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Association Between Clinical Encounter Frequency and HIV-Related Stigma Among Newly-Diagnosed People Living with HIV in Rwanda

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Abstract

HIV-related stigma in healthcare settings remains a key barrier to engaging people living with HIV (PLHIV) in care. This study investigated the association between clinical encounter frequency and HIV-related anticipated, enacted, and internalized stigma among newly-diagnosed PLHIV in Rwanda. From October 2020 to May 2022, we collected data from adult PLHIV on antiretroviral therapy (ART) in Kigali, Rwanda who were participating in a randomized, controlled trial testing early entry into differentiated care at 6 months after ART initiation. We measured anticipated HIV stigma with five-point Likert HIV Stigma Framework measures, enacted stigma with the four-point Likert HIV/AIDS Stigma Instrument, and internalized stigma with the four-point Likert HIV/AIDS Stigma Instrument. We used multivariable linear regression to test the associations between clinical encounter frequency (average inter-visit interval ≥ 50 days vs. < 50 days) and change in mean anticipated, enacted and internalized HIV stigma over the first 12 months in care. Among 93 individuals enrolled, 76 had complete data on encounter frequency and stigma measurements and were included in the present analysis. Mean internalized stigma scores of all participants decreased over the first 12 months in care. Anticipated and enacted stigma scores were low and did not change significantly over time. There was no association between encounter frequency and change in internalized stigma. In this pilot study of newly-diagnosed Rwandan PLHIV with relatively low levels of HIV-related stigma, clinical encounter frequency was not associated with change in stigma. Additional research in diverse settings and with larger samples is necessary to further explore this relationship.

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Abbreviations

ART:

Antiretroviral therapy

DSD:

Differentiated service delivery

HIV/AIDS:

Human immunodeficiency virus/Acquired immunodeficiency syndrome

IRB:

Institutional review board

PLHIV:

People living with HIV

RWF:

Rwandan Franc

WHO:

World Health Organization

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Acknowledgements

We thank all of the staff and participants from the Gikondo, Kicukiro, and Remera clinics in Kigali, Rwanda for their time and contributions that made this study possible.

Funding

This work was supported by the U.S. National Institute of Mental Health (K23 MH114752); by the U.S. National Institutes of Health’s National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, and the National Institute on Drug Abuse, as part of Central Africa IeDEA (U01 AI096299); and by the Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine (P30-AI124414), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHBL, NIDA, NIMH, NIA, FIC, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA

    Sarah E. Hill, Chenshu Zhang, Marcel Yotebieng, Kathryn Anastos & Jonathan Ross

  2. HIV/AIDS and STIs Diseases Division, Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda

    Eric Remera & Gallican Rwibasira

  3. Rwanda Military Hospital, Kigali, Rwanda

    Charles Ingabire, Francine Umwiza, Athanase Munyaneza, Benjamin Muhoza & Gad Murenzi

  4. Research for Development, Kigali, Rwanda

    Charles Ingabire, Francine Umwiza, Athanase Munyaneza, Benjamin Muhoza & Gad Murenzi

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  1. Sarah E. Hill
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Hill, S.E., Zhang, C., Remera, E. et al. Association Between Clinical Encounter Frequency and HIV-Related Stigma Among Newly-Diagnosed People Living with HIV in Rwanda. AIDS Behav 28, 1390–1400 (2024). https://doi.org/10.1007/s10461-023-04226-6

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