title: Perceived stigma by children on antiretroviral treatment in Cambodia.
abstract: BACKGROUND
  HIV-related stigma diminishes the quality of life of affected patients. Little is known about perceived and enacted stigma of HIV-infected children in resources-limited settings. We documented the prevalence of perceived stigma and associated factors associated among children on antiretroviral therapy (ART) at a referral hospital in Cambodia.
  
  
  METHODS
  After informed consent, a standardized pre-tested 47-item questionnaire was confidentially administered to consecutive children (7 to 15 years) or their guardians if the child was 18 months to 6 years, during their routine ART visits. The questionnaire explored the sociodemographics of the child and the parents, HIV history, adherence to ART, tolerance of ART and perceived stigma. Associations between perceived stigma and the children's characteristics were measured by bivariate and multivariate analyses.
  
  
  RESULTS
  Of 183 children, 101 (55.2%) had lost at least one and 45 (24.6%) both parents; 166 (90.7%) went to school. Of 183 children (female: 84, 45.9%, median age 7.0 years, interquartile range: 2.0-9.6), 79 (43.2%) experienced perceived stigma, including rejection by others (26.8%), no invitations to social activities (18.6%) and exclusion from games (14.2%). A total of 43 (23.5%) children were fearful of their disease and 61 (53.9%) of 113 older than 6 years reported knowledge of their HIV status. Of 136 children over five years and eligible for education, 7 (3.8%) could not go to school due to perceived stigma. Incomplete adherence to ART was reported for 17 (9.2%) children. In multivariate analysis, school attendance (odds ratio [OR]: 3.9; 95% confidence interval [CI]: 2.0-7.9) and income of less than one dollar per person per day (OR: 2.2, 95% CI: 1.1-4.5) were associated with perceived stigma. Conversely, receipt of social support (OR: 0.4, 95% CI 0.2-0.9) was associated with lower risk of perceived stigma.
  
  
  CONCLUSIONS
  Perceived stigma in pediatric ART patients remains a significant issue in Cambodia. Psychological support and interventions should be developed in hospitals, schools, and underprivileged communities to prevent HIV-related stigma for affected children.
authors.affiliation: Agence Nationale de Recherche sur le VIH et les Hepatites, Preah Monyvong 5 Blvd, Phnom Penh, Cambodia. barenneshub@yahoo.fr.|Institut Francophone pour la Médecine Tropicale, Vientiane, Vientiane, Lao PDR. barenneshub@yahoo.fr.|ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, F-33000, Bordeaux, France. barenneshub@yahoo.fr.|Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia. barenneshub@yahoo.fr.
authors.forename: Hubert
authors.initials: H
authors.lastname: Barennes
authors.affiliation: Agence Nationale de Recherche sur le VIH et les Hepatites, Preah Monyvong 5 Blvd, Phnom Penh, Cambodia. sovanntat@yahoo.com.|Stung Treng Regional Training Center for Nursing and Midwifery Cambodia, Stung Treng, Cambodia. sovanntat@yahoo.com.
authors.forename: Sovann
authors.initials: S
authors.lastname: Tat
authors.affiliation: Institut Francophone pour la Médecine Tropicale, Vientiane, Vientiane, Lao PDR. daniel.reinharz@auf.org.|Département de médecine sociale et préventive, Université Laval, Québec, Canada. daniel.reinharz@auf.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reinharz
authors.affiliation: University of Health Science, Phnom Penh, Cambodia. uvibol@uhs.edu.kh.
authors.forename: Ung
authors.initials: U
authors.lastname: Vibol
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002160:Cambodia; D002648:Child; D005239:Fear; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies; D057545:Social Stigma; D012944:Social Support; D011795:Surveys and Questionnaires
chemical_list: D044966:Anti-Retroviral Agents