Logo

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

A treatment that can help to increase confidentiality

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]
A treatment that is not a constant reminder of status

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]
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.

References

Ociskova M, et al. Neurpsychiatr Dis Treat. 2018; 14: 383–392.
World Aids Day Report 2015. ‘On the Fast-Track to end AIDS by 2030’. Available at: https://www.unaids.org/en/resources/documents/2015/FocusLocationPopulation (accessed September 2020).
Chidrawi HC, et al. Health SA Gesondheid 2016; 21: 196–205.
Stangl A, et al. London School of Hygiene & Tropical Medicine, June 2018. Available at: http://strive.lshtm.ac.uk/system/files/attachments/STRIVE%20technical%20brief%20stigma.pdf (accessed September 2020).
Pantelic M, et al. BMC Infectious Diseases 2019; 19: 210.
Turan B, et al. AIDS Behav. 2017; 21(1): 283–291.
Nobre N, et al. J Assoc Nurses AIDS Care 2018; 29(2): 254–265.
Vu VT, et al. AIDS Care 2011; 23(2): 139–145.
Pulerwitz J, et al. Public Health Rep. 2010; 125(2): 272–281.
Bhatta & Liabsuetrakul. AIDS Behav. 2017; 21: 1620–1631.
Nawrat A. Pharmaceutical Technology, October 2019. Available at: https://www.pharmaceutical-technology.com/news/emotional-challenges-art-hiv-viiv/ (accessed September 2020).
Wu F, et al. Arch Sex Behav. 2018; 47(7): 2061–2069.
Maiese EM, et al. Curr Med Res Opin. 2016; 32(12): 2039–2046.
Martikainen P, et al. Int J Epidemiol. 2002; 31: 1091–1093.
Harding R, et al. J Acquir Immune Defic Syndr. 2015; 70(5): e176–177.
Martikainen P, et al. Int J Epidemiol. 2002; 31: 1091–1093.
Harding R, et al. J Acquir Immune Defic Syndr. 2015; 70(5): e176–177.
Dang B, et al. PLOS One 2013; 8(1): e54729.
Ahmed SI, et al. Eur J Pers Cent Healthc. 2017; 5(1): 138–144.