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Experiences of Gender-Based Stigma and Health Care-Related Outcomes in the African Region: A Scoping Review

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Carmen Logie at University of Toronto
Carmen Logie
Valerie Earnshaw
Valerie Earnshaw
Valerie Earnshaw
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Rushdia Ahmed at University of Toronto
Rushdia Ahmed
Shannen Elizabeth Rowe
Shannen Elizabeth Rowe
Shannen Elizabeth Rowe
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Abstract

Gender-based stigma (GBS) occurs across the globe and harms health and well-being, particularly among women. Yet, there remains a need for synthesized literature to better understand the impact of GBS on health care-related outcomes. Addressing this gap, this scoping review summarizes what is known about GBS and health care-related outcomes among cisgender persons in Africa. We followed Preferred Reporting Items for Systematic Reviews and Meta Analysis extension for Scoping Reviews guidelines to examine the state of evidence related to GBS and health care-related outcomes in African countries. We searched two online electronic databases (PubMed, PsychINFO) for articles published on/before April 20th, 2023. Articles were included if they (a) were published in the English language, (b) reported primary research in Africa, (c) examined GBS at the individual level among cisgender persons, and (d) examined health care-related outcomes. We identified 24 articles for inclusion spanning 14 countries, including 18 qualitative, three quantitative, and three mixed-methods studies. Thematic analyses of qualitative articles identified four overarching themes: GBS is intersectional; differential treatment from societal gender norms and gender role expectations; gendered loss of autonomy and human rights violations in health care; and gender-based violence (GBV). Quantitative findings included that GBV experiences are widespread and may shape health care access, and there are linkages between GBV and HIV. Findings underscore that intersectional, multilevel experiences of GBS impede health care access and rights in the African region across diverse contexts, populations, and health issues. Future research can include additional GBS dimensions and marginalized communities.
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Stigma and Health
Experiences of Gender-Based Stigma and Health Care-Related Outcomes in
the African Region: A Scoping Review
Carmen H. Logie, Valerie Earnshaw, Rushdia Ahmed, Shannen Elizabeth Rowe, Adam Fagan, Alexis
Argyropoulos, Nicole Lorimer, Frannie MacKenzie, Junye Ma, Ingrid Yu, Angela Kaida, Lawrence Mbuagbaw,
Mzikazi Nduna, Julia Kagunda, Blandina T. Mmbaga, Amaya Perez-Brumer, Mildred Mudany, and Stephanie
A. Meyers-Pantele
Online First Publication, June 13, 2024. https://dx.doi.org/10.1037/sah0000538
CITATION
Logie, C. H., Earnshaw, V., Ahmed, R., Rowe, S. E., Fagan, A., Argyropoulos, A., Lorimer, N., MacKenzie, F.,
Ma, J., Yu, I., Kaida, A., Mbuagbaw, L., Nduna, M., Kagunda, J., Mmbaga, B. T., Perez-Brumer, A., Mudany,
M., & Meyers-Pantele, S. A. (2024). Experiences of gender-based stigma and health care-related outcomes
in the African region: A scoping review.. Stigma and Health. Advance online publication. https://dx.doi.org/
10.1037/sah0000538
... Researchers www.co-infectiousdiseases.com could also explore, for instance, HIV prevention opportunities during extreme heat, wildfires, and hurricanes/storms. Second, extreme heat and HIV care remains understudied, despite its potential harms for people with HIV, including during pregnancy [13,40], heat-related illness [41], and its linkages with increased gender-based violence which already disproportionately affects people with HIV [42][43][44]. Third, as documented in Fig. 1, there are research gaps across global geographical regions that are highly vulnerable to the impacts of climate change and experience increasing rates of HIV, such as Middle East and Northern Africa [45]. Fourth, few studies examined the interplay between climate change, EWE, and intersecting forms of stigma. ...
... Fourth, few studies examined the interplay between climate change, EWE, and intersecting forms of stigma. As EWE [12,46], water insecurity [47], and food insecurity [48] are associated with increased genderbased violence, research could explore associations between EWE and gender-based stigma [44]. ...
Climate change and extreme weather events and linkages with HIV outcomes: recent advances and ways forward
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  • Dec 2024
  • CURR OPIN INFECT DIS
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... It is plausible that our intervention did not sufficiently address mental health stigma drivers (e.g. social norms, values) (Stangl et al. 2019), and we did not apply an intersectional approach that addressed the intersection of genderbased stigma and mental health stigma (Logie et al. 2024a). Intersectional approaches to mental health stigma reduction (Sievwright et al. 2022) are particularly important, as prior work in the United States noted gender, racial and ethnic identity differences in adolescent mental illness stigma and called for tailored stigma reduction (DuPont-Reyes et al. 2020). ...
Findings from the Tushirikiane-4-MH (supporting each other for mental health) mobile health–supported virtual reality randomized controlled trial among urban refugee youth in Kampala, Uganda
Article
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... This demonstrates the relationship between gender-based discrimination and HIV-related stigma. HIV-positive women frequently bear a dual burden: they are discriminated against because of their gender identity and stigmatized for having the virus 91,92 . Higher educational attainment was signi cantly associated with lower odds of experiencing discrimination. ...
Stigma, Discrimination and Associated Determinants Among People Living With Hiv/aids Accessing Anti-retroviral Therapy in Ikeja, Lagos State, Nigeria
Preprint
Full-text available
  • Dec 2024
Discrimination and stigma towards those living with HIV/AIDS (PLWHAs) pose serious obstacles to their ability to manage their disease and achieve overall wellbeing. These obstacles make it difficult to receive mental health assistance, prolong social isolation, and impede access to healthcare resources. The purpose of this study is to look into the types, prevalence, and factors that influence stigma and prejudice that PLWHAs in Ikeja, Lagos State, Nigeria, face when they seek antiretroviral therapy (ART). The study also aims to comprehend the ways in which these experiences impact PLWHAs' mental health and ability to receive healthcare. Structured questionnaires were used in this cross-sectional study to gather data from 400 PLWHAs in Ikeja who were undergoing ART. Aspects of stigma such as negative self-image, disclosure concerns, personalized stigma, and public attitudes were all included in the questionnaire. The data were summarized using descriptive statistics, and significant predictors of discrimination and stigma were found using logistic regression analysis. The study also looked at how stigma affects mental health and healthcare access, with an emphasis on identifying important socio-demographic variables that influence these outcomes. The results showed high prevalence of stigma against PLWHAs in Ikeja, in particular, 37.75% of respondents reported they have encountered stigma associated to HIV while seeking healthcare services, and 89.75% of respondents said they were aware of this stigma. Furthermore, 52% of respondents agreed that stigma is exacerbated by the media and societal views, and 45.5% thought that cultural and religious beliefs affected how PLWHAs were treated in their society. Gender, socioeconomic class, and educational attainment were found to be significant predictors of stigma. In addition, 41.5% of respondents experienced unfavorable views from family or friends, and 48.75% of respondents felt ashamed or condemned due to their HIV status. Similarly, 64.25% of PLWHAs said stigma had a major negative impact on their social interactions and mental health, and 65% said stigma made them decide not to disclose their HIV status. While more than a third, 39.75%, of the respondents said that stigma made it difficult for them to get ART and other essential medical services, two-thirds, 67%, stated that the attitudes of healthcare providers influenced their desire to ask for assistance. The study found widespread stigma and prejudice against PLWHAs with a negative influence on mental health and access to healthcare. The study suggests strengthening anti-discrimination laws, holding frequent training sessions for healthcare professionals, improving education and awareness campaigns, and increasing support services for PLWHAs in order to solve these problems. Stakeholders can improve the inclusive and supportive environment for people living with HIV/AIDS by putting these focused actions into practice, which will eventually improve health outcomes and quality of life. These initiatives are essential for reducing HIV/AIDS stigma and advancing a more equitable and compassionate society.
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“If I don’t take my treatment, I will die and who will take care of my child?”: An investigation into an inclusive community-led approach to addressing the barriers to HIV treatment adherence by postpartum women living with HIV
Article
Full-text available
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Article
Full-text available
  • Feb 2023
Infertility is a reproductive health concern that deserves attention, as reconfirmed by the 2018 report of the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR). However, governments and SRHR organisations tend to neglect infertility. We conducted a scoping review of existing interventions aiming to decrease the stigmatisation of infertility in low- and middle-income countries (LMICs). The review consisted of a combination of research methods: academic database (Embase, Socological abstracts, google scholar; resulting in 15 articles), Google and social media searches, and primary data collection (18 key informant interviews and 3 focus group discussions). The results distinguish between infertility stigma interventions targeted at intrapersonal, interpersonal and structural levels of stigma. The review shows that published studies on interventions tackling infertility stigmatisation in LMICs are rare. Nevertheless, we found several interventions at intra- and interpersonal levels aiming to support women and men to cope with and mitigate infertility stigmatisation (e.g. counselling, telephone hotlines, and support groups). A limited number of interventions addressed stigmatisation at a structural level (e.g. empowering infertile women to become financially independent). The review suggests that infertility destigmatisation interventions need to be implemented across all levels. Interventions geared to individuals experiencing infertility should include women and men and also be offered beyond the clinical setting; and interventions should also aim to combat stigmatising attitudes of family or community members. At the structural level, interventions could aim to empower women, reshape masculinities and improve access to and quality of comprehensive fertility care. Interventions should be undertaken by policymakers, professionals, activists, and others working on infertility in LMICs, and accompanied with evaluation research to assess their effectiveness.
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Identity management in the face of HIV and intersecting stigmas: A metasynthesis of qualitative reports from sub-Saharan Africa
Article
Full-text available
  • Feb 2023
While stigma experienced by people living with HIV (PLWH) is well documented, intersectional stigma and additional stigmatized identities have not received similar attention. The purpose of this metasynthesis is to identify salient stigmatized intersections and their impact on health outcomes in PLWH in sub-Saharan Africa. Using Sandelowski and Barroso’s metasynthesis method, we searched four databases for peer-reviewed qualitative literature. Included studies (1) explored personal experiences with intersecting stigmas, (2) included ≥1 element of infectious disease stigma, and (3) were conducted in sub-Saharan Africa. Our multinational team extracted, aggregated, interpreted, and synthesized the findings. From 454 screened abstracts, the 34 studies included in this metasynthesis reported perspectives of at least 1258 participants (282 men, 557 women, and 109 unspecified gender) and key informants. From these studies, gender and HIV was the most salient stigmatized intersection, with HIV testing avoidance and HIV-status denial seemingly more common among men to preserve traditional masculine identity. HIV did not threaten female identity in the same way with women more willing to test for HIV, but at the risk of abandonment and withdrawal of financial support. To guard against status loss, men and women used performative behaviors to highlight positive qualities or minimize perceived negative attributes. These identity management practices ultimately shaped health behaviors and outcomes. From this metasynthesis, the Stigma Identity Framework was devised for framing identity and stigma management, focusing on role expectation and fulfillment. This framework illustrates how PLWH create, minimize, or emphasize other identity traits to safeguard against status loss and discrimination. Providers must acknowledge how stigmatization disrupts PLWH’s ability to fit into social schemas and tailor care to individuals’ unique intersecting identities. Economic security and safety should be considered in women’s HIV care, while highlighting antiretrovirals’ role in preserving strength and virility may improve care engagement among men.
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A qualitative synthesis of the impact of infertility on the mental health of African women
Article
Full-text available
  • Dec 2022
  • Afr J Reprod Health
Infertility is a reproductive problem that affects all gender, race, or social class. In many African countries, the burden of infertility is usually associated with economic, psychological, and socio-cultural factors. This review aimed to explore the factors that impact the mental health of African women with primary infertility. A qualitative evidence synthesis was used to summarise and analyse primary qualitative studies focused on the impact of primary infertility on African women. Seventeen studies met the eligibility criteria and were included in the review. The review found that social pressure, stigma from family and community members, and financial constraints led to psychological distress. In addition, social stigma also led to marital problems which led to significant psychological distress and low self-worth, especially on the wife. Recommendations to reduce stigma among African infertile women were as follows: advocacy and community mobilisation, education by health professionals, and holistic person-centred care. An intersectional approach to inform public health and social policy was also suggested.
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Gender-Based Violence Laws in Ten African Countries with High HIV Prevalence and Incidence Among Adolescent Girls and Young Women
Preprint
  • Apr 2023
Published in the UC Davis Journal of International Law and Policy, Volume 29:2, Pages 59-92 (2023). https://jilp.law.ucdavis.edu/sites/g/files/dgvnsk15346/files/media/documents/JILP-29-2-Kageyama_Gender-based-Violence.pdf
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