• HIV
• Vietnam
• qualitative study
• stigma
• women

• Humans
• Female
• Vietnam/ethnology
• HIV Infections/psychology
• HIV Infections/ethnology
• Social Stigma
• Adult
• Adaptation, Psychological
• Qualitative Research
• Middle Aged
• Interviews as Topic
• Stereotyping

• P30 MH058107 NIMH NIH HHS
• R21 TW012018 FIC NIH HHS

• HIV, Midwifery, Grounded theory
• Pregnancy decision making
• Pregnancy experience

• HIV
• Vietnam
• industrial zones
• stigmatizing attitudes
• women migrant workers

• Attitude
• Cross-Sectional Studies
• Female
• HIV Infections/epidemiology
• Health Knowledge, Attitudes, Practice
• Humans
• Social Stigma
• Stereotyping
• Transients and Migrants
• Vietnam

• R21 MH118986 NIMH NIH HHS
• R21MH118986 NIMH NIH HHS

• confirmatory factor analysis
• coping
• explanatory factor analysis

The United Nations (UN) Organization Stabilization Mission in the Democratic Republic of Congo (MONUSCO) comprises the largest and longest serving peacekeeping operation to date. Since the launch of the mission in 1999, sexual relations between UN peacekeepers and the local population regularly occur; some resulting in children being conceived. Reports have indicated that women and girls bearing children from such relations face difficult socio-economic realities. The present study is the first to explore the situation of peacekeeper fathered children (PKFC) through a qualitative analysis that includes interview material from mothers and child participants.

The article uses theories from stigma research to illustrate how children conceived through sexual relations with UN peacekeepers integrate into social networks. We conducted a case study of mothers and their PKFC at different sites of UN peacekeeping (UNPK) in eastern Democratic Republic of Congo (DRC). Based on 95 in-depth interviews held in 2018, a thematic qualitative analysis examined experiences of stigma and discrimination. In order to understand the challenges of mothers and children from a transgenerational perspective, we evaluated perceptions of rejection rooted in the mother-child relationship.

Of the mothers and children surveyed, a large majority struggled with stigmatizing behaviour by family and/or community members. PKFC perceived their discrimination to be based upon their mixed ethnicity, fatherlessness, illegitimacy at birth, as well as a lack of resources and opportunity. Mothers most often attributed their stigma to economic deprivation, extra-marital sexual relations, single parenting and being associated with UNPK. Parallels in the experiences of mothers and children suggest a bi-directional transmission of status loss and stigma between generations.

This is the first empirical study to compare the situation of PKFC and their mothers in any country of UNPK deployment. The findings highlight multiple burdens that affect their daily lives and illustrate an interplay between drivers of stigmatization for mothers and children. The overarching needs identified are financial, and these call for action regarding policies and programmes that provide resources to those concerned. The results further demonstrate the need for psychosocial support that considers transgenerational dynamics and both mothers and children as core addressees of assistance.

• Children Born of War
• Democratic Republic of Congo
• Peacekeeping
• Sexual Misconduct
• Stigma
• Transgenerational
• United Nations

Stigmatization against HIV/AIDS greatly hinders efforts to increase the accessibility and utilization of HIV/AIDS services to meet the 90-90-90 goal. This study assessed the stigmatization and discrimination experienced by people living with HIV (PLWH) across multiple social settings such as family, community, and healthcare facilities in Vietnam. A total of 1,016 patients (63.8% males, mean age = 35.4) participated in a cross-sectional study using a culturally tailored HIV stigma measure in three HIV-epidemic-concentrated cities in Vietnam. Zero-inflated Poisson models were used to examine factors associated with the number of types of stigma that patients experienced. 86.2% PLWH reported experiencing stigma against HIV/AIDS, more frequently from their community (62.8%) and family (30.2%) than from health care facilities (8%). The level of stigma from community reported by PLWH is associated with socioeconomic status (e.g., income, occupation). The poor and middle economic classes and unemployed patients reported more stigmatization and discrimination from the community. Across all settings, PLWH experienced fewer stigmatization over the course of ART indicating the benefits of rapidly expanded ART programs. PLWH reported more stigmatization and discrimination at the provincial level of the health administration. Those with the history of drug injection reported significantly less stigmatization from healthcare setting. More culturally tailored interventions to reduce stigmatization overall to improve the quality of life and health outcomes of PLWH should be warranted to achieve the 90-90-90 goal. Improving HIV-related knowledge of the general population and providing opportunities for PLWH to be reintegrated into should be considered. Using mass media with positive messages and images would also foster positive attitudes towards HIV/AIDS among the population and could potentially change social values. Continuous training of health staffs' attitude could minimize the occurrence of stigmatization and discrimination at healthcare facilities.

• Child desire
• HIV/AIDS
• Sex preference
• Vietnam
• Willingness to pay

• Adult
• Counseling
• Female
• Fertility
• HIV Infections/drug therapy
• HIV Infections/prevention & control
• HIV Infections/transmission
• Health Services Accessibility
• Humans
• Income
• Infectious Disease Transmission, Vertical/prevention & control
• Logistic Models
• Male
• Marital Status
• Pregnancy
• Pregnancy Complications, Infectious/drug therapy
• Program Development
• Vietnam

• HIV, women, fertility desire, stigma, Thailand

Depression is the most common mental health issue among people living with HIV/AIDS (PLWHA). This study explored how different types and sources of social support are associated with depression among HIV-infected patients in Vietnam. We carried out a cross-sectional survey on 1,503 HIV-infected patients receiving antiretroviral therapy at two HIV clinics in Hanoi in 2016. Depression was prevalent in 26.2% of participants. Higher score of social support, especially emotional/informational support and positive social interaction, showed significant association with lower depression rate. Although family was primary source of all types of social support, receiving emotional/informational support not only from family but also from outside of family correlated with a lower proportion of depression. In countries with constrained social resources and/or with family-oriented social structures, as in Vietnam, expanding social networks between HIV populations and society is a potentially important option for reducing depression.

• AIDS
• HIV
• infection
• pregnancy
• social discrimination
• society
• stigma

• Divulgation
• Prévention de Transmission de la mère à l'enfant
• Soutien
• Succès (French)
• Syndrome Immunodéficitaire Acquis
• Transmission Mère à l'enfant du VIH
• Virus Immunodéficitaire Human
• acquired immune-deficiency syndrome
• disclosure
• human immunodeficiency virus
• mother to child transmission of HIV
• prevention of mother to child transmission
• success
• support

In HIV-discordant relationships, the HIV-negative partner also carries the burden of a stigmatised disease. For this reason, couples often hide their HIV-discordant status from family, friends and community members. This perpetuates the silence around HIV-discordant relationships and impacts on targeted HIV prevention, treatment and counselling efforts. This article reports on experiences of stigma and discrimination among HIV-discordant couples in South Africa, Tanzania and Ukraine. During 2008, HIV-discordant couples who had been in a relationship for at least one year were recruited purposively through health-care providers and civil society organisations in the three countries. Participants completed a brief self-administered questionnaire, while semi-structured interviews were conducted with each partner separately and with both partners together. Interviews were analysed using thematic content analysis. Fifty-one couples were recruited: 26 from South Africa, 10 from Tanzania, and 15 from Ukraine. Although most participants had disclosed their HIV status to someone other than their partner, few were living openly with HIV discordance. Experiences of stigma were common and included being subjected to gossip, rumours and name-calling, and HIV-negative partners being labelled as HIV-positive. Perpetrators of discrimination included family members and health workers. Stigma and discrimination present unique and complex challenges to couples in HIV sero-discordant relationships in these three diverse countries. Addressing stigmatisation of HIV-discordant couples requires a holistic human rights approach and specific programme efforts to address discrimination in the health system.

• Afrique du Sud
• HIV-discordance
• South Africa
• Tanzania
• Tanzanie
• Ukraine
• couples
• discrimination
• stigma
• stigmatisation
• sérodiscordants pour le VIH

• Female
• Human immunodeficiency virus infection
• Patient acceptance of health care
• Pregnancy
• Research
• Testing/screening

Antiretroviral therapy has created new expectations in the possibilities of procreation for persons living with HIV. Our objectives were to evaluate reproductive desire and to analyze the associated sociodemographic and clinical factors in HIV-infected women in the Spanish AIDS Research Network Cohort (CoRIS).

A mixed qualitative-quantitative approach was designed. Women of reproductive age (18–45) included in CoRIS were interviewed by phone, and data were collected between November 2010 and June 2012 using a specifically designed questionnaire. Reproductive desire was defined as having a desire to be pregnant at present or having unprotected sex with the purpose of having children or wanting to have children in the near future.

Overall, 134 women were interviewed. Median age was 36 years (IQR 31–41), 55% were Spanish, and 35% were unemployed. 84% had been infected with HIV through unprotected sex, with a median time since diagnosis of 4.5 years (IQR 2.9-6.9). Reproductive desire was found in 49% of women and was associated with: 1) Age (women under 30 had higher reproductive desire than those aged 30–39; OR = 4.5, 95% CI 1.4-14.3); 2) having no children vs. already having children (OR = 3.2; 1.3-7.7 3); Being an immigrant (OR = 2.2; 1.0-5.0); and 4) Not receiving antiretroviral treatment (OR = 3.6; 1.1-12.1). The main reasons for wanting children were related to liking children and wanting to form a family. Reasons for not having children were HIV infection, older age and having children already. Half of the women had sought or received information about how to have a safe pregnancy, 87% had disclosed their serostatus to their family circle, and 39% reported having experienced discrimination due to HIV infection.

The HIV-infected women interviewed in CoRIS have a high desire for children, and the factors associated with this desire are not fundamentally different from those of women in the general population. Maternity may even help them face a situation they still consider stigmatized and prefer not to disclose. Health-care protocols for handling HIV-positive women should incorporate specific interventions on sexual and reproductive health to help them fulfill their procreation desire and experience safe pregnancies.

Some aspects of HIV-related stigma have been shown to be a barrier to HIV services uptake and adherence to antiretroviral treatment (ART). Distinguishing which domains of stigma impact HIV services uptake can enhance the efficacy and efficiency of stigma-reduction interventions.

The relationships between use of voluntary counseling and testing (VCT) services and two domains of community stigma identified through factor analysis, negative labeling/devaluation and social exclusion, were investigated among 3749 female heads of household. Data were from a general household survey conducted in rural Mozambique. Multivariable logistic regression outcomes were: lifetime VCT use, past-6-months VCT use and VCT endorsement.

Thirteen percent (13%) of the participants reported lifetime VCT use, 10% reported past-6-months VCT use and 63% endorsed VCT. A 25-point decrease (from 50 to 25) in the score for negative labeling and devaluation stigma was associated with increased lifetime VCT use (adjusted OR: 1.6, 95% CI: 1.1-2.3) and past-6-months VCT use (adjusted OR: 1.6, 95% CI: 1.1-2.4). A decrease from 50 to 25-points in the score for social exclusion stigma was associated with 1.5 and 1.3-fold increase in odds for past-6-months VCT use and endorsing VCT use, respectively (p < 0.001 for both). Compared with never-testers, considerably high endorsement of VCT use was observed among testers who did not receive HIV test results (adjusted OR: 2.7, 95% CI: 1.6-4.6) and much higher among testers who received results (adjusted OR: 7.3, 95% CI: 4.9-11.0). Distance from health facilities was associated with lower VCT use, but not lower endorsement of VCT.

VCT use and endorsement might differ by domains of stigma held by individuals in the community. Greater uptake and favorable disposition towards use of VCT services in rural settings might be achieved by addressing stigma via domain-specific interventions and by improving the proximity of services and the dissemination of HIV test results.

• HIV
• Vietnam
• population quality
• reproduction
• risk
• stigma

• Female
• Goals
• HIV Infections/mortality
• HIV Infections/prevention & control
• HIV Infections/transmission
• Humans
• Infant, Newborn
• Infectious Disease Transmission, Vertical/prevention & control
• Infectious Disease Transmission, Vertical/statistics & numerical data
• Maternal Mortality/trends
• Maternal Welfare
• Patient Acceptance of Health Care/psychology
• Patient Acceptance of Health Care/statistics & numerical data
• Pregnancy
• Prejudice
• Social Stigma
• Utilization Review/statistics & numerical data

• PEPFAR

• disclosure
• mixed feeding
• pmtct
• exclusive breastfeeding
• exclusive formula feeding
• postnatal
• hiv-positive mothers
• partners
• family

• Breast Feeding/methods
• Counseling
• Family
• Female
• Focus Groups
• HIV Infections/prevention & control
• HIV Infections/psychology
• HIV Infections/transmission
• Health Knowledge, Attitudes, Practice
• Humans
• Infant
• Infant Formula/methods
• Infectious Disease Transmission, Vertical/prevention & control
• Mothers/psychology
• Patient Compliance
• Poverty Areas
• Self Disclosure
• Sexual Partners
• Social Support
• South Africa/epidemiology

Among people living with HIV (PLHIV) on antiretroviral therapy (ART), it is important to determine how quality of life (QOL) may be improved and HIV-related stigma can be lessened over time. This study assessed the effect of peer support on QOL and internal stigma during the first year after initiating ART among a cohort of PLHIV in north-eastern Vietnam.

A sub-sample study of a randomised controlled trial was implemented between October 2008 and November 2010 in Quang Ninh, Vietnam. In the intervention group, participants (n = 119) received adherence support from trained peer supporters who visited participants’ houses biweekly during the first two months, thereafter weekly. In the control group, participants (n = 109) were treated according to standard guidelines, including adherence counselling, monthly health check and drug refills. Basic demographics were measured at baseline. QOL and internal stigma were measured using a Vietnamese version of the WHOQOL-HIVBREF and Internal AIDS-related Stigma Scale instruments at baseline and 12 months. T-tests were used to detect the differences between mean values, multilevel linear regressions to determine factors influencing QOL.

Overall, QOL improved significantly in the intervention group compared to the control group. Among participants initiating ART at clinical stages 3 and 4, education at high school level or above and having experiences of a family member dying from HIV were also associated with higher reported QOL. Among participants at clinical stage 1 and 2, there was no significant effect of peer support, whereas having children was associated with an increased QOL. Viral hepatitis was associated with a decreased QOL in both groups. Lower perceived stigma correlated significantly but weakly with improved QOL, however, there was no significant relation to peer support.

The peer support intervention improved QOL after 12 months among ART patients presenting at clinical stages 3 and 4 at baseline, but it had no impact on QOL among ART patients enrolled at clinical stages 1 and 2. The intervention did not have an effect on Internal AIDS-related stigma. To improve QOL for PLHIV on ART, measures to support adherence should be contextualized in accordance with individual clinical and social needs.

• Adolescent
• Adult
• Clinical Competence
• Delivery, Obstetric
• Demography
• Female
• HIV Infections/complications
• Health Facilities/statistics & numerical data
• Health Services/statistics & numerical data
• Humans
• Kenya
• Logistic Models
• Multivariate Analysis
• Parturition/physiology
• Postpartum Period
• Pregnancy
• Pregnancy Complications, Infectious/virology
• Prospective Studies
• Rural Population
• Social Stigma
• Surveys and Questionnaires
• Young Adult

• K01 MH081777 NIMH NIH HHS
• P30 AI027763 NIAID NIH HHS
• K01MH081777 NIMH NIH HHS

The negative effects of stigma on persons living with HIV (PLHIV) have been documented in many settings and it is thought that stigma against PLHIV leads to more difficulties for those who need to access HIV testing, treatment and care, as well as to limited community uptake of HIV prevention and testing messages. In order to understand and prevent stigma towards PLHIV, it is important to be able to measure stigma within communities and to understand which factors are associated with higher stigma.

To analyze patterns of community stigma and determinants to stigma toward PLHIV, we performed an exploratory population-based survey with 1874 randomly sampled adults within a demographic surveillance site (DSS) in rural Vietnam. Participants were interviewed regarding knowledge of HIV and attitudes towards persons living with HIV. Data were linked to socioeconomic and migration data from the DSS and latent class analysis and multinomial logistic regression were conducted to examine stigma group sub-types and factors associated with stigma group membership.

We found unexpectedly high and complex patterns of stigma against PLHIV in this rural setting. Women had the greatest odds of belong to the highest stigma group (OR 1.84, 95% CI 1.42-2.37), while those with more education had lower odds of highest stigma group membership (OR 0.45, 95% CI 0.32-0.62 for secondary education; OR 0.19, 95% CI 0.10-0.35 for tertiary education). Long-term migration out of the district (OR 0.61, 95% CI 0.4-0.91), feeling at-risk for HIV (OR 0.42, 95% CI 0.27-0.66), having heard of HIV from more sources (OR 0.44, 95% CI 0.3-0.66), and knowing someone with HIV (OR 0.76, 95% CI 0.58-0.99) were all associated with lower odds of highest stigma group membership. Nearly 20% of the population was highly unsure of their attitudes towards PLHIV and persons in this group had significantly lower odds of feeling at-risk for HIV (OR 0.54, 95% CI 0.33-0.90) or of knowing someone with HIV (OR 0.32, 95% CI 0.22-0.46).

Stigma towards PLHIV is high generally, and very high in some sub-groups, in this community setting. Future stigma prevention efforts could be enhanced by analyzing community stigma sub-groups and tailoring intervention messages to community patterns of stigma.

HIV/AIDS stigma is a common thread in the narratives of pregnant women affected by HIV/AIDS globally and may be associated with refusal of HIV testing. We conducted a cross-sectional study of women attending antenatal clinics in Kenya (N = 1525). Women completed an interview with measures of HIV/AIDS stigma and subsequently information on their acceptance of HIV testing was obtained from medical records. Associations of stigma measures with HIV testing refusal were examined using multivariate logistic regression. Rates of anticipated HIV/AIDS stigma were high—32% anticipated break-up of their relationship, and 45% anticipated losing their friends. Women who anticipated male partner stigma were more than twice as likely to refuse HIV testing, after adjusting for other individual-level predictors (OR = 2.10, 95% CI: 1.15–3.85). This study demonstrated quantitatively that anticipations of HIV/AIDS stigma can be barriers to acceptance of HIV testing by pregnant women and highlights the need to develop interventions that address pregnant women’s fears of HIV/AIDS stigma and violence from male partners.