Hiv stigma and care seeking behaviour-

We hypothesise that stigma relates to the behaviour of PLHIV themselves and with societal reactions, including those of healthcare professionals. From a literature review, we identified the following as important correlates of care-seeking behavior: beliefs about pathways of HIV infection and people infected with HIV, social reactions, coping strategies, knowledge of HIV and AIDS, and self-efficacy in finding care and treatment in addition to coping with the disease. Poverty, gender, age, religion and policy were found to be moderating variables. The Precede-Proceed model was adapted to build an explanatory model of healthcare-seeking behaviour among PLHIV and particularly to explore the role of stigma in the non-utilisation of healthcare institutions.

Hiv stigma and care seeking behaviour

Hiv stigma and care seeking behaviour

Hiv stigma and care seeking behaviour

Another form of stigma management included refusing treatment altogether [ 87 ]:. Cochrane Database Syst Rev. There has been a growing body of literature exploring stigma and health for people with HIV. Ahsan Ullah AK. Penis rings variety H. The nature of prejudice. J Urban Health. Consequently, stigmatizing attitudes against people living with HIV were demonstrated by those individuals and systems to whom people with HIV xtigma expected seeing entrust their health. Thus, HIV-related stigma did not work in isolation; it was mutually constituted within other forms of marginalization to create interlocking matrices of oppression []. Basic Hiv stigma and care seeking behaviour Applied Social Psychology.

Professional athletes male are violent. Background

Adjusting HIV prevalence estimates for non-participation: an application to demographic surveillance. Dynamic and game theory of infectious disease stigmas. Interviews Hiv stigma and care seeking behaviour 13 patients, three family members and two health professionals helped us to access the complete information, repetition and saturation of data. Psychol Health Med. Rapid implementation of an integrated large-scale HIV counseling and Hiv stigma and care seeking behaviour, malaria, and diarrhea prevention campaign in rural Kenya. The interviews started with an open—ended question, like: "What were your challenges in your social interactions with others? These disparities have resulted Gay thoart blowjobs a life expectancy gap of up to 10 years between HIV-positive men and women [ 2 — 5 ]. Colvin C, Robins S. Stigma and the social burden of neglected tropical diseases. VanLandingham et al.

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  • However, low rates of voluntary testing, late entry into healthcare and delayed treatment continue to be major challenges.

However, low rates of voluntary testing, late entry into healthcare and delayed treatment continue to be major challenges. Stigma associated with HIV has been cited as a significant barrier preventing a successful and co-ordinated response.

HIV-related stigma is known to exist among Thai communities. However, less is known about the attitudes of healthcare workers towards people living with HIV, and how this impacts health-seeking behaviours. This paper considers recent literature from Thailand , which discusses how HIV-related stigma affects health-seeking behaviour, as well as experiences of HIV-related stigma in healthcare settings.

Materials and Methods: Information was collected from electronic databases and websites using the search terms 'HIV stigma healthcare'. Literature published in English, from onwards, discussing the relationship between HIV-related stigma and health-seeking behaviour, or HIV-related stigma in healthcare settings in Thailand was included in this review.

Interactions and negative experiences in government healthcare settings have contributed to a reduced engagement around seeking healthcare. Reluga,Rachel A. Smith,David P. Hughes Journal of Theoretical Biology. Kendall,Sean B. Truong,David V. Kuehl,Karli R. Jacobs,Michael D. Repplinger,William J. Ehlenbach,David W. Seal,James M. Sosman,Ryan P.

How to cite this article: Churcher S. Figure 1: Key socio-cognitive approaches to understanding stigma Click here to view.

Figure 2: Identification of articles for review Click here to view. Table 3: Studies based on or including the perspectives of the community Click here to view. Table 4: Studies based on the perspectives of the health care workers Click here to view. Lancet ; Stigma and its public health implications. Structural approaches to HIV prevention. Weiss MG, Ramakrishna J.

Stigma interventions and research for international health. World Health Organization. Geneva: WHO; Parker R. Stigma, prejudice and discrimination in global public health. Cad Saude Publica ; Soc Sci Med ; HIV-related stigma: Adapting a theoretical framework for use in India. Herek GM. Sexual stigma and sexual prejudice in the United States: A conceptual framework. Nebr Symp Motiv ; Stigma and prejudice: One animal or two?

Nyblade LC. Measuring HIV stigma: Existing knowledge and gaps. Psychol Health Med ; A method for the quantitative analysis of the layering of HIV-related stigma. AIDS Care ; Parker R, Aggleton P. Gregory M, Herek LM. Davis: University of California; Weiss MG. Stigma and the social burden of neglected tropical diseases.

Goffman E. Stigma: Notes on the management of spoiled identity. New York: Simon and Schuster; Ekstrand M. How does stigma affect HIV prevention and treatment. Zamberia AM. Dev South Afr ; Impact of stigma, culture and law on healthcare providers after occupational exposure to HIV and Hepatitis C.

Cult Health Sex ; Stigma as experienced by women accessing prevention of parent-to-child transmission of HIV services in Karnataka, India. Stigma, an important source of dissatisfaction of health workers in HIV response in Vietnam: A qualitative study.

Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health ; Ahsan Ullah AK. Understanding and measuring AIDS-related stigma in health care settings: A developing country perspective. Int J Drug Policy ; Provider and clinic-level correlates of deferring antiretroviral therapy for people who inject drugs: A survey of North American HIV providers.

Int J Psychol ; Combating HIV stigma in health care settings: What works? HIV stigma: A health policy approach. Regions and countries: Thailand. WHO country cooperation strategy Thailand Bangkok: MOPH; Ministry of Public Health.

Promoting health-seeking behaviors and quality of care: Among men who have sex with men and transgender women: Evidence from 5 provinces in Thailand.

Bangkok: Ministry of Health; Harm Reduct J ; AIDS Behav ; Thanawuth N, Chongsuvivatwong V. Stigma, social support, and depression among people living with HIV in Thailand. Known to be positive but not in care: A pilot study from Thailand. Social stigma and knowledge of tuberculosis and HIV among patients with both diseases in Thailand. PLoS One ;4:e Trop Med Int Health ; Ford K, Chamratrithirong A. Migrant seafarers and HIV risk in Thai communities.

A comparison of HIV stigma and discrimination in five international sites: The influence of care and treatment resources in high prevalence settings. Report of the regional consultation on compulsory centres for drug users in Asia and the Pacific.

United Nations. Joint statement: UN calls to close compulsory drug detention and rehabilitation centres without delay. Financing healthcare for migrants: A case study from Thailand. World Health Orgnization. Retention in HIV programmes: Defining the challenges and identifying the solutions: Meeting report September, Together we will end AIDS.

The World Health Organization. Expanding community through ARV provision in Thailand. Measuring the degree of HIV-related stigma and discrimination in health facilities and providers: Working report. This article has been cited by. Journal of Preventive Medicine and Public Health.

Edited by: Boesten J, Poku N. Search Pubmed for Churcher S. Cancel Continue. Weiss MG, Ramakrishna J. Returning user. Periodically monitor stigma among health workers One way to ensure that this happens is by enacting health care setting regulations that mandate the monitoring of health worker attitudes and behaviours to assess progress. Adjusting HIV prevalence estimates for non-participation: an application to demographic surveillance.

Hiv stigma and care seeking behaviour

Hiv stigma and care seeking behaviour

Hiv stigma and care seeking behaviour

Hiv stigma and care seeking behaviour

Hiv stigma and care seeking behaviour. What is HIV discrimination?

He refused to provide any services to me. In the presence of other patients, he tore out my record file and put it in the trash" a year-old woman.

The participants experienced lack of attention in care and treatment needs and long-time waiting. No one came to check me for some time. I felt my rights are ignored as a human" a year-old woman. The ideas obtained from this research involved three main themes and nine subthemes. The main themes were multilateral stigma, rejection, and insult and discrimination in receiving services. Lekganyane et al. It started from a nonsense cycle through which people talked about the fear of their disease and infection disclosure.

Gaudine et al. These stigma themes included three important aspects, as shame and shyness, different behaviors, and stigma due to the fear of transmission and recall. Deacon et al. Stigma is often multidimensional Liamputtong et al. AIDS is a health and medical phenomenon with broad economic, cultural and social aspects.

Its stigma targets the social status of infected people. In this study, however, stigma was associated with cultural backgrounds. As homosexual behaviors contradict Islamic beliefs, they are not confirmed by our society.

Since homosexual behaviors oppose Islamic socio-cultural rules, they have a religiously stigma base which creates assertive judgments and thus, they are not socially accepted. VanLandingham et al. Stigma alters during the time. The past stigma may not be the today stigma. Women living with HIV are blamed of sexual deviances and adultery. Stigma may appear because of sexual misuses or adultery. It may cause rejection and degradation 9. This can negatively affect care and treatment fields and act as a major barrier for infected patients to receive services.

Discrimination itself has many effects on the society. It cannot weaken the HIV stigma. It can cause other problems. Concealment of the disease from health professionals may lead to a rise in the number of infected people and the disease prevalence. The bad looks of the community to patients with HIV have caused the patients not to introduce themselves to health professionals and physicians while referring to treatment centers.

They have found out that they will face rejection or discrimination while receiving services if their disease is disclosed. Discrimination means to distinguish between HIV-positive people and other patients. Not tracing the treatment process by patients is the result of discrimination and rejection. This can create a cycle of health and social issues. Participants of the study explained their experiences associated with giving services and insult and degradation from health professionals.

Some claimed that they concealed their disease to receive services in subsequent visits with physicians. Along with the present study and the discrimination problem in offering medical and dental services, a study in Nigeria was conducted. A study in Kenya highlighted the fear of being infected among midwifery caregivers, which concluded social stigma and discrimination for patients 5. They may assist them to reduce the outcomes and complication of their disease by planning and support.

Studies have indicated that insufficient knowledge, misconceptions about the transmission ways, and the fear of being infected may lead to inappropriate social behaviors towards these patients. In this way, their social difficulties can be lessened. The researchers appreciate the full cooperation of Tarbiat Modares University. Surely, without their help and support, conducting this study would not be easy. Sima Mohammad Khan Kermanshahi and Eesa Mohammadi were involved in revising the codes and data analysis and reviewing the content critically.

Minoo Mohraz was involved in final revisions and critical reading. National Center for Biotechnology Information , U.

Iran Red Crescent Med J. Published online Jun Author information Article notes Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. This article has been cited by other articles in PMC. Objectives: The purpose of this study was to explain the perceived experiences of the patients from stigma and discrimination and their roles on health-seeking services among patients.

Conclusions: Stigma and discrimination play an important role in patients' lives and hinder them from accessing the treatment. Background AIDS is regarded as one of the greatest human challenges and risk factors for health 1. Objectives The aim of the study was to explain the perceived experiences of patients from stigma and discrimination and their roles on health-seeking services among patients during - in Iran. Patients and Methods The present study was a qualitative research using conventional content analysis.

Table 1. Demographic Features of Participant. Open in a separate window. Table 2. As they understand your status, they tell you indirectly that you are an immoral person.

I asked about the label. They told "it is a drug abuse label" Marginalized patient in the hospital Health system stigma In some cases, I prefer not to disclose my positive HIV status when I am in a group. My problem becomes all family's problem. My problem may degrade my family reputation.

Even this can affect their job conditions. My brothers have the best social positions. I do not want to devaluate their social statuses. Belief on family members' social labels Self-stigma Multidimensional stigma.

Table 3. Social Stigma The participants claimed that social stigma caused them to be judged wrongly in their social relations. Health Professionals Patients' experiences from stigma indicated that some physicians and health professionals labeled positive patients with HIV with stigma and discrimination. Self-Isolation The participants reduced and cut their social relations and kept away from the community.

Family and Relative Rejection The participants' experiences suggested the family's unwillingness in having relations with them. Ignorance in Giving Services The participants experienced lack of attention in care and treatment needs and long-time waiting. Acknowledgments The researchers appreciate the full cooperation of Tarbiat Modares University. References 1. Norman LR, Carr R. Health Edu. AIDS Care. Perspectives of HIV-related stigma in a community in Vietnam: a qualitative study.

Int J Nurs Stud. Thomas F. Soc Sci Med. Describing the Chinese HIV surveillance system and the influences of political structures and social stigma. Health-related stigma: rethinking concepts and interventions. Psychol Health Med. Zhou YR. Parker R, Aggleton P. Cullinane J. Med Anthropol. HIV-related stigma discrimination and human rights violations: case studies of successful programmes. Stigma, disclosure, and psychological functioning among HIV-infected and non-infected African-American women.

Women Health. Psychol Health. Qual Health Res. Gosling J. J Anal Psychol. Effects of HIV-related stigma among an early sample of patients receiving antiretroviral therapy in Botswana. AIDS Behav. Three approaches to qualitative content analysis. Nursing research: generating and Assessing Evidence for Nursing Practice. Streubert H, Carpenter D. Qualitative research in nursing: Advancing the humanistic imperative.

Table 4: Studies based on the perspectives of the health care workers Click here to view. Lancet ; Stigma and its public health implications. Structural approaches to HIV prevention. Weiss MG, Ramakrishna J. Stigma interventions and research for international health.

World Health Organization. Geneva: WHO; Parker R. Stigma, prejudice and discrimination in global public health. Cad Saude Publica ; Soc Sci Med ; HIV-related stigma: Adapting a theoretical framework for use in India.

Herek GM. Sexual stigma and sexual prejudice in the United States: A conceptual framework. Nebr Symp Motiv ; Stigma and prejudice: One animal or two? Nyblade LC. Measuring HIV stigma: Existing knowledge and gaps.

Psychol Health Med ; A method for the quantitative analysis of the layering of HIV-related stigma. AIDS Care ; Parker R, Aggleton P. Gregory M, Herek LM. Davis: University of California; Weiss MG. Stigma and the social burden of neglected tropical diseases. Goffman E. Stigma: Notes on the management of spoiled identity. New York: Simon and Schuster; Ekstrand M. How does stigma affect HIV prevention and treatment. Zamberia AM. Dev South Afr ; Impact of stigma, culture and law on healthcare providers after occupational exposure to HIV and Hepatitis C.

Cult Health Sex ; Stigma as experienced by women accessing prevention of parent-to-child transmission of HIV services in Karnataka, India.

Stigma, an important source of dissatisfaction of health workers in HIV response in Vietnam: A qualitative study.

Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health ; Ahsan Ullah AK. Understanding and measuring AIDS-related stigma in health care settings: A developing country perspective. Int J Drug Policy ; Provider and clinic-level correlates of deferring antiretroviral therapy for people who inject drugs: A survey of North American HIV providers. Int J Psychol ; Combating HIV stigma in health care settings: What works?

HIV stigma: A health policy approach. Regions and countries: Thailand. WHO country cooperation strategy Thailand Bangkok: MOPH; Ministry of Public Health. Promoting health-seeking behaviors and quality of care: Among men who have sex with men and transgender women: Evidence from 5 provinces in Thailand.

Bangkok: Ministry of Health; Harm Reduct J ; AIDS Behav ; Thanawuth N, Chongsuvivatwong V. Stigma, social support, and depression among people living with HIV in Thailand. Known to be positive but not in care: A pilot study from Thailand.

Metrics details. HIV-related stigma continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health. This review aims to synthesize qualitative evidence that explored the intersections of stigma and health for people with HIV.

A thematic summary was conducted that was guided by the qualitative metasummary technique developed by Sandelowski and Barraso. Literature searches yielded 8, references of which 55 qualitative studies were identified that illustrated HIV-related stigma in the context of health. The metasummary classified qualitative findings into three overarching categories: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma is avoided or addressed.

A number of health care practices were identified — some rooted in institutional practices, others shaped by personal perceptions held by practitioners — that could be stigmatizing or discriminatory towards people with HIV.

There existed interconnections between enacted stigma and felt stigma that influenced health care utilization, treatment adherence, and overall health and well-being of people with HIV. Intersectional stigma also emerged as instrumental in the stigma experiences of people living with HIV. A number of strategies to address stigma were identified including social support, education, self-efficacy, resilience activities, and advocacy.

This review of the qualitative evidence indicates that HIV-related stigma within health contexts is a broad social phenomenon that manifests within multiple social spheres, including health care environments. Findings from this review indicate that future stigma research should consider the social structures and societal practices — within and outside of health care environments — that perpetuate and reinforce stigma and discrimination towards people with HIV.

Though health-related stigma has been associated with other health conditions such as mental illness, cancer, and other sexually transmitted infections, much of the recent illness stigma literature has been devoted to the stigma and discrimination associated with HIV and AIDS HIV-related stigma and the development of conceptual frameworks specific to HIV-related stigma [ 3 — 9 ].

These conceptual frameworks have identified particularities of stigma in the context of HIV including: the moral valuations ascribed to the illness, modes of transmission, and populations impacted; the intersections of HIV-related stigma with other forms of social marginalization; and the recognition of societal power relations within mechanisms of stigma [ 3 — 9 ].

There has been a growing body of literature exploring stigma and health for people with HIV. Studies have reported on discrimination in healthcare environments towards people with HIV manifesting as denial of care, confidentiality breaches, negative attitudes, and humiliating practices by health care workers [ 12 — 14 ]. Stigma has been shown to impact mental health factors for people with HIV including anxiety [ 17 — 19 ], depression [ 20 — 22 ], suicidal ideation [ 23 , 24 ], emotional health [ 25 ], psychological well being [ 26 ], life satisfaction [ 27 ], and quality of life [ 28 , 29 ].

Stigma has also been linked to health care seeking and adherence to antiretroviral medication [ 30 — 33 ]. Fears of disclosure, anticipated stigma, internalized shame, and experiences of discrimination within health care settings and in greater society can influence future decision making around prevention activities [ 35 — 38 ].

Although there has been a number of recent reviews that examined stigma and HIV [ 16 , 39 — 41 , 42 ], there has been limited research that systematically integrates qualitative evidence in its exploration of stigma, HIV and health. Qualitative synthesis, a method of aggregating qualitative evidence, is a burgeoning approach to synthesizing research evidence and has grown in popularity within health research [ 43 — 47 ].

While syntheses of quantitative evidence have been used to understand causal mechanisms, to measure effect size, or to determine intervention effectiveness, qualitative syntheses are better suited for understanding the nature of a phenomenon, to explore contextual features of experience and to develop theoretical concepts derived from findings across studies [ 48 — 50 ].

Qualitative evidence is particularly helpful in understanding the socially constructed nature of HIV infection, interpreting the social processes, interactions, or contextual features that influence health care decision making, and delineating the interconnections between stigma-related processes and related health impacts.

The original objectives of this project were to conduct a synthesis of the qualitative and quantitative research evidence to better understand the impacts of stigma on the health of people with HIV. This paper reports on the qualitative evidence that explored the intersections of stigma and health for people with HIV.

From February to May , a series of electronic and manual searches were carried out to yield qualitative and quantitative literature related to HIV, stigma and health. To ensure that important evidence not captured in an electronic database search was not missed, manual search strategies were also performed including: citation searches of systematic reviews addressing the topic of stigma for people with HIV [16, 39, 40, 41, 42, 52], a bibliographical review of articles included after full paper review, and recommendations from content experts knowledgable in HIV-related stigma.

The date range of the literature search spanned from January to The literature search was restricted to post, since the introduction of cART is often cited as a key turning point in the HIV epidemic.

The inclusion criteria were as follows: 1 qualitative studies; 2 published after ; 3 that reported thematic findings on stigma and health; 4 and had participants with experiential knowledge of stigma based on their own experience people with HIV or from the perspective of living with or working with people with HIV i. Although language restrictions were not applied as an inclusion criterion, this review was only able to synthesize studies that were written in English, French or Spanish.

Prior to extracting the data, the authors developed an analytical focus guided by the following questions:. The analysis of qualitative literature also accounted for any other health-related findings that may further delineate the interconnection between stigma and health i.

The conceptualization of stigma used for analysis was shaped by broad conceptual frameworks of stigma such as those proposed by Goffman [ 2 ]; Alonzo and Reynolds [ 3 ]; and Link and Phelan [ 54 ]; and HIV-specific frameworks of stigma such as the work of Herek et al. The authors chose these frameworks as they captured the particularities of stigma in the context of HIV and delineated the social mechanisms that could potentially contribute to emotions, beliefs and behaviours that shape health-related experiences for people with HIV.

A thematic summary guided by the qualitative metasummary technique developed by Sandelowski and Barraso was completed. Qualitative metasummary is a synthesis method used to aggregate qualitative findings and to create a thematic taxonomy across studies [ 46 , 55 ].

Thematic analytical approaches were also used to identify, interpret, and report overarching themes and patterns of meanings emerging from the included literature [ 50 , 56 , 57 ]. An inductive analytical approach was used so that the themes identified for the synthesis were strongly linked to the thematic findings reported within each study [ 58 ]. Next, similar findings were grouped using a coding key developed from the analysis.

The coding key was established using the themes identified in the original studies. Each reviewer coded each study independently, then met to compare coding to ensure consensus. Using constant comparison methods, codes were grouped into themes, then findings were organized thematically based on replication confirming what is said in other studies , extension providing additional contextual information that extends findings or refutation providing a contrary view to what is said in other studies.

Conceptual frameworks for stigma also guided the integration of findings into the overarching themes. Each included reference was reviewed and appraised in duplicate by two independent reviewers. Data extraction was conducted by one reviewer and verified by a second reviewer. Any disagreements between reviewers were resolved by consensus and, if that failed, a third independent reviewer resolved the disagreement.

Thematic analysis was conducted by a team of two reviewers with audits conducted by a third reviewer to ensure authenticity of extracted data to the original study, and to ensure consistency of thematic analysis.

The qualitative team met regularly to discuss review findings. The literature searches yielded 8, references 5, after duplicate references were removed of which papers were included for qualitative or quantitative data extraction. From the studies that met the criteria for inclusion, 76 were excluded from the qualitative synthesis see Additional file 2 for a listing of articles excluded from qualitative data extraction : 65 studies that reported only quantitative findings and 11 studies published in languages other than English, French or Spanish.

The inclusion process has been documented in Fig. Screening process for qualitative synthesis. The settings for included studies were geographically diverse, with a mixture of studies conducted in high-, middle- and low-income countries see Additional file 3 for a summary of study characteristics. Of the 55 studies included in this qualitative synthesis, only two specifically aimed to study the intersections of HIV, stigma and health [ , ].

Nineteen studies applied an explicit concept of stigma to their study findings. Of these nineteen studies, four developed conceptual stigma frameworks using the original study findings [ 77 , , , ].

While the qualitative studies on HIV-related stigma were geographically and topically diverse, review findings suggest that the included studies shared some common conceptions of stigma within the health context. In this synthesis, we initially categorized the qualitative findings using the themes commonly identified across the included literature; then, in the thematic analysis, we identified overarching themes in relation to HIV, stigma and health.

The metasummary classified qualitative findings into three overarching themes: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma was circumvented, buffered or combated. See Additional file 4 , for a matrix summary classifying the common themes identified in the included literature; see Additional file 5 , for a detailed description of these themes.

These dimensions informed how stigma was experienced by people with HIV and addressed within health care contexts.

Lastly, these studies offered various strategies through which stigma was managed. To better illustrate these connections, summarized here are aspects of HIV, stigma and health that were prominent in the qualitative literature. The first section, HIV and stigma in health care environments describes some of the ways in which health care practices can be discriminatory towards or interpreted as stigmatizing by people with HIV.

In the last section, strategies identified to address HIV-related stigma are explored. These modes of addressing stigma offer people with HIV, as well as health care practitioners and other advocates in their care, alternative ways of managing stigma that could contribute to stigma reduction.

Three practice strategies emerged from the literature: risk management, where strategies to mitigate perceived health risks were institutionalized in care; fear management, where care practices stemmed from practitioner fears of HIV exposure; and moral management, where care practices derived from judgmental perceptions towards people with HIV and transmission activities. The literature also identified intersectional stigma, or interconnections between HIV-related stigma and other forms of social marginalization as they inform access to health care.

Whether these practices were codified in institutional systems or engaged indiscriminately by health care providers, they were distinguished as stigmatizing health care practices as they had the potential to expose people with HIV to discrimination or enacted stigma.

A number of risk management procedures institutionalized in organizational policies were characterized as being potentially discriminatory towards people with HIV.

Segregation of people with HIV was an example of a precautionary measure that could incite stigma. Other studies noted acts of segregation that may intially have been instituted to protect people with HIV, such as protecting them from opportunistic infections.

The qualitative literature also discussed segregation practices as intentionally used to differentiate people with HIV from the general care population.

Infected people want as few people to know about their situation as possible. This disease is repellent. Anyone coming there is infected. That room is for this disease. You go elsewhere for other diseases or for consultation. As illustrated above, segregation as an institutional practice could demark people with HIV. Confidentiality violations were another form of disclosure within health care settings discussed as inciting stigma.

Everyplace I went I was carrying this. Whether confidentiality was violated consciously or unconsciously, enacted by individuals or codified in health care practices, it had a profound impact on how people with HIV experienced health care and on their future health care seeking behaviours. The qualitative literature identified ways in which health care strategies designed to mitigate health risks could become discriminatory care practices.

However, Li et al. Additionally, historical experiences of discrimination may influence the interpretation of behaviors as discriminatory [ ]. Nevertheless, the literature illustrated ways in which institutional practices became stigmatizing forces for a person with HIV even if discrimination was not intended. Behaviors that may seem benign to a health care practitioner may be stigmatizing for a person with HIV, particularly if these actions mirror prior discriminatory experiences within health care settings or are reflective of HIV-related stigma within greater society.

The qualitative literature also illustrated that misperceptions of HIV transmission could fuel fears of infection. For example, Rintamaki et al. Other examples of fear management were excessive precautions used by practitioners such as wearing protective clothing for general care, double gloving, or placing protective covering for services that only involved casual touch. Excessive precautions enacted at the discretion of individual health care practitioners may have resulted from limited enforcement of universal health care precautions.

However, these precautionary practices, when excessively or discriminately practiced may stigmatize people with HIV. These selective or discretionary uses of precautionary measures could also expose HIV-positive individuals to disclosure as well as to stigma. In these examples, health care practitioners were positioned as social judges perceived to be blaming patients for their infection. People with HIV discussed being moralized within health care environments in a number of ways: being ignored or infantilized, drawing disparaging comments, receiving neglectful care or being denied care due to a perceived denigrated lifestyle.

As remarked in Rutledge et al. He told me to pull down my pants and press my hands against the wall.

Hiv stigma and care seeking behaviour

Hiv stigma and care seeking behaviour