Background The provision of effective health care to people with HIV and those from usually marginalised backgrounds, such as drug users and sex workers is a growing concern in Nepal, because these populations often do not seek health care, as willingly as the general population. Exploration of the factors, which hinder them seeking health care is crucial. The 'lived' experiences of the usually marginalized participants in this research will reflect on the constraining factors, and contribute to the development of appropriate strategies, which will facilitate people with HIV and other marginal populations to seek more readily appropriate health services. Methods This study explored the healthcare-seeking experiences of 20 HIV-positive participants in Nepal, as well as 10 drug-using participants who had never had an HIV test and did not know their HIV status. Using grounded theory, this study investigated the perceptions and experiences of HIV-positive persons, or those perceived to be at risk for HIV, as they sought health care services in locations around Kathmandu Valley. Results Health professionals were perceived to lack knowledge and sensitivity in providing health care to often marginalized and stigmatized injecting drug users, sex workers and HIV-positive people. Stigma and marginalization seem to interfere with doctors' and other health professionals' decisions to voluntarily treat persons who they perceive to be at high risk for HIV infections. Doctors and other health professionals appear suspicious, even unaware, of contemporary biomedical knowledge as it relates to HIV. The fear that certain marginalized groups, such as injecting drug users and sex workers, would be infected with HIV has further intensified stigma against these groups. Conclusion The study identified the beginning of a change in the experiences of HIV-positive people, or those at risk of HIV, in their seeking of health care. With focused, contemporary HIV education and training, the
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).
Datta, Saikat; Sherpa, Pasang Lahmu; Banik, Smarajit
Introduction Despite the advent of modern technologies, India is still grappling with the HIV/AIDS pandemic. Stigma is one of the key aspects which can interfere with HIV test-seeking behaviour, care-seeking behaviour upon diagnosis, quality of care given to HIV-positive patients and perception and treatment of People Living with HIV/AIDS (PLHA) by communities, families, and partners. Aim To determine the perceived stigma associated with HIV/AIDS and its correlates among PLHAs attending the Anti Retroviral Therapy (ART) centre of North Bengal Medical College, Darjeeling, West Bengal, India. Materials and Methods An observational cross-sectional study was conducted over a period of four months among 454 patients aged ≥18years attending ART centre of North Bengal Medical College. Perceived stigma among the study subjects were assessed using a face and content validated version of Berger’s HIV stigma scale. Linear regression analysis was used for statistical analysis of the predictors of perceived stigma. Data were analysed using SPSS version 16 software. Results The majority of the study population had moderate to low stigma. Regression analysis showed that being on treatment with ART had the highest contribution towards stigma followed by gender and HIV serostatus of the patients. Conclusion The patients attending ART centre of North Bengal Medical College had moderate to low level of stigma. In absence of any efficacious stigma reduction programs in this region, more work needs to be done to assist PLHA in coping with stigma. PMID:27891432
McDoom, M Maya; Bokhour, Barbara; Sullivan, Meg; Drainoni, Mari-Lynn
As black women over age 50 represent a growing share of women living with HIV, understanding what helps them persist and engage in ongoing HIV care will become increasingly important. Delineating the specific roles of social support and stigma on HIV care experiences among this population remains unclear. We qualitatively examined how experiences with stigma and social support either facilitated or inhibited engagement in HIV care, from the perspective of older black women. Semi-structured interviews were conducted with 20 older black women currently receiving HIV care at primary care clinics in the Metropolitan Boston area. Women expressed that experiences with stigma and seeking support played an important role in evaluating the risks and benefits of engaging in care. Social support facilitated their ability to engage in care, while stigma interfered with their ability to engage in care throughout the course of their illness. Providers in particular, can facilitate engagement by understanding the changes in these women's lives as they struggle with stigma and disclosure while engaging in HIV care. The patient's experiences with social support and stigma and their perceptions about engagement are important considerations for medical teams to tailor efforts to engage older black women in regular HIV care.
Valencia-Garcia, Dellanira; Rao, Deepa; Strick, Lara; Simoni, Jane M
In Peru, HIV/AIDS is increasing among heterosexual women. In this qualitative study researchers examined HIV-related stigma among 14 women in Lima, Peru, who were HIV positive and at least 18 years of age. Data were analyzed using thematic analysis and indicated that women experienced stigma from health care providers. Two broad themes emerged from the data: forms of stigma and response to stigma. Within these themes, subthemes included maltreatment during care, neglect of patients' rights to confidentiality and privacy, and the process of women speaking out. Stigma from health care providers had a long-term, negative impact on women's willingness to seek treatment. Future stigma reduction initiatives, on a global level, should include health care workers.
Li, Jing; Assanangkornchai, Sawitri; Lu, Lin; Jia, Manhong; McNeil, Edward B; You, Jing; Chongsuvivatwong, Virasakdi
Background HIV/AIDS-related stigma is a major barrier of access to care for those infected with HIV. The aim of this study was to examine, validate, and adapt measuring scales of internalized, personal, and occupational stigma developed in Africa into a Chinese context. Methods A cross-sectional study was conducted from January to September 2015 in Kunming, People’s Republic of China. Various scales were constructed on the basis of the previous studies with modifications by experts using exploratory and confirmatory factor analyses (EFA + CFA). Validation of the new scales was done using multiple linear regression models and hypothesis testing of the factorial structure invariance. Results The numbers of subjects recruited for the development/validation samples were 696/667 HIV-positive patients, 699/667 non-HIV patients, and 157/155 health care providers. EFA revealed a two-factor solution for internalized and personal stigma scales (guilt/blaming and being refused/refusing service), which were confirmed by CFA with reliability coefficients (r) of 0.869 and 0.853, respectively. The occupational stigma scale was found to have a three-factor structure (blaming, professionalism, and egalitarianism) with a reliability coefficient (r) of 0.839. Higher correlations of factors in the HIV patients (r=0.537) and non-HIV patients (r=0.703) were observed in contrast to low-level correlations (r=0.231, 0.286, and 0.266) among factors from health care providers. Conclusion The new stigma scales are valid and should be used to monitor HIV/AIDS stigma in different groups of Chinese people in health care settings. PMID:27877022
Valenzuela, Carla; Ugarte-Gil, Cesar; Paz, Jorge; Echevarria, Juan; Gotuzzo, Eduardo; Vermund, Sten H; Kipp, Aaron M
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.
Valenzuela, Carla; Ugarte-Gil, Cesar; Paz, Jorge; Echevarria, Juan; Gotuzzo, Eduardo; Vermund, Sten H.; Kipp, Aaron M.
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
Feyissa, Garumma Tolu; Abebe, Lakew; Girma, Eshetu; Woldie, Mirkuzie
Background Stigma and discrimination (SAD) against people living with human immunodeficiency virus (HIV) are barriers affecting effective responses to HIV. Understanding the causes and extent of SAD requires the use of a psychometrically reliable and valid scale. The objective of this study was to validate an HIV-related stigma scale among health care providers in a resource-poor setting. Methods A cross-sectional validation study was conducted in 18 health care institutions in southwest Ethiopia, from March 14, 2011 to April 14, 2011. A total of 255 health care providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support (PIS) and HIV-related SAD. Exploratory factor analysis (EFA) with principal component extraction and varimax with Kaiser normalization rotation were employed to develop scales for SAD. Eigenvalues greater than 1 were used as a criterion of extraction. Items with item-factor loadings less than 0.4 and items loading onto more than one factor were dropped. The convergent validity of the scales was tested by assessing the association with HIV knowledge, PIS, training on topics related to SAD, educational status, HIV case load, presence of an antiretroviral therapy (ART) service in the health care facility, and perceived religiosity. Results Seven factors emerged from the four dimensions of SAD during the EFA. The factor loadings of the items ranged from 0.58 to 0.93. Cronbach’s alphas of the scales ranged from 0.80 to 0.95. An in-depth knowledge of HIV, perceptions of institutional support, attendance of training on topics related to SAD, degree or higher education levels, high HIV case loads, the availability of ART in the health care facility and claiming oneself as nonreligious were all negatively associated with SAD as measured by the seven newly identified latent factors. Conclusion The findings in this study demonstrate that the HIV-related stigma scale is valid and
Florom-Smith, Aubrey L.; De Santis, Joseph P.
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
Levi-Minzi, Maria A; Surratt, Hilary L
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.
Gesesew, Hailay Abrha; Tesfay Gebremedhin, Amanuel; Demissie, Tariku Dejene; Kerie, Mirkuzie Woldie; Sudhakar, Morankar; Mwanri, Lillian
Background Late presentation for human immunodeficiency virus (HIV) care is a major impediment for the success of antiretroviral therapy (ART) outcomes. The role that stigma plays as a potential barrier to timely diagnosis and treatment of HIV among people living with HIV/AIDS (acquired immunodeficiency syndrome) is ambivalent. This review aimed to assess the best available evidence regarding the association between perceived HIV related stigma and time to present for HIV/AIDS care. Methods Quantitative studies conducted in English language between 2002 and 2016 that evaluated the association between HIV related stigma and late presentation for HIV care were sought across four major databases. This review considered studies that included the following outcome: ‘late HIV testing’, ‘late HIV diagnosis’ and ‘late presentation for HIV care after testing’. Data were extracted using a standardized Joanna Briggs Institute (JBI) data extraction tool. Meta- analysis was undertaken using Revman-5 software. I2 and chi-square test were used to assess heterogeneity. Summary statistics were expressed as pooled odds ratio with 95% confidence intervals and corresponding p-value. Results Ten studies from low- and middle- income countries met the search criteria, including six (6) and four (4) case control studies and cross-sectional studies respectively. The total sample size in the included studies was 3,788 participants. Half (5) of the studies reported a significant association between stigma and late presentation for HIV care. The meta-analytical association showed that people who perceived high HIV related stigma had two times more probability of late presentation for HIV care than who perceived low stigma (pooled odds ratio = 2.4; 95%CI: 1.6–3.6, I2 = 79%). Conclusions High perceptions of HIV related stigma influenced timely presentation for HIV care. In order to avoid late HIV care presentation due the fear of stigma among patients, health professionals should
McMahon, Shannon A; Kennedy, Caitlin E; Winch, Peter J; Kombe, Miriam; Killewo, Japhet; Kilewo, Charles
Millions of children are living with HIV in sub-Saharan Africa, and the primary mode of these childhood infections is mother-to-child transmission. While existing interventions can virtually eliminate such transmission, in low- and middle-income settings, only 63 % of pregnant women living with HIV accessed medicines necessary to prevent transmission. In Tanzania, HIV prevalence among pregnant women is 3.2 %. Understanding why HIV-positive women disengage from care during and after pregnancy can inform efforts to reduce the impact of HIV on mothers and young children. Informed by the tenets of Grounded Theory, we conducted qualitative interviews with 40 seropositive postpartum women who had disengaged from care to prevent mother-to-child transmission (PMTCT). Nearly all women described antiretroviral treatment (ART) as ultimately beneficial but effectively inaccessible given concerns related to stigma. Many women also described how their feelings of health and vitality coupled with concerns about side effects underscored a desire to forgo ART until they deemed it immediately necessary. Relatively fewer women described not knowing or forgetting that they needed to continue their treatment regimens. We present a theory of PMTCT disengagement outlining primary and ancillary barriers. This study is among the first to examine disengagement by interviewing women who had actually discontinued care. We urge that a combination of intervention approaches such as mother-to-mother support groups, electronic medical records with same-day tracing, task shifting, and mobile technology be adapted, implemented, and evaluated within the Tanzanian setting.
Bunn, Janice Yanushka; Solomon, Sondra E.; Miller, Carol; Forehand, Rex
Stigma associated with HIV infection can unfavorably impact the lives and behavior of people living with HIV/AIDS. The HIV Stigma Scale was designed to measure the perception of stigma by those who are HIV infected. Reanalysis of the psychometric properties of this scale was conducted in a new sample of 157 individuals living with HIV/AIDS in…
Davis, Katy B
Low-income women of color who are HIV positive and living in violent relationships are at significant risk for stigma and problems with attachment security. This article explores the ways in which these women may experience internalized stigma from incorporating society's negative views of HIV and domestic violence. It also addresses the ways in which insecure attachment may develop or intensify in this population through violence in their adult intimate relationships and/or living with a life threatening illness. A model of medical and psychosocial care utilized at the Women's HIV Program at the University of California San Francisco is offered as an intervention to reduce stigma and enhance healthy attachment. Clinical examples demonstrate how this system of medical and psychosocial care can help women in this situation establish stability and improve their lives despite the intense challenges they face.
The continuing paucity of effective interventions to reduce HIV/AIDS stigma is troubling, given that stigma has long been recognized as a significant barrier to HIV prevention, treatment, care, and support. Ineffectual HIV/AIDS stigma-reduction interventions are the product of inadequate conceptual frameworks and methodological tools. And while there is a paucity of effective interventions to reduce stigma, there is no shortage of conceptual frameworks intending to offer a comprehensive understanding of stigma, ranging from sociocognitive models at the individual level to structural models at the macrolevel. Observations highlighting inadequacies in the individualistic and structural models are offered, followed by the theory of structuration as a possible complementary conceptual base for designing HIV/AIDS stigma-reduction interventions.
The continuing paucity of effective interventions to reduce HIV/AIDS stigma is troubling, given that stigma has long been recognized as a significant barrier to HIV prevention, treatment, care, and support. Ineffectual HIV/AIDS stigma-reduction interventions are the product of inadequate conceptual frameworks and methodological tools. And while there is a paucity of effective interventions to reduce stigma, there is no shortage of conceptual frameworks intending to offer a comprehensive understanding of stigma, ranging from sociocognitive models at the individual level to structural models at the macrolevel. Observations highlighting inadequacies in the individualistic and structural models are offered, followed by the theory of structuration as a possible complementary conceptual base for designing HIV/AIDS stigma-reduction interventions.
Brown, Monique J; Serovich, Julianne M; Kimberly, Judy A; Hu, Jinxiang
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
Toth, Steven; A York, Jill; DePinto, Nicholas
Background. In the medical sense, stigma has been defined as the collection of negative attitudes and beliefs that are directed at people living with a particular condition or disease process. A cohort study was conducted to explore the HIV stigma that is perceived by HIV-positive individuals versus that perceived by the general population within a community-based dental clinic. Methods. Two separate and independent cross-sectional surveys, the Berger Stigma Scale and the Rutgers-Modified Berger Stigma Scale, were employed in order to analyze the stigma factors of an HIV-positive population versus an HIV-negative general population, respectively. The HIV stigma factors studied included personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes. Results. The total stigma scale scores for the studied HIV-positive population were significantly lower than the total stigma scale scores for the studied HIV-negative population (P < 0.05). Conclusion. Interestingly, there is a misplaced expectation by the general population that HIV-positive individuals experience more stigma than the HIV-positive population in the clinic actually reported. Interventions to reduce HIV stigma should be an integral component of comprehensive care for all patients.
Toth, Steven; A. York, Jill; DePinto, Nicholas
Background. In the medical sense, stigma has been defined as the collection of negative attitudes and beliefs that are directed at people living with a particular condition or disease process. A cohort study was conducted to explore the HIV stigma that is perceived by HIV-positive individuals versus that perceived by the general population within a community-based dental clinic. Methods. Two separate and independent cross-sectional surveys, the Berger Stigma Scale and the Rutgers-Modified Berger Stigma Scale, were employed in order to analyze the stigma factors of an HIV-positive population versus an HIV-negative general population, respectively. The HIV stigma factors studied included personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes. Results. The total stigma scale scores for the studied HIV-positive population were significantly lower than the total stigma scale scores for the studied HIV-negative population (P < 0.05). Conclusion. Interestingly, there is a misplaced expectation by the general population that HIV-positive individuals experience more stigma than the HIV-positive population in the clinic actually reported. Interventions to reduce HIV stigma should be an integral component of comprehensive care for all patients. PMID:28096954
Stein, Judith A.; Li, Li
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
Bunn, Janice Yanushka; Solomon, Sondra E; Miller, Carol; Forehand, Rex
Stigma associated with HIV infection can unfavorably impact the lives and behavior of people living with HIV/AIDS. The HIV Stigma Scale was designed to measure the perception of stigma by those who are HIV infected. Reanalysis of the psychometric properties of this scale was conducted in a new sample of 157 individuals living with HIV/AIDS in rural New England. This resulted in revision of the scale: shortening it from 40 to 32 items and retaining the original four factors but renaming one: Enacted Stigma (formerly Personalized Stigma), Disclosure Concerns, Negative Self-image, and Concern With Public Attitudes. These four subscales have been refined such that each consists of unique items. Cronbach's alphas for the subscales ranged from .90 to .97, and .95 for the overall scale, indicating internal consistency. Correlations with other scales confirmed the validity of the HIV Stigma Scale in another sample of people living with HIV/AIDS.
Nebhinani, Naresh; Mattoo, Surendra Kumar; Wanchu, Ajay
Background: Worldwide, the stigma and discrimination impede HIV-AIDS programs across the continuum of prevention to care. We studied stigma and related issues in HIV-positive subjects. Materials and Methods: At a tertiary care hospital in North India, we studied 100 HIV-positive outpatients not receiving antiretroviral therapy. The subjects self-administered ‘Tanzania Stigma Indicator and Community Endline-Individual Questionnaire’. Psychiatric morbidity was screened with General Health Questionnaire (GHQ-I2 Hindi) and diagnosed with Structured Clinical Interview for DSM-IV (SCID). Results: A typical subject was middle aged (25-44 years, 77%), school non-completer (63%), village dweller (61%), and male (59%). Only 35 subjects could differentiate between HIV and AIDS, and only 24 were aware of antiretroviral therapy. Unprotected sex, sharing injections, and blood transfusions were reported spontaneously as possible sources of transmission by 56-79% subjects each. About 80% of subjects reported no fear in touching HIV-positive subjects or their objects. Avoiding injections, being faithful to uninfected partner, avoiding blood transfusions, using condoms, and avoiding sharing razors/blades were reported spontaneously as HIV preventive measures by 40 to 26 subjects each. Half of the subjects blamed self for contracting HIV. Only 38 subjects reported others behaving differently with HIV-positive subjects. HIV status disclosure was reported by 98 subjects (73 to family or relatives). Urban subjects reported higher primary stigma and shame or blame. Psychiatric disorders, present in 45 subjects, showed no association with stigma items. Conclusions: The subjects had a limited knowledge, especially of treatment aspects. Stigma showed no association with psychiatric disorders. The study reflects a strong need for public health measures to enhance awareness and knowledge about HIV/AIDS. PMID:23723539
Sivaram, Sudha; Zelaya, Carla; Srikrishnan, A. K.; Latkin, Carl; Go, V. F.; Solomon, Suniti; Celentano, David
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…
Audet, Carolyn M.; McGowan, Catherine C.; Wallston, Kenneth A.; Kipp, Aaron M.
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
Cama, Elena; Brener, Loren; Slavin, Sean; de Wit, John
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.
McAteer, Carole Ian; Truong, Nhan-Ai Thi; Aluoch, Josephine; Deathe, Andrew Roland; Nyandiko, Winstone M; Marete, Irene; Vreeman, Rachel Christine
Introduction HIV-related stigma impacts the quality of life and care management of HIV-infected and HIV-affected individuals, but how we measure stigma and its impact on children and adolescents has less often been described. Methods We conducted a systematic review of studies that measured HIV-related stigma with a quantitative tool in paediatric HIV-infected and HIV-affected populations. Results and discussion Varying measures have been used to assess stigma in paediatric populations, with most studies utilizing the full or variant form of the HIV Stigma Scale that has been validated in adult populations and utilized with paediatric populations in Africa, Asia and the United States. Other common measures included the Perceived Public Stigma Against Children Affected by HIV, primarily utilized and validated in China. Few studies implored item validation techniques with the population of interest, although scales were used in a different cultural context from the origin of the scale. Conclusions Many stigma measures have been used to assess HIV stigma in paediatric populations, globally, but few have implored methods for cultural adaptation and content validity. PMID:27717409
Ranjbar, Vania; McKinlay, Andy; McVittie, Chris
In this article, we examine how HIV/AIDS caregivers negotiate stigma in their discourse of providing care to HIV-positive individuals. Using interview data, we demonstrate how participants employed discourse of control in attempting to avoid and counter HIV-related stigma: participants rejected fear of associating with HIV-positive individuals by drawing on their knowledge of HIV transmission and their ability to control and avoid infection. Such discourses backfire, however, as the concept of HIV infection being controllable and thus avoidable maintains accountability for the disease. Thus, participants' micro discourse of control can maintain the macro discourse that produces HIV-related stigma.
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.
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
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
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.
Grossman, Cynthia I; Stangl, Anne L
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
Grossman, Cynthia I; Stangl, Anne L
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.
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
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.
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.
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
Mihan, Robert; Kerr, Jelani; Maticka-Tyndale, Eleanor
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
Cuca, Yvette P; Asher, Alice; Okonsky, Jennifer; Kaihura, Alphoncina; Dawson-Rose, Carol; Webel, Allison
Women living with HIV (WLWH) continue to experience HIV-related stigma. Social capital is one resource that could mitigate HIV stigma. Our cross-sectional study examined associations between social capital and HIV-related stigma in 135 WLWH in the San Francisco Bay Area. The mean age of study participants was 48 years; 60% were African American; 29% had less than a high school education; and 19% were employed. Age was significantly associated with perceived HIV stigma (p = .001), but total social capital was not. Women with lower Value of Life social capital scores had significantly higher total stigma scores (p = .010) and higher Negative Self-image stigma scores (p = .001). Women who felt less valued in their social worlds may have been more likely to perceive HIV stigma, which could have negative health consequences. This work begins to elucidate the possible relationships between social capital and perceived HIV stigma.
Berger, B E; Ferrans, C E; Lashley, F R
An instrument to measure the stigma perceived by people with HIV was developed based on the literature on stigma and psychosocial aspects of having HIV. Items surviving two rounds of content review were assembled in a booklet and distributed through HIV-related organizations across the United States. Psychometric analysis was performed on 318 questionnaires returned by people with HIV (19% women, 21% African American, 8% Hispanic). Four factors emerged from exploratory factor analysis: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes toward people with HIV. Extraction of one higher-order factor provided evidence of a single overall construct. Construct validity also was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas between .90 and .93 for the subscales and .96 for the 40-item instrument provided evidence of internal consistency reliability. The HIV Stigma Scale was reliable and valid with a large, diverse sample of people with HIV.
Owolabi, Rotimi S; Araoye, Margaret O; Osagbemi, Gordon K; Odeigah, Louis; Ogundiran, Adeniyi; Hussain, Nurudeen A
The research was designed to assess the stigma and discrimination faced by People living with HIV and AIDS (PLWHA) that are receiving treatment in UITH, Ilorin. The study was a descriptive cross-sectional survey conducted on three hundred (300) people living with HIV and AIDS receiving care at the antiretroviral therapy (ART) clinics within University of Ilorin Teaching Hospital (which was the only ART site in Kwara State as at then). A quantitative method through the use of interviewer administered questionnaire was used for data collection. This study was a cross-sectional descriptive study design. All the patients who came to the clinic and met the selection criteria were recruited until the desired sample size was reached. Data were analyzed by EPI-INFO 2005 software package. The mean age of the respondents was 39 years (SD = 9.32), and their age ranged between 19 and 65 years. About two thirds (64.7%) of the respondents were females, 62.7% were married, and 62.9% were from monogamous family settings. Slightly less than half (47.3%) of the respondents were not informed before they were tested for HIV, majority (63.3%) were not counseled before the test, but only 11% did not receive posttest counseling. One quarter of the respondents had experienced stigmatization/discrimination. Various forms of stigmatization/discrimination experienced by the respondents include blame for being responsible for their HIV status, various name callings, telling them that they are no more useful to anybody, violation of confidentiality, social isolation, restriction of their participation in family/religious activities, rejection by their spouses/families, dismissal from place of work, isolating them from other patients, and denying them care at health centers. It is therefore recommended that government at all levels should develop and implement programs to educate health care providers about HIV and AIDS, ethics, and treatment and care; educate the general population on HIV and
Calabrese, Sarah K; Burke, Sara E; Dovidio, John F; Levina, Olga S; Uusküla, Anneli; Niccolai, Linda M; Heimer, Robert
Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services.
Burke, Sara E.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Heimer, Robert
Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services. PMID:26050155
Visser, Maretha J; Kershaw, Trace; Makin, Jennifer D; Forsyth, Brian W C
HIV-related stigma is a multidimensional concept which has pervasive effects on the lives of HIV-infected people as well as serious consequences for the management of HIV/AIDS. In this research three parallel stigma scales were developed to assess personal views of stigma, stigma attributed to others, and internalised stigma experienced by HIV-infected individuals. The stigma scales were administered in two samples: a community sample of 1,077 respondents and 317 HIV-infected pregnant women recruited at clinics from the same community in Tshwane (South Africa). A two-factor structure referring to moral judgment and interpersonal distancing was confirmed across scales and sample groups. The internal consistency of the scales was acceptable and evidence of validity is reported. Parallel scales to assess and compare different perspectives of stigma provide opportunities for research aimed at understanding stigma, assessing the consequences or evaluating possible interventions aimed at reducing stigma.
Cuca, Yvette P; Onono, Maricianah; Bukusi, Elizabeth; Turan, Janet M
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.
Fuster-RuizdeApodaca, Maria José; Molero, Fernando; Holgado, Francisco Pablo; Ubillos, Silvia
The primary goal of this study was to adapt Berger, Ferrans, & Lahley (2001) HIV Stigma Scale in Spain, using Bunn, Solomon, Miller, & Forehand (2007) version. A second goal assessed whether the four-factor structure of the adapted scale could be explained by two higher-order dimensions, perceived external stigma and internalized stigma. A first qualitative study (N = 40 people with HIV, aged 28-59) was used to adapt the items and test content validity. A second quantitative study analyzed construct and criterion validity. In this study participants were 557 people with HIV, aged 18-76. The adapted HIV Stigma Scale for use in Spain (HSSS) showed a good internal consistency (α = .88) and good construct validity. Confirmatory Factor Analyses yielded a first-order, four-factor structure and a higher-order, bidimensional structure with the two expected factors (RMSEA = .051, 90% CI [.046, .056]; RMR = .073; GFI = .96; AGFI = .96; CFI = .98). Negative relations were found between stigma and quality of life (r = -.39; p < .01), self-efficacy to cope with stigma (r = -.50; p < .01) and the degree of HIV status disclosure (r = -.35; p < .01). Moreover, the people who had suffered AIDS-related opportunistic infections had a higher score in the Perceived External Stigma dimension than those who had not suffered them, t (493) = 3.02, p = .003, d = 0.26.
Elizondo, Jesus Eduardo; Treviño, Ana Cecilia; Violant, Deborah
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
Pearson, C. R.; Micek, M. A.; Pfeiffer, J.; Montoya, P.; Matediane, E.; Jonasse, T.; Cunguara, A.; Rao, D.; Gloyd, S. S.
The pathways through which stigma is associated with psychological distress remains understudied in Africa. This study evaluates stigma among 277 Mozambicans who were on an antiretroviral therapy (ART) regimens for a full year. Using bivariate and multiple regression analyses, we examine psychosocial factors (disclosure decisions, perceived social support, and depression) associated with stigma, at ART initiation and one year later. We found one year after initiating ART, participants reported no change in stigma, a decreased in perceived social support, and an increase in depressive symptomology. Disclosing HIV status to friends (vs. family or partner) was associated with lower levels of stigma. These findings suggest that HIV care in comparable settings should include counselling, support groups, and peer support, that includes stigma and disclosure concerns prior to and during the first year following diagnosis. Most importantly, assessment and treatment of depression should be incorporated into ongoing HIV care. PMID:19639405
An in-depth mixed-methods approach to Ryan White HIV/AIDS care program comprehensive needs assessment from the Northeast Georgia Public Health District: the significance of patient privacy, psychological health, and social stigma to care.
Huff, Amber; Chumbler, Neale; Cherry, Colleen O'Brien; Hill, Miranda; Veguilla, Vic
We apply a social-ecological interpretive framework to understanding relationships among patient privacy, psychological health, social stigma, and continuity in care in the HIV treatment cascade in the rural southeastern US. This research was conducted as part of the 2013 comprehensive needs assessment for the Northeast Georgia Ryan White Consortium using an anthropologically informed mixed-methods design, and a deductive-inductive approach to thematic analysis of qualitative data obtained in interviews and focus groups with service providers and service utilizers. Our comprehensive needs assessment yielded two key components. First, we identified salient phenomena influencing introduction to, retention among, and satisfaction of patients in the Ryan White-coordinated treatment cascade in NE-GA. Second, we formulated actionable recommendations around leverage points identified in the current district-wide system of care. Results highlight spatial, institutional, and interpersonal aspects of the system of care that intersect around issues of patient privacy, psychological health, and social stigma. These intersections constitute pathways by which persons living with HIV are exposed to stigma and other negative social signals regarding their health status without sufficient access to behavioral health services. These negative issues, in turn, can erect significant barriers to long-term continuity in care.
Earnshaw, Valerie A; Rosenthal, Lisa; Lang, Shawn M
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
Stahlman, Shauna; Grosso, Ashley; Ketende, Sosthenes; Sweitzer, Stephanie; Mothopeng, Tampose; Taruberekera, Noah; Nkonyana, John; Baral, Stefan
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
Stahlman, Shauna; Grosso, Ashley; Ketende, Sosthenes; Sweitzer, Stephanie; Mothopeng, Tampose; Taruberekera, Noah; Nkonyana, John; Baral, Stefan
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.
Mbonu, Ngozi C.; van den Borne, Bart; De Vries, Nanne K.
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
Reyes-Estrada, Marcos; Varas-Díaz, Nelson; Martínez-Sarson, Miluska T.
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
Velloza, Jennifer; Watt, Melissa H.; Choi, Karmel W.; Abler, Laurie; Kalichman, Seth C.; Skinner, Donald; Pieterse, Desiree; Sikkema, Kathleen J.
Alcohol-serving venues in South Africa are sites for high-risk behaviours that may lead to HIV transmission. Prevention and treatment interventions are sorely needed in these settings, but HIV-related stigma may limit their effectiveness. This study explored expressions of stigma among alcohol-serving venue patrons in Cape Town and examined the potential impact of stigma on HIV disclosure, testing, and treatment-seeking behaviours. A total of 92 in-depth interviews with male and female, Black and Coloured patrons were conducted. Transcripts were analysed via memo-writing and diagramming techniques. Many participants mentioned knowing other patrons living with HIV/AIDS (PLWH), and this visibility of HIV impacted expressions of HIV-related stigma. Participants discussed four forms of HIV-related stigma in the venues: fearing PLWH, fearing HIV acquisition, blaming others for spreading HIV, and isolating PLWH. HIV visibility and expressions of HIV-related stigma, particularly fear of isolation, influenced participants’ willingness to disclose their status. HIV-related stigma in the venues also appeared to indirectly influence testing and treatment-seeking behaviour outside the venue. Results suggest that efforts to change norms and reduce expressions of HIV-related stigma in alcohol-serving venues are necessary to successfully deliver tailored HIV prevention interventions and increase uptake of HIV testing and care in this important social setting. PMID:25630531
Dowshen, Nadia; Binns, Helen J; Garofalo, Robert
Young men who have sex with men (MSM) represent an increasing number of new HIV infections in many communities. Many individuals still hold beliefs that may lead to discrimination against HIV-positive individuals. HIV stigma is associated with negative health and psychosocial outcomes and may lead to greater challenges for this marginalized population. This study describes stigma experienced by HIV-positive young MSM, explores its relationship to psychosocial measures, and tests the hypothesis that stigma scores will be higher in those diagnosed less than 1 year ago versus more than 1 year. From August 2004 to September 2005 young MSM completed a questionnaire including demographic information and psychosocial measures. Descriptive and bivariate analyses of association were used to interpret data from the total stigma scale and four subscales: personalized stigma (PS), public attitudes (PA), negative self-image (NSI), and disclosure concerns (DC). Index scores were calculated by standardizing each subscale for direct comparisons. The 42 participants were: mean 21.3 years; 45% black, 24% Hispanic, 26% white; 14% transgender; and 50% diagnosed HIV-positive less than 1 year. Participants reported HIV-related stigma across all domains with mean index subscale scores: PS 0.57, PA 0.61, NSI 0.63, DC 0.75 indicating that disclosure concerns were prevalent in comparison to other forms of HIV-related stigma. Stigma scores correlated with depression, social support, self-esteem, and romantic loneliness. Stigma scores did not differ for those diagnosed less than 1 year ago versus more than 1 year ago. Providers should address HIV-related stigma concerns, particularly disclosure, throughout the trajectory of the illness when caring for HIV-positive young MSM as a factor affecting health outcomes and psychosocial functioning.
Binns, Helen J.; Garofalo, Robert
Abstract Young men who have sex with men (MSM) represent an increasing number of new HIV infections in many communities. Many individuals still hold beliefs that may lead to discrimination against HIV-positive individuals. HIV stigma is associated with negative health and psychosocial outcomes and may lead to greater challenges for this marginalized population. This study describes stigma experienced by HIV-positive young MSM, explores its relationship to psychosocial measures, and tests the hypothesis that stigma scores will be higher in those diagnosed less than 1 year ago versus more than 1 year. From August 2004 to September 2005 young MSM completed a questionnaire including demographic information and psychosocial measures. Descriptive and bivariate analyses of association were used to interpret data from the total stigma scale and four subscales: personalized stigma (PS), public attitudes (PA), negative self-image (NSI), and disclosure concerns (DC). Index scores were calculated by standardizing each subscale for direct comparisons. The 42 participants were: mean 21.3 years; 45% black, 24% Hispanic, 26% white; 14% transgender; and 50% diagnosed HIV-positive less than 1 year. Participants reported HIV-related stigma across all domains with mean index subscale scores: PS 0.57, PA 0.61, NSI 0.63, DC 0.75 indicating that disclosure concerns were prevalent in comparison to other forms of HIV-related stigma. Stigma scores correlated with depression, social support, self-esteem, and romantic loneliness. Stigma scores did not differ for those diagnosed less than 1 year ago versus more than 1 year ago. Providers should address HIV-related stigma concerns, particularly disclosure, throughout the trajectory of the illness when caring for HIV-positive young MSM as a factor affecting health outcomes and psychosocial functioning. PMID:19320600
Cianelli, Rosina; Villlegas, Natalia; De Oliveira, Giovanna; Hires, Kimberly; Gattamorta, Karina; Ferrer, Lilian; Peragallo, Nilda
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
Maluccio, John A; Wu, Fan; Rokon, Redwan B; Rawat, Rahul; Kadiyala, Suneetha
HIV-related stigma among persons living with HIV/AIDS (PLHIV) is prevalent throughout sub-Saharan Africa. There is limited evidence, however, on which interventions are effective in reducing it. We used data from a prospective impact evaluation of a 12-month food assistance intervention among 904 antiretroviral therapy (ART)- naïve PLHIV in Uganda to examine the program impact on stigma. Stigma was measured using the comprehensive HASI-P scale, which demonstrated good internal consistency (Cronbach's alpha = 0.87) and was correlated with several related constructs including physical and mental health-related quality of life, disclosure, and physical health symptoms in the sample. Using quasi-experimental difference-in-difference matching methods to better infer causality, we tested whether the intervention improved the overall stigma scale and its subscales. The food assistance intervention had a significant effect on reported internalized (but not external) stigma of approximately 0.2 SD (p < 0.01). The HASI-P stigma scale is a useful tool for measuring and tracking stigma. Food assistance interventions, embedded in an HIV care program, can reduce internalized stigma.
Earnshaw, Valerie A.; Bogart, Laura M.; Dovidio, John F.; Williams, Davird R.
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
Andrinopoulos, Katherine; Figueroa, J Peter; Kerrigan, Deanna; Ellen, Jonathan M.
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
Andrinopoulos, Katherine; Figueroa, J Peter; Kerrigan, Deanna; Ellen, Jonathan M
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.
Varas-Díaz, Nelson; Neilands, Torsten B; Rodríguez-Madera, Sheilla L; Padilla, Mark
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.
Varas-Díaz, Nelson; Neilands, Torsten B.; Rodríguez-Madera, Sheilla L.; Padilla, Mark
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
Earnshaw, Valerie A.; Bogart, Laura M.; Dovidio, John F.; Williams, David R.
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…
Lichtenstein, Bronwen; DeCoster, Jamie
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…
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.
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
Zelaya, Carla E; Sivaram, Sudha; Johnson, Sethulakshmi C; Srikrishnan, A K; Suniti, Solomon; Celentano, David D
HIV/AIDS stigma can severely compromise the quality of life of people living with HIV/AIDS (PLHA) by reducing access and quality of care, adherence to therapy, and disclosure of HIV status, thereby potentially increasing transmission. The objective of this study was to develop and psychometrically test three parallel scales measuring self, experienced, and perceived stigma among PLHA (n=188) in Chennai, India. Exploratory factor analysis (EFA), which was used to facilitate item reduction and assess construct validity, confirmed the presence of three underlying theoretical domains. The final number of items and Cronbach's Alpha for each scale were: 8 items, Alpha of 0.84, for self stigma; 7 items, Alpha of 0.86, for experienced stigma; and 7 items, Alpha of 0.83, for perceived stigma. External validity was ascertained by confirming a significant positive association between the measure of each type of stigma and depression (measured using CES-D), using structural equation modeling (SEM). Therefore, scales were parsimonious, reliable, and were found to be valid measures of HIV/AIDS stigma. Using these validated scales, researchers can accurately collect data to inform the design of stigma reduction programs and interventions and enable subsequent evaluation of their effectiveness.
Liu, Hongjie; Xu, Yongfang; Sun, Yehuan; Dumenci, Levent
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.
Cuca, Yvette P.; Onono, Maricianah; Bukusi, Elizabeth; Turan, Janet M.
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
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
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 HIV education in
Mitigation of the tuberculosis (TB) and HIV syndemic is undermined by critical clinical, operational and social challenges of which the social aspects have been least explored. This paper examines the lived experience of TB disease and HIV from the perspective of affected individuals to analyze how they may think about their dual illness; how they understand their illness with TB in relation to HIV, and vice versa; and how they characterize their (stigmatized) experiences in the context of their perceptions and identities. From February-August 2009, qualitative, semi-structured interviews were conducted with 40 adults with HIV and TB disease at three ambulatory clinics in KwaZulu-Natal, South Africa. Subjective meanings of illness experience were analyzed using modified grounded-theory. Emergent themes on illness perception and disclosure revealed how patients constructed dichotomous identities associated with TB and HIV through social constructs of moral susceptibility and (im)permanence. Each identity was associated with relatively disparate degrees of stigma as a product of labeling, negative stereotyping and discrimination. HIV bore the least desirable identity and invoked the greatest stigma. However, the confluence of the two epidemics rendered TB symbolic and symptomatic of HIV, and enhanced the visibility of AIDS. Dual illness thus introduced a paradox to patients' identity constructions, and produced a unique, overlapping double stigma. This facilitated new forms of stigma against TB, and aggravated existing stigma against HIV. It also conferred visibility to some forms of extra-pulmonary TB. Patients managed their double stigmas through novel forms of information sharing that relied on segregating their dual illness identities. Patients deflected the dominant stigma of HIV through concurrent processes of HIV 'othering' - their symbolic distancing from persons affected by HIV, and 'covering' - their selective disclosure of illness (and identity associated
Bulgiba, Awang; Oche, Oche Mansur; Adekunjo, Felix Oluyemi
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
Cianelli, Rosina; Ferrer, Lilian; Norr, Kathleen F.; McCreary, Linda; Irarrázabal, Lisette; Bernales, Margarita; Miner, Sarah
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
Emlet, Charles A.; Fredriksen-Goldsen, Karen I.; Kim, Hun-Jun; Hoy-Ellis, Charles
This study investigates how internalized sexual minority stigma and enacted sexual minority stigma in health care settings are associated with sexual health risk behaviors (SRBs) and the mediating role of infrequent routine health care and perceived stress among older gay and bisexual (G/B) men living with HIV disease. Survey responses from 135 sexually active older G/B men living with HIV were analyzed using hierarchical linear regression models. Results indicate that one fifth of G/B older adult men living with HIV are engaged in multiple SRBs. Internalized sexual minority stigma and enacted sexual minority stigma in health care settings are significantly associated with SRBs. The relationship between internalized sexual minority stigma and SRBs are mediated by infrequent routine health care and elevated levels of perceived stress. Improved primary and secondary prevention strategies are needed for the growing number of sexually active older G/B men. PMID:26100507
Ogunmefun, Catherine; Gilbert, Leah; Schatz, Enid
South Africa's HIV/AIDS epidemic poses a major public health threat with multi-faceted harmful impacts and 'socially complex' outcomes. While some outcomes relate to structural issues, others stem from society's attitudinal milieu. Due to negative attitudes toward People Living with HIV/AIDS, stigmatisation mars their own experience and often extends to those close to them, in particular their caregivers. Many of the caregivers in South Africa are older women; thus, older women are the focus of this paper, which aims to examine HIV/AIDS-related stigma from their perspective. This paper explores secondary stigma as a socio-cultural impact of HIV/AIDS through repeated semistructured interviews with 60 women aged 50-75 in the MRC/Wits Rural Public Health and Health Transitions Unit research site (Agincourt), many of whom had cared for a family member with HIV/AIDS. Respondents' narratives reveal that many older persons attribute high rates of death in their community to young persons' lack of respect for societal norms and traditions. The findings illustrate the forms and expressions of HIV/AIDS-related secondary stigma and their impacts on older female caregivers. The types of secondary stigma experienced by the respondents include physical stigma in the form of isolation and separation from family members; social stigma in the form of voyeurism and social isolation; and verbal stigma in the form of being gossiped about, finger-pointing and jeering at them. Despite mixed reports about community responses toward infected and affected people, HIV/AIDS-related stigma remains a cause for concern, as evidenced by the reports of older women in this study.
Singleton, Judith L; Raunig, Manuela; Brunsteter, Halley; Desmond, Michelle; Rao, Deepa
African American men have the highest rates of HIV in the USA, and research has shown that stigma, mistrust of health care, and other psychosocial factors interfere with optimal engagement in care with this population. In order to further understand reducing stigma and other psychosocial issues among African American men, we conducted qualitative interviews and focus groups with African American men in two metropolitan areas in the USA: Chicago and Seattle. We examined transcripts for relationships across variables of stigma, anonymity, self-identity, and space within the context of HIV. Our analysis pointed to similarities between experiences of stigma across the two cities and illustrated the relationships between space, isolation, and preferred anonymity related to living with HIV. The men in our study often preferred that their HIV-linked identities remain invisible and anonymous, associated with perceived and created isolation from physical community spaces. This article suggests that our health care and housing institutions may influence preferences for anonymity. We make recommendations in key areas to create safer spaces for African American men living with HIV and reduce feelings of stigma and isolation.
Rao, Deepa; Molina, Yamile; Lambert, Nina; Cohn, Susan E.
Purpose In the present study, we validated a culturally adapted stigma scale designed to assess stigma among African Americans living with HIV. Methods We collected data on the scale using an audio computer assisted self-interview (ACASI) format. We validated the scale with a sample of 62 African American participants living with HIV. Results Findings demonstrated that stigma can be measured succinctly and effectively in a 14-item scale with two subscales measuring enacted and internalized stigma. Discussion We identified many advantages to using the scale, which demonstrated good psychometric properties when used with an audio computer assisted self-interview format and with an African American sample. We recommend this scale’s use in both clinical practice and research study of HIV-stigma reduction interventions with African American populations. PMID:27761520
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
O'Brien, Stephen; Broom, Alex
HIV is a significant social, political and economic problem in Zimbabwe. However, few researchers have explored peoples' experiences of living with HIV in that country. Drawing on 60 qualitative interviews conducted with Zimbabweans living in Harare in 2010, this paper focuses on how people from four different urban communities cope with HIV-related social stigma. To provide theoretical context to this issue, we utilised the ideas of Erving Goffman for exploring the individual experience of stigma and the concept of structural violence to understand stigma as a social phenomenon. This paper considers the relevance and role of stigma in the context of a country undergoing significant social, political and economic crisis. We investigated the strategies adopted by the Zimbabwean state and the influence of traditional and religious interpretations to appreciate the historical roots of HIV-related stigma. We took into account the ways in which the articulation of HIV with gender has caused women to experience stigma differently than men, and more intensely, and how grassroots activism and biomedical technologies have transformed the experience of stigma.
Judgeo, N; Moalusi, K P
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 , the HIV/AIDS stigma is seen as about relationships.
Nyblade, Laura; Reddy, Aditi; Mbote, David; Kraemer, John; Stockton, Melissa; Kemunto, Caroline; Krotki, Karol; Morla, Javier; Njuguna, Stella; Dutta, Arin; Barker, Catherine
The barrier HIV-stigma presents to the HIV treatment cascade is increasingly documented; however less is known about female and male sex worker engagement in and the influence of sex-work stigma on the HIV care continuum. While stigma occurs in all spheres of life, stigma within health services may be particularly detrimental to health seeking behaviors. Therefore, we present levels of sex-work stigma from healthcare workers (HCW) among male and female sex workers in Kenya, and explore the relationship between sex-work stigma and HIV counseling and testing. We also examine the relationship between sex-work stigma and utilization of non-HIV health services. A snowball sample of 497 female sex workers (FSW) and 232 male sex workers (MSW) across four sites was recruited through a modified respondent-driven sampling process. About 50% of both male and female sex workers reported anticipating verbal stigma from HCW while 72% of FSW and 54% of MSW reported experiencing at least one of seven measured forms of stigma from HCW. In general, stigma led to higher odds of reporting delay or avoidance of counseling and testing, as well as non-HIV specific services. Statistical significance of relationships varied across type of health service, type of stigma and gender. For example, anticipated stigma was not a significant predictor of delay or avoidance of health services for MSW; however, FSW who anticipated HCW stigma had significantly higher odds of avoiding (OR = 2.11) non-HIV services, compared to FSW who did not. This paper adds to the growing evidence of stigma as a roadblock in the HIV treatment cascade, as well as its undermining of the human right to health. While more attention is being paid to addressing HIV-stigma, it is equally important to address the key population stigma that often intersects with HIV-stigma.
Mill, Judy; Harrowing, Jean; Rae, Tania; Richter, Solina; Minnie, Karin; Mbalinda, Scovia; Hepburn-Brown, Cerese
Some nurses who provide AIDS care, in addition to experiencing stigma themselves, also exhibit negative attitudes and perpetrate stigma and discrimination toward persons living with HIV (PLWHAs). We used a participatory research approach to explore the nature, context, and influence of stigma on the nursing care provided to PLWHAs in four low- and middle-income countries: Jamaica, Kenya, South Africa, and Uganda. Eighty-four registered nurses, enrolled nurses, and midwives participated in interviews and 79 participated in 11 focus groups. Nurses were very aware of the stigma and discrimination that AIDS evoked, and made adjustments to their care to decrease the manifestation of AIDS stigma. Despite the assurance that PLWHAs were treated equally, and that universal precautions were used consistently, we found that in reality, nurses sometimes made decisions about nursing care that were based on the appearance of the patient or knowledge of his or her status.
Logie, Carmen; James, Llana; Tharao, Wangari; Loutfy, Mona
Abstract African, Caribbean, and Black (ACB) women are greatly overrepresented in new HIV infections in comparison with Canada's general population. Social and structural factors such as HIV-related stigma, gender discrimination, and racial discrimination converge to increase vulnerability to HIV infection among ACB women by reducing access to HIV prevention services. Stigma and discrimination also present barriers to treatment, care, and support and may contribute to mental health problems. We administered a cross-sectional survey to HIV-positive ACB women (n=173) across Ontario in order to examine the relationships between HIV-related stigma, gender discrimination, racial discrimination, and depression. One-third of participants reported moderate/severe depression scores using the Beck Depression Inventory Fast-Screen guidelines. Hierarchical block regression, moderation, and mediation analyses were conducted to measure associations between independent (HIV-related stigma, gender discrimination, racial discrimination), moderator/mediator (social support, resilient coping), and dependent (depression) variables. Findings included: (1) HIV-related stigma was associated with increased depression; (2) resilient coping was associated with reduced depression but did not moderate the influence of HIV-related stigma on depression; and (3) the effects of HIV-related stigma on depression were partially mediated through resilient coping. HIV-related stigma, gender discrimination, and racial discrimination were significantly correlated with one another and with depression, highlighting the salience of examining multiple intersecting forms of stigma. Generalizability of findings may be limited due to nonrandom sampling. Findings emphasize the importance of multi-component interventions, including building resilient coping skills, mental health promotion and assessment, and stigma reduction programs.
Singh, Basant; Chingono, Alfred; Sibanda, E.; Machingura, Ian
HIV related stigma and discrimination is a known barrier for HIV prevention and care. We aimed to assess the relationship between socio-economic status (SES) and HIV related stigma in Zimbabwe. This paper uses data from Project Accept, which examined the impact of community-based voluntary counseling and testing intervention on HIV incidence and stigma. Total of 2522 eligible participants responded to a psychometric assessment tool, which assessed HIV related stigma and discrimination attitudes on 4 point Likert scale. The tool measured three components of HIV-related stigma: shame, blame and social isolation, perceived discrimination, and equity. Participants’ ownership of basic assets was used to assess the socio-economic status. Shame, blame and social isolation component of HIV related stigma was found to be significantly associated with medium [odds ratio (OR)=1.73, P<0.01] and low SES (OR=1.97, P<0.01), indicating more stigmatizing attitudes by participants belonging to medium and low SES in comparison to high SES. For HIV related stigma and discrimination programs to be effective, they should take into account the socio-economic context of target population. PMID:28299151
Mateveke, Kudzanai; Singh, Basant; Chingono, Alfred; Sibanda, E; Machingura, Ian
HIV related stigma and discrimination is a known barrier for HIV prevention and care. We aimed to assess the relationship between socio-economic status (SES) and HIV related stigma in Zimbabwe. This paper uses data from Project Accept, which examined the impact of community-based voluntary counseling and testing intervention on HIV incidence and stigma. Total of 2522 eligible participants responded to a psychometric assessment tool, which assessed HIV related stigma and discrimination attitudes on 4 point Likert scale. The tool measured three components of HIV-related stigma: shame, blame and social isolation, perceived discrimination, and equity. Participants' ownership of basic assets was used to assess the socio-economic status. Shame, blame and social isolation component of HIV related stigma was found to be significantly associated with medium [odds ratio (OR)=1.73, P<0.01] and low SES (OR=1.97, P<0.01), indicating more stigmatizing attitudes by participants belonging to medium and low SES in comparison to high SES. For HIV related stigma and discrimination programs to be effective, they should take into account the socio-economic context of target population.
Davtyan, Mariam; Farmer, Shu; Brown, Brandon; Sami, Mojgan; Frederick, Toni
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.
Hargreaves, J R; Busza, J; Mushati, P; Fearon, E; Cowan, F M
HIV stigma can inhibit uptake of HIV testing and antiretroviral therapy as well as negatively affect mental health. Efforts to reduce discrimination against people living with HIV (LWH) have contributed to greater acceptance of the infection. Female sex workers (FSW) LWH may experience overlapping stigma due to both their work and HIV status, although this is poorly understood. We examined HIV and sex-work stigma experienced by FSW LWH in Zimbabwe. Using the SAPPH-IRe cluster-randomised trial baseline survey, we analysed the data from 1039 FSW self-reporting HIV. The women were recruited in 14 sites using respondent-driven sampling. We asked five questions to assess internalised and experienced stigma related to working as a sex worker, and the same questions were asked in reference to HIV. Among all FSW, 91% reported some form of sex-work stigma. This was not associated with sociodemographic or sex-work characteristics. Rates of sex-work stigma were higher than those of HIV-related stigma. For example, 38% reported being "talked badly about" for LWH compared with 77% for their involvement in sex work. Those who reported any sex-work stigma also reported experiencing more HIV stigma compared to those who did not report sex-work stigma, suggesting a layering effect. FSW in Zimbabwe experience stigma for their role as "immoral" women and this appears more prevalent than HIV stigma. As HIV stigma attenuates, other forms of social stigma associated with the disease may persist and continue to pose barriers to effective care.
Culbert, Gabriel J; Earnshaw, Valerie A; Wulanyani, Ni Made Swasti; Wegman, Martin P; Waluyo, Agung; Altice, Frederick L
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.
Culbert, Gabriel J.; Earnshaw, Valerie A.; Wulanyani, Ni Made Swasti; Wegman, Martin P.; Waluyo, Agung; Altice, Frederick L.
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 4 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
Muessig, Kathryn E; Rosen, David L; Farel, Claire E; White, Becky L; Filene, Eliza J; Wohl, David A
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.
Onyebuchi-Iwudibia, Oscar; Brown, Amy
To examine the prevalence of depression among HIV-positive patients in Eastern Nigeria and to explore its association with HIV-related stigma. One hundred and five patients with a diagnosis of HIV attending HIV clinics in Eastern Nigeria completed a questionnaire consisting of demographic and health background, the Patients Health Questionnaire (to measure depression) and the Berger HIV stigma scale. As many as 33.3% of participants were considered depressed. Depression was positively correlated with overall stigma score with further analysis finding a positive correlation with all four subscales of the questionnaire (personalised stigma, disclosure, negative self-image and public attitudes). Individuals experiencing more side effects of HIV treatment were also rated as more depressed. A regression analysis found that negative self-image and number of treatment side effects were significant predictors of depression. Depression is positively associated with HIV-related stigma in this sample in Eastern Nigeria. As both stigma and depression have been shown to have a negative impact on quality of life for those with HIV, health professionals working to support them should be aware of the impact of stigma on risk of depression. Screening for both HIV-related stigma and depression would be an important intervention to promote both physical and psychological well-being amongst HIV-positive patients in Eastern Nigeria.
Singleton, Judith L.; Raunig, Manuela; Brunsteter, Halley; Desmond, Michelle; Rao, Deepa
African American men have the highest rates of HIV in the United States, and research has shown that stigma, mistrust of healthcare, and other psychosocial factors interfere with optimal engagement in care with this population. In order to further understand reducing stigma and other psychosocial issues among African American men, we conducted qualitative interviews and focus groups with African American men in two metropolitan areas in the United States: Chicago and Seattle. We examined transcripts for relationships across variables of stigma, anonymity, self-identity, and space within the context of HIV. Our analysis pointed to similarities between experiences of stigma across the two cities, and illustrated the relationships between space, isolation and preferred anonymity related to living with HIV. The men in our study often preferred their HIV-linked identities remain invisible and anonymous, associated with perceived and created isolation from physical community spaces. This article suggests that our healthcare and housing institutions may influence preferences for anonymity. We make recommendations in key areas to create safer spaces for African American men living with HIV and reduce feelings of stigma and isolation. PMID:26863561
Díaz, Nelson Varas; Neilands, Torsten B.
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
Logie, Carmen H.; Jenkinson, Jesse I. R.; Earnshaw, Valerie; Tharao, Wangari; Loutfy, Mona R.
African and Caribbean Black women in Canada have new HIV infection rates 7 times higher than their white counterparts. This overrepresentation is situated in structural contexts of inequities that result in social, economic and health disparities among African and Caribbean Black populations. Economic insecurity is a distal driver of HIV vulnerability, reducing access to HIV testing, prevention and care. Less is known about how economic insecurity indicators, such as housing security, continue to influence the lives of women living with HIV following HIV-positive diagnoses. The aim of this study was to test a conceptual model of the pathways linking HIV-related stigma, racial discrimination, housing insecurity, and wellbeing (depression, social support, self-rated health). We implemented a cross-sectional survey with African and Caribbean Black women living with HIV in 5 Ontario cities, and included 157 participants with complete data in the analyses. We conducted structural equation modeling using maximum likelihood estimation to evaluate the hypothesized conceptual model. One-fifth (22.5%; n = 39) of participants reported housing insecurity. As hypothesized, racial discrimination had significant direct effects on: HIV-related stigma, depression and social support, and an indirect effect on self-rated health via HIV-related stigma. HIV-related stigma and housing insecurity had direct effects on depression and social support, and HIV-related stigma had a direct effect on self-rated health. The model fit the data well: χ2 (45, n = 154) = 54.28, p = 0.387; CFI = 0.997; TLI = 0.996; RMSEA = 0.016. Findings highlight the need to address housing insecurity and intersecting forms of stigma and discrimination among African and Caribbean Black women living with HIV. Understanding the complex relationships between housing insecurity, HIV-related stigma, racial discrimination, and wellbeing can inform multi-level interventions to reduce stigma and enhance health. PMID
Letteney, Susan; LaPorte, Heidi Heft
This study addressed the perceptions of stigma and disclosure behavior of HIV-seropositive mothers. Eighty-eight HIV-seropositive women in New York City completed two independent measures of stigma, the Perceived Stigma Scale and the Devaluation-Discrimination Measure. Disclosers (67%) and nondisclosers (33%) were similar in most sociodemographic characteristics-marital status, race, religion and employment, with the exception of age and education. Significant differences were found between disclosure groups in the use of secrecy as a stigmamanagement tool and in perceived devaluation-discrimination associated with an HIV diagnosis. Nondisclosers to children were significantly more likely than disclosers to use secrecy as a stigma management tool (t =-2.76; p =.01), and to feel devalued and discriminated against as a result of HIV serostatus (t = 3.11; p =.01). Disclosure of parental HIV serostatus to children is an important aspect of continuous care and custody planning. Secrecy and perceptions of devaluation and discrimination related to HIV diagnosis should be seen as barriers to disclosure of serostatus to children.
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
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.
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.
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
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
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.
Logie, Carmen H.; James, LLana; Tharao, Wangari; Loutfy, Mona R.
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
Relf, Michael V; Silva, Susan G; Williams, Megan Scull; Moore, Elizabeth; Arscott, Joyell; Caiola, Courtney; Barroso, Julie
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.
Belenko, Steven; Dembo, Richard; Copenhaver, Michael; Hiller, Matthew; Swan, Holly; Albizu Garcia, Carmen; O'Connell, Daniel; Oser, Carrie; Pearson, Frank; Pankow, Jennifer
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.
Dembo, Richard; Copenhaver, Michael; Hiller, Matthew; Swan, Holly; Garcia, Carmen Albizu; O’Connell, Daniel; Oser, Carrie; Pearson, Frank; Pankow, Jennifer
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
Cao, Xiaobin; Sullivan, Sheena G.; Xu, Jie; Wu, Zunyou
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…
Keikelame, Mpoe Johannah; Murphy, Colleen K; Ringheim, Karin E; Woldehanna, Sara
The extent of the HIV pandemic-particularly in the hardest-hit countries, including South Africa-has prompted a call for greater engagement of all groups, including faith-based organisations (FBOs). Although FBOs are known to play a substantial role in providing care and support to those affected by HIV and AIDS, empirical evidence in regard to their actions in the broader context of stigma is limited. A qualitative, key-informant survey was conducted in South Africa as part of a six-country international study to examine perceptions of how FBOs have contributed to reduction in HIV risk, vulnerability and related impacts. The special emphasis of this paper is the influence of FBOs on stigma and discrimination. In-depth interviews were held with 34 senior-level key informants who act as key decision-makers in the response to HIV and AIDS in South Africa. Secular and faith-based respondents shared their perceptions of the faith-based response, including FBOs' actions in relation to HIV/AIDS stigma and discrimination. Our study revealed that while FBOs were perceived as taking some action to address stigma in South Africa, FBOs were also thought to contribute to HIV/AIDS- discrimination through conflating issues of sexuality and morality, and through associating HIV and AIDS with sin. The interviewees indicated a number of internal and external challenges faced by FBOs to deal effectively with stigma, including lack of information and skills, the difficulty of maintaining confidentiality in health services, and self-stigmatisation which prevents HIV-infected persons from revealing their status. Findings from this study may help both faith-based and secular groups capitalise on the perceived strengths of FBOs as well as to elucidate their perceived weaknesses so that these areas of concern can be further explored and addressed.
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.
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
Pulerwitz, J; Michaelis, A P; Lippman, S A; Chinaglia, M; Díaz, J
HIV-related stigma and discrimination (S&D) have been shown to impede prevention, care and treatment. Yet, few quantitative studies have tested the associations between stigma, service utilization and status disclosure, especially in countries with concentrated HIV epidemics. Surveys, administered to a random sample of 1,775 truck drivers crossing Southern borders in Brazil, included items on multiple conceptual domains of S&D, such as fear of casual contact and blame towards people living with HIV/AIDS. Pearson's chi-square tests and logistic regression were used to examine correlations. Less stigma (both individual items and grouped as a scale) was significantly correlated with VCT use (p
Kerr, Jelani C.; Valois, Robert F.; Diclemente, Ralph J.; Fletcher, Faith; Carey, Michael P.; Romer, Daniel; Vanable, Peter A.; Farber, Naomi
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
Varas-Díaz, Nelson; Neilands, Torsten B.; Cintrón-Bou, Francheska; Santos-Figueroa, Axel; Marzán-Rodríguez, Melissa; Marques, Domingo
HIV/AIDS stigma continues to be a challenge for HIV prevention and treatment. When health professionals manifest stigma it can limit access to quality treatment. With an ever-growing epidemic among Latinos, including Puerto Ricans living on the Caribbean Island, the social and structural factors that foster HIV/AIDS stigma need to be understood. In this study, we documented the association of religion with HIV/AIDS stigma in a sample of medical students in Puerto Rico. Findings suggest that importance placed on religion, and participation in religious activities, is associated with HIV/AIDS stigma for this population. PMID:23442492
Varas-Díaz, Nelson; Neilands, Torsten B; Cintrón-Bou, Francheska; Santos-Figueroa, Axel; Marzán-Rodríguez, Melissa; Marques, Domingo
HIV/AIDS stigma continues to be a challenge for HIV prevention and treatment. When health professionals manifest stigma it can limit access to quality treatment. With an ever-growing epidemic among Latinos, including Puerto Ricans living on the Caribbean Island, the social and structural factors that foster HIV/AIDS stigma need to be understood. In this study, we documented the association of religion with HIV/AIDS stigma in a sample of medical students in Puerto Rico. Findings suggest that importance placed on religion, and participation in religious activities, is associated with HIV/AIDS stigma for this population.
Burke, Sara E; Calabrese, Sarah K; Dovidio, John F; Levina, Olga S; Uusküla, Anneli; Niccolai, Linda M; Abel-Ollo, Katri; Heimer, Robert
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.
Zhao, Qun; Li, Xiaoming; Zhao, Guoxiang; Zhao, Junfeng; Fang, Xiaoyi; Lin, Xiuyun; Stanton, Bonita
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…
Qiao, Shan; Li, Xiaoming; Zhou, Yuejiao; Shen, Zhiyong; Tang, Zhenzhu; Stanton, Bonita
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
Doty, Nathan; Hawkins, Linda A.; Gaskins, Clare S.; Beidas, Rinad; Rudy, Bret J.
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
Zhang, Chen; Li, Xiaoming; Liu, Yu; Qiao, Shan; Zhang, Liying; Zhou, Yuejiao; Tang, Zhenzhu; Shen, Zhiyong; Chen, Yi
intervention strategies to mitigate the effects of stigma and enhance HIV care utilization among PLWHA in China. PMID:26981636
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.
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
Nattabi, Barbara; Li, Jianghong; Thompson, Sandra C.; Orach, Christopher G.; Earnest, Jaya
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…
Winskell, Kate; Holmes, Kathleen; Neri, Elizabeth; Berkowitz, Rachel; Mbakwem, Benjamin; Obyerodhyambo, Oby
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
Yannessa, John F; Reece, Michael; Basta, Tania B
Recent literature has documented growing concerns related to access to HIV care services for rural individuals living with both HIV and a dual diagnosis of substance abuse. Previous research has investigated issues from a client perspective, but limited research has investigated provider perspectives of rural issues surrounding HIV and substance abuse. The purpose of this qualitative study was to examine issues that impact the ability of care providers to create sustainable linkages to care for dual diagnosed individuals who live in rural areas. In-depth interviews were conducted in late 2005 with 39 HIV service providers at 11 agencies that provided HIV-related services to individuals in rural areas of a Midwestern state in the United States. Findings suggest multidimensional stigma in the medical referral network as the leading factor that presents challenges to service providers in rural areas. The service providers reported verbal stigma in the form of insults, a loss of role/respect, and a global loss of resources such as poorer quality health care or no health care provided. The stigma is conceptualized in four themes: (1) staff of medical referral sources stigmatizing against rural dual-diagnosis clients, (2) physicians stigmatizing against rural dual-diagnosis clients, (3) medical specialists stigmatizing against rural dual-diagnosis clients, and (4) client-perceived stigma. These themes were expressed equally among all of the providers, regardless of geographic location, type of HIV-related organization, or job title.
Rydström, Lise-Lott; Wiklander, Maria; Navér, Lars; Ygge, Britt-Marie; Eriksson, Lars E
The relationship between HIV-related stigma and health-related quality of life (HRQoL) among children living with HIV infection is unknown. The objectives of this study were to describe HIV-related stigma and HRQoL among children with perinatal HIV living in Sweden, and to investigate the relationship between these two factors in the same infection group. In a cross-sectional nationwide survey, HIV-related stigma was measured with the 8-item HIV Stigma Scale for Children. HRQoL was measured with the 37-item DISABKIDS Chronic Generic Module. Structural equation modeling was used to explore the relationship between HIV-related stigma and HRQoL. Fifty-eight children participated, age 9-18 years (mean = 13.9). The HIV stigma general scale showed a mean score of 17.6 (SD = 5.0; possible range 8-32). DISABKIDS Chronic Generic Module general scale showed a mean score of 80.7 (SD = 14.1; possible range 0-100). HIV-related stigma was negatively associated with HRQoL (standardized β = -0.790, p = .017). The results indicate that children's concerns related to disclosure of their HIV infection seem to be common (i.e. 75% agreed) which, together with the negative association between ratings of HIV-relatively stigma and HRQoL, might indicate that disclosure concerns would be a relevant target for interventions to decrease HIV-related stigma and increase HRQoL.
Golub, Sarit A; Gamarel, Kristi E
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.
Kerr, Jelani; Jackson, Trinidad
The relationship between drug policy and HIV vulnerability is well documented. However, little research examines the links between racial/ethnic HIV disparities via the Drug War, sexual risk, and stigma. The Drug War HIV/AIDS Inequities Model has been developed to address this dearth. This model contends that inequitable policing and sentencing promotes sexual risks, resource deprivation, and ultimately greater HIV risk for African-Americans. The Drug War also socially marginalizes African Americans and compounds stigma for incarcerated and formerly incarcerated persons living with HIV/AIDS. This marginalization has implications for sexual risk-taking, access to health-promoting resources, and continuum of care participation. The Drug War HIV/AIDS Inequities Model may help illuminate mechanisms that promote increased HIV vulnerability as well as inform structural intervention development and targeting to address racial/ethnic disparities.
Mason, Sally; Berger, Barbara; Ferrans, Carol Estwing; Sultzman, Vickey; Fendrich, Michael
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…
Francis, D.; Francis, E.
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…
Smith, Edward A.; Miller, Jacqueline A.; Newsome, Valerie; Sofolahan, Yewande A.; Airhihenbuwa, Collins O.
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…
Farotimi, Adekunbi A; Nwozichi, Chinomso Ugochukwu; Ojediran, Tolulope D
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
Stringer, Kristi L.; Turan, Bulent; McCormick, Lisa; Durojaiye, Modupeoluwa; Nyblade, Laura; Kempf, Mirjam-Colette; Lichtenstein, Bronwen; Turan, Janet M.
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 = −.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
Hasan, M Tanvir; Nath, Samir Ranjan; Khan, Nabilah S; Akram, Owasim; Gomes, Tony Michael; Rashid, Sabina F
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.
Nath, Samir Ranjan; Khan, Nabilah S.; Akram, Owasim; Gomes, Tony Michael; Rashid, Sabina F.
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
Knight, Rod; Small, Will; Shoveller, Jean A.
As routine HIV testing approaches are implemented to enhance participation rates in HIV testing, it is often widely believed that these approaches are socially and ethically justifiable given the underlying assumption that these practices will result in the widespread reduction of HIV-related stigma. Nonetheless, a variety of empirical and theoretical gaps regarding how HIV testing practices may impact HIV stigma remain, raising questions about the social underpinnings of the public health rationale. We draw on 50 interviews with 18-24-year-old men to determine how HIV-related stigma is experienced differentially across subgroups of young men in relation to both voluntary and routine testing practices. Men's experiences with routine testing highlight how (mis)interpretations of universal, routine testing practices may serve to (unintentionally) burden disadvantaged population subgroups of men; however, when sufficiently explicated, the universal dimension of a routine offer greatly diminished these concerns. These findings also highlight that, under the right conditions, a routine offer can provide transformative opportunities for individuals to reconceptualise expectations pertaining to HIV and HIV-related stigma. PMID:26382632
Soto, Tomas; Komaie, Goldie; Neilands, Torsten B; Johnson, Mallory O
Active engagement in HIV clinical care, including uptake and adherence to antiretroviral therapy (ART), is necessary to optimize treatment benefit and can reduce the spread of HIV infection. Among a predominately minority sample of 303 HIV-infected men who have sex with men (MSM) who were either newly diagnosed with HIV or showed evidence of inconsistent engagement in HIV care, we explored rates of exposure to crime, sexual and physical trauma, and associations with factors potentially related to poor engagement in care. Two thirds of participants experienced a crime-related event, and nearly one third reported exposure to physical and/or sexual trauma. All three types of exposure were related to HIV stigma and to concerns about initiating ART. Associations between exposure and social support and HIV disclosure needs were also observed. Findings have implications for the role of trauma exposure and efforts to optimize treatment engagement for HIV-infected MSM.
Li, Li; Wu, Zunyou; Wu, Sheng; Jia, Manhong; Lieber, Eli; Lu, Yao
This study examines the impact of HIV-related stigma on families living with HIV/AIDS in China. In-depth, semistructured interviews were conducted with 30 people living with HIV/AIDS and with 15 of their family members, including spouses, parents, and siblings. Findings show that HIV-related stigma is associated with bringing shame to the family, losing family “face,” and damaging within-family relations and broader family social networks. HIV/AIDS stigma was reported to have major impacts on family identity and interactions. In order to cope with these pressures, families reported joining self-support programs, educating family members, and helping other families. This study illustrates that HIV-related stigma is an issue faced by entire families in China, points to specific aspects of family life in which these impacts take place, and suggests the importance of including families in HIV/AIDS and stigma reduction interventions. PMID:19662099
Rosser, Joelle I; Njoroge, Betty; Huchko, Megan J
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.
Medema-Wijnveen, José S.; Onono, Maricianah; Bukusi, Elizabeth A.; Miller, Suellen; Cohen, Craig R.; Turan, Janet M.
Introduction HIV prevalence among pregnant women in Kenya is high. Furthermore, there is a high risk of maternal mortality, as many women do not give birth with a skilled healthcare provider. Previous research suggests that fears of HIV testing and unwanted disclosure of HIV status may be important barriers to utilizing maternity services. We explored relationships between women’s perceptions of HIV-related stigma and their attitudes and intentions regarding facility-based childbirth. Methods 1,777 pregnant women were interviewed at their first antenatal care visit. We included socio-demographic characteristics, stigma scales, HIV knowledge measures, and an 11-item scale measuring health facility birth attitudes (HFBA). HFBA includes items on cost, transport, comfort, interpersonal relations, and services during delivery at a health facility versus at home. A higher mean HFBA score indicates a more positive attitude towards facility-based childbirth. The mean HFBA score was dichotomized at the median and analyses were conducted with this dichotomized HFBA score using mixed effects logit models. Results Women who anticipated HIV-related stigma from their male partner had lower adjusted odds of having positive attitudes about giving birth at the health facility (adjusted OR = .63, 95% CI 0.50–0.78) and less positive attitudes about health facility birth were strongly related to women’s intention to give birth outside a health facility (adjusted OR = 5.56, 95% CI 2.69–11.51). Conclusions In this sample of pregnant women in rural Kenya, those who anticipated HIV-related stigma were less likely to have positive attitudes towards facility-based childbirth. Furthermore, negative attitudes about facility-based childbirth were associated with the intention to deliver outside a health facility. Thus, HIV-related stigma reduction efforts might result in more positive attitudes towards facility-based childbirth, and thereby lead to an increased level of skilled
Arnold, Emily A; Rebchook, Gregory M; Kegeles, Susan M
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.
Wei, Wei; Li, Xiaoming; Harrison, Sayward; Zhao, Junfeng; Zhao, Guoxiang
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
Rogers, S J; Tureski, K; Cushnie, A; Brown, A; Bailey, A; Palmer, Q
While considerable research has documented stigma toward key populations affected by HIV and AIDS - men who have sex with men (MSM), sex workers (SWs) - it provided limited empirical evidence on the presence of layered stigma among health-care professionals providing services for these populations. C-Change conducted a survey among 332 staff of health-care and social service agencies in Jamaica and The Bahamas to understand the levels of stigma toward people living with HIV (PLHIV), including MSM and SWs and factors associated with stigma. While most health-care professionals responding to the survey said that PLHIV, MSM, and SWs deserved quality care, they expressed high levels of blame and negative judgments, especially toward MSM and SWs. Across a stigma assessment involving eight vignette characters, the highest levels of stigma were expressed toward PLHIV who were also MSM or SWs, followed by PLHIV, MSM, and SWs. Differences were assessed by gender, country, type of staff, type of agency, and exposure to relevant training. Findings indicate higher reported stigma among nonclinical vs. clinical staff, staff who worked in general vs. MSM/SW-friendly health facilities, and among untrained vs. training staff. This implies the need for targeted staff capacity strengthening as well as improved facility environments that are MSM/SW-friendly.
Hong, Yan; Stanton, Bonita; Fang, Xiaoyi; Lin, Danhua; Wang, Jing; Mao, Rong; Yang, Hongmei
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
Hong, Yan; Li, Xiaoming; Stanton, Bonita; Fang, Xiaoyi; Lin, Danhua; Wang, Jing; Mao, Rong; Yang, Hongmei
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.
Malavé, S.; Ramakrishna, J.; Heylen, E.; Bharat, S.; Ekstrand, M.L.
Approximately 2.4 million people in India are living with HIV. Gender inequality affects HIV prevention, detection, and management. The purpose of this paper was to describe gender differences in the experience of living with HIV in Bengaluru, India. A subsample of n = 313 (159 men and 154 women) from a larger cohort was used for these analyses. Participants were recruited through AIDS service organizations. They completed an interviewer-administered survey assessing HIV testing experience, types of stigma, and perceived consequences of stigmatization. The majority of men (67%) reported getting HIV tested because of illness, while women were more likely to be tested after learning their spouse’s HIV-positive status (42%). More men (59%) than women (45%, p <0.05) were tested in private care settings. Men reported significantly higher mean levels of internalized stigma (men: M = 0.71, SD = 0.63; women: M = 0.46, SD=0.55; p<0.001), whereas the women reported significantly higher scores for enacted stigma (men: M = 1.30, SD = 1.69; women: M = 2.10, SD = 2.17; p <0.001). These differences remained significant after controlling for potential socio-demographic covariates. Following their diagnosis, more women reported moving out of their homes (men: 16%; women: 26%; p <0.05). More men (89%) than women (66%; p <0.001) reported to have modified their sexual behavior after being diagnosed. These findings suggest that the experience of living with HIV and HIV stigma varies by gender in this population. Suggestions for a gender-based approach to HIV prevention and stigma reduction are provided. PMID:23869716
Li, Li; Lin, Chunqing; Ji, Guoping
Although studies have demonstrated that females experience more HIV-related stigma than males do, questions remain regarding the different dimensions of the stigma (i.e., perceived versus internalized) in China. The present study investigated gender differences in perceived and internalized HIV-related stigma, taking into account the potential influence of education. The study was conducted between October 2011 and March 2013. A total of 522 people living with HIV (PLH) were recruited from Anhui Province, China. The PLH participated in a survey using the Computer Assisted Personal Interview (CAPI) method. The gender differences in perceived and internalized HIV-related stigma were calculated with and without stratifying by education level. Female participants had significantly less education than the male participants. No significant difference was observed between females and males with respect to perceived stigma. However, females reported significantly higher internalized stigma than males did (p < .001). When socio-demographic characteristics were controlled, the gender difference in internalized stigma remained significant among educated participants (p = .038). The findings suggested that gender differences in HIV-related stigma were primarily found for internalized stigma. Heightened intervention efforts are encouraged to reduce internalized HIV-related stigma, particularly among female PLH in China and other regions with similar gender dynamics.
Yeo, Tien Ee Dominic; Chu, Tsz Hang
HIV-related stigma in the wider community compounds the suffering of people living with HIV (PLWH) and hampers effective HIV prevention and care. This study examines the level of public stigma toward PLWH in Hong Kong and associated social-cultural factors. A telephone survey was conducted in June-July 2016 with 1080 Chinese adults aged 18-94 randomly selected from the general population. The results indicate substantial degree of public stigma toward PLWH. Overall, 58.1% of the participants endorsed at least one statement indicating negative social judgment of PLWH. Over 40% attributed HIV infections to irresponsible behaviors and nearly 30% perceived most PLWH as promiscuous. About 20% considered HIV to be a punishment for bad behavior and believed that PLWH should feel ashamed of themselves. These statistics indicate that HIV-related stigma among the general Hong Kong population had no noticeable reduction in a decade but is lower than that among rural and urban populations in China. Our findings suggest that the lower stigma in Hong Kong may be linked to higher education levels rather than Hongkongers' more Westernized outlook. The results of a multiple regression analysis showed that education level (β = -.19), homophobia (β = .30), and conformity to norms (β = .14) were independent predictors of HIV-related stigma but not age, income, or cultural orientations. By differentiating between associated social-cultural factors, this study provides a more nuanced understanding of the layered nature of HIV-related stigma: not broadly grounded in religion or Chinese culture but stemming from more specific social-cultural beliefs - perceptions of norm violation and negative attitudes toward homosexuality, which were not mutually exclusive. These findings have implications for HIV-related stigma reduction by providing evidence for the importance of addressing homophobia. Existing HIV publicity activities should be re-examined for inadvertent contribution
Berkley-Patton, Jannette Y; Moore, Erin; Berman, Marcie; Simon, Stephen D; Thompson, Carole Bowe; Schleicher, Thomas; Hawes, Starlyn M
Introduction The African American church is a highly influential institution with the potential to greatly increase the reach of HIV prevention interventions and address HIV-related stigma in US African American communities. However, there are few studies on HIV-related stigma and African American church populations. This study explored HIV-related stigma among church and community members participating in an HIV education and testing intervention pilot study in African American churches, named Taking It to the Pews. Methods Four African American churches located in Kansas City, MO and KS, were randomized to either intervention or comparison groups. Churches assigned to the intervention group received religiously tailored HIV education, testing and compassion messages/activities (e.g., sermons, brochures/church bulletins, testimonials) via the Taking It to the Pews HIV Tool Kit. Comparison churches received non-religiously tailored HIV information. HIV-related stigma was assessed with 543 church members and with community members served through church outreach services (e.g., food/clothing pantries, social services) in the four churches. Participants completed surveys at baseline, 6 months and 12 months to assess their HIV-related stigma beliefs, exposure to intervention components and satisfaction with the study. Results At baseline, HIV-related stigma beliefs were similar across experimental groups and were quite low. Mean HIV-related stigma scores were not significantly different between experimental groups at 6 months (p=0.92) or at 12 months (p=0.70). However, mean HIV-related stigma scores within both groups showed decreasing trends at six months, which approached significance. Analysis of previously studied HIV-related stigma factors (e.g., age, gender, income, HIV knowledge, religiosity) did not yield changes in the null findings. Intervention group participants were highly exposed to several intervention components (sermons, HIV resource tables, posters
Smith, Rachel A; Baker, Michelle
Social network analysis was used to examine the relationship between HIV/AIDS stigmatization, perceived risk, and centrality in the community network (via participation in community groups). The findings from respondents in Keetmanshoop, Namibia (N = 375) showed an interaction between stigma and risk perceptions: those who perceived higher HIV risk and stronger HIV stigma participated in fewer community groups and participated in groups with members who participated less widely across the network. In contrast, those who perceived higher HIV risk and weaker HIV stigma participated more, and were in community groups that are located on a greater share of the paths between entities in the network. Taboo, secrecy, resistance, knowing a person living with HIV/AIDS, and desire for diagnosis secrecy were also related to centrality. Findings suggest that the interaction of perceived HIV risk and HIV stigma are related to structural-level features of community networks based on participation in community groups. PMID:22327408
Turan, Janet M; Bukusi, Elizabeth A; Onono, Maricianah; Holzemer, William L; Miller, Suellen; Cohen, Craig R
HIV/AIDS stigma is a common thread in the narratives of pregnant women affected by HIV/AIDS globally and may be associated with refusal of HIV testing. We conducted a cross-sectional study of women attending antenatal clinics in Kenya (N = 1525). Women completed an interview with measures of HIV/AIDS stigma and subsequently information on their acceptance of HIV testing was obtained from medical records. Associations of stigma measures with HIV testing refusal were examined using multivariate logistic regression. Rates of anticipated HIV/AIDS stigma were high-32% anticipated break-up of their relationship, and 45% anticipated losing their friends. Women who anticipated male partner stigma were more than twice as likely to refuse HIV testing, after adjusting for other individual-level predictors (OR = 2.10, 95% CI: 1.15-3.85). This study demonstrated quantitatively that anticipations of HIV/AIDS stigma can be barriers to acceptance of HIV testing by pregnant women and highlights the need to develop interventions that address pregnant women's fears of HIV/AIDS stigma and violence from male partners.
Smolak, Alex; El-Bassel, Nabila
Central Asia is experiencing one of the fastest growing HIV epidemics in the world, with some areas' infection rates doubling yearly since 2000. This study examines the impact of multilevel stigma (individual, family, and community) on uptake of HIV testing and receipt of HIV testing results among women in Central Asia. The sample consists of 38,884 ever-married, Central Asian women between the ages of 15 and 49. Using multilevel modeling (MLM), HIV stigma variables at the individual, family, and community levels were used to assess the significance of differences in HIV testing and receipt of HIV test results among participants while adjusting for possible confounding factors, such as age, wealth, and education. MLM results indicate that HIV stigma is significantly associated with decreased HIV testing uptake at the individual, family, and community levels and with a decrease in receipt at the community level. A one standard deviation increase in individual, family, and community level composite stigma score was associated with a respective 49 %, 59 %, and 94 % (p < 0.001) decrease in the odds of having been tested for HIV. A one standard deviation increase in community composite stigma score was associated with a 99 % (p < 0.001) decrease in the odds of test receipt. HIV stigma operates on the individual, family, and community levels to hinder HIV testing uptake and at the community level to hinder receipt. These findings have important interventions implications to improve uptake of HIV testing and receipt of HIV test results.
Derose, Kathryn Pitkin; Kanouse, David E.; Bogart, Laura M.; Griffin, Beth Ann; Haas, Ann; Stucky, Brian D.; Williams, Malcolm V.; Flórez, Karen R.
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
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.
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
Chao, Li-Wei; Szrek, Helena; Leite, Rui; Ramlagan, Shandir; Peltzer, Karl
HIV stigma and discrimination affect care-seeking behavior and may also affect entrepreneurial activity. We interview 2382 individuals in Pretoria, South Africa, and show that respondents believe that businesses with known HIV+ workers may lose up to half of their customers, although the impact depends on the type of business. Survey respondents' fear of getting HIV from consuming everyday products sold by the business-despite a real infection risk of zero-was a major factor driving perceived decline in customers, especially among food businesses. Respondents' perceptions of the decline in overall life satisfaction when one gets sick from HIV and the respondent's dislike of people with HIV were also important predictors of potential customer exit. We suggest policy mechanisms that could improve the earnings potential of HIV+ workers: reducing public health scare tactics that exacerbate irrational fear of HIV infection risk and enriching public health education about HIV and ARVs to improve perceptions about people with HIV.
Andrade, Rosário Gregório; Iriart, Jorge Alberto Bernstein
The HIV/AIDS epidemic is a serious public health problem in Mozambique. The country has high prevalence rates, and the epidemic's impact is aggravated by the stigma affecting HIV-positive persons. This study takes a socio-anthropological perspective to analyze the experience of HIV-positive women in poor neighborhoods of Maputo and the ways they cope with stigma and discrimination. Semi-structured interviews were conducted with 10 HIV-positive women. The results show how gender inequalities increase women's vulnerability to HIV and contribute to their stigmatization and discrimination. In dealing with stigma, women try to keep their diagnosis confidential, seeking support in group meetings with others living with HIV. Public policies should focus on women's empowerment and the reduction of HIV/AIDS-related stigma.
Muessig, Kathryn E.; Rosen, David L.; Farel, Claire E.; White, Becky L.; Filene, Eliza J.; Wohl, David A.
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
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
Rongkavilit, C; Wright, K; Chen, X; Naar-King, S; Chuenyam, T; Phanuphak, P
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.
Lindberg, Maria H.; Wettergren, Lena; Wiklander, Maria; Svedhem-Johansson, Veronica; Eriksson, Lars E.
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
Tate, Allan D.; Gaddist, Bambi; White, Jacob
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
Tsai, Alexander C.
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
Wu, Fei; He, Xin; Guida, Jennifer; Xu, Yongfang; Liu, Hongjie
HIV stigma occurs among peers in social networks. However, the features of social networks that drive HIV stigma are not well understood. The objective of this study is to investigate anticipated HIV stigma within the social networks of people living with HIV/AIDS (PLWHA) (N = 147) and the social networks of PLWHA's caregivers (N = 148). The egocentric social network data were collected in Guangxi, China. More than half of PLWHA (58%) and their caregivers (53%) anticipated HIV stigma from their network peers. Both PLWHA and their caregivers anticipated that spouses or other family members were less likely to stigmatise them, compared to friend peers or other relationships. Married network peers were believed to stigmatise caregivers more than unmarried peers. The association between frequent contacts and anticipated stigma was negative among caregivers. Being in a close relationship with PLWHA or caregivers (e.g., a spouse or other family member) was associated with less anticipated stigma. Lower network density was associated with higher anticipated stigma among PLWHA's alters, but not among caregivers' alters. Findings may shed light on innovative stigma reduction interventions at the social network level and therefore improve HIV/AIDS treatment utilisation.
Ojikutu, Bisola O.; Pathak, Subash; Srithanaviboonchai, Kriengkrai; Limbada, Mohammed; Friedman, Ruth; Li, Shuying; Mimiaga, Matthew J.; Mayer, Kenneth H.; Safren, Steven A.
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
Amuri, Mbaraka; Mitchell, Steve; Cockcroft, Anne; Andersson, Neil
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.
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
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.
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.
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
Bernays, Sarah; Rhodes, Tim; Janković Terźić, Katarina
The expectation that universal HIV treatment access in resource-stretched settings will reduce stigma is a powerful aspiration that has been incorporated into a global rhetoric of hope around the HIV pandemic. Between 2005 and 2007, we undertook qualitative longitudinal research with people living with HIV/AIDS (PLHIV) in Serbia. We draw here upon the thematic analysis of prospective interview accounts of 20 individuals to analyse PLHIV's perceptions of the influence of HIV treatment upon their quality of life. HIV is one of few conditions in Serbia where its treatment is fully funded by the state. Inconsistent treatment delivery means HIV treatment is experienced as insecure. Competitive claims for stretched national resources interplay with a moral economy which sees PLHIV as "undeserving" citizens. The guilt and anxiety felt by PLHIV intersect with severely curtailed employment opportunities, which weaken the anticipated restorative and empowering properties embedded within the promise of universal HIV treatment access. Rationed expectations of patient or system instigated change mean PLHIV's efforts are orientated towards short-term individualised self-care, drawing on bureaucratic technologies to mediate their uncertainty. These factors integrate to create a specific cultural and historical context for an altered but continuing stigma towards PLHIV in this era of treatment. This case study cautions against neglecting the underlying structural process of stigmatisation that constrains the capacity of PLHIV to participate in anti-stigma and community organising activities, indicating that in this setting HIV treatment is insufficient alone to reduce stigma or enable major social and economic change in the everyday lives of PLHIV.
Nikus Fido, Neno; Aman, Mamusha; Brihnu, Zewdie
Background HIV stigma has an important role in the spread of the AIDS epidemic. It profoundly affects the lives of individuals living with HIV/AIDS. Fear of being identified as having HIV may discourage a person from getting tested, accessing medical services, and obtaining medications. Thus, this study was aimed at assessing HIV-related stigma and associated factors among antiretroviral treatment (ART) clients in Jimma town, Oromia region, Southwest Ethiopia. Methods A facility-based cross-sectional study was conducted from March 11 to April 26, 2015, in ART clinics in Jimma town. Consecutively identified sample was obtained from ART clients who voluntarily participated in the survey after signing written consent. A structured interviewer-administered questionnaire was used to collect the data. Multiple linear regressions were conducted to assess the factors associated with various stigma domains. Results Out of 349 clients requested, 318 (91.1%) respondents voluntarily participated in the study; among them, 204 (64.2%) respondents were females and the mean age of the respondents was 32.9 years. The mean score (and possible range) of experienced HIV stigma was 41.5±12.6 (20.0–86.7), internalized stigma was 50.5±16.4 (20–96.5), and perceived stigma was 56.2±19.2 (20–100). Conclusion The study revealed that duration of ART use and provider-initiated and forced HIV testing were significantly associated with the three HIV stigma domains. Despite the lower experienced HIV stigma, there were higher internalized and perceived stigmas. Therefore, HIV counseling services should be strengthened for new ART beginners, including pretest counseling. PMID:27920581
Jürgensen, Marte; Sandøy, Ingvild Fossgard; Michelo, Charles; Fylkesnes, Knut
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.
Cuadra-Hernández, Silvia Magali; Zarco-Mera, Ángel; Infante-Xibillé, César; Caballero-García, Marta
A qualitative and quantitative approach forms the base of this analysis of the results of "Vida Digna," a project aimed at abating stigma and discrimination in the HIV transmission field with actions taken by civil society organizations from 2005 to 2009 in the Mexican region of El Bajío. The results were analyzed in 2009 and 2010. The organizations involved were made up of key populations, defined as groups vulnerable to infection but also capable of resisting and controlling the transmission of HIV and the stigma and discrimination that are important barriers in the seeking of care and the achievement of effective HIV control. We describe and analyze the actions taken and the strengthening of the participating organizations. The visibility of new social actors such as transgender women and injecting drug users, as well as informative activities directed at journalists, the police and the military to prevent the criminalization and persecution of these groups, are highlighted.
Vlassoff, Carol; Weiss, Mitchell G; Rao, Shobha
This paper describes a simple question module to assess community stigma in rural India. Fear of stigma is known to prevent people from seeking HIV testing and to contribute to further disease transmission, yet relatively little attention has been paid to community stigma and ways of measuring it. The module, based on a vignette of a fictional HIV-positive woman, was administered to 494 married women and 186 unmarried male and female adolescents in a village in rural Maharashtra, India. To consider the usefulness of the question module, a series of hypotheses were developed based on the correlations found in other studies between HIV-related stigma and socio-demographic characteristics (age, education, discussion of HIV with others, knowing someone living with HIV, knowledge about its transmission and whether respondents acknowledged stigmatizing attitudes as their own or attributed them to others). Many of the study's hypotheses were confirmed. Among married women, correlates of stigma included older age, lack of discussion of HIV and lack of knowledge about transmission; among adolescents, lower education and lack of discussion of HIV were the most significant correlates. The paper concludes that the question module is a useful tool for investigating the impact of interventions to reduce stigma and augment social support for people living with HIV in rural India.
Salter, Megan L.; Go, Vivian F.; Le Minh, Nguyen; Gregowski, Amy; Ha, Tran Viet; Rudolph, Abby; Latkin, Carl; Celentano, David D.; Quan, Vu Minh
The full impact of secondary stigma (stigma directed at family) on an HIV-positive individual is unknown. This qualitative research explores perceptions of secondary stigma in the Vietnamese context and its influence on the ways in which an injection drug user (IDU) copes with HIV infection. Data on experiences learning one’s HIV status, disclosure decisions, family reactions, and stigma from family and community were collected through in-depth interviews with 25 HIV-positive IDUs recruited through a health center in Thai Nguyen, Vietnam. Participants felt despair when learning they were HIV-positive and expressed concerns focused on the emotional burden and the consequences of HIV stigma that extended to family. Many participants engaged in self-isolating behaviors to prevent transmission and minimize secondary stigma. Data illustrated the strong value given to family in Vietnam and underscored the importance of secondary stigma in the coping process including gaining social support and engaging in risk reduction. PMID:21204631
Bennett, David S; Hersh, Jill; Herres, Joanna; Foster, Jill
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.
Stangl, Anne L; Lloyd, Jennifer K; Brady, Laura M; Holland, Claire E; Baral, Stefan
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
Martinez-Hume, Anna C; Baker, Allison M; Bell, Hannah S; Montemayor, Isabel; Elwell, Kristan; Hunt, Linda M
Under the Affordable Care Act, Medicaid Expansion programs are extending Medicaid eligibility and increasing access to care. However, stigma associated with public insurance coverage may importantly affect the nature and content of the health care beneficiaries receive. In this paper, we examine the health care stigma experiences described by a group of low-income public insurance beneficiaries. They perceive stigma as manifest in poor quality care and negative interpersonal interactions in the health care setting. Using an intersectional approach, we found that the stigma of public insurance was compounded with other sources of stigma including socioeconomic status, race, gender, and illness status. Experiences of stigma had important implications for how subjects evaluated the quality of care, their decisions impacting continuity of care, and their reported ability to access health care. We argue that stigma challenges the quality of care provided under public insurance and is thus a public health issue that should be addressed in Medicaid policy.
McCoy, Katryna; Higgins, Melinda; Zuñiga, Julie Ann; Holstad, Marcia McDonnell
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
Watson, Victoria J.; Guagnano, Gregory; Davis, Shannon N.
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.…
Earnshaw, Valerie A; Lang, Shawn M; Lippitt, Margaret; Jin, Harry; Chaudoir, Stephenie R
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.
Smit, Peter J.; Brady, Michael; Carter, Michael; Fernandes, Ricardo; Lamore, Lance; Meulbroek, Michael; Ohayon, Michel; Platteau, Tom; Rehberg, Peter; Rockstroh, Jürgen K.; Thompson, Marc
While stigma associated with HIV infection is well recognised, there is limited information on the impact of HIV-related stigma between men who have sex with men and within communities of gay men. The consequences of HIV-related stigma can be personal and community-wide, including impacts on mood and emotional well-being, prevention, testing behaviour, and mental and general health. This review of the literature reports a growing division between HIV-positive and HIV-negative gay men, and a fragmentation of gay communities based along lines of perceived or actual HIV status. The literature includes multiple references to HIV stigma and discrimination between gay men, men who have sex with men, and among and between many gay communities. This HIV stigma takes diverse forms and can incorporate aspects of social exclusion, ageism, discrimination based on physical appearance and health status, rejection and violence. By compiling the available information on this understudied form of HIV-related discrimination, we hope to better understand and target research and countermeasures aimed at reducing its impact at multiple levels. PMID:22117138
Tsai, Alexander C; Bangsberg, David R; Weiser, Sheri D
Alexander Tsai and colleagues highlight the complex relationship between poverty and HIV stigma in sub-Saharan Africa, and discuss possible ways to break the cycle. Please see later in the article for the Editors' Summary.
Tsai, Alexander C.; Bangsberg, David R.; Kegeles, Susan M.; Katz, Ingrid T.; Haberer, Jessica E.; Muzoora, Conrad; Kumbakumba, Elias; Hunt, Peter W.; Martin, Jeffrey N.; Weiser, Sheri D.
Background HIV is highly stigmatized, compromising both treatment and prevention in resource-limited settings. Purpose To study the relationship between internalized HIV-related stigma and serostatus disclosure and to determine the extent to which this association varies with the degree of social distance. Methods We fit multivariable Poisson regression models, with cluster-correlated robust estimates of variance, to data from 259 persons with HIV enrolled in an ongoing cohort study in rural Uganda. Results Persons with more internalized stigma were less likely to disclose their seropositivity. The magnitude of association increased with social distance such that the largest association was observed for public disclosures and the smallest association was observed for disclosures to sexual partners. Conclusions Among persons with HIV in rural Uganda, internalized stigma was negatively associated with serostatus disclosure. The inhibiting effect of stigma was greatest for the most socially distant ties. PMID:23690283
Zang, Chunpeng; Guida, Jennifer; Sun, Yehuan; Liu, Hongjie
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.
Rael, Christine Tagliaferri; Carballo-Diéguez, Alex; Norton, Rachel; Thorley, Eryka; Giguere, Rebecca; Sheinfil, Alan; Rios, Javier López
Internalized HIV-related stigma negatively impacts the mental and physical health of women living with HIV/AIDS (WLWHA). Yet, some women can successfully confront stigma. The present work uses qualitative methods to investigate the successful stigma coping strategies displayed by 19 WLWHA who reported the least internalized stigma possible on the Internalized AIDS-Related Stigma Scale out of a larger pool of 233 WLWHA in San Felipe de Puerto Plata, Dominican Republic. Such strategies included, HIV disclosure control; preemptive disclosure of HIV-status; educating oneself/others about HIV; viewing HIV as a manageable condition; and looking to family, friends and partners for support. Our findings add to current knowledge about how WLWHA successfully manage internalized stigma, particularly in the context of the Dominican Republic. Clinicians should work closely with WLWHA to counsel them about the stigma coping strategies that best fit their life context.
Ross, Michael W.
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
Li, Michael Jonathan; Murray, Jordan Keith; Suwanteerangkul, Jiraporn; Wiwatanadate, Phongtape
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.
Li, Michael Jonathan; Murray, Jordan Keith; Suwanteerangkul, Jiraporn; Wiwatanadate, Phongtape
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
Holmes, Kathleen; Winskell, Kate
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.
Weiss, Mitchell G.; Rao, Shobha; Ali, Firdaus; Prentice, Tracey
Stigma is a recognized barrier to early detection of HIV and causes great suffering for those affected. This paper examines HIV-related stigma in rural and tribal communities of Maharashtra, an area of relatively high HIV prevalence in India. The study used a mix of qualitative and quantitative methods to compare adult women and adolescents in a rural area, women in a rural area, and women in a tribal area. The respondents included 494 married women and 186 adolescents in a rural community and 49 married women in six tribal villages. HIV-related stigma was prevalent in all communities and was the highest among tribal and older respondents. High-risk behaviour was reported in both areas, accompanied with denial of personal risk. Our findings suggest that HIV may be spreading silently in these communities. To our knowledge, this is the first community-based study to make an in-depth assessment of HIV-related stigma in rural and tribal areas of India. By situating our findings within the broader discourse on stigma in the national and state-level data, this study helps explain the nature and persistence of stigma and how to address it more effectively among subcultural groups in India. PMID:23304905
Background Stigma and discrimination against people living with human immunodeficiency virus (HIV) are obstacles in the way of effective responses to HIV. Understanding the extent of stigma / discrimination and the underlying causes is necessary for developing strategies to reduce them. This study was conducted to explore stigma and discrimination against PLHIV amongst healthcare providers in Jimma zone, Southwest Ethiopia. Methods A cross-sectional study, employing quantitative and qualitative methods, was conducted in 18 healthcare institutions of Jimma zone, during March 14 to April 14, 2011. A total of 255 healthcare providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support and HIV-related stigma and discrimination. Factor analysis was employed to create measurement scales for stigma and factor scores were used in one way analysis of variance (ANOVA), T-tests, Pearson’s correlation and multiple linear regression analyses. Qualitative data collected using key-informant interviews and Focus Group Discussions (FGDs) were employed to triangulate with the findings from the quantitative survey. Results Mean stigma scores (as the percentages of maximum scale scores) were: 66.4 for the extra precaution scale, 52.3 for the fear of work-related HIV transmission, 49.4 for the lack of feelings of safety, 39.0 for the value-driven stigma, 37.4 for unethical treatment of PLHIV, 34.4 for discomfort around PLHIV and 31.1 for unofficial disclosure. Testing and disclosing test results without consent, designating HIV clients and unnecessary referral to other healthcare institutions and refusal to treat clients were identified. Having in-depth HIV knowledge, the perception of institutional support, attending training on stigma and discrimination, educational level of degree or higher, high HIV case loads, the presence of ART service in the healthcare facility and claiming to be non-religious were negative
Kuteesa, Monica O.; Wright, Stuart; Seeley, Janet; Mugisha, Joseph; Kinyanda, Eugene; Kakembo, Frederick; Mwesigwa, Richard; Scholten, Francis
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
Davtyan, Mariam; Brown, Brandon; Folayan, Morenike Oluwatoyin
Background HIV/AIDS and Ebola Virus Disease (EVD) are contemporary epidemics associated with significant social stigma in which communities affected suffer from social rejection, violence, and diminished quality of life. Objective To compare and contrast stigma related to HIV/AIDS and EVD, and strategically think how lessons learned from HIV stigma can be applied to the current EVD epidemic. Methods To identify relevant articles about HIV/AIDS and EVD-related stigma, we conducted an extensive literature review using multiple search engines. PubMed was used to search for relevant peer-reviewed journal articles and Google for online sources. We also consulted the websites of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and the National Institutes of Health to retrieve up-to-date information about EVD and HIV/AIDS. Results Many stigmatizing attitudes and behaviors directed towards those with EVD are strikingly similar to those with HIV/AIDS but there are significant differences worthy of discussion. Both diseases are life-threatening and there is no medical cure. Additionally misinformation about affected groups and modes of transmission runs rampant. Unlike in persons with EVD, historically criminalized and marginalized populations carry a disproportionately higher risk for HIV infection. Moreover, mortality due to EVD occurs within a shorter time span as compared to HIV/AIDS. Conclusions Stigma disrupts quality of life, whether it is associated with HIV infection or EVD. When addressing EVD, we must think beyond the immediate clinical therapeutic response, to possible HIV implications of serum treatment. There are emerging social concerns of stigma associated with EVD infection and double stigma associated with EVD and HIV infection. Drawing upon lessons learned from HIV, we must work to empower and mobilize prominent members of the community, those who recovered from the disease, and organizations working at the grassroots
Zhang, Chen; Li, Xiaoming; Liu, Yu; Qiao, Shan; Zhang, Liying; Zhou, Yuejiao; Shen, Zhiyong; Tang, Zhengzhu
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
Jiménez, Julio; Morales, Marangelie; Castro, Eida; Puig, Marieva; Vélez, Carmen N.; Santiago, Lydia; Zorrilla, Carmen
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
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.
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
Remien, Robert H; Chowdhury, Jenifar; Mokhbat, Jacques E; Soliman, Cherif; Adawy, Maha El; El-Sadr, Wafaa
HIV transmission and occurrence of AIDS in the Middle East and North Africa region (MENA) is increasing, while access to ART in the region lags behind most low to middle-income countries. Like in other parts of the world, there is a growing feminization of the epidemic, and men and women each confront unique barriers to adequate HIV prevention and treatment services, while sharing some common obstacles as well. This paper focuses on important gender dimensions of access to HIV testing, care and treatment in the MENA region, including issues related to stigma, religion and morality, gender power imbalances, work status, and migration. Culturally specific policy and programmatic recommendations for improving HIV prevention and treatment in the MENA region are offered.
Varas-Díaz, N.; Neilands, T.B.; Malavé Rivera, S.; Betancourt, E.
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
Varas-Díaz, N; Neilands, T B; Malavé Rivera, S; Betancourt, E
Abstract 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 sub-optimal 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.
KELLY, J. Daniel; WEISER, Sheri D.; TSAI, Alexander C.
The extent to which HIV stigma at the community level remains a barrier to greater uptake is poorly understood. We used nationally representative data from the 2008 Sierra Leone Demographic and Health Survey. The primary outcome was HIV testing (past 12 months). Our explanatory variable was HIV stigmatizing attitudes (5-item scale). After multivariable adjustment, HIV testing had an inverse association with HIV stigmatizing attitudes measured at the individual (adjusted odds ratio [AOR]=0.94; 95% CI, 0.87–1.01) and community level (AOR=0.70; 95% CI, 0.58–0.85). HIV stigma had a stronger negative association with HIV testing when modeled at the community rather than individual level. PMID:25771909
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.
Airhihenbuwa, Collins; Okoror, Titilayo; Shefer, Tammy; Brown, Darigg; Iwelunmor, Juliet; Smith, Ed; Adam, Mohamed; Simbayi, Leickness; Zungu, Nompumelelo; Dlakulu, Regina; Shisana, Olive
HIV- and AIDS-related stigma has been reported to be a major factor contributing to the spread of HIV. In this study, the authors explore the meaning of stigma and its impact on HIV and AIDS in South African families and health care centers. They conducted focus group and key informant interviews among African and Colored populations in Khayelitsha, Gugulethu, and Mitchell’s Plain in the Western Cape province. The audio-recorded interviews were transcribed and coded using NVivo. Using the PEN-3 cultural model, the authors analyzed results showing that participants’ shared experiences ranged from positive/nonstigmatizing, to existential/unique to the contexts, to negative/stigmatizing. Families and health care centers were found to have both positive nonstigmatizing values and negative stigmatizing characteristics in addressing HIV/AIDS-related stigma. The authors conclude that a culture-centered analysis, relative to identity, is central to understanding the nature and contexts of HIV/AIDS-related stigma in South Africa. PMID:22505784
Miller, Robin Lin; Reed, Sarah J; Francisco, Vincent T; Ellen, Jonathan M
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.
Breet, Elsie; Kagee, Ashraf; Seedat, Soraya
HIV stigma plays a major role in the etiology of psychological distress among persons living with HIV, but may be ameliorated by social support. This cross-sectional study examined whether social support mediates or moderates the relationship between HIV stigma and psychological symptoms. We recruited a convenience sample of 210 individuals living with HIV in three peri-urban communities in the Western Cape, South Africa. People living with HIV and AIDS (PLWHA) completed self-report questionnaires that assessed HIV-related stigma, social support, post-traumatic stress disorder (PTSD) and depression. Product-term regression analyses showed that social support played a mediating role in the relationship between HIV-related stigma and symptoms of PTSD (not depression). Social support did not, however, moderate the relationship between HIV-related stigma and PTSD or depression. The results indicate that perceived HIV-related stigma may decrease PLWHA's perceived level of social support, which in turn may increase PTSD symptoms. Moreover, these findings suggest that despite the protective role of social support, there are other factors that affect the relationship between HIV-related stigma and mental health that hinder the buffering role of social support in this relationship. These findings may have implications for designing and implementing interventions that increase perceived social support and decrease perceived HIV-related stigma, which in turn may decrease symptoms of PTSD among PLWHA.
Jiménez, Julio; Puig, Marieva; Sala, Ana Cecilia; Ramos, Juan Carlos; Castro, Eida; Morales, Marangelie; Santiago, Lydia; Zorrilla, Carmen
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
Li, Haochu; Chen, Xinguang; Yu, Bin
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.
Creel, A H; Rimal, R N; Mkandawire, G; Böse, K; Brown, J W
HIV-related stigma has been recognized as a significant public health issue, yet gaps remain in development and evaluation of mass media interventions to reduce stigma. The Malawi 'Radio Diaries' (RD) program features people with HIV telling stories about their everyday lives. This study evaluates the program's effects on stigma and the additional effects of group discussion. Thirty villages with 10 participants each were randomized to listen to RD only, to the program followed by group discussion or to a control program. Post-intervention surveys assessed four stigma outcomes: fear of casual contact, shame, blame and judgment and willingness to disclose HIV status. Regression analyses indicated that fear of casual contact was reduced by the intervention. Shame was reduced by the radio program, but only for those reporting prior exposure to the radio program and for those who did not have a close friend or relative with HIV. Shame was not reduced when the radio program was followed by discussion. The intervention reduced blame for men and not women and for younger participants but not older participants. Including people with HIV/AIDS in mass media interventions has potential to reduce stigma.
Katz, Ingrid T; Ryu, Annemarie E; Onuegbu, Afiachukwu G; Psaros, Christina; Weiser, Sheri D; Bangsberg, David R; Tsai, Alexander C
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
Corrigan, Patrick W; Druss, Benjamin G; Perlick, Deborah A
Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.
Xiao, Zhiwen; Li, Xiaoming; Qiao, Shan; Zhou, Yuejiao; Shen, Zhiyong
The current study examined whether gender, HIV-related stigma, social support, and the interaction between gender and social support are associated with coping responses among people living with HIV and AIDS (PLWHA) in Guangxi, China. A total of 2987 PLWHA in Guangxi participated from October 2012 to August 2013. Multivariate analysis of covariance was conducted with gender and social support as main factors in the model, and stigma and other variables as covariates. After controlling for demographic variables and stigma, there were significant main effects of emotional social support (F = 1.61, p < .001), functional social support (F = 1.67, p < .001), and informational social support (F = 3.67, p < .001) on various coping strategies. The interaction between gender and informational social support (F = 1.33, p < .05), internalized stigma (F = 37.03, p < .001) and perceived stigma (F = 9.16, p < .001) were associated with various coping strategies. Findings signify the importance of HIV-related stigma and social support differences in the coping strategies among PLWHA in Guangxi, China.
Okumu, Eunice; Jolly, David H.; Alston, Le’Marus; Eley, Natalie T.; Laws, Michelle; MacQueen, Kathleen M.
The southeast is identified as the epicenter of the nation’s human immunodeficiency virus (HIV) epidemic, accounting for nearly 44% of all persons living with a HIV diagnosis in the United States. HIV stigma and knowledge have been cited as some of the complex factors increasing risk of acquiring HIV within African-American communities. We sought to understand how HIV knowledge and HIV-related stigma impact HIV testing experience among young Black adults who completed a community-based participatory research survey in a Southeastern city. Survey measures were developed with active engagement among the research team and community members, with the goal of balancing community knowledge, interests and concerns with scientific considerations, and the realities of funding and the project timeline. A total of 508 of the 513 audio computer-assisted self-interview questionnaires completed were analyzed. Eighty-one percent of participants had ever tested and had an intention-to-test for HIV in the next 12 months. Overall, analyses revealed low HIV-related stigma and relatively moderate to high HIV knowledge among young Black adults in the Southeastern city. Logistic regression indicated that having ever tested for HIV was positively correlated with HIV knowledge [odds ratio (OR): 1.50; 95% confidence interval (CI): 1.23–1.84, p < 0.001], but inversely correlated with low HIV-related stigma (OR: 0.08; 95% CI: 0.01–0.76, p < 0.03). However, there were no significant relationships between HIV-related stigma, HIV knowledge, and intention-to test for HIV in the future. These findings suggest that reducing HIV-related stigma and increasing HIV knowledge are not sufficient in promoting HIV testing (i.e., intention-to-test) among young Black adults in this city, unless specific emphasis is placed on addressing internalized HIV-related stigma and misperceptions about HIV prevention and control. PMID:28349049
Rivera, Alexis V; DeCuir, Jennifer; Crawford, Natalie D; Amesty, Silvia; Harripersaud, Katherine; Lewis, Crystal F
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
In response to World Bank critiques in 2007, the Indian Ministry of Health and Family Welfare declared that human immunodeficiency virus (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 a historically inflected process of devaluation, this article details the history and transformation of NGO involvement in the HIV epidemic from 1986 through economic liberalisation in the 1990s up to the Second National AIDS Control Programme (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' of the NGO workers. Drawing upon noteworthy exceptions to this trend from the first wave of Indian HIV-related NGOs, the article 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.
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
Dinkel, Andreas; Nather, Christina; Jaeger, Hans; Jaegel-Guedes, Eva; Lahmann, Claas; Steinke, Christina; Wolf, Eva; Ronel, Joram
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.
Tsai, Alexander C.; Venkataramani, Atheendar S.
Rationale HIV is highly stigmatized in sub-Saharan Africa. This is an important public health problem because HIV stigma has many adverse effects that threaten to undermine efforts to control the HIV epidemic. Objective The implementation of a universal primary education policy in Uganda in 1997 provided us with a natural experiment to test the hypothesis that education is causally related to HIV stigma. Methods For this analysis, we pooled publicly available, population-based data from the 2011 Uganda Demographic and Health Survey and the 2011 Uganda AIDS Indicator Survey. The primary outcomes of interest were negative attitudes toward persons with HIV, elicited using four questions about anticipated stigma and social distance. Results Standard least squares estimates suggested a statistically significant, negative association between years of schooling and HIV stigma (each P<0.001, with t-statistics ranging from 4.9 to 14.7). We then used a natural experiment design, exploiting differences in birth cohort exposure to universal primary education as an instrumental variable. Participants who were <13 years old at the time of the policy change had 1.36 additional years of schooling compared to those who were ≥13 years old. Adjusting for linear age trends before and after the discontinuity, two-stage least squares estimates suggested no statistically significant causal effect of education on HIV stigma (P-values ranged from 0.21 to 0.69). Three of the four estimated regression coefficients were positive, and in all cases the lower confidence limits convincingly excluded the possibility of large negative effect sizes. These instrumental variables estimates have a causal interpretation and were not overturned by several robustness checks. Conclusion We conclude that, for young adults in Uganda, additional years of education in the formal schooling system driven by a universal primary school intervention have not had a causal effect on reducing negative attitudes
Balaji, Alexandra B; Bowles, Kristina E; Hess, Kristen L; Smith, Justin C; Paz-Bailey, Gabriela
MSM bear a disproportionate burden of the HIV epidemic. Enacted stigma (overt negative actions) against sexual minorities may play an important role in increasing HIV risk among this population. Using data from the 2011 National HIV Behavioral Surveillance system, MSM cycle, we examined the independent associations between three measures of enacted stigma (verbal harassment, discrimination, physical assault) and engagement in each of four HIV-related risk behaviors as outcomes: condomless anal intercourse (CAI) at last sex with a male partner of HIV discordant or unknown status and, in the past 12 months, CAI with a male partner, ≥4 male sex partners, and exchange sex. Of 9819 MSM, 32% experienced verbal harassment in the past 12 months, 23% experienced discrimination, and 8% experienced physical assault. Discordant CAI at last sex with a male partner was associated with previous discrimination and physical assault. Past 12 month CAI with a male partner, ≥4 male sex partners, and exchange sex were each associated with verbal harassment, discrimination, and physical assault. These findings indicate that a sizable proportion of MSM report occurrences of past 12 month enacted stigma and suggest that these experiences may be associated with HIV-related risk behavior. Addressing stigma towards sexual minorities must involve an integrated, multi-faceted approach, including interventions at the individual, community, and societal level.
Kerrigan, Deanna; Vazzano, Andrea; Bertoni, Neilane; Malta, Monica; Bastos, Francisco Inacio
Limited research has examined the social context surrounding stigma and discrimination and HIV outcomes among people living with HIV (PLHIV). We surveyed 900 PLHIV in Brazil and examined the relationship between stigma, discrimination and HIV outcomes utilising multivariable logistic regression. HIV stigma and discrimination were inversely associated with age (AOR Stigma 0.65, 95% CI 0.49-0.88; AOR Discrimination 0.72, 95% CI 0.54-0.95) and income (AOR Stigma 0.74, 95% CI 0.55-0.99; AOR Discrimination 0.62, 95% CI 0.46-0.82). Stigma was inversely associated with education (AOR 0.71, 95% CI 0.52-0.96) and no history of sex work (AOR 0.56, 95% CI 0.35-0.90), and positively associated with having children (AOR 1.71, 95% CI 1.18-2.48). Discrimination was inversely associated with no history of drug use (AOR 0.63, 95% CI 0.42-0.95). Stigma and discrimination were found to be inversely associated with overall health (AOR Stigma 0.54, 95% CI 0.40-0.74; AOR Discrimination 0.71, 95% CI 0.52-0.97). Discrimination was associated with having a sexually transmitted infection since HIV diagnosis (AOR 1.63, 95% CI 1.14-2.32). Findings suggest that future interventions should address multiple social inequalities faced by PLHIV to reduce HIV stigma and discrimination and improve health and HIV outcomes.
Maughan-Brown, Brendan; Nyblade, Laura
Although HIV-related stigma in general is known to deter HIV-testing, the extent to which different dimensions of stigma independently influence testing behaviour is poorly understood. We used data on young black men (n = 553) and women (n = 674) from the 2009 Cape Area Panel Study to examine the independent effects of stigmatising attitudes, perceived stigma and observed enacted stigma on HIV-testing. Multivariate logistic regression models showed that stigma had a strong relationship with HIV-testing among women, but not men. Women who held stigmatising attitudes were more likely to have been tested (OR 3, p < 0.01), while perceived stigma (OR 0.61, p < 0.1) and observed enacted stigma (OR 0.42, p < 0.01) reduced the odds significantly of women having had an HIV test. Our findings highlight that different dimensions of stigma may have opposite effects on HIV testing, and point towards the need for interventions that limit the impact of enacted and perceived stigma on HIV-testing among women.
Church, Kathryn; Wringe, Alison; Fakudze, Phelele; Kikuvi, Joshua; Simelane, Dudu; Mayhew, Susannah H
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
Becker, Davida; Espinoza, Lilia; Nguyen-Rodriguez, Selena; Diaz, Gaby; Carricchi, Ana; Galvez, Gino; Garcia, Melawhy
Objectives Latinos are at an elevated risk for HIV infection. Continued HIV/AIDS stigma presents barriers to HIV testing and affects the quality of life of HIV-positive individuals, yet few interventions addressing HIV/AIDS stigma have been developed for Latinos. Methods An intervention led by community health workers (promotores de salud, or promotores) targeting underserved Latinos in three southwestern U.S. communities was developed to decrease HIV/AIDS stigma and increase HIV knowledge and perception of risk. The intervention was led by HIV-positive and HIV-affected (i.e., those who have, or have had, a close family member or friend with HIV/AIDS) promotores, who delivered interactive group-based educational sessions to groups of Latinos in Spanish and English. To decrease stigma and motivate behavioral and attitudinal change, the educational sessions emphasized positive Latino cultural values and community assets. The participant pool comprised 579 Latino adults recruited in El Paso, Texas (n=204); San Ysidro, California (n=175); and Los Angeles, California (n=200). Results From pretest to posttest, HIV/AIDS stigma scores decreased significantly (p<0.001). Significant increases were observed in HIV/AIDS knowledge (p<0.001), willingness to discuss HIV/AIDS with one's sexual partner (p<0.001), and HIV risk perception (p=0.006). Willingness to test for HIV in the three months following the intervention did not increase. Women demonstrated a greater reduction in HIV/AIDS stigma scores when compared with their male counterparts, which may have been related to a greater increase in HIV/AIDS knowledge scores (p=0.016 and p=0.007, respectively). Conclusion Promotores interventions to reduce HIV/AIDS stigma and increase HIV-related knowledge, perception of risk, and willingness to discuss sexual risk with partners show promise in reaching underserved Latino communities. PMID:26327724
Kalichman, S; Simbayi, L
Objectives: A cornerstone of HIV prevention in South Africa is voluntary HIV antibody counselling and testing (VCT), but only one in five South Africans aware of VCT have been tested. This study examined the relation between HIV testing history, attitudes towards testing, and AIDS stigmas. Methods: Men (n = 224) and women (n = 276) living in a black township in Cape Town completed venue intercept surveys; 98% were black, 74% age 35 or younger. Results: 47% of participants had been tested for HIV. Risks for exposure to HIV were high and comparable among people tested and not tested. Comparisons on attitudes toward VCT, controlling for demographics and survey venue, showed that individuals who had not been tested for HIV and those tested but who did not know their results held significantly more negative testing attitudes than individuals who were tested, particularly people who knew their test results. Compared to people who had been tested, individuals who were not tested for HIV demonstrated significantly greater AIDS related stigmas; ascribing greater shame, guilt, and social disapproval to people living with HIV. Knowing test results among those tested was not related to stigmatising beliefs. Conclusions: Efforts to promote VCT in South Africa require education about the benefits of testing and, perhaps more important, reductions in stigmatising attitudes towards people living with AIDS. Structural and social marketing interventions that aim to reduce AIDS stigmas will probably decrease resistance to seeking VCT. PMID:14663117
Bekalu, Mesfin Awoke; Eggermont, Steven; Ramanadhan, Shoba; Viswanath, Kasisomayajula
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.
Kang, Ezer; Chin, John J.; Behar, Elana
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
Kang, Ezer; Chin, John J; Behar, Elana
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.
Winskell, Kate; Hill, Elizabeth; Obyerodhyambo, Oby
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
Ketende, Sosthenes; Diouf, Daouda; Drame, Fatou M.; Liestman, Benjamin; Coly, Karleen; Ndour, Cheikh; Turpin, Gnilane; Mboup, Souleymane; Diop, Karim; Toure-Kane, Coumba; Castor, Delivette; Leye-Diouf, Nafissatou; Baral, Stefan
Background: Men who have sex with men (MSM) and female sex workers (FSW) are consistently shown to have a higher burden of HIV compared with other adults in Senegal. This study, HIV Prevention 2.0, evaluates the impact of the 3-tiered integrated stigma mitigation interventions (ISMIs) approach to optimizing HIV service delivery for key populations in Senegal. Methods: Baseline assessment includes a questionnaire and biological testing for HIV. A proportion of participants enrolled into a 24-month longitudinal cohort with questionnaires and biological testing every 3 months. In these preliminary analyses, ISMIs are evaluated from participants in the cohort through uptake of HIV services and implementation outcomes. Results: Overall, 724 MSM and 758 FSW participated in the baseline assessment. HIV prevalence is 30.2% (n = 219/724) among MSM and 5.3% (n = 40/758) among FSW. Fear of seeking health services among MSM is 17.7% (n = 128/724) at baseline, 10.5% (n = 18/172) at month 3, and 9.8% (n = 10/102) at month 6 (P < 0.004); and among FSW is 21.9% (n = 166/758) at baseline, 8.1% (n = 15/185) at month 3, and 10.7% (n = 18/168) at month 6 (P < 0.001). Overall, 63.9% (n = 62/97) of MSM and 82.5% (n = 118/143) of FSW agreed that the intervention is effective in addressing stigma; however, loss to follow-up was 41.1% among MSM and 10% among FSW. Conclusion: Baseline data reinforce the need for stigma mitigation interventions, combined with enhanced linkage and retention to optimize HIV treatment. Preliminary results show high levels of HIV-related risk determinants and suggest the potential utility of the ISMI to decrease perceived stigma relating to engagement in HIV prevention, treatment, and care services among key populations in Senegal. PMID:27930612
Li, Haochu; Li, Xiaoming; Zhang, Lei; Chow, Eric
Previous review studies explored factors related to the process of HIV disclosure. However, none of these review studies specifically focused on the effects of stigma on HIV disclosure to sex partners. A comprehensive systematic review of empirical studies on the effects of stigma on HIV disclosure to sex partners was conducted until December 2014. Twenty-seven articles published in English-language journals were selected, and study characteristics and findings were evaluated. Inconsistent findings in the assessment of impacts of stigma on HIV disclosure to sex partners were documented. Three underlying plausible reasons were identified, and these included: (1) different types of stigma may have different effects on HIV disclosure to sex partners; (2) studies used different measurement strategies; and (3) varied personal backgrounds and health factors that can mitigate, facilitate or moderate the effect of stigma on HIV disclosure to sex partners. Studies with precise definition measurements of specific types of stigma used them appropriately in a matching context to provide more consistent research results. This review identifies the need for further investigation into how the HIV disclosure process is shaped by particular types of stigma, types of sex partners and demographic characteristics of people living with HIV/AIDS.
Fakolade, R; Adebayo, S B; Anyanti, J; Ankomah, A
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).
Kamen, Charles; Vorasarun, Chaniga; Canning, Ty; Kienitz, Eliza; Weiss, Carolyn; Flores, Sergio; Etter, Darryl; Lee, Susanne; Gore-Felton, Cheryl
Given high rates of trauma in people living with HIV (PLH) and the health benefits of posttraumatic growth (PTG), understanding how to foster PTG in PLH exposed to trauma could be of interest to clinical psychologists working with this population. The current study examined factors theoretically related to development of PTG in PLH, namely HIV-related stigma, disclosure of HIV status, and emotional support. A sample of 334 HIV-positive adults answered a battery of self-report questionnaires. HIV-related stigma, disclosure to sexual partners, and emotional support were significant predictors of PTG: stigma was associated with lower PTG, whereas disclosure and emotional support were associated with higher PTG. Disclosure and emotional support remained significantly associated with PTG in the model including demographic factors and stigma. These findings highlight the need for development of interventions that can aid PLH in disclosing their HIV status to sexual partners and increasing available social support.
Anderson, Moji; Elam, Gillian; Gerver, Sarah; Solarin, Ijeoma; Fenton, Kevin; Easterbrook, Philippa
This paper explores the effects of HIV/AIDS-related stigma and discrimination (HASD) on HIV-positive Caribbean people in the Caribbean and the UK. In-depth, semi-structured interviews were held with a purposively selected group of 25 HIV-positive people of Caribbean origin, using primary selection criteria of sex, age, sexuality and country of birth. Interviews with respondents revealed that they are keenly aware of the stigma surrounding HIV/AIDS, which some attribute to a particularly Caribbean combination of fear of contamination, homophobia, and ignorance, reinforced by religious beliefs. In fact, religion serves a double role: underpinning stigma and assisting in coping with HIV. HASD has usually occurred where respondents have lost or do not have control over disclosure. Compared to UK-born respondents, the accounts of Caribbean-born respondents, most of whom were born in Jamaica, include more reports of severe HASD, particularly violence and employment discrimination. All respondents mobilise a variety of strategies in order to avoid HASD, which have implications for their social interactions and emotional well being. While some manage to avoid the "spoiled identity" of the stigmatised, thereby creating their own understandings of HIV infection, these may remain individual-level negotiations. HASD affects HIV-positive Caribbean people at home and in the diaspora in a variety of ways: emotionally, mentally, financially, socially and physically. Interventions specifically addressing stigma and discrimination must be formulated for the UK's Caribbean population. Tackling stigma and discrimination requires more than education; it requires "cultural work" to address deeply entrenched notions of sexuality.
Kamen, Charles; Arganbright, Jill; Kienitz, Eliza; Weller, Melissa; Khaylis, Anna; Shenkman, Tammy; Smith, Sarah; Koopman, Cheryl; Gore-Felton, Cheryl
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
Pantelic, Marija; Shenderovich, Yulia; Cluver, Lucie; Boyes, Mark
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.
Davis, Tracy; Teaster, Pamela B.; Thornton, Alice; Watkins, John F.; Alexander, Linda; Zanjani, Faika
Purpose To explore primary care providers' HIV prevention practices for older adults. Primary care providers' perceptions and awareness were explored to understand factors that affect their provision of HIV prevention materials and HIV screening for older adults. Design and Method Data were collected through 24 semistructured interviews with primary care providers (i.e., physicians, physician assistants, and nurse practitioners) who see patients older than 50 years. Results Results reveal facilitators and barriers of HIV prevention for older adults among primary care providers and understanding of providers' HIV prevention practices and behaviors. Individual, patient, institutional, and societal factors influenced HIV prevention practices among participants, for example, provider training and work experience, lack of time, discomfort in discussing HIV/AIDS with older adults, stigma, and ageism were contributing factors. Furthermore, factors specific to primary and secondary HIV prevention were identified, for instance, the presence of sexually transmitted infections influenced providers' secondary prevention practices. Implications HIV disease, while preventable, is increasing among older adults. These findings inform future research and interventions aimed at increasing HIV prevention practices in primary care settings for patients older than 50. PMID:25736425
Harper, Gary W; Lemos, Diana; Hosek, Sybil G
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.
Elkington, Katherine S.; McKinnon, Karen; Mann, Claudio Gruber; Collins, Pamela Y.; Leu, Cheng-Shiun; Wainberg, Milton L.
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
Jimenez, Julio Cesar; Puig, Marieva; Ramos, Juan Carlos; Morales, Marangelie; Asencio, Gloria; Sala, Ana Cecilia; Castro, Eida; Velez Santori, Carmen; Santiago, Lydia; Zorrilla, Carmen
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.
Jimenez, Julio Cesar; Puig, Marieva; Ramos, Juan Carlos; Morales, Marangelie; Asencio, Gloria; Sala, Ana Cecilia; Castro, Eida; Santori, Carmen Vélez; Santiago, Lydia; Zorrilla, Carmen
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
Nyamathi, Adeline; Ekstrand, Maria; Zolt-Gilburne, Jessica; Ganguly, Kalyan; Sinha, Sanjeev; Ramakrishnan, Padma; Suresh, P.; Marfisee, Mary; Leake, Barbara
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
Surratt, Hilary L.; O’Grady, Catherine; Kurtz, Steven P.; Buttram, Mance E.; Levi-Minzi, Maria A.
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
Ugarte, William J; Högberg, Ulf; Valladares, Eliette C; Essén, Birgitta
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.
Mitra, Sanjana; Chen, Shiyi; Gogolishvili, David; Globerman, Jason; Chambers, Lori; Wilson, Mike; Logie, Carmen H; Shi, Qiyun; Morassaei, Sara; Rourke, Sean B
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
French, Heleen; Greeff, Minrie; Watson, Martha J; Doak, Coleen M
We describe the implementation of a comprehensive HIV stigma-reduction and wellness-enhancement community intervention that focused on people living with HIV (PLWH), as well as people living close to them (PLC) from six designated groups. A holistic multiple case study design was used in urban and rural settings in the North West Province, South Africa. Purposive voluntary sampling was used to recruit the PLWH group; snowball sampling was used for the PLCs. Data were analyzed by means of open coding and text document analysis. The comprehensive nature of the intervention ensured enhancement in relationships in all groups. The increase in knowledge about stigma, coping with it, and improved relationships led to PLWH feeling less stigmatized and more willing to disclose. PLCs became aware of their stigmatizing behaviors and were empowered to lead stigma reduction in their communities. Many community members were reached through these initiatives.
Kellett, Nicole Coffey; Gnauck, Katherine
HIV stigma remains a major problem of the AIDS epidemic in sub-Saharan Africa. Women fear impending social stigma including blame, isolation and abuse. HIV infection and HIV stigma interact cyclically, creating and reinforcing economic and social exclusion for individuals living with HIV. Evidence suggests that interventions for people living with HIV infection that include, in combination, antiretroviral therapy (ART), peer support and economic empowerment are likely to be more effective than if used alone. We report a qualitative study in West Nile Uganda that explored perceptions of HIV stigma among fifty-four HIV-positive women who had similar access to ART and HIV peer support programmes, but varying levels of participation (full-time, intermittent, none) in economic empowerment programmes. Our study found that access to ART, peer support groups, and economic empowerment programmes helped to curb perceptions of deep-seated HIV stigma for participants. More expressions of usefulness, hope and psychological well-being prevailed with participants who had increased participation in economic empowerment programmes. Our findings underscore the value of HIV outreach programmes which combine ART, peer support and economic empowerment to alleviate HIV stigma. Further research to quantify the interaction of these factors is warranted.
Fongkaew, Warunee; Viseskul, Nongkran; Suksatit, Benjamas; Settheekul, Saowaluck; Chontawan, Ratanawadee; Grimes, Richard M; Grimes, Deanna E
HIV/AIDS-related stigma has been linked to poor adherence resulting in drug resistance and the failure to control HIV. This study used both quantitative and qualitative methods to examine stigma and its relationship to adherence in 30 HIV-infected Thai youth aged 14 to 21 years. Stigma was measured using the HIV stigma scale and its 4 subscales, and adherence was measured using a visual analog scale. Stigma and adherence were also examined by in-depth interviews. The interviews were to determine whether verbal responses would match the scale's results. The mean score of stigma perception from the overall scale and its 4 subscales ranged from 2.14 to 2.45 on a scale of 1 to 4, indicating moderate levels of stigma. The mean adherence score was .74. The stigma scale and its subscales did not correlate with the adherence. Totally, 17 of the respondents were interviewed. Contrary to the quantitative results, the interviewees reported that the stigma led to poor adherence because the fear of disclosure often caused them to miss medication doses. The differences between the quantitative and the qualitative results highlight the importance of validating psychometric scales when they are translated and used in other cultures.
Oduro, Georgina Yaa; Otsin, Mercy
This paper examines Ghanaian young people's perceptions of the determinants of HIV- and AIDS-related stigma and discrimination, and how these perceptions may influence the de-stigmatisation process. Drawing on findings from an in-depth, multi-method qualitative study involving 104 school and street young people aged between 14 and 19 years, the…
Ramirez-Valles, Jesus; Fergus, Stevenson; Reisen, Carol A.; Poppen, Paul J.; Zea, Maria Cecilia
Theories of social integration and stress process posit that community involvement may buffer or may compensate the adverse effects of stigma on psychological well-being. In this article, the authors explore this thesis in a stigmatized and seldom studied group of HIV-positive Latino gay men. Specifically, they examine the effects of community…
Jeter, Natasha Harden
Black men who have sex with men (MSM) on Historically Black College/University (HBCU) campuses face a unique set of challenges. In addition to being disproportionately affected by HIV, Black MSM are impacted by risk behavior, stigma, and environmental policies and practices that adversely influence their experiences. The purpose of this study was…
Arreola, Sonya; Santos, Glenn-Milo; Beck, Jack; Sundararaj, Mohan; Wilson, Patrick A; Hebert, Pato; Makofane, Keletso; Do, Tri D; Ayala, George
Globally, HIV disproportionately affects men who have sex with men (MSM). This study explored associations between access to HIV services and (1) individual-level perceived sexual stigma; (2) country-level criminalization of homosexuality; and (3) country-level investment in HIV services for MSM. 3,340 MSM completed an online survey assessing access to HIV services. MSM from over 115 countries were categorized according to criminalization of homosexuality policy and investment in HIV services targeting MSM. Lower access to condoms, lubricants, and HIV testing were each associated with greater perceived sexual stigma, existence of homosexuality criminalization policies, and less investment in HIV services. Lower access to HIV treatment was associated with greater perceived sexual stigma and criminalization. Criminalization of homosexuality and low investment in HIV services were both associated with greater perceived sexual stigma. Efforts to prevent and treat HIV among MSM should be coupled with structural interventions to reduce stigma, overturn homosexuality criminalization policies, and increase investment in MSM-specific HIV services.
Ganju, Deepika; Saggurti, Niranjan
Among marginalised groups in India, HIV prevalence is highest among transgender persons; however, little is known about their HIV vulnerability. This study describes transgender sex workers' experiences of stigma and violence, a key driver of the HIV epidemic, and explores their coping responses. In-depth interviews were conducted with 68 respondents in Maharashtra state, India. Findings show that respondents face pervasive stigma and violence due to multiple marginalised social identities (transgender status, sex work, gender non-conformity), which reinforce and intersect with social inequities (economic and housing insecurity, employment discrimination, poverty), fuelling HIV vulnerability at the micro, meso and macro levels. Several factors, such as felt and internalised stigma associated with psycho-social distress and low self-efficacy to challenge abuse and negotiate condom use; clients' power in sexual transactions; establishing trust in regular partnerships through condomless sex; norms condoning violence against gender non-conforming persons; lack of community support; police harassment; health provider discrimination and the sex work environment create a context for HIV vulnerability. In the face of such adversity, respondents adopt coping strategies to shift power relations and mobilise against abuse. Community mobilisation interventions, as discussed in the paper, offer a promising vulnerability reduction strategy to safeguard transgender sex workers' rights and reduce HIV vulnerability.
Lancaster, Kathryn E; Cernigliaro, Dana; Zulliger, Rose; Fleming, Paul F
Female sex workers (FSW) living with HIV in sub-Saharan Africa have poor engagement to HIV care and treatment. Understanding the HIV care and treatment engagement experiences of FSW has important implications for interventions to enhance care and treatment outcomes. We conducted a systematic review to examine the HIV care experiences and determinants of linkage and retention in care, antiretroviral therapy (ART) initiation, and ART adherence and viral suppression among FSW living with HIV in sub-Saharan Africa. The databases PubMed, Embase, Web of Science, SCOPUS, CINAHL, Global Health, Psycinfo, Sociological Abstracts, and Popline were searched for variations of search terms related to sex work and HIV care and treatment among sub-Saharan African populations. Ten peer-reviewed articles published between January 2000 and August 2015 met inclusion criteria and were included in this review. Despite expanded ART access, FSW in sub-Saharan Africa have sub-optimal HIV care and treatment engagement outcomes. Stigma, discrimination, poor nutrition, food insecurity, and substance use were commonly reported and associated with poor linkage to care, retention in care, and ART initiation. Included studies suggest that interventions with FSW should focus on multilevel barriers to engagement in HIV care and treatment and explore the involvement of social support from intimate male partners. Our results emphasise several critical points of intervention for FSW living with HIV, which are urgently needed to enhance linkage to HIV care, retention in care, and treatment initiation, particularly where the HIV prevalence among FSW is greatest.
Carrasco, Maria Augusta; Barrington, Clare; Kennedy, Caitlin; Perez, Martha; Donastorg, Yeycy; Kerrigan, Deanna
This study explores social cohesion as a strategy used by female sex workers to address layered HIV and sex work-related stigma. Data derive from a thematic analysis of 23 in-depth interviews and 2 focus groups with female sex workers living with HIV enrolled in a multi-level HIV/STI prevention, treatment and care intervention in Santo Domingo, Dominican Republic. Drawing on Foucault's conceptualisation of modern power, discipline and resistance, we argue that social cohesion provides the psychosocial space (of trust, solidarity and mutual aid) to subvert oppressive societal norms, enabling the reconstruction of identity. Among study participants, identity reconstruction happened through the production, repetition and performance of new de-stigmatised narratives that emerged and were solidified through collective interaction. Findings highlight that enabling the collective reconstruction of identity through social cohesion - rather than solely attempting to change individual beliefs - is a successful approach to addressing stigma.
Mill, Judy; Caine, Vera; Arneson, Cheryl; Maina, Geoffrey; De Padua, Anthony; Dykeman, Margaret
Nurses may have inadequate basic education and opportunities for continuing education in relation to HIV care. As well nurses may perpetuate and impose stigma. We developed, implemented and evaluated an educational intervention to reduce stigma and discrimination among nurses providing HIV care. The intervention used a mentorship model that brought experienced nurses in HIV care and people living with HIV together with nurses who wanted to learn more about HIV nursing care. We examined our findings in relation to past experiences, current realities and future possibilities for HIV nursing education and care in Canada. Our findings demonstrated that many nurses were interested in improving their HIV care, yet few opportunities existed for them to do so. We found that HIV nursing education and expertise were significantly different among participants and across clinical sites. This difference was visible in basic education, services offered for HIV and AIDS care, the collaborative and inter-professional nature of care, and opportunities for continuing education. Mentorship education is an effective strategy to not only address a critical void in knowledge, but also to promote a fundamental shift in attitudes. With the recent call by the World Health Organization to place nurses in key positions to provide HIV care, treatment and prevention, it is imperative to prepare nurses at both the undergraduate and graduate level, as well as those in practice, to fulfill this call. PMID:27152130
Cao, Haijun; He, Na; Jiang, Qingwu; Yang, Meixia; Liu, Zhenyao; Gao, Meiyang; Ding, Pengli; Chen, Li; Detels, Roger
We examined the characteristics of 601 female migrants in Shanghai regarding stigmatizing attitudes toward people living with HIV/AIDS (PLWHA). A community-based cross-sectional study was conducted July and August 2008, using an anonymous questionnaire. Most participants (88%) were married, 9.2% reported multiple sexual partners, 19.1% knew about voluntary counseling and testing clinics, and 3.7% had been tested for HIV. About half (56.4%) agreed that people who acquire HIV/AIDS through sex or drug use deserve it. About 80% admitted that they were afraid of PLWHA. Low knowledge of HIV/AIDS, being older, low levels of education, and longer duration in Shanghai were correlates for having stigmatizing attitudes, while having premarital sex and/or multiple sex partners correlated with less stigma. HIV-related stigma among female migrants in Shanghai is common. Future stigma reduction prevention and intervention programs among female migrants should target those who are older, less educated, and have lived in Shanghai relatively longer.
Lemos, Diana; Hosek, Sybil G.
Abstract 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
Murphy, Patrick J; Hevey, David; O'Dea, Siobhán; Ní Rathaille, Neans; Mulcahy, Fiona
In this study, we examined how non-infectiousness due to antiretroviral therapy has affected HIV-positive gay men's experience of serostatus disclosure to casual sex partners. Interviews were conducted with 15 seropositive gay men living in Ireland. Using grounded theory, three constructions of non-disclosure were proposed-as self-protection, as a morally permissible act, and as a rejection of the HIV-positive identity. Each construction entailed an aspect related to the sexual exclusion of those living with HIV, and an aspect related to their social exclusion. The extent to which the lives of those interviewed were affected by stigma was starkly revealed, as was the extent to which they stigmatized others living with HIV and rejected the HIV-positive identity. The research highlights the failure to socially normalize HIV and that interventions are needed to reduce the distress associated with seropositivity.
Hosseinzadeh, Hassan; Hossain, Syeda Zakia; Niknami, Shamsaddin
Objective: This study examines the levels of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) related stigma among the Iranian population and the factors that contribute to the formation of stigma within the study population. Design: A quantitative research design was used in this research whereby participants completed…
Curtis, Jena Nicols
Advances in HIV/AIDS treatment have dramatically changed the nature of HIV/AIDS education and prevention, creating new opportunities and challenges. This activity is designed to help participants reflect on the impact that HIV treatment can have on a person's life. It also enables trainers to engage participants in a dialogue about the impact of…
Objectives. I incorporated qualitative methods to explore how HIV-related stigma functions in New York City’s House and Ball Community (HBC). Methods. From January through March 2009, I conducted 20 in-depth 1-on-1 interviews with a diverse sample of New York City HBC members. Interviews addressed perceptions of HIV-related stigma, the treatment of HIV-positive members in the community, and the potential impact of HIV-related stigma on risk behaviors. Results. HIV-related stigma contributes to a loss of moral experience for HBC members. Moral experience (i.e., threats to what really matters in a community) disrupts established social connections and hinders the attainment of “ball status” (i.e., amassing social recognition) in the local world of these individuals. Conclusions. My recommendations address HIV-related stigma in the New York City HBC from the vantage of moral experience and highlight the need for longitudinal studies of individual house members and for the implementation of stigma-focused interventions in the community that utilize the unique ball status hierarchy and HBC network to influence social norms surrounding the treatment of HIV-positive community members. PMID:23237182
Valois, Robert F.; DiClemente, Ralph J.; Carey, Michael P.; Stanton, Bonita; Romer, Daniel; Fletcher, Faith; Farber, Naomi; Brown, Larry K.; Vanable, Peter A.; Salazar, Laura F.; Juzang, Ivan; Fortune, Thierry
Abstract HIV-related stigma undermines HIV prevention, testing, and treatment. Multipronged risk-reduction strategies may reduce stigma among African American adolescents. To test the effectiveness of a risk-reduction strategy in addressing stigma, 1613 African American adolescents from four mid-sized cities participated in a randomized control trial. Participants received a sexual-risk reduction [Focus on Youth (FOY)] or general health curriculum [Promoting Health Among Teens (PHAT)]. Two cities received a culturally-tailored media intervention. Participants completed baseline, 3-, 6-, and 12-month surveys to measure HIV-related stigma and knowledge. Analysis of covariance tested for stigma and knowledge differences by media city status and curriculum/media city status (PHAT media vs. PHAT non-media, FOY media vs. FOY non-media; FOY media vs. PHAT media; FOY non-media vs. PHAT non-media) at each measurement. Hierarchical linear modeling (HLM) determined stigma and knowledge differences over time. Media participants demonstrated greater HIV-related knowledge (p<0.10) at 6 months and lower stigma at 3 months (p<0.10). FOY media participants had lower 3-month (p<0.05) and 12-month (p<0.10) stigma scores than non-media FOY participants. FOY media and non-media participants had greater knowledge than PHAT for all intervals after baseline. FOY media had lower stigma than PHAT media after baseline for all intervals after baseline. HLM indicated greater knowledge slopes for the media group (p<0.05). FOY media participants had greater knowledge slopes (p<0.05) relative to non-media FOY participants and media PHAT participants (p<0.01). A combination of a HIV risk-reduction curriculum and culturally-tailored media demonstrated some effectiveness in reducing stigma. Future use of media in HIV-prevention should include and evaluate effects on stigma. PMID:25738952
Fletcher, Faith; Ingram, Lucy Annang; Kerr, Jelani; Buchberg, Meredith; Bogdan-Lovis, Libby; Philpott-Jones, Sean
African American women bear a disproportionate burden of HIV/AIDS in the United States. Although they constitute only 13% of the US population, African Americans account for nearly 65% of all new HIV infections among American women. In addition, this population suffers comparatively greater adverse health outcomes related to HIV status. African American women living with HIV in the South may be further burdened by HIV/AIDS stigma, which is comparatively more pronounced in this region. To further explore this burden, we used narrative data and the Social Ecological Model to explore how African American women living with HIV in the US South recount, conceptualize, and cope with HIV/AIDS stigma at interpersonal, community, and institutional levels. Our narrative analysis suggests that HIV-positive African American women living in the South are vulnerable to experiences of multilevel HIV stigma in various settings and contexts across multiple domains of life. Stigma subsequently complicated disclosure decisions and made it difficult for women to feel supported in particular social, professional and medical settings that are generally regarded as safe spaces for noninfected individuals. Findings suggest that the debilitating and compounded effect of multilevel HIV/AIDS stigma on HIV-positive African American women in the South warrants closer examination to tailor approaches that effectively address the unique needs of this population.
Ha, Toan Huu; Liu, Hongjie; Li, Jian; Nield, Jennifer; Lu, Zhouping
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 (seven items), drug-use public stigma (nine items), and fear of HIV infection (seven 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 (χ(2) /degree ratio=1.98, comparative fit index [CFI]=0.92, root mean square error of approximation [RMSEA]=0.055, standardized root mean square residual [SRMR]=0.057) and in the parent sample (χ(2)/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.
Thi, Mai Doan Anh; Brickley, Deborah Bain; Vinh, Dang Thi Nhat; Colby, Donn J; Sohn, Annette H; Trung, Nguyen Quang; Giang, Le Truong; Mandel, Jeffrey S
Stigma and discrimination against people living with HIV/AIDS (PLHIV) are a pressing problem in Vietnam, in particular because of propaganda associating HIV with the "social evils" of sex work and drug use. There is little understanding of the causes and sequelae of stigma and discrimination against PLHIV in Vietnam. Fifty-three PLHIV participated in focus group discussions in Ho Chi Minh City. Nearly all participants experienced some form of stigma and discrimination. Causes included exaggerated fears of HIV infection, misperceptions about HIV transmission, and negative representations of PLHIV in the media. Participants faced problems getting a job, perceived unfair treatment in the workplace and experienced discrimination in the healthcare setting. Both discrimination and support were reported in the family environment. There is a need to enforce laws against discrimination and provide education to decrease stigma against PLHIV in Vietnam. Recent public campaigns encouraging compassion toward PLHIV and less discrimination from healthcare providers who work with PLHIV have been encouraging.
Wolfe, W R; Weiser, S D; Bangsberg, D R; Thior, I; Makhema, J M; Dickinson, D B; Mompati, K F; Marlink, R G
Botswana, with its estimated HIV prevalence of 37%, instituted a policy of universal access to antiretroviral therapy (ART) in 2002. Initial enrolment lagged behind expectations, with a shortfall in voluntary testing that observers have attributed to HIV-related stigma - although there are no published data on stigma among HIV-positive individuals in Botswana. We interviewed 112 patients receiving ART in 2000, finding evidence of pervasive stigma in patterns of disclosure, social sequelae, and delays in HIV testing. Ninety-four percent of patients reported keeping their HIV status secret from their community, while 69% withheld this information even from their family. Twenty-seven percent of patients said that they feared loss of employment as a result of their HIV status. Forty percent of patients reported that they delayed getting tested for HIV; of these, 51% cited fear of a positive test result as the primary reason for delay in seeking treatment, which was often due to HIV-related stigma. These findings suggest that success of large-scale national ART programmes will require initiatives targeting stigma and its social, economic and political correlates.
Rendina, H Jonathon; Golub, Sarit A; Grov, Christian; Parsons, Jeffrey T
A better exploration of factors associated with sexual compulsivity (SC) among various subpopulations may help to explain its etiology, development, and course, as well as provide implications for treatment. Criticisms of SC highlight the need to have a better understanding of SC that takes into account both behavioral and psychosocial variables such as stigma, particularly stigma related to sexual orientation and HIV status. The purpose of this study was to investigate the association of SC with sexual behavior and stigma in a sample of HIV-positive gay and bisexual men. A cross-sectional, street-intercept method was adapted to survey a sample of 127 HIV-positive gay and bisexual males at two large-scale LGBT community events in the fall of 2008 and spring of 2009. We found that the number of recent male sexual partners (AOR = 1.05) and internalized HIV stigma (AOR = 8.20) were significantly associated with SC symptomology, while internalized homonegativity and interpersonal HIV stigma were not. These findings contradict many prominent criticisms of SC while highlighting the need to better understand the mechanisms related to the development of SC symptomology and the potential role stigma may have for the psychosexual well-being of HIV-positive gay and bisexual men.
Gould, Matthew; Adler, Amy; Zamorski, Mark; Castro, Carl; Hanily, Natalie; Steele, Nicole; Kearney, Steve; Greenberg, Neil
Summary Objectives Military organizations are keen to address barriers to mental health care yet stigma and barriers to care remain little understood, especially potential cultural differences between Armed Forces. The aim of this study was to compare data collected by the US, UK, Australian, New Zealand and Canadian militaries using Hoge et al.'s perceived stigma and barriers to care measure (Combat duty in Iraq and Afghanistan, mental health problems and barriers to care. New Engl J Med 2004;351:13–22). Design Each member country identified data sources that had enquired about Hoge et al.'s perceived stigma and perceived barriers to care items in the re-deployment or immediate post-deployment period. Five relevant statements were included in the study. Setting US, UK Australian, New Zealand and Canadian Armed Forces. Results Concerns about stigma and barriers to care tended to be more prominent among personnel who met criteria for a mental health problem. The pattern of reported stigma and barriers to care was similar across the Armed Forces of all five nations. Conclusions Barriers to care continue to be a major issue for service personnel within Western military forces. Although there are policy, procedural and cultural differences between Armed Forces, the nations studied appear to share some similarities in terms of perceived stigma and barriers to psychological care. Further research to understand patterns of reporting and subgroup differences is required. PMID:20382906
Allen, Heidi; Wright, Bill J; Harding, Kristin; Broffman, Lauren
Context The Affordable Care Act provides new Medicaid coverage to an estimated 12 million low-income adults. Barriers to access or quality could hamper the program's success. One of these barriers might be the stigma associated with Medicaid or poverty. Methods Our mixed-methods study involved 574 low-income adults and included data from an in-person survey and follow-up interviews. Our analysis of the interviews showed that many participants who were on Medicaid or uninsured described a perception or fear of being treated poorly in the health care setting. We defined this experience as stigma and merged our qualitative interviews coded for stigma with our quantitative survey data to see whether stigma was related to other sociodemographic characteristics. We also examined whether stigma was associated with access to care, quality of care, and self-reported health. Findings We were unable to identify other sociodemographic characteristics associated with stigma in this low-income sample. The qualitative interviews suggested that stigma was most often the result of a provider-patient interaction that felt demeaning, rather than an internalized sense of shame related to receiving public insurance or charity care. An experience of stigma was associated with unmet health needs, poorer perceptions of quality of care, and worse health across several self-reported measures. Conclusions Because a stigmatizing experience in the health system might interfere with the delivery of high-quality care to new Medicaid enrollees, further research and policy interventions that target stigma are warranted. PMID:24890249
Johnson, Eboneé T.; Yaghmaian, Rana A.; Best, Andrew; Chan, Fong; Burrell, Reginald, Jr.
Purpose: The purpose of this study was to validate the 10-item version of the HIV Stigma Scale (HSS-10) in a sample of African Americans with HIV/AIDS. Method: One hundred and ten African Americans living with HIV/AIDS were recruited from 3 case management agencies in Baton Rouge, Louisiana. Measurement structure of the HSS-10 was evaluated using…
Hosseinzadeh, Hassan; Hossain, Syeda Zakia
Functional theory proposes that attitudes may serve a variety of purposes for individuals. This study aimed to determine whether stigmatized attitudes toward HIV/AIDS serve the same function for all (consensus function) or serve different functions for different individuals (divergence function) by assessing various aspects of HIV/AIDS stigma…
Wei, Chongyi; Cheung, Doug H.; Yan, Hongjing; Li, Jianjun; Shi, Ling-en; Raymond, H. Fisher
BACKGROUND Gay and HIV-related stigma and discrimination are major barriers to accessing HIV prevention services among MSM worldwide. We aimed to identify modifiable factors that mediate the relationships between gay and HIV-related stigma and discrimination and HIV testing uptake among Chinese MSM. METHODS We conducted a cross-sectional survey study of 523 HIV-uninfected or unknown MSM in Jiangsu Province, China between November 2013 and January 2014. Multivariable analyses were conducted to examine the associations among experienced homophobia, HIV stigma, and recent HIV testing. Causal mediation parametric analyses were conducted to assess whether depression and social norms mediated hypothesized associations. RESULTS Stronger subjective norms toward testing was associated with higher odds of recent HIV testing (AOR: 1.10, 95% CI: 1.01, 1.21) while increasing levels of depression and HIV stigma were both associated with lower odds of recent testing (AOR: 0.96, 95% CI: 0.92, 0.99; and AOR: 0.91, 95% CI: 0.84, 0.99, respectively). There was an indirect relationship (natural indirect effect) of experienced homophobia on recent testing (ORNIE: 0.96, 95% CI: 0.93, 0.98) mediated (35.0%) through depression. Furthermore, there was an indirect relationship of HIV stigma on recent testing (ORNIE: 0.98, 95% CI: 0.95, 0.99) mediated (19.2%) through subjective norms. CONCLUSIONS Depression and social norms are important mediators of HIV testing uptake among stigmatized Chinese MSM. Therefore, in addition to advocacy efforts and policies that address social-level stigma and discrimination, HIV prevention programs should also address mental health issues and incorporate community-based approaches to changing social norms toward HIV testing. PMID:26334742
Phelan, S M; Burgess, D J; Yeazel, M W; Hellerstedt, W L; Griffin, J M; van Ryn, M
The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care.
Bannan, Ciaran L; Lynch, Pamela A; Conroy, Emmett P; O'Dea, Siobhan; Surah, Saloni; Betts-Symonds, Graham; Lyons, Fiona E
HIV is more prevalent in the prison population compared to the general population. Prison inmates are at an increased risk of blood-borne infections. Considerable stigma has been documented amongst inmates with HIV infection. In collaboration with the schools, healthcare facilities, prison authorities and inmate Irish Red Cross groups in Wheatfield, Cloverhill and Mountjoy prisons in Dublin, Ireland, the Department of Genito Urinary Medicine and Infectious Diseases at St James' Hospital in Dublin developed a campaign for raising awareness of HIV, educating inmates about HIV and tackling HIV stigma. Following this campaign, large-scale point-of-care testing for HIV was offered over a short period. In total, 741 inmates were screened for HIV. One inmate tested positive for HIV. We experienced a large number of invalid test results, requiring formal laboratory serum testing, and a small number of false positive results. Large-scale point-of-care testing in the Irish prison setting is acceptable and achievable.
Kipp, Aaron M; Audet, Carolyn M; Earnshaw, Valerie A; Owens, Jared; McGowan, Catherine C; Wallston, Kenneth A
There is little consensus about which of the many validated human immunodeficiency virus (HIV) stigma scales should be regularly used, with few being re-validated in different contexts or evaluated for how they compare to other, existing HIV stigma scales. The purpose of this exploratory study was to re-validate the Van Rie HIV/AIDS-Related Stigma Scale, originally validated in Thailand and using a third-person wording structure, for use with people living with HIV in the United States. Adult HIV clinic patients completed a survey including the Berger and Van Rie scales, and measures of social support and depression. Eighty-five of 211 (40%) eligible participants provided data for both stigma scales. Exploratory factor analyses identified three factors to the Van Rie scale: Loss of Social Relationships (new subscale), Managing HIV Concealment (new subscale), and Perceived Community Stigma (original subscale). These subscales were moderately inter-related (r = 0.51 to 0.58) with acceptable to excellent reliability (Cronbach's alpha = 0.69 to 0.90). The Van Rie subscales were also moderately inter-correlated with the Berger subscales (r = 0.44 to 0.76), had similar construct validity, and tended to have higher mean stigma scores when compared with Berger subscales that were conceptually most similar. The revised Van Rie HIV-related Stigma Scale demonstrates good validity and internal consistency, offering a valid measure of HIV stigma with a three-factor structure. The third-person wording may be particularly suitable for measuring stigmatizing attitudes during an individual's transition from at-risk and undergoing HIV testing to newly diagnosed, a time when experiences of discrimination and processing issues of disclosure have not yet occurred. The stigma mechanisms for individuals making this transition have not been well explored. These scenarios, combined with the observed non-response to the Berger Enacted Stigma subscale items (a surprise finding), highlight
Dobbs, Debra; Eckert, J. Kevin; Rubinstein, Bob; Keimig, Lynn; Clark, Leanne; Frankowski, Ann Christine; Zimmerman, Sheryl
Purpose This study explored aspects of stigmatization for older adults who live in residential care or assisted living (RC–AL) communities and what these settings have done to address stigma. Design and recognition of resident preferences and strengths, rather than their limitations. Methods We used ethnography and other qualitative data-gathering and analytic techniques to gather data from 309 participants (residents, family and staff) from six RC–AL settings in Maryland. We entered the transcript data into Atlas.ti 5.0. We analyzed the data by using grounded theory techniques for emergent themes. Results Four themes emerged that relate to stigma in RC–AL: (a) ageism in long-term care; (b) stigma as related to disease and illness; (c) sociocultural aspects of stigma; and (d) RC–AL as a stigmatizing setting. Some strategies used in RC–AL settings to combat stigma include family member advocacy on behalf of stigmatized residents, assertion of resident autonomy, and administrator awareness of potential stigmatization. Implications: Findings suggest that changes could be made to the structure as well as the process of care delivery to minimize the occurrence of stigma in RC–AL settings. Structural changes include an examination of how best, given the resident case mix, to accommodate care for persons with dementia (e.g., separate units or integrated care); processes of care include staff PMID:18728301
Boone, Melissa R; Cook, Stephanie H; Wilson, Patrick A
Experiences of internalized homophobia and HIV stigma in young Black gay and bisexual men (GBM) may lead to psychological distress, but levels of distress may be dependent upon their sexual identity or HIV status. In this study, we set out to explore the associations between psychological distress, sexual identity, and HIV status in young Black GBM. Participants were 228 young Black GBM who reported on their psychological distress, their HIV status, and their sexual identity. Results indicated that internalized homophobia was significantly related to psychological distress for gay men, but not for bisexual men. HIV stigma was related to psychological stress for HIV-positive men, but not for HIV-negative men. Results indicate a need for more nuanced examinations of the role of identity in the health and well-being of men who have sex with men.
Barrington, Clare; Knudston, Kelly; Bailey, Olga Alicia; Aguilar, Jose Manuel; Loya-Montiel, Marilu Itzel; Morales-Miranda, Sonia
Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in Guatemala, yet little is known about their experiences with diagnosis, linkage to care, and retention. We conducted qualitative in-depth interviews with 26 MSM and transgender women living with HIV in Guatemala City. HIV diagnosis experiences changed over time with increasing asymptomatic testing at non-governmental organizations. Fear of the physical and social impacts of HIV delayed testing, acceptance of diagnosis, and linkage to HIV care. These fears were driven by layered stigma and discrimination due to non-normative gender expressions and / or sexual orientation. Retention-specific determinants included HIV clinic dynamics and limited employment opportunities. There is an urgent need to improve support systems for early testing and linkage to care and to expand employment opportunities. Stigma and discrimination must be addressed at the family, clinic and contextual levels to reduce fear of diagnosis and improve access to care.
Lippman, Sheri A.; Treves-Kagan, Sarah; Gilvydis, Jennifer M.; Naidoo, Evasen; Khumalo-Sakutukwa, Gertrude; Darbes, Lynae; Raphela, Elsie; Ntswane, Lebogang; Barnhart, Scott
Objective Building a successful combination prevention program requires understanding the community’s local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa. Method The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO’s Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews. Results We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV. Conclusions Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four ‘themes’ identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills
Hu, Yifei; Lu, Hongyan; Raymond, H Fisher; Sun, Yanming; Sun, Jiangping; Jia, Yujiang; He, Xiong; Fan, Song; Xiao, Yan; McFarland, Willi; Ruan, Yuhua
Social norms around condom use and safe sex as well as HIV/AIDS stigma are used to identify persons at higher risk for HIV. These measures have been developed and tested in a variety of settings and populations. While efforts have been undertaken to develop context specific measures of these domains among Chinese MSM, the feasibility of using existing measures is unknown. A survey of MSM, based on respondent-driven sampling, was conducted in Beijing. Existing measures of condom social norms, attitudes towards safer sex and HIV/AIDS stigma were piloted. Internal consistency of all measures was high. As expected higher levels of condom social norms and positive attitudes towards safer sex were associated with condom use. HIV/AIDS stigma and discrimination had a significant relationship with never having an HIV test and lack of discussion of HIV/AIDS with male partners. Correlates of low condom social norms were age, education, employment and resident status. Existing measures of condom social norms, attitudes towards safer sex and HIV/AIDS stigma appear to be appropriate for use among Chinese MSM. Using existing measures as opposed to developing new measures has the potential to expedite investigations into psychosocial correlates of HIV risk behavior.
Hu, Yifei; Lu, Hongyan; Raymond, H. Fisher; Sun, Yanming; Sun, Jiangping; Jia, Yujiang; He, Xiong; Fan, Song; Xiao, Yan; McFarland, Willi; Ruan, Yuhua
Social norms around condom use and safe sex as well as HIV/AIDS stigma are used to identify persons at higher risk for HIV. These measures have been developed and tested in a variety of settings and populations. While efforts have been undertaken to develop context specific measures of these domains among Chinese MSM, the feasibility of using existing measures is unknown. A survey of MSM, based on respondent-driven sampling (RDS), was conducted in Beijing. Existing measures of condom social norms, attitudes towards safer sex and HIV/AIDS stigma were piloted. Internal consistency of all measures was high. As expected higher levels of condom social norms and positive attitudes towards safer sex were associated with condom use. HIV / AIDS stigma and discrimination had a significant relationship with never having an HIV test and lack of discussion of HIV/AIDS with male partners. Correlates of low condom social norms were age, education, employment and resident status. Existing measures of condom social norms, attitudes towards safer sex and HIV/AIDS stigma appear to be appropriate for use among Chinese MSM. Using existing measures as opposed to developing new measures has the potential to expedite investigations into psychosocial correlates of HIV risk behavior. PMID:24057931
Background Despite the recognition of stigma as a hindrance to public health treatment and prevention there are gaps in evidence on the relationship between HIV stigma and VCT services utilization in Nigeria. The purpose of this study was to examine a community’s perceptions, feelings and attitudes towards people living with HIV/AIDS and how this is associated with access to utilization of voluntary counselling and treatment in Nigeria. Methods A cross-sectional random study of Nigerians, using a mixed-method approach was carried out in two distinct ethnic areas of the country. Both quantitative and qualitative methods (mixed-methods) were used to collect data in Osun State (Yoruba ethnic group) in the South-West and Imo State (Igbo ethnic group) in the South East. Multivariate logistic regression was the model used to examine the association of interest. Results It is shown that Nigerian public attitudes to HIV/AIDS and those infected with the disease are negative. The markers for stigma on the overall stigma index are significant predictors of utilization of voluntary counselling and testing. As the sum of negative feelings increases, there is less likelihood to using voluntary counselling and testing (VCT) and vice versa. Conclusions Current national efforts at addressing the AIDS pandemic can only be successful when the issue of AIDS is de-stigmatized and is made a critical part of those efforts. One way to do this is through well-designed messages that should be posted in the media, community halls, health centers and other public places aimed at humanizing the disease and those affected and infected by it. PMID:23668880
Moffett, Alexander; Ross, Lainie Friedman
We conducted an empirical pilot study to assess the attitudes of health care professionals (HCPs) to the personal identification of heterozygote carrier status for two autosomal recessive conditions (cystic fibrosis and a hemoglobinopathy) and for an X-linked disorder (Duchenne muscular dystrophy) using the Health Orientation Scale (HOS) and a modified HIV Stigma Scale. Attitudes towards carrier identification of children were also assessed. Three hundred and ten of 742 (42%) eligible HCPs fully or partly completed the survey. As measured with the HOS and the modified HIV scale, respondents had a more negative reaction to the hypothetical discovery of being a carrier for an autosomal recessive genetic condition that was less likely given their self-identified ancestry. Female respondents had a more negative reaction on both scales to being a carrier for an X-linked disorder than men thought their partners would feel. However, the differences found on the HOS and modified HIV scale are small and their clinical relevance unknown. Fifty-seven percent of respondents agreed that parents should tell their children to keep their carrier status private with many (44%) agreeing that children who learn that they are carriers may suffer from a decrease in self-esteem. The vast majority of respondents would inform immediate family members and HCPs of their carrier status, but would be unlikely to share this information with neighbors or employers. Further study is needed to develop a heterozygote genetic carrier stigma scale.
Whitehead, J.; Shaver, John; Stephenson, Rob
Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas. PMID:26731405
Edwards, Todd; Crane, Heidi M.; Crane, Paul K.; Merlin, Jessica; Gibbons, Laura E.; Rao, Deepa; Batey, D. Scott; Dant, Lydia; Páez, Edgar; Church, Anna; Patrick, Donald L.
We sought to understand how HIV-infected patients, their providers, and HIV care researchers prioritize self-reported domains of clinical care. Participants rank-ordered two lists of domains. A modified Delphi process was used for providers and researchers. Approximately 25% of patients were interviewed to discuss rationale for rank order choices. List 1 included anger, anxiety, depression, fatigue, physical function, pain, and sleep disturbance. List 2 included alcohol abuse, cognitive function, HIV stigma, HIV and treatment symptoms, medication adherence, positive affect, sexual risk behavior, sexual function, social roles, spirituality/meaning of life, and substance abuse. Seventy-four providers, 80 HIV care researchers and 66 patients participated. Patients ranked context-based domains, such as HIV stigma, more highly than providers, while health behaviors, such as drug or alcohol use, ranked lower. Patients described a need to address wider-context challenges such as HIV stigma in order to positively impact health behaviors. Divergent patient and provider priorities highlights the importance of incorporating views from all stakeholders and suggests the need for a care approach that more effectively addresses contextual barriers to adverse health behaviors. PMID:26304263
Li, Xiaoming; Liu, Yu; Qiao, Shan; Zhou, Yuejiao; Shen, Zhiyong; Chen, Yi
This study examined whether the impact of HIV stigma on psychosocial status and substance use among people living with HIV/AIDS (PLWHA) differed by their socio-economic status (SES) in a Chinese setting. A total of 2,987 PLWHA were recruited from 12 sites with the highest number of cumulative HIV incidence in Guangxi, China. Participants were asked to provide information regarding their psychosocial status (e.g., depression, anxiety), history of substance use (e.g., tobacco, alcohol and drug) and SES (e.g., education, monthly income, residence type, and job category). By employing stratified multivariate regression analyses, we assessed stratum-specific impacts of HIV stigma on PLWHA’s psychosocial status and behaviors of substance use based upon participants’ SES. The impact of HIV stigma differed significantly on psychosocial status across SES gradients. Psychosocial status among people with higher education was more sensitive to HIV stigma compared with PLWHA who were less educated. The odds of substance use behaviors were higher among people with better monthly income than their low-income peers. Our study is the first paper to document the paucity of SES stratified analyses between HIV stigma and psychosocial status and substance use among PLWHA in China. We call for tailored intervention programs to target PLWHA with different backgrounds and characteristics in order to help them to better manage their seropositivity. PMID:27824948
Pachankis, John E.; Hatzenbuehler, Mark L.; Hickson, Ford; Weatherburn, Peter; Berg, Rigmor C.; Marcus, Ulrich; Schmidt, Axel J.
Objective Substantial country-level variation exists in prejudiced attitudes towards male homosexuality and in the extent to which countries promote the unequal treatment of MSM through discriminatory laws. The impact and underlying mechanisms of country-level stigma on odds of diagnosed HIV, sexual opportunities, and experience of HIV-prevention services, needs and behaviours have rarely been examined, however. Design Data come from the European MSM Internet Survey (EMIS), which was administered between June and August 2010 across 38 European countries (N =174 209). Methods Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes held by the citizens of each country. We also assessed concealment, HIV status, number of past 12-month male sex partners, and eight HIV-preventive services, knowledge, and behavioural outcomes. Results MSM living in countries with higher levels of stigma had reduced odds of diagnosed HIV and fewer partners but higher odds of sexual risk behaviour, unmet prevention needs, not using testing services, and not discussing their sexuality in testing services. Sexual orientation concealment mediated associations between country-level stigma and these outcomes. Conclusion Country-level stigma may have historically limited HIV transmission opportunities among MSM, but by restricting MSM’s public visibility, it also reduces MSM’s ability to access HIV-preventive services, knowledge and precautionary behaviours. These findings suggest that MSM in European countries with high levels of stigma are vulnerable to HIV infection. Although they have less opportunity to identify and contact other MSM, this might change with emerging technologies. PMID:26035323
Nelson, LaRon E; Wilton, Leo; Agyarko-Poku, Thomas; Zhang, Nanhua; Aluoch, Marilyn; Thach, Chia T; Owiredu Hanson, Samuel; Adu-Sarkodie, Yaw
Ghanaian men who have sex with men (MSM) have a high HIV seroprevalence, but despite a critical need to address this public health concern, research evidence has been extremely limited on influences on sexual risk behavior among MSM in Ghana. To investigate associations between HIV/STD knowledge, HIV stigma, and sexual behaviors in a sample of MSM in Ghana, we conducted a secondary data analysis of cross-sectional survey data from a non-probability sample of Ghanaian MSM (N = 137). Nearly all the men (93%) had more than one current sex partner (M = 5.11, SD = 7.4). Of those reported partners, the average number of current female sexual partners was 1.1 (SD = 2.6). Overall, knowledge levels about HIV and STDs were low, and HIV stigma was high. There was no age-related difference in HIV stigma. Younger MSM (≤25 years) used condoms less often for anal and vaginal sex than did those over 25. Relative frequency of condom use for oral sex was lower in younger men who had higher STD knowledge and also was lower in older men who reported high HIV stigma. Knowledge and stigma were not associated with condom use for anal or vaginal sex in either age group. These descriptive data highlight the need for the development of intervention programs that address HIV/STD prevention knowledge gaps and reduce HIV stigma in Ghanaian communities. Intervention research in Ghana should address age-group-specific HIV prevention needs of MSM youth.
Akande, WA; Tserere, MM; Adewuyi, MF; Akande, E Titilola; Adetoun, BE
Background: The purpose of the present study was to explore further the cross-cultural validity, consistency, and replicability of FAIDSS among students when assessing HIV/AIDS-related stigma and fear of people living with HIV/AIDS (PLWHA) in Lagos metropolis. Methods: Using a purposive method, participants in Lagos Metropolis were surveyed using a questionnaire and conceptualization derived from the work of Ross and Hunter (1992) to measure a variety of HIV-related attitudinal and behavioural items. Quantitative data analyzed employing factor analysis using maximum-likelihood extraction followed by oblique rotation (direct oblimin, delta= 0). Results: On the factor scale measuring having fear of sex with a particular person, younger respondents especially females significantly more likely to report greater fear than for any other groups. Our findings further suggest that levels of fear of outsiders are high among males and need urgent action and intervention at both individual and societal levels. Conclusion: It is argued that messages and interventions must be targeted to promote a positive social environment for those living with or affected by HIV/AIDS, and to be useful in understanding stigma, fear and prejudice more fully and in reducing them. A crosscurrent behavioral change that can transform AIDS from an inevitably fatal pandemic to a chronic and manageable disease is the answer. PMID:23113052
Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services.
Mmeje, Okeoma; Njoroge, Betty; Akama, Eliud; Leddy, Anna; Breitnauer, Brooke; Darbes, Lynae; Brown, Joelle
Reproduction is important to many HIV-affected individuals and couples and healthcare providers (HCPs) are responsible for providing resources to help them safely conceive while minimizing the risk of sexual and perinatal HIV transmission. In order to fulfill their reproductive goals, HIV-affected individuals and their partners need access to information regarding safer methods of conception. The objective of this qualitative study was to develop a Safer Conception Counseling Toolkit that can be used to train HCPs and counsel HIV-affected individuals and couples in HIV care and treatment clinics in Kenya. We conducted a two-phased qualitative study among HCPs and HIV-affected individuals and couples from eight HIV care and treatment sites in Kisumu, Kenya. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) to assess the perspectives of HCPs and HIV-affected individuals and couples in order to develop and refine the content of the Toolkit. Subsequently, IDIs were conducted among HCPs who were trained using the Toolkit and FGDs among HIV-affected individuals and couples who were counseled with the Toolkit. HIV-related stigma, fears, and recommendations for delivery of safer conception counseling were assessed during the discussions. One hundred and six individuals participated in FGDs and IDIs; 29 HCPs, 49 HIV-affected women and men, and 14 HIV-serodiscordant couples. Participants indicated that a safer conception counseling and training program for HCPs is needed and that routine provision of safer conception counseling may promote maternal and child health by enhancing reproductive autonomy among HIV-affected couples. They also reported that the Toolkit may help dispel the stigma and fears associated with reproduction in HIV-affected couples, while supporting them in achieving their reproductive goals. Additional research is needed to evaluate the Safer Conception Toolkit in order to support its implementation and use in HIV care and
Saewyc, Elizabeth; Clark, Terryann; Barney, Lucy; Brunanski, Dana; Homma, Yuko
Enacted stigma has been linked to increased HIV risk behaviours among sexual minority youth, but despite higher rates of HIV and other STIs, there is very little research with Indigenous youth. In this study, secondary analyses of three population-based, school surveys were conducted to explore the associations between HIV risk and enacted stigma among sexual minority Indigenous youth in Canada, the US, and New Zealand. Data were analyzed and interpreted with guidance from Indigenous and sexual minority research team members, Indigenous advisory groups, and community consultations. In all three countries, Indigenous sexual minority youth were more likely to experience enacted stigma (such as bullying, discrimination, exclusion, harassment, or school-based violence) and report increased HIV risk behaviours (such as lack of condom use, multiple sexual partners, pregnancy involvement, and injection drug use) compared to heterosexual peers. Data were analyzed by age, gender, and sexual orientation, and for some groups, higher levels of enacted stigma was associated with higher HIV risk. The findings highlight the need for more research, including identifying protective factors, and developing interventions that focus on promoting resilience, addressing the levels of stigma and homophobic violence in school, and restoring historical traditions of positive status for Indigenous sexual minority people. PMID:26793243
Sharp, Marie-Louise; Fear, Nicola T; Rona, Roberto J; Wessely, Simon; Greenberg, Neil; Jones, Norman; Goodwin, Laura
Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation.
South Africa is one of the sub Saharan countries where considerable progress in providing antiretroviral treatment (ART) has been made. The increased access to ART contributes to improvements in the prognosis of HIV and parents are more likely to raise their children than ever before. The study examined the social context influencing disclosure of parental HIV status to children from the perspectives of fathers and mothers accessing ART from an academic hospital in South Africa. Three focus group interviews were conducted with 26 non-disclosed biological parents of children aged between 7 and 18 years. Their ages ranged between 20-60 years and they cared for a total of 60 children. Parental decision not to disclose their HIV status to children was influenced by the fear of death and dying, the influence of television and media, stigma and discrimination. Parents delayed disclosure of their HIV status to children because children believed that AIDS kills. Parents also feared that the child may not be able to keep the parent's HIV status secret and might result in the family being subjected to stigma, discrimination, and isolation. Fear of stigma and discrimination were also responsible for the continuous efforts by parents to protect their HIV status from their children, family and neighbour's. Parents also delayed disclosure to children because they lacked disclosure skills and needed support for disclosure from health care providers. Healthcare providers are in a unique position to provide such support and guidance and assist parents to disclose and children to cope with parental HIV infection.
DiStefano, Anthony S
A syndemics orientation has become a valuable lens through which to understand the complex system dynamics of HIV, HIV's links to other social and health problems, and the design of effective, comprehensive interventions. Using data from a broader ethnographic study of HIV epidemics in the Kansai Region and Tokyo Metropolitan Area of Japan, I found that HIV was synergistically linked with poor mental health, substance use, and violence, suggesting the existence of at least three syndemics. These occurred in an environment of stigma and social and health disparities, particularly for men who have sex with men, transgender persons, immigrants, and people living with HIV. Integrated interventions, led by Japan's HIV nongovernmental organizations and supported by the government, should more aggressively target stigma, which underlies most of the syndemic connections. Quantitative research should build upon the ethnographically derived associations shown here and test whether there are additive syndemic effects.
Padilla, Mark; Castellanos, Daniel; Guilamo-Ramos, Vincent; Reyes, Armando Matiz; Sánchez Marte, Leonardo E.; Soriano, Martha Arredondo
Some quantitative behavioral studies in the USA have concluded that bisexually behaving Latino men are less likely than White men to disclose to their female partners that they have engaged in same-sex risk behavior and/or are HIV-positive, presumably exposing female partners to elevated risk for HIV infection. Nevertheless, very little theoretical or empirical research has been conducted to understand the social factors that promote or inhibit sexual risk disclosure among Latino men who have sex with men (MSM), and much of the existing literature has neglected to contextualize disclosure patterns within broader experiences of stigma and social inequality. This paper examines decisions about disclosure of sex work, same-sex behavior, and sexual risk for HIV among male sex workers in two cities in the Dominican Republic. Data derive from long-term ethnography and qualitative in-depth interviews with 72 male sex workers were used to analyze the relationships among experiences of stigma, social inequality, and patterns of sexual risk disclosure. Thematic analysis of interviews and ethnographic evidence revealed a wide range of stigma management techniques utilized by sex workers to minimize the effects of marginality due to their engagement in homosexuality and sex work. These techniques imposed severe constraints on men’s sexual risk disclosure, and potentially elevated their own and their female partners’ vulnerability to HIV infection. Based on the study’s findings, we conclude that future studies of sexual risk disclosure among ethnic minority MSM should avoid analyzing disclosure as a decontextualized variable, and should seek to examine sexual risk communication as a dynamic social process constrained by hierarchical systems of power and inequality. PMID:18410986
Adebayo, Samson B; Fakolade, Richard; Anyanti, Jennifer; Ekweremadu, Bright; Ladipo, Olaronke; Ankomah, Augustine
People living with HIV and AIDS (PLHA) often face stigma and discrimination. Stigma is a powerful tool for social control and PLHA are to varying degrees stigmatised against. Consequences of stigma and discrimination against PLHA may result in low turn-out for HIV counselling and testing, identity crises, isolation, loneliness, low self-esteem and lack of interest in containing the disease. To achieve the millennium development goal on HIV reduction, efforts should be targeted at measuring impact of HIV preventive interventions. In this paper, effort was made to explore geographical variations in addition to level and trend of accepting attitude towards PLHA using 2003 - 2007 population-based household survey data. Inferences are based on Markov Chain Monte Carlo techniques, while model selection was based on Deviance Information Criteria. Findings revealed significant positive trend and spatial variations on level of accepting attitude towards PLHA. Level of exposure to HIV prevention interventions and perceptions about social support received on HIV are significantly associated with accepting attitude towards PLHA. Findings provide policy makers with tools to discern states where prevention efforts on HIV-related stigma and discrimination should be intensified. This in turn, can enhance an effective utilization of scarce resources that is paramount in developing countries.
Gonzalez, Adam; Locicero, Briana; Mahaffey, Brittain; Fleming, Crystal; Harris, Jalana; Vujanovic, Anka A
Rates of both traumatic event exposure and posttraumatic stress disorder (PTSD; 22%-54%) are disproportionately elevated among people living with HIV/AIDS (PLHA). Trauma and related psychopathology significantly affect quality of life and disease management in this patient population. The current study examined associations between internalized HIV stigma, mindfulness skills, and the severity of PTSD symptoms in trauma-exposed PLHA. Participants included 137 PLHA (14.6% female; Mage = 48.94, SD = 8.89) who reported experiencing on average, five (SD = 2.67) traumatic events; 34% met diagnostic criteria for PTSD. Results indicate that after controlling for sex, age, education, and number of traumatic events, internalized HIV stigma was positively related to overall PTSD symptom severity (β = .16, p < .05) and severity of re-experiencing (β = .19, p < .05) and hyper-arousal (β = .16, p = .05), but not avoidance, PTSD symptom clusters. Among the mindfulness facets measured, acting with awareness was uniquely negatively related to the overall severity of PTSD symptoms (β = -.25, p < .01) and the severity of re-experiencing (β = -.25, p < .05), avoidance (β = -.25, p < .05), and hyper-arousal (β = -.29, p < .01) PTSD symptom clusters. These effects were observed after accounting for covariates and shared variance with other mindfulness facets. Theoretically, the present findings suggest that internalized HIV stigma may serve as a vulnerability factor for the severity of certain PTSD symptoms, whereas acting with awareness may function as a protective or resiliency factor for the severity of PTSD symptoms. Implications for the treatment of trauma-exposed PLHA are discussed.
French, Heleen; Greeff, Minrie; Watson, Martha J.
Abstract HIV stigma remains high globally. Although there is a selection of HIV stigma reduction interventions discussed in the literature, there is a paucity of research about the effectiveness of these interventions. This study aimed at gaining a deeper understanding of the experiences of people living with HIV (PLWH) and people living close to them from six designated groups during and after having undergone a comprehensive HIV stigma reduction community intervention in both an urban and a rural setting. Attention was focused on their expressed experiences of the workshop and projects executed. A qualitative interpretive description approach was used. PLWH as participants were selected through purposive voluntary sampling and through snowball sampling for the people living close to them. Recruitment was from both urban and rural settings in the North West Province, South Africa. Data collection was via in-depth interviews with 23 PLWH and 60 people living close to them from specific designated groups. The data were thematically analysed through manual open coding. The results from the urban and rural settings were pooled, as there were no noteworthy differences in the themes between them. The results indicated that there was an increase in knowledge in all the groups, as well as experiences of enhanced relationships and of being equipped with leadership skills in order to go out into the community and being part of HIV stigma reduction actions. The intervention in its comprehensive nature was found to have been successful and promising for future use in reducing HIV stigma. PMID:25019454
Wainberg, Milton L.; Cournos, Francine; Wall, Melanie M.; Pala, Andrea Norcini; Mann, Claudio Gruber; Pinto, Diana; Pinho, Veronica; McKinnon, Karen
Objective Among people in psychiatric care worldwide, the majority is sexually active, and sharply elevated rates of HIV infection compared to the general population have been shown. Recovery-oriented treatment does not routinely address sexuality. We examined the relationship between gender, severe mental illness diagnosis, and stigma experiences related to sexuality among people in psychiatric outpatient care. Method 641 sexually active adults attending eight public outpatient psychiatric clinics in Rio de Janeiro were interviewed for psychiatric diagnosis and stigma experiences. Stigma mechanisms well established in the literature but not previously examined in relation to sexuality were measured with the Mental Illness Sex Stigma Questionnaire, a 27-item interview about stigma in sexual situations and activities. Results Experiences of stigma were reported by a majority of participants for 48% of questionnaire items. Most people reported supportive attitudes toward their sexuality from providers and family members. Those with severe mental illness diagnoses showed greater stigma on Individual Discrimination and Structural Stigma mechanisms than those with non-severe mental illness diagnoses, while there was no difference on the Social Psychological Processes (internalized stigma) mechanism. Regardless of diagnosis or gender, a majority of participants devalued themselves as sexual partners. Conclusions and Implications for Practice Adults in psychiatric outpatient care frequently reported stigma experiences related to aspects of their sexual lives. From the perspectives of both HIV prevention and recovery from mental illness, examining the consequences of stigma in the sexual lives of people in psychiatric care and improving their measurement would have wide applicability. PMID:27030909
Cuca, Yvette P; Rose, Carol Dawson
As more women become infected with HIV, the issue of childbearing becomes increasingly salient. A more nuanced understanding of women's situations is needed to provide high-quality and relevant services and support. We examined reproductive decision making among 20 women living with HIV through in-depth interviews. These women made decisions within situations of chaos, instability, and trauma, which often limited their ability to make truly informed choices about their lives and childbearing. Despite their HIV, many of the women wanted children, but experienced stigmatization related both to their HIV and to their decisions to have children. This stigmatization came from multiple sources, including health care providers, some of whom encouraged their patients to abort pregnancies because of their HIV. Participants, however, demonstrated resistance to stigmatization, through building supportive communities and developing trusting relationships with HIV providers. These results support the need for specialized HIV care for women of childbearing age.
Zúñiga, María Luisa; Brennan, Jesse; Scolari, Rosana; Strathdee, Steffanie A
We studied barriers to HIV care among HIV-positive Latinos in the US-Mexico border region, where HIV prevalence is increasing. HIV-positive participants receiving HIV care were recruited from clinics in Southern California and underwent structured interviews (n = 157). Logistic regression explored covariates associated with > or =1 barrier to HIV care. HIV-positive patients were mostly male (84.7%), of Mexican-origin (82.8%), and had a mean age of 37.3 years. Among males (n = 133), 67% identified as men who have sex with men. In the prior year, patients received the following care in Mexico: HIV care (33.1%), non-HIV care (43.3%), prescription medications (51.6%), and traditional medications/herbs (17.2%). The most common barriers to HIV care included stigma and medication side effects concerns. Factors independently associated with > or =1 barrier to HIV care were HIV diagnosis >1 year ago; being of Mexican-origin; crossing the US-Mexico border <5 times in the past year; obtaining medications in Mexico; and age. Findings illustrate that bi-national health care utilization is common, which has implications for HIV service delivery in both countries. Additional studies are needed to better understand individual, provider and system level barriers to HIV care in the San Diego/Tijuana border region.
Rodríguez, Melissa Marzán; Madera, Sheilla Rodríguez; Díaz, Nelson Varas
Men who have sex with men (MSM) are one of the most affected populations by HIV/AIDS. Over the last years an increase of cases has been reported in younger groups. The Center for Disease Control and Prevention has stated that stigma and homophobia may have a profound impact on the lives of MSM, and could influence them to engage in HIV risky behaviors. In the U.S and Puerto Rico, an increase in HIV cases among young MSM has been reported. For the period of 2005-2009 an increase of HIV cases was reported with 4.3% in the age group of 13-24 and 55.6% in the age group of 25-34. Understanding the dynamics related HIV risk behaviors among young MSM requires transcending traditional individual behavior oriented perspectives in order to adopt a more comprehensive socio-structural approach. In this manuscript we present a critical analysis of HIV prevention issues among young MSM in Puerto Rico. PMID:25678720
Wouters, Edwin; Rau, Asta; Engelbrecht, Michelle; Uebel, Kerry; Siegel, Jacob; Masquillier, Caroline; Kigozi, Gladys; Sommerland, Nina; Yassi, Annalee
Background The dual burden of tuberculosis and human immunodeficiency virus (HIV) is severely impacting the South African healthcare workforce. However, the use of on-site occupational health services is hampered by stigma among the healthcare workforce. The success of stigma-reduction interventions is difficult to evaluate because of a dearth of appropriate scientific tools to measure stigma in this specific professional setting. Methods The current pilot study aimed to develop and test a range of scales measuring different aspects of stigma—internal and external stigma toward tuberculosis as well as HIV—in a South African healthcare setting. The study employed data of a sample of 200 staff members of a large hospital in Bloemfontein, South Africa. Results Confirmatory factor analysis produced 7 scales, displaying internal construct validity: (1) colleagues’ external HIV stigma, (2) colleagues’ actions against external HIV stigma, (3) respondent’s external HIV stigma, (4) respondent’s internal HIV stigma, (5) colleagues’ external tuberculosis stigma, (6) respondent’s external tuberculosis stigma, and (7) respondent’s internal tuberculosis stigma. Subsequent analyses (reliability analysis, structural equation modeling) demonstrated that the scales displayed good psychometric properties in terms of reliability and external construct validity. Conclusions The study outcomes support the use of the developed scales as a valid and reliable means to measure levels of tuberculosis- and HIV-related stigma among the healthcare workforce in a resource-limited context. Future studies should build on these findings to fine-tune the instruments and apply them to larger study populations across a range of different resource-limited healthcare settings with high HIV and tuberculosis prevalence. PMID:27118854
Thackeray, Rosemary; Keller, Heidi; Heilbronner, Jennifer Messenger; Dellinger, Laura K Lee
Since its inception in 2005, articles in Health Promotion Practice's social marketing department have focused on describing social marketing's unique contributions and the application of each to the practice of health promotion. This article provides a brief review of six unique features (marketing mix, consumer orientation, segmentation, exchange, competition, and continuous monitoring) and then presents two case studies-one on reducing stigma related to mental health and the other a large-scale campaign focused on increasing HIV testing among African American youth. The two successful case studies show that social marketing principles can be applied to a wide variety of topics among various population groups.
Kintu, Betty N.
Introduction. While four in ten female sex workers (FSWs) in sub-Saharan Africa are infected with HIV, only a small proportion is enrolled in HIV care. We explored facilitators and barriers to linkage to HIV care among FSWs receiving HIV testing services at a community-based organization in periurban Uganda. Methods. The cross-sectional qualitative study was conducted among 28 HIV positive FSWs from May to July 2014. Key informant interviews were conducted with five project staff and eleven peer educators. Data were collected on facilitators for and barriers to linkage to HIV care and manually analyzed following a thematic framework approach. Results. Facilitators for linkage to HIV care included the perceived good quality of health services with same-day results and immediate initiation of treatment, community peer support systems, individual's need to remain healthy, and having alternative sources of income. Linkage barriers included perceived stigma, fear to be seen at outreach HIV clinics, fear and myths about antiretroviral therapy, lack of time to attend clinic, and financial constraints. Conclusion. Linkage to HIV care among FSWs is influenced by good quality friendly services and peer support. HIV service delivery programs for FSWs should focus on enhancing these and dealing with barriers stemming from stigma and misinformation. PMID:27493826
Emlet, Charles A.
Purpose: Older adults living with HIV infection may be doubly stigmatized, as they are branded by both age as well as HIV status. Through semistructured interviews, this study sought to examine whether older adults with HIV/AIDS experience both ageism and HIV stigma and how those experiences manifest in their lives. Design and Methods: This was a…
Winskell, Kate; Hill, Elizabeth; Obyerodhyambo, Oby
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 April2005. 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
Garett, Renee; Smith, Justin; Chiu, Jason; Young, Sean D
The recent increase in social media use allows these technologies to rapidly reach communities with higher HIV prevalence, such as African-American and Latino men who have sex with men (MSM). However, no studies have looked at HIV/AIDS stigma among social media users from African-American and Latino MSM communities, or the association between stigma and social media use among these groups. This study sought to assess the level of HIV/AIDS stigma among a sample of social media-using African-American and Latino MSM from Los Angeles. A total of 112 (primarily African-American and Latino, n = 98, 88%) MSM Facebook users completed a survey on demographics, online social network use, and HIV/AIDS stigma. A composite stigma score was created by taking the cumulative score from a 15-item stigma questionnaire. Cumulative logistic models were used to assess the association between HIV/AIDS stigma and online social network use. In general, participants reported a low level of HIV/AIDS stigma (mean = 22.2/75, SD = 5.74). HIV/AIDS stigma composite score was significantly associated with increased time spent on online social networks each day (Adjusted odds ratios (AOR): 1.07, 95% CI: 1.00, 1.15). Among this diverse sample of MSM online social network users, findings suggest that HIV/AIDS stigma is associated with usage of social media. We discuss the implications of this work for future HIV prevention.
Sison, Nathan; Yolken, Annajane; Poceta, Joanna; Mena, Leandro; Chan, Philip A; Barnes, Arti; Smith, Erin; Nunn, Amy
The Mississippi Delta region is one of the communities most heavily impacted by HIV/AIDS in the United States. To understand local provider attitudes and practices regarding HIV testing and care, we conducted 25 in-depth qualitative interviews with local primary care providers and infectious disease specialists. Interviews explored attitudes and practices regarding HIV testing and linkage to care. Most providers did not routinely offer HIV testing, noting financial barriers, financial disincentives to offer routine screening, misperceptions about local informed consent laws, perceived stigma among patients, and belief that HIV testing was the responsibility of the health department. Barriers to enhancing treatment and care included stigma, long distances, lack of transportation, and paucity of local infectious disease specialists. Opportunities for enhancing HIV testing and care included provider education programs regarding billing, local HIV testing guidelines, and informed consent, as well as telemedicine services for underserved counties. Although most health care providers in our study did not currently offer routine HIV testing, all were willing to provide more testing and care services if they were able to bill for routine testing. Increasing financial reimbursement and access to care, including through the Affordable Care Act, may provide an opportunity to enhance HIV/AIDS services in the Mississippi Delta.
Shinde, Nagesh; Baad, Rajendra; Nagpal, Deepak Kumar J; Prabhu, Prashant R; Surekha, L Chavan; Karande, Prasad
People with HIV/HBsAg in India frequently encounter discrimination while seeking and receiving health care services. The knowledge and attitudes of health care workers (HCWs) influences the willingness and ability of people with HIV/HBsAg to access care, and the quality of the care they receive. The objective of this study was to asses HIV/HBsAg-related knowledge, attitudes and risk perception among students and dental HCWs. A cross-sectional survey was conducted on 250 students and 120 dental HCWs in the form of objective questionnaire. Information was gathered regarding demographic details (age, sex, duration of employment, job category); HIV/ HBsAg-related knowledge and attitudes; risk perception; and previous experience caring for HIV-positive patients. The HCWs in this study generally had a positive attitude to care for the people with HIV/HBsAg. However, this was tempered by substantial concerns about providing care, and the fear of occupational infection with HIV/HBsAg. A continuing dental education program was conducted to resolve all the queries found interfering to provide care to HIV/HBsAg patients. But even after the queries were resolved the care providing capability was not attained. These findings show that even with advanced knowledge and facilities the attitude of dental HCWs and students require more strategic training with regards to the ethics and moral stigma associated with the dreaded infectious diseases (HIV/HBsAg).
Olley, B O; Ogunde, M J; Oso, P O; Ishola, A
Although links between HIV-related stigma and self-disclosure of HIV status among people living with HIV have been well established, it is unclear whether levels of perceived discrimination are differentially associated with self-disclosure. The present study using a multi-factorial survey design investigated the role of stigma and other self-related factors (e.g., anticipated discrimination, self-esteem, HIV-related factors [e.g., drug use combination; knowledge of duration of HIV diagnosis] and socio-demographic factors [e.g., multiple spouse; age, gender, educational level] and psychological distress [depression]) in self-disclosure among People living with HIV/AIDs has been added (PLWHA) on follow-up management in State Specialist Hospital Akure, Nigeria. One hundred and thirty nine HIV/AIDS patients (49 males and 90 females) participated in the study. Mean age and mean time in months since diagnosis were 39.56 ± 10.26 and 37.78 ± 48.34, respectively. Four variables: multiple spouse, anticipated discrimination, HIV-related stigma and self-esteem were related to self-disclosure at (p < .05). Product-term regression analyses demonstrated that perceived discrimination mediated the relationship between self-esteem (Sobel test: z = 2.09, Aroian = 2.06, p < .001), perceived stigma (Sobel test: z = 2.78, Aroaian = 2.75 p < .01) and self-disclosure. Interaction term analysis between HIV-related stigma t (5, 137) = 1.69, p > .05, self-esteem t (5, 137) = .59, p > .05 and anticipated discrimination were non-significant, suggesting a non-moderation effect of discrimination and disclosure. The results indicate that anticipated discrimination may impact HIV-related stigma to reduce self-disclosure among the PLWHAs in Akure, Nigeria. Interventions should incorporate anticipated discrimination in educational programs of HIV stigma in encouraging self-disclosure among PLWHAs.
Osório, Carlos; Jones, Norman; Fertout, Mohammed; Greenberg, Neil
Perceived stigma and organizational barriers to care (stigma/BTC) can influence the decision to seek help for military personnel when they are suffering from mental health problems. We examined the relationship between stigmatizing beliefs, perceived BTC, and probable post-traumatic stress disorder (PTSD) in 23,101 UK military personnel deployed to Afghanistan and Iraq both during and after deployment; and in a smaller group some six months later. Overall, our results suggest that stigma/BTC perceptions were significantly, and substantially higher during deployment than when personnel are returning home; however, within the smaller follow-up group, the rates climbed significantly over the first six-months post-deployment although they still remained lower than during-deployment levels. Male personnel, those who reported higher levels of PTSD symptoms and/or greater combat exposure were significantly more likely to endorse more stigma/BTC at both sampling points. Rates of stigma/BTC on deployment are substantially higher than rates measured when personnel are in less threatening environments. We suggest that the considerable efforts that military forces make to encourage effective help seeking should take account of the fluctuating levels of stigma/BTC. Commanders should be aware that encouraging help seeking may be more difficult in operational environments than when personnel have returned home.
Frye, Victoria; Paige, Mark Q; Gordon, Steven; Matthews, David; Musgrave, Geneva; Kornegay, Mark; Greene, Emily; Phelan, Jo C; Koblin, Beryl A; Taylor-Akutagawa, Vaughn
HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and "pop-up" street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team's experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related "space" as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.
Johnson, Margaret; Samarina, Anna; Xi, He; Valdez Ramalho Madruga, José; Hocqueloux, Laurent; Loutfy, Mona; Fournelle, Marie-Josée; Norton, Michael; Van Wyk, Jean; Zachry, Woodie; Martinez, Marisol
Increased access to successful antiretroviral therapy (ART) is necessary in order to achieve an AIDS-free generation. Importantly, slightly over half of the people living with HIV are women. Small studies have described many barriers to accessing treatment and care among women living with HIV. This cross-sectional, non-interventional, epidemiological study assessed the prevalence of barriers to accessing care for women living with HIV across 27 countries, divided into four global regions. HIV-positive women attending routine clinical visits were offered the opportunity to participate in the study. Data describing the study sites and demographic characteristics of the participating women were collected. Participating women filled out questionnaires including the Barriers to Care Scale (BACS) questionnaire, on which they reported the extent to which they found each of the 12 potential barriers to accessing health care problematic. A total of 1931 women living with HIV were included in the study: 760 from Western Europe and Canada (WEC), 532 from Central and Eastern Europe (CEE), 519 from Latin America (LA), and 120 from China. The mean age of participating women was 40.1 ± 11.4 years. A total of 88.2% were currently taking ART. A total of 81.8% obtained HIV treatment under a government health plan. The most prevalent barrier to care was community HIV/AIDS stigma. Community HIV/AIDS knowledge, lack of supportive/understanding work environments, lack of employment opportunities, and personal financial resources were also highly prevalent barriers to accessing care. These findings indicate that, more than 30 years after the start of the AIDS epidemic, stigma is still a major issue for women living with HIV. Continued efforts are needed to improve community education on HIV/AIDS in order to maximize access to health care among women living with HIV. PMID:26168817
Herron, Patrick D
Identifying sources of and eliminating social stigma associated with the promotion and use of pre-exposure prophylaxis (PrEP) for the prevention of sexually acquired HIV infection among men who have sex with men (MSM) is both a moral imperative and necessary requirement to ensure that public health objectives of HIV prevention can be met. This article will examine and address ethical concerns and criticisms regarding the use of PrEP, barriers to its promotion, and use among MSM and examine the types of social stigma associated with PrEP. An ethical justification for both healthcare and LGBT communities to address and overcome social stigma regarding the use of PrEP among MSM is offered.
Okoror, Titilayo A; Falade, Catherine O; Olorunlana, Adetayo; Walker, Ebunlomo M; Okareh, Oladapo T
This study explored the cultural context of HIV stigma on antiretroviral therapy adherence among people living with HIV/AIDS (PLWHA) in southwest Nigeria. Using purposive sampling, participants were recruited through a community-based organization. Consenting PLWHA participated in in-depth interviews and focus group discussions that were audio-taped. Using Deacon's conceptual framework of stigma, four opinion guides facilitated the interviews and discussions. Interviews and discussions were conducted in three languages, and lasted from 45 min to 2 h. A total of 35 women and men participated in the study. Participants ranged in age from 22 to 58 years, with an average of 4 years since clinical diagnosis of HIV/AIDS. All participants were receiving ART, and self-reported high adherence level. Using thematic analysis, three themes emerged: life before ART, life after ART, and strategies used in ART adherence. In describing their lives before ART, participants reported experiencing self, anticipated and enacted stigmas due to their sickly appearance from HIV-related complications. After initiating ART, participants talked about friends and families "returning to them" and "apologizing for abandoning" them once they started "looking well." In response to anticipated stigma, many reported sticking to their medications. Drawing from the cultural milieu as part of their strategies, participants discussed the use of plastic bags for medications and àkònpó, as ways of diverting attention from their use of many medications. Implications for ART program policies and stigma interventions were discussed, along with limitation of a short-term ART study on stigma since long-term use of ART can contribute to stigma by way of lipoatrophy as PLWHA age.
Zeelen, Jacques; Wijbenga, Hieke; Vintges, Marga; de Jong, Gideon
Purpose: This paper aims to explore the role of a small-scale project around storytelling as a form of informal education in five health clinics in rural areas of the Limpopo Province in South Africa. The aim of the project is to decrease the stigma around HIV/AIDS and to start an open dialogue in local communities about the disease.…
Varas-Diaz, Nelson; Toro-Alfonso, Jose; Serrano-Garcia, Irma
AIDS related stigma continues to impact the lives of "People Living With HIV/AIDS" (PLWHA) negatively. Although the consequences of stigmatization have been widely documented, certain areas of study need to be further addressed in order to better understand their implications for PLWHA; such is the case of the perceptions of the body's…
Ebrahimi-Kalan, Mohammad; Rimaz, Shahnaz; AsghariJafarabadi, Mohammad; Abbasian, Ladan; Dastoorpour, Maryam; Yekrang-Sis, Hassan; JafariKhonig, Ali; Gharibnavaz, Hassan
Background: HIV/AIDS disease has remained highly stigmatized all over the world even though the increasing accessibility of its treatment. This study was designed to adapt the HIV/AIDS Stigma Instrument (HASI) to the Iranian People Living with HIV/AIDS (PLWHA). Methods: Translation –back translation of the scale into Persian was done. Then, the validity and reliability of the instrument were evaluated. The validity of the translated scale was assessed in three ways: evaluating its linguistic validity, assessing its content validity by a panel of nine experts, and exploring its construct validity by factor analysis. The internal consistency of the translated scale was evaluated by Cronbach’s Alpha. Results: HASI showed a good Content Validity Index (CVI value >0.75) and Content Validity Ratio (CVR >0.78). The internal consistency of the instrument regarding the total score was α=0.89. The three stigma subscales that were distancing and blaming (8 items, α=0.87), fear (3 items, α=0.82), and discrimination (5 items, α=0.83). Conclusion: This article reports the development and validation of a new measure of stigma, i.e. HIV/AIDS Stigma Instrument in PLWHA (HASI-P), and provides evidence to support its content validity and internal consistency. PMID:24688969
Nattabi, Barbara; Li, Jianghong; Thompson, Sandra C; Orach, Christopher G; Earnest, Jaya
Background HIV-related stigma, among other factors, has been shown to have an impact on the desire to have children among people living with HIV (PLHIV). Our objective was to explore the experiences of HIV-related stigma among PLHIV in post-conflict northern Uganda, a region of high HIV prevalence, high infant and child mortality and low contraception use, and to describe how stigma affected the desires of PLHIV to have children in the future. Methods Semi-structured interviews were conducted with 26 PLHIV in Gulu district, northern Uganda. The interviews, conducted in Luo, the local language, were audio recorded, transcribed and then translated into English. Thematic data analysis was undertaken using NVivo8 and was underpinned by the “Conceptual Model of HIV/AIDS Stigma”. Results HIV-related stigma continues to affect the quality of life of PLHIV in Gulu district, northern Uganda, and also influences PLHIV's desire to have children. PLHIV in northern Uganda continue to experience stigma in various forms, including internal stigma and verbal abuse from community members. While many PLHIV desire to have children and are strongly influenced by several factors including societal and cultural obligations, stigma and discrimination also affect this desire. Several dimensions of stigma, such as types of stigma (received, internal and associated stigma), stigmatizing behaviours (abusing and desertion) and agents of stigmatization (families, communities and health systems), either directly, or indirectly, enhanced or reduced PLHIV's desire to have more children. Conclusion The social-cultural context within which PLHIV continue to desire to have children must be better understood by all health professionals who hope to improve the quality of PLHIV's lives. By delineating the stigma process, the paper proposes interventions for reducing stigmatization of PLHIV in northern Uganda in order to improve the quality of life and health outcomes for PLHIV and their children
Yi, Siyan; Chhoun, Pheak; Suong, Samedy; Thin, Kouland; Brody, Carinne; Tuot, Sovannary
Background AIDS-related stigma and mental disorders are the most common conditions in people living with HIV (PLHIV). We therefore conducted this study to examine the association of AIDS-related stigma and discrimination with mental disorders among PLHIV in Cambodia. Methods A two-stage cluster sampling method was used to select 1,003 adult PLHIV from six provinces. The People Living with HIV Stigma Index was used to measure stigma and discrimination, and a short version of general health questionnaire (GHQ-12) was used to measure mental disorders. Multivariate logistic regression analysis was conducted. Results The reported experiences of discrimination in communities in the past 12 months ranged from 0.8% for reports of being denied health services to 42.3% for being aware of being gossiped about. Internal stigma was also common ranging from 2.8% for avoiding going to a local clinic and/or hospital to 59.6% for deciding not to have (more) children. The proportions of PLHIV who reported fear of stigma and discrimination ranged from 13.9% for fear of being physically assaulted to 34.5% for fear of being gossiped about. The mean score of GHQ-12 was 3.2 (SD = 2.4). After controlling for several potential confounders, higher levels of mental disorders (GHQ-12≥ 4) remained significantly associated with higher levels of experiences of stigma and discrimination in family and communities (AOR = 1.9, 95% CI = 1.4–2.6), higher levels of internal stigma (AOR = 1.7, 95% CI = 1.2–2.3), and higher levels of fear of stigma and discrimination in family and communities (AOR = 1.5, 95% CI = 1.1–2.2). Conclusions AIDS-related stigma and discrimination among PLHIV in Cambodia are common and may have potential impacts on their mental health conditions. These findings indicate a need for community-based interventions to reduce stigma and discrimination in the general public and to help PLHIV to cope with this situation. PMID:25806534
Barroso, Julie; Relf, Michael V; Williams, Megan Scull; Arscott, Joyell; Moore, Elizabeth D; Caiola, Courtney; Silva, Susan G
The aim of this study was to compare outcomes (self-esteem, coping self-efficacy, and internalized stigma) across time in HIV-infected women living in the Deep South who received a stigma reduction intervention (n=51) with those of a control group (n=49) who received the usual care at baseline, and at 30 and 90 days. We recruited 99 women from clinics and an AIDS service organization; they were randomized by recruitment site. A video developed from the results of a qualitative metasynthesis study of women with HIV infection was loaded onto iPod Touch devices. Participants were asked to watch the video weekly for 4 weeks, and to record the number of times they viewed it over a 12-week period. We examined the trajectory model results for efficacy outcomes for the intent-to-treat and the supplemental completers groups. There was a treatment-by-time effect for improved self-esteem (intent-to-treat: p=0.0308; completers: p=0.0284) and decreases in internalized stigma (intent-to-treat: p=0.0036; completers: p=0.0060), and a treatment-by-time-by-time effect for improved coping self-efficacy (intent-to-treat: p=0.0414; completers: p=0.0321). A medium effect of the intervention in terms of improving self-esteem was observed when compared with the control condition in those who completed the study. The magnitude of the intervention effect, however, was large with regard to reducing overall stigma, improving social relationships, and decreasing stereotypes in both groups.
Dobbs, Debra; Eckert, J. Kevin; Rubinstein, Bob; Keimig, Lynn; Clark, Leanne; Frankowski, Ann Christine; Zimmerman, Sheryl
Purpose: This study explored aspects of stigmatization for older adults who live in residential care or assisted living (RC-AL) communities and what these settings have done to address stigma. Design and Methods: We used ethnography and other qualitative data-gathering and analytic techniques to gather data from 309 participants (residents, family…
Chidrawi, H. Christa; Greeff, Minrie; Temane, Q. Michael
Abstract All over the world, health behaviour is considered a complex, far reaching and powerful phenomenon. People's lives are influenced by their own or others' health behaviour on a daily basis. Whether it has to do with smoking, drinking, pollution, global warming or HIV management, it touches lives and it challenges personal and community responses. Health behaviour, and health behaviour change, probably holds the key to many a person's immediate or prolonged life or death outcomes. The same can be said about communities, culture groups and nations. This SANPAD-funded study focused on research questions relating to health behaviour change for people living with HIV (PLWH) in the North-West Province in South Africa. It investigated whether a comprehensive community-based HIV stigma reduction intervention caused health behaviour change in PLWH. An quantitative single system research design with one pre- and four repetitive post-tests utilizing purposive sampling was used to test change-over-time in the health behaviour of 18 PLWH. The results of the study indicated statistical and/or practical significant change-over-time. The intervention not only addressed the health behaviour of PLWH, but also their HIV stigma experiences, HIV signs and symptoms and their quality of life in the context of being HIV positive. The recommendations include popularization of the comprehensive community-based HIV stigma reduction intervention and extending it to include a second intervention to strengthen health behaviour and quality of life for PLWH in the community at large. PMID:25495580
Puplampu, Gideon L; Olson, Karin; Ogilvie, Linda; Mayan, Maria
Attracting and retaining nurses in HIV care is essential to treatment success, preventing the spread of HIV, slowing its progression, and improving the quality of life of people living with HIV. Despite the wealth of studies examining HIV care, few have focused on the factors that influenced nurses' choices to specialize in HIV care. We examined the factors that attracted and retained eight nurses currently working in HIV care in two large Canadian cities. Participants were primarily women between the ages of 20 and 60 years. Interviews were conducted between November 2010 and September 2011 using interpretive description, a qualitative design. Factors that influenced participants to focus their careers in HIV care included both attracting factors and retaining factors. Although more research is needed, this exploration of attracting and retaining factors may motivate others to specialize in HIV nursing, and thus help to promote adequate support for individuals suffering from the disease.
Background The health-related quality of life (HRQL) of people living with HIV infection is an important consideration in HIV management. The PROQOL-HIV psychometric instrument was recently developed internationally as a contemporary, discriminating HIV-HRQL measure incorporating influential emotional dimensions such as stigma. Here we present the first within-country results of PROQOL-HIV using qualitative and quantitative data collected from a West Australian cohort who participated in the development and validation of PROQOL-HIV, and provide a comprehensive picture of HRQL in our setting. Methods We carried out a secondary analysis of data from Australian patients who participated in the international study: 15 in-depth interviews were conducted and 102 HRQL surveys using the PROQOL-HIV instrument and a symptom questionnaire were administered. We employed qualitative methods to extract description from the interview data and linear regression for exploration of the composite and sub-scale scores derived from the survey. Results Interviews revealed the long-standing difficulties of living with HIV, particularly in the domains of intimate relationships, perceived stigma, and chronic ill health. The novel PROQOL-HIV instrument discriminated impact of treatment via symptomatology, pill burden and treatment duration. Patients demonstrated lower HRQL if they were: newly diagnosed (p=0.001); naive to anti-retroviral treatment (p=0.009); reporting depression, unemployment or a high frequency of adverse symptoms, (all p<0.001). Total HRQL was notably reduced by perceived stigma with a third of surveyed patients reporting persistent fears of both disclosing their HIV status and infecting others. Conclusions The analysis showed that psychological distress was a major influence on HRQL in our cohort. This was compounded in people with poor physical health which in turn was associated with unemployment and depression. People with HIV infection are living longer and residual
Stevelink, S A M; van Brakel, W H; Augustine, V
Stigma is a common phenomenon worldwide and infectious diseases like HIV/AIDS and leprosy are often associated with high levels of stigma. Several studies have been conducted concerning the effects of stigma and the impact on social participation, but comparative studies are rare. The objective of this study was to identify differences and similarities between HIV/AIDS and leprosy-related stigma. From April till July 2009, 190 questionnaire-based interviews were conducted to assess the levels of internalized stigma (Internalized Stigma of Mental Illness scale), perceived stigma (Explanatory Model Interview Catalogue stigma scale) and social participation (Participation scale) in a cross-sectional sample of people affected by leprosy (PL) and people living with HIV/AIDS (PLHA). Respondents were selected from several hospitals, charity projects and during home visits in Vellore district, Tamil Nadu. Our results showed that both PLHA (n = 95) and leprosy-affected respondents (n = 95) faced a substantial burden of internalized and perceived stigma, with the former reporting a significantly higher level of stigma. As a result, PLHA faced more frequent and also more severe participation restrictions than PL. Especially, restrictions in work-related areas were reported by the majority of the respondents. In conclusion, PLHA faced a significantly higher level of stigma and participation restriction than PL. However, the latter also reported a substantial burden of stigma and participation restrictions. The study suggests that it may be possible to develop joint interventions based on the commonalities found. More research is needed to define these more precisely and to test the effectiveness of such joint interventions in reducing stigma and improving social participation.
Hernansaiz-Garrido, Helena; Alonso-Tapia, Jesús
Internalized stigma and disclosure concerns are key elements for the study of mental health in people living with HIV. Since no measures of these constructs were available for Spanish population, this study sought to develop such instruments, to analyze their reliability and validity and to provide a short version. A heterogeneous sample of 458 adults from different Spanish-speaking countries completed the HIV-Internalized Stigma Scale and the HIV-Disclosure Concerns Scale, along with the Hospital Anxiety and Depression Scale, Rosenberg's Self-esteem Scale and other socio-demographic variables. Reliability and correlation analyses, exploratory factor analyses, path analyses with latent variables, and ANOVAs were conducted to test the scales' psychometric properties. The scales showed good reliability in terms of internal consistency and temporal stability, as well as good sensitivity and factorial and criterion validity. The HIV-Internalized Stigma Scale and the HIV-Disclosure Concerns Scale are reliable and valid means to assess these variables in several contexts.
Dennis, Alexis C; Barrington, Clare; Hino, Sayaka; Gould, Michele; Wohl, David; Golin, Carol E
Most HIV-infected inmates leave prison with a suppressed viral load; many, however, become disconnected from care and nonadherent to medications during reentry to community life. In this secondary data analysis of focus groups (n = 6) and in-depth interviews (n = 9) with 46 formerly incarcerated HIV-infected people during reentry, we used an inductive analytic approach to explore the interplay between individual, interpersonal, community, and structural factors and HIV management. Participants described barriers and facilitators to care engagement and adherence at each of these four levels, as well as a milieu of HIV and incarceration-related stigma and discrimination. The constellation of barriers and facilitators created competing demands and a sense of chaos in participants' lives, which led them to address reentry-related basic needs (e.g., housing, food) before health care needs. Interventions that simultaneously address multiple levels, including augmenting employment and housing opportunities, enhancing social support, and reducing stigma, are needed.
Raingruber, Bonnie; Uwazie, Ernest; Bowie, Sylvester
Attitudes and behaviors of sex workers have a pivotal influence on the spread of AIDS. A qualitative descriptive study was undertaken to elicit Ghanaian female sex workers' perspectives regarding effective methods of HIV prevention, sources of AIDS-related stigma, and challenges associated with sex work. Women described that: (1) sex work is hard; (2) they felt God would protect their health; (3) staying safe is both a gift and a priority; (4) sex work allows for autonomy; and (5) AIDS-related stigma is very real. To design effective prevention programs it is necessary to consider the culture and perspectives of those who will be served.
... through the Affordable Care Act. Doctors, nurses, and health care systems can Test patients for HIV as a regular part of medical care. Counsel patients who do not have HIV on how to prevent ... or mental health services. Work with health departments to get and ...
Desmond, Michelle; Andrasik, Michele; Rasberry, Tonya; Lambert, Nina; Cohn, Susan E.; Simoni, Jane
Abstract Observational studies have examined the prevalence and impact of internalized stigma among African American women living with HIV, but there are no intervention studies investigating stigma reduction strategies in this population. Based on qualitative data previously collected, we adapted the International Center for Research on Women's HIV Stigma Toolkit for a domestic population of African American women to be consistent with Corrigan's principles of strategic stigma change. We implemented the intervention, led by an African American woman living with HIV, as a workshop across two afternoons. The participants discussed issues “triggered” by videos produced specifically for this purpose, learned coping mechanisms from each other, and practiced them in role plays with each other. We pilot tested the intervention with two groups of women (total N=24), measuring change in internalized stigma with the Stigma Scale for Chronic Illness before and after workshop participation. Sixty-two percent of the participants self-reported acquiring HIV through heterosexual sexual contact, 17% through intravenous drug use, 4% in utero, and 13% did not know the route of transmission. The intervention was feasible, enthusiastically accepted by the women, and led to decreased stigma from the start of the workshop to the end (p=0.05) and 1 week after (p=0.07) the last session of workshop. Findings suggest the intervention warrants further investigation. PMID:22984780
Mukolo, Abraham; Torres, Isabel; Bechtel, Ruth M.; Sidat, Mohsin; Vergara, Alfredo E.
Stigma has been implicated in poor outcomes of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) care. Reducing stigma is important for HIV prevention and long-term treatment success. Although stigma reduction interventions are conducted in Mozambique, little is known about the current nature of stigma and the efficacy and effectiveness of stigma reduction initiatives. We describe action research to generate consensus on critical characteristics of HIV stigma and anti-stigma interventions in Zambézia Province, Mozambique. Qualitative data gathering methods, including indepth key-informant interviews, community interviews and consensus group sessions, were utilized. Delphi methods and the strategic options development analysis technique were used to synthesize qualitative data. Key findings are that stigma enacted by the general public might be declining in tandem with the HIV/AIDS epidemic in Mozambique, but there is likely excessive residual fear of HIV disease and community attitudes that sustain high levels of perceived stigma. HIV-positive women accessing maternal and child health services appear to shoulder a disproportionate burden of stigma. Unintentional biases among healthcare providers are currently the critical frontier of stigmatization, but there are few interventions designed to address them. Culturally sensitive psychotherapies are needed to address psychological distress associated with internalized stigma and these interventions should complement current supports for voluntary counseling and testing. While advantageous for defining stakeholder priorities for stigma reduction efforts, confirmatory quantitative studies of these consensus positions are needed before the launch of specific interventions. PMID:24527744
Mukolo, Abraham; Torres, Isabel; Bechtel, Ruth M; Sidat, Mohsin; Vergara, Alfredo E
Stigma has been implicated in poor outcomes of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) care. Reducing stigma is important for HIV prevention and long-term treatment success. Although stigma reduction interventions are conducted in Mozambique, little is known about the current nature of stigma and the efficacy and effectiveness of stigma reduction initiatives. We describe action research to generate consensus on critical characteristics of HIV stigma and anti-stigma interventions in Zambézia Province, Mozambique. Qualitative data gathering methods, including in-depth key-informant interviews, community interviews and consensus group sessions, were utilized. Delphi methods and the strategic options development analysis technique were used to synthesize qualitative data. Key findings are that stigma enacted by the general public might be declining in tandem with the HIV/AIDS epidemic in Mozambique, but there is likely excessive residual fear of HIV disease and community attitudes that sustain high levels of perceived stigma. HIV-positive women accessing maternal and child health services appear to shoulder a disproportionate burden of stigma. Unintentional biases among healthcare providers are currently the critical frontier of stigmatization, but there are few interventions designed to address them. Culturally sensitive psychotherapies are needed to address psychological distress associated with internalized stigma and these interventions should complement current supports for voluntary counseling and testing. While advantageous for defining stakeholder priorities for stigma reduction efforts, confirmatory quantitative studies of these consensus positions are needed before the launch of specific interventions.
Moutier, Christine; Cornette, Michelle; Lehrmann, Jon; Geppert, Cynthia; Tsao, Carol; DeBoard, Renee; Hammond, Katherine Green; Roberts, Laura Weiss
Objective: Whether and under what circumstances medical residents seek personal health care is a growing concern that has important implications for medical education and patient welfare, but has not been thoroughly investigated. Barriers to obtaining care have been previously documented, but very little empirical work has focused on trainees who…
Nambiar, Devaki; Nguyen, Mai Huong; Giang, Le Minh; Hirsch, Jennifer
Stigma reduction efforts in Vietnam have been encumbered by contradictory and dynamic views of People Living With HIV (PLWH) and the epidemic over the past two decades. World AIDS Day 2010 saw the launch of Pain and Hope, a museum exhibition showcasing the lives and experiences of Vietnamese People Living with AIDS at the Vietnam Museum of Ethnology (VME). Between December 2010 and May 2011, a random sample of visitors completed exit surveys regarding attitudes towards the exhibition and Vietnamese living with HIV/AIDS. The survey sought to determine what kind of visitors the museum and exhibition attracted, and the stigma-related impacts of this kind of exposure and parasocial contact. Of 2,500 Vietnamese visitors randomly selected, 852 completed the computer surveys (response rate of 34.1%), 92.3% of whom had seen Pain and Hope. We found two sub-strata or types of visitors attending the exhibition, with varying demographic characteristics, HIV-related knowledge, some differences in stigma ideation, and clear differences in intended behaviours specifically attributable to the exhibition. Social desirability biases notwithstanding, there has emerged a diptych typology of visitors to the VME, for whom the experience of the exhibition is likely interacting with divergent prior knowledge, experiences, interests and motivations. PMID:22974183
Brooks, Ronald A.; Etzel, Mark A.; Hinojos, Ernesto; Henry, Charles L.; Perez, Mario
HIV-related stigma, discrimination, and homophobia impede community based efforts to combat HIV disease among Latino and African American gay and bisexual men. This commentary highlights ways to address these social biases in communities of color in Los Angeles from the perspectives of staff from HIV prevention programs. Information was collected from HIV prevention program staff participating in a two-day symposium. The outcomes from the symposium offer strategies for developing and implementing HIV prevention services for Latino and African American gay and bisexual men, which include: 1) addressing social biases present in a community that can hinder, and even prohibit, utilization of effective HIV prevention programs; 2) recasting HIV prevention messages in a broader social or health context; 3) developing culturally appropriate HIV prevention messages; 4) exploring new modalities and venues for delivering HIV prevention messages that are appropriate for gay and bisexual men of color and the communities in which they live; and 5) broadening the target of HIV prevention services to include service providers, local institutions and agencies, and the community at-large. These strategies underscore the need to consider the social and contextual factors of a community when designing and implementing HIV prevention programs. PMID:16283834
Chidrawi, H Christa; Greeff, Minrie; Temane, Q Michael; Ellis, Suria
HIV stigma continues to affect the psychosocial wellbeing of people living with HIV (PLWH) and people living close to them (PLC). Literature unequivocally holds the view that HIV stigma and psychosocial wellbeing interact with and have an impact on each other. This study, which is part of a larger research project funded by the South Africa Netherlands research Programme on Alternatives in Development (SANPAD), responds to the lack of interventions mitigating the impactful interaction of HIV stigma and psychosocial wellbeing and tests one such intervention. The research objectives were to test the changeover-time in the psychosocial wellbeing of PLWH and PLC in an urban and a rural setting, following a comprehensive community-based HIV stigma reduction and wellness enhancement intervention. An experimental quantitative single system research design with a pre- and four repetitive post-tests was used, conducting purposive voluntary sampling for PLWH (n = 18) and snowball sampling for PLC (n = 60). The average age of participants was 34 years old. The five measuring instruments used for both groups were the mental health continuum short-form scale, the patient health questionnaire, the satisfaction with life scale, the coping self-efficacy scale and the spirituality wellbeing scale. No significant differences were found between the urban-rural settings and data were pooled for analysis. The findings show that initial psychosocial wellbeing changes after the intervention were better sustained (over time) by the PLC than by the PLWH and seemed to be strengthened by interpersonal interaction. Recommendations included that the intervention should be re-utilised and that its tenets, content and activities be retained. A second intervention three to six months after the first should be included to achieve more sustainability and to add focused activities for the enhancement of psychosocial wellbeing. PLWH and PLC are to be encouraged to engage with innovative community
Background As with the general population, a proportion of military personnel with mental health problems do not seek help. As the military is a profession at high risk of occupational psychiatric injury, understanding barriers to help-seeking is a priority. Method Participants were drawn from a large UK military health study. Participants undertook a telephone interview including the Patient Health Questionnaire (PHQ); a short measure of PTSD (Primary Care PTSD, PC-PTSD); a series of questions about service utilisation; and barriers to care. The response rate was 76% (821 participants). Results The most common barriers to care reported are those relating to the anticipated public stigma associated with consulting for a mental health problem. In addition, participants reported barriers in the practicalities of consulting such as scheduling an appointment and having time off for treatment. Barriers to care did not appear to be diminished after people leave the Armed Forces. Veterans report additional barriers to care of not knowing where to find help and a concern that their employer would blame them for their problems. Those with mental health problems, such as PTSD, report significantly more barriers to care than those who do not have a diagnosis of a mental disorder. Conclusions Despite recent efforts to de-stigmatise mental disorders in the military, anticipated stigma and practical barriers to consulting stand in the way of access to care for some Service personnel. Further interventions to reduce stigma and ensuring that Service personnel have access to high quality confidential assessment and treatment remain priorities for the UK Armed Forces. PMID:21310027
Bauman, Laurie J; Braunstein, Sarah; Calderon, Yvette; Chhabra, Rosy; Cutler, Blayne; Leider, Jason; Rivera, Angelic; Sclafane, Jamie; Tsoi, Benjamin; Watnick, Dana
One in 5 people living with HIV are unaware of their status; they account for an estimated 51% of new infections. HIV transmission can be reduced through a "Test and Treat" strategy, which can decrease both viral load and risk behaviors. However, linkage of newly diagnosed HIV-positive persons to care has proved challenging. We report quantitative and qualitative data on linkage to care from HIV testing sites that partnered with the New York City Department of Health and Mental Hygiene to implement "The Bronx Knows" (TBK), an initiative that tested 607,570 residents over 3 years. During TBK, partner agencies reported the aggregate number of HIV tests conducted, the number of confirmed positives (overall and new), and the number of confirmed positives linked to medical care. We conducted qualitative interviews with directors of 24 of 30 TBK HIV testing agencies to identify linkage barriers and selected 9 for case studies. Barriers to linkage fell into 3 domains: (1) health care system factors (long wait for provider appointments, requirement of a positive confirmatory test before scheduling an appointment, system navigation, and disrespect to patients); (2) social factors (HIV stigma); and (3) characteristics of risk populations (eg, mental illness, homelessness, substance use, and immigrant). Best practices for linkage included networking among community organizations, individualized care plans, team approach, comprehensive and coordinated care services, and patient peer navigation. Research and public health implications are discussed.
In South Africa, 2.5% of children are living with HIV. KwaZulu-Natal is the province most affected by the epidemic and has the highest number of pregnant women living with HIV. This study reports on a qualitative study to assess the views and experiences of those involved in caring for a child with HIV/AIDS. In-depth interviews were conducted in KwaZulu-Natal with 13 women who were the primary caregivers of a child with HIV/AIDS and 12 key informants who worked with children and families living with HIV/AIDS. The combination of widespread poverty and HIV-related stigma was perceived to compromise the health of a child with HIV/AIDS. Caregivers’ primary focus was on economic survival and there was little income to meet basic human needs including the child’s. Stigmatizing attitudes caused some caregivers to keep their child’s sickness a secret and symptoms were sometimes ignored or treatment delayed. Little material and emotional support was available to caregivers who were overwhelmed by multiple stresses in this context. Support group interventions for caregivers of children with HIV/AIDS can be a useful resource provided that they jointly address the economic and psychological needs of caregivers. A stronger commitment at the national level to reduce poverty and HIV-related stigma is needed to strengthen the capacity of families who are caring for children with HIV/AIDS. PMID:21400305
Levi, J; Kates, J
HIV offers a lens through which the underlying problems of the US health care system can be examined. New treatments offer the potential of prolonged quality of life for people living with HIV if they have adequate access to health care. However, increasing numbers of new cases of HIV occur among individuals with poor access to health care. Restrictions on eligibility for Medicaid (and state-by-state variability) contribute to uneven access to the most important safety net source of HIV care financing, while relatively modest discretionary programs attempt to fill in the gap with an ever-increasing caseload. Many poor people with HIV are going without care, even though aggregate public spending on HIV-related care will total $7.7 billion in fiscal year 2000, an amount sufficient to cover the care costs of one half of those living with HIV. But inefficiencies and inequities in the system (both structural and geographic) require assessment of the steps that can be taken to create a more rational model of care financing for people living with HIV that could become a model for all chronic diseases. PMID:10897178
Costelloe, Stephanie; Kemppainen, Jeanne; Brion, John; MacKain, Sally; Reid, Paula; Frampton, Art; Rigsbee, Elizabeth
This analysis examined the relationships between HIV-related stigma, depression, and anxiety in rural and urban sites. Participants were HIV-positive urban (n = 100) and rural (n = 100) adult residents of a US southern state, drawn from a sample for a larger international study of self-esteem and self-compassion. Measures included demographic and health information, the HIV Stigma Scale, the Center for Epidemiology Studies Depression Scale (CES-D), and the Symptom Checklist 90 Revised (SCL-R-90) anxiety scale. Independent sample t-tests showed no significant differences between urban/rural groups on measures of HIV-related stigma, anxiety, or depression, except that rural participants reported greater disclosure concerns (t = 2.11, df = 196, p = .036). Both groups indicated high levels of depression and anxiety relative to published norms and clinically relevant cut-off scores. Hierarchical regression analyses were conducted for the HIV Stigma Scale including its four subscales and total stigma scores. Block 1 (control) contained health and demographic variables known to predict HIV-related stigma. Block 2 included the CES-D and the SCL-R-90, and Block 3 was urban/rural location. Mental health symptom scores contributed a significant amount to explained variance in total stigma scores (5.5%, FΔ = 6.020, p < .01), personalized stigma (4.8%, FΔ = 5.035, p < .01), negative self-image (9.7%, FΔ = 12.289, p < .001), and concern with public attitudes (4.9%, FΔ = 5.228, p < .01), but not disclosure concerns. Urban/rural location made significant additional contributions to the variance for total stigma (1.7%, FΔ = 3.899, p < .05), disclosure concerns (2.6%, FΔ = 5.446, p < .05), and concern with public attitudes (1.9%, FΔ = 4.169, p < .05) but not personalized stigma or negative self-image. Depression scores consistently and significantly predicted perceived stigma total and subscale scores
Rimal, Rajiv N; Creel, Alisha H
Relatively little is known about the extent to which health campaigns can play a constructive role in reducing HIV/AIDS-related stigma. The Malawi Radio Diaries is a program in which HIV-positive men and women openly discuss day-to-day events in their lives with the goal of reducing stigma in the population. Adopting a social marketing perspective, we analyze the various components of the Radio Diaries program in terms of three of the "Four P's": product (stigma reduction), place (radio), and promotion (the program itself). We first investigated the important dimensions of stigma and then developed a model to test the demographic and psychosocial correlates of these dimensions. A midterm household survey was then used to determine the relationship between exposure to the Radio Diaries program and stigma. In multivariate analyses, lower education and knowledge were associated with stronger beliefs that persons living with HIV should be isolated from others. Exposure to the Radio Diaries program did not have a main-effect on stigma, but there was a significant interaction between exposure and efficacy to reduce number of partners such that there was little difference in stigma by exposure level for those with low efficacy, but a significant difference by exposure level for those with high efficacy. Findings are discussed in terms of social marketing principles.
de Lind van Wijngaarden, Jan W; Schunter, Bettina T; Iqbal, Qasim
This study describes the experiences of 10 young feminised men in Pakistan. They face high levels of stigma, violence and sexual abuse. The average age of first sex was 11 years old and all reported having been been raped during childhood and early adolescence, often several times. While some mothers and siblings were quietly supportive, young feminised men often end up running away from home, finding support as a member of a hijra dera, a 'pseudo-household' led by an older feminised man or guru, in which they find employment as dancers or sex workers. After their entry into sex work there is little or no opportunity to use condoms. The hijra dera offer an important entry point for improved social support and sexual health programmes, including efforts to ensure young feminised men postpone their sexual debut and/or improve their sexual health, retain access to education, explore alternative forms of employment and improve access to health care.
Kohi, Thecla W; Makoae, Lucy; Chirwa, Maureen; Holzemer, William L; Phetlhu, Deliwe René; Uys, Leana; Naidoo, Joanne; Dlamini, Priscilla S; Greeff, Minrie
The situation and human rights of people living with HIV and AIDS were explored through focus groups in five African countries (Lesotho, Malawi, South Africa, Swaziland and Tanzania). A descriptive qualitative research design was used. The 251 informants were people living with HIV and AIDS, and nurse managers and nurse clinicians from urban and rural settings. NVivo software was used to identify specific incidents related to human rights, which were compared with the Universal Declaration of Human Rights. The findings revealed that the human rights of people living with HIV and AIDS were violated in a variety of ways, including denial of access to adequate or no health care/services, and denial of home care, termination or refusal of employment, and denial of the right to earn an income, produce food or obtain loans. The informants living with HIV and AIDS were also abused verbally and physically. Country governments and health professionals need to address these issues to ensure the human rights of all people.
When women face social and cultural inequality they inevitably bear increased HIV infection risks. The success of antiretroviral therapies in suppressing HIV's viral load and prolonging patient lives has made HIV a treatable chronic disease. Given the same follow-up treatments, research shows no significant differences between men and women in terms of either clinical, immunological or virological parameters at baseline or mortality after one year of antiretroviral therapy. Also, advances in assisted reproductive technologies now makes having HIV-free children possible for HIV couples. Gender equality and human right are essential to effective HIV prevention. Nurses must take all appropriate measures to eliminate discrimination against women in HIV prevention, treatment and care programs in order to ensure equal gender access to critical healthcare services.
Millions of people living with HIV/AIDS (PLHA) in Asia need access to palliative care as part of a comprehensive response to their support needs. There are many causes of pain in HIV/AIDS, and its prevalence is as high if not higher than in cancer, but it is frequently undertreated. Access to adequate pain relief and palliative care is impeded by the barriers which face PLHA in Asia. These include few care and support services, lack of recognition and acknowledgement of pain in HIV/AIDS by health care professionals, widespread stigma and discrimination especially towards vulnerable groups such as injecting drug users, government regulatory mechanisms which make access to opioids even more difficult for the care services which have developed and a lack of understanding of or advocacy for pain relief and palliative care in the literature on HIV/AIDS care and support. During the growth of palliative care in Asia, there is opportunity for advocates of palliative care and care for PLHA to collaborate to influence national policy.
Burnham, Kaylee E; Cruess, Dean G; Kalichman, Moira O; Grebler, Tamar; Cherry, Chauncey; Kalichman, Seth C
Gay, bisexual, and other men who have sex with men (MSM) remain the highest risk group for HIV infection. One reason is the increased use of the Internet to meet potential sex partners, which is associated with greater sexual risk behavior. To date, few studies have investigated psychosocial predictors of sexual risk behavior among gay and bisexual men seeking sex partners online. The purpose of the current study was to test a conceptual model of the relationships between trauma symptoms indexed on the event of HIV diagnosis, internalized HIV stigma, and social support on sexual risk behavior among gay and bisexual MSM who seek sex partners online. A sample of 142 gay and bisexual MSM recruited on- and offline completed a comprehensive online assessment battery assessing the factors noted above. A number of associations emerged; most notably internalized HIV stigma mediated the relationship between trauma-related symptoms indexed on the event of HIV diagnosis and sexual risk behavior with HIV-negative and unknown serostatus sex partners. This suggests that gay and bisexual MSM who are in greater distress over their HIV diagnosis and who are more sensitive to HIV stigma engage in more HIV transmission risk behavior. As sexual risk environments expand with the increasing use of the Internet to connect with others for sex, it is important to understand the predictors of sexual risk behavior so that tailored interventions can promote sexual health for gay and bisexual MSM seeking sex online.
Parsons, Janet A.; Bond, Virginia A.; Nixon, Stephanie A.
Background The advent of anti-retroviral therapy (ART) in Southern Africa holds the promise of shifting the experience of HIV toward that of a manageable chronic condition. However, this potential can only be realized when persons living with HIV are able to access services without barriers, which can include stigma. Our qualitative study explored experiences of persons living with disabilities (PWD) in Lusaka, Zambia who became HIV-positive (PWD/HIV+). Methods and Findings We conducted interviews with 32 participants (21 PWD/HIV+ and 11 key informants working in the fields of HIV and/or disability). Inductive thematic analysis of interview transcripts was informed by narrative theory. Participants’ accounts highlighted the central role of stigma experienced by PWD/HIV+, with stigmatizing attitudes closely linked to prevailing societal assumptions that PWD are asexual. Seeking diagnostic and treatment services for HIV was perceived as evidence of PWD being sexually active. Participants recounted that for PWD/HIV+, stigma was enacted in a variety of settings, including the queue for health services, their interactions with healthcare providers, and within their communities. Stigmatizing accounts told about PWD/HIV+ were described as having important consequences. Not only did participants recount stories of internalized stigma (with its damaging effects on self-perception), but also that negative experiences resulted in some PWD preferring to “die quietly at home” rather than being subjected to the stigmatizing gaze of others when attempting to access life-preserving ART. Participants recounted how experiences of stigma also affected their willingness to continue ART, their willingness to disclose their HIV status to others, as well as their social relations. However, participants also offered counter-stories, actively resisting stigmatizing accounts and portraying themselves as resilient and resourceful social actors. Conclusions The study highlights a
Fergusson, Pamela; Chikaphupha, Kingsley; Bongololo, Grace; Makwiza, Ireen; Nyirenda, Lot; Chinkhumba, Jobiba; Aslam, Anisa; Theobald, Sally
In Malawi, HIV and malnutrition are two of the most common causes of childhood morbidity and mortality. This qualitative study based in Nutrition Rehabilitation Units (NRU) in HIV-endemic Malawi explores caregiver's (staff and family) perspectives on quality of care for severely malnourished children. Three carer focus groups and 30 carer and staff in-depth interviews were conducted in two NRUs. The interviews and data analysis used a grounded theory approach, using both male and female Malawian researchers. Trustworthiness was enhanced through the researchers' prolonged engagement with the study setting and participants. The use of multiple methods - interviews, focus groups and observation - allowed for triangulation of the data. Data was then cross-referenced between staff and family caregiver reports. The analysis generated five themes. 'We have different blood' referring to staff attitudes and underperformance, 'What wrong did I do to God?' referring to stigma and chronic illness, 'My other children back home' referring to the carer's multiple responsibilities and challenges, 'Always in short supply' referring to resources available in the NRU (milk, medicine, space, hygiene) and 'you are always lagging behind' referring to the need for change and participants recommendations. Quality of care is a complex issue, bound by resources and capacity, influenced by stigma and hierarchy and limited by caregivers' conflicting responsibilities. Valuing and involving caregivers is essential in improving quality of care. Care should be patient and family centred and HIV services should be integrated into malnutrition care at the hospital and community level.
Haile, Rahwa; Padilla, Mark B.; Parker, Edith A.
In this paper, we analyse the life history narratives of 10 poor gay and bisexual Black men over the age of 50 living with HIV/AIDS in New York City, focusing on experiences of stigma. Three overarching themes are identified. First, participants described the ways in which stigma marks them as just one more body within social and medical institutions, emphasising the dehumanisation they experience in these settings. Second, respondents described the process of knowing your place within social hierarchies as a means through which they are rendered tolerable. Finally, interviewees described the dynamics of stigma as all-consuming, relegating them to the quagmire of an HIV ghetto. These findings emphasise that despite advances in treatment and an aging population of persons living with HIV, entrenched social stigmas continue to endanger the well-being of Black men who have sex with men. PMID:21229421
White, Worawan; Grant, Joan S; Pryor, Erica R; Keltner, Norman L; Vance, David E; Raper, James L
Social support, stigma, and social problem solving may be mediators of the relationship between sign and symptom severity and depressive symptoms in people living with HIV (PLWH). However, no published studies have examined these individual variables as mediators in PLWH. This cross-sectional, correlational study of 150 PLWH examined whether social support, stigma, and social problem solving were mediators of the relationship between HIV-related sign and symptom severity and depressive symptoms. Participants completed self-report questionnaires during their visits at two HIV outpatient clinics in the Southeastern United States. Using multiple regression analyses as a part of mediation testing, social support, stigma, and social problem solving were found to be partial mediators of the relationship between sign and symptom severity and depressive symptoms, considered individually and as a set.
Castro, Arachu; Farmer, Paul
For the past several years, diverse and often confused concepts of stigma have been invoked in discussions on AIDS. Many have argued compellingly that AIDS-related stigma acts as a barrier to voluntary counseling and testing. Less compelling are observations regarding the source of stigma or its role in decreasing interest in HIV care. We reviewed these claims as well as literature from anthropology, sociology, and public health. Preliminary data from research in rural Haiti suggest that the introduction of quality HIV care can lead to a rapid reduction in stigma, with resulting increased uptake of testing. Rather than stigma, logistic and economic barriers determine who will access such services. Implications for scale-up of integrated AIDS prevention and care are explored. PMID:15623859
Okoror, T A; Airhihenbuwa, C O; Zungu, M; Makofani, D; Brown, D C; Iwelunmor, J
The purpose of this study was to examine the role of food as an instrument in expressing and experiencing HIV/AIDS stigma by HIV-positive women and their families, with the goal of reducing discrimination. It goes beyond willingness to share utensils, which has been identified in HIV/AIDS research. As part of an ongoing capacity-building HIV/AIDS stigma project in South Africa, 25 focus groups and 15 key informant interviews were conducted among 195 women and 54 men in three Black communities. Participants were asked to discuss how they were treated in the family as women living with HIV and AIDS, and data was organized using the PEN-3 model. Findings highlight both the positive and negative experiences HIV-positive women encounter. Women would not disclose their HIV status to avoid being isolated from participating in the socio-cultural aspects of food preparation, while others that have disclosed their status have experienced alienation. The symbolic meanings of food should be a major consideration when addressing the elimination of HIV/AIDS stigma in South Africa.
Remien, Robert H.; Bauman, Laurie J.; Mantell, Joanne; Tsoi, Benjamin; Lopez-Rios, Javier; Chhabra, Rosy; DiCarlo, Abby; Watnick, Dana; Rivera, Angelic; Teitelman, Nehama; Cutler, Blayne; Warne, Patricia
Background Engagement in HIV care helps to maximize viral suppression, which, in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41% of all persons estimated to be living with HIV (PLWH) had a suppressed viral load, while nearly three-quarters of those in clinical care achieved viral suppression. Thus, retaining PLWH in HIV care addresses this central goal of both the US National HIV/AIDS Strategy and Governor Cuomo's plan to end the AIDS epidemic in New York State. Methods We conducted 80 in-depth qualitative interviews with PLWH in four NYC populations that were identified as being inconsistently engaged in HIV medical care: African immigrants, previously incarcerated adults, transgender women, and young men who have sex with men. Results Barriers to and facilitators of HIV care engagement fell into three domains: (1) system factors (e.g., patient-provider relationship, social service agencies, transitions between penal system and community); (2) social factors (e.g., family and other social support; stigma related to HIV, substance use, sexual orientation, gender identity, and incarceration); and (3) individual factors (e.g., mental illness, substance use, resilience). Similarities and differences in these themes across the four populations as well as research and public health implications were identified. Conclusions Engagement in care is maximized when the social challenges confronted by vulnerable groups are addressed; patient-provider communication is strong; and coordinated services are available, including housing, mental health and substance use treatment, and peer navigation. PMID:25867774
Shrestha, Roman; Copenhaver, Michael; Bazazi, Alexander R; Huedo-Medina, Tania B; Krishnan, Archana; Altice, Frederick L
Although it is well established that HIV-related stigma, depression, and lack of social support are negatively associated with health-related quality of life (HRQoL) among people living with HIV (PLH), no studies to date have examined how these psychosocial factors interact with each other and affect HRQoL among incarcerated PLH. We, therefore, incorporated a moderated mediation model (MMM) to explore whether depression mediates the effect of HIV-related stigma on HRQoL as a function of the underlying level of social support. Incarcerated HIV-infected men with opioid dependence (N = 301) were recruited from the HIV units in Kajang prison in Malaysia. Participants completed surveys assessing demographic characteristics, HIV-related stigma, depression, social support, and HRQoL. Results showed that the effect of HIV-related stigma on HRQoL was mediated via depression (a1:β = 0.1463, p < 0.001; b1:β = -0.8392, p < 0.001), as demonstrated by the two-tailed significance test (Sobel z = -3.8762, p < 0.001). Furthermore, the association between social support and HRQoL was positive (β = 0.4352, p = 0.0433), whereas the interaction between HIV-related stigma and depression was negatively associated with HRQOL (β = -0.0317, p = 0.0133). This indicated that the predicted influence of HIV-related stigma on HRQoL via depression had negative effect on HRQoL for individuals with low social support. The results suggest that social support can buffer the negative impact of depression on HRQoL and highlights the need for future interventions to target these psychosocial factors in order to improve HRQoL among incarcerated PLH.
Smith, Whitney; Cohen, Mardge H.; Wilson, Tracey E.; Adimora, Adaora A.; Merenstein, Daniel; Adedimeji, Adebola; Wentz, Eryka L.; Foster, Antonina G.; Metsch, Lisa; Tien, Phyllis C.; Weiser, Sheri D.; Turan, Janet M.
Background: Internalization of HIV-related stigma may inhibit a person's ability to manage HIV disease through adherence to treatment regimens. Studies, mainly with white men, have suggested an association between internalized stigma and suboptimal adherence to antiretroviral therapy (ART). However, there is a scarcity of research with women of different racial/ethnic backgrounds and on mediating mechanisms in the association between internalized stigma and ART adherence. Methods: The Women's Interagency HIV Study (WIHS) is a multicenter cohort study. Women living with HIV complete interviewer-administered questionnaires semiannually. Cross-sectional analyses for the current article included 1168 women on ART for whom data on medication adherence were available from their last study visit between April 2013 and March 2014, when the internalized stigma measure was initially introduced. Results: The association between internalized stigma and self-reported suboptimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.69, P = 0.009, 95% CI: 0.52 to 0.91), but not for non-Hispanic whites (AOR = 2.15, P = 0.19, 95% CI: 0.69 to 6.73). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and suboptimal adherence in the whole sample, as well as in the subsample of minority participants. In serial mediation models, internalized stigma predicted less-perceived social support (or higher loneliness), which in turn predicted more depressive symptoms, which in turn predicted suboptimal medication adherence. Conclusions: Findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multifaceted interventions addressing both mental health and interpersonal factors, especially for minority women. PMID:26885803
Abara, Winston E; Garba, Ibrahim
Recent research has presented evidence that men who have sex with men (MSM) bear a disproportionate burden of HIV and are at increased risk for HIV in sub-Saharan Africa (SSA). However, many countries in SSA have failed to address the needs of MSM in national HIV/AIDS programmes. Furthermore, many MSM face structural barriers to HIV prevention and care, the most significant of which include laws that criminalise male-to-male sexual contact and facilitate stigma and discrimination. This in turn increases the vulnerability of MSM to acquiring HIV and presents barriers to HIV prevention, care, and surveillance. This relationship illustrates the link between human rights, social justice, and health outcomes and presents considerable challenges to addressing the HIV epidemic among MSM in SSA. The response to the HIV epidemic in SSA requires a non-discriminatory human rights approach to all at-risk groups, including MSM. Existing international human rights treaties, to which many SSA countries are signatories, and a 'health in all policies' approach provides a strong basis to reduce structural barriers to HIV prevention, care, surveillance, and research, and to ensure that all populations in SSA, including MSM, have access to the full range of rights that help ensure equal opportunities for health and wellness.
Berendes, Sima; Rimal, Rajiv N
This study was carried out to test the hypothesis that HIV-related stigma would function as a barrier to uptake of HIV testing and that knowledge and self-efficacy would serve as facilitators. We also hypothesized that exposure to a behavior-change campaign would be associated with lower levels of stigma and higher levels of knowledge and self-efficacy. We conducted two separate cross-sectional surveys as part of the Malawi BRIDGE Project, including one at baseline in eight districts (n = 891), and another at mid-term in four districts in Malawi (n = 881). HIV-related knowledge, self-efficacy, and lack of stigma were positively associated with HIV testing. A positive association was also found between program exposure, on one hand, and knowledge, self-efficacy, and lack of stigma, on the other. These findings suggest that important psychosocial variables are linked with people's likelihood of HIV testing, and that these variables may be influenced by behavior-change programs.
... and Care in the United States Through the HIV Care Continuum Initiative #0; #0; #0; Presidential... Improvements in HIV Prevention and Care in the United States Through the HIV Care Continuum Initiative By the... increasing the use of evidence-based approaches to prevention and care among populations and in regions...
Reyes, Emily; Levine, Elizabeth A.; Khan, Shah Z.; Garduño, L. Sergio; Donastorg, Yeycy; Hammer, Scott M.; Brudney, Karen; Hirsch, Jennifer S.
Abstract Migration and geographic mobility increase risk for HIV infection and may influence engagement in HIV care and adherence to antiretroviral therapy. Our goal is to use the migration-linked communities of Santo Domingo, Dominican Republic, and New York City, New York, to determine the impact of geographic mobility on HIV care engagement and adherence to treatment. In-depth interviews were conducted with HIV+Dominicans receiving antiretroviral therapy, reporting travel or migration in the past 6 months and key informants (n=45). Mobility maps, visual representations of individual migration histories, including lifetime residence(s) and all trips over the past 2 years, were generated for all HIV+ Dominicans. Data from interviews and field observation were iteratively reviewed for themes. Mobility mapping revealed five distinct mobility patterns: travel for care, work-related travel, transnational travel (nuclear family at both sites), frequent long-stay travel, and vacation. Mobility patterns, including distance, duration, and complexity, varied by motivation for travel. There were two dominant barriers to care. First, a fear of HIV-related stigma at the destination led to delays seeking care and poor adherence. Second, longer trips led to treatment interruptions due to limited medication supply (30-day maximum dictated by programs or insurers). There was a notable discordance between what patients and providers perceived as mobility-induced barriers to care and the most common barriers found in the analysis. Interventions to improve HIV care for mobile populations should consider motivation for travel and address structural barriers to engagement in care and adherence. PMID:24839872
Taylor, Barbara S; Reyes, Emily; Levine, Elizabeth A; Khan, Shah Z; Garduño, L Sergio; Donastorg, Yeycy; Hammer, Scott M; Brudney, Karen; Hirsch, Jennifer S
Migration and geographic mobility increase risk for HIV infection and may influence engagement in HIV care and adherence to antiretroviral therapy. Our goal is to use the migration-linked communities of Santo Domingo, Dominican Republic, and New York City, New York, to determine the impact of geographic mobility on HIV care engagement and adherence to treatment. In-depth interviews were conducted with HIV+Dominicans receiving antiretroviral therapy, reporting travel or migration in the past 6 months and key informants (n=45). Mobility maps, visual representations of individual migration histories, including lifetime residence(s) and all trips over the past 2 years, were generated for all HIV+ Dominicans. Data from interviews and field observation were iteratively reviewed for themes. Mobility mapping revealed five distinct mobility patterns: travel for care, work-related travel, transnational travel (nuclear family at both sites), frequent long-stay travel, and vacation. Mobility patterns, including distance, duration, and complexity, varied by motivation for travel. There were two dominant barriers to care. First, a fear of HIV-related stigma at the destination led to delays seeking care and poor adherence. Second, longer trips led to treatment interruptions due to limited medication supply (30-day maximum dictated by programs or insurers). There was a notable discordance between what patients and providers perceived as mobility-induced barriers to care and the most common barriers found in the analysis. Interventions to improve HIV care for mobile populations should consider motivation for travel and address structural barriers to engagement in care and adherence.
Ransome, Yusuf; Kawachi, Ichiro; Dean, Lorraine T
High neighborhood social capital could facilitate earlier diagnosis of HIV and higher rates of linkage and HIV care engagement. Multivariate analysis was used to examine whether social capital (social cohesion, social participation, and collective engagement) in 2004/2006 was associated with lower 5-year average (2007-2011) prevalence of (a) late HIV diagnosis, (b) linked to HIV care, and (c) engaged in HIV care within Philadelphia, PA, United States. Census tracts (N = 332). Higher average neighborhood social participation was associated with higher prevalence of late HIV diagnosis (b = 1.37, se = 0.32, p < 0.001), linked to HIV care (b = 1.13, se = 0.20, p < 0.001) and lower prevalence of engaged in HIV care (b = -1.16, se = 0.30, p < 0.001). Higher collective engagement was associated with lower prevalence of linked to HIV care (b = -0.62, se = 0.32, p < 0.05).The findings of different directions of associations among social capital indicators and HIV-related outcomes underscore the need for more nuanced research on the topic that include longitudinal assessment across key populations.
Espínola-Nadurille, Mariana; Crail-Melendez, Daniel; Sánchez-Guzmán, Maria Alejandra
Epilepsy is a neurological disorder with neurobiological, cognitive, psychological, and social consequences. Epilepsy stigma is a social determinant of ill health that affects the quality of life of people who suffer from epilepsy and that renders a poor social prognosis even worse than the clinical one. From a phenomenological approach, between January and July 2011, we explored the experience of epilepsy stigma through 25 in-depth qualitative interviews with 10 persons with temporal lobe epilepsy (PWE) (we avoided terms such as "epileptics" or "epileptic patients" because they can be labeling and stigmatizing), 10 carers (CEs) of PWE who attended the epilepsy clinic of the Institute of Neurology and Neurosurgery of Mexico, and 5 physicians specialized in epilepsy. The objective of the study was to identify the following: perceptions that could indicate any form of discrimination due to having epilepsy, reactions of people in front of a person having seizures, and social functioning of PWE since epilepsy onset, particularly their interpersonal relationships and participation in educational or working activities. Through the health providers' narratives, we explored the mainstream care practices, their perspectives on epilepsy, and their views about how the disease should be addressed. Thematic guidelines were elaborated for each type of participant. All information was processed with the use of the computer-assisted data analysis, Atlas.ti5. We made a codification of broad themes that corresponded to the main topics of the interview guidelines and then proceeded to finer categorization to elaborate the analytical categories. Epilepsy was attached to a powerful stereotype that includes notions of contamination, danger, sin, divine punishment, supernatural forces, and madness. Internalized, interpersonal, and institutional stigma prevents PWE from participating in school and employment and reduces their opportunities to establish peer and couple relationships
Franse, Carmen B; Kayigamba, Felix R; Bakker, Mirjam I; Mugisha, Veronicah; Bagiruwigize, Emmanuel; Mitchell, Kirstin R; Asiimwe, Anita; Schim van der Loeff, Maarten F
HIV testing and counselling forms the gateway to the HIV care and treatment continuum. Therefore, the World Health Organization recommends provider-initiated testing and counselling (PITC) in countries with a generalized HIV epidemic. Few studies have investigated linkage-to-HIV-care among out-patients after PITC. Our objective was to study timely linkage-to-HIV-care in six Rwandan health facilities (HFs) before and after the introduction of PITC in the out-patient departments (OPDs). Information from patients diagnosed with HIV was abstracted from voluntary counselling and testing, OPD and laboratory registers of six Rwandan HFs during three-month periods before (March-May 2009) and after (December 2009-February 2010) the introduction of PITC in the OPDs of these facilities. Information on patients' subsequent linkage-to-pre-antiretroviral therapy (ART) care and ART was abstracted from ART clinic registers of each HF. To triangulate the findings from HF routine, a survey was held among patients to assess reasons for non-enrolment. Of 635 patients with an HIV diagnosis, 232 (36.5%) enrolled at the ART clinic within 90 days of diagnosis. Enrolment among out-patients decreased after the introduction of PITC (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.2; p = .051). Survey findings showed that retesting for HIV among patients already diagnosed and enrolled into care was not uncommon. Patients reported non-acceptance of disease status, stigma and problems with healthcare services as main barriers for enrolment. Timely linkage-to-HIV-care was suboptimal in this Rwandan study before and after the introduction of PITC; the introduction of PITC in the OPD may have had a negative impact on linkage-to-HIV-care. Healthier patients tested through PITC might be less ready to engage in HIV care. Fear of HIV stigma and mistrust of test results appear to be at the root of these problems.
Parker, Caroline M; Garcia, Jonathan; Philbin, Morgan M; Wilson, Patrick A; Parker, Richard G; Hirsch, Jennifer S
Black men who have sex with men in the USA face disproportionate incidence rates of HIV. This paper presents findings from an ethnographic study conducted in New York City that explored the structural and socio-cultural factors shaping men's sexual relationships with the goal of furthering understandings of their HIV-related vulnerability. Methods included participant observation and in-depth interviews with 31 Black men who have sex with men (three times each) and 17 key informants. We found that HIV vulnerability is perceived as produced through structural inequalities including economic insecurity, housing instability, and stigma and discrimination. The theoretical concepts of social risk, intersectional stigma, and the social production of space are offered as lenses through which to analyse how structural inequalities shape HIV vulnerability. We found that social risk shaped HIV vulnerability by influencing men's decisions in four domains: 1) where to find sexual partners, 2) where to engage in sexual relationships, 3) what kinds of relationships to seek, and 4) whether to carry and to use condoms. Advancing conceptualisations of social risk, we show that intersectional stigma and the social production of space are key processes through which social risk generates HIV vulnerability among Black men who have sex with men.
Guise, Andy; Rhodes, Tim; Ndimbii, James; Ayon, Sylvia; Nnaji, Obiora
People who inject drugs (PWID) experience a range of barriers to HIV treatment and care access. The Kenyan government and community-based organisations have sought to develop HIV care for PWID. A principal approach to delivery in Kenya is to provide care from clinics serving the general population and for this to be linked to support from community-based organisations providing harm reduction outreach. This study explores accounts of PWID accessing care in Kenya to identify care barriers and facilitators. PWID accounts were collected within a qualitative longitudinal study. In-depth interviews with PWID living with HIV (n = 44) are combined with interviews with other PWID, care providers and community observation. Results show that some PWID are able to access care successfully, whilst other PWID report challenges. The results focus on three principal themes to give insights into these experiences: the hardship of addiction and the costs of care, the silencing of HIV in the community and then discrimination and support in the clinic. Some PWID are able to overcome, often with social and outreach support, barriers to clinic access; for others, the challenges of addiction, hardship, stigma and discrimination are too constraining. We discuss how clinics serving the general population could be further adapted to increase access. Clinic-based care, even with community links, may, however, be fundamentally challenging for some PWID to access. Additional strategies to develop stand-alone care for PWID and also decentralise HIV treatment and care to community settings and involve peers in delivery should be considered.
Peris, Tara S; Teachman, Bethany A; Nosek, Brian A
This study examined implicit and explicit measures of bias toward mental illness among people with different levels of mental health training, and investigated the influence of stigma on clinically-relevant decision-making. Participants (N = 1539) comprised of (1) mental health professionals and clinical graduate students, (2) other health care/social services specialists, (3) undergraduate students, and (4) the general public self-reported their attitudes toward people with mental illness, and completed implicit measures to assess mental illness evaluations that exist outside of awareness or control. In addition, participants predicted patient prognoses and assigned diagnoses after clinical vignettes. Compared with people without mental health training, individuals with mental health training demonstrated more positive implicit and explicit evaluations of people with mental illness. Further, explicit (but not implicit) biases predicted more negative patient prognoses, but implicit (and not explicit) biases predicted over-diagnosis, underscoring the value of using both implicit and explicit measures.
McDonald, R; Free, D; Ross, F; Mitchell, P
This study was concerned with preferences for inpatient models of care by the HIV/AIDS client group, in particular the difference between gay white men (European) and black heterosexuals of African/Caribbean origin. Satisfaction with the care currently provided was also an area of interest. Thirteen per cent (n = 79) of the were surveyed. Seventy per cent (n = 56) of the HIV/AIDS client group indicated a preference for a dedicated care model. Significant results were obtained demonstrating differences in the care model preferred by gay white men and black heterosexuals (p < 0.01). Gay white men were much more likely to state they would leave the trust to receive dedicated care (p < 0.01). Black heterosexuals were more likely to state that they would change treatment areas to avoid dedicated care (p < 0.01) Differences in concern about confidentiality were noted between the two groups. Confidentiality may be one of a number of factors influencing preference of care for African/Caribbeans and this needs to be studied further. The clients surveyed were not universally satisfied with the care they had been receiving. Following the results of the survey radical changes in the management of HIV inpatient care were made.
Ojikutu, Bisola; Nnaji, Chioma; Sithole, Juliet; Schneider, Karen L; Higgins-Biddle, Molly; Cranston, Kevin; Earls, Felton
Non-U.S.-born black individuals comprise a significant proportion of the new diagnoses of HIV in the United States. Concurrent diagnosis (obtaining an AIDS diagnosis in close proximity to an initial diagnosis of HIV) is common in this subpopulation. Although efforts have been undertaken to increase HIV testing among African Americans, little is known about testing patterns among non-U.S.-born black people. A cross-sectional survey was self-administered by 1060 black individuals in Massachusetts (57% non-U.S.-born) to assess self-reported rates of HIV testing, risk factors, and potential barriers to testing, including stigma, knowledge, immigration status, and access to health care. Bivariate analysis comparing responses by birthplace and multivariate logistic regression assessing correlates of recent testing were completed. Non-U.S.-born individuals were less likely to report recent testing than U.S.-born (41.9% versus 55.6%, p<0.0001). Of those who recently tested, the majority did so for immigration purposes, not because of perceived risk. Stigma was significantly higher and knowledge lower among non-U.S.-born individuals. In multivariate analysis, greater length of time since immigration was a significant predictor of nontesting among non-U.S.-born (adjusted odds ratio [AOR] 0.56, 95% confidence interval [CI] 0.36-0.87). Poor health care access and older age were correlated to nontesting in both U.S.- and non-U.S.-born individuals. Our findings indicate that differences in HIV testing patterns exist by nativity. Efforts addressing unique factors limiting testing in non-U.S.-born black individuals are warranted.
... Occupational Health Occupational Exposure to HIV: Advice for Health Care Workers Occupational Exposure to HIV: Advice for Health Care Workers Occupational HealthPrevention and WellnessStaying Healthy Share Occupational ...
Kertz, Barbara L.; Cully, Jeffery A.; Stanley, Melinda A.; Davila, Jessica A.; Dang, Bich N.; Rodriguez-Barradas, Maria C.; Giordano, Thomas P.
Poor retention in HIV medical care is associated with increased mortality among patients with HIV/AIDS. Developing new interventions to improve retention in HIV primary care is needed. The Department of Veteran Affairs (VA) is the largest single provider of HIV care in the US. We sought to understand what veterans would want in an intervention to improve retention in VA HIV care. We conducted 18 one-on-one interviews and 15 outpatient focus groups with 46 patients living with HIV infection from the Michael E. DeBakey VAMC (MEDVAMC). Analysis identified three focus areas for improving retention in care: developing an HIV friendly clinic environment, providing mental health and substance use treatment concurrent with HIV care and encouraging peer support from other Veterans with HIV. PMID:26829641
Kester, Rachel; Braga, Patrícia Emília; Peluso, Érica T. P.; Blay, Sérgio L.; R. Menezes, Paulo; E. Ribeiro, Euler
This study investigates three domains of public stigma (perceived negative reactions, perceived discrimination, and dangerousness) against older adults with depression. The sample comprised of older adults registered with primary care clinics (n = 1,291) and primary health care professionals (n = 469) from São Paulo and Manaus, Brazil. Participants read a vignette describing a 70-year-old individual (Mary or John) with a depressive disorder and answered questions measuring stigma. The prevalence of the three stigma domains was between 30.2 and 37.6% among older participants from São Paulo and between 27.6 and 35.4% among older participants from Manaus. Older adults from both cities reported similar prevalence of perceived stigma. Key factors associated with stigmatizing beliefs among older participants were reporting depressive symptoms, having physical limitations, and identifying the case of the vignette as a case of mental disorder. Among health professionals, the prevalence of the three stigma domains was between 19.8 and 34.8% in São Paulo and 30.2 and 44.6% in Manaus. The key factor associated with stigma among primary health care professionals was city, with consistently higher risk in Manaus than in São Paulo. Findings confirm that public stigma against older adults in Brazil is common. It is important to educate the public and primary health care providers in Brazil on stigma related to mental illness in order to reduce barriers to adequate mental health treatment. PMID:27352293
Scazufca, Marcia; P de Paula Couto, Maria Clara; Huang, Hsiang; Kester, Rachel; Braga, Patrícia Emília; Peluso, Érica T P; Blay, Sérgio L; R Menezes, Paulo; E Ribeiro, Euler
This study investigates three domains of public stigma (perceived negative reactions, perceived discrimination, and dangerousness) against older adults with depression. The sample comprised of older adults registered with primary care clinics (n = 1,291) and primary health care professionals (n = 469) from São Paulo and Manaus, Brazil. Participants read a vignette describing a 70-year-old individual (Mary or John) with a depressive disorder and answered questions measuring stigma. The prevalence of the three stigma domains was between 30.2 and 37.6% among older participants from São Paulo and between 27.6 and 35.4% among older participants from Manaus. Older adults from both cities reported similar prevalence of perceived stigma. Key factors associated with stigmatizing beliefs among older participants were reporting depressive symptoms, having physical limitations, and identifying the case of the vignette as a case of mental disorder. Among health professionals, the prevalence of the three stigma domains was between 19.8 and 34.8% in São Paulo and 30.2 and 44.6% in Manaus. The key factor associated with stigma among primary health care professionals was city, with consistently higher risk in Manaus than in São Paulo. Findings confirm that public stigma against older adults in Brazil is common. It is important to educate the public and primary health care providers in Brazil on stigma related to mental illness in order to reduce barriers to adequate mental health treatment.
Daniel, O J; Oladapo, O T
A survey of 333 pregnant women receiving antenatal care at the primary healthcare centres in Sagamu Local Government Area of Ogun State, southwest Nigeria was conducted between January and March 2005 to assess the acceptability of prenatal HIV screening among them. A total of 325 (97.8%) of the respondents were aware of HIV/AIDS but only 181 (54.3%) of them believed it is a problem in Nigeria. A total of 257 (77.2%) respondents agreed to undergo voluntary counselling and HIV testing (VCT). Multivariate logistic regression analysis of associated factors indicated that being married, self-perception of no risk of HIV infection, awareness of benefits of prenatal HIV testing and Christianity are independent predictors of acceptance of prenatal HIV testing in this population. Most of the respondents (78.9%) who were unwilling to take the test cited fear of being infected with its consequences of stigma and discrimination as the reason for their attitude. The survey suggests that a successful integration of VCT programme into the existing primary healthcare services for prevention of vertical HIV transmission is feasible in this part of Nigeria.
Background In Gambella region, inhabitants owe socio-cultural factors that might favor refusal for HIV testing service utilization among Antenatal Care attendees. Objective To assess determinants for refusal of HIV testing service utilization among ANC attendees in Gambella Region. Methods A comparative cross sectional study was conducted among ANC attendees from March 2008 to May 2008 in four selected health facilities of Gambella region. Sample size of 332 participants (83 who refused HIV testing and 249 who accepted HIV testing) were taken for the study. The study was supplemented with four focus group discussions. Multivariate binary logistic regression was employed to control for confounding factors. Results When adjusted with other factors pregnant women with 2–3 live births in the past; who claimed divorce as a perceived response of their husband following HIV positive test result; who had not sought agreement from their husband for testing; disclosure of test for husband and being from certain ethnic group (E.g. Mejenger) were independent predictors for refusal of HIV testing among ANC attendees. Conclusion and recommendation Based on the findings, the following recommendations were forwarded: Provision of innovative information and education on the pre-test session for those pregnant women having two or more children; community involvement to tackle stigma; women empowerment; designing couple friendly counseling service; and fighting harmful traditional practices related with decision of HIV testing. PMID:22834566
Mhode, Maisara; Nyamhanga, Tumaini
Background. The impact of stigma on adherence to antiretroviral therapy (ART) has been less studied in Tanzania. Recent studies indicate that people on ART still experience stigma. Qualitative information on the subject matter is especially insufficient. Objective. This paper reports on the dimensions of stigma and discrimination and their impact on adherence to ART as experienced by people living with HIV (PLHIV). Design. A phenomenological approach was used to gather information on the lived experiences of stigma and discrimination. The sample size was determined according to the saturation principle. Results. Respondents experienced different forms of HIV-related stigma such as verbal, social, and perceived stigma. Various forms of discrimination were experienced, including relational discrimination, mistreatment by health care workers, blame and rejection by spouses, and workplace discrimination. HIV-related stigma and discrimination compromised ART adherence by reinforcing concealment of HIV status and undermining social suppport. Conclusion. After nearly a decade of increasing the provision of ART in Tanzania, PLHIV still experience stigma and discrimination; these experiences still appear to have a negative impact on treatment adherence. Efforts to reduce stigma and discrimination remain relevant in the ART period and should be given more impetus in order to maximize positive treatment outcomes. PMID:27110395
O'Toole, Thomas P; Johnson, Erin E; Redihan, Stephan; Borgia, Matthew; Rose, Jennifer
We describe data from a multi-center community-based survey of homeless veterans who were not accessing available primary care to identify reasons for not getting this care as well as for not seeking health care when it was needed. Overall, 185 homeless veterans were interviewed: The average age was 48.7 years (SD 10.8), 94.6% were male, 43.2% were from a minority population. The majority identified a recent need for care and interest in having a primary care provider. Reasons for delaying care fell into three domains: 1) trust; 2) stigma; and 3) care processes. Identifying a place for care (OR 3.3; 95% CI: 1.4-7.7), having a medical condition (OR 5.5; 95% CI 1.9-15.4) and having depression (OR 3.4; 95% CI: 1.4-8.7) were associated with receiving care while not being involved in care decisions was associated with no care (OR 0.7; 95% CI 0.5-0.9). Our findings support the importance of considering health access within an expanded framework that includes perceived stigma, inflexible care systems and trust issues.
Hewlett, Indira K.
Effective prevention of HIV/AIDS requires early diagnosis, initiation of therapy, and regular plasma viral load monitoring of the infected individual. In addition, incidence estimation using accurate and sensitive assays is needed to facilitate HIV prevention efforts in the public health setting. Therefore, more affordable and accessible point-of-care (POC) technologies capable of providing early diagnosis, HIV viral load measurements, and CD4 counts in settings where HIV is most prevalent are needed to enable appropriate intervention strategies and ultimately stop transmission of the virus within these populations to achieve the future goal of an AIDS-free generation. This review discusses the available and emerging POC technologies for future application to these unmet public health needs. PMID:24579041
Laisaar, Kaja-Triin; Raag, Mait; Lutsar, Irja; Uusküla, Anneli
Estonia had the highest rate of newly diagnosed human immunodeficiency virus (HIV) cases in the European Union (24.6/100,000) and an estimated adult HIV prevalence of 1.3% in 2013. HIV medical care, including antiretroviral therapy (ART), is free of charge for people living with HIV (PLHIV). To maximise the health benefits of HIV treatment, universal access should be achieved. Using data from surveillance and administrative databases and the treatment cascade model, we assessed the number of people infected with HIV, diagnosed with HIV, linked to HIV care, retained in HIV care, on ART, and with suppressed viral load (HIV-RNA: < 200 copies/mL). We identified that about one quarter of the 8,628 HIV-positive people estimated to live in Estonia in 2013 had not been diagnosed with HIV, and another quarter, although aware of their HIV-positive serostatus, had not accessed HIV medical care. Although altogether only 12–15% of all PLHIV in Estonia had achieved viral suppression, the main gap in HIV care in Estonia were the 58% of PLHIV who had accessed HIV medical care at least once after diagnosis but were not retained in care in 2013. PMID:27813471
Laisaar, Kaja-Triin; Raag, Mait; Lutsar, Irja; Uusküla, Anneli
Estonia had the highest rate of newly diagnosed human immunodeficiency virus (HIV) cases in the European Union (24.6/100,000) and an estimated adult HIV prevalence of 1.3% in 2013. HIV medical care, including antiretroviral therapy (ART), is free of charge for people living with HIV (PLHIV). To maximise the health benefits of HIV treatment, universal access should be achieved. Using data from surveillance and administrative databases and the treatment cascade model, we assessed the number of people infected with HIV, diagnosed with HIV, linked to HIV care, retained in HIV care, on ART, and with suppressed viral load (HIV-RNA: < 200 copies/mL). We identified that about one quarter of the 8,628 HIV-positive people estimated to live in Estonia in 2013 had not been diagnosed with HIV, and another quarter, although aware of their HIV-positive serostatus, had not accessed HIV medical care. Although altogether only 12-15% of all PLHIV in Estonia had achieved viral suppression, the main gap in HIV care in Estonia were the 58% of PLHIV who had accessed HIV medical care at least once after diagnosis but were not retained in care in 2013.
Ungar, Thomas; Knaak, Stephanie; Szeto, Andrew C H
Reducing the stigma and discrimination associated with mental illness is becoming an increasingly important focus for research, policy, programming and intervention work. While it has been well established that the healthcare system is one of the key environments in which persons with mental illnesses experience stigma and discrimination there is little published literature on how to build and deliver successful anti-stigma programs in healthcare settings, towards healthcare providers in general, or towards specific types of practitioners. Our paper intends to address this gap by providing a set of theoretical considerations for guiding the design and implementation of anti-stigma interventions in healthcare.
Portillo, Carmen J; Stringari-Murray, Suzan; Fox, Christopher B; Monasterio, Erica; Rose, Carol Dawson
The increasing demand for primary care services and the current health care workforce shortage is predicted to cause drastic reductions in the number of clinicians who are competent to provide HIV care. For the past decade, the University of California, San Francisco (UCSF) School of Nursing has provided HIV specialty education for Advanced Practice Nursing students in the Master's curriculum. In 2013, UCSF was funded by the Health Resources Services Administration to establish a nurse practitioner (NP) HIV primary care education program to expand the number of NPs prepared to provide culturally appropriate comprehensive HIV primary care. To this end, UCSF faculty have developed and validated a set of HIV Primary Care entry-level NP competencies, integrated general HIV knowledge into the NP curriculum, and enhanced our current HIV Specialty curriculum and clinical training. Described herein is UCSF's Integrated HIV/AIDS Primary Care Capacity Nurse Practitioner Program.
Fisher, Jeffrey D.; Cunningham, Chinazo O.; Amico, K. Rivet
Abstract The current study provides a qualitative test of a recently proposed application of an Information, Motivation, Behavioral Skills (IMB) model of health behavior situated to the social-environmental, structural, cognitive-affective, and behavioral demands of retention in HIV care. Mixed-methods qualitative analysis was used to identify the content and context of critical theory-based determinants of retention in HIV care, and to evaluate the relative fit of the model to the qualitative data collected via in-depth semi-structured interviews with a sample of inner-city patients accessing traditional and nontraditional HIV care services in the Bronx, NY. The sample reflected a diverse marginalized patient population who commonly experienced comorbid chronic conditions (e.g., psychiatric disorders, substance abuse disorders, diabetes, hepatitis C). Through deductive content coding, situated IMB model-based content was identified in all but 7.1% of statements discussing facilitators or barriers to retention in HIV care. Inductive emergent theme identification yielded a number of important themes influencing retention in HIV care (e.g., acceptance of diagnosis, stigma, HIV cognitive/physical impairments, and global constructs of self-care). Multiple elements of these themes strongly aligned with the model's IMB constructs. The convergence of the results from both sets of analysis demonstrate that participants' experiences map well onto the content and structure of the situated IMB model, providing a systematic classification of important theoretical and contextual determinants of retention in care. Future intervention efforts to enhance retention in HIV care should address these multiple determinants (i.e., information, motivation, behavioral skills) of self-directed retention in HIV care. PMID:22612447
Silverman, Michael J
Stigma is a major social barrier that can restrict access to and willingness to seek psychiatric care. Psychiatric consumers may use secrecy and withdrawal in an attempt to cope with stigma. The purpose of this study was to determine the effects of music therapy on self- and experienced stigma in acute care psychiatric inpatients using a randomized design with wait-list control. Participants (N=83) were randomly assigned by cluster to one of three single-session group-based conditions: music therapy, education, or wait-list control. Participants in the music therapy and education conditions completed only posttests while participants in the wait-list control condition completed only pretests. The music therapy condition was a group songwriting intervention wherein participants composed lyrics for "the stigma blues." Results indicated significant differences in measures of discrimination (experienced stigma), disclosure (self-stigma), and total stigma between participants in the music therapy condition and participants in the wait-list control condition. From the results of this randomized controlled investigation, music therapy may be an engaging and effective psychosocial technique to treat stigma. Limitations, suggestions for future research, and implications for clinical practice and psychiatric music therapy research are provided.
Nyblade, Laura; Stockton, Melissa; Nyato, Daniel; Wamoyi, Joyce
Young people - particularly girls and young women in sub-Saharan Africa - face significant challenges accessing sexual and reproductive health information and services. These challenges are shaped in part by sociocultural factors, including stigma. This paper presents findings from a qualitative study that explored the micro-level social process of stigma surrounding young people's sexual and reproductive health in two communities in Tanzania. Respondents described an environment of pervasive stigma surrounding the sexual and reproductive health of unmarried young people. Stigma manifested itself in multiple forms, ranging from verbal harassment and social isolation to physical punishment by families, community members, peers and healthcare providers. Respondents perceived that stigma was a barrier to young people accessing sexual and reproductive health services and identified excessive questioning, scolding and requirements to bring sexual partners or parents to receive services at health facilities as obstacles to accessing care. The pervasiveness and complexities of stigma surrounding young people's sexual and reproductive health in the two study communities and its potential consequences for health suggest both a need for care in using the term stigma as well as further studies on the feasibility of incorporating stigma-reduction strategies into young people's sexual and reproductive health programmes.
Phillips, Rachel; Benoit, Cecilia
Stigma by association, also referred to as “courtesy stigma,” involves public disapproval evoked as a consequence of associating with stigmatized persons. While a small number of sociological studies have shown how stigma by association limits the social support and social opportunities available to family members, there is a paucity of research examining this phenomenon among the large network of persons who provide health and social services to stigmatized groups. This paper presents results from a primarily qualitative study of the work-place experiences of a purposive sample of staff from an organization providing services to sex workers. The findings suggest that stigma by association has an impact on staff health because it shapes both the workplace environment as well as staff perceptions of others' support. At the same time, it is evident that some staff, owing to their more advantaged social location, are better able to manage courtesy stigma than others. PMID:24289946
Phillips, Rachel; Benoit, Cecilia
Stigma by association, also referred to as "courtesy stigma," involves public disapproval evoked as a consequence of associating with stigmatized persons. While a small number of sociological studies have shown how stigma by association limits the social support and social opportunities available to family members, there is a paucity of research examining this phenomenon among the large network of persons who provide health and social services to stigmatized groups. This paper presents results from a primarily qualitative study of the work-place experiences of a purposive sample of staff from an organization providing services to sex workers. The findings suggest that stigma by association has an impact on staff health because it shapes both the workplace environment as well as staff perceptions of others' support. At the same time, it is evident that some staff, owing to their more advantaged social location, are better able to manage courtesy stigma than others.
Kutzen, H S
Nurses in AIDS care need to support patients and promote patient autonomy throughout the continuum of HIV/AIDS. Nurses are essential for assisting patients and family members in making difficult treatment decisions, including choices regarding death. Discussions of end of life issues should be postponed until the patient demonstrates active signs and symptoms of approaching death. These discussions require expert knowledge of subtle cues and knowledge of advancing disease, as well as options for improved symptom management without focusing on curative aspects of care. Through these discussions, the nurse empowers the family in decision making while realizing patients and loved ones are still faced with existential or spiritual crises, psychological pain, and grief associated with terminal illness. Towards the end of life, nursing contacts should increase and be armed with an understanding of palliative care planning with patients with advanced HIV disease.
Taira, Rikizo; Yokomaku, Yoshiyuki; Koibuchi, Tomohiko; Rahman, Mahbubur; Izumi, Yoko; Tadokoro, Kenji
Japan has been known as a low HIV-prevalence country with a concentrated epidemic among high-risk groups. However, it has not been determined whether Japan meets the 90-90-90 goals set by the Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO). Moreover, to date, the HIV care cascade has not been examined. We estimated the total number of diagnosed people living with HIV/AIDS (PLWHA) (n = 22,840) based on legal reports to the Ministry of Health, Labour and Welfare by subtracting the number of foreigners who left Japan (n = 2,273) and deaths (n = 2,321) from the cumulative diagnosis report (n = 27,434). The number of total undiagnosed PLWHA was estimated by age and sex specific HIV-positive rates observed among first-time blood donors between 2011–2015 in Japan. Our estimates show that 14.4% (n = 3,830) of all PLWHA (n = 26,670) were undiagnosed in Japan at the end of 2015. The number of patients retained in care (n = 20,615: 77.3% of PLWHA), the percentage of those on antiretroviral therapy (n = 18,921: 70.9% of PLWHA) and those with suppressed viral loads (<200 copies/mL; n = 18,756: 70.3% of PLWHA) were obtained through a questionnaire survey conducted in the AIDS Core Hospitals throughout the country. According to these estimates, Japan failed to achieve the first two of the three UNAIDS/WHO targets (22,840/26,670 = 85.6% of HIV-positive cases were diagnosed; 18,921/22,840 = 82.8% of those diagnosed were treated; 18,756/18,921 = 99.1% of those treated experienced viral suppression). Although the antiretroviral treatment uptake and success after retention in medical care appears to be excellent in Japan, there are unmet needs, mainly at the surveillance level before patients are retained in care. The promotion of HIV testing and treatment programs among the key affected populations (especially men who have sex with men) may contribute to further decreasing the HIV epidemic and achieving the UNAIDS/WHO targets in Japan. PMID
Gwadz, Marya; de Guzman, Rebecca; Freeman, Robert; Kutnick, Alexandra; Silverman, Elizabeth; Leonard, Noelle R.; Ritchie, Amanda Spring; Muñoz-Plaza, Corinne; Salomon, Nadim; Wolfe, Hannah; Hilliard, Christopher; Cleland, Charles M.; Honig, Sylvie
Drug use is associated with low uptake of HIV antiretroviral therapy (ART), an under-studied step in the HIV care continuum, and insufficient engagement in HIV primary care. However, the specific underlying mechanisms by which drug use impedes these HIV health outcomes are poorly understood. The present qualitative study addresses this gap in the literature, focusing on African-American/Black and Hispanic persons living with HIV (PLWH) who had delayed, declined, or discontinued ART and who also were generally poorly engaged in health care. Participants (N = 37) were purposively sampled from a larger study for maximum variation on HIV indices. They engaged in 1–2 h audio-recorded in-depth semi-structured interviews on HIV histories guided by a multilevel social-cognitive theory. Transcripts were analyzed using a systematic content analysis approach. Consistent with the existing literature, heavy substance use, but not casual or social use, impeded ART uptake, mainly by undermining confidence in medication management abilities and triggering depression. The confluence of African-American/Black or Hispanic race/ethnicity, poverty, and drug use was associated with high levels of perceived stigma and inferior treatment in health-care settings compared to their peers. Furthermore, providers were described as frequently assuming participants were selling their medications to buy drugs, which strained provider–patient relationships. High levels of medical distrust, common in this population, created fears of ART and of negative interactions between street drugs and ART, but participants could not easily discuss this concern with health-care providers. Barriers to ART initiation and HIV care were embedded in other structural- and social-level challenges, which disproportionately affect low-income African-American/Black and Hispanic PLWH (e.g., homelessness, violence). Yet, HIV management was cyclical. In collaboration with trusted providers and ancillary staff
Layer, Erica H.; Kennedy, Caitlin E.; Beckham, Sarah W.; Mbwambo, Jessie K.; Likindikoki, Samuel; Davis, Wendy W.; Kerrigan, Deanna L.; Brahmbhatt, Heena
Progression through the HIV continuum of care, from HIV testing to lifelong retention in antiretroviral therapy (ART) care and treatment programs, is critical to the success of HIV treatment and prevention efforts. However, significant losses occur at each stage of the continuum and little is known about contextual factors contributing to disengagement at these stages. This study sought to explore multi-level barriers and facilitators influencing entry into and engagement in the continuum of care in Iringa, Tanzania. We used a mixed-methods study design including facility-based assessments and interviews with providers and clients of HIV testing and treatment services; interviews, focus group discussions and observations with community-based providers and clients of HIV care and support services; and longitudinal interviews with men and women living with HIV to understand their trajectories in care. Data were analyzed using narrative analysis to identify key themes across levels and stages in the continuum of care. Participants identified multiple compounding barriers to progression through the continuum of care at the individual, facility, community and structural levels. Key barriers included the reluctance to engage in HIV services while healthy, rigid clinic policies, disrespectful treatment from service providers, stock-outs of supplies, stigma and discrimination, alternate healing systems, distance to health facilities and poverty. Social support from family, friends or support groups, home-based care providers, income generating opportunities and community mobilization activities facilitated engagement throughout the HIV continuum. Findings highlight the complex, multi-dimensional dynamics that individuals experience throughout the continuum of care and underscore the importance of a holistic and multi-level perspective to understand this process. Addressing barriers at each level is important to promoting increased engagement throughout the continuum. PMID
Layer, Erica H; Kennedy, Caitlin E; Beckham, Sarah W; Mbwambo, Jessie K; Likindikoki, Samuel; Davis, Wendy W; Kerrigan, Deanna L; Brahmbhatt, Heena
Progression through the HIV continuum of care, from HIV testing to lifelong retention in antiretroviral therapy (ART) care and treatment programs, is critical to the success of HIV treatment and prevention efforts. However, significant losses occur at each stage of the continuum and little is known about contextual factors contributing to disengagement at these stages. This study sought to explore multi-level barriers and facilitators influencing entry into and engagement in the continuum of care in Iringa, Tanzania. We used a mixed-methods study design including facility-based assessments and interviews with providers and clients of HIV testing and treatment services; interviews, focus group discussions and observations with community-based providers and clients of HIV care and support services; and longitudinal interviews with men and women living with HIV to understand their trajectories in care. Data were analyzed using narrative analysis to identify key themes across levels and stages in the continuum of care. Participants identified multiple compounding barriers to progression through the continuum of care at the individual, facility, community and structural levels. Key barriers included the reluctance to engage in HIV services while healthy, rigid clinic policies, disrespectful treatment from service providers, stock-outs of supplies, stigma and discrimination, alternate healing systems, distance to health facilities and poverty. Social support from family, friends or support groups, home-based care providers, income generating opportunities and community mobilization activities facilitated engagement throughout the HIV continuum. Findings highlight the complex, multi-dimensional dynamics that individuals experience throughout the continuum of care and underscore the importance of a holistic and multi-level perspective to understand this process. Addressing barriers at each level is important to promoting increased engagement throughout the continuum.
Rutledge, Scott Edward; Abell, Neil; Padmore, Jacqueline; McCann, Theresa J
Stigma obstructs HIV/AIDS prevention and care worldwide, including in the Caribbean, where the prevalence of AIDS is second only to sub-Saharan Africa. To contextualise the experience of AIDS stigma in health services in Grenada and Trinidad and Tobago, we conducted eight focus groups with 51 people living with HIV/AIDS (PLHA), families, and service providers. Quasi-deductive content analysis revealed consonance with Western and Northern conceptualisations of AIDS stigma wherein stigma is enacted upon marginalized populations and reinforced through psycho-sociological processes comparing 'in' and 'out' groups. Socially constructed to be physically contagious and socially deviant, PLHA are scorned by some service providers, especially when they are perceived to be gay or bisexual. PLHA and providers identified passive neglect and active refusal by hospital and clinic staff to provide care to PLHA. Institutional practices for safeguarding patient confidentiality are perceived as marginally enforced. Interventions are needed to reduce provider stigma so the public will access HIV testing and PLHA will seek treatment.
stress disorder or traumatic brain injury. Additionally, the Defense Suicide Prevention Office reports through the Executive Director of the Office of...Efforts to Address Mental Health Care Stigma Why GAO Did This Study A 2010 DOD task force on suicide prevention concluded that stigma—the negative...Representatives A 2010 Department of Defense (DOD) Task Force on the Prevention of Suicide by Members of the Armed Forces concluded that
Servin, Argentina E.; Muñoz, Fátima A.; Strathdee, Steffanie A.; Kozo, Justine; Zúñiga, María Luisa
Background We compared HIV-positive patients receiving care in the border cities of San Diego, United States, with Tijuana, Mexico. Methods Participants were HIV-positive Latinos (n = 233) receiving antiretroviral therapy (ART) from San Diego– Tijuana clinics (2009-2010). Logistic regression identified correlates of receiving HIV care in San Diego versus Tijuana. Results Those with their most recent HIV visit in San Diego (59%) were more likely to be older, have at least a high school education, and were less likely to have been deported than those with last visits in Tijuana. Despite reporting better patient–provider relationships and less HIV-related stigma than those with visits in Tijuana, San Diego patients were twice as likely to make unsupervised changes in their ART regimen. Conclusions We observed poorer relative adherence among HIV-positive Latinos receiving care in San Diego, despite reports of good clinical relationships. Further study is needed to ascertain underlying reasons to avoid ART-related resistance. PMID:22930794
Garcia, Jonathan; Parker, Caroline; Parker, Richard G; Wilson, Patrick A; Philbin, Morgan; Hirsch, Jennifer S
Black men who have sex with men (BMSM) bear an increasingly disproportionate burden of HIV in the United States. The Centers for Disease Control and Prevention recommends high-impact combination prevention for populations at high risk for HIV infection, such as BMSM. However, few scholars have considered the types of behavioral interventions that combined with biomedical prevention could prove effective for mitigating the epidemic among BMSM. Between June 2013 and May 2014, we conducted three in-depth interviews each with 31 BMSM, interviews with 17 community stakeholders, and participant observation in New York City to understand the sociocultural and structural factors that may affect the acceptance of and adherence to oral preexposure prophylaxis among BMSM and to inform an adherence clinical trial. BMSM and community leaders frequently described condomless sex as a consequence of psychosocial factors and economic circumstances stemming from internalized homophobia resulting from rejection by families and religious groups. BMSM revealed that internalized homophobia and HIV stigma resulted in perceived lack of self- and community efficacy in accepting and adhering to preexposure prophylaxis. Our results indicate that addressing internalized homophobia and fostering emotional social support in peer networks are key elements to improve the effectiveness of combination prevention among BMSM.
Chao, Li-Wei; Gow, Jeff; Akintola, Goke; Pauly, Mark
Background: One hundred and twenty educators from KwaZulu-Natal, South Africa, underwent HIV/AIDS training. The educators were surveyed about their attitudes toward people with HIV. Methods: The educators completed self-administered survey questionnaires both before and after 2 interventions. Measures included demographic characteristics,…
Cahill, Sean; Valadéz, Robert; Ibarrola, Sabina
Men who have sex with men (MSM) have been disproportionately affected by HIV since the onset of the epidemic. Public health discourse about prevention has traditionally focused on individual risk behavior and less on the socio-structural factors that place MSM at increased risk of infection. Anti-gay bias and stigma are key structural drivers of HIV and must therefore be treated as a public health threat. Community-based prevention intervention programs that affirm the healthy formation of gay and transgender identities are strongly needed. Gay affirming school-based interventions and resiliency-focused social marketing campaigns have shown positive impact on health outcomes and should be implemented on a broader scale to challenge anti-gay stigma.
Anand, Tarandeep; Nitpolprasert, Chattiya; Kerr, Stephen J; Muessig, Kathryn E; Promthong, Sangusa; Chomchey, Nitiya; Hightow-Weidman, Lisa B; Chaiyahong, Prachya; Phanuphak, Praphan; Ananworanich, Jintanat; Phanuphak, Nittaya
In Thailand, young men who have sex with men (YMSM) and transgender women (TG) are disproportionately affected by HIV and have suboptimal care continuum outcomes. Although Thai YMSM and young TG are early adopters of emerging technologies and have high Internet and technology access and utilization, the potential of technology has not been harnessed to optimize the HIV treatment cascade. We interviewed 18 behaviorally HIV-infected YMSM and young TG regarding care challenges, identified how eHealth could address care needs, and elicited preferences for eHealth interventions. Participants reported struggling with individual and societal-level stigma which negatively impacted linkage to and retention in care, and antiretroviral therapy adherence. YMSM and young TG described inadequate in-person support services and heavily relied on random online resources to fill information and support gaps, but sometimes viewed them as untrustworthy or inconsistent. Participants universally endorsed the development of eHealth resources and proposed how they could ameliorate individual-level fears over stigma and improve public perceptions about HIV. Personalized and integrated eHealth interventions with interactive, user-driven structures, credible content, rewards for engagement, real-time counseling and reminder support could help overcome barriers YMSM and young TG face in traditional HIV healthcare systems and have the potential to improve care outcomes.
Pescosolido, Bernice A.; Martin, Jack K.
Since the beginning of the twenty-first century, research on stigma has continued. Building on conceptual and empirical work, the recent period clarifies new types of stigmas, expansion of measures, identification of new directions, and increasingly complex levels. Standard beliefs have been challenged, the relationship between stigma research and public debates reconsidered, and new scientific foundations for policy and programs suggested. We begin with a summary of the most recent Annual Review articles on stigma, which reminded sociologists of conceptual tools, informed them of developments from academic neighbors, and claimed findings from the early period of “resurgence.” Continued (even accelerated) progress has also revealed a central problem. Terms and measures are often used interchangeably, leading to confusion and decreasing accumulated knowledge. Drawing from this work but focusing on the past 14 years of stigma research (including mental illness, sexual orientation, HIV/AIDS, and race/ethnicity), we provide a theoretical architecture of concepts (e.g., prejudice, experienced/received discrimination), drawn together through a stigma process (i.e., stigmatization), based on four theoretical premises. Many characteristics of the mark (e.g., discredited, concealable) and variants (i.e., stigma types and targets) become the focus of increasingly specific and multidimensional definitions. Drawing from complex and systems science, we propose a stigma complex, a system of interrelated, heterogeneous parts bringing together insights across disciplines to provide a more realistic and complicated sense of the challenge facing research and change efforts. The Framework Integrating Normative Influences on Stigma (FINIS) offers a multilevel approach that can be tailored to stigmatized statuses. Finally, we outline challenges for the next phase of stigma research, with the goal of continuing scientific activity that enhances our understanding of stigma and builds
Kohli, Rewa; Purohit, Vidula; Karve, Latika; Bhalerao, Vinod; Karvande, Shilpa; Rangan, Sheela; Reddy, Srikanth; Paranjape, Ramesh; Sahay, Seema
Introduction In low resource settings, the vast majority of ‘Person/people Living with HIV’ (PLHIV/s) and inadequate healthcare delivery systems to meet their treatment and care needs, caregivers play a vital role. Home based caregivers are often unrecognized with limited AIDS policies and programs focusing on them. We explored the perceptions and norms regarding care being provided by family caregivers of PLHIVs in India. Methodology A community based qualitative study to understand the issues pertaining to home based care for PLHIV was conducted in urban settings of Pune city, in Maharashtra, India. Eight Focus Group Discussions (FGDs) among men, women and peer educators were carried out. A total of 44 in-depth Interviews (IDIs) with PLHIVs (20) and their caregivers (24), were conducted using separate guides respectively. Data was analyzed thematically. Results Home based care was perceived as economically viable option available for PLHIVs. ‘Care’ comprised of emotional, adherence, nursing and financial support to PLHIV. Home based care was preferred over hospital based care as it ensured confidentiality and patient care without hampering routine work at home. Women emerged as more vital primary caregivers compared to men. Home based care for men was almost unconditional while women had no such support. The natal family of women also abandoned. Their marital families seemed to provide support. Caregivers voiced the need for respite care and training. Discussion Gender related stigma and discrimination existed irrespective of women being the primary family caregivers. The support from marital families indicates a need to explore care and support issues at natal and marital homes of the women living with HIV respectively. Home based care training and respite care for the caregivers is recommended. Gender sensitive interventions addressing gender inequity and HIV related stigma should be modeled while designing interventions for PLHIVs and their family
Lelutiu-Weinberger, Corina; Gamarel, Kristi E.; Golub, Sarit A.; Parsons, Jeffrey T.
Objective In the US, young men who have sex with men (YMSM) are disproportionately affected by HIV, with YMSM of color being the most impacted by the epidemic. Methods To advance prevention research, we examined race-based differences in gay-related stress in conjunction with the moderating role of mental health on substance use and sexual risk among 206 high-risk YMSM, recruited September 2007–2010. Results Negative binomial regressions and three-way interaction graphs indicated that psychological distress and acute gay-related stigma placed all participants at most risk for HIV acquisition. Low psychological distress appeared to “buffer” all YMSM against HIV risk, while the reverse was evidenced for those reporting low gay-related stigma and psychological distress. YMSM of color reported more risk behavior, and less decreases in risk with attenuated psychological distress, compared to white YMSM. We hypothesize these trends to be associated with experiencing multiple stigmatized identities, indicating points of intervention for YMSM of color to achieve positive identity integration. There were sharper increases in HIV risk behavior for white YMSM with increasing gay-related stigma than for YMSM of color, which could be attributed to the latter’s prolonged exposure to discrimination necessitating building coping skills to manage the influx of adversity. Conclusions Emphases on: 1) identity-based interventions for YMSM of color; and 2) skills-based interventions for white YMSM should supplement existing successful HIV-risk reduction programs. Lastly, mental health needs to be a target of intervention, as it constitutes a protective factor against HIV risk for all YMSM. PMID:25545041
Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction—which removes judgment and operates at the patient’s stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system. Methods. Qualitative, phenomenological, semi-structured, individual interviews with patients and providers were conducted in three publicly-funded clinics in Chicago, located in areas of high HIV prevalence and drug use and serving African-American patients (N = 38). A deductive thematic analysis guided the process, including: the creation of an index code list, transcription and verification of interviews, manual coding, notation of emerging themes and refinement of code definitions, two more rounds of coding within AtlasTi, calculation of Cohen’s Kappa for interrater reliability, queries of major codes and analysis of additional common themes. Results. Thematic analysis of findings indicated that the majority of patients felt receptive to harm reduction interventions (safer injection counseling, safer stimulant use counseling, overdose prevention information, supply provision) from their provider, and expressed anticipated gratitude for harm reduction information and/or supplies within the HIV care visit, although some were reluctant to talk openly about their drug use. Provider results were mixed, with more receptivity reported by advanced practice nurses, and more barriers cited by physicians. Notable barriers included: role-perceptions, limited time, inadequate training, and the patients themselves. Discussion. Patients are willing to receive harm reduction
Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction-which removes judgment and operates at the patient's stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system. Methods. Qualitative, phenomenological, semi-structured, individual interviews with patients and providers were conducted in three publicly-funded clinics in Chicago, located in areas of high HIV prevalence and drug use and serving African-American patients (N = 38). A deductive thematic analysis guided the process, including: the creation of an index code list, transcription and verification of interviews, manual coding, notation of emerging themes and refinement of code definitions, two more rounds of coding within AtlasTi, calculation of Cohen's Kappa for interrater reliability, queries of major codes and analysis of additional common themes. Results. Thematic analysis of findings indicated that the majority of patients felt receptive to harm reduction interventions (safer injection counseling, safer stimulant use counseling, overdose prevention information, supply provision) from their provider, and expressed anticipated gratitude for harm reduction information and/or supplies within the HIV care visit, although some were reluctant to talk openly about their drug use. Provider results were mixed, with more receptivity reported by advanced practice nurses, and more barriers cited by physicians. Notable barriers included: role-perceptions, limited time, inadequate training, and the patients themselves. Discussion. Patients are willing to receive harm reduction interventions from
Monteiro, Simone; Villela, Wilza; Fraga, Livia; Soares, Priscilla; Pinho, Adriana
The study analyses the relationship between AIDS-related stigma and the processes of discrimination prior to diagnosis among pregnant women living with HIV/AIDS. The fieldwork involved interviews about the life trajectories of 29 pregnant women living with HIV/AIDS, recruited at two AIDS services in Rio de Janeiro, Brazil. The analysis revealed that before HIV diagnosis, social and gender inequalities experienced by these women reduced their access to material and symbolic goods that could have enhanced educational and career prospects and their ability and autonomy to exercise sexual and reproductive rights. Being diagnosed with HIV triggered fear of moral judgment and of breakdown in social and family support networks. Given these fears, pregnant women living with HIV/AIDS opt for concealment of the diagnosis. It is necessary for health services, NGOs and government agencies to work together to face the factors that fuel stigma, such as socioeconomic and gender inequalities, taboos and prejudices related to sexuality, and also develop actions to enable women to redefine the meaning of the disease.
Chen, Wei-Ti; Shiu, Cheng-Shi; Simoni, Jane M.; Zhao, Hongxin; Bao, Mei Juan; Lu, Hongzhou
In China, there are currently an estimated 180,000 women between 16 and 45 years of age living with HIV. However, we know very little about their lived experiences. Given the spread of the AIDS epidemic in China and the burden it exerts on quality of life, there is an urgent need to understand how HIV affects Chinese women, particularly in the context of their marriages. How do they negotiate the extreme stigma of their illness in making decisions about disclosure and social support, especially in the context of their family life? We recruited 26 Chinese women with HIV in Beijing and Shanghai for in-depth interviews employing a phenomenological approach. We examined the process and outcomes of disclosure within the course of the women’s search for social support. Women in HIV-discordant relationships often experienced a termination of their marriage after disclosure, yet others exhibited remarkably resilience, finding new strength through the challenge of their illness. Findings underscore the need for accessible and culturally acceptable interventions for Chinese women with HIV who face considerable stigma in their search for support. PMID:21660758
Kato, Asuka; Fujimaki, Yuko; Fujimori, Shin; Isogawa, Akihiro; Onishi, Yukiko; Suzuki, Ryo; Yamauchi, Toshimasa; Ueki, Kohjiro; Kadowaki, Takashi; Hashimoto, Hideki
Objective Growing qualitative evidence reveals that many patients with chronic illnesses struggle to rebuild a positive self-image after diagnosis while attempting to find a balance between their current physical status and their ongoing social duties. One factor destabilizing patients’ identities is self-stigma, which seems to affect their behavioral goals through decreased self-efficacy. We hypothesized that self-stigma would be an independent factor, distinct from self-efficacy, for developing self-care behaviors in patients with type 2 diabetes. Methods We used a consecutive sample of 209 outpatients with type 2 diabetes treated by endocrinologists at two university hospitals, one general hospital and one clinic. We performed multiple linear regression analyses to test the relationship between the patients’ activation levels for self-care behaviors (dependent variable) and self-stigma, self-efficacy, and depression symptoms (independent variables), adjusting for covariates involving sociodemographic and clinical characteristics. Results In a multiple linear regression model adjusted for prior covariates, there was significant association between self-stigma and activation levels for self-care behaviors in patients with type 2 diabetes (adjusted R2=0.26, F (12,196)=7.20, p<0.001). The standardized partial regression coefficient of self-stigma was −0.23 (p=0.001), whereas that of self-efficacy was 0.19 (p=0.007). Conclusions Self-stigma is a negative independent factor, separate from self-efficacy, affecting the self-care behaviors of patients with type 2 diabetes. Self-stigma also has, at least, a similar impact on self-care behaviors to that of self-efficacy. To optimize treatment outcomes, patients’ self-stigma should be minimized, whereas their self-efficacy should be enhanced. PMID:26835138
Tafese, Zelalem; Birhan, Yifru; Abebe, Hiwot
Background Improving nutritional care and support for people living with HIV (PLHIV) is an integral part of comprehensive HIV treatment according to the National Nutritional Strategy of Ethiopia. However, there is no adequate published study that assesses the nutritional care and support services for adult people living with HIV/ AIDS (PLHIV) in this setting. Objective The objective of the study was to identify the existing nutritional care and support services and determine the challenges facing adults living with HIV at Hawassa Referral Hospital in southern Ethiopia. Methods A qualitative study was carried out using focus group discussions (FGDs), in-depth interviews and participant observation. Four FDGs were held and five in-depth interviews were conducted. A two-week participant observation was also conducted by trained nurses. All interviews and FDGs were tape-recorded and transcribed; those conducted in Amharic were translated back to English. Finally thematic analysis of the transcripts was performed. Results Most of the FDG participants were unsatisfied with their nutritional care and support services and expressed difficulty with disclosing their HIV status for fear of stigma and discrimination. The in-depth interviews and participant observation showed results similar to those of the FDG. Some key informants expressed a fear that such poor nutritional care and support may threaten the quality of life of people living with HIV and suggested that all stakeholders work on improving the services. Conclusion Current nutritional care and support services for people living with HIV are not well coordinated. They focus mainly on monthly supplementation of antiretroviral drugs and occasional handouts of food. The need to provide health education on antiretroviral drugs and nutrition, and to emphasise strategies aimed at improving the nutritional status of peoples living with HIV is critical. Furthermore, the study recommended strengthening the initiatives of some
Thomas, Sanjeev V.; Nair, Aparna
Stigma and resultant psychosocial issues are major hurdles that people with epilepsy confront in their daily life. People with epilepsy, particularly women, living in economically weak countries are often ill equipped to handle the stigma that they experience at multiple levels. This paper offers a systematic review of the research on stigma from sociology and social psychology and details how stigma linked to epilepsy or similar conditions can result in stereotyping, prejudice and discrimination. We also briefly discuss the strategies that are most commonly utilized to mitigate stigma. Neurologists and other health care providers, social workers, support groups and policy makers working with epilepsy need to have a deep understanding of the social and cultural perceptions of epilepsy and the related stigma. It is necessary that societies establish unique determinants of stigma and set up appropriate strategies to mitigate stigma and facilitate the complete inclusion of people with epilepsy as well as mitigating any existing discrimination. PMID:22028525
Perceived social support, hopefulness, and emotional regulations as mediators of the relationship between enacted stigma and post-traumatic growth among children affected by parental HIV/AIDS in rural China.
Wei, Wei; Li, Xiaoming; Tu, Xiaoming; Zhao, Junfeng; Zhao, Guoxiang
Some previous studies have revealed a negative impact of enacted stigma on post-traumatic growth (PTG) of children affected by HIV/AIDS, but little is known about protective psychological factors that can mitigate the effect of enacted stigma on children's PTG. This study aims to examine the mediating effects of perceived social support, hopefulness, and emotional regulation on the relationship between enacted stigma and PTG among HIV-affected children. Cross-sectional data were collected from 790 children affected by parental HIV (382 girls, 408 boys) aged 6-17 years in 2012 in rural central China. Multiple regression was conducted to test the mediation model. The study found that the experience of enacted stigma had a negative effect on PTG among children affected by HIV/AIDS. Emotional regulation together with hopefulness and perceived social support mediated the impact of enacted stigma on PTG. Perceived social support, hopefulness, and emotional regulation offer multiple levels of protection that can mitigate the impact of enacted stigma on PTG. Results suggest that future psychological intervention programs should seek strategies to reduce the stigmatizing experience of these children and promote children's level of PTG, and health professionals should also emphasize the development of these protective psychological factors.
Perceived social support, hopefulness, and emotional regulations as mediators of the relationship between enacted stigma and post-traumatic growth among children affected by parental HIV/AIDS in rural China
Wei, Wei; Li, Xiaoming; Tu, Xiaoming; Zhao, Junfeng; Zhao, Guoxiang
ABSTRACT Some previous studies have revealed a negative impact of enacted stigma on post-traumatic growth (PTG) of children affected by HIV/AIDS, but little is known about protective psychological factors that can mitigate the effect of enacted stigma on children's PTG. This study aims to examine the mediating effects of perceived social support, hopefulness, and emotional regulation on the relationship between enacted stigma and PTG among HIV-affected children. Cross-sectional data were collected from 790 children affected by parental HIV (382 girls, 408 boys) aged 6–17 years in 2012 in rural central China. Multiple regression was conducted to test the mediation model. The study found that the experience of enacted stigma had a negative effect on PTG among children affected by HIV/AIDS. Emotional regulation together with hopefulness and perceived social support mediated the impact of enacted stigma on PTG. Perceived social support, hopefulness, and emotional regulation offer multiple levels of protection that can mitigate the impact of enacted stigma on PTG. Results suggest that future psychological intervention programs should seek strategies to reduce the stigmatizing experience of these children and promote children's level of PTG, and health professionals should also emphasize the development of these protective psychological factors. PMID:26899475
Bofill, Lina Margarita; Lopez, Maria; Dorigo, Analia; Bordato, Alejandra; Lucas, Mar; Cabanillas, Graciela Fernandez; Sued, Omar; Cahn, Pedro; Cassetti, Isabel; Weiss, Stephen; Jones, Deborah
Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients' lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient-provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.
Semugoma, Paul; Beyrer, Chris; Baral, Stefan
Uganda's response to the HIV epidemic has been lauded for its robustness and achievements. However, a key component of HIV prevention programming has been missing, for men who have sex with men (MSM). The main reason cited has been criminalization of male homosexual behavior. In 2009, the Anti-Homosexuality Bill (AHB) was introduced in the parliament to enhance existing anti-homosexuality law. A multi-disciplinary team made a Health Impact Assessment of the proposed AHB. The bill as tabled would severely increase punishments, increased closeting. Social capital of MSM would be eroded by clauses mandating reporting by friends, relatives, and acquaintances. Health-care professionals would have to inform on homosexuals. Mandatory HIV testing would be a blow to programming. Probable disclosure of HIV status in a public space (court) would also be a deterrent. Heftier punishments for those testing positive increases stigma and hobbles subsequent care. The AHB argues for exclusion, and more discrimination targeting persons living with HIV and sexual minorities. It will exacerbate the negative public health consequences of the existing legislation. The government of Uganda should review guidance documents published by authoritative bodies including the World Bank, World Health Organization to develop and bring to scale Human rights-affirming HIV prevention, treatment, and care responses.
Lifson, Alan R; Workneh, Sale; Hailemichael, Abera; Demissie, Workneh; Slater, Lucy; Shenie, Tibebe
Social support significantly enhances physical and mental health for persons with human immunodeficiency virus (HIV). We surveyed 142 rural Ethiopian HIV patients newly enrolled in care for perceived social support and factors associated with low support levels. Using the Social Provisions Scale (SPS), the mean summary score was 19.1 (possible scores = 0-48). On six SPS subscales, mean scores (possible scores = 0-8), were: Reliable Alliance (others can be counted on for tangible assistance) = 2.8, Attachment (emotional closeness providing sense of security) = 2.9, Reassurance of Worth (recognition of competence and value by others) = 3.2, Guidance (provision of advice or information by others) = 3.2, Social Integration (belonging to a group with similar interests and concerns) = 3.5, and Nurturance (belief that others rely on one for their well-being) = 3.6. In multivariate analysis, factors significantly associated with lower social support scores were: lower education level (did not complete primary school) (p = .019), lower total score on knowledge items about HIV care/treatment (p = .038), and greater number of external stigma experiences in past three months (p < .001); greater number of chronic disease symptoms was of borderline significance (p = .098). Among rural Ethiopian patients newly entering HIV care, we found moderate and varying levels of perceived social support, with lowest scores for subscales reflecting emotional closeness and reliance on others for tangible assistance. Given that patients who have recently learned their diagnosis and entered care may be an especially vulnerable group, programs to help identify and address social support needs can provide multiple benefits in facilitating the best possible physical, emotional and functional quality of life for people living with HIV.
Smith, Rachel A; Morrison, Daniel
People often perceive risks for others and themselves differently. This study examines whether personal beliefs about HIV and experience with those living with HIV influence personal risk assessments of contracting HIV in an interview sample of northern Namibians (N=400), but not others' assessments as explained by singular-distribution theory [Klar, Medding, & Sarel (1996). Nonunique invulnerability: Singular versus distributional probabilities and unrealistic optimism in comparative risk judgments. Organizational Behavior and Human Decision Processes, 67, 229-245]. Findings indicate that personal risk perceptions decrease with more HIV stigmatizing beliefs and increase with greater experience, but that those characteristics had no impact on assessments for others' risk. The study also examines whether the size and characteristics of the referent group, peers and the general Namibian population, influence others' risk assessments. Optimistic biases for personal risk versus others' risk appear with the highest discrepancy emerging between personal and general population risk assessments. Further, we found that personal risk perceptions did not mediate the relationship between personal characteristics, beliefs and experiences, and intentions to seek HIV testing.
Elliott, Jennifer C; Aharonovich, Efrat; O'Leary, Ann; Wainberg, Milton; Hasin, Deborah S
Heavy drinking among individuals with HIV is associated with poor medication adherence and other health problems. Understanding reasons for drinking (drinking motives) in this population is therefore important and could inform intervention. Using concepts of drinking motives from previous alcohol research, we assessed these motives and drinking in 254 HIV-positive primary care patients (78.0 % male; 94.5 % African American or Hispanic) prior to their participation in an alcohol intervention trial. Three motives had good factor structure and internal consistency: "drinking to cope with negative affect", "drinking for social facilitation" (both associated with heavier drinking), and "drinking due to social pressure" (associated with less drinking). Drinking motives may provide important content for alcohol intervention; clinical trials could indicate whether inclusion of such content improves intervention efficacy. Discussing motives in session could help providers assist clients in better managing psychological and social aspects of their lives without reliance on alcohol.
Beyrer, Chris; Baral, Stefan; Kerrigan, Deanna; El-Bassel, Nabila; Bekker, Linda-Gail; Celentano, David D
The provision of appropriate HIV prevention, treatment, and care services for most-at-risk populations (MARP) will challenge many health care systems. For people who sell sex (SW) or inject drugs (IDU) and for men who have sex with men (MSM), stigma, discrimination, and criminalization can limit access to care, inhibit service uptake, and reduce the disclosure of risks. Several models for provision of HIV services to MARP may address these issues. We discuss integrated models, stand-alone services, and hybrid models, which may be appropriate for some MARP in some settings. Both public health and human rights frameworks concur that those at greatest risk should have expanded access to services. PMID:21857306
Lazarus, Lisa; Deering, Kathleen N; Nabess, Rose; Gibson, Kate; Tyndall, Mark W; Shannon, Kate
Individuals working in the sex industry continue to experience many negative health outcomes. As such, disentangling the factors shaping poor health access remains a critical public health priority. Within a quasi-criminalised prostitution environment, this study aimed to evaluate the prevalence of occupational stigma associated with sex work and its relationship to barriers to accessing health services. Analyses draw on baseline questionnaire data from a community-based cohort of women in street-based sex work in Vancouver, Canada (2006-2008). Of a total of 252 women, 141 (55.9%) reported occupational sex work stigma (defined as hiding occupational sex work status from family, friends and/or home community), while 125 (49.6%) reported barriers to accessing health services in the previous six months. In multivariable analysis, adjusting for sociodemographic, interpersonal and work environment risks, occupational sex work stigma remained independently associated with an elevated likelihood of experiencing barriers to health access. Study findings indicate the critical need for policy and societal shifts in views of sex work as a legitimate occupation, combined with improved access to innovative, accessible and non-judgmental health care delivery models for street-based sex workers that include the direct involvement of sex workers in development and implementation.
Closson, Elizabeth F.; Mimiaga, Matthew J.; Sherman, Susan G.; Tangmunkongvorakul, Arunrat; Friedman, Ruth K.; Limbada, Mohammed; Moore, Ayana T.; Srithanaviboonchai, Kriengkrai; Alves, Carla A.; Roberts, Sarah; Oldenburg, Catherine E.; Elharrar, Vanessa; Mayer, Kenneth H.; Safren, Steven A.
The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010–2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that
Li, Li; Liang, Li-Jung; Wu, Zunyou; Lin, Chunqing; Wen, Yi
This study examined HIV/AIDS-related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals, 18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor-nurse ratio of each hospital or clinic. Lab technicians were over-sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary, anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV-related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs. Cette étude a examiné le VIH/SIDA lié à stigmatisation parmi les agences chinoises fournissant des soins en comparant leurs attitudes
Ramakrishnan, P; Rane, A; Dias, A; Bhat, J; Shukla, A; Lakshmi, S; Ansari, B K; Ramaswamy, R S; Reddy, R A; Tribulato, A; Agarwal, A K; SatyaPrasad, N; Mushtaq, A; Rao, P H; Murthy, P; Koenig, H G
Persons with mental illnesses in India and rest of developing world continue to consult religious/spiritual (R/S) healers or traditional, complementary and alternative medicine (TCAM) professionals prior to seeking psychiatric services that are devoid of spiritual components of care. We aim to understand TCAM and allopathic professionals' perspectives on patients' R/S needs within mental health services, cross-sectional study was conducted at five TCAM and two allopathic tertiary care hospitals in three different Indian states; 393 participants completed RSMPP, a self-administered, semi-structured survey questionnaire. Perspectives of TCAM and allopathic health professionals on role of spirituality in mental health care were compared. Substantial percentage, 43.7 % TCAM and 41.3 % allopathic, of participants believe that their patients approach R/S or TCAM practitioners for severe mental illness; 91.2 % of TCAM and 69.7 % of allopaths were satisfied with R/S healers (p = 0.0019). Furthermore, 91.1 % TCAM and 73.1 % allopaths (p = 0.000) believe that mental health stigma can be minimized by integrating with spiritual care services. Overall, 87 % of TCAM and 73 % of allopaths agreed to primary criterion variable: 'spiritual healing is beneficial and complementary to psychiatric care.' A quarter of allopaths (24.4 %) and 38 % of TCAM physicians reportedly cross-refer their grieving patients to religious/TCAM healer and psychiatrist/psychologist, respectively; on logistic regression, significant (p < 0.05) predictors were clinical interactions/references to r/s healers. Providing spiritual care within the setup of psychiatric institution will not only complement psychiatric care but also alleviate stigma against mental health services. Implications on developing spiritual care services like clinical chaplaincy are discussed.
Guise, Andy; Seguin, Maureen; Mburu, Gitau; McLean, Susie; Grenfell, Pippa; Islam, Zahed; Filippovych, Sergii; Assan, Happy; Low, Andrea; Vickerman, Peter; Rhodes, Tim
People who use drugs in many contexts have limited access to opioid substitution therapy and HIV care. Service integration is one strategy identified to support increased access. We reviewed and synthesized literature exploring client and provider experiences of integrated opioid substitution therapy and HIV care to identify acceptable approaches to care delivery. We systematically reviewed qualitative literature. We searched nine bibliographic databases, supplemented by manual searches of reference lists of articles from the database search, relevant journals, conferences, key organizations and consultation with experts. Thematic synthesis was used to develop descriptive themes in client and provider experiences. The search yielded 11 articles for inclusion, along with 8 expert and policy reports. We identify five descriptive themes: the convenience and comprehensive nature of co-located care, contrasting care philosophies and their role in shaping integration, the limits to disclosure and communication between clients and providers, opioid substitution therapy enabling HIV care access and engagement, and health system challenges to delivering integrated services. The discussion explores how integrated opioid substitution therapy and HIV care needs to adapt to specific social conditions, rather than following universal approaches. We identify priorities for future research. Acceptable integrated opioid substitution therapy and HIV care for people who use drugs and providers is most likely through co-located care and relies upon attention to stigma, supportive relationships and client centred cultures of delivery. Further research is needed to understand experiences of integrated care, particularly delivery in low and middle income settings and models of care focused on community and non-clinic based delivery.
Zunner, Brian; Dworkin, Shari L.; Neylan, Thomas C.; Bukusi, Elizabeth A.; Oyaro, Patrick; Cohen, Craig R.; Abwok, Matilda; Meffert, Susan M.
Background HIV-infected (HIV+) women have high rates of Gender Based Violence (GBV). Studies of GBV find that approximately 50-90% of survivors develop mood and anxiety disorders. Given that women in sub-Saharan African constitute the largest population of HIV+ individuals in the world and the region's high GBV prevalence, mental health research with HIV+ women affected by GBV (HIV+GBV+) in this region is urgently needed. Methods Qualitative methods were used to evaluate the mental health care needs of HIV+GBV+ female patients at an HIV clinic in the Kisumu County, Kenya. Thirty in-depth interviews and four focus groups were conducted with patients, healthcare providers and community leaders. Interviews were transcribed, translated and analyzed using qualitative data software. Results Respondents stated that physical, sexual and emotional violence against HIV+ women was widely prevalent and perpetrated primarily by untested husbands accusing a wife of marital infidelity following her positive HIV test result. Mental health problems among HIV+GBV+ women included depressive, anxiety, traumatic stress symptoms and suicidal thoughts. Participants opined that emotional distress from GBV not only caused HIV treatment default, but also led to poor HIV health even if adherent. Respondents agreed that mental health treatment was needed for HIV+GBV+ women; most agreed that the best treatment modality was individual counseling delivered weekly at the HIV clinic. Limitations Emotional distress may be higher and/or more varied among HIV+GBV+ women who are not engaged in HIV care. Conclusions Mental health care is needed and desired by HIV+GBV+ women in Kisumu County, Kenya. PMID:25574781
Gómez, Cynthia A; Tat, Susana A; Allen, Debra; Gordon, Danielle; Browe, Dennis
The 2015 National HIV/AIDS Strategy renewed its goal of increasing access to care for people living with HIV/AIDS (PLWHA) and called for an increased focus on linkage to care efforts. As many PLWHA face multiple barriers to care and live on the margins of society, adoption of intensive outreach activities is necessary to engage the most disenfranchised PLWHA into care and to ultimately end the HIV epidemic. The Bay Area Network for Positive Health (BANPH), comprising 12+ agencies, established a network outreach model for our linkage-to-care project to engage the hardest-to-reach populations in the San Francisco Bay Area. During the years 2010-2013, BANPH agencies conducted street outreach, analyzed internal tracking systems to identify out-of-care individuals and individuals experiencing tenuous care, and surveyed participants using Apple iPod Touch devices. During the 3-year project, BANPH agencies engaged 602 out-of-care PLWHA and linked 440 to care. On average, outreach workers made 10 contact attempts with a client to link them to care. Sixty-three percent of participants were linked to care on an average of 56 days after initial contact. Factors, including lack of case management, lack of transportation, competing concerns, substance abuse, and HIV stigma, were significantly associated with linkage-to-care outcomes. Intensive outreach efforts could help to reduce barriers to care for hard-to-reach PLWHA, but these efforts require a tremendous amount of time and resources. A network outreach model could help facilitate sharing of limited resources and increase regional outreach capacity for linkage-to-care programs.
Airhihenbuwa, Collins O; Ford, Chandra L; Iwelunmor, Juliet I
Theories about health behavior are commonly used in public health and often frame problems as ascribed or related to individuals' actions or inaction. This framing suggests that poor health occurs because individuals are unable or unwilling to heed preventive messages or recommended treatment actions. The recent United Nations call for strategies to reduce the global disease burden of noncommunicable diseases like diabetes requires a reassessment of individual-based approaches to behavior change. We argue that public health and health behavior intervention should focus more on culture than behavior to achieve meaningful and sustainable change resulting in positive health outcomes. To change negative health behaviors, one must first identify and promote positive health behaviors within the cultural logic of its contexts. To illustrate these points, we discuss stigma associated with obesity and human immunodeficiency virus and acquired immune deficiency syndrome. We conclude that focusing on positive behaviors and sustaining cultural and personal transfo