Factors That Enhance Health Literacy in Dealing with HIV Stigma: A Scoping Review

Document Type : Review Article.


1 Doctoral Student, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia

2 Faculty of Health Sciences, Universitas Aisyiyah Bandung, Indonesia

3 Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia

4 Centre for Nursing Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Malaysia Puncak Alam Campus, Selangor, Malaysia

5 Faculty of Health Sciences, Universitas Aisyiyah Bandung, Bandung, Indonesia


Background and Objectives: Efforts to reveal the factors that drive health literacy toward eradicating stigma in people with HIV/AIDS are significant. This study aimed to identify and extract the factors that promote health literacy in eliminating HIV stigma in society. 

Material and Methods: The scoping reviews study was used to map out the evidence for recommendations based on PRISMA-ScR. Systematically search through Scopus, Web of Science (WOS), CINAHL via EBSCOhost, and SpringerLink to find articles published during 2017-2022. Studies were selected based on inclusion criteria, focusing on factors that mediate health literacy in eradicating HIV/AIDS stigma. 

Results: Twenty-eight articles met the criteria and were used in the review. After reviewing the articles, the factors that promote health literacy in eradicating HIV stigma in society were divided into three main dimensions: personal characteristics, societal and environmental factors, and situational factors regarding the disease, with 16 component factors. 

Conclusion: Health literacy impacts reducing social stigma against people with HIV in society. Factors influencing health literacy must be considered to optimize social stigma reduction. The factors mentioned comprise individual traits, knowledge, motivation, social support, information media, awareness of the disease, fear of HIV transmission, perception of the disease, and personal beliefs about HIV disease. Health professionals could use this evidence to promote health literacy to address the social stigma against people living with HIV based on the factors related to health literacy.


Acknowledgements: We express our profound appreciation to all the respondents involved in this study. We also thank the Directorate General of Higher Education, Research, and Technology, Ministry of Education, Culture, Research, and Technology of the Republic of Indonesia and Universitas Airlangga, Surabaya, Indonesia, for supporting this study.

Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Conflicts of interests: The authors declare that they have no competing interests.

Consent for publication: Not applicable.

Ethical approval and consent to participate: Not applicable.

Funding: This study was funded by the Directorate General of Higher Education, Research, and Technology, Ministry of Education, Culture, Research, and Technology of the Republic of Indonesia (Contract Number 1323/UN3/LPPM/PT.01.03/2023).

Author contributions: AW created the study's presented idea, concept, and design. AW and ATW wrote the draft of the manuscript. AW directed the study, is the guarantor, accepts full responsibility for the finished work and the study's conduct, and has access to the data. AY, NDK and SY performed the review. AW and ATW revised the manuscript. All authors discussed the findings and provided feedback on the manuscript. All authors approved the final version of the manuscript to be published and revised the manuscript. All authors discussed the results and provided input on the manuscript.

1- Kiviniemi MT, Orom H, Waters EA, McKillip M, Hay JL. Education‐based disparities in knowledge of novel health risks: The case of knowledge gaps in HIV risk perceptions. Br J Health Psychol. 2018;23:420-435. doi: https://doi.org/10.1111/bjhp.12297.
PMid:29388364 PMCid:PMC5882541
2- Marcelin JR, Siraj DS, Victor R, Kotadia S, Maldonado YA. The impact of unconscious bias in healthcare: how to recognize and mitigate it. J Infect Dis. 2019;220:S62-S73. doi: https://doi.org/10.1093/infdis/jiz214.
3-Jugeo N, Moalusi KP. My secret: The social meaning of HIV/AIDS stigma. SAHARA-J J Soc Asp HIV/AIDS. 2014;11:76-83.
PMid:24980478 PMCid:PMC4272192
4- Saki M, Kermanshahi SMK, Mohammadi E, Mohraz M. Perception of patients with HIV/AIDS from stigma and discrimination. Iran Red Crescent Med J. 2015;17. doi: https://doi.org/10.5812/ircmj.25831v2.
PMid:26290751 PMCid:PMC4537784
5- Pescosolido BA, Martin JK. The stigma complex. Annu Rev Sociol. 2015;41:87. doi: https://doi.org/10.1146/annurev-soc-071312-145702.
PMid:26855471 PMCid:PMC4737963
6-Turan B, Budhwani H, Fazeli PL, Browning WR, Raper JL, Mugavero MJ, Turan JM. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS Behav. 2017;21:283-291. doi: https://doi.org/10.1007/s10461-016-1451-5.
PMid:27272742 PMCid:PMC5143223
7- Sweeney SM, Vanable PA. The association of HIV-related stigma to HIV medication adherence: a systematic review and synthesis of the literature. AIDS Behav. 2016;20:29-50. doi: https://doi.org/10.1007/s10461-015-1164-1.
8- Charles B, Jeyaseelan L, Pandian AK, Sam AE, Thenmozhi M, Jayaseelan V. Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India-a community based cross sectional study. BMC Public Health. 2012;12:1-11. doi: https://doi.org/10.1186/1471-2458-12-463.
PMid:22720691 PMCid:PMC3444349
9- Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, Wilson M, Logie CH, Shi Q, Morassaei S, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open [Internet]. 2016;6:e011453. doi: 10.1136/bmjopen-2016-011453.
PMid:27412106 PMCid:PMC4947735
10- James TG, Ryan SJ. HIV knowledge mediates the relationship between HIV testing history and stigma in college students. J Am Coll Heal. 2018;66:561-569. doi: https://doi.org/10.1080/07448481.2018.1432623.
11- Li X, Yuan L, Li X, Shi J, Jiang L, Zhang C, Yang X, Zhang Y, Zhao D, Zhao Y. Factors associated with stigma attitude towards people living with HIV among general individuals in Heilongjiang, Northeast China. BMC Infect Dis. 2017;17:1-6. doi: https://doi.org/10.1186/s12879-017-2216-0.
PMid:28212610 PMCid:PMC5316215
12- Diress GA, Ahmed M, Linger M. Factors associated with discriminatory attitudes towards people living with HIV among adult population in Ethiopia: analysis on Ethiopian demographic and health survey. Sahara J [Internet]. 2020;17:38-44. doi: 10.1080/17290376.2020.1857300.
PMid:33357027 PMCid:PMC7759280
13- Ziersch A, Walsh M, Baak M, Rowley G, Oudih E, Mwanri L. "It is not an acceptable disease": A qualitative study of HIV-related stigma and discrimination and impacts on health and wellbeing for people from ethnically diverse backgrounds in Australia. BMC Public Health. 2021;21:1-15.
PMid:33892683 PMCid:PMC8063420
14- Guzys D, Kenny A, Dickson-Swift V, Threlkeld G. A critical review of population health literacy assessment. BMC Public Health. 2015;15:1-7. doi: https://doi.org/10.1186/s12889-015-1551-6.
PMid:25885742 PMCid:PMC4351936
15- Ancker JS, Grossman L V, Benda NC. Health literacy 2030: is it time to redefine the term? J Gen Intern Med. 2020;35:2427-2430. doi: https://doi.org/10.1007/s11606-019-05472-y.
PMid:31659662 PMCid:PMC7403287
16- Arriaga M, Francisco R, Nogueira P, Oliveira J, Silva C, Câmara G, Sørensen K, Dietscher C, Costa A. Health Literacy in Portugal: Results of the Health Literacy Population Survey Project 2019-2021. Int J Environ Res Public Health [Internet]. 2022;19:4225. doi: 10.3390/ijerph19074225.
PMid:35409905 PMCid:PMC8998262
17- Wilandika A, Pandin MGR, Yusuf A. The roles of nurses in supporting health literacy: a scoping review. Front Public Heal [Internet]. 2023;11:1022803. doi: 10.3389/fpubh.2023.1022803.
PMid:37663836 PMCid:PMC10469320
18- Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:1-13. doi: https://doi.org/10.1186/1471-2458-12-80.
PMid:22276600 PMCid:PMC3292515
19- Zarcadoolas C, Pleasant A, Greer DS. Understanding health literacy: an expanded model. Health Promot Int. 2005;20:195-203. doi: https://doi.org/10.1093/heapro/dah609.
20- Munangatire T, Tomas N, Mareka V. Nursing students' understanding of health literacy and health practices: a cross-sectional study at a university in Namibia. BMC Nurs. 2022;21:1-8. doi: https://doi.org/10.1186/s12912-021-00776-z.
PMid:34983503 PMCid:PMC8725331
21- Koduah AO, Amoah PA, Nkansah JO, Leung AYM. A Comparative Analysis of Student and Practising Nurses' Health Literacy Knowledge in Ghana. Healthcare. Multidisciplinary Digital Publishing Institute; 2021. p. 38.
PMid:33406747 PMCid:PMC7823597
22- Ayaz-Alkaya S, Terzi H. Investigation of health literacy and affecting factors of nursing students. Nurse Educ Pract. 2019;34:31-35. doi: https://doi.org/10.1016/j.nepr.2018.10.009.
23- Grau LE, Brothers S, Kim JY, Khwaja A, Heimer R, Stopka TJ. The HIV Care Continuum in Small Cities of Southern New England: Perspectives of People Living with HIV/AIDS, Public Health Experts, and HIV Service Providers. AIDS Behav [Internet]. 2021;25:897-907. doi: 10.1007/s10461-020-03049-z.
PMid:33001353 PMCid:PMC7887013
24- Kim S, Oh J. The relationship between e-health literacy and health-promoting behaviors in nursing students: A multiple mediation model. Int J Environ Res Public Health. 2021;18:5804. doi: https://doi.org/10.3390/ijerph18115804.
PMid:34071469 PMCid:PMC8199246
25- Yang Q, Yu S, Wang C, Gu G, Yang Z, Liu H. Health literacy and its socio-demographic risk factors in Hebei: A cross-sectional survey. Medicine (Baltimore). 2021;100. doi: https://doi.org/10.1097/md.0000000000025975.
PMid:34032709 PMCid:PMC8154485
26- Wittenberg E, Ferrell B, Kanter E, Buller H. Health literacy: exploring nursing challenges to providing support and understanding. Clin J Oncol Nurs. 2018;22:53-61. doi: https://doi.org/10.1188/18.cjon.53-61.
PMid:29350714 PMCid:PMC5776742
27- Izadirad H, Zareban I. The relationship of health literacy with health status, preventive behaviors and health services utilization in Baluchistan, Iran. J Educ Community Heal. 2022;2:43-50. doi: https://doi.org/10.20286/jech-02036.
28- Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med [Internet]. 2018;169:467-473. doi: 10.7326/M18-0850.
29- Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol [Internet]. 2018;18:143. doi: 10.1186/s12874-018-0611-x.
PMid:30453902 PMCid:PMC6245623
30- Peters MDJ, Godfrey CM, McInerney P, Soares CB, Khalil H, Parker D. The Joanna Briggs Institute reviewers' manual 2015: methodology for JBI scoping reviews. 2015;
31- Pieper D, Antoine S-L, Neugebauer EAM, Eikermann M. Up-to-dateness of reviews is often neglected in overviews: a systematic review. J Clin Epidemiol [Internet]. 2014;67:1302-1308. doi: https://doi.org/10.1016/j.jclinepi.2014.08.008.
32- Ballard M, Montgomery P. Risk of bias in overviews of reviews: a scoping review of methodological guidance and four-item checklist. Res Synth Methods [Internet]. 2017;8:92-108. doi: 10.1002/jrsm.1229.
33- Lockwood C, dos Santos KB, Pap R. Practical Guidance for Knowledge Synthesis: Scoping Review Methods. Asian Nurs Res (Korean Soc Nurs Sci) [Internet]. 2019;13:287-294. doi: 10.1016/j.anr.2019.11.002.
34- Sianturi EI, Perwitasari DA, Soltief SN, Atiqul Islam M, Geboers B, Taxis K. Health literacy of people living with HIV in a rural area in Indonesia: A cross‐sectional study. Health Soc Care Community. 2021;29:127-134.
PMid:32649018 PMCid:PMC7818436
35- Akpotor ME, Ajao EO, Okwuikpo MI, Leslie TA. Personal dispositions as predictors of student nurses' prejudice, stereotyping, and discrimination against human immunodeficiency virus-infected persons in Osun State, Nigeria. Nurs Midwifery Stud [Internet]. 2020;9:21. doi: 10.4103/nms.nms_60_19.
36- Tang J, Zheng Y, Zhang DY, Yu XL, Ren JL, Li M, Luo Y, Tian M, Chen YH. Evaluation of an AIDS Educational Mobile Game (AIDS Fighter Health Defense) for Young Students to Improve AIDS-Related Knowledge, Stigma, and Attitude Linked to High-Risk Behaviors in China: Randomized Controlled Trial. JMIR SERIOUS GAMES. 2022;10. doi: 10.2196/32400.
PMid:34870603 PMCid:PMC8822421
37- Alemi Q, Stempel C. Association between HIV knowledge and stigmatizing attitudes towards people living with HIV in Afghanistan: Findings from the 2015 Afghanistan Demographic and Health Survey. Int Health [Internet]. 2019;11:440-446. doi: 10.1093/inthealth/ihz013.
38- Pitasi MA, Chavez PR, DiNenno EA, Jeffries IV WL, Johnson CH, Demeke H, August EM, Bradley H. Stigmatizing attitudes toward people living with hiv among adults and adolescents in the United States. AIDS Behav [Internet]. 2018;22:3887-3891. doi: 10.1007/s10461-018-2188-0.
PMid:29948338 PMCid:PMC6209522
39- Budhwani H, Gakumo C, Yigit I, Rice WS, Fletcher FE, Whitfield S, Ross S, Konkle-Parker DJ, Cohen MH, Wingood GM. Patient health literacy and communication with providers among women living with HIV: a mixed methods study. AIDS Behav. 2022;26:1422-1430.
PMid:34642834 PMCid:PMC9001740
40- Limbasiya RD, Prabhakar MM, Gadhavi R. Stigmatizing Attitudes in Community towards People Living with HIV/AIDS: A Cross-Sectional Study. Indian J Physiother Occup Ther [Internet]. 2018;12:107-111. doi: 10.5958/0973-5674.2018.00019.9.
41- Siegel K, Meunier É, Lekas H-M. The experience and management of HIV stigma among HIV-negative adults in heterosexual serodiscordant relationships in New York City. AIDS Care [Internet]. 2018;30:871-878. doi: 10.1080/09540121.2018.1441971.
PMid:29458264 PMCid:PMC5989564
42- Koseoglu-Ornek O, Tabak F, Mete B. Stigma in Hospital: an examination of beliefs and attitudes towards HIV/AIDS patients, Istanbul. AIDS Care [Internet]. 2020;32:1045-1051. doi: 10.1080/09540121.2020.1769833.
43- Shrestha R, Lim SH, Altice FL, Copenhaver M, Wickersham JA, Saifi R, Ab Halim MA, Naning H, Kamarulzaman A. Use of Smartphone to Seek Sexual Health Information Online Among Malaysian Men Who Have Sex with Men (MSM): Implications for mHealth Intervention to Increase HIV Testing and Reduce HIV Risks. J Community Health [Internet]. 2020;45:10-19. doi: 10.1007/s10900-019-00713-x.
PMid:31375976 PMCid:PMC6957731
44- Ortiz-Sánchez EJ, Rodríguez-Díaz CE, Jovet-Toledo GG, Santiago-Rodríguez EI, Vargas-Molina RL, Rhodes SD, Ortiz-Sanchez EJ, Rodriguez-Diaz CE, Jovet-Toledo GG, Santiago-Rodriguez EI, et al. Sexual health knowledge and stigma in a community sample of HIV-positive gay, bisexual, and other men who have sex with men in Puerto Rico. J HIV-AIDS Soc Serv [Internet]. 2017;16:143-153. doi: 10.1080/15381501.2016.1169467.
PMid:29033695 PMCid:PMC5636013
45- Leyva-Moral JM, Dominguez-Cancino KA, Guevara-Vasquez GM, Edwards JE, Palmieri PA. Faculty attitudes about caring for people living with HIV/AIDS: A comparative study. J Nurs Educ [Internet]. 2019;58:712-717. doi: 10.3928/01484834-20191120-06.
46- Tavakoli F, Karamouzian M, Rafiei-Rad AA, Iranpour A, Farrokhnia M, Noroozi M, Sharifi A, Marshall BDL, Shokoohi M, Sharifi H. HIV-related stigma among healthcare providers in different healthcare settings: A cross-sectional study in Kerman, Iran. Int J Heal Policy Manag [Internet]. 2020;9:163-169. doi: 10.15171/ijhpm.2019.92.
PMid:32331496 PMCid:PMC7182146
47- Mathew RS, Boonsuk P, Dandu M, Sohn AH. Experiences with stigma and discrimination among adolescents and young adults living with HIV in Bangkok, Thailand. AIDS Care [Internet]. 2020;32:530-535. doi: 10.1080/09540121.2019.1679707.
48- Thainiyom P, Elder K. Emotional Appeals in HIV Prevention Campaigns: Unintended Stigma Effects. Am J Health Behav [Internet]. 2017;41:390-400. doi: 10.5993/AJHB.41.4.3.
49- Bozkurt O, Bayırlı Turan D. Evaluation of the knowledge and stigmatization level of HIV/AIDS and related factors. J Psychiatr Nurs [Internet]. 2020;11:41-48. doi: 10.14744/phd.2020.88156.
50- Ching CY, Mawardi M, Ismail AH. Stigmatizing attitudes toward people living with HIV/AIDS (PLWHA) among primary health care providers in Kinta District, Perak. Malaysian Fam Physician [Internet]. 2021;16:31-49. doi: 10.51866/OA0001.
PMid:33948140 PMCid:PMC8088731
51- Govender R, Bowen P, Edwards P, Cattell K. AIDS-related knowledge, stigma and customary beliefs of South African construction workers. AIDS Care [Internet]. 2017;29:711-717. doi: 10.1080/09540121.2016.1227764. Cited: in: : PMID: 27590530.
52- Williams LD, Korobchuk A, Pavlitina E, Nikolopoulos GK, Skaathun B, Schneider J, Kostaki E-G, Smyrnov P, Vasylyeva TI, Psichogiou M, et al. Experiences of Stigma and Support Reported by Participants in a Network Intervention to Reduce HIV Transmission in Athens, Greece; Odessa, Ukraine; and Chicago, Illinois. AIDS Behav [Internet]. 2019;23:1210-1224. doi: 10.1007/s10461-019-02402-1.
PMid:30680540 PMCid:PMC6511315
53- Tran BX, Than PQT, Tran TT, Nguyen CT, Latkin CA. Changing Sources of Stigma against Patients with HIV/AIDS in the Rapid Expansion of Antiretroviral Treatment Services in Vietnam. Biomed Res Int [Internet]. 2019;1-9. doi: 10.1155/2019/4208638.
PMid:30805364 PMCid:PMC6363237
54- Kadengye DT, Dalal S. Social intolerance, risky sexual behaviors and their association with HIV knowledge among Ugandan adults: results from a national survey. AIDS Care [Internet]. 2019;31:250-254. doi: 10.1080/09540121.2018.1488028.
55- Akpotor ME, Emuraye UA, Akpotor OE, Oyibocha EO, Ogheneriode I, Chigbo CA. Knowledge about HIV and HIV Stigma Mechanism of Nursing Students in Southwestern Nigeria. Int J Caring Sci [Internet]. 2018;11:819-830.
56- Maponyane E, Govender I, Nel K, Marincowitz G. Knowledge, attitudes, behaviour and beliefs of sefako makgatho health sciences university undergraduate students regarding human immunodeficiency virus and acquired immune deficiency syndrome. Stud Ethno-Medicine [Internet]. 2018;12:285-291. doi: 10.31901/24566772.2018/12.04.573.
57- Ncitakalo N, Mabaso M, Joska J, Simbayi L. Factors associated with external HIV-related stigma and psychological distress among people living with HIV in South Africa. SSM - Popul Heal [Internet]. 2021;14. doi: 10.1016/j.ssmph.2021.100809.
PMid:34027011 PMCid:PMC8121694
58- Cook L. HIV stigma reduction and health literacy education program with a cross-generational populaton in an African American faith-based church. J Public Heal. 2021;29:1089-1106. doi: 10.1007/s10389-020-01203-4.
59- Naserirad M, Ayari F, Hamdini A, Hadiji K. Effectiveness of a peer-led HIV/AIDS education program on HIV-related health literacy of jailed adolescents in Tunis, Tunisia. J Public Heal. 2019;27:425-433. doi: 10.1007/s10389-018-0975-8.
60- Bauermeister JA, Muessig KE, LeGrand S, Flores DD, Choi SK, Dong W, Sallabank G, Hightow-Weidman LB. HIV and sexuality stigma reduction through engagement in online forums: results from the HealthMPowerment intervention. AIDS Behav. 2019;23:742-752.
PMid:30121727 PMCid:PMC6379154
61- Grotkamp SL, Cibis WM, Nüchtern EAM, von Mittelstaedt G, Seger WKF. Personal Factors in the International Classification of Functioning, Disability and Health: Prospective Evidence. Aust J Rehabil Couns [Internet]. 2012;18:1-24. doi: 10.1017/jrc.2012.4.
62- Alstveit M, Lahti S, Jónsdóttir SS, Egeland N, Sørensen SK, Eklund AJ. Public health nurse education in the Nordic countries. Public Health Nurs [Internet]. 2022;39:270-278. doi: 10.1111/phn.13029.
63- Khasanah U, Rahardjo S, Nurlaili A. Usage of Information Media toward Teenage Girl Knowledge about Reproductive Health at Bangkalan Regency. Aloha Int J Educ Adv. 2019;1:4-7.
64- UNAIDS. Key programmes to reduce stigma and discrimination and increase access to justice in national HIV responses Guidance note 2012. Geneva; 2012.
65- SaeidiFard N, Haeri-Mehrizi AA, Akbarzadeh Z, Janbozorgi N, Montazeri A, Yaseri M, Shab-Bidar S. Association of health literacy and nutritional literacy with sun exposure in adults using structural equation modelling. BMC Public Health. 2022;22:1-9. doi: https://doi.org/10.1186/s12889-022-13465-6.
PMid:35689215 PMCid:PMC9185953
66- Leung AYM, Cheung MKT, Chi I. Supplementing vitamin D through sunlight: associating health literacy with sunlight exposure behavior. Arch Gerontol Geriatr. 2015;60:134-141. doi: https://doi.org/10.1016/j.archger.2014.10.005.
67- Miller CT, Grover KW, Bunn JY, Solomon SE. Community Norms About Suppression of AIDS-Related Prejudice and Perceptions of Stigma by People With HIV or AIDS. Psychol Sci [Internet]. 2011;22:579-583. doi: 10.1177/0956797611404898.
PMid:21478473 PMCid:PMC3433166
68- Miller CT, Varni SE, Solomon SE, DeSarno MJ, Bunn JY. Macro-level implicit HIV prejudice and the health of community residents with HIV. Heal Psychol [Internet]. 2016;35:807-815. doi: 10.1037/hea0000314.
PMid:27505199 PMCid:PMC4979556