Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability

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Abstract

Background

Stigma across HIV/AIDS, mental illness, and physical disability can be co-occurring and may interact with other forms of stigma related to social identities like race, gender, and sexuality. Stigma is especially problematic for people living with these conditions because it can create barriers to accessing necessary social and structural supports, which can intensify their experiences with stigma. This review aims to contribute to the knowledge on stigma by advancing a cross-analysis of HIV/AIDS, mental illness, and physical disability stigma, and exploring whether and how intersectionality frameworks have been used in the systematic reviews of stigma.

Methods

A search of the literature was conducted to identify systematic reviews which investigated stigma for HIV/AIDS, mental illness and/or physical disability. The electronic databases MEDLINE, CINAHL, EMBASE, COCHRANE, and PsycINFO were searched for reviews published between 2005 and 2017. Data were extracted from eligible reviews on: type of systematic review and number of primary studies included in the review, study design study population(s), type(s) of stigma addressed, and destigmatizing interventions used. A keyword search was also done using the terms “intersectionality”, “intersectional”, and “intersection”; related definitions and descriptions were extracted. Matrices were used to compare the characteristics of reviews and their application of intersectional approaches across the three health conditions.

Results

Ninety-eight reviews met the inclusion criteria. The majority (99%) of reviews examined only one of the health conditions. Just three reviews focused on physical disability. Most reviews (94%) reported a predominance of behavioural rather than structural interventions targeting stigma in the primary studies. Only 17% of reviews used the concept and/or approach of intersectionality; all but one of these reviews examined HIV/AIDS.

Conclusions

The lack of systematic reviews comparing stigma across mental illness, HIV/AIDS, and physical disability indicates the need for more cross-comparative analyses among these conditions. The integration of intersectional approaches would deepen interrogations of co-occurring social identities and stigma.

Related collections

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Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward.

Anish P Mahajan, Jennifer N. Sayles, Vishal A. Patel … (2008)

Although stigma is considered a major barrier to effective responses to the HIV/AIDS epidemic, stigma reduction efforts are relegated to the bottom of AIDS programme priorities. The complexity of HIV/AIDS-related stigma is often cited as a primary reason for the limited response to this pervasive phenomenon. In this paper, we systematically review the scientific literature on HIV/AIDS-related stigma to document the current state of research, identify gaps in the available evidence and highlight promising strategies to address stigma. We focus on the following key challenges: defining, measuring and reducing HIV/AIDS-related stigma as well as assessing the impact of stigma on the effectiveness of HIV prevention and treatment programmes. Based on the literature, we conclude by offering a set of recommendations that may represent important next steps in a multifaceted response to stigma in the HIV/AIDS epidemic.

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From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures.

Valerie Earnshaw, Stephenie Chaudoir (2009)

Recent analyses suggest that lack of clarity in the conceptualization and measurement of HIV stigma at an individual level is a significant barrier to HIV prevention and treatment efforts. In order to address this concern, we articulate a new framework designed to aid in clarifying the conceptualization and measurement of HIV stigma among individuals. The HIV Stigma Framework explores how the stigma of HIV elicits a series of stigma mechanisms, which in turn lead to deleterious outcomes for HIV uninfected and infected people. We then apply this framework to review measures developed to gauge the effect of HIV stigma since the beginning of the epidemic. Finally, we emphasize the utility of using three questions to guide future HIV stigma research: who is affected by, how are they affected by, and what are the outcomes of HIV stigma?

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When Multiplication Doesn't Equal Quick Addition: Examining Intersectionality as a Research Paradigm

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Author and article information

Contributors

Fatimah Jackson-Best:

ORCID: http://orcid.org/0000-0002-8214-1346

fatimahzjackson@gmail.com

Nancy Edwards: Nancy.Edwards@uottawa.ca

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 27 July 2018

Publication date PMC-release: 27 July 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 919

Affiliations

[1 ]I Am One, 58C Cypress Ridge, Union Hall, San Fernando, Trinidad and Tobago

[2 ]ISNI 0000 0001 2182 2255, GRID grid.28046.38, School of Nursing, Faculty of Health Sciences, , University of Ottawa, ; 1 Stewart Street, Room 205, Ottawa, ON K1N 7M9 Canada

Author information

Fatimah Jackson-Best http://orcid.org/0000-0002-8214-1346

Article

Publisher ID: 5861

DOI: 10.1186/s12889-018-5861-3

PMC ID: 6062983

PubMed ID: 30049270

SO-VID: 48a9bd3b-cdf5-4ced-b6be-ca34fff4246f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 30 March 2018

Date accepted : 17 July 2018

Custom metadata

ScienceOpen disciplines: Public health

Keywords: stigma,intersectionality,hiv/aids,mental illness,physical disability

Data availability:

ScienceOpen disciplines: Public health

Keywords: stigma, intersectionality, hiv/aids, mental illness, physical disability