Stigma and HIV care in low- and middle-income countries (LMICs)
Human immunodeficiency virus (HIV)-related stigma is a global public health issue and substantially affects low- and middle-income countries (LMICs) which are known to be the hardest hit by HIV. Despite HIV testing services and HIV treatment (antiretroviral therapy, ART) being freely available in several LMICs, HIV testing coverage is very low, early access to ART is low, and retention in care is not satisfactory. Stigma is a cross-cutting barrier to the entire HIV care continuum, which includes the following: HIV testing and counseling, access to HIV treatment, treatment adherence, retention, and virological suppression. As such, HIV-related stigma contributes to negative HIV care and treatment outcomes such as delayed HIV diagnosis, delayed HIV treatment access, poor adherence, clinical, immunological, and virological failure, and subsequently attrition. In relation to this, in 2014, UNAIDS proposed an ambitious goal called UNAIDS 90–90–90 where respectively it was expected that 90% of individuals would know their HIV status, would receive sustained ART, and through ART would have viral suppression. The goal was planned to be achieved by 2020, however, several LMICs are yet to achieve this target by far. Stigma has been consistently named as a cross-cutting factor. As such, contextual studies are needed to explore the link between stigma and HIV care and possible strategies to halt stigma.