Task

Qualitative Exploration of Stigma and Discrimination Experienced by People Living with HIV in Brazil: A Systematic Review

1. Background

1.1. Introduction

In Brazil, the number of people with HIV has increased a lot. Recent numbers from 2021 show a big jump in the number of people with HIV, reaching around 960,00. This is up by almost half compared to last year (Statista, 2023).

The increase in HIV cases shows that Brazil still has many problems managing and stopping the spread of this disease. This health problem is important because it affects a lot of people in Brazil. More and more Brazilians are having to deal with HIV as the disease spreads.

Importantly, giving medicines for HIV treatment has become a key part of the fight. In Brazil in 2021 about 73% or people with HIV used these special health helpers (Statista, 2023).

The study by Saffier et al. (2017), looked at how HIV is spreading among young people in Brazil. They found some complex parts of this problem that other types of data don't show us clearly.

The country is doing well in the fight against AIDS, but a report shows there are problems reaching and helped by programs. This especially affects young women who should be protected from getting HIV (Saffier et al., 2017).

The growing number of HIV infections among young people, as shown by rising AIDS cases, requires us to study the personal feelings and problems they face when living with HIV in Brazil. This study aims to help understand the complex problems of HIV in Brazil.

1.2. Scope of the Problem

Many people with HIV is a big health problem in Brazil. The discussion needs to look at the stigma connected with it and how they can hurt people or their loved ones. A study in Brazil by Kerrigan et al. (2017) found that unfair treatment and shame can make HIV positive for people with AIDS. A study of 900 individuals with HIV discovered that getting older and having less money can lead to feelings of embarrassment and unfair treatment. Kids and those with less money faced bad times due to unfair treatment. This made it harder for different groups in Brazil to work together (Kerrigan et al., 2017).

Ferraz et al. (2019) contributed to this discussion by examining how AIDS stigma influences the use of nPEP for HIV following sex. Their results, by talking to people who use nPEP medicine support, show how much worry affects getting medical care. People want to keep their romance a secret and get hurt when they do nPEP. This changes how decisions about health are made. This shows how much shame can change decisions about health care (Ferraz et al., 2019).

The study by Brandelli et al. (2022) The Stigma Index Brazil found that many HIV patients are mistreated in hospitals and healthcare centers. Studies show that after 40 years of trying in Brazil to stop HIV related stigma by protecting human rights, people are still not treated fairly.

This is really true for those who need extra help as a result of marginalisation. They have a higher chance of getting ill from the sickness. The results show that there is a need to act quickly against unfair treatment related to HIV as soon as possible, especially in healthcare (Brandelli Costa et al., 2022).

Also, a study by Giacomozzi et al. (2019) examines how people in Brazil think about living with HIV/AIDS socially. The research shows that when someone learns about their health issue is a big deal. Afterwards, they consider their sickness as something they need to handle forever. The study shows that dealing with bias is more difficult than living with HIV/AIDS. This shows how much and for a long time social views can impact people with HIV in Brazil (Giacomozzi et al., 2019).

1.3. Literature Review

Books on HIV-related stigma and discrimination in Brazil for people who have the virus help understand all their different problems. This section examines previous writings, fills in gaps and discusses uncertainties. It shows that we need to study more for better understanding.

People's views on stigma and HIV by Yuvaraj et al. (2020) show how hard it is to handle this complex problem around the world. Stigma does not only affect people with HIV personally, it also connects a lot to larger community rules and unfair issues.

Discrimination shows up differently in things like gender, race and sexual orientation. It looks various ways such as being alone or laughed at because of it in Brazilian society (Yuvaraj et al., 2020).

Kontomanolis et al. (2017) showed the special problems that women giving birth with AIDS in Brazil face. These ladies have mental problems during pregnancy, along with unfair and shameful actions from their surroundings. This paper points out that it's important for the whole society to learn and be aware. This will help include more people wth HIV into their communities, because some folks aren't informed enough about it which leads them to ignore others (Kontomanolis et al., 2017).

Du and others (2018) looked at different countries, exploring the connection between HIV rate and stigma. The study reveals a counterintuitive finding: Having more HIV prevalence in a region means there is less shame around the illness.

The study shows that in countries where HIV is more common, knowing how it spreads helps change negative thoughts about people with the disease. This finding makes us look again at programs to fight stigma. It asks for a new view that sees both how common the disease is and what people know about it (Du et al., 2018).

Kerrigan et al. (2017) give a special view of Brazil. They study the social situation around stigma, discrimination and HIV results among people with AIDS in Rio de Janeiro. The research with 900 people who have HIV shows that various social unfairnesses add up to make experiences of being judged and treated wrong.

Age, money earnt, schooling level and history of doing sex work are found to be important things affecting how often stigma and bad treatment happen. This shows that extra work is needed to deal with the many issues faced by those in Brazil with HIV (Kerrigan et al., 2017).

Ferraz et al. (2019) discuss the shame around AIDS and sex connected to using nPEP, a medicine for stopping infection in Brazil. The study shows how shame from HIV AIDS impacts the experiences of those trying to get nPEP.

It changes how they think, guess and see themselves about this subject. This study wants to add extra solutions when more people use ARV-based prevention methods.

This involves things like big public events and classes that try to stop bad feelings around AIDS and having sex. Also, it's important to use money for studying stigma problems so we can watch them closer (Ferraz et al., 2019).

Finally, Caliari et al. (2017) study what causes people in Minas Gerais, Brazil to view HIV-positive individuals negatively. The research highlights factors that increase or decrease how people are looked down on. It shows how much this can change the lives of those with HIV, such as feeling bad about themselves or being sad on their own.

They may also stop getting help because they feel so unwanted. This study shows it's very important to make special efforts so we can deal with the specific things causing unfair treatment in these people (Caliari, et al., 2017).

In short, the writing about HIV-related stigma and discrimination in Brazil gives a complete description. It emphasizes how important it is to have special help and make people careful about this problem. 

1.4. Critical Analysis

The important study of the writing about HIV-related stigma and discrimination among people living with HIV (PLHIV) in Brazil shows both good points and things to think about. Looking at all the studies together, the criticism covers how they were done and what ideas guided their work. The study by Yuvaraj et al. (2020) shows a broad view of HIV stigma all around the world.

Strength comes from understanding that stigma has different levels. These include personal, relationships between people, rules in institutions and communities, as well as laws. Yet, the study doesn't focus much on special details of Brazil. This might limit how useful it is for that country's unique social and cultural life.

Kontomanolis et al. (2017) looked into the problems faced by women who give birth and have AIDS in Brazil, which is good because it showed attention on a certain group of people. Mental problems and unfair actions should be looked at. However, the study could use a more detailed look at other things like money status or gender preference when discussing how they all connect together.

The study done by Du et al. (2018) looks at how HIV rates are connected with stigma across different countries, giving a new viewpoint. But, the study's use of national information might miss differences in local areas across Brazil. So a closer look is needed to understand how HIV people from all around experience it differently.

Kerrigan et al. (2017) studied in Rio de Janeiro the social matter of stigma and discrimination for HIV positive people. The study is strong because it includes many things, but maybe can go deeper. This could be done by looking at feelings and stories from people's lives first-hand.

Ferraz et al. (2019) looked at AIDS-related shame or confusion about sex in relation to taking medicine soon after getting poisoned. This shows how these shames can connect with each other. The study, which has a lot of understanding details from people's experiences, could learn more by looking at how different kinds of stigmas meet.

This needs to also think about other things like where someone is from and what gender they are. Caliari et al. (2017) research on things linked with feeling stigmatized gives helpful information. But, the design of looking at things all together in one group stops us from showing for sure that some things cause others. Adding a part where we follow changes over time could make this study deeper and more helpful.

2. Objectives/Systematic Review Question

2.1. Focused Systematic Review Question

How are in Brazil with HIV (Group) impacted (O) as a result the discrimination they face because of HIV-related stigma (Exposure)?

2.2. Question Structure

Table 1: Research Question Structure
(Source: Researcher)

Type of Question

The question of systematic review is qualitative, trying to explore the detailed aspects that people with HIV face in Brazil. These include stigma and unfair treatment because they are living with this illness. The subjective experiences and the state of affairs, and not just what is counted or measured, should be important for really understanding the different parts of this issue (Murphy, 2017).

2.3. Objectives

Aligned with the research question, the systematic review will pursue the following objectives:

1.    To look at the impact of different Kinds of Stigma and Discrimination.
2.    To evaluate Coping Mechanisms and Resilience.
3.    To check the Role of Help Networks.
2.4. Philosophical Underpinning

The idea behind this qualitative study comes from constructivism philosophy. This way of thinking respects that people's experiences are unique (Van der Walt, 2020). It stresses how the researcher and those taking part both create knowledge together (Boon, 2017). This means it understands how important someone's situation, viewpoint and social interactions are in forming the life experiences of people dealing with stigma and discrimination related to HIV issues within Brazilian society (Kamal, 2019).

3. Methods of the Review

3.1. Search Strategy

For the methodical review on HIV stigma and discrimination in Brazil, a careful plan was made to cover everything important. The picked databases - Scopus, Medline and Embase - were chosen because they have strong coverage of medical and social science books. This makes them the best places to find different views on topics from many angles.

Rationale for Database Selection:

Scopus:

Scopus was chosen because it covers a lot of scientific, technical, medical and social science books. It's a big database that cuts across many fields (Schotten et al., 2017). It includes lots of journals, conference papers and books about HIV-related stigma and mistreatment. This gives a complete picture of the research in this area. The different areas that this subject covers make Scopus a helpful place to find many related papers (Zhu and Liu, 2020).

Medline:

Medline, found on the PubMed website, is famous for its resources in biomedical literature (Lee et al., 2023). This database helps collect research about health issues, treatment for healthcare and studies of HIV spreading. Looking at HIV health problems and experiences in Brazil, Medline is very important for finding medical books about care.

Embase:
Embase was added to the search plan because it focuses on drug and health literature (Bramer et al., 2017). This database adds to the medical focus of Medline, but it also covers extra information about drugs and medicine. The review is about helping people who have HIV live better lives. Embase helps by giving information on medicine use, results from treatment and other related things in taking care of the sick with HIV.

Use of PEO Framework for Key Terms:

In the context of population (P), important keywords often used include "people with HIV," "HIV-positive individuals". The context of Exposure would include terms like “stigma”, “discrimination”, “AIDS-related stigma”, and “HIV-related stigma”. In the context of outcome (O), the keywords like “health outcomes”, “psychosocial outcomes”, and “impact of stigma”.

Use of Boolean Operators:

Boolean operators, especially "AND", "OR" and "NOT" are used carefully to make search more accurate and include everything (Scells et al., 2020). "AND" is used to mix terms in each PEO group, making the search more specific for writings that cover all parts. "OR" is used between similar words, making the search wider to include many different ways of saying things. "NOT" is carefully used to get rid of terms that don't matter (Atkinson and Cipriani, 2018). This makes the search only look at things relevant for the planned review. Using Boolean operators in a planned way makes the search for important papers better on chosen databases.
 

Table 2: Search terms
(Source: Researcher)

3.2. Study Selection

Table 3: Study Inclusion and Exclusion Criteria
(Source: Researcher)

3.2.1. Population

The Population (P) in this study is based on those with HIV/AIDS who live in Brazil. Therefore, as per inclusion criteria people with HIV should be included. This makes sure the systematic review only studies apsects like stigma and discrimination for this group of individuals. The time limits, from 2013 to 2023, make sure that new discoveries are included in the daily lives of people with HIV/AIDS (Andersson et al., 2020).

3.2.2. Exposure

The Exposure (E) in the careful review is about how people living with HIV/AIDS feel stigma and are treated badly in Brazil. The choice rules make sure a complete look at different types of stigma, including personal relationships, rules in buildings and society-wide views (Eisinger and Fauci, 2018). Studies looking into different forms of stigma like being alone, making fun of people, not getting help and unequal treatment at work will be part of our research. 

3.2.3. Outcome

The Outcome (O) pertaining to the detailed review is about how stigma and bias affect people with HIV/AIDS in Brazil. The chosen studies must give information on different results, like mental health and overall wellness. Studies in Brazil are important because they show how things like culture and society might affect results of being treated badly or unfairly (Benzaken et al., 2019). The review wants to look at the impact that is suffered by people in terms of social, psychological, psychosocial as well as holistic well-being. This will help the systematic review understand how HIV stigma can affect the health and well-being of infected people in Brazil for a long time.

3.3. Study Quality Assessment

The Critical Appraisal Skills Programme (CASP) checklist will be used to assess the quality and trustworthiness of chosen studies. This helps the discourse make sure they are strong in their methodology.

The CASP checklist is famous for being effective at reviewing various kinds of research. It provides a proper method to check if research methods are clear, important and fit (Long et al., 2020). To know how reliable a study is, the person doing research must closely look at each study that follows CASP rules.

The researcher will check things like how the study is set up, ways to collect information, population and methods for looking at data (Buccheri and Sharifi, 2017). The criteria will be carefully checked to measure the total strength of the research method used in these studies (Majid and Vanston, 2018).

The chosen tool for checking how good a study is, called CASP, fits well with different types of studies. This makes it great for research on stigma and discrimination connected to HIV/AIDS as those things can be very varied too.

By using CASP, the careful review makes sure a complete check that is more than just treating everything the same (Maeda et al., 2023). The checklist's organized and detailed way gives a clear understanding of the good points and bad parts for each study. This makes what was found in the thorough review trusted more (Wang et al., 2020).

Therefore, the use of CASP as a quality check tool shows that efforts are being made to keep good methods and ensure that summarized evidence helps us better understand how people living with HIV in Brazil face stigma and discrimination.

4. Data Extraction 

It is very important to use a careful and organized method in the data-extraction stage, so the researcher can put together information correctly. A data collection table has been made to help this process (Chen, 2017). It contains important things like study name, year of publication, design type and country size. It helps the resarcher systematically look at what others have written in an organized manner.

The table for collecting data is made to fit the exact requirements set by what can be included or left out (Munn et al., 2018). Each box in the table comes from a different study. It gives important information like what kind of research it is; how many people were part of it and where these studies happened (country).

The year when they published their work can also be found there. This amount of detail not only helps to sort out information in an orderly manner but also sets up a complete summary of results (Munn et al., 2018).

By using this simple method, the review tries to keep things clear and strict when it comes to getting information from studies. This strong way of doing things is very important to make sure the results are true and accurate. This helps the systematic review carefully study how people with HIV in Brazil feel bad treatment from others due to their condition.
 

Table 4: Sample Data Extraction Table
(Source: Researcher)

5. Data Synthesis

To study the stigma and discrimination faced by people with HIV in Brazil, the systematic review will use thematic synthesis. The process of combining themes based on the results from different qualitative studies, called thematic synthesis is a well-accepted and strong method (Clarke and Braun, 2017). It helps in finding common patterns or notions across many pieces of research.

The decision to use a thematic combination works because it can support different study plans and ways of doing things found in the chosen articles (Terry et al., 2017).

Since the research question is complex and many different ideas are present in the studies, thematic analysis offers a flexible way to gather, sort out and understand data (Castleberry and Nolen, 2018).

This way lets the systematic review find common things and ideas in the qualitative information. It helps to know better what stigma experiences people with HIV face in Brazil.

Thematic synthesis is a step-by-step way of organizing information and sorting it into groups (Herzog et al., 2019). Then, the researcher will create summary themes that describe or analyse the details found in the data. This way, the systematic review tries to find out not just how common and different types of stigma are (Maguire and Delahunt).

This way of putting things together makes it easier to get complete understanding from many different kinds of studies (Braun and Clarke, 2022). It helps make sure that the study review looks carefully at problems with judgement and unfair treatment related to HIV in Brazil so the discourse can understand the complexity of the issues. 
 

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References

Andersson, G.Z., Reinius, M., Eriksson, L.E., Svedhem, V., Esfahani, F.M., Deuba, K., Rao, D., Lyatuu, G.W., Giovenco, D. and Ekström, A.M., 2020. Stigma reduction interventions in people living with HIV to improve health-related quality of life. The Lancet HIV, 7(2), pp.e129-e140.
Atkinson, L.Z. and Cipriani, A., 2018. How to carry out a literature search for a systematic review: a practical guide. BJPsych Advances, 24(2), pp.74-82.
Benzaken, A.S., Pereira, G.F., Costa, L., Tanuri, A., Santos, A.F. and Soares, M.A., 2019. Antiretroviral treatment, government policy and economy of HIV/AIDS in Brazil: is it time for HIV cure in the country?. AIDS research and therapy, 16(1), pp.1-7.
Boon, M., 2017, May. Philosophy of science in practice: A proposal for epistemological constructivism. In Logic, methodology and philosophy of science–Proceedings of the 15th international congress (pp. 289-310).
Brandelli Costa, A., de Moura Filho, J.B., Silva, J.M., Beloqui, J.A., Espindola, Y., de Araujo, C.F., Aloia, S.A.V. and de Lima, C.E., 2022. Key and general population HIV-related stigma and discrimination in HIV-specific health care settings: Results from the Stigma Index Brazil. AIDS care, 34(1), pp.16-20.
Braun, V. and Clarke, V., 2022. Conceptual and design thinking for thematic analysis. Qualitative Psychology, 9(1), p.3.
Buccheri, R.K. and Sharifi, C., 2017. Critical appraisal tools and reporting guidelines for evidence‐based practice. Worldviews on Evidence‐Based Nursing, 14(6), pp.463-472.
Caliari, J.D.S., Teles, S.A., Reis, R.K. and Gir, E., 2017. Factors related to the perceived stigmatization of people living with HIV. Revista da Escola de Enfermagem da USP, 51, p.e03248.
Castleberry, A. and Nolen, A., 2018. Thematic analysis of qualitative research data: Is it as easy as it sounds?. Currents in pharmacy teaching and learning, 10(6), pp.807-815.
Chen, C., 2017. Science mapping: a systematic review of the literature. Journal of data and information science, 2(2), pp.1-40.
Clarke, V. and Braun, V., 2017. Thematic analysis. The journal of positive psychology, 12(3), pp.297-298.
Du, H., Chi, P. and Li, X., 2018. High HIV prevalence predicts less HIV stigma: a cross-national investigation. AIDS care, 30(6), pp.714-721.
Eisinger, R.W. and Fauci, A.S., 2018. Ending the HIV/AIDS pandemic. Emerging infectious diseases, 24(3), p.413.
Ferraz, D., Couto, M.T., Zucchi, E.M., Calazans, G.J., Dos Santos, L.A., Mathias, A. and Grangeiro, A., 2019. AIDS-and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study. Sexual and reproductive health matters, 27(3), pp.107-121.
Ferraz, D., Couto, M.T., Zucchi, E.M., Calazans, G.J., Dos Santos, L.A., Mathias, A. and Grangeiro, A., 2019. AIDS-and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study. Sexual and reproductive health matters, 27(3), pp.107-121.
Giacomozzi, A.I., Bousfield, A.B.S., Coltro, B.P. and Xavier, M., 2019. Social representations of living with HIV/AIDS and experiences of prejudice in Brazil. Liberabit. Revista Peruana de Psicología, 25(1), pp.85-98.
Herzog, C., Handke, C. and Hitters, E., 2019. Analyzing talk and text II: Thematic analysis (pp. 385-401). Springer International Publishing.
Kamal, S.S.L.B.A., 2019. Research paradigm and the philosophical foundations of a qualitative study. PEOPLE: International Journal of Social Sciences, 4(3), pp.1386-1394.
Kerrigan, D., Vazzano, A., Bertoni, N., Malta, M. and Bastos, F.I., 2017. Stigma, discrimination and HIV outcomes among people living with HIV in Rio de Janeiro, Brazil: the intersection of multiple social inequalities. Global Public Health, 12(2), pp.185-199.
Kerrigan, D., Vazzano, A., Bertoni, N., Malta, M. and Bastos, F.I., 2017. Stigma, discrimination and HIV outcomes among people living with HIV in Rio de Janeiro, Brazil: the intersection of multiple social inequalities. Global Public Health, 12(2), pp.185-199.
Kontomanolis, E.N., Michalopoulos, S., Gkasdaris, G. and Fasoulakis, Z., 2017. The social stigma of HIV–AIDS: society’s role. HIV/AIDS-Research and Palliative Care, pp.111-118.
Lee, J.C., Lee, B.J., Park, C., Song, H., Ock, C.Y., Sung, H., Woo, S., Youn, Y., Jung, K., Jung, J.H. and Ahn, J., 2023. Efficacy improvement in searching MEDLINE database using a novel PubMed visual analytic system: EEEvis. Plos one, 18(2), p.e0281422.
Long, H.A., French, D.P. and Brooks, J.M., 2020. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research Methods in Medicine & Health Sciences, 1(1), pp.31-42.
Maeda, Y., Caskurlu, S., Kozan, K. and Kenney, R.H., 2023. Development of a critical appraisal tool for assessing the reporting quality of qualitative studies: a worked example. Quality & Quantity, 57(2), pp.1011-1031.
Maguire, M. and Delahunt, B., 2017. Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. All Ireland Journal of Higher Education, 9(3).
Majid, U. and Vanstone, M., 2018. Appraising qualitative research for evidence syntheses: a compendium of quality appraisal tools. Qualitative health research, 28(13), pp.2115-2131.
Munn, Z., Peters, M.D., Stern, C., Tufanaru, C., McArthur, A. and Aromataris, E., 2018. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology, 18, pp.1-7.
Munn, Z., Stern, C., Aromataris, E., Lockwood, C. and Jordan, Z., 2018. What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC medical research methodology, 18(1), pp.1-9.
Murphy, E., 2017. Qualitative methods and health policy research. Routledge.
Saffier, I.P., Kawa, H. and Harling, G., 2017. A scoping review of prevalence, incidence and risk factors for HIV infection amongst young people in Brazil. BMC infectious diseases, 17(1), pp.1-13.
Scells, H., Zuccon, G., Koopman, B. and Clark, J., 2020, April. Automatic boolean query formulation for systematic review literature search. In Proceedings of the web conference 2020 (pp. 1071-1081).
Schotten, M., Meester, W.J., Steiginga, S. and Ross, C.A., 2017. A brief history of Scopus: The world’s largest abstract and citation database of scientific literature. In Research analytics (pp. 31-58). Auerbach Publications.
Statista, 2023. Number of people living with HIV in Brazil between 2010 and 2021. [online] Available at: https://www.statista.com/statistics/940559/number-people-hiv-brazil/ (Accessed on: 29-12-2023)
Terry, G., Hayfield, N., Clarke, V. and Braun, V., 2017. Thematic analysis. The SAGE handbook of qualitative research in psychology, 2, pp.17-37.
Thomas, J., Utley, J., Hong, S.Y., Korkmaz, H. and Nugent, G., 2020. A Review of the Research. Handbook of Research on STEM Education.
Van der Walt, J.L., 2020. Interpretivism-constructivism as a research method in the humanities and social sciences–more to it than meets the eye. International Journal of Philosophy and Theology, 8(1), pp.59-68.
Wang, Y.Y., Liang, D.D., Lu, C., Shi, Y.X., Zhang, J., Cao, Y., Fang, C., Huang, D. and Jin, Y.H., 2020. An exploration of how developers use qualitative evidence: content analysis and critical appraisal of guidelines. BMC Medical Research Methodology, 20(1), pp.1-28.
Yuvaraj, A., Mahendra, V.S., Chakrapani, V., Yunihastuti, E., Santella, A.J., Ranauta, A. and Doughty, J., 2020. HIV and stigma in the healthcare setting. Oral Diseases, 26, pp.103-111.
Zhu, J. and Liu, W., 2020. A tale of two databases: The use of Web of Science and Scopus in academic papers. Scientometrics, 123(1), pp.321-335.