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Review
. 2018 Nov 20;18(1):1277.
doi: 10.1186/s12889-018-6156-4.

Stigma reduction in relation to HIV test uptake in low- and middle-income countries: a realist review

Subash Thapa  1 , Karin Hannes  2 , Margaret Cargo  3 , Anne Buve  4 , Sanne Peters  5 , Stephanie Dauphin  5 , Catharina Mathei  5
Affiliations
Review

Stigma reduction in relation to HIV test uptake in low- and middle-income countries: a realist review

Subash Thapa et al. BMC Public Health. .

Abstract

Background: This realist review was conducted to understand how stigma is reduced in relation to HIV test uptake in low- and middle-income countries (LMICs).

Methods: A systematic search of eight databases resulted in 34 articles considered for synthesis. Data synthesis was guided by a preliminary programme theory and included coding the meaning units to develop themes or intervention pathways that corresponded to context-mechanism-outcome configurations.

Results: We found that the interventions produced an effect through two pathways: (a) knowledge leads to changes in stigmatizing attitudes and increases in HIV test uptake and (b) knowledge and attitudes lead to changes in stigmatizing behaviours and lead to HIV test uptake. We also found one competing pathway that illustrated the direct impact of knowledge on HIV test uptake without changing stigmatizing attitudes and behaviour. The identified pathways were found to be influenced by some structural factors (e.g., anti-homosexuality laws, country-specific HIV testing programmes and policies), community factors (e.g., traditional beliefs and practices, sexual taboos and prevalence of intimate partner violence) and target-population characteristics (e.g., age, income and urban-rural residence).

Conclusions: The pathways and underlying mechanisms support the adaptation of intervention strategies in terms of social context and the target population in LMICs.

Keywords: And stigma reduction interventions; Context-mechanism-outcome configurations; HIV test uptake; Low- and middle-income countries; Realist review.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Preliminary programme theory explaining the effect of stigma-reduction intervention strategies on HIV test uptake
Fig. 2
Fig. 2
Systematic searching and selection of primary studies
Fig. 3
Fig. 3
Programme theory illustrating mechanisms for stigma reduction in relation to the distal outcome of HIV test uptake
Fig. 4
Fig. 4
Pathways for stigma reduction in terms of HIV test uptake
See this image and copyright information in PMC

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