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‘Management of a spoiled identity’: systematic review of interventions to address self-stigma among people living with and affected by HIV
  1. Marija Pantelic1,2,
  2. Janina I Steinert3,
  3. Jay Park4,
  4. Shaun Mellors2,
  5. Fungai Murau2
  1. 1 Department of Social Policy and Intervention, Oxford University, Oxford, UK
  2. 2 Frontline AIDS, Brighton, UK
  3. 3 Department of Economics, University of Goettingen, Goettingen, Germany
  4. 4 School of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Marija Pantelic; mpantelic{at}frontlineaids.org

Abstract

Background Self-stigma, also known as internalised stigma, is a global public health threat because it keeps people from accessing HIV and other health services. By hampering HIV testing, treatment and prevention, self-stigma can compromise the sustainability of health interventions and have serious epidemiological consequences. This review synthesised existing evidence of interventions aiming to reduce self-stigma experienced by people living with HIV and key populations affected by HIV in low-income and middle-income countries.

Methods Studies were identified through bibliographic databases, grey literature sites, study registries, back referencing and contacts with researchers, and synthesised following Cochrane guidelines.

Results Of 5880 potentially relevant titles, 20 studies were included in the review. Represented in these studies were 9536 people (65% women) from Ethiopia, India, Kenya, Lesotho, Malawi, Nepal, South Africa, Swaziland, Tanzania, Thailand, Uganda and Vietnam. Seventeen of the studies recruited people living with HIV (of which five focused specifically on pregnant women). The remaining three studies focused on young men who have sex with men, female sex workers and men who inject drugs. Studies were clustered into four categories based on the socioecological level of risk or resilience that they targeted: (1) individual level only, (2) individual and relational levels, (3) individual and structural levels and (4) structural level only. Thirteen studies targeting structural risks (with or without individual components) consistently produced significant reductions in self-stigma. The remaining seven studies that did not include a component to address structural risks produced mixed effects.

Conclusion Structural interventions such as scale-up of antiretroviral treatment, prevention of medication stockouts, social empowerment and economic strengthening may help substantially reduce self-stigma among individuals. More research is urgently needed to understand how to reduce self-stigma among young people and key populations, as well as how to tackle intersectional self-stigma.

  • self-stigma
  • HIV
  • key populations
  • stigma
  • low- and middle-income countries

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Handling editor Seye Abimbola

  • Twitter New #systematicreview by @PantelichMarija et al. identifies what works to address self #stigma among people living with and affected by #HIV in resource-limited settings.

  • Contributors MP conceptualised the study with input from SM. JIS double-screened and double-coded the studies. JIS contributed to interpretation of findings. MP had the final responsibility of writing the paper, with feedback from all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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