Measuring HIV stigma for PLHAs and nurses over time in five African countries

Abstract

The aim of this article is to document the levels of HIV stigma reported by persons living with HIV infections and nurses in Lesotho, Malawi, South Africa, Swaziland and Tanzania over a 1-year period. HIV stigma has been shown to negatively affect the quality of life for people living with HIV infection, their adherence to medication, and their access to care. Few studies have documented HIV stigma by association as experienced by nurses or other health care workers who care for people living with HIV infection. This study used standardised scales to measure the level of HIV stigma over time. A repeated measures cohort design was used to follow persons living with HIV infection and nurses involved in their care from five countries over a 1-year period in a three-wave longitudinal design. The average age of people living with HIV/AIDS (PLHAs) (N=948) was 36.15 years (SD=8.69), and 67.1% (N=617) were female. The average age of nurses (N=887) was 38.44 years (SD=9.63), and 88.6% (N=784) were females. Eighty-four per cent of all PLHAs reported one or more HIV-stigma events at baseline. This declined, but was still significant 1 year later, when 64.9% reported experiencing at least one HIV-stigma event. At baseline, 80.3% of the nurses reported experiencing one or more HIV-stigma events and this increased to 83.7% 1 year later. The study documented high levels of HIV stigma as reported by both PLHAs and nurses in all five of these African countries. These results have implications for stigma reduction interventions, particularly focused at health care providers who experience HIV stigma by association.

Le but de cet article est de documenter les niveaux de la stigmatisation autour du VIH rapportés par les personnes vivant avec le VIH et les infirmières au Lesotho, au Malawi, en Afrique du Sud, au Swaziland et en Tanzanie pendant une période d'un an. Il a été démontré que la stigmatisation du VIH a un effet négatif sur la qualité de vie des personnes vivant avec le VIH, leur adhérence au traitement et leur accès à l'aide. Peu d'études ont documenté la stigmatisation du VIH par association comme elle est vécue par les infirmières et d'autres personnes travaillant dans le secteur de la santé qui soignent les personnes vivant avec le VIH. Cette étude a utilisé des échelles standardisées pour mesurer le taux de stigmatisation autour du VIH au cours d'une période de temps. Une conception de cohorte en mesures répétées a été utilisée pour suivre les personnes vivant avec le VIH et les infirmières impliquées dans leur aide dans cinq pays pendant une période d'un an selon une conception longitudinale en trois vagues. L'âge moyen des PVVIH (N=948) était de 36.15 ans (SD=8.69), et 67.1% (N=617) étaient des femmes. L'âge moyen des infirmières (N=887) était de 38.44 ans (SD=9.63), et 88.6% (N=784) étaient des femmes. Quatre-vingt-quatre pour cent de toutes les PVVHI ont rapporté un ou plusieurs événements de stigmatisation autour du VIH à la base. Ce taux a baissé, mais était toujours considérable un an plus tard quand 64.9% ont rapporté avoir vécu au moins une instance de stigmatisation autour du VIH. A la base, 80.3% des infirmières ont rapporté avoir vécu un ou plusieurs événements de stigmatisation liés au VIH et cela a augmenté jusqu'à 83.7% une année plus tard. Cette étude a documenté de hauts taux de stigmatisations rapportés autant par les PVVIH que les infirmières dans ces cinq pays africains. Ces résultats ont des implications pour les interventions de réduction de la stigmatisation, en particulier celles qui visent les prestataires de services de santé qui vivent la stigmatisation du VIH par association.

Keywords:

• HIV/AIDS
• stigma
• Africa
• nurses
• people living with HIV/AIDS (PLHAs)

Mots clés:

• VIH/SIDA
• stigmatisation
• Afrique
• infirmières
• PVVIH

Additional information

Notes on contributors

William L Holzemer

William L Holzemer is Professor and Associate Dean for International Programs at the University of California, San Francisco, School of Nursing. He is an internationally recognised expert in academic nursing and HIV/AIDS care providing global leadership to the World Health Organization, the International Council of Nurses, and many universities around the world. Dr Holzemer is a member of the Institute of Medicine, and an elected member of the International Council of Nurses Board of Directors. For the last 20 years his research has focused on symptom management, adherence, stigma and quality of life for people living with the HIV infection.

Lucy N Makoae

Lucy N Makoae is a Lecturer at the National University of Lesotho Faculty of Health Sciences, in the Department of Nursing. She teaches and supervises research projects and also teaches various courses in public health such as epidemiology, surveillance of infectious diseases and control of communicable diseases. She has published papers in the areas of reproductive health, HIV and AIDS and in human resources for health.

Minrie Greeff

Minrie Greeff is Professor in research in the Africa Unit for Trans-disciplinary Health Research of the Faculty of Health Science at North-West University, Potchefstroom campus. She has served as Head of the Department of Nursing as well as Director of the School of Nursing Science, where her research focused on HIV and AIDS and indigenous knowledge. She is elected director of the research committee of the Tau Lambda Chapter-at-Large of the Sigma Theta Tau International Honor Society for Nurses since 2006. In 2008 she became one of the few rated researchers of the National Research Foundation.

Priscilla S Dlamini

Priscilla S Dlamini is Senior Lecturer at the University of Swaziland, Faculty of Health Sciences. She has served as Dean of the Faculty of Health Sciences for a 5-year period. She is involved in many country-level research studies on HIV/AIDS with a special interest in the role of traditional medicine and HIV/AIDS.

Thecla W Kohi

Thecla W Kohi is a Senior Lecturer in Nursing at the Muhimbili University of Health and Allied Sciences. She is research collaborator in a consortium of Higher Education Nursing and Midwifery Schools in Africa aimed at introducing or strengthening higher education in SADC countries. She is also working in collaboration with UCSF on an AIHA Twinning Center project.

Maureen L Chirwa

Maureen L Chirwa is a Senior Lecturer, University of Malawi, specialising in health management and health systems. She has extensive research degree supervision and other postgraduate teaching experience. She also leads three studies for the Ministry of Health on documenting and evaluating relief, income and expenditure; and locum systems. Dr Chirwa is currently working on a performance management study for the Ministry of Health, commissioned by GTZ.

Joanne R Naidoo

Joanne R Naidoo is a Lecturer at the School of Nursing, University of KwaZulu-Natal. She is core team member of the Joanna Briggs Institute for Evidence Based Nursing and Midwifery, completing a systematic review on the relationship of disclosure of HIV status and adherence to antiretroviral therapy among adults in Africa. She has participated in numerous HIV related studies as co-investigator or collaborator.

Kevin Durrheim

Kevin Durrheim is professor of psychology at the University of KwaZulu-Natal, where he teaches social psychology and research methods. He has published more than 80 peer-reviewed articles and book chapters on topics related to racism, segregation and social change.

Yvette Cuca

Yvette Cuca is Project Director at the University of California, San Francisco, School of Nursing. She holds Master's degrees in Public Health and International Affairs, and her research focus is reproductive health and HIV/AIDS.

Leana R Uys

Leana R Uys is a Professor in Nursing and Deputy Vice Chancellor of the Faculty of Health Sciences at the University of KwaZulu-Natal. She has served as President of the South African Nursing Council and the Tau Lambda Chapter-at-Large of the Sigma Theta Tau International Honor Society for Nurses.