The University of California, San Francisco (UCSF), the University of KwaZulu-Natal, and a group of nurse researchers in southern Africa have received funding to study HIV/AIDS and stigma. AIDS stigma and discrimination continue to affect those living with and affected by HIV disease and their health care providers, particularly in southern Africa where the burden of AIDS is so significant. Many health care workers in this region have come to the conclusion that unless stigma is conquered, the illness will not be defeated. This five-year collaborative project links researchers in Lesotho, Malawi, South Africa, Swaziland, and Tanzania, along with the Southern African AIDS Network of Nurses and Midwives (SANNAM), with UCSF and the University of KwaZulu-Natal to:

1. Develop and validate two linguistically and culturally appropriate measures of perceived HIV/AIDS stigma appropriate for person living with HIV/AIDS and nurses;

2. Test a model, using longitudinal data, of how stigma affects, and is affected by (2a) quality of health care and quality of life for persons living with HIV/AIDS and (2b) quality of work life and quality of life for nurses and;

3. Utilize community-based participatory research methods to intervene at a community level with five national nurses associations and to track the impact of the community-level events on the perceived stigma of nurse members of those associations.

In October 2003, representatives from all of the sites met in Pretoria, South Africa to begin the first stages of the research that will take place through this project. Participants developed research tools and protocols, and received further training in relevant research methodologies.

In March 2005, members of the team were Scholars in Residence at the Rockefeller Foundation's Bellagio Study and Conference Center. At this meeting, the team drafted the two stigma scales and made plans for testing and implementing them.

In June 2006, the team met in Windhoek, Namibia to review data from the first phase of the cohort study. Plans were made for the next phase of data collection, and the team discussed the first stages of the stigma reduction intervention.

In February 2007, the team met in San Francisco. And also met at the Africa Center in South Africa in August 2007. Both meetings focused on plans for a stigma reduction intervention that is currently under way.

This project was supported by a grant from the National Institutes of Health's Fogarty International Center, R01 TW006395 (PI: Holzemer & Co-PI: Uys) and partially supported by the Health Resources and Services Administration's Global HIV/AIDS Program, U.S. Government.
 

Published articles:

Holzemer, W.L. & Uys, L. (2004). Managing AIDS Stigma. Journal of Social Aspects of HIV/AIDS. 1(3): 165-174.

Uys, L., Chirwa, M., Dlamini, P., Greeff, M., Kohi, T., Holzemer, W.L., Makoae, L., Naidoo, J.R., & Phetlhu, R. (2005).  Eating plastic, winning the lotto, joining the WWW: Descriptions of HIV/AIDS in Africa.  Journal of the Association of Nurses in AIDS Care. 16(3): 11-21.

Kohi, T.W., Makoae, L., Chirwa, M., Holzemer, W.L., Phetlhu, D.R., Uys, L., Naidoo, J., Dlamini, P.S., Greeff, M. (2006). HIV and AIDS stigma violates human rights in five African countries. Nursing Ethics. 13(4): 404-415. 

Naidoo, J.R., Uys, L.R., Greeff, M., Holzemer, W.L., Makoae, L., Dlamini, P., Phetlhu, R.D., Chirwa, M., & Kohi, T.(2007). Urban and rural differences in HIV/AIDS stigma in five African countries. African Journal of AIDS Research. 6(1): 17-23. 

Holzemer, W.L., Uys, L., Makoae, L., Stewart, A., Phetlhu, R., Dlamini, P., Greeff, M., Kohi, T.W., Chirwa, M., Cuca, Y., & Naidoo, J. (2007). A conceptual model of HIV/AIDS stigma from five African countries Journal of Advanced Nursing. 58(6): 541-551. 

Dlamini, P., Kohi, T., Uys, L. Phetlhu, R., Chirwa, M., Naidoo, J., Holzemer, W., Greeff, M., Makoae, L. (2007) Manifestations of HIV/AIDS stigma: Verbal and physical and neglect abuse in five African countries. Public Health Nursing. 24(5): 389-399. 

Holzemer, W.L., Uys, L.R., Chirwa, M.L., Greeff, M., Makoae, L.N., Kohi, T.W., Dlamini, P.S., Stewart, A.L., Mullan, J., Phetlhu, R.D., Wantland, D. & Durrheim, K. (2007) Validation of the HIV/AIDS Stigma Instrument- PLWA (HASI-P). AIDS Care. 19(8): 1002-1012.

In press articles:

Greeff, M., Phetlhu, D.R., Makoae, L.N., Dlamini, P.S., Holzemer, W.L., Naidoo, J., Kohi, T.W., Uys, L.R., & Chirwa, M.L. Disclosure of HIV status: Experiences and perceptions of persons living with HIV/AIDS and nurses involved in their care in five Africa countries. Qualitative Health Research.

Greeff, M. & Phetlhu, D.R. The meaning and effect of HIV/AIDS stigma for people living with AIDS and nurses involved in their care in the North West Province, South Africa. Curationis.

Makoae, L., Greeff, M., Phethlu, R., Uys, L.R., Naidoo, J.R., Kohi, T., Dlamini, P., Chirwa, M. & Holzemer, W.L. Coping strategies for HIV and AIDS: A multinational African Study. Journal of the Association of Nurses in AIDS Care

Instruments:

For a copy of the HIV/AIDS Stigma Instrument-PLWA (HASI-P), click here.
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 2.5 License.

For a copy of the HIV/AIDS Stigma Instrument-Nurse (HASI-N), click here.
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 2.5 License.

For more information, please contact:

William L. Holzemer, RN, PhD, FAAN
Principal Investigator
UCSF School of Nursing
Community Health Systems
2 Koret Way, Box 0608
San Francisco, CA 94143-0608
Email: bill.holzemer@nursing.ucsf.edu

Leana Uys, RN, RM, DSocSc
Co-Principal Investigator
University of KwaZulu-Natal
School of Nursing
Private Bag x54001
Durban, 4000, South Africa
Email: uys@ukzn.ac.za
 

Country Principal Investigators:

Lesotho
Lucy N. Makoae, RN, RM, PhD
National University of Lesotho
PO Roma 180
Maseru, 0100, Lesotho
Email: lmakoae@yahoo.com

Malawi
Maureen Chirwa, RN, RM, PhD
Senior Lecturer
University of Malawi
Kamuzu College of Nursing, Basic Studies
Private Bag 1
Lilongwe, Malawi
Email: maureen_chirwa@yahoo.co.uk

South Africa
Minrie Greeff, RN, RM, PhD
North-West University,
Potchefstroom Campus
School of Nursing Science
Private Bag X 6001
Potchefstroom, 2520, South Africa
Email: vpkmg@puknet.puk.ac.za

Swaziland
Priscilla Dlamini, RN, RM, PhD
University of Swaziland
Faculty of Health Sciences
PO Box 369
Mbabane, Swaziland
Email: pdlamini@healthsci.uniswa.sz

Tanzania
Thecla W. Kohi, RN, RM, PhD
Muhimbili University
School of Nursing
College of Health Sciences
PO Box 65004
Dar es Salaam, Tanzania
Email: tkohi@muchs.ac.tz