EC Psychology And Psychiatry

Research Article Volume 13 Issue 1 - 2024

The Burden of HIV Stigma and Associated Factors among HIV Infected Adolescents Attending HIV Clinics in Kampala City: A Cross-Sectional Study in Uganda

Justine Diana Namuli1*, Noeline Nakasujja1, Blaise Kiyimba2, Fred Ssewamala3, Mary McKay3, Nakimuli-Mpungu1 and Janet Nakigudde1

1Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
2School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
3Brown School, Washington University in St. Louis, U.S.A
*Corresponding Author: Justine Diana Namuli, Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda.
Received: December 20, 2023; Published: December 29, 2023



Background and Aim: The Current HIV/AIDS pandemic is accompanied by undeniable stigma against people living with HIV/AIDS (PLWHA). Most studies on HIV-related stigma have been among adults, and they report that it is a major hindrance to various HIV treatment goals among PLWHA. However, there is scanty literature on HIV-related stigma among adolescents. This study aimed to determine the burden of HIV stigma and associated factors among HIV-infected adolescents in Uganda.

Methods: We conducted a descriptive cross-sectional study among 370 HIV-infected adolescents aged 10-17 years attending HIV clinics in Kampala Capital City Authority (KCCA) health facilities. HIV stigma was assessed using the 11-item Stigma in AIDS Family Inventory (SAFI) tool, depression and suicidal ideation were assessed using the Child Depression Inventory (CDI) tool, while HA ART adherence and social support determined using the missed-dose method and the 12-item Multidimensional Scale of Perceived Social Support (MSPSS) tools respectively. Data was analysed using STATA 16. Logistic regression analyses were used to assess the factors associated with HIV stigma. A P < 0.05 was considered statistically significant.

Results: Overall, 370 adolescents, with a mean age of 15.5 years (Standard deviation, SD = 2.88) and a female preponderance (216, 58.4%) participated in this study. The prevalence of high-level HIV stigma was 33.5% (Mean score = 9.53, SD = 6.33). Orphan status (AOR = 1.65, 95% CI = 1.15 - 2.37, P = 0.007), Depression (AOR = 1.10, 95%CI = 1.06 - 1.15, P < 0.0001), being with suicidal ideation (AOR = 2.48, 95%CI = 1.06-5.81, P = 0.036), perceived low social support (AOR = 0.94, 95%CI = 0.91 - 0.97, P = < 0.0001), Poor HAART adherence (AOR = 2.12, 95%CI = 1.23 = 3.63, P = 0.007), and undisclosed HIV status (AOR = 0.06, 95%CI = 0.01 - 0.42, P = 0.004) were independently associated with high HIV stigma.

Conclusion: The prevalence of HIV stigma among adolescents living with HIV/AIDS is substantial. HIV-infected adolescents should be provided with psychosocial counseling, social support, and routine close mental health monitoring to combat psychological stigma which can lead to full-blown psychiatric disorders. This may be better achieved by integrating mental health services into HIV care.

 Keywords: Stigma; Prevalence; HIV; Adolescents; Uganda

  1. The path that ends aids 2023 UNAIDS global aids update.
  2. UNAIDS data 2019.
  3. UPHIA-Summary-Sheet-2020.
  4. Mahajan AP., et al. “Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward”. AIDS (London, England)2 (2008): S67-S79.
  5. Kimani-Murage EW., et al. “It’s my secret: Barriers to paediatric HIV treatment in a poor rural South African setting”. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV6 (2013): 744-747.
  6. Barennes H., et al. “Perceived stigma by children on antiretroviral treatment in Cambodia”. BMC Pediatrics 1 (2014): 300.
  7. Monjok E., et al. “HIV/AIDS-related stigma and discrimination in Nigeria: Review of research studies and future directions for prevention strategies”. African Journal of Reproductive Health 3 (2009): 21-35.
  8. Nabunya P., et al. “Factors associated with HIV disclosure and HIV-related stigma among adolescents living with HIV in Southwestern Uganda”. Frontiers in Psychiatry 11 (2020): 772.
  9. Franco LM., et al. “Evidence base for children affected by HIV and AIDS in low prevalence and concentrated epidemic countries: Applicability to programming guidance from high prevalence countries”. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV1 (2009): 49-59.
  10. Wang B., et al. “Risk and protective factors for depression symptoms among children affected by HIV/AIDS in rural China: A structural equation modeling analysis”. Social Science and Medicine 9 (2012): 1435-1443.
  11. Deacon H. “Towards a sustainable theory of health-related stigma: Lessons from the HIV/AIDS literature”. Journal of Community and Applied Social Psychology 6 (2006): 418-425.
  12. Hejoaka F. “Care and secrecy: Being a mother of children living with HIV in Burkina Faso”. Social Science and Medicine 6 (2009): 869-876.
  13. Vreeman RC., et al. “Validation of an HIV/AIDS stigma measure for children living with HIV and their families”. Journal of the International Association of Providers of AIDS Care 18 (2019): 2325958219880570.
  14. Uganda HIV/AIDS country progress report 2016.
  15. The people living with HIV stigma index Uganda (2013).
  16. MOH-2010.
  17. Ashaba S., et al. “Internalized HIV stigma, bullying, major depressive disorder, and high-risk suicidality among HIV-positive adolescents in rural Uganda”. Global Mental Health 5 (2018): e22.
  18. Kovacs M. “Manual for children’s depression inventory”. In New York: North Tonawanda (1992): 87-91.
  19. Zimet GD., et al. “The multidimensional scale of perceived social support”. Journal of Personality Assessment 1 (1988): 30-41.
  20. Nakigudde J., et al. “Adaptation of the multidimensional scale of perceived social support in a Ugandan setting”. African Health Sciences1 (2009): S35-S41.
  21. Surkan PJ., et al. “Perceived discrimination and stigma toward children affected by HIV/AIDS and their HIV-positive caregivers in central Haiti”. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV7 (2010): 803-815.
  22. The people living with HIV stigma index 2019.
  23. Dow DE., et al. “Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania”. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV7 (2016): 825-833.
  24. Ogunyemi AO., et al. “Stigma, discrimination and non-disclosure among young people living with HIV in Lagos, Nigeria”. Pan African Medical Journal 41 (2022): 106.
  25. Kalichman S., et al. “Population density and AIDS-related stigma in large-urban, small-urban, and rural communities of the southeastern USA”. Prevention Science5 (2017): 517-525.
  26. Li Z., et al. “HIV-related stigma among people living with HIV/AIDS in rural Central China”. BMC Health Services Research 1 (2018): 453.
  27. Pantelic M., et al. “HIV, violence, blame and shame: Pathways of risk to internalized HIV stigma among South African adolescents living with HIV: Pathways”. Journal of the International AIDS Society1 (2017): 21771.
  28. Du H., et al. “High HIV prevalence predicts less HIV stigma: a cross-national investigation”. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV6 (2018): 714-721.
  29. Musisi S and Kinyanda E. “East African medical journal emotional and behavioural disorders in HIV seropositive adolescents in urban Uganda”. East African Medical Journal1 (2009): 16-24.
  30. Tao J., et al. “Relationship of stigma and depression among newly HIV-diagnosed Chinese men who have sex with men”. AIDS and Behavior 1 (2017): 292-299.
  31. Nakimuli-Mpungu E., et al. “Group support psychotherapy for depression treatment in people with HIV/AIDS in northern Uganda: a single-centre randomised controlled trial”. Lancet HIV5 (2015): e190-e199.
  32. Rukundo GZ., et al. “Burden of suicidal ideation and attempt among persons living with HIV and AIDS in Semiurban Uganda”. AIDS Research and Treatment (2016): 3015468.
  33. Namuli JD., et al. “Prevalence and factors associated with suicidal ideation among children and adolescents attending a pediatric HIV clinic in Uganda”. Frontiers in Sociology 6 (2021): 656739.
  34. Wang W., et al. “Psychosocial health and suicidal ideation among people living with HIV/AIDS: A cross-sectional study in Nanjing, China”. PLoS One2 (2018): e0192940.
  35. Bitew H., et al. “Suicidal ideation, attempt, and determining factors among HIV/AIDS patients, Ethiopia”. Depression Research and Treatment (2016): 8913160.
  36. Rueda S., et al. “Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses”. BMJ Open7 (2016): e011453.
  37. Thapinta D., et al. “Association between internalized stigma and depression among people living with HIV in Thailand”. International Journal of Environmental Research and Public Health 8 (2022): 4471.
  38. Earnshaw VA., et al. “Stigma, depression, and substance use problems among perinatally HIV-infected youth in South Africa”. AIDS and Behavior 12 (2018): 3892-3896.
  39. Wei L., et al. “Perceived HIV stigma, depressive symptoms, self-esteem, and suicidal ideation among people living with HIV/AIDS in China: a moderated mediation modeling analysis”. Journal of Racial and Ethnic Health Disparities 2 (2023): 671-679.
  40. Harms S., et al. “The orphaning experience: descriptions from Ugandan youth who have lost parents to HIV/AIDS”. Child and Adolescent Psychiatry and Mental Health 4 (2010): 6.
  41. Cluver LD., et al. “Effects of stigma on the mental health of adolescents orphaned by AIDS”. Journal of Adolescent Health4 (2008): 410-417.
  42. Caserta TA., et al. “Stigma, marginalization and psychosocial well-being of orphans in Rwanda: Exploring the mediation role of social support”. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV6 (2016): 736-744.
  43. Boyes ME and Cluver LD. “Relationships among HIV/AIDS orphanhood, stigma, and symptoms of anxiety and depression in South African youth: A longitudinal investigation using a path analysis framework”. Clinical Psychological Science 3 (2013): 323-330.
  44. Kyohangirwe L., et al. “Prevalence and factors associated with major depressive disorder among adolescents attending a primary care facility in Kampala, Uganda”. Tropical Doctor 1 (2020): 30-36.
  45. Onu DU. “Treatment adherence mediates the relationship between HIV-related stigma and health-related quality of life”. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV10 (2021): 1335-1339.
  46. Hoffman S., et al. “Stigma and HIV care continuum outcomes among Ethiopian adults initiating art”. Journal of Acquired Immune Deficiency Syndromes 4 (2017): 382-387.
  47. Rice WS., et al. “Association between internalized HIV-related stigma and HIV care visit adherence”. Journal of Acquired Immune Deficiency Syndromes 76.5 (2017): 482-487.
  48. Sweeney SM and Vanable PA. “The association of HIV-related stigma to HIV medication adherence: A systematic review and synthesis of the literature”. AIDS and Behavior1 (2016): 29-50.
  49. Katz IT., et al. “Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis”. Journal of the International AIDS Society3 (2013): 18640.
  50. Turan B., et al. “Buffering internalization of HIV stigma: implications for treatment adherence and depression”. Journal of Acquired Immune Deficiency Syndromes (1988) 3 (2019): 284-291.
  51. Spielman KL., et al. “Depressive symptoms, HIV-related stigma and ART adherence among caregivers of children in vulnerable households in rural southern Malawi”. PLoS One3 (2021): e0247974.
  52. Small E., et al. “Exploring factors associated with HIV secondary stigma among adolescents and young adults in Uganda: A cross-sectional study”. Global Public Health 4 (2022): 526-537.
  53. Chekole YA and Tarekegn D. “HIV-related perceived stigma and associated factors among patients with HIV, Dilla, Ethiopia: A cross-sectional study”. Annals of Medicine and Surgery 71 (2021): 102921.

Justine Diana Namuli., et al. “The Burden of HIV Stigma and Associated Factors among HIV Infected Adolescents Attending HIV Clinics in Kampala City: A Cross-Sectional Study in Uganda” ”. EC Psychology and Psychiatry  13.1 (2024): 01-14.

ECronicon Journal

Our Services

Quick Links

Information

Creative Commons LicenseOpen Access by ECronicon is licensed under a Creative Commons Attribution 4.0 International License
Based on a work at www.ecronicon.net