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HIV Stigma as a Barrier to Retention in HIV Care at a General Hospital in Lima, Peru: A Case–Control Study

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Abstract

HIV stigma as a barrier to retention in HIV care has not been well-studied outside the United States. We conducted a case–control study in Lima, Peru to examine this issue. Cases were out-of-care for ≥12 months (n = 66) and controls were recruited from patients in active care presenting for a clinic visit (n = 110). A previously validated HIV stigma scale with four domains was used. Associations between being out-of-care and each stigma domain were assessed using multivariable logistic regression. Stigma scores were highest for disclosure concerns. Modest associations were found for greater disclosure concerns (OR 1.16; 95 % CI 0.99, 1.36) and concerns with public attitudes (OR 1.20; 95 % CI 1.03, 1.40). Enacted stigma and negative self-image showed non-linear associations with being out-of-care that plateaued or declined, respectively, at higher levels of stigma. The threshold effect for enacted stigma warrants further exploration, while disclosure concerns may be especially amenable to intervention in this population.

Resumen

El rol del estigma social asociado al VIH, como una barrera para la retención en el cuidado de VIH, no ha sido bien estudiado fuera de los Estados Unidos. Para examinar este problema, se realizó un estudio de casos y controles en Lima, Perú. Los casos fueron aquellos pacientes que estuvieron fuera del cuidado para VIH por ≥12 meses (n = 66) y los controles aquellos que se encontraban bajo cuidado activo para el VIH (n = 110). Se utilizó una escala para estigma en VIH previamente validada con cuatro dominios. Las asociaciones entre estar fuera del cuidado y cada dominio de estigma fueron evaluadas mediante una regresion logistica multivariable. Los puntajes más altos de estigma fueron para la preocupacion sobre divulgacion de estatus. Se encontraron asociaciones modestas para la preocupacion de divulgación de estatus (OR 1,16; 95 % CI 0,99, 1,36) y la preocupacion por las actitudes publicas (OR 1,20; 95 % IC 1,03 a 1,40). El estigma establecido y la auto-imagen negativa mostraron asociaciones no lineales con estar fuera del cuidado. Estas se estabilizaron o se redujeron, respectivamente, con niveles más altos de estigma. El efecto umbral del estigma declarado merece una mayor exploración, mientras que la preocupacion de divulgación de estatus puede ser un foco de especial atencion en esta población.

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Acknowledgments

We thank the dedicated research and support staff at HNCH and Vanderbilt Institute for Global Health. Funding and support for this study came from the Vanderbilt Institute for Clinical and Translational Research (grant UL1 TR000445 from the National Center for Advancing Translational Sciences at the National Institutes of Health); Vanderbilt Emphasis Program, Tinker Field Research Grant, and the Infectious Disease Society of America Medical Scholars Program (to C. Valenzuela); Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Peru, ICOHRTA Network for AIDS/TB Research Training (NIH Grant 1U2RTW007368-01A1-Fogarty International Center, Lima Peru) (to C Ugarte and J Paz).

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Authors and Affiliations

  1. Vanderbilt University School of Medicine, Nashville, TN, USA

    Carla Valenzuela

  2. Instituto de Medicina Tropical, Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru

    Cesar Ugarte-Gil, Jorge Paz, Juan Echevarria & Eduardo Gotuzzo

  3. Departamento de Enfermedades Infecciosas y Tropicales, Hospital Nacional Cayetano Heredia, Lima, Peru

    Juan Echevarria & Eduardo Gotuzzo

  4. Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA

    Sten H. Vermund & Aaron M. Kipp

  5. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA

    Sten H. Vermund

  6. Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave., 8th Floor, Nashville, TN, 37203, USA

    Aaron M. Kipp

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  1. Carla Valenzuela
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  2. Cesar Ugarte-Gil
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  3. Jorge Paz
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  7. Aaron M. Kipp
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Correspondence to Aaron M. Kipp.

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Valenzuela, C., Ugarte-Gil, C., Paz, J. et al. HIV Stigma as a Barrier to Retention in HIV Care at a General Hospital in Lima, Peru: A Case–Control Study. AIDS Behav 19, 235–245 (2015). https://doi.org/10.1007/s10461-014-0908-7

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  • DOI: https://doi.org/10.1007/s10461-014-0908-7

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