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Sambou C, Pourette D, Debeaudrap P, Slama L, Katlama C, Cazanave C, Bonnet F, Meyer L, Allavena C. The burden of secrecy in the management of multimorbidity in older people living with HIV aged 70 and over. AIDS Care 2024:1-8. [PMID: 38976641 DOI: 10.1080/09540121.2024.2372723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024]
Abstract
The secrecy surrounding HIV continues to be a major concern for older people living with HIV (OPWH) despite their long-term experience of HIV and the presence of other chronic diseases. Our study aims to highlight how the secrecy surrounding HIV can affect the management of the other conditions. The results of this socio-anthropological sub-study of the ANRS EP66 SEPTAVIH study, which assesses frailty in OPWH, are based on in-depth interviews conducted with 20 OPWH with multimorbidities aged 70 years and over and 9 caregivers. Based on a cross-sectional thematic analysis, this study shows that HIV infection differs from other chronic diseases due to the secrecy and stigma associated with HIV. These specific issues associated with HIV complicate the lives of OPWH, depriving them of support from loved ones and forcing them to exclude their general practitioner from their care system. This then causes OPWH with multiple chronic diseases to become socially vulnerable and isolated. Interventions that support the sharing of information on HIV among OPWH and also among caregivers need to be identified as a matter of urgency in order to improve the lives and management of OPWH with multimorbidities.Trial Registration: ClinicalTrials.gov identifier: NCT03958786.
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Affiliation(s)
- C Sambou
- Bordeaux Population Health, University of Bordeaux, Bordeaux, France
- Les Afriques dans le Monde (LAM), Pessac, France
| | - D Pourette
- CEPED, Institut de Recherche pour le Développement, Paris Cité University, Paris, France
- UMR Espace-Dev Réunion, Fellow of Institut Convergences Migrations, France
| | - P Debeaudrap
- CEPED, Institut de Recherche pour le Développement, Paris Cité University, Paris, France
| | - L Slama
- Department of Internal and Geriatric Medicine, Montpelier University Hospital, Montpelier, France
| | - C Katlama
- Department of Infectious Diseases, Hôpital la Pitié-Salpêtrière, Paris, France
| | - C Cazanave
- Department of Infectious Diseases, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - F Bonnet
- Department of Infectious Diseases, Hôpital Saint André, Bordeaux University Hospital, Bordeaux, France
| | - L Meyer
- CESP, INSERM U1018 - Hôpital du Kremlin-Bicêtre, Paris, France
| | - C Allavena
- Department of Infectious Diseases, Nantes University Hospital, University of Nantes, Nantes, France
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2
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Delle Donne V, Massaroni V, Lombardi F, Dusina A, Salvo PF, Borghetti A, Ciccullo A, Visconti E, Di Giambenedetto S. The association between stigma and wellbeing in an Italian cohort of PLWH: The role of social support and personal factors. Int J STD AIDS 2024; 35:176-187. [PMID: 37956698 DOI: 10.1177/09564624231213115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Our aim was to assess the association between different types of stigma and physical, behavioural and emotional wellbeing, and to evaluate whether these associations were mediated by the level of social support, age, education, sex and time from HIV diagnosis in an Italian cohort of people living with HIV (PLWH). We enrolled 96 PLWH and had them complete a cross-sectional online survey that included the "HSS-12", the "SF-12" and the "DASS-21". We performed linear regression analyses to explore the associations between the HSS-12 scores and cART adherence, viral load, SF-12 and DASS-21 scores, and a mediation analysis to identify mediators in the significant associations. We showed that higher level of depression and worse perception of mental health were significantly associated with higher HSS-12 "personalised stigma" (p = .009, p = .020) "disclosure concerns" (p = .012, p = .039), "concerns about public attitudes" (p =.007, p = .005) and "negative self-image" scores; (p < .001, p = .001); worse perception of physical health status was associated with higher HSS-12 "personalised stigma" scores (p = .018); higher level of anxiety and stress were associated with higher "negative self-image" scores (0.001 and p < .001). The association between higher HSS-12 "negative self-image" and higher levels of depression, anxiety and stress were mediated by lower age (a*b = +0.10; a*b = +0.12; a*b = +0.11). This study may have important implications for clinical practice as it contributes to understanding the characteristics and consequences of HIV-related stigma in a population of PLWH with excellent viroimmunological status and therapeutic adherence.
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Affiliation(s)
- Valentina Delle Donne
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Valentina Massaroni
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Francesca Lombardi
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alex Dusina
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Alberto Borghetti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arturo Ciccullo
- UOC Infectious Diseases, Ospedale S. Salvatore, L'Aquila, Italy
| | - Elena Visconti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Di Giambenedetto
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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3
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Tam C, Wang L, Salters K, Moore D, Wesseling T, Grieve S, Parry R, Barath J, Hogg R, Barrios R. Evaluating experiences of HIV-related stigma among people living with HIV diagnosed in different treatment eras in British Columbia, Canada. AIDS Care 2024; 36:238-247. [PMID: 37963415 DOI: 10.1080/09540121.2023.2277150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
There is mixed evidence on whether experiences of HIV-related stigma are mitigated with lived experience. We sought to examine whether people living with HIV (PLWH) with longer living experience reported varying levels of HIV-related stigma. Between January 2016-September 2018, we used purposive sampling to enrol PLWH aged ≥19 across British Columbia, Canada, where participants completed the 10-item Berger HIV Stigma Scale. We conducted bivariate analyzes examining key sociodemographic characteristics and HIV-related stigma scores. Multivariable linear regression modelled the association between year of HIV diagnosis by treatment era and HIV-related stigma scores. We enrolled 644 participants; median age at enrolment was 50 years (Q1-Q3: 42-56), with 37.4% (n = 241) diagnosed before the year 2000. The median HIV-stigma scores of all participants (19.0, Q1-Q3: 13-25, range 0-40) stratified by treatment era were: 17.0 (pre-1996), 20.0 (1996-1999), 20.0 (2000-2009), 19.0 (2010-2018) (p = 0.03). While there was a significant association at the univariate level, year of HIV diagnosis by treatment era was not associated with stigma scores after controlling for age, gender, HIV key populations, ethnicity, relationship status, social support, and ever having a mental health disorder diagnosis. This suggests that PLWH still experience HIV-related stigma today, compared to those diagnosed in earlier time periods.
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Affiliation(s)
- Clara Tam
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kate Salters
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - David Moore
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Tim Wesseling
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Sean Grieve
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Rebeccah Parry
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Justin Barath
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert Hogg
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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4
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Semler M, Pax L, McNamara KF, Joyce C, Shore J, Morey C, Gawne E, Clark NM. Reported HIV-related stigma according to race and ethnicity. AIDS Care 2023:1-8. [PMID: 37128634 DOI: 10.1080/09540121.2023.2206097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
People living with HIV/AIDS (PLWHA) have long experienced structural, community, and personal stigma. We explored differences in experienced HIV-related stigma according to race/ethnicity using quantitative and qualitative measures. Sixty-four patients were enrolled in this study (22 White and 42 people of color [POC]). POC scored higher than White PLWHA on all 12 survey statements, with statistically significant differences in disclosure concerns and with one of the statements on public attitudes towards PLWHA. Common themes in the qualitative interview were HIV disclosure concerns and fear of rejection. These data demonstrate that stigma continues to be a significant concern for PLWHA, particularly POC, meaningfully impacting their lives. By acknowledging and working to reduce negative perceptions about PLWHA, physicians may improve care for their patients by developing more trusting relationships.
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Affiliation(s)
- Matthew Semler
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Laura Pax
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | - Cara Joyce
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
- Center for Health Outcomes and Informatics Research, Loyola University Chicago, Maywood, IL, USA
| | | | - Craig Morey
- Loyola University Medical Center, Maywood, IL, USA
| | | | - Nina M Clark
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
- Loyola University Medical Center, Maywood, IL, USA
- Infectious Disease & Immunology Research Institute, Loyola University Chicago, Maywood, IL, USA
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5
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Davtyan M, Uraga S, Wilson ML, Frederick T. Internalized HIV-related stigma in women of color obtaining care at an HIV specialty center in Los Angeles County, California. AIDS Care 2023; 35:658-662. [PMID: 36260067 DOI: 10.1080/09540121.2022.2137100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/09/2022] [Indexed: 11/17/2022]
Abstract
The current study examined the role of internalized HIV-related stigma in antiretroviral therapy adherence, viral load, and retention in care among women of color living with HIV in Los Angeles County, California. African American and Hispanic/Latino women 18 years of age and older completed a one-time brief survey between September 2017 and February 2018. Descriptive statistics, and univariable and multivariable logistic regressions were used to analyze the data. Seventy-six participants enrolled in the study and 74 completed the entire survey. Seventy-six percent of respondents were Hispanic/Latino, 24% were African American, 71% were unemployed, and 54% had less than a high school education. Thirty-five percent were defined as having "high" stigma with a score in the upper quartile of the scale. Being unemployed, having a high school education or less, and not meeting the Health Resources and Services Administration's annual retention in care measure were associated with "high" stigma. When controlling for education and employment status, those reporting "high" stigma vs. "low" stigma were 18.8 times more likely to not meet the criteria for annual retention in care (OR = 18.8, 95% CI = 1.9-189.2, p = 0.013). Stigma-reduction interventions targeting healthcare settings may be necessary to improve patient retention and engagement in care.
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Affiliation(s)
- Mariam Davtyan
- Department of Pediatrics, Keck School of Medicine, Maternal, Child & Adolescent Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, CA, USA
| | - Susana Uraga
- Department of Pediatrics, Keck School of Medicine, Maternal, Child & Adolescent Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, CA, USA
| | - Melissa L Wilson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Toinette Frederick
- Department of Pediatrics, Keck School of Medicine, Maternal, Child & Adolescent Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, CA, USA
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6
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Brown MJ, Gao C, Kaur A, Qiao S, Li X. Social Support, Internalized HIV Stigma, Resilience and Depression Among People Living with HIV: A Moderated Mediation Analysis. AIDS Behav 2023; 27:1106-1115. [PMID: 36094638 PMCID: PMC10115436 DOI: 10.1007/s10461-022-03847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/30/2022]
Abstract
Internalized HIV stigma has been associated with depression among people living with HIV (PLWH). However, it is still unclear whether resilience would mediate the association between internalized HIV stigma and depression and how this indirect effect would be moderated by social support. Data were collected from 402 PLWH in South Carolina using a cross-sectional survey. Data were fitted using a path model that specified the extent to which internalized HIV stigma and depression were related through resilience and how this effect was moderated by social support. Sociodemographic characteristics were included in the model as covariates. The indirect effect of internalized HIV stigma on depression through resilience was statistically significant for high social support but not for low social support. To mitigate negative impacts of internalized HIV stigma on mental health of PLWH, intervention efforts should integrate multilevel components for promoting both resilience and social support.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States.
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, United States.
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, United States.
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, United States.
| | - Chuanji Gao
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Shan Qiao
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Xiaoming Li
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
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Brown MJ, Amoatika D, Kaur A, Addo PNO, Yoo-Jeong M. Psychosocial Protective and Risk Factors of Quality of Life Outcomes Among Older Adults Living With HIV. AIDS Behav 2023:10.1007/s10461-023-03989-2. [PMID: 36717423 DOI: 10.1007/s10461-023-03989-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
HIV continues to be a public health issue for older adults. Previous studies have examined predictors of quality of life (QoL) among people living with HIV (PLWH), but the majority have been in international settings and have not focused on older adults living with HIV (OALH). The aim of this study was to examine the associations between psychosocial protective and risk factors (resilience, internalized HIV-related stigma, and depression), and overall and domains (physical, psychological, independence, social, environmental, and spiritual) of QoL among OALH. Data were obtained from 156 OALH living in South Carolina. Resilience was positively associated with all QoL domains except the spiritual domain. Internalized HIV-related stigma was associated with all QoL domains except the psychological and environmental domains. Depression was associated with the overall QoL measure and all domains. Interventions aimed at increasing resilience, attenuating internalized HIV-related stigma and depressive symptoms may be warranted for OALH, which may improve overall and varying domains of QoL.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. .,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. .,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, SC, Columbia, USA. .,Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, SC, Columbia, USA.
| | - Daniel Amoatika
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Prince Nii Ossah Addo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Moka Yoo-Jeong
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, MA, Boston, USA
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Bradley H, Zhu Y, Duan X, Kang H, Qu B. HIV-Specific Reported Outcome Measures: Systematic Review of Psychometric Properties. JMIR Public Health Surveill 2022; 8:e39015. [PMID: 36222289 PMCID: PMC9782451 DOI: 10.2196/39015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/03/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The management of people living with HIV and AIDS is multidimensional and complex. Using patient-reported outcome measures (PROMs) has been increasingly recognized to be the key factor for providing patient-centered health care to meet the lifelong needs of people living with HIV and AIDS from diagnosis to death. However, there is currently no consensus on a PROM recommended for health care providers and researchers to assess health outcomes in people living with HIV and AIDS. OBJECTIVE The purpose of this systematic review was to summarize and categorize the available validated HIV-specific PROMs in adults living with HIV and AIDS and to assess these PROMs using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. METHODS This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of 3 recommended databases (PubMed, Embase, and PsychINFO) was conducted on January 15, 2021. Studies were included if they assessed any psychometric property of HIV-specific PROMs in adults living with HIV and AIDS and met the eligibility criteria. The PROMs were assessed for 9 psychometric properties, evaluated in each included study following the COSMIN methodology by assessing the following: the methodological quality assessed using the COSMIN risk of bias checklist; overall rating of results; level of evidence assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation approach; and level of recommendation. RESULTS A total of 88 PROMs classified into 8 categories, assessing the psychometric properties of PROMs for adults living with HIV and AIDS, were identified in 152 studies including 79,213 people living with HIV and AIDS. The psychometric properties of most included PROMs were rated with insufficient evidence. The PROMs that received class A recommendation were the Poz Quality of Life, HIV Symptom Index or Symptoms Distress Module of the Adult AIDS Clinical Trial Group, and People Living with HIV Resilience Scale. In addition, because of a lack of evidence, recommendations regarding use could not be made for most of the remaining assessed PROMs (received class B recommendation). CONCLUSIONS This systematic review recommends 3 PROMs to assess health outcomes in adults living with HIV and AIDS. However, all these PROMs have some shortcomings. In addition, most of the included PROMs do not have sufficient evidence for assessing their psychometric properties and require a more comprehensive validation of the psychometric properties in the future to provide more scientific evidence. Thus, our findings may provide a reference for the selection of high-quality HIV-specific PROMs by health care providers and researchers for clinical practice and research.
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Affiliation(s)
| | - Yaxin Zhu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Xiyu Duan
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Hao Kang
- Administration Department of Nosocomial Infection, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bo Qu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China.,School of Public Health, China Medical University, Shenyang, China
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9
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Alenezi A. Stigmatization and discrimination towards human immunodeficiency virus seropositive patients in psychiatric and mental health facilities. Int J Ment Health Nurs 2022; 31:1198-1212. [PMID: 35678330 DOI: 10.1111/inm.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
Stigmatization and discriminatory attitudes of nurses towards human immunodeficiency (HIV) patients have been reported in many countries. The current study was undertaken to assess the knowledge, attitudes and factors associated with stigmatizing attitudes and discrimination among psychiatric and mental health nurses and nurse interns towards patients diagnosed with the human immunodeficiency virus; utilizing a single-centre hospital-based survey design. Primary data were collected using a previously validated questionnaire in a large mental health care hospital in Riyadh, Saudi Arabia. Knowledge, attitudes, acts of discrimination and associated factors on the part of mental health nurses towards those diagnosed with the HIV were identified. The study described herein is in accordance with the STROBE guideline. A total of 241 psychiatric and mental health nurses completed the questionnaire, yielding a completion rate of 74.4%. Overall, more than half of the nurses demonstrated gaps in knowledge and reported higher stigmatizing attitudes and acts of discrimination. Factors associated with stigmatization and/or discrimination include higher exposure to seropositive patients, no formal HIV training, lower religiousness, lower awareness of HIV testing policy and lower level of knowledge about HIV infection. There is an urgent need to implement a training program that will help to reduce stigma among nurses caring for people diagnosed with this illness.
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Affiliation(s)
- Atallah Alenezi
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
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10
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Wang M, Chen X, Ma S, Liu G, Chen C. Effectiveness of a mobile-based HIV prevention intervention for the rural and low-income population involving incentive policy to doctors in Liangshan, China: a randomized controlled trial protocol. BMC Public Health 2022; 22:1682. [PMID: 36064390 PMCID: PMC9447340 DOI: 10.1186/s12889-022-13930-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/02/2022] [Indexed: 11/14/2022] Open
Abstract
Background The HIV/AIDS epidemic is a concerning problem in many parts of the world, especially in rural and poor areas. Due to health service inequality and public stigma towards the disease, it is difficult to conduct face-to-face interventions. The widespread use of mobile phones and social media applications thus provide a feasible and acceptable approach for HIV prevention and education delivery in this population. The study aims to develop a generalizable, effective, acceptable, and convenient mobile-based information intervention model to improve HIV-related knowledge, attitudes, practices, and health outcomes in poverty-stricken areas in China and measure the impact of incentive policies on the work of village doctors in Liangshan, China. Methods A randomized controlled trial design is used to evaluate the effectiveness of an 18-month mobile-based HIV prevention intervention, collaborating with local village doctors and consisting of group-based knowledge dissemination and individualized communication on WeChat and the Chinese Version of TikTok in Liangshan, China. Each village is defined as a cluster managed by a village doctor with 20 adults possessing mobile phones randomly selected from different families as participants, totaling 200 villages. Clusters are randomized (1:1:1) to the Control without mobile-based knowledge dissemination, Intervention A with standardized compensation to the village doctors, or Intervention B with performance-based compensation to the village doctors. The intervention groups will receive biweekly messages containing HIV-related educational modules. Data will be collected at baseline and 6-, 12-, and 18-month periods for outcome measurements. The primary outcomes of the study are HIV-related knowledge improvement and the effectiveness of village doctor targeted incentive policies. The secondary outcomes include secondary knowledge transmission, behavioral changes, health outcomes, social factors, and study design’s acceptability and reproducibility. These outcomes will be explored via various qualitative and quantitative means. Discussion The findings will provide insights into the effectiveness, generalizability, and challenges of the mobile-based HIV prevention intervention for the population living in rural communities with low education levels and will guide the development of similar models in other low-income and culturally isolated regions. Trial registration ClinicalTrial.gov: NCT05015062; Registered on June 6, 2022.
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Affiliation(s)
- Meijiao Wang
- School of Public Administration and Humanities, Dalian Maritime University, Dalian, Liaoning, People's Republic of China.,National School of Development, Peking University, Beijing, People's Republic of China.,China Center for Health Economic Research, Peking University, Beijing, People's Republic of China
| | - Xiaotong Chen
- China Center for Health Economic Research, Peking University, Beijing, People's Republic of China
| | - Sai Ma
- China Center for Health Economic Research, Peking University, Beijing, People's Republic of China
| | - Gordon Liu
- National School of Development, Peking University, Beijing, People's Republic of China. .,China Center for Health Economic Research, Peking University, Beijing, People's Republic of China. .,PKU Institute for Global Health and Developmnent, Peking University, Beijing, People's Republic of China.
| | - Chen Chen
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, People's Republic of China.
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11
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Mi T, Lan G, Yang X, Li X, Qiao S, Shen Z, Zhou Y. HIV-Related Stigma, Sexual Identity, and Depressive Symptoms Among MSM Living With HIV in China: A Moderated Mediation Modeling Analysis. Am J Mens Health 2022; 16:15579883221087531. [PMID: 35343811 PMCID: PMC8966094 DOI: 10.1177/15579883221087531] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Depression is one of the biggest health issues among men who have sex with men (MSM) living with HIV, where sexual identity might play an intricate role. Yet, findings of the relationship between sexual identity and depression were mixed and few studies explored its underlying mechanisms. This study aimed to examine the association between sexual identity and depression, and the potential mediating role of HIV-related stigma and moderating role of age. A cross-sectional survey was conducted among 203 MSM living with HIV in Guangxi, China. Participants provided information on sexual identity, depression, HIV-related stigma, and background information. Descriptive statistics, bivariate analysis, and path analysis were applied to examine our hypotheses. Bivariate analysis demonstrated that participants who self-identified as gay reported a lower level of HIV-related stigma and depression. Path analysis revealed an insignificant direct effect of identifying as gay on depression. Yet, the indirect pathway was significant, with identifying as gay being associated with a lower level of HIV stigma and thus a lower level of depression. This indirect effect was moderated by age. The conditional indirect effect was significant in the younger group yet ceased in the older group. The study provided information to better understand the effect of sexual identity on mental health among stigmatized sexual and gender minorities by highlighting the mediating effect of HIV-related stigma and the protective effect of age. Interventions targeting mental health of MSM living with HIV might consider placing greater emphasis on addressing HIV-related stigma among younger MSM.
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Affiliation(s)
- Tianyue Mi
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Guanghua Lan
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Xueying Yang
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, China
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12
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Luo L, Yang D, Tian Y, Gao W, Yang J, Yuan J. Awe weakens the AIDS-related stigma: The mediation effects of connectedness and empathy. Front Psychiatry 2022; 13:1043101. [PMID: 36532200 PMCID: PMC9755721 DOI: 10.3389/fpsyt.2022.1043101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
Stigma toward people with HIV or AIDS produces significant harms to their life and also hinders the prevention of AIDS. In the present study, we tested whether awe can weaken AIDS-related stigma and the mediating role of connectedness and empathy between them through a cross-sectional study (Study 1, N = 372) and two experimental studies (Study 2a and 2b, N = 110 and N = 180, respectively). Results showed that awe reduced AIDS-related stigma (Study 2a and 2b), via the serial mediation of connectedness and empathy (Study 1 and 2b). These findings suggest that the experience of awe increases one's connectedness to the world, which then enhances empathy and decreases AIDS-related stigma. This study expands our understanding of the relationship between awe and stigma, providing empirical basis for decreasing social prejudice to others.
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Affiliation(s)
- Li Luo
- The Affect Cognition and Regulation Laboratory (ACRLab), Faculty of Psychology, Southwest University, Chongqing, Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China.,School of Educational Science, Neijiang Normal University, Neijiang, China
| | - Dong Yang
- The Affect Cognition and Regulation Laboratory (ACRLab), Faculty of Psychology, Southwest University, Chongqing, Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Yu Tian
- The Affect Cognition and Regulation Laboratory (ACRLab), Faculty of Psychology, Southwest University, Chongqing, Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Wei Gao
- The Affect Cognition and Regulation Laboratory (ACRLab), Faculty of Psychology, Southwest University, Chongqing, Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Jiemin Yang
- The Affect Cognition and Regulation Laboratory (ACRLab), Faculty of Psychology, Southwest University, Chongqing, Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Jiajin Yuan
- The Affect Cognition and Regulation Laboratory (ACRLab), Faculty of Psychology, Southwest University, Chongqing, Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
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13
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Wanjala SW, Too EK, Luchters S, Abubakar A. Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13074. [PMID: 34948690 PMCID: PMC8701211 DOI: 10.3390/ijerph182413074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
Addressing HIV-related stigma requires the use of psychometrically sound measures. However, despite the Berger HIV stigma scale (HSS) being among the most widely used measures for assessing HIV-related stigma, no study has systematically summarised its psychometric properties. This review investigated the psychometric properties of the HSS. A systematic review of articles published between 2001 and August 2021 was undertaken (CRD42020220305) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additionally, we searched the grey literature and screened the reference lists of the included studies. Of the total 1241 studies that were screened, 166 were included in the review, of which 24 were development and/or validation studies. The rest were observational or experimental studies. All the studies except two reported some aspect of the scale's reliability. The reported internal consistency ranged from acceptable to excellent (Cronbach's alpha ≥ 0.70) in 93.2% of the studies. Only eight studies reported test-retest reliability, and the reported reliability was adequate, except for one study. Only 36 studies assessed and established the HSS's validity. The HSS appears to be a reliable and valid measure of HIV-related stigma. However, the validity evidence came from only 36 studies, most of which were conducted in North America and Europe. Consequently, more validation work is necessary for more precise insights.
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Affiliation(s)
- Stanley W. Wanjala
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Department of Social Sciences, Pwani University, Kilifi P.O. Box 195-80108, Kenya
| | - Ezra K. Too
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
| | - Stanley Luchters
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Public Health, Pwani University, Kilifi P.O. Box 195-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi P.O. Box 230-80108, Kenya
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14
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Budhwani H, Yigit I, Ofotokun I, Konkle-Parker DJ, Cohen MH, Wingood GM, Metsch LR, Adimora AA, Taylor TN, Wilson TE, Weiser SD, Kempf MC, Sosanya O, Gange S, Kassaye S, Turan B, Turan JM. Examining the Relationships Between Experienced and Anticipated Stigma in Health Care Settings, Patient-Provider Race Concordance, and Trust in Providers Among Women Living with HIV. AIDS Patient Care STDS 2021; 35:441-448. [PMID: 34739336 PMCID: PMC8817693 DOI: 10.1089/apc.2021.0096] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Stigma in health care settings can have negative consequences on women living with HIV, such as increasing the likelihood of missed visits and reducing trust in their clinical providers. Informed by prior stigma research and considering knowledge gaps related to the effect of patient-provider race concordance, we conducted this study to assess if patient-provider race concordance moderates the expected association between HIV-related stigma in health care settings and patients' trust in their providers. Moderation analyses were conducted using Women's Interagency HIV Study data (N = 931). We found significant main effects for patient-provider race concordance. Higher experienced stigma was associated with lower trust in providers in all patient-provider race combinations [White-White: B = -0.89, standard error (SE) = 0.14, p = 0.000, 95% confidence interval, CI (-1.161 to -0.624); Black patient-White provider: B = -0.19, SE = 0.06, p = 0.003, 95% CI (-0.309 to -0.062); and Black-Black: B = -0.30, SE = 0.14, p = 0.037, 95% CI (-0.575 to -0.017)]. Higher anticipated stigma was also associated with lower trust in providers [White-White: B = -0.42, SE = 0.07, p = 0.000, 95% CI (-0.552 to -0.289); Black patient-White provider: B = -0.17, SE = 0.03, p = 0.000, 95% CI (-0.232 to -0.106); and Black-Black: B = -0.18, SE = 0.06, p = 0.002, 95% CI (-0.293 to -0.066)]. Significant interaction effects indicated that the negative associations between experienced and anticipated HIV-related stigma and trust in providers were stronger for the White-White combination compared with the others. Thus, we found that significant relationships between HIV-related experienced and anticipated stigma in health care settings and trust in providers exist and that these associations vary across different patient-provider race combinations. Given that reduced trust in providers is associated with antiretroviral medication nonadherence and higher rates of missed clinical visits, interventions to address HIV-related stigma in health care settings may improve continuum of care outcomes.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | | | - Igho Ofotokun
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | | | | - Adaora A Adimora
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tonya N Taylor
- Downstate Health Sciences University, Brooklyn, New York, USA
| | - Tracey E Wilson
- Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sheri D Weiser
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Seble Kassaye
- Georgetown University, Washington, District of Columbia, USA
| | | | - Janet M Turan
- University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
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15
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Javier SJ, Troszak LK, Shimada SL, McInnes DK, Ohl ME, Avoundjian T, Erhardt TA, Midboe AM. Racial and ethnic disparities in use of a personal health record by veterans living with HIV. J Am Med Inform Assoc 2021; 26:696-702. [PMID: 30924875 DOI: 10.1093/jamia/ocz024] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine sociodemographic characteristics associated with use of My HealtheVet (MHV) by veterans living with HIV. MATERIALS AND METHODS Veterans Health Administration administrative data were used to identify a cohort of veterans living with HIV in fiscal years 2011-2017. Descriptive analyses were conducted to examine demographic characteristics and racial/ethnic differences in MHV registration and tool use. Chi-Square tests were performed to assess associations between race/ethnicity and MHV registration and tool use. RESULTS The highest proportion of registrants were non-Hispanic White veterans living with HIV (59%), followed by Hispanic/Latino (55%) and Black veterans living with HIV (40%). Chi-Square analyses revealed that: (1) MHV account registration was significantly lower for both Black and Hispanic/Latino veterans in comparison to White veterans and (2) Black MHV registrants were less likely to utilize any MHV tool compared with White MHV registrants including Blue Button record download, medication refills, secure messaging, lab, and appointment views. DISCUSSION In line with prior research on personal health record (PHR) use among non-veteran populations, these findings show racial and ethnic inequities in MHV use among veterans living with HIV. Racial and ethnic minorities may be less likely to use PHRs for a myriad of reasons, including PHR privacy concerns, decreased educational attainment, and limited access to the internet. CONCLUSION This is the first study to examine racial and ethnic disparities in use of MHV tools by veterans living with HIV and utilizing Veterans Health Administration health care. Future research should examine potential moderating factors linked to decreased PHR use among racial and ethnic minority veterans, which could inform strategies to increase PHR use among vulnerable populations.
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Affiliation(s)
- Sarah J Javier
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Lara K Troszak
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - D Keith McInnes
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michael E Ohl
- Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, Iowa, USA.,Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Tigran Avoundjian
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.,University of Washington School of Public Health, University of Washington, Seattle, Washington, USA
| | - Taryn A Erhardt
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Amanda M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA
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16
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Mgbako O, Benoit E, Iyengar NS, Kuhner C, Brinker D, Duncan DT. "Like a ticking time bomb": the persistence of trauma in the HIV diagnosis experience among black men who have sex with men in New York City. BMC Public Health 2020; 20:1247. [PMID: 32807117 PMCID: PMC7433074 DOI: 10.1186/s12889-020-09342-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 08/04/2020] [Indexed: 11/18/2022] Open
Abstract
Background Black men who have sex with men (MSM) are disproportionately affected by HIV compared to almost every other demographic group in the country and have worse outcomes along the care continuum. Diagnosis is a critical juncture. This study aims to explore the impact and meaning of an HIV diagnosis for Black MSM, and how this has changed over time, both for the individual’s experience living with HIV as well as for Black MSM in general. Methods From 2017 to 2018, we conducted in-depth interviews with 16 black MSM living with HIV in New York City diagnosed between 1985 and 2016. Results Inductive analysis of the qualitative data allowed three major themes to emerge: diagnosis trauma, lack of patient -centeredness in the healthcare system, and acceptance of HIV diagnosis over time. Conclusions This small pilot study signals that an HIV diagnosis experience possibly remains traumatic for black MSM even in the era of highly effective ART, and they often perceive a lack of patient-centeredness in the delivery of a new diagnosis. This has persisted over time. In most cases, black MSM in our sample overcame this trauma due to self-motivation, social support and seeking out and fostering trusting relationships with their HIV provider and the healthcare system.
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Affiliation(s)
- Ofole Mgbako
- Division of Infectious Disease, Department of Internal Medicine, Columbia University Medical Center, 630 W. 168th St., P&S Box 82, New York, NY, 10032, USA.
| | - Ellen Benoit
- North Jersey Community Research Initiative, Newark, NJ, USA
| | | | | | | | - Dustin T Duncan
- Columbia Spatial Epidemiology Lab, Social and Spatial Epidemiology Unit, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
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17
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Brewer R, Hood KB, Moore M, Spieldenner A, Daunis C, Mukherjee S, Smith-Davis M, Brown G, Bowen B, Schneider JA. An Exploratory Study of Resilience, HIV-Related Stigma, and HIV Care Outcomes Among Men who have Sex with Men (MSM) Living with HIV in Louisiana. AIDS Behav 2020; 24:2119-2129. [PMID: 31916097 DOI: 10.1007/s10461-020-02778-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The various forms of HIV-related stigma continue to serve as major barriers to HIV care and treatment among men who have sex with men (MSM). The study of resilience within the context of HIV-related stigma among MSM living with HIV represents a promising area of research to inform the development of future HIV interventions for this population. We examined resilience within the context of HIV related stigma among MSM living with HIV in Louisiana with a particular interest in how resilience may be more relevant for Black MSM. We utilized Pearson's correlations and layered chi-square non-parametric tests to examine associations and racial differences in resilience, four HIV-related stigma measures/consequences (i.e., anticipated, internalized, enacted, and consequences of enacted HIV stigma), and HIV care outcomes (i.e., length of time since last HIV care visit, time since last HIV lab result, most recent HIV viral load result) among 110 MSM living with HIV in Louisiana who participated in the Louisiana HIV Stigma Index Project. The majority of MSM participants were Black (75%), lived in New Orleans (52%), and reported limited education (52%) and income (76%). MSM who reported higher levels of enacted HIV stigma, consequences of enacted HIV stigma, and internalized HIV stigma reported poorer HIV care outcomes. Both internalized and anticipated HIV stigma significantly negatively impacted Black MSM perceptions of their overall health compared with White MSM. Compared with White MSM, Black MSM who reported greater consequences of enacted HIV stigma had poorer HIV care outcomes. Resilience was associated with positive HIV care outcomes for both Black and White MSM. However, having higher levels of resilience may have been more protective for Black MSM such that higher levels of resilience were associated with less time since last HIV care visit for Black MSM than for White MSM. The current study provides preliminary information on the potential positive relationship between resilience and HIV care outcomes among MSM, particularly Black MSM. However, these findings need to be confirmed among a more representative sample of Black and White MSM in Louisiana.
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Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.
- Chicago Center for HIV Elimination, Chicago, IL, USA.
| | | | - Mary Moore
- Dillard University, New Orleans, LA, USA
| | | | | | - Snigdha Mukherjee
- Educational Commission for Foreign Medical Graduates, Philadelphia, PA, USA
| | | | - Gina Brown
- Southern AIDS Coalition, New Orleans, LA, USA
| | - Brandi Bowen
- New Orleans Regional AIDS Planning Council, New Orleans, LA, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
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18
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Saine ME, Moore TM, Szymczak JE, Bamford LP, Barg FK, Mitra N, Schnittker J, Holmes JH, Lo Re V. Validation of a modified Berger HIV stigma scale for use among patients with hepatitis C virus (HCV) infection. PLoS One 2020; 15:e0228471. [PMID: 32023310 PMCID: PMC7001940 DOI: 10.1371/journal.pone.0228471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/15/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV prevention, treatment, and elimination. To date, no validated instrument exists to measure patients' experiences of HCV stigma. This study aimed to revise the Berger (2001) HIV stigma scale and evaluate its psychometric properties among patients with HCV infection. METHODS The Berger HIV stigma scale was revised to ask about HCV and administered to patients with HCV (n = 270) in Philadelphia, Pennsylvania. Scale reliability was evaluated as internal consistency by calculating Cronbach's alpha. Exploratory factor analysis was performed to evaluate construct validity by comparing item clustering to the Berger HIV stigma scale subscales. Item response theory was employed to further evaluate individual items and to calibrate items for simulated computer adaptive testing sessions in order to identify potential shortened instruments. RESULTS The revised HCV Stigma Scale was found to have good reliability (α = 0.957). After excluding items for low loadings, the exploratory factor analysis indicated good construct validity with 85% of items loading on pre-defined factors. Analyses strongly suggested the predominance of an underlying unidimensional factor solution, which yielded a 33-item scale after items were removed for low loading and differential item functioning. Adaptive simulations indicated that the scale could be substantially shortened without detectable information loss. CONCLUSIONS The 33-item HCV Stigma Scale showed sufficient reliability and construct validity. We also conducted computer adaptive testing simulations and identified shortened six- and three-item scale alternatives that performed comparably to the original 40-item scale.
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Affiliation(s)
- M. Elle Saine
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Tyler M. Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Julia E. Szymczak
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Laura P. Bamford
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA, United States of America
| | - Frances K. Barg
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Nandita Mitra
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jason Schnittker
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - John H. Holmes
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Vincent Lo Re
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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19
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Fabian K, Molina Y, Kemp CG, Nevin PE, McCoy K, Simoni JM, Andrasik M, Cohn SE, Micci S, Rao D. Internalized HIV-Related Stigma and Breast Health Beliefs Among African-American Women Receiving Care for HIV in the USA. J Racial Ethn Health Disparities 2020; 7:45-51. [PMID: 31452148 PMCID: PMC6980483 DOI: 10.1007/s40615-019-00632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/30/2019] [Accepted: 08/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES African-American women suffer disproportionately from HIV, breast cancer, and other illnesses. Little is known about the relationship between internalized HIV-related stigma and health beliefs related to other illnesses, including breast cancer. Our study examined (1) the relationship between internalized HIV-related stigma and breast health beliefs over time and (2) the moderating effects of participating in a stigma reduction intervention and/or social support. METHODS Data from 239 African-American women receiving care for HIV in Chicago, IL, or Birmingham, AL, enrolled in the Unity randomized controlled trial, were used in this secondary analysis. Threat of breast cancer was measured in terms of perceived susceptibility, fear, and adverse consequences as well as an overall perceived threat of breast cancer. We used multivariate models with generalized estimating equations to examine the relationship between internalized HIV-related stigma and breast health beliefs across three time points (baseline, immediately post-workshop, and at 12-month follow-up) and to examine if the study arm (HIV stigma reduction vs. breast cancer education) or social support moderated the relationship. RESULTS Internalized HIV-related stigma was associated with greater overall perceived threat (p < 0.001), susceptibility (p = 0.03), fear (p < 0.001), and perceived adverse consequences (p < 0.001) of breast cancer. These associations remained consistent across study arms and across all levels of social support. CONCLUSIONS Future studies that examine co-morbid health conditions among African-American women living with HIV should consider the impact of HIV-related stigma on attitudes and beliefs related to co-morbid conditions.
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Affiliation(s)
- Katrin Fabian
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Yamilé Molina
- Community Health Sciences Division, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL, 60612, USA.
| | | | - Paul E Nevin
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Katryna McCoy
- School of Nursing & Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - Jane M Simoni
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Susan E Cohn
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Sandy Micci
- CORE Center/Division of Infectious Diseases, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry, University of Washington, Seattle, WA, USA
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20
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Husbands W, Oakes W, Mbulaheni T, Ongoïba F, Pierre-Pierre V, Luyombya H. Resourceful masculinities: exploring heterosexual Black men's vulnerability to HIV in Ontario, Canada. ETHNICITY & HEALTH 2020; 25:17-33. [PMID: 29082777 DOI: 10.1080/13557858.2017.1395817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Heterosexually active Black men are alleged to endorse masculine norms that increase their and their female partners' vulnerability to HIV. These norms include Black men's inability or reluctance to productively engage their own health-related personal and interpersonal vulnerabilities. We draw on data from the iSpeak research study in Ontario, Canada, to assess whether and how heterosexual Black men cope with personal and inter-personal vulnerability, namely that heterosexual Black men: avoid emotionally supportive relationships with other men (and women), which diminishes their capacity to productively acknowledge and resolve their health-related challenges; are reticent to productively acknowledge and address HIV and health on a personal level; and are pathologically secretive about their health, which compounds their vulnerability and precipitates poor health outcomes.Design: iSpeak was implemented in 2011 to 2013, and included two focus groups with HIV-positive and HIV-negative self-identified heterosexual men (N = 14) in Toronto and London, a focus group with community-based health promotion practitioners who provide HIV-related services to Black communities in Ontario (N = 6), and one-on-one interviews with four researchers distinguished for their scholarship with/among Black communities in Toronto. Participants in the men's focus group were recruited discretely through word-of-mouth. Focus groups were audiotaped and transcribed verbatim. Team members independently read the transcripts, and then met to identify, discuss and agree on the emerging themes.Results: We demonstrate that iSpeak participants (a) engage their personal and interpersonal vulnerabilities creatively and strategically, (b) complicate and challenge familiar interpretations of Black men's allegedly transgressive masculinity through their emotional and practical investment in their health, and (c) demonstrate a form of resourceful masculinity that ambiguously aligns with patriarchy.Conclusion: We conclude with a range of actionable recommendations to strengthen the discursive framework for understanding heterosexual Black men in relation to HIV and health, and substantively engaging them in community responses to HIV.
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Affiliation(s)
| | - Wesley Oakes
- Africans in Partnership Against AIDS, Toronto, ON, Canada
| | - Tola Mbulaheni
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, ON, Canada
| | - Fanta Ongoïba
- Africans in Partnership Against AIDS, Toronto, ON, Canada
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21
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Moalusi KP. Employees' experiences of the stigma of HIV in a retail organisation: secrecy, privacy or trust? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:313-322. [PMID: 30466350 DOI: 10.2989/16085906.2018.1536671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study unveiled the participants' experiences of HIV-related stigma in a retail organisation located in the Western Cape province of South Africa. A qualitative approach was adopted because of its appropriateness for unravelling subjective phenomena such as employees' experiences of HIV-related stigma. In-depth interviews were conducted with 10 HIV-positive employees who volunteered to participate. The findings reveal that the participants concealed their HIV-positive status because they feared that the co-workers and managers might stigmatise them and breach confidentiality. The results also revealed that despite being HIV-positive, the participants seemed not to experience a lower work-related self-concept as they said that they are as competent as other employees. The study draws on these empirical findings to theorise about whether concealment of an HIV-positive status is symptomatic of secrecy, the desire for privacy or low levels of trust.
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Affiliation(s)
- Kgope P Moalusi
- a Industrial and Organisational Psychology , University of South Africa , Pretoria , South Africa
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22
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Odimegwu CO, Alabi O, De Wet N, Akinyemi JO. Ethnic heterogeneity in the determinants of HIV/AIDS stigma and discrimination among Nigeria women. BMC Public Health 2018; 18:763. [PMID: 29914438 PMCID: PMC6006838 DOI: 10.1186/s12889-018-5668-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stigma and discrimination remains a barrier to uptake of HIV/AIDS counselling and treatment as well as effective HIV reduction programmes. Despite ethnic diversity of Nigeria, studies on determinants of HIV stigma incorporating the ethnic dimension are very few. This paper provides empirical explanation of the ethnic dimension of determinant of HIV stigma and discrimination in Nigeria. METHODS Nationally representative data from Nigerian Demographic and Health Survey 2013 (Individual recode) was analysed to explore ethnic differentials and homogeneity in the determinants of HIV/AIDS stigma and discrimination among women in multi-ethnic Nigeria. RESULTS Result shows that determinants of HIV stigma and discrimination varies by ethnicity in Nigeria. Significant ethnic differentials in HIV/AIDS stigma and discrimination by Secondary school education exist among Hausa and Igbo respectively (OR = 0.79; CI: 1.49-2.28 and OR=1.62; CI: 1.18-2.23, p<0.05). Wealth status significantly influenced HIIV/AIDS stigma and discrimination among Hausa, Igbo and Yoruba ethnic groups (p<0.05). Knowledge of HIV/AIDS was significantly associated with lower odds of discriminating attitudes among the Hausa and Fulani ethnic groups (OR = 0.45; CI: 0.30-0.67 and OR=0.36; CI: 0.16-0.83, p<0.05). CONCLUSIONS Identifying ethnic differential and homogeneity in predictors of HIV/AIDS stigma is key to reducing HIV/AIDS prevalence in Nigeria and countries with similar settings.
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Affiliation(s)
- Clifford O Odimegwu
- Demography and Population Studies Program, School of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Olatunji Alabi
- Demography and Population Studies Program, School of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Demography and Social Statistics, Federal University, Birnin Kebbi, Kebbi State, Nigeria.
| | - Nicole De Wet
- Demography and Population Studies Program, School of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joshua O Akinyemi
- Demography and Population Studies Program, School of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Reinius M, Rao D, Manhart LE, Wiklander M, Svedhem V, Pryor J, Mayer R, Gaddist B, Kumar S, Mohanraj R, Jeyaseelan L, Wettergren L, Eriksson LE. Differential item functioning for items in Berger's HIV Stigma Scale: an analysis of cohorts from the Indian, Swedish, and US contexts. Qual Life Res 2018; 27:1647-1659. [PMID: 29574526 PMCID: PMC5951887 DOI: 10.1007/s11136-018-1841-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To examine whether items in Berger's HIV Stigma Scale function differently with persons of different age, gender, and cultural backgrounds. METHODS Secondary data from cohorts, collected in South India (n = 250), Sweden (n = 193), and the US (n = 603) were reanalyzed to evaluate DIF within, between, and across these cohorts. All participants had answered the revised version of the HIV stigma scale consisting of 32 items forming the subscales Personalized stigma, Disclosure concerns, Concerns about public attitudes, and Negative self-image. Differential Item Functioning (DIF) for these items was assessed using hybrid ordinal regression-IRT technique. When DIF was detected, the cumulative impact of DIF on individual subscale scores was evaluated. RESULTS DIF was detected for 9 items within, between, or across cohorts, but the DIF was negligible in general. Detected DIF between the Swedish and Indian cohorts had a cumulative salient impact on individual scores for the subscale Disclosure Concerns; Disclosure concerns were overestimated in the Swedish cohort and both over- and underestimated in the Indian cohort. CONCLUSIONS The items in the 32-item version of the HIV stigma scale did not seem to be particularly prone to present DIF. The DIF between the Indian and Swedish cohort for items in the subscale Disclosure Concerns could, however, result in both type I and type II errors if scores should be compared between the Indian and Swedish cohort.
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Affiliation(s)
- Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Solna, Sweden.
| | - Deepa Rao
- Department of Global Health and Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, 325 9th Ave, UW Campus Mailbox Number 359931, Seattle, WA, 98104, USA
| | - Lisa E Manhart
- Department of Epidemiology, Harborview Medical Center, University of Washington, 325 9th Ave, UW Campus Mailbox Number 35993, Seattle, WA, 98104, USA
| | - Maria Wiklander
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, SE-141 86, Huddinge, Sweden
- Department of Medicine, Huddinge, Unit of Infectious Diseases, Karolinska Institutet, 141 86, Huddinge, Sweden
| | - John Pryor
- Department of Psychology, Illinois State University, Normal, IL, USA
| | - Randall Mayer
- Iowa Department of Public Health, 321 E. 12th St, Des Moines, IA, 50319-0075, USA
| | - Bambi Gaddist
- Joseph H. Neal Wellness Center Dba SC HIV Council, 1813 Laurel Street, Columbia, SC, 29201, USA
| | - Shuba Kumar
- Department of Social Sciences, Samarth, Chennai, India
| | - Rani Mohanraj
- Department of Social Sciences, Samarth, Chennai, India
| | | | - Lena Wettergren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Solna, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, SE-141 86, Huddinge, Sweden
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
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Maas J, Wismeijer AAJ, Van Assen MALM. Associations Between Secret-Keeping and Quality of Life in Older Adults. Int J Aging Hum Dev 2018; 88:250-265. [PMID: 29482331 PMCID: PMC6388410 DOI: 10.1177/0091415018758447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the effects of secrecy on quality of life in a sample consisting of older adults (>50 years; N = 301). Three key components of secrecy were examined with the Tilburg Secrecy Scale-25 (TSS25; possession of a secret, self-concealment, and cognitive preoccupation). The TSS25 distinguishes between the tendency to conceal personal information (self-concealment) and the tendency to worry or ruminate about the secret (cognitive preoccupation), thereby enabling investigation of the effects of secrecy on quality of life in detail. Confirming previous findings in younger samples, we found a positive effect of possession of a secret on quality of life, after controlling for both TSS25’s self-concealment and cognitive preoccupation. This suggests that keeping secrets may have a positive association with quality of life in older adults as well, as long as they do not have the tendency to self-conceal and are not cognitively preoccupied with their secret.
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Affiliation(s)
- Joyce Maas
- 1 Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Andreas A J Wismeijer
- 2 Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Marcel A L M Van Assen
- 3 Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands.,Department of Sociology, Utrecht University, Utrecht, The Netherlands
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McCree DH, Beer L, Prather C, Gant Z, Harris N, Sutton M, Sionean C, Dunbar E, Smith J, Wortley P. An Approach to Achieving the Health Equity Goals of the National HIV/AIDS Strategy for the United States Among Racial/Ethnic Minority Communities. Public Health Rep 2018; 131:526-30. [PMID: 27453595 DOI: 10.1177/0033354916662209] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Donna Hubbard McCree
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Linda Beer
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Cynthia Prather
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Zanetta Gant
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Norma Harris
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Madeline Sutton
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Catlainn Sionean
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Erica Dunbar
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Jennifer Smith
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Pascale Wortley
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
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Ironson G, Fitch C, Stuetzle R. Depression and Survival in a 17-Year Longitudinal Study of People With HIV: Moderating Effects of Race and Education. Psychosom Med 2017; 79:749-756. [PMID: 28498278 PMCID: PMC8233157 DOI: 10.1097/psy.0000000000000488] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The prevalence of clinically significant depressive symptoms is three times higher in people living with HIV than in the general population. Although studies have shown that depression predicts worse course with HIV, few have investigated its relationship with mortality, and none have had a 17-year follow-up period and been conducted entirely during the time since the advent of protease inhibitors. METHODS We followed a diverse sample of HIV-positive people (N = 177) in the mid-range of illness for a study on stress and coping. Participants were assessed every 6 months (for 12 years) via blood draw, questionnaires, and interview. Depression was measured using the Beck Depression Inventory. The study began in March 1997 and mortality was assessed in April 2014. RESULTS In the primary analysis depression, analyzed as a continuous variable, significantly predicted all-cause mortality (hazard ratio = 1.038, 95% confidence interval = 1.008-1.068). With Beck Depression Inventory scores dichotomized, the hazard ratio was 2.044 (95% confidence interval = 1.176-3.550). Furthermore, this result was moderated by race and educational attainment such that depression only predicted worse survival for non-African Americans and those with a college education or higher. CONCLUSION Depression is associated with worse long-term survival in people with HIV during 17 years of follow-up. Interventions targeting depression may improve well-being and potentially survival in individuals with HIV. However, since depression did not predict survival in African Americans or those with low education, more research is needed to identify risk factors for long term outcomes in these groups.
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Affiliation(s)
- Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, FL
- Department of Psychiatry, University of Miami, Miami, FL
| | - Calvin Fitch
- Department of Psychology, University of Miami, Coral Gables, FL
| | - Rick Stuetzle
- Department of Psychology, University of Miami, Coral Gables, FL
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27
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Concordance Between Self-Report and Performance-Based Measures of Everyday Functioning in HIV-Associated Neurocognitive Disorders. AIDS Behav 2017; 21:2124-2134. [PMID: 28108876 DOI: 10.1007/s10461-017-1689-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Self-report is typically used to differentiate between asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND) in the assessment of HIV-associated neurocognitive disorders (HAND). Yet, it is unclear whether the lack of self-reported functional impairments in individuals with ANI is indicative of a genuine absence of functional impairment, or of inaccurate self-reports. In the present study, we examined the relationship between previously validated self-report (patient's assessment of own functioning inventory; instrumental activities of daily living inventory) and performance-based (the Texas Functional Living Scale) measures of functional abilities in 112 virologically-controlled HIV-infected, and 40 well-matched, HIV-uninfected participants. Participants with symptomatic cognitive impairment (CI) had significantly lower overall scores and higher rates of impairment on a performance-based measure of everyday functioning as compared to participants with either asymptomatic CI or normal cognitive performance (WNL [within normal limits]; all p < 0.05), while asymptomatic CI and WNL participants had comparable rates of impairment and performance within the average range on the performance-based measure. The concordance between self-report and performance-based measures of everyday functioning in asymptomatic and symptomatic CI provide support for ANI and MND as clinically distinct diagnostic entities, and support the use of self-reports as appropriate measures of everyday functioning in the diagnosis of HAND.
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HIV Stigma, Retention in Care, and Adherence Among Older Black Women Living With HIV. J Assoc Nurses AIDS Care 2017; 28:518-531. [DOI: 10.1016/j.jana.2017.03.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/10/2017] [Indexed: 11/20/2022]
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Logie CH, Ahmed U, Tharao W, Loutfy MR. A Structural Equation Model of Factors Contributing to Quality of Life Among African and Caribbean Women Living with HIV in Ontario, Canada. AIDS Res Hum Retroviruses 2017; 33:290-297. [PMID: 27750027 DOI: 10.1089/aid.2016.0013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
African and Caribbean Black (ACB) women in Canada are disproportionately impacted by new HIV infections. ACB women's HIV vulnerability is shaped by contexts of stigma and discrimination. HIV-related stigma compromises quality of life (QOL) among women living with HIV (WLWH), yet scant research has examined concomitant effects of racial discrimination and HIV-related stigma on QOL. We used data from a cross-sectional survey with ACB WLWH in Ontario (n = 173) to test a conceptual model of pathways between HIV-related stigma, racial discrimination, depression, social support, and QOL. We conducted structural equation modeling using maximum likelihood estimation to test the model. In independent models, HIV-related stigma was associated with lower QOL, and depression partially mediated the association between HIV-related stigma and QOL. In the simultaneous model, HIV-related stigma had significant direct effects on depression, social support, and an indirect effect on QOL. When social support was added as a mediator, the direct effect between HIV-related stigma and QOL was no longer significant, suggesting mediation. Racial discrimination had significant direct effects on HIV-related stigma, depression, and social support and an indirect effect on QOL. QOL was associated with higher social support and lower depression scores. The model fit the data well: χ2 = 203.266, degrees of freedom (DF): 112, p < .0001; Comparative Fit Index (CFI): 0.929, Tucker-Lewis Index (TLI): 0.912, Root-Mean Square Error of Approximation (RMSEA): 0.071. We found racial discrimination was associated with increased HIV-related stigma, and HIV-related stigma and racial discrimination compromised QOL. Findings suggest the need for multilevel interventions to reduce stigma and discrimination, address depression, and build social support to improve QOL among ACB WLWH.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Uzma Ahmed
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Wangari Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Canada
| | - Mona R. Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
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Quinn K, Voisin DR, Bouris A, Jaffe K, Kuhns L, Eavou R, Schneider J. Multiple Dimensions of Stigma and Health Related Factors Among Young Black Men Who Have Sex with Men. AIDS Behav 2017; 21:207-216. [PMID: 27233249 PMCID: PMC5124546 DOI: 10.1007/s10461-016-1439-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study is among the first to examine the association between multiple domains of HIV-related stigma and health-related correlates including viral load and medication adherence among young Black men who have sex with men (N = 92). Individual logistic regressions were done to examine the hypothesized relationships between HIV-related stigma and various health and psychosocial outcomes. In addition to examining total stigma, we also examined four domains of HIV stigma. Findings revealed the various domains of stigma had differential effects on health-related outcomes. Individuals who reported higher levels of total stigma and personalized stigma were less likely to be virally suppressed (OR 0.96, 95 % CI 0.91-1.00 and OR 0.50, 95 % CI 0.25-1.02, respectively). Concerns about public attitudes toward HIV were positively related to medication adherence (OR 2.18, 95 % CI 1.20-3.94) and psychological distress (OR 5.02, 95 % CI 1.54-16.34). The various domains of HIV stigma differentially affected health and psychosocial outcomes, and our findings suggest that some forms of HIV stigma may significantly affect viral load and medication adherence among this population. Stigma-informed approaches to care and treatment are needed, along with incorporated psychological and social supports.
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Affiliation(s)
- Katherine Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Kate Jaffe
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lisa Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca Eavou
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John Schneider
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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Hu J, Serovich JM, Chen YH, Brown MJ, Kimberly JA. Psychometric Evaluation of the HIV Disclosure Belief Scale: A Rasch Model Approach. AIDS Behav 2017; 21:174-183. [PMID: 27395432 DOI: 10.1007/s10461-016-1478-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study provides psychometric assessment of an HIV disclosure belief scale (DBS) among men who have sex with men (MSM). This study used baseline data from a clinical trial evaluating the effectiveness of an HIV serostatus disclosure intervention of 338 HIV-positive MSM. The Rasch model was used after unidimensionality and local independence assumptions were tested for application of the model. Results suggest that there was only one item that did not fit the model well. After removing the item, the DBS showed good model-data fit and high item and person reliabilities. This instrument showed measurement invariance across two different age groups, but some items showed differential item functioning between Caucasian and other minority groups. The findings suggest that the DBS is suitable for measuring the HIV disclosure beliefs, but it should be cautioned when the DBS is used to compare the disclosure beliefs between different racial/ethnic groups.
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Affiliation(s)
- Jinxiang Hu
- College of Behavioral and Community Science, University of South Florida, 13301 Bruce B Downs Blvd, MHC 2503, Tampa, FL, 33612, USA.
| | - Julianne M Serovich
- College of Behavioral and Community Science, University of South Florida, 13301 Bruce B Downs Blvd, MHC 2503, Tampa, FL, 33612, USA
| | - Yi-Hsin Chen
- College of Education, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL, 33620, USA
| | - Monique J Brown
- College of Behavioral and Community Science, University of South Florida, 13301 Bruce B Downs Blvd, MHC 2503, Tampa, FL, 33612, USA
| | - Judy A Kimberly
- College of Behavioral and Community Science, University of South Florida, 13301 Bruce B Downs Blvd, MHC 2503, Tampa, FL, 33612, USA
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Shamburger-Rousseau AE, Conyers LM, Armstrong AJ. Rehabilitation Service Utilization Among African American Women Living With HIV/AIDS. REHABILITATION COUNSELING BULLETIN 2016. [DOI: 10.1177/0034355215601354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
African American women are disproportionately affected by HIV/AIDS. As individuals with HIV/AIDS are living longer and healthier lives, research exploring the appropriateness of rehabilitation services has increased. To date, no research has examined the specific use of vocational rehabilitation (VR) services among HIV-positive African American women. The purpose of this study was to apply the behavioral model for vulnerable populations (BMVP) to examine key predisposing, enabling, and need variables related to and predictive of the utilization of VR services among African American women with HIV/AIDS. Survey research methods were used to collect data from a sample of 313 African American women living with HIV/AIDS, recruited from AIDS Service Organizations and national HIV/AIDS networks across the United States, who volunteered to complete the National Working Positive Coalition–Vocational Development and Employment Needs Survey. Hierarchical logistic regression statistical analyses were conducted to identify key factors predictive of use of VR services. Receipt of income benefits and knowledge of VR services were found to be predictive of the utilization of VR services among African American women living with HIV/AIDS.
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Rao D, Molina Y, Lambert N, Cohn SE. Assessing Stigma among African Americans Living with HIV. STIGMA AND HEALTH 2016; 1:146-155. [PMID: 27761520 PMCID: PMC5067075 DOI: 10.1037/sah0000027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Deepa Rao
- Department of Global Health, University of Washington, Seattle Washington
| | - Yamile Molina
- Health Services Department, University of Washington, Seattle, Washington
| | - Nina Lambert
- Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Susan E Cohn
- Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, Illinois
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Zarei N, Joulaei H, Fararouei M. Perceived Stigma and Quality of Life Among Women Living with HIV/AIDS. WOMEN’S HEALTH BULLETIN 2016. [DOI: 10.17795/whb-34535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Zhang C, Li X, Liu Y, Qiao S, Zhang L, Zhou Y, Shen Z, Tang Z. Emotional, physical and financial burdens of stigma against people living with HIV/AIDS in China. AIDS Care 2016; 28 Suppl 1:124-31. [PMID: 26886415 PMCID: PMC4828606 DOI: 10.1080/09540121.2016.1146206] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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.
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Affiliation(s)
- Chen Zhang
- a Vanderbilt Institute of Global Health , Vanderbilt University , Nashville , TN , USA
| | - Xiaoming Li
- b Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
| | - Yu Liu
- a Vanderbilt Institute of Global Health , Vanderbilt University , Nashville , TN , USA
| | - Shan Qiao
- b Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
| | - Liying Zhang
- c Department of Pediatrics , Wayne State University , Detroit , MI , USA
| | - Yuejiao Zhou
- d Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
| | - Zhiyong Shen
- d Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
| | - Zhengzhu Tang
- d Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
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Moore KE, Stuewig JB, Tangney JP. THE EFFECT OF STIGMA ON CRIMINAL OFFENDERS' FUNCTIONING: A LONGITUDINAL MEDIATIONAL MODEL. DEVIANT BEHAVIOR 2016; 37:196-218. [PMID: 26973364 PMCID: PMC4788463 DOI: 10.1080/01639625.2014.1004035] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Research has rarely considered criminal offenders' psychological responses to stigma, but these responses may significantly influence behavior after release from jail/prison. Jail inmates' perceived and anticipated stigma was assessed prior to release from jail/prison (N = 163), and outcomes were assessed one year post-release (N = 371). We hypothesized that perceived stigma would predict poor adjustment in several domains (i.e. recidivism, substance dependence, mental health symptoms, community adjustment) through anticipated stigma. Results showed that perceived stigma predicted worse community adjustment through anticipated stigma, and this varied by race. Results are explored from an interdisciplinary perspective.
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Cederbaum JA, Adhikari AB, Guerrero EG, Hutchinson MK. Relationship Satisfaction and Communication Among Urban Minority HIV-Positive and HIV-Negative Mothers: The Influence on Daughter's Alcohol Use. JOURNAL OF FAMILY ISSUES 2016; 37:155-176. [PMID: 26900198 PMCID: PMC4758986 DOI: 10.1177/0192513x13513582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Family relationships influence children's beliefs and behaviors. This work examined qualities associated with communication about alcohol among 176 mothers and the influence of this communication on daughters' alcohol use. Path analyses by maternal HIV status indicated significant differences. Relationship satisfaction was associated with self-efficacy for both HIV-positive (β = 0.545, p < .001) and HIV-negative (β = 0.557, p < .001) mothers. Maternal self-efficacy was associated with communication for both HIV-positive (β = 0.364, p < .01) and HIV-negative (β = 0.310, p < .05) mothers; maternal attitudes toward alcohol use were associated with communication among HIV-negative mothers (β = 0.20, p < .05). Relationship satisfaction was indirectly related to daughter's alcohol use in HIV-positive dyads (β = 0.153, p < .05). In families with interfamilial and environmental stressors, investing in the mother-daughter relationship, in part by discussing issues related to alcohol use, is protective in nature.
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Fredericksen RJ, Edwards TC, Merlin JS, Gibbons LE, Rao D, Batey DS, Dant L, Páez E, Church A, Crane PK, Crane HM, Patrick DL. Patient and provider priorities for self-reported domains of HIV clinical care. AIDS Care 2015; 27:1255-64. [PMID: 26304263 DOI: 10.1080/09540121.2015.1050983] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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 highlight 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.
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Affiliation(s)
- Rob J Fredericksen
- a Center for AIDS Research , University of Washington , Seattle , WA 98104 , USA
| | - Todd C Edwards
- b Seattle Quality of Life Group , University of Washington , Seattle , WA 98104 , USA
| | - Jessica S Merlin
- c School of Medicine, Division of Infectious Diseases , University of Alabama at Birmingham , Birmingham , AL 35294 , USA
| | - Laura E Gibbons
- d Department of General Internal Medicine , University of Washington , Seattle , WA 98104 , USA
| | - Deepa Rao
- e Department of Global Health , University of Washington , Seattle , WA 98104 , USA
| | - D Scott Batey
- f Department of Medicine, Division of Infectious Diseases, Research and Informatics Service Center , University of Alabama at Birmingham , Birmingham , AL 35294 , USA
| | - Lydia Dant
- g The Fenway Institute , Boston , MA 02215 , USA
| | - Edgar Páez
- h UCSD Medical Center - Owen Clinic , San Diego , CA 92103-8681 , USA
| | - Anna Church
- a Center for AIDS Research , University of Washington , Seattle , WA 98104 , USA
| | - Paul K Crane
- i Internal Medicine , University of Washington , Seattle , WA 98104 , USA
| | - Heidi M Crane
- j Department of Medicine , University of Washington , Seattle , WA 98104 , USA
| | - Donald L Patrick
- b Seattle Quality of Life Group , University of Washington , Seattle , WA 98104 , USA
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Brener L, Wilson H, Jackson LC, Johnson P, Saunders V, Treloar C. The role of Aboriginal community attachment in promoting lifestyle changes after hepatitis C diagnosis. Health Psychol Open 2015; 2:2055102915601581. [PMID: 28070368 PMCID: PMC5193287 DOI: 10.1177/2055102915601581] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This research assessed whether greater attachment to an Aboriginal community buffers against the negative effects of stigma and promotes positive health outcomes. Aboriginal Australians (n = 203) living with hepatitis C completed a survey assessing community attachment, stigma, resilience, quality of life, treatment intent, hepatitis C knowledge and positive lifestyle changes. A stronger sense of community attachment was associated with greater resilience, increased quality of life, less hepatitis C–related stigma and with increased lifestyle changes after diagnosis. Hence, community attachment can buffer against the negative health effects of stigma and may promote the resources to engage in positive behaviour changes, ultimately increasing long-term health outcomes.
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Jeffries WL, Townsend ES, Gelaude DJ, Torrone EA, Gasiorowicz M, Bertolli J. HIV stigma experienced by young men who have sex with men (MSM) living with HIV infection. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:58-71. [PMID: 25646730 DOI: 10.1521/aeap.2015.27.1.58] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Stigma can compromise the health of persons living with HIV. Although HIV is increasingly affecting young men who have sex with men (MSM), little is known about their experiences with HIV stigma. We used narrative data to examine HIV stigma experienced by young MSM living with HIV. Data came from 28 qualitative interviews with young MSM. We used inductive content analysis to identify themes across these interviews. Participants commonly discussed negative perceptions and treatment of persons living with HIV. Stigma could result in nondisclosure of HIV status, internalized stigma, and avoidance of HIV-related things. Some men discussed strategies that might combat stigma. Findings suggest that HIV stigma might challenge young MSM's health by undermining health-conducive resources (e.g., social support) and contributing to HIV vulnerability. Interventions that counteract HIV stigma may help to create environments that promote well-being among young MSM living with HIV.
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Gomes RRDFM, Batista JR, Ceccato MDGB, Kerr LRFS, Guimarães MDC. HIV/AIDS knowledge among men who have sex with men: applying the item response theory. Rev Saude Publica 2015; 48:206-15. [PMID: 24897041 PMCID: PMC4206150 DOI: 10.1590/s0034-8910.2014048004911] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 11/12/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the level of HIV/AIDS knowledge among men who have sex with men in Brazil using the latent trait model estimated by Item Response Theory. METHODS Multicenter, cross-sectional study, carried out in ten Brazilian cities between 2008 and 2009. Adult men who have sex with men were recruited (n = 3,746) through Respondent Driven Sampling. HIV/AIDS knowledge was ascertained through ten statements by face-to-face interview and latent scores were obtained through two-parameter logistic modeling (difficulty and discrimination) using Item Response Theory. Differential item functioning was used to examine each item characteristic curve by age and schooling. RESULTS Overall, the HIV/AIDS knowledge scores using Item Response Theory did not exceed 6.0 (scale 0-10), with mean and median values of 5.0 (SD = 0.9) and 5.3, respectively, with 40.7% of the sample with knowledge levels below the average. Some beliefs still exist in this population regarding the transmission of the virus by insect bites, by using public restrooms, and by sharing utensils during meals. With regard to the difficulty and discrimination parameters, eight items were located below the mean of the scale and were considered very easy, and four items presented very low discrimination parameter (< 0.34). The absence of difficult items contributed to the inaccuracy of the measurement of knowledge among those with median level and above. CONCLUSIONS Item Response Theory analysis, which focuses on the individual properties of each item, allows measures to be obtained that do not vary or depend on the questionnaire, which provides better ascertainment and accuracy of knowledge scores. Valid and reliable scales are essential for monitoring HIV/AIDS knowledge among the men who have sex with men population over time and in different geographic regions, and this psychometric model brings this advantage.
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Kulesza M, Raguram R, Rao D. Perceived mental health related stigma, gender, and depressive symptom severity in a psychiatric facility in South India. Asian J Psychiatr 2014; 9:73-7. [PMID: 24813041 DOI: 10.1016/j.ajp.2014.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 03/04/2014] [Accepted: 03/08/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few studies exist on the topic of gender associated with depression and mental health-related stigma coming out of non-Western countries such as India. We aimed to add to the literature by assessing these relationships among adults seeking psychiatric services in India. METHODS Participants were 60 individuals seeking care at a psychiatric clinic in Bangalore, India. The majority of participants were female with a mean age of 36 years (SD=9.75). RESULTS Contrary to our prediction, there were no significant differences between men (M=28.96; SD=9.85) and women (M=33.03; SD=12.08) on depression severity, t(58)=1.42, p=.16. Yet, women (M=10.09, SD=8.23) reported significantly more perceived stigma than men (M=5.79, SD=5.86), t(58)=2.30, p=.02. CONCLUSION While men and women seeking psychiatric services at the psychiatric clinic in India report similar levels of depression severity, women reported more perceived mental illness stigma. Having experienced regular forms of discrimination associated with female status in India, it may be the case that women are more attuned to other forms of stigma, such as mental health stigma investigated in the present study. Given the detrimental impact of stigma on treatment adherence and engagement in care, additional research is needed support this work, including research on interventions to reduce stigma and improve engagement in care.
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Affiliation(s)
- Magdalena Kulesza
- Department of Psychiatry and Behavioral Sciences, Center for Study of Health and Risk Behaviors, University of Washington, 1100 NE 45th Street, Suite 300, Seattle, WA 98105, United States.
| | - R Raguram
- Department of Psychiatry, Kempegowda Institute of Medical Sciences, Bangalore, India
| | - Deepa Rao
- Department of Global Health, University of Washington, 325 9th Avenue, Seattle, WA 98104, United States
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Evaluation of Stigma Index Among People Living With HIV/AIDS (PLWHA) in Six Cities in Iran. ACTA ACUST UNITED AC 2013. [DOI: 10.5812/thrita.11801] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Moore K, Stuewig J, Tangney J. Jail Inmates' Perceived and Anticipated Stigma: Implications for Post-release Functioning. SELF AND IDENTITY 2013; 12:527-547. [PMID: 25045324 DOI: 10.1080/15298868.2012.702425] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Research shows that offenders perceive stigma, but the accuracy of these perceptions has not been assessed, nor their impact on successful reintegration. In a longitudinal study, jail inmates (N = 168) reported perceptions of stigma toward criminals and anticipated stigma just prior to release. A diverse college sample completed a parallel survey assessing stigmatizing attitudes toward criminals. Inmates' perceived stigma was significantly higher than students' stigmatizing attitudes. Perceived stigma positively predicted post-release employment for African-American inmates, but not for Caucasians. Anticipated stigma negatively predicted arrests for Caucasian inmates, but not for African Americans. Perceived and anticipated stigma may have different implications for reintegration, and these implications may vary across race.
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Affiliation(s)
- Kelly Moore
- Department of Psychology, George Mason University
| | | | - June Tangney
- Department of Psychology, George Mason University
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Chiao S, Rosen HJ, Nicolas K, Wendelken LA, Alcantar O, Rankin KP, Miller B, Valcour V. Deficits in self-awareness impact the diagnosis of asymptomatic neurocognitive impairment in HIV. AIDS Res Hum Retroviruses 2013; 29:949-56. [PMID: 23432363 DOI: 10.1089/aid.2012.0229] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A recent national survey of HIV(+) adults noted that nearly three-quarters of cognitively impaired individuals are categorized as having asymptomatic neurocognitive impairment (ANI), lacking documented compromise of everyday function. The clinical impact and long-term consequences of ANI are unknown and the importance of this asymptomatic diagnosis has raised concerns in clinical care settings where competing priorities often exist. In this study, we conducted structured tests of everyday functioning in a sample of HIV(+) subjects over 60 years of age and asked subjects to rate their performance relative to peers. We demonstrate that individuals with neuropsychological testing impairment often lack self-awareness of functional performance deficits. Specifically, ANI subjects rated functional performance similar to that of HIV-negative control subjects, despite noted deficits in objective measures of function. These findings have important implications for use of self-report of function in the diagnosis of HIV-associated neurocognitive disorders (HAND), likely underestimating symptomatic impairment.
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Affiliation(s)
- Stephanie Chiao
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Krista Nicolas
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Lauren A. Wendelken
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Oscar Alcantar
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Katherine P. Rankin
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Bruce Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
- Division of Geriatric Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
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Ramirez-Valles J, Molina Y, Dirkes J. Stigma towards PLWHA: the role of internalized homosexual stigma in Latino gay/bisexual male and transgender communities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2013; 25:179-89. [PMID: 23631713 PMCID: PMC3718259 DOI: 10.1521/aeap.2013.25.3.179] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
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.
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Affiliation(s)
- Jesus Ramirez-Valles
- Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor, Chicago, IL 60612-4394, USA.
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Abstract
OBJECTIVES This article explores the associations between medical care providers' attitudes towards patients living with HIV (PLH) and the service satisfaction reported from general patients. METHODS Data were collected from 40 county-level hospitals in China, including 1760 service providers and 1000 patients receiving medical services from the hospitals. Provider and patient assessments were conducted by self-administered questionnaires and face-to-face interviews, respectively. Random-effect regression models were used to examine relationships between the providers' avoidance attitudes and patient satisfaction at the hospital level while taking into account variations in demographics and professional experience within each hospital. RESULTS AND CONCLUSIONS Service providers' avoidance attitudes towards PLH were negatively associated with general patients' satisfaction with service providers at the hospital level. The relationship was strong and significant whether or not adjustments were made for background characteristics. Medical care providers' stigmatizing attitudes towards PLH could be a reflection of the providers' general outlook with all patients. This study underscores a broader focus for HIV-related stigma reduction interventions in medical settings at both individual and institutional levels, targeting attitudes towards both patients with HIV/AIDS and the general patient population.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA 90024, USA.
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Storholm ED, Halkitis PN, Kupprat SA, Hampton MC, Palamar JJ, Brennan-Ing M, Karpiak S. HIV-Related Stigma as a Mediator of the Relation Between Multiple-Minority Status and Mental Health Burden in an Aging HIV-Positive Population. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2013; 12:9-25. [PMID: 36919144 PMCID: PMC10010679 DOI: 10.1080/15381501.2013.767557] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Cross-sectional analyses of 904 diverse men and women aged 50 years and older living with HIV in New York City were conducted to examine the unique experiences and needs of aging HIV-positive individuals. Using Minority Stress Theory and Syndemic Theory as guiding paradigms, the authors documented the mental health burdens of the sample with regard to depression, loneliness, and diminished psychological well-being and examined how multiple-minority status and HIV-related stigma explained these burdens. Mediation modeling demonstrated that the effects of minority stressors on mental health burden were mediated by HIV-related stigma. The mediation was significant for the overall sample and for the male subsample. Results suggest that to fully address the mental health burdens experienced by aging HIV-positive individuals, we must continue to address mental health burdens directly, and at the same time, look beyond the psychiatric symptoms to address the structural inequities faced by individuals based on their multiple-minority status.
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Affiliation(s)
- Erik David Storholm
- Center for Health, Identity, Behavior & Prevention Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA
| | - Perry N Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA
| | - Sandra A Kupprat
- Center for Health, Identity, Behavior & Prevention Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA
| | - Melvin C Hampton
- Center for Health, Identity, Behavior & Prevention Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA
| | - Joseph J Palamar
- Center for Health, Identity, Behavior & Prevention Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA
| | - Mark Brennan-Ing
- AIDS Community Research Initiative of America, New York, New York, USA, and New York University College of Nursing, New York, New York, USA
| | - Stephen Karpiak
- AIDS Community Research Initiative of America, New York, New York, USA, and New York University College of Nursing, New York, New York, USA
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Abstract
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.
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50
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Arrivillaga M, Springer AE, Lopera M, Correa D, Useche B, Ross MW. HIV/AIDS treatment adherence in economically better off women in Colombia. AIDS Care 2012; 24:929-35. [DOI: 10.1080/09540121.2011.647678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Marcela Arrivillaga
- a Department of Public Health & Epidemiology, Health & Quality of Life Research Group , Pontificia Universidad Javeriana Cali , Cali , Colombia
| | - Andrew E. Springer
- b Michael & Susan Dell Center for Advancement of Healthy Living , University of Texas School of Public Health-Austin Regional Campus , Austin , TX , USA
| | - Monica Lopera
- c National Faculty of Public Health , University of Antioquia , Medellín , Colombia
| | - Diego Correa
- d Health & Quality of Life Research Group , Pontificia Universidad Javeriana Cali , Cali , Colombia
| | - Bernardo Useche
- e Associate Researcher Health & Quality of Life Research Group , Pontificia Universidad Javeriana Cali , Colombia
| | - Michael W. Ross
- f Center for Health Promotion and Prevention Research, School of Public Health Houston , University of Texas , Houston , TX , USA
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