Understanding the relationships among HIV/AIDS-related stigma, health service utilization, and HIV prevalence and incidence in Sub-Saharan Africa: a multi-level theoretical perspective.
HIV-positive individuals often face community-wide discrimination or public shame and humiliation as a result of their HIV-status. In Sub-Saharan Africa, high HIV incidence coupled with unique cultural contexts make HIV-positive individuals particularly likely to experience this kind of HIV/AIDS-related (HAR) stigma. To date, there is a relatively small amount of high-quality empirical literature specific to HAR stigma in this context, supporting the notion that a better understanding of this phenomenon is needed to inform potential interventions. This paper provides a thorough review of the literature specific to HAR stigma in Sub-Saharan Africa, finding (a) qualitative support for the existence of important relationships between HAR stigma and health service utilization and barriers; (b) a need for more quantitative study of stigma and its relationships both to health service utilization and to HIV outcomes directly; and (c) a disconnect between methodological techniques used in this context-specific literature and well-known theories about stigma as a general phenomenon. This paper then draws from its empirical literature review, as well as from well-known theoretical frameworks from multiple disciplines, to propose a theoretical framework for the ecological and multilevel relationships among HAR stigma, health service utilization, and HIV outcomes in this context.
Psychology and Social Intervention, New York University, 246 Greene Street, Room 415E, New York, NY, 10003, USA, leslie.williams@nyu.edu.
Leslie D
LD
Williams
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000523:psychology; D017954:Africa South of the Sahara / Q000453:epidemiology; D001294:Attitude to Health; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D055361:Multilevel Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D015995:Prevalence; D057545:Social Stigma