Interventions to reduce HIV/AIDS stigma: what have we learned?

This article reviews 22 studies that test a variety of interventions to decrease AIDS stigma in developed and developing countries. This article assesses published studies that met stringent evaluation criteria in order to draw lessons for future development of interventions to combat stigma. The target group, setting, type of intervention, measures, and scale of these studies varied tremendously. The majority (14) of the studies aimed to increase tolerance of persons living with HIV/AIDS (PLHA) among the general population. The remaining studies tested interventions to increase willingness to treat PLHA among health care providers or improve coping strategies for dealing with AIDS stigma among PLHA or at-risk groups. Results suggest some stigma reduction interventions appear to work, at least on a small scale and in the short term, but many gaps remain especially in relation to scale and duration of impact and in terms of gendered impact of stigma reduction interventions.

[1]  B. Gerbert,et al.  Primary care physicians and AIDS. Attitudinal and structural barriers to care. , 1991, JAMA.

[2]  J. Pawlikowski Report From South Africa , 1976 .

[3]  R L Sowell,et al.  Resources, stigma, and patterns of disclosure in rural women with HIV infection. , 1997, Public health nursing.

[4]  C. Uwakwe Systematized HIV/AIDS education for student nurses at the University of Ibadan, Nigeria: impact on knowledge, attitudes and compliance with universal precautions. , 2000, Journal of advanced nursing.

[5]  R. Durant,et al.  An evaluation of a school-based AIDS/HIV education program for young adolescents. , 1993, AIDS education and prevention : official publication of the International Society for AIDS Education.

[6]  K Macintyre,et al.  "It's not what you know, but who you knew": examining the relationship between behavior change and AIDS mortality in Africa. , 2001, AIDS Education and Prevention.

[7]  P. Aggleton,et al.  HIV/AIDS-related Stigma and Discrimination: A Conceptual Framework and Agenda for Action , 2002 .

[8]  Bruce G. Link,et al.  The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided? , 1991, Journal of health and social behavior.

[9]  P. A. Scollay,et al.  AIDS education of college students: the effect of an HIV-positive lecturer. , 1992, AIDS education and prevention : official publication of the International Society for AIDS Education.

[10]  D. Skinner,et al.  Stigma, discrimination and the implications for people living with HIV/AIDS in South Africa , 2004, SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance.

[11]  P. Aggleton,et al.  HIV-related stigmatization and discrimination: Its forms and contexts , 1998 .

[12]  B. Gerbert,et al.  Changing dentists' knowledge, attitudes, and behaviors relating to AIDS: a controlled educational intervention. , 1988, Journal of the American Dental Association.

[13]  K. Rothenberg,et al.  Partner notification and the threat of domestic violence against women with HIV infection. , 1993, The New England journal of medicine.

[14]  E. Katabira,et al.  Participatory evaluation of counselling, medical and social services of The AIDS Support Organization (TASO) in Uganda. , 1997, AIDS care.

[15]  G. Hart,et al.  Uptake and acceptability of antenatal HIV testing: randomised controlled trial of different methods of offering the test , 1998, BMJ.

[16]  E. Goffman Stigma; Notes On The Management Of Spoiled Identity , 1964 .

[17]  S. Held The effects of an AIDS education program on the knowledge and attitudes of a physical therapy class. , 1993, Physical therapy.

[18]  S. Benatar Health care reform and the crisis of HIV and AIDS in South Africa. , 2004, The New England journal of medicine.

[19]  G. Herek,et al.  AIDS Stigma and Contact With Persons With AIDS: Effects of Direct and Vicarious Contact.1 , 1997 .

[20]  W. Brieger,et al.  A school-based AIDS education programme for secondary school students in Nigeria: a review of effectiveness. , 1999, Health education research.

[21]  D. Penn,et al.  Dispelling the stigma of schizophrenia: what sort of information is best? , 1994, Schizophrenia bulletin.

[22]  K. Rothenberg,et al.  The risk of domestic violence and women with HIV infection: implications for partner notification, public policy, and the law. , 1995, American journal of public health.

[23]  W. Shera,et al.  Changing MSW students' attitudes towards the severely mentally Ill , 1996, Community Mental Health Journal.

[24]  W. Pearson,et al.  Treatment of HIV/AIDS in the Nursing Home: Variations in Rural and Urban Long-term Care Settings , 2004, Southern medical journal.

[25]  S. Knopp,et al.  The AIDS epidemic: social dimensions of an infectious disease. , 1995 .

[26]  A. Jacoby,et al.  Felt versus enacted stigma: a concept revisited. Evidence from a study of people with epilepsy in remission. , 1994, Social science & medicine.

[27]  G. Herek,et al.  Symbolic Prejudice or Fear of Infection? A Functional Analysis of AIDS-Related Stigma Among Heterosexual Adults , 1998 .

[28]  J. Bean,et al.  Methods for the reduction of AIDS social anxiety and social stigma. , 1989, AIDS education and prevention : official publication of the International Society for AIDS Education.

[29]  Ray C. Rist,et al.  Groups in Contact: The Psychology of Desegregation , 1984 .

[30]  M B King,et al.  Prejudice and AIDS: the views and experiences of people with HIV infection. , 1989, AIDS care.

[31]  E. Cameron Legal rights, human rights and AIDS: the first decade. Report from South Africa 2. , 1993, AIDS analysis Africa.

[32]  R. N. Mary Keane Contemporary Beliefs About Mental Illness Among Medical Students: Implications for Education and Practice , 1990, Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry.

[33]  C. Kunzel,et al.  Continuing education and patients with HIV: attitudes, perceived risk, and willingness to treat. , 1992, General dentistry.

[34]  M. Brewer,et al.  13 – Beyond the Contact Hypothesis: Theoretical Perspectives on Desegregation , 1984 .

[35]  J. van den Broek,et al.  Evaluation of a sustained 7-year health education campaign on leprosy in Rufiji District, Tanzania. , 1998, Leprosy review.

[36]  J. S. St. Lawrence,et al.  Stigmatization of AIDS patients by physicians. , 1987, American journal of public health.

[37]  C. Kunzel,et al.  Measuring dentists' willingness to treat HIV-positive patients. , 1994, Journal of the American Dental Association.

[38]  L. Moneyham,et al.  Experiences of violence in HIV-seropositive women in the south-eastern United States of America. , 1999, Journal of advanced nursing.

[39]  C. Goldin Stigmatization and AIDS: critical issues in public health. , 1994, Social science & medicine.

[40]  K. Pargament,et al.  Religion and HIV: A Review of the Literature and Clinical Implications , 2004, Southern medical journal.

[41]  G. Green,et al.  The psychosocial and health care needs of HIV‐positive people in the United Kingdom: a review , 2004, HIV medicine.

[42]  J. Seeley,et al.  Social aspects of AIDS-related stigma in rural Uganda. , 1997, Health & place.

[43]  E. Cameron The deafening silence of AIDS. , 2000, Canadian HIV/AIDS policy & law review.

[44]  P. Hannan,et al.  AIDS education in Tanzania: promoting risk reduction among primary school children. , 1997, American journal of public health.

[45]  D. Smith Premarital sex, procreation, and HIV risk in Nigeria. , 2004, Studies in family planning.

[46]  P. Gillies,et al.  Evaluation of an AIDS education programme for young adults. , 1993, Journal of epidemiology and community health.

[47]  V. Raveis,et al.  Factors associated with HIV-infected women's delay in seeking medical care. , 1998, AIDS care.

[48]  Sally C. Morton,et al.  Violence victimization after HIV infection in a US probability sample of adult patients in primary care. , 2000, American journal of public health.

[49]  R. Baggaley,et al.  HIV counselling and testing. , 1998 .

[50]  G. Herek,et al.  An epidemic of stigma. Public reactions to AIDS. , 1988, The American psychologist.

[51]  I. G. Esters,et al.  Effects of a unit of instruction in mental health on rural adolescents' conceptions of mental illness and attitudes about seeking help. , 1998, Adolescence.

[52]  G. Āllport The Nature of Prejudice , 1954 .

[53]  D. Mechanic,et al.  Sociological dimensions of illness behavior. , 1995, Social science & medicine.

[54]  S. Perry,et al.  Effectiveness of psychoeducational interventions in reducing emotional distress after human immunodeficiency virus antibody testing. , 1991, Archives of general psychiatry.

[55]  R G Priest,et al.  Changes in public attitudes to depression during the Defeat Depression Campaign , 1998, British Journal of Psychiatry.

[56]  D. Roth Asking women why: a study in Tanzania. , 1998 .

[57]  R. Durant,et al.  An experimental evaluation of an AIDS educational intervention for WIC mothers. , 1994, AIDS education and prevention : official publication of the International Society for AIDS Education.

[58]  G. Herek Illness, Stigma, and AIDS , 2001 .

[59]  E. Harmon-Jones,et al.  Empathy and attitudes: can feeling for a member of a stigmatized group improve feelings toward the group? , 1997, Journal of personality and social psychology.

[60]  G. Wolff,et al.  Public Education for Community Care: a New Approach , 1996, European Psychiatry.

[61]  J. Leff,et al.  Public Education for Community Care , 1996, British Journal of Psychiatry.

[62]  G. Scambler Stigma and disease: changing paradigms , 1998, The Lancet.

[63]  W. Nittayananta,et al.  Changing knowledge, attitudes, and practices of Thai oral health personnel with regard to AIDS: an evaluation of an educational intervention. , 2000, Community dental health.

[64]  S. Prentice-Dunn,et al.  Children's perceptions of peers with AIDS: assessing the impact of contagion information, perceived similarity, and illness conceptualization. , 1996, Journal of pediatric psychology.

[65]  Graham Scambler,et al.  Being epileptic: coming to terms with stigma , 1986 .

[66]  C. Mathews,et al.  Participation of the school community in AIDS education: an evaluation of a high school programme in South Africa. , 1994, AIDS care.

[67]  G. Samsa,et al.  Physicians' Attitudes and Practices Regarding Treatment of HIV‐Infected Patients , 1992, Southern medical journal.

[68]  J. Meisenhelder,et al.  Fear of contagion: A stress response to acquired immunodeficiency syndrome , 1989, ANS. Advances in nursing science.

[69]  S. Sontag Illness as metaphor ; and, AIDS and its metaphors , 1990 .

[70]  G. Hart,et al.  What do pregnant women think about the HIV test? A qualitative study. , 1999, AIDS care.