What if we could help PLHIV redefine themselves?

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Self-Stigma is a concern for many PLHIV and can lower treatment adherence, increase anxiety and worsen treatment outcomes[1]

Globally, over half of people report having discriminatory attitudes to PLHIV[2]

Of the four types of HIV stigma, (received stigma,[3] associated stigma,[3] anticipated stigma[4] and self-stigma[4]), self-stigma is arguably the most prevalent[5] and harmful.[6] Self-stigma significantly lowers QoL and HRQoL in PLHIV.[7]

Current strategies do not go far enough to tackle self-stigma and its consequences.[5] We need to consider how else we can help PLHIV renew their sense of self

PLHIV may have strong desires of non-disclosure, impelling them to opt for more confidential ways of receiving ART[8]

New thinking is needed for interventions that oppose self-stigma at an individual level, such as:[5]

  • Responding to the needs of stigmatised groups[9][10]
  • Empowering PLHIV to practice self-care and contribute to community activism[11]
  • Deploying social and structural initiatives[5]

For some PLHIV, the constant reminder of HIV status through treatment use can intensify feelings of self stigma[12][13]

In a survey of over 2000 PLHIV:[12]

  • Although 87% of respondents were satisfied with their current ART, 66% said that daily treatment was a constant reminder of HIV status

A further qualitative analysis of 26 PLHIV also cited that need for regular medication was a persistent cue of status and strengthened feelings of self-stigma[13]

Similarly to switching treatment because of physical events,[14] switching treatment due to mental, emotional and social needs can save lives, enhance outcomes,[17][18] and ensure PLHIV have a life worth living

Patient satisfaction with ART can contribute to improved clinical outcomes[19]
Autonomy is also a key determinant of patient satisfaction[20]

It may be time to look at the non-clinical adverse events of ART and consider the new possibilities of switching to a treatment that can change the way patients live with HIV

All images are for illustrative purposes only. Any person depicted is a model.

ABBREVIATIONS
ART: antiretroviral therapy; HRQoL: health-related QoL; PLHIV: people living with HIV; QoL: quality of life.