The effect of HIV-related stigma on antiretroviral therapy adherence

Abstract

Overview of the topic: From its discovery in the 1980s, HIV has claimed over 32 million lives, but with pharmacological advances this disease has become a chronic manageable disease. Although antiretroviral therapy (ART) enables HIV-positive individuals to live long and healthy lives, a high level of adherence is needed for this therapy to work efficiently. Several barriers may interfere with ART adherence, including HIV-related stigma, as it poses a significant threat to prevention and treatment. In this literature review, the aim is to analyse whether HIV-related stigma has an effect on ART adherence, guided by the research question: In adults living with HIV, does HIV-related stigma have an effect on antiretroviral therapy adherence? The PEO framework is used as follows: (P) Adults living with HIV, (E) HIV-related stigma, (O) Antiretroviral therapy adherence. Methods: Keywords and synonyms have been used for a systematic search of articles. A number of electronic databases, namely EBSCO and Google Scholar have been used in order to obtain the key articles, while local experts were also consulted to obtain local information. The inclusion criteria used for the selection of the key studies included that participants were adults, that studies used both adequate tools to measure HIV-related stigma as well as adherence to ART. Additionally, studies were excluded if they focused on multiple exposures, as this hindered the focus of the PEO question. Five cross-sectional studies were found and the AXIS appraisal tool has been used to critically appraise their methods and results. Results and conclusion: Although there was a general inclination that HIV-related stigma has an effect on ART adherence, not all studies found a significant association, and there were several inconsistences and limitations when the methods and findings were compared. Furthermore, since stigma is complex, there are several socio-demographic and psychosocial factors that may influence ART adherence. Therefore, these findings should be interpreted with caution and further research needs to be done. Implications and recommendations: Further research in the local context is required to assess the barriers of ART adherence, whilst more educational and prevention campaigns are needed to reduce the number of new HIV-cases. Additionally, pre- and post-registration health care programmes should incorporate how to address the psychological needs of HIV-positive individuals. Furthermore, evidence-based protocols are needed to help guide healthcare workers working with HIV-positive individuals. Moreover, collaboration between policy-makers and other stakeholders is essential to develop new policies and plan health strategies.