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Background: Stigma associated with HIV shapes all aspect of prevention and treatment, yet there are limited data on how HIV-infected adolescents are affected by stigma. Stigma increases risk of psychological problems among HIV-infected individuals which can affect access to treatment and social support services. This study aimed at identifying psychosocial factors of stigma and relationship to healthcare services among adolescents on antiretroviral therapy (ART) in Gwale Local Government Area (LGA) of Kano state, Nigeria. Methods: A facility-based cross-sectional survey was carried out from January 26 to February 28, 2020 across six health facilities providing ART service in Gwale local government. A structured interviewer-administered questionnaire was used to collect the data. ART clients attending clinics were interviewed following an informed consent. Descriptive statistics was used to summarize the data and results are presented using simple frequency tables and percentages. Upon completion of univariate analysis, the data was analyzed at the bivariate level using chi-square test to determine associations between different variables. Results: One hundred and eight (108) clients voluntarily participated in the study of which 54 (50%) are male respondents and 54 (50%) are female respondents. Under the internalized stigma item, 67% of HIV-infected adolescents who have lost their father or mother to AIDS reported feeling less valuable than other children who are not infected with HIV. Under the perceived stigma items, 86% of participants who have lost their father or mother to AIDS reported to have excluded themselves from health services and social activities in the last twelve months due to fear of being insulted. Under the experienced stigma items, 62% of participants who have lost their father or mother to AIDS reported to have been avoided by friends and colleagues in the last twelve months. Conclusion: The study revealed that loss of intimate relation (father or mother) to AIDS and equal treatment with other HIV negative siblings were found to be significantly associated with the three forms of stigma (internalized stigma, perceived stigma, and experienced stigma) including access to healthcare services. There is a need for social and psychological support programs among HIV-infected adolescents.
This study was a health facility-based cross-sectional survey of adolescents living with HIV/AIDS (ALWHA) in Gwale Local Government Area of Kano state from January 26 to February 28, 2020. Eligible participants were ALWHA enrolled on antiretroviral therapy (ART) who gave voluntary informed consent to participate in the study. Only participants (age 10–20 years) who attended ART clinics were recruited successively and interviewed by health workers during their visit to the clinics in the selected health facilities. A health facility based cross-sectional survey was carried out in six health facilities providing ART services for People Living with HIV/AIDS (PLWHA) across Gwale Local Government Area (LGA). Gwale LGA is located within Greater Kano City with an area of 18km2 and population of 362,059 according to the 2016 census. There are twelve primary healthcare facilities distributed across twelve wards in the area. However only six healthcare facilities (Gwale Primary Health Center (PHC), Dorayi Karama PHC, Jaen PHC, Kabuga PHC, Unguwar Dabai PHC, and Pilot Kwanar Ganduje) were providing ART services. Number of ALWHA who were enrolled on ART was obtained from the Department of Health at Gwale Local Government Area Secretariat which was 108. All the 108 ALWHA attending ART clinics at the time of the survey were enrolled in the study. The questionnaire was distributed and administered through trained interviewers who are health workers across the six health facilities that provide ART. Health workers who interviewed the study participants were recruited across the six health facilities. Interviewers who understood the local language were recruited for the study in order to properly interpret the questionnaire in instances where participants do not understand English. ALWHA who are eligible for the study were recruited by trained health workers at the selected health facilities in the local government and consecutive sampling technique was used to enroll participants. The questionnaire was administered after voluntary informed consent was obtained from participants to signify intention to participate in the study. Anonymity and confidentiality of response were assured, while participation was entirely voluntary. The principal investigator supervised the data collection process on daily basis. No incentive was given to our respondents for participating in the study. A structured questionnaire was adapted from HIV stigma index evaluation survey conducted in six cities in Iran (SayedAlinaghi et al., 2013). The questionnaire was pretested among five ALWHA during clinic visit at Maternal Child Health Center in Gwale local government and these respondents were not included in the main study. The feedback obtained from the pretest led to minor modification of the questionnaire. The questionnaire was assessed for ambiguity and content validity by two researchers in order to ascertain the comprehensiveness of the question items. The questionnaire was grouped into four sections. Section A captured sociodemographic characteristics and psychosocial factors, Section B comprised questions on internalized stigma, Section C was on experienced stigma and Section D comprised questions on perceived stigma. Data was checked for appropriateness of responses and completeness before it was entered into Microsoft Excel spreadsheet 2013. After completing the data entry, the data were transferred to STATA version 13 for analysis. Descriptive statistics were used to summarize the data and the results were presented using simple frequency tables and percentages to see the overall distribution of the study subject with the variable under study was done. Upon completion of univariate analysis, the data was also analyzed at the bivariate level of analysis using Chi-Square test. This statistic was used to test the associations between different variables. The statistical significance was set at p-value less than 0.05. Ethical approval for the study was obtained from Kano State Ministry of Health Institutional Review Board. All study participants were informed about the purpose of the study and voluntary informed consent was obtained from all participants.
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