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Article ; Online: Stigma reduction: an essential ingredient to ending AIDS by 2030.

Nyblade, Laura / Mingkwan, Pia / Stockton, Melissa A

The lancet. HIV

2021 Volume 8, Issue 2, Page(s) e106–e113

Abstract: Ending the AIDS epidemic by 2030 will require addressing stigma more systematically and at a larger scale than current efforts. Existing global evidence shows that stigma is a barrier to achieving each of the 90-90-90 targets; it undermines HIV testing, ... ...

Abstract	Ending the AIDS epidemic by 2030 will require addressing stigma more systematically and at a larger scale than current efforts. Existing global evidence shows that stigma is a barrier to achieving each of the 90-90-90 targets; it undermines HIV testing, linkage to care, treatment adherence, and viral load suppression. However, findings from both research studies and programmatic experience have helped to inform the growing body of knowledge regarding how to reduce stigma, leading to key principles for HIV stigma reduction. These principles include immediately addressing actionable drivers of stigma, centring groups affected by stigma at the core of the response, and engaging opinion leaders and building partnerships between affected groups and opinion leaders. Although there is still room to strengthen research on stigma measurement and reduction, in particular for intersectional stigma, the proliferation of evidence over the past several decades on how to measure and address stigma provides a solid foundation for immediate and comprehensive action.
MeSH term(s)	Acquired Immunodeficiency Syndrome/diagnosis ; Acquired Immunodeficiency Syndrome/prevention & control ; Acquired Immunodeficiency Syndrome/psychology ; Acquired Immunodeficiency Syndrome/virology ; Anti-HIV Agents/therapeutic use ; Epidemics/prevention & control ; Fear/psychology ; Female ; HIV/drug effects ; HIV/growth & development ; HIV/pathogenicity ; HIV Testing/ethics ; Humans ; Male ; Patient Compliance/psychology ; Patient Compliance/statistics & numerical data ; Social Isolation/psychology ; Social Stigma ; Treatment Adherence and Compliance/psychology ; Treatment Adherence and Compliance/statistics & numerical data ; Viral Load/drug effects
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2021-01-07
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2352-3018
ISSN (online)	2352-3018
DOI	10.1016/S2352-3018(20)30309-X
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Article ; Online: "I told myself, be bold and go and test": Motivators and barriers to HIV testing among gay, bisexual, and other cis-gender men who have sex with men in Ghana ‒ West Africa.

Abu-Ba'are, Gamji Rabiu / Aidoo-Frimpong, Gloria / Stockton, Melissa / Zigah, Edem Yaw / Amuah, Samuel / Amu-Adu, Prince / Amoh-Otoo, Richard Panix / Nyblade, Laura / Torpey, Kwasi / Nelson, LaRon E

PLOS global public health

2024 Volume 4, Issue 1, Page(s) e0002231

Abstract: Despite a disproportionately high burden of HIV, GBMSM in Ghana and sub-Saharan Africa often delay testing until the point of illness. However, limited studies examine factors that affect their participation in testing. We used qualitative in-depth ... ...

Abstract	Despite a disproportionately high burden of HIV, GBMSM in Ghana and sub-Saharan Africa often delay testing until the point of illness. However, limited studies examine factors that affect their participation in testing. We used qualitative in-depth interviews (IDIs) and focus group discussions (FGDs) to collect insights into experiences, motivators, and barriers to HIV testing among GBMSM. Two community-based organizations used snowball and convenience sampling to recruit 10 GBMSM for IDIs and 8 to 12 for FGDs. We transcribed, coded, identified, and analyzed the relationship and commonalities between the participants' responses. Under experiences with testing, 1) fear of HIV infection created a stressful HIV testing experience, and 2) a friendly and supportive healthcare environment facilitated a positive experience in healthcare facilities. Motivators or facilitators of testing include 1) the perception or belief that HIV testing is an HIV prevention strategy; 2) encouragement from friends and peers; 3) understanding risk associated with certain sexual behaviors; 4) education or information on HIV; 5) access to free testing and incentives; 6) early symptoms and provider recommendation. Barriers to HIV testing include 1) negative community perceptions of HIV; 2) individual-level low-risk perception or indifference about HIV infection; 3) health system issues; 5) Perceived stigma at healthcare facilities. The findings point to the need to address critical issues around stigma, education, peer support, and healthcare resources through interventions and research to improve HIV testing among GBMSM in the country.
Language	English
Publishing date	2024-01-11
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0002231
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Article: "One pastor advised him to stop taking HIV medication": Promoters and barriers to HIV care among gay, bisexual, and men who have sex with men living with HIV in Ghana.

Abu-Ba'are, Gamji Rabiu / Aidoo-Frimpong, Gloria / Amu-Adu, Prince / Zigah, Edem Yaw / Stockton, Melissa / Amuah, Samuel / Amoh-Otoo, Richard Panix / Nyblade, Laura / Torpey, Kwasi / Nelson, LaRon E

Research square

2024

Abstract: Introduction: Few studies examine Ghanaian gay, bisexual, and other men who have sex with men (GBMSM) experience with HIV diagnoses and linkage to care. This article provides qualitative accounts of promoters and barriers to care among GBMSM living with ...

Abstract	Introduction: Few studies examine Ghanaian gay, bisexual, and other men who have sex with men (GBMSM) experience with HIV diagnoses and linkage to care. This article provides qualitative accounts of promoters and barriers to care among GBMSM living with HIV in Ghana. Methods: We recruited and interviewed 10 GBMSM living with HIV in two Ghanaian cities. We transcribed the interviews, coded the data, and used thematic content analysis. Results: We found that community and healthcare facility (HCF) level HIV and sexual stigma, confidentiality issues, alternative medicine, and substance use remain the key barriers to care. Other barriers include healthcare system issues such as long wait times and economic problems (e.g., health insurance and financial difficulties). Nonetheless, HCF-level factors such as positive experiences with providers, HIV counseling, and detailed medication information facilitate adherence to care among GBMSM. Conclusion: This study highlights the need for interventions that address linkage to care issues, especially substance use, disinformation, and misinformation among GBMSM and other Ghanaian communities.
Language	English
Publishing date	2024-03-22
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-4087718/v1
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Article: Friendship Bench Intervention to Address Depression and Improve HIV Care Engagement Among Adolescents Living with HIV in Malawi: Study Protocol for a Pilot Randomized Controlled Trial.

Dao, Thuy T / Gaynes, Bradley N / Pence, Brian W / Mphonda, Steven M / Kulisewa, Kazione / Udedi, Michael / Stockton, Melissa A / Kramer, Jack / Faidas, Maria / Mortensen, Hillary / Bhushan, Nivedita L

medRxiv : the preprint server for health sciences

2024

Abstract: Background: Adolescents in Sub-Saharan Africa are disproportionately affected by the HIV epidemic. Comorbid depression is prevalent among adolescents living with HIV (ALWH) and poses numerous challenges to HIV care engagement and retainment. We present ... ...

Abstract	Background: Adolescents in Sub-Saharan Africa are disproportionately affected by the HIV epidemic. Comorbid depression is prevalent among adolescents living with HIV (ALWH) and poses numerous challenges to HIV care engagement and retainment. We present a pilot trial designed to investigate feasibility, fidelity, and acceptability of an adapted and an enhanced Friendship Bench intervention (henceforth: AFB and EFB) in reducing depression and improving engagement in HIV care among ALWH in Malawi. Methods: Design:: Discussion: This pilot study will provide insights into youth-friendly adaptations of the Friendship Bench model for ALWH in Malawi and the value of adding group peer support for HIV care engagement. The information gathered in this study will lead to a R01 application to test our adapted intervention in a large-scale cluster randomized controlled trial to improve depression and engagement in HIV care among ALWH.
Language	English
Publishing date	2024-04-12
Publishing country	United States
Document type	Preprint
DOI	10.1101/2024.04.11.24305686
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Article ; Online: A scoping review of the role of HIV-related stigma and discrimination in noncommunicable disease care.

Stockton, Melissa A / Giger, Kayla / Nyblade, Laura

PloS one

2018 Volume 13, Issue 6, Page(s) e0199602

Abstract: Background: People living with HIV are increasingly burdened by noncommunicable diseases (NCDs) as a result of the NCD susceptibility that accompanies increased life expectancy and the rising global prevalence of NCDs. Health systems are being ... ...

Abstract	Background: People living with HIV are increasingly burdened by noncommunicable diseases (NCDs) as a result of the NCD susceptibility that accompanies increased life expectancy and the rising global prevalence of NCDs. Health systems are being strengthened and programs are being developed to address this burden, often building on HIV care strategies and infrastructure or through integrated care models. HIV remains a stigmatized condition and the role of HIV stigma in the provision of NCD care is not well understood. Methods: We conducted a scoping literature review of both peer reviewed and grey literature to identify evidence of the role of HIV stigma in the NCD-care continuum (prevention, diagnosis, care seeking, retention in care, and adherence to treatment of NCDs). We searched PsychInfo and Pubmed and conducted additional searches of programmatic reports and conference abstracts. Included studies were published in English within the past decade and examined HIV-related stigma as it relates to NCD-care or to integrated NCD-and HIV-care programs. Results: Sixteen articles met the inclusion criteria. Findings suggest: fear of disclosure, internalized shame and embarrassment, and negative past experiences with or negative perceptions of health care providers negatively influence engagement with NCD care; HIV stigma can adversely affect not only people living with HIV in need of NCD care, but all NCD patients; some NCDs are stigmatized in their own right or because of their association with HIV; integrating NCD and HIV care can both reduce stigma for people living with HIV and a present a barrier to access for NCD care. Conclusion: Due to the dearth of available research and the variability in initial findings, further research on the role of HIV stigma in the NCD-care continuum for people living with HIV is necessary. Lessons from the field of HIV-stigma research can serve as a guide for these efforts.
MeSH term(s)	HIV Infections/complications ; HIV Infections/psychology ; HIV Infections/therapy ; Humans ; Noncommunicable Diseases/psychology ; Noncommunicable Diseases/therapy ; Social Discrimination/psychology ; Social Stigma
Keywords	covid19
Language	English
Publishing date	2018-06-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0199602
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Article ; Online: Validating a measure of anticipated sex work-related stigma among male and female sex workers in Kenya.

Oga, Emmanuel / Stockton, Melissa A / Stewart, Christin / Kraemer, John / Kimani, Joshua / Mbote, David / Njuguna, Stella / Nyblade, Laura

Global public health

2022 Volume 17, Issue 12, Page(s) 3583–3595

Abstract: Sex workers face different types of sex work-related stigma, which may include anticipated, perceived, experienced, or internalized stigma. Sex work stigma can discourage health care seeking and hamper STI and HIV prevention and treatment efforts. There ... ...

Abstract	Sex workers face different types of sex work-related stigma, which may include anticipated, perceived, experienced, or internalized stigma. Sex work stigma can discourage health care seeking and hamper STI and HIV prevention and treatment efforts. There is a paucity of validated sex work-related stigma measures, and this limits the ability to study the stigma associated with sex work. A cross-sectional survey was conducted that measured
MeSH term(s)	Humans ; Male ; Female ; Sex Workers ; Kenya ; Sex Work ; Reproducibility of Results ; Cross-Sectional Studies ; HIV Infections/prevention & control ; HIV Infections/epidemiology ; Social Stigma
Language	English
Publishing date	2022-08-07
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2234129-8
ISSN	1744-1706 ; 1744-1706
ISSN (online)	1744-1706
ISSN	1744-1706
DOI	10.1080/17441692.2022.2105377
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Article ; Online: Estimating the effect of anticipated depression treatment-related stigma on depression remission among people with noncommunicable diseases and depressive symptoms in Malawi.

Dussault, Josée M / Zimba, Chifundo / Akello, Harriet / Stockton, Melissa / Hill, Sherika / Aiello, Allison E / Keil, Alexander / Gaynes, Bradley N / Udedi, Michael / Pence, Brian W

PloS one

2023 Volume 18, Issue 3, Page(s) e0282016

Abstract: Purpose: While mental health stigma research is sparse in Malawi, research in other settings suggests that stigma represents a barrier to mental health treatment and recovery. Accordingly, we conducted an analysis to understand the role of treatment- ... ...

Abstract	Purpose: While mental health stigma research is sparse in Malawi, research in other settings suggests that stigma represents a barrier to mental health treatment and recovery. Accordingly, we conducted an analysis to understand the role of treatment-related stigma in depression care in Malawi by estimating the effect of patients' baseline anticipated treatment-related stigma on their 3-month probability of depression remission when newly identified with depression. Methods: We conducted depression screening and treatment at 10 noncommunicable disease (NCD) clinics across Malawi from April 2019 through December 2021. Eligible cohort participants were 18-65 years with depressive symptoms indicated by a PHQ-9 score ≥5. Questionnaires at the baseline and 3-month interviews included a vignette-based quantitative stigma instrument that measured treatment-related stigma, i.e., concerns about external stigma because of receiving depression treatment. Using inverse probability weighting to adjust for confounding and multiple imputation to account for missing data, this analysis relates participants' baseline levels of anticipated treatment stigma to the 3-month probability of achieving depression remission (i.e., PHQ-9 score < 5). Results: Of 743 included participants, 273 (37%) achieved depression remission by their 3-month interview. The probability of achieving depression remission at the 3-month interview among participants with high anticipated treatment stigma (0.31; 95% Confidence Interval [CI]: 0.23, 0.39)) was 10 percentage points lower than among the low/neutral stigma group (risk: 0.41; 95% CI: 0.36, 0.45; RD: -0.10; 95% CI: -0.19, -0.003). Conclusion: In Malawi, a reduction in anticipated depression treatment-related stigma among NCD patients initiating depression treatment could improve depression outcomes. Further investigation is necessary to understand the modes by which stigma can be successfully reduced to improve mental health outcomes and quality of life among people living with depression.
MeSH term(s)	Humans ; Depression/psychology ; Noncommunicable Diseases/psychology ; Malawi ; Quality of Life ; Social Stigma
Language	English
Publishing date	2023-03-16
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0282016
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Article ; Online: Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana.

Saalim, Khalida / Amu-Adu, Prince / Amoh-Otu, Richard Panix / Akrong, Ransford / Abu-Ba'are, Gamji Rabiu / Stockton, Melissa A / Vormawor, Richard / Torpey, Kwasi / Nyblade, Laura / Nelson, LaRon E

BMC public health

2023 Volume 23, Issue 1, Page(s) 166

Abstract: Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. ...

Abstract	Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated [1] what was the range of sexual stigma manifestations, and [2] how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana.
MeSH term(s)	Male ; Humans ; Homosexuality, Male ; Ghana/epidemiology ; Sexual and Gender Minorities ; HIV Infections ; Sexual Behavior ; Social Stigma
Language	English
Publishing date	2023-01-24
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-023-15087-y
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Article ; Online: The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspective.

Kulisewa, Kazione / Minnick, Caroline E / Stockton, Melissa A / Gaynes, Bradley N / Hosseinipour, Mina C / Mphonda, Steven / Sansbury, Griffin / Udedi, Michael M / Pence, Brian W

Global public health

2023 Volume 18, Issue 1, Page(s) 2201327

Abstract: Depression is common among people living with HIV (PLWH). Measurement-based care models that measure depression severity and antidepressant side effects, and use an algorithm to guide antidepressant prescription by non-specialized health workers ... ...

Abstract	Depression is common among people living with HIV (PLWH). Measurement-based care models that measure depression severity and antidepressant side effects, and use an algorithm to guide antidepressant prescription by non-specialized health workers represent an evidence-based treatment for severe depression in sub-Saharan Africa. We conducted in-depth interviews from June to December 2018 with eleven patients enrolled in Project SOAR-Mental Health, a pilot project integrating depression treatment into HIV care in Malawi. Patients treated with amitriptyline or fluoxetine participated in interviews exploring antidepressant acceptability through patient knowledge, side effect severity, pill burden, adherence, perceived efficacy, and tolerability. Patients described a lack of detailed antidepressant education from their providers. Variable, typically self-limiting side effects were reported from both amitriptyline and fluoxetine. While most side effects were mild, three patients reported functional impairment. Patients reported high adherence, though the additional pill burden was a challenge. Most patients found the antidepressants efficacious, tolerable, beneficial and acceptable. Although patient psychoeducation is notably lacking as a facet of clinical management, antidepressant prescription by primary care providers appears acceptable for comorbid severe depression in PLWH initiating HIV care in sub-Saharan Africa. Health workers should be mindful of dosing to minimise side effects and considerate of the additional pill burden.
MeSH term(s)	Humans ; Depression/drug therapy ; Depression/epidemiology ; Amitriptyline/therapeutic use ; Fluoxetine/therapeutic use ; Malawi/epidemiology ; Pilot Projects ; Antidepressive Agents/adverse effects ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/psychology
Chemical Substances	Amitriptyline (1806D8D52K) ; Fluoxetine (01K63SUP8D) ; Antidepressive Agents
Language	English
Publishing date	2023-04-20
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	2234129-8
ISSN	1744-1706 ; 1744-1706
ISSN (online)	1744-1706
ISSN	1744-1706
DOI	10.1080/17441692.2023.2201327
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Article ; Online: Perceived, anticipated and experienced stigma: exploring manifestations and implications for young people's sexual and reproductive health and access to care in North-Western Tanzania.

Nyblade, Laura / Stockton, Melissa / Nyato, Daniel / Wamoyi, Joyce

Culture, health & sexuality

2017 Volume 19, Issue 10, Page(s) 1092–1107

Abstract: Young people - particularly girls and young women in sub-Saharan Africa - face significant challenges accessing sexual and reproductive health information and services. These challenges are shaped in part by sociocultural factors, including stigma. This ... ...

Abstract	Young people - particularly girls and young women in sub-Saharan Africa - face significant challenges accessing sexual and reproductive health information and services. These challenges are shaped in part by sociocultural factors, including stigma. This paper presents findings from a qualitative study that explored the micro-level social process of stigma surrounding young people's sexual and reproductive health in two communities in Tanzania. Respondents described an environment of pervasive stigma surrounding the sexual and reproductive health of unmarried young people. Stigma manifested itself in multiple forms, ranging from verbal harassment and social isolation to physical punishment by families, community members, peers and healthcare providers. Respondents perceived that stigma was a barrier to young people accessing sexual and reproductive health services and identified excessive questioning, scolding and requirements to bring sexual partners or parents to receive services at health facilities as obstacles to accessing care. The pervasiveness and complexities of stigma surrounding young people's sexual and reproductive health in the two study communities and its potential consequences for health suggest both a need for care in using the term stigma as well as further studies on the feasibility of incorporating stigma-reduction strategies into young people's sexual and reproductive health programmes.
Language	English
Publishing date	2017-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2023577-X
ISSN	1464-5351 ; 1369-1058
ISSN (online)	1464-5351
ISSN	1369-1058
DOI	10.1080/13691058.2017.1293844
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