Experiences of Stigma and Discrimination among Adults Living with HIV in a Low HIV-Prevalence Context: A Qualitative Analysis

Little is known about how people living with HIV in low prevalence contexts face the challenges of stigma and discrimination. Low prevalence and rural communities are unique environments in which HIV-related stigma and discrimination may be intensified due to lower tolerance of differences among people and greater fear of HIV. This study examined the experiences of 16 individuals living with HIV who reside in a predominantly rural area with low HIV prevalence. We used in-depth interviews to explore participants’ experience with stigma and discrimination in social and health care settings and their behavioral and emotional responses. In their day-today lives, participants described feeling social rejection, being forced to follow different rules of social contact, and being treated differently. In health care settings, participants described specific instances when they felt providers were afraid of them and when they were refused or discouraged treatment or treated differently based on their HIV status. Participants experienced stigma and acts of discrimination in different settings (e.g., physician and dentist offices and hospitals) and from a range of types of providers (e.g., physicians, nurses, and dentists). Behavioral and emotional responses to perceived acts of stigma and discrimination included anger, shame, social isolation, and self-advocacy. Findings point to a need to develop tailored interventions to address stigma and discrimination for individuals, health care personnel and the community-at-large

Using theories of action to guide national program evaluation and local strategy in the community care network demonstration

Evaluations of multisite community-based projects are notoriously difficult to conceptualize and conduct. Projects may share an overarching vision but operate in varying contexts and pursue different initiatives. One tool that can assist evaluators facing these challenges is to developa theory of action (TOA) that identifies critical assumptions regarding how a program expects to achieve its goals. Community Care Network (CCN) evaluators used the TOA to refine research questions, define key variables, relate questions to each other, and identify when we might realistically expect to observe answers. In this article, the authors present their national-level CCN TOA. They also worked with sites to helpthem surface their local TOA; the article analyzes the results to determine the content, clarity, extent of evidence base, and strategic orientation of theories articulated by different sites