Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination

Abstract

A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been tried. Using a PICOTS framework and applying the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, we undertook a systematic review to determine the success of interventions aiming to address internalized stigma, stigma and discrimination in healthcare, and at the legal or policy level, and to identify their critical success factors. Random effects meta-analyses summarized results wherever possible. We carried out a component analysis to identify and characterize successful interventions. Internalized stigma interventions were diverse: across all studies, we found a reduction of stigma but it was not statistically significant [standardized mean difference (SMD) 0.56; confidence interval (CI) 0.31-1.02; 17 studies). For interventions to address stigma and discrimination in healthcare settings, effect estimates varied considerably but most studies showed positive effects (SMD 0.71; CI 0.60-0.84, 8 studies). Boosted regression analyses found that a combined approach comprising education, counseling, community participation, support person, and access to a HIV specialist often yielded success. Studies of efforts to address stigma and discrimination through law and policy documented, mostly qualitatively, the effect of court cases and directives. Across a range of settings and populations, promising interventions have been identified that, through diverse pathways, have positively impacted the types of stigma and discrimination studied. This evidence base must be built upon and brought to scale to help reach global HIV-related targets and, most importantly, improve the health and quality of life of people with HIV.

Associations between Stigma, Depression, and Adherence to Antiretroviral Therapy in Brazilian Men Who Have Sex with Men Living with HIV

“…Since HIV-related stigma, in its different manifestations, has been identified as a threat to the global response to the HIV epidemic [ 14 , 25 , 26 ], several interventions have been developed and tested to address it. A recent systematic review, in which 70 articles were evaluated, indicated different fronts for confronting HIV-related stigma [ 52 ]. The most-tested measures aimed at treating the harmful effects associated with stigma include tailored interventions to manage internalized homophobia, which usually shows a bidirectional relationship with HIV-related stigma.…”

“…Interventions in this area mostly involve the creation of support groups for people living with HIV, respecting sociodemographic specificities and those related to other possible additional stigmas, such as sexual stigma, racism, and ageism [ 52 ]. Meetings typically occur weekly, for several months, and are led by trained facilitators or mental health professionals.…”

“…Interventions comprised psychoeducational stages, in which information is presented about HIV diagnosis, treatment, possible impacts on physical and mental health, as well as strategies to minimize them. There are also psychotherapeutic approaches, usually based on cognitive-behavioral psychotherapies, associated with the identification and analysis of dysfunctional beliefs about HIV, as well as training in socioemotional skills [ 52 ]. The focus of these groups is also the prevention of social isolation, which is a common phenomenon among MSM diagnosed with HIV, and is associated with poorer mental and physical health [ 27 , 53 ].…”

“…The focus of these groups is also the prevention of social isolation, which is a common phenomenon among MSM diagnosed with HIV, and is associated with poorer mental and physical health [ 27 , 53 ]. Thus, these groups promote social networking and the exchange of literacy between individuals in a similar situation [ 52 ].…”

“…The occasional participation of trained lawyers to act as advocates for the rights of people living with HIV also takes place. These professionals provide information on rights guaranteed by law to people living with HIV, such as the right to HIV confidentiality, the illegality of requesting HIV serology by companies and the right to dignity in the community, as well as information on how to proceed in situations in which these legal frameworks may be disrespected [ 52 ]. Furthermore, meetings specifically arranged for the purpose of health education are also developed, in which a health professional, in addition to presenting relevant information about the dynamics of HIV infection and its effects on the body, also promotes nutritional and lifestyle counseling, with the aim of increasing the quality of life and promoting protective factors for the physical and mental health of participants.…”