Perceived stigma by children on antiretroviral treatment in Cambodia

BMC Pediatrics

Ung Vibol²  Daniel Reinharz⁴  Sovann Tat¹  Hubert Barennes³ 

[1] Stung Treng Regional Training Center for Nursing and Midwifery Cambodia, Stung Treng, Cambodia;University of Health Science, Phnom Penh, Cambodia;Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia;Département de médecine sociale et préventive, Université Laval, Québec, Canada

关键词: Stigmatization;    Stigma;    School;    Perceived stigma;    HIV;    Exclusion;    Discrimination;    Children;    Cambodia;    AIDS;   

Others  :  1223787
DOI  :  10.1186/s12887-014-0300-9

 received in 2014-05-15, accepted in 2014-11-19,  发布年份 2014

【 摘 要 】

Background

HIV-related stigma diminishes the quality of life of affected patients. Little is known about perceived and enacted stigma of HIV-infected children in resources-limited settings. We documented the prevalence of perceived stigma and associated factors associated among children on antiretroviral therapy (ART) at a referral hospital in Cambodia.

Methods

After informed consent, a standardized pre-tested 47-item questionnaire was confidentially administered to consecutive children (7 to 15 years) or their guardians if the child was 18 months to 6 years, during their routine ART visits. The questionnaire explored the sociodemographics of the child and the parents, HIV history, adherence to ART, tolerance of ART and perceived stigma. Associations between perceived stigma and the children’s characteristics were measured by bivariate and multivariate analyses.

Results

Of 183 children, 101 (55.2%) had lost at least one and 45 (24.6%) both parents; 166 (90.7%) went to school. Of 183 children (female: 84, 45.9%, median age 7.0 years, interquartile range: 2.0-9.6), 79 (43.2%) experienced perceived stigma, including rejection by others (26.8%), no invitations to social activities (18.6%) and exclusion from games (14.2%). A total of 43 (23.5%) children were fearful of their disease and 61 (53.9%) of 113 older than 6 years reported knowledge of their HIV status. Of 136 children over five years and eligible for education, 7 (3.8%) could not go to school due to perceived stigma. Incomplete adherence to ART was reported for 17 (9.2%) children. In multivariate analysis, school attendance (odds ratio [OR]: 3.9; 95% confidence interval [CI]: 2.0-7.9) and income of less than one dollar per person per day (OR: 2.2, 95% CI: 1.1-4.5) were associated with perceived stigma. Conversely, receipt of social support (OR: 0.4, 95% CI 0.2-0.9) was associated with lower risk of perceived stigma.

Conclusion

Perceived stigma in pediatric ART patients remains a significant issue in Cambodia. Psychological support and interventions should be developed in hospitals, schools, and underprivileged communities to prevent HIV-related stigma for affected children.

【 授权许可】

   
2014 Barennes et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]UNAIDS: 26th Meeting of the UNAIDS Programme Coordinating Board Non-Discrimination in HIV Responses. UNAIDS. http://www.unaids.org/sites/default/files/en/media/unaids/contentassets/dataimport/pub/agenda/2010/26pcb_decision_points_en.pdf.
• [2]Nyblade LC: Measuring HIV stigma: existing knowledge and gaps. Psychol Health Med 2006, 11:335-345. [doi]:10.1080/13548500600595178
• [3]Zhao J, Li X, Fang X, Hong Y, Zhao G, Lin X, Zhang L, Stanton B: Stigma against children affected by AIDS (SACAA): psychometric evaluation of a brief measurement scale. AIDS Behav 2010, 14:1302-1312.
• [4]Lin X, Zhao G, Li X, Stanton B, Zhang L, Hong Y, Zhao J, Fang X: Perceived HIV stigma among children in a high HIV-prevalence area in central China: beyond the parental HIV-related illness and death. AIDS Care 2010, 22:545-555.
• [5]Lee MB, Wu Z, Rotheram-Borus MJ, Detels R, Guan J, Li L: HIV-related stigma among market workers in China. Health Psychol 2005, 24:435-438.
• [6]Castle S: Rural children’s attitudes to people with HIV/AIDS in Mali: the causes of stigma. Cult Health Sex 2004, 6:1-18.
• [7]Thorsen VC, Sundby J, Martinson F: Potential initiators of HIV-related stigmatization: ethical and programmatic challenges for PMTCT programs. Dev World Bioeth 2008, 8:43-50.
• [8]Morineau G, Vun MC, Barennes H, Wolf RC, Song N, Prybylski D, Song N, Prybylski D: Survival and quality of life among HIV-positive people on antiretroviral therapy in Cambodia. AIDS Patient Care STDS 2009, 23:669-677.
• [9]Ehiri JE, Anyanwu EC, Donath E, Kanu I, Jolly PE: AIDS-related stigma in sub-Saharan Africa: its contexts and potential intervention strategies. AIDS Public Policy J 2005, 20:25-39.
• [10]Kimani-Murage EW, Manderson L, Norris SA, Kahn K: “It’s my secret”: barriers to paediatric HIV treatment in a poor rural South African setting. AIDS Care 2012, 25:744-747.
• [11]Ngarina M, Popenoe R, Kilewo C, Biberfeld G, Ekstrom AM: Reasons for poor adherence to antiretroviral therapy postnatally in HIV-1 infected women treated for their own health: experiences from the Mitra Plus study in Tanzania. BMC Public Health 2013, 13:450. BioMed Central Full Text
• [12]Cao X, Sullivan SG, Xu J, Wu Z: Understanding HIV-related stigma and discrimination in a “blameless” population. AIDS Educ Prev 2006, 18:518-528.
• [13]Franco LM, Burkhalter B, de WA, Jennings L, Kelley AG, Hammink ME: 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 2009, 21(Suppl 1):49-59.
• [14]Wang B, Li X, Barnett D, Zhao G, Zhao J, Stanton B: Risk and protective factors for depression symptoms among children affected by HIV/AIDS in rural China: a structural equation modeling analysis. Soc Sci Med 2012, 74:1435-1443.
• [15]Boyes ME, Mason SJ, Cluver LD: Validation of a brief stigma-by-association scale for use with HIV/AIDS-affected youth in South Africa. AIDS Care 2013, 25:215-222.
• [16]Zhao G, Li X, Zhao J, Zhang L, Stanton B: Relative importance of various measures of HIV-related stigma in predicting psychological outcomes among children affected by HIV. Community Ment Health J 2012, 48:275-283.
• [17]NCHADS: Annual Report 2011.http://www.nchads.org/Report/Annual%20Report%202011%20Eng.pdf.
• [18]NCHADS, Chhea C, Saphonn V: Estimations and Projections of HIV/AIDS in Cambodia 2010–2015. Ministry of Health. National Center for HIV/AIDS Dermatology and STD; 2011:1–58. 10-8-0014. http://www.nchads.org/Publication/HSS/Estimations%20and%20Projections%20of%20HIV-AIDS%20in%20Cambodia%202010-2015_eng.pdf.
• [19]CPN+. People Living with HIV Stigma Index Cambodia, 2010. 1–125. 2013. Phnom Penh, UNAIDS. People Living with HIV Stigma Index.http://www.stigmaindex.org/sites/default/files/reports/Cambodia%20People%20Living%20with%20HIV%20Stigma%20Index%20Report%202010.pdf.
• [20]Raguenaud ME, Isaakidis P, Zachariah R, Te V, Soeung S, Akao K, Kumar V: Excellent outcomes among HIV+ children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia. BMC Pediatr 2009, 9:54. BioMed Central Full Text
• [21]Isaakidis P, Raguenaud ME, Te V, Tray CS, Akao K, Kumar V, Ngin S, Nerrienet E, Zachariah R: High survival and treatment success sustained after two and three years of first-line ART for children in Cambodia. J Int AIDS Soc 2010, 13:11. BioMed Central Full Text
• [22]Harimanana A, Clavel S, Chivorakul P, Perez F, Preux PM, Barennes H: Associated factors with adherence to antiepileptic drug in the capital city of Lao PDR. Epilepsy Res 2013, 104:158-166.
• [23]Jacoby A: Felt versus enacted stigma: a concept revisited. Evidence from a study of people with epilepsy in remission. Soc Sci Med 1994, 38:269-274.
• [24]Lee MB, Rotheram-Borus MJ: Parents’ disclosure of HIV to their children. AIDS 2002, 16:2201-2207.
• [25]Zhao Q, Li X, Zhao G, Zhao J, Fang X, Lin X, Stanton B: AIDS knowledge and HIV stigma among children affected by HIV/AIDS in rural China. AIDS Educ Prev 2011, 23:341-350.
• [26]Li L, Liang LJ, Lin C, Wu Z, Rotheram-Borus MJ: HIV prevention intervention to reduce HIV-related stigma: evidence from China. AIDS 2010, 24:115-122.
• [27]Chi P, Li X: Impact of parental HIV/AIDS on children’s psychological well-being: a systematic review of global literature. AIDS Behav 2012, 17:2554-2574.
• [28]Marie Stopes International China, UNAIDS, Institute of Social Development Research of the China Central Pary School. The China Stigma Index Report. Geneva: UNAIDS; 2009:1–21. http://data.unaids.org/pub/Report/2009/20091127_stigmaindexsummaryreport_en.pdf.
• [29]Gonzalez-Rivera M, Bauermeister JA: Children’s attitudes toward people with AIDS in Puerto Rico: exploring stigma through drawings and stories. Qual Health Res 2007, 17:250-263.
• [30]Tran T, Mwanri L: Addressing stigma and discrimination in HIV/AIDS affected orphans and vulnerable children in Vietnam. J Preventive Medicine 2013, 1:30-35.
• [31]Ishikawa N, Pridmore P, Carr-Hill R, Chaimuangdee K: The attitudes of primary schoolchildren in Northern Thailand towards their peers who are affected by HIV and AIDS. AIDS Care 2011, 23:237-244.
• [32]Schonfeld DJ: Teaching young children about HIV and AIDS. Child Adolesc Psychiatr Clin N Am 2000, 9:375-387.
• [33]Smith Fawzi MC, Eustache E, Oswald C, Louis E, Surkan PJ, Scanlan F, Hook S, Mancuso A, Mukherjee JS: Psychosocial support intervention for HIV-affected families in Haiti: implications for programs and policies for orphans and vulnerable children. Soc Sci Med 2012, 74:1494-1503.
• [34]Cluver LD, Gardner F, Operario D: Effects of stigma on the mental health of adolescents orphaned by AIDS. J Adolesc Health 2008, 42:410-417.
• [35]Lambert V, Gallagher P, O'Toole S, Benson A: Stigmatising feelings and disclosure apprehension among children with epilepsy. Nurs Child Young People 2014, 26:22-26.
• [36]Cluver L, Gardner F: Risk and protective factors for psychological well-being of children orphaned by AIDS in Cape Town: a qualitative study of children and caregivers' perspectives. AIDS Care 2007, 19:318-325.
• [37]The National AIDS Authority: Cambodia Country Progress Report. Cambodia; 2014. http://www.unaids.org/sites/default/files/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/KHM_narrative_report_2014.pdf.
• [38]Messer LC, Pence BW, Whetten K, Whetten R, Thielman N, O’Donnell K, Ostermann J: Prevalence and predictors of HIV-related stigma among institutional- and community-based caregivers of orphans and vulnerable children living in five less-wealthy countries. BMC Public Health 2010, 10:504. BioMed Central Full Text
• [39]Wu S, Li L, Wu Z, Liang LJ, Cao H, Yan Z, Li J: A brief HIV stigma reduction intervention for service providers in China. AIDS Patient Care STDS 2008, 22:513-520.
• [40]Carael M, Curran L, Gacad E, Harding R, Gnaore E, Mandofia B, Stahlhofer M, Timberlake S, Ummel M, Murphy T: Protocol for the Identification of Discrimination Against People Living With HIV. UNAIDS, Geneva; 2000.
• [41]Sengupta S, Banks B, Jonas D, Miles MS, Smith GC: HIV interventions to reduce HIV/AIDS stigma: a systematic review. AIDS Behav 2011, 15:1075-1087.
• [42]Kalichman SC, Simbayi LC, Jooste S, Toefy Y, Cain D, Cherry C, Kagee A: Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS Behav 2005, 9:135-143.
• [43]Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T: Measuring AIDS stigmas in people living with HIV/AIDS: the internalized AIDS-related stigma scale. AIDS Care 2009, 21:87-93.
• [44]Genberg BL, Kawichai S, Chingono A, Sendah M, Chariyalertsak S, Konda KA, Celentano DD: Assessing HIV/AIDS stigma and discrimination in developing countries. AIDS Behav 2008, 12:772-780.