Perceived discrimination and stigma toward children affected by HIV/AIDS and their HIV-positive caregivers in central Haiti

Abstract

In many settings worldwide, HIV-positive individuals have experienced a significant level of stigma and discrimination. This discrimination may also impact other family members affected by the disease, including children. The aim of our study was to identify factors associated with stigma and/or discrimination among HIV-affected youth and their HIV-positive caregivers in central Haiti. Recruitment of HIV-positive patients with children aged 10–17 years was conducted in 2006–2007. Data on HIV-related stigma and/or discrimination were based on interviews with 451 youth and 292 caregivers. Thirty-two percent of caregivers reported that children were discriminated against because of HIV/AIDS. Commune of residence was associated with discrimination against children affected by HIV/AIDS and HIV-related stigma among HIV-positive caregivers, suggesting variability across communities. Multivariable regression models showed that lacking social support, being an orphan, and caregiver HIV-related stigma were associated with discrimination in HIV-affected children. Caregiver HIV-related stigma demonstrated a strong association with depressive symptoms. The results could inform strategies for potential interventions to reduce HIV-related stigma and discrimination. These may include increasing social and caregiver support of children affected by HIV, enhancing support of caregivers to reduce burden of depressive symptoms, and promoting reduction of HIV-related stigma and discrimination at the community-level.

Keywords:

• discrimination
• stigma
• HIV
• Haiti
• youth
• caregivers

Acknowledgements

The authors would like to acknowledge the parents and youths who participated in the study and staff at Zanmi Lasante and Harvard Medical School who contributed significantly to this study. Special thanks are extended to: Arachu Castro, Nancy Dorsinville, Felton Earls, Paul Farmer, Garrett Fitzmaurice, Yaulene Gracia. The social worker and data clerks: Rivot St. Fluer, and Jean Renald Pierre, Ketsia Lambert (Hinche), Marianne Appolon, Lisette Fetiere, Wideline Dessources (Thomonde), Sherley Piard, Madame Branel Joseph, and Mike Cadichon (Cange), Wilder Dubiusson, John Guillaume, Ruth Jean (Boucan Carre), Naomie Emmanuel, Oupet Evenson, Louis Jean Joseph (Lascahobas), Ernst Origine, Joly Larame, and Adeline Severe (Belladere). In addition we would like to thank other staff at Zamni Lasante: Joas Fleurimond, Louise Ivers, Leneus Joseph, Fernet Leandre, Julie Mann, Anna Muriel, Cheri Verrilie, and Loune Viaud. Finally we acknowledge the social service residents Dr. Romain, Dr. Desulme. We thank Patrice Nevil who oversaw data clerk training and Leneus Joseph and Joas Fluerimore who transcribed the qualitative data. This study was supported by a grant provided by the National Institute of Mental Health (R21-MH076447). The work at Zanmi Lasante is made possible through the generosity of other public institutions as well as private foundations and donors, especially Thomas J. White.