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Your Title: Welcome to our blog on HIV related stigma in Eastern and Southern Sierra Leone ?

Updated: Oct 30, 2023

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HIV stigma.


Mini's Village foundation is a not for profit organization that is currently under charity commissioner registration process. MVF will be operation in Sierra Leone West Africa, were it functional actives will be to provide/build health center facilities in the provision of free medical assessments, free diagnostic screening, and treatment of HIV/AIDs, hepatitis B, and sexually transmitted diseases.

Todays blog will focus on the stigma associated with HIV especially in Sierra Leone.





Introduction

HIV/AIDs ( human immunodeficiency virus continues to be a global public health problem. According to WHO (World Health Organization) 38 million people are currently living with HIV in Africa. Although there is currently no cure of this disease, there are treatments with reduces the viral load which helps individuals to live in a manageable condition. Furthermore, despite the success of ART (antiretroviral therapy) which significantly improve the survival of people livening with HIV, HIV related discrimination persist, posing a formidable barrier in the global respond to HIV epidemic.

Stigma has been defined as set of behavior or attitude that is negatively attack individuals with HIV/AIDS

Methods


Stigma has been defined as a set of attributes that is deeply discrediting [3]. As a complex social phenomenon, stigma encompasses negative attitudes, beliefs, and behaviors directed towards individuals or groups based on perceived differences or characteristics that deviate from societal norms [3-5]. HIV-related stigma is multifaceted in its expression. Perceived (also referred to as felt) stigma refers to the subjective beliefs and attitudes held by PWH about the negative judgments and social rejection they anticipate from others [6]. Enacted stigma, on the other hand, encompasses the actual experiences of discrimination, mistreatment, and marginalization faced by PWH due to their real or perceived serostatus [6]. HIV stigma can have profound impacts on the psychosocial well-being, mental health, quality of life, and clinical outcomes of PWH [7-17]. Studies have shown that HIV stigma leads to increased levels of depression and anxiety [7], unwillingness to test for HIV [8, 9], fear of status disclosure [10, 11], and poor treatment adherence [12, 13]. Furthermore, the fear of stigma contributes to poor retention in HIV care, compromising treatment outcomes [14]. Moreover, HIV stigma is linked to higher HIV viremia and lower CD4 cell counts, indicating negative effects on disease progression and immune health [15-17]. Thus, understanding and addressing the various dimensions of HIV stigma is essential for comprehensive approaches to HIV prevention, care, and psychosocial support


Another study by Kelly et al. [20] demonstrated that HIV stigma at the community level significantly influenced disclosure concerns, condom usage, and self-reported sexually transmitted diseases, especially among women. Additionally, a qualitative study by Lahai et al. [20], involving 16 PWH and 4 healthcare workers identified stigma as a major barrier to ART adherence. These findings underscore the exigent need for targeted interventions addressing HIV stigma at both individual and community levels in Sierra Leone. However, to the best of our knowledge, no study to date has measured HIV stigma from the perspective of PWH in the country. This could be due, in part, to the lack of validated instruments to measure HIV-related stigma in this setting.


Participants, study sites and recruitment We employed convenience sampling to consecutively enroll participants in two hospital based HIV treatment clinics in Sierra Leone between August and November 2022. Bo Government Hospital (BGH) is a 400-bed secondary health facility that serves over 1 million individuals in the Southern region. Kenema Government Hospital (KGH) is a regional 350-bed hospital providing health services to 670,000 people in the Eastern region of Sierra Leone. Trained research staff approached potential study participants at the HIV treatment clinics in BHG and KGH and provided them with information about the study. Those who expressed interest and provided informed consent were enrolled in the study. The inclusion criteria were age ≥ 18 years, confirmed positive HIV serostatus by an approved diagnostic method such as serological testing or polymerase chain reaction methods, or documentation of infection in clinic records. Exclusion criteria included age < 18 years and being unable or unwilling to provide informed consent. The research staff were native Sierra Leoneans with experience in survey methods and a deep understanding of the local context, including languages, norms, and customs. They were affiliated with Njala University in the Southern region and Eastern Technical University in Kenema, both public tertiary educational institutions in Sierra Leone. Before the study, a one-week training seminar was conducted to discuss and make necessary modifications to the survey methods and instruments based on feedback from researchers. HIV stigma assessment tools and procedures We collected socio-demographic information (sex, age, relationship status, educational attainment, employment, and religion) and HIV-related history (HIV status disclosure, duration since diagnosis, and having family or friends living with HIV) using a survey questionnaire. We assessed enacted HIV stigma using four questions adapted from the United States Agency for International Development (USAID) indicators for assessing discrimination toward PWH [21]. The indicators assessed partner/spousal abandonment, isolation from family members, social exclusion, and workplace stigma [21]. Participants responded with "yes" or "no" to indicate whether they had experienced each form of enacted stigma. Each "yes" response was scored as 1 point, while a "no" response received no points. The possible range of scores for enacted HIV stigma was 0-4. We evaluated perceived HIV stigma using the 12-item HIV Stigma Scale by Reinius et al. [22] (Supplementary Materials). This is an abridged and validated version of the 40-item HIV Stigma Scale originally developed and validated by Berger et al [23]. Similar to the full-length Berger scale, the abridged version by Reinius et al. [22] consists of four domains or subscales, with three items in each: (1) personalized stigma (consequences of others knowing about one's HIV status), (2) disclosure concerns (worries about disclosing HIV status), (3) concern with public attitudes (perception of discriminatory attitudes from the public), and (4) negative self-image (also known as self-stigma or internalized stigma). All items on the scale (consecutively labeled Q1 to Q12) were positively worded and rated on a 4-point Likert scale with equidistant scores, as follows: 1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree, with higher scores indicating higher levels of perceived HIV stigma. The possible range of scores was 12-48. For the purposes of our study, we examined and adapted the 12-item HIV Stigma Scale by Reinius et al. [22] for content and construct validity. The scale replicated Berger’s original scale's 4-dimensional structure and demonstrated high internal consistency (Cronbach's α = 0.80- 0.88) [18]. To assist participants without a satisfactory command of the English language, we translated the scale into Krio, the lingua franca and de facto national language, which we piloted

Conclusion

combating stigma associated with HIV will improved and decrease the spread of HIV/AIDS.

It will allows individuals to be confident in screening for the diseases.

it will increase screening and reduce the burden of HIV/AIDS, HBV and STDS globally

HIV is not a death sentence. I believe if we all come together to change the mindset the world will be a better place for all.

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