Stigma, social risk, and health policy: public attitudes toward HIV surveillance policies and the social construction of illness

HIV Testing Among Spanish Youth: Analysis of the Mediating Role of the Big Five Personality and Other Psychological Factors

Early diagnosis of HIV improves the effectiveness of treatments and stops the progression of the disease. The influence of personality and other psychological variables in testing for HIV is analyzed. The first part of the study is composed of 4,929 young people (M age = 20.45, SD = 2.16). For the second part, young heterosexuals who participated in a broader project on HIV prevention were selected (n = 240, M age = 20.78, SD = 2.29). Only 23.3 % of the total sample have ever been tested for HIV antibodies. The main reason for not testing was fear of positive result (25.4 %). Statistically significant differences in Agreeableness (p = .027), Trust (p = .022) and Straightforwardness (p = .024) were found between HIV-tested and not HIV-tested youth. Trust explained 3.3 % of variance of HIV-test. Knowing barriers to testing and individual differences could be useful in developing preventive campaigns.

Perceptions about hemodialysis and transplantation among African American adults with end-stage renal disease: inferences from focus groups

Background

Disparities in access to kidney transplantation (KT) remain inadequately understood and addressed. Detailed descriptions of patient attitudes may provide insight into mechanisms of disparity. The aims of this study were to explore perceptions of dialysis and KT among African American adults undergoing hemodialysis, with particular attention to age- and sex-specific concerns.

Methods

Qualitative data on experiences with hemodialysis and views about KT were collected through four age- and sex-stratified (males <65, males ≥65, females <65, and females ≥65 years) focus group discussions with 36 African American adults recruited from seven urban dialysis centers in Baltimore, Maryland.

Results

Four themes emerged from thematic content analysis: 1) current health and perceptions of dialysis, 2) support while undergoing dialysis, 3) interactions with medical professionals, and 4) concerns about KT. Females and older males tended to be more positive about dialysis experiences. Younger males expressed a lack of support from friends and family. All participants shared feelings of being treated poorly by medical professionals and lacking information about renal disease and treatment options. Common concerns about pursuing KT were increased medication burden, fear of surgery, fear of organ rejection, and older age (among older participants).

Conclusions

These perceptions may contribute to disparities in access to KT, motivating granular studies based on the themes identified.

How older black women perceive the effects of stigma and social support on engagement in HIV care

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.

Personal meaning, social support, and perceived stigma in individuals receiving HIV mental health services

Human immunodeficiency virus (HIV) stigma represents a significant source of stress among individuals living with HIV disease, prompting interest in research to identify factors that may help to ameliorate the stress burden associated with HIV stigma. Consistent with this research line, the current study was conducted as a cross-sectional investigation examining associations between positive global personal meaning, social support, and perceived HIV stigma. Global personal meaning refers to beliefs and aspirations through which one ascribes value and purpose in living. The study sample was comprised of individuals living with HIV disease who presented for an initial visit in a specialty HIV mental health services program. In bivariate analyses, social support was negatively correlated with multidimensional aspects of HIV stigma that included distancing, blaming, and discrimination stigma, whereas personal meaning was negatively associated only with blaming stigma. In further analyses using structural equation modeling, social support significantly mediated the association between personal meaning and both distancing and blaming stigma. Interactions between positive personal meaning and social support may be useful to consider in future research on psychological resource factors and HIV stigma. Understanding these interactions may also inform clinical efforts to address HIV stigma concerns.

Stigmatizing attitudes towards people living with HIV/AIDS: validation of a measurement scale

BACKGROUND

Although stigmatization has long been recognized as a major obstacle to HIV prevention. The lack of a valid and reliable measurement tool for stigmatization is a major gap in the research. This study aimed to: 1) develop a scale of stigmatizing attitudes towards people living with HIV (SAT-PLWHA-S) and 2) demonstrate its reliability and validity.

METHODS

French and English-speaking experts (n = 21) from different professional communities (academics, practitioners) assessed the clarity and relevance of the proposed items. The psychometric properties of the SAT-PLWHA-S were assessed with a random digit dial population based telephone survey (n = 1,500) of respondents in Quebec, Canada. Analyses included exploratory and confirmatory factor analyses, correlations, multiple linear regressions, t-tests, hypothesis testing of factorial structure invariance, and Cronbach's alpha.

RESULTS

Confirmatory factor analysis (CFA) supported a 27-item structure with seven factors: 1) concerns about occasional encounters; 2) avoidance of personal contact; 3) responsibility and blame, 4) liberalism, 5) non-discrimination, 6) confidentiality of seropositive status, and 7) criminalization of HIV transmission. Cronbach's alphas indicate satisfactory internal consistency. An assessment of concurrent validity using Pearson's correlation and multiple linear regression shows that homophobia and HIV transmission knowledge are significant determinants of stigmatizing attitudes toward PLHIV. Discriminant validity (t-test) results suggest that the SAT-PLWHA-S can differentiate attitudes between different groups and indicates invariant factor structure across language.

CONCLUSIONS

The results of this study suggest that the SAT-PLWHA-S is a reliable and valid tool for measuring stigmatizing attitudes toward PLHIV and that it can contribute to a deeper understanding of HIV stigma.

Addressing Ebola-related stigma: lessons learned from HIV/AIDS

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 level to disseminate clear and accurate information about EVD transmission and prevention while promoting stigma reduction in the process. In the long run, education, prevention, and a therapeutic vaccine will be the optimal solutions for reducing the stigma associated with both EVD and HIV.

Sex differences in benzodiazepine use in the HIV-infected population

In the HIV-infected population there is a high prevalence of psychiatric disorders, conditions that often coexist with drug and alcohol dependence. Symptoms associated with psychiatric disorders are frequently managed with benzodiazepines, a class of medication often abused. We examined whether HIV-infected patients were more likely to fill a benzodiazepine prescription than their uninfected counterparts using a privately insured, nationally representative sample receiving clinical care between January 2007 and December 2009. Odds ratios (OR) and 95% confidence intervals (CI) to quantify the likelihood of receiving a benzodiazepine were calculated using multivariate logistic regression models. We examined the presence of interaction between HIV infection and sex using backwards elimination and by comparing stratum-specific OR to identify clinically meaningful differences. Overall, 323,796 beneficiaries were included in the sample, of which 723 were HIV infected. Bivariate analyses showed that compared to the uninfected sample, HIV-infected patients were more likely to have filled a benzodiazepine prescription (24% vs. 19%) during the study period. HIV-infected patients were also more likely to be male (80% vs. 44%), black (21% vs. 7%) and have a diagnosis of depression (12% vs. 8%) or insomnia (6% vs. 3%) than were uninfected patients. Adjusted for other covariates, HIV infection was associated with an increase (OR): 1.68, 95% CI: 1.39, 2.02) in the likelihood of filling a benzodiazepine prescription. When stratified by sex, HIV-infected males were more likely (OR: 1.68, 95% CI: 1.05, 2.67) than uninfected males to fill a benzodiazepine prescription while there was no observed difference in the likelihood of filling a benzodiazepine prescription between HIV-infected and uninfected females (OR: 1.12, 95% CI: 0.73, 1.70). Our findings suggest that HIV-infected patients, particularly HIV-infected males, are more likely to fill benzodiazepine prescriptions than their uninfected counterparts, highlighting the need for further research to investigate reasons for these observed differences.

Racial Disparities in Health Behaviors and Conditions Among Lesbian and Bisexual Women: The Role of Internalized Stigma

There are documented disparities in physical health behaviors and conditions, such as physical activity and obesity, with regard to both race/ethnicity and sexual orientation. However, physical health disparities for lesbian and bisexual (LB) women who are also racial minorities are relatively unexplored. Minority stressors, such as internalized stigma, may account for disparities in such multiply marginalized populations. We sought to (1) characterize inequalities among non-Hispanic white and African American LB women and (2) examine the roles of internalized sexism and homophobia in disparities. Data on health behaviors (diet, physical activity); physical health (hypertension, diabetes, overweight/obesity); internalized sexism; and internalized homophobia were collected via a web-based survey. Recruitment ads were sent electronically to over 200 listservs, online groups, and organizations serving the lesbian, gay, and bisexual community in all 50 U.S. states. The analytic sample consisted of 954 white and 75 African American LB women. African American participants were more likely than white participants to report low fruit/vegetable intake and physical activity, a higher body mass index, and a history of diabetes and hypertension. There were no racial differences in internalized homophobia, but African American women reported higher levels of internalized sexism. Internalized sexism partially mediated racial disparities in physical activity and diabetes, but not in the other outcomes. Findings suggest that African American LB women may be at greater risk than their white counterparts for poor health and that internalized sexism may be a mediator of racial differences for certain behaviors and conditions.

HIV/AIDS Knowledge, Stigmatizing Attitudes, and Related Behaviors and Factors that Affect Stigmatizing Attitudes against HIV/AIDS among Korean Adolescents

OBJECTIVES

This study examined the sex differentials for specific aspects of knowledge regarding HIV, stigmatizing attitudes toward people with HIV/AIDS (PWHAs) and sexual behavior. In addition, the factors that affect stigmatizing attitudes toward PWHAs were investigated.

METHODS

The population of this study comprised of senior high students in Seoul, Korea. Eight high schools were selected randomly and 1566 adolescents participated in the survey. A total sample of 1548 cases (18 cases were excluded) was used for analysis. A self-administered questionnaire measuring their general and transmission and discriminatory attitudes was used.

RESULTS

The level of HIV/AIDS knowledge among Korean adolescents was low, as indicated by a correct response rate of 54% (7.0 out of 13). The students answered correctly about HIV transmission by kissing at 50.2%, toilets at 59.4%, cup sharing at 57.4%, and daily school life at 60.5%. The level of discriminatory attitudes towards HIV-infected persons was high. Boys reported a higher proportion of sexual experience (7.0% vs. 2.6%, OR=2.89, p < 0.001). Only 39.0% used a condom during their last sexual encounter and more girls (53.3%) than boys (35.3%) reported using a condom.

CONCLUSIONS

These findings highlight the need for increasing HIV knowledge, reducing HIV stigma, and providing sex education focusing on safer sex practices.

Changes in Human Immunodeficiency Virusrelated Knowledge and Stigmatizing Attitudes among Korean Adolescents from 2006 to 2011

Objectives

This study assessed the prevalence and changes of human immunodeficiency virus (HIV) knowledge and stigmatizing attitudes in 2006, 2008, and 2011.

Methods

Three cross-sectional surveys were conducted in 2006, 2008, and 2011. A cross-sectional sample of high school students in Seoul, South Korea was targeted. A self-administered questionnaire measuring general and transmission and discriminatory attitudes was used.

Results

Misconceptions about casual contact were widespread, even though the proportion responding incorrectly decreased significantly over the 5-year period. The respondents in all surveys displayed a high level of discrimination against those with HIV/AIDS in some situations, particularly in the idea of HIV/AIDS making the respondent feel disgusted (63.3% in 2006, 57.5% in 2008, and 52.6% in 2011), avoiding sitting with people with HIV/AIDS (50.6% in 2006, 50.5% in 2008, and 48.5% in 2011), and blaming those with HIV for becoming infected (46.6% in 2006, 42.8% in 2008, and 43.0% in 2011). Even though respondents had a high level of stigmatizing attitudes, the survey showed that the stigma has declined over the 5-year period.

Conclusion

The survey results showed that public health policy should recognize that HIV stigmatizing attitudes persist in Korea. This finding has implications for the development of intervention programs focusing on reducing the levels of discrimination.

Stigmatisation of a formerly obese young female

BACKGROUND

Weight loss does not necessarily decrease the negative appraisal of a formerly overweight individual. Since past weight history tends to be disclosed in several contexts, this study aims to investigate whether negative appraisals are gender-specific and if they are modulated by the evaluators' own BMI.

METHODS

202 young adults (106 male and 96 female) viewed a picture of a young attractive female (target) accompanied by one of two statements about her past weight (overweight (OW) or always kept a normal weight (NW)), and then rated her using the Fat Phobia Scale (FPS).

RESULTS

Female evaluators rated the target with the OW statement more negatively than the target with the NW statement. In contrast, males exposed to the OW statement rated the target as having fewer emotional/psychological problems and being less stupid/uncreative. BMI only influenced ratings in males, where those with higher BMI ascribed more negative attributes to the target with the NW statement than the OW statement.

CONCLUSION

Information on weight history impacts upon the appraisal of peers. These effects are dependent on gender and BMI. Knowing that a young female was overweight triggered negative evaluations from females but did not appear to impact the judgment of males.

Multilevel stigma as a barrier to HIV testing in Central Asia: a context quantified

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.

Obesity and Internalized Weight Stigma: A Formulation Model for an Emerging Psychological Problem

Background:Obese individuals frequently experience weight stigma and this is associated with psychological distress and difficulties. The process of external devaluation can lead to negative self-perception and evaluation and some obese individuals develop “internalized weight stigma”. The prevalence of weight stigma is well established but there is a lack of information about the interplay between external and internal weight stigma.Aims:To synthesize the literature on the psychological effects of weight stigma into a formulation model that addresses the maintenance of internalized weight stigma.Method:Current research on the psychological impact of weight stigma was reviewed. We identify cognitive, behavioural and attentional processes that maintain psychological conditions where self-evaluation plays a central role. A model was developed based on clinical utility.Results:The model focuses on identifying factors that influence and maintain internalized weight stigma. We highlight the impact of negative societal and interpersonal experiences of weight stigma on how individuals view themselves as an obese person. Processing the self as a stigmatized individual is at the core of the model. Maintenance factors include negative self-judgements about the meaning of being an obese individual, attentional and mood shifts, and avoidance and safety behaviours. In addition, eating and weight management behaviours become deregulated and maintain both obesity and weight stigma.Conclusion:As obesity increases, weight stigma and the associated psychological effects are likely to increase. We provide a framework for formulating and intervening with internalized weight stigma as well as making therapists aware of the applicability and transferability of strategies that they may already use with other presenting problems.

Differences in testing, stigma, and perceived consequences of stigmatization among heterosexual men and women living with HIV in Bengaluru, India

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.

Incidences of preformed and de novo donor-specific HLA antibodies and their clinicohistological correlates in the early course of kidney transplantation

Our center started routine monitoring of preformed and de novo human leukocyte antigen donor-specific antibodies (DSA) in September 2010 using single antigen beads on the Luminex platform. Recipients with preformed DSA or other high immunological risk factors had serial DSA monitoring at 3, 6, and 12-months posttransplant, and low-risk recipients were screened only at 12-months. Surveillance biopsies were performed at 3, 6, and 12-months post-transplant for all recipients. In addition, for-cause biopsies and DSA testing were performed when clinically indicated for allograft dysfunction. Among 150 adult kidney and kidney/pancreas transplant recipients included in the analysis, 14% had preformed DSA and 7.8% of recipients without preformed DSA developed de novo DSA by 12-months. De novo DSA developed in 25% of recipients on cyclosporine compared to 5% of those on tacrolimus (p = 0.02). The incidences of acute rejection were 34%, 48%, and 70% in recipients with no DSA, with preformed DSA, and with de novo DSA, respectively (p = 0.05). In all recipients with de novo DSA and rejection, the first rejection episode preceded or was concurrent with the emergence of de novo DSA. Despite the difference in rejection incidences, the estimated glomerular filtration rate at 1-year was not significantly different between recipients with or without DSA.

Stigma towards PLWHA: the role of internalized homosexual stigma in Latino gay/bisexual male and transgender communities

Stigma negatively affects the health of people living with HIV/AIDS (PLWHA). Negative attitudes and discriminatory actions towards PLWHA are thought to be based, among other factors, on stigma towards sexual minorities and beliefs about personal responsibility. Yet, there is little evidence to support these linkages and explain how they take place, especially among Latinos. This study analyzes attitudes towards PLWHA among 643 Latino gay/bisexual men and transgender (GBT) people. It examines whether discriminatory actions are predicted by beliefs about personal responsibility and internalized homosexual stigma. Results indicate that Discriminatory Actions towards PLWHA is associated with HIV/AIDS Personal Responsibility Beliefs and Internalized Homosexual Stigma. Further, HIV/AIDS Personal Responsibility Beliefs partially mediates the relationship between Internalized Homosexual Stigma and Discriminatory Actions towards PLWHA. Latino GBT persons who have internalized negative views about homosexuality may project those onto PLWHA. They may think PLWHA are responsible for their serostatus and, hence, deserving of rejection.

Professionalisation and social attitudes: a protocol for measuring changes in HIV/AIDS-related stigma among healthcare students

INTRODUCTION

HIV/AIDS-related stigma affects the access and utilisation of health services. Although HIV/AIDS-related stigma in the health services has been studied, little work has attended to the relationship between professional development and stigmatising attitudes. Hence, in this study, we will extend earlier research by examining the relationship between the stage of professional development and the kinds of stigmatising attitudes held about people living with HIV/AIDS.

METHODS AND ANALYSIS

A serial cross-sectional design will be combined with a two-point in time longitudinal design to measure the levels of stigma among healthcare students from each year of undergraduate and graduate courses in Malaysia and Australia. In the absence of suitable measures, we will carry out a sequential mixed methods design to develop such a tool. The questionnaire data will be analysed using mixed effects linear models to manage the repeated measures.

ETHICS AND DISSEMINATION

We have received ethical approval from the Monash MBBS executive committee as well as the Monash University Human Research Ethics Committee. We will keep the data in a locked filing cabinet in the Monash University (Sunway campus) premises for 5 years, after which the information will be shredded and disposed of in secure bins, and digital recordings will be erased in accordance with Monash University's regulations. Only the principal investigator and the researcher will have access to the filing cabinet. We aim to present and publish the results of this study in national and international conferences and peer-reviewed journals, respectively.

Why culture matters in health interventions: lessons from HIV/AIDS stigma and NCDs

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 transformations requires a culturally grounded approach to public health interventions, such as that provided by the PEN-3 model.

Tóth T, Mocsonaki L, Amirkhanian Y. Effects of Stigmatization on Gay Men Living with HIV/AIDS in a Central-Eastern European Context: A Qualitative Analysis from Hungary

This qualitative study highlights the social dynamics affecting people living with HIV (PLH) in Hungary and in the Central-Eastern European region. The study focused on the special needs and concerns of men living with HIV/AIDS as well as changes in their social relationships and institutional support provision, coping strategies and patterns of social functioning, especially in the context of social stigmatization. Consistent with international qualitative research findings in the field of HIV/AIDS prevention, the present study contributes to a fuller understanding of relationship between sexual behavior, HIV/AIDS related risks and risk perceptions as well as homosexuality-and HIV/AIDS stigma-related social exclusion in a previously under-researched socio-cultural setting. The findings of our study point to several barriers to effective HIV prevention, which should be overcome to improve the present situation by lessening the adverse effects of HIV/AIDS-and homosexuality-related stigma within the gay community, the general population and especially among service providers. One of the main barriers is the lack of public health programs specifically targeting MSM in Hungary, where the predominant mode of HIV transmission remains sex between men.

Identity-related growth and loss in a sample of HIV-positive gay and bisexual men: initial scale development and psychometric evaluation

Past examinations of the impact of chronic illness on identity have focused primarily on positive adaptation (i.e., benefit finding or posttraumatic growth). Given that associations between these constructs and psychosocial wellbeing are equivocal, greater investigation is needed into interactions among perceived positive and negative identity changes pursuant to illness. A cross-sectional study was conducted between 2006 and 2007 with an ethnically diverse sample of 129 HIV-positive gay and bisexual men. Participants completed a brief quantitative survey, including a new measure, the Impact on Self-Concept Scale (ISCS), as well as gay-related stigma, quality of life, and regulatory focus. Factor analysis supported the existence of two ISCS subscales: self-growth and self-loss. Both subscales demonstrated strong internal consistency and were weakly but positively correlated. Preliminary assessment of construct validity indicated distinct patterns of association, with self-loss being more strongly associated with stigma and quality of life than self-growth. In multivariate models, associations between self-loss and both quality of life and regulatory focus were moderated by self-growth. The ISCS demonstrated preliminary reliability and validity in this sample. Findings suggest that self-growth and self-loss are meaningfully distinct constructs that may interact to produce important implications for understanding the experience of chronic illness.

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

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.

Include, differentiate and manage: gay male youth, stigma and healthcare utilization

In Canada, there has been a recent increase in HIV incidence among young men who have sex with men. However, gay male youth (GMY) may forego HIV testing due to fear of stigmatization. Therefore, the aim of this research was to explore the perceptions of stigma in health care within this population. The research was conducted through a series of semi-structured interviews with eight GMY aged 20-29, who frequented a gay-friendly clinic in downtown Ottawa, Canada. In a sub-analysis of the interviews utilizing the work of Hardt and Negri's three-part sequence - inclusion, differentiation and management - we found that homosexuality-related stigmatization affects the interaction between GMY and health professionals. Interview participants perceived HIV-related risk counselling as a manifestation of stigma. These findings reveal that the experience of stigma and stigmatization is not necessarily based on health professionals' intentions, but rather, on patients' perceptions of the interactions they have with health professionals. Specific modifications to the delivery of health care may help to overcome stigmatization.

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

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

Photovoice as a Community-Based Participatory Research Method among Women Living with HIV/AIDS: Ethical Opportunities and Challenges

Photovoice is a method in which participants use photography to identify, express, and disseminate their experiences. We conducted photovoice projects with women living with HIV/AIDS ( N=21) to explore opportunities and challenges associated with the method. Photovoice provided a means to achieve two key principles of ethical public health practice: It gives participants opportunities to define their health priorities, and facilitates participant empowerment. Ethical challenges that were encountered related to exposing, through photographs, one's identity as living with HIV/AIDS, illicit activities, and other people. We discuss lessons learned for future practice to maximize the ethical opportunities and manage the challenges associated with using photovoice as an HIV-related CBPR strategy.

HIV/AIDS-related stigma felt by people living with HIV from Buea, Cameroon

The universal access to treatment and care for people living with HIV (PLWHIV) is a major problem especially in Sub-Saharan Africa, where the majority of HIV infected people live. However, equally important is the fact that HIV/AIDS-related stigma is recognized to be a major obstacle to successfully control the spread of this disease. In this study we measured the HIV/AIDS-related stigma felt by PLWHIV in Cameroon using "The people living with HIV stigma index" questionnaire developed by UNAIDS, International Planned Parenthood Federation and Global Network of PLWHIV/AIDS among others. A total of 200 questionnaires were anonymously administered to PLWHIV in the HIV/AIDS treatment center of the Regional Hospital Annex Buea in the South West Region of Cameroon by trained academics who were themselves PLWHIV. In this setting the major problems faced by the PLWHIV with regard to stigmatization and discrimination were gossiping and verbal insults, which was felt by about half of the interviewees. Equally important was internal stigma, half of the PLWHIV felt ashamed and guilty to be HIV infected. This is the first report of this kind in Cameroon. These results will help to better understand HIV/AIDS-related stigma in this setting and in turn will improve the quality of life of PLWHIV by promoting their acceptance by the community.

Attitudes and beliefs related to HIV/AIDS in urban religious congregations: barriers and opportunities for HIV-related interventions

HIV-related stigmas have been seen as a barrier to greater religious congregation involvement in HIV prevention and care in the United States and elsewhere. We explored congregational and community norms and attitudes regarding HIV, sexuality, and drug use through a qualitative case study of 14 diverse religious congregations in Los Angeles County, California between December 2006 and May 2008. Data collected included semi-structured interviews with 57 clergy and lay leaders across the congregations, structured observations of congregational activities, review of archival documents, and a questionnaire on congregational characteristics. Across and within congregations, we found a wide range of views towards HIV, people with HIV, and populations at risk for HIV, from highly judgmental and exclusionary, to "loving the sinner, not the sin," to accepting and affirming. Attitudes and norms about HIV, homosexuality, and substance abuse appeared to be related to the type and intensity of congregational HIV-related activities. However, even among the higher activity congregations, we found a range of perceptions, including ones that were stigmatizing. Results suggest that affirming norms and attitudes are not a prerequisite for a congregation to initiate HIV activities, a finding relevant for HIV service providers and researchers seeking to engage congregations on this issue. HIV stigma reduction is not a prerequisite for congregational HIV involvement: both may occur simultaneously, or one before the other, and they dynamically affect each other. Strategies that are congruent with congregations' current levels of comfort and openness around HIV can themselves facilitate a process of attitudinal and normative change.

Health worker attitudes toward peer workers in hepatitis C prevention

Attitudes toward people who inject drugs (PWID) and attitudes toward peer workers among a cross-section of 101 Australian hepatitis C health workers were assessed. A survey consisting of Likert-type questions and one open-ended question regarding training was used. Bivariate and regression analyses demonstrated that health workers' attitudes toward peer workers were associated with their attitudes toward PWID, independent of type of organization or time in the hepatitis C sector. Qualitative analysis revealed four training areas suggested by health workers for peer workers. Implications of these findings for staff and peer training are discussed and future research directions suggested.

Acceptance of HIV testing in medical inpatients: a local acceptability study

Late diagnosis remains the most important factor related to death due to HIV in the UK. To reduce late diagnosis, the British HIV Association (BHIVA), the British Association for Sexual Health and HIV (BASHH), and the British Infection Society jointly released national guidelines for HIV testing in the UK in 2008. They recommend local evaluation of HIV testing for all medical admissions aged 15-59 years in areas where the local prevalence is above 2/1000. The local prevalence of HIV in Croydon is 4.17/1000. We carried out a local acceptability study at Mayday Hospital in Croydon and found that 84/101 medical patients agreed to have an HIV test. A previous audit showed that only 9/1047 medical admissions had been tested for HIV. This study shows that HIV testing is acceptable and that more patients could be tested.

Race and social attitudes about sickle cell disease

OBJECTIVE

Sickle cell disease is perhaps the most racialized condition in the history of modern medicine, yet very little research has focused on how racial perceptions influence social attitudes about the disease. Subsequently, the implications of these perceptions for public health prevention efforts and the provision of clinical care are not well known.

DESIGN

In this brief commentary, we posit that social cognitive and media framing theories provide useful approaches for assessing relations between race and social attitudes about sickle cell disease.

CONCLUSION

Such inquiries might lead to more rigorous study of mechanisms that shape perceptions about sickle cell risk, interpersonal empathy toward patients, and public support for sickle cell-related policies.

HIV vaccine acceptability and culturally appropriate dissemination among sexually diverse Aboriginal peoples in Canada

This study explored HIV vaccine acceptability and strategies for culturally appropriate dissemination among sexually diverse Aboriginal peoples in Canada, among those at highest HIV risk. We conducted four focus groups (n=23) with Aboriginal male (1) and female (1) service users, peer educators (1) and service providers (1) in Ontario, Canada. Transcripts were analysed with narrative thematic techniques from grounded theory, using NVivo. Participants' mean age was 37 years; about half (52%) were female, half (48%) Two-spirit or lesbian, gay or bisexual (LGB)-identified, 48% had a high-school education or less and 57% were unemployed. Vaccine uptake was motivated by community survival; however, negative HIV vaccine perceptions, historically based mistrust of government and healthcare institutions, perceived conflict between western and traditional medicine, sexual prejudice and AIDS stigma within and outside of Aboriginal communities, and vaccine cost may present formidable obstacles to HIV vaccine acceptability. Culturally appropriate processes of engagement emerged on individual levels (i.e., respect for self-determination, explanations in Native languages, use of modelling and traditional healing concepts) and community levels (i.e., leadership by Aboriginal HIV advocates and political representatives, identification of gatekeepers, and procuring Elders' endorsements). Building on cultural strengths and acknowledging the history and context of mistrust and social exclusion are fundamental to effective HIV vaccine dissemination.

An examination of the relationships among gender, health status, social support, and HIV-related stigma

This secondary analysis used E. Goffman's (1963) model of stigma to examine how social support and health status are related to HIV stigma, after controlling for specific sociodemographic factors, and how these relationships differed between men and women living with HIV. Baseline data from 183 subjects in a behavioral randomized clinical trial were analyzed using multigroup structural equation modeling. Women reported significantly higher levels of stigma than men after controlling for race, history of injection drug use, and exposure category. HIV-related stigma was negatively predicted by social support regardless of gender. The theorized model explained a significant amount of the variance in stigma for men and women (24.4% and 44%, respectively) and may provide novel and individualized intervention points for health care providers to effect positive change in perceived stigma for the person living with HIV. The study offers insight into understanding the relationships among gender, health status, social support, and HIV-related stigma.

The relationship between HIV testing, stigma, and health service usage

We explore whether HIV stigma is associated with seeking to conceal testing interest. We examine 86,899 outpatient visits in a 1993-1997 national survey and compare HIV testing to four non-stigmatized tests: spirometry, allergy testing, mammography, and colonoscopy. We explore whether people testing for HIV, compared to people receiving control services, listed reasons for visit (RFV) less related to the test performed, listed their interest in testing more frequently as a non-primary RFV, and received more services unrelated to testing. A total of 48.7% of people tested for HIV listed a reason unrelated to testing as their primary RFV (spirometry: 8.9%; allergy testing: 29.3%), and 69.9% of people asking to test requested HIV testing as a secondary RFV (spirometry: 52%; allergy testing: 0%). People who tested for HIV received more services (M=1.83 additional services) than non-testers (M=0.95) on an index of seven services. We did not find this association for spirometry, allergy testing, colonoscopy, or mammography. We interpret these results to indicate that stigma may have behavioral correlates and that people may attempt to avoid HIV stigma by seeking a psychological cover for HIV testing. To our knowledge, this is the first study to attempt to use observational data on health service usage for assessing stigma and people's attempts to deal with HIV testing stigma.

Obesity stigma: important considerations for public health

Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.

Demographic and social factors associated with homophobia and fear of AIDS in a community sample

Examinations of demographic and social factors associated with homophobia and fear of AIDS are limited by the frequent use of homogeneous, college student samples and limited examination of interrelationships among variables. The present study examined community attitudes toward homosexuality and fear of HIV/AIDS as a function of age, education, race/ethnicity, religious affiliation, political party affiliation, and personal contact with homosexual individuals and persons living with HIV/AIDS. A community sample of 463 adults completed standardized measures of homophobia and fear of AIDS as well as demographic and social background items. When examined separately, each demographic and social factor assessed, with the exception of race/ethnicity, was associated with homophobia and all but race/ethnicity and political party affiliation were associated with fear of AIDS. However, when entered into multiple regression analyses, 24% of the variance in homophobia was predicted by a single variable, including only personal contact with homosexual individuals, while 18% of the variance in fear of AIDS was accounted for by five variables, including personal contact with homosexual individuals, religious affiliation, political affiliation, education, and personal contact with someone living with HIV/AIDS. Findings suggest that it is important to consider intercorrelations among social and demographic factors, particularly when considering homophobia.