Description
1.0 Introduction
HIV-related stigma has been a concern in our society which have continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health. With the introduction of combination antiretroviral treatments (cART) in 1996, there was optimism that HIV/AIDS and the resulting stigma and discrimination could be addressed. Despite advancements in treatment and the evolution of care to combat HIV/AIDS worldwide, in addition to the proliferation of HIV-related education, work remains to combat the stigma associated with HIV infection. Due to the perceptions and judgements of HIV that continue to persist, stigma remains one of the biggest challenges in the social response to HIV/AIDS (Logie et al., 2019).
This study aims to synthesize qualitative proof that explored the intersections of stigma and health for people with HIV.
1.1 Qualitative Analysis
The working definition of health used for this synthesis derived from the health domains (physical health, mental health and substance use, health care access/utilization, and adherence to antiretroviral medications) identified in a parallel quantitative systematic review on the effects of HIV-related stigma on health outcomes that was conducted by some of the authors (Rueda et al., 2014). The analysis of qualitative literature also accounted for any other health-related findings that may further delineate the interconnection between stigma and health (i.e., achieving wellness while suffering stigma, secondary health-related factors that may act as a pathway between stigma and health).
Qualitative meta summary is a synthesis method used to aggregate qualitative findings and to create a thematic taxonomy across studies (Sandelowski et al , 2013). Thematic analytical approaches were also used to identify, interpret, and report overarching themes and patterns of meanings emerging from the included literature (McInnes et al., 2018). An inductive analytical approach was used so that the themes identified for the synthesis were strongly linked to the thematic findings reported within each study (McInnes et al., 2018).
1.2 Result
The meta summary classified qualitative findings into three overarching categories: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma is avoided or addressed. To better illustrate these connections, the qualitative literature was summarized into the following themes: stigma within health care settings, the role of stigma in caring for one’s health, and strategies to address HIV-related stigma in the health context. A number of health care practices were identified some rooted in institutional practices, others shaped by personal perceptions held by practitioners–that could be stigmatizing or discriminatory towards people with HIV. There existed interconnections between enacted stigma and felt stigma that influenced health care utilization, treatment adherence, and overall health and well-being of people with HIV. Intersectional stigma also emerged as instrumental in the stigma experiences of people living with HIV. A number of approaches to address stigma were recognized including social support, education, self-efficacy, resilience activities, and advocacy.
1.3 Conclusion
This examination of the qualitative evidence indicates that HIV-related stigma within health contexts is a broad social phenomenon that manifests within multiple social spheres, including health care environments. Findings from this study indicate that future stigma research should reflect the social structures and societal practices within and outside of health care environmentsthat spread and reinforce stigma and discrimination towards people with HIV.
