The Role of Stigma in HIV Prevention: A Focused Analysis of PrEP Hesitancy in Guyana
Abstract:
Human immunodeficiency virus (HIV) remains a major
global health challenge, responsible for more than 42.3 million deaths as of
July 2024. Despite the proven efficacy of pre-exposure prophylaxis (PrEP),
uptake in Guyana remains limited, particularly among high-risk populations.
This mixed-methods study investigated barriers to PrEP uptake in Guyana,
focusing on stigma. A total of 280 participants completed structured
questionnaires and 10 took part in in-depth interviews. Quantitative data were
analyzed descriptively to determine prevalence of awareness and barriers, while
thematic analysis using NVivo was employed for qualitative data. Findings
revealed that 60% of participants had considered PrEP; however, stigma (50%),
lack of awareness (36%), affordability (32%), side-effect concerns (29%), and
confidentiality fears (21%) emerged as key barriers. Stigma was consistently
described in interviews as fear of being labeled promiscuous or HIV-positive,
leading to reluctance to seek PrEP services. Younger participants and LGBTQ+
individuals reported higher stigma experiences. Integration of both strands
demonstrated how stigma interacts with structural issues such as cost and
clinic availability, creating cumulative deterrents. Recommendations include
provider training, culturally sensitive anti-stigma campaigns, community
outreach, and decentralized service delivery. These findings underscore the
urgent need for Guyana to address stigma as part of national HIV prevention
strategies and to achieve UNAIDS 95-95-95 targets. Limitations include reliance
on convenience sampling and descriptive statistics, which may restrict
representativeness and generalizability.
References:
[1].
World
Health Organization, HIV – Global. Available at: https://www.who.int (Accessed:
2024).
[2].
World
Health Organization, HIV Data and Statistics. Available at:
https://www.who.int/data (Accessed: 2024).
[3].
National
AIDS Program Secretariat, 2022, National AIDS Program Secretariat Annual
Report, Georgetown, Guyana.
[4].
World
Health Organization, Pre-Exposure Prophylaxis (PrEP). Available at:
https://www.who.int (Accessed: 2024).
[5].
World
Health Organization, 2016, Consolidated guidelines on HIV prevention,
diagnosis, treatment, and care for key populations – 2016 update, Geneva: WHO.
[6].
Munthali,
T., Banda, H., & Chirwa, M., 2022, HIV PrEP uptake and barriers among
adolescents in sub-Saharan Africa, Journal of HIV Prevention and Care,
19(2), 115–128.
[7].
Davoudpour,
M., Haynes, S., & Kumar, P., 2024, Stigma and adherence to PrEP: Insights
from low-income settings, AIDS Care, 36(1), 45–59.
[8].
UNAIDS,
2024, Guyana Country Overview. Available at:
https://www.unaids.org/en/regionscountries/countries/guyana (Accessed: 2024).
[9].
Calabrese,
S., 2020, Understanding stigma and HIV prevention in diverse populations, The
Lancet HIV, 7(5), e301–e309.
[10]. World Health Organization, 2024, Global
HIV/AIDS Statistics. Available at: https://www.who.int (Accessed: 2024).
[11]. Bureau of Statistics, Guyana, 2023,
Demography, Vital, and Social Statistics. Available at:
https://statisticsguyana.gov.gy (Accessed: 2024).
[12]. Cohen, L., Manion, L., & Morrison, K.,
2017, Research Methods in Education, 8th ed., Routledge: Abingdon.
[13]. Cosmas, R., Joseph, L., & Browne, A.,
2024, Stigma and PrEP use in the Caribbean: Evidence from the Eastern
Caribbean, Caribbean Journal of Health, 9(2), 45–58.
[14]. Mizuno, Y., et al., 2022, Healthcare
providers’ views on practice models that may facilitate PrEP prescribing: A
qualitative meta-synthesis, Health Promotion Practice, 23(6), 999–1014. https://doi.org/10.1177/15248399211038364
[15]. Kiggundu, V., et al., 2024, Structural
barriers to PrEP uptake in Africa, HIV Research & Clinical Practice,
28(3), 234–243.
[16]. U.S. Food and Drug Administration, 2012, FDA
approves first drug for reducing the risk of sexually acquired HIV infection.
Available at: https://www.fda.gov
[17]. U.S. Food and Drug Administration, 2019, FDA
approves second drug to prevent HIV infection as part of ongoing efforts to end
the HIV epidemic. Available at: https://www.fda.gov
[18]. Wang, J., Li, M., Chen, X., & Zhao, H.,
2022, PrEP implementation challenges in low-income countries: Lessons for the
Caribbean, BMC Infectious Diseases, 22(315), 1–10. https://doi.org/10.1186/s12879-022-07315-2
[19]. Murphy, L., Singh, A., & Lopez, R., 2023, Barriers to HIV prevention: A global systematic review, Journal of Public Health Research, 12(1), 33–42. https://doi.org/10.4081/jphr.2023.3342
