Combating HIV stigma in low- and middle-income healthcare settings: a scoping review

M. Kumi Smith, Richie H. Xu, Shanda L. Hunt, Chongyi Wei, Joseph D. Tucker, Weiming Tang, Danyang Luo, Hao Xue, Cheng Wang, Ligang Yang, Bin Yang, Li Li, Benny L. Joyner, Sean Y. Sylvia

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Nearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low- and middle-income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research. Methods: We conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews. Results and discussion: Our search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings. Conclusions: Combating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self-reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.

Original languageEnglish (US)
Article numbere25553
JournalJournal of the International AIDS Society
Volume23
Issue number8
DOIs
StatePublished - Aug 1 2020

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Numbers R34MH121251, R34MH119963 and K24AI143471. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

  • HIV prevention
  • LMIC
  • health systems
  • intervention
  • public health
  • stigma

PubMed: MeSH publication types

  • Journal Article
  • Review

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