Experiences of stigma amongst HIV-positive people encountering the healthcare system in Scandinavia: a systematic review.

Abstract

Abstract Objective: This systematic review aims to investigate the experiences of HIV-related stigma among people living with HIV in Scandinavia Introduction: Stigma has existed for centuries, with some groups of people being more prone to stigma than others, one example being people living with HIV. HIV-related stigma has existed from the beginning of the epidemic, 1980's, and may still be experienced after almost 40 years. HIV-related stigma may cause both physical and psychological illnesses and is seen as a barrier to treatment and medication adherence, as well as being an obstacle in the fight against HIV. The treatment and attitudes have changed since the 1980s, thus it is expected that people living with HIV should be treated as any other patients. This review attempts to explore the experiences of people living with HIV in relation to stigma and the health care system in modern times. Inclusion criteria: This systematic review included studies dated between 2011 and 2021 that are conducted in the Scandinavian countries. Participants were living with HIV, and with focus on their experiences of stigma in relation to their diagnosis. If not solely focusing on the healthcare system, the included studies had to include experiences from the healthcare system. The studies had to be written in English or any of the Scandinavian languages (Swedish, Danish, and Norwegian. Methods: The databases used to obtain relevant studies were Cinahl, Medline, PsychInfo, and Norart. Pubmed, google scholar and grey literature were used for supporting and background information. Articles included is written in English or any of the Scandinavian languages (Swedish, Danish, and Norwegian). Four studies were included in the review, three from Sweden, and one from Norway – all written in English. Last search was conducted in 10th of January 2022. When writing this review and conducting the search and critical appraisal JBI approach for systematic review were used, as well as the CASP-checklist and Finding What Works in Health Care: Standards for Systematic Reviews description on synthesizing body of evidence. This review explored only qualitative studies with in-depth interviews. One study was excluded due to methodological approach being quantitative, the other studies excluded were due to lack of information concerning stigma in the healthcare system. Results: The studies reviewed did not primarily focus on experiences of stigma within the health care system/setting, however, they all reported to some extent situations and experiences of HIV-related stigma in their study. All the participants were living with HIV in Sweden or in Norway and were both male and female. The review extracted 21 findings regarding experiences of HIV-related stigma in healthcare system. These was subcategorized into two sub-categories: Experiences with health care providers and treatment. Conclusions: Across the reviewed studies, participants reported being fairly satisfied to satisfied with their experience in the healthcare system, however HIV-related stigma in the healthcare system in Scandinavia is still experienced. Experiences of HIV-related stigma has become evident in this review, and current literature support the evidence found. Further research on HIV-related stigma in the health care in Norway, as well as further research on healthcare providers knowledge on HIV so as to determine where the knowledge gap lies.