Correlates of HIV stigma in HIV-positive women: Study

For some women, planning a family can be the first step towards one of life's most rewarding experiences. But a study led by Ryerson University researchers has found strong evidence that some HIV-positive women feel that they are being judged negatively by their healthcare providers for wanting to become moms and feel stigmatized by their physicians due to their medical condition.

Anne Wagner, a PhD student at Ryerson's Department of Psychology's HIV Prevention Lab, is the lead author of a new study that examines social stigmas perceived by HIV-positive women living in Ontario. The study is part of a larger report that examines HIV-positive women's desire to have children.

"In this study, I was interested in the construct of HIV stigma, how the women perceived it and what was contributing to it," said Wagner, who is presenting studies on HIV homeless youth in Canada and adults living in India at the International AIDS Conference this week in Vienna, Austria.

The study on HIV stigma is co-authored by Professor Trevor Hart, Wagner's academic supervisor and the director of Ryerson's Department of Psychology's HIV Prevention Lab; Mona Loutfy of the University of Toronto's Department of Medicine and Women's College Hospital; and Saira Mohammed, Elena Ivanova and Joanna Wong, all of whom are with Women's College Hospital.

According to the Public Health Agency of Canada, in 2007 nearly 17 per cent of the estimated 64,800 people living with HIV are women. The researchers surveyed 159 women who are HIV positive and living in Ontario. These women were recruited from various AIDS service organizations, HIV clinics and community health centres. Slightly over half of the women (55 per cent) were born outside Canada, mostly from HIV-endemic countries such as sub-Saharan Africa and the Caribbean; the other group was born in Canada. They were asked to answer demographic-related questions (age, education level, birthplace, ethnicity, income); medical questions relating to their HIV treatments; and psychological questions (level of anxiety, depression). They were also asked if they felt they were being negatively judged by their health-care providers, family and friends about their desire to have children.

"We do have strong evidence that women are feeling they are being judged negatively by healthcare providers for wanting to have babies," said Hart.

The research also uncovered stark differences between the women born outside and within Canada when it came to the factors contributing to stigmas perceived because of their HIV-positive status. For those not born in Canada, being negatively judged by a physician in Canada for wanting to become pregnant was the strongest predictor of HIV stigma. On the other hand, women born in Canada who reported higher levels of anxiety and lower levels of education were more likely to feel stigmatized by their medical condition. Women born in Canada also reported they felt negatively judged by their healthcare providers, but not to the same degree as those women born outside of the country. Interestingly for both groups, family and friends did not play a significant role in the perceived stigmatization of the women's desire to have kids.

"Physicians may also be following out-of-date guidelines created in the late 1980s recommending that HIV-positive women shouldn't plan a family, which could explain this perceived stigmatization by these women," Wagner said.

Hart says with the advent of new antiretroviral medications on the market, HIV-positive women can now conceive without worrying about passing on HIV to their newborns, and health care providers should be informing their patients.

"There needs to be more efforts to make physicians aware of the practically nil chance of HIV-positive women transmitting HIV to their newborns as long as the women are continuing to receive appropriate medical treatment," said Hart. "There also needs to be continuing medical education to reduce the stigma perceived by HIV-positive women, which will improve their mental health and well-being."

Looking to the future, Wagner is interested in examining medical practitioners' attitudes towards HIV-positive women to come up with possible solutions to improve HIV health care.

The study, Correlates of HIV Stigma in HIV-Positive Women, was published in the June issue of the journal Archives of Women's Mental Health and was funded by the Canadian Foundation for AIDS Research.