Journal Article

Ebola virus disease-related stigma among survivors declined in Liberia over an 18-month, post-outbreak period: An observational cohort study

Wilson, Barthalomew, Reilly, Cavan, Fallah, Mosoka P., Glayweon, Meekie, Weiser, Sheri D., Kelly, J. Daniel, Cooper, Joseph B., Steward, Wayne T., Drew, Clara, Sneller, Michael C., Johnson, Kumblytee

2019

Overview

While qualitative assessments of Ebola virus disease (EVD)-related stigma have been undertaken among survivors and the general public, quantitative tools and assessment targeting survivors have been lacking. Beginning in June 2015, EVD survivors from seven Liberian counties, where most of the country's EVD cases occurred, were eligible to enroll in a longitudinal cohort. Seven stigma questions were adapted from the People Living with HIV Stigma Index and asked to EVD survivors over the age of 12 at initial visit (median 358 days post-EVD) and 18 months later. Primary outcome was a 7-item EVD-related stigma index. Explanatory variables included age, gender, educational level, pregnancy status, post-EVD hospitalization, referred to medical care and EVD source. Proportional odds logistic regression models and generalized linear mixed-effects models were used to assess stigma at initial visit and over time. The stigma questions were administered to 859 EVD survivors at initial visit and 741 (86%) survivors at follow-up. While 63% of survivors reported any stigma at initial visit, only 5% reported any stigma at follow-up. Over the 18-month period, there was a significant decrease in stigma among EVD survivors (Adjusted Odds Ratio [AOR], 0.02; 95% Confidence Interval [CI], 0.01-0.04). At initial visit, having primary, junior high or vocational education, and being referred to medical care was associated with higher odds of stigma (educational level: AOR, 1.82; 95%CI, 1.27-2.62; referred: AOR, 1.50; 95%CI, 1.16-1.94). Compared to ages of 20-29, those who had ages of 12-19 or 50+ experienced lower odds of stigma (12-19: AOR, 0.32; 95%CI, 0.21-0.48; 50+: AOR, 0.58 95%CI, 0.37-0.91). Our data suggest that EVD-related stigma was much lower more than a year after active Ebola transmission ended in Liberia. Among survivors who screened negative for stigma, additional probing may be considered based on age, education, and referral to care.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Age / Analysis / Attitudes / Biology and life sciences / Cohort analysis / Cohort Studies / Cohorts / Community / Confidence intervals / Disease / Disease Outbreaks / Disease transmission / Ebola hemorrhagic fever / Ebola virus / Ebolavirus / Education / Epidemics / Female / Gender / Health aspects / Health care / Health surveys / Hemorrhagic Fever, Ebola - epidemiology / Hemorrhagic Fever, Ebola - virology / HIV / HIV carriers discrimination / HIV patients / Human immunodeficiency virus / Humans / Liberia - epidemiology / Logistic Models / Male / Marginalized groups / Medicine and Health Sciences / Middle Aged / Observational studies / Odds Ratio / Outbreaks / People and Places / Pregnancy / Public health / Qualitative research / Questions / Regression analysis / Regression models / Research and Analysis Methods / Social Sciences / Social Stigma / Statistical analysis / Stigma / Surveys and Questionnaires / Survival / Survivors - psychology / Survivors - statistics & numerical data / Transmission / Tropical diseases / Viral diseases / Virus diseases / Viruses / Young Adult