Delayed HIV testing and treatment seeking, and associated support needs among people living with HIV in Malaysia: a qualitative study
Susan C. S. Chong
A B F , Adeeba Kamarulzaman C D , Iskandar Azwa C , Rong-Xiang Ng C , Meng-Li Chong D , Nishaan Raman C and Adam Bourne B E
+ Author Affiliations
- Author Affiliations
A Department of Public Health, La Trobe University, Melbourne, Vic., Australia.
B Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia.
C Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
D Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia.
E Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
F Corresponding author. Email: s.chong@latrobe.edu.au
Sexual Health 18(2) 147-155 https://doi.org/10.1071/SH20180
Submitted: 28 September 2020 Accepted: 11 December 2020 Published: 15 March 2021
Abstract
Background: By the end of 2017, an estimated 83% of people living with HIV in Malaysia knew their serostatus. However, the Ministry of Health reported a high proportion of those newly diagnosed had low CD4 counts <200 cells/µL, indicating late presentation for testing may be pervasive. Methods: A qualitative study was conducted to explore the context and experiences of people at risk of HIV infection testing and seeking treatment later in the course of their infection. Participants recruited (n = 20) were HIV positive, aged >18 years who fit the description of late presentation (World Health Organization defined as CD4 cell count <350 cells/µL). Semi-structured interviews were conducted, and a framework approach was used to interrogate the data. Results: Many participants perceived themselves at low risk of HIV infection and did not undergo routine voluntary testing; rather, they were diagnosed when seeking treatment for serious illness or as part of mandatory employment-related testing. Perceived lack of confidentiality and potential discriminatory behaviour at public health facilities were significant deterrents to testing. Participants were satisfied with HIV treatment, but rarely sought psychosocial support in order to ‘protect’ their privacy. Conclusion: Unless drivers of HIV infection are effectively addressed, including stigmatising and discriminatory practices, and low health literacy, the occurrence of late presentation will persist. Their collective impact will not only jeopardise efforts to improve the treatment cascade, but may also impact engagement with other biomedical prevention and care technologies.
Keywords: HIV/AIDS, HIV testing, HIV treatment cascade, late diagnosis, late presentation, Malaysia, men who have sex with men, risk behaviours, vulnerable populations.
References
[1] Joint United Nations Programme on HIV/AIDS (UNAIDS). 90–90–90 An ambitious treatment target to help end the AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS; 2014.[2] Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 2006; 20 1447–50.
| Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA.Crossref | GoogleScholarGoogle Scholar | 16791020PubMed |
[3] Moreno S, Mocroft A, Monforte A. Medical and societal consequences of late presentation. Antivir Ther 2010; 15 9–15.
| Medical and societal consequences of late presentation.Crossref | GoogleScholarGoogle Scholar | 20442456PubMed |
[4] Shah RM, Bulgiba A, Lee CK, Haniff J, Ali MM. Highly active antiretroviral therapy reduces mortality and morbidity in patients with AIDS in Sungai Buloh Hospital. J Exp Clin Med 2012; 4 239–44.
| Highly active antiretroviral therapy reduces mortality and morbidity in patients with AIDS in Sungai Buloh Hospital.Crossref | GoogleScholarGoogle Scholar |
[5] Zolopa A, Andersen J, Powderly W, Sanchez A, Sanne I, Suckow C, et al Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial. PLoS One 2009; 4 e5575
| Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial.Crossref | GoogleScholarGoogle Scholar | 19440326PubMed |
[6] Krentz HB, Gill MJ. Cost of medical care for HIV-infected patients within a regional population from 1997 to 2006. HIV Med 2008; 9 721–30.
| Cost of medical care for HIV-infected patients within a regional population from 1997 to 2006.Crossref | GoogleScholarGoogle Scholar | 18643856PubMed |
[7] Sabin CA, Smith CJ, Gumley H, Murphy G, Lampe FC, Phillips AN, et al Late presenters in the era of highly active antiretroviral therapy: uptake of and responses to antiretroviral therapy. AIDS 2004; 18 2145–51.
| Late presenters in the era of highly active antiretroviral therapy: uptake of and responses to antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 15577647PubMed |
[8] World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: World Health Organization; 2016.
[9] Antiretroviral Therapy Cohort Collaboration Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 2008; 372 293–9.
| Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies.Crossref | GoogleScholarGoogle Scholar | 18657708PubMed |
[10] Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2019. Geneva: UNAIDS; 2019.
[11] HIV/STI/Hepatitis C Section of Ministry of Health Malaysia. Country progress report on HIV/AIDS 2019 – Malaysia. Kuala Lumpur: Ministry of Health Malaysia; 2019. Available online at: https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/Umum/Report_GAM_2019_(Final).pdf [verified 12 February 2021].
[12] Sector HIV/STI/Hepatitis C, Disease Control Division, Ministry of Health Malaysia. Malaysia 2018: country progress report on HIV/AIDS. Kuala Lumpur, Malaysia; 2018. Available online at: https://tinyurl.com/zp5ds84k [verified 12 February 2021].
[13] Ahmed SI, Syed Sulaiman SA, Hassali MA, Thiruchelvam K, Hasan SS, Lee CK. Attitudes and barriers towards HIV screening: a qualitative study of people living with HIV/AIDS (PLWHA) in Malaysia. J Infect Prev 2017; 18 242–7.
| Attitudes and barriers towards HIV screening: a qualitative study of people living with HIV/AIDS (PLWHA) in Malaysia.Crossref | GoogleScholarGoogle Scholar | 29317901PubMed |
[14] Lubis R, Bulgiba A, Kamarulzaman A, Hairi NN, Dahlui M, Peramalah D. Predictors of death in Malaysian HIV-infected patients on anti-retroviral therapy. Prev Med 2013; 57 S54–6.
| Predictors of death in Malaysian HIV-infected patients on anti-retroviral therapy.Crossref | GoogleScholarGoogle Scholar | 23352555PubMed |
[15] Hanna DB, Gupta LS, Jones LE, Thompson DM, Kellerman SE, Sackoff JE. AIDS-defining opportunistic illnesses in the HAART era in New York City. AIDS Care 2007; 19 264–72.
| AIDS-defining opportunistic illnesses in the HAART era in New York City.Crossref | GoogleScholarGoogle Scholar | 17364409PubMed |
[16] Iliyasu Z, Abubakar IS, Kabir M, Aliyu MH. Knowledge of HIV/AIDS and attitude towards voluntary counseling and testing among adults. J Natl Med Assoc 2006; 98 1917–22.
| 17225834PubMed |
[17] JinHee L, GabJung K, ByeongSun C, KeeJong H, SungSoon K, MeeKyung K. Increasing late diagnosis in HIV infection in South Korea: 2000–2007. BMC Public Health 2010; 10 411
| Increasing late diagnosis in HIV infection in South Korea: 2000–2007.Crossref | GoogleScholarGoogle Scholar |
[18] Lemoh C, Guy R, Yohannes K, Lewis J, Street A, Biggs B, et al Delayed diagnosis of HIV infection in Victoria 1994 to 2006. Sex Health 2009; 6 117–22.
| Delayed diagnosis of HIV infection in Victoria 1994 to 2006.Crossref | GoogleScholarGoogle Scholar | 19457290PubMed |
[19] Mukolo A, Villegas R, Aliyu M, Wallston KA. Predictors of late presentation for HIV diagnosis: a literature review and suggested way forward. AIDS Behav 2013; 17 5–30.
| Predictors of late presentation for HIV diagnosis: a literature review and suggested way forward.Crossref | GoogleScholarGoogle Scholar | 22218723PubMed |
[20] Manga NM, Diop SA, Ndour CT, Dia NM, Mendy A, Coudec M, et al Late diagnosis of HIV infection in the Fann, Dakar clinic of infectious diseases: testing circumstances, therapeutic course of patients, and determining factors. Med Mal Infect 2009; 39 95–100.
| Late diagnosis of HIV infection in the Fann, Dakar clinic of infectious diseases: testing circumstances, therapeutic course of patients, and determining factors.Crossref | GoogleScholarGoogle Scholar | 19019603PubMed |
[21] Celesia BM, Castronuovo D, Pinzone MR, Bellissimo F, Mughini MT, Lupo G, et al Late presentation of HIV infection: predictors of delayed diagnosis and survival in Eastern Sicily. Eur Rev Med Pharmacol Sci 2013; 17 2218–24.
| 23893189PubMed |
[22] Dickson N, McAllister S, Sharples K, Paul C. Late presentation of HIV infection among adults in New Zealand: 2005–2010. HIV Med 2012; 13 182–9.
| 22093231PubMed |
[23] Helleberg M, Engsig FN, Kronborg G, Laursen AL, Pedersen G, Larsen O, et al Late presenters, repeated testing, and missed opportunities in a Danish nationwide HIV cohort. Scand J Infect Dis 2012; 44 282–8.
| Late presenters, repeated testing, and missed opportunities in a Danish nationwide HIV cohort.Crossref | GoogleScholarGoogle Scholar | 22066814PubMed |
[24] Zoufaly A, Heiden M, Marcus U, Hoffmann C, Stellbrink H, Voss L, et al Late presentation for HIV diagnosis and care in Germany. HIV Med 2012; 13 172–81.
| Late presentation for HIV diagnosis and care in Germany.Crossref | GoogleScholarGoogle Scholar | 22093171PubMed |
[25] Jeong SJ, Italiano C, Chaiwarith R, Ng OT, Vanar S, Jiamsakul A, et al Late presentation into care of HIV disease and its associated factors in Asia: results of TAHOD. AIDS Res Hum Retroviruses 2016; 32 255–61.
| Late presentation into care of HIV disease and its associated factors in Asia: results of TAHOD.Crossref | GoogleScholarGoogle Scholar | 26414065PubMed |
[26] Mojumdar K, Vajpayee M, Chauhan NK, Mendiratta S. Late presenters to HIV care and treatment, identification of associated risk factors in HIV-1 infected Indian population. BMC Public Health 2010; 10 416
| Late presenters to HIV care and treatment, identification of associated risk factors in HIV-1 infected Indian population.Crossref | GoogleScholarGoogle Scholar | 20626905PubMed |
[27] Pe R, Chim B, Thai S, Lynen L, van Griensven J. Advanced HIV disease at enrolment in HIV care: trends and associated factors over a ten year period in Cambodia. PLoS One 2015; 10 e0143320
| Advanced HIV disease at enrolment in HIV care: trends and associated factors over a ten year period in Cambodia.Crossref | GoogleScholarGoogle Scholar | 26606057PubMed |
[28] de Olalla PG, Manzardo C, Sambeat MA, Ocaña I, Knobel H, Humet V, et al Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001–2009. AIDS Res Ther 2011; 8 22
| Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001–2009.Crossref | GoogleScholarGoogle Scholar | 21729332PubMed |
[29] Arnold EA, Rebchook GM, Kegeles SM. ‘Triply cursed’: racism, homophobia and HIV-related stigma are barriers to regular HIV testing, treatment adherence and disclosure among young Black gay men. Cult Health Sex 2014; 16 710–22.
| ‘Triply cursed’: racism, homophobia and HIV-related stigma are barriers to regular HIV testing, treatment adherence and disclosure among young Black gay men.Crossref | GoogleScholarGoogle Scholar | 24784224PubMed |
[30] Chong SCS, Hollingshead BM, Lim SH, Bourne A. A scoping review of sexual transmission related HIV research among key populations in Malaysia: implications for interventions across the HIV care cascade. Glob Public Health 2020; 1–14.
| A scoping review of sexual transmission related HIV research among key populations in Malaysia: implications for interventions across the HIV care cascade.Crossref | GoogleScholarGoogle Scholar | 32985388PubMed |
[31] Lazarus JV, Safreed-Harmon K, Barton SE, Costagliola D, Dedes N, del Amo Valero J, et al Beyond viral suppression of HIV–the new quality of life frontier. BMC Med 2016; 14 94
| Beyond viral suppression of HIV–the new quality of life frontier.Crossref | GoogleScholarGoogle Scholar | 27334606PubMed |
[32] Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In Huberman AM, Miles MB, editors. The qualitative researcher’s companion. Thousand Oaks, CA: SAGE Publications Inc.; 2002; pp. 305–29.
[33] Department of Statistics Malaysia, editor. Household Income and Basic Amenities Survey Report 2019. Kuala Lumpur: Department of Statistics Malaysia; 2020.
[34] Verghis S, Kulasingam KK, Yap KH. A study on medical insurance coverage for people living with HIV (PLHIV) in selected multinational insurance companies in Malaysia. Geneva: International Labour Organization; 2020.
[35] Department of Occupational Safety and Health, editor. Code of Practice on Prevention and Management of HIV/AIDS at the Workplace. Kuala Lumpur: Ministry of Human Resources Malaysia; 2001.
[36] HIV/STI Section, Disease Control Division, Ministry of Health Malaysia. Global AIDS Response Progress Report Malaysia 2015. Kuala Lumpur: Ministry of Health Malaysia; 2015.
[37] Haile BJ, Chambers JW, Garrison JL. Correlates of HIV knowledge and testing: results of a 2003 South African survey. J Black Stud 2007; 38 194–208.
| Correlates of HIV knowledge and testing: results of a 2003 South African survey.Crossref | GoogleScholarGoogle Scholar |
[38] Qiao S, Zhang Y, Li X, Menon JA. Facilitators and barriers for HIV-testing in Zambia: a systematic review of multi-level factors. PLoS One 2018; 13 e0192327
| Facilitators and barriers for HIV-testing in Zambia: a systematic review of multi-level factors.Crossref | GoogleScholarGoogle Scholar | 30517183PubMed |
[39] Sasaki Y, Ali M, Sathiarany V, Kanal K, Kakimoto K. Prevalence and barriers to HIV testing among mothers at a tertiary care hospital in Phnom Penh, Cambodia. Barriers to HIV testing in Phnom Penh, Cambodia. BMC Public Health 2010; 10 494
| Prevalence and barriers to HIV testing among mothers at a tertiary care hospital in Phnom Penh, Cambodia. Barriers to HIV testing in Phnom Penh, Cambodia.Crossref | GoogleScholarGoogle Scholar | 20716380PubMed |
[40] Jean K, Anglaret X, Moh R, Lert F, Dray-Spira R. Barriers to HIV testing in Côte d’Ivoire: the role of individual characteristics and testing modalities. PLoS One 2012; 7 e41353
| Barriers to HIV testing in Côte d’Ivoire: the role of individual characteristics and testing modalities.Crossref | GoogleScholarGoogle Scholar | 22815995PubMed |
[41] Woodford MR, Chakrapani V, Newman PA, Shunmugam M. Barriers and facilitators to voluntary HIV testing uptake among communities at high risk of HIV exposure in Chennai, India. Glob Public Health 2016; 11 363–79.
| Barriers and facilitators to voluntary HIV testing uptake among communities at high risk of HIV exposure in Chennai, India.Crossref | GoogleScholarGoogle Scholar | 26315563PubMed |
[42] Wise JM, Ott C, Azuero A, Lanzi RG, Davies S, Gardner A, et al Barriers to HIV testing: patient and provider perspectives in the Deep South. AIDS Behav 2019; 23 1062–72.
| Barriers to HIV testing: patient and provider perspectives in the Deep South.Crossref | GoogleScholarGoogle Scholar | 30607759PubMed |
[43] Leblanc NM, Flores DD, Barroso J. Facilitators and barriers to HIV screening: a qualitative meta-synthesis. Qual Health Res 2016; 26 294–306.
| Facilitators and barriers to HIV screening: a qualitative meta-synthesis.Crossref | GoogleScholarGoogle Scholar | 26631679PubMed |
[44] Wong LP. Multi-ethnic perspective of uptake of HIV testing and HIV-related stigma: a cross-sectional population-based study. AIDS Care 2013; 25 1356–69.
| Multi-ethnic perspective of uptake of HIV testing and HIV-related stigma: a cross-sectional population-based study.Crossref | GoogleScholarGoogle Scholar | 23406514PubMed |
[45] Schwarcz S, Richards TA, Frank H, Wenzel C, Chin Hsu L, Chin C-SJ, et al Identifying barriers to HIV testing: personal and contextual factors associated with late HIV testing. AIDS Care 2011; 23 892–900.
| Identifying barriers to HIV testing: personal and contextual factors associated with late HIV testing.Crossref | GoogleScholarGoogle Scholar | 21424942PubMed |
[46] Deblonde J, De Koker P, Hamers FF, Fontaine J, Luchters S, Temmerman M. Barriers to HIV testing in Europe: a systematic review. Eur J Public Health 2010; 20 422–32.
| Barriers to HIV testing in Europe: a systematic review.Crossref | GoogleScholarGoogle Scholar | 20123683PubMed |
[47] Worthington C, Myers T. Factors underlying anxiety in HIV testing: risk perceptions, stigma, and the patient-provider power dynamic. Qual Health Res 2003; 13 636–55.
| Factors underlying anxiety in HIV testing: risk perceptions, stigma, and the patient-provider power dynamic.Crossref | GoogleScholarGoogle Scholar | 12756685PubMed |
[48] de Wit JBF, Adam PCG. To test or not to test: psychosocial barriers to HIV testing in high-income countries. HIV Med 2008; 9 20–2.
| To test or not to test: psychosocial barriers to HIV testing in high-income countries.Crossref | GoogleScholarGoogle Scholar |
[49] Kanter J, Koh C, Razali K, Tai R, Izenberg J, Rajan L, et al Risk behaviour and HIV prevalence among men who have sex with men in a multiethnic society: a venue-based study in Kuala Lumpur, Malaysia. Int J STD AIDS 2011; 22 30–7.
| Risk behaviour and HIV prevalence among men who have sex with men in a multiethnic society: a venue-based study in Kuala Lumpur, Malaysia.Crossref | GoogleScholarGoogle Scholar | 21364064PubMed |
[50] den Daas C, Doppen M, Schmidt AJ, de Coul EO. Determinants of never having tested for HIV among MSM in the Netherlands. BMJ Open 2016; 6 e009480
| Determinants of never having tested for HIV among MSM in the Netherlands.Crossref | GoogleScholarGoogle Scholar | 26758261PubMed |
[51] Dowson L, Kober C, Perry N, Fisher M, Richardson D. Why some MSM present late for HIV testing: a qualitative analysis. AIDS Care 2012; 24 204–9.
| Why some MSM present late for HIV testing: a qualitative analysis.Crossref | GoogleScholarGoogle Scholar | 21780956PubMed |
[52] Lim SH, Brown S-E, Shaw SA, Kamarulzaman A, Altice FL, Beyrer C. “You have to keep yourself hidden”: perspectives from Malaysian Malay-Muslim men who have sex with men on policy, network, community, and individual influences on HIV risk. J Homosex 2020; 67 104–26.
| “You have to keep yourself hidden”: perspectives from Malaysian Malay-Muslim men who have sex with men on policy, network, community, and individual influences on HIV risk.Crossref | GoogleScholarGoogle Scholar | 30307803PubMed |
[53] Lim SH, Alias H, Kien JKW, Akbar M, Kamarulzaman A, Wong LP. A qualitative study of HIV “Test-and-Treat” experience among men who have sex with men in Malaysia. AIDS Educ Prev 2019; 31 193–205.
| A qualitative study of HIV “Test-and-Treat” experience among men who have sex with men in Malaysia.Crossref | GoogleScholarGoogle Scholar | 31145000PubMed |
[54] Kickbusch I, Maag D, Kris H. Health literacy. In Kris H, Stella Q, editors. International encyclopedia of public health. Vol. 3. San Diego: Academic Press; 2008. pp. 204–11.
[55] Kalichman SC, Benotsch E, Suarez T, Catz S, Miller J, Rompa D. Health literacy and health-related knowledge among persons living with HIV/AIDS. Am J Prev Med 2000; 18 325–31.
| Health literacy and health-related knowledge among persons living with HIV/AIDS.Crossref | GoogleScholarGoogle Scholar | 10788736PubMed |
[56] Mokhtar MM, Rosenthal DA, Hocking JS, Satar NA. Bridging the gap: Malaysian youths and the pedagogy of school-based sexual health education. Procedia Soc Behav Sci 2013; 85 236–45.
| Bridging the gap: Malaysian youths and the pedagogy of school-based sexual health education.Crossref | GoogleScholarGoogle Scholar |
[57] Burch WJ, Hart GJ, Lim SH. A qualitative study of young men who have sex with men and multilevel factors related to HIV risks in Malaysia. AIDS Educ Prev 2018; 30 85–95.
| A qualitative study of young men who have sex with men and multilevel factors related to HIV risks in Malaysia.Crossref | GoogleScholarGoogle Scholar | 29688771PubMed |
[58] Amal NM, Paramesarvathy R, Tee GH, Gurpreet K, Karuthan C. Prevalence of chronic illness and health seeking behaviour in Malaysian population: results from the Third National Health Morbidity Survey (NHMS III) 2006. Med J Malaysia 2011; 66 36–41.
| 23765141PubMed |
[59] Jin H, Earnshaw VA, Wickersham JA, Kamarulzaman A, Desai MM, John J, et al An assessment of health-care students’ attitudes toward patients with or at high risk for HIV: implications for education and cultural competency. AIDS Care 2014; 26 1223–8.
| An assessment of health-care students’ attitudes toward patients with or at high risk for HIV: implications for education and cultural competency.Crossref | GoogleScholarGoogle Scholar | 24625279PubMed |
[60] Earnshaw VA, Jin H, Wickersham JA, Kamarulzaman A, John J, Lim SH, et al Stigma toward men who have sex with men among future healthcare providers in Malaysia: would more interpersonal contact reduce prejudice? AIDS Behav 2016; 20 98–106.
| Stigma toward men who have sex with men among future healthcare providers in Malaysia: would more interpersonal contact reduce prejudice?Crossref | GoogleScholarGoogle Scholar | 26324078PubMed |
[61] HIV/STI Section of Ministry of Health Malaysia. National Strategic Plan: ending AIDS 2016–2030. Kuala Lumpur: Ministry of Health Malaysia; 2015. Available online at: https://www.aidsdatahub.org/sites/default/files/resource/malaysia-national-strategic-plan-ending-aids-2016-2030.pdf [verified 12 February 2021].
[62] AIDS/STD Section, Department of Public Health, Ministry of Health Malaysia. Guideline for anonymous and voluntary HIV screening. Kuala Lumpur: Ministry of Health; 2003. Available online at: https://tinyurl.com/njc52n7k [verified 12 February 2021].
[63] Medical Services Unit, Medical Development Division, Ministry of Health Malaysia. Guidelines for the management of adult HIV infection with antiretroviral therapy. Kuala Lumpur: Ministry of Health Malaysia; 2011. Available online at: https://www.moh.gov.my/moh/resources/auto%20download%20images/589d71c4dd799.pdf [verified 12 February 2021].
[64] Nyblade L, Jain A, Benkirane M, Li L, Lohiniva AL, McLean R, et al A brief, standardized tool for measuring HIV-related stigma among health facility staff: results of field testing in China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. J Int AIDS Soc 2013; 16 18718
| A brief, standardized tool for measuring HIV-related stigma among health facility staff: results of field testing in China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis.Crossref | GoogleScholarGoogle Scholar | 24242266PubMed |
[65] Yadav S. Perceived social support, hope, and quality of life of persons living with HIV/AIDS: a case study from Nepal. Qual Life Res 2010; 19 157–66.
| Perceived social support, hope, and quality of life of persons living with HIV/AIDS: a case study from Nepal.Crossref | GoogleScholarGoogle Scholar | 20047029PubMed |
[66] Li L, Lee S-J, Thammawijaya P, Jiraphongsa C, Rotheram-Borus MJ. Stigma, social support, and depression among people living with HIV in Thailand. AIDS Care 2009; 21 1007–13.
| Stigma, social support, and depression among people living with HIV in Thailand.Crossref | GoogleScholarGoogle Scholar | 20024757PubMed |
[67] Jia H, Uphold CR, Wu S, Reid K, Findley K, Duncan PW. Health-related quality of life among men with HIV infection: effects of social support, coping, and depression. AIDS Patient Care STDS 2004; 18 594–603.
| Health-related quality of life among men with HIV infection: effects of social support, coping, and depression.Crossref | GoogleScholarGoogle Scholar | 15630787PubMed |
[68] Forouzan A, Shushtari Z, Sajjadi H, Salimi Y, Dejman M. Social support network among people living with HIV/AIDS in Iran. AIDS Research and Treatment 2013; 2013 715381
| Social support network among people living with HIV/AIDS in Iran.Crossref | GoogleScholarGoogle Scholar | 23710351PubMed |
[69] Wong L, Nur Syuhada AR. Stigmatization and discrimination towards people living with or affected by HIV/AIDS by the general public in Malaysia. Southeast Asian J Trop Med Public Health 2011; 42 1119–29.
| 22299438PubMed |
[70] Zulkifli SN, Huang SL, Low W, Wong YL. Study on the impact of HIV on people living with HIV, their families and community in Malaysia Project Report. Kuala Lumpur: United Nations Country Team on HIV/AIDS Malaysia; 2007.
[71] Mehrabi D, Tamam E, Bolong J, Hasan H. A rapid review of the literature on HIV-related stigmatization and discrimination studies in Malaysia. Pertanika J Soc Sci Humanit 2016; 24 701–20.
[72] Positive Malaysian Treatment Access and Advocacy Group (MTAAG+). The People Living with HIV Stigma Index Study in Malaysia. Selangor, Malaysia: Positive Malaysian Treatment Access and Advocacy Group (MTAAG+); 2012. Available online at: https://www.aidsdatahub.org/sites/default/files/resource/plhiv-stigma-index-2012-malaysia.pdf [verified 12 February 2021]
[73] Taylor BS, Fornos L, Tarbutton J, Muñoz J, Saber JA, Bullock D, et al Improving HIV care engagement in the south from the patient and provider perspective: the role of stigma, social support, and shared decision-making. AIDS Patient Care STDS 2018; 32 368–78.
| Improving HIV care engagement in the south from the patient and provider perspective: the role of stigma, social support, and shared decision-making.Crossref | GoogleScholarGoogle Scholar | 30179530PubMed |
[74] Grossman CI, Stangl AL. Global action to reduce HIV stigma and discrimination. J Int AIDS Soc 2013; 16 18881
| Global action to reduce HIV stigma and discrimination.Crossref | GoogleScholarGoogle Scholar | 24242269PubMed |
[75] Audet CM, McGowan CC, Wallston KA, Kipp AM. Relationship between HIV stigma and self-isolation among people living with HIV in Tennessee. PLoS One 2013; 8 e69564
| Relationship between HIV stigma and self-isolation among people living with HIV in Tennessee.Crossref | GoogleScholarGoogle Scholar | 23950897PubMed |
[76] Harris GE, Larsen D. HIV peer counseling and the development of hope: perspectives from peer counselors and peer counseling recipients. AIDS Patient Care STDS 2007; 21 843–60.
| HIV peer counseling and the development of hope: perspectives from peer counselors and peer counseling recipients.Crossref | GoogleScholarGoogle Scholar | 18240894PubMed |
[77] Liamputtong P, Haritavorn N, Kiatying-Angsulee N. HIV and AIDS, stigma and AIDS support groups: perspectives from women living with HIV and AIDS in central Thailand. Soc Sci Med 2009; 69 862–8.
| HIV and AIDS, stigma and AIDS support groups: perspectives from women living with HIV and AIDS in central Thailand.Crossref | GoogleScholarGoogle Scholar | 19539417PubMed |
[78] Peterson JL, Rintamaki LS, Brashers DE, Goldsmith DJ, Neidig JL. The forms and functions of peer social support for people living with HIV. J Assoc Nurses AIDS Care: JANAC 2012; 23 294–305.
| The forms and functions of peer social support for people living with HIV.Crossref | GoogleScholarGoogle Scholar | 22079673PubMed |
[79] Ncama BP, McInerney PA, Bhengu BR, Corless IB, Wantland DJ, Nicholas PK, et al Social support and medication adherence in HIV disease in KwaZulu-Natal, South Africa. Int J Nurs Stud 2008; 45 1757–63.
| Social support and medication adherence in HIV disease in KwaZulu-Natal, South Africa.Crossref | GoogleScholarGoogle Scholar | 18653188PubMed |
[80] Simoni JM, Frick PA, Huang B. A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol 2006; 25 74–81.
| A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 16448300PubMed |
[81] Van Tam V, Larsson M, Pharris A, Diedrichs B, Nguyen HP, Nguyen CTK, et al Peer support and improved quality of life among persons living with HIV on antiretroviral treatment: a randomised controlled trial from north-eastern Vietnam. Health Qual Life Outcomes 2012; 10 53
| Peer support and improved quality of life among persons living with HIV on antiretroviral treatment: a randomised controlled trial from north-eastern Vietnam.Crossref | GoogleScholarGoogle Scholar | 22606977PubMed |
