Effects of Anticipated Stigma and Discrimination on Self-Disclosure of HIV Seropositive Status among People Living with HIV and AIDS in Kenya
Abstract
The purpose of the study was to establish whether anticipated stigma and discrimination from intimate partners and social support networks such as family, friends, neighbours, community, religious affiliates and workmates predicted the likelihood of self-disclosure of HIV seropositive status by People Living with HIV and AIDS (PLWHA) in Kenya. A survey was conducted among a random sample of 232 adult Persons Living with HIV and AIDS in Nairobi, Kenya. Data was collected using interviews and focus group discussions. The results revealed that 50.5% had disclosed their HIV seropositive status, while 49.5% had not. The results of regression analysis revealed that anticipated stigma and discrimination by intimate partners and social support networks were statistically significant negative predictors of self-disclosure of HIV seropositive status among PLWHA as evidenced by the Adjusted Odds Ratio (AOR < 1.000). The negative predictors included anticipated intimate partner violence (AOR= 0.635; p = 0.016), abandonment by the family (AOR= 0.410; p = 0.002), isolation by friends (AOR=0.136; p=0.001), exclusion from social functions (AOR= 0.365; p = 0.002), exclusion from access to community amenities (AOR= 0.416; p = 0.032), exclusion by the religious group (AOR= 0.446; p = 0.032), and dismissal from the workplace (AOR= 0.266; p = 0.002). However, the anticipated desertion by intimate partners (AOR= 0.539; p = 0.086) and the anticipated segregation by the community (AOR= 0.0.538; p = 0.076) were not statistically significant predictors. These findings established that the study participants who anticipated negative consequences from their intimate partners and social support networks were not likely to disclose their HIV seropositive status. These findings further established that there was an inverse relationship between anticipated stigma and discrimination and self-disclosure of HIV seropositive status among PLWHA. This implies that anticipated stigma and discrimination promoted the non-disclosure of HIV seropositive status instead of fostering disclosure. The study concluded that anticipated stigma and discrimination against PLWHA act as risk factors for non-disclosure of HIV seropositive status thereby putting intimate partners and significant others at risk of HIV infection.
Downloads
References
Arthur, G., Nduba, V., Forsythe, S., Mutemi-Wangahu, R., Odhiambo, J., & Franklin, C. (2020). Behaviour change in clients of health centre based voluntary HIV counseling and testing (VCT) services in Kenya. Retrieved 2 August, 2020 from http://sti.bmj.com/cgi/content/abstract/sti.
Bronfenbrenner, U., (1994). Ecological models of human development. International Encyclopedia of Education, 3 (2), 1643-1647.
Campbell, C. C., Foulis, A., Maimane, S. & Sibiya, Z. (2005). “I Have an Evil Child at My House”: Stigma and HIV and AIDS Management in a South African Community. American Journal of Public Health, 5 (5), 808-815.
Daniel, O. & Oladapo O., (2004). Self-disclosure of HIV sero-status to sexual partners in Nigeria. Sexual Health Matters, 6, 38-40.
Gretchen, S., Fawzi, M., C. Kaaya, S., Mbwambo, J., Msamanga, G., Hunter, I., David, J. F. & Wafaie, W. (2001). Predictors of HIV-1 serostatus disclosure: a prospective study among HIV-infected pregnant women in Dar es Salaam, Tanzania. Epidemiology & social Aspects of AIDS 15 (14):1865-1874.
Issiaka, S., Cartoux, M., Ky-Zerbo, O., Meda, N., Dabis, F. & Van de Perre, P. (2001). Living with HIV: Women’s experience in Burkina Faso, West Africa. AIDS Care, 13 (1): 123-128.
Kenya National Bureau of Statistics (KNBS) & ICF Macro, (2010). Kenya Demographic and Health Survey 2008-2009. Calverton, Maryland: KNBS and ICF Macro.
Heijnders, M., & Van Der Meij, S. (2006). The fight against stigma: an overview of stigma-reduction strategies and interventions. Psychology, health & medicine, 11(3), 353-363.
Kalichman, S. C., Rompa, D. & M. Cage, M. (2005). Group intervention to reduce HIV transmission risk behavior among persons living with HIV and AIDS. Behavior Modification, 29 (2): 256-285.
Kim, B., France L., Remi S., Annie S., Bruno S. & Dray-Spira, R. (2007). Factors Correlated with disclosure of HIV infections in the French Antilles and French Guiana: Results from the ANRS-ENRS-EN13-VESPA-DFA Study. AIDS, 21 (Suppl. 1), S89-S94.
Letteney, S., & Laporte, H. H. (2004). De-constructing stigma: perceptions of HIV seropositive mothers and their disclosure to children. Social Work in Health Care, 38 (3), 105-123.
Liu, H., Hu, Z., Li, X., Stanton, B., Naar-King, S., & Yang, H. (2006). Understanding the interrelationships among HIV related stigma, concern about HIV infection, and intent to disclose HIV serostatus: a pretest-posttest study in rural area of Eastern China. AIDS Patient Care & STDs, 20 (2), 133-142.
Maman, S. & Medley A., (2004). Gender dimensions of HIV status disclosure to sexual partners: rates, barriers and outcomes. A WHO review paper. Geneva: World Health Organisation.
Medley, A., Garcia-Moreno, C. & Maman, S. (2004). Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull. World Health Organ. 82 (4), 299-307.
Nyblade, L., Stockton, M.A., Giger, K. Stigma in health facilities: why it matters and how we can change it. BMC Med 17, 25 (2019). https://doi.org/10.1186/s12916-019-1256-2.
National AIDS and STI Control Programme (NASCOP), Kenya, (2007). Kenya AIDS Indicator Survey (KAIS). Nairobi, Kenya.
Ogden, J. & Nyblade, L. (2020). Common at its core: HIV-related stigma across contexts. Retrieved 8, August 2020 from https://www.icrw.org.
Population Council/Horizons (2001). HIV and Partner Violence: Implications for HIV Voluntary Counseling and Testing Programs. New York: The Population Council Inc.
Sarna, A., Chersich, M., Okal, J., Luchters, S., Mandaliya, K., Rutenberg, N. & Temmerman, M., (2009). Changes in sexual risk taking with antiretroviral treatment: influence of context and gender norms in Mombasa, Kenya. Culture, Health and Sexuality: An International Journal for Research, Intervention and Care, 11 (8), 783-797.
Serovich, J. M., (2001). A Test of Two HIV Disclosure Theories. AIDS Education. PubMed articles 13 (4): 355-364.
Simbayi, L., Kalichman, S., Strebel, A., Cloete, A., Henda, N., & Mqeketo, A., (2007). Disclosure of HIV status to sex partners and sexual risk behaviours among HIV positive men and women, Cape Town, South Africa. Sex Transmitted Infections, 83, 29-34.
Simoni, J.M., (2005). HIV disclosure and safe sex. In S. C. Kalichman (Ed.), Positive Prevention: Reducing HIV transmission among people living with HIV/AIDS, (65-98). New York: Springer.
UNAIDS (2003). Fact sheet on stigma and discrimination. Retrieved 17, August 2020 from https://unaids.org.
UNAIDS (2018). HIV and AIDS: Country Report - Kenya. Retrieved 14, August 2020 from https://unaids.org.
UNAIDS (2020). Global AIDS Update-2020. Retrieved 14, August 2020 from https://unaids.org.
Wiener, L. S., Battles, H. B., Wood, L. V. (2007). A longitudinal study of adolescents with perinatally or transfusion acquired HIV infection: Sexual knowledge, risk reduction self-efficacy and sexual behavior. AIDS Behavior 11; 471 -478.
Wolfe, W.R., Weiser, S.D., Bangsberg, D.R. (2006). Effects of HIV related stigma among an early sample of patients receiving antiretroviral therapy in Botswana. AIDS Care, 18 (8), 931-933.
World Health Organization (2008). ‘Towards Universal Access: Scaling up priority HIV and AIDS interventions in the health sector: Progress report. Geneva: WHO.
Xiaobin C., Sheena, G., Jie, X. & Zunyou, W., (2006). Understanding HIV-Related Stigma and Discrimination in a “Blameless” Population. AIDS Education and Prevention, 18 (6), 518-528.
Copyright (c) 2020 Lucy W Ngige, PhD, Phoebe D Ndayala, PhD
This work is licensed under a Creative Commons Attribution 4.0 International License.
