Open AccessDimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial
Author(s) -
Cecilia Akatukwasa,
Monica Getahun,
Alison M. El Ayadi,
Judith Namanya,
Irene Maeri,
Harriet Itiakorit,
Lawrence Owino,
Naomi Sanyu,
Jane Kabami,
Emmanuel Ssemmondo,
Norton Sang,
Dalsone Kwarisiima,
Maya Petersen,
Edwin D. Charlebois,
Gabriel Chamie,
Tamara D. Clark,
Craig R. Cohen,
Moses R. Kamya,
Elizabeth A. Bukusi,
Diane V. Havlir,
Carol S. Camlin
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0249462
Subject(s) - stigma (botany) , psychological intervention , verbal abuse , shame , medicine , social stigma , qualitative research , psychiatry , thematic analysis , clinical psychology , psychology , human immunodeficiency virus (hiv) , poison control , social psychology , suicide prevention , family medicine , environmental health , social science , sociology
HIV-related stigma is a frequently cited barrier to HIV testing and care engagement. A nuanced understanding of HIV-related stigma is critical for developing stigma-reduction interventions to optimize HIV-related outcomes. This qualitative study documented HIV-related stigma across eight communities in east Africa during the baseline year of a large HIV test-and-treat trial (SEARCH, NCT: 01864603), prior to implementation of widespread community HIV testing campaigns and efforts to link individuals with HIV to care and treatment. Findings revealed experiences of enacted, internalized and anticipated stigma that were highly gendered, and more pronounced in communities with lower HIV prevalence; women, overwhelmingly, both held and were targets of stigmatizing attitudes about HIV. Past experiences with enacted stigma included acts of segregation, verbal discrimination, physical violence, humiliation and rejection. Narratives among women, in particular, revealed acute internalized stigma including feelings of worthlessness, shame, embarrassment, and these resulted in anxiety and depression, including suicidality among a small number of women. Anticipated stigma included fears of marital dissolution, verbal and physical abuse, gossip and public ridicule. Anticipated stigma was especially salient for women who held internalized stigma and who had experienced enacted stigma from their partners. Anticipated stigma led to care avoidance, care-seeking at remote facilities, and hiding of HIV medications. Interventions aimed at reducing individual and community-level forms of stigma may be needed to improve the lives of PLHIV and fully realize the promise of test-and-treat strategies.