HIV/AIDS-related stigma reduction intervention in China, a systematic review Open Access

Abstract

Introduction:

HIV/AIDS-related stigma persists to be one of the most impactful factors on the physical and mental well-being of people living with HIV/AIDS. The identification of key effective elements aiming to reduce HIV/AIDS-related stigma is an indispensable step in combating the HIV/AIDS epidemic.

Methods:

The article conducted a systematic review of existing studies that assessed the effectiveness of interventions reducing HIV/AIDS-related stigma in the Chinese population. Four electronic databases were searched to retrieve relevant studies, including PubMed, EMBASE, COCHRANE library, and PsychInfo. Studies with an intervention design conducted in mainland China, Hong Kong, Taiwan or Macao, and aimed to reduce HIV/AIDS-related stigma as primary or secondary outcome were included. Studies without intervention effectiveness assessments and sufficient pre- and post-intervention data were excluded. 

Results:

Among 371 peer-reviewed articles identified, 11 articles retained for the systematic review. 91% of the studies were assessed as high-quality studies. 90% of the high-quality interventions found statistically significant HIV/AIDS-related stigma reduction outcomes. The majority of interventions utilized more than one strategy approach. Most interventions were individual-oriented, only two studies intervened at multi-faceted socio-ecological levels. However, target population and intervention location lacked variation and representativeness. Outcome measurements lacked consistency, posing challenges in comparing effectiveness across interventions. Intervention duration and dosage varied widely, making it challenging to examine the sustainability of the effectiveness of interventions. 

Conclusions:

The article revealed considerable progress in reducing HIV/AIDS-related stigma in the past two decades. Identified gaps and challenges that continue to hamper our collective efforts in ending the HIA/AIDS epidemic are needed to be addressed in future research. The development of standardized and culturally appropriate stigma measure is needed to allow comparison of effectiveness across interventions. Research resources on developing and implementing interventions with multi-faceted structural designs and mixed-strategy approaches are needed to reduce HIV/AIDS-related stigma among the Chinese population. 

Table of Contents

Abstract 3

CHAPTER 1. INTRODUCTION 7

1.1 Introduction and rationale 7

1.2 Problem statement 9

1.3 Purpose statement 9

1.4 Significance statement 9

CHAPTER 2. LITERATURE REVIEW 11

2.1 Status of HIV/AIDS Epidemics in China 11

2.1.1 IDU populations 12

2.1.2 Illegal commercial plasma donor 13

2.1.3 Migrant workers 14

2.1.4 Men having sex with men (MSM) 15

2.2 HIV/AIDS stigma 16

2.2.1 Stigma 17

2.2.2 Classification of HIV/AIDS-related stigma 18

2.3 Impact of HIV/AIDS stigma 18

2.3.1 Impacts on PLWHA individual 19

2.3.2 Impacts on the uninfected, including family and community 19

2.4 Characteristics of HIV/AIDS stigma in China 20

2.5 Literature gap 21

2.6 Summary 23

CHAPTER 3. METHODOLOGY 24

3.1 Search strategy 24

3.2 Inclusion criteria 24

3.3 Exclusion criteria 25

3.4 Data Synthesis 25

3.4.1 Socio-ecological framework 25

3.4.2 Intervention strategy approach 26

3.5 Quality assessment 27

CHAPTER 4. RESULTS 28

4.1 Study characteristics 28

4.1.1 Geographic distribution 28

4.1.2 Target population 29

4.1.3 Study design 29

4.2 Stigma outcome measures and study findings 29

4.3. Intervention characteristics 31

4.3.1 Intervention duration and dosage 31

4.3.2 Socio-ecological level 32

4.3.3 Strategy approach 32

4.3.4 Popular opinion leaders (POL) model 34

4.4 Quality appraisal 35

4.5 Result summary 37

CHAPTER 5. DISCUSSION AND RECOMMENDATION 37

5.1 Strengths 39

5.2 Limitations 39

5.3 Implications 41

5.3.1 Implication for future research 41

5.3.2 Public health significance 43

5.4 Conclusion 44

References: 46

Figure 1. PRISMA flowchart of search strategy 51

Table 1. Characteristics of included studies (n=11) 52

Table 2. Summary of HIV/AIDS stigma reduction intervention by study population, stigma measure, and outcomes from 11 studies 53

Table 3. Quality assessment of 11 selected studies 59

Appendix 1. Modified Downs and Black checklist for the assessment of the methodological quality of selected studies 60

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	CHINA STIGMA REDUCTION INTERVENTION HIV SYSTEMATIC REVIEW AIDS
Committee Chair / Thesis Advisor	Waford, Rachel, Emory University

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