Stigma Remains a Significant Barrier to HIV Knowledge and Treatment in Zambia

Background: Despite high HIV prevalence in Zambia, which lies within the heart of sub-Saharan Africa, early implementation of public policy and programs to effectively manage the burden of disease has insured consistently high testing rates. Zambian strategies to combat the HIV/AIDS crisis employ governmental support for HIV testing and public education and can serve as models for neighboring countries to advance the development of effective testing and treatment initiatives. Although these testing programs have proven highly successful, stigma and gaps in public knowledge continue to hamper access to treatment. Through this review of the current literature, we sought to better understand HIV-specific educational programs, the impact of HIV-related stigma, and the cultural components that influence patient care. Methods: Literature searches were conducted in multiple databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Complete, and the U.S. National Library of Medicine through the National Institutes of Health (Medline/PubMed). The search terms were structured to include all text of each article rather than restricting the search to titles or keywords. While these search criteria resulted in identification of 38 peer-reviewed articles, the inclusion criteria (HIV prevention, community education, HIV knowledge and stigma) led to the exclusion of all except 22 articles. Their findings are described here. Results: Individuals who reported negative experiences with health workers perceived HIV-related stigma was common. The fear of involuntary status disclosure while filling prescriptions for anti-retroviral medications led to higher levels of perceived stigma and treatment refusal. Observation of stigma and bullying experienced by people living with HIV/AIDS in the educational system increased fear in both teachers and students. Conclusions: Cultural and religious considerations were found to be important in stigma reduction. In sum, collaboration with key community leaders, church elders, and politicians were seen as vital in strengthening HIV programs. We propose using train-the-trainer models to empower teachers, particularly women, to become HIV educators and reduce stigma.