Background: The lack of cause of death information is the main challenge in monitoring the effectiveness of interventions aimed at reducing HIV and AIDS-related deaths in countries where the majority of deaths occur a...Background: The lack of cause of death information is the main challenge in monitoring the effectiveness of interventions aimed at reducing HIV and AIDS-related deaths in countries where the majority of deaths occur at home. Objective: To evaluate the accuracy of physician reviewers of verbal autopsies in diagnosing HIV and AIDS-related deaths in the adult population of Addis Ababa, the capital of Ethiopia. Methods: This study was done within the context of a burial surveillance system in Addis Ababa. Trained interviewers completed a standard verbal autopsy questionnaire and an independent panel of physicians reviewed the completed form to assign cause of death. Physicians' review was compared to a reference standard constructed based on prospectively collected HIV-serostatus and patients' hospital record. Sensitivity and specificity were calculated to validate the physicians' verbal autopsy diagnoses against reference standards. Results: Physicians accurately identified AIDS-related deaths with sensitivity and specificity of 0.88 (95% CI: 0.80 - 0.93) and 0.77 (95% CI: 0.64 - 0.87), respectively. Generally, there was high level of agreement (Cohen's Kappa Statistic (K > 0.6) between the first two physicians with some yearly variations. In 2008 and 2009 there was an almost perfect agreement (K > 0.80). Conclusion: This study demonstrated the agreement level between two independent physicians in diagnosing AIDS-related death is very high and thus using a single verbal autopsy coder is practical for programmatic purposes in countries where there is critical shortage of doctors.展开更多
Purpose: There is extensive evidence regarding the relationship between HIV related stigma and disclosure;however, the influence of depression in this relationship is not well understood, and thus is the focus of our ...Purpose: There is extensive evidence regarding the relationship between HIV related stigma and disclosure;however, the influence of depression in this relationship is not well understood, and thus is the focus of our analysis. Methods: Baseline data from a prospective longitudinal cohort of 798 HIV patients starting ART in Kampala, Uganda were examined. A staged-approach regression analysis was used to examine variables associated with HIV disclosure to most people (general disclosure) and disclosure to primary sex partner. Internalized HIV stigma plus demographic and background covariates were first entered into the model;the binary indicator of clinical depression was added on step two, followed by the addition of the interaction of stigma and depression in step three. Separate analyses were conducted for each of the two disclosure outcomes. Results: 39% indicated that they kept their HIV status as a secret from most people, while 19% of respondents with a regular sex partner had not disclosed their HIV status to the partner. In bivariate analysis, respondents who preferred to keep their HIV status as a secret from most people had higher internalized HIV stigma (p < 0.001) and depression (p < 0.01), and were more likely to be clinically depressed (p < 0.01) compared with others in the sample. Similarly, participants who had not disclosed their HIV status to their main sex partner had higher internalized HIV stigma (p < 0.01) and depression (p < 0.05), and were more likely to be clinically depressed (p < 0.01) compared with those who had informed their partner of their HIV status. The regression analysis revealed that internalized HIV stigma was strongly negatively correlated with disclosure to primary partner, while depression was not associated. In the regression analysis for general disclosure, both stigma and depression were negatively correlated with disclosure when the interaction term was included in the model. Further analysis showed that internalized HIV stigma was more strongly associated with general disclosure among participants who were not depressed. Conclusions: Although there was clearly a strong and consistent association between internalized HIV stigma and depression symptoms, the strong association between internalized HIV stigma and general disclosure among respondents who were not depressed indicated that HIV stigma was in itself remained a strong barrier to HIV disclosure. Therefore, interventions to reduce internalized HIV stigma may aid in efforts to decrease secondary transmission of HIV.展开更多
A study was conducted to explore stigma and discrimination among people living with HIV and AIDS who were on home based care in the Lilongwe district of Malawi. The study design was descriptive through sectional and u...A study was conducted to explore stigma and discrimination among people living with HIV and AIDS who were on home based care in the Lilongwe district of Malawi. The study design was descriptive through sectional and utilized qualitative data collection and analysis method. Fifteen people living with HIV and AIDS, aged between 15 and 60 years were purposively sampled from three organizations, which were: Light House, National Association for people living with HIV and AIDS in Malawi and Lilongwe Diocese. Qualitative data were collected using an open ended interview guide during in-depth face to face interviews with the participants. The data were analysed using ATLAS. ti 5.0. Results show that all the participants were facing stigma and discrimination because they were living with HIV and AIDS. Distant relatives were the main source of stigma and discrimination followed by friends and church members. Most participants indicated that they felt they were discriminated because HIV infection is associated with bad behaviours such as prostitution or promiscuity. However some of them complained that they contracted the virus from their married partners and hence they did not deserve to be stigmatized or discriminated against. Results show that there is a need for creation of awareness among community members on the transmission of HIV and the need for home based care for the chronically ill people living with HIV and AIDS.展开更多
Labor migrants are those of the at-risk groups for HIV. This cross-sectional study has tried to examine HIV/AIDS-related stigma among Nepalese returnee male labor migrants. Migrant workers who have worked at least six...Labor migrants are those of the at-risk groups for HIV. This cross-sectional study has tried to examine HIV/AIDS-related stigma among Nepalese returnee male labor migrants. Migrant workers who have worked at least six months abroad were asked different questions related to sexual behavior, knowledge on HIV/AIDS & condom and HIV/AIDS-related stigma. Stigma was measured on a three-point rating scale as high, average and low stigma. About 58% of migrants had the view “I would rather not know if I have HIV” followed by “I don’t want to be friends with people living with HIV” (53.6% migrants) and “people with HIV are cursed” (35.5% migrants). High stigma was present among 15.5% of the total respondents with high proportion among those with higher age, lower education, rural residence, and no knowledge on Voluntary Counseling and Testing (VCT) service. About a quarter of respondents were of the view that migrants infected with HIV while abroad should not be allowed to return Nepal. Some level of stigma on HIV/AIDS exists among male labor migrants in Nepal. Interventions aiming at reducing stigma should consider the factors like migrants’ age, education, place of residence and knowledge on VCT services.展开更多
Namibia has been affected by the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) pandemic with infected and affected persons experiencing stigma at different levels. Despite the high ...Namibia has been affected by the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) pandemic with infected and affected persons experiencing stigma at different levels. Despite the high level of knowledge?on HIV/AIDS, stigma remains a challenge. It was for this reason that this paper describes and measures the level of HIV/AIDS stigma in a rural community in Namibia. Mixed methods were used to collect data from 224 participants consisting of 93 people living with HIV/AIDS (PLWHA) who were recruited voluntarily from their support groups, 77 family members nominated by PLWHA participants, 31 community members who were recruited through simple random sampling and 19 opinion leaders who were purposefully selected and four health care workers from an Antiretroviral clinic who were available at the time of this study. Three measurement instruments namely HIV/AIDS Stigma Instrument-PLWHA (HASI-P), Family & Community Stigma Instrument (F&C-SI) and HIV/AIDS Stigma Instrument-Nurse (HASI- N) were used. In-depth interviews were conducted to complement the quantitative results. The study found that stigma manifests in different ways and results revealed that verbal abuse (55%, n = 50, PLWHA), social isolation (73%, n = 67), negative self-perception (33%, n = 30), and household stigma (26% n = 19, family members) were the most common form of stigma experienced by PLWHA. Furthermore health care workers reported stigma of association (50%, n = 2) as care providers for people living with HIV/AIDS. The study concluded that stigma exists although some scores such as fear of contagion and workplace stigma were low. Therefore, interventions in knowledge on basic facts of HIV transmission need to be strengthened. Nonetheless the majority of participants confirmed their willingness to care for sick relatives with HIV and AIDS. This study did not explore stigma of association against caregivers with other participants other than the four health care workers from the antiretroviral clinic. Future researchers can take this further.展开更多
Research encourages evidence-based guidelines for practice. This paper describes the guidelines for HIV/AIDS stigma reduction in the community. These guidelines were developed by the authors based on findings of the s...Research encourages evidence-based guidelines for practice. This paper describes the guidelines for HIV/AIDS stigma reduction in the community. These guidelines were developed by the authors based on findings of the study which was conducted to develop and evaluate HIV/AIDS stigma reduction intervention in a rural Namibian community. The developed intervention consisted of three strategies which are recommended as baseline for these guidelines. The three strategies were: education, community involvement and contacts with infected and affected groups that were implemented in this study. These strategies were implemented among the people living with HIV/AIDS (PLWHA), their families and community members from the intervention group. The post-intervention results showed significant differences on stigma reduction between the intervention and control groups, therefore these strategies were recommended for future use. Furthermore, the study found that a combination of strategies was more effective than using a single approach. Another strategy that was absent in this study but was recommended in these guidelines for future stigma reduction was: counselling approach, which could be used to address internal stigma. This paper therefore recommends that these combined strategies: education, community involvement, contacts with affected and infected groups and continuous counselling, which will be named ECCC approach might be useful to reduce HIV/AIDS stigma in the community.展开更多
目的了解深圳市宝安区医疗机构中医务工作者艾滋病(HIV)相关的羞辱和歧视(S&D)现况,为制定相关政策提供依据。方法在2019年10月至2020年1月期间,采用标准化测量工具,对18家公立和私立医院的1235名医务人员进行横断面调查。收集人口...目的了解深圳市宝安区医疗机构中医务工作者艾滋病(HIV)相关的羞辱和歧视(S&D)现况,为制定相关政策提供依据。方法在2019年10月至2020年1月期间,采用标准化测量工具,对18家公立和私立医院的1235名医务人员进行横断面调查。收集人口学资料、HIV感染担忧、医疗机构中存在的羞辱与歧视现象或政策等数据信息。结果医务人员HIV感染担忧发生率为73.1%(95%CI:70.5%~75.6%);包扎伤口65.0%(95%CI:62.2%~67.8%)和测体温82.5%(95%CI:78.8%~83.4%)时最为担忧;与男性相比,女性更容易产生担忧情绪;护士比医生更担忧HIV职业感染;接受培训是防止因接触HIV患者而产生感染焦虑的保护因素。21.3%(95%CI:18.9%~23.6%)的受访者承认会避免与艾滋病感染者(people living with HIV,PLWH)有身体接触;53.0%(95%CI:50.1%~55.9%)的受访者在与PLWH接触时会选择戴双层手套,有75.4%(95%CI:72.9%~77.9%)的受访者认为艾滋病感染者应该到指定的传染病专科医院就诊。60.7%(95%CI:72.9%~77.9%)的医务人员认为,HIV育龄妇女不应该再生育。42.7%(95%CI:39.8%~45.6%)的受访者报告自己所在医疗机构中没有或不知道关于严禁歧视PLWH的文件或制度。结论在医疗卫生机构中,存在针对PLWH羞辱与歧视的现象。保障PLWH获得平等医疗卫生服务的权利,医疗机构中减少HIV相关羞辱与歧视的干预工作必要且紧迫。展开更多
目的了解我国HIV感染者/AIDS患者的感知歧视水平,并分析其影响因素。方法便利抽取河南省和湖北省四地市的313例HIV感染者/AIDS患者为研究对象,采用Berger艾滋病耻辱量表(Berger HIV stigma scale,BHSS)对其进行调查。结果 HIV感染者/AID...目的了解我国HIV感染者/AIDS患者的感知歧视水平,并分析其影响因素。方法便利抽取河南省和湖北省四地市的313例HIV感染者/AIDS患者为研究对象,采用Berger艾滋病耻辱量表(Berger HIV stigma scale,BHSS)对其进行调查。结果 HIV感染者/AIDS患者的BHSS得分为(107.36±17.64)分,处于中等水平;其中,感染途径、居住地、家人知晓病情状况、患病时间、CD4细胞数目等是HIV感染者/AIDS患者感知歧视的影响因素。结论我国HIV感染者/AIDS患者存在一定程度的感知歧视,医护人员应根据患者的具体情况及影响因素采取针对性的干预措施。展开更多
文摘Background: The lack of cause of death information is the main challenge in monitoring the effectiveness of interventions aimed at reducing HIV and AIDS-related deaths in countries where the majority of deaths occur at home. Objective: To evaluate the accuracy of physician reviewers of verbal autopsies in diagnosing HIV and AIDS-related deaths in the adult population of Addis Ababa, the capital of Ethiopia. Methods: This study was done within the context of a burial surveillance system in Addis Ababa. Trained interviewers completed a standard verbal autopsy questionnaire and an independent panel of physicians reviewed the completed form to assign cause of death. Physicians' review was compared to a reference standard constructed based on prospectively collected HIV-serostatus and patients' hospital record. Sensitivity and specificity were calculated to validate the physicians' verbal autopsy diagnoses against reference standards. Results: Physicians accurately identified AIDS-related deaths with sensitivity and specificity of 0.88 (95% CI: 0.80 - 0.93) and 0.77 (95% CI: 0.64 - 0.87), respectively. Generally, there was high level of agreement (Cohen's Kappa Statistic (K > 0.6) between the first two physicians with some yearly variations. In 2008 and 2009 there was an almost perfect agreement (K > 0.80). Conclusion: This study demonstrated the agreement level between two independent physicians in diagnosing AIDS-related death is very high and thus using a single verbal autopsy coder is practical for programmatic purposes in countries where there is critical shortage of doctors.
文摘Purpose: There is extensive evidence regarding the relationship between HIV related stigma and disclosure;however, the influence of depression in this relationship is not well understood, and thus is the focus of our analysis. Methods: Baseline data from a prospective longitudinal cohort of 798 HIV patients starting ART in Kampala, Uganda were examined. A staged-approach regression analysis was used to examine variables associated with HIV disclosure to most people (general disclosure) and disclosure to primary sex partner. Internalized HIV stigma plus demographic and background covariates were first entered into the model;the binary indicator of clinical depression was added on step two, followed by the addition of the interaction of stigma and depression in step three. Separate analyses were conducted for each of the two disclosure outcomes. Results: 39% indicated that they kept their HIV status as a secret from most people, while 19% of respondents with a regular sex partner had not disclosed their HIV status to the partner. In bivariate analysis, respondents who preferred to keep their HIV status as a secret from most people had higher internalized HIV stigma (p < 0.001) and depression (p < 0.01), and were more likely to be clinically depressed (p < 0.01) compared with others in the sample. Similarly, participants who had not disclosed their HIV status to their main sex partner had higher internalized HIV stigma (p < 0.01) and depression (p < 0.05), and were more likely to be clinically depressed (p < 0.01) compared with those who had informed their partner of their HIV status. The regression analysis revealed that internalized HIV stigma was strongly negatively correlated with disclosure to primary partner, while depression was not associated. In the regression analysis for general disclosure, both stigma and depression were negatively correlated with disclosure when the interaction term was included in the model. Further analysis showed that internalized HIV stigma was more strongly associated with general disclosure among participants who were not depressed. Conclusions: Although there was clearly a strong and consistent association between internalized HIV stigma and depression symptoms, the strong association between internalized HIV stigma and general disclosure among respondents who were not depressed indicated that HIV stigma was in itself remained a strong barrier to HIV disclosure. Therefore, interventions to reduce internalized HIV stigma may aid in efforts to decrease secondary transmission of HIV.
文摘A study was conducted to explore stigma and discrimination among people living with HIV and AIDS who were on home based care in the Lilongwe district of Malawi. The study design was descriptive through sectional and utilized qualitative data collection and analysis method. Fifteen people living with HIV and AIDS, aged between 15 and 60 years were purposively sampled from three organizations, which were: Light House, National Association for people living with HIV and AIDS in Malawi and Lilongwe Diocese. Qualitative data were collected using an open ended interview guide during in-depth face to face interviews with the participants. The data were analysed using ATLAS. ti 5.0. Results show that all the participants were facing stigma and discrimination because they were living with HIV and AIDS. Distant relatives were the main source of stigma and discrimination followed by friends and church members. Most participants indicated that they felt they were discriminated because HIV infection is associated with bad behaviours such as prostitution or promiscuity. However some of them complained that they contracted the virus from their married partners and hence they did not deserve to be stigmatized or discriminated against. Results show that there is a need for creation of awareness among community members on the transmission of HIV and the need for home based care for the chronically ill people living with HIV and AIDS.
文摘Labor migrants are those of the at-risk groups for HIV. This cross-sectional study has tried to examine HIV/AIDS-related stigma among Nepalese returnee male labor migrants. Migrant workers who have worked at least six months abroad were asked different questions related to sexual behavior, knowledge on HIV/AIDS & condom and HIV/AIDS-related stigma. Stigma was measured on a three-point rating scale as high, average and low stigma. About 58% of migrants had the view “I would rather not know if I have HIV” followed by “I don’t want to be friends with people living with HIV” (53.6% migrants) and “people with HIV are cursed” (35.5% migrants). High stigma was present among 15.5% of the total respondents with high proportion among those with higher age, lower education, rural residence, and no knowledge on Voluntary Counseling and Testing (VCT) service. About a quarter of respondents were of the view that migrants infected with HIV while abroad should not be allowed to return Nepal. Some level of stigma on HIV/AIDS exists among male labor migrants in Nepal. Interventions aiming at reducing stigma should consider the factors like migrants’ age, education, place of residence and knowledge on VCT services.
文摘Namibia has been affected by the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) pandemic with infected and affected persons experiencing stigma at different levels. Despite the high level of knowledge?on HIV/AIDS, stigma remains a challenge. It was for this reason that this paper describes and measures the level of HIV/AIDS stigma in a rural community in Namibia. Mixed methods were used to collect data from 224 participants consisting of 93 people living with HIV/AIDS (PLWHA) who were recruited voluntarily from their support groups, 77 family members nominated by PLWHA participants, 31 community members who were recruited through simple random sampling and 19 opinion leaders who were purposefully selected and four health care workers from an Antiretroviral clinic who were available at the time of this study. Three measurement instruments namely HIV/AIDS Stigma Instrument-PLWHA (HASI-P), Family & Community Stigma Instrument (F&C-SI) and HIV/AIDS Stigma Instrument-Nurse (HASI- N) were used. In-depth interviews were conducted to complement the quantitative results. The study found that stigma manifests in different ways and results revealed that verbal abuse (55%, n = 50, PLWHA), social isolation (73%, n = 67), negative self-perception (33%, n = 30), and household stigma (26% n = 19, family members) were the most common form of stigma experienced by PLWHA. Furthermore health care workers reported stigma of association (50%, n = 2) as care providers for people living with HIV/AIDS. The study concluded that stigma exists although some scores such as fear of contagion and workplace stigma were low. Therefore, interventions in knowledge on basic facts of HIV transmission need to be strengthened. Nonetheless the majority of participants confirmed their willingness to care for sick relatives with HIV and AIDS. This study did not explore stigma of association against caregivers with other participants other than the four health care workers from the antiretroviral clinic. Future researchers can take this further.
文摘Research encourages evidence-based guidelines for practice. This paper describes the guidelines for HIV/AIDS stigma reduction in the community. These guidelines were developed by the authors based on findings of the study which was conducted to develop and evaluate HIV/AIDS stigma reduction intervention in a rural Namibian community. The developed intervention consisted of three strategies which are recommended as baseline for these guidelines. The three strategies were: education, community involvement and contacts with infected and affected groups that were implemented in this study. These strategies were implemented among the people living with HIV/AIDS (PLWHA), their families and community members from the intervention group. The post-intervention results showed significant differences on stigma reduction between the intervention and control groups, therefore these strategies were recommended for future use. Furthermore, the study found that a combination of strategies was more effective than using a single approach. Another strategy that was absent in this study but was recommended in these guidelines for future stigma reduction was: counselling approach, which could be used to address internal stigma. This paper therefore recommends that these combined strategies: education, community involvement, contacts with affected and infected groups and continuous counselling, which will be named ECCC approach might be useful to reduce HIV/AIDS stigma in the community.
文摘目的了解深圳市宝安区医疗机构中医务工作者艾滋病(HIV)相关的羞辱和歧视(S&D)现况,为制定相关政策提供依据。方法在2019年10月至2020年1月期间,采用标准化测量工具,对18家公立和私立医院的1235名医务人员进行横断面调查。收集人口学资料、HIV感染担忧、医疗机构中存在的羞辱与歧视现象或政策等数据信息。结果医务人员HIV感染担忧发生率为73.1%(95%CI:70.5%~75.6%);包扎伤口65.0%(95%CI:62.2%~67.8%)和测体温82.5%(95%CI:78.8%~83.4%)时最为担忧;与男性相比,女性更容易产生担忧情绪;护士比医生更担忧HIV职业感染;接受培训是防止因接触HIV患者而产生感染焦虑的保护因素。21.3%(95%CI:18.9%~23.6%)的受访者承认会避免与艾滋病感染者(people living with HIV,PLWH)有身体接触;53.0%(95%CI:50.1%~55.9%)的受访者在与PLWH接触时会选择戴双层手套,有75.4%(95%CI:72.9%~77.9%)的受访者认为艾滋病感染者应该到指定的传染病专科医院就诊。60.7%(95%CI:72.9%~77.9%)的医务人员认为,HIV育龄妇女不应该再生育。42.7%(95%CI:39.8%~45.6%)的受访者报告自己所在医疗机构中没有或不知道关于严禁歧视PLWH的文件或制度。结论在医疗卫生机构中,存在针对PLWH羞辱与歧视的现象。保障PLWH获得平等医疗卫生服务的权利,医疗机构中减少HIV相关羞辱与歧视的干预工作必要且紧迫。
文摘目的了解我国HIV感染者/AIDS患者的感知歧视水平,并分析其影响因素。方法便利抽取河南省和湖北省四地市的313例HIV感染者/AIDS患者为研究对象,采用Berger艾滋病耻辱量表(Berger HIV stigma scale,BHSS)对其进行调查。结果 HIV感染者/AIDS患者的BHSS得分为(107.36±17.64)分,处于中等水平;其中,感染途径、居住地、家人知晓病情状况、患病时间、CD4细胞数目等是HIV感染者/AIDS患者感知歧视的影响因素。结论我国HIV感染者/AIDS患者存在一定程度的感知歧视,医护人员应根据患者的具体情况及影响因素采取针对性的干预措施。
