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Vol. 35. Issue S2.
The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)
Pages S337-S339 (January 2021)
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Vol. 35. Issue S2.
The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)
Pages S337-S339 (January 2021)
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Combination model in reducing HIV-related stigma: A systematic review
Sri Handayania,b,
Corresponding author
, M. Alimin Maidinb, Agus Bintara Birawidab, Ansariadib, Rahayu Indriasarib
a Tamalatea College of Health Sciences, Makassar 90245, Indonesia
b Faculty of Public Health, Hasanuddin University, Makassar 90245, Indonesia
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Table 1. Synthesis table on model in reducing HIV-related stigma.
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This article identifies and explains the various research models related to HIV stigma.


This systematic review is done using the PRISMA 2015 guidelines. Source of this review uses 3 online journal databases which are Pubmed, Scinapse, Elsevier. Search criteria include articles published this past 10 years between 2010 and 2020.


4146 articles were obtained and 9 articles which are suited with the inclusion criteria and were chosen in the literature review. It was discovered that stigmatization is a cultural construct and its experiences varies between countries and communities. Models which differentiate are interpersonal and intrapersonal process in handling the stigma.


Stigmas are still an important issues because often times it became an obstacle in the effort to reduce the prevalence of HIV/AIDS. Therefore there needs to be a gold standard scenario in reducing HIV related stigma, one of them being cultural in source.

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HIV/AID is a global health issue1,2 and is a challenge in reaching the 2030 SDGs.3 World Health Organization (WHO) data shows that 54% of people with HIV are new infections.4 Since the beginning of the epidemic, 75 million people were infected with HIV and around 32 million have since died from HIV.5 Globally, around 37.9 million [32.7–44.0 million] people are living with HIV at the end of 2018. 1.7 million [1.4–2.3] millions are newly infected cases of HIV dan 770,000 [570,000–1.1 million] people are dying due to AIDS related conditions.3,4

A myriad of efforts are done in terms of prevention of HIV/AIDS are done,6 however the stigmatization still an important issue.7–9 Societal stigma to the family or the person infected HIV/AIDS often times becomes the main obstacle in the effort to reduce the prevalence of HIV/AIDS.10,11 Stigma and discrimination such as discrimination and rejection in the family, work and social environment can cause the people infected with HIV/AIDS (ODHA) to become overly stressed.12,13 The reason is that according to society, HIV/AIDS is an infectious and dangerous disease with knowing the process of infection.14 People infected with HIV (HIV Positive) receives unfair and unjust treatment due to the stigma of the condition that they suffer from.15

This particular issue needs a comprehensive attention and management by involving all elements starting from the nation, LSM, International Society and also The UN.5 HIV/AIDS epidemic will cause detrimental effect to national development at holistic scale due to the fact that other than negatively impact the health aspect, it can also negatively impact the socio-economic development and cause live expectancy to become halted and even reduced which can threaten the life of the populace and even the life of a nation.16


Sources found using online databases provides online journal which provides articles in the form of PDF such as Pubmed, Scinapse and Elsevier. Articles retrieved from each databases were imported the Mendeley Library. The inserted criterion in the databases was (1) focus on the stigma of HIV, (2) published within the last 10 years (2010–2020) (3) articles in English and full text were chosen. Exclusion criteria were (1) Review/Editorials, (2) Conference Process, (3) Systematic Review/Literature Reviews, (4) Protocol Studies and (5) Meta-Analysis. The study selection process follows the data extraction based on PRISMA 2015 Guidelines in Fig. 1.

The Author filters all publication by reading the title and abstract. In the final filtering process, by reading the complete text from the remaining articles and maintains the study which falls into the inclusion criteria/exceptions. The chosen study summary were noted, consisting of; author, year of publication, design and study outcome/results (Table 1).

Table 1.

Synthesis table on model in reducing HIV-related stigma.

Author and year  Dependent variable/latent  Independent variable  Methods/modeling  Results 
Randolph C.H. Chan et al., 202117  Stigma from society  Stigma anticipation, self-stigma, psychological pressure and life satisfaction  A structural equation model (SEM)  Interpersonal and intrapersonal process which bases the HIV related stigma and mental health. Moreover, the stigma has direct effects on psychological process and life satisfaction of the HIV infected (ODHA). 
Collins Airhihenbuwa et al., 201918  Cultural identity (CI), cultural empowerment (CE) and relations and expectations (RE)  Social support and perception  A structural equation model (SEM)  On the cultural and social contexts. Family and care center are the two main contexts of stigma in relations with the HIV/AIDS infected individuals (ODHA). 
Chengbo Zeng et al., 201819  The perceived and internalized stigma (PIS), depression and suicide status  Effects of depression; positive influence; somatic and activity incapability; interpersonal problems; perceived stigma; internalized stigma  A structural equation model (SEM)  Perceived stigma and internalized stigma were correlated with the increase of depression and potential suicidal status. Depression related with a positive suicidal states on individuals infected HIV/AIDS (ODHA). 
Carmen H. Logie et al., 201820  HIV related stigma: depersonalization, negative self image, public behavior and depression  Starting the use of anti-retroviral (ART), the usage of ART on present, and its obedience in usage is 90%  Pathways analysis  Depression mediates the pathways of self-stigmatization to obedience on using ART and negative self-image on the usage of ART dan current obedience level of ART. 
Wei Wang et al., 201721  Suicide  The perceived stigma, social support, depression and self-respect  A structural equation model (SEM)  Self-respect and depression are really perceived to be impactful to stigma plays an important part on suicidal ideas among individuals Infected with HIV/AIDS (ODHA). 
Loutfy, R. et al., 201622  Self-stigma, expression of worry, negative self-image, public behavior and social support  HIV related stigma, housing insecurity, depression, social support.  A structural equation model (SEM)  A complex interaction between structural problems such as housing insecurity, community level stigma and social discrimination. 
Winnie W.S. Mak et al., 201523  Self stigma between the Lian and Mianzi culture upon the mental health of individual infected with HIV/AIDS (ODHA)  Moral emotions=Guilt and Shame  A structural equation model (SEM)  A significant, albeit indirect effect to self stigma and mental health through moral emotion on Lian culture, however the same effect was not found on Mianzi culture. 
Chunpeng Zang, 201424  Public stigma and self stigma  Three social groups, family members, friends and neighbors  A path analytic model  Stigma related to HIV is public and self stigma is reinforced by culture and mediated a relationship between collectivist culture and social group support. 
Na-Yeun Choi and Matthew J. Miller, 201425  The willingness of the individual to seek counseling  Sikap,stigma antara budaya Asia dan Eropa Amerika  A path analytic model  Culture is a distal variable which transmit its influence through stigma unto willingness to seek counseling and treatment. 

Literature search (Fig. 1).

Fig. 1.

Flow chart literature.


Modeling is a process in creating a model of a system. The purpose of modeling is to analyze and give proper prediction which can closely simulate reality, before a model is applied to the field. This situation also applies on the stigma problem related to HIV, by creating a model, it can formulized a particular process to reduce stigma.

Stigmatization is cultural construct and its corresponding experience can vary between countries and community. This opposite perspective can help explain the difference in faith, behavior and cross culture action. According to a research by Collins Airhihenbuwa, 2019 which applies the Budaya PEN-3 in grading stigma, which is Cultural Identity (CI), Cultural Empowerment (CE), and Relationship and Expectations (RE). Result of the research mentioned that family and Healthcare Centers were found to have a positive non-stigmatization and negative stigmatization in caring for HIV/AIDS related stigma.18

A research done by Zang Chunpeng (2014) mentioned that HIV related stigma is deeply rooted on culture, therefore it is important to investigate it on a cultural context. As a result of cultural behavior to HIV/AIDS, Individuals Infected with HIV/AIDS (ODHA) can and will internalize their feeling as a negative stigma which are felt by society.24

A particularly notable cultural factor (which becomes a center of attention) in self stigma. This particular problem is not unlike the previous research, by saying that self-stigma can impact the stigmatized society's welfare on their society. This cause a hampering in cultural intervention whose goal is to reduce self-stigmatization and increase mental health between the stigmatized groups.22

HIV related stigma are also tied with housing comfort or place of living, social support such as emotional help, informational support, real support and loving support, positive social interaction.26 Research by Carmen H. Logie et al. (2016) from the Structural Equation model mentions that racial discrimination has a significant direct effect on: HIV related stigma, depression and social support, and indirect effect on health which are self-graded through stigma.20 Other modeling research that were done by Tiffany R. Glynn (2019) recounted that HIV related stigma and stress were directly related with depression, and depression has a direct relationship with health.20,26 Moreover Randolph C.H. Chan et al. (2020) conduct a research on 2 modeling process which is intrapersonal and interpersonal. The research results expressed a process in which Interpersonal and intrapersonal which acted as a base for HIV related stigma and mental health. However stigma that are applied has a direct effect on psychological pressure and life satisfaction. Internally, Individuals Infected with HIV/AIDS (ODHA) also realized on the stigmatization that directly relates with the identity of HIV, which in turns relates with a larger psychological pressure, and worst of all, their satisfaction with their own life.17


HIV related stigma is a complex problem, therefore there needs to be a modeling as a media to reach an optimal solution. Several modeling research that were done stated that HIV Related Stigma were deeply rooted on different culture of different nations and community. Moreover, it also important to note the difference between interpersonal and intrapersonal process in addressing stigma.

Conflicts of interest

The authors declare no conflict of interest.

M. Naseer, F.E. Dailey, A. Al Juboori, et al.
Epidemiology, determinants, and management of AIDS cholangiopathy: a review.
World J Gastroenterol, 24 (2018), pp. 767
J. Hemelaar, R. Elangovan, J. Yun, et al.
Global and regional molecular epidemiology of HIV-1, 1990–2015: a systematic review, global survey, and trend analysis.
Lancet Infect Dis, 19 (2019), pp. 143-155
United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2018 [Internet]. Geneva, Switzerland: United Nations Programme on HIV/AIDS (UNAIDS); 2018. 1–376 p. Available at:
World Health Organization (WHO).
Global Health Observatory (GHO) data HIV/AIDS.
World Health Organization (WHO), (2019),
United Nations Programme on HIV/AIDS (UNAIDS).
Global HIV Statistics.
United Nations Programme on HIV/AIDS (UNAIDS), (2019),
D.A.M.C. van de Vijver, C.A.B. Boucher.
Insights on transmission of HIV from phylogenetic analysis to locally optimize HIV prevention strategies.
Curr Opin HIV AIDS, 13 (2018), pp. 95-101
L. Nyblade, K. Srinivasan, A. Mazur, et al.
HIV stigma reduction for health facility staff: development of a blended-learning intervention.
Front Public Heal, 6 (2018), pp. 165
B.X. Tran, M. Jimba, K. Kikuchi, et al.
Changing sources of stigma against patients with HIV/AIDS in the rapid expansion of antiretroviral treatment services in Vietnam.
Biomed Res Int, (2019),
S. Vorasane, P.Q.T. Than, T.T. Tran, et al.
An investigation of stigmatizing attitudes towards people living with HIV/AIDS by doctors and nurses in Vientiane, Lao PDR.
BMC Health Serv Res, 17 (2017), pp. 1-13
O.O. Oke, A.O. Akinboro, F.O. Olanrewaju, et al.
Assessment of HIV-related stigma and determinants among people living with HIV/AIDS in Abeokuta, Nigeria: a cross-sectional study.
SAGE open Med, 7 (2019),
M.A. Bekalu, S. Eggermont.
Socioeconomic and socioecological determinants of AIDS stigma and the mediating role of AIDS knowledge and media use.
J Commun Healthc., 8 (2020), pp. 316-324
M. Feijoo-Cid, A. Rivero-santana, D. Mori, et al.
in antiretroviral trials, 35 (2020), pp. 6-11
T.E. Flickinger, C. Debolt, A. Xie, et al.
Addressing Stigma Through a Virtual Community for People Living with HIV: A Mixed Methods Study of the PositiveLinks Mobile Health Intervention.
AIDS Behav., 22 (2018), pp. 3395-3406
A.S. Motunrayo, B.Y. Oyindamola, O.A. Joshua, et al.
Determinants of perceived stigmatizing and discriminating attitudes towards people living with HIV/AIDS among women of reproductive age in Nigeria.
J AIDS HIV Res., 9 (2017), pp. 139-151
F. Sheet, G.A. Update, N. HIV, et al.
Global HIV Statistics.
(2019), pp. 1-6
World Health Organization (WHO).
Global Health Sector Strategy on HIV 2016–2021 towards ending AIDS.
R.C.H. Chan, W.W.S. Mak, G.Y.K. Ma, et al.
Interpersonal and intrapersonal manifestations of HIV stigma and their impacts on psychological distress and life satisfaction among people living with HIV: toward a dual-process model.
C. Airhihenbuwa, W. Lafayette, T. Shefer, et al.
Stigma, culture, and HIV and AIDS in the Western Cape, South Africa: an application of the PEN-3 cultural model for community-based research.
J Black Psychol, 35 (2009), pp. 407-432
C. Zeng, L. Li, Y.A. Hong, et al.
A structural equation model of perceived and internalized stigma, depression, and suicidal status among people living with HIV/AIDS.
BMC Public Health, (2018), pp. 1-11
C.H. Logie, A. Lacombe-duncan, Y. Wang, et al.
Pathways from HIV-related stigma to antiretroviral therapy measures in the HIV care cascade for women living with HIV in Canada.
J Acquir Immune Defic Syndr, 77 (2018), pp. 144-153
W. Wang, Y. Wang, C. Xiao, et al.
Accepted Manuscript Psychological pathway to suicidal ideation among Structural Equation Model Reference: To appear in: Psychiatry Res.
W.W.S. Mak, C.Y.Y. Ho, V.U.T. Wong, et al.
Cultural model of self-stigma among Chinese with substance use problems.
Drug Alcohol Depend, 155 (2015), pp. 83-89
C. Zang, J. Guida, S. Yehuan, et al.
Collectivism culture, HIV stigma and social network support in Anhui, China: a path analytic model.
AIDS Patient Care STDS, 28 (2014), pp. 452-458
N.-Y. Choi, M.J. Miller.
AAPI college students’ willingness to seek counseling: The role of culture, stigma, and attitudes.
J Couns Psychol, 61 (2014), pp. 340-351
T.R. Glynn, et al.
Pathways to health: an examination of HIV-related stigma, life stressors, depression, and substance use.
Int J Behav Med, 26 (2020), pp. 286-296

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