HIV/AIDS stigma-reduction on VCT uptake: An adapted systematic review

Abstract. Both qualitative and quantitative studies have shown that stigma and discrimination impact people's decisions to access voluntary counseling and testing, (VCT) and treatment services. This systematic review attempts to answer the research question: What is the impact of HIV/AIDS-related stigma reduction interventions on VCT uptake in the developing world? This study used a systematic review. Data was collected from five major databases during 2000 – 2011, and four studies which involved 6.651 participants. The studies were assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool which addressed selection bias, study design, confounders, blinding, data collection, and withdrawals and drop-outs. One study had a 'Strong' Global rating; one had a 'Weak' Global rating. Two had a 'Moderate' Global rating. Other results revealed that lack of stigma, HIV-related knowledge, and self-efficacy were positively related to HIV testing. Also, stigma was found to be a significant barrier to HIV testing and disclosure. In addition, reduced stigma had significant correlations to VCT use, knowing where to get tested, and willingness to disclose test results. Very importantly, positive correlations were found between exposure to a radio serial drama program (intervention) and reduced stigma as well as greater intention to obtain HIV testing. It would appear that revising the existing knowledge about the effectiveness of stigma interventions in reducing stigma is critical to appreciate the effects of reducing HIV/AIDS stigma on VCT uptake in the developing world. More exploratory studies, similar to the study which had a ‘Strong’ Global rating, should be conducted. Key words: HIV/AIDS, Systematic review, Stigma, Interventions, VCT uptake

Keywords:

HIV/AIDS, Systematic review, Stigma, Interventions VCT uptake,

PDF

___

UNAIDS Fast facts about HIV testing and counseling, unaids.org. UNAIDS 2011.
Mann J Statement at an informal briefing on AIDS to the 42nd Session of the United Nations General Assembly, 20 October 1987, New York.
Goffman E. Stigma: Notes on the Management of Spoiled Identity. Garden City, NY: Anchor Books 19 Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Res Nurs Health 2001; 24: 518-5
Scambler G, Hopkins A. Being epileptic: coming to terms with stigma. Sociol Health Illn 1986 1: 26-43.
Markowitz FE. The effects of stigma on the psychological wellbeing and life satisfaction of persons with mental illness. J Health Soc Behav 1998; 39: 335-347.
Deacon H. Towards a sustainable theory of healthrelated stigma: lessons from the HIV/AIDS literature. J Community Appl Soc Psychol 2006; 16: 418-4
Herek GM, Widaman KF, Capitanio JP. When sex equals AIDS: Symbolic stigma and heterosexual adults' inaccurate beliefs about sexual transmission of AIDS. Soc Probl 2005; 52: 15-37.
Link BG. Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. Am Sociol Rev 1987; 52: 96CDC. Revised guidelines for HIV counseling, testing and referral and revised recommendations for HIV screening of pregnant women. MMWR 2001; 50: 1
UNAIDS. Voluntary counseling and testing (VCT). UNAIDS best practice collection: technical update. 2000; 1-12.
Bateganya M, Abdulwadud O A, Kiene S M (2010) Home-based HIV voluntary counseling and testing (VCT) for improving uptake of HIV testing. Cochrane Database of Systematic Reviews 7. Doi: 101002/14651858. CD006493. Pub 4.
McGrath JW, Ankrah EM, Schumann DA, Nkumbi S, Lubega M. AIDS and the urban family: Its impact in Kampala, Uganda. AIDS Care 1993; 5: 55-79.
Alonso AA, Reynolds NR. Stigma, HIV and AIDS: an exploration and elaboration of a stigma trajectory. Soc Sci Med 1995; 41: 303-315.
Raveis VH, Siegel K, Gorey E. Factors associated with HIV-infected women’s delay in seeking medical care. AIDS Care 1998; 10: 549-562.
Bharat S, Aggleton PJ, Tyrer P. India: HIV and AIDS related discrimination, stigmatization and denial. UNAIDS - Joint United Nations Programme on HIV/AIDS, (UNAIDS /01.46E) 2001.
Lieber E, Li L, Wu Z, Rotheram-Borus MJ, Guan J. HIV/STD Stigmatization Fears as Health-Seeking Barriers in China. AIDS Behav 2006; 10: 463-471.
Plummer ML, Mshana G, Wamoyi J, et al. The man who believed he had AIDS was cured’: AIDS and sexually-transmitted infection treatment-seeking behavior in rural Mwanza, Tanzania. AIDS Care 2006; 18: 460-466.
Campbell C, Foulis CA, Maimane S, Sibiya Z. The impact of social environments on the effectiveness of youth HIV prevention: A South African case study. AIDS Care 2005; 17: 471-478.
Sambisa W, Curtis S, Mishra V. AIDS stigma as an obstacle to uptake of HIV testing: evidence from a Zimbabwean national population-based survey. AIDS Care 2010; 22: 170-186.
Ayenew A, Leykun A, Colebunders R, Deribew A. Predictors of HIV testing among patients with tuberculosis in North West Ethiopia: A case-control study. PLoS One 2010; 5: 9702.
Kalichman SC, Simbayi LC. HIV testing attitudes, AIDS stigma, and voluntary HIV counseling and testing in a black township in Cape Town, South Africa. Sex Transm Infect 2003; 79: 442-447.
Babalola S. Readiness for HIV testing among young people in Northern Nigeria: The roles of social norm and perceived stigma. AIDS Behav 2007; 11: 7597
Wolfe WR, Weiser SD, Bangsberg DR, et al. Effects of HIV-related stigma among an early sample of patients receiving antiretroviral therapy in Botswana. AIDS Care 2006; 18: 931-933.
Hutchinson PL, Mahlalela X. Utilization of voluntary counseling and testing services in the Eastern Cape, South Africa. AIDS Care Psychological and Socio-Medical Aspects of AIDS/HIV 2006; 18: 446-455.
Iyaniwura CA, Oloyede O. HIV testing among youths in a Nigerian local population. West Afr J Med 2006; 25: 27-31.
Weiser SD, Heisler M, Leiter K, et al. Routine HIV testing in Botswana: A population-based study on attitudes, practices, and human rights concerns. PLoS, 2006; 3: e261.
Herek G, Capitanio JP, Widaman KF. HIV-related stigma and knowledge in the United States: prevalence and trends, 1991-1999. Am J Public Health 2002; 92: 371-377.
Valdiserri RO. HIV/AIDS Stigma: An Impediment to Public Health. Am J Public Health 2002; 92: 3413
UNAIDS Policy Statement on HIV testing. UNAIDS 200 UNAIDS Reducing HIV stigma and discrimination: a critical part of national AIDS programs. Geneva: Joint United Nations Program on HIV/AIDS 2007.
De Zoysa I, Phillips KA, Kamenga MC, et al. The role of HIV counseling and testing in changing risk behavior in developing countries. AIDS 9 (Suppl A) 1995; 95-101.
Kaiser Family Foundation Hearing their voices: a qualitative research study on HIV testing and higherrisk teens. Washington. The Henry J. Kaiser Family Foundation DC: Kaiser Family Foundation 1999.
Summers T, Spielberg F, Collins C, Coates T. Voluntary counseling and testing and referral for HIV: new technologies, research findings create dynamic opportunities. J Acquir Immune Defic Syndr 2000; 25(2): 128-135.
Pulerwitz J, Michaelis A, Weiss E, Brown L, Mahendra V. Reducing HIV-related stigma: lessons learned from horizons research and programs. Public Health Rep 2010; 125: 272-281.
Mahajan AP, Sayles JN, Patel VA, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS, 2008; 22(2): 67-79.
Cameron E. Breaking the silence. Opening remarks at International Conference on AIDS, Durban, South Africa, 13(1) 2000.
Goldin CS. Stigmatization and AIDS: critical issues in public health. Soc Sci Med 1994; 39: 1359-1366.
Malcolm A, Aggleton P, Bronfman M, et al. HIVrelated stigmatization and discrimination: Its forms and contexts. Crit Public Health 1998; 8: 347-370.
Rennie S, Behets F. Desperately seeking targets: the ethics of HIV testing in low-income countries. Bull World Health Organ 2006; 84: 52-57.
UNDP The Human Development Indices. United Nations Development Programme. Human Development Report 2006.
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6.4, Chichester, The Cochrane Library, UK: John Wiley & Sons, Ltd 2006.
Armstrong R, Waters E, Doyle J eds. Chapter 21: Reviews in health promotion and public health. In: JPT Higgins and S. Green eds. 2007. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0. The Cochrane Collaboration 2007. www.cochrane-handbook.org
Jackson N, Waters E. Criteria for the systematic review of health promotion and public health interventions. Health Promot Int 2005; 20: 367-374.
EPHPP (Effective Public Health Practice Project) Quality Assessment Tool for Quantitative Studies 19 www.ephpp.ca/index.html Fabiani M, Cawthorne A, Nattabi B, et al. Investigating factors associated with uptake of HIV voluntary counseling and testing among pregnant women living in North Uganda. AIDS CarePsychological and Socio-Medical Aspects of AIDS/HIV 2007; 19: 733-739.
Song Y, Li X, Zhang L, et al. HIV-testing behavior among young migrant men who have sex with men (MSM) in Beijing, China. AIDS Care 2011; 23: 1791
Sarker M, Milkowski A, Slanger T, et al. The role of HIV-related knowledge and ethnicity in determining HIV risk perception and willingness to undergo HIV testing among rural women in Burkina Faso. AIDS Behav 2005; 9: 243-249.
Ma W, Wu Z, Qin Y, et al. A comparison of voluntary counseling and testing uptake between a China CARES county and a county not designated for the China CARES program. AIDS Patient Care STDS 2008; 22: 521-533.
Pai NP, Joshi R, Moodie EE, et al. Profile of adults seeking voluntary HIV testing and counseling in rural Central India: Results from a hospital-based study. AIDS Care 2009; 21: 294-300.
Peltzer K, Mlambo G, Phaweni K. Factors determining prenatal HIV testing for prevention of mother to child transmission of HIV in Mpumalanga, South Africa. AIDS Behav 2010; 14: 1115-1123.
Nuwaha F, Kabatesi D, Muganwa M, Whalen CC. Factors influencing acceptability of voluntary counseling and testing for HIV in Bushenyi District of Uganda. East Afr Med J 2002; 79: 626-632.
Kellerman SE, Lehman SJ, Lansky A, et al. HIV Testing Within At-Risk Populations in the United States and the Reasons for Seeking or Avoiding HIV Testing. Journal of Acquired Immune Deficiency Syndromes. J Acquir Immune Defic Syndr 2002; 31: 202-2 Maman S, Mbwambo J, Hogan NM, Kilonzo GP, Sweat M. Women's barriers to HIV-1 testing and disclosure: Challenges for HIV-1 voluntary counseling and testing. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV 2001; 13: 595-60
Hendriksen ES, Hlubinka D, Chariyalertsak S, et al. Keep talking about it: HIV/AIDS-related communication and prior HIV testing in Tanzania, Zimbabwe, South Africa, and Thailand. AIDS Behav 2009; 13: 1213-1221.
Peralta L, Deeds BG, Hipszer S, Ghalib K. Barriers and facilitators to adolescent HIV testing. AIDS Patient Care STDs 2007; 21: 400-408.
Keane V, Hammond G, Keane H, Hewitt J. Quantitative evaluation of counseling associated with HIV testing. Southeast Asian J Trop Med Public Health 2005; 36: 228-232.
Fylkesnes K, Siziya S. A randomized trial on acceptability of voluntary HIV counseling and testing. Trop Med Int Health 2004; 9: 566-572. Bokhour BG, Solomon JL, Knapp H, Asch SM, Gifford AL. Barriers and facilitators to routine
HIV testing in VA primary care. J Gen Intern Med 2009; 24: 1109-1114.
De Paoli MM, Manongi R, Klepp KI. Factors influencing acceptability of voluntary counseling and HIV-testing among pregnant women in Northern Tanzania. AIDS Care 2004; 16: 411-425.
Vidanapathirana J, Abramson Michael J, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database of Systematic Reviews 3, John Wiley & Sons, Ltd., Chichester, UK 200 Exner TM, Hoffman S, Parikh K, Leu CS, Ehrhardt A. HIV counseling and testing: Women's experiences and the perceived role of testing as a prevention strategy. Perspect Sex Reprod Health 2002; 34: 76 Burnett SM, Weaver MR, Mody-Pan PN, Thomas LA, Mar CM. Evaluation of an intervention to increase human immunodeficiency virus testing among youth in Manzini, Swaziland: A randomized control trial. J Adolesc Health 2011; 48: 507-513.
Koku E F. Desire for, and uptake of HIV tests by Ghanaian women: The relevance of community level stigma. J Community Health 2011; 36: 289-299.
Pulerwitz J, Michaelis AP, Lippman SA, Chionalgia M, Diaz J. HIV-related stigma, service utilization, and status disclosure among truck drivers crossing the Southern borders in Brazil. AIDS Care 2008; 20: 764-7
Lippman SA, Pulerwitz J, Chinaglia M, et al. Mobility and its liminal context: Exploring sexual partnering among truck drivers crossing the Southern Brazilian border. . Soc Sci Med 2007; 65: 246424
Berendes S, Rimal NJ. Addressing the Slow Uptake of HIV Testing in Malawi: The Role of Stigma, Selfefficacy, and Knowledge in the Malawi BRIDGE Project. AIDS Care 2011; 22: 215-228.
Pappas-DeLuca KA, Kraft JM, Galavotti C, et al. Entertainment–Education Radio Serial Drama and Outcomes Related to HIV Testing in Botswana. AIDS Educ Prev 2008; 20: 486-503.
Uys L, Chirwa M, Kohi T, et al. Evaluation of a Health Setting-Based Stigma Intervention in Five African Countries. AIDS Patient Care STDS 2009 23: 1059-1066.
Brown L, Macintyre K, Trujillo L. Interventions to reduce HIV/AIDS stigma: what have we learned? AIDS Educ Prev 2003; 15: 49-69.
Sengupta S, Banks B, Jonas D, Miles MS, Smith GC. HIV interventions to reduce HIV/AIDS stigma: a systematic review. AIDS Behav 2011; 15: 107510
Heijnders M, Van Der Meij S. The fight against stigma: an overview of stigma-reduction strategies and interventions. Psychol Health Med 2006; 11: 353-3
Reeve J. An introduction prepared by Dr. Joanne Reeve, as part of the MPH/MRes in Public Health, University of Manchester 2010.
Doucet A, Mauthner N. Knowing responsibly: ethics, feminist epistemologies and methodologies. In: Mauthner M, Birch M, Jessop J, and Miller T (Eds.). Ethics in Qualitative Research. London: Sage. 2002; 123-1
Goodman E, Tipton AC, Hecht L, Chesney MA. Perseverance pays off: health care providers' impact on HIV testing decisions by adolescent females. Pediatrics 1994; 94: 878-882.
Ivers LC, Freedberg KA, Mukherjee JS. Providerinitiated HIV testing in rural Haiti: low rate of missed opportunities for diagnosis of HIV in a primary care clinic. AIDS Res Ther 4: doi:1186/1742-6405-4-28 2007.
Jerene D, Endale A, Lindtjorn B. Acceptability of HIV counselling and testing among tuberculosis patients in south Ethiopia. BMC Int Health Hum Rights 7: doi:10.1186/1472-698X-7-4 2007.