Predictors of internalised HIV-related stigma: a systematic review of studies in sub-Saharan Africa

Abstract

This systematic review aims to synthesise evidence on predictors of internalised HIV stigma amongst people living with HIV in sub-Saharan Africa. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Studies were identified through electronic databases, grey literature, reference harvesting and contacts with key researchers. Quality of findings was assessed through an adapted version of the Cambridge Quality Checklists. A total of 590 potentially relevant titles were identified. Seventeen peer-reviewed articles and one draft book chapter were included. Studies investigated socio-demographic, HIV-related, intra-personal and interpersonal correlates of internalised stigma. Eleven articles used cross-sectional data, six articles used prospective cohort data and one used both prospective cohort and cross-sectional data to assess correlates of internalised stigma. Poor HIV-related health weakly predicted increases in internalised HIV stigma in three longitudinal studies. Lower depression scores and improvements in overall mental health predicted reductions in internalised HIV stigma in two longitudinal studies, with moderate and weak effects, respectively. No other consistent predictors were found. Studies utilising analysis of change and accounting for confounding factors are necessary to guide policy and programming but are scarce. High-risk populations, other stigma markers that might layer upon internalised stigma, and structural drivers of internalised stigma need to be examined.

Keywords:

• stigma
• HIV/AIDS
• systematic review
• self-perception
• self-image
• shame

Acknowledgements

We would like to thank authors of primary studies included in this review for pioneering crucial work on internalised HIV/AIDS stigma in sub-Saharan Africa. We are also grateful for the assistance from researchers who have supplied the additional information and references needed to complete this review, in particular Alexander Tsai, Yvette Cuca, Eme Owoaye, Cynthia Pearson, Maretha Visser, Leickness Simbayi, Seth Kalichman, Michael Evangeli, Nuala McGrath and Cilna de Kock.

Supplemental material

Supplemental material for this article can be accessed here: http://dx.doi.org/10.1080/17437199.2014.996243.

Additional information

Funding

This work was supported by the Joint Green Templeton College – Clarendon Scholarship, University of Oxford and the the European Research Council under the European Union's Seventh Framework Programme (FP7/2007-2013)/ERC agreement n°313421.