Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis

Introduction: Adherence to HIV antiretroviral therapy (ART) is a critical determinant of HIV-1 RNA viral suppression and health outcomes. It is generally accepted that HIV-related stigma is correlated with factors that may undermine ART adherence, but its relationship with ART adherence itself is not well established. We therefore undertook this review to systematically assess the relationship between HIV-related stigma and ART adherence. Methods: We searched nine electronic databases for published and unpublished literature, with no language restrictions. First we screened the titles and abstracts for studies that potentially contained data on ART adherence. Then we reviewed the full text of these studies to identify articles that reported data on the relationship between ART adherence and either HIV-related stigma or serostatus disclosure. We used the method of meta-synthesis to summarize the findings from the qualitative studies. Results: Our search protocol yielded 14,854 initial records. After eliminating duplicates and screening the titles and abstracts, we retrieved the full text of 960 journal articles, dissertations and unpublished conference abstracts for review. We included 75 studies conducted among 26,715 HIV-positive persons living in 32 countries worldwide, with less representation of work from Eastern Europe and Central Asia. Among the 34 qualitative studies, our meta-synthesis identified five distinct third-order labels through an inductive process that we categorized as themes and organized in a conceptual model spanning intrapersonal, interpersonal and structural levels. HIV-related stigma undermined ART adherence by compromising general psychological processes, such as adaptive coping and social support. We also identified psychological processes specific to HIV-positive persons driven by predominant stigmatizing attitudes and which undermined adherence, such as internalized stigma and concealment. Adaptive coping and social support were critical determinants of participants’ ability to overcome the structural and economic barriers associated with poverty in order to successfully adhere to ART. Among the 41 quantitative studies, 24 of 33 cross-sectional studies (71%) reported a positive finding between HIV stigma and ART non-adherence, while 6 of 7 longitudinal studies (86%) reported a null finding (Pearson's χ 2=7.7; p=0.005). Conclusions: We found that HIV-related stigma compromised participants’ abilities to successfully adhere to ART. Interventions to reduce stigma should target multiple levels of influence (intrapersonal, interpersonal and structural) in order to have maximum effectiveness on improving ART adherence

Analysis of the Dimensions and Determinants of Household Food Security Status among Maize Farming Households in Lagos State, Nigeria

The study focused on analysis of the dimensions and determinants of household food security status among maize farming households in Lagos State, Nigeria. The specific objectives of the study were to describe the socio-economic characteristics of the respondents, examine the dimensions of food security status of the households, determine their food security status and examine the factors influencing food security among the maize farming households in the study area. Primary data for the study were obtained from 155 maize farming household heads with the aid of structured questionnaire. Descriptive statistics, food security index assessment and logit regression model were used to analyse the data. The results showed that majority (91.6%) of the households were headed by males who were aged 59 years, on the average, married (91.6%) and their level of literacy was very high as all of the respondents had a form of formal education. The mean household size of the study area was 7 members. The household heads had farming experience of 32 years, a mean farm size of 2.14 hectares for maize farming and an average of 1.24 hectares for farming other crops. The results further showed that 77.4% of the household heads perceived food to be moderately available for consumption throughout the year, 81.3% had three square meals each day and 81.2% perceived their food quality consumed to be high all year round. Consequently, majority (97%) of them were food secure. Significant determinants of food security status among the households were farm size, household size and access to credit facilities. Farm size and access to credit facilities influenced food security positively while household size affected it negatively. It was recommended that government should create enabling environment for the farmers to have easy access to more arable land and credit facilities to help them expand their production in order to improve food security for both the farmers and the citizens at large. Keywords: food security, household, socio-economics DOI: 10.7176/JESD/12-20-04 Publication date:October 31st 202

Stigma, culture, and HIV and AIDS in the Western Cape, South Africa: an application of the PEN-3 cultural model for community-based research

HIV- and AIDS-related stigma has been reported to be a major factor contributing to the spread of HIV. In this study, the authors explore the meaning of stigma and its impact on HIV and AIDS in South African families and health care centres. They conducted focus groups and key informant interviews among African and colored populations in Khayelitsha, Gugulethu and Mitchell's Plain in the Western Cape Province. Families and health care centres were found to have both positive/nonstigmatizing values and negative stigmatizing characteristics in addressing HIV/AIDS-related stigma. The authors conclude that a culture-centered analysis, relative to identity, is central to understanding the nature and contexts of HIV/AIDS-related stigma in South Africa.