The influence of AIDS stigma and discrimination and social cohesion on HIV testing and willingness to disclose HIV in rural KwaZulu-Natal, South Africa

Karim, Quarraisha Abdool; Meyer-Weitz, Anna; Mboyi, L.; Carrara, Henri; Mahlase, Gethwana; Fröhlich, Janet A.; Karim, Salim S Abdool

doi:10.1080/17441690802076496

Cited by 44 publications

(23 citation statements)

References 25 publications

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“…These directions are consistent with associations reported in prior research [41, 42, 71]. However, findings in this study cannot preclude reverse causality given the cross-sectional nature of these data.…”

Section: Discussionsupporting

confidence: 92%

Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement

2016

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High neighborhood social capital could facilitate earlier diagnosis of HIV and higher rates of linkage and HIV care engagement. Multivariate analysis was used to examine whether social capital (social cohesion, social participation, and collective engagement) in 2004/2006 was associated with lower 5-year average (2007–2011) prevalence of (a) late HIV diagnosis, (b) linked to HIV care, and (c) engaged in HIV care within Philadelphia, PA, United States. Census tracts (N = 332). Higher average neighborhood social participation was associated with higher prevalence of late HIV diagnosis (b = 1.37, se = 0.32, p < 0.001), linked to HIV care (b = 1.13, se = 0.20, p < 0.001) and lower prevalence of engaged in HIV care (b = −1.16, se = 0.30, p < 0.001). Higher collective engagement was associated with lower prevalence of linked to HIV care (b = −0.62, se = 0.32, p < 0.05).The findings of different directions of associations among social capital indicators and HIV-related outcomes underscore the need for more nuanced research on the topic that include longitudinal assessment across key populations.

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Section: Discussionsupporting

confidence: 92%

Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement

2016

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“…Whilst we aimed to collect data on ART use from 2009, we obtained a low response rate which could be due to HIV-related stigma and discriminations which remains pervasive in this community. 46–49 We therefore relied on the district ART data 10, 11 …”

Section: Discussionmentioning

confidence: 99%

Trends in HIV Prevalence in Pregnant Women in Rural South Africa

Kharsany

Fröhlich

Yende‐Zuma

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Despite substantial progress in the delivery of HIV prevention programs, some communities continue to experience high rates of HIV infection. We report on temporal trends in HIV prevalence in pregnant women in a community in rural KwaZulu-Natal (KZN) in South Africa. Methods Annual, anonymous cross-sectional HIV sero-prevalence surveys were conducted between 2001 and 2013 amongst first visit prenatal clinic attendees. The time periods 2001 to 2003 were defined as pre-antiretroviral therapy (ART), 2004 to 2008 as early ART and 2009 to 2013 as contemporary ART roll-out to correspond with the substantial scale-up of ART program. Results Overall, HIV prevalence rose from 35.3% [95% confidence interval (CI) 32.3–38.3] pre-ART (2001–2003) to 39.0% (CI: 36.8–41.1) in the early ART (2004–2008) to 39.3% (CI: 37.2–41.4) in the contemporary ART (2009–2013) roll-out periods. In teenage women (<20 years), HIV prevalence declined from 22.5% (CI: 17.5–27.5) to 20.7% (CI: 17.5–23.8) and to 17.2% (CI: 14.3–20.2) over the similar ART roll-out periods (p=0.046). Prevalence increased significantly in women 30 years and older (p<0.001) over the same time period largely due to survival following ART scale up. Teenage girls with male partners 20–24 and ≥25 years had a 1.7-fold (CI: 1.3–2.4; p=0.001) and 3-fold (CI: 2.1–4.3; p<0.001) higher HIV prevalence respectively. Conclusion Notwithstanding the encouraging decline in teenagers, the ongoing high HIV prevalence in pregnant women in this rural community, despite prevention and treatment programs, is deeply concerning. Targeted interventions for teenagers, especially for those in age-disparate relationships, are needed to impact this HIV epidemic trajectory.

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“…39 Pathways at the ecological level 19,40 include reduced HIV stigma and discrimination, 37 increased availability of information sharing resources 41 such as education for those at risk, and increase economic and social support for those at risk and already infected with HIV. 42 …”

Section: Introductionmentioning

confidence: 99%

Social Capital is Associated With Late HIV Diagnosis: An Ecological Analysis

Ransome

Galea

Pabayo

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Late HIV diagnosis is associated with higher medical costs, early mortality among individuals, and HIV transmission in the population. Even under optimal configurations of stable or declining HIV incidence and increase in HIV case findings, no change in proportion of late HIV diagnosis is projected after year 2019. We investigated the association among social capital, gender, and late HIV diagnosis. Methods We conduct ecological analyses (ZIP code, N=166) using negative binomial regression of gender-specific rates of late HIV diagnoses (an AIDS defining illness or a CD4 count ≤200 cell/µL within 12 months of a new HIV diagnosis) in 2005 and 2006 obtained from the New York City HIV Surveillance Registry, and social capital indicators (civic engagement, political participation, social cohesion, and informal social control) from the New York Social Indicators Survey, 2004. Results Overall, low to high political participation and social cohesion corresponded with significant (p<.0001) decreasing trends in late HIV diagnosis rates. Among men (RR=0.66, 95% CI [0.47—0.98]) and women (RR=0.43, 95% CI [0.28—0.67]), highest political participation was associated with lower relative odds of late HIV diagnosis, independent of income inequality. Highest informal social control (RR=0.67, 95% CI [0.48—0.93]) among men only, and moderate social cohesion (RR=0.71, 95% CI [0.55—0.92]) among women only, were associated with the outcome adjusting for social fragmentation, income inequality, and racial composition. Discussion The magnitude of association between social capital and late HIV diagnosis varies by gender and by social capital indicator.

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The influence of AIDS stigma and discrimination and social cohesion on HIV testing and willingness to disclose HIV in rural KwaZulu-Natal, South Africa

Cited by 44 publications

References 25 publications

Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement

Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement

Trends in HIV Prevalence in Pregnant Women in Rural South Africa

Social Capital is Associated With Late HIV Diagnosis: An Ecological Analysis

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