months. This was a secondary analysis to examine whether perceived stigma was related to treatment delivery. Perceived stigma scores declined after 12 months of treatment from a mean of 44.9 (sd=7.6) to a mean of 41.4 (sd=7.7), (t=6.14, P<0.001). No differences were found between the mean scores of participants in both study arms. Also, no difference in scores was detected using GLM, controlling for socio-demographic characteristics and baseline scores. Findings indicate that a well managed clinic-based m-DOT does not increase perceived HIV-related stigma.

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

“…Our primary finding, that there was a trend towards decreasing internalized stigma scores over time on ART, is consistent with both qualitative [20–23] and large-sample [24, 25] studies. The effect on stigma was substantive in magnitude and sustained over at least two years of treatment.…”

“…These observations have also been borne out in qualitative studies showing that treatment was associated with improved self-image among HIV-infected persons in South Africa and Zimbabwe [20–23]. Large sample studies have yielded conflicting findings about the extent to which treatment reduces the stigma of HIV [24–27]. These studies were restricted to relatively brief periods of data collection, however, and were unable to ascertain the robustness of any observed trends.…”

Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs

“…In Mombasa, the network of positive people is small and poorly organized and, our previous study showed that PLHIV were reluctant to reveal their status and were poorly networked, with high levels of internalized stigma. This has also been reported by other African studies [11,12,28]. Our study sample consisted of 76% female participants.…”

“…Health workers identified PLHIV in their community and asked these PLHIV to bring in others they knew. As our previous study showed us that PLHIV in Mombasa are relatively isolated due to stigma and disclosure concerns [28], health workers were permitted to add new 'seeds' if PLHIV were unable to bring in peers.…”

Effectiveness of a community-based positive prevention intervention for people living with HIV who are not receiving antiretroviral treatment: a prospective cohort study

“…PLHIV in Mombasa are poorly networked and reluctant to reveal their status 17 . As there is no listing of PLHIV in the community, each CHW first identified 2 to 3 unrelated index PLHIV and then asked the index PLHIVs to connect the CHW to other PLHIV they knew.…”