The role of stigma and discrimination on the health and well-being of PLWHA receiving ongoing clinical care in Brazil: advances and challenges within the context of universal access to HIV treatment
D. Kerrigan1, M. Malta2, N. Betroni3, F. Bastos3, Rio Collaborative Group
1Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, 2Oswaldo Cruz Institute, Rio de Janeiro, Brazil, 3Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
Background: Stigma and discrimination are critical drivers of the HIV epidemic globally and core aspects of collective and individual-level vulnerability to poor health among PLWHA. Brazil has made tremendous progress in tackling stigma and discrimination by developing and implementing a human rights framework to guide their national HIV prevention and treatment program, which has become an internationally recognized model for other lower and middle income countries. Limited empirical research has been conducted on stigma and discrimination among PLWHA in Brazil within the context of universal access to treatment.
Methods: Structured surveys were conducted with a sample of 900 PLWHA attending 6 large public health clinics for ongoing clinical care in Rio de Janeiro, Brazil. Both psychosocial and structural aspects of participants´ health and well-being were evaluated. The Berger HIV Stigma Scale was adapted and an 8-item aggregate measure of perceived stigma was developed utilizing reliability and factor analysis. The relationship between stigma and discrimination and HIV-related outcomes was tested using bivariate and multivariate regression analysis.
Results: Almost one third (32.6%) of participants reported suffering some form of discrimination related to their HIV status, 10% reported being rejected from a health care center and 15% loosing a job in relation to HIV. Our adapted aggregate measure of perceived stigma was found to be reliable (Alpha=.78) and valid. Additionally, significant inverse associations between stigma and discrimination and positive HIV-related prevention and care outcomes were detected.
Conclusions: Important advances in combating stigma and discrimination have been made in Brazil relative to other countries. However, our study findings indicate gaps in service delivery and social mobilization which must be addressed to improve the health and well-being of PLWHA and so that Brazil might continue to serve as an example of how a human rights perspective can advance the health of PLWHA for other countries.
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