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Gender, HIV-Related Stigma, and Health-Related Quality of Life Among Adults Enrolling in HIV Care in Tanzania

  • Angela M. ParcesepeEmail author
  • Denis Nash
  • Olga Tymejczyk
  • William Reidy
  • Sarah Gorrell Kulkarni
  • Batya Elul
Original Paper
  • 72 Downloads

Abstract

HIV-related stigma has been associated with worse health-related quality of life (HRQoL) among people living with HIV (PLWH). Little is known about how different types of HIV-related stigma (i.e., anticipatory, internalized, or enacted HIV-related stigma) influence HRQoL and whether these relationships differ by gender. The sample included 912 PLWH aged 18 years or older enrolling in HIV care at four health facilities in Tanzania. HRQoL was assessed with the life satisfaction and overall function subscales of the HIV/AIDS-Targeted Quality of Life (HAT-QoL) instrument. Sex-stratified multivariable logistic regression modeled the association of anticipatory, internalized, and enacted HIV-related stigma on poor HRQoL. Across all participants, the mean life satisfaction score was 63.4 (IQR: 43.8, 81.3) and the mean overall function score was 72.0 (IQR: 58.3, 91.7). Mean HRQoL scores were significantly higher for women compared to men for overall function (5.1 points higher) and life satisfaction (4.3 points higher). Fourteen percent of respondents reported recent enacted HIV-related stigma and 13% reported recent medium or high levels of internalized stigma. In multivariable models, high internalized and high anticipatory stigma were significantly associated with higher odds of poor life satisfaction and poor overall function in both men and women. Psychosocial interventions to prevent or reduce the impact of internalized and anticipatory stigma may improve HRQoL among persons in HIV care. Future research should longitudinally examine mechanisms between HIV-related stigma, poor HRQoL, and HIV care outcomes.

Keywords

HIV Stigma Quality of life Tanzania 

Notes

Acknowledgements

This project was supported by a research grant from the National Institute of Mental Health (Supplement to Grant Number R01MH089831). The clinics included in this analysis received support from ICAP at Columbia University through funding from the President’s Emergency Plan for AIDS Relief. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all participants included in the study.

References

  1. 1.
    World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: World Health Organization; 2015.Google Scholar
  2. 2.
    World Health Organization. Progress report 2016: prevent HIV, test and treat all. Geneva: World Health Organization; 2016.CrossRefGoogle Scholar
  3. 3.
    Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. New Engl J Med. 2015;373(9):795–807.CrossRefGoogle Scholar
  4. 4.
    Danel C, Moh R, Gabillard D, Badje A, Le Carrou J, Ouassa T, et al. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. New Engl J Med. 2015;373(9):808–22.CrossRefGoogle Scholar
  5. 5.
    Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. New Engl J Med. 2011;365(6):493–505.CrossRefGoogle Scholar
  6. 6.
    Nakagawa F, May M, Phillips A. Life expectancy living with HIV: recent estimates and future implications. Curr Opin Infect Dis. 2013;26(1):17–25.CrossRefGoogle Scholar
  7. 7.
    Nsanzimana S, Remera E, Kanters S, Chan K, Forrest JI, Ford N, et al. Life expectancy among HIV-positive patients in Rwanda: a retrospective observational cohort study. Lancet Glob Health. 2015;3(3):e169–77.CrossRefGoogle Scholar
  8. 8.
    Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525–33.CrossRefGoogle Scholar
  9. 9.
    Centers for Disease Control and Prevention. Measuring healthy days: population assessment of health-related quality of life. Atlanta, Georgia; 2000.Google Scholar
  10. 10.
    Mannheimer SB, Matts J, Telzak E, Chesney M, Child C, Wu AW, et al. Quality of life in HIV-infected individuals receiving antiretroviral therapy is related to adherence. AIDS Care. 2005;17(1):10–22.CrossRefGoogle Scholar
  11. 11.
    de Boer-van der Kolk IM, Sprangers MA, Prins JM, Smit C, de Wolf F, Nieuwkerk PT. Health-related quality of life and survival among HIV-infected patients receiving highly active antiretroviral therapy: a study of patients in the AIDS Therapy Evaluation in the Netherlands (ATHENA) Cohort. Clin Infect Dis. 2010;50(2):255–63.CrossRefGoogle Scholar
  12. 12.
    Pokhrel KN, Sharma VD, Shibanuma A, Pokhrel KG, Mlunde LB, Jimba M. Predicting health-related quality of life in people living with HIV in Nepal: mental health disorders and substance use determinants. AIDS Care. 2017;29(9):1137–43.CrossRefGoogle Scholar
  13. 13.
    Vo QT, Hoffman S, Nash D, El-Sadr WM, Tymejczyk OA, Gadisa T, et al. Gender differences and psychosocial factors associated with quality of life among ART initiators in Oromia, Ethiopia. AIDS Behav. 2016;20(8):1682–91.CrossRefGoogle Scholar
  14. 14.
    Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;6(7):e011453.CrossRefGoogle Scholar
  15. 15.
    Ekstrand ML, Heylen E, Mazur A, Steward WT, Carpenter C, Yadav K, et al. The role of HIV stigma in ART adherence and quality of life among rural women living with HIV in India. AIDS Behav. 2018;22(12):3859–68.CrossRefGoogle Scholar
  16. 16.
    Shrestha S, Shibanuma A, Poudel KC, Nanishi K, Koyama Abe M, Shakya SK, et al. Perceived social support, coping, and stigma on the quality of life of people living with HIV in Nepal: a moderated mediation analysis. AIDS Care. 2019;31(4):413–20.CrossRefGoogle Scholar
  17. 17.
    Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.CrossRefGoogle Scholar
  18. 18.
    Sherwood J, Sharp A, Cooper B, Roose-Snyder B, Blumenthal S. HIV/AIDS National Strategic Plans of Sub-Saharan African countries: an analysis for gender equality and sex-disaggregated HIV targets. Health Policy Plan. 2017;32(10):1361–7.CrossRefGoogle Scholar
  19. 19.
    Remien RH, Chowdhury J, Mokhbat JE, Soliman C, Adawy ME, El-Sadr W. Gender and care: access to HIV testing, care, and treatment. J Acquir Immune Defic Syndr. 2009;51(Suppl 3):S106–10.CrossRefGoogle Scholar
  20. 20.
    Fekete EM, Williams SL, Skinta MD, Bogusch LM. Gender differences in disclosure concerns and HIV-related quality of life. AIDS Care. 2016;28(4):450–4.CrossRefGoogle Scholar
  21. 21.
    Li L, Lin C, Ji G. Gendered aspects of perceived and internalized HIV-related stigma in China. Women Health. 2017;57(9):1031–43.CrossRefGoogle Scholar
  22. 22.
    Sandelowski M, Lambe C, Barroso J. Stigma in HIV-positive women. J Nurs Scholarsh. 2004;36(2):122–8.CrossRefGoogle Scholar
  23. 23.
    Holmes WC, Shea JA. Performance of a new, HIV/AIDS-targeted quality of life (HAT-QoL) instrument in asymptomatic seropositive individuals. Qual Life Res. 1997;6(6):561–71.CrossRefGoogle Scholar
  24. 24.
    Holmes WC, Bilker WB, Wang H, Chapman J, Gross R. HIV/AIDS-specific quality of life and adherence to antiretroviral therapy over time. J Acquir Immune Defic Syndr. 2007;46(3):323–7.CrossRefGoogle Scholar
  25. 25.
    Taylor TN, Dolezal C, Tross S, Holmes WC. Reliability and validity of two HIV/AIDS-specific quality of life instruments adapted for use in HIV-positive Zimbabweans. AIDS Care. 2009;21(5):598–607.CrossRefGoogle Scholar
  26. 26.
    Phaladze NA, Human S, Dlamini SB, Hulela EB, Hadebe IM, Sukati NA, et al. Quality of life and the concept of “living well” with HIV/AIDS in sub-Saharan Africa. J Nurs Scholarsh. 2005;37(2):120–6.CrossRefGoogle Scholar
  27. 27.
    Holzemer WL, Uys LR, Chirwa ML, Greeff M, Makoae LN, Kohi TW, et al. Validation of the HIV/AIDS Stigma Instrument—PLWA (HASI-P). AIDS Care. 2007;19(8):1002–12.CrossRefGoogle Scholar
  28. 28.
    van der Kop ML, Muhula S, Patel A, Thabane L, Awiti P, Kyomuhangi L, et al. Gender differences in health-related quality of life at the time of a positive HIV test—a cross-sectional study in a resource-poor, high prevalence setting in Nairobi, Kenya. AIDS Care. 2018;30(4):493–9.CrossRefGoogle Scholar
  29. 29.
    Tesfay A, Gebremariam A, Gerbaba M, Abrha H. Gender differences in health related quality of life among people living with HIV on highly active antiretroviral therapy in Mekelle Town, Northern Ethiopia. Biomed Res Int. 2015;2015:516369.CrossRefGoogle Scholar
  30. 30.
    Reinius M, Wiklander M, Wettergren L, Svedhem V, Eriksson LE. The relationship between stigma and health-related quality of life in people living with HIV who have full access to antiretroviral treatment: an assessment of Earnshaw and Chaudoir’s HIV stigma framework using empirical data. AIDS Behav. 2018;22(12):3795–806.CrossRefGoogle Scholar
  31. 31.
    Endeshaw M, Walson J, Rawlins S, Dessie A, Alemu S, Andrews N, et al. Stigma in Ethiopia: association with depressive symptoms in people with HIV. AIDS Care. 2014;26(8):935–9.CrossRefGoogle Scholar
  32. 32.
    Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health. 2012;12:522.CrossRefGoogle Scholar
  33. 33.
    Odimegwu CO, Akinyemi JO, Alabi OO. HIV-stigma in Nigeria: review of research studies, policies, and programmes. AIDS Res Treat. 2017;2017:5812650.Google Scholar
  34. 34.
    Fuster-Ruizdeapodaca MJ, Molero F, Holgado FP, Mayordomo S. Enacted and internalized stigma and quality of life among people with HIV: the role of group identity. Qual Life Res. 2014;23(7):1967–75.CrossRefGoogle Scholar
  35. 35.
    Tsai AC, Bangsberg DR, Emenyonu N, Senkungu JK, Martin JN, Weiser SD. The social context of food insecurity among persons living with HIV/AIDS in rural Uganda. Soc Sci Med. 2011;73(12):1717–24.CrossRefGoogle Scholar
  36. 36.
    Elul B, Basinga P, Nuwagaba-Biribonwoha H, Saito S, Horowitz D, Nash D, et al. High levels of adherence and viral suppression in a nationally representative sample of HIV-infected adults on antiretroviral therapy for 6, 12 and 18 months in Rwanda. PLoS ONE. 2013;8(1):e53586.CrossRefGoogle Scholar
  37. 37.
    Chang LW, Kagaayi J, Nakigozi G, Ssempijja V, Packer AH, Serwadda D, et al. Effect of peer health workers on AIDS care in Rakai, Uganda: a cluster-randomized trial. PLoS ONE. 2010;5(6):e10923.CrossRefGoogle Scholar
  38. 38.
    Pearson CR, Micek MA, Simoni JM, Hoff PD, Matediana E, Martin DP, et al. Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. J Acquir Immune Defic Syndr. 2007;46(2):238–44.CrossRefGoogle Scholar
  39. 39.
    Treves-Kagan S, El Ayadi AM, Pettifor A, MacPhail C, Twine R, Maman S, et al. Gender, HIV testing and stigma: the association of HIV testing behaviors and community-level and individual-level stigma in rural South Africa differ for men and women. AIDS Behav. 2017;21(9):2579–88.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Angela M. Parcesepe
    • 1
    • 2
    Email author
  • Denis Nash
    • 2
    • 3
  • Olga Tymejczyk
    • 2
    • 3
  • William Reidy
    • 4
  • Sarah Gorrell Kulkarni
    • 2
  • Batya Elul
    • 4
  1. 1.Department of Maternal and Child Health, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Institute for Implementation Science in Population HealthCity University of New YorkNew YorkUSA
  3. 3.Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkUSA
  4. 4.Department of EpidemiologyColumbia UniversityNew YorkUSA

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