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AIDS and Behavior
Published in: AIDS and Behavior 2/2015

01-02-2015 | Original Paper

HIV Stigma as a Barrier to Retention in HIV Care at a General Hospital in Lima, Peru: A Case–Control Study

Authors: Carla Valenzuela, Cesar Ugarte-Gil, Jorge Paz, Juan Echevarria, Eduardo Gotuzzo, Sten H. Vermund, Aaron M. Kipp

Published in: AIDS and Behavior | Issue 2/2015

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Abstract

HIV stigma as a barrier to retention in HIV care has not been well-studied outside the United States. We conducted a case–control study in Lima, Peru to examine this issue. Cases were out-of-care for ≥12 months (n = 66) and controls were recruited from patients in active care presenting for a clinic visit (n = 110). A previously validated HIV stigma scale with four domains was used. Associations between being out-of-care and each stigma domain were assessed using multivariable logistic regression. Stigma scores were highest for disclosure concerns. Modest associations were found for greater disclosure concerns (OR 1.16; 95 % CI 0.99, 1.36) and concerns with public attitudes (OR 1.20; 95 % CI 1.03, 1.40). Enacted stigma and negative self-image showed non-linear associations with being out-of-care that plateaued or declined, respectively, at higher levels of stigma. The threshold effect for enacted stigma warrants further exploration, while disclosure concerns may be especially amenable to intervention in this population.
Literature
1.
Mugavero MJ, Davila JA, Nevin CR, Giordano TP. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDS. 2010;24(10):607–13.CrossRefPubMedCentralPubMed
2.
Thompson MA, Mugavero MJ, Amico KR, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an international association of physicians in AIDS care panel. Ann Intern Med. 2012;156(11):817–33.CrossRefPubMedCentralPubMed
3.
Walensky RP, Paltiel AD, Losina E, et al. The survival benefits of AIDS treatment in the United States. J Infect Dis. 2006;194(1):11–9.CrossRefPubMed
4.
Wada N, Jacobson LP, Cohen M, French A, Phair J, Munoz A. Cause-specific life expectancies after 35 years of age for human immunodeficiency syndrome-infected and human immunodeficiency syndrome-negative individuals followed simultaneously in long-term cohort studies, 1984–2008. Am J Epidemiol. 2013;177(2):116–25.CrossRefPubMedCentralPubMed
5.
6.
Ulett KB, Willig JH, Lin HY, et al. The therapeutic implications of timely linkage and early retention in HIV care. AIDS Patient Care STDS. 2009;23(1):41–9.CrossRefPubMedCentralPubMed
7.
Mugavero MJ, Lin HY, Willig JH, et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis. 2009;48(2):248–56.CrossRefPubMedCentralPubMed
8.
Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS Res Hum Retroviruses. 2011;27(7):751–8.CrossRefPubMed
9.
Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57.CrossRefPubMed
10.
Mugavero MJ. Improving engagement in HIV care: what can we do? Top HIV Med. 2008;16(5):156–61.PubMed
11.
Kempf M-C, McLeod J, Boehme AK, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural southeastern United States: implications for targeted interventions. AIDS Patient Care STDS. 2010;24(8):515–20.CrossRefPubMed
12.
13.
Chesney MA, Smith AW. Critical delays in HIV testing and care: the potential role of stigma. Am Behav Sci. 1999;42(7):1162–74.CrossRef
14.
Golin C, Isasi F, Bontempi JB, Eng E. Secret pills: HIV-positive patients’ experiences taking antiretroviral therapy in North Carolina. AIDS Educ Prev. 2002;14(4):318–29.CrossRefPubMed
15.
Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med. 2003;57(1):13–24.CrossRefPubMed
16.
Deacon H. Towards a sustainable theory of health-related stigma: lessons from the HIV/AIDS literature. J Commun Appl Soc Psychol. 2006;16:418–25.CrossRef
17.
Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001;27:363–85.CrossRef
18.
Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.CrossRefPubMed
19.
Nyblade LC. Measuring HIV stigma: existing knowledge and gaps. Psychol Health Med. 2006;11(3):335–45.CrossRefPubMed
20.
21.
Rajabiun S, Mallinson RK, McCoy K, et al. “Getting me back on track”: the role of outreach interventions in engaging and retaining people living with HIV/AIDS in medical care. AIDS Patient Care STDS. 2007;21(Suppl 1):S20–9.PubMed
22.
Bogart LM, Chetty S, Giddy J, et al. Barriers to care among people living with HIV in South Africa: contrasts between patient and healthcare provider perspectives. AIDS Care. 2013;25(7):843–53.CrossRefPubMedCentralPubMed
23.
Ware NC, Wyatt MA, Tugenberg T. Social relationships, stigma and adherence to antiretroviral therapy for HIV/AIDS. AIDS Care. 2006;18(8):904–10.CrossRefPubMed
24.
Wolitski RJ, Pals SL, Kidder DP, Courtenay-Quirk C, Holtgrave DR. The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV. AIDS Behav. 2009;13(6):1222–32.CrossRefPubMed
25.
Peltzer K, Friend-du Preez N, Ramlagan S, Anderson J. Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa. BMC Public Health. 2010;10:111.CrossRefPubMedCentralPubMed
26.
Rintamaki LS, Davis TC, Skripkauskas S, Bennett CL, Wolf MS. Social stigma concerns and HIV medication adherence. AIDS Patient Care STDS. 2006;20(5):359–68.CrossRefPubMed
27.
Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24(10):1101–8.CrossRefPubMedCentralPubMed
28.
Wohl AR, Galvan FH, Myers HF, et al. Do social support, stress, disclosure and stigma influence retention in HIV care for Latino and African American men who have sex with men and women? AIDS Behav. 2011;15(6):1098–110.CrossRefPubMed
29.
Dietz E, Clum GA, Chung S-E, et al. Adherence to scheduled appointments among HIV-infected female youth in five US cities. J Adolesc Health. 2010;46(3):278–83.CrossRefPubMedCentralPubMed
30.
Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95.CrossRefPubMedCentralPubMed
31.
WHO. Global HIV, AIDS response: epidemic update and health sector progress towards universal access: progress report, 2011 Geneva World Health Organization, Switzerland, 2011.
32.
UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2013. Geneva, Switzerland: joint United Nations programme on HIV/AIDS (UNAIDS), 2013 Contract No.: UNAIDS/JC2502/1/E.
33.
Bastos FI, Caceres C, Galvao J, Veras MA, Castilho EA. AIDS in Latin America: assessing the current status of the epidemic and the ongoing response. Int J Epidemiol. 2008;37(4):729–37.CrossRefPubMed
34.
Chi BH, Yiannoutsos CT, Westfall AO, et al. Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America. PLoS Med. 2011;8(10):e1001111.CrossRefPubMedCentralPubMed
35.
Shepherd BE, Blevins M, Vaz LME, et al. Impact of definitions of loss to follow-up on estimates of retention, disease progression, and mortality: application to an HIV program in Mozambique. Am J Epidemiol. 2013;178(5):819–28.CrossRefPubMedCentralPubMed
36.
Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29.CrossRefPubMed
37.
Franke MF, Muñoz M, Finnegan K, et al. Validation and abbreviation of an HIV stigma scale in an adult spanish-speaking population in urban Peru. AIDS Behav. 2010;14(1):189–99.CrossRefPubMed
38.
Carey MP, Morrison-Beedy D, Johnson BT. The HIV-knowledge questionnaire: development and evaluation of a reliable, valid, and practical self-administered questionnaire. AIDS Behav. 1997;1(1):61–74.CrossRef
39.
O’Brien K, Wortman CB, Kessler RC, Joseph JG. Social relationships of men at risk for AIDS. Soc Sci Med. 1993;36(9):1161–7.CrossRefPubMed
40.
Diez-Quevedo C, Rangil T, Sanchez-Planell L, Kroenke K, Spitzer RL. Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients. Psychosom Med. 2001;63(4):679–86.CrossRefPubMed
41.
Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742–53.CrossRefPubMed
42.
Emlet CA, Brennan DJ, Brennenstuhl S, 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.CrossRefPubMed
43.
Fleishman JA, Yehia BR, Moore RD, Korthuis PT, Gebo KA. Establishment, retention, and loss to follow-up in outpatient HIV care. J Acquir Immune Defic Syndr. 2012;60(3):249–59.CrossRefPubMedCentralPubMed
44.
Giordano TP, Visnegarwala F, White AC Jr, et al. Patients referred to an urban HIV clinic frequently fail to establish care: factors predicting failure. AIDS Care. 2005;17(6):773–83.CrossRefPubMed
45.
Howe CJ, Cole SR, Napravnik S, Eron JJ. Enrollment, retention, and visit attendance in the University of North Carolina Center for AIDS research HIV clinical cohort, 2001–2007. AIDS Res Hum Retroviruses. 2010;26(8):875–81.CrossRefPubMedCentralPubMed
46.
Gardner LI, Metsch LR, Anderson-Mahoney P, et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS. 2005;19(4):423–31.CrossRefPubMed
47.
Greenland S. Introduction to regression models. In: Rothman KJ, Greenland S, Lash TL, editors. Modern epidemiology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008.
48.
Nachega JB, Morroni C, Zuniga JM, et al. HIV-related stigma, isolation, discrimination, and serostatus disclosure: a global survey of 2035 HIV-infected adults. J Int Assoc Physicians AIDS Care. 2012;11(3):172–8.CrossRef
49.
50.
Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc. 2013;16(3 Suppl 2):18734.PubMedCentralPubMed
51.
Hatzenbuehler ML, O’Cleirigh C, Mayer KH, Mimiaga MJ, Safren SA. Prospective associations between HIV-related stigma, transmission risk behaviors, and adverse mental health outcomes in men who have sex with men. Ann Behav Med. 2011;42(2):227–34.CrossRefPubMedCentralPubMed
52.
Logie C, James L, Tharao W, Loutfy M. Associations between HIV-related stigma, racial discrimination, gender discrimination, and depression among HIV-positive African, Caribbean, and Black Women in Ontario, Canada. AIDS Patient Care STDS. 2013;27(2):114–22.CrossRefPubMed
53.
Tanney MR, Naar-King S, MacDonnel K. Depression and stigma in high-risk youth living with HIV: a multi-site study. J Pediatr Health Care. 2012;26(4):300–5.CrossRefPubMedCentralPubMed
54.
Wohl AR, Galvan FH, Carlos JA, et al. A Comparison of MSM Stigma, HIV stigma and depression in HIV-positive Latino and African American men who have sex with men (MSM). AIDS Behav. 2013;17:1454–64.CrossRefPubMed
55.
Chaudoir SR, Norton WE, Earnshaw VA, Moneyham L, Mugavero MJ, Hiers KM. Coping with HIV stigma: do proactive coping and spiritual peace buffer the effect of stigma on depression? AIDS Behav. 2012;16(8):2382–91.CrossRefPubMed
56.
Pungrassami P, Kipp AM, Stewart PW, Chongsuvivatwong V, Strauss RP, Van Rie A. Tuberculosis and AIDS stigma among patients who delay seeking care for tuberculosis symptoms. Int J Tuberc Lung Dis. 2010;14(2):181–7.PubMedCentralPubMed
57.
Paz J, Ugarte-Gil C, Valenzuela C, et al. Challenges in finding HIV patients who have dropped out of care after diagnosis at an HIV reference service in Lima, Peru. American Society for Topical Medicine and Hygiene Annual Meeting; November 14–16, Washington, DC; 2013.
Metadata
Title
HIV Stigma as a Barrier to Retention in HIV Care at a General Hospital in Lima, Peru: A Case–Control Study
Authors
Carla Valenzuela
Cesar Ugarte-Gil
Jorge Paz
Juan Echevarria
Eduardo Gotuzzo
Sten H. Vermund
Aaron M. Kipp
Publication date
01-02-2015
Publisher
Springer US
Published in
AIDS and Behavior / Issue 2/2015
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-014-0908-7

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