Experience of stigma and discrimination and the implications for healthcare seeking behavior among people living with HIV/AIDS in resource-limited setting

Background: Stigma and discrimination can limit access to care and treatment services. Stigma hides HIV from the public; resulting in reduced pressure for behavioral change. For effective behavior change; empirically grounded and theory-based behavioral change approaches are fundamental as a prevention interventions directed on decreasing stigma and discrimination. The objective of the study was to assess the experience of stigma and discrimination on the psychosocial and health care seeking behavior of people living with HIV/AIDS (PLHIV) in Arba Minch; Ethiopia. Methods: This study uses qualitative methods involving focus-group discussions and in-depth interviews conducted in Arba Minch town and nearby Kebeles. Our sample consisted of PLHIV and other key informants who were purposively selected. Data were analyzed manually using thematic content analysis framework. Results: It appears that the magnitude of stigma and discrimination in the area has decreased to a considerably lower level; however; the problem's severity is still being influenced by various factors including: current residence; disclosure status and level of community's awareness about HIV/AIDS. Care and support services provided to PLHIV were well accepted by the respondents and the majority of them were willing to make use of any service available. Health information messages that have been disseminated to the public through mass media since the start of the epidemic in 1984 and AIDS cases in 1986 have played a significant role regarding the current prevailing problem of stigma and discrimination of PLHIV. Conclusion: Stigma and discrimination have come to a level that can be tolerated by most PLHIV that live in this region; especially those who have disclosed their HIV status and were living in urban areas. This calls for a strategy that improves the rates of serostatus disclosure after HIV counseling and testing and strengthens and integrates activities in the task of expanding care and support activities

Discordance between Providers Estimated and Caregivers Self Reported Adherence to HAART and Immunological Response among HIV Infected Children in Ethiopia

Purpose: Poor concordance between patient and physician reports of adherence might lead to inappropriate decisions regarding therapy. This study was undertaken to determine the rate of discordance between caregivers of children and physicians on adherence to Highly Active Antiretroviral Therapy (HAART). Methods: In a cross sectional study involving 390 respondents that was conducted in five hospitals in Addis Ababa; agreement between caregiver-reported adherence and providers' estimate of adherence was compared using Kappa (k) statistic. The association between the CD4 counts and measure of adherence was evaluated using a receiver operating characteristic (ROC) curve. Results: Caregivers reported dose adherence was 87in the last 7 days and physician estimated 84of the children as adherent based on their judgment. Fair agreement was observed between caregivers-reported dose adherence and providers' estimate adherence (Kappa = 0.27; p=0.0001). In a ROC curve; the association between a current CD4 count slope and physician estimated was poor. Conclusions: There is fair agreement and high rate of discordance (18) between physicians estimated and caregivers reported adherence. These recall for an intervention to augment better mutual understanding between physicians and caregivers on the issue of adherence to HAART under clinical care programme