TY - JOUR
T1 - Stigma reduction in relation to HIV test uptake in low- and middle-income countries
T2 - A realist review
AU - Thapa, Subash
AU - Hannes, Karin
AU - Cargo, Margaret
AU - Buve, Anne
AU - Peters, Sanne
AU - Dauphin, Stephanie
AU - Mathei, Catharina
PY - 2018/11/20
Y1 - 2018/11/20
N2 - Background: This realist review was conducted to understand how stigma is reduced in relation to HIV test uptake in low- and middle-income countries (LMICs). Methods: A systematic search of eight databases resulted in 34 articles considered for synthesis. Data synthesis was guided by a preliminary programme theory and included coding the meaning units to develop themes or intervention pathways that corresponded to context-mechanism-outcome configurations. Results: We found that the interventions produced an effect through two pathways: (a) knowledge leads to changes in stigmatizing attitudes and increases in HIV test uptake and (b) knowledge and attitudes lead to changes in stigmatizing behaviours and lead to HIV test uptake. We also found one competing pathway that illustrated the direct impact of knowledge on HIV test uptake without changing stigmatizing attitudes and behaviour. The identified pathways were found to be influenced by some structural factors (e.g., anti-homosexuality laws, country-specific HIV testing programmes and policies), community factors (e.g., traditional beliefs and practices, sexual taboos and prevalence of intimate partner violence) and target-population characteristics (e.g., age, income and urban-rural residence). Conclusions: The pathways and underlying mechanisms support the adaptation of intervention strategies in terms of social context and the target population in LMICs.
AB - Background: This realist review was conducted to understand how stigma is reduced in relation to HIV test uptake in low- and middle-income countries (LMICs). Methods: A systematic search of eight databases resulted in 34 articles considered for synthesis. Data synthesis was guided by a preliminary programme theory and included coding the meaning units to develop themes or intervention pathways that corresponded to context-mechanism-outcome configurations. Results: We found that the interventions produced an effect through two pathways: (a) knowledge leads to changes in stigmatizing attitudes and increases in HIV test uptake and (b) knowledge and attitudes lead to changes in stigmatizing behaviours and lead to HIV test uptake. We also found one competing pathway that illustrated the direct impact of knowledge on HIV test uptake without changing stigmatizing attitudes and behaviour. The identified pathways were found to be influenced by some structural factors (e.g., anti-homosexuality laws, country-specific HIV testing programmes and policies), community factors (e.g., traditional beliefs and practices, sexual taboos and prevalence of intimate partner violence) and target-population characteristics (e.g., age, income and urban-rural residence). Conclusions: The pathways and underlying mechanisms support the adaptation of intervention strategies in terms of social context and the target population in LMICs.
KW - And stigma reduction interventions
KW - Context-mechanism-outcome configurations
KW - HIV test uptake
KW - Low- and middle-income countries
KW - Realist review
KW - Mass Screening/psychology
KW - Humans
KW - Developing Countries
KW - Social Stigma
KW - HIV Infections/diagnosis
KW - Randomized Controlled Trials as Topic
UR - http://www.scopus.com/inward/record.url?scp=85056695283&partnerID=8YFLogxK
UR - http://www.mendeley.com/research/stigma-reduction-relation-hiv-test-uptake-low-middleincome-countries-realist-review
U2 - 10.1186/s12889-018-6156-4
DO - 10.1186/s12889-018-6156-4
M3 - Article
C2 - 30453923
AN - SCOPUS:85056695283
SN - 1471-2458
VL - 18
SP - 1
EP - 21
JO - BMC Public Health
JF - BMC Public Health
IS - 1
M1 - 1277
ER -