Stigma, isolation, and discrimination and their impact on HIV serostatus disclosure: a global survey of 2035 HIV+ patients
J.M. Zuniga1, S. Solomon2, R. Sherer3, M. Schechter4, J. Rockstroh5, J. Nachega6
1International Association of Physicians in AIDS Care, Chicago, United States, 2Y.R. Gaitonde Center for AIDS Research and Education, Chennai, India, 3University of Chicago, Chicago, United States, 4The Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 5The University of Bonn, Bonn, Germany, 6Stellenbosch University, Cape Town, South Africa
Background: With the recent global drive for universal HIV testing and access to care and treatment, little is known about patients´ perspectives on HIV-associated stigma and HIV serostatus disclosure on a global scale.
Methods: A cross-sectional study was undertaken January-March 2010 in 12 countries involving 2035 HIV+ patients (1275 males, 749 females, 9 transgender, 2 unspecified), which assessed awareness and attitudes related to living with HIV/AIDS, including understanding patients' perceptions of stigma.
Results: Survey revealed co-morbidities affecting respondents, most notably depression (27%). 37% reported feelings of isolation, more so in North America (NA) (42%) and Asia-Pacific (A/P) (52%, p< 0.05), and least so in Africa (24%). 42% cited “strong concerns” about others learning their serostatus. Primary drivers were social discrimination (79%) and impact on establishing future relationships (46%). 96% reported having disclosed their serostatus to at least 1 person - most commonly a family member (89%), except Korean respondents, of whom 29% (p< 0.05) had not disclosed to anyone, and 45% (p< 0.05) had not disclosed to their spouse/partner. 17% of respondents who reported being in a long-term relationship indicated they had not disclosed their serostatus to their spouse/partner. 38% feel they are being judged by others, with 47% - most notably in A/P (71%, p< 0.05) - indicating people believe they engage in risky behavior (e.g., sexual promiscuity, drug use, prostitution). Few reported discrimination by healthcare providers, but 16% (p< 0.05) and 10% of NA and European respondents cited discrimination due to their sexual orientation. Many (60%) reported improvement in society's perception (past 5 years) that PLWHA do not live a long time, but less improvement (31%) when it comes to perception that PLWHA engage in risky behavior.
Conclusions: Despite great strides, 29 years into pandemic, HIV-associated stigma, isolation, and discrimination persist. Addressing these challenges can benefit individual, community, and public health.
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