Michelle C Davidson1, Scott Lu2,3, M Bailor Barrie3,4, Adams Freeman4, Mohamed Mbayoh4, Mohamed Kamara4, Alexander C Tsai5, Thomas Crea6, George W Rutherford2,3, Sheri D Weiser7, J Daniel Kelly2,3,8. 1. School of Medicine, University of California, San Francisco, CA, USA. 2. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. 3. Institute for Global Health Sciences, University of California, San Francisco, CA, USA. 4. Partners In Health, Freetown, Sierra Leone. 5. Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA. 6. School of Social Work, Boston College, Boston, MA, USA. 7. Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA. 8. F.I. Proctor Foundation, University of California, San Francisco, CA, USA.
Abstract
Background: Based on findings from other contexts, informed by intergroup contact theory, that more contact is associated with less stigma, we hypothesized that community members with greater exposure to cases of Ebola virus disease (EVD) were less likely to report EVD-related stigma towards EVD survivors. We assessed personal stigmatizing attitudes towards Ebola survivors, which reflects personal fear and judgement, as well as perceived stigma towards EVD survivors, which reflects an individual's perception of the attitudes of the community towards a stigmatized group. Methods: From September 2016 to July 2017, we conducted a cross-sectional, community-based study of EVD-related stigma among individuals who did not contract Ebola in four EVD-affected rural communities of Kono District, Sierra Leone. We identified individuals from all quarantined households and obtained a random sample of those who were unexposed. Exposed individuals either lived in a quarantined household or were reported to have been in contact with an EVD case. Our explanatory variable was proximity to an EVD case during the outbreak. Our primary outcome was stigma towards EVD survivors, measured by a 6-item adapted HIV-related stigma index validated in Zambia and South Africa, with 1 item reflecting personal stigmatizing attitudes and 5 items reflecting perceived community stigma. The 6-item EVD stigma index had good internal consistency (Cronbach's alpha=0.82). We used modified Poisson and negative binomial regression models, adjusting for potential confounders, to estimate the association between exposure proximity and EVD stigma. Results: We interviewed 538 participants aged 12 to 85 years. Most (57%) had been quarantined. Over one-third (39%) reported personal stigmatizing attitudes or perceived community stigma; the most frequently endorsed item was fear and judgment towards EVD survivors. Having contact with someone with EVD was significantly associated with a lower likelihood of perceived community stigma (prevalence ratio [PR], 0.26; 95% CI, 0.13-0.54) and personal stigmatizing attitudes (PR, 0.44; 95% CI, 0.29-0.65). In contrast, being quarantined was significantly associated with a higher likelihood of perceived community stigma (PR, 3.9; 95% CI, 1.5-10.1). Conclusions: In this cross-sectional study, we found evidence of an inverse relationship between EVD-related stigma and contact with an EVD case. This finding substantiates intergroup contact theory and may form the basis for anti-stigma interventions.
Background: Based on findings from other contexts, informed by intergroup contact theory, that more contact is associated with less stigma, we hypothesized that community members with greater exposure to cases of Ebola virus disease (EVD) were less likely to report EVD-related stigma towards EVD survivors. We assessed personal stigmatizing attitudes towards Ebola survivors, which reflects personal fear and judgement, as well as perceived stigma towards EVD survivors, which reflects an individual's perception of the attitudes of the community towards a stigmatized group. Methods: From September 2016 to July 2017, we conducted a cross-sectional, community-based study of EVD-related stigma among individuals who did not contract Ebola in four EVD-affected rural communities of Kono District, Sierra Leone. We identified individuals from all quarantined households and obtained a random sample of those who were unexposed. Exposed individuals either lived in a quarantined household or were reported to have been in contact with an EVD case. Our explanatory variable was proximity to an EVD case during the outbreak. Our primary outcome was stigma towards EVD survivors, measured by a 6-item adapted HIV-related stigma index validated in Zambia and South Africa, with 1 item reflecting personal stigmatizing attitudes and 5 items reflecting perceived community stigma. The 6-item EVD stigma index had good internal consistency (Cronbach's alpha=0.82). We used modified Poisson and negative binomial regression models, adjusting for potential confounders, to estimate the association between exposure proximity and EVD stigma. Results: We interviewed 538 participants aged 12 to 85 years. Most (57%) had been quarantined. Over one-third (39%) reported personal stigmatizing attitudes or perceived community stigma; the most frequently endorsed item was fear and judgment towards EVD survivors. Having contact with someone with EVD was significantly associated with a lower likelihood of perceived community stigma (prevalence ratio [PR], 0.26; 95% CI, 0.13-0.54) and personal stigmatizing attitudes (PR, 0.44; 95% CI, 0.29-0.65). In contrast, being quarantined was significantly associated with a higher likelihood of perceived community stigma (PR, 3.9; 95% CI, 1.5-10.1). Conclusions: In this cross-sectional study, we found evidence of an inverse relationship between EVD-related stigma and contact with an EVD case. This finding substantiates intergroup contact theory and may form the basis for anti-stigma interventions.
Entities:
Keywords:
Ebola; Sierra Leone; Social epidemiology; Stigma; sub-Saharan Africa
Authors: David M Ndetei; Victoria Mutiso; Anika Maraj; Kelly K Anderson; Christine Musyimi; Kwame McKenzie Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2015-07-08 Impact factor: 4.328
Authors: Tine Van Bortel; Anoma Basnayake; Fatou Wurie; Musu Jambai; Alimamy Sultan Koroma; Andrew T Muana; Katrina Hann; Julian Eaton; Steven Martin; Laura B Nellums Journal: Bull World Health Organ Date: 2016-01-21 Impact factor: 9.408
Authors: Azizeh Nuriddin; Mohamed F Jalloh; Erika Meyer; Rebecca Bunnell; Franklin A Bio; Mohammad B Jalloh; Paul Sengeh; Kathy M Hageman; Dianna D Carroll; Lansana Conteh; Oliver Morgan Journal: BMJ Glob Health Date: 2018-04-01
Authors: Anne L Stangl; Valerie A Earnshaw; Carmen H Logie; Wim van Brakel; Leickness C Simbayi; Iman Barré; John F Dovidio Journal: BMC Med Date: 2019-02-15 Impact factor: 8.775
Authors: J Daniel Kelly; Sheri D Weiser; Barthalomew Wilson; Joseph B Cooper; Meekie Glayweon; Michael C Sneller; Clara Drew; Wayne T Steward; Cavan Reilly; Kumblytee Johnson; Mosoka P Fallah Journal: PLoS Negl Trop Dis Date: 2019-02-27
Authors: Mohamed F Jalloh; Wenshu Li; Rebecca E Bunnell; Kathleen A Ethier; Ann O'Leary; Kathy M Hageman; Paul Sengeh; Mohammad B Jalloh; Oliver Morgan; Sara Hersey; Barbara J Marston; Foday Dafae; John T Redd Journal: BMJ Glob Health Date: 2018-03-17