# Evaluating the Impact of Intersectional Stigma on Linkage to Cancer Care in HIV-Associated Kaposi's Sarcoma in East Africa

> **NIH NIH U54** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2021 · $198,085

## Abstract

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as "NOT-
CA-21-026”. In sub-Saharan Africa, Kaposi’s sarcoma (KS) remains one of the most common HIV-related
cancers and — by virtue of the high prevalence of HIV infection in the region — one of the commonest in
the general population. Not only is KS common in Africa, but it is also frequently fatal; two-year mortality
following KS diagnosis is as high as 45%. Reasons for poor survival are diverse, but one potentially
modifiable cause is failure to promptly link patients to cancer care following diagnosis. In one setting in
Kenya, for example, only 50% of patients with KS clinically eligible for chemotherapy actually received it.
 Stigma occurs when individuals are recognized, labeled as “other”, and discriminated against because of
socially undesirable characteristics. In resource-rich settings, the health consequences of stigma, including
amongst persons with cancer, have been recognized for over 50 years. In resource-limited settings, stigma
has been most intensely studied amongst persons with HIV infection. There has been comparatively scant
investigation of stigma amongst patients with cancer in resource-limited settings, but where it has been
studied, manifestations are similar to resource-rich settings. HIV-associated KS in Africa has the potential
to confer three co-occurring forms of stigma: cancer-related stigma, skin disease-related stigma, and
HIV-related stigma. As such, this cancer provides a unique lens to study stigma in resource-limited settings.
If present amongst patients with HIV-associated KS, these three “intersecting” forms of stigma may impact
healthcare engagement at many levels, including the crucial initial linkage to cancer care after diagnosis.
 As an administrative supplement to U54 CA254571, our overarching goal is to study the magnitude and
impact of stigma on linkage to care in patients with HIV-associated KS in East Africa. Our specific aims are:
 Aim 1. Describe intersectional stigma in patients with newly diagnosed HIV-associated KS. Using
 semi-structured interviews and quantitative instruments, we will describe the prevalence and relationship
 between 3 forms of stigma: a) cancer-related, b) skin disease-related; and c) HIV-related.
 Aim 2. Assess the impact of stigma on linkage to cancer care in HIV-associated KS. Among
 patients with newly-diagnosed HIV-associated KS in western Kenya, we will evaluate the impact of the 3
 stigma types on linkage to cancer care, defined as time to a) first Oncology Clinic visit, b) first evaluation
 by an oncology provider at the clinic qualified to make a treatment plan, and c) initial chemotherapy use.
To address these aims, we will study stigma in an already-existing population laboratory for the investigation
of HIV-associated KS in the AMPATH network in western Kenya, supported by parent grant U54 CA254571.
Findings from this work are expected to expand our understanding...

## Key facts

- **NIH application ID:** 10406121
- **Project number:** 3U54CA254571-02S1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Andrew Ddungu Kambugu
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $198,085
- **Award type:** 3
- **Project period:** 2020-07-13 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10406121

## Citation

> US National Institutes of Health, RePORTER application 10406121, Evaluating the Impact of Intersectional Stigma on Linkage to Cancer Care in HIV-Associated Kaposi's Sarcoma in East Africa (3U54CA254571-02S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10406121. Licensed CC0.

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