Stigma against children affected by AIDS (SACAA): psychometric evaluation of a brief measurement scale

Enacted Stigma Influences Bereavement Coping Among Children Orphaned by Parental AIDS: A Longitudinal Study with Network Analysis

Purpose

The study aims to understand how enacted stigma influences bereavement coping at the style (scale) level and the specific pathways at the strategy (item) level.

Methods

The longitudinal data of 755 children orphaned by parental Acquired Immune Deficiency Syndrome (AIDS) in rural China were used. Grief processing and deliberate grief avoidance were measured at wave 1 (baseline) and wave 2 (one-year follow-up) to reflect bereavement coping in the contexts of being with family members, being with friends, being with community members, and being alone. Enacted stigma that measured at wave 1 was used to assess the experienced stigma of these AIDS-orphaned children. Network analyses were run following regressions.

Results

Controlling for demographics and baseline-level bereavement coping, multivariate regressions revealed that enacted stigma at wave 1 significantly predicted grief processing and deliberate grief avoidance at wave 2. Network analyses showed that, for grief processing, stigma increased searching for meaning alone and with friends and expressing feelings to community members, which then provoked the same strategy across contexts. Meanwhile, stigma triggered the deliberate grief avoidance network by initially suppressing the expression of feelings to community members.

Conclusion

Enacted stigma contributes to bereavement coping. Stigma stirs up complex feelings but forces AIDS-orphaned children to suppress expressions, and it increases needs to process grief through meaning making but cuts supporting forces by promoting avoidance. Interventions are imperative to reduce stigma, improve emotion regulation, and facilitate meaning making for people bereaved by stigmatized deaths.

Future Orientation Among Children Affected by Parental HIV in China: An Exploratory Analysis of Complex Interactions

We utilized an exploratory analytic approach to examine predictors of children's future beliefs, an internal asset associated with resilience among children affected by HIV, with emphasis on complex interactions among multisystem factors. Children (N = 1221) affected by parental HIV in China reported on psychosocial functioning, as well as internal, familial, and community resilience assets. Exploratory data analysis was conducted using a binary segmentation program. Six binary splits on predictors accounted for 22.78% of the variance in future expectation, suggesting interactions between children's perceived control of their future, loneliness, caregiver trust, and social support. Four binary splits accounted for 23.15% of the variance in future orientation, suggesting multiway interactions between control of the future, loneliness, social support, and perceived stigma. Findings suggest combinations of resilience factors are associated with children's positive future beliefs. Implications for screening, prevention, and intervention among Chinese children affected by parental HIV are discussed.

Does HIV-Related Stigma Depress Social Well-Being of Youths Affected by Parental HIV/AIDS?

Parental illness or death due to HIV/AIDS has long-term impacts on children's social well-being, potentially challenging the children's basic developmental needs and future. Based on the theoretical model of social well-being, the present study tested a moderated mediation model that HIV-related stigma moderated the mediating role of social trust on the relationship between perceived social support (PSS) and social well-being. A sample of 297 youths aged 20-30 years affected by parental HIV/AIDS (57.2% male), including 129 (43.40%) AIDS orphans and 168 vulnerable youths (56.60%) completed questionnaires of perceived social support, social well-being, social trust, and HIV-related stigma. IBM SPSS 25.0 was used to conduct descriptive statistics and multiple regressions. Results showed that the mean score of PSS was 61.34 (SD = 13.99), social well-being was 57.33 (SD = 10.15), social trust was 56.21 (SD = 11.55), perceived stigma was 64.44 (SD = 16.72), and enacted stigma was 21.91 (SD = 9.73) among youths affected by parental HIV/AIDS and the PSS could predict increasing social well-being via increasing social trust. Moreover, the positive influence of PSS on social trust was moderated by the enacted stigma (p = 0.03), in which the positive influence was stronger among youths affected by parental HIV/AIDS who perceived or experienced low enacted stigma than those who perceived or experienced high enacted stigma. The positive impact of social trust on social well-being was moderated by perceived stigma (p = 0.04), in which the positive impact was more significant among youths affected by parental HIV/AIDS who perceived or experienced high perceived stigma than those who perceived or experienced low perceived stigma. These findings explained how and when the PSS affected social well-being and contributed toward an understanding of the experiences and perceptions of HIV-related stigma among youths affected by parental HIV/AIDS. This understanding may inform future research and policies toward improving the social well-being of youths affected by parental HIV/AIDS. The study also highlighted the importance of strengthening interventions on social relations and reducing HIV-related stigma for them.

The prevalence of sexual compulsivity and its correlates among adults living with HIV/AIDS attending antiretroviral therapy clinic in Gambella town, Southwest Ethiopia, 2020

INTRODUCTION

Sexual compulsivity is a concealed psychiatric disease marked by intrusive thoughts followed by ritualized sexual acts. In Ethiopia, the prevalence of HIV/AIDS has recently increased. Furthermore, sexual compulsivity among adults living with HIV/AIDS receives less attention, particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of sexual compulsivity and its correlates among adults living with HIV/AIDS attending ART clinic in Gambella town, Southwest Ethiopia, 2020.

METHOD

A hospital-based study employing cross-sectional design and simple random sampling technique was used to select the study participants. Data were collected by using interview technique. A 10 item Sexual Compulsivity Scale (SCS) questionnaire was used to assess sexual compulsivity. The translated version of the questionnaire was used for data collection. Bivariate and multivariable logistic regression was conducted to determine factors associated with the outcome variable at p-value < 0.05 with a 95% confidence interval.

RESULT

Out of 300 respondents, 27% (24.3, 29.2) of them were scored above the mean score of the Sexual Compulsivity Scale. Age less than 31 years old, widowed, involving in risky sexual behaviors, current substance use, not received any skill training about safer sex behaviors, and not attending support group discussion on HIV prevention were significantly associated with sexual compulsivity.

CONCLUSION

Almost one fourth of the respondents have high score for Sexual Compulsivity Scale score. Therefore, there is a need of routine sexual behavior screening program and collaboration with mental health workers for addressing the problem. Furthermore, the emphasis should be given on the identified high-risk categories.

A model to understand HIV-related stigma and the psychosocial well-being of children orphaned by AIDS: a theory generative approach

HIV-related stigma has negatively impacted the psychosocial well-being of children who have been orphaned by AIDS-related causes. Response to reducing stigma and ensuring child well-being is hindered by the limited understanding of HIV-related stigma and how it affects the psychosocial well-being of children. Due to the call for a comprehensive understanding of HIV-related stigma, this study aimed to develop a model to understand the manner in which HIV-related stigma affects the psychosocial well-being of children orphaned by AIDS. The study implemented a mixed method, exploratory, sequential design within a theory generative approach that included concept development, statement development, model description, and model evaluation. The developed model indicated that HIV-related stigma is embedded in social interaction and mediated by children orphaned by AIDS response to stigma. HIV-related stigma and maladaptive coping strategies collectively affect several domains of child psychosocial well-being and elevate psychosocial distress. This is the first model to provide a child-centred understanding of HIV-related stigma and its consequences for psychosocial well-being. The model may be used to guide future research and inform the development of appropriate interventions.

HIV-related perceived stigma and associated factors among patients with HIV, Dilla, Ethiopia: A cross-sectional study

Introduction

Understanding HIV-related perceived stigma has importance in improving the quality of patients and provides a better tackling of HIV stigma. Therefore; the study aimed to assess the prevalence and associated factors of perceived stigma among Patients with HIV attending the clinic at Dilla University Referral Hospital in Ethiopia 2019.

Method

In this Institution based cross-sectional study, a 10-item perceived HIV stigma scale was used to assess HIV-related perceived stigma. Oslo social support scale was used to assess social support related factors. Bivariate and multivariate binary logistic analysis was done to identify associated factors to HIV-related perceived stigma.

Results

The prevalence of HIV-related perceived stigma by using perceived HIV stigma scale among patients with living HIV was 42.7%. Patients who are age groups 25-30 years (AOR = 2.8, 95% CI: 5.72-11.5), age groups 31-39 years (AOR = 1.11, 95% CI: 1.26,4.65), Females (AOR = 2.4, 95% CI: 1.28-4.33), divorced marital status (AOR = 8.9, 95% CI: 3.52-10.61), widowed marital status (AOR = 3.0, 95% CI: 2.74-7.60), Primary educational status (AOR = 7.5,95% CI: 3.45-9.74) and Study participants those who use alcohol (AOR = 1.0 95% CI: 1.57-2.11) were more likely to have HIV-related perceived stigma.

Conclusion

This calls a holistic approach to the prevention and intervention of HIV-related perceived stigma. Emphasis should also be given for HIV-related perceived stigma.

Registration

This study was registered research registry with the registration number (researchregistry7112).

Application of the Chinese version of Zelaya's HIV-related stigma scale to undergraduates in mainland China

Background

This cross-sectional study aims to validate the Chinese version of Zelaya’s HIV-related Stigma Scale (CVZHSS) among a large undergraduate sample in mainland China, and apply it to measure the level of different dimensions of stigma and their respective determinants.

Methods

From September 10, 2018, to January 9, 2019, a total of 10,665 eligible undergraduates conveniently drawn from 30 provinces in mainland China (except for Tibet) completed the self-designed online questionnaire distributed via sojump.com voluntarily, anonymously and confidentially. Both exploratory and confirmatory factor analyses (EFA and CFA) were first performed to test its construct validity, Cronbach’s alpha was then used to assess its internal consistency, and Logistic regression analyses were finally carried out to identify predictors of various dimensions of stigma.

Results

As expected from the original model, four factors (i.e., “fear of casual transmission”, “moral judgment”, “personal stigma” and “perceived community stigma”) were extracted using principal component analysis with varimax rotation, accounting for 63.26% of the total variance. The CFA further confirmed the four-factor construct (CFI = 0.92, GFI = 0.91, RMSEA = 0.07). In addition, all the four factors demonstrated acceptable internal consistency with Cronbach’s alpha ranging from 0.83 to 0.92. Stigma as measured by “fear of casual transmission” (74.4%), “moral judgement” (61.6%), “personal stigma” (79.0%) and “perceived community stigma”(36.5%) is highly prevalent among undergraduates. Except for non-freshmen, less knowledge about HIV and unsafe sex which were consistently associated with higher levels of stigma in all four dimensions, other eight variables including gender, residential area, major, sexual orientation, having ever being tested perception of HIV risk, willingness to utilize HTC service and awareness of the national AIDS policy played differential roles in affecting different dimensions of stigma.

Conclusions

The CVZHSS is a reliable and valid measurement tool and can be used to identify undergraduates with high levels of stigma. However, the four dimensions (Fear, moral judgement, personal stigma and perceived community stigma) were respectively influenced by different determinants, and thus should be treated independently when designing, implementing and evaluating stigma reduction programs.

Stigma and psychosocial wellbeing among children affected by parental HIV in China

OBJECTIVES

Parental HIV infection presents unique psychosocial challenges for families. Affected children are vulnerable to stigma-related distress from a parent's HIV status and are more likely to experience symptoms of depression and low self-esteem than unaffected peers. This study examined whether HIV-related stigma predicted poorer mental health among children affected by parental HIV and whether psychosocial assets mediated this relationship.

METHODS

A sample of 790 children (ages 6-17) affected by parental HIV in Henan, China reported on HIV-related stigma, social support, emotional regulation, future outlook, and mental health symptoms. Structural equation modeling was used to examine the direct and indirect effects of stigma on mental health.

RESULTS

Results indicated that stigma was associated with psychosocial resources, which in turn were associated with mental health symptoms. The indirect pathways from stigma to mental health symptoms through psychosocial resources were consistent across age and gender.

CONCLUSION

The experience of HIV-related stigma was associated with poorer overall mental health among children affected by parental HIV in China. Children's psychosocial resources, including social support, emotional regulation, and future outlook, mediated the relationship between HIV-related stigma and mental health symptoms. Future interventions may wish to target these modifiable aspects of wellbeing to improve social and behavioral outcomes in this vulnerable population.

A physical symptom-based measure of quality of care for children affected by HIV/AIDS

Based on cross-sectional data of 1,625 children aged 6-18 years who were affected by parental HIV/AIDS in central rural China, we evaluated a physical symptom based measure of quality of care (QOC_PS) for these children. The QOC_PS has acceptable reliability estimates for children of both genders, at different age, and by orphanhood status. Known-group validation and construct validity analysis demonstrated a good validity of QOC_PS indicator. The QOC_PS score was significantly associated with psychosocial well-being measures among children. The physical symptom based measure provides a psychometrically appropriate indicator of quality of care for children affected by HIV/AIDS in China. It could be used as an alternative measure to assess quality of care in resource-poor settings where other objective measurements are not available or feasible. Future research is needed to further validate the scale among children in different living environments across various cultural settings.

Peer victimization and diurnal cortisol rhythm among children affected by parental HIV: Mediating effects of emotional regulation and gender differences

The hypothalamic-pituitary-adrenal (HPA) axis activity has been demonstrated as one of the physiological mechanisms underlying the long-lasting effects of peer victimization on physical and mental health. However, the mechanisms linking peer victimization to dysregulations of HPA axis activity remain inadequately understood. The present study examined the potential mediating role of emotional regulation in the association between peer victimization and HPA axis activity in a large community-based sample of 645 children affected by parental HIV (Mage = 10.67 years, ranging from 8 to 15 years old). The three-level growth curve model revealed that higher peer victimization was associated with lower emotional regulation, which in turn was related to lower cortisol at awakening and more blunted diurnal slopes in girls, but not in boys. The findings highlight the protective effect of emotional regulation in relation to HPA axis activity in victimized children, particularly in girls.

Psychological wellbeing of children at public primary schools in Jimma town: An orphan and non-orphan comparative study

Introduction

Orphans face multiple challenges including insufficient food, shelter, schooling, and medical care. Most research on orphans in developing countries concentrates on nutrition and health status. The present study aims to explore the psychological wellbeing of in-school orphaned and non-orphaned children.

Method

A comparative cross-sectional study design was used in 370 randomly selected children aged between 10 and 18. Two rosters (one for orphans and one for non-orphans) were created, and then 185 were selected from each roster. Trained field workers used structured questionnaires to obtain information from participants. An adapted Ryff Psychological Wellbeing Scale was used to measure psychological wellbeing. Mean scores were determined for each dimension and for total psychological wellbeing. The mean split was used to divide psychological wellbeing into “high” and “low”. Data were coded, entered, cleaned, and analyzed using SPSS version 20. The independent sample t-test was used to determine statistically significant differences in psychological wellbeing between orphaned and non-orphaned children. P values < 0.05 were deemed statistically significant.

Results

Of 370 children, 185 (50%) were orphans. Among orphaned children, only 62 (33.5%) scored high on the total psychological wellbeing scale whereas 107 (57.8%) of their non-orphaned peers scored highly. The non-orphaned children had about 10.8 higher mean psychological wellbeing scores than their orphan counterparts (P<0.001). The mean (±SD) psychological wellbeing of the non-orphaned children was 164.0 (17.2) vs. 153.2 (17.2) in the orphaned group.

Conclusion

The psychological wellbeing of orphans is significantly lower than their non-orphaned peers. Orphan support projects must consider psychosocial wellbeing in addition to material support.

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

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

A systematic review of measures of HIV/AIDS stigma in paediatric HIV-infected and HIV-affected populations

INTRODUCTION

HIV-related stigma impacts the quality of life and care management of HIV-infected and HIV-affected individuals, but how we measure stigma and its impact on children and adolescents has less often been described.

METHODS

We conducted a systematic review of studies that measured HIV-related stigma with a quantitative tool in paediatric HIV-infected and HIV-affected populations.

RESULTS AND DISCUSSION

Varying measures have been used to assess stigma in paediatric populations, with most studies utilizing the full or variant form of the HIV Stigma Scale that has been validated in adult populations and utilized with paediatric populations in Africa, Asia and the United States. Other common measures included the Perceived Public Stigma Against Children Affected by HIV, primarily utilized and validated in China. Few studies implored item validation techniques with the population of interest, although scales were used in a different cultural context from the origin of the scale.

CONCLUSIONS

Many stigma measures have been used to assess HIV stigma in paediatric populations, globally, but few have implored methods for cultural adaptation and content validity.

Social ecological factors associated with future orientation of children affected by parental HIV infection and AIDS

From a social ecological perspective, this study examined the effects of stigma (societal level), trusting relationships with current caregivers (familial level), and self-esteem (individual level) on future orientation of children affected by HIV infection and AIDS. Comparing self-report data from 1221 children affected by parental HIV infection and AIDS and 404 unaffected children, affected children reported greater stigma and lower future orientation, trusting relationships, and self-esteem. Based on structural equation modeling, stigma experiences, trusting relationships, and self-esteem had direct effects on future orientation, with self-esteem and trusting relationships partially mediating the effect of stigma experiences on children's future orientation. Implications are discussed.

Stigma, marginalization and psychosocial well-being of orphans in Rwanda: exploring the mediation role of social support

Stigma and marginalization are one of the major challenges orphans face in their daily lives, particularly in developing countries, but little is known about their impacts on mental health. This study examines how orphan-related characteristics, stigma and marginalization are associated with psychosocial well-being. It further analyses the role of social support in mediating between stigma and marginalization and mental health, indicated by emotional well-being and mental distress. The participants in this study were 430 Rwandan orphans who were 10-25 years of age, and of whom 179 were females and 251 were males. Results showed that high levels of stigma and marginalization were associated with a lower level of emotional well-being and higher levels of mental distress. A mediation analysis indicated that low level of social support due to stigma and marginalization contributed significantly to low level of emotional well-being. Once stigma, marginalization and social support were fully accounted for, AIDS orphans exhibited higher levels of mental distress than those who were orphaned by genocide or other causes. Future interventions designed to reduce stigma and marginalization for orphans and actions that facilitate social support can significantly improve emotional well-being and reduce mental distress among orphans.

Orphanhood by AIDS-Related Causes and Child Mental Health: A Developmental Psychopathology Approach

While the number of new HIV infections has declined, the number of orphans as a result of AIDS-related deaths continues to increase. The aim of this paper was to systematically review empirical research on the mental health of children affected by HIV/AIDS in the developing world, specifically with an eye on developing a theoretical framework to guide intervention and research. Articles for review were gathered by following the Preferred Reporting Items for Systemic Reviews and Meta Analyses (PRISMA standards), reviewed and then organized and synthesized with a Developmental Psychopathology framework. Results showed that the immediate and longterm effects of AIDS orphanhood are moderated by a number of important risk and protective factors that may serve as strategic targets for intervention. Research and clinical implications are discussed.

Perceived Stigmatization, Resilience, and Diurnal Cortisol Rhythm Among Children of Parents Living With HIV

Stigmatization often puts at risk the health and well-being of children from marginalized groups. One potential protective factor for such children is resilience--one's capability to adapt flexibly, persistently, and resourcefully to stressful situations. In this study, we investigated the associations among stigmatization, resilience, and hypothalamic-pituitary-adrenal (HPA) axis function in a sample of 645 youths affected by parents infected with HIV. Perceived stigmatization was associated with lower cortisol levels at awakening and flatter cortisol slopes, whereas resilience was independently associated with higher levels of salivary cortisol at awakening and steeper cortisol slopes. We found evidence for an indirect effect of resilience on diurnal cortisol through lower perceived stigmatization. These associations remained significant after we controlled for demographic and health factors and stressful life events. Our findings demonstrate that perceived stigmatization and resilience are associated with HPA-axis functioning in childhood. Broadly, the data suggest that resilience-promoting and stigma-reducing efforts should be considered to improve the health of children from disadvantaged groups.

Perceived stigma by children on antiretroviral treatment in Cambodia

Background

HIV-related stigma diminishes the quality of life of affected patients. Little is known about perceived and enacted stigma of HIV-infected children in resources-limited settings. We documented the prevalence of perceived stigma and associated factors associated among children on antiretroviral therapy (ART) at a referral hospital in Cambodia.

Methods

After informed consent, a standardized pre-tested 47-item questionnaire was confidentially administered to consecutive children (7 to 15 years) or their guardians if the child was 18 months to 6 years, during their routine ART visits. The questionnaire explored the sociodemographics of the child and the parents, HIV history, adherence to ART, tolerance of ART and perceived stigma. Associations between perceived stigma and the children’s characteristics were measured by bivariate and multivariate analyses.

Results

Of 183 children, 101 (55.2%) had lost at least one and 45 (24.6%) both parents; 166 (90.7%) went to school. Of 183 children (female: 84, 45.9%, median age 7.0 years, interquartile range: 2.0-9.6), 79 (43.2%) experienced perceived stigma, including rejection by others (26.8%), no invitations to social activities (18.6%) and exclusion from games (14.2%). A total of 43 (23.5%) children were fearful of their disease and 61 (53.9%) of 113 older than 6 years reported knowledge of their HIV status. Of 136 children over five years and eligible for education, 7 (3.8%) could not go to school due to perceived stigma. Incomplete adherence to ART was reported for 17 (9.2%) children. In multivariate analysis, school attendance (odds ratio [OR]: 3.9; 95% confidence interval [CI]: 2.0-7.9) and income of less than one dollar per person per day (OR: 2.2, 95% CI: 1.1-4.5) were associated with perceived stigma. Conversely, receipt of social support (OR: 0.4, 95% CI 0.2-0.9) was associated with lower risk of perceived stigma.

Conclusion

Perceived stigma in pediatric ART patients remains a significant issue in Cambodia. Psychological support and interventions should be developed in hospitals, schools, and underprivileged communities to prevent HIV-related stigma for affected children.

Parental HIV disclosure: from perspectives of children affected by HIV in Henan, China

Culturally and developmentally appropriate parental HIV disclosure (i.e., parents disclose their HIV infection to children) has been shown to be closely related with the well-being of both HIV-infected parents and their children. However, current practices and effects of parental HIV disclosure remain poorly understood in low- and middle-income countries including China. Quantitative data from 626 children affected by parental HIV (orphans and vulnerable children) in Henan, China, were collected in 2011 to examine children's perceptions and knowledge regarding their parents' HIV disclosure practices and to assess the associations of these practices with children's demographic and psychosocial factors. The data in the current study revealed that only a small proportion of children learned parental HIV infection from their parents (direct disclosure), and many of these disclosure seemed being unplanned. Among the children who were not told by their parents, at least 95% of them either knew parental illness from others (indirect disclosure) or from their own observations or suspicions. The children reported similar disclosure practices by fathers and mothers. There were minimum differences between disclosed and nondisclosed children on a number of psychosocial measures. The findings support the notion that parental HIV disclosure is a complex process and can only be beneficial if it is carefully planned. The data in the current study suggest the needs for the culturally and developmentally appropriate approach in parental HIV disclosure in order to maximize both short- and long-term benefits to children, parents, and family functioning.

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

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

Prevalence and associated factors of depression among people living with HIV in two cities in China

OBJECTIVES

Depression has significant effects on morbidity and mortality in people living with HIV (PLWH). Current study estimated the rate of depressive disorder and identified the correlates of depressive disorder among PLWH in China.

METHODS

258 PLWH in China were recruited and interviewed with a structured questionnaire including measurements testing perceived stress, social support, perceived discrimination, and depression. Mediating effect of perceived stress between perceived discrimination and depression and moderating effect of social support on effect of perceived discrimination and perceived stress to depression were tested. Multivariate regression was used to examine the determinants of depression.

RESULTS

The prevalence of mild to severe depression is 71.9%. The relationship between the perceived discrimination and depression is fully mediated by perceived stress (perceived discrimination that was statistically significant (β=0.153) to depression became non-significant after adding perceived stress in the regression model). Interaction term between social support and perceived stress has negative effects (β=-0.117) and explained a significant amount of variance (R(2)=0.018) in depression. Lower income, and higher perceived stress predicted more depressive symptoms.

LIMITATIONS

Cross-sectional study and self-report bias are major limitations of this study.

CONCLUSION

Depression among PLWH is a severe problem in China. Primary health care workers need to be trained in recognition and treatment in depression. Stress management skills and social support for PLWH are warranted.

Secondary disclosure of parental HIV status among children affected by AIDS in Henan, China

For children affected by AIDS, one psychological challenge is whether or how to disclose their parents' HIV status to others (secondary disclosure). The current study, utilizing data from 962 rural children affected by AIDS in central China, examines children's perceptions regarding secondary disclosure (intention of disclosure, openness, and negative feelings) and their association with children's demographic and psychosocial factors. The findings indicated that a high proportion of children preferred not to disclose parental HIV status to others, would not like to tell the truth to others in the situations of having to talk about parental HIV, and also had strong negative feelings about the disclosure. The study findings confirmed that keeping secrecy of parental HIV infection was associated with higher level of negative psychological outcomes (e.g., depression, loneliness, perceived stigma, and enacted stigma), and children's age was strongly associated with both their perceptions of secondary disclosure and psychological measures.

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

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

Risk and protective factors for depression symptoms among children affected by HIV/AIDS in rural China: a structural equation modeling analysis

Previous research has revealed a negative impact of orphanhood and HIV-related stigma on the psychological well-being of children affected by HIV/AIDS. Little is known about psychological protective factors that can mitigate the effect of orphanhood and HIV-related stigma on psychological well-being. This research examines the relationships among several risk and protective factors for depression symptoms using structural equation modeling. Cross-sectional data were collected from 755 AIDS orphans and 466 children of HIV-positive parents aged 6-18 years in 2006-2007 in rural central China. Participants reported their experiences of traumatic events, perceived HIV-related stigma, perceived social support, future orientation, trusting relationships with current caregivers, and depression symptoms. We found that the experience of traumatic events and HIV-related stigma had a direct contributory effect on depression among children affected by HIV/AIDS. Trusting relationships together with future orientation and perceived social support mediated the effects of traumatic events and HIV-related stigma on depression. The final model demonstrated a dynamic interplay among future orientation, perceived social support and trusting relationships. Trusting relationships was the most proximate protective factor for depression. Perceived social support and future orientation were positively related to trusting relationships. We conclude that perceived social support, trusting relationships, and future orientation offer multiple levels of protection that can mitigate the effect of traumatic events and HIV-related stigma on depression. Trusting relationships with caregivers provides the most immediate source of psychological support. Future prevention interventions seeking to improve psychological well-being among children affected by HIV/AIDS should attend to these factors.

AIDS knowledge and HIV stigma among children affected by HIV/AIDS in rural China

The current study was designed to assess the level of AIDS knowledge and its relationship with personal stigma toward people living with HIV/AIDS (PLWHA) among children living in communities of high HIV prevalence in rural China. The data were collected in 2009 from 118 orphanage orphans (children who had lost both of their parents to HIV and living in AIDS orphanages), 299 family-cared orphans (children who had lost one or both of their parents to HIV and living with surviving parents or extended families), 326 vulnerable children (children who were living with HIV-infected alive parents), and 276 comparison children (children from the same community who did not experience HIV-related illness and death in their family). Children were asked to answer 20 questions of AIDS knowledge. A 10-item stigma scale was employed to assess children's own attitude toward PLWHA. Both bivariate and multivariate tests were performed to answer our research questions. The data in the current study demonstrate a relatively low percent of correct AIDS knowledge (60%) among samples. The comparison children reported the best score of AIDS knowledge and orphanage orphans scored the lowest. The children with better AIDS knowledge have less personal stigma toward PLWHA. The findings in the current study suggest the need of appropriate education strategies to provide AIDS knowledge to children, particularly for HIV-affected children living in communities of high HIV prevalence in rural China.

Childhood sexual abuse and its relationship with psychosocial outcomes among children affected by HIV in rural China

This study assessed the prevalence of childhood sexual abuse (CSA) and its association with psychosocial outcomes among children residing in communities with a high prevalence of HIV in rural China. Data were collected from HIV orphans (n = 417; children who had lost one or both parents to HIV), vulnerable children (n = 326; children living with HIV-infected parents), and comparison children (n = 276; children who had not experienced HIV-related familial illness or death). Approximately 30% of the children reported having experienced at least one form of CSA; boys (37%) reported more cases of CSA as compared with girls (24%); 24% reported experiencing only nonphysical CSA, 5% reported both physical and nonphysical CSA, and 2% reported only physical CSA. Multivariate analysis revealed that CSA was significantly associated with problem behaviors and quality of life independent of key demographic factors. These findings suggest that the children in this study were vulnerable to CSA and also highlight the need to address the issues of CSA in this population.