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Sample records for care hiv stigma

  1. STIGMA AROUND HIV IN DENTAL CARE: PATIENTS' EXPERIENCES.

    PubMed

    Brondani, Mario A; Phillips, J Craig; Kerston, R Paul; Moniri, Nardin R

    2016-02-01

    Tooth decay and other oral diseases can be highly prevalent among people living with HIV/AIDS (PLWHA). Even though dental professionals are trained to provide equal and non-judgemental services to all, intentional or unintentional biases may exist with regard to PLWHA. We conducted qualitative descriptive research using individual interviews to explore the experiences of PLWHA accessing dental care services in Vancouver, Canada. We interviewed 25 PLWHA, aged 23-67 years; 21 were men and 60% reported fair or poor oral health. Thematic analysis showed evidence of both self-stigma and public stigma with the following themes: fear, self-stigma and dental care; overcoming past offences during encounters with dental care professionals; resilience and reconciliation to achieve quality care for all; and current encounters with dental care providers. Stigma attached to PLWHA is detrimental to oral care. The social awareness of dental professionals must be enhanced, so that they can provide the highest quality care to this vulnerable population. PMID:27548661

  2. Re-thinking HIV-Related Stigma in Health Care Settings: A Qualitative Study.

    PubMed

    Gagnon, Marilou

    2015-01-01

    People living with HIV (PLWH) continue to endure stigma and discrimination in the context of health care. This paper presents the findings of a qualitative study designed to (a) describe stigmatizing and discriminatory practices in health care settings, and (b) explore both symbolic and structural stigma from the perspectives of PLWH. For the purpose of this qualitative study, 21 semi-structured in-depth interviews were conducted in the province of Quebec, Canada. The data were analyzed following the principles of thematic analysis. During analysis, three themes were identified, and relations between these themes were delineated to reflect the experiences of participants. The findings suggest that HIV-related stigma in health care settings is episodic in nature. The findings also suggest that HIV-related stigma is experienced through interactions with health care providers (symbolic stigma) and, finally, that it is applied systematically to manage risk in the context of health care (structural stigma). PMID:26300466

  3. Stigma in HIV-infected health care workers in Kenya: a mixed-method approach.

    PubMed

    Opollo, Jackline G; Gray, Jennifer

    2015-01-01

    HIV-related stigma decreases access to HIV testing, prevention, and treatment services. Our mixed methods study explored stigma as perceived, experienced, and managed in a sample of 76 HIV-infected health care workers in Kisumu, Kenya. Stigma was quantitatively measured using the HIV/AIDS Stigma Instrument for People Living with AIDS (HASI-P). Overall, subjects experienced low stigma levels (mean = 7.88, SD = 12.90; range = 0-61), and none of the sociodemographic variables were predictive of stigma. Transcript analysis of 20 qualitative interviews revealed two negative themes (blame, lack of knowledge) and five positive themes (living positively, optimism, empathy, support, changes over time). Three themes emerged on reducing stigma (normalizing, empowerment, leading by example). Disclosure, access to treatment, stigma reduction training, workplace support groups, and awareness of an HIV workplace policy may have contributed to low stigma scores. Qualitative findings corroborated quantitative findings and corresponded to the six domains of the HASI-P. PMID:25769752

  4. Reducing HIV-related stigma among health-care professionals: a game-based experiential approach.

    PubMed

    Mak, Winnie W S; Cheng, Shannon S Y; Law, Rita W; Cheng, Winnie W L; Chan, Fei

    2015-01-01

    Stigmatizing attitudes from health professionals toward people living with HIV (PLHIV) constitute a key barrier to HIV care. Despite considerable progress in HIV stigma-reduction research, we are still searching for effective strategies that can be implemented on a larger scale. To narrow this research gap, the present study investigated a novel cost-effective approach to reducing HIV-related stigma among health professionals. Interactive experiential games were used to help participants gain first-hand experience of potential stressors that PLHIV might encounter. The effectiveness of this game-based experiential approach was compared with that of in vivo contact in reducing HIV-related stigma among students in the health-care fields. Eighty-eight students of health-related programs in Hong Kong were randomly assigned to either the game-based or in vivo contact program. They completed measures of stigmatizing attitudes and HIV/AIDS-related knowledge at pre-program, post-program, and one-month follow-up. Findings showed that the effectiveness of the game-based experiential approach in reducing HIV-related stigma was similar to that of in vivo contact both at post-program and one-month follow-up. Further research is needed to explore the potential value of the game-based approach in reducing HIV stigma among health professionals. PMID:25671591

  5. Navigating identity, territorial stigma, and HIV care services in Vancouver, Canada: A qualitative study.

    PubMed

    Collins, Alexandra B; Parashar, Surita; Closson, Kalysha; Turje, Rosalind Baltzer; Strike, Carol; McNeil, Ryan

    2016-07-01

    This study examines the influence of territorial stigma on access to HIV care and other support services. Qualitative interviews were conducted with thirty people living with HIV (PLHIV) who use drugs recruited from the Dr. Peter Centre (DPC), an HIV care facility located in Vancouver, Canada's West End neighbourhood that operates under a harm reduction approach. Findings demonstrated that territorial stigma can undermine access to critical support services and resources in spatially stigmatized neighbourhoods among PLHIV who use drugs who have relocated elsewhere. Furthermore, PLHIV moving from spatially stigmatized neighbourhoods - in this case, Vancouver's Downtown Eastside - to access HIV care services experienced tension with different groups at the DPC (e.g., men who have sex with me, people who use drugs), as these groups sought to define who constituted a'normative' client. Collectively, these findings demonstrate the urgent need to consider the siting of HIV care services as the epidemic evolves. PMID:27341275

  6. Patient and Provider Perspectives on HIV and HIV-Related Stigma in Dutch Health Care Settings

    PubMed Central

    Sicking, Lenneke; Brands, Ronald; Baas, Ineke; Roberts, Hilde; van Brakel, Wim H.; Lechner, Lilian; Kok, Gerjo; Bos, Arjan E. R.

    2014-01-01

    Abstract Ensuring that people living with HIV (PLWH) feel accepted in health care settings is imperative. This mixed methods study explored the perspectives of PLWH and health professionals on their interactions. A total of 262 predominantly gay men of Dutch origin participated in a survey study of possible negative interactions with health professionals, and semi-structured interviews were subsequently conducted with 22 PLWH and 14 health professionals. Again, most PLWH were gay men of Dutch origin. All health professionals were Dutch. PLWH reported negative experiences with health professionals including awkward interactions, irrelevant questions, rude treatment, blame, pity, excessive or differential precautions, care refusal, unnecessary referrals, delayed treatment, poor support, and confidentiality breaches. They also reported positive experiences including equal treatment, being valued as a partner in one's health, social support provision, and confidentiality assurances. Health professionals reported having little experience with PLWH and only basic knowledge of HIV. They contended that PLWH are treated equally and that HIV is no longer stigmatized, but also reported fear of occupational infection, resulting in differential precautions. Additionally, they conveyed labeling PLWH's files to warn others, and curiosity regarding how patients acquired HIV. The findings suggest that there is a gap in perception between PLWH and health professionals regarding the extent to which negative interactions occur, and that these interactions should be improved. Implications for stigma reduction and care optimization are discussed. PMID:25459231

  7. Perceived stigma reductions following participation in mental health services integrated within community-based HIV primary care.

    PubMed

    Farber, Eugene W; Shahane, Amit A; Brown, Jennifer L; Campos, Peter E

    2014-01-01

    HIV stigma remains a significant challenge for individuals living with HIV disease that can adversely affect overall well-being and patterns of HIV health service engagement. Finding ways to effectively address stigma concerns is, therefore, an important consideration in the clinical management of HIV disease. This study examined changes in perceived stigma in a sample of 48 adults living with HIV disease as an outcome of their participation in a mental health services program integrated with community-based HIV primary care. Participants completed a self-report instrument that provided a multidimensional measure of perceived HIV stigma, including distancing, blaming, and discrimination dimensions. This scale was administered at the baseline mental health service visit and then re-administered at the three-month follow-up point. Study results showed reductions in self-reported perceived HIV stigma over time for the distancing (t = 4.01, p = 0.000, d = 0.43), blaming (t = 2.79, p = 0.008, d = 0.35), and discrimination (t = 2.90, p = 0.006, d = 0.42) dimensions of stigma. These findings suggest that participation in HIV mental health services may have a favorable impact on perceived HIV stigma. Implications of these findings are discussed, including possible mechanisms that might explain the observed results as well as suggested directions for future research in this area. Randomized controlled trials would represent an important next step to investigate the extent to which HIV mental health services can reduce levels of perceived HIV stigma. PMID:24093931

  8. EXPERIENCES OF HIV/AIDS STIGMA OF PERSONS LIVING WITH HIV/AIDS AND NURSES INVOLVED IN THEIR CARE FROM FIVE AFRICAN COUNTRIES

    PubMed Central

    Greeff, Minrie; Uys, Leana R; Holzemer, William L; Makoae, Lucia N; Dlamini, Priscilla S; Kohi, Thecla W; Chirwa, Maureen L; Naidoo, Joanne R; Phetlhu, Rene D.

    2009-01-01

    The concept of stigma has received significant attention in recent years in the HIV/AIDS literature. Although there is some change towards the positive, AIDS still remains a significantly stigmatized condition. AIDS stigma and discrimination continue to influence people living with and affected by HIV (PLWA), as well as their health-care providers. Unless stigma is conquered, the illness will not be defeated. Due to the burden that HIV/AIDS places on people living in Africa, a five-year project entitled Perceived AIDS Stigma: A Multinational African Study was undertaken. The focus of the first phase of this project was on exploring and describing the meaning and effect of stigma on PLWA from the experiences of PLWA and the nurses involved in their care in five African countries: Lesotho, Swaziland, Malawi, South Africa and Tanzania. An exploratory descriptive qualitative research design was used to explore and describe the experience of stigma through the critical incident method. Purposive voluntary sampling was utilized. Forty-three focus group discussions were held with respondents to relate incidences which they themselves observed, as well as those that they themselves experienced in the community and in families. The transcribed data was analyzed through the technique of open coding using the NVivo 2.0 analysis package. Three types of stigma (received stigma, internal stigma and associated stigma) and several dimensions for each of these types of stigma emerged from the data. Recommendations were made to pursue these findings further. PMID:20052299

  9. EXPERIENCES OF HIV/AIDS STIGMA OF PERSONS LIVING WITH HIV/AIDS AND NURSES INVOLVED IN THEIR CARE FROM FIVE AFRICAN COUNTRIES.

    PubMed

    Greeff, Minrie; Uys, Leana R; Holzemer, William L; Makoae, Lucia N; Dlamini, Priscilla S; Kohi, Thecla W; Chirwa, Maureen L; Naidoo, Joanne R; Phetlhu, Rene D

    2008-01-01

    The concept of stigma has received significant attention in recent years in the HIV/AIDS literature. Although there is some change towards the positive, AIDS still remains a significantly stigmatized condition. AIDS stigma and discrimination continue to influence people living with and affected by HIV (PLWA), as well as their health-care providers. Unless stigma is conquered, the illness will not be defeated. Due to the burden that HIV/AIDS places on people living in Africa, a five-year project entitled Perceived AIDS Stigma: A Multinational African Study was undertaken. The focus of the first phase of this project was on exploring and describing the meaning and effect of stigma on PLWA from the experiences of PLWA and the nurses involved in their care in five African countries: Lesotho, Swaziland, Malawi, South Africa and Tanzania. An exploratory descriptive qualitative research design was used to explore and describe the experience of stigma through the critical incident method. Purposive voluntary sampling was utilized. Forty-three focus group discussions were held with respondents to relate incidences which they themselves observed, as well as those that they themselves experienced in the community and in families. The transcribed data was analyzed through the technique of open coding using the NVivo 2.0 analysis package. Three types of stigma (received stigma, internal stigma and associated stigma) and several dimensions for each of these types of stigma emerged from the data. Recommendations were made to pursue these findings further. PMID:20052299

  10. Workplace interventions to reduce HIV and TB stigma among health care workers - Where do we go from here?

    PubMed

    Siegel, Jacob; Yassi, Annalee; Rau, Asta; Buxton, Jane A; Wouters, Edwin; Engelbrecht, Michelle C; Uebel, Kerry E; Nophale, Letshego E

    2015-01-01

    Fear of stigma and discrimination among health care workers (HCWs) in South African hospitals is thought to be a major factor in the high rates of HIV and tuberculosis infection experienced in the health care workforce. The aim of the current study is to inform the development of a stigma reduction intervention in the context of a large multicomponent trial. We analysed relevant results of four feasibility studies conducted in the lead up to the trial. Our findings suggest that a stigma reduction campaign must address community and structural level drivers of stigma, in addition to individual level concerns, through a participatory and iterative approach. Importantly, stigma reduction must not only be embedded in the institutional management of HCWs but also be attentive to the localised needs of HCWs themselves. PMID:25769042

  11. HIV stigma as a barrier to retention in HIV care at a general hospital in Lima, Peru: a case-control study.

    PubMed

    Valenzuela, Carla; Ugarte-Gil, Cesar; Paz, Jorge; Echevarria, Juan; Gotuzzo, Eduardo; Vermund, Sten H; Kipp, Aaron M

    2015-02-01

    HIV stigma as a barrier to retention in HIV care has not been well-studied outside the United States. We conducted a case-control study in Lima, Peru to examine this issue. Cases were out-of-care for ≥12 months (n = 66) and controls were recruited from patients in active care presenting for a clinic visit (n = 110). A previously validated HIV stigma scale with four domains was used. Associations between being out-of-care and each stigma domain were assessed using multivariable logistic regression. Stigma scores were highest for disclosure concerns. Modest associations were found for greater disclosure concerns (OR 1.16; 95 % CI 0.99, 1.36) and concerns with public attitudes (OR 1.20; 95 % CI 1.03, 1.40). Enacted stigma and negative self-image showed non-linear associations with being out-of-care that plateaued or declined, respectively, at higher levels of stigma. The threshold effect for enacted stigma warrants further exploration, while disclosure concerns may be especially amenable to intervention in this population. PMID:25269871

  12. HIV Stigma as a Barrier to Retention in HIV Care at a General Hospital in Lima, Peru: a Case-Control Study

    PubMed Central

    Valenzuela, Carla; Ugarte-Gil, Cesar; Paz, Jorge; Echevarria, Juan; Gotuzzo, Eduardo; Vermund, Sten H.; Kipp, Aaron M.

    2015-01-01

    HIV stigma as a barrier to retention in HIV care has not been well-studied outside the United States. We conducted a case-control study in Lima, Peru to examine this issue. Cases were out-of-care for ≥12 months (n=66) and controls were recruited from patients in active care presenting for a clinic visit (n=110). A previously validated HIV stigma scale with four domains was used. Associations between being out-of-care and each stigma domain were assessed using multivariable logistic regression. Stigma scores were highest for disclosure concerns. Modest associations were found for greater disclosure concerns (OR=1.16; 95% CI: 0.99, 1.36) and concerns with public attitudes (OR=1.20; 95% CI: 1.03, 1.40). Enacted stigma and negative self-image showed non-linear associations with being out-of-care that plateaued or declined, respectively, at higher levels of stigma. The threshold effect for enacted stigma warrants further exploration, while disclosure concerns may be especially amenable to intervention in this population. PMID:25269871

  13. A comparison of HIV stigma and discrimination in five international sites: the influence of care and treatment resources in high prevalence settings.

    PubMed

    Maman, Suzanne; Abler, Laurie; Parker, Lisa; Lane, Tim; Chirowodza, Admire; Ntogwisangu, Jacob; Srirak, Namtip; Modiba, Precious; Murima, Oliver; Fritz, Katherine

    2009-06-01

    What accounts for differences in HIV stigma across different high prevalence settings? This study was designed to examine HIV stigma and discrimination in five high prevalence settings. Qualitative data were collected as part of the U.S. National Institute of Mental Health (NIMH) Project Accept, a multi-site community randomized trial of community-based HIV voluntary counseling and testing. In-depth interviews were conducted with 655 participants in five sites, four in Sub-Saharan Africa and one in Southeast Asia. Interviews were conducted in the local languages by trained research staff. Data were audiotaped, transcribed, translated, coded and computerized for thematic data analysis. Participants described the stigmatizing attitudes and behaviors perpetuated against people living with HIV/AIDS (PLWHA). The factors that contribute to HIV stigma and discrimination include fear of transmission, fear of suffering and death, and the burden of caring for PLWHA. The family, access to antiretrovirals and other resources, and self-protective behaviors of PLWHA protected against HIV stigma and discrimination. Variation in the availability of health and socioeconomic resources designed to mitigate the impact of HIV/AIDS helps explain differences in HIV stigma and discrimination across the settings. Increasing access to treatment and care resources may function to lower HIV stigma, however, providing services is not enough. We need effective strategies to reduce HIV stigma as treatment and care resources are scaled up in the settings that are most heavily impacted by the HIV epidemic. PMID:19394121

  14. A comparison of HIV stigma and discrimination in five international sites: The influence of care and treatment resources in high prevalence settings

    PubMed Central

    Maman, Suzanne; Abler, Laurie; Parker, Lisa; Lane, Tim; Chirowodza, Admire; Ntogwisangu, Jacob; Srirak, Namtip; Modiba, Precious; Murima, Oliver; Fritz, Katherine

    2009-01-01

    What accounts for differences in HIV stigma across different high prevalence settings? This study was designed to examine HIV stigma and discrimination in five high prevalence settings. Qualitative data were collected as part of the US National Institute of Mental Health (NIMH) Project Accept, a multi-site community randomized trial of community-based HIV voluntary counseling and testing. In-depth interviews were conducted with 655 participants in five sites, four in Sub-Saharan Africa and one in Southeast Asia. Interviews were conducted in the local languages by trained research staff. Data were audiotaped, transcribed, translated, coded and computerized for thematic data analysis. Participants described the stigmatizing attitudes and behaviors perpetuated against people living with HIV/AIDS (PLWHA). The factors that contribute to HIV stigma and discrimination include fear of transmission, fear of suffering and death, and the burden of caring for PLWHA. The family, access to antiretrovirals and other resources, and self-protective behaviors of PLWHA protected against HIV stigma and discrimination. Variation in the availability of health and socioeconomic resources designed to mitigate the impact of HIV/AIDS helps explain differences in HIV stigma and discrimination across the settings. Increasing access to treatment and care resources may function to lower HIV stigma, however providing services is not enough. We need effective strategies to reduce HIV stigma as treatment and care resources are scaled up in the settings that are most heavily impacted by the HIV epidemic. PMID:19394121

  15. Improving hospital-based quality of care by reducing HIV-related stigma: evaluation results from Vietnam.

    PubMed

    Pulerwitz, Julie; Oanh, Khuat Thi Hai; Akinwolemiwa, Dayo; Ashburn, Kim; Nyblade, Laura

    2015-02-01

    Operations Research conducted at four hospitals in Vietnam sought to reduce HIV-related stigma and discrimination among hospital workers. The quasi-experimental study compared effects of focusing on 'fear-based' stigma (stemming from lack of knowledge) versus both fear-based and social stigma (stemming from moral judgments). Interventions included staff training (ranging from physicians to ward cleaners), hospital policy development, and supplies provision. At baseline (n = 795), reported stigma was substantial (e.g., about half of hospital workers indicated fear of casually touching PLHIV, and felt HIV was a punishment for bad behavior). By endline, stigma measures had improved significantly for both intervention groups (e.g., proportion reporting signs on beds indicating HIV status decreased from 51 to 24 % in Arm 1, and 31 to 7 % in Arm 2), with the combined intervention group showing greater effects. This study highlights successful strategies to reduce stigma, and thus, improve quality of care for PLHIV. PMID:25382350

  16. Reducing HIV-Related Stigma in Health Care Settings: A Randomized Controlled Trial in China

    PubMed Central

    Wu, Zunyou; Liang, Li-Jung; Guan, Jihui; Jia, Manhong; Rou, Keming; Yan, Zhihua

    2013-01-01

    Objectives. The objective of the intervention was to reduce service providers’ stigmatizing attitudes and behaviors toward people living with HIV. Methods. The randomized controlled trial was conducted in 40 county-level hospitals in 2 provinces of China between October 2008 and February 2010. Forty-four service providers were randomly selected from each hospital, yielding a total of 1760 study participants. We randomized the hospitals to either an intervention condition or a control condition. In the intervention hospitals, about 15% of the popular opinion leaders were identified and trained to disseminate stigma reduction messages. Results. We observed significant improvements for the intervention group in reducing prejudicial attitudes (P < .001), reducing avoidance intent towards people living with HIV (P < .001), and increasing institutional support in the hospitals (P = .003) at 6 months after controlling for service providers’ background factors and clinic-level characteristics. The intervention effects were sustained and strengthened at 12 months. Conclusions. The intervention reduced stigmatizing attitudes and behaviors among service providers. It has the potential to be integrated into the health care systems in China and other countries. PMID:23237175

  17. Exploring the Concept of HIV-Related Stigma

    PubMed Central

    Florom-Smith, Aubrey L.; De Santis, Joseph P.

    2013-01-01

    BACKGROUND HIV infection is a chronic, manageable illness. Despite advances in the care and treatment of people living with HIV infection, HIV-related stigma remains a challenge to HIV testing, care, and prevention. Numerous studies have documented the impact of HIV-related stigma among various groups of people living with HIV infection, but the concept of HIV-related stigma remains unclear. PURPOSE Concept exploration of HIV-related stigma via an integrative literature review was conducted in order to examine the existing knowledge base of this concept. METHODS Search engines were employed to review the existing knowledge base of this concept. CONCLUSION After the integrative literature review, an analysis of HIV-related stigma emerged. Implications for future concept analysis, research, and practice are included. PMID:22861652

  18. HIV stigma among substance abusing people living with HIV/AIDS: implications for HIV treatment.

    PubMed

    Levi-Minzi, Maria A; Surratt, Hilary L

    2014-08-01

    HIV-related stigma has a major impact on quality of life and health among people living with HIV and AIDS (PLWHA). This study examines demographic, mental health, behavioral, contextual, and HIV care-related correlates of HIV stigma among 503 substance abusing PLWHA. Stigma was measured with the HIV Internalized Stigma Measure which has four subscales: stereotypes about HIV, self-acceptance, disclosure concerns, and social relationships. Severe substance dependence (55.3%) and depression (54.7%) were associated with higher HIV stigma across all domains. 49.9% of the sample reported antiretroviral (ARV) medication diversion (the unlawful sale and trading of ARV medications); diverters endorsed significantly higher stigma related to disclosure. 54.1% of the sample reported ≥95% ARV adherence; these individuals reported significantly lower stigma for self-acceptance, disclosure, and social relationships. Multivariate linear regression showed that depression and social support demonstrated significant main effects across stigma domains. Findings suggest that interventions to decrease HIV related stigma may be an important component of initiatives to increase engagement in HIV care. PMID:24983302

  19. Inmates with HIV, stigma, and disclosure decision-making.

    PubMed

    Derlega, Valerian J; Winstead, Barbara A; Gamble, Kimberly A; Kelkar, Kalika; Khuanghlawn, Priscilla

    2010-03-01

    Seventeen male, former inmates with HIV were interviewed about their experiences with HIV in a jail or prison in the southeastern region of the United States. Participants reported that stereotypes and prejudicial attitudes about HIV/AIDS were widely held by other inmates, and that concerns about HIV/AIDS stigma affected their decisions about HIV disclosure. The results suggest the need to better educate inmates and institutional staff about HIV/AIDS stigma and to increase privacy protection for inmates with HIV, especially in the context of providing medical care and dispensing medications. PMID:20207669

  20. From Conceptualizing to Measuring HIV Stigma: A Review of HIV Stigma Mechanism Measures

    PubMed Central

    Chaudoir, Stephenie R.

    2015-01-01

    Recent analyses suggest that lack of clarity in the conceptualization and measurement of HIV stigma at an individual level is a significant barrier to HIV prevention and treatment efforts. In order to address this concern, we articulate a new framework designed to aid in clarifying the conceptualization and measurement of HIV stigma among individuals. The HIV Stigma Framework explores how the stigma of HIV elicits a series of stigma mechanisms, which in turn lead to deleterious outcomes for HIV uninfected and infected people. We then apply this framework to review measures developed to gauge the effect of HIV stigma since the beginning of the epidemic. Finally, we emphasize the utility of using three questions to guide future HIV stigma research: who is affected by, how are they affected by, and what are the outcomes of HIV stigma? PMID:19636699

  1. Understanding HIV-related stigma among Indonesian nurses.

    PubMed

    Waluyo, Agung; Culbert, Gabriel J; Levy, Judith; Norr, Kathleen F

    2015-01-01

    Evidence indicates widespread stigmatization of persons living with HIV (PLWH) in Indonesia. Such attitudes among health care workers could impede the country's policies for effective diagnosis and medical treatment of PLWH. Nonetheless, research to guide interventions to reduce stigma in health care settings is lacking. Also, the contributions of workplace, religion, and HIV knowledge to nurses' HIV-related stigma are poorly understood. Our cross-sectional study aimed to describe factors associated with nurses' stigmatizing attitudes toward PLWH. Four hundred nurses recruited from four hospitals in Jakarta, Indonesia, were surveyed using the Nurse AIDS Attitude Scale to measure stigma. Stigmatizing attitudes were significantly predicted by education, HIV training, perceived workplace stigma, religiosity, Islamic religious identification, and affiliation with the Islamic hospital. HIV knowledge was not a significant predictor of stigmatizing attitudes. Organization changes fostering workplace diversity are likely to substantially reduce stigmatizing attitudes in nurses. PMID:24759060

  2. Understanding HIV-related stigma among Indonesian nurses

    PubMed Central

    Waluyo, Agung; Culbert, Gabriel J.; Levy, Judith; Norr, Kathleen

    2014-01-01

    Evidence indicates widespread stigmatization of persons living with HIV (PLWH) in Indonesia. Such attitudes among health care workers could impede the country’s policies for effective diagnosis and medical treatment of PLWH. Nonetheless, research to guide interventions to reduce stigma in health care settings is lacking. Also, the contributions of workplace, religion, and HIV knowledge to nurses’ HIV-related stigma are poorly understood. Our cross-sectional study aimed to describe factors associated with nurses’ stigmatizing attitudes toward PLWH. Four hundred nurses recruited from 4 hospitals in Jakarta, Indonesia, were surveyed using the Nurse AIDS Attitude Scale (NAAS) to measure stigma. Stigmatizing attitudes were significantly predicted by education, HIV training, perceived workplace stigma, religiosity, Islamic religious identification, and affiliation with the Islamic hospital. HIV knowledge was not a significant predictor of stigmatizing attitudes. Organization changes fostering workplace diversity are likely to substantially reduce stigmatizing attitudes in nurses. PMID:24759060

  3. The value of reducing HIV stigma.

    PubMed

    Brent, Robert J

    2016-02-01

    HIV-stigma is a major reason why HIV continues to be a global epidemic. Interventions targeting HIV-stigma are therefore necessary. To find an intervention that is worthwhile, a Cost-Benefit Analysis is needed which compares costs and benefits. There are many documented costs of HIV-stigma. What is missing is a valuation of the benefits of reducing HIV-stigma. The purpose of this paper is to present a general method that can be used to value the benefits of stigma reduction programs. The method involves estimating the marginal rate of substitution (MRS) between stigma and income in the utility function of older people with HIV. To illustrate how our framework can be used, we applied it to a sample of just over 900 people coming from the 2005-06 ROAH study (Research on Older Adults with HIV) in New York City. PMID:26820574

  4. Psychological reactance and HIV-related stigma among women living with HIV.

    PubMed

    Brown, Monique J; Serovich, Julianne M; Kimberly, Judy A; Hu, Jinxiang

    2016-06-01

    Psychological reactance is defined as the drive to re-establish autonomy after it has been threatened or constrained. People living with HIV may have high levels of psychological reactance due to the restrictions that they may perceive as a result of living with HIV. People living with HIV may also exhibit levels of HIV-related stigma. The relationship between psychological reactance and HIV-related stigma is complex yet understudied. Therefore, the main aim of this study was to examine the association between psychological reactance and HIV-related stigma among women living with HIV. Data were obtained from one time-point (a cross-sectional assessment) of a longitudinal HIV disclosure study. Psychological reactance was measured using the 18-item Questionnaire for the Measurement of Psychological Reactance. HIV-related stigma was measured using the HIV Stigma Scale, which has four domains: personalized, disclosure concerns, negative self-image, and concerns with public attitudes. Principal component analysis was used to derive components of psychological reactance. Linear regression models were used to determine the association between overall psychological reactance and its components, and stigma and its four domains, and depressive and anxiety symptoms. The associations between stigma and mental health were also examined. Three components of psychological reactance were derived: Opposition, Irritability, and Independence. Overall psychological reactance and irritability were associated with all forms of stigma. Opposition was linked to overall and negative self-image stigma. Overall psychological reactance, opposition, and irritability were positively associated with anxiety symptoms while opposition was also associated with Centers for Epidemiologic Studies-Depression depressive symptoms. There were also positive associations between all forms of stigma, and depressive and anxiety symptoms. Health-care providers and counselors for women living with HIV

  5. Stigma Prolongs Global HIV Epidemic Among Gays

    MedlinePlus

    ... gov/medlineplus/news/fullstory_159757.html Stigma Prolongs Global HIV Epidemic Among Gays High-risk men still ... some countries will repeal anti-gay laws. "The global epidemic of HIV in gay men is ongoing ...

  6. Coping with HIV/AIDS Stigma in Five African Countries

    PubMed Central

    Makoae, Lucia N.; Greeff, Minrie; Phetlhu, René D.; Uys, Leana R.; Naidoo, Joanne R.; Kohi, Thecla W.; Dlamini, Priscilla S.; Chirwa, Maureen L.; Holzemer, William L.

    2008-01-01

    People living with HIV (PLWH) and their families are subjected to prejudice, discrimination and hostility related to the stigmatization of AIDS. This paper examines how PLWH cope with HIV-related stigma in the five southern African countries of Lesotho, Malawi, South Africa, Swaziland, and Tanzania. A descriptive, qualitative research design was used to explore the experience of HIV-related stigma of PLWH and nurses in 2004. Forty-three focus groups were conducted with 251 participants (114 nurses, 111 PLWHs and 26 volunteers). In describing incidents of stigma, respondents reported strategies used or observed to cope with those incidents of stigma. Nurse reports of coping strategies that they used as well as coping strategies they observed as used by HIV-infected patients were coded. Coping strategies used by PLWH in dealing with HIV-related stigma were coded. Seventeen different self-care strategies were identified: restructuring, seeing oneself as OK, letting go, turning to God, hoping, changing behavior, keeping oneself active, using humor, joining a support or social group, disclosing one’s HIV status, speaking to others with same problem, getting counseling, helping others to cope with the illness, educating others, learning from others, acquiring knowledge and understanding about the disease, and getting help from others. Coping appears to be self-taught and only modestly helpful in managing perceived stigma. PMID:18328964

  7. Associations between Social Capital and HIV Stigma in Chennai, India: Considerations for Prevention Intervention Design

    ERIC Educational Resources Information Center

    Sivaram, Sudha; Zelaya, Carla; Srikrishnan, A. K.; Latkin, Carl; Go, V. F.; Solomon, Suniti; Celentano, David

    2009-01-01

    Stigma against persons living with HIV/AIDS (PLHA) is a barrier to seeking prevention education, HIV testing, and care. Social capital has been reported as an important factor influencing HIV prevention and social support upon infection. In the study, we explored the associations between social capital and stigma among men and women who are…

  8. Relationship between HIV Stigma and Self-Isolation among People Living with HIV in Tennessee

    PubMed Central

    Audet, Carolyn M.; McGowan, Catherine C.; Wallston, Kenneth A.; Kipp, Aaron M.

    2013-01-01

    Introduction HIV stigma is a contributing factor to poor patient outcomes. Although HIV stigma has been documented, its impact on patient well-being in the southern US is not well understood. Methods Thirty-two adults participated in cognitive interviews after completing the Berger HIV or the Van Rie stigma scale. Participant responses were probed to ensure the scales accurately measured stigma and to assess the impact stigma had on behavior. Results Three main themes emerged regarding HIV stigma: (1) negative attitudes, fear of contagion, and misperceptions about transmission; (2) acts of discrimination by families, friends, health care providers, and within the workplace; and (3) participants’ use of self-isolation as a coping mechanism. Overwhelming reluctance to disclose a person’s HIV status made identifying enacted stigma with a quantitative scale difficult. Discussion Fear of discrimination resulted in participants isolating themselves from friends or experiences to avoid disclosure. Participant unwillingness to disclose their HIV status to friends and family could lead to an underestimation of enacted HIV stigma in quantitative scales. PMID:23950897

  9. The impact of HIV treatment-related stigma on uptake of antiretroviral therapy.

    PubMed

    Cama, Elena; Brener, Loren; Slavin, Sean; de Wit, John

    2015-01-01

    HIV-related stigma has been linked to avoidance of health care services and suboptimal adherence to antiretroviral therapy (ART). However, less is known about concerns of stigma related specifically to the taking of ART in uptake of treatment. This study examines experiences of HIV treatment-related stigma and assesses if these experiences are associated with ART uptake, independent of general HIV-related stigma. People living with HIV (PLHIV; n = 697) were targeted to complete an online questionnaire measuring perceived HIV- and treatment-related stigma, social support, self-esteem, resilience, psychological distress, health satisfaction and quality of life. Findings suggest that experiences of general and treatment-related stigma were common, and that participants appear to experience greater stigma related to taking HIV treatment than general stigma associated with HIV. Neither general nor treatment-related stigma uniquely impacted HIV treatment uptake. Instead, treatment uptake was associated with being older (adjusted OR 1.05; 95% CIs: 1.03, 1.08), greater duration of HIV infection (adjusted OR 1.07; 95% CIs: 1.03-1.11) and having greater health satisfaction (adjusted OR 1.28; 95% CIs: 1.03, 1.59). Findings highlight that concerns around taking HIV treatment can be an added source of stigma for PLHIV, however other factors may be greater contributors to the likelihood of taking HIV treatment. PMID:25564893

  10. HIV Stigma and Nurse Job Satisfaction in Five African Counties

    PubMed Central

    Chirwa, Maureen L.; Greeff, Minrie; Kohi, Thecla W.; Naidoo, Joanne R.; Makoae, Lucy N.; Dlamini, Priscilla S.; Kaszubski, Christopher; Cuca, Yvette P.; Uys, Leana R.; Holzemer, William L.

    2009-01-01

    This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross-sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The subscale, Personal Satisfaction, was the highest in this sample as in the other 2. Job Satisfaction scores differed significantly among the 5 countries and these differences were consistent across all subscales. A hierarchical regression demonstrated that mental and physical health, marital status, education level, urban/rural setting, and perceived HIV stigma had significant influences on job satisfaction. Perceived HIV stigma was the strongest predictor of job dissatisfaction. These findings provide new areas for intervention strategies that might enhance the work environment for nurses in these countries. PMID:19118767

  11. HIV stigma and nurse job satisfaction in five African countries.

    PubMed

    Chirwa, Maureen L; Greeff, Minrie; Kohi, Thecla W; Naidoo, Joanne R; Makoae, Lucy N; Dlamini, Priscilla S; Kaszubski, Christopher; Cuca, Yvette P; Uys, Leana R; Holzemer, William L

    2009-01-01

    This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross-sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The Personal Satisfaction subscale was the highest in this sample, as in the other 2. Job satisfaction scores differed significantly among the 5 countries, and these differences were consistent across all subscales. A hierarchical regression showed that mental and physical health, marital status, education level, urban/rural setting, and perceived HIV stigma had significant influence on job satisfaction. Perceived HIV stigma was the strongest predictor of job dissatisfaction. These results provide new areas for intervention strategies that might enhance the work environment for nurses in these countries. PMID:19118767

  12. Voices of Women Facing HIV-Related Stigma in the Deep South.

    PubMed

    Relf, Michael V; Williams, Megan; Barroso, Julie

    2015-12-01

    One in 139 women will be diagnosed with HIV in their lifetime. Thirty-four years into the epidemic, stigma remains part of the trajectory of the disease process for all individuals with HIV. Stigma associated with HIV makes it difficult for women to access HIV testing and counseling, disclose HIV status to sexual partners and health care providers, seek and remain actively engaged in medical care, effectively self-manage the disease after diagnosis, and adhere to antiretroviral therapy. The current article reports the qualitative results from a study designed to test the feasibility and acceptability of a technologically delivered stigma intervention for women with HIV in the Southeastern United States. Qualitative analysis revealed women with HIV uniformly experience, anticipate, and/or internalize stigma associated with HIV. Consequently, women with HIV experience isolation and a threat to self-concept as they make decisions about disclosure, work to maintain the secrecy of their HIV status, and contemplate a future. PMID:26505522

  13. Editorial: Global action to reduce HIV stigma and discrimination.

    PubMed

    Grossman, Cynthia I; Stangl, Anne L

    2013-01-01

    There is no question that the stigma and discrimination associated with HIV and AIDS can be reduced through intervention. The inclusion of stigma and discrimination reduction as a critical component of achieving an AIDS-free generation in recent UNAIDS, UN and PEPFAR political initiatives is promising. Yet national governments need evidence on effective interventions at the individual, community and societal levels in order to strategically incorporate stigma and discrimination reduction into national AIDS plans. Currently, the heterogeneity of stigma and discrimination reduction approaches and measurement makes it challenging to compare and contrast evaluated interventions. Moving forward, it is critical for the research community to: (1) clearly link intervention activities to the domains of stigma to be shifted; (2) assess the stigma domains in a consistent manner; and (3) link stigma and discrimination reduction with HIV prevention, care and treatment outcomes (e.g., uptake, adherence and retention of ART). These steps would further advance the scientific evidence base of stigma and discrimination reduction and allow for the identification of effective interventions that could be scaled up by national governments. PMID:24242269

  14. Global action to reduce HIV stigma and discrimination

    PubMed Central

    Grossman, Cynthia I; Stangl, Anne L

    2013-01-01

    There is no question that the stigma and discrimination associated with HIV and AIDS can be reduced through intervention. The inclusion of stigma and discrimination reduction as a critical component of achieving an AIDS-free generation in recent UNAIDS, UN and PEPFAR political initiatives is promising. Yet national governments need evidence on effective interventions at the individual, community and societal levels in order to strategically incorporate stigma and discrimination reduction into national AIDS plans. Currently, the heterogeneity of stigma and discrimination reduction approaches and measurement makes it challenging to compare and contrast evaluated interventions. Moving forward, it is critical for the research community to: (1) clearly link intervention activities to the domains of stigma to be shifted; (2) assess the stigma domains in a consistent manner; and (3) link stigma and discrimination reduction with HIV prevention, care and treatment outcomes (e.g., uptake, adherence and retention of ART). These steps would further advance the scientific evidence base of stigma and discrimination reduction and allow for the identification of effective interventions that could be scaled up by national governments. PMID:24242269

  15. Relative importance of various measures of HIV-related stigma in predicting psychological outcomes among children affected by HIV.

    PubMed

    Zhao, Guoxiang; Li, Xiaoming; Zhao, Junfeng; Zhang, Liying; Stanton, Bonita

    2012-06-01

    To assess the relative importance of four different measures of HIV-related stigma in predicting psychological problems among children affected by HIV in rural China. Cross-sectional data were collected from 755 orphans (i.e., children who lost one or both of their parents to HIV), 466 vulnerable children (children who were living with HIV-infected parents), and 404 comparison children who were from the same community and did not have HIV-related illness or death in their families. Four HIV-related stigma measures include perceived public stigma against people living with HIV/AIDS (PLWHA), perceived public stigma against children affected by HIV (orphans and vulnerable children), personal stigmatizing attitudes against PLWHA, and enacted stigma among children affected by HIV. Psychological problems included depression and adjustment problems. Various measures of HIV-related stigma independently and differentially contribute to children's psychological problems. Enacted stigma and children's perceived public stigma against PLWHA or children affected by HIV are generally stronger predictors of psychological problems than their own feelings or attitudes towards PLWHA. Various aspects of HIV-related stigma are important for us to understand the perception, attitudes, and experience of children affected by HIV, including both children experiencing HIV-related parental illness and death in their own family and children who were living in the communities hardly hit by HIV. Future health promotion and psychological care efforts for children affected by HIV need to consider the effect of various forms of HIV-related stigma on these children's psychosocial well-being and mobilize the community resources to mitigate the negative effect of HIV-related stigma on PLWHA and their children. PMID:21681458

  16. Coping with HIV-related stigma in five African countries.

    PubMed

    Makoae, Lucia N; Greeff, Minrie; Phetlhu, René D; Uys, Leana R; Naidoo, Joanne R; Kohi, Thecla W; Dlamini, Priscilla S; Chirwa, Maureen L; Holzemer, William L

    2008-01-01

    People living with HIV (PLWH) and their families are subjected to prejudice, discrimination, and hostility related to the stigmatization of AIDS. This report examines how PLWH cope with HIV-related stigma in the five southern African countries of Lesotho, Malawi, South Africa, Swaziland, and Tanzania. A descriptive qualitative research design was used to explore the experience of HIV-related stigma of PLWH and nurses in 2004. A total of 43 focus groups were conducted with 251 participants (114 nurses, 111 PLWH, and 26 volunteers). In describing incidents of stigma, respondents reported strategies used or observed to cope with those incidents. Nurse reports of coping strategies that they used as well as observed in HIV-infected patients were coded. Coping strategies used by PLWH in dealing with HIV-related stigma were coded. A total of 17 different self-care strategies were identified: restructuring, seeing oneself as OK, letting go, turning to God, hoping, changing behavior, keeping oneself active, using humor, joining a support or social group, disclosing one's HIV status, speaking to others with same problem, getting counseling, helping others to cope with the illness, educating others, learning from others, acquiring knowledge and understanding about the disease, and getting help from others. Coping appears to be self-taught and only modestly helpful in managing perceived stigma. PMID:18328964

  17. Measuring HIV stigma for PLHAs and nurses over time in five African countries.

    PubMed

    Holzemer, William L; Makoae, Lucy N; Greeff, Minrie; Dlamini, Priscilla S; Kohi, Thecla W; Chirwa, Maureen L; Naidoo, Joanne R; Durrheim, Kevin; Cuca, Yvette; Uys, Yvette R

    2009-09-01

    The aim of this article is to document the levels of HIV stigma reported by persons living with HIV infections and nurses in Lesotho, Malawi, South Africa, Swaziland and Tanzania over a 1-year period. HIV stigma has been shown to negatively affect the quality of life for people living with HIV infection, their adherence to medication, and their access to care. Few studies have documented HIV stigma by association as experienced by nurses or other health care workers who care for people living with HIV infection. This study used standardised scales to measure the level of HIV stigma over time. A repeated measures cohort design was used to follow persons living with HIV infection and nurses involved in their care from five countries over a 1-year period in a three-wave longitudinal design. The average age of people living with HIV/AIDS (PLHAs) (N=948) was 36.15 years (SD=8.69), and 67.1% (N=617) were female. The average age of nurses (N=887) was 38.44 years (SD=9.63), and 88.6% (N=784) were females. Eighty-four per cent of all PLHAs reported one or more HIV-stigma events at baseline. This declined, but was still significant 1 year later, when 64.9% reported experiencing at least one HIV-stigma event. At baseline, 80.3% of the nurses reported experiencing one or more HIV-stigma events and this increased to 83.7% 1 year later. The study documented high levels of HIV stigma as reported by both PLHAs and nurses in all five of these African countries. These results have implications for stigma reduction interventions, particularly focused at health care providers who experience HIV stigma by association. PMID:19936409

  18. Measuring HIV Stigma for PLHAs and Nurses over Time in Five African Countries

    PubMed Central

    Holzemer, William L.; Makoae, Lucy N.; Greeff, Minrie; Dlamini, Priscilla S.; Kohi, Thecla W.; Chirwa, Maureen L.; Naidoo, Joanne R.; Durrheim, Kevin; Cuca, Yvette; Uys, Leana R.

    2013-01-01

    The aim of this article is to document the levels of HIV stigma reported by persons living with HIV infections and nurses in Lesotho, Malawi, South Africa, Swaziland and Tanzania over a one-year period. HIV stigma has been shown to affect negatively the quality of life for people living with HIV infection, their adherence to medication, and their access to care. Few studies have documented HIV stigma by association as experienced by nurses or other health care workers who care for people living with HIV infection. This study used standardized scales to measure the level of HIV stigma over time. A repeated measures cohort design was used to follow persons living with HIV infection and nurses involved in their care from five countries over a one-year period in a three-wave longitudinal design. The average age of PLHAs (n = 948) was 36.15 years (SD= 8.69), and 67.1% (n= 617) were female. The average age of nurses (n = 887) was 38.44 years (SD=9.63), and 88.6% (n=784) were females. Eighty-four percent of all PLHAs reported one or more HIV stigma event at baseline. This declined, but was still significant one year later when 64.9% reported experiencing at least one HIV stigma event. At baseline, 80.3% of the nurses reported experiencing one or more HIV stigma events and this increased to 83.7% one year later. The study documented high levels of HIV stigma as reported by both PLHAs and nurses in all five of these African countries. These results have implications for stigma reduction interventions, particularly focused at health care providers who experience HIV stigma by association. PMID:19936409

  19. Addressing HIV stigma in protected medical settings.

    PubMed

    Li, Li; Liang, Li-Jung; Lin, Chunqing; Wu, Zunyou

    2015-01-01

    Previous studies suggest that the implementation of universal precaution (UP) plays a role in reducing HIV stigma. In this study we investigate the efficacy of a stigma reduction intervention on UP compliance and explore whether UP compliance could potentially influence HIV stigma reduction in medical settings. A randomized controlled intervention trial was conducted in two provinces of China with 1760 healthcare service providers recruited from 40 county-level hospitals. Longitudinal analyses included data collection at baseline, 6-, and 12-month follow-up assessments. Using a hierarchical modeling approach, we estimated the intervention effect for each provider's UP compliance and its potential mediating role on HIV stigma with the bootstrapping method. A significant intervention effect on UP compliance was observed at both the 6- and 12-month follow-up assessments. The intervention effect on provider avoidance intent was partially mediated by the provider's own UP compliance at the two follow-up points. This study provides evidence that UP compliance should be part of HIV stigma reduction programs, especially in resource-restrained countries. Findings suggest that a protected work environment may be necessary but not sufficient to address HIV stigma in medical settings. PMID:26608559

  20. Addressing HIV stigma in protected medical settings

    PubMed Central

    Li, Li; Liang, Li-Jung; Lin, Chunqing; Wu, Zunyou

    2015-01-01

    Previous studies suggest that the implementation of universal precaution (UP) plays a role in reducing HIV stigma. In this study we investigate the efficacy of a stigma reduction intervention on UP compliance and explore whether UP compliance could potentially influence HIV stigma reduction in medical settings. A randomized controlled intervention trial was conducted in two provinces of China with 1760 healthcare service providers recruited from 40 county-level hospitals. Longitudinal analyses included data collection at baseline, 6-, and 12-month follow-up assessments. Using a hierarchical modeling approach, we estimated the intervention effect for each provider’s UP compliance and its potential mediating role on HIV stigma with the bootstrapping method. A significant intervention effect on UP compliance was observed at both the 6- and 12-month follow-up assessments. The intervention effect on provider avoidance intent was partially mediated by the provider’s own UP compliance at the two follow-up points. This study provides evidence that UP compliance should be part of HIV stigma reduction programs, especially in resource-restrained countries. Findings suggest that a protected work environment may be necessary but not sufficient to address HIV stigma in medical settings. PMID:26608559

  1. Persistent HIV-related stigma among an outpatient US clinic population.

    PubMed

    Shacham, Enbal; Rosenburg, Neal; Önen, Nur F; Donovan, Michael F; Overton, E Turner

    2015-03-01

    Despite advancements in the public's understanding of HIV infection, felt stigma towards individuals living with HIV persists. Stigma has been associated with adverse health outcomes, including poor adherence to care, and increased participation in HIV transmission risk behaviours. We evaluated the level of felt stigma and its relationship to other psychosocial and medical factors among a sample of 201 individuals with HIV engaged in care. The overall mean stigma score, as measured by the Reece Stigma Scale, was 21.7 (SD 8.7). In univariate analysis, felt stigma scores were higher among women, African Americans, younger participants, and individuals with less education. Higher felt stigma scores were also found among individuals who reported having fair to poor overall health, moderate to severe symptoms of depression and anxiety, and those with a current diagnosis of alcohol dependence, generalised anxiety disorder, agoraphobia, pain disorder, and current smokers. Higher felt stigma scores were independently associated with individuals with anxiety symptoms. These analyses highlight that stigma persists among individuals with HIV and may play an important role in HIV care. The relationship between psychiatric disorders and psychosocial factors highlights an opportunity to develop interventions that will address these common comorbidities and reduce stigma. PMID:24828557

  2. HIV stigma and unprotected sex among PLWH in KwaZulu-Natal, South Africa: a longitudinal exploration of mediating mechanisms.

    PubMed

    Earnshaw, Valerie A; Smith, Laramie R; Shuper, Paul A; Fisher, William A; Cornman, Deborah H; Fisher, Jeffrey D

    2014-01-01

    Social and structural factors including HIV stigma are theorized to drive global disparities in HIV prevalence. This study tests whether HIV self-stigma, or experiences of stigma at the individual level, is associated with engagement in unprotected sex among people living with HIV (PLWH) in KwaZulu-Natal, South Africa, where 37.4% of adults are living with HIV compared with 0.8% worldwide. It further explores whether depressive symptoms, HIV status disclosure to sex partners, and/or condom use attitudes mediate potential associations between HIV self-stigma and unprotected sex. Participants, including 924 PLWH, were recruited from primary care clinics and completed baseline, 6-, 12-, and 18-month survey assessments between 2008 and 2011. Hierarchical linear modeling analyses were used to examine longitudinal within-subjects associations between HIV self-stigma, mediators, and unprotected sex with both HIV-negative/unknown and HIV-positive partners. Results demonstrate that HIV self-stigma was prospectively associated with greater likelihood of unprotected sex with HIV-negative/unknown partners. None of the variables explored significantly mediated this association. HIV self-stigma was also prospectively associated with greater likelihood of unprotected sex with HIV-positive partners via the mediators of greater depressive symptoms and more negative condom use attitudes. The current study suggests that HIV self-stigma undermines HIV secondary prevention and care efforts among PLWH in KwaZulu-Natal. It is therefore critical to address HIV stigma at the social/structural level to reduce HIV self-stigma at the individual level and ultimately curb global disparities in HIV prevalence. In the absence of widespread social/structural change, interventions that treat depressive symptoms and encourage more positive condom use attitudes despite the existence of HIV stigma may buffer associations between HIV self-stigma and unprotected sex with HIV-positive partners among PLWH

  3. Situating experiences of HIV-related stigma in Swaziland.

    PubMed

    Root, R

    2010-01-01

    With the world's highest antenatal HIV prevalence rate (39.2%), Swaziland has also been described as among the most stigmatising. Yet, only recently was an anti-HIV stigma and discrimination (S&D) platform included in the government's National Multisectoral HIV and AIDS Policy. This study draws on a medical anthropological project in rural Swaziland to examine experiences of stigma among people living with HIV/AIDS (PLWH). Qualitative methods included a semi-structured questionnaire and interviews (n=40) to identify patterns of stigma across three domains: verbal, physical and social. Key informant interviews (n=5) were conducted with health personnel and support group leaders. Descriptive statistics were situated within a thematic analysis of open-ended content. Among the findings, participants reported extensive HIV-related rumouring (36.4%) and pejorative name-calling (37.5%). Nearly one in five (18.2%) could no longer partake of family meals. Homesteads, which are an organising principle of Swazi life, were often markedly stigmatising environments. In contrast to documented discrimination in health care settings, the health centre emerged as a space where PLWH could share information and support. Given the UNAIDS call for national partners to 'know your epidemic' by tracking the prevalence of HIV-related S&D, results from this study suggested that unless 'knowing your epidemic' includes the lived experiences of HIV stigma that blister into discernible patterns, effectiveness of national initiatives is likely to be limited. Multidisciplinary and locale-specific studies are especially well suited in examining the cultural dynamics of HIV stigma and in providing grounded data that deepen the impact of comprehensive HIV/AIDS policies and programming. PMID:19787517

  4. The lion at the gate: an HIV-affected caregiver resists stigma.

    PubMed

    Poindexter, Cynthia Cannon

    2005-02-01

    This article examines two bounded stories of HIV stigma told by an older woman who took care of her adult son as he died of AIDS. Her self-definition as a protector of her dying son was challenged when she encountered ostracism and prejudice. Her words and expressions illuminate her confrontation and resistance to associative stigma. An expansion of Goffman's view of stigma management is necessary to understand this caregiver's experiences in the face of the larger cultural narrative of HIV stigma:This caregiver did not manage stigma, she actively fought it. PMID:15847239

  5. A systematic review of HIV/AIDS-related stigma and discrimination in India: current understanding and future needs.

    PubMed

    Bharat, Shalini

    2011-01-01

    HIV/AIDS-related stigma is recognised as a major barrier to HIV prevention efforts and an impediment to mitigating its impact on individuals and communities. This paper reviews the existing research literature on AIDS stigma in India with the objective of documenting the current status of research, highlighting major findings and identifying key gaps remaining. Thirty publications were identified through a careful search of which a majority focused on stigma assessment and very few on stigma measurement, conceptual aspects of stigma or stigma reduction interventions. A few standardised stigma measures are available but more are required to assess causes of stigma among general population and compounded and internalised stigma among positive people. Research exploring linkages between stigma and HIV services uptake or the effect of HIV care and treatment programs on stigma levels are largely missing and need to be prioritised. In addition, more research is needed to advance conceptual understanding of stigma within the cultural context of the country including research on the neglected groups such as, transgender people. Context-specific (health care, community) interventions are needed to address various forms of stigma - enacted, perceived, internalised and layered - including structural approaches besides inter-personal and information-based approaches. A major gap relates to meager research on developing and evaluating stigma reduction interventions and needs priority focus. Overall, the review recommends developing a national agenda on AIDS stigma research and interventions to help realise the government's goal of stigma reduction. PMID:23237728

  6. Factors associated with pregnant women's anticipations and experiences of HIV-related stigma in rural Kenya.

    PubMed

    Cuca, Yvette P; Onono, Maricianah; Bukusi, Elizabeth; Turan, Janet M

    2012-01-01

    Pregnant women who fear or experience HIV-related stigma may not get care for their own health or medications to reduce perinatal transmission of HIV. This study examined factors associated with anticipating and experiencing HIV-related stigma among 1777 pregnant women attending antenatal care clinics in rural Kenya. Women were interviewed at baseline, offered HIV testing and care, and a sub-set was re-interviewed at 4-8 weeks postpartum. Women who were older, had less education, whose husbands had other wives, and who perceived community discrimination against people with HIV had significantly greater adjusted odds of anticipating HIV stigma. Over half of the HIV-positive women interviewed postpartum reported having experienced stigma, much of which was self-stigma. Women experiencing minor depression, and those whose family knew of their HIV status had significantly greater adjusted odds of experiencing stigma. Lack of women's empowerment, as well as depression, may be important risk factors for HIV-related stigma and discrimination. PMID:22799618

  7. Dentistry and HIV/AIDS related stigma

    PubMed Central

    Elizondo, Jesus Eduardo; Treviño, Ana Cecilia; Violant, Deborah

    2015-01-01

    OBJECTIVE To analyze HIV/AIDS positive individual’s perception and attitudes regarding dental services. METHODS One hundred and thirty-four subjects (30.0% of women and 70.0% of men) from Nuevo León, Mexico, took part in the study (2014). They filled out structured, analytical, self-administered, anonymous questionnaires. Besides the sociodemographic variables, the perception regarding public and private dental services and related professionals was evaluated, as well as the perceived stigma associated with HIV/AIDS, through a Likert-type scale. The statistical evaluation included a factorial and a non-hierarchical cluster analysis. RESULTS Social inequalities were found regarding the search for public and private dental professionals and services. Most subjects reported omitting their HIV serodiagnosis and agreed that dentists must be trained and qualified to treat patients with HIV/AIDS. The factorial analysis revealed two elements: experiences of stigma and discrimination in dental appointments and feelings of concern regarding the attitudes of professionals or their teams concerning patients’ HIV serodiagnosis. The cluster analysis identified three groups: users who have not experienced stigma or discrimination (85.0%); the ones who have not had those experiences, but feel somewhat concerned (12.7%); and the ones who underwent stigma and discrimination and feel concerned (2.3%). CONCLUSIONS We observed a low percentage of stigma and discrimination in dental appointments; however, most HIV/AIDS patients do not reveal their serodiagnosis to dentists out of fear of being rejected. Such fact implies a workplace hazard to dental professionals, but especially to the very own health of HIV/AIDS patients, as dentists will not be able to provide them a proper clinical and pharmaceutical treatment. PMID:26538100

  8. The influence of stigma and discrimination on female sex workers' access to HIV services in St. Petersburg, Russia.

    PubMed

    King, Elizabeth J; Maman, Suzanne; Bowling, J Michael; Moracco, Kathryn E; Dudina, Viktoria

    2013-10-01

    Stigma associated with HIV and risk behaviors is known to be a barrier to health care access for many populations. Less is known about female sex workers (FSW) in Russia, a population that is especially vulnerable to HIV-infection, and yet hard-to-reach for service providers. We administered a questionnaire to 139 FSW to better understand how stigma and discrimination influence HIV service utilization. Logistic regression analysis indicated that HIV-related stigma is negatively associated with uptake of HIV testing, while sex work-related stigma is positively associated with HIV testing. HIV-positive FSW are more likely than HIV-negative FSW to experience discrimination in health care settings. While decreasing societal stigma should be a long-term goal, programs that foster inclusion of marginalized populations in Russian health care settings are urgently needed. PMID:23525789

  9. The Influence of Stigma and Discrimination on Female Sex Workers’ Access to HIV Services in St. Petersburg, Russia

    PubMed Central

    King, Elizabeth J.; Maman, Suzanne; Bowling, J. Michael; Moracco, Kathryn E.; Dudina, Viktoria

    2013-01-01

    Stigma associated with HIV and risk behaviors is known to be a barrier to health care access for many populations. Less is known about female sex workers (FSW) in Russia, a population that is especially vulnerable to HIV-infection, and yet hard-to-reach for service providers. We administered a questionnaire to 139 FSW to better understand how stigma and discrimination influence HIV service utilization. Logistic regression analysis indicated that HIV-related stigma is negatively associated with uptake of HIV testing, while sex work-related stigma is positively associated with HIV testing. HIV-positive FSW are more likely than HIV-negative FSW to experience discrimination in health care settings. While decreasing societal stigma should be a long-term goal, programs that foster inclusion of marginalized populations in Russian health care settings are urgently needed. PMID:23525789

  10. Stigma, activism, and well-being among people living with HIV.

    PubMed

    Earnshaw, Valerie A; Rosenthal, Lisa; Lang, Shawn M

    2016-06-01

    Evidence demonstrates that HIV stigma undermines the psychological and physical health of people living with HIV (PLWH). Yet, PLWH describe engaging in HIV activism to challenge stigma, and research suggests that individuals may benefit from activism. We examine associations between experiences of HIV stigma and HIV activism, and test whether HIV activists benefit from greater well-being than non-activists. Participants include 93 PLWH recruited from drop-in centers, housing programs, and other organizations providing services to PLWH in the Northeastern USA between 2012 and 2013 (mean age = 50 years; 56% Black, 20% White, 18% Other; 61% non-Latino(a), 39% Latino(a); 59% male, 38% female, 3% transgender; 82% heterosexual, 15% sexual minority). Participants completed a cross-sectional written survey. Results of regression analyses suggest that PLWH who experienced greater enacted stigma engaged in greater HIV activism. Anticipated, internalized, and perceived public stigma, however, were unrelated to HIV activism. Moreover, results of a multivariate analysis of variance suggest that HIV activists reported greater social network integration, greater social well-being, greater engagement in active coping with discrimination, and greater meaning in life than non-activists. Yet, HIV activists also reported somewhat greater depressive symptoms than non-activists, suggesting that the association between HIV activism and well-being is complex. By differentiating between HIV stigma mechanisms, the current study provides a more nuanced understanding of which experiences of HIV stigma may be associated with HIV activism. It further suggests that engagement in activism may offer benefits to PLWH, while raising the possibility that activists could experience greater depressive symptoms than non-activists. Given the preliminary nature of this study, future research should continue to examine these complex associations between HIV stigma, activism, and well-being among PLWH

  11. Depression and Social Stigma Among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention.

    PubMed

    Stahlman, Shauna; Grosso, Ashley; Ketende, Sosthenes; Sweitzer, Stephanie; Mothopeng, Tampose; Taruberekera, Noah; Nkonyana, John; Baral, Stefan

    2015-08-01

    Social stigma is common among men who have sex with men (MSM) across Sub-Saharan Africa, and may influence risks for HIV and sexually transmitted infections (STIs) via its association with depression. We conducted a cross-sectional study of 530 MSM in Lesotho accrued via respondent-driven sampling. Using generalized structural equation models we examined associations between stigma, social capital, and depression with condom use and testing positive for HIV/STIs. Depression was positively associated with social stigma experienced or perceived as a result of being MSM. In contrast, increasing levels of social cohesion were negatively associated with depression. Social stigma was associated with testing positive for HIV; however, this association did not appear to be mediated by depression or condom use. These data suggest a need for integrated HIV and mental health care that addresses stigma and discrimination and facilitates positive social support for MSM. PMID:25969182

  12. Depression and Social Stigma among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention

    PubMed Central

    Stahlman, Shauna; Grosso, Ashley; Ketende, Sosthenes; Sweitzer, Stephanie; Mothopeng, Tampose; Taruberekera, Noah; Nkonyana, John; Baral, Stefan

    2016-01-01

    Social stigma is common among men who have sex with men (MSM) across Sub-Saharan Africa, and may influence risks for HIV and sexually transmitted infections (STIs) via its association with depression. We conducted a cross-sectional study of 530 MSM in Lesotho accrued via respondent-driven sampling. Using generalized structural equation models we examined associations between stigma, social capital, and depression with condom use and testing positive for HIV/STIs. Depression was positively associated with social stigma experienced or perceived as a result of being MSM. In contrast, increasing levels of social cohesion were negatively associated with depression. Social stigma was associated with testing positive for HIV; however, this association did not appear to be mediated by depression or condom use. These data suggest a need for integrated HIV and mental health care that addresses stigma and discrimination and facilitates positive social support for MSM. PMID:25969182

  13. Stigma of People with HIV/AIDS in Sub-Saharan Africa: A Literature Review

    PubMed Central

    Mbonu, Ngozi C.; van den Borne, Bart; De Vries, Nanne K.

    2009-01-01

    The aim of this literature review is to elucidate what is known about HIV/AIDS and stigma in Sub-Saharan Africa. Literature about HIV/AIDS and stigma in Sub-Saharan Africa was systematically searched in Pubmed, Medscape, and Psycinfo up to March 31, 2009. No starting date limit was specified. The material was analyzed using Gilmore and Somerville's (1994) four processes of stigmatizing responses: the definition of the problem HIV/AIDS, identification of people living with HIV/AIDS (PLWHA), linking HIV/AIDS to immorality and other negative characteristics, and finally behavioural consequences of stigma (distancing, isolation, discrimination in care). It was found that the cultural construction of HIV/AIDS, based on beliefs about contamination, sexuality, and religion, plays a crucial role and contributes to the strength of distancing reactions and discrimination in society. Stigma prevents the delivery of effective social and medical care (including taking antiretroviral therapy) and also enhances the number of HIV infections. More qualitative studies on HIV/AIDS stigma including stigma in health care institutions in Sub-Saharan Africa are recommended. PMID:20309417

  14. Religion and HIV/AIDS Stigma: Considerations for the Nursing Profession

    PubMed Central

    Reyes-Estrada, Marcos; Varas-Díaz, Nelson; Martínez-Sarson, Miluska T.

    2016-01-01

    Nurses’ stigmatization of people living with HIV/AIDS hinders effective health care provisions for this sector of the population. Scientific literature on HIV/AIDS stigma has emphasized cognitive, individual, and interpersonal factors that are relevant to the understanding of the stigmatization process among health care professionals (e.g. a health care professional’s accuracy in knowledge of the workings of the virus, effectiveness of emotion management, degree of proximity to the stigmatized group, etc.). However, researchers have also examined the socio-structural factors underlying stigma, and religion has consequently emerged as a social phenomenon that may foster it. The role of religion among professional nurses who specifically service people living with HIV/AIDS remains understudied. Focusing on evidence-based literature, we discuss the relationship between religion and HIV/AIDS stigma, explore potential implications of this relationship for the nursing profession, and make recommendations for stigma-reducing interventions. PMID:26858806

  15. HIV Stigma and Social Support among African Americans

    PubMed Central

    Davis, E. Maxwell; Banks, Denedria; Bing, Eric G.

    2008-01-01

    Abstract HIV-related stigma and discrimination negatively impact African Americans living with HIV. Social support theory hypothesizes that social support can serve to protect individuals against the negative effects of stressors, such as discrimination, by leading them to interpret stressful occasions less negatively. This study sought to examine the relationship between perceived social support and perceived HIV stigma among HIV-positive African Americans. A cross-sectional convenience sample of 283 HIV-positive African Americans was recruited from three social service agencies. Bivariate and multivariate regressions were used to determine the variables predicting perceived HIV stigma. The study participants were found to have a wide variety of opinions concerning perceived HIV stigma. Of the three different sources of perceived social support examined (from family, friends and a “special person”), only perceived social support from friends was found to be related to perceived HIV stigma when controlling for the presence of other relevant factors. High perceived social support from friends was associated with less perceived HIV stigma. Other factors associated with low perceived HIV stigma included a lack of current symptoms of major depression, a longer time since HIV diagnosis and higher education. Information about the beneficial effects of perceived social support from friends and other factors can help to provide guidance to those working to decrease the negative impact of HIV stigma among HIV-positive African Americans. PMID:18373417

  16. Felt and Enacted Stigma Among HIV/HCV-Coinfected Adults: The Impact of Stigma Layering

    PubMed Central

    Lekas, Helen-Maria; Siegel, Karolynn; Leider, Jason

    2015-01-01

    The realization that many persons with HIV/AIDS are subjected to multiple layers of stigmatization because they belong to socially deviant and disenfranchised groups (e.g., injection drug users, racial/ethnic and sexual minorities) accounts for an increasing interest in the phenomenon of stigma layering. The stigma associated with HCV has also been conceptualized as layered. However, researchers have overlooked the fact that HCV adds a layer to the HIV stigma and vice versa. Qualitative interviews with 132 HIV/HCV coinfected patients were analyzed to explore how they experience the two layers of stigma. Most participants hierarchically ordered the stigmas associated with each disease and regarded HIV as the more stigmatizing of the two. A small number perceived HIV and HCV as equally stigmatizing. The impact of the hierarchical and non-hierarchical ordering of the two stigmas on coinfected patients’ felt and enacted stigmatization is explored and implications for interventions are discussed. PMID:21498828

  17. Predictors of HIV enacted stigma among Chilean women

    PubMed Central

    Cianelli, Rosina; Villlegas, Natalia; De Oliveira, Giovanna; Hires, Kimberly; Gattamorta, Karina; Ferrer, Lilian; Peragallo, Nilda

    2015-01-01

    Aims and objectives To investigate if socio-demographic factors, religiosity, HIV-related knowledge, Marianismo, history of having been tested for HIV, knowing someone who died of AIDS and HIV risk perception were predictive factors to HIV enacted stigma predictors among Chilean women. Background HIV infection is the number one cause of death among women during their reproductive years. In Chile, studies with people living with HIV demonstrate the existence of HIV-related stigma. However, limited evidence is available about the underlying causes of HIV enacted stigma that results in stigmatisation and discrimination. Design The current cross-sectional study is a secondary analysis of data collected to assess the impact of an HIV prevention intervention (Mano a Mano-Mujer) designed for Chilean women. A quasi-experimental design was used in the original study. Methods This study was conducted in two communities in Santiago, Chile. The sample for this study consisted of 496 Chileans between ages 18–49. Descriptive statistics and multiple regression were used for the analysis. Results Participants in the study reported high levels (77·8%) of HIV enacted stigma. Higher levels of HIV-related knowledge were associated with lower levels of HIV enacted stigma. Women with higher education had lower levels of HIV enacted stigma than women with elementary education. In addition, greater levels of marianismo (cultural belief that women should be passive, faithful, and devoted to family) were associated with higher HIV enacted stigma scores. Conclusions The findings reflected the presence of HIV enacted stigma among Chilean women. Identifying the significant predictors of HIV enacted stigma can help the nursing community to design HIV prevention interventions that include the reduction in HIV enacted stigma. HIV evidence-based prevention interventions should incorporate contents related to stigma to contribute to prevent HIV enacted stigma at individual and community levels

  18. Coping strategies for HIV-related stigma in Liuzhou, China.

    PubMed

    Zhang, Ying-Xia; Ying-Xia, Zhang; Golin, Carol E; Bu, Jin; Jin, Bu; Emrick, Catherine Boland; Nan, Zhang; Li, Ming-Qiang; Ming-Qiang, Li

    2014-02-01

    This study explores the feelings, experiences, and coping strategies of people living with HIV (PLHIV) in Liuzhou, China. In a southwestern Chinese city with high HIV prevalence, we conducted semi-structured in-depth interviews with 47 PLHIV selected to represent individuals who had acquired HIV via different acquisition routes. Many participants felt severely stigmatized; they commonly reported having very low self-esteem and feelings of despair. Based on style of coping and whether it occurred at the interpersonal or intrapersonal level, four types of coping that participants used to deal with HIV-associated stigma were identified: (1) Compassion (Passive/Avoidant-Interpersonal); (2) Hiding HIV status (Passive/Avoidant-Intrapersonal); (3) Social support (Active/Problem-focused-Interpersonal; and (4) Self-care (Active/Problem-focused-Intrapersonal). Educational and stigma-reduction interventions targeting potential social support networks for PLHIV (e.g., family, close friends, and peers) could strengthen active interpersonal PLHIV coping strategies. Interventions teaching self-care to PLHIV would encourage active intrapersonal coping, both of which may enhance PLHIV quality of life in Liuzhou, China. PMID:24337724

  19. How Stigma Interferes with Mental Health Care

    ERIC Educational Resources Information Center

    Corrigan, Patrick

    2004-01-01

    Many people who would benefit from mental health services opt not to pursue them or fail to fully participate once they have begun. One of the reasons for this disconnect is stigma; namely, to avoid the label of mental illness and the harm it brings, people decide not to seek or fully participate in care. Stigma yields 2 kinds of harm that may…

  20. Stigma and Racial/Ethnic HIV Disparities: Moving Toward Resilience

    PubMed Central

    Earnshaw, Valerie A.; Bogart, Laura M.; Dovidio, John F.; Williams, Davird R.

    2013-01-01

    Prior research suggests that stigma plays a role in racial/ethnic health disparities. However, there is limited understanding about the mechanisms by which stigma contributes to HIV-related disparities in risk, incidence and screening, treatment, and survival and what can be done to reduce the impact of stigma on these disparities. We introduce the Stigma and HIV Disparities Model to describe how societal stigma related to race and ethnicity is associated with racial/ethnic HIV disparities via its manifestations at the structural level (e.g., residential segregation) as well as the individual level among perceivers (e.g., discrimination) and targets (e.g., internalized stigma). We then review evidence of these associations. Because racial/ethnic minorities at risk of and living with HIV often possess multiple stigmas (e.g., HIV-positive, substance use), we adopt an intersectionality framework and conceptualize interdependence among co-occurring stigmas. We further propose a resilience agenda and suggest that intervening on modifiable strength-based moderators of the association between societal stigma and disparities can reduce disparities. Strengthening economic and community empowerment and trust at the structural level, creating common ingroup identities and promoting contact with people living with HIV among perceivers at the individual level, and enhancing social support and adaptive coping among targets at the individual level can improve resilience to societal stigma and ultimately reduce racial/ethnic HIV disparities. PMID:23688090

  1. Homophobia, stigma and HIV in Jamaican prisons

    PubMed Central

    Andrinopoulos, Katherine; Figueroa, J Peter; Kerrigan, Deanna; Ellen, Jonathan M.

    2010-01-01

    Success in addressing HIV and AIDS among men who have sex with men, a key population in the global epidemic, is impeded by homophobia. Homophobia as a barrier to HIV prevention and AIDS treatment is a particularly acute problem in the prison setting. In this qualitative study, we explore HIV and AIDS, stigma, and homosexuality in the largest all male prison in Jamaica by conducting iterative in-depth interviews with 25 inmates. Participant narratives unveil a purposeful manipulation of beliefs related to homosexuality that impedes an effective response to HIV and AIDS both in prison and wider society. Findings indicate that homophobia is both a social construction and a tangible tool used to leverage power and a sense of solidarity in a larger political and economic landscape. This use of homophobia may not be unique to Jamaica, and is an important issue to address in other low and middle income post-colonialist societies. PMID:20972916

  2. HIV-related stigma among African, Caribbean, and Black youth in Windsor, Ontario.

    PubMed

    Mihan, Robert; Kerr, Jelani; Maticka-Tyndale, Eleanor

    2016-01-01

    HIV-related stigma has been shown to undermine prevention, care, treatment, and the well-being of people living with HIV. A disproportion burden of HIV infection, as well as elevated levels of HIV-related stigma, is evidenced in sub-Saharan African (SSA) and African-diasporic populations. This study explores factors that influence HIV-related stigma among 16- to 25-year-old youth residing in a Canadian city who identify as African, Caribbean, or Black. Stigma, as rooted in cultural norms and beliefs and related social institutions, combined with insights from research on stigma in SSA and African-diasporic populations, guided the development of a path analytic structural equation model predicting levels of HIV-related stigmatizing attitudes. The model was tested using survey responses of 510 youth to estimate the direct and indirect influences of ethno-religious identity, religious service attendance, time in Canada, HIV/AIDS knowledge, HIV-testing history, sexual health service contact, and gender on HIV-related stigma. Statistically significant negative associations were found between levels of stigma and knowledge and HIV-testing history. Ethno-religious identity and gender had both direct and indirect effects on stigma. African-Muslim participants had higher levels of stigma, lower knowledge, and were less likely to have been tested for HIV infection than other ethno-religious groups. Male participants had higher levels of stigma and lower knowledge than women. Time in Canada had only indirect effects on stigma, with participants in Canada for longer periods having higher knowledge and less likely to have been tested than more recent arrivals. While the strength of the effect of knowledge on stigmatizing attitudes in this research is consistent with other research on stigma and evaluations of stigma-reduction programs, the path analytic results provide additional information about how knowledge and HIV-testing function as mediators of non

  3. The role of emotions in the reduction of HIV/AIDS stigma among physicians in training

    PubMed Central

    Varas-Díaz, Nelson; Neilands, Torsten B.; Rodríguez-Madera, Sheilla L.; Padilla, Mark

    2016-01-01

    Scientific literature has systematically documented the negative effects of social stigma for people living with HIV/AIDS (PLWHA). HIV/AIDS stigma has the potential to negatively impact self-care strategies for those already affected, and simultaneously hinder prevention efforts to deter the emergence of new infections. When health professionals manifest these negative attitudes access to quality health-care and prevention strategies can be seriously affected. Scientifically tested interventions to reduce HIV/AIDS stigma among health professionals are still scarce. Although the number of tested interventions has increased over the past decade, few of them target Latino health professionals or Spanish-speaking populations. Furthermore, although some of those interventions have been reported as effective for stigma reduction, more work is needed to better understand the underlying variables that account for the reduction of stigma attitudes in those efforts. The SPACES intervention has been documented as an effective HIV/AIDS stigma-reduction intervention focusing on health-care professionals in training. The intervention, which is delivered in Spanish, has been previously tested with medical students in Puerto Rico and shown significant results in addressing negative attitudes toward PLWHA. The main objective of this study was to document the underlying variables that fostered reduction of HIV/AIDS stigma due to participation in the SPACES intervention. Results evidence that health professionals in training who participated in the intervention (n = 507) had less stigmatizing attitudes toward PLWHA due to an increase in their positive emotions toward this population. In light of these results, we discuss the importance of engaging health professionals in HIV/AIDS stigma-reduction interventions that go beyond the provision of information and skills for interacting with PLWHA, and address the emotional component of HIV/AIDS stigma. PMID:26444133

  4. Stigma and Racial/Ethnic HIV Disparities: Moving toward Resilience

    ERIC Educational Resources Information Center

    Earnshaw, Valerie A.; Bogart, Laura M.; Dovidio, John F.; Williams, David R.

    2013-01-01

    Prior research suggests that stigma plays a role in racial/ethnic health disparities. However, there is limited understanding about the mechanisms by which stigma contributes to HIV-related disparities in risk, incidence and screening, treatment, and survival and what can be done to reduce the impact of stigma on these disparities. We introduce…

  5. Issues of expressed stigma of HIV/AIDS among professionals in Southern Sudan.

    PubMed

    Machine, Edwin M; Ross, Michael W; McCurdy, Sheryl A

    2011-08-01

    HIV-related stigma continues to be a significant barrier to HIV testing, treatment, and care. Understanding the factors that underlie this stigma could help remove barriers to HIV/AIDS intervention. We identified these factors among nurses as well as community leaders in Lui, Southern Sudan. Participants included health workers at a local hospital, a women's group, local market traders, religious leaders, and teachers. We categorized the responses generated from group interaction forums as concerns, fears, and perceptions. We found that stigma persisted not only toward people with conspicuous signs of full-blown AIDS, but also toward community programs, like voluntary counseling and testing centers. Future interventions, including delabeling the counseling and testing centers and demonstrating the efficacy of highly active antiretroviral therapy, will be critical in reducing the stigma of HIV/AIDS in communities. PMID:21149851

  6. Lessons on Stigma: Teaching about HIV/AIDS

    ERIC Educational Resources Information Center

    Lichtenstein, Bronwen; DeCoster, Jamie

    2014-01-01

    Teaching about the sociology of HIV/AIDS involves teaching about the causes and effects of stigma. We describe a Sociology of HIV/AIDS course at the University of Alabama in which stigma reduction was assessed as a primary objective. The syllabus involved theory-based instruction, class visits, service learning, and student research on community…

  7. A Qualitative Examination of Stigma Among Formerly Incarcerated Adults Living With HIV

    PubMed Central

    Swan, Holly

    2016-01-01

    The over-representation of people with stigmatized characteristics in the U.S. criminal justice population, including adults living with HIV, makes formerly incarcerated adults susceptible to multiple stigmas. Yet, the experience of HIV-related stigma, especially among individuals who have an additional compromising status in society (i.e., a criminal record) is understudied. This study used qualitative data from 30 interviews with formerly incarcerated adults living with HIV to explore the contexts within which one of these statuses becomes more salient than another for these individuals. Anticipated stigma was the primary barrier to disclosure of either status. The salience of anticipated stigma depended on the context within which disclosure may occur, including social interactions, employment, and engaging in HIV care. Communities with a high prevalence of HIV and incarceration, and health care providers within those communities should be targeted for stigma reduction efforts. Practitioners should work to empower individuals living with HIV, especially in the face of multiple potential stigmas. PMID:27182459

  8. Measuring HIV-related stigma among Chinese service providers: confirmatory factor analysis of a multidimensional scale.

    PubMed

    Stein, Judith A; Li, Li

    2008-09-01

    An HIV-related stigma scale for health care workers needs to be multidimensional in that it should encompass attitudes that might be experienced by the general public about people living with HIV/AIDS (PLWHA) (e.g., fear, shame, blame) and, further, specifically capture perceptions of appropriate professional care and medical responsibilities regarding PLWHA. A 17-item, 5-factor multidimensional HIV-related stigma scale was developed and validated using both exploratory and confirmatory factor analysis among 1,101 service providers in China. The sample was divided into a development sample (N = 551) and a validation sample (N = 550). The fit of the final confirmatory factor model with five hypothesized subscales was excellent in both samples. The final stigma subscales included: Discrimination Intent at Work, Opinion about Health Care for HIV/AIDS Patients, Prejudiced Attitudes, Internalized Shame, and Fear of PLWHA. PMID:18064554

  9. Factors Associated with Pregnant Women’s Anticipations and Experiences of HIV-related Stigma in Rural Kenya

    PubMed Central

    Cuca, Yvette P.; Onono, Maricianah; Bukusi, Elizabeth; Turan, Janet M.

    2012-01-01

    Pregnant women who fear or experience HIV-related stigma may not get care for their own health or medications to reduce perinatal transmission of HIV. This study examined factors associated with anticipating and experiencing HIV-related stigma among 1,777 pregnant women attending antenatal care clinics in rural Kenya. Women were interviewed at baseline, offered HIV testing and care, and a sub-set was re-interviewed at 4–8 weeks postpartum. Women who were older, had less education, whose husbands had other wives, and who perceived community discrimination against people with HIV had significantly greater adjusted odds of anticipating HIV stigma. Over half of the HIV-positive women interviewed postpartum reported having experienced stigma, much of which was self-stigma. Women experiencing minor depression, and those whose family knew of their HIV status had significantly greater adjusted odds of experiencing stigma. Lack of women’s empowerment, as well as depression, may be important risk factors for HIV-related stigma and discrimination. PMID:22799618

  10. Duty and destiny: psychometric properties and correlates of HIV-related stigma among youth NGO workers in Delhi, India.

    PubMed

    Nambiar, Devaki; Rimal, Rajiv N

    2012-01-01

    Nongovernmental organizations (NGOs) are increasingly providing critical health-related services to hard-to-reach populations. In India, stigma has been cited as a barrier to NGO participation in HIV-prevention activities with high-risk populations. Our study undertook to characterize and contextualize HIV-related stigma within HIV NGOs in Delhi, India. We investigated psychometric characteristics and correlates of HIV-related stigma in a sample of youth NGO practitioners (N=122) working on peer HIV prevention. Factor analyses revealed a "cultural inflection" of stigma in this population: assignment of blame on people living with HIV (PLWH) factored along with individual behaviors and care-taking (Dharma, or Duty), distinct from the perception of HIV as God's punishment, which was connected to ostracism from society (Karma, or Destiny). Exposure to HIV-related messages in newspapers was associated with 55.7% lower levels of Dharma-related stigma (p=0.07) and 58% lower levels of Karma-related stigma scores (p=0.01), respectively, while recall of HIV-related messages on the radio was associated with 57.3% lower Dharma-related (p=0.03) and 34.1% lower Karma-related stigma scores (p=0.06), respectively. The strongest correlate of lower HIV-related stigma was social proximity to PLWH (~76% reduction on both stigma factors, p<0.03). Future research on HIV-related stigma should consider the unique cultural properties and correlates of stigma among young NGO practitioners. PMID:22292453

  11. HIV/AIDS Related Stigma and Discrimination against PLWHA in Nigerian Population

    PubMed Central

    Bulgiba, Awang; Oche, Oche Mansur; Adekunjo, Felix Oluyemi

    2015-01-01

    Background HIV/AIDS remain a major public health concern in Nigeria. People living with HIV/AIDS (PLWHA) face not only personal medical problems but also social problems associated with the disease such as stigma and discriminatory attitudes. This study provides an insight into HIV/AIDS related stigma and discrimination against PLWHA in Nigeria. Methods The data for this study was extracted from the 2013 Nigeria Demographic and Health Survey conducted by the National Population Commission. All men and women aged 15–49 years, permanent residents and visitors of the households were eligible for the interview. Several questionnaires were used in the survey, some covering questions on HIV/AIDS. Results A total of 56 307 men and women aged 15–49 years participated in this national survey. About half of the population in Nigeria have HIV stigma. Younger persons, men, those without formal education and those within poor wealth index are more likely to have stigma towards PLWHA. In addition, married people are more likely to have stigma on PLWHA and are more likely to blame PLWHA for bringing the disease to the community. Also about half of the population discriminates against PLWHA. However, those with higher levels of education and those from higher wealth index seem to be more compassionate towards PLWHA. About 70% in the population are willing to care for relative with AIDS, even more so among those with higher level of education. Conclusion There is a high level of HIV stigma and discrimination against PLWHA in the Nigerian population. Education seems to play a major role in the society with respect to HIV stigma and discrimination against PLWHA. Educating the population with factual information on HIV/AIDS is needed to reduce stigma and discrimination towards PLWHA in the community. PMID:26658767

  12. Size matters: community size, HIV stigma, & gender differences.

    PubMed

    Gonzalez, Adam; Miller, Carol T; Solomon, Sondra E; Bunn, Janice Yanushka; Cassidy, Daniel G

    2009-12-01

    Conclusions regarding HIV stigma in rural areas are hampered by lack of agreement about rural classification. This investigation examined perceptions of HIV stigma among males and females with HIV/AIDS in metropolitan, micropolitan, and rural areas. Two-hundred people with HIV/AIDS completed a measure of perceived HIV stigma. Their county or town of residence was used to classify community size. Results indicated that community size was related to one aspect of perceived stigma, disclosure concerns, differently for men and women. Rural women reported more disclosure concerns than did metropolitan and micropolitan women. They also reported more disclosure concerns than rural men. Men in micropolitan communities reported more disclosure concerns than men in rural areas and tended to report more disclosure concerns than men in metropolitan areas. Understanding the relationship of community size to HIV stigmatization requires acknowledging that many communities are neither urban nor rural, and it requires considering gender differences. PMID:18815878

  13. Stigma Related to HIV among Community Health Workers in Chile

    PubMed Central

    Cianelli, Rosina; Ferrer, Lilian; Norr, Kathleen F.; McCreary, Linda; Irarrázabal, Lisette; Bernales, Margarita; Miner, Sarah

    2011-01-01

    Purpose When healthcare workers have stigmatizing attitudes toward people living with HIV it may lead to discriminatory behavior that interferes with prevention, treatment, and care. This research examined the HIV-related stigmatizing attitudes reported by health workers in Santiago, Chile. Methods The study used focus group data from the first phase of a larger study to develop and test a HIV prevention intervention for Chilean health workers. Ten focus groups were conducted with Health workers in two communities in Santiago, Chile. Content analysis was used to analyze the data. Results Two central themes emerged: Societal stigma and discrimination towards people living with HIV and healthcare system’s policies related to HIV. Both inaccurate fears of transmission among the general public and Chilean Health workers and societal prejudices against homosexuals contributed to stigmatization and discrimination. Conclusions Health workers did not recognize their own stigmatizing attitudes or discriminatory behaviors, but their discussion indicated that these behaviors and attitudes did exist. Healthcare system issues identified included problems with confidentiality due to the desire to inform other health workers about client HIV status. Health workers must be sensitized to the current stigmatization and misinformation associated with HIV and its negative impacts on persons living with HIV and the general community. Implications All clinical and non-clinical workers at community clinics need mandatory education for HIV prevention that focuses on changing attitudes as well as sharing knowledge. Also, the Chilean law protecting people living with HIV and the confidentiality of their medical care needs to be publicized, along with guidelines for its enactment in clinics and other health facilities. PMID:21687824

  14. My secret: The social meaning of HIV/AIDS stigma

    PubMed Central

    Judgeo, N.; Moalusi, K.P.

    2014-01-01

    Abstract This study uses Goffman's [1963. Stigma: Notes on the Management of Spoiled Identity, New Jersey, Prentice-Hall] theory of stigma as an intellectual scaffold to help understand the social meaning of HIV/AIDS stigma from People Living with HIV/AIDS. The study adopts a qualitative approach because of its appropriateness for unravelling subjective phenomena such as the experiences of HIV/AIDS stigma. In-depth interviews were conducted with 10 HIV-positive employees of a retailing company located in the Western Cape province of South Africa who volunteered to participate in the study. The participants with the discreditable stigma internalised society's prejudice towards those living with the virus. As a result, the participants relied on self-isolation and social withdrawal to cope with enacted stigma. Managing information about one's status and deciding whether, who, when, etc., to tell are crucial questions. The participants feared being devalued by family, friends, co-workers and the community. In concurrence with Goffman [1963. Stigma: Notes on the Management of Spoiled Identity, New Jersey, Prentice-Hall] the HIV/AIDS stigma is seen as about relationships. PMID:24980478

  15. Predictors of HIV-related Stigma among Young People Living with HIV

    PubMed Central

    Swendeman, Dallas; Rotheram-Borus, Mary Jane; Comulada, Scott; Weiss, Robert; Ramos, Maria Elena

    2008-01-01

    Enacted and perceived HIV-stigma was examined among substance using young people living with HIV (YPLH) in Los Angeles, San Francisco, and New York City (N = 147). Almost all YPLH (89%) reported perceived stigma and 31% report enacted experiences in the past three months; 64% reported experiences during their lifetime. The HIV-stigma questions were characterized by factors of avoidance, social rejections, abuse and shame. In multivariate models enacted stigma was associated with gay/bisexual identity, symptomatic HIV or AIDS, and bartering sex. Perceived stigma was associated with female gender, symptomatic HIV or AIDS, bartering sex, lower injection drug use, and fewer friends and family knowing serostatus. Gay/bisexual YPLH who were also HIV symptomatic or AIDS diagnosed experienced more HIV-stigma than their heterosexual peers. PMID:16846325

  16. Community patterns of stigma towards persons living with HIV: A population-based latent class analysis from rural Vietnam

    PubMed Central

    2011-01-01

    Background The negative effects of stigma on persons living with HIV (PLHIV) have been documented in many settings and it is thought that stigma against PLHIV leads to more difficulties for those who need to access HIV testing, treatment and care, as well as to limited community uptake of HIV prevention and testing messages. In order to understand and prevent stigma towards PLHIV, it is important to be able to measure stigma within communities and to understand which factors are associated with higher stigma. Methods To analyze patterns of community stigma and determinants to stigma toward PLHIV, we performed an exploratory population-based survey with 1874 randomly sampled adults within a demographic surveillance site (DSS) in rural Vietnam. Participants were interviewed regarding knowledge of HIV and attitudes towards persons living with HIV. Data were linked to socioeconomic and migration data from the DSS and latent class analysis and multinomial logistic regression were conducted to examine stigma group sub-types and factors associated with stigma group membership. Results We found unexpectedly high and complex patterns of stigma against PLHIV in this rural setting. Women had the greatest odds of belong to the highest stigma group (OR 1.84, 95% CI 1.42-2.37), while those with more education had lower odds of highest stigma group membership (OR 0.45, 95% CI 0.32-0.62 for secondary education; OR 0.19, 95% CI 0.10-0.35 for tertiary education). Long-term migration out of the district (OR 0.61, 95% CI 0.4-0.91), feeling at-risk for HIV (OR 0.42, 95% CI 0.27-0.66), having heard of HIV from more sources (OR 0.44, 95% CI 0.3-0.66), and knowing someone with HIV (OR 0.76, 95% CI 0.58-0.99) were all associated with lower odds of highest stigma group membership. Nearly 20% of the population was highly unsure of their attitudes towards PLHIV and persons in this group had significantly lower odds of feeling at-risk for HIV (OR 0.54, 95% CI 0.33-0.90) or of knowing someone

  17. Gender differences in HIV-related stigma in Kenya.

    PubMed

    Mugoya, George C T; Ernst, Kacey

    2014-02-01

    Stigma associated with HIV/AIDS directly and indirectly drives HIV transmission. We examined how factors associated with HIV-related stigma differed by gender, using data from the 2008-2009 Kenya Demographic and Health Survey (KDHS). Descriptive, bivariate and multinomial logistic regression analyses were conducted on selected HIV-related stigma indicators for men and women. Bivariate analyses showed significant gender differences in the overall HIV Stigma index with a higher proportion of women than men presented at the highest stigma level (4.9% vs 2.7%, p < 0.01). Women were more likely to express higher stigmatic attitudes for all components of stigma measured than men. Multivariate analyses showed that HIV-related knowledge had significant inverse dose-response for both men and women. For instance, compared to women in the first HIV-related knowledge quartile, a 1 unit increase in HIV-related knowledge among women at the third HIV-related knowledge quartile was expected to lead to a 63.8% decrease in HIV-related stigma (95% CI [0.21, 0.63]) for women with high stigma, 57.8% decrease for similar women with medium stigma (95% CI [0.33, 0.55]) and 28.4% decrease for those with low stigma (95% CI [0.57, 0.90]). Acceptance with the statement "a husband is justified to hit or beat his wife if she refuses to have sex with him" was a significant risk factor for expression of stigmatising attitudes at all levels for women (High: OR = 1.49, 95% CI [1.02, 2.17]), Medium: OR = 1.47, 95% CI [1.18, 1.82], Low: OR = 1.38, 95% CI [1.10, 1.73]) and men at medium stigma (OR = 2.02, 95% CI [1.38, 2.95]). Other notable gender differences were found in employment, marital status, ethnicity, region of residence, wealth and media exposure. Our results showed that women in the general Kenyan population had higher stigmatic attitudes than men. This was associated with differences in risk factor profile and confirmed previous literature on complexity of social-cultural factors

  18. Understanding internalized HIV/AIDS-related stigmas in the Dominican Republic: a short report.

    PubMed

    Rael, Christine Tagliaferri; Hampanda, Karen

    2016-03-01

    HIV/AIDS-related stigmas can become internalized, resulting in declines in physical and mental health. Pathways to internalized HIV-related stigma (IS), characterized by persistently negative, self-abasing thoughts, are not well established among women living with HIV/AIDS (WLWHA) in the Dominican Republic (DR). Identifying factors involved in self-directed shaming and blaming is important, given the high HIV prevalence in the DR's most vulnerable populations. The present study sheds light on factors involved in negative and self-abasing thoughts in WLWHA in the DR by examining the relationship between depression, perceived HIV-related stigma from the community (PSC), perceived HIV-related stigma from family (PSF), and IS. The Internalized AIDS-Related Stigma Scale (IA-RSS), the Center for Epidemiologic Studies Short Depression Scale (CES-D 10), and an instrument designed to measure perceived HIV-related stigma from the community and family was administered to 233 WLWHA in Puerto Plata, DR. Data were analyzed using descriptive statistics and ordered multiple logistic regression. Results showed that depression (OR = 1.60; p < .05), PSC (OR = 3.68; p < .001), and PSF (OR = 1.60; p < .01) were positively associated with IS. These findings indicate that IS-reducing interventions should address HIV-related depression. Additionally, HIV-related treatment and care services should work with WLWHA to adopt healthier attitudes about how community members view people living with HIV/AIDS in the DR. PMID:26466239

  19. Understanding Internalized HIV/AIDS-Related Stigmas in the Dominican Republic: A Short Report

    PubMed Central

    Hampanda, Karen

    2016-01-01

    HIV/AIDS-related stigmas can become internalized, resulting in declines in physical and mental health. Pathways to internalized HIV-related stigma (IS), characterized by persistently negative, self-abasing thoughts, are not well established among women living with HIV/AIDS (WLWHA) in the Dominican Republic (DR). Identifying factors involved in self-directed shaming and blaming is important, given the high HIV prevalence in the DR’s most vulnerable populations. The present study sheds light on factors involved in negative and self-abasing thoughts in WLWHA in the DR by examining the relationship between depression, perceived HIV-related stigma from the community (PSC), perceived HIV-related stigma from family (PSF) and IS. The Internalized AIDS-Related Stigma Scale (IA-RSS), the Center for Epidemiologic Studies Short Depression Scale (CES-D 10), and an instrument designed to measure perceived HIV-related stigma from the community and family was administered to 233 WLWHA in Puerto Plata, DR. Data were analyzed using descriptive statistics and ordered multiple logistic regression. Results showed that depression (OR=1.60; p<0.05), PSC (OR=3.68; p<0.001), and PSF (OR=1.60; p<0.01) were positively associated with IS. These findings indicate that IS-reducing interventions should address HIV-related depression. Additionally, HIV-related treatment and care services should work with WLWHA to adopt healthier attitudes about how community members view people living with HIV/AIDS in the Dominican Republic. PMID:26466239

  20. Testing the efficacy of an HIV stigma reduction intervention with medical students in Puerto Rico: the SPACES project

    PubMed Central

    Varas-Díaz, Nelson; Neilands, Torsten B; Cintrón-Bou, Francheska; Marzán-Rodríguez, Melissa; Santos-Figueroa, Axel; Santiago-Negrón, Salvador; Marques, Domingo; Rodríguez-Madera, Sheilla

    2013-01-01

    Introduction Stigma associated with HIV has been documented as a barrier for accessing quality health-related services. When the stigma manifests in the healthcare setting, people living with HIV receive substandard services or even be denied care altogether. Although the consequences of HIV stigma have been documented extensively, efforts to reduce these negative attitudes have been scarce. Interventions to reduce HIV stigma should be implemented as part of the formal training of future healthcare professionals. The interventions that have been tested with healthcare professionals and published have several limitations that must be surpassed (i.e., lack of comparison groups in research designs and longitudinal follow-up data). Furthermore, Latino healthcare professionals have been absent from these intervention efforts even though the epidemic has affected this population disproportionately. Methods In this article, we describe an intervention developed to reduce HIV stigma among medical students in Puerto Rico. A total of 507 medical students were randomly introduced into our intervention and control conditions. Results The results show statistically significant differences between the intervention and control groups; intervention group participants had lower HIV stigma levels than control participants after the intervention. In addition, differences in HIV stigma levels between the groups were sustained for a 12-month period. Conclusions The results of our study demonstrate the efficacy of the modes of intervention developed by us and serve as a new training tool for future healthcare professionals with regard to stigma reduction. PMID:24242260

  1. Measuring HIV Stigma at the Family Level: Psychometric Assessment of the Chinese Courtesy Stigma Scales (CCSSs)

    PubMed Central

    Liu, Hongjie; Xu, Yongfang; Sun, Yehuan; Dumenci, Levent

    2014-01-01

    Courtesy stigma is the stigmatization a person perceives or experiences due to their association with a stigmatized individual or group. Most HIV-related stigma scales have been developed for people living with HIV/AIDS (PLWHAs), but not for their HIV-uninfected family members. To date, few measurement scales have been designed to measure the degree of stigma among both PLWHAs and their HIV-uninfected family members at the family level. We developed a set of courtesy stigma scales and estimated their reliability and validity from 256 PLWHAs and 256 of their HIV-uninfected family members. Exploratory and confirmatory factor analyses were performed in two independent samples: a development sample (N = 216) and a validation sample (N = 296), respectively. Two factors (“public stigma” and “self-perceived stigma”) had high internal consistency reliability (Cronbach's alpha coefficient between 0.83–0.90) and good construct validity (standardized factor loading range: 0.37–0.95) in both samples. These findings document that the newly developed brief instrument is a psychometrically sound measure of HIV-related stigma among both PLWHAs and their HIV-uninfected family members. PMID:24658364

  2. My secret: the social meaning of HIV/AIDS stigma.

    PubMed

    Judgeo, N; Moalusi, K P

    2014-01-01

    This study uses Goffman's [1963. Stigma: Notes on the Management of Spoiled Identity, New Jersey, Prentice-Hall] theory of stigma as an intellectual scaffold to help understand the social meaning of HIV/AIDS stigma from People Living with HIV/AIDS. The study adopts a qualitative approach because of its appropriateness for unravelling subjective phenomena such as the experiences of HIV/AIDS stigma. In-depth interviews were conducted with 10 HIV-positive employees of a retailing company located in the Western Cape province of South Africa who volunteered to participate in the study. The participants with the discreditable stigma internalised society's prejudice towards those living with the virus. As a result, the participants relied on self-isolation and social withdrawal to cope with enacted stigma. Managing information about one's status and deciding whether, who, when, etc., to tell are crucial questions. The participants feared being devalued by family, friends, co-workers and the community. In concurrence with Goffman [1963], the HIV/AIDS stigma is seen as about relationships. PMID:24980478

  3. Women of Color Reflect on HIV-Related Stigma through PhotoVoice.

    PubMed

    Davtyan, Mariam; Farmer, Shu; Brown, Brandon; Sami, Mojgan; Frederick, Toni

    2016-01-01

    HIV-related stigma affects people living with HIV (PLWH), especially in communities of color. In our study, African American and Latina/Hispanic women living with HIV (WLWH) described experiences of stigma through PhotoVoice, a community-based participatory method of documentary photography. Ten WLWH from Los Angeles documented stigma experiences through photographs for up to 5 weeks and discussed their images during a focus group or semi-structured individual interview. Qualitative interpretive phenomenological analysis of participant narratives and photographs revealed lack of education and cultural myths as the main triggers of the stigma our participants faced. Stigma was experienced in health care settings, and participants identified depression, fear of intimate relationships, and nondisclosure of HIV status as its consequences. Social support and faith were noted as key coping mechanisms. WLWH recommended involving PLWH and public health officials in stigma reduction campaigns and youth education. PhotoVoice was perceived as a useful tool for education and self-improvement. PMID:27085253

  4. Validation of 2 Spanish-Language Scales to Assess HIV-Related Stigma in Communities.

    PubMed

    Franke, Molly F; Nelson, Adrianne K; Muñoz, Maribel; Cruz, Janeth Santa; Atwood, Sidney; Lecca, Leonid; Shin, Sonya S

    2015-01-01

    We report the psychometric properties of 2 Spanish-language scales designed to measure (1) opinions about HIV in the community and particularly among health care workers and (2) observed acts of stigma toward people living with HIV/AIDS (PLWHA) by health care workers. The Opinions about HIV Scale included 3 components (policy, avoidance, and empathy) and 9 items, while an adapted version of the HIV/AIDS Stigma Instrument-Nurse, designed to capture acts of stigma, included 2 components (discrimination related to clinical care and refusal to share or exchange food/gifts). Scales demonstrated good reliability and construct validity. Relative to community health workers, treatment supporters were more likely to have stigmatizing opinions related to avoidance and empathy. We offer 2 Spanish-language scales that could be used to identify populations with high levels of stigmatizing opinions and behaviors toward PLWHA. Formal training of health care workers, especially treatment supporters, may raise awareness and reduce stigma toward HIV. PMID:25294853

  5. Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis.

    PubMed

    Culbert, Gabriel J; Earnshaw, Valerie A; Wulanyani, Ni Made Swasti; Wegman, Martin P; Waluyo, Agung; Altice, Frederick L

    2015-01-01

    In Indonesia, the syndemic nature of HIV, drug use, and incarceration may influence experiences of stigma for HIV-infected prisoners. This mixed-method study explores HIV stigma in prisoners living with HIV in Indonesia. Randomly selected male HIV-infected prisoners (n = 102) from two large prisons in Jakarta completed in-depth interviews and a structured HIV stigma survey. Quantitative results found four groups of HIV-infected prisoners with significantly higher HIV stigma levels, including those: (a) with drug-related offenses, (b) seeking help to decrease drug use, (c) diagnosed with HIV before the current incarceration, and (d) who had not disclosed their HIV status to family members or friends. Qualitative results highlighted the prominent role of HIV stigma in decisions to disclose HIV status to family members, partners, and other prisoners. Interventions should address HIV stigma in HIV-infected prisoners in Indonesia to achieve HIV treatment as prevention goals. PMID:26304049

  6. "Inside These Fences Is Our Own Little World": Prison-Based HIV Testing and HIV-Related Stigma Among Incarcerated Men and Women.

    PubMed

    Muessig, Kathryn E; Rosen, David L; Farel, Claire E; White, Becky L; Filene, Eliza J; Wohl, David A

    2016-04-01

    Correctional facilities offer opportunities to provide comprehensive HIV services including education, testing, treatment, and coordination of post- release care. However, these services may be undermined by unaddressed HIV stigma. As part of a prison-based HIV testing study, we interviewed 76 incarcerated men and women from the North Carolina State prison system. The sample was 72% men, median age 31.5 years (range: 19 to 60). Thematic analysis revealed high levels of HIV-related fear and stigma, homophobia, incomplete HIV transmission knowledge, beliefs that HIV is highly contagious within prisons ("HIV miasma"), and the View of HIV testing as protective. Interviewees described social distancing behaviors and coping mechanisms they perceived to be protective, including knowing their HIV status and avoiding contact with others and shared objects. Interviewees endorsed universal testing, public HIV status disclosure, and segregation of HIV-positive inmates. Intensified education and counseling efforts are needed to ameliorate entrenched HIV-transmission fears and stigmatizing beliefs. PMID:27459162

  7. Development and Validation of a Culturally Appropriate HIV/AIDS Stigma Scale for Puerto Rican Health Professionals in Training

    PubMed Central

    Díaz, Nelson Varas; Neilands, Torsten B.

    2009-01-01

    HIV/AIDS stigma continues to be an obstacle for primary and secondary HIV prevention. Its consequences for the lives of people living with the disease have been well documented and continue to be of great concern for health care providers and researchers in the field. These consequences are worsened when such stigma emanates from health professionals, as this can limit access to services. One of the main obstacles for HIV/AIDS Stigma research in Puerto Rico is the absence of quantitative measures to assess HIV/AIDS stigma manifestations among health professionals. In light of this gap in the scientific literature, the main objective of this study was to develop and test the psychometric properties of a culturally appropriate HIV/AIDS stigma scale for Puerto Rican health care providers and to develop a reduced form of the scale suitable for use in time-limited clinical settings. The developed measure was based on previous qualitative evidence gathered from Puerto Rican health professionals (Varas-Díaz, Serrano-García & Toro-Alfonso, 2005) and administered to a sample of 421 health professionals in training. The scale addresses 12 HIV/AIDS stigma dimensions. In quantitative analyses 11 of these dimensions demonstrated satisfactory validity and reliability. These dimensions in turn were subcomponents of a higher-order general stigma factor. Implications and limitations of these findings are discussed. PMID:20024702

  8. HIV-related stigma: Impact on healthcare workers in Vietnam.

    PubMed

    Ha, Pham Nguyen; Chuc, Nguyen Thi Kim; Hien, Ho Thi; Larsson, Mattias; Pharris, Anastasia

    2013-01-01

    Stigma has been identified as a major barrier to HIV response. While much is known about stigma directed towards people living with HIV (PLHIV), less is known about stigma experienced by health workers who treat PLHIV. This study aims to explore the perceptions and experiences of health workers regarding how stigma influences their work with HIV-positive patients. The study employed a qualitative design involving individual semi-structured in-depth interviews with 14 health workers, purposively selected from hospitals and detention centres for people who use drugs and sex workers in Hanoi, Vietnam. Findings showed that the stigma experienced by health workers may be organised around several themes: (1) lack of social prestige associated with HIV work; (2) fear of infection expressed by family members; (3) feelings of being devalued within the healthcare field; and (4) work-related stress and burnout, especially for staff working in detention centres for drug users and female sex workers. Efforts are needed to improve the public image of HIV work, scale up stigma reduction, enhance stress management and create a safe and supportive working environment for health workers. PMID:23738991

  9. Vicious circle of perceived stigma, enacted stigma and depressive symptoms among children affected by HIV/AIDS in China.

    PubMed

    Chi, Peilian; Li, Xiaoming; Zhao, Junfeng; Zhao, Guoxiang

    2014-06-01

    Previous research has found a deleterious impact of stigma on the mental health of children affected by HIV/AIDS. Little is known about the longitudinal relationship of stigma and children's mental health. This study explores the longitudinal reciprocal effects of depressive symptoms and stigma, specifically enacted stigma and perceived stigma, among children affected by HIV/AIDS aged 6-12. Longitudinal data were collected from 272 children orphaned by AIDS and 249 children of HIV-positive parents in rural China. Cross-lagged panel analysis was conducted in the study. Results showed that the autoregressive effects were stable for depressive symptoms, perceived stigma and enacted stigma suggesting the substantially stable individual differences over time. The cross-lagged effects indicated a vicious circle among the three variables in an order of enacted stigma → depressive symptom → perceived stigma → enacted stigma. The possibility of employing equal constraints on cross-lagged paths suggested that the cross-lagged effects were repeatable over time. The dynamic interplay of enacted stigma, perceived stigma and depressive symptoms suggests the need of a multilevel intervention in stigma reduction programming to promote mental health of children affected by HIV/AIDS. PMID:24158487

  10. Associations between Perceived HIV Stigma and Quality of Life at the Dyadic Lvel: The Actor-Partner Interdependence Model

    PubMed Central

    Liu, Hongjie; Xu, Yongfang; Lin, Xinjin; Shi, Jian; Chen, Shiyi

    2013-01-01

    Background Few studies have investigated the relationship between HIV-related stigma and quality life at the dyadic level. The objective of this study was to examine the actor and partner effects of stigma that was perceived by people living with HIV/AIDS (PLWHAs) and caregivers on quality of life at the dyadic level. Method A survey was conducted among 148 dyads consisting of one PLWHA and one caregiver (296 participants) in Nanning, China. The interdependent relationship between a pair of dyadic members that influences the associations between stigma and quality of life was analyzed, using an innovative dyadic analysis technique: the Actor-Partner Interdependence Model (APIM). Results We found in this dyadic analysis that (1) PLWHAs compared to their caregivers exhibited a higher level of perceived HIV stigma and lower level of quality of life measured in four domains; (2) both PLWHAs' and caregivers' perceived HIV stigma influenced their own quality of life; (3) The quality of life was not substantially influenced by their partners' perceived stigma; and (4) Both actor and partner effects of stigma on quality of life were similar among PLWHAs and their caregivers. Conclusion As HIV stigma and quality of life are complex phenomena rooted in cultures, intervention programs should be carefully planned based on social or cognitive theories and should be culturally adopted. PMID:23383343

  11. HIV/AIDS-related stigma in Kumasi, Ghana

    PubMed Central

    Ulasi, Chijioke I; Preko, Peter O; Baidoo, Joseph A.; Bayard, Budry; Ehiri, John E; Jolly, Curtis M; Jolly, Pauline E

    2009-01-01

    Objective To assess HIV/AIDS-related stigma and discrimination of people living with HIV/AIDS (PLWHA) in Kumasi, Ghana. Methods A cross-sectional survey of 104 adults from the four sub-districts in Kumasi was conducted. Results Four stigma constructs, employment-based discrimination, screening and identification of HIV positive people, revelation of HIV status and social contact stigma were determined based on reliability measures from responses to the questionnaire. Regression analysis showed that participants with higher educational attainment were more likely to favor policies denying employment to PLWHA (p<0.05), but disapproved of revealing HIV sero-status (p<0.05). Muslims were more likely than Christians to agree with identifying PLWHA (p<0.05) and more likely to advocate revealing HIV sero-status (p<0.05). Males were more likely to favor revealing HIV status (p<0.05). Employed persons were more likely to have social contact with PLWHA (p<0.05). Conclusions These findings are useful in guiding the design of interventions against HIV/AIDS-related stigma in Kumasi. PMID:18632302

  12. Managing uncertainty: a grounded theory of stigma in transgender health care encounters.

    PubMed

    Poteat, Tonia; German, Danielle; Kerrigan, Deanna

    2013-05-01

    A growing body of literature supports stigma and discrimination as fundamental causes of health disparities. Stigma and discrimination experienced by transgender people have been associated with increased risk for depression, suicide, and HIV. Transgender stigma and discrimination experienced in health care influence transgender people's health care access and utilization. Thus, understanding how stigma and discrimination manifest and function in health care encounters is critical to addressing health disparities for transgender people. A qualitative, grounded theory approach was taken to this study of stigma in health care interactions. Between January and July 2011, fifty-five transgender people and twelve medical providers participated in one-time in-depth interviews about stigma, discrimination, and health care interactions between providers and transgender patients. Due to the social and institutional stigma against transgender people, their care is excluded from medical training. Therefore, providers approach medical encounters with transgender patients with ambivalence and uncertainty. Transgender people anticipate that providers will not know how to meet their needs. This uncertainty and ambivalence in the medical encounter upsets the normal balance of power in provider-patient relationships. Interpersonal stigma functions to reinforce the power and authority of the medical provider during these interactions. Functional theories of stigma posit that we hold stigmatizing attitudes because they serve specific psychological functions. However, these theories ignore how hierarchies of power in social relationships serve to maintain and reinforce inequalities. The findings of this study suggest that interpersonal stigma also functions to reinforce medical power and authority in the face of provider uncertainty. Within functional theories of stigma, it is important to acknowledge the role of power and to understand how stigmatizing attitudes function to maintain

  13. AN INTERVENTION TO REDUCE HIV-RELATED STIGMA IN PARTNERSHIP WITH AFRICAN AMERICAN AND LATINO CHURCHES

    PubMed Central

    Derose, Kathryn Pitkin; Bogart, Laura M.; Kanouse, David E.; Felton, Alexandria; Collins, Deborah Owens; Mata, Michael A.; Oden, Clyde W.; Domínguez, Blanca X.; Flórez, Karen R.; Hawes-Dawson, Jennifer; Williams, Malcolm V.

    2014-01-01

    HIV-related stigma negatively affects prevention and care, and community-based interventions are needed. Here we describe the development of a multi-ethnic, faith-based intervention to reduce HIV stigma that included: educational workshops on HIV, testing, and stigma; peer leader workshops using role plays and drawing on principles of motivational interviewing; a pastor-delivered sermon on HIV that incorporated theological reflection and an imagined contact scenario; and congregation-based HIV testing events. Lessons learned include: partnership development is essential and requires substantial investment; tailoring intervention components to single race-ethnic groups may not be preferable in diverse community settings; and adapting testing processes to be able to serve larger numbers of people in shorter time frames is needed for congregational settings. This development process successfully combined the rigorous application of social science theory and community engagement to yield a multifaceted HIV stigma reduction intervention appropriate for Protestant and Catholic churches in African American and Latino communities. PMID:24450276

  14. Validation of the HIV/AIDS Stigma Instrument - PLWA (HASI-P).

    PubMed

    Holzemer, William L; Uys, Leana R; Chirwa, Maureen L; Greeff, Minrie; Makoae, Lucia N; Kohi, Thecla W; Dlamini, Priscilla S; Stewart, Anita L; Mullan, Joseph; Phetlhu, René D; Wantland, Dean; Durrheim, Kevin

    2007-09-01

    This article describes the development and testing of a quantitative measure of HIV/AIDS stigma as experienced by people living with HIV/AIDS. This instrument is designed to measure perceived stigma, create a baseline from which to measure changes in stigma over time, and track potential progress towards reducing stigma. It was developed in three phases from 2003-2006: generating items based on results of focus group discussions; pilot testing and reducing the original list of items; and validating the instrument. Data for all phases were collected from five African countries: Lesotho, Malawi, South Africa, Swaziland and Tanzania. The instrument was validated with a sample of 1,477 persons living with HIV/AIDS from all of the five countries. The sample had a mean age of 36.1 years and 74.1% was female. The participants reported they knew they were HIV positive for an average of 3.4 years and 46% of the sample was taking antiretroviral medications. A six factor solution with 33 items explained 60.72% of the variance. Scale alpha reliabilities were examined and items that did not contribute to scale reliability were dropped. The factors included: Verbal Abuse (8 items, alpha=0.886); Negative Self-Perception (5 items, alpha=0.906); Health Care Neglect (7 items, alpha=0.832); Social Isolation (5 items, alpha=0.890); Fear of Contagion (6 items, alpha=0.795); and Workplace Stigma (2 items, alpha=0.758). This article reports on the development and validation of a new measure of stigma, HIV/AIDS Stigma Instrument - PLWA (HASI-P) providing evidence that supports adequate content and construct validity, modest concurrent validity, and acceptable internal consistency reliability for each of the six subscales and total score. The scale is available is several African languages. PMID:17851997

  15. HIV, Gender, Race, Sexual Orientation, and Sex Work: A Qualitative Study of Intersectional Stigma Experienced by HIV-Positive Women in Ontario, Canada

    PubMed Central

    Logie, Carmen H.; James, LLana; Tharao, Wangari; Loutfy, Mona R.

    2011-01-01

    deleterious effects of stigma and discrimination on HIV risk, mental health, and access to care among HIV-positive women can inform health care provision, stigma reduction interventions, and public health policy. Please see later in the article for the Editors' Summary PMID:22131907

  16. Feasibility of using an iPod touch device and acceptability of a stigma reduction intervention with HIV-infected women in the Deep South.

    PubMed

    Relf, Michael V; Silva, Susan G; Williams, Megan Scull; Moore, Elizabeth; Arscott, Joyell; Caiola, Courtney; Barroso, Julie

    2015-10-01

    As with many infectious diseases throughout history, stigma is a part of the trajectory of the HIV disease process. HIV-related stigma impedes women from being tested for HIV. Once infected, HIV-related stigma hinders women from disclosing their HIV status to sexual partners and health care providers, engaging in medical care, effectively self-managing the disease after infection, and adhering to anti-retroviral therapy. After three decades of the HIV epidemic, no evidenced-based, culturally relevant, gender-specific interventions exist to help women infected with HIV manage the stigma associated with HIV infection. This manuscript reports the feasibility of using an iPod touch device and acceptability of a stigma reduction intervention with HIV-infected women in the Deep South in a mixed-method, randomized clinical trial. Results from the study demonstrate that it is feasible to utilize an iPod touch device to deliver an HIV-related stigma intervention to women. Further, women report that the HIV-related stigma intervention is acceptable and meaningful. PMID:25761644

  17. HIV Stigma in Prisons and Jails: Results from a Staff Survey.

    PubMed

    Belenko, Steven; Dembo, Richard; Copenhaver, Michael; Hiller, Matthew; Swan, Holly; Albizu Garcia, Carmen; O'Connell, Daniel; Oser, Carrie; Pearson, Frank; Pankow, Jennifer

    2016-01-01

    With numerous HIV service gaps in prisons and jails, there has been little research on HIV stigma attitudes among correctional staff. Such attitudes may undermine HIV services for inmates at risk of or infected with HIV. This HIV stigma attitudes survey among 218 correctional staff in 32 US facilities (1) provides an overview of staff's stigma attitudes, (2) reports psychometric analyses of domains in Earnshaw and Chaudoir's HIV Stigma Framework (HSF), and (3) explores differences in stigma attitudes among different staff types. Overall, correctional and medical staff expressed non stigmatizing attitudes toward people living with HIV/AIDS, but perceived that stigma and discrimination exist in others. Factor analyses revealed a three factor structure capturing two mechanisms of the HSF (prejudice, discrimination). Few factor score differences were found by staff type or setting. Implications for correctional HIV services and future research on HIV stigma attitudes are discussed. PMID:26036464

  18. Understanding HIV-Related Stigma and Discrimination in a "Blameless" Population

    ERIC Educational Resources Information Center

    Cao, Xiaobin; Sullivan, Sheena G.; Xu, Jie; Wu, Zunyou

    2006-01-01

    HIV-related stigma and discrimination are major barriers to the successful control of HIV. Stigma is associated with the disease as well as the behaviors that lead to infection. A qualitative study was conducted to identify the reasons, sources, and types of HIV-related stigma prevalent in rural China. Eighty in-depth interviews were conducted…

  19. HIV knowledge, stigma, and illness beliefs among pediatric caregivers in Ghana who have not disclosed their child's HIV status

    PubMed Central

    Paintsil, Elijah; Renner, Lorna; Antwi, Sampson; Dame, Joycelyn; Enimil, Anthony; Ofori-Atta, Angela; Alhassan, Amina; Ofori, Irene Pokuaa; Cong, Xiangyu; Kyriakides, Tassos; Reynolds, Nancy R.

    2015-01-01

    The majority of HIV-infected children in sub-Saharan Africa have not been informed of their HIV status. Caregivers are reluctant to disclose HIV status to their children because of concern about the child’s ability to understand, parental sense of guilt, and fear of social rejection and isolation. We hypothesized that the low prevalence of pediatric HIV disclosure in Ghana is due to lack of accurate HIV information and high HIV stigma among caregivers. This is a preliminary analysis of baseline data of an HIV pediatric disclosure intervention study in Ghana (“Sankofa”). “Sankofa” – is a two-arm randomized controlled clinical trial comparing disclosure intervention plus usual care (intervention arm) vs usual care (control arm) at Korle-Bu Teaching Hospital (KBTH; control arm) and Komfo-Anokye Teaching Hospital (KATH; intervention arm). We enrolled HIV-infected children, ages 7–18 years who do not know their HIV status, and their caregivers. Baseline data of caregivers included demographic characteristics; Brief HIV Knowledge Questionnaire (HIV-KQ-18); Brief Illness Perception Questionnaire; and HIV Stigma Scale. Simple and multivariable linear regression analyses were used to assess the relationship between caregiver characteristics and HIV knowledge, stigma, and illness perception. Two hundred and ninety-eight caregivers were enrolled between January 2013 and July 2014 at the two study sites; KBTH (n = 167) and KATH (n = 131). The median age of caregivers was 41 years; 80.5% of them were female and about 60% of caregivers were HIV-positive. Seventy-eight percent of caregivers were self-employed with low household income. In both unadjusted and adjusted analyses, HIV negative status and lower level of education were associated with poor scores on HIV-KQ. HIV positive status remained significant for higher level of stigma in the adjusted analyses. None of the caregiver’s characteristics predicted caregiver’s illness perception. Intensification of

  20. Is HIV/AIDS Stigma Dividing the Gay Community? Perceptions of HIV-Positive Men Who Have Sex with Men

    ERIC Educational Resources Information Center

    Courtenay-Quirk, Cari; Wolitski, Richard J.; Parsons, Jeffrey T.; Gomez, Cynthia A.

    2006-01-01

    Stigma surrounding HIV/AIDS has existed since the beginning of the epidemic, but little is known about HIV/AIDS stigma within the gay community and how it affects men who have sex with men (MSM) living with HIV. A better understanding of the effects of stigma on this population is needed to reduce it and its harmful effects. Our study used…

  1. Managing HIV among serodiscordant heterosexual couples: serostatus, stigma and sex.

    PubMed

    van der Straten, A; Vernon, K A; Knight, K R; Gómez, C A; Padian, N S

    1998-10-01

    A qualitative study was conducted with 28 men and women in HIV-serodiscordant couples to explore the management of HIV in their relationship. Content analysis of the interviews revealed the role of serostatus and stigma in shaping partners' experience of HIV, sex and risk. Partners' differing serostatus often created feelings of alienation within the relationship. Compounding this interpersonal dynamic, the HIV service community was experienced as segregating because they were not funded or prepared to work with seronegative partners. Thus many, particularly seronegative women, felt invisible both within and outside of the relationship. Yet, the uninfected partners shared the burden of a stigmatizing illness because of the serodiscordant relationship. Stigma hindered communication about HIV and sex, disclosure to others and access to services. Many experienced HIV as a loss of their sexuality. Seronegative partners spoke about 'keeping sex alive' and often had to push to continue having sex. Couples used multiple strategies to manage HIV, including developing strict behavioural guidelines, connecting with other couples, accessing scientific information and becoming educators and activists. These altruistic activities, which also included participation in research, helped to transcend external and internalized stigma. Implications for developing interventions for HIV-serodiscordant couples are discussed. PMID:9828951

  2. HIV-related stigma among African-American youth in the Northeast and Southeast US.

    PubMed

    Kerr, Jelani C; Valois, Robert F; Diclemente, Ralph J; Fletcher, Faith; Carey, Michael P; Romer, Daniel; Vanable, Peter A; Farber, Naomi

    2014-06-01

    HIV-related stigma inhibits optimal HIV prevention and treatment among African-Americans. Regional differences in HIV/AIDS prevalence may be related to stigma among young African-Americans. Baseline data (N = 1,606) from an HIV prevention intervention were used to investigate regional differences in HIV-related stigma and knowledge among African-American adolescents in four midsized cities in the Northeastern and Southeastern US. Analyses indicated greater HIV-related stigma among adolescents from the Southeast relative to adolescents from the Northeast (F = 22.23; p < 0.0001). Linear regression indicated a negative relationship between HIV stigma and HIV knowledge (b = -0.65; p < 0.0001). Addressing HIV/AIDS in high prevalence locales should include efforts to reduce HIV-related stigma. PMID:24402690

  3. Link to slower access to care: what is the stigma?: an Indian perspective.

    PubMed

    Kandwal, Rashmi; Bahl, Taru

    2011-12-01

    Stigma and discrimination have been "bed fellows" of HIV and AIDS in India. Perpetuated by lack of awareness, deep-rooted traditional beliefs, adherence to harmful practices, and a moralistic tag associated with a condition connected with sex (in India the method of HIV transmission being largely heterosexual in nature) and high-risk individuals such as sex workers, it made it difficult for the country to fight an epidemic that was hard to track, estimate, diagnose, and treat. Various interventions under India's National AIDS Control Program (NACP) have targeted stigma and discrimination among different groups. The program has been fairly successful in its outreach programs, bringing about a reduction in adult HIV prevalence and new infections. As the country transitions from NACP Phase III (2007-2012) to IV (2012-2017), making treatment and longevity its top priority, stigma is no longer such a terrifying word. This review discusses the social and cultural context of HIV/AIDS-related stigma in general and highlights various policies and intervention programs that have led India's campaign against HIV/AIDS-driven stigma into the testing, care, support, and treatment ambit. PMID:21898073

  4. A tale of two cities: stigma and health outcomes among people with HIV who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia.

    PubMed

    Burke, Sara E; Calabrese, Sarah K; Dovidio, John F; Levina, Olga S; Uusküla, Anneli; Niccolai, Linda M; Abel-Ollo, Katri; Heimer, Robert

    2015-04-01

    Experiences of stigma are often associated with negative mental and physical health outcomes. The present work tested the associations between stigma and health-related outcomes among people with HIV who inject drugs in Kohtla-Järve, Estonia and St. Petersburg, Russia. These two cities share some of the highest rates of HIV outside of sub-Saharan Africa, largely driven by injection drug use, but Estonia has implemented harm reduction services more comprehensively. People who inject drugs were recruited using respondent-driven sampling; those who indicated being HIV-positive were included in the present sample (n = 381 in St. Petersburg; n = 288 in Kohtla-Järve). Participants reported their health information and completed measures of internalized HIV stigma, anticipated HIV stigma, internalized drug stigma, and anticipated drug stigma. Participants in both locations indicated similarly high levels of all four forms of stigma. However, stigma variables were more strongly associated with health outcomes in Russia than in Estonia. The St. Petersburg results were consistent with prior work linking stigma and health. Lower barriers to care in Kohtla-Järve may help explain why social stigma was not closely tied to negative health outcomes there. Implications for interventions and health policy are discussed. PMID:25703668

  5. A Tale of Two Cities: Stigma and Health Outcomes Among People with HIV who Inject Drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia

    PubMed Central

    Burke, Sara E.; Calabrese, Sarah K.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Abel-Ollo, Katri; Heimer, Robert

    2015-01-01

    Experiences of stigma are often associated with negative mental and physical health outcomes. The present work tested the associations between stigma and health-related outcomes among people with HIV who inject drugs in Kohtla-Järve, Estonia and St. Petersburg, Russia. These two cities share some of the highest rates of HIV outside of sub-Saharan Africa, largely driven by injection drug use, but Estonia has implemented harm reduction services more comprehensively. People who inject drugs were recruited using respondent-driven sampling; those who indicated being HIV-positive were included in the present sample (n=381 in St. Petersburg; n=288 in Kohtla-Järve). Participants reported their health information and completed measures of internalized HIV stigma, anticipated HIV stigma, internalized drug stigma, and anticipated drug stigma. Participants in both locations indicated similarly high levels of all four forms of stigma. However, stigma variables were more strongly associated with health outcomes in Russia than in Estonia. The St. Petersburg results were consistent with prior work linking stigma and health. Lower barriers to care in Kohtla-Järve may help explain why social stigma was not closely tied to negative health outcomes there. Implications for interventions and health policy are discussed. PMID:25703668

  6. Understanding the Effects of Multiple Stigmas Among Formerly Incarcerated HIV-Positive African American Men.

    PubMed

    Brinkley-Rubinstein, Lauren

    2015-04-01

    Race, HIV, and incarceration, as individual and intersecting markers of social identity, have associated stigma. While some research has indicated multiple burdens of stigma can be additive, there remains a lack of investigation relative to the effects of stigma among minorities who experience both HIV and incarceration. Therefore, the current study examines the impact of multiple forms of stigma via a series of ethnographic interviews (n = 46) conducted with 12 African American men over a one-year period. Results suggest that intersecting forms of stigma can have a severe impact on the general health, mental health, and the reintegration process of formerly incarcerated HIV-positive men. Additionally, participants often conceptualized all forms of stigma separately, which resulted in compounded burden of navigation. The experience of multiple forms of stigma was also often internalized as self-stigma whereby HIV-positive individuals with a history of incarceration assumed dominant norms related to both HIV and incarceration. PMID:25915701

  7. AIDS Knowledge and HIV Stigma among Children Affected by HIV/AIDS in Rural China

    ERIC Educational Resources Information Center

    Zhao, Qun; Li, Xiaoming; Zhao, Guoxiang; Zhao, Junfeng; Fang, Xiaoyi; Lin, Xiuyun; Stanton, Bonita

    2011-01-01

    The current study was designed to assess the level of AIDS knowledge and its relationship with personal stigma toward people living with HIV/AIDS (PLWHA) among children living in communities of high HIV prevalence in rural China. The data were collected in 2009 from 118 orphanage orphans (children who had lost both of their parents to HIV and…

  8. Resisting and challenging stigma in Uganda: the role of support groups of people living with HIV

    PubMed Central

    Mburu, Gitau; Ram, Mala; Skovdal, Morten; Bitira, David; Hodgson, Ian; Mwai, Grace W; Stegling, Christine; Seeley, Janet

    2013-01-01

    Introduction Global scale up of antiretroviral therapy is changing the context of HIV-related stigma. However, stigma remains an ongoing concern in many countries. Groups of people living with HIV can contribute to the reduction of stigma. However, the pathways through which they do so are not well understood. Methods This paper utilizes data from a qualitative study exploring the impact of networked groups of people living with HIV in Jinja and Mbale districts of Uganda. Participants were people living with HIV (n=40), members of their households (n=10) and their health service providers (n=15). Data were collected via interviews and focus group discussions in 2010, and analyzed inductively to extract key themes related to the approaches and outcomes of the groups’ anti-stigma activities. Results Study participants reported that HIV stigma in their communities had declined as a result of the collective activities of groups of people living with HIV. However, they believed that stigma remained an ongoing challenge. Gender, family relationships, social and economic factors emerged as important drivers of stigma. Challenging stigma collectively transcended individual experiences and united people living with HIV in a process of social renegotiation to achieve change. Groups of people living with HIV provided peer support and improved the confidence of their members, which ultimately reduced self-stigma and improved their ability to deal with external stigma when it was encountered. Conclusions Antiretroviral therapy and group-based approaches in the delivery of HIV services are opening up new avenues for the collective participation of people living with HIV to challenge HIV stigma and act as agents of social change. Interventions for reducing HIV stigma should be expanded beyond those that aim to increase the resilience and coping mechanisms of individuals, to those that build the capacity of groups to collectively cope with and challenge HIV stigma. Such

  9. The role of enacted stigma in parental HIV disclosure among HIV-infected parents in China.

    PubMed

    Qiao, Shan; Li, Xiaoming; Zhou, Yuejiao; Shen, Zhiyong; Tang, Zhenzhu; Stanton, Bonita

    2015-01-01

    Existing studies have delineated that HIV-infected parents face numerous challenges in disclosing their HIV infection to the children ("parental HIV disclosure"), and practices of parental HIV disclosure vary with individual characteristics, family contexts, and social environment. Using cross-sectional data from 1254 HIV-infected parents who had children aged 5-16 years in southwest China, the current study examined the association of parental HIV disclosure with mental health and medication adherence among parents and explored the possible effect of enacted stigma on such association. Multivariate analysis of variance revealed that parents who had experienced disclosure to children reported higher level enacted stigma, worse mental health conditions, and poorer medication adherence. Enacted stigma partially mediated the associations between disclosure and both mental health and medication adherence after controlling basic background characteristics. Our findings highlight the importance of providing appropriate disclosure-related training and counseling service among HIV-infected parents. In a social setting where HIV-related stigma is still persistent, disclosure intervention should address and reduce stigma and discrimination in the practice of parental HIV disclosure. PMID:26616123

  10. The role of enacted stigma in parental HIV disclosure among HIV-infected parents in China

    PubMed Central

    Qiao, Shan; Li, Xiaoming; Zhou, Yuejiao; Shen, Zhiyong; Tang, Zhenzhu; Stanton, Bonita

    2015-01-01

    Existing studies have delineated that HIV-infected parents face numerous challenges in disclosing their HIV infection to the children (“parental HIV disclosure”), and practices of parental HIV disclosure vary with individual characteristics, family contexts, and social environment. Using cross-sectional data from 1254 HIV-infected parents who had children aged 5–16 years in southwest China, the current study examined the association of parental HIV disclosure with mental health and medication adherence among parents and explored the possible effect of enacted stigma on such association. Multivariate analysis of variance revealed that parents who had experienced disclosure to children reported higher level enacted stigma, worse mental health conditions, and poorer medication adherence. Enacted stigma partially mediated the associations between disclosure and both mental health and medication adherence after controlling basic background characteristics. Our findings highlight the importance of providing appropriate disclosure-related training and counseling service among HIV-infected parents. In a social setting where HIV-related stigma is still persistent, disclosure intervention should address and reduce stigma and discrimination in the practice of parental HIV disclosure. PMID:26616123

  11. HIV-related knowledge, stigma, and willingness to disclose: A mediation analysis

    PubMed Central

    YANG, H.; LI, X.; STANTON, B.; FANG, X.; LIN, D.; NAAR-KING, S.

    2007-01-01

    Increasing HIV knowledge is a focus of many HIV education and prevention efforts. While the bivariate relationship of HIV serostatus disclosure with HIV-related knowledge and stigma has been reported in the literature, little is known about the mediation effect of stigma on the relationship of HIV knowledge with HIV serostatus disclosure. Data from 4,208 rural-to-urban migrants in China were analyzed to explore this issue. Overall, 70% of respondents reported willingness to disclose their HIV status if they were HIV-positive. Willingness to disclose was negatively associated with misconceptions about HIV transmission and stigma. Stigma mediated the relationship between misconceptions and willingness to disclose among women but not men. The mediation effect of stigma suggests that stigmatization reduction would be an important component of HIV prevention approaches. Gender inequality needs to be addressed in stigmatization reduction efforts. PMID:16971280

  12. Stigma and Sexual Health Risk in HIV-Positive African American Young Men Who Have Sex with Men

    PubMed Central

    Doty, Nathan; Hawkins, Linda A.; Gaskins, Clare S.; Beidas, Rinad; Rudy, Bret J.

    2010-01-01

    Abstract Understanding the multiple forms of stigma experienced by young HIV-positive African American men who have sex with men and how they relate to sexual risk behaviors is essential to design effective HIV prevention programs. This study of 40 African American young MSM found that 90% of those surveyed experienced sexual minority stigma, 88% experienced HIV stigma, and 78% experienced dual stigma. Sexual minority stigma was characterized by experiences of social avoidance, and HIV stigma, by shame. Individuals with high HIV stigma were significantly more likely to engage in unprotected sex while high or intoxicated. Associations between stigma and sexual practices were examined; youth endorsing higher levels of sexual minority stigma engaged in less insertive anal intercourse. Individuals endorsing more HIV stigma reported more receptive anal intercourse. These findings support the development of stigma-informed secondary prevention interventions for African American HIV-positive young MSM. PMID:20673080

  13. The Impact of Taking or Not Taking ARVs on HIV Stigma as Reported by Persons Living with HIV Infection in Five African Countries

    PubMed Central

    Makoae, Lucy N.; Portillo, Carmen J.; Uys, Leana R.; Dlamini, Priscilla S.; Greeff, Minrie; Chirwa, Maureen; Kohi, Thecla W.; Naidoo, Joanne; Mullan, Joseph; Wantland, Dean; Durrheim, Kevin; Holzemer, William L.

    2009-01-01

    Aim This study examined the impact of taking or not taking antiretroviral (ARV) medications on stigma, as reported by people living with HIV infection in five African countries. Design A two group (taking or not taking ARVs) by three (time) repeated measures analysis of variance examined change in reported stigma in a cohort sample of 1,454 persons living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Participants self-reported taking ARV medications and completed a standardized stigma scale validated in the African context. Data were collected at three points in time, from January 2006 to March 2007. Participants taking ARV medications self-reported a mean CD4 count of 273 and those not taking ARV self-reported a mean CD4 count of 418. Results Both groups reported significant decreases in total HIV stigma over time; however, people taking ARVs reported significantly higher stigma at Time 3 compared to those not taking ARVs. Discussion This study documents that this sample of 1,454 HIV infected persons in five countries in Africa reported significantly less HIV stigma over time. In addition, those participants taking ARV medications experienced significantly higher HIV stigma over time compared to those not taking ARVs. This finding contradicts some authors’ opinions that when clients enroll in ARV medication treatment it signifies that they are experiencing less stigma. This work provides caution to health care providers to alert clients new to ARV treatment that they may experience more stigma from their families and communities when they learn they are taking ARV medications. PMID:20024711

  14. Stigma against People Living with HIV/AIDS in China: Does the Route of Infection Matter?

    PubMed Central

    Zhang, Chen; Li, Xiaoming; Liu, Yu; Qiao, Shan; Zhang, Liying; Zhou, Yuejiao; Tang, Zhenzhu; Shen, Zhiyong; Chen, Yi

    2016-01-01

    intervention strategies to mitigate the effects of stigma and enhance HIV care utilization among PLWHA in China. PMID:26981636

  15. Stigma against People Living with HIV/AIDS in China: Does the Route of Infection Matter?

    PubMed

    Zhang, Chen; Li, Xiaoming; Liu, Yu; Qiao, Shan; Zhang, Liying; Zhou, Yuejiao; Tang, Zhenzhu; Shen, Zhiyong; Chen, Yi

    2016-01-01

    strategies to mitigate the effects of stigma and enhance HIV care utilization among PLWHA in China. PMID:26981636

  16. Perceived discrimination and stigma toward children affected by HIV/AIDS and their HIV-positive caregivers in central Haiti

    PubMed Central

    Surkan, Pamela J.; Mukherjee, Joia S.; Williams, David R.; Eustache, Eddy; Louis, Ermaze; Jean-Paul, Thierry; Lambert, Wesler; Scanlan, Fiona C.; Oswald, Catherine M.; Fawzi, Mary C. Smith

    2010-01-01

    In many settings worldwide, HIV-positive individuals have experienced a significant level of stigma and discrimination. This discrimination may also impact other family members affected by the disease, including children. The aim of our study was to identify factors associated with stigma and/or discrimination among HIV-affected youth and their HIV-positive caregivers in central Haiti. Recruitment of HIV-positive patients with children aged 10–17 years was conducted in 2006–2007. Data on HIV-related stigma and/or discrimination were based on interviews with 451 youth and 292 caregivers. Thirty-two percent of caregivers reported that children were discriminated against because of HIV/AIDS. Commune of residence was associated with discrimination against children affected by HIV/AIDS and HIV-related stigma among HIV-positive caregivers, suggesting variability across communities. Multivariable regression models showed that lacking social support, being an orphan, and caregiver HIV-related stigma were associated with discrimination in HIV-affected children. Caregiver HIV-related stigma demonstrated a strong association with depressive symptoms. The results could inform strategies for potential interventions to reduce HIV-related stigma and discrimination. These may include increasing social and caregiver support of children affected by HIV, enhancing support of caregivers to reduce burden of depressive symptoms, and promoting reduction of HIV-related stigma and discrimination at the community-level. PMID:20635244

  17. Perceived discrimination and stigma toward children affected by HIV/AIDS and their HIV-positive caregivers in central Haiti.

    PubMed

    Surkan, Pamela J; Mukherjee, Joia S; Williams, David R; Eustache, Eddy; Louis, Ermaze; Jean-Paul, Thierry; Lambert, Wesler; Scanlan, Fiona C; Oswald, Catherine M; Fawzi, Mary Smith

    2010-07-01

    In many settings worldwide, HIV-positive individuals have experienced a significant level of stigma and discrimination. This discrimination may also impact other family members affected by the disease, including children. The aim of our study was to identify factors associated with stigma and/or discrimination among HIV-affected youth and their HIV-positive caregivers in central Haiti. Recruitment of HIV-positive patients with children aged 10-17 years was conducted in 2006-2007. Data on HIV-related stigma and/or discrimination were based on interviews with 451 youth and 292 caregivers. Thirty-two percent of caregivers reported that children were discriminated against because of HIV/AIDS. Commune of residence was associated with discrimination against children affected by HIV/AIDS and HIV-related stigma among HIV-positive caregivers, suggesting variability across communities. Multivariable regression models showed that lacking social support, being an orphan, and caregiver HIV-related stigma were associated with discrimination in HIV-affected children. Caregiver HIV-related stigma demonstrated a strong association with depressive symptoms. The results could inform strategies for potential interventions to reduce HIV-related stigma and discrimination. These may include increasing social and caregiver support of children affected by HIV, enhancing support of caregivers to reduce burden of depressive symptoms, and promoting reduction of HIV-related stigma and discrimination at the community-level. PMID:20635244

  18. Influences of stigma and HIV transmission knowledge on member support for faith-placed HIV initiatives in Chinese immigrant Buddhist and protestant religious institutions in New York City.

    PubMed

    Kang, Ezer; Delzell, Darcie A P; Chin, John J; Behar, Elana; Li, Ming Ying

    2013-10-01

    Ethnic religious institutions in the United States are uniquely positioned to influence HIV programming within Asian immigrant communities at large. This article examines how knowledge of HIV transmission and stigma potentially influenced attendees' support for their institutions' involvement in HIV programs. Quantitative questionnaires were individually administered to 400 Chinese attendees of Protestant churches and 402 attendees of Buddhist temples in New York City. Mediational analyses indicated that HIV stigma significantly mediated the direct effects of HIV transmission knowledge on attendees' support of their institution's involvement in HIV education (bias corrected and accelerated [BCa] 95% confidence interval [CI], 0.004 to 0.051), HIV care (BCa 95% CI, 0.019 to 0.078), and stigma reduction initiatives (BCa 95% CI, 0.013 to 0.070), while controlling for religious affiliation, age, gender, and education. To mobilize Chinese churches and temples to engage in HIV programming, it remains important to support educational programs on HIV transmission that specifically help to mitigate stigma toward persons living with HIV. PMID:24059881

  19. Influences of Stigma and HIV Transmission Knowledge on Member Support for Faith-Placed HIV Initiatives in Chinese Immigrant Buddhist and Protestant Religious Institutions in New York City

    PubMed Central

    Kang, Ezer; Delzell, Darcie; Chin, John J.; Behar, Elana; Li, Ming Ying

    2015-01-01

    Ethnic religious institutions in the US are uniquely positioned to influence HIV programming within Asian immigrant communities at-large. This paper examined how knowledge of HIV transmission and stigma potentially influenced attendees’ support for their institutions’ involvement in HIV programs. Quantitative questionnaires were individually administered to 400 Chinese attendees of Protestant churches, and 402 attendees of Buddhist temples in New York City. Mediational analyses indicated that HIV-stigma significantly mediated the direct effects of HIV transmission knowledge on attendees’ support of their institution’s involvement in HIV education (bias corrected and accelerated [BCa] 95% confidence interval [CI], 0.004 to 0.051), HIV care (BCa 95% CI, 0.019 to 0.078), and stigma reduction initiatives (BCa 95% CI, 0.013 to 0.070), while controlling for religious affiliation, age, gender, and education. To mobilize Chinese churches and temples to engage in HIV programming, it remains important to support educational programs on HIV transmission that specifically helps to mitigate stigma towards persons living with HIV. PMID:24059881

  20. Factors Associated with Perceived Stigma among People Living with HIV/AIDS in Post-Conflict Northern Uganda

    ERIC Educational Resources Information Center

    Nattabi, Barbara; Li, Jianghong; Thompson, Sandra C.; Orach, Christopher G.; Earnest, Jaya

    2011-01-01

    HIV-related stigma continues to persist in several African countries including Uganda. This study quantified the burden of stigma and examined factors associated with stigma among 476 people living with HIV (PLHTV) in Gulu, northern Uganda. Data were collected between February and May 2009 using the HIV/AIDS Stigma Instrument-PLWA. Females more…

  1. Making sense of HIV stigma: representations in young Africans’ HIV-related narratives

    PubMed Central

    Winskell, Kate; Holmes, Kathleen; Neri, Elizabeth; Berkowitz, Rachel; Mbakwem, Benjamin; Obyerodhyambo, Oby

    2015-01-01

    In addition to undermining the quality of life of those infected and affected by HIV, HIV-related stigma impedes access to prevention and treatment services, thereby threatening to erode the promise of recent advances in these areas. This paper provides insights into the socio-contextual and sense-making processes that inform HIV stigma through an innovative form of empirical data: creative fictional narratives written by young Africans (aged 10–24) for an HIV-themed scriptwriting competition. From a sample of 586 narratives from six sub-Saharan countries, we selected for illustrative purposes three on account of the complexity of their representation of HIV stigma. We conducted a close reading of each, using stigma theory as a lens. Through their explicit accounts of stigmatizing attitudes and behaviours of characters and through implicit contradictions, tensions, and ambivalence in their messaging, the narratives provides insights into the symbolic and social processes that create and sustain HIV stigma. Our analysis illuminates the authors’ struggles to navigate the cultural resources available to them in their efforts to make sense of HIV, gender and sexuality. It highlights some limitations of current communication efforts and the potential for narrative-based communication approaches to engage with representations that devalue women and people living with HIV. PMID:26132087

  2. Making sense of HIV stigma: Representations in young Africans' HIV-related narratives.

    PubMed

    Winskell, Kate; Holmes, Kathleen; Neri, Elizabeth; Berkowitz, Rachel; Mbakwem, Benjamin; Obyerodhyambo, Oby

    2015-01-01

    In addition to undermining the quality of life of those infected and affected by HIV, HIV-related stigma impedes access to prevention and treatment services, thereby threatening to erode the promise of recent advances in these areas. This paper provides insights into the socio-contextual and sense-making processes that inform HIV stigma through an innovative form of empirical data: creative fictional narratives written by young Africans (aged 10-24) for an HIV-themed scriptwriting competition. From a sample of 586 narratives from six sub-Saharan countries, we selected for illustrative purposes three on account of the complexity of their representation of HIV stigma. We conducted a close reading of each, using stigma theory as a lens. Through their explicit accounts of stigmatising attitudes and behaviours of characters and through implicit contradictions, tensions and ambivalence in their messaging, the narratives provide insights into the symbolic and social processes that create and sustain HIV stigma. Our analysis illuminates the authors' struggles to navigate the cultural resources available to them in their efforts to make sense of HIV, gender and sexuality. It highlights some limitations of current communication efforts and the potential for narrative-based communication approaches to engage with representations that devalue women and people living with HIV. PMID:26132087

  3. The impact of anticipated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women in New York City.

    PubMed

    Golub, Sarit A; Gamarel, Kristi E

    2013-11-01

    Treatment as prevention (TaSP) is a critical component of biomedical interventions to prevent HIV transmission. However, its success is predicated on testing and identifying undiagnosed individuals to ensure linkage and retention in HIV care. Research has examined the impact of HIV-associated stigma on HIV-positive individuals, but little work has explored how anticipated HIV stigma-the expectation of rejection or discrimination against by others in the event of seroconversion-may serve as a barrier to HIV testing behaviors. This study examined the association between anticipated stigma and HIV testing behaviors among a sample of 305 men who have sex with men (MSM) and transgender women living in New York City. Participants' mean age was 33.0; 65.5% were racial/ethnic minority; and 50.2% earned <$20,000 per year. Overall, 32% of participants had not had an HIV test in the past 6 months. Anticipated stigma was negatively associated with risk perception. In multivariate models, anticipated stigma, risk perception, and younger age were significant predictors of HIV testing behaviors. Anti-HIV stigma campaigns targeting HIV-negative individuals may have the potential to significantly impact social norms around HIV testing and other biomedical strategies, such pre-exposure prophylaxis, at a critical moment for the redefinition of HIV prevention. PMID:24138486

  4. HIV Stigma and Missed Medications in HIV-Positive People in Five African Countries

    PubMed Central

    Dlamini, Priscilla S.; Wantland, Dean; Makoae, Lucy N.; Chirwa, Maureen; Kohi, Thecla W.; Greeff, Minrie; Naidoo, Joanne; Mullan, Joseph; Uys, Leana R.

    2009-01-01

    Abstract The availability of antiretroviral medications has transformed living with HIV infection into a manageable chronic illness, and high levels of adherence are necessary. Stigma has been identified as one reason for missing medication doses. The objective of this study was to explore the relationship between perceived HIV stigma and self-reported missed doses of antiretroviral medications in a 12-month, repeated measures cohort study conducted in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Data were collected from 1457 HIV-positive individuals at three times between January 2006 and March 2007. Participants completed a series of questionnaires. Of the 1457 participants, 698 were taking ARVs during the study and are included in this analysis. There was a significant relationship between perceived HIV stigma and self-report of missed medications over time (t = 6.04, p ≤ 0.001). Individuals who reported missing more ARV medications also reported higher levels of perceived HIV stigma. Individuals reporting fewer medication worries reported decreased stigma over the one year period (t = −4.79, p ≤ 0.001). While those who reported increased symptom intensity also reported increased stigma initially (t = 8.67, p ≤ 0.001) that remained high over time. This study provides evidence of a significant and stable correlation that documents the relationship between perceived HIV stigma and self-reported reasons for missed medications over time. These findings suggest that part of the reason for poor adherence to ARV medications is linked to the stigma experienced by people living with HIV. PMID:19327098

  5. HIV stigma and missed medications in HIV-positive people in five African countries.

    PubMed

    Dlamini, Priscilla S; Wantland, Dean; Makoae, Lucy N; Chirwa, Maureen; Kohi, Thecla W; Greeff, Minrie; Naidoo, Joanne; Mullan, Joseph; Uys, Leana R; Holzemer, William L

    2009-05-01

    The availability of antiretroviral medications has transformed living with HIV infection into a manageable chronic illness, and high levels of adherence are necessary. Stigma has been identified as one reason for missing medication doses. The objective of this study was to explore the relationship between perceived HIV stigma and self-reported missed doses of antiretroviral medications in a 12-month, repeated measures cohort study conducted in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Data were collected from 1457 HIV-positive individuals at three times between January 2006 and March 2007. Participants completed a series of questionnaires. Of the 1457 participants, 698 were taking ARVs during the study and are included in this analysis. There was a significant relationship between perceived HIV stigma and self-report of missed medications over time (t = 6.04, p HIV stigma. Individuals reporting fewer medication worries reported decreased stigma over the one year period (t = -4.79, p stigma initially (t = 8.67, p HIV stigma and self-reported reasons for missed medications over time. These findings suggest that part of the reason for poor adherence to ARV medications is linked to the stigma experienced by people living with HIV. PMID:19327098

  6. Understanding HIV-related stigma in older age in rural Malawi.

    PubMed

    Freeman, Emily

    2016-09-01

    The combination of HIV- and age-related stigma exacerbates prevalence of HIV infection and late diagnosis and initiation of anti-retroviral therapy among older populations (Moore, 2012; Richards et al. 2013). Interventions to address these stigmas must be grounded in understanding of situated systems of beliefs about illness and older age. This study analyses constructions of HIV and older age that underpinned the stigmatisation of older adults with HIV in rural Balaka, Malawi. It draws on data from a series of in-depth interviews (N = 135) with adults aged 50-∼90 (N = 43) in 2008-2010. Around 40% (n = 18) of the sample had HIV. Dominant understandings of HIV in Balaka pertained to the sexual transmission of the virus and poor prognosis of those infected. They intersected with understandings of ageing. Narratives about older age and HIV in older age both centred on the importance of having bodily, moral and social power to perform broadly-defined "work". Those who could not work were physically and socially excluded from the social world. This status, labelled as "child-like", was feared by all participants. In participants' narratives, growing old involves a gradual decline in the power required to produce one's membership of the social world through work. HIV infection in old age is understood to accelerate this decline. Understandings of the sexual transmission of HIV, in older age, imply the absence of moral power and in turn, loss of social power. The prognosis of those with HIV, in older age, reflects and causes amplified loss of bodily power. In generating dependency, this loss of bodily power infantilises older care recipients and jeopardises their family's survival, resulting in further loss of social power. This age-and HIV-related loss of power to produce social membership through work is the discrediting attribute at the heart of the stigmatisation of older people with HIV. PMID:27459023

  7. Developing a Measure of Stigma by Association with African American Adolescents Whose Mothers Have HIV

    ERIC Educational Resources Information Center

    Mason, Sally; Berger, Barbara; Ferrans, Carol Estwing; Sultzman, Vickey; Fendrich, Michael

    2010-01-01

    Objectives: African American urban adolescents are one of the fastest growing groups of children affected by their mother's HIV status. These children experience HIV stigma by association with their HIV-positive mothers. Stigma may contribute to adverse outcomes for these teens. Methods: The authors describe a multistage process of scale…

  8. Raising Awareness of HIV-Related Stigma and Its Associated Prejudice and Discrimination

    ERIC Educational Resources Information Center

    Francis, D.; Francis, E.

    2006-01-01

    HIV/AIDS will remain a problem for a long time. Many people with HIV/AIDS still live in fear of discovery because of the prevalent stigma and its associated prejudice and discrimination. This article examines how HIV-related stigma and its associated prejudice and discrimination can be addressed in a classroom--in the field of education. (Contains…

  9. Measuring HIV/AIDS-Related Stigma across South Africa: A Versatile and Multidimensional Scale

    ERIC Educational Resources Information Center

    Smith, Edward A.; Miller, Jacqueline A.; Newsome, Valerie; Sofolahan, Yewande A.; Airhihenbuwa, Collins O.

    2014-01-01

    Reducing HIV/AIDS-related stigma is critical in the fight against HIV/AIDS. Although national campaigns and prevention programs have been implemented across South Africa to address this critical concern, assessing the impact of these initiatives is difficult as it requires that measurement of HIV/AIDS-related stigma is uniform and comparable…

  10. Stigma and HIV risk among Metis in Nepal.

    PubMed

    Wilson, Erin; Pant, Sunil Babu; Comfort, Megan; Ekstrand, Maria

    2011-03-01

    Similar to other parts of Asia, the HIV epidemic in Nepal is concentrated among a small number of groups, including transgender people, or Metis. This study was conducted to explore the social context of stigma among Metis in Nepal to better understand their risk for HIV. Fourteen in-depth interviews were conducted with Metis in Kathmandu, Nepal. We found that stigma from families leading to rural-urban migration exposed Metis to discrimination from law enforcement, employers and sexual partners, which influenced their risk for HIV. Specific HIV-related risks identified were rape by law enforcement officers, inconsistent condom use and high reported numbers of sexual partners. These data point to an immediate need to work with law enforcement to reduce violence targeting Metis. HIV prevention, housing and employment outreach to Metis in rural areas and those who migrate to urban areas is also needed. Finally, there is a need for more research to determine the prevalence of HIV among Metis, to explore risk within sexual networks and to better understand of the relationship between Metis and their families in order to develop future programmes and interventions. PMID:21058085

  11. Stigma and HIV risk among Metis in Nepal

    PubMed Central

    Wilson, Erin; Pant, Sunil Babu; Comfort, Megan; Ekstrand, Maria

    2011-01-01

    Similar to other parts of Asia, the HIV epidemic in Nepal is concentrated among a small number of groups, including transgender people, or Metis. This study was conducted to explore the social context of stigma among Metis in Nepal to better understand their risk for HIV. Fourteen in-depth interviews were conducted with Metis in Kathmandu, Nepal. We found that stigma from families leading to rural-urban migration exposed Metis to discrimination from law enforcement, employers and sexual partners, which influenced their risk for HIV. Specific HIV-related risks identified were rape by law enforcement officers, inconsistent condom use and high reported numbers of sexual partners. These data point to an immediate need to work with law enforcement to reduce violence targeting Metis. HIV prevention, housing and employment outreach to Metis in rural areas and those who migrate to urban areas is also needed. Finally, there is a need for more research to determine the prevalence of HIV among Metis, to explore risk within sexual networks and to better understand of the relationship between Metis and their families in order to develop future programmes and interventions. PMID:21058085

  12. Knowledge, attitude, and practice of HIV/AIDS-related stigma and discrimination reduction among nursing students in southwest Nigeria

    PubMed Central

    Farotimi, Adekunbi A; Nwozichi, Chinomso Ugochukwu; Ojediran, Tolulope D

    2015-01-01

    Background: One of the reported obstacles to the achievement of universal access to Human Immunodeficiency Virus (HIV) prevention, treatment, care, and support programs includes stigma and discrimination from health workers, particularly nurses. Since nursing students would become future practising nurses and are most likely exposed to caring for people living with HIV/AIDS (PL WHA) during their training, it is of great importance to assess the knowledge, attitude, and practice of student nurses toward the reduction of HIV/AIDS-related stigma and discrimination. Materials and Methods: A descriptive survey research design was used. A total of 150 nursing students were selected using the simple random sampling technique of fish bowl method with replacement. Data were obtained using a self-administered (33-item) validated questionnaire to assess the knowledge, attitude, and practice of student nurses with regard to HIV/AIDS-related stigma and discrimination reduction strategies. Reliability of the tool was tested using Cronbach alpha (R) yielding a reliability value of 0.72. Data collected were analyzed with descriptive statistics of frequencies and percentages. Results: Majority (76.0%) of the respondents were females and 82.7% were married. Respondents were found to have high knowledge (94.0%) of strategies for reducing HIV/AIDS-related stigma and discrimination. Also, 64% had moderate discriminatory attitude, 74% engaged in low discriminatory practice, while 26% engaged in high discriminatory practice. Conclusions: Student nurses had adequate knowledge about strategies for reducing HIV/AIDS-related stigma and discrimination; negative discriminatory attitude toward PLWHA and some form of discriminatory practices exist in participants’ training schools. It is, therefore, recommended that an educational package on reduction of HIV/AIDS-related stigma and discrimination be developed and implemented for the participants. PMID:26793257

  13. HIV-Related Stigma, Social Norms and HIV Testing in Soweto and Vulindlela, South Africa: NIMH Project Accept (HPTN 043)

    PubMed Central

    Young, Sean D.; Hlavka, Zdenek; Modiba, Precious; Gray, Glenda; Van Rooyen, Heidi; Richter, Linda; Szekeres, Greg; Coates, Thomas

    2010-01-01

    Objective HIV testing is necessary to curb the increasing epidemic. However, HIV-related stigma and perceptions of low likelihood of societal HIV testing may reduce testing rates. This study aimed to explore this association in South Africa, where HIV rates are extraordinarily high. Methods Data were taken from the Soweto and Vulindlela, South African sites of Project Accept, a multi-national HIV prevention trial. Self-reported HIV testing, stigma, and social norms items were used to study the relationship between HIV testing, stigma, and perceptions about societal testing rates. The stigma items were broken into 3 factors: negative attitudes, negative perceptions about people living with HIV, and perceptions of fair treatment for people living with HIV (equity). Results Results from a univariate logistic regression suggest that past history of HIV testing was associated with decreased negative attitudes about people living with HIV/AIDS, increased perceptions that people living with HIV/AIDS experience discrimination, and increased perceptions that people with HIV should be treated equitably. Results from a multivariate logistic regression confirm these effects and suggests these differences vary according to gender and age. Compared to people who had never tested for HIV, those who had previously tested were more likely to believe that the majority of people have tested for HIV. Conclusion Data suggest that interventions designed to increase HIV testing in South Africa should address stigma and perceptions of societal testing. Keywords: stigma, HIV testing, South Africa, Project Accept PMID:20980913

  14. HIV-Related Stigma Among Healthcare Providers in the Deep South.

    PubMed

    Stringer, Kristi L; Turan, Bulent; McCormick, Lisa; Durojaiye, Modupeoluwa; Nyblade, Laura; Kempf, Mirjam-Colette; Lichtenstein, Bronwen; Turan, Janet M

    2016-01-01

    Stigma towards people living with HIV (PLWH) in healthcare settings is a barrier to optimal treatment. However, our understanding of attitudes towards PLWH from healthcare providers' perspective in the United States is limited and out-of-date. We assessed HIV-related stigma among healthcare staff in Alabama and Mississippi, using online questionnaires. Participants included 651 health workers (60 % White race; 83 % female). Multivariate regression suggests that several factors independently predict stigmatizing attitudes: Protestant compared to other religions (β = 0.129, p ≤ 0.05), White race compared to other races (β = 0.162, p ≤ 0.001), type of clinic (HIV/STI clinic: β = 0.112, p ≤ 0.01), availability of post-exposure prophylaxis (yes: β = -0.107, p ≤ 0.05), and perceptions of policy enforcement (policies not enforced: β = 0.058, p = p ≤ 0.05). These findings may assist providers wishing to improve the quality care for PLWH. Enforcement of policies prohibiting discrimination may be a useful strategy for reducing HIV-related stigma among healthcare workers. PMID:26650383

  15. Internalized HIV/AIDS-related stigma in a sample of HIV-positive people in Bangladesh.

    PubMed

    Hasan, M Tanvir; Nath, Samir Ranjan; Khan, Nabilah S; Akram, Owasim; Gomes, Tony Michael; Rashid, Sabina F

    2012-03-01

    Internalized stigma among people living with HIV/AIDS (PLHA) is prevalent in Bangladesh. A better understanding of the effects of stigma on PLHA is required to reduce this and to minimize its harmful effects. This study employed a quantitative approach by conducting a survey with an aim to know the prevalence of internalized stigma and to identify the factors associated with internalized stigma among a sample of 238 PLHA (male=152 and female=86) in Bangladesh. The findings suggest that there is a significant difference between groups with the low- and the high-internalized HIV/AIDS stigma in terms of both age and gender. The prevalence of internalized stigma varied according to the poverty status of PLHA. An exploratory factor analysis (EFA) found 10 of 15 items loaded highly on the three factors labelled self-acceptance, self-exclusion, and social withdrawal. About 68% of the PLHA felt ashamed, and 54% felt guilty because of their HIV status. More than half (87.5% male and 19.8% female) of the PLHA blamed themselves for their HIV status while many of them (38.2% male and 8.1% female) felt that they should be punished. The male PLHA more frequently chose to withdraw themselves from family and social gatherings compared to the female PLHA. They also experienced a higher level of internalized stigma compared to the female PLHA. The results suggest that the prevalence of internalized stigma is high in Bangladesh, and much needs to be done by different organizations working for and with the PLHA to reduce internalized stigma among this vulnerable group. PMID:22524116

  16. Development and Psychometric Assessment of a Multidimensional Measure of Internalized HIV Stigma in a sample of HIV-positive Adults

    PubMed Central

    Sayles, Jennifer N.; Hays, Ron D.; Sarkisian, Catherine A.; Mahajan, Anish P.; Spritzer, Karen L.; Cunningham, William E.

    2010-01-01

    There is a need for a psychometrically sound measure of the stigma experienced by diverse persons living with HIV/AIDS (PLHA). The goal of this study was to develop and evaluate a multidimentional measure of internalized HIV stigma that captures stigma related to treatment and other aspects of the disease among sociodemographically diverse PLHA. We developed a 28-item measure of internalized HIV stigma composed of four scales based on previous qualitative work. Internal consistency reliability estimates in a sample of 202 PLHA was 0.93 for the overall measure, and exceeded 0.85 for three of the four stigma scales. Items discriminated well across scales, and correlations of the scales with shame, social support, and mental health supported construct validity. This measure should prove useful to investigators examining in the role of stigma in HIV treatment and health outcomes, and evaluating interventions designed to mitigate the impacts of stigma on PLHA. PMID:18389363

  17. Geographic distribution of HIV stigma among women of childbearing age in rural Kenya

    PubMed Central

    Akullian, Adam; Kohler, Pamela; Kinuthia, John; Laserson, Kayla; Mills, Lisa A.; Okanda, John; Olilo, George; Ombok, Maurice; Odhiambo, Frank; Rao, Deepa; Wakefield, Jonathan; John-Stewart, Grace

    2015-01-01

    Objective(s) HIV stigma is considered to be a major driver of the HIV/AIDS pandemic, yet there is a limited understanding of its occurrence. We describe the geographic patterns of two forms of HIV stigma in a cross-sectional sample of women of childbearing age from western Kenya: internalized stigma (associated with shame) and externalized stigma (associated with blame). Design Geographic studies of HIV stigma provide a first step in generating hypotheses regarding potential community-level causes of stigma and may lead to more effective community-level interventions. Methods Spatial regression using generalized additive models and point pattern analyses using K-functions were used to assess the spatial scale(s) at which each form of HIV stigma clusters, and to assess whether the spatial clustering of each stigma indicator was present after adjustment for individual-level characteristics. Results There was evidence that externalized stigma (blame) was geographically heterogeneous across the study area, even after controlling for individual-level factors (P=0.01). In contrast, there was less evidence (P=0.70) of spatial trend or clustering of internalized stigma (shame). Conclusion Our results may point to differences in the underlying social processes motivating each form of HIV stigma. Externalized stigma may be driven more by cultural beliefs disseminated within communities, whereas internalized stigma may be the result of individual-level characteristics outside the domain of community influence. These data may inform community-level interventions to decrease HIV-related stigma, and thus impact the HIV epidemic. PMID:24835356

  18. “Triply cursed”: Racism, homophobia, and HIV-related stigma are barriers to regular HIV testing, treatment adherence, and disclosure among young Black gay men

    PubMed Central

    Arnold, Emily A.; Rebchook, Gregory M.; Kegeles, Susan M.

    2014-01-01

    In the USA, young Black gay men are disproportionately impacted by HIV. In this qualitative study consisting of in-depth interviews with 31 young Black gay men and 9 service providers, where we used thematic analysis to guide our interpretations, we found that HIV-related stigma and homophobia, within the larger societal context of racism, were related to sexual risk behaviour, reluctance to obtain HIV testing or care, lower adherence to treatment medication, and disclosure of a positive HIV status to sexual partners. Participants experienced homophobia and HIV-related stigma from churches and families within the Black community, and from friends within the Black gay community, that otherwise provide support in the face of racism. Vulnerability to HIV was related to strategies that young Black gay men enacted to avoid being stigmatised or as a way of coping with their alienation and rejection. PMID:24784224

  19. 'Triply cursed': racism, homophobia and HIV-related stigma are barriers to regular HIV testing, treatment adherence and disclosure among young Black gay men.

    PubMed

    Arnold, Emily A; Rebchook, Gregory M; Kegeles, Susan M

    2014-06-01

    In the USA, young Black gay men are disproportionately impacted upon by HIV. In this qualitative study consisting of in-depth interviews with 31 young Black gay men and nine service providers, where we used thematic analysis to guide our interpretations, we found that HIV-related stigma and homophobia, within the larger societal context of racism, were related to sexual risk behaviour, reluctance to obtain HIV testing or care, lower adherence to treatment medication, and non-disclosure of a positive HIV status to sexual partners. Participants experienced homophobia and HIV-related stigma from churches and families within the Black community and from friends within the Black gay community, which otherwise provide support in the face of racism. Vulnerability to HIV was related to strategies that young Black gay men enacted to avoid being stigmatised or as a way of coping with alienation and rejection. PMID:24784224

  20. The relationships between HIV stigma, emotional status, and emotional regulation among HIV-affected children in rural China

    PubMed Central

    Wei, Wei; Li, Xiaoming; Harrison, Sayward; Zhao, Junfeng; Zhao, Guoxiang

    2016-01-01

    ABSTRACT Children affected by HIV/AIDS have unique psychosocial needs that often go unaddressed in traditional treatment approaches. They are more likely than unaffected peers to encounter stigma, including overt discriminatory behaviors, as well as stereotyped attitudes. In addition, HIV-affected children are at risk for experiencing negative affect, including sadness and depression. Previous studies have identified a link between HIV stigma and the subsequent emotional status of children affected by HIV/AIDS. However, limited data are available regarding protective psychological factors that can mitigate the effects of HIV stigma and thus promote resiliency for this vulnerable population. Utilizing data from 790 children aged 6–17 years affected by parental HIV in rural central China this study aims to examine the association between HIV stigma, including both enacted and perceived stigma, and emotional status among HIV-affected children, as well as to evaluate the mediating effects of emotional regulation on the relationship between HIV stigma and emotional status. In addition, the moderating role of age is tested. Multiple regression was conducted to test the mediation model. We found that the experience of HIV stigma had a direct positive effect on negative emotions among children affected by HIV. Emotional regulation offers a level of protection, as it mediated the impact of HIV stigma on negative emotions. Moreover, age was found to moderate the relationship between perceived stigma and negative emotions. A significant interaction between perceived stigma and age suggested that negative emotions increase with age among those who perceived a higher level of stigmatization. Results suggest that children affected by HIV may benefit from interventions designed to enhance their capacity to regulate emotions and that health professionals should be aware of the link between stigma and negative emotion in childhood and adolescence and use the knowledge to inform

  1. Cervical Cancer Stigma in Rural Kenya: What Does HIV Have to Do with It?

    PubMed

    Rosser, Joelle I; Njoroge, Betty; Huchko, Megan J

    2016-06-01

    Cervical cancer is a leading cause of cancer-related death amongst women in sub-Saharan Africa, largely due to the lack of early screening and treatment. In addition to poor access to screening services, inadequate uptake of available services is a barrier to early identification of precancerous lesions. Given that cervical cancer is caused by a sexually transmitted virus and is associated with HIV positivity, stigma is one of the potential barriers to the utilization of cervical cancer programs in sub-Saharan Africa. We conducted a cross-sectional survey of 419 women attending health facilities in rural western Kenya to measure levels of cervical cancer and HIV stigma and to measure the associations between cervical cancer stigma, HIV stigma, and HIV status. Women who qualified for cervical cancer screening were asked to complete an oral questionnaire using a modified 9-point HIV stigma scale. Low cervical cancer stigma was reported in this study, with only 85/419 (20.3 %) of respondents answering yes to at least one cervical cancer stigma question. However, cervical cancer stigma was highly correlated with HIV stigma (correlation coefficient 0.72) and was significantly lower in HIV-positive women (p < 0.001). Reducing cervical cancer stigma in the general population is an important part of promoting screening in sub-Saharan Africa. PMID:25982550

  2. Expressions of HIV-related stigma among rural-to-urban migrants in China.

    PubMed

    Hong, Yan; Li, Xiaoming; Stanton, Bonita; Fang, Xiaoyi; Lin, Danhua; Wang, Jing; Mao, Rong; Yang, Hongmei

    2008-10-01

    In China, HIV-related stigma is considered as a formidable barrier in the combat against the HIV epidemic. There have been few qualitative investigations on HIV-related stigma in China, especially among a vulnerable population of rural-to-urban migrants. Based on 90 in-depth interviews conducted in 2002-2003 with rural-to-urban migrants in Beijing and Nanjing, China, this study examines the forms and expressions of HIV-related stigma from migrants' perspectives regarding HIV infection and individuals at risk of HIV infection. Consistent with the general framework on stigma, Chinese rural-to-urban migrants' attitudes toward HIV infected individuals take forms of denial, indifference, labeling, separation, rejection, status loss, shame, hopelessness, and fear. These stigmatizing attitudes were mainly derived from fears of AIDS contagion and its negative consequences, fears of being associated with the diseases, and culturally relevant moral judgments. In addition to universal AIDS stigma, both traditional Chinese culture and socially marginalized position of rural migrant population have contributed to culturally unique aspects of stigmatizing attitudes among rural-to-urban migrants. These multifaceted manifestations of HIV-related stigma suggest that HIV stigma reduction intervention needs to address multiple aspects of HIV stigma and stigmatization including personal, cultural, institutional, and structural factors. PMID:18847389

  3. Expressions of HIV-Related Stigma among Rural-to-Urban Migrants in China

    PubMed Central

    Hong, Yan; Stanton, Bonita; Fang, Xiaoyi; Lin, Danhua; Wang, Jing; Mao, Rong; Yang, Hongmei

    2008-01-01

    Abstract In China, HIV-related stigma is considered as a formidable barrier in the combat against the HIV epidemic. There have been few qualitative investigations on HIV-related stigma in China, especially among a vulnerable population of rural-to-urban migrants. Based on 90 in-depth interviews conducted in 2002–2003 with rural-to-urban migrants in Beijing and Nanjing, China, this study examines the forms and expressions of HIV-related stigma from migrants' perspectives regarding HIV infection and individuals at risk of HIV infection. Consistent with the general framework on stigma, Chinese rural-to-urban migrants' attitudes toward HIV infected individuals take forms of denial, indifference, labeling, separation, rejection, status loss, shame, hopelessness, and fear. These stigmatizing attitudes were mainly derived from fears of AIDS contagion and its negative consequences, fears of being associated with the diseases, and culturally relevant moral judgments. In addition to universal AIDS stigma, both traditional Chinese culture and socially marginalized position of rural migrant population have contributed to culturally unique aspects of stigmatizing attitudes among rural-to-urban migrants. These multifaceted manifestations of HIV-related stigma suggest that HIV stigma reduction intervention needs to address multiple aspects of HIV stigma and stigmatization including personal, cultural, institutional, and structural factors. PMID:18847389

  4. Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran

    PubMed Central

    2010-01-01

    Background People living with HIV (PLHIV) sometimes experience discrimination. There is little understanding of the causes, forms and consequences of this stigma in Islamic countries. This qualitative study explored perceptions and experiences of PLHIV regarding both the quality of healthcare and the attitudes and behaviours of their healthcare providers in the Islamic Republic of Iran. Methods In-depth, semi-structured interviews were held with a purposively selected group of 69 PLHIV recruited from two HIV care clinics in Tehran. Data were analyzed using the content analysis approach. Results and discussion Nearly all participants reported experiencing stigma and discrimination by their healthcare providers in a variety of contexts. Participants perceived that their healthcare providers' fear of being infected with HIV, coupled with religious and negative value-based assumptions about PLHIV, led to high levels of stigma. Participants mentioned at least four major forms of stigma: (1) refusal of care; (2) sub-optimal care; (3) excessive precautions and physical distancing; and (4) humiliation and blaming. The participants' healthcare-seeking behavioural reactions to perceived stigma and discrimination included avoiding or delaying seeking care, not disclosing HIV status when seeking healthcare, and using spiritual healing. In addition, emotional responses to perceived acts of stigma included feeling undeserving of care, diminished motivation to stay healthy, feeling angry and vengeful, and experiencing emotional stress. Conclusions While previous studies demonstrate that most Iranian healthcare providers report fairly positive attitudes towards PLHIV, our participants' experiences tell a different story. Therefore, it is imperative to engage both healthcare providers and PLHIV in designing interventions targeting stigma in healthcare settings. Additionally, specialized training programmes in universal precautions for health providers will lead to stigma reduction

  5. Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS

    PubMed Central

    Varni, Susan E.; Miller, Carol T.; McCuin, Tara; Solomon, Sondra E.

    2012-01-01

    The stigma associated with HIV/AIDS poses a psychological challenge to people living with HIV/AIDS. We hypothesized that that the consequences of stigma-related stressors on psychological well-being would depend on how people cope with the stress of HIV/AIDS stigma. Two hundred participants with HIV/AIDS completed a self-report measure of enacted stigma and felt stigma, a measure of how they coped with HIV/AIDS stigma, and measures of depression and anxiety, and self-esteem. In general, increases in felt stigma (concerns with public attitudes, negative self-image, and disclosure concerns) coupled with how participants reported coping with stigma (by disengaging from or engaging with the stigma stressor) predicted self-reported depression, anxiety, and self-esteem. Increases in felt stigma were associated with increases in anxiety and depression among participants who reported relatively high levels of disengagement coping compared to participants who reported relatively low levels of disengagement coping. Increases in felt stigma were associated with decreased self-esteem, but this association was attenuated among participants who reported relatively high levels of engagement control coping. The data also suggested a trend that increases in enacted stigma predicted increases in anxiety, but not depression, among participants who reported using more disengagement coping. Mental health professionals working with people who are HIV positive should consider how their clients cope with HIV/AIDS stigma and consider tailoring current therapies to address the relationship between stigma, coping, and psychological well-being. PMID:22611302

  6. HIV stigma intervention in a low-HIV prevalence setting: a pilot study in an Egyptian healthcare facility.

    PubMed

    Lohiniva, Anna-Leena; Benkirane, Manal; Numair, Tarek; Mahdy, Abdelrahman; Saleh, Hanan; Zahran, Amin; Okasha, Omar; Talaat, Maha; Kamal, Walid

    2016-05-01

    This pilot study is the first to evaluate stigma-reduction intervention in a healthcare setting in Egypt and in the Middle East and North Africa region. It also contributes to knowledge on how to address stigma in low-HIV prevalence settings. A quasi-experimental study design was used to evaluate the effect of anti-HIV stigma intervention in one hospital in Egypt. A control hospital was selected and matched to the intervention hospital by type, size and location. The intervention focused on HIV-related stigma, infection control and medical ethics. Stigma was measured at baseline and at three months post-intervention. A standardized, 10-point scale was developed to measure stigmatizing attitudes and fear-based stigma among participants. Comparisons of overall and job-stratified stigma scores were made across the intervention and control hospitals, before and after the intervention, using two-sample t-test and multivariate regression analysis. Mean stigma scores did not reveal significant differences between the intervention and control hospitals at baseline. After intervention, the overall value-based and fear-based stigma scores were significantly lower in the intervention hospital compared to the control hospital (2.1 and 1.1 compared to 3.8 and 3.2, respectively; p < .001). Context-specific and culturally appropriate HIV stigma-reduction interventions in low-HIV prevalence settings can reduce fear-based and value-based stigma among physicians and nurses. PMID:26717980

  7. Predictors of HIV-related stigmas among African American and Latino religious congregants

    PubMed Central

    Derose, Kathryn Pitkin; Kanouse, David E.; Bogart, Laura M.; Griffin, Beth Ann; Haas, Ann; Stucky, Brian D.; Williams, Malcolm V.; Flórez, Karen R.

    2015-01-01

    Objectives Inform church-based stigma interventions by exploring dimensions of HIV stigma among African American and Latino religious congregants and how these are related to drug addiction and homosexuality stigmas and knowing someone HIV-positive. Methods In-person, self-administered surveys of congregants 18+ years old across two African American and three Latino churches (n=1235, response rate 73%) in a western US city with high HIV prevalence. Measures included 12 items that captured dimensions of HIV stigma, a 5-item scale that assessed attitudes towards people who are addicted to drugs, a 7-item scale assessing attitudes towards homosexuality, and questions regarding socio-demographics and previous communication about HIV. Results 63.8% of survey participants were women, mean age was 40.2 years, and 34.4% were African American, 16.8% were U.S.-born Latinos, 16.0% were foreign-born, English-speaking Latinos, and 32.9% were foreign-born, Spanish-speaking Latinos. Exploratory and confirmatory factor analyses identified four dimensions of HIV stigma – discomfort interacting with people with HIV (4 items, α=0.86), feelings of shame “if you had HIV” (3 items, α=0.78), fears of rejection “if you had HIV” (3 items, α=0.71) and feelings of blame towards people with HIV (2 items, α=0.65). Across all dimensions, after controlling for socio-demographic characteristics and previous communication about HIV, knowing someone with HIV was associated with lower HIV stigma, and greater stigma concerning drug addiction and homosexuality were associated with higher HIV stigma. Conclusions Congregation-based HIV stigma reduction interventions should consider incorporating contact with HIV-affected people. It may also be helpful to address attitudes toward drug addiction and sexual orientation. PMID:26213890

  8. Gender and ethnicity differences in HIV-related stigma experienced by people living with HIV in Ontario, Canada.

    PubMed

    Loutfy, Mona R; Logie, Carmen H; Zhang, Yimeng; Blitz, Sandra L; Margolese, Shari L; Tharao, Wangari E; Rourke, Sean B; Rueda, Sergio; Raboud, Janet M

    2012-01-01

    This study aimed to understand gender and ethnicity differences in HIV-related stigma experienced by 1026 HIV-positive individuals living in Ontario, Canada that were enrolled in the OHTN Cohort Study. Total and subscale HIV-related stigma scores were measured using the revised HIV-related Stigma Scale. Correlates of total stigma scores were assessed in univariate and multivariate linear regression. Women had significantly higher total and subscale stigma scores than men (total, median = 56.0 vs. 48.0, p<0.0001). Among men and women, Black individuals had the highest, Aboriginal and Asian/Latin-American/Unspecified people intermediate, and White individuals the lowest total stigma scores. The gender-ethnicity interaction term was significant in multivariate analysis: Black women and Asian/Latin-American/Unspecified men reported the highest HIV-related stigma scores. Gender and ethnicity differences in HIV-related stigma were identified in our cohort. Findings suggest differing approaches may be required to address HIV-related stigma based on gender and ethnicity; and such strategies should challenge racist and sexist stereotypes. PMID:23300514

  9. Gender and Ethnicity Differences in HIV-related Stigma Experienced by People Living with HIV in Ontario, Canada

    PubMed Central

    Loutfy, Mona R.; Logie, Carmen H.; Zhang, Yimeng; Blitz, Sandra L.; Margolese, Shari L.; Tharao, Wangari E.; Rourke, Sean B.; Rueda, Sergio; Raboud, Janet M.

    2012-01-01

    This study aimed to understand gender and ethnicity differences in HIV-related stigma experienced by 1026 HIV-positive individuals living in Ontario, Canada that were enrolled in the OHTN Cohort Study. Total and subscale HIV-related stigma scores were measured using the revised HIV-related Stigma Scale. Correlates of total stigma scores were assessed in univariate and multivariate linear regression. Women had significantly higher total and subscale stigma scores than men (total, median = 56.0 vs. 48.0, p<0.0001). Among men and women, Black individuals had the highest, Aboriginal and Asian/Latin-American/Unspecified people intermediate, and White individuals the lowest total stigma scores. The gender-ethnicity interaction term was significant in multivariate analysis: Black women and Asian/Latin-American/Unspecified men reported the highest HIV-related stigma scores. Gender and ethnicity differences in HIV-related stigma were identified in our cohort. Findings suggest differing approaches may be required to address HIV-related stigma based on gender and ethnicity; and such strategies should challenge racist and sexist stereotypes. PMID:23300514

  10. Stigma, HIV and AIDS: An Exploration and Elaboration of the Illness Trajectory Surrounding HIV Infection and AIDS.

    ERIC Educational Resources Information Center

    Alonzo, Angelo A.; Reynolds, Nancy R.

    In this paper, human immunodeficiency virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are analyzed in terms of stigma and illness trajectory. The primary purpose is to conceptualize how individuals with HIV/AIDS experience stigma and to demonstrate how these experiences are affected by the social and biophysical dimensions of the…

  11. HIV-associated dementia in the Dominican Republic: a consequence of stigma, domestic abuse and limited health literacy.

    PubMed

    Santoso, Laura Frances; Erkkinen, Emily E; Deb, Anindita; Adon, Carlos

    2016-01-01

    A 38-year-old Dominican woman presented at an infectious disease clinic in Santo Domingo, with subacute dementia and psychomotor slowing. Based on physical findings and laboratory results, she was diagnosed with AIDS and HIV-associated dementia (HAD). She subsequently began combined antiretroviral therapy (cART). Psychiatric complications later emerged: the patient developed suicidal ideation and her partner expressed homicidal thoughts. After extensive interviewing, it was revealed that the patient had known her HIV-positive serostatus for years. However, several factors, including HIV stigma, mental illness stigma, domestic abuse and limited health literacy, had prevented her from seeking treatment and from disclosing her status to her partner. This patient's HIV was unmanaged as a consequence of social and educational circumstance, which resulted in severe sequelae, namely HAD. Compounded barriers to care can lead to the presentation of disease complications that are rarely seen today in countries with widespread access to antiretroviral therapy. PMID:27097891

  12. An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa: the People Living with HIV Stigma Index

    PubMed Central

    2014-01-01

    Background The continued presence of stigma and its persistence even in areas where HIV prevalence is high makes it an extraordinarily important, yet difficult, issue to eradicate. The study aimed to assess current and emerging HIV/AIDS stigma and discrimination trends in South Africa as experienced by people living with HIV/AIDS (PLHIV). Methods The PLHIV Stigma Index, a questionnaire that measures and detects changing trends in relation to stigma and discrimination experienced by PLHIV, was used as the survey tool. The study was conducted in 10 clinics in four provinces supported by the Foundation for Professional Development (FPD), with an interview total of 486 PLHIV. A cross-sectional design was implemented in the study, and both descriptive and inferential analysis was conducted on the data. Results Findings suggest that PLHIV in this population experience significant levels of stigma and discrimination that negatively impact on their health, working and family life, as well as their access to health services. Internalised stigma was prominent, with many participants blaming themselves for their status. Conclusion The findings can be used to develop and inform programmes and interventions to reduce stigma experienced by PLHIV. The current measures for dealing with stigma should be expanded to incorporate the issues related to health, education and discrimination experienced in the workplace, that were highlighted by the study. PMID:24461042

  13. HIV stigma, disclosure and psychosocial distress among Thai youth living with HIV.

    PubMed

    Rongkavilit, C; Wright, K; Chen, X; Naar-King, S; Chuenyam, T; Phanuphak, P

    2010-02-01

    The objective of the present paper is to assess stigma and to create an abbreviated 12-item Stigma Scale based on the 40-item Berger's Stigma Scale for Thai youth living with HIV (TYLH). TYLH aged 16-25 years answered the 40-item Stigma Scale and the questionnaires on mental health, social support, quality of life and alcohol/substance use. Sixty-two (88.6%) of 70 TYLH reported at least one person knowing their serostatus. Men having sex with men were more likely to disclose the diagnosis to friends (43.9% versus 6.1%, P < 0.01) and less likely to disclose to families (47.6% versus 91.8%, P < 0.01). Women were more likely to disclose to families (90.2% versus 62.1%, P < 0.01) and less likely to disclose to friends (7.3% versus 31%, P < 0.05). The 12-item Stigma Scale was reliable (Cronbach's alpha, 0.75) and highly correlated with the 40-item scale (r = 0.846, P < 0.01). Half of TYLH had mental health problems. The 12-item Stigma Scale score was significantly associated with mental health problems (beta = 0.21, P < 0.05). Public attitudes towards HIV were associated with poorer quality of life (beta = -1.41, P < 0.01) and mental health problems (beta = 1.18, P < 0.01). In conclusion, the12-item Stigma Scale was reliable for TYLH. Increasing public understanding and education could reduce stigma and improve mental health and quality of life in TYLH. PMID:20089999

  14. Development of an instrument to measure internalized stigma in those with HIV/AIDS.

    PubMed

    Phillips, Kenneth D; Moneyham, Linda; Tavakoli, Abbas

    2011-01-01

    Stigma has grave consequences for persons living with HIV/AIDS. Stigma hampers prevention of HIV transmission to sexual partners and to unborn babies, diagnosis, and early treatment, and negatively affects mental and physical health, quality of life, and life satisfaction. Internalized stigma of HIV/AIDS may have even more severe consequences than perceived or enacted stigma. The purpose of this study was to develop an instrument to measure internalized stigma in those with HIV/AIDS. Data were drawn from the Rural Women's Health Project. Research assistants administered structured interviews at baseline, 3 months, and 6 months. Instruments used in these analyses included a demographic data form, the Centers for Epidemiological Studies Depression Scale (CES-D), the Perceived Stigma Scale (PSS), and the Internalized Stigma of AIDS Tool (ISAT). Exploratory factor analysis confirmed that the ten items of the ISAT measure a single factor that explains 88% of the variance in the construct. Internal consistency was demonstrated by a Cronbach's alpha of .91 (Time 1), .92 (Time 2), and .92 (Time 3). Convergent validity was supported with significant positive correlations with the CES-D (rho = 0.33, p < 0.0001) and the PSS (rho = 0.56, < 0.0001). The Internalized Stigma of AIDS Tool appears to be a reliable and valid instrument to measure internalization of the stigma of HIV/AIDS. It may be of value in research and clinical assessment. PMID:21692574

  15. Managing and resisting stigma: a qualitative study among people living with HIV in South Africa

    PubMed Central

    Abrahams, Naeemah; Jewkes, Rachel

    2012-01-01

    Background Living with HIV is of daily concern for many South Africans and poses challenges including adapting to a chronic illness and continuing to achieve and meet social expectations. This study explored experiences of being HIV-positive and how people manage stigma in their daily social interactions. Methods Using qualitative methods we did repeat interviewed with 42 HIV-positive men and women in Cape Town and Mthatha resulting in 71 interviews. Results HIV was ubiquitous in our informants’ lives, and almost all participants reported fear of stigma (perceived stigma), but this fear did not disrupt them completely. The most common stigma experiences were gossips and insults where HIV status was used as a tool, but these were often resisted. Many feared the possibility of stigma, but very few had experiences that resulted in discrimination or loss of social status. Stigma experiences were intertwined with other daily conflicts and together created tensions, particularly in gender relations, which interfered with attempts to regain normality. Evidence of support and resistance to stigma was common, and most encouraging was the evidence of how structural interventions such as de-stigmatizing policies impacted on experiences and transference into active resistance. Conclusions The study showed the complex and shifting nature of stigma experiences. These differences must be considered when we intensify stigma reduction with context- and gender-specific strategies focussing on those not yet on ARV programmes. PMID:22905361

  16. The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature.

    PubMed

    Sweeney, Shannon M; Vanable, Peter A

    2016-01-01

    This paper provides a review of the quantitative literature on HIV-related stigma and medication adherence, including: (1) synthesis of the empirical evidence linking stigma to adherence, (2) examination of proposed causal mechanisms of the stigma and adherence relationship, and (3) methodological critique and guidance for future research. We reviewed 38 studies reporting either cross-sectional or prospective analyses of the association of HIV-related stigma to medication adherence since the introduction of antiretroviral therapies (ART). Although there is substantial empirical evidence linking stigma to adherence difficulties, few studies provided data on psychosocial mechanisms that may account for this relationship. Proposed mechanisms include: (a) enhanced vulnerability to mental health difficulties, (b) reduction in self-efficacy, and (c) concerns about inadvertent disclosure of HIV status. Future research should strive to assess the multiple domains of stigma, use standardized measures of adherence, and include prospective analyses to test mediating variables. PMID:26303196

  17. Psychometric Evaluation of the HIV Stigma Scale in a Swedish Context

    PubMed Central

    Lindberg, Maria H.; Wettergren, Lena; Wiklander, Maria; Svedhem-Johansson, Veronica; Eriksson, Lars E.

    2014-01-01

    Background HIV-related stigma has negative consequences for infected people's lives and is a barrier to HIV prevention. Therefore valid and reliable instruments to measure stigma are needed to enable mapping of HIV stigma. This study aimed to evaluate the psychometric properties of the HIV stigma scale in a Swedish context with regard to construct validity, data quality, and reliability. Methods The HIV stigma scale, developed by Berger, Ferrans, and Lashley (2001), was distributed to a cross-sectional sample of people living with HIV in Sweden (n = 194). The psychometric evaluation included exploratory factor analysis together with an analysis of the distribution of scores, convergent validity by correlations between the HIV stigma scale and measures of emotional well-being, and an analysis of missing items and floor and ceiling effects. Reliability was assessed using Cronbach's α. Results The exploratory factor analysis suggested a four-factor solution, similar to the original scale, with the dimensions personalised stigma, disclosure concerns, negative self-image, and concerns with public attitudes. One item had unacceptably low loadings and was excluded. Correlations between stigma dimensions and emotional well-being were all in the expected direction and ranged between −0.494 and −0.210. The instrument generated data of acceptable quality except for participants who had not disclosed their HIV status to anybody. In line with the original scale, all subscales demonstrated acceptable internal consistency with Cronbach's α 0.87–0.96. Conclusion A 39-item version of the HIV stigma scale used in a Swedish context showed satisfactory construct validity and reliability. Response alternatives are suggested to be slightly revised for items assuming the disclosure of diagnosis to another person. We recommend that people that have not disclosed should skip all questions belonging to the dimension personalised stigma. Our analysis confirmed construct validity

  18. Socioeconomic gradients in internalized stigma among persons with HIV in sub-Saharan Africa

    PubMed Central

    Tsai, Alexander C.

    2015-01-01

    The stigma attached to HIV is a major public health problem. HIV-associated morbidity, the specter of impending premature mortality, and reduced capacity to reciprocate within networks of mutual aid are key contributors to status loss and the social exclusion of persons with HIV in sub-Saharan Africa. The pooled dataset used in my analysis, which includes 4,314 persons with HIV surveyed in 12 different sub-Saharan African countries, represents the largest study to date of internalized stigma among persons with HIV. My findings indicate that nearly one-fifth of study participants provided survey responses consistent with internalization of stigmatizing beliefs. Furthermore, striking socioeconomic gradients in internalized stigma were observed. A clear implication of my findings is that the adverse health and psychosocial impacts of HIV stigma are likely concentrated among those with the fewest socioeconomic resources for managing and resisting it. PMID:25572833

  19. Social Determinants of HIV-Related Stigma in Faith-Based Organizations

    PubMed Central

    Tate, Allan D.; Gaddist, Bambi; White, Jacob

    2016-01-01

    Objectives. To examine the association between social factors in faith-based settings (including religiosity and proximity to people living with HIV/AIDS) and HIV stigma. Methods. A total of 1747 congregants from primarily African American faith-based organizations of Project FAITH (Fostering AIDS Initiatives That Heal), a South Carolina statewide initiative to address HIV-related stigma, completed a survey. Results. Female gender (P = .001), higher education (P < .001), knowing someone with HIV/AIDS (P = .01), and knowing someone who is gay (P < .001), but not religiosity, were associated with lower levels of stigma and with lower odds of stigmatizing attitudes (P < .05). Conclusions. Opportunities for connection with people living with HIV/AIDS tailored to the social characteristics of faith-based organizations may address HIV stigma in African American communities. PMID:26794158

  20. Community Cultural Norms, Stigma and Disclosure to Sexual Partners among Women Living with HIV in Thailand, Brazil and Zambia (HPTN 063)

    PubMed Central

    Ojikutu, Bisola O.; Pathak, Subash; Srithanaviboonchai, Kriengkrai; Limbada, Mohammed; Friedman, Ruth; Li, Shuying; Mimiaga, Matthew J.; Mayer, Kenneth H.; Safren, Steven A.

    2016-01-01

    Background Serostatus disclosure may facilitate decreased HIV transmission between serodiscordant partners by raising risk awareness and heightening the need for prevention. For women living with HIV (WLWH), the decision to disclose may be influenced by culturally determined, community-level stigma and norms. Understanding the impact of community HIV stigma and gender norms on disclosure among WLWH in different countries may inform intervention development. Methods HPTN063 was a longitudinal, observational study of sexually active HIV-infected individuals, including heterosexual women, in care in Zambia, Thailand and Brazil. At baseline, a questionnaire measuring community HIV stigma and gender norms, anticipated stigma, demographic, partner/relationship characteristics, and intimate partner violence was administered. Longitudinal HIV disclosure to sexual partners was determined via audio-computer assisted self-interview (ACASI) at the baseline and quarterly during the one year following up. Logistic regression was conducted to identify the predictors of disclosure. Results Almost half (45%) of women living with HIV acknowledged perceived community HIV stigma (the belief that in their community HIV infection among women is associated with sex work and multiple sexual partners). Many women (42.9%) also acknowledged perceived community gender norms (the belief that traditional gender norms such as submissiveness to husbands/male sexual partners is necessary and that social status is lost if one does not procreate). HIV disclosure to current sex partners was reported by 67% of women. In multivariate analysis, among all women, those who were older [OR 0.16, 95%CI(0.06,0.48)], reported symptoms of severe depression [OR 0.53, 95%CI(0.31, 0.90)], endorsed anticipated stigma [OR 0.30, 95%CI(0.18, 0.50)], and were unmarried [OR 0.43, 95%CI(0.26,0.71)] were less likely to disclose to current partners. In an analysis stratified by marital status and cohabitation, unmarried

  1. "Why are you pregnant? What were you thinking?": How women navigate experiences of HIV-related stigma in medical settings during pregnancy and birth.

    PubMed

    Greene, Saara; Ion, Allyson; Kwaramba, Gladys; Smith, Stephanie; Loutfy, Mona R

    2016-02-01

    Having children is a growing reality for women living with HIV in Canada. It is imperative to understand and respond to women's unique experiences and psychosocial challenges during pregnancy and as mothers including HIV-related stigma. This qualitative study used a narrative methodological approach to understand women's experiences of HIV-related stigma as they navigate health services in pregnancy (n = 66) and early postpartum (n = 64). Narratives of women living with HIV expose the spaces where stigmatizing practices emerge as women seek perinatal care and support, as well as highlight the relationship between HIV-related stigma and disclosure, and the impact this has on women's pregnancy and birthing experiences. PMID:26684355

  2. Socio-economic status and HIV/AIDS stigma in Tanzania.

    PubMed

    Amuri, Mbaraka; Mitchell, Steve; Cockcroft, Anne; Andersson, Neil

    2011-03-01

    Tanzania has a generalised AIDS epidemic but the estimated adult HIV prevalence of 6% is much lower than in many countries in Southern Africa. HIV infection rates are reportedly higher in urban areas, among women and among those with more education. Stigma has been found to be more common in poorer, less-educated people, and those in rural areas. We examined associations between poverty and other variables and a stigmatising attitude (belief that HIV/AIDS is punishment for sinning). The variables we examined in a multivariate model included: food sufficiency (as an indicator of poverty), age, sex, marital status, education, experience of intimate partner violence, condom-related choice disability, discussion about HIV/AIDS, sources of information about HIV/AIDS and urban or rural residence. Of the 1,130 men and 1,803 women interviewed, more than half (58%) did not disagree that "HIV/AIDS is punishment for sinning". Taking other variables into account, people from the poorest households (without enough food in the last week) were more likely to believe HIV/AIDS is punishment for sinning (Odds Ratio [OR] 1.29, 95% confidence intervals [CI] 1.06-1.59). Others factors independently associated with this stigmatising attitude were: having less than primary education (OR 1.29, 95% CI 1.03-1.62); having experienced intimate partner violence in the last year (OR 1.40, 95% CI 1.12-1.75); being choice disabled for condom use (OR 1.36, 95% CI 1.08-1.71); and living in rural areas (OR 1.76, 95% CI 1.06-2.90). The level of HIV and AIDS stigma in Tanzania is high with independent associations with several disadvantages: poverty, less education and living in rural areas. Other vulnerable groups, such as survivors of intimate partner violence, are also more likely to have a stigmatising attitude. HIV prevention programmes should take account of stigma, especially among the disadvantaged, and take care not to increase it. PMID:21347901

  3. The development and validation of the HIV/AIDS Stigma Instrument - Nurse (HASI-N)

    PubMed Central

    Uys, Leana R.; Holzemer, William L.; Chirwa, Maureen L.; Dlamini, Priscilla S.; Greeff, Minrie; Kohi, Thecla W.; Makoae, Lucia N.; Stewart, Anita L.; Mullan, Joseph; Phetlhu, René D.; Wantland, Dean J.; Durrheim, Kevin L.; Cuca, Yvette P.; Naidoo, Joanne R.

    2009-01-01

    Illness-related stigma remains a serious problem in the management of HIV disease in Africa. This article describes a series of study phases conducted to develop and validate an instrument to measure HIV/AIDS-related stigma as perpetrated and experienced by nurses. Data were collected in Lesotho, Malawi, South Africa, Swaziland and Tanzania, from 2004-2006. The first phase was a qualitative study with focus group participants (n = 251) to gather emic and etic descriptions of HIV/AIDS-related stigma in the five countries. Based on the qualitative data, a 46-item instrument was developed and tested during a second phase in the same five countries (n = 244). The result of this phase was a 33-item, three-factor instrument with an average Cronbach alpha of 0.85. A third phase tested the instrument in 1474 nurses. The result was a final 19-item instrument, the HIV/AIDS Stigma Instrument - Nurse (HASI-N), comprised of two factors (Nurses Stigmatizing Patients and Nurses Being Stigmatized) with a Cronbach alpha of 0.90. Concurrent validity was tested by comparing the level of stigma with job satisfaction and quality of life. A significant negative correlation was found between stigma and job satisfaction. The HASI-N is the first inductively derived instrument measuring stigma experienced and enacted by nurses. It has the potential to be used not only to measure stigma, but also to develop stigma-reduction interventions. PMID:19229683

  4. The development and validation of the HIV/AIDS Stigma Instrument - Nurse (HASI-N).

    PubMed

    Uys, Leana R; Holzemer, William L; Chirwa, Maureen L; Dlamini, Priscilla S; Greeff, Minrie; Kohi, Thecla W; Makoae, Lucia N; Stewart, Anita L; Mullan, Joseph; Phetlhu, René D; Wantland, Dean J; Durrheim, Kevin L; Cuca, Yvette P; Naidoo, Joanne R

    2009-02-01

    Illness-related stigma remains a serious problem in the management of HIV disease in Africa. This article describes a series of study phases conducted to develop and validate an instrument to measure HIV/AIDS-related stigma as perpetrated and experienced by nurses. Data were collected in Lesotho, Malawi, South Africa, Swaziland and Tanzania, from 2004-2006. The first phase was a qualitative study with focus group participants (n=251) to gather emic and etic descriptions of HIV/AIDS-related stigma in the five countries. Based on the qualitative data, a 46-item instrument was developed and tested during a second phase in the same five countries (n=244). The result of this phase was a 33-item, three-factor instrument with an average Cronbach alpha of 0.85. A third phase tested the instrument in 1474 nurses. The result was a final 19-item instrument, the HIV/AIDS Stigma Instrument - Nurse (HASI-N), comprised of two factors (Nurses Stigmatizing Patients and Nurses Being Stigmatized) with a Cronbach alpha of 0.90. Concurrent validity was tested by comparing the level of stigma with job satisfaction and quality of life. A significant negative correlation was found between stigma and job satisfaction. The HASI-N is the first inductively derived instrument measuring stigma experienced and enacted by nurses. It has the potential to be used not only to measure stigma, but also to develop stigma-reduction interventions. PMID:19229683

  5. Protective and risk factors associated with stigma in a population of older adults living with HIV in Ontario, Canada.

    PubMed

    Emlet, Charles A; Brennan, David J; Brennenstuhl, Sarah; Rueda, Sergio; Hart, Trevor A; Rourke, Sean B

    2013-01-01

    Although the deleterious effects of HIV stigma are well documented, less is known about how various types of stigma impact older adults living with HIV disease and what factors exacerbate or lessen the effects of HIV stigma. Using cross-sectional data from the OHTN cohort study (OCS), we undertook multiple linear regression to determine the predictors of overall HIV stigma, and enacted, anticipated, and internalized stigma subscales in a sample of OCS participants age 50 and over (n = 378). Being female, heterosexual, engaging in maladaptive coping, and having poor self-rated health were associated with greater overall stigma while being older, having greater mastery, increased emotional-informational social support, and a longer time since HIV diagnosis were associated with lower levels of stigma. The final model accounted for 31% of the variance in overall stigma. Differences in these findings by subscale and implications for practice are discussed. PMID:23452022

  6. Effects of home-based voluntary counselling and testing on HIV-related stigma: findings from a cluster-randomized trial in Zambia.

    PubMed

    Jürgensen, Marte; Sandøy, Ingvild Fossgard; Michelo, Charles; Fylkesnes, Knut

    2013-03-01

    HIV-related stigma continues to be a prominent barrier to testing, treatment and care. However, few studies have investigated changes in stigma over time and the factors contributing to these changes, and there is no evidence of the impact of HIV testing and counselling on stigma. This study was nested within a pair-matched cluster-randomized trial on the acceptance of home-based voluntary HIV counselling and testing conducted in a rural district in Zambia between 2009 and 2011, and investigated changes in stigma over time and the impact of HIV testing and counselling on stigma. Data from a baseline survey (n = 1500) and a follow-up survey (n = 1107) were used to evaluate changes in stigma. There was an overall reduction of seven per cent in stigma from baseline to follow-up. This was mainly due to a reduction in individual stigmatizing attitudes but not in perceived stigma. The reduction did not differ between the trial arms (β = -0.22, p = 0.423). Being tested for HIV was associated with a reduction in stigma (β = -0.57, p = 0.030), and there was a trend towards home-based Voluntary Counselling and Testing having a larger impact on stigma than other testing approaches (β = -0.78, p = 0.080 vs. β = -0.37, p = 0.551), possibly explained by a strong focus on counselling and the safe environment of the home. The reduction observed in both arms may give reason to be optimistic as it may have consequences for disclosure, treatment access and adherence. Yet, the change in stigma may have been affected by social desirability bias, as extensive community mobilization was carried out in both arms. The study underscores the challenges in measuring and monitoring HIV-related stigma. Adjustment for social desirability bias and inclusion of qualitative methods are recommended for further studies on the impact of HIV testing on stigma. PMID:23422056

  7. Sexual behavior as a function of stigma and coping with stigma among people with HIV/AIDS in rural New England.

    PubMed

    Varni, Susan E; Miller, Carol T; Solomon, Sondra E

    2012-11-01

    The relationship between coping with HIV/AIDS stigma and engaging in risky sexual behavior (i.e., inconsistent condom use) was examined in HIV-positive adults living in rural areas. Participants answered questions about their experiences with HIV/AIDS prejudice and discrimination (enacted stigma) and their perceptions of felt HIV/AIDS stigma (disclosure concerns, negative self-image, and concern with public attitudes). They were also asked about how they coped with HIV/AIDS stigma, and about their sexual activity during the past 90 days. We hypothesized that using disengagement coping to manage the stress of HIV/AIDS stigma would be related to risky sexual behavior. Multinomial logistic regression results showed that using disengagement coping (avoidance, denial, and wishful thinking) coupled with high levels of enacted stigma was associated with less risky rather than more risky sexual behavior. That is, disengagement coping coupled with high stigma increased the odds of not having vaginal or anal sex versus inconsistently using condoms. Implications for people with HIV/AIDS who use disengagement coping to manage stress to deal with HIV/AIDS stigma are discussed. PMID:22782789

  8. Sexual Behavior as a Function of Stigma and Coping with Stigma Among People with HIV/AIDS in Rural New England

    PubMed Central

    Solomon, Sondra E.

    2012-01-01

    The relationship between coping with HIV/AIDS stigma and engaging in risky sexual behavior (i.e., inconsistent condom use) was examined in HIV-positive adults living in rural areas. Participants answered questions about their experiences with HIV/AIDS prejudice and discrimination (enacted stigma) and their perceptions of felt HIV/AIDS stigma (disclosure concerns, negative self-image, and concern with public attitudes). They were also asked about how they coped with HIV/AIDS stigma, and about their sexual activity during the past 90 days. We hypothesized that using disengagement coping to manage the stress of HIV/AIDS stigma would be related to risky sexual behavior. Multinomial logistic regression results showed that using disengagement coping (avoidance, denial, and wishful thinking) coupled with high levels of enacted stigma was associated with less risky rather than more risky sexual behavior. That is, disengagement coping coupled with high stigma increased the odds of not having vaginal or anal sex versus inconsistently using condoms. Implications for people with HIV/AIDS who use disengagement coping to manage stress to deal with HIV/AIDS stigma are discussed. PMID:22782789

  9. A Community "Hub" Network Intervention for HIV Stigma Reduction: A Case Study.

    PubMed

    Prinsloo, Catharina D; Greeff, Minrie

    2016-01-01

    We describe the implementation of a community "hub" network intervention to reduce HIV stigma in the Tlokwe Municipality, North West Province, South Africa. A holistic case study design was used, focusing on community members with no differentiation by HIV status. Participants were recruited through accessibility sampling. Data analyses used open coding and document analysis. Findings showed that the HIV stigma-reduction community hub network intervention successfully activated mobilizers to initiate change; lessened the stigma experience for people living with HIV; and addressed HIV stigma in a whole community using a combination of strategies including individual and interpersonal levels, social networks, and the public. Further research is recommended to replicate and enhance the intervention. In particular, the hub network system should be extended, the intervention period should be longer, there should be a stronger support system for mobilizers, and the multiple strategy approach should be continued on individual and social levels. PMID:26627447

  10. Stigma, social reciprocity and exclusion of HIV/AIDS patients with illicit drug histories: A study of Thai nurses' attitudes

    PubMed Central

    Chan, Kit Yee; Stoové, Mark A; Reidpath, Daniel D

    2008-01-01

    Background Stigma is a key barrier for the delivery of care to patients living with HIV/AIDS (PLWHA). In the Asia region, the HIV/AIDS epidemic has disproportionately affected socially marginalised groups, in particular, injecting drug users. The effect of the stigmatising attitudes towards injecting drug users on perceptions of PLWHA within the health care contexts has not been thoroughly explored, and typically neglected in terms of stigma intervention. Methods Semi-structured interviews were conducted with a group of twenty Thai trainee and qualified nurses. Drawing upon the idea of 'social reciprocity', this paper examines the constructions of injecting drug users and PLWHA by a group of Thai nurses. Narratives were explored with a focus on how participants' views concerning the high-risk behaviour of injecting drug use might influence their attitudes towards PLWHA. Results The analysis shows that active efforts were made by participants to separate their views of patients living with HIV/AIDS from injecting drug users. While the former were depicted as patients worthy of social support and inclusion, the latter were excluded on the basis that they were perceived as irresponsible 'social cheaters' who pose severe social and economic harm to the community. Absent in the narratives were references to wider socio-political and epidemiological factors related to drug use and needle sharing that expose injecting drug users to risk; these behaviours were constructed as individual choices, allowing HIV positive drug users to be blamed for their seropositive status. These attitudes could potentially have indirect negative implications on the nurses' opinions of patients living with HIV/AIDS more generally. Conclusion Decreasing the stigma associated with illicit drugs might play crucial role in improving attitudes towards patients living with HIV/AIDS. Providing health workers with a broader understanding of risk behaviours and redirecting government injecting drug

  11. HIV-Related Stigma, Shame, and Avoidant Coping: Risk Factors for Internalizing Symptoms Among Youth Living with HIV?

    PubMed

    Bennett, David S; Hersh, Jill; Herres, Joanna; Foster, Jill

    2016-08-01

    Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12-24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH. PMID:26458909

  12. Dyadic Effects of Stigma and Discrimination on Distress in Chinese HIV Discordant Couples.

    PubMed

    Yu, Nancy Xiaonan; Chan, Cecilia L W; Zhang, Jianxin

    2016-08-01

    The present study investigated the dyadic effects of stigma and discrimination on distress in Chinese couples affected by HIV. Chinese people living with HIV (PLHIV) and their seronegative spouses (N = 119 couples) participated in this study. The PLHIV completed measures on stigma beliefs about being better off dead and dignity-related distress. The spouses completed measures on perceived discrimination and exclusion and caregiver distress. The results showed that there was no significant correlation between the PLHIV's stigma beliefs and the spouses' perceived discrimination and exclusion. The couples showed significant associations in their dignity-related distress and caregiver distress. Analyses using the actor-partner interdependence model showed that PLHIV's stigma beliefs and the spouses' perceived discrimination and exclusion both had significant actor and partner effects on distress within the dyad. Psychosocial interventions aiming for distress reduction in the context of HIV should tackle stigma and discrimination and target the couples rather than solely the patient or spouse. PMID:27427923

  13. Perception of Patients With HIV/AIDS From Stigma and Discrimination

    PubMed Central

    Saki, Mandana; Mohammad Khan Kermanshahi, Sima; Mohammadi, Eesa; Mohraz, Minoo

    2015-01-01

    Background: Stigma and discrimination among patients with HIV/AIDS cause various problems for the patients and their health systems. Objectives: The purpose of this study was to explain the perceived experiences of the patients from stigma and discrimination and their roles on health-seeking services among patients. Patients and Methods: This was a qualitative research using content analysis approach and semi-structured interviews, conducted on patients living with HIV/ADS, during 2013 - 2014 in Iran. Sampling started purposefully and continued in a snowball. Results: The experiences of patients with HIV/AIDS from stigma and discrimination led to exploring three main themes and nine subthemes. The main themes were multidimensional stigma, rejection, and insult and discrimination in receiving health services. Conclusions: Stigma and discrimination play an important role in patients' lives and hinder them from accessing the treatment. The patients' responses to this event by secrecy strategy can be an important factor in the disease prevalence. PMID:26290751

  14. The Role of Stigma and Medical Mistrust in the Routine Health Care Engagement of Black Men Who Have Sex With Men

    PubMed Central

    Driffin, Daniel D.; Kegler, Christopher; Smith, Harlan; Conway-Washington, Christopher; White, Denise; Cherry, Chauncey

    2015-01-01

    Objectives. We assessed how health care–related stigma, global medical mistrust, and personal trust in one’s health care provider relate to engaging in medical care among Black men who have sex with men (MSM). Methods. In 2012, we surveyed 544 Black MSM attending a community event. We completed generalized linear modeling and mediation analyses in 2013. Results. Twenty-nine percent of participants reported experiencing racial and sexual orientation stigma from heath care providers and 48% reported mistrust of medical establishments. We found that, among HIV-negative Black MSM, those who experienced greater stigma and global medical mistrust had longer gaps in time since their last medical exam. Furthermore, global medical mistrust mediated the relationship between stigma and engagement in care. Among HIV-positive Black MSM, experiencing stigma from health care providers was associated with longer gaps in time since last HIV care appointment. Conclusions. Interventions focusing on health care settings that support the development of greater awareness of stigma and mistrust are urgently needed. Failure to address psychosocial deterrents will stymie progress in biomedical prevention and cripple the ability to implement effective prevention and treatment strategies. PMID:25521875

  15. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come?

    PubMed Central

    Stangl, Anne L; Lloyd, Jennifer K; Brady, Laura M; Holland, Claire E; Baral, Stefan

    2013-01-01

    Introduction HIV-related stigma and discrimination continue to hamper efforts to prevent new infections and engage people in HIV treatment, care and support programmes. The identification of effective interventions to reduce stigma and discrimination that can be integrated into national responses is crucial to the success of the global AIDS response. Methods We conducted a systematic review of studies and reports that assessed the effectiveness of interventions to reduce HIV stigma and discrimination between 1 January 2002 and 1 March 2013. Databases searched for peer-reviewed articles included PubMed, Scopus, EBSCO Host –CINAHL Plus, Psycinfo, Ovid, Sociofile and Popline. Reports were obtained from the www.HIVAIDSClearinghouse.eu, USAID Development Experience Clearinghouse, UNESCO HIV and AIDS Education Clearinghouse, Google, WHO and UNAIDS. Ancestry searches for articles included in the systematic review were also conducted. Studies of any design that sought to reduce stigma as a primary or secondary objective and included pre- and post-intervention measures of stigma were included. Results Of 2368 peer-reviewed articles and reports identified, 48 were included in our review representing 14 different target populations in 28 countries. The majority of interventions utilized two or more strategies to reduce stigma and discrimination, and ten included structural or biomedical components. However, most interventions targeted a single socio-ecological level and a single domain of stigma. Outcome measures lacked uniformity and validity, making both interpretation and comparison of study results difficult. While the majority of studies were effective at reducing the aspects of stigma they measured, none assessed the influence of stigma or discrimination reduction on HIV-related health outcomes. Conclusions Our review revealed considerable progress in the stigma-reduction field. However, critical challenges and gaps remain which are impeding the identification of

  16. Depression is not an inevitable outcome of disclosure avoidance: HIV stigma and mental health in a cohort of HIV-infected individuals from Southern India.

    PubMed

    Steward, Wayne T; Chandy, Sara; Singh, Girija; Panicker, Siju T; Osmand, Thomas A; Heylen, Elsa; Ekstrand, Maria L

    2011-01-01

    Previous research has shown that HIV stigma in India can be characterized by a framework dividing manifestations into enacted (discrimination), vicarious (hearing stories of discrimination), felt normative (perceptions of stigma's prevalence), and internalized stigma (personal endorsement of stigma beliefs). We examined whether this framework could explain associations among stigma, efforts to avoid HIV serostatus disclosure, and depression symptoms in a cohort of 198 HIV-infected individuals from Southern India who were followed up for one year as part of a study of antiretroviral adherence. Prior studies had suggested that disclosure avoidance was a primary outcome of stigma and that impaired well-being was a primary outcome of disclosure avoidance. Analyses from our longitudinal research revealed that the pattern of associations among stigma, disclosure avoidance, and depression symptoms remained consistent over time. Enacted and vicarious stigmas were correlated with felt normative stigma beliefs. In turn, felt normative stigma was correlated with disclosure avoidance. And, enacted stigma, internalized stigma, and disclosure avoidance were all associated with depression symptoms. However, even though the overall framework held together, internalized stigma and depression symptoms dropped significantly over time while other components remained unchanged. These findings suggest that, although HIV stigma may limit disclosure, it does not invariably lead to psychological maladjustment. Amidst ongoing perceptions and experiences of stigma, HIV-positive individuals can achieve significant improvements in their acceptance of the disease and in mental well-being. PMID:21218366

  17. Understanding HIV Stigma among University Students: Judgment, Blame, and Interpersonal Avoidance

    ERIC Educational Resources Information Center

    Watson, Victoria J.; Guagnano, Gregory; Davis, Shannon N.

    2012-01-01

    Using vignettes, levels of HIV stigma among university students (n = 971) were examined to identify the likelihood of judging and blaming or avoiding personal and intimate contact with an HIV-positive individual. Reactions to the vignettes showed judgment and blame and intimate avoidance were higher when HIV was contracted through unprotected sex.…

  18. Age, Stigma, Adherence and Clinical Indicators in HIV-Infected Women

    PubMed Central

    McCoy, Katryna; Higgins, Melinda; Zuñiga, Julie Ann; Holstad, Marcia McDonnell

    2016-01-01

    Stigma has become a gendered phenomenon that affects increasing numbers of HIV-infected women worldwide. This study examined the role of age as a possible moderator of the relationship between stigma and antiretroviral therapy adherence, CD4% and viral load among 120 HIV-infected women. A secondary analysis was conducted using data from the Keeping Healthy and Active with Risk Reduction and Medication Adherence (KHARMA) Project, an National Institutes of Health (NIH) funded randomized controlled trial to improve Antiretroviral treatment (ART) adherence and reduce risky behaviors in HIV-infected women at five clinical sites in a South-eastern city from 2005 to 2008. Stigma was measured using the Perceived Personal Stigma of Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) scale. Among participants <50 years old (n=90), age was significantly associated with viral load (rho=−.24, p=.02) and stigma was negatively associated with CD4% (r =−.26, p=.02). For the 30 participants >50 years old, age was not significantly associated with viral load, stigma or CD4%, and there was no significant association between stigma and CD4% (r=.07, p=.70). These findings indicate the need for further study regarding this potential moderating effect and possible interventions to address the susceptibility of younger women to the harmful effects of stigma. PMID:27200416

  19. Association of Internalized and Social Network Level HIV Stigma With High-Risk Condomless Sex Among HIV-Positive African American Men.

    PubMed

    Wagner, Glenn J; Bogart, Laura M; Klein, David J; Green, Harold D; Mutchler, Matt G; McDavitt, Bryce; Hilliard, Charles

    2016-08-01

    We examined whether internalized HIV stigma and perceived HIV stigma from social network members (alters), including the most popular and most similar alter, predicted condomless intercourse with negative or unknown HIV status partners among 125 African American HIV-positive men. In a prospective, observational study, participants were administered surveys at baseline and months 6 and 12, with measures including sexual behavior, internalized HIV stigma, and an egocentric social network assessment that included several measures of perceived HIV stigma among alters. In longitudinal multivariable models comparing the relative predictive value of internalized stigma versus various measures of alter stigma, significant predictors of having had condomless intercourse included greater internalized HIV stigma (in all models), the perception that a popular (well-connected) alter or alter most like the participant agrees with an HIV stigma belief, and the interaction of network density with having any alter that agrees with a stigma belief. The interaction indicated that the protective effect of greater density (connectedness between alters) in terms of reduced risk behavior dissipated in the presence of perceived alter stigma. These findings call for interventions that help people living with HIV to cope with their diagnosis and reduce stigma, and inform the targets of social network-based and peer-driven HIV prevention interventions. PMID:26718361

  20. Adapting the minority stress model: associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India.

    PubMed

    Logie, Carmen H; Newman, Peter A; Chakrapani, Venkatesan; Shunmugam, Murali

    2012-04-01

    Marginalization and stigmatization heighten the vulnerability of sexual minorities to inequitable mental health outcomes. There is a dearth of information regarding stigma and mental health among men who have sex with men (MSM) in India. We adapted Meyer's minority stress model to explore associations between stigma and depression among MSM in South India. The study objective was to examine the influence of sexual stigma, gender non-conformity stigma (GNS) and HIV-related stigma (HIV-S) on depression among MSM in South India. A cross-sectional survey was administered to MSM in urban (Chennai) (n=100) and semi-urban (Kumbakonam) (n=100) locations in Tamil Nadu. The majority of participants reported moderate/severe depression scores. Participants in Chennai reported significantly higher levels of GNS, social support and resilient coping, and lower levels of HIV-S and depression, than participants in Kumbakonam. Hierarchical block regression analyses were conducted to measure associations between independent (GNS, HIV-S), moderator (social support, resilient coping) and dependent (depression) variables. Sexual stigma was not included in regression analyses due to multicollinearity with GNS. The first regression analyses assessed associations between depression and stigma subtypes. In Chennai, perceived GNS was associated with depression; in Kumbakonam enacted/perceived GNS and vicarious HIV-S were associated with depression. In the moderation analyses, overall GNS and HIV-S scores (subtypes combined) accounted for a significant amount of variability in depression in both locations, although HIV-S was only a significant predictor in Kumbakonam. Social support and resilient coping were associated with lower depression but did not moderate the influence of HIV-S or GNS on depression. Differences in stigma, coping, social support and depression between locations highlight the salience of considering geographical context in stigma analyses. Associations between HIV-S and

  1. HIV Stigma and Physical Health Symptoms: Do Social Support, Adaptive Coping, and/or Identity Centrality Act as Resilience Resources?

    PubMed Central

    Lang, Shawn M.; Lippitt, Margaret; Jin, Harry; Chaudoir, Stephenie R.

    2015-01-01

    Despite efforts to eliminate it at the societal level, HIV stigma persists and continues to threaten the health of people living with HIV (PLWH). We tested whether social support, adaptive coping, and/or HIV identity centrality act as resilience resources by buffering people from the negative impact of enacted and/or anticipated stigma on stress and ultimately HIV symptoms. Ninety-three PLWH completed a survey, and data analyses tested for evidence of mediation and moderation. Results demonstrated that instrumental social support, perceived community support, and HIV identity centrality buffered participants from the association between anticipated stigma and HIV symptoms. That is, anticipated stigma was associated with HIV symptoms via stress only at low levels of these resources. No resources buffered participants from the impact of enacted stigma. Identifying and enhancing resilience resources among PLWH is critical for protecting PLWH from the harmful effects of stigma. PMID:24715226

  2. Collectivism culture, HIV stigma and social network support in Anhui, China: a path analytic model.

    PubMed

    Zang, Chunpeng; Guida, Jennifer; Sun, Yehuan; Liu, Hongjie

    2014-08-01

    HIV stigma is rooted in culture and, therefore, it is essential to investigate it within the context of culture. The objective of this study was to examine the interrelationships among individualism-collectivism, HIV stigma, and social network support. A social network study was conducted among 118 people living with HIVAIDS in China, who were infected by commercial plasma donation, a nonstigmatized behavior. The Individualism-Collectivism Interpersonal Assessment Inventory (ICIAI) was used to measure cultural norms and values in the context of three social groups, family members, friends, and neighbors. Path analyses revealed (1) a higher level of family ICIAI was significantly associated with a higher level of HIV self-stigma (β=0.32); (2) a higher level of friend ICIAI was associated with a lower level of self-stigma (β=-035); (3) neighbor ICIAI was associated with public stigma (β=-0.61); (4) self-stigman was associated with social support from neighbors (β=-0.27); and (5) public stigma was associated with social support from neighbors (β=-0.24). This study documents that HIV stigma may mediate the relationship between collectivist culture and social network support, providing an empirical basis for interventions to include aspects of culture into HIV intervention strategies. PMID:24853730

  3. Depression is not an Inevitable Outcome of Disclosure Avoidance: HIV Stigma and Mental Health in a Cohort of HIV Infected Individuals from Southern India

    PubMed Central

    Steward, Wayne T.; Chandy, Sara; Singh, Girija; Panicker, Siju Thomas; Osmand, Thomas A.; Heylen, Elsa; Ekstrand, Maria L.

    2010-01-01

    Previous research has shown that HIV stigma in India can be characterized by a framework dividing manifestations into enacted (discrimination), vicarious (hearing stories of discrimination), felt normative (perceptions of stigma’s prevalence) and internalized stigma (personal endorsement of stigma beliefs). We examined if this framework could explain associations among stigma, efforts to avoid HIV serostatus disclosure, and depression symptoms in a cohort of 198 HIV-infected individuals from southern India who were followed for one year as part of a study of antiretroviral adherence. Prior studies had suggested that disclosure avoidance was a primary outcome of stigma and that impaired well-being was a primary outcome of disclosure avoidance. Analyses from our longitudinal research revealed that the pattern of associations among stigma, disclosure avoidance, and depression symptoms remained consistent over time. Enacted and vicarious stigmas were correlated with felt normative stigma beliefs. In turn, felt normative stigma was correlated with disclosure avoidance. And enacted stigma, internalized stigma, and disclosure avoidance were all associated with depression symptoms. However, even though the overall framework held together, internalized stigma and depression symptoms dropped significantly over time while other components remained unchanged. These findings suggest that, although HIV stigma may limit disclosure, it does not invariably lead to psychological maladjustment. Amidst ongoing perceptions and experiences of stigma, HIV-positive individuals can achieve significant improvements in their acceptance of the disease and in mental wellbeing. PMID:21218366

  4. The Second Closet: A Qualitative Study of HIV Stigma Among Seropositive Gay Men in a Southern U.S. City

    PubMed Central

    Ross, Michael W.

    2014-01-01

    Objectives Stigma connected with HIV/AIDS has decreased considerably since the early epidemic yet affects those living with HIV in many ways. Little research, particularly qualitative research, concerning HIV stigma from the perspective of gay men has emerged. The present qualitative study aimed to fill this evidence gap by examining how HIV stigma is perceived and experienced by gay men who have become HIV-infected and how they respond to this stigma. Methods Thematic analysis of 19 gay men's narratives identified six main themes. Results Encountering HIV stigmatization was common and was linked to the physical stigmata identifying respondents as HIV-positive. Overwhelmingly, they found stigmatization to be most intensely felt within gay communities. One profound theme was internalized HIV stigma, referring to respondents' internalized negative feelings about their HIV status. A related theme was the closeted nature of HIV. Lastly, regarding how the men dealt with the HIV diagnosis and experiences of HIV stigma, a theme of adaptation became clear. Conclusions Although exploratory, the results can serve as a beginning framework for understanding and assisting seropositive gay men who experience HIV stigma. The findings are important because it is realistic to expect that in a climate in which HIV has become increasingly invisible and closeted and in which infections are on the rise, gay and bisexual men will be increasingly affected and infected by HIV. PMID:25170366

  5. STIGMA, SOCIAL SUPPORT, AND TREATMENT ADHERENCE AMONG HIV-POSITIVE PATIENTS IN CHIANG MAI, THAILAND

    PubMed Central

    Li, Michael Jonathan; Murray, Jordan Keith; Suwanteerangkul, Jiraporn; Wiwatanadate, Phongtape

    2016-01-01

    Our study assessed the influence of HIV-related stigma on treatment adherence among people living with HIV in Chiang Mai, Thailand, and whether social support had a moderating effect on this relationship. We recruited 128 patients living with HIV from Sansai Hospital, a community hospital in Chiang Mai, Thailand, and collected data through structured interviews. All forms of HIV-related stigma considered in this study (personalized experience, disclosure, negative self-image, and public attitudes) were negatively correlated with adherence to anti-retroviral regimens. Multiple linear regression indicated that total HIV-related stigma was more predictive of treatment adherence than any individual stigma type, after adjusting for socio-demographic and health characteristics. Tests of interaction showed that social support did not appear to moderate the association between HIV stigma and treatment adherence. Our findings suggest that community and government efforts to improve public perceptions about people living with HIV might promote treatment adherence behaviors among HIV-positive patients. PMID:25299810

  6. Stigma, social support, and treatment adherence among HIV-positive patients in Chiang Mai, Thailand.

    PubMed

    Li, Michael Jonathan; Murray, Jordan Keith; Suwanteerangkul, Jiraporn; Wiwatanadate, Phongtape

    2014-10-01

    Our study assessed the influence of HIV-related stigma on treatment adherence among people living with HIV in Chiang Mai, Thailand, and whether social support had a moderating effect on this relationship. We recruited 128 patients living with HIV from Sansai Hospital, a community hospital in Chiang Mai, Thailand, and collected data through structured interviews. All forms of HIV-related stigma considered in this study (personalized experience, disclosure, negative self-image, and public attitudes) were negatively correlated with adherence to anti-retroviral regimens. Multiple linear regression indicated that total HIV-related stigma was more predictive of treatment adherence than any individual stigma type, after adjusting for socio-demographic and health characteristics. Tests of interaction showed that social support did not appear to moderate the association between HIV stigma and treatment adherence. Our findings suggest that community and government efforts to improve public perceptions about people living with HIV might promote treatment adherence behaviors among HIV-positive patients. PMID:25299810

  7. Qualitative Contributions to a Randomized Controlled Trial Addressing HIV/AIDS-Stigma in Medical Students

    PubMed Central

    Marzán-Rodríguez, Melissa; Varas-Díaz, Nelson; Neilands, Torsten

    2016-01-01

    Specialized training for healthcare professionals (HCP) in order to reduce HIV/AIDS related stigma must be part of a public health model for HIV/AIDS. Tested interventions to reduce HIV/AIDS related stigma among HCP have been mostly absent from these efforts. A qualitative approach was used to assess stigma reduction within a traditional randomized controlled design in order to better understand how our current stigma intervention worked and was understood by 2nd year medical students. After conducting a quantitative follow up survey one-year post intervention we conducted 20 in-depth qualitative interviews with a subsample of our intervention group participants as part of the overall evaluation process. Once the interviews were finished, we transcribed them and used NVivo (v.8) to organized the qualitative data. In the process of analyzing the qualitative data we identified core intervention areas participants described as useful for their training and development: (1) acquiring more HIV/AIDS-related knowledge, (2) increased skills for management of high stigma situations, and (3) the ability to identify socio-structural factors that foster HIV infection among clients. The gathered information is important in order to have a deep understanding of how attitudinal change happens as part of our intervention strategies. Keywords: HIV/AIDS, Stigma, Randomized Controlled Trial, Qualitative Evaluation, Medical Students, Puerto Rico PMID:26855975

  8. Understanding and mitigating HIV-related resource-based stigma in the era of antiretroviral therapy.

    PubMed

    Holmes, Kathleen; Winskell, Kate

    2013-01-01

    The perception in low-resource settings that investment of resources in people living with HIV (PLHIV) is wasted because AIDS is both an incurable and deadly disease is known as resource-based stigma. In this paper, we draw on in-depth interviews (IDI), focus group discussions (FGD), and key informant interviews (KII) with 77 HIV-positive microfinance participants and nongovernmental organization leaders to examine resource-based stigma in the context of increased access to antiretroviral therapy (ART) at an individual, household, and community level in Côte d'Ivoire. The purpose of this exploratory paper is to examine: (1) resource-based stigmatization in the era of ART and (2) the relationship among microfinance, a poverty-reduction intervention, and HIV stigmatization. The frequency with which resource-based stigma was discussed by respondents suggests that it is an important component of HIV-related stigma in this setting. It affected PLHIV's access to material as well as social resources, leading to economic discrimination and social devaluation. Participation in village savings and loans groups, however, mitigated resource-based HIV stigma, suggesting that in the era of increased access to antiretroviral therapy, economic programs should be considered as one possible HIV stigma-reduction intervention. PMID:23394104

  9. Experiences of HIV-related stigma among HIV-positive older persons in Uganda--a mixed methods analysis.

    PubMed

    Kuteesa, Monica O; Wright, Stuart; Seeley, Janet; Mugisha, Joseph; Kinyanda, Eugene; Kakembo, Frederick; Mwesigwa, Richard; Scholten, Francis

    2014-01-01

    There is limited data on stigma among older HIV-infected adults in sub-Saharan Africa. We describe the experiences of stigma and disclosure in a cohort of HIV-positive older people in Uganda. Using data from the Wellbeing of Older Peoples' Study of Kalungu (rural site) and Wakiso district (peri-urban site) residents, we measured self-reported stigma levels for 183 respondents (94 on antiretroviral therapy (ART); 88, not on ART) using a stigma score generated using three questions on stigma perceptions where 0 meant no stigma at all and 100 was maximum stigma. Based on two questions on disclosure, an overall score was computed. High disclosure was assigned to those who often or very often disclosed to the family and were never or seldom afraid to disclose elsewhere. We examined the experiences of HIV stigma of 25 adults (52% females) using semi-structured, open-ended interviews and monthly oral diaries over one year. Mean age of the respondents was 70 years (range 60-80 years) and 80% of all respondents were enrolled in ART. Interview transcripts were analysed using thematic content analysis. Overall, 55% of respondents had a high disclosure score, meaning they disclosed easily, and 47% had a high stigma score. The stigma scores were similar among those with high and low disclosure scores. In multivariate analyses with disclosure and stigma scores as dependent variables none of the respondents' characteristics had a significant effect at the 5% level. Qualitative data revealed that stigma ranges from: (1) perceptions (relatively passive, but leading to behaviour such as gossip, especially if not intended maliciously); to (2) discriminatory behaviour (active or enacted stigma; from malicious gossip to outright discrimination). Despite the relatively high levels of disclosure, older people suffer from high levels of stigma of various forms apart from HIV-related stigma. Efforts to assess for different forms of stigma at an individual level deserve greater attention

  10. Experiences of HIV-related stigma among HIV-positive older persons in Uganda – a mixed methods analysis

    PubMed Central

    Kuteesa, Monica O.; Wright, Stuart; Seeley, Janet; Mugisha, Joseph; Kinyanda, Eugene; Kakembo, Frederick; Mwesigwa, Richard; Scholten, Francis

    2014-01-01

    Abstract There is limited data on stigma among older HIV-infected adults in sub-Saharan Africa. We describe the experiences of stigma and disclosure in a cohort of HIV-positive older people in Uganda. Using data from the Wellbeing of Older Peoples' Study of Kalungu (rural site) and Wakiso district (peri-urban site) residents, we measured self-reported stigma levels for 183 respondents (94 on antiretroviral therapy (ART); 88, not on ART) using a stigma score generated using three questions on stigma perceptions where 0 meant no stigma at all and 100 was maximum stigma. Based on two questions on disclosure, an overall score was computed. High disclosure was assigned to those who often or very often disclosed to the family and were never or seldom afraid to disclose elsewhere. We examined the experiences of HIV stigma of 25 adults (52% females) using semi-structured, open-ended interviews and monthly oral diaries over one year. Mean age of the respondents was 70 years (range 60–80 years) and 80% of all respondents were enrolled in ART. Interview transcripts were analysed using thematic content analysis. Overall, 55% of respondents had a high disclosure score, meaning they disclosed easily, and 47% had a high stigma score. The stigma scores were similar among those with high and low disclosure scores. In multivariate analyses with disclosure and stigma scores as dependent variables none of the respondents' characteristics had a significant effect at the 5% level. Qualitative data revealed that stigma ranges from: (1) perceptions (relatively passive, but leading to behaviour such as gossip, especially if not intended maliciously); to (2) discriminatory behaviour (active or enacted stigma; from malicious gossip to outright discrimination). Despite the relatively high levels of disclosure, older people suffer from high levels of stigma of various forms apart from HIV-related stigma. Efforts to assess for different forms of stigma at an individual level deserve greater

  11. Stigma, discrimination, and sexual (dis)satisfaction among people living with HIV: results from the "AIDES et toi" survey.

    PubMed

    Rojas Castro, D; Le Gall, J M; Andreo, C; Spire, B

    2010-08-01

    The effects of HIV-related stigma and discrimination have been studied in several areas, such as access to testing, quality of care quality, and access to work. Nevertheless, the effects of stigma and discrimination on the sexual life of people living with HIV/AIDS (PLWHA) have not been studied enough. AIDES, a French community-based organization, has developed a biannual survey which assesses several socioeconomical and psychosocial dimensions of the people in contact with this organization. A focus on the results concerning sexual (dis)satisfaction and the factors associated are presented here. A convenience sample of 521 HIV-positive men having sex with men, heterosexual men and women was analyzed. A logistic regression was performed to examine which factors were significantly associated with sexual dissatisfaction. Results showed that being older, not having a full-time job, not having a steady sexual partner, lower frequency of sexual intercourse, discrimination in the sexual relationship setting, and the perception of loneliness were independently associated with sexual dissatisfaction. A quality health approach must include the aspects linked to sexual life and sexual satisfaction. Given the potentially harmful effects that HIV-related stigma and discrimination have on PLWHA's well-being, more specific actions and advocacy in this direction should be developed and implemented. PMID:20552468

  12. Emotional, physical and financial burdens of stigma against people living with HIV/AIDS in China

    PubMed Central

    Zhang, Chen; Li, Xiaoming; Liu, Yu; Qiao, Shan; Zhang, Liying; Zhou, Yuejiao; Shen, Zhiyong; Tang, Zhengzhu

    2016-01-01

    ABSTRACT Numerous researches have shown pernicious effects of stigma against people living with HIV/AIDS (PLWHA). However, no available studies have reported these negative effects including emotional, physical to financial burdens to PLWHA. In the current study, we aim to explore different types of stigma (e.g., perceived, internalized and enacted) and the relevant consequences among PLWHA in China. A cross-sectional study was conducted from 2012 to 2013 in the Guangxi Autonomous Region in China. The validated Berger HIV Stigma Scale was used to measure various types of stigma. We employed a series of linear, logistic and polytomous regression models to assess the association between stigma and different consequences while accounting for potential confounders for each specific model. Of the total sample, 2987 PLWHA provided valid responses with 63% being male and having an average age of 42.9 years. Perceived, internalized and enacted HIV stigma were prevalent among participants, and resulted in various burdens with different magnitudes in their life contexts. Specially, PLWHA who reported higher perceived and internalized stigma were more likely to be imposed on emotional and physical burdens (p < .05). People who reported higher enacted stigma had heavier financial burden compared to their peers (p < .05). Our findings revealed that devastating consequences of HIV-related stigma in China. The prevalent stigmatizing attitudes have pushed PLWHA to the fringes of society and affected them at multiple aspects in their life context. We call for tailored efforts to overcome stigma and discrimination against PLWHA. PMID:26886415

  13. Emotional, physical and financial burdens of stigma against people living with HIV/AIDS in China.

    PubMed

    Zhang, Chen; Li, Xiaoming; Liu, Yu; Qiao, Shan; Zhang, Liying; Zhou, Yuejiao; Shen, Zhiyong; Tang, Zhengzhu

    2016-01-01

    Numerous researches have shown pernicious effects of stigma against people living with HIV/AIDS (PLWHA). However, no available studies have reported these negative effects including emotional, physical to financial burdens to PLWHA. In the current study, we aim to explore different types of stigma (e.g., perceived, internalized and enacted) and the relevant consequences among PLWHA in China. A cross-sectional study was conducted from 2012 to 2013 in the Guangxi Autonomous Region in China. The validated Berger HIV Stigma Scale was used to measure various types of stigma. We employed a series of linear, logistic and polytomous regression models to assess the association between stigma and different consequences while accounting for potential confounders for each specific model. Of the total sample, 2987 PLWHA provided valid responses with 63% being male and having an average age of 42.9 years. Perceived, internalized and enacted HIV stigma were prevalent among participants, and resulted in various burdens with different magnitudes in their life contexts. Specially, PLWHA who reported higher perceived and internalized stigma were more likely to be imposed on emotional and physical burdens (p < .05). People who reported higher enacted stigma had heavier financial burden compared to their peers (p < .05). Our findings revealed that devastating consequences of HIV-related stigma in China. The prevalent stigmatizing attitudes have pushed PLWHA to the fringes of society and affected them at multiple aspects in their life context. We call for tailored efforts to overcome stigma and discrimination against PLWHA. PMID:26886415

  14. HIV/AIDS and the gendering of stigma in Tamil Nadu, South India.

    PubMed

    Van Hollen, Cecilia

    2010-12-01

    Drawing on the seminal theoretical work on stigma by Goffman, this article analyzes stigma through the lens of Parker and Aggleton, who call for the joining of Goffman and Foucault to better grasp relationships among stigma, power and social inequality. Studies on the social impact of HIV/AIDS globally have demonstrated that women tend to be blamed for the spread of HIV/AIDS, and as a result, HIV-positive women face greater stigma and discrimination than HIV-positive men. Based on ethnographic research among 50 HIV-positive women in South India in 2002-2003 and 2004, my research supports this standard argument. However, my findings suggest that the gendering of stigma and discrimination is more complex and context specific. The gendering of stigma varies depending on the social context of private versus public spheres. The tendency to stigmatize women is due in part to cultural constructions of gendered bodies and not only to a gendered double standard of sexual morality, as has been previously reported. Even when a cultural argument about women's wayward sexuality is evoked, this rhetoric must be understood in part as a strategy to mask economically motivated responses, rather simply being attributed to sexist ideology per se. PMID:20842521

  15. Levels of Felt Stigma among a Group of People with HIV in Puerto Rico

    PubMed Central

    Jiménez, Julio; Morales, Marangelie; Castro, Eida; Puig, Marieva; Vélez, Carmen N.; Santiago, Lydia; Zorrilla, Carmen

    2016-01-01

    Objective HIV felt stigma is a major problem needing to be addressed because of its association with poor treatment adherence, decreases in help-seeking behaviors, high-risk sexual conduct, emotional discomfort, and the reduction of well-being in people with HIV/AIDS (PWHA). The aim of this study was to identify the frequency of felt stigma among PWHA in Puerto Rico. Methods A cross-sectional study was conducted with 249 subjects (59% men, 41% women). Participants completed the Puerto Rico Comprehensive Center for HIV Disparities (PR-CCHD) Sociodemographic Questionnaire and the HIV Felt Sigma Scale. Results 80% of the subjects showed some level of felt stigma. Women showed significantly higher levels of HIV-related felt stigma than did men. Disclosure, negative self-image, and public attitude scores were also higher in women than in men. Sociodemographic variables such as age, marital status, employment status, income, and educational level showed significant associations with felt stigma and its dimensions. Conclusion Results of this study evidence the need to develop culturally sensitive intervention models to reduce the felt-stigma burden in PWHA. PMID:22783698

  16. Persistent HIV-related stigma in rural Uganda during a period of increasing HIV incidence despite treatment expansion

    PubMed Central

    Chan, Brian T.; Weiser, Sheri D.; Boum, Yap; Siedner, Mark J.; Mocello, A. Rain; Haberer, Jessica E.; Hunt, Peter W.; Martin, Jeffrey N.; Mayer, Kenneth H.; Bangsberg, David R.; Tsai, Alexander C.

    2014-01-01

    Objective Program implementers have argued that the increasing availability of anti-retroviral therapy (ART) will reduce the stigma of HIV. We analyzed data from Uganda to assess how HIV-related stigma has changed during a period of ART expansion. Design Serial cross-sectional surveys. Methods We analyzed data from the Uganda AIDS Rural Treatment Outcomes (UARTO) study during 2007-2012 to estimate trends in internalized stigma among people living with HIV (PLHIV) at the time of treatment initiation. We analyzed data from the Uganda Demographic and Health Surveys (DHS) from 2006 and 2011 to estimate trends in stigmatizing attitudes and anticipated stigma in the general population. We fitted regression models adjusted for socio-demographic characteristics, with year of data collection as the primary explanatory variable. Results We estimated an upward trend in internalized stigma among PLHIV presenting for treatment initiation (adjusted b=0.18; 95% CI, 0.06 to 0.30). In the general population, the odds of reporting anticipated stigma were greater in 2011 compared to 2006 (adjusted OR=1.80; 95% CI, 1.51 to 2.13), despite an apparent decline in stigmatizing attitudes (adjusted OR=0.62; 95% CI, 0.52 to 0.74). Conclusions Internalized stigma has increased over time among PLHIV in the setting of worsening anticipated stigma in the general population. Further study is needed to better understand the reasons for increasing HIV-related stigma in Uganda and its impact on HIV prevention efforts. PMID:25268886

  17. Positive Coping Strategies and HIV-Related Stigma in South India

    PubMed Central

    Kumar, Shuba; Mohanraj, Rani; Rao, Deepa; Murray, Katherine R.

    2015-01-01

    Abstract Whether perceived or enacted, HIV-related stigma is widespread in India, and has had a crippling effect on People Living with HIV/AIDS (PLHA). Research has shown that a positive attitude towards the illness sets a proactive framework for the individual to cope with his or her infection; therefore, healthy coping mechanisms are essential to combat HIV-related stigma. This qualitative study involving in-depth interviews and focus group discussions with PLHA affiliated with HIV support groups in South India explored positive coping strategies employed by PLHA to deal with HIV-related stigma. Interviews and focus group discussions were translated, transcribed, and analyzed for consistent themes. Taboos surrounding modes of transmission, perceiving sex workers as responsible for the spread of HIV, and avoiding associating with PLHA provided the context of HIV-related stigma. Despite these challenges, PLHA used several positive strategies, classified as Clear Knowledge and Understanding of HIV, Social Support and Family Well-Being, Selective Disclosure, Employment Building Confidence, and Participation in Positive Networks. Poor understanding of HIV and fears of being labeled immoral undermined healthy coping behavior, while improved understanding, affiliation with support groups, family support, presence of children, and financial independence enhanced PLHA confidence. Such positive coping behaviours could inform culturally relevant interventions. PMID:25612135

  18. Positive coping strategies and HIV-related stigma in south India.

    PubMed

    Kumar, Shuba; Mohanraj, Rani; Rao, Deepa; Murray, Katherine R; Manhart, Lisa E

    2015-03-01

    Whether perceived or enacted, HIV-related stigma is widespread in India, and has had a crippling effect on People Living with HIV/AIDS (PLHA). Research has shown that a positive attitude towards the illness sets a proactive framework for the individual to cope with his or her infection; therefore, healthy coping mechanisms are essential to combat HIV-related stigma. This qualitative study involving in-depth interviews and focus group discussions with PLHA affiliated with HIV support groups in South India explored positive coping strategies employed by PLHA to deal with HIV-related stigma. Interviews and focus group discussions were translated, transcribed, and analyzed for consistent themes. Taboos surrounding modes of transmission, perceiving sex workers as responsible for the spread of HIV, and avoiding associating with PLHA provided the context of HIV-related stigma. Despite these challenges, PLHA used several positive strategies, classified as Clear Knowledge and Understanding of HIV, Social Support and Family Well-Being, Selective Disclosure, Employment Building Confidence, and Participation in Positive Networks. Poor understanding of HIV and fears of being labeled immoral undermined healthy coping behavior, while improved understanding, affiliation with support groups, family support, presence of children, and financial independence enhanced PLHA confidence. Such positive coping behaviours could inform culturally relevant interventions. PMID:25612135

  19. The Role of HIV-Related Stigma in Utilization of Skilled Childbirth Services in Rural Kenya: A Prospective Mixed-Methods Study

    PubMed Central

    Turan, Janet M.; Hatcher, Abigail H.; Medema-Wijnveen, José; Onono, Maricianah; Miller, Suellen; Bukusi, Elizabeth A.; Turan, Bulent; Cohen, Craig R.

    2012-01-01

    Background Childbirth with a skilled attendant is crucial for preventing maternal mortality and is an important opportunity for prevention of mother-to-child transmission of HIV. The Maternity in Migori and AIDS Stigma Study (MAMAS Study) is a prospective mixed-methods investigation conducted in a high HIV prevalence area in rural Kenya, in which we examined the role of women's perceptions of HIV-related stigma during pregnancy in their subsequent utilization of maternity services. Methods and Findings From 2007–2009, 1,777 pregnant women with unknown HIV status completed an interviewer-administered questionnaire assessing their perceptions of HIV-related stigma before being offered HIV testing during their first antenatal care visit. After the visit, a sub-sample of women was selected for follow-up (all women who tested HIV-positive or were not tested for HIV, and a random sample of HIV-negative women, n = 598); 411 (69%) were located and completed another questionnaire postpartum. Additional qualitative in-depth interviews with community health workers, childbearing women, and family members (n = 48) aided our interpretation of the quantitative findings and highlighted ways in which HIV-related stigma may influence birth decisions. Qualitative data revealed that health facility birth is commonly viewed as most appropriate for women with pregnancy complications, such as HIV. Thus, women delivering at health facilities face the risk of being labeled as HIV-positive in the community. Our quantitative data revealed that women with higher perceptions of HIV-related stigma (specifically those who held negative attitudes about persons living with HIV) at baseline were subsequently less likely to deliver in a health facility with a skilled attendant, even after adjusting for other known predictors of health facility delivery (adjusted odds ratio = 0.44, 95% CI 0.22–0.88). Conclusions Our findings point to the urgent need for interventions to reduce HIV

  20. Religion and HIV/AIDS stigma: Implications for health professionals in Puerto Rico

    PubMed Central

    Varas-Díaz, N.; Neilands, T.B.; Malavé Rivera, S.; Betancourt, E.

    2009-01-01

    HIV/AIDS stigma continues to be a barrier for prevention efforts. Its detrimental effects have been documented among people living with HIV/AIDS and encompass loss of social support and depression. When it is manifested by health professionals, it can lead to suboptimal services. Although strides have been made to document the effects of HIV/AIDS stigma, much needs to be done in order to understand the structural factors that can foster it. Such is the case of religion’s role on HIV/AIDS stigma in Puerto Rico. The Caribbean Island has a Judeo-Christian based culture due to years of Spanish colonisation. This religious influence continued under Protestantism as part of the Island’s integration as a non-incorporated territory of the USA. The main objective of this study was to explore the role of religion in HIV/AIDS stigma manifested by Puerto Rican health professionals in practice and in training. Through a mixed method approach, 501 health professionals completed qualitative interviews (n=80) and self-administered questionnaires (n=421). Results show that religion plays some role in conceptualisations of health and illness among participants in the study. Furthermore, the importance placed on religion and participation in such activities was related to higher levels of HIV/AIDS stigma. PMID:20087809

  1. A Mid-South Perspective: African American Faith-based Organizations, HIV, and Stigma.

    PubMed

    Otey, Tamara D; Miller, Wendy Renee

    2016-01-01

    Shelby County, Tennessee has the fastest growing rate of HIV infection in the state, and the majority of new infections are in African Americans. In 2011, a Centers for Disease Control and Prevention report stated that Memphis (the largest city in Shelby County) ranked seventh highest in new HIV infections. Little research has addressed HIV-related themes in African American culture that could hinder HIV prevention measures. Our qualitative study engaged African American, faith-based leaders in areas with high rates of HIV in meaningful conversations regarding their attitudes toward HIV and those who are infected. Although faith-based leaders felt they had a role in HIV prevention, only 4% in our study had participated in HIV prevention activities, but they were open to HIV prevention programs. We found that faith-based leaders had limited knowledge of health disparities and ongoing stigma concerning HIV, which served as a major barrier to HIV prevention. PMID:27209431

  2. 'The mercurial piece of the puzzle': Understanding stigma and HIV/AIDS in South Africa.

    PubMed

    Gilbert, Leah

    2016-01-01

    Although stigma and its relationship to health and disease is not a new phenomenon, it has not been a major feature in the public discourse until the emergence of HIV. The range of negative responses associated with the epidemic placed stigma on the public agenda and drew attention to its complexity as a phenomenon and concept worthy of further investigation. Despite the consensus that stigma is one of the major contributors to the rapid spread of HIV and the frequent use of the term in the media and among people in the street, the exact meaning of 'stigma' remains ambiguous. The aim of this paper is to briefly re-visit some of the scholarly deliberations and further interrogate their relevance in explaining HIV-related stigma evidenced in South Africa. In conclusion a model is presented. Its usefulness--or explanatory potential--is that it attempts to provide a comprehensive framework that offers insights into the individual as well as the social/structural components of HIV-related stigma in a particular context. As such, it has the potential to provide more nuanced understandings as well as to alert us to knowledge-gaps in the process. PMID:26781444

  3. Conflict transformation, stigma, and HIV-preventive structural change.

    PubMed

    Miller, Robin Lin; Reed, Sarah J; Francisco, Vincent T; Ellen, Jonathan M

    2012-06-01

    Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed. PMID:21805217

  4. Felt Stigma in Injection Drug Users and Sex Workers: Focus Group Research with HIV-Risk Populations in Puerto Rico

    PubMed Central

    Jiménez, Julio; Puig, Marieva; Sala, Ana Cecilia; Ramos, Juan Carlos; Castro, Eida; Morales, Marangelie; Santiago, Lydia; Zorrilla, Carmen

    2016-01-01

    Though many studies have conclusively linked felt stigma and HIV, few have focused on the experiences of rejection felt by members of such socially marginalized groups as intravenous drug users (IDU) and sex workers (SW). Using focus groups, our study explored these experiences in 34 individuals (17 male UDUs and 17 female SWs) at risk of becoming infected with HIV, the objective being to discover why they engaged in maladaptive behaviors as a way of coping with felt stigma. We used deductive and inductive analysis to codify the resulting data. Concepts associated with the word stigma, emotional reactions to felt stigma, and the impact of felt stigma on self-schema helped elucidate how the internalization of felt stigma can lead to negative affective states and self-destructive behaviors (e.g., drug use and syringe exchange). Results underline the importance of developing intervention models that reduce stigma as a means of HIV prevention in vulnerable populations. PMID:27013930

  5. HIV/AIDS stigma: Measurement and relationships to psycho-behavioral factors in Latino gay/bisexual men and transgender women

    PubMed Central

    Molina, Y.; Ramirez-Valles, J.

    2013-01-01

    Despite the increased interest in HIV/AIDS stigma and its negative effects on the health and social support of people living with HIV/AIDS (PLWHA), little attention has been given to its assessment among Latino gay/bisexual men and transgender women (GBT) living with HIV/AIDS. The purpose of this paper is twofold: to develop a multidimensional assessment of HIV/AIDS stigma for Latino GBT living with HIV/AIDS, and to test whether such stigma is related to self-esteem, safe sex self-efficacy, social support, and alcohol and drug use. The sample included 170 HIV+ Latino GBT persons. The results revealed three dimensions of stigma: internalized, perceived, and enacted HIV/AIDS stigma. Enacted HIV/AIDS stigma comprised two domains: generalized and romantic and sexual. Generalized enacted HIV/AIDS stigma was related to most outcomes. Internalized HIV/AIDS stigma mediated the associations between generalized enacted HIV/AIDS stigma and self-esteem and safe sex self-efficacy. In addition, romantic and sexual enacted HIV/AIDS stigma significantly predicted drug use. Perceived HIV/AIDS stigma was not associated with any outcome. These findings expand the understanding of the multi-dimensionality of stigma and the manner in which various features impact marginalized PLWHA. PMID:23668809

  6. Vocational Counseling of HIV-infected People: A Role for Nurses in HIV Care.

    PubMed

    Wagener, Marlies N; Miedema, Harald S; Kleijn, Liselotte M; van Gorp, Eric C M; Roelofs, Pepijn D D M

    2015-01-01

    People living with HIV (PLWH) face various work-related problems, such as stigma and physical difficulties. Health care professionals can help improve the employment situation of PLWH. Nurses who work in HIV care play a central role in the care of PLWH in the Netherlands. The aim of this cross-sectional study was to investigate the contributions of nurses to the vocational counseling of PLWH, and to make an inventory of needs for future care. Our findings, collected with a self-administered survey, clarified that HIV nurses in the Netherlands regularly faced patients with problems at work, but that they didn't have the required knowledge to provide assistance. Our study emphasized the important role of HIV nurses in vocational counseling because of their central positions in care and their confidential relationship with patients. The study underlined the importance of available, up-to-date knowledge about HIV and work, as well as a clear referral network. PMID:26066689

  7. Stigma, an important source of dissatisfaction of health workers in HIV response in Vietnam: a qualitative study

    PubMed Central

    2012-01-01

    Background Like in many other low- and middle-income countries, the recent development of an HIV epidemic in Vietnam has led to a growing need for prevention, treatment, care, and support services for people living with HIV (PLHIV). This puts greater demands on the national HIV services, primarily on health workers, which increases the importance of their job satisfaction and working conditions. This study describes health worker perceptions and explores the factors that influence job satisfaction and dissatisfaction of health personnel working on the HIV response in Vietnam. Spector’s job satisfaction model was used as the theoretical framework for the study design and analysis. Methods The study employed a qualitative design with 7 focus group discussions and 15 semi-structured interviews with health workers, purposively selected from national and provincial organizations responsible for HIV services in 5 cities and provinces in Vietnam. Data were analyzed using a hybrid approach of theory-driven and data-driven coding and theme development using qualitative analysis software. Results HIV services are perceived by Vietnamese health workers as having both positive and negative aspects. Factors related to job satisfaction included training opportunities, social recognition, and meaningful tasks. Factors related to job dissatisfaction included unsatisfactory compensation, lack of positive feedback and support from supervisors, work-related stress from a heavy workload, fear of infection, and HIV-related stigma because of association with PLHIV. An adjusted Spector’s model of job satisfaction for HIV service health workers was developed from these results. Conclusion This study confirmed the relationship between stigmatization of PLHIV and stigma experienced by staff because of association with PLHIV from families, colleagues, and society. The experiencing stigma results in additional work-related stress, low self-esteem, poor views of their profession, and lower

  8. Disclosure appraisal mediating the association between perceived stigma and HIV disclosure to casual sex partners among HIV+ MSM: a path model analysis.

    PubMed

    Li, Haochu; Chen, Xinguang; Yu, Bin

    2016-06-01

    HIV stigma is widely believed to be related to HIV disclosure. However, there is a dearth of studies examining the mechanisms that link stigma to disclosure. This is a specific study to assess the relationship between perceived stigma and HIV disclosure to casual sex partners based on a social cognitive theory. HIV+ men who have sex with men (MSM) from two US cities (N = 297) completed questionnaires administered using audio computer-assisted self-interviewing. Path modeling analysis was used to assess the theory-based structural relationships. Perceived stigma was negatively associated with attitudes, intention and behavior of HIV disclosure to casual sex partners. The association was fully mediated by disclosure appraisal, including disclosure outcome expectations, costs and self-efficacy. Findings of this study add new knowledge regarding HIV stigma and disclosure, and provide timely data supporting more effective behavioral interventions to encourage HIV disclosure among MSM. PMID:27009408

  9. Details for Manuscript Number SSM-D-07-01631R1 “HIV-Related Stigma: Adapting a Theoretical Framework for Use in India”

    PubMed Central

    Herek, Gregory M; Ramakrishna, Jayashree; Bharat, Shalini; Chandy, Sara; Wrubel, Judith; Ekstrand, Maria L

    2008-01-01

    Stigma complicates the treatment of HIV worldwide. We examined whether a multi-component framework, initially consisting of enacted, felt normative, and internalized forms of individual stigma experiences, could be used to understand HIV-related stigma in Southern India. In Study 1, qualitative interviews with a convenience sample of 16 people living with HIV revealed instances of all three types of stigma. Experiences of discrimination (enacted stigma) were reported relatively infrequently. Rather, perceptions of high levels of stigma (felt normative stigma) motivated people to avoid disclosing their HIV status. These perceptions often were shaped by stories of discrimination against others HIV-infected individuals, which we adapted as an additional component of our framework (vicarious stigma). Participants also varied in their acceptance of HIV stigma as legitimate (internalized stigma). In Study 2, newly-developed measures of the stigma components were administered in a survey to 229 people living with HIV. Findings suggested that enacted and vicarious stigma influenced felt normative stigma; that enacted, felt normative, and internalized stigma were associated with higher levels of depression; and that the associations of depression with felt normative and internalized forms of stigma were mediated by the use of coping strategies designed to avoid disclosure of one's HIV serostatus. PMID:18599171

  10. Multiple dimensions of HIV stigma and psychological distress among Asians and Pacific Islanders living with HIV illness.

    PubMed

    Kang, Ezer; Rapkin, Bruce D; Remien, Robert H; Mellins, Claude Ann; Oh, Alina

    2005-06-01

    Asians and Pacific Islanders (APIs) living with HIV/AIDS in the US are particularly vulnerable to HIV-related stigma largely due to ingrained socio-cultural norms that strongly associate HIV transmission with activities perceived to be immoral. This cross-sectional study examined the relationship between five HIV-stigma factors and psychological distress among 54 HIV-seropositive APIs. Social Rejection, Negative Self-Worth, Perceived Interpersonal Insecurity, and Financial Security were all significantly associated with psychological distress. Results from hierarchical multiple regression analyses indicated that Social Rejection, Negative Self-Worth, and Perceived Interpersonal Insecurity significantly predicted psychological distress after control for physical symptoms and country of birth. Undocumented Asians endorsed higher levels of Social Rejection, Negative Self-Worth and Perceived Interpersonal Insecurity than documented APIs. Future studies examining mechanisms of psychological distress among HIV-seropositive APIs are needed. PMID:15933834

  11. Stigma, burden, social support, and willingness to care among caregivers of PLWHA in home-based care in South Africa.

    PubMed

    Singh, Dinesh; Chaudoir, Stephenie R; Escobar, Maria C; Kalichman, Seth

    2011-07-01

    Despite its benefits for people living with HIV/AIDS (PLWHA), home-based care (HBC) may have negative effects on caregivers. Caregivers experience high levels of burden and may be targets of HIV-related prejudice and discrimination. In this cross-sectional survey of 358 caregivers from five hospices across KwaZulu-Natal, South Africa, 49 (13.7%) caregivers personally experienced discrimination as a result of caring for PLWHA. One hundred and seventy (47.5%) marked one or more items on the HIV stigma scale. Eighty-eight percent had low to moderate levels of caregiver burden. People with higher level of burden and higher income were more likely to hold stigmatizing beliefs. Caregivers with the following characteristics: support from a nurse, support from community careworker, HIV stigmatizing beliefs, and personal experience of discrimination as result of caring for PLWHA and low caregiver burden, had more than twice the odds of wanting to care for another PLWA in the future. Overall, caregivers in HBC experience low level of severe caregiver burden. The support offered to caregivers from the hospice and relatively low levels of discrimination encourage expansion of HBC programs for PLWHA. PMID:21400316

  12. HIV coping self-efficacy: a key to understanding stigma and HIV test acceptance among incarcerated men in Jamaica.

    PubMed

    Andrinopoulos, Katherine; Kerrigan, Deanna; Figueroa, J Peter; Reese, Richard; Ellen, Jonathan M

    2010-03-01

    Although prisons have been noted as important venues for HIV testing, few studies have explored the factors within this context that may influence HIV test acceptance. Moreover, there is a dearth of research related to HIV and incarcerated populations in middle and low-income countries, where both the burden of HIV and the number of people incarcerated is higher compared to high-income countries. This study explores the relationship between HIV coping self-efficacy, HIV-related stigma, and HIV test acceptance in the largest prisons in Jamaica. A random sample of inmates (n=298) recruited from an HIV testing demonstration project were asked to complete a cross-sectional quantitative survey. Participants who reported high HIV coping self-efficacy (adjusted odds ratio (AOR) 1.86: 95% confidence interval CI 1.24-2.78, p-value=0.003), some perceived risk of HIV (AOR 2.51: 95% (CI) 1.57-4.01, p-value=0.000), and low HIV testing stigma (AOR 1.71: 95% CI 1.05-2.79, p-value=0.032) were more likely to test for HIV. Correlates of HIV coping self-efficacy included external and internal HIV stigma (AOR 1.28: 95% CI 1.25-1.32, p-value=0.000 and AOR 1.76: 95% CI 1.34-2.30, p-value=0.000, respectively), social support (AOR 2.09: 95% CI 1.19-3.68, p-value=0.010), and HIV knowledge (AOR 2.33: 95% CI 1.04-5.22, p-value=0.040). Policy and programs should focus on the interrelationships of these constructs to increase participation in HIV testing in prison. PMID:20390514

  13. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis

    PubMed Central

    Katz, Ingrid T; Ryu, Annemarie E; Onuegbu, Afiachukwu G; Psaros, Christina; Weiser, Sheri D; Bangsberg, David R; Tsai, Alexander C

    2013-01-01

    Introduction Adherence to HIV antiretroviral therapy (ART) is a critical determinant of HIV-1 RNA viral suppression and health outcomes. It is generally accepted that HIV-related stigma is correlated with factors that may undermine ART adherence, but its relationship with ART adherence itself is not well established. We therefore undertook this review to systematically assess the relationship between HIV-related stigma and ART adherence. Methods We searched nine electronic databases for published and unpublished literature, with no language restrictions. First we screened the titles and abstracts for studies that potentially contained data on ART adherence. Then we reviewed the full text of these studies to identify articles that reported data on the relationship between ART adherence and either HIV-related stigma or serostatus disclosure. We used the method of meta-synthesis to summarize the findings from the qualitative studies. Results Our search protocol yielded 14,854 initial records. After eliminating duplicates and screening the titles and abstracts, we retrieved the full text of 960 journal articles, dissertations and unpublished conference abstracts for review. We included 75 studies conducted among 26,715 HIV-positive persons living in 32 countries worldwide, with less representation of work from Eastern Europe and Central Asia. Among the 34 qualitative studies, our meta-synthesis identified five distinct third-order labels through an inductive process that we categorized as themes and organized in a conceptual model spanning intrapersonal, interpersonal and structural levels. HIV-related stigma undermined ART adherence by compromising general psychological processes, such as adaptive coping and social support. We also identified psychological processes specific to HIV-positive persons driven by predominant stigmatizing attitudes and which undermined adherence, such as internalized stigma and concealment. Adaptive coping and social support were critical

  14. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action.

    PubMed

    Parker, Richard; Aggleton, Peter

    2003-07-01

    Internationally, there has been a recent resurgence of interest in HIV and AIDS-related stigma and discrimination, triggered at least in part by growing recognition that negative social responses to the epidemic remain pervasive even in seriously affected communities. Yet, rarely are existing notions of stigma and discrimination interrogated for their conceptual adequacy and their usefulness in leading to the design of effective programmes and interventions. Taking as its starting point, the classic formulation of stigma as a 'significantly discrediting' attribute, but moving beyond this to conceptualize stigma and stigmatization as intimately linked to the reproduction of social difference, this paper offers a new framework by which to understand HIV and AIDS-related stigma and its effects. It so doing, it highlights the manner in which stigma feeds upon, strengthens and reproduces existing inequalities of class, race, gender and sexuality. It highlights the limitations of individualistic modes of stigma alleviation and calls instead for new programmatic approaches in which the resistance of stigmatized individuals and communities is utilized as a resource for social change. PMID:12753813

  15. A qualitative exploration of parental experiences of stigma while living with HIV in Bangladesh.

    PubMed

    Islam, Md Shahidul; Scott, John; Minichiello, Victor

    2016-01-01

    With much of the focus on the "risk" groups, families have often been less studied in HIV research. Further, because of a focus on the aetiology and epidemiology of HIV, the social impacts associated with HIV on families and neighbours are sometimes overlooked. This study examined parental experiences of stigma and discrimination while living with HIV within a family context in Bangladesh. A qualitative research design using a grounded theory approach was used for this research. Data was collected through in-depth interviews with 19 HIV-positive parents, recruited with the support of two self-help groups of HIV-positive people, in two settings namely Khulna and Dhaka in Bangladesh. The findings indicate that HIV-positive parents held the view that they continue to experience significant stigma and their narratives clearly show how this affected them and their children. A range of informal practices were enacted in everyday contexts by extended family and community members to identify, demarcate and limit the social interaction of HIV-positive parents. Parents highlighted a number of factors including negative thoughts and behaviours, rejection, isolation and derogatory remarks as manifestations of stigma and discrimination, impacting upon them and their children because of their association with HIV. PMID:26279471

  16. Factors associated with HIV stigma and the impact of a nonrandomized multi-component video aimed at reducing HIV stigma among a high-risk population in New York City.

    PubMed

    Rivera, Alexis V; DeCuir, Jennifer; Crawford, Natalie D; Amesty, Silvia; Harripersaud, Katherine; Lewis, Crystal F

    2015-01-01

    We examined characteristics associated with HIV stigma and evaluated a multi-component video designed to normalize HIV and reduce HIV stigma. Three pharmacies located in heavy, drug-active neighborhoods in New York City and registered to sell nonprescription syringes were trained to recruit their nonprescription syringe customers who inject drugs and their under/uninsured customers. Syringe customer participants were trained to recruit up to three of their peers. As part of a larger intervention to increase HIV testing, participants in two of three study arms viewed the "Health Screenings for Life" video and were administered pre/post-video surveys capturing HIV stigma. Participants in the nonvideo arm were administered one assessment of HIV stigma. Log-binomial regression with generalized estimating equations to account for clustering of peer networks was used to: (1) determine factors associated with HIV stigma and (2) determine differences in HIV stigma by study arm. A total of 716 participants were recruited. Factor analyses showed HIV stigma measures loading on two factors: HIV blame and HIV shame. After adjustment, HIV blame was positively associated with younger age (PR: 1.24; 95% CI: 1.07-1.43) and inversely associated with educational attainment (PR: 0.66; 95% CI: 0.58-0.76) and employment (PR: 0.76; 95% CI: 0.60-0.96). HIV shame was inversely associated with educational attainment (PR: 0.75; 95% CI: 0.62-0.92), HIV-positive status (PR: 0.60; 95% CI: 0.39-0.92), and injecting drugs (PR: 0.72; 95% CI: 0.54-0.94) and was positively associated with multiple sex partnerships (PR: 1.24; 95% CI: 1.01-1.52). Those who viewed the video were also less likely to report HIV blame and HIV shame, post-video, compared to those in the nonvideo arm. These data provide evidence of an association between HIV stigma and lower socioeconomic status groups, and between HIV stigma and HIV sexual risk. These data also provide evidence that a multi-component video aimed at

  17. Factors associated with HIV stigma and the impact of a non-randomized multi-component video aimed at reducing HIV stigma among a high risk population in New York City

    PubMed Central

    Rivera, Alexis V.; DeCuir, Jennifer; Crawford, Natalie D.; Amesty, Silvia; Harripersaud, Katherine; Lewis, Crystal Fuller

    2015-01-01

    We examined characteristics associated with HIV stigma and evaluated a multi-component video designed to normalize HIV and reduce HIV stigma. Three pharmacies located in heavy, drug-active neighborhoods in New York City and registered to sell non-prescription syringes were trained to recruit their non-prescription syringe customers who inject drugs and their under/uninsured customers. Syringe customer participants were trained to recruit up to three of their peers. As part of a larger intervention to increase HIV testing, participants in two of three study arms viewed the “Health Screenings for Life” video and were administered pre/post video surveys capturing HIV stigma. Participants in the non-video arm were administered one assessment of HIV stigma. Log-binomial regression with GEE to account for clustering of peer networks was used to: 1) determine factors associated with HIV stigma, and 2) determine differences in HIV stigma by study arm. A total of 716 participants were recruited. Factor analyses showed HIV stigma measures loading on two factors: HIV blame and HIV shame. After adjustment, HIV blame was positively associated with younger age (PR: 1.24, 95% CI: 1.07–1.43) and inversely associated with educational attainment (PR: 0.66, 95% CI: 0.58–0.76) and employment (PR: 0.76, 95% CI: 0.60–0.96). HIV shame was inversely associated with educational attainment (PR: 0.75, 95% CI:0.62–0.92), HIV-positive status (PR: 0.60, 95% CI:0.39–0.92), injecting drugs (PR:0.72, 95% CI:0.54–0.94) and was positively associated with multiple sex partnerships (PR:1.24, 95% CI:1.01–1.52). Those who viewed the video were also less likely to report HIV blame and HIV shame, post-video, compared to those in the non-video arm. These data provide evidence of an association between HIV stigma and lower SES groups, and between HIV stigma and HIV sexual risk. These data also provide evidence that a multi-component video aimed at normalizing HIV may assist in reducing HIV

  18. HIV-related stigma and NGO-isation in India: an historico-empirical analysis

    PubMed Central

    Nambiar, Devaki

    2011-01-01

    In response to World Bank critiques in 2007, the Indian Ministry of Health and Family Welfare declared that HIV-related stigma was a barrier to the participation of Non-Governmental Organisations (NGOs) in the implementation of HIV prevention Targeted Interventions. Taking a deeper view of HIV-related stigma as an historically inflected process of devaluation, this paper details the history and transformation of NGO involvement in the HIV epidemic from 1986 through economic liberalisation in the 1990s up to the recently concluded National AIDS Control Program (NACP II, 1999-2006). It additionally examines findings from interviews and participant observation of NGO workers (N=24) from four Targeted Intervention NGOs in Delhi funded under NACP II. Analysis reveals that a ‘second wave’ of HIV-related NGO involvement has mushroomed in the past two decades, affording NGO workers multiple pathways to credibility in the Indian response to the epidemic. Contradictions embedded in the overlap of these pathways produce stigma, reflecting ‘adverse incorporation.’ Drawing upon noteworthy exceptions to this trend from the ‘first wave’ of Indian HIV-related NGOs, the paper calls for NGO participation as an explicitly political project of addressing the social inequalities that shape stigma as well as vulnerability to illness writ large. PMID:22150236

  19. Are integrated HIV services less stigmatizing than stand-alone models of care? A comparative case study from Swaziland

    PubMed Central

    Church, Kathryn; Wringe, Alison; Fakudze, Phelele; Kikuvi, Joshua; Simelane, Dudu; Mayhew, Susannah H

    2013-01-01

    Introduction Integrating HIV with primary health services has the potential to reduce HIV-related stigma through delivering care in settings disassociated with HIV. This study investigated the relationship between integrated care and felt stigma. The study design was a comparative case study of four models of HIV care in Swaziland, ranging from fully integrated to fully stand-alone HIV care. Methods An exit survey (N=602) measured differences in felt stigma across model of care; the primary outcome “perception of HIV status exposure through clinic attendance” was analyzed using multivariable logistic regression. In-depth interviews (N=22) explored whether and how measured differences in stigma experiences were related to service integration. Results There were significant differences in perceived status exposure across models of care. After adjustment for potential confounding between sites, those at a partially integrated site and a partially stand-alone site had greater odds of perceived status exposure than those at the fully stand-alone site (aOR 3.33, 95% CI 1.98–5.60; and aOR 11.84, 95% CI 6.89–20.36, respectively). There was no difference between the fully stand-alone and the fully integrated clinic. Qualitative data suggested that many clients at HIV-only sites felt greater confidentiality knowing that those around them were positive, and support was gained from other HIV care clients. Confidentiality was maintained in various ways, even in stand-alone sites, through separate waiting areas for HIV testing and HIV treatment, and careful clinic and room labelling. Conclusions The relationship between model of care and stigma was complex, and the hypothesis that stigma is higher at stand-alone sites did not hold true in this high prevalence setting. Policy-makers should ensure that service integration does not increase stigma, in particular within partially integrated models of care. PMID:23336726

  20. "The way I see it": the effect of stigma and depression on self-perceived body image among HIV-positive individuals on treatment in British Columbia, Canada.

    PubMed

    Palmer, Alexis K; Duncan, Katrina C; Ayalew, Beza; Zhang, Wendy; Tzemis, Despina; Lima, V; Montaner, Julio S G; Hogg, Robert S

    2011-11-01

    With significant reductions in AIDS-related morbidity and mortality, HIV is increasingly viewed as a chronic condition. However, people on antiretroviral therapy (ART) are experiencing new challenges such as metabolic and morphological body changes, which may affect self-perceived body image. The concept of body image is complex and encompasses an individual's perception of their existential self, physical self and social interpretation of their body by others. The Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) cohort is a prospective study of HIV-positive persons on ART. An interviewer-administered survey collects socio-demographic and health information including body image, stigma, depression, food insecurity, and quality of life (QoL). In bivariate analyses, Chi-squared or Wilcoxon rank sum tests were used to compare individuals reporting positive body image with those reporting negative body image. Multivariate logistic regression was used to examine associations between negative body image and covariates. Of 451 LISA participants, 47% reported negative body image. The adjusted multivariate analysis showed participants who reported high stigma in the presence of depressive symptoms were more likely to have negative body image compared to people reporting low stigma and no depressive symptoms (adjusted odds ratio [AOR]: 2.41, confidence interval [CI]: 1.24-4.68). The estimated probability of a person having positive body image without stigma or depression was 68%. When stigma alone was included, the probability dropped to 59%, and when depression was included alone the probability dropped to 34%. Depressive symptoms and high stigma combined resulted in a probability of reporting positive body image of 27%. Further efforts are needed to address body image among people living with HIV. In order to lessen the impacts of depression on body image, such issues must be addressed in health care settings. Community interventions are

  1. 'We keep her status to ourselves': experiences of stigma and discrimination among HIV-discordant couples in South Africa, Tanzania and Ukraine.

    PubMed

    Rispel, Laetitia C; Cloete, Allanise; Metcalf, Carol A

    2015-01-01

    In HIV-discordant relationships, the HIV-negative partner also carries the burden of a stigmatised disease. For this reason, couples often hide their HIV-discordant status from family, friends and community members. This perpetuates the silence around HIV-discordant relationships and impacts on targeted HIV prevention, treatment and counselling efforts. This article reports on experiences of stigma and discrimination among HIV-discordant couples in South Africa, Tanzania and Ukraine. During 2008, HIV-discordant couples who had been in a relationship for at least one year were recruited purposively through health-care providers and civil society organisations in the three countries. Participants completed a brief self-administered questionnaire, while semi-structured interviews were conducted with each partner separately and with both partners together. Interviews were analysed using thematic content analysis. Fifty-one couples were recruited: 26 from South Africa, 10 from Tanzania, and 15 from Ukraine. Although most participants had disclosed their HIV status to someone other than their partner, few were living openly with HIV discordance. Experiences of stigma were common and included being subjected to gossip, rumours and name-calling, and HIV-negative partners being labelled as HIV-positive. Perpetrators of discrimination included family members and health workers. Stigma and discrimination present unique and complex challenges to couples in HIV sero-discordant relationships in these three diverse countries. Addressing stigmatisation of HIV-discordant couples requires a holistic human rights approach and specific programme efforts to address discrimination in the health system. PMID:25778765

  2. ‘We keep her status to ourselves’: Experiences of stigma and discrimination among HIV-discordant couples in South Africa, Tanzania and Ukraine

    PubMed Central

    Rispel, Laetitia C.; Cloete, Allanise; Metcalf, Carol A.

    2015-01-01

    Abstract In HIV-discordant relationships, the HIV-negative partner also carries the burden of a stigmatised disease. For this reason, couples often hide their HIV-discordant status from family, friends and community members. This perpetuates the silence around HIV-discordant relationships and impacts on targeted HIV prevention, treatment and counselling efforts. This article reports on experiences of stigma and discrimination among HIV-discordant couples in South Africa, Tanzania and Ukraine. During 2008, HIV-discordant couples who had been in a relationship for at least one year were recruited purposively through health-care providers and civil society organisations in the three countries. Participants completed a brief self-administered questionnaire, while semi-structured interviews were conducted with each partner separately and with both partners together. Interviews were analysed using thematic content analysis. Fifty-one couples were recruited: 26 from South Africa, 10 from Tanzania, and 15 from Ukraine. Although most participants had disclosed their HIV status to someone other than their partner, few were living openly with HIV discordance. Experiences of stigma were common and included being subjected to gossip, rumours and name-calling, and HIV-negative partners being labelled as HIV-positive. Perpetrators of discrimination included family members and health workers. Stigma and discrimination present unique and complex challenges to couples in HIV sero-discordant relationships in these three diverse countries. Addressing stigmatisation of HIV-discordant couples requires a holistic human rights approach and specific programme efforts to address discrimination in the health system. PMID:25778765

  3. Actor and partner effects of perceived HIV stigma on social network components among people living with HIV/AIDS and their caregivers

    PubMed Central

    Hao, Chun; Liu, Hongjie

    2014-01-01

    Background Few studies have investigated the relationship between HIV stigma and social network components at the dyadic level. The objective of this study was to examine the actor and partner effects of perceived HIV stigma by people living with HIV/AIDS (PLWHAs) and their caregivers on social network variables at the dyadic level. Method An egocentric social network study was conducted among 147 dyads consisting of one PLWHA and one caregiver (294 participants) in Nanning, China. The actor-partner interdependence model (APIM) was used to analyze the relationships between perceived HIV stigma and social network components (network relations, network structures, and network functions) at the dyadic level. Results We found in this dyadic analysis that: (1) social network components were similar between PLWHAs and their caregivers; (2) HIV stigma perceived by PLWHAs influenced their own social network components, whereas this influence did not exist between caregivers' perceived HIV stigma and their own social network components; (3) a few significant partner effects were observed between HIV stigma and social network components among both PLWHAs and caregivers. Conclusion The interrelationships between HIV stigma and social network components were complex at the dyadic level. Future interventions programs targeting HIV stigma should focus on the interpersonal relationship at the dyadic level, beyond the intrapersonal factors. PMID:25085478

  4. [Stigmatization in HIV/AIDS: first German adaptation of the HIV-stigma scale (HSS-D)].

    PubMed

    Dinkel, Andreas; Nather, Christina; Jaeger, Hans; Jaegel-Guedes, Eva; Lahmann, Claas; Steinke, Christina; Wolf, Eva; Ronel, Joram

    2014-01-01

    Despite improvements in medical treatment and numerous public health campaigns stigmatization remains a potent stressor for people living with HIV/ AIDS. This study provides an initial German adaptation of the HIV Stigma Scale (HSS-D). Participants were 167 HIV-positive homosexual men aged 22-74 years. Exploratory factor analysis replicated the original four-factor structure (subscales: enacted stigma, disclosure concerns, negative self-image, concern with public attitudes). Further psychometric analysis led to a revised version comprising 21 items (HSS-D21). The scale showed high reliability (α=0.90). Significant associations with anxiety, depres-sion, life satisfaction and perceived social support confirmed for construct validity. The majority of the respondents expressed high acceptance of the stigma measure. In order to eslish a thorough German adaptation further research with diverse samples is needed. PMID:23677626

  5. Faith-Based HIV Care and Prevention in Chinese Immigrant Communities: Rhetoric or Reality?

    PubMed Central

    Kang, Ezer; Chin, John J.; Behar, Elana

    2012-01-01

    Ethnic churches attended by first generation Chinese immigrants are uniquely positioned to address emerging HIV prevention and care needs within the Chinese community at-large. Efforts to develop faith-based HIV programs necessitate identifying how HIV intersects with the sinicization of Christianity within Chinese churches. This paper will review the process of contextualizing HIV within theological and cultural frameworks that are meaningful for ethnic Chinese church leaders and members. The authors specifically propose two points of integration between public health and ecclesial functions: (1) HIV stigma-mitigation initiatives as informed by Christo-centric teachings of compassion and justice, and (2) HIV prevention and care reframed as social responsibility and informed by the Christian tradition of evangelism. Systems and practices that hinder and promote the involvement of Chinese churches in HIV prevention, care, and stigma-reduction will be discussed. PMID:23483037

  6. HIV/AIDS knowledge and stigma among women of reproductive age in Ethiopia.

    PubMed

    Gurmu, Eshetu; Etana, Dula

    2015-01-01

    HIV/AIDS stigma is one of the major public health challenges in Ethiopia. This study examined knowledge about HIV/AIDS and factors behind stigmatisation towards people living with the virus based on demographic and health survey data collected in 2011 from women in the age group 15-49 years. The result shows that 49.3% of rural women had adequate knowledge about HIV/AIDS compared with 74.7% of urban women. About three-fourths (72.1%) of the rural women had stigmatising attitudes towards PLWHA whilst the proportion in urban areas was only about a third (34.2%). The likelihood of having adequate knowledge about HIV/AIDS was significantly higher among educated women but lower among those living in Afar, Somali, and Gambella regions and Dire Dawa City. Women with higher levels of education and frequent access to media had a lower tendency to stigmatise people living with the virus. Adequate knowledge about HIV/AIDS was also significantly associated with lower likelihood of stigmatisation. The results generally indicate that HIV/AIDS stigma in Ethiopia is partly explained by people's knowledge about HIV/AIDS and by socio-cultural factors that shape their perception of the epidemic. Awareness-raising efforts should thus consider the socio-cultural contexts in which stigma occurs to tackle discrimination against people living with HIV/AIDS. PMID:26285101

  7. Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions

    PubMed Central

    Ekstrand, Maria L; Ramakrishna, Jayashree; Bharat, Shalini; Heylen, Elsa

    2013-01-01

    Introduction HIV stigma inflicts hardship and suffering on people living with HIV (PLHIV) and interferes with both prevention and treatment efforts. Health professionals are often named by PLHIV as an important source of stigma. This study was designed to examine rates and drivers of stigma and discrimination among doctors, nurses and ward staff in different urban healthcare settings in high HIV prevalence states in India. Methods This cross-sectional study enrolled 305 doctors, 369 nurses and 346 ward staff in both governmental and non-governmental healthcare settings in Mumbai and Bengaluru, India. The approximately one-hour long interviews focused on knowledge related to HIV transmission, personal and professional experiences with PLHIV, instrumental and symbolic stigma, endorsement of coercive policies, and intent to discriminate in professional and personal situations that involve high and low risk of fluid exposure. Results High levels of stigma were reported by all groups. This included a willingness to prohibit female PLHIV from having children (55 to 80%), endorsement of mandatory testing for female sex workers (94 to 97%) and surgery patients (90 to 99%), and stating that people who acquired HIV through sex or drugs “got what they deserved” (50 to 83%). In addition, 89% of doctors, 88% of nurses and 73% of ward staff stated that they would discriminate against PLHIV in professional situations that involved high likelihood of fluid exposure, and 57% doctors, 40% nurses and 71% ward staff stated that they would do so in low-risk situations as well. Significant and modifiable drivers of stigma and discrimination included having less frequent contact with PLHIV, and a greater number of transmission misconceptions, blame, instrumental and symbolic stigma. Participants in all three groups reported high rates of endorsement of coercive measures and intent to discriminate against PLHIV. Stigma and discrimination were associated with multiple modifiable

  8. Mental health-related stigma in health care and mental health-care settings.

    PubMed

    Henderson, Claire; Noblett, Jo; Parke, Hannah; Clement, Sarah; Caffrey, Alison; Gale-Grant, Oliver; Schulze, Beate; Druss, Benjamin; Thornicroft, Graham

    2014-11-01

    This Review considers the evidence for mental-health-related stigma in health-care and mental-health-care settings. Do mental-health-care and other health-care professionals stigmatise people using their services? If so, what are the effects on quality of mental and physical health care? How can stigma and discrimination in the context of health care be reduced? We show that the contact mental-health-care professionals have with people with mental illness is associated with positive attitudes about civil rights, but does not reduce stigma as does social contact such as with friends or family members with mental illness. Some evidence suggests educational interventions are effective in decreasing stigma especially for general health-care professionals with little or no formal mental health training. Intervention studies are needed to underpin policy; for instance, to decrease disparity in mortality associated with poor access to physical health care for people with mental illness compared with people without mental illness. PMID:26361202

  9. Psychometric assessment of scales measuring HIV public stigma, drug-use public stigma and fear of HIV infection among young adolescents and their parents

    PubMed Central

    Ha, Toan; Liu, Hongjie; Li, Jian; Nield, Jennifer; Lu, Zhouping

    2011-01-01

    The objective of this study was to design and assess measurement instruments that accurately measure the levels of stigma among individuals with a primarily collectivist culture. A cross-sectional study was conducted among middle school students and their parents or guardians in a rural area of China. Exploratory and confirmatory factor analyses were used to examine and determine the latent factors of the sub-scales of stigma respectively among students and their parents. Factor analyses identified three sub-scales: HIV public stigma (7 items), drug-use public stigma (9 items), and fear of HIV infection (7 items). There were no items with cross-loading onto multiple factors, supporting the distinctness of the constructs that these scales were meant to measure. Goodness of fit indices indicated that a three-factor solution fit the data at an acceptable level in the student sample (χ2/degree ratio = 1.98, CFI = 0.92, RMSEA = 0.055, SRMR = 0.057) and in the parent sample (χ2/degree ratio = 1.95, CFI = 0.91, RMSEA = 0.06, SRMR = 0.059). Reliability of the three scales was excellent (Cronbach’s alpha: 0.78–0.92 for students; 0.80–0.94 for parents or guardians) and stable across split samples and for the data as a whole. The scales are brief and suitable for use in developing countries where the collectivist culture prevails. PMID:21756072

  10. Effect of Media Use on HIV-Related Stigma in Sub-Saharan Africa: A Cross-Sectional Study

    PubMed Central

    Bekalu, Mesfin Awoke; Eggermont, Steven; Ramanadhan, Shoba; Viswanath, Kasisomayajula

    2014-01-01

    It is known that HIV-related stigma hinders prevention efforts. Previous studies have documented that HIV-related stigma may be associated with socioeconomic and socioecological factors. Mass media use may moderate this association, but there is limited research addressing that possibility. In this study, based on cross-sectional data pooled from the 2006–2011 Demographic and Health Surveys of 11 sub-Saharan African countries (N = 204,343), we investigated the moderating effects of exposure to mass media on HIV-related stigma. Hierarchical regression analysis indicated that HIV-related stigma tends to be higher among rural residents and individuals with low levels of education and HIV knowledge, as well as those who do not know people living with HIV. Media use was generally associated with low levels of HIV-related stigma, and attenuated the gap between individuals with high and low educational levels. However, the effect of mass media was found to be stronger among urbanites rather than among rural residents, which could lead to a widening gap between the two groups in endorsement of HIV-related stigma. The implication of this study regarding the effect of media use on HIV-related stigma in sub-Saharan Africa is twofold: 1) mass media may have the potential to minimize the gap in HIV-related stigma between individuals with high and low educational levels, and hence future efforts of reducing HIV-related stigma in the region may benefit from utilizing media; 2) due perhaps to low media penetration to rural sub-Saharan Africa, mass media could have the unintended effect of widening the urban-rural gap further unless other more customized and rural-focused communication interventions are put in place. PMID:24945251

  11. Effect of media use on HIV-related stigma in Sub-Saharan Africa: a cross-sectional study.

    PubMed

    Bekalu, Mesfin Awoke; Eggermont, Steven; Ramanadhan, Shoba; Viswanath, Kasisomayajula

    2014-01-01

    It is known that HIV-related stigma hinders prevention efforts. Previous studies have documented that HIV-related stigma may be associated with socioeconomic and socioecological factors. Mass media use may moderate this association, but there is limited research addressing that possibility. In this study, based on cross-sectional data pooled from the 2006-2011 Demographic and Health Surveys of 11 sub-Saharan African countries (N = 204,343), we investigated the moderating effects of exposure to mass media on HIV-related stigma. Hierarchical regression analysis indicated that HIV-related stigma tends to be higher among rural residents and individuals with low levels of education and HIV knowledge, as well as those who do not know people living with HIV. Media use was generally associated with low levels of HIV-related stigma, and attenuated the gap between individuals with high and low educational levels. However, the effect of mass media was found to be stronger among urbanites rather than among rural residents, which could lead to a widening gap between the two groups in endorsement of HIV-related stigma. The implication of this study regarding the effect of media use on HIV-related stigma in sub-Saharan Africa is twofold: 1) mass media may have the potential to minimize the gap in HIV-related stigma between individuals with high and low educational levels, and hence future efforts of reducing HIV-related stigma in the region may benefit from utilizing media; 2) due perhaps to low media penetration to rural sub-Saharan Africa, mass media could have the unintended effect of widening the urban-rural gap further unless other more customized and rural-focused communication interventions are put in place. PMID:24945251

  12. HIV Testing and Engagement in Care among Highly Vulnerable Female Sex Workers: Implications for Treatment as Prevention Models

    PubMed Central

    Surratt, Hilary L.; O’Grady, Catherine; Kurtz, Steven P.; Buttram, Mance E.; Levi-Minzi, Maria A.

    2014-01-01

    Background Although emerging Treatment as Prevention models can be effective in reducing HIV incidence among high-risk populations, many HIV infected individuals remain undiagnosed or fail to engage in HIV care. Methods This study examined the factors associated with HIV testing and care among a population of substance using female sex workers. Results Recent HIV testing was associated with higher education level, having a regular health care provider or clinic, recent crack use, and higher sexual risk behaviors; HIV treatment utilization was associated with higher levels of social support, having a regular health care provider or clinic, housing stability and insurance coverage. Qualitative data revealed HIV-related stigma, denial, social isolation, and substance use as barriers to HIV testing and treatment; social support and accessibility of services were key enablers. Conclusions Improving HIV testing and linkage to treatment among female sex workers will require structural initiatives to reduce stigma and increase service seeking support. PMID:25130245

  13. Employment discrimination and HIV stigma: survey results from civil society organisations and people living with HIV in Africa.

    PubMed

    Sprague, Laurel; Simon, Sara; Sprague, Courtenay

    2011-01-01

    The article presents findings from three surveys of people living with HIV (PLHIV) and civil society organisations about the experience of employment discrimination and stigma in the workplace. The work seeks to contribute to efforts by businesses and other organisations to effectively respond to the HIV epidemic within the world of work, and to deepen our understanding of the ways in which HIV stigma and employment discrimination persist in the workplace. The findings of global and regional surveys indicate the existence of high levels of employment discrimination based on HIV status worldwide, including forced disclosure of HIV status, exclusion in the workplace, refusals to hire or promote, and terminations of people known to be living with HIV. The survey findings show that employment discrimination based on HIV status is experienced in all African subregions. Country-level surveys conducted in Kenya and Zambia indicated that PLHIV face marked barriers to employment, including discrimination in hiring, loss of promotions, and termination because of HIV status. Additionally, large variances were found in the degree of support versus discrimination that employees living with HIV in those two countries received following their disclosure. The discussion emphasises the importance of the workplace as a site for intervention and behaviour change. To address this, we introduce a conceptual framework - the employment continuum - that maps multiple points of entry within the workplace to address HIV-related stigma and discrimination. Additional recommendations include: actions to ensure equal opportunity in hiring for PLHIV; ensuring that HIV testing is voluntary, never mandatory, and that disclosure is not necessary for employment; ensuring confidentiality of HIV status; communicating and enforcing HIV-related antidiscrimination policies; establishing support groups in the workplace; providing safe and confidential processes for resolving complaints of employment

  14. The impact of exposure to mass media campaigns and social support on levels and trends of HIV-related stigma and discrimination in Nigeria: tools for enhancing effective HIV prevention programmes.

    PubMed

    Fakolade, R; Adebayo, S B; Anyanti, J; Ankomah, A

    2010-05-01

    People living with HIV and AIDS (PLWHAs) often face stigma and discrimination, especially in developing countries. HIV-related stigma is expressed through social ostracism, personal rejection, direct and indirect discrimination, and denial from families and friends. Consequently, it is associated with reduced adoption of preventive and care behaviours, including condom use, seeking for HIV test and care-seeking behaviour subsequent to diagnosis. Ignorance about the epidemiology of the disease on modes of transmission and prevention aggravates HIV-related stigma in Nigeria. Behaviour change communication activities through mass media have been shown to be an effective approach in improving people's knowledge about the disease. This paper monitors trends in the level of accepting attitudes towards PLWHAs in Nigeria between 2003 and 2007. It also evaluates the impact of exposure to mass media and social support on the levels of accepting attitudes towards PLWHAs. A significant and positive trend was evident between 2003 and 2007 (p<0.0001). Furthermore, exposure to mass media communications on HIV and AIDS issues and social support were significantly related to the reduced stigma and discrimination against PLWHAs (p<0.0001). PMID:20018118

  15. Comparing HIV-related symbolic stigma in six African countries: social representations in young people's narratives.

    PubMed

    Winskell, Kate; Hill, Elizabeth; Obyerodhyambo, Oby

    2011-10-01

    HIV-related symbolic stigma arises from moralistic value judgements attached to people living with HIV and has negative consequences from both public health and human rights perspectives. Relatively little is known about cross-national variation in symbolic stigma. With the purpose of informing stigma reduction efforts within and across settings, we compared social representations of HIV in six African countries with estimated adult HIV prevalence rates ranging from 1 to 33%. Our study used a unique data source, namely a stratified random sample (n = 586, ∼5%) from 11,354 creative ideas contributed from six countries to a continent-wide HIV-related scriptwriting contest held between February and April 2005. The narratives were written by equal numbers of males and females aged 10-24 in urban and rural areas of Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso and Senegal. We combined three analytical approaches: descriptive statistics on certain quantifiable characteristics of the narratives, thematic data analysis, and a narrative-based approach. The association of HIV with outsiders ("othering") and preoccupation with the circumstances of infection are more common in lower prevalence countries but vary substantially in tone depending on the sociocultural context. The highest proportion both of moralising narratives and of narratives with pessimistic outcomes come from South-East Nigeria and, to a lesser extent, from Kenya, countries with prevalence levels of 3.9 and 6.1% respectively, in which evangelical Christian movements, including Pentecostalism, have sizeable followings. The data provide a rare cross-cultural overview of symbolic stigma, identify country-specific needs, and point to strategies for future programming. Social representations from the highest prevalence countries, Swaziland and Namibia, and from lower prevalence Burkina Faso offer potential models for the framing of HIV in ways that serve to increase social proximity and counteract

  16. HIV-Related Stigma and HIV Prevention Uptake Among Young Men Who Have Sex with Men and Transgender Women in Thailand.

    PubMed

    Logie, Carmen H; Newman, Peter A; Weaver, James; Roungkraphon, Surachet; Tepjan, Suchon

    2016-02-01

    HIV-related stigma is a pervasive structural driver of HIV. With an HIV epidemic among young men who have sex with men (MSM) and transgender women (TG) in Thailand characterized as explosive, we conducted a cross-sectional survey among MSM and TG aged 18-30 years. From April-August 2013, participants recruited using venue-based sampling from gay entertainment sites and community-based organizations completed a tablet-assisted survey interview in Thai language. We conducted multiple logistic regression to assess correlations between HIV-related stigma (felt-normative, vicarious domains) and socio-demographic variables, HIV vulnerabilities (gay entertainment employment, sex work, forced sex history), and HIV prevention uptake (condom use, HIV testing, rectal microbicide acceptability). Among participants (n = 408), 54% identified as gay, 25% transgender, and 21% heterosexual. Two-thirds (65.7%) were employed at gay entertainment venues, 67.0% had more than three male partners (past month), 55.6% had been paid for sex, and 4.5% were HIV-positive. One-fifth (21.3%) reported forced sex. Most participants reported experiencing felt-normative and vicarious HIV-related stigma. Adjusting for socio-demographics, participants with higher total HIV-related stigma scores had significantly lower odds of HIV testing and rectal microbicide acceptability, and higher odds of having experienced forced sex. Both vicarious and felt-normative dimensions of HIV-related stigma were inversely associated with HIV testing and rectal microbicide acceptability. Our findings suggest that HIV-related stigma harms the health of HIV-negative MSM and TG at high risk for HIV infection. HIV-related interventions and research among young MSM and TG in Thailand should address multiple dimensions of HIV-related stigma as a correlate of risk and a barrier to accessing prevention. PMID:26788978

  17. HIV-related stigma in African and Afro-Caribbean communities in the Netherlands: manifestations, consequences and coping.

    PubMed

    Stutterheim, Sarah E; Bos, Arjan E R; Shiripinda, Iris; de Bruin, Marijn; Pryor, John B; Schaalma, Herman P

    2012-01-01

    HIV-related stigma in African and Afro-Caribbean diaspora communities in the Netherlands was investigated. Interviews with HIV-positive and HIV-negative community members demonstrated that HIV-related stigma manifests as social distance, physical distance, words and silence. The psychological consequences of HIV-related stigma among those diagnosed with HIV reported were emotional pain, sadness, loneliness, anger, frustration and internalised stigma. The social consequences included decreased social network size, limited social support and social isolation, and resulted from not only enacted stigma but also self-imposed social withdrawal. Also, poor treatment adherence was a health-related consequence. People living with HIV employed both problem-focused and emotion-focused coping strategies to mitigate the negative consequences of stigma. Problem-focused coping strategies included selective disclosure, disengagement, affiliating with similar others, seeking social support and, to a lesser extent, activism. Emotion-focused strategies included distraction, positive reappraisal, religious coping, external attributions, disidentification and acceptance. HIV-related stigma clearly permeates African and Afro-Caribbean communities in the Netherlands, and should be targeted for intervention. PMID:21678184

  18. HIV-Related Stigma: Implications for Symptoms of Anxiety and Depression among Malawian Women

    PubMed Central

    Kamen, Charles; Arganbright, Jill; Kienitz, Eliza; Weller, Melissa; Khaylis, Anna; Shenkman, Tammy; Smith, Sarah; Koopman, Cheryl; Gore-Felton, Cheryl

    2015-01-01

    An estimated 11% of the adult population in Malawi, Africa, is living with HIV/AIDS. The disease has taken a toll on communities, resulting in high morbidity and mortality. Malawian women carry the burden of being caretakers for individuals infected with HIV while also worrying about their own health; however, little is known about how HIV/AIDS affects psychological functioning among Malawian women in areas hit hardest by the epidemic. To that end, this paper examined the influence of HIV-related stigma on symptoms of anxiety and depression among 59 women 17-46 years old who were recruited from the Namitete area of Malawi. Women who reported greater worry about being infected with HIV and greater HIV-related stigma were significantly more likely to report greater symptoms of anxiety and depression. These findings suggest that interventions that reduce HIV-related stigma are likely to enhance psychological functioning among Malawian women, which in turn will improve the women's quality of life and well-being. PMID:25920985

  19. Predictors of internalised HIV-related stigma: a systematic review of studies in sub-Saharan Africa.

    PubMed

    Pantelic, Marija; Shenderovich, Yulia; Cluver, Lucie; Boyes, Mark

    2015-01-01

    This systematic review aims to synthesise evidence on predictors of internalised HIV stigma amongst people living with HIV in sub-Saharan Africa. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Studies were identified through electronic databases, grey literature, reference harvesting and contacts with key researchers. Quality of findings was assessed through an adapted version of the Cambridge Quality Checklists. A total of 590 potentially relevant titles were identified. Seventeen peer-reviewed articles and one draft book chapter were included. Studies investigated socio-demographic, HIV-related, intra-personal and interpersonal correlates of internalised stigma. Eleven articles used cross-sectional data, six articles used prospective cohort data and one used both prospective cohort and cross-sectional data to assess correlates of internalised stigma. Poor HIV-related health weakly predicted increases in internalised HIV stigma in three longitudinal studies. Lower depression scores and improvements in overall mental health predicted reductions in internalised HIV stigma in two longitudinal studies, with moderate and weak effects, respectively. No other consistent predictors were found. Studies utilising analysis of change and accounting for confounding factors are necessary to guide policy and programming but are scarce. High-risk populations, other stigma markers that might layer upon internalised stigma, and structural drivers of internalised stigma need to be examined. PMID:25559431

  20. Stigma reduction in adolescents and young adults newly diagnosed with HIV: findings from the Project ACCEPT intervention.

    PubMed

    Harper, Gary W; Lemos, Diana; Hosek, Sybil G

    2014-10-01

    This article describes the influence of a group-based behavioral intervention for adolescents and young adults newly diagnosed with HIV (Project ACCEPT) on four dimensions of HIV-related stigma-personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes about people with HIV-as measured by the Berger HIV Stigma Scale. Stigma was addressed in a holistic manner during the intervention by providing HIV/AIDS-related information, facilitating the acquisition of coping skills, and providing contact with other youth living with HIV in order to improve social support. Fifty youth (28 male, 22 female; mean age=19.24 years) newly diagnosed with HIV from four geographically diverse clinics participated in a one-group pretest-posttest design study whereby they received the intervention over a 12-week period, and completed assessments at baseline, post-intervention, and 3-month follow-up. Results from the combined sample (males and females) revealed overall reductions in stigma in three dimensions: personalized stigma, disclosure concerns, and negative self-image, although only the combined-sample effects for negative self-image were maintained at 3-month follow-up. Gender-specific analyses revealed that the intervention reduced stigma for males across all four dimensions of stigma, with all effects being maintained to some degree at the 3-month follow-up. Only personalized stigma demonstrated a decrease for females, although this effect was not maintained at the 3-month follow-up; while the other three types of stigma increased at post-intervention and 3-month follow-up. Findings are discussed in terms of gender specific outcomes and the need for a different type of intervention to reduce stigma for young women. PMID:25216106

  1. Perceived Mental Illness Stigma and HIV Risk Behaviors Among Adult Psychiatric Outpatients in Rio de Janeiro, Brazil

    PubMed Central

    Elkington, Katherine S.; McKinnon, Karen; Mann, Claudio Gruber; Collins, Pamela Y.; Leu, Cheng-Shiun; Wainberg, Milton L.

    2009-01-01

    We examined the associations between perceived mental illness stigma and HIV risk and protective behaviors among adults with severe mental illness (SMI) in Rio de Janeiro, Brazil. We measured mental illness stigma across three domains (“Personal Experiences,” “Perceived Attractiveness,” and “Relationship Discrimination”), and examined the relationship between experiences of stigma in each domain and HIV risk and protective behaviors over the past three months in 98 outpatients with SMI. Those who reported greater “Relationship Discrimination” stigma were significantly more likely to be sexually active and to have unprotected sex; they were significantly less likely to report deliberately having fewer partners as a way to protect themselves from HIV. The role of stigma in unprotected sexual behavior should be examined further and considered in any HIV prevention intervention for people with SMI. PMID:19543974

  2. Measuring HIV felt stigma: a culturally adapted scale targeting PLWHA in Puerto Rico.

    PubMed

    Jimenez, Julio Cesar; Puig, Marieva; Ramos, Juan Carlos; Morales, Marangelie; Asencio, Gloria; Sala, Ana Cecilia; Castro, Eida; Velez Santori, Carmen; Santiago, Lydia; Zorrilla, Carmen

    2010-11-01

    The objective of this study was to culturally adapt and validate a scale to measure HIV-related felt stigma in a group of People living with HIV/AIDS (PLWHA) in Puerto Rico. The researchers conducted a two-phase cross-sectional study with 216 participants (60, first phase; 156, second phase). The first phase consisted of the cultural adaptation of the scale; the second evaluated its psychometric properties. After conducting a factor analysis, a 17-item scale, the HIV Felt-Stigma Scale (HFSS), resulted. Participants completed the Puerto Rico Comprehensive Center for the Study of Health Disparities Socio-demographic Questionnaire, the HFSS, the Beck Depression Inventory-II, and the Sexual Abuse dimension of the History of Abuse Questionnaire; the case managers completed the Case Manager Stigma Guide with subjects. The HFSS measures four dimensions: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes. The alpha and Pearson correlation coefficients (0.91 and 0.68, respectively) indicated satisfactory validity and reliability; the scale suggested adequate convergent validity. The HFSS is a culturally sensitive instrument that fills the existing gap in the measurement of felt stigma in Spanish-speaking PLWHA. PMID:20665283

  3. Measuring HIV felt stigma: a culturally adapted scale targeting PLWHA in Puerto Rico

    PubMed Central

    Jimenez, Julio Cesar; Puig, Marieva; Ramos, Juan Carlos; Morales, Marangelie; Asencio, Gloria; Sala, Ana Cecilia; Castro, Eida; Santori, Carmen Vélez; Santiago, Lydia; Zorrilla, Carmen

    2016-01-01

    The objective of this study was to culturally adapt and validate a scale to measure HIV-related felt stigma in a group of People living with HIV/AIDS (PLWHA) in Puerto Rico. The researchers conducted a two-phase cross-sectional study with 216 participants (60, first phase; 156, second phase). The first phase consisted of the cultural adaptation of the scale; the second evaluated its psychometric properties. After conducting a factor analysis, a 17-item scale, the HIV Felt-Stigma Scale (HFSS), resulted. Participants completed the Puerto Rico Comprehensive Center for the Study of Health Disparities Socio-demographic Questionnaire, the HFSS, the Beck Depression Inventory-II, and the Sexual Abuse dimension of the History of Abuse Questionnaire; the case managers completed the Case Manager Stigma Guide with subjects. The HFSS measures four dimensions: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes. The alpha and Pearson correlation coefficients (0.91 and 0.68, respectively) indicated satisfactory validity and reliability; the scale suggested adequate convergent validity. The HFSS is a culturally sensitive instrument that fills the existing gap in the measurement of felt stigma in Spanish-speaking PLWHA. PMID:20665283

  4. Correlates of Stigma among Rural Indian Women Living with HIV/AIDS

    PubMed Central

    Nyamathi, Adeline; Ekstrand, Maria; Zolt-Gilburne, Jessica; Ganguly, Kalyan; Sinha, Sanjeev; Ramakrishnan, Padma; Suresh, P.; Marfisee, Mary; Leake, Barbara

    2012-01-01

    AIDS-related stigma has received increasing attention in the literature; however, little is known about the devastating impact it has on rural women living with AIDS (WLA) in India. This cross-sectional study (N = 68), analyzed from complete baseline data, identified a number of correlates of stigma among rural WLA in South India. Structured instruments were used to capture sociodemographic history, stigma, knowledge of HIV, depressive symptoms along with the recording of CD4 data. A higher level of felt stigma and more AIDS symptoms were related to avoidant coping, while fewer adherence strategies and lower support for ART adherence were also associated with avoidant coping. These findings promote the need for support and resources for rural India WLA. PMID:21915715

  5. Measuring HIV- and AIDS-related stigma and discrimination in Nicaragua: results from a community-based study.

    PubMed

    Ugarte, William J; Högberg, Ulf; Valladares, Eliette C; Essén, Birgitta

    2013-04-01

    Psychometric properties of external HIV-related stigma and discrimination scales and their predictors were investigated. A cross-sectional community-based study was carried out among 520 participants using an ongoing health and demographic surveillance system in León, Nicaragua. Participants completed an 18-item HIV stigma scale and 19 HIV and AIDS discrimination-related statements. A factor analysis found that 15 of the 18 items in the stigma scale and 18 of the 19 items in the discrimination scale loaded clearly into five- and four-factor structures, respectively. Overall Cronbach's alpha of .81 for the HIV stigma scale and .91 for the HIV discrimination scale provided evidence of internal consistency. Hierarchical multiple linear regression analysis identified that females, rural residents, people with insufficient HIV-related transmission knowledge, those not tested for HIV, those reporting an elevated self-perception of HIV risk, and those unwilling to disclose their HIV status were associated with higher stigmatizing attitudes and higher discriminatory actions towards HIV-positive people. This is the first community-based study in Nicaragua that demonstrates that overall HIV stigma and discrimination scales were reliable and valid in a community-based sample comprised of men and women of reproductive age. Stigma and discrimination were reported high in the general population, especially among sub-groups. The findings in the current study suggest community-based strategies, including the monitoring of stigma and discrimination, and designing and implementing stigma reduction interventions, are greatly needed to reduce inequities and increase acceptance of persons with HIV. PMID:23514083

  6. Perceptions of people living with HIV/AIDS regarding access to health care.

    PubMed

    Vaswani, Vina; Vaswani, Ravi

    2014-04-01

    Although the health care is replete with technology in the present day, it is not freely accessible in a developing country. The situation could be even more compromised in the case of people living with HIV/AIDS, with the added dimension of stigma and discrimination. What are the factors that act as barriers to health care? This study was conducted to look into perceptions of people living with HIV/AIDS with regard to access to health care. The study looked into accessibility of general health vis-à-vis access to antiretroviral therapy. Demographic variables like age, gender, income were studied in relation to factors such as counseling, confidentiality, stigma and discrimination, which are known to influence access to health care. People living with HIV/AIDS perceive general health care as more accessible than care for HIV treatment. Discrimination by health care workers causes a barrier to accessibility. PMID:24946513

  7. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses

    PubMed Central

    Mitra, Sanjana; Chen, Shiyi; Gogolishvili, David; Globerman, Jason; Chambers, Lori; Wilson, Mike; Logie, Carmen H; Shi, Qiyun; Morassaei, Sara; Rourke, Sean B

    2016-01-01

    Objective To conduct a systematic review and series of meta-analyses on the association between HIV-related stigma and health among people living with HIV. Data sources A structured search was conducted on 6 electronic databases for journal articles reporting associations between HIV-related stigma and health-related outcomes published between 1996 and 2013. Study eligibility criteria Controlled studies, cohort studies, case-control studies and cross-sectional studies in people living with HIV were considered for inclusion. Outcome measures Mental health (depressive symptoms, emotional and mental distress, anxiety), quality of life, physical health, social support, adherence to antiretroviral therapy, access to and usage of health/social services and risk behaviours. Results 64 studies were included in our meta-analyses. We found significant associations between HIV-related stigma and higher rates of depression, lower social support and lower levels of adherence to antiretroviral medications and access to and usage of health and social services. Weaker relationships were observed between HIV-related stigma and anxiety, quality of life, physical health, emotional and mental distress and sexual risk practices. While risk of bias assessments revealed overall good quality related to how HIV stigma and health outcomes were measured on the included studies, high risk of bias among individual studies was observed in terms of appropriate control for potential confounders. Additional research should focus on elucidating the mechanisms behind the negative relationship between stigma and health to better inform interventions to reduce the impact of stigma on the health and well-being of people with HIV. Conclusions This systematic review and series of meta-analyses support the notion that HIV-related stigma has a detrimental impact on a variety of health-related outcomes in people with HIV. This review can inform the development of multifaceted, intersectoral interventions to

  8. Effects of a Pilot Church-Based Intervention to Reduce HIV Stigma and Promote HIV Testing Among African Americans and Latinos.

    PubMed

    Derose, Kathryn P; Griffin, Beth Ann; Kanouse, David E; Bogart, Laura M; Williams, Malcolm V; Haas, Ann C; Flórez, Karen R; Collins, Deborah Owens; Hawes-Dawson, Jennifer; Mata, Michael A; Oden, Clyde W; Stucky, Brian D

    2016-08-01

    HIV-related stigma and mistrust contribute to HIV disparities. Addressing stigma with faith partners may be effective, but few church-based stigma reduction interventions have been tested. We implemented a pilot intervention with 3 Latino and 2 African American churches (4 in matched pairs) in high HIV prevalence areas of Los Angeles County to reduce HIV stigma and mistrust and increase HIV testing. The intervention included HIV education and peer leader workshops, pastor-delivered sermons on HIV with imagined contact scenarios, and HIV testing events. We surveyed congregants at baseline and 6 month follow-up (n = 1235) and found statistically significant (p < 0.05) reductions in HIV stigma and mistrust in the Latino intervention churches but not in the African American intervention church nor overall across matched African American and Latino pairs. However, within matched pairs, intervention churches had much higher rates of HIV testing (p < 0.001). Stigma reduction and HIV testing may have synergistic effects in community settings. PMID:27000144

  9. Chinese health care providers' attitudes about HIV: a review.

    PubMed

    Webber, G C

    2007-05-01

    China has one of the fastest growing HIV epidemics in the world with an increase in reported cases of about 30% yearly (UNAIDS, 2004). As the epidemic has grown, there have been several studies of health care provider attitudes towards HIV in China over the last 15 years. While attitudes have evolved, misconceptions about transmission of HIV, low levels of support for people living with HIV/AIDS and stigmatized groups, and a poor understanding of the importance of condoms in HIV prevention, remain. The studies are limited by a weakness of survey instruments and an absence of focus on the gendered nature of the HIV epidemic. Recommendations for future research in this area include development of a theoretical base, consideration of gender and stigma, and incorporation of these issues into the survey instruments. PMID:17505931

  10. Community-based interventions that work to reduce HIV stigma and discrimination: results of an evaluation study in Thailand

    PubMed Central

    Jain, Aparna; Nuankaew, Ratana; Mongkholwiboolphol, Nungruthai; Banpabuth, Arunee; Tuvinun, Rachada; Oranop na Ayuthaya, Pakprim; Richter, Kerry

    2013-01-01

    Introduction HIV stigma and discrimination are major issues affecting people living with HIV in their everyday lives. In Thailand, a project was implemented to address HIV stigma and discrimination within communities with four activities: (1) monthly banking days; (2) HIV campaigns; (3) information, education and communication (IEC) materials and (4) “Funfairs.” This study evaluates the effect of project interventions on reducing community-level HIV stigma. Methods A repeated cross-sectional design was developed to measure changes in HIV knowledge and HIV-related stigma domains among community members exposed to the project. Two cross-sectional surveys were implemented at baseline (respondent n=560) and endline (respondent n=560). T-tests were employed to assess changes on three stigma domains: fear of HIV infection through daily activity, shame associated with having HIV and blame towards people with HIV. Baseline scales were confirmed at endline, and each scale was regressed on demographic characteristics, HIV knowledge and exposure to intervention activities. Results No differences were observed in respondent characteristics at baseline and endline. Significant changes were observed in HIV transmission knowledge, fear of HIV infection and shame associated with having HIV from baseline to endline. Respondents exposed to three specific activities (monthly campaign, Funfair and IEC materials) were less likely to exhibit stigma along the dimensions of fear (3.8 points lower on average compared to respondents exposed to none or only one intervention; 95% CI: −7.3 to −0.3) and shame (4.1 points lower; 95% CI: −7.7 to −0.6), net of demographic controls and baseline levels of stigma. Personally knowing someone with HIV was associated with low fear and shame, and females were less likely to possess attitudes of shame compared to males. Conclusions The multivariate linear models suggest that a combination of three interventions was critical in shifting