Healthcare professionals' perceived stigmatization about direct care of COVID-19 Patients: development and validation of the discrimination about COVID-19 (DisCOV-19) instrument

Background: The novel coronavirus disease 2019 (COVID-19) is a public health concern worldwide. Healthcare professionals are among the most vulnerable groups in the fight against COVID-19 because they are directly involved in the care of at-risk persons and patients with Covid-19. Objectives: This study aimed to measure the level to which healthcare workers feel that they can be discriminated due to their involvement in the direct care of COVID-19 patients. Methods: A cross-sectional online survey was conducted among healthcare professionals in Nigeria. A nineteen-item discrimination against COVID-19 (DisCOV-19) questionnaire was developed and validated for the study. Descriptive statistics and OneWay Analysis of Variance were used for data analysis. P<0.05 was considered statistically significant. Results: Out of the 286 healthcare practitioners that participated in the study, 58.4% and 30.1% were pharmacists and physicians, respectively. The majority of the participants were at least "moderately concerned" about disability (60.9%), death (71.7%), unknown complications (65.1%), and risk of infecting family members and friends (83.2%) if asked to provide care for COVID-19 patients. The physicians had a significantly higher mean discrimination score compared to the pharmacists (p=0.041). Pharmacists had a significantly lower mean discrimination score than the nurses (p=0.011). Conclusions: Many of the healthcare professionals reported a certain level of concern and perceived that they could face some forms of discrimination for providing care to COVID-19 patients

Restricted participation: Drivers, experiences and implications of disability stigma in Ethiopia

Background: Community-based inclusive development (CBID) acknowledges society's critical role in supporting the active participation of persons with disabilities. However, research on how this approach relates to the context-sensitive socially situated barriers of disability stigma is underexplored. Objectives: This study aimed to understand the drivers and experiences of disability stigma in Ethiopia, from the perspective of persons with disabilities engaged in CBID programmes, and to establish how disability stigma acts as a barrier to participation. Methods: An inductive methodological approach guided the research design. Mixed methods were used including a narrative review of disabilities studies literature, 16 semi-structured interviews with persons with disabilities, and a quantitative survey of 970 persons with disabilities across three communities in Ethiopia. Results: Informed by theories of epistemic justice, this study identified specific indicators of meaningful participation and examined how these relate to experiences of disability stigma. The study found that the participation of adults with disabilities in society is restricted across different areas of life. Misconceptions about the causes of disability and social perceptions regarding the capacities of persons with disabilities are found to exacerbate stigma and act as a barrier to participation. Conclusion: Targeted efforts to challenge internalised norms and harmful beliefs within CBID approaches are required to address disadvantages arising from embedded disability stigma. Contribution: This study makes conceptual, empirical and practical contributions that advance insights into the relationship between disability stigma and participation in Ethiopia and the dimensions of epistemic justice relevant to understanding the nature and drivers of disability stigma.

Quality of life of people living with HIV and AIDS attending Irrua Specialist Teaching Hospital, Edo State, Nigeria

Background: With the use of highly active antiretroviral therapy (HAART), life expectancy of HIV-infected persons had increased and the disease is now managed as a chronic one, but the quality of life (QOL) of the patients is now a concern. Social support enhances QOL of patients with chronic illnesses. However, no study has been done to determine the QOL of people living with HIV and AIDS (PLWHA) in our environment. This study therefore assessed the QOL of PLWHA attending antiretroviral therapy (ART) clinic of Irrua Specialist Teaching Hospital (ISTH), Edo State of Nigeria Methodology: A descriptive cross-sectional study design was used. Two hundred and thirty PLWHA attending the ART clinic of ISTH, Irrua, Edo State, Nigeria, were systematically selected for the study. A structured questionnaire was interviewer-administered to collect data on sociodemographic and clinical profiles of selected participants, and the WHOQOL-HIV BREF questionnaire was used to collect data the QOL of each participant. Data were analyzed with IBM SPSS version 20.0. Results: The overall mean QOL score for the participants was 89.13±1.18 (95% CI=87.95-90.31). The scores in three of the six life domains in the WHOQOL-HIV BREF instrument were similar and high; spirituality/ religion/personal beliefs (16.33±0.36), physical health (15.83±0.28) and psychological health (15.07±0.24). Lower mean QOL scores were observed in the social relationships (13.49±0.28) and environment (13.45±0.20) domains. Clinical HIV stage, marital status, educational status and gender were significantly associated with mean QOL scores in bivariate analysis while only HIV stage 1 and 2 were significantly associated with good QOL in multivariate logistic regression analysis. Conclusion: It is pertinent that PLWHA are kept in early stages of HIV disease through combination of efforts such as prompt enrolment, commencement and monitoring compliance of HAART, and treatment of opportunistic infections, as well as public health measures including education, de-stigmatization, early diagnosis by extensive accessible screening/testing of at-risk population, social supports and economic empowerment, psychotherapy and social integration of affected individuals especially in a functional home.

Psychosocial impact of the implementation of COVID-19 protocols

BACKGROUND: The COVID-19 pandemic has spread globally since the first case was diagnosed in Wuhan, China in December 2019 and we are now experiencing the fourth wave. Several measures are being taken to care for the infected and to curtail the spread of this novel infectious virus. The psychosocial impact of these measures on patients, relatives, caregivers, and medical personnel also needs to be assessed and catered for. METHODS: This is a review article on the psychosocial impact of the implementation of COVID-19 protocols. The literature search was done using Google Scholar, PubMed, and Medline. DISCUSSION: Modalities of transportation of the patient to isolation and quarantine centres have led to stigma and negative attitudes towards such individuals. When diagnosed with the infection, fear of dying from COVID-19, fear of infecting family members and close associates, fear of stigmatization, and loneliness are common among COVID-19 patients. Isolation and quarantine procedures also cause loneliness and depression, and the person is at risk of post-traumatic stress disorder. Caregivers are continually stressed out and have the constant fear of contracting SARS-CoV-2. Despite clear guidelines to help with closure for family members of people dying from COVID-19, inadequate resources make this unrealistic. CONCLUSION: Mental and emotional distress resulting from fear of SARS-Cov-2 infection, the mode of transmission, and consequences have a tremendous negative impact on the psychosocial well-being of those affected, their caregivers, and relatives. There is a need for the government, health institutions, and NGOs to establish platforms to cater to these concerns

A preliminary analysis of the association between perceived stigma and HIV-related pain in South Africans living with HIV

Background: Stigma related to the human immunodeficiency virus (HIV) remains common and has been associated with severity of HIV-related symptoms. Associations between HIV stigma and HIV-related pain, one of the most common symptoms in HIV, have however not been investigated. Data from low back pain populations suggest that stigma is associated with worse pain intensity and so we hypothesised that the same would be the case in HIV.Aim: The goal of this study was to assess the association between HIV stigma and pain intensity in people living with HIV (PLWH) with chronic pain whilst controlling for depression, a well-established correlate of pain.Setting: The study took place at an HIV clinic in Johannesburg, South Africa.Methods: Mediation analysis was used to assess the effect of depression on the relationship between stigma and pain intensity in a cross-sectional cohort of 50 PLWH and chronic pain (pain most days of the week for > 3 months). All participants were assessed using the HIV/AIDS Stigma Instrument ­ PLWA, an 11-point numerical pain rating scale and the Beck Depression Inventory II.Results: In all, 88% (44/50) of participants reported experiencing some form of HIV stigma (HIV stigma scale score ≥ 1). Worst pain intensity and depressive symptoms individually correlated with total stigma score (Spearman's r = 0.33, p = 0.02 for both). The mediation analysis highlighted that mediation of the relationship by depression was equivocal (b = -0.002, bootstrapped confidence interval -0.02 to 0.00).Conclusion: Whilst these preliminary data are marginal, they do suggest that associations between HIV stigma and HIV-related pain warrant further investigation. Future study should also include potential mechanisms, which may include mediation through depression

Challenges faced by caregivers of children on antiretroviral therapy at Mutale Municipality selected healthcare facilities, Vhembe District, Limpopo Province

Background: Children depend solely on caregivers who can be either parents or guardians for drug administration to enhance adherence to antiretroviral treatment (ART), which might pose any number of challenges.Purpose: The purpose of this study was to explore and describe the challenges faced by caregivers of children on ART at Mutale Municipality, Vhembe District, Limpopo Province.Research design and method: The research design was qualitative, explorative, descriptive and contextual in nature. The population consisted of 16 caregivers who were 18 years of age and above, and mentally capable, irrespective of educational qualifications, caring for children aged between 0 and 15 years who were on ART between April 2013 and October 2014. Non-probability, purposive sampling was used to select the 16 caregivers. Required permission, approval and ethical clearance were obtained from the University of Venda Higher Degree Committee, Limpopo Provincial Health Department and relevant institutions. An in-depth, individual, unstructured interview method was used to collect data. One central question was asked: 'What are the challenges you experience when caring for a child on antiretroviral treatment?' Subsequent questions were based on the participants' responses to the central question. Qualitative data were analysed by means of Tesch's open-coding method.Results: The findings of this study revealed that participants, that is, caregivers of children on ART, experienced financial burdens because of transport costs needed to comply with follow-up dates and insufficient of money for food, clothing the child in need of care, pocket money for lunch boxes during school hours and time lost while waiting for consultations. Participants reported some level of stigmatisation against children on ART by family members, especially the husbands or in-laws of the secondary caregivers. Many primary and secondary caregivers seemed to have given up seeking support from government and community structures.Conclusion: The conclusions drawn from this research are that caregivers hardly receive any support from family members or the community. Fear of disclosing the HIV-positive status of children resulted in the delay of financial support from the government, thus leading to serious financial burden on the caregivers

Stigma and HIV Disclosure in the Cape Metropolitan Area; South Africa

Disclosure rates of HIV-positive status remain low and are considered to be related to stigmatisation. Determining the factors that influence a person's decision to disclose a positive status is essential to understanding the process of and ways to improve disclosure rates. This study investigated the factors that influence the disclosure of a person's HIV-positive status and focused on socio-demographic factors; stigma and discrimination; religion; culture; fear of abandonment and rejection as well as knowledge of the disease that may all influence disclosure rates. A facility based descriptive cross-sectional research design with a quantitative approach was applied using convenience sampling. The sample comprised 150 individuals which was 12.5 of the study population. A self-administered questionnaire comprising mainly closed-ended questions; with a limited number of open ended questions was designed; tested and utilised. Statistical associations were determined between the demographic factors and responses to the questions. The open ended questions were analysed thematically by means of content analysis to extract meaning. The results revealed that fear of stigmatisation; especially among the male participants; was a major reason for delayed or non-disclosure. The results of the total study sample also showed that the level of education influenced the fear of stigmatisation; those with secondary school level education were most afraid of this (29). There was a statistically significant association between fear of blame or discrimination and disclosure to the sexual partner. This fear was most often cited by the participants who had never married (19). The participants who feared blame or discrimination the most reported having no income (23). The findings of this study indicate that numerous factors influence HIV disclosure. Stigma of individuals who are HIV-positive remains a barrier to disclosure as well as fear of blame and discrimination. Recommendations were made to facilitate and increase disclosure rates. This should include community based support groups and advocating partners to attend voluntary counselling and testing together to minimise the fear of blame

Barriers to Men who have Sex with Men Attending HIV Related Health Services in Dar es Salaam; Tanzania

The HIV/ AIDS disease burden is disproportionately high among men who have sex with men (MSM) worldwide. If this group will continue to be ignored they will continue to be the focus of HIV infection to the general population. This study explored barriers impeding MSM utilizing the HIV related health services currently available. The objectives of the study were to: (i) determine how stigma and discrimination affect MSM attendance to HIV related health services; (ii) determine how health care worker's (HCW's) practices and attitudes towards MSM affect their attendance to HIV related health service; (iii) learn MSM's perception towards seeking HIV related health services and other factors affecting accessibility of HIV related health services among MSM in Dar es Salaam; Tanzania. This was a descriptive study whereby qualitative methods were employed; using in-depth interviews for 50 individuals and focus group discussions for 5 groups which were conducted at PASADA premises; in Temeke district in 2012. After transcription data was read through; codes created were then collapsed into themes which were interpreted. The findings of this study show that majority of the study participants access HIV related health services in Dar es Salaam when they need to. However; they reported stigma and discrimination; lack of confidentiality and privacy; lack of availability and MSM friendly HIV related health services; financial challenges; poor practices and negative attitudes directed towards them by health workers; fears and lack of HIV knowledge among them as barriers for them to access these services. With these findings; there is an importance of enabling MSM to overcome the perceived stigma when seeking for HIV related health services. Also there is a need to conduct further research with regards to how HCW's treat this group and their understanding on same sex practices

The Perspectives of Users of Antiretroviral Therapy on Structural Barriers to Adherence in South Africa

Background: The effectiveness of antiretroviral therapy (ART) and the importance of adherence to treatment regimens are widely known. Yet; suboptimal adherence to ART and retention in care of patients still persists and; by many accounts; is fairly widespread. The aim of this study was to identify the structural barriers that influenced adherence among patients who were enrolled in the national ART programme in South Africa.Method: In this qualitative study; semi-structured interviews were conducted with a sample of 10 patients receiving ART at a public hospital in South Africa.Results: The results of the interviews were categorised according to poverty-related; institution-related and social barriers to clinic attendance and pill-taking; which collectively formed the structural barriers to adherence. The chief structural barriers to clinic attendance were time away from work; transport expenses; long waiting times and negative experiences with clinic staff. The chief barriers to pill-taking were food insecurity; stigma and discrimination.Conclusion: The barriers to adherence are discussed. Attention is called to the extraindividual factors that influenced ART adherence. We conclude that contextual factors; such as a healthcare-enabling environment; might play an important role in influencing healthcare-promoting behaviour among patients

Social and Cultural Aspects of HIV and AIDS in West Africa: A Narrative Review of Qualitative Research

With the increasing focus on the role of social aspects of the HIV epidemic in sub-Saharan Africa; the need for an overview of existing research dealing with such issues has become more urgent. The objective of this article is to provide a thematic overview of existing qualitative research on HIV and AIDS in the West African region and to analyze the main research findings in order to identify possible gaps and recommend new research themes to inform future research-based interventions. The analysis is based on a total of 58 articles published from 2001 to 2009 in eng or French identified through a literature search in seven scientific; bibliographical databases. Searches included terms related to qualitative studies combined with various terms related to HIV/AIDS. The results of this narrative review show that there was a geographical concentration on Nigeria; Ghana; Burkina Faso and Co. e d'Ivoire and a strong urban bias; with most studies taking place in the capital cities of these countries. The majority of the studies focused on women or women and men; only four articles dealt exclusively with men; of which only two were on men who have sex with men. The main study groups were people living with HIV; young people or female sex workers. Sexual risk-taking and stigmatization were the themes that were most prominently explored in the articles we reviewed. We conclude that research needs to be strengthened in relation to the analysis of experiences with antiretroviral therapy and the non-optimal access to treatment in West Africa. Also; more research is needed on men and their exposure to HIV/AIDS; as well as on the role of concurrent partnership in the spread of HIV

Stigma of People with HIV/AIDS in Sub-Saharan Africa: A Literature Review

The aim of this literature review is to elucidate what is known about HIV/AIDS and stigma in Sub-Saharan Africa. Literature about HIV/AIDS and stigma in Sub-Saharan Africa was systematically searched in Pubmed; Medscape; and Psycinfo up to March 31; 2009. No starting date limit was specified. The material was analyzed using Gilmore and Somerville's (1994) four processes of stigmatizing responses: the definition of the problem HIV/AIDS; identification of people living with HIV/AIDS (PLWHA); linking HIV/AIDS to immorality and other negative characteristics; and finally behavioural consequences of stigma (distancing; isolation; ination in care). It was found that the cultural construction of HIV/AIDS; based on beliefs about contamination; sexuality; and religion; plays a crucial role and contributes to the strength of distancing reactions and discrimination in society. Stigma prevents the delivery of effective social and medical care (including taking antiretroviral therapy) and also enhances the number of HIV infections. More qualitative studies on HIV/AIDS stigma including stigma in health care institutions in Sub-Saharan Africa are recommended

Sterility and stigma in an era of HIV/AIDS: narratives of risk assessment among men and women in Botswana

This paper examines the experience and interpretations of infertility and sterility in northern Botswana. Specifically it highlights the role of stigma and impression management among Tswana men and women through their narratives and discourse about childbearing and personhood in an era of HIV/AIDS. The paper demonstrates that in a country with one of the highest HIV/AIDS infection rates in the world, risky sexual practices are weighed against cultural norms that suggest being a full person and productive adult is to be a reproductive man or woman. Through longitudinal qualitative research the narratives and life histories of several individuals offer ethnographic evidence on the power of stigma. The research finds that even with ubiquitous HIV/AIDS education and prevention programmes throughout Botswana, Tswana engage in various kinds of risk taking behaviours as means through which impressions and identities as full persons of value may be managed successfully (Afr J Reprod Health 2011; 15[1]: 95-100)

We also have Cases of the Disease that you are researching about. Small-scale Enterprises and the Challenges of HIV/AIDS-Related Stigma and Discrimination in Kabale; Uganda

At the workplace; the HIV epidemic has brought about loss of productivity; staff turnover and increased labour costs among others. HIV stigma presents barriers to HIV prevention in different settings including the workplace. Unlike large scale enterprises; small-scale enterprises have received less attention in the fight against HIV/AIDS. This study employed a qualitative case study design. Data were collected from eighteen participants in three small-scale enterprises in Kabale; Uganda. Findings indicate that although there are effectively no workplace policies in small-scale enterprises; employees in the visited workplaces do not fear HIV/AIDS testing and disclosing their HIV/AIDS status as main sources of HIV-stigma although their perceptions remain hypothetical. Integrating clear anti-discriminatory HIV/AIDS policies may empower some small-scale enterprises with related HIV knowledge and skills in an effort to overcome the challenges of HIV-related stigma and discrimination

Perceptions of Body Size and Its Association with HIV/AIDS

Objective: To explore the perception among black South African women that people who are thin are infected with HIV or have AIDS.Setting: Khayelitsha; an urban township in Cape Town.Subjects: 513 women aged 18-65 years.Methods: This was an exploratory study employing both quantitative and qualitative research methodology. Data were collected in two phases. The first phase involved collecting quantitative data among 513 participants. During the second phase; qualitative data were collected in a purposely selected sub-sample of 20 women. For the qualitative data collection; participants were shown eight body figures; ranging from thin to obese; and asked to choose a figure representing the ideal figure; a preferred figure and a figure thought to symbolise health. They were also invited to choose a figure that they thought represented a person infected with HIV or who had AIDS. They had the option of saying that they did not associate any of the figures with people infected with HIV or who had AIDS. Weight and height measurements were also taken. After the quantitative analysis was completed; focus group discussions explored perceptions about body image and the relation to HIV among purposely selected participants. Data were summarised by content based on questions discussed. Results: Sixty-nine per cent of the participants associated a thin figure with a person infected with HIV; or who had AIDS. Only 10.2thought the thin figure symbolised health. Fifty per cent preferred a normal-weight figure; while 34.2thought that normal weight symbolised health. Only 2thought that people in the normal-weight category were infected with HIV or had AIDS.Thirty-four per cent preferred to be overweight and 31thought that being overweight symbolised health. None of the participants thought the overweight figure represented people infected with HIV or who had AIDS. Only 8preferred the obese figure. The results of the qualitative data analysis suggested that participants preferred to be overweight and at risk of acquiring cardiovascular diseases; rather than being thin and stigmatised as a person infected with HIV or who had AIDS.Conclusion: This study revealed that the stigma associated with HIV and AIDS may undermine strategies for prevention of chronic noncommunicable diseases among urban black South African women

Perceptions of Body Size and Its Association with HIV/AIDS

Objective: To explore the perception among black South African women that people who are thin are infected with HIV or have AIDS.Setting: Khayelitsha; an urban township in Cape Town.Subjects: 513 women aged 18-65 years.Methods: This was an exploratory study employing both quantitative and qualitative research methodology. Data were collected in two phases. The first phase involved collecting quantitative data among 513 participants. During the second phase; qualitative data were collected in a purposely selected sub-sample of 20 women. For the qualitative data collection; participants were shown eight body figures; ranging from thin to obese; and asked to choose a figure representing the ideal figure; a preferred figure and a figure thought to symbolise health. They were also invited to choose a figure that they thought represented a person infected with HIV or who had AIDS. They had the option of saying that they did not associate any of the figures with people infected with HIV or who had AIDS. Weight and height measurements were also taken. After the quantitative analysis was completed; focus group discussions explored perceptions about body image and the relation to HIV among purposely selected participants. Data were summarised by content based on questions discussed. Results: Sixty-nine per cent of the participants associated a thin figure with a person infected with HIV; or who had AIDS. Only 10.2thought the thin figure symbolised health. Fifty per cent preferred a normal-weight figure; while 34.2thought that normal weight symbolised health. Only 2thought that people in the normal-weight category were infected with HIV or had AIDS.Thirty-four per cent preferred to be overweight and 31thought that being overweight symbolised health. None of the participants thought the overweight figure represented people infected with HIV or who had AIDS. Only 8preferred the obese figure. The results of the qualitative data analysis suggested that participants preferred to be overweight and at risk of acquiring cardiovascular diseases; rather than being thin and stigmatised as a person infected with HIV or who had AIDS.Conclusion: This study revealed that the stigma associated with HIV and AIDS may undermine strategies for prevention of chronic noncommunicable diseases among urban black South African women

Barriers to use of Antiretroviral Drugs in Rakai District of Uganda

Background: About 75of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries. Objective: To investigate the barriers to use of ART in Rakai district of Uganda Methods: We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART; sources of information for ART; beliefs regarding ART; social support; use of alternative medicine; stigma/discrimination towards PHAs; distance to ART centres; transport costs to ART centres; waiting time; and on suggestions as how to improve the use of ART. Results: The major barriers mentioned regarding use of ART included: inadequate mobilization; long waiting time at ART treatment centres; high cost of transport to reach ART centres; stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs. Conclusions: Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approaches such as through music; dance and videos; increasing the number of providers who are able to provide ART as through engagement of non health professionals in ART care; bringing ART nearer to where people live and instituting measures aimed at reducing stigma/discrimination such as through involvement of PHAs in demystisfying HIV/AIDS

Mental health stigma: what is being done to raise awareness and reduce stigma in South Africa?

Objective: Stigma plays a major role in the persistent suffering; disability and economic loss associated with mental illnesses. There is an urgent need to find effective strategies to increase awareness about mental illnesses and reduce stigma and discrimination. This study surveys the existing anti-stigma programmes in South Africa. Method: The World Health Organization's Assessment Instrument for Mental Health Systems Version 2.2 and semi-structured interviews were used to collect data on mental health education programmes in South Africa. Results: Numerous anti-stigma campaigns are in place in both government and non-government organizations across the country. All nine provinces have had public campaigns between 2000 and 2005; targeting various groups such as the general public; youth; different ethnic groups; health care professionals; teachers and politicians. Some schools are setting up education and prevention programmes and various forms of media and art are being utilized to educate and discourage stigma and discrimination. Mental health care users are increasingly getting involved through media and talks in a wide range of settings. Yet very few of such activities are systematically evaluated for the effectiveness and very few are being published in peer-review journals or in reports where experiences and lessons can be shared and potentially applied elsewhere. Conclusion: A pool of evidence for anti-stigma and awareness-raising strategies currently exists that could potentially make a scientific contribution and inform policy in South Africa as well as in other countries