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01.02.2023 | Original Paper

Characterization of HIV-Related Stigma in Myanmar

verfasst von: Su Aung, Nicole Hardy, Joseph Hogan, Allison DeLong, Aung Kyaw, Min San Tun, Khaymar Win Aung, Rami Kantor

Erschienen in: AIDS and Behavior | Ausgabe 8/2023

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Abstract

Characterizing HIV-related stigma and its impacts are important for interventions toward their elimination. A cross-sectional study was conducted in 2016 to evaluate enacted and internalized stigma among adult people living with HIV (PLWH) across four cities in Myanmar using the India Stigma Index questionnaire. Multivariable regression analyses were performed to determine differences in measured enacted and internalized stigma outcomes. Among 1,006 participants, 89% reported any stigma indicator, 47% enacted stigma, and 87% internalized stigma. In regression analysis, city and duration of illness were associated with higher enacted stigma, and younger age was associated with higher internalized stigma. Those with HIV duration > 7.4 years had mean enacted stigma nearly 2 units higher than the overall mean. Internalized stigma increased with duration of illness and leveled off at 5 years. PLWH from smaller cities experienced lower stigma. In Myanmar, nearly 90% of PLWH experience stigma, results that reflect a unique transition point.

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Dybul M, Attoye T, Baptiste S, Cherutich P, Dabis F, Deeks SG, et al. The case for an HIV cure and how to get there. Lancet HIV. 2021;8(1):e51–e8.PubMedCrossRef

Andersson GZ, Reinius M, Eriksson LE, Svedhem V, Esfahani FM, Deuba K, et al. Stigma reduction interventions in people living with HIV to improve health-related quality of life. Lancet HIV. 2020;7(2):e129–e40.PubMedCrossRef

Sidibe M, Goosby EP, Foreword. Global action to reduce HIV stigma and discrimination. J Int AIDS Soc. 2013;16(3 Suppl 2):18893.PubMedPubMedCentralCrossRef

Mi T, Lan G, Yang X, Li X, Qiao S, Shen Z, et al. HIV-Related stigma, sexual identity, and depressive symptoms among MSM Living with HIV in China: a moderated mediation modeling analysis. Am J Mens Health. 2022;16(2):15579883221087531.PubMedPubMedCentralCrossRef

Akatukwasa C, Getahun M, El Ayadi AM, Namanya J, Maeri I, Itiakorit H, et al. Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial. PLoS ONE. 2021;16(5):e0249462.PubMedPubMedCentralCrossRef

Turan B, Budhwani H, Fazeli PL, Browning WR, Raper JL, Mugavero MJ, et al. How does Stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV Stigma in the Effects of Perceived Community Stigma on Health and Psychosocial Outcomes. AIDS Behav. 2017;21(1):283–91.PubMedPubMedCentralCrossRef

Thanh DC, Moland KM, Fylkesnes K. Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam. BMC Health Serv Res. 2012;12:428.PubMedPubMedCentralCrossRef

Mekuria LA, Sprangers MA, Prins JM, Yalew AW, Nieuwkerk PT. Health-related quality of life of HIV-infected adults receiving combination antiretroviral therapy in Addis Ababa. AIDS Care. 2015;27(8):934–45.PubMedCrossRef

Harris TG, Wu Y, Parmley LE, Musuka G, Mapingure MP, Chingombe I, et al. HIV care cascade and associated factors among men who have sex with men, transgender women, and genderqueer individuals in Zimbabwe: findings from a biobehavioural survey using respondent-driven sampling. Lancet HIV. 2022;9(3):e182–e201.PubMedCrossRef

10.

Ekstrand ML, Bharat S, Srinivasan K. HIV stigma is a barrier to achieving 90-90-90 in India. Lancet HIV. 2018;5(10):e543–e5.PubMedPubMedCentralCrossRef

11.

Gilbert SS. The influence of Islam on AIDS prevention among senegalese university students. AIDS Educ Prev. 2008;20(5):399–407.PubMedCrossRef

12.

Parsons SK, Cruise PL, Davenport WM, Jones V. Religious beliefs, practices and treatment adherence among individuals with HIV in the southern United States. AIDS Patient Care STDS. 2006;20(2):97–111.PubMedCrossRef

13.

Bunn JY, Solomon SE, Miller C, Forehand R. Measurement of stigma in people with HIV: a reexamination of the HIV Stigma Scale. AIDS Educ Prev. 2007;19(3):198–208.PubMedCrossRef

14.

Fuster-Ruizdeapodaca MJ, Molero F, Holgado FP, Mayordomo S. Enacted and internalized stigma and quality of life among people with HIV: the role of group identity. Qual Life Res. 2014;23(7):1967–75.PubMedCrossRef

15.

Lee RS, Kochman A, Sikkema KJ. Internalized Stigma among People living with HIV-AIDS. AIDS Behav. 2002;6(4):309–19.CrossRef

16.

Lo Hog Tian JM, Watson JR, Ibáñez-Carrasco F, Tran B, Parsons JA, Maunder RG, et al. Impact of experienced HIV stigma on health is mediated by internalized stigma and depression: results from the people living with HIV stigma index in Ontario. BMC Public Health. 2021;21(1):1595.PubMedPubMedCentralCrossRef

17.

Smolak A, El-Bassel N. Multilevel stigma as a barrier to HIV testing in Central Asia: a context quantified. AIDS Behav. 2013;17(8):2742–55.PubMedCrossRef

18.

Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006;10(5):473–82.PubMedPubMedCentralCrossRef

19.

Ojikutu BO, Pathak S, Srithanaviboonchai K, Limbada M, Friedman R, Li S, et al. Community Cultural norms, Stigma and Disclosure to sexual partners among women living with HIV in Thailand, Brazil and Zambia (HPTN 063). PLoS ONE. 2016;11(5):e0153600.PubMedPubMedCentralCrossRef

20.

Turan JM, Bukusi EA, Onono M, Holzemer WL, Miller S, Cohen CR. HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study. AIDS Behav. 2011;15(6):1111–20.PubMedCrossRef

21.

Ji G, Li L, Lin C, Sun S. The impact of HIV/AIDS on families and children–a study in China. AIDS. 2007;21(Suppl 8):157–61.CrossRef

22.

Lieber E, Li L, Wu Z, Rotheram-Borus MJ, Guan J, National Institute of Mental Health Collaborative HIVPTG. HIV/STD stigmatization fears as health-seeking barriers in China. AIDS Behav. 2006;10(5):463–71.PubMedPubMedCentralCrossRef

23.

Kang E, Rapkin BD, Remien RH, Mellins CA, Oh A. Multiple dimensions of HIV stigma and psychological distress among Asians and Pacific Islanders living with HIV illness. AIDS Behav. 2005;9(2):145–54.PubMedCrossRef

24.

Yoshioka MR, Schustack A. Disclosure of HIV status: cultural issues of asian patients. AIDS Patient Care STDS. 2001;15(2):77–82.PubMedCrossRef

25.

Tesfay A, Gebremariam A, Gerbaba M, Abrha H. Gender differences in health related quality of life among people living with HIV on highly active antiretroviral therapy in Mekelle Town, Northern Ethiopia. Biomed Res Int. 2015;2015:516369.PubMedPubMedCentralCrossRef

26.

Geary C, Parker W, Rogers S, Haney E, Njihia C, Haile A, et al. Gender differences in HIV disclosure, stigma, and perceptions of health. AIDS Care. 2014;26(11):1419–25.PubMedCrossRef

27.

Mugoya GC, Ernst K. Gender differences in HIV-related stigma in Kenya. AIDS Care. 2014;26(2):206–13.PubMedCrossRef

28.

Asiedu GB, Myers-Bowman KS. Gender differences in the experiences of HIV/AIDS-related stigma: a qualitative study in Ghana. Health Care Women Int. 2014;35(7–9):703–27.PubMedCrossRef

29.

Subramanian T, Gupte MD, Dorairaj VS, Periannan V, Mathai AK. Psycho-social impact and quality of life of people living with HIV/AIDS in South India. AIDS Care. 2009;21(4):473–81.PubMedCrossRef

30.

Tzemis D, Forrest JI, Puskas CM, Zhang W, Orchard TR, Palmer AK, et al. Identifying self-perceived HIV-related stigma in a population accessing antiretroviral therapy. AIDS Care. 2013;25(1):95–102.PubMedCrossRef

31.

Visser MJ, Makin JD, Vandormael A, Sikkema KJ, Forsyth BW. HIV/AIDS stigma in a south african community. AIDS Care. 2009;21(2):197–206.PubMedPubMedCentralCrossRef

32.

Chiu J, Grobbelaar J, Sikkema K, Vandormoel A, Bomela N, Kershaw T. HIV-related stigma and social capital in South Africa. AIDS Educ Prev. 2008;20(6):519–30.PubMedCrossRef

33.

Galvan FH, Davis EM, Banks D, Bing EG. HIV stigma and social support among African Americans. AIDS Patient Care STDS. 2008;22(5):423–36.PubMedPubMedCentralCrossRef

34.

Loutfy MR, Logie CH, Zhang Y, Blitz SL, Margolese SL, Tharao WE, et al. Gender and ethnicity differences in HIV-related stigma experienced by people living with HIV in Ontario, Canada. PLoS ONE. 2012;7(12):e48168.PubMedPubMedCentralCrossRef

35.

Emlet CA, Brennan DJ, Brennenstuhl S, Rueda S, Hart TA, Rourke SB, et al. Protective and risk factors associated with stigma in a population of older adults living with HIV in Ontario, Canada. AIDS Care. 2013;25(10):1330–9.PubMedCrossRef

36.

UNAIDS, Country Factsheets. Myanmar 2018 [Available from: https://www.unaids.org/en/regionscountries/countries/myanmar.

37.

Oo HN, Hone S, Fujita M, Maw-Naing A, Boonto K, Jacobs M, et al. Evolution of the health sector response to HIV in Myanmar: progress, challenges and the way forward. J Virus Erad. 2016;2(Suppl 4):20–6.PubMedPubMedCentralCrossRef

38.

Aung NM, Hanson J, Kyi TT, Htet ZW, Cooper DA, Boyd MA, et al. HIV care in Yangon, Myanmar; successes, challenges and implications for policy. AIDS Res Ther. 2017;14(1):10.PubMedPubMedCentralCrossRef

39.

National AIDS, Programme. Myanmar Progress Report 2018. In: Programme NA, editor. Myanmar2018.

40.

Kyaw KWY, Oo MM, Kyaw NTT, Phyo KH, Aung TK, Mya T, et al. Low mother-to-child HIV transmission rate but high loss-to-follow-up among mothers and babies in Mandalay, Myanmar; a cohort study. PLoS ONE. 2017;12(9):e0184426.PubMedPubMedCentralCrossRef

41.

Kyaw NT, Harries AD, Kumar AM, Oo MM, Kyaw KW, Win T, et al. High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005–2015. PLoS ONE. 2017;12(2):e0171780.PubMedPubMedCentralCrossRef

42.

National AIDS. Programme. National Strategic Plan on HIV and AIDS: Myanmar 2016–2020. 2017.

43.

UNAIDS, Fast-Track. Ending The AIDS Epidemic by 2030. [Available from: https://www.unaids.org/en/resources/documents/2014/JC2686_WAD2014report.

44.

Aung S, Hardy N, Chrysanthopoulou S, Htun N, Kyaw A, Tun MS et al. Evaluation of peer-to-peer HIV counseling in Myanmar: a measure of knowledge, adherence, and barriers.AIDS Care. 2021:1–9.

45.

Aung S, Hardy N, Chrysanthopoulou SA, Kyaw A, San Tun M, Aung KW, et al. Stigma determines antiretroviral adherence in adults with HIV in Myanmar. J Acquir Immune Defic Syndr. 2022;89(1):19–26.PubMedPubMedCentralCrossRef

46.

Steward WT, Herek GM, Ramakrishna J, Bharat S, Chandy S, Wrubel J, et al. HIV-related stigma: adapting a theoretical framework for use in India. Soc Sci Med. 2008;67(8):1225–35.PubMedPubMedCentralCrossRef

47.

Malave S, Ramakrishna J, Heylen E, Bharat S, Ekstrand ML. Differences in testing, stigma, and perceived consequences of stigmatization among heterosexual men and women living with HIV in Bengaluru, India. AIDS Care. 2014;26(3):396–403.PubMedCrossRef

48.

Busza JR. Promoting the positive: responses to stigma and discrimination in Southeast Asia. AIDS Care. 2001;13(4):441–56.PubMedCrossRef

49.

Lau JTF, Tsui HY, Chan K. Reducing discriminatory attitudes toward people living with HIV/AIDS (PLWHA) in Hong Kong: an intervention study using an integrated knowledge-based PLWHA participation and cognitive approach. AIDS Care. 2005;17(1):85–101.PubMedCrossRef

50.

Reidpath DD, Brijnath B, Chan KY. An Asia Pacific six-country study on HIV-related discrimination: introduction. AIDS Care. 2005;17(sup2):117–27.CrossRef

51.

Pannetier J, Lelièvre E, Le Cœur S. HIV-related stigma experiences: understanding gender disparities in Thailand. AIDS Care. 2016;28(2):170–8.PubMedCrossRef

52.

Bennett DS, Traub K, Mace L, Juarascio A, O’Hayer CV. Shame among people living with HIV: a literature review. AIDS Care. 2016;28(1):87–91.PubMedCrossRef

53.

Li L, Lee S-J, Thammawijaya P, Jiraphongsa C, Rotheram-Borus MJ. Stigma, social support, and depression among people living with HIV in Thailand. AIDS Care. 2009;21(8):1007–13.PubMedPubMedCentralCrossRef

54.

Yang LH, Kleinman A, Link BG, Phelan JC, Lee S, Good B. Culture and stigma: adding moral experience to stigma theory. Soc Sci Med. 2007;64(7):1524–35.PubMedCrossRef

55.

Tran BX, Than PQT, Tran TT, Nguyen CT, Latkin CA. Changing sources of stigma against patients with HIV/AIDS in the Rapid Expansion of Antiretroviral Treatment Services in Vietnam. Biomed Res Int. 2019;2019:4208638.PubMedPubMedCentralCrossRef

56.

Hasan MT, Nath SR, Khan NS, Akram O, Gomes TM, Rashid SF. Internalized HIV/AIDS-related stigma in a sample of HIV-positive people in Bangladesh. J Health Popul Nutr. 2012;30(1):22–30.PubMedPubMedCentralCrossRef

57.

Shin SS, Carpenter CL, Ekstrand ML, Yadav K, Shah SV, Ramakrishnan P, et al. Household Food Insecurity as Mediator of the Association between internalized stigma and opportunistic infections. AIDS Behav. 2018;22(12):3897–904.PubMedPubMedCentralCrossRef

58.

Adia AC, Bermudez ANC, Callahan MW, Hernandez LI, Imperial RH, Operario D. “An evil Lurking behind You”: drivers, Experiences, and Consequences of HIV-Related Stigma among Men who have sex with men with HIV in Manila, Philippines. AIDS Educ Prev. 2018;30(4):322–34.PubMedCrossRef

59.

de Lind JW, Fongkaew K. “Being Born like This, I Have No Right to Make Anybody Listen to Me”: Understanding Different Forms of Stigma among Thai Transgender Women Living with HIV in Thailand.J Homosex. 2020:1–18.

60.

Kang E, Delzell DA, Chin JJ, Behar E, Li MY. Influences of stigma and HIV transmission knowledge on member support for faith-placed HIV initiatives in chinese immigrant Buddhist and protestant religious institutions in New York City. AIDS Educ Prev. 2013;25(5):445–56.PubMedPubMedCentralCrossRef

61.

Gee GC, Hing A, Mohammed S, Tabor DC, Williams DR. Racism and the Life Course: taking Time seriously. Am J Public Health. 2019;109(S1):43–S7.CrossRef

62.

Rice WS, Crockett KB, Mugavero MJ, Raper JL, Atkins GC, Turan B. Association between internalized HIV-Related Stigma and HIV Care visit adherence. J Acquir Immune Defic Syndr. 2017;76(5):482–7.PubMedPubMedCentralCrossRef

63.

Tsai AC, Bangsberg DR, Frongillo EA, Hunt PW, Muzoora C, Martin JN, et al. Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med. 2012;74(12):2012–9.PubMedPubMedCentralCrossRef

64.

Wagner GJ, Ghosh-Dastidar B, Garnett J, Kityo C, Mugyenyi P. Impact of HIV antiretroviral therapy on depression and mental health among clients with HIV in Uganda. Psychosom Med. 2012;74(9):883–90.PubMedCrossRef

65.

Chan BT, Maughan-Brown BG, Bogart LM, Earnshaw VA, Tshabalala G, Courtney I, et al. Trajectories of HIV-related internalized stigma and disclosure concerns among ART initiators and non-initiators in South Africa. Stigma Health. 2019;4(4):433–41.PubMedPubMedCentralCrossRef

66.

Eaton LA, Earnshaw VA, Maksut JL, Thorson KR, Watson RJ, Bauermeister JA. Experiences of stigma and health care engagement among black MSM newly diagnosed with HIV/STI. J Behav Med. 2018;41(4):458–66.PubMedPubMedCentralCrossRef

67.

Quan AML, Mah C, Krebs E, Zang X, Chen S, Althoff K, et al. Improving health equity and ending the HIV epidemic in the USA: a distributional cost-effectiveness analysis in six cities. Lancet HIV. 2021;8(9):e581–e90.PubMedPubMedCentralCrossRef

68.

Souteyrand YP, Collard V, Moatti JP, Grubb I, Guerma T. Free care at the point of service delivery: a key component for reaching universal access to HIV/AIDS treatment in developing countries. AIDS. 2008;22(Suppl 1):161–8.CrossRef

69.

Rebeiro PF, McPherson TD, Goggins KM, Turner M, Bebawy SS, Rogers WB, et al. Health literacy and demographic disparities in HIV Care Continuum Outcomes. AIDS Behav. 2018;22(8):2604–14.PubMedPubMedCentralCrossRef

70.

Pantelic M, Boyes M, Cluver L, Meinck F. HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among south african adolescents living with HIV. J Int AIDS Soc. 2017;20(1):21771.PubMedPubMedCentralCrossRef

71.

MacLean JR, Wetherall K. The Association between HIV-Stigma and depressive symptoms among people living with HIV/AIDS: a systematic review of studies conducted in South Africa. J Affect Disord. 2021;287:125–37.PubMedCrossRef

72.

Emlet CA. Measuring stigma in older and younger adults with HIV/AIDS: an analysis of an HIV stigma scale and initial exploration of subscales. Res Social Work Pract. 2005;15(4):291–300.CrossRef

73.

Emlet CA. A comparison of HIV stigma and disclosure patterns between older and younger adults living with HIV/AIDS. AIDS Patient Care STDS. 2006;20(5):350–8.PubMedCrossRef

74.

Amuri M, Mitchell S, Cockcroft A, Andersson N. Socio-economic status and HIV/AIDS stigma in Tanzania. AIDS Care. 2011;23(3):378–82.PubMedCrossRef

75.

Rao D, Chen WT, Pearson CR, Simoni JM, Fredriksen-Goldsen K, Nelson K, et al. Social support mediates the relationship between HIV stigma and depression/quality of life among people living with HIV in Beijing, China. Int J STD AIDS. 2012;23(7):481–4.PubMedPubMedCentralCrossRef

76.

Nachega JB, Morroni C, Zuniga JM, Sherer R, Beyrer C, Solomon S, et al. HIV-related stigma, isolation, discrimination, and serostatus disclosure: a global survey of 2035 HIV-infected adults. J Int Assoc Physicians AIDS Care (Chic). 2012;11(3):172–8.PubMedCrossRef

Titel: Characterization of HIV-Related Stigma in Myanmar
verfasst von: Su Aung
Nicole Hardy
Joseph Hogan
Allison DeLong
Aung Kyaw
Min San Tun
Khaymar Win Aung
Rami Kantor
Publikationsdatum: 01.02.2023
Verlag: Springer US
Erschienen in: AIDS and Behavior / Ausgabe 8/2023
Print ISSN: 1090-7165
Elektronische ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-023-03998-1

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