‘Management of a spoiled identity’: systematic review of interventions to address self-stigma among people living with and affected by HIV

Pantelic, Marija; Steinert, Janina I; Park, Jay; Mellors, Shaun; Murau, Fungai

doi:10.1136/bmjgh-2018-001285

Cited by 156HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskHIV/AIDS Impact and Responses

‘Management of a spoiled identity’: systematic review of interventions to address self-stigma among people living with and affected by HIV

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Pantelic, Marija, Steinert, Janina I, Park, Jay, Mellors, Shaun, Murau, Fungai·2019·BMJ Global Health

DOI 10.1136/bmjgh-2018-001285PMC PMC6441299

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Abstract

BACKGROUND: Self-stigma, also known as internalised stigma, is a global public health threat because it keeps people from accessing HIV and other health services. By hampering HIV testing, treatment and prevention, self-stigma can compromise the sustainability of health interventions and have serious epidemiological consequences. This review synthesised existing evidence of interventions aiming to reduce self-stigma experienced by people living with HIV and key populations affected by HIV in low-income and middle-income countries. METHODS: Studies were identified through bibliographic databases, grey literature sites, study registries, back referencing and contacts with researchers, and synthesised following Cochrane guidelines. RESULTS: Of 5880 potentially relevant titles, 20 studies were included in the review. Represented in these studies were 9536 people (65% women) from Ethiopia, India, Kenya, Lesotho, Malawi, Nepal, South Africa, Swaziland, Tanzania, Thailand, Uganda and Vietnam. Seventeen of the studies recruited people living with HIV (of which five focused specifically on pregnant women). The remaining three studies focused on young men who have sex with men, female sex workers and men who inject drugs. Studies were clustered into four categories based on the socioecological level of risk or resilience that they targeted: (1) individual level only, (2) individual and relational levels, (3) individual and structural levels and (4) structural level only. Thirteen studies targeting structural risks (with or without individual components) consistently produced significant reductions in self-stigma. The remaining seven studies that did not include a component to address structural risks produced mixed effects. CONCLUSION: Structural interventions such as scale-up of antiretroviral treatment, prevention of medication stockouts, social empowerment and economic strengthening may help substantially reduce self-stigma among individuals. More research is urgently needed to understand how to reduce self-stigma among young people and key populations, as well as how to tackle intersectional self-stigma.

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A systematic review of internalized HIV stigma interventions for key populations and PWH found methodologically strong evidence for the effect of interventions targeting HIV stigma at both the structural and individual levels.
“A systematic review of internalized HIV stigma interventions for key populations and PWH found methodologically strong evidence for the effect of interventions targeting HIV stigma at both the structural and individual levels.33”
From An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs—a randomized clinical trial (2023) · cites this paper as [33]
The Results (Outcomes; page unavailable) report consistent reductions in self-stigma in eight studies combining structural- and individual-level components, and the Discussion describes the evidence for approaches that buffer structural risks and enhance individual resilience as consistent and robust. But the Study quality subsection reports substantial variation in methodological quality and limited evidence for social empowerment interventions; the Conclusions also call for more research among key populations. Thus, describing the evidence as methodologically strong across these populations and interventions overstates the review. (LLM, conf=0.87)
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Research works printed but not linked: 1

[20]Goffman E Stigma: the management of spoiled identity. Harmmondsworth Penguin, 1968.

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Authors: Pantelic, M., Steinert, J. I., Park, J., Mellors, S., & Murau, F.
Affiliations: University of Oxford (GB)
University of Göttingen (DE)
University of British Columbia (CA)
Frontline AIDS, Brighton, UK
Corresponding author: Pantelic, Marija
ORCID: Pantelic, Marija
Steinert, Janina I
Park, Jay
Murau, Fungai
Venue: BMJ Global Health
Publisher: BMJ
Published: 2019-03
Volume: 4
Issue: 2
Pages: e001285
ISSN: 2059-7908 (ISSN-L)
DOI: 10.1136/bmjgh-2018-001285
PMC: PMC6441299
OpenAlex: W2924936460
Cited by: 156
References: 91
Citations by year: 2026: 16 · 2025: 24 · 2024: 21 · 2023: 19 · 2022: 30 · 2021: 32 · 2020: 13 · 2019: 1
FWCI: 2.66
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
Locations: BMJ Global Health (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
Keywords: self-stigma, HIV, people living with HIV, key populations, structural interventions, socio-ecological model, medication stockouts, social empowerment, economic strengthening, young men who have sex with men, female sex workers, men who inject drugs, pregnant women, intersectional stigma, low- and middle-income countries

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‘Management of a spoiled identity’: systematic review of interventions to address self-stigma among people living with and affected by HIV

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