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Hanson OR, Weglarz AJ, Barabara ML, Cohen SR, Minja LM, Mlay PS, Stephens MJ, Olomi GA, Mlay J, Mmbaga BT, Watt MH. HIV-related Shame among Women Giving Birth in Tanzania: A Mixed Methods Study. AIDS Behav 2024; 28:2276-2285. [PMID: 38526642 DOI: 10.1007/s10461-024-04322-1] [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: 03/11/2024] [Indexed: 03/27/2024]
Abstract
Women living with HIV (WLHIV) commonly experience HIV-related shame which can interfere with HIV care-seeking behavior and lead to poor clinical outcomes. HIV-related shame may be particularly heightened during the pregnancy and postpartum periods. This study aimed to describe HIV-related shame among WLHIV giving birth, identify associated factors, and qualitatively examine the impacts of HIV-related shame on the childbirth experience. Postpartum WLHIV (n = 103) were enrolled in the study between March and July 2022 at six clinics in the Kilimanjaro Region, Tanzania. Participants completed a survey within 48 h after birth, prior to being discharged. The survey included a 13-item measure of HIV-related shame, which assessed levels of HIV-related shame (Range: 0-52). Univariable and multivariable regression models examined factors associated with HIV-related shame. Qualitative in-depth interviews were conducted with pregnant WLHIV (n = 12) and postpartum WLHIV (n = 12). Thematic analysis, including memo writing, coding, and synthesis, was employed to analyze the qualitative data. The survey sample had a mean age of 29.1 (SD = 5.7), and 52% were diagnosed with HIV during the current pregnancy. Nearly all participants (98%) endorsed at least one item reflecting HIV-related shame, with an average endorsement of 9 items (IQR = 6). In the final multivariable model, HIV-related shame was significantly associated with being Muslim vs. Christian (ß = 6.80; 95%CI: 1.51, 12.09), attending less than four antenatal care appointments (ß = 5.30; 95%CI: 0.04, 10.55), and reporting experiences of HIV stigma in the health system (ß = 0.69; 95%CI: 0.27, 1.12). Qualitative discussions revealed three key themes regarding the impact of HIV-related shame on the childbirth experience: reluctance to disclose HIV status, suboptimal adherence to care, and the influence on social support networks. WLHIV giving birth experience high rates of HIV-related shame, and social determinants may contribute to feelings of shame. HIV-related shame impacts the childbirth experience for WLHIV, making the labor and delivery setting an important site for intervention and support.The study is funded by the National Institutes of Health (R21 TW012001) and is registered on clinicaltrials.gov (NCT05271903).
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Affiliation(s)
- Olivia R Hanson
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Anya J Weglarz
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | | | - Susanna R Cohen
- Department of Obstetrics and Gynecology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Pendo S Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Maya J Stephens
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Gaudensia A Olomi
- Health Management Department, Kilimanjaro Regional Secretary's Office, Moshi, Tanzania
| | - Janeth Mlay
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Melissa H Watt
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
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Brener L, Cama E, Broady T, Harrod ME, Holly C, Caruana T, Beadman K, Treloar C. Experiences of stigma and subsequent reduced access to health care among women who inject drugs. Drug Alcohol Rev 2024; 43:1071-1079. [PMID: 38271084 DOI: 10.1111/dar.13806] [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: 11/23/2022] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Research into stigma and injecting drug use has typically involved predominantly male participants, with limited research about the unique experience of women who inject drugs. METHODS This study used survey methods to assess reduced access to health care due to stigma among a sample of women who inject drugs. Women (n = 232) completed a survey as part of a broader national study of people who inject drugs. RESULTS Only 46 (19.9%) women reported that they had not experienced any injecting drug use-related stigma in the past year and most commonly noted 'sometimes' experiencing injecting-related stigma (36.8%) with more than 75% of women reporting that health workers had treated them negatively because of their injecting drug use. Most women undertook strategies to prevent experiencing stigma, such as not disclosing drug use to a health worker (81.3%), not attending follow-up appointments (76.7%) and delaying accessing health care (76.8%). Women with lower levels of personal wellbeing, who had experienced poorer treatment by health workers, had engaged in greater past month injecting, were employed and identified as lesbian, gay, bisexual, transgender or queer (LGBTQ) reported more reduced access to health care. DISCUSSION AND CONCLUSIONS Stigma has concerning health care implications for women who inject drugs and this research highlights the importance of understanding the impact of stigma in impeding health care access. Public health interventions should focus on addressing the systemic factors that reduce health care access for women who inject and take account of the impact of stigma in diminishing the quality and accessibility of health care for this group.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Yigit I, Paulino-Ramírez R, Waters J, Long DM, Turan JM, Budhwani H. A Moderated Mediation Analysis of HIV and Intersectional Stigmas and Antiretroviral Adherence in People Living with HIV in the Dominican Republic. AIDS Behav 2024:10.1007/s10461-024-04425-9. [PMID: 38916689 DOI: 10.1007/s10461-024-04425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
Experiencing HIV and intersectional stigmas in healthcare settings may affect antiretroviral treatment (ART) adherence among people with HIV (PWH), given their need for frequent interactions with clinical settings and healthcare providers. Considering the importance of reducing stigmas to promote well-being and the need to elucidate how stigma influences health across various settings, we examined how experienced HIV stigma in Dominican Republic healthcare settings impacts ART adherence through internalized HIV stigma and whether race or sexual orientation stigma moderates this relationship. Participants were 471 PWH (aged 17-71) who were recruited from two HIV clinics in the Dominican Republic in 2021-2022. Results revealed a significant mediation effect (B=-0.10, SE = 0.05, CI [-0.234, - 0.014]) after adjusting for effect of age and time since HIV diagnosis, suggesting that experienced HIV stigma in healthcare settings was associated with more internalized HIV stigma (B = 0.39, SE = 0.11, p = .001), subsequently linked to lower ART adherence (B=-0.26, SE = 0.11, p = .016). The indirect effect was significant at low levels of race stigma (B=-0.16, SE = 0.09, CI [-0.369, - 0.001]) but not at high levels of race stigma (B=-0.06, SE = 0.05, CI [-0.175, 0.038]). This indirect effect was also significant at low levels of sexual orientation stigma (B=-0.19, SE = 0.10, CI [-0.401, - 0.023]) but not at high levels of sexual orientation stigma (B=-0.04, SE = 0.06, CI [-0.160, 0.074]). These findings suggest that addressing experienced HIV stigma in Dominican Republic healthcare settings, along with various dimensions of HIV-related stigma (e.g., internalized stigma) and intersecting stigmas (e.g., race, sexual orientation), is vital for improving health outcomes, such as optimal ART adherence.
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Affiliation(s)
- Ibrahim Yigit
- College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, USA.
- Institute on Digital Health and Innovation, Florida State University (FSU), Tallahassee, FL, USA.
| | | | - John Waters
- Caribbean Vulnerable Communities Coalition (CVC), Kingston, Jamaica
| | - Dustin M Long
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, Koç University, Istanbul, Turkey
| | - Henna Budhwani
- College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, USA
- Institute on Digital Health and Innovation, Florida State University (FSU), Tallahassee, FL, USA
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Jordans CCE, Vliegenthart-Jongbloed KJ, van Bruggen AW, van Holten N, van Beek JEA, Vriesde M, van der Sluis D, Verbon A, Roukens AHE, Stutterheim SE, Rokx C. Unmasking Individual and Institutional HIV Stigma in Hospitals: Perspectives of Dutch Healthcare Providers. AIDS Behav 2024:10.1007/s10461-024-04404-0. [PMID: 38869755 DOI: 10.1007/s10461-024-04404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/14/2024]
Abstract
People with HIV continue to experience HIV stigma. Quantitative data on HIV stigma perpetrated by healthcare providers of hospitals providing HIV care in high-income countries are limited. The aim of this study is to investigate factors associated with HIV stigma in Dutch healthcare settings from the healthcare providers' perspective. We conducted a cross-sectional study using the questionnaire 'Measuring HIV Stigma and Discrimination Among Health Facility Staff - Monitoring Tool for Global Indicators' to assess HIV stigma among healthcare providers (n = 405) in two academic hospitals. Healthcare providers licensed to provide medical care were eligible for inclusion. The primary outcome was the self-reported prevalence of at least one manifestation of HIV stigma measured by six stigma indicators (four individual, two institutional). Secondary outcomes were the prevalence of HIV stigma per indicator, per occupation, per department, and factors associated with individual stigma indicators. HIV stigma was prevalent among 88.1% (95%CI 84.5% - 91.2%) of participants. Stigma was mostly driven by negative attitudes towards people with HIV and worry to acquire HIV. Multivariate analysis showed that several factors were associated with HIV stigma, including younger age, male sex, working at one of the surgical departments, and working as a nurse. Having received any training on HIV stigma and/or discrimination was associated with less HIV stigma among all indicators. In conclusion, HIV stigma is highly prevalent among Dutch healthcare providers. Targeted approaches, including training on HIV stigma and discrimination, are needed to reduce HIV stigma in healthcare and should, among others, focus on younger healthcare providers.
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Affiliation(s)
- C C E Jordans
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3015 CN, The Netherlands
| | - K J Vliegenthart-Jongbloed
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands
| | - A W van Bruggen
- Master student Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N van Holten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - J E A van Beek
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands
| | - M Vriesde
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands
| | - D van der Sluis
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - A Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3015 CN, The Netherlands
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A H E Roukens
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - S E Stutterheim
- Department of Health Promotion & Care and Public Health Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands
| | - C Rokx
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3015 CN, The Netherlands.
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands.
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Portilla-Tamarit I, Rubio-Aparicio M, Fuster-RuizdeApodaca MJ, Portilla-Tamarit J, Reus S, Portilla J. Health-Related Quality of Life in People with Advanced HIV Disease, from 1996 to 2021: Systematic Review and Meta-analysis. AIDS Behav 2024; 28:1978-1998. [PMID: 38743382 PMCID: PMC11161547 DOI: 10.1007/s10461-024-04298-y] [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: 02/16/2024] [Indexed: 05/16/2024]
Abstract
The purpose of the study was to assess the effects of advanced HIV disease (AHD) on health-related quality of life (HRQoL) in PLHIV, the changes in HRQoL outcomes over the last 25 years, and the differences between countries according to level of economic development. We conducted a systematic review and meta-analysis. The search was conducted in PubMed and Web of Science using the terms: "health-related quality of life", "HQRoL", "HIV", "AIDS", "advanced HIV disease" and "low CD4 cells". Studies inclusion criteria were: adult population; initiated after 1996 and published before July 2021; clinical trials, cross-sectional, cohort, and case-control studies; studies analyzing the relationship between AHD and HRQoL; English or Spanish language. Standardized mean differences (d+) were calculated to estimate the effect size for the meta-analyses. Summary statistics were calculated using a random-effects model, and analyses of effect moderators, using mixed-effects models. The meta-analysis included 38 studies. The results indicated that HRQoL is worse in patients with AHD compared to those without. The main HRQoL domains affected were overall health perception and concern and physical and functional health and symptoms. We found a moderate impact for age and gender on some HRQoL domains. There were no differences in relation to socioeconomic inequities, country of residence, or time period analyzed. In conclusion, advanced HIV disease has a negative impact on health and well-being in PLHIV. Our results show that despite all the advances in antiretroviral treatments over the last 25 years, AHD persists as a source of extreme vulnerability, regardless of where PLHIV live.
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Affiliation(s)
- I Portilla-Tamarit
- Department of Health Psychology, University of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Alicante University General Hospital, Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
| | - M Rubio-Aparicio
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
- Department of Basic Psychology & Methodology, Faculty of Psychology and Speech Therapy, University of Murcia, Avda. Teniente Flomesta, 5, 30003, Murcia, Spain.
| | - M J Fuster-RuizdeApodaca
- Faculty of Psychology, National Distance Learning University (UNED), Madrid, Spain
- Spanish Interdisciplinary AIDS Society (SEISIDA), 28036, Madrid, Spain
| | - J Portilla-Tamarit
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Alicante University General Hospital, Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
| | - S Reus
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Alicante University General Hospital, Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- Department of Clinical Medicine, Miguel Hernandez University, Elche, Alicante, Spain
| | - J Portilla
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Alicante University General Hospital, Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- Department of Clinical Medicine, Miguel Hernandez University, Elche, Alicante, Spain
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West BS, Darisheva M, McCrimmon T, Zholnerova N, Grigorchuk E, Starbird L, Terlikbayeva A, Primbetova S, Baiserkin B, Mussina Z, Kasymbekova S, Cordingley O, Frye VA. Scaling Up HIV Self-Testing and Linkage to Care Among Women Who Exchange Sex and/or Use Drugs in Kazakhstan. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:216-228. [PMID: 38917303 DOI: 10.1521/aeap.2024.36.3.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
HIV testing is the point of entry for linkage to treatment and prevention and is critically important to ending the HIV epidemic. HIV self-testing (HST) is an acceptable, user-controlled tool that can address testing barriers, which is especially important for populations who need to test frequently, like women who exchange or trade sex for money or other needed resources (WES) and women who use drugs. HST is feasible and acceptable among WES, but research among WES who also use drugs is limited, particularly in places like Kazakhstan, where HIV rates remain high and where scale-up of HST and pre-exposure prophylaxis (PrEP) is in process. To develop effective programming, there is a need to develop tailored services for WES and/or use drugs that address key barriers. We discuss opportunities to increase HST and linkage to services among WES and/or use drugs in Kazakhstan, with a focus on stigma reduction.
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Affiliation(s)
- Brooke S West
- School of Social Work, Columbia University, New York, New York
| | | | - Tara McCrimmon
- Sociomedical Sciences, Columbia University, New York, New York
| | | | | | - Laura Starbird
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Baurzhan Baiserkin
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, Kazakhstan
| | - Zhannat Mussina
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, Kazakhstan
| | | | | | - Victoria A Frye
- School of Social Work, Columbia University, New York, New York
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Pulerwitz J, Gottert A, Tun W, Eromhonsele AF, Oladimeji PL, Shoyemi E, Akoro M, Ndeloa C, Adedimeji A. Reducing stigma and promoting HIV wellness/mental health of sexual and gender minorities: RCT results from a group-based programme in Nigeria. J Int AIDS Soc 2024; 27:e26256. [PMID: 38837614 DOI: 10.1002/jia2.26256] [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: 07/16/2023] [Accepted: 04/15/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION High levels of HIV stigma as well as stigma directed towards sexual and/or gender minorities (SGMs) are well documented in the African setting. These intersecting stigmas impede psychosocial wellbeing and HIV prevention and care. Yet, there are few if any evidence-based interventions that focus on reducing internalized stigma and promoting mental health and HIV wellness for SGMs in Africa. We developed and evaluated a group-based intervention drawing on cognitive behavioural therapy (CBT) strategies for men who have sex with men (MSM) and transgender women (TGW) at risk for or living with HIV in Lagos, Nigeria. METHODS The intervention comprised four weekly in-person group sessions facilitated by community health workers. We conducted a delayed intervention group randomized controlled trial (April-September 2022), with pre-post surveys plus 3-month follow-up (immediate group only), as well as qualitative research with participants and programme staff. Outcomes included internalized stigma related to SGM and HIV status, depression, resiliency/coping and pre-exposure prophylaxis (PrEP)/HIV treatment use. RESULTS Mean age of the 240 participants was 26 years (range 18-42). Seventy-seven percent self-identified as MSM and 23% TGW; 27% were people with HIV. Most (88%) participants attended all four sessions, and 98% expressed high intervention satisfaction. There was significant pre-post improvement in each psychosocial outcome, in both the immediate and delayed arms. There were further positive changes for the immediate intervention group by 3-month follow-up (e.g. in intersectional internalized stigma, depression). While baseline levels of ever-PrEP use were the same, 75% of immediate-group participants reported currently using PrEP at 3 months post-intervention versus 53% of delayed-group participants right after the intervention (p<0.01). Participants post-intervention described (in qualitative interviews) less self-blame, and enhanced social support and resilience when facing stigma, as well as motivation to use PrEP, and indicated that positive pre-intervention changes in psychosocial factors found in the delayed group mainly reflected perceived support from the study interviewers. CONCLUSIONS This study demonstrated the feasibility and acceptability of a group-based CBT model for MSM and TGW in Nigeria. There were also some indications of positive shifts related to stigma, mental health and PrEP, despite issues with maintaining the randomized design in this challenging environment.
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Affiliation(s)
- Julie Pulerwitz
- Social and Behavioural Science Research Division, Population Council, Washington, DC, USA
| | - Ann Gottert
- Social and Behavioural Science Research Division, Population Council, Washington, DC, USA
| | - Waimar Tun
- Social and Behavioural Science Research Division, Population Council, Washington, DC, USA
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Nabunya P, Ssewamala FM, Kizito S, Mugisha J, Brathwaite R, Neilands TB, Migadde H, Namuwonge F, Ssentumbwe V, Najjuuko C, Sensoy Bahar O, Mwebembezi A, McKay MM. Preliminary Impact of Group-Based Interventions on Stigma, Mental Health, and Treatment Adherence Among Adolescents Living with Human Immunodeficiency Virus in Uganda. J Pediatr 2024; 269:113983. [PMID: 38401789 PMCID: PMC11095998 DOI: 10.1016/j.jpeds.2024.113983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/13/2024] [Accepted: 02/18/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To examine the preliminary impact of group cognitive behavioral therapy and multiple family group-based family strengthening to address HIV stigma and improve the mental health functioning of adolescents living with HIV in Uganda. STUDY DESIGN We analyzed data from the Suubi4Stigma study, a 2-year pilot randomized clinical trial that recruited adolescents living with HIV (10-14 years) and their caregivers (n = 89 dyads), from 9 health clinics. We fitted separate three-level mixed-effects linear regression models to test the effect of the interventions on adolescent outcomes at 3 and 6 months post intervention initiation. RESULTS The average age was 12.2 years and 56% of participants were females. Participants in the multiple family group-based family strengthening intervention reported lower levels of internalized stigma (mean difference = -0.008, 95% CI = -0.015, -0.001, P = .025) and depressive symptoms at 3 months (mean difference = -0.34, 95% CI = -0.53, -0.14, P < .001), compared with usual care. On the other hand, participants in the group cognitive behavioral therapy intervention reported lower levels of anticipated stigma at 3 months (mean difference = -0.039, 95% CI = -0.072, -0.006), P = .013) and improved self-concept at 6 months follow-up (mean difference = 0.04, 95% CI = 0.01, 0.01, P = .025). CONCLUSION Outcome trends from this pilot study provide compelling evidence to support testing the efficacy of these group-based interventions on a larger scale. TRIAL REGISTRATION The study is registered in the Clinical trials.gov database (Identifier #: NCT04528732).
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO.
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rachel Brathwaite
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Torsten B Neilands
- Division of Prevention Science, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Herbert Migadde
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Claire Najjuuko
- Division of Computational & Data Sciences, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | | | - Mary M McKay
- Vice Provost Office, Washington University in St. Louis, St. Louis, MO
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9
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Nilsson Schönnesson L, Dahlberg M, Reinius M, Zeluf-Andersson G, Ekström AM, Eriksson LE. Prevalence of HIV-related stigma manifestations and their contributing factors among people living with HIV in Sweden - a nationwide study. BMC Public Health 2024; 24:1360. [PMID: 38769531 PMCID: PMC11106865 DOI: 10.1186/s12889-024-18852-9] [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: 01/20/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND With access to antiretroviral therapy (ART) HIV infection is a chronic manageable condition and non-sexually transmissible. Yet, many people living with HIV still testify about experiencing HIV-related stigma and discrimination. It is well-documented that HIV-related stigma and discrimination continue to be critical barriers to prevention, treatment, care and quality of life. From an individual stigma-reduction intervention perspective, it is essential to identify individual and interpersonal factors associated with HIV-related stigma manifestations. To address this issue and to expand the literature, the aim of this study was to assess the prevalence of HIV-related stigma manifestations and their associated factors among a diverse sample of people living with HIV in Sweden. METHOD Data from 1 096 participants were derived from a nationally representative, anonymous cross-sectional survey "Living with HIV in Sweden". HIV-related stigma manifestations were assessed using the validated Swedish 12-item HIV Stigma Scale encompassing four HIV-related stigma manifestations: personalised stigma, concerns with public attitudes towards people living with HIV, concerns with sharing HIV status, and internalized stigma. Variables potentially associated with the HIV-related stigma manifestations were divided into four categories: demographic characteristics, clinical HIV factors, distress and ART adherence, and available emotional HIV-related support. Four multivariable hierarchical linear regression analyses were employed to explore the associations between multiple contributors and HIV-related stigma manifestations. RESULTS The most dominating stigma feature was anticipation of HIV-related stigma. It was manifested in high scores on concerns with sharing HIV status reported by 78% of the participants and high scores on concerns about public attitudes towards people living with HIV reported by 54% of the participants. High scores on personalised stigma and internalized stigma were reported by around one third of the participants respectively. Between 23 and 31% of the variance of the four reported HIV-related stigma manifestations were explained mainly by the same pattern of associated factors including female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support. CONCLUSION The most dominating stigma feature was anticipation of stigma. Female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support constituted potential vulnerability factors of the four HIV-related stigma manifestations. Our findings highlight the vital necessity to support people living with HIV to increase their resilience to stigma in its different forms. Exploring associated factors of HIV-related stigma manifestations may give an indication of what circumstances may increase the risk of stigma burden and factors amenable to targeted interventions. As individual stigma-reductions interventions cannot be performed isolated from HIV-related stigma and discrimination in society, a key challenge is to intensify anti-stigma interventions also on the societal level.
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Affiliation(s)
| | - Marie Dahlberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna-Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital/Venhälsan, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Psychological Sciences, City, University of London, London, UK
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
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10
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Filiatreau LM, Ebasone PV, Dzudie A, Wainberg M, Yotebieng M, Anastos K, Parcesepe AM. Intersectional HIV- and Depression-Related Stigma Among People with HIV Entering HIV Care in Cameroon. AIDS Behav 2024:10.1007/s10461-024-04375-2. [PMID: 38767726 DOI: 10.1007/s10461-024-04375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Mental health-related stigma is a prominent barrier to improved mental health outcomes globally and may be particularly harmful to populations with other stigmatized identities. We aimed to understand intersectional depression- and HIV-related stigma among people with HIV (PWH) entering HIV care in Cameroon. Using baseline data from a cohort of PWH entering HIV care in Cameroon between 2019 and 2020, we characterized depression- and HIV-related stigma in the population overall and by sociodemographic sub-group. We also explored substantively meaningful variation in stigma endorsement by depressive symptom severity (Patient Health Questionnaire-9 [PHQ-9]) and causal attribution of depression. Among those with elevated depressive symptoms (PHQ-9 scores > 4), we estimated the association between stigma type and depressive symptom severity using binomial regression. Among 398 participants, 49% endorsed low HIV- and depression-related stigma (N = 195), 10% endorsed high HIV- and depression-related stigma (N = 38), 29% endorsed high depression-related stigma only (N = 116), and 12% endorsed high HIV-related stigma only (N = 49). Respondents with and without heightened depressive symptoms commonly believed depressive symptoms were caused by HIV (N = 140; 32.9%). Among those with elevated depressive symptoms, the prevalence of moderate to severe symptoms was higher among those endorsing high HIV-related stigma only (prevalence ratio 1.55; 95% confidence interval: 1.01, 2.37) compared to those reporting low HIV- and depression-related stigma. HIV- and depression-related stigma are both common among PWH entering HIV care in Cameroon. The consistent association between HIV-related stigma and poor psychosocial well-being among people with HIV necessitates the urgent scale-up of evidence-based HIV-related stigma interventions specifically.
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Affiliation(s)
- Lindsey M Filiatreau
- School of Medicine, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Yuan GF, Qiao S, Li X, Shen Z, Zhou Y. How Does Anticipated HIV Stigma Affect Medication Adherence? A Longitudinal Path Analysis Model. AIDS Behav 2024; 28:1684-1693. [PMID: 38340222 DOI: 10.1007/s10461-024-04293-3] [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: 02/05/2024] [Indexed: 02/12/2024]
Abstract
Prior research has documented that anticipated HIV stigma may play an important predictive role in medication adherence among people living with HIV (PLWH). However, longitudinal data on the mechanisms underlying this linkage are scarce. The current study aimed to explore the longitudinal mediation association among anticipated HIV stigma, medication adherence support, HIV self-management, and medication adherence. A four-wave sample consisting of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20; 63.9% male) with a six-month interval was used in the current study. Participants were asked to complete self-report questionnaires. A path analysis model was analyzed. Results indicate that anticipated HIV stigma at baseline was positively related to medication adherence at Time 4 (T4). Medication adherence support at Time 2 (T2) and HIV self-management at Time 3 (T3) serially mediated the anticipated HIV stigma at Time 1 (T1) and medication adherence at T4. These findings provide critical insights into the mediating roles of medication adherence support and HIV self-management in the relationship between anticipated HIV stigma and medication adherence over time. Such an understanding has important implications for the development of tailored interventions and public health strategies aimed at improving medication adherence among PLWH in the context of HIV-related stigma.
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Affiliation(s)
- Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, Leshan, Sichuan, China.
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Shan Qiao
- Department of Health Promotion Education and Behavior, 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
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, 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
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
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12
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Parisi CE, Varas-Rodriguez E, Algarin AB, Richards V, Li W, Cruz Carrillo L, Ibañez GE. A Content Analysis of HIV-Related Stigmatizing Language in the Scientific Literature, From 2010-2020: Findings and Recommendations for Editorial Policy. HEALTH COMMUNICATION 2024; 39:1209-1217. [PMID: 37161354 PMCID: PMC10636239 DOI: 10.1080/10410236.2023.2207289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Despite negative effects of HIV-related stigma on people with HIV, some scientific literature continues to use stigmatizing terms. Our study aimed to explore the use of HIV-related stigmatizing language in the scientific literature between 2010 and 2020 based on 2015 UNAIDS terminology guidelines. We searched for articles with the stigmatizing term "HIV/AIDS-infected" or any variations that were peer-reviewed, published between 2010 and 2020, and in English or with an English translation. Our search yielded 26,476 articles that used the stigmatizing term of interest. Frequencies on the variables of interest (journal, year, and country) were run. The use of these terms increased from 2010 to 2017 and decreased from 2018 to 2020. Most journals using the terms were HIV/AIDS specific or on infectious diseases, but the journal with the greatest frequency of use was on general science and medicine. Thirty-six percent of the articles emanated from the United States. To reduce the use of stigmatizing language in the HIV literature, action should be taken by authors, reviewers, editors,educators, and publishers should create formal policies promoting use of non-stigmatizing language.
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Affiliation(s)
- Christina E Parisi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida
| | - Emil Varas-Rodriguez
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University
| | - Angel B Algarin
- Edson College of Nursing and Health Innovation, Arizona State University
| | - Veronica Richards
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University
| | - Wei Li
- Department of Psychiatry, Yale School of Medicine, Yale University
| | - Liset Cruz Carrillo
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University
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13
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Dai Z, Wu Y, Liu X, Fu J, Si M, Chen X, Wang H, Xiao W, Huang Y, Yu F, Mi G, Su X. Characteristics and influencing factors of anticipated HIV stigma among HIV-negative/unknown MSM in China: A regression mixture model. Brain Behav 2024; 14:e3472. [PMID: 38549560 PMCID: PMC10979188 DOI: 10.1002/brb3.3472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Anticipated HIV stigma among men who have sex with men's (MSM) has a severe negative effect on their physical and mental health wellbeing and hence requires specific attention. The current study aims to identify the characteristics and the psychosocial influencing factors of anticipated HIV stigma in MSM using regression mixture model (RMM) and to determine the cut-off point of the seven-item Anticipated HIV Stigma Questionnaire (AHSQ) using the receiver operating characteristic (ROC) analysis. METHODS A cross-sectional study was conducted among HIV-negative/unknown MSM from Blued online platform in China from December 16th, 2020 to March 1st, 2021, enrolling 1394 participants. Data were collected on demographic characteristics, perceived social support, anticipated HIV stigma, depressive symptoms, and HIV knowledge. Latent profile analysis was performed to identify different profiles of anticipated HIV stigma level. Chi-square test, analysis of variance, and RMM analysis were conducted to explore the influencing factors in different profiles. ROC analyses were carried out to identify the cut-off value of anticipated stigma. RESULTS Among the participants, three profiles of anticipated stigma were identified: "low anticipated HIV stigma" (12.0%), "moderate anticipated HIV stigma" (52.1%), and "severe anticipated HIV stigma" (35.9%). RMM analysis showed that higher income and higher levels of knowledge were positively associated with moderate anticipated HIV stigma, whereas full-time job and social support were negatively associated with moderate anticipated HIV stigma; higher income, depressive symptoms, and knowledge were positively associated with severe anticipated HIV stigma, whereas minor ethnicity and social support were negatively associated with severe anticipated HIV stigma. ROC curve of the AHSQ showed that the optimal cut-off value of ≥16 could indicate positive anticipated HIV stigma. CONCLUSION The study focuses on the level of anticipated HIV stigma and its psycho-socio influencing factors among HIV-negative/unknown MSM. It provides evidence for implementing relevant psychological interventions to HIV-negative/unknown MSM.
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Affiliation(s)
- Zhenwei Dai
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yijin Wu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xin Liu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Jiaqi Fu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Mingyu Si
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xu Chen
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Hao Wang
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Weijun Xiao
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yiman Huang
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Fei Yu
- Danlan Public WelfareBeijingChina
| | | | - Xiaoyou Su
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
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14
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Jiménez-Rivagorza L, Orozco R, Medina-Mora ME, Rafful C. HIV-Related Stigma and Treatment Adherence Among Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Meth in the Metropolitan Area of Mexico City. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1561-1574. [PMID: 38409457 PMCID: PMC10954905 DOI: 10.1007/s10508-024-02816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/28/2024]
Abstract
Internationally, HIV-related stigma and crystal methamphetamine (meth) use have been described as barriers to treatment adherence among gay, bisexual, and other men who have sex with men (gbMSM). Crystal meth use has been increasing among gbMSM in the Metropolitan Area of Mexico City (MAMC). Therefore, this study aimed to determine the association between HIV-related stigma and HIV treatment adherence among gbMSM who use crystal meth in the MAMC. This study was undertaken as part of an exploratory study of crystal meth use in the MAMC. The data were collected from September to December 2021 through an encrypted online survey. Participants (n = 89) were gbMSM adults living with HIV who reported crystal meth use in the past month that were recruited through an online snowball sampling. The online survey included questions about HIV treatment adherence, sexual behaviors, the Alcohol, Smoking, and Substance Involved Screening Test, and the HIV-Related Stigma Mechanisms Scale. Logistic regression analyses assessed the association between HIV-related stigma and HIV treatment adherence. The multivariate logistic regression model showed that, controlling for health insurance [adjusted odds ratio (AOR) = 0.13; 95% confidence intervals (CI) = 0.02-0.59] and educational level (AOR = 0.16; 95% CI = 0.02-0.88), non-adherence to HIV treatment was independently associated with higher HIV-related stigma (AOR = 1.06; 95% CI = 1.01-1.12). Public health policies must include HIV-related stigma and substance use in treating gbMSM with HIV.
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Affiliation(s)
- Leonardo Jiménez-Rivagorza
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico
| | - Ricardo Orozco
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - María Elena Medina-Mora
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico.
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico.
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15
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Verinumbe T, Katomski AS, Turpin G, Syarif O, Looze P, Lalak K, Anoubissi J, Brion S, Dunaway K, Sprague L, Matyushina D, De Leon Moreno CG, Baral SD, Rucinski K, Lyons C. Characterizing the Relationship between HIV Peer Support Groups and Internalized Stigma Among People Living with HIV in Nigeria. AIDS Behav 2024; 28:1068-1076. [PMID: 37889362 PMCID: PMC11234473 DOI: 10.1007/s10461-023-04217-7] [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: 10/14/2023] [Indexed: 10/28/2023]
Abstract
HIV-related stigma remains a significant barrier to implementing effective HIV treatment and prevention strategies in Nigeria. Despite the high uptake of peer support groups among people living with HIV (PLHIV) in Nigeria, the potential role of such peer support on the burden of internalized stigma remains understudied. To address this gap, we conducted a secondary analysis of the PLHIV Stigma Index 2.0, a socio-behavioral survey implemented by PLHIV led-organizations to assess the relationship between group membership and internalized stigma. Internalized stigma was measured using the Internalized AIDS-related Stigma Scale. Multinomial logistic regression was used to measure the association between self-reported engagement in peer support groups and internalized stigma adjusting for age, education, duration since HIV diagnosis, employment, disclosure status, and sex-work engagement. Of the 1,244 respondents in this study, 75.1% were engaged in HIV peer support groups. Over half (55.5%) and about one-fourth (27.3%) demonstrated low/moderate and high levels of internalized stigma, respectively. PLHIV engaged in HIV peer support groups were less likely to report both low/moderate (versus no) (adjusted odds ratio (aOR): 0.47 [95% CI: 0.27 to 0.81]; p = 0.006) and high (versus no) (aOR: 0.30 [95% CI: 0.17 to 0.53]; p < 0.001) levels of internalized stigma compared to those not engaged. In this study, the burden of internalized stigma is high among PLHIV in Nigeria. However, engagement in peer support groups appears to mitigate these stigmas. Stigma mitigation strategies to increase peer support may represent a critical tool in decreasing sustained HIV treatment gaps among PLHIV in Nigeria.
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Affiliation(s)
- Tarfa Verinumbe
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1717 East Monument St., Baltimore, MD, 21205, USA.
| | - Anna-Sophia Katomski
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Omar Syarif
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Pim Looze
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Katarzyna Lalak
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Jean Anoubissi
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Sophie Brion
- The International Community of Women Living with HIV (ICW), London, UK
| | - Keren Dunaway
- The International Community of Women Living with HIV (ICW), London, UK
| | - Laurel Sprague
- The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Daria Matyushina
- The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | | | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Katherine Rucinski
- Department of International Health, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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16
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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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17
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YIGIT I, TURAN B, KURT G, WEISER SD, JOHNSON MO, MUGAVERO MJ, TURAN JM. Longitudinal Associations of Experienced and Perceived Community Stigma With Antiretroviral Therapy Adherence and Viral Suppression in New-to-Care People With HIV: Mediating Roles of Internalized Stigma and Depression Symptoms. J Acquir Immune Defic Syndr 2024; 95:231-237. [PMID: 38180894 PMCID: PMC10922854 DOI: 10.1097/qai.0000000000003360] [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: 07/01/2023] [Accepted: 11/15/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Although cross-sectional studies have suggested that HIV-related stigma and depression symptoms may result in poor HIV treatment and health outcomes, few studies have investigated potential longitudinal mechanisms in these relationships. Furthermore, longitudinal effects of HIV-related stigma on health outcomes have not been examined in people with HIV (PWH) newly initiating HIV clinical care. We examined longitudinal associations between experienced and perceived community stigma and health outcomes (antiretroviral therapy [ART] adherence and viral load), mediated by internalized stigma and depression symptoms among new-to-care PWH in the United States. SETTING/METHODS Data were obtained from 371 PWH who initiated HIV medical care at 4 HIV sites at baseline and 48 weeks later between December 2013 and 2018. Validated measures were used to assess experienced stigma, perceived community stigma, internalized stigma, depression symptoms, and ART adherence, and viral load was obtained from medical records at the final study visit. RESULTS Serial mediation models revealed significant indirect effects of experienced stigma and perceived community stigma on ART adherence and on viral suppression, first through internalized stigma and then through depression symptoms. CONCLUSIONS These results suggest that PWH may tend to internalize HIV-related stigma when they experience acts of stigmatization or perceive negative attitudes in society, which in turn may result in negative effects on psychological and physical well-being. These findings about how stigma in society may be an antecedent mechanism for PWH to develop internalized stigma, which in turn affects individual health outcomes, can be used to tailor both individual-level and community-level interventions.
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Affiliation(s)
- Ibrahim YIGIT
- Department of Psychology, TED University, Ankara, Turkey
| | - Bulent TURAN
- Department of Psychology, Koc University, Istanbul, Turkey; Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gülşah KURT
- School of Psychiatry, University of New South Wales, Sydney NSW 2052, Australia
| | - Sheri D. WEISER
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mallory O. JOHNSON
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael J. MUGAVERO
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M. TURAN
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, Department of Public Health, Koc University, Istanbul, Turkey
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18
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Ballesty KL, Newton-John TR, Hennessy RM, Alperstein DM, Begley K, Bulsara SM. 'What doesn't kill you. . .': A qualitative analysis of factors impacting the quality of life of people living with HIV. J Health Psychol 2024:13591053241235091. [PMID: 38411113 DOI: 10.1177/13591053241235091] [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: 02/28/2024] Open
Abstract
Despite viral suppression, people living with HIV (PLHIV) report lower quality of life (QoL) than the general population, negatively impacting treatment adherence and wellbeing. This qualitative study explored factors influencing QoL of PLHIV. Participants completed a QoL questionnaire, with cut-off scores used to allocate participants into Low-Moderate QoL (n = 11) or High-Very High QoL (n = 10) focus groups. Thematic analysis indicated convergence across factors perceived to impact QoL, with some notable discrepancies. Socioeconomic stability, social connection and support, maintaining good health, adaptive attitudes and reduced impact of stigma were perceived to improve QoL, while obstacles to connection, ageing and poor HIV literacy in the general population were perceived to worsen QoL in both groups. The Low-Moderate QoL group alone identified socioeconomic stressors and ongoing burden of negative life experiences worsened their QoL. Results are presented in the context of local and global HIV health strategies, with implications for clinical management noted.
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Affiliation(s)
| | | | | | | | | | - Shiraze M Bulsara
- University of Technology Sydney (UTS), Australia
- The Albion Centre, Australia
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19
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Adekoya P, Lannap FD, Ajonye FA, Amadiegwu S, Okereke I, Elochukwu C, Aruku CA, Oluwaseyi A, Kumolu G, Ejeh M, Olutola AO, Magaji D. Experiences of Stigmatization and Discrimination in Accessing Health Care Services Among People Living with HIV (PLHIV) in Akwa Ibom State, Nigeria. HIV AIDS (Auckl) 2024; 16:45-58. [PMID: 38406768 PMCID: PMC10891273 DOI: 10.2147/hiv.s447551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/01/2024] [Indexed: 02/27/2024] Open
Abstract
Background Recent advances in care and treatment have turned HIV into a "chronic but manageable condition". Despite this, some people living with HIV (PLHIV) continue to suffer from stigma and discrimination in accessing health care services. This study examined the experience of stigma and discrimination and access to health care services among PLHIV in Akwa Ibom State. Methods The Center for Clinical Care and Clinical Research (CCCRN), implementing a USAID-funded Integrated Child Health and Social Services Award (ICHSSA 1) project, conducted a community-based cross-sectional survey in 12 randomly selected local government areas in Akwa Ibom State, Nigeria. A structured quantitative questionnaire was used for data collection. In total, 425 randomly selected PLHIV were interviewed after providing informed consent. Descriptive statistics and bivariate analyses were conducted using the data analytical application Stata 14. Results The study revealed that 215 PLHIV (50.4%) had been denied access to health care services, including dental care, because of their HIV status in Akwa Ibom State. Respondents reported being afraid of: gossip (78%), being verbally abused (17%), or being physically harassed or assaulted because of their positive status (13%). Self-stigmatization was also evident; respondents reported being ashamed because of their positive HIV status (29%), exhibiting self-guilt (16%), having low self-esteem (38%), and experiencing self-isolation (36%). Women, rural residents, PLHIV with no education, unemployed, single, young people aged between 19 and 29 years, and older adults were more likely to experience HIV-related stigmatization. Conclusion Data from the study revealed that the percentage of PLHIV who experience health-related stigmatization because of their HIV status is high in Akwa Ibom State. This finding calls for the prioritization of interventions to reduce stigma, enhance self-esteem, and promote empathy and compassion for PLHIV. It also highlights the need for HIV education for family and community members and health care providers, to enhance the knowledge of HIV and improve acceptance of PLHIV within families, communities, and health care settings.
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Affiliation(s)
- Peters Adekoya
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | - Faith D Lannap
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | | | | | | | | | | | | | - Grace Kumolu
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | - Michael Ejeh
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | | | - Doreen Magaji
- United States Agency for International Development, Abuja, Nigeria
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D'Anna LH, Chang K. Healthcare discrimination, anticipated HIV stigma, and income as predictors of HIV testing among a community sample of YBMSM. AIDS Care 2024; 36:212-219. [PMID: 37607018 DOI: 10.1080/09540121.2023.2240068] [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: 02/18/2022] [Accepted: 07/18/2023] [Indexed: 08/24/2023]
Abstract
Young Black men who have sex with men (YBMSM) are at particular risk for HIV, and knowing one's HIV status is key to preventing new HIV infections. Data were derived from a community-based study involving 250 YBMSM to examine the relationships between race-based discrimination experienced in healthcare settings, anticipated HIV stigma, household income and lifetime HIV testing. Lifetime HIV testing was regressed on racial discrimination in healthcare settings, anticipated HIV stigma, and income, and a significant 3-way interaction was found. To help interpret the 3-way interaction, lifetime HIV testing was regressed on racial discrimination in healthcare settings and anticipated HIV stigma in two separate models; with low-income and higher-income YBMSM. Anticipated HIV stigma was found to predict HIV testing among low-income YBMSM. A significant interaction was detected such that low-income YBMSM with low levels of anticipated HIV stigma were more likely to get tested for HIV regardless of experiences with healthcare discrimination, while low-income YBMSM who reported greater anticipated HIV stigma and more experiences of healthcare discrimination were less likely to get tested for HIV. Understanding the complexity of potential barriers is crucial for developing interventions to increase HIV testing within this population.
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Affiliation(s)
- Laura Hoyt D'Anna
- Center for Health Equity Research, California State University, Long Beach
| | - Kyle Chang
- Center for Health Equity Research, California State University, Long Beach
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21
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Schweitzer AM, Dišković A, Krongauz V, Newman J, Tomažič J, Yancheva N. Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe. AIDS Res Ther 2023; 20:87. [PMID: 38082352 PMCID: PMC10714556 DOI: 10.1186/s12981-023-00585-1] [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: 08/08/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Surging HIV prevalence across countries of Central and Eastern Europe (CEE) is largely a result of poor HIV care engagement and a lack of comprehensive support for key populations. This is fostered by widespread stigma across healthcare, community, and legislative settings. DISCUSSION Throughout CEE, HIV stigma and intersectional stigma are serious obstacles to providing adequate medical care to people living with HIV. Anticipated and enacted (experienced) stigma from healthcare professionals, and fears of breaches in confidentiality, deter individuals from having an HIV test and engaging in HIV care. Furthermore, negative connotations surrounding HIV infection can lead to discrimination from family, friends, colleagues, and the public, leading to internalized stigma and depression. Key populations that have higher HIV prevalence, such as men who have sex with men, people who inject drugs, transgender individuals, and sex workers, experience additional stigma and discrimination based on their behaviour and identities. This contributes to the concentrated HIV epidemics seen in these populations in many CEE countries. The stigma is exacerbated by punitive legislation that criminalizes HIV transmission and penalizes sexual orientation, drug use, gender identities, and sex work. Despite high levels of HIV stigma and intersectional stigma, there are many evidence-based interventions that have reduced stigma in other parts of the world. Here, we discuss the interventions that are currently being enacted in various countries of CEE, and we suggest additional effective, evidence-based interventions that will tackle stigma and lead to increased HIV care engagement and higher rates of viral suppression. We cover the promotion of the undetectable = untransmittable (U = U) message, stigma-reduction education and training for healthcare professionals, patient-centric approaches for testing and treatment, and advocacy for non-discriminatory legislation, policies, and practices. We also consider targeted stigma-reduction interventions that acknowledge the wider challenges faced by marginalized populations. CONCLUSIONS HIV stigma and intersectional stigma in CEE drive poor engagement with HIV testing services and care. Widespread adoption of evidence-based interventions to tackle stigma highlighted in this review will improve the quality of life of people living with HIV, improve HIV care engagement, and ultimately slow the surging HIV prevalence and concentrated epidemics occurring throughout CEE.
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Affiliation(s)
| | - Arian Dišković
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | - Veronica Krongauz
- European Distributor Markets, Medical Department, Gilead Sciences, Uxbridge, UK
| | - Julie Newman
- HIV Strategic Implementation & Franchise, Global Medical Affairs, Gilead Sciences, Melbourne, Australia
| | - Janez Tomažič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
- Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
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22
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Davis A, Stringer KL, Drainoni ML, Oser CB, Knudsen HK, Aldrich A, Surratt HL, Walker DM, Gilbert L, Downey DL, Gardner SD, Tan S, Lines LM, Vandergrift N, Mack N, Holloway J, Lunze K, McAlearney AS, Huerta TR, Goddard-Eckrich DA, El-Bassel N. Community-level determinants of stakeholder perceptions of community stigma toward people with opioid use disorders, harm reduction services and treatment in the HEALing Communities Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104241. [PMID: 37890391 PMCID: PMC10841835 DOI: 10.1016/j.drugpo.2023.104241] [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: 07/17/2023] [Revised: 09/16/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Community stigma toward people with opioid use disorder (OUD) can impede access to harm reduction services and treatment with medications for opioid use disorder (MOUD). Such community OUD stigma is partially rooted in community-level social and economic conditions, yet there remains a paucity of large-scale quantitative data examining community-level factors associated with OUD stigma. We examined whether rurality, social inequity, and racialized segregation across communities from four states in the HEALing Communities Study (HCS) were associated with 1) greater perceived community stigma toward people treated for OUD, 2) greater perceived intervention stigma toward MOUD, and 3) greater perceived intervention stigma toward naloxone by community stakeholders in the HCS. METHODS From November 2019-January 2020, a cross-sectional survey about community OUD stigma was administered to 801 members of opioid overdose prevention coalitions across 66 communities in four states prior to the start of HCS intervention activities. Bivariate analyses assessed pairwise associations between community rural/urban status and each of the three stigma variables, using linear mixed effect modeling to account for response clustering within communities, state, and respondent sociodemographic characteristics. We conducted similar bivariate analyses to assess pairwise associations between racialized segregation and social inequity. RESULTS On average, the perceived community OUD stigma scale score of stakeholders from rural communities was 4% higher (β=1.57, SE=0.7, p≤0.05), stigma toward MOUD was 6% higher (β=0.28, SE=0.1, p≤0.05), and stigma toward naloxone was 10% higher (β=0.46, SE=0.1, p≤0.01) than among stakeholders from urban communities. No significant differences in the three stigma variables were found among communities based on racialized segregation or social inequity. CONCLUSION Perceived community stigma toward people treated for OUD, MOUD, and naloxone was higher among stakeholders in rural communities than in urban communities. Findings suggest that interventions and policies to reduce community-level stigma, particularly in rural areas, are warranted.
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Affiliation(s)
- Alissa Davis
- Columbia University School of Social Work, New York, NY, United States.
| | - Kristi Lynn Stringer
- Department of Health and Human Performance, Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, United States
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Alison Aldrich
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Hilary L Surratt
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Louisa Gilbert
- Columbia University School of Social Work, New York, NY, United States
| | - Dget L Downey
- Columbia University School of Social Work, New York, NY, United States
| | - Sam D Gardner
- Columbia University School of Social Work, New York, NY, United States
| | - Sylvia Tan
- RTI International, Research Triangle Park, NC, United States
| | - Lisa M Lines
- RTI International, Research Triangle Park, NC, United States
| | | | - Nicole Mack
- RTI International, Research Triangle Park, NC, United States
| | - JaNae Holloway
- RTI International, Research Triangle Park, NC, United States
| | - Karsten Lunze
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | - Nabila El-Bassel
- Columbia University School of Social Work, New York, NY, United States
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Yuan GF, Tam CC, Yang X, Qiao S, Li X, Shen Z, Zhou Y. Associations Between Internalized and Anticipated HIV Stigma and Depression Symptoms Among People Living with HIV in China: A four-wave Longitudinal Model. AIDS Behav 2023; 27:4052-4061. [PMID: 37392272 DOI: 10.1007/s10461-023-04119-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
Previous research has documented that HIV-related stigma (e.g., internalized and anticipated stigma) is detrimental to the mental health of people living with HIV (PLWH). However, longitudinal data on the bidirectional relationship between HIV-related stigma and depression symptoms are limited. The purpose of this study was to examine the bidirectional association among internalized and anticipated HIV stigma and depression symptoms among Chinese PLWH. A four-wave longitudinal design (6 months intervals) was employed among 1,111 Chinese PLWH (Mage = 38.58, SD = 9.16, age range: 18-60 years; 64.1% men). The bidirectional model was examined using a random-intercept cross-lagged panel model (RI-CLPM), which evaluated the within- and between-person effects of study variables. At the within-person level, results indicated that depression symptoms at T2 mediated the linkage between internalized HIV stigma at T1 and anticipated HIV stigma at T3, and that anticipated HIV stigma at both T2 and T3 mediated the relationship between depression symptoms at the previous time point and internalized HIV stigma at the subsequent time point. Furthermore, a bidirectional association was found between anticipated HIV stigma and depression symptoms across four waves. At the between-person level, internalized and anticipated HIV stigma were significantly associated with depression symptoms. This study highlights the complex interplay between different forms of HIV-related stigma and mental health problems among PLWH and underscores the importance of considering the bidirectional relationship between the development of psychopathology and stigmatization process in clinical practice.
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Affiliation(s)
- Guangzhe Frank Yuan
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Cheuk Chi Tam
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xueying Yang
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Shan Qiao
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, 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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24
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Mathai R, Hinestrosa F, DeJesus E, Rolle CP. Racial/ethnic disparities in HIV care outcomes among insured patients at a large urban sexual health clinic. J Investig Med 2023; 71:946-952. [PMID: 37365802 DOI: 10.1177/10815589231182313] [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: 06/28/2023]
Abstract
Prior studies demonstrate that non-White patients are less likely to achieve human immunodeficiency virus (HIV) suppression compared to White patients due to lack of health insurance. This study aims to determine whether racial disparities in the HIV care cascade persist among a cohort of privately and publicly insured patients. This retrospective analysis evaluated HIV care outcomes during the first year of care. Eligible patients were aged 18-65 years, treatment-naïve, and seen between 2016 and 2019. Demographic and clinical variables were extracted from the medical record. Differences in the proportion of patients achieving each HIV care cascade stage by race were evaluated using unadjusted chi-square testing. Risk factors for viral non-suppression at 52 weeks were analyzed using multivariate logistic regression. We included 285 patients; ninety-nine were White, 101 were Black, and 85 identified as Hispanic/LatinX ethnicity. Significant differences in retention in care for Hispanic/LatinX patients (odds ratio (OR): 0.214, 95% confidence interval (CI): 0.067-0.676) and viral suppression for both Black (OR: 0.348, 95% CI: 0.178, 0.682) and Hispanic/LatinX patients (OR: 0.392, 95% CI: 0.195, 0.791) compared to White patients were observed. In multivariate analyses, Black patients were less likely to achieve viral suppression compared to White patients (OR: 0.464, 95% CI: 0.236, 0.902). This study showed that non-White patients were less likely to achieve viral suppression after 1 year despite insurance and suggests that other unmeasured factors may disproportionately affect viral suppression in these patients. Interventions to identify and address these factors are needed to improve HIV care outcomes for non-White populations.
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Affiliation(s)
- Reanne Mathai
- University of Central Florida, College of Medicine, Orlando, USA
| | | | - Edwin DeJesus
- University of Central Florida, College of Medicine, Orlando, USA
- Orlando Immunology Center, Orlando, FL, USA
| | - Charlotte-Paige Rolle
- Orlando Immunology Center, Orlando, FL, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
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25
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Restall G, Ukoli P, Mehta P, Hydesmith E, Payne M. Resisting and disrupting HIV-related stigma: a photovoice study. BMC Public Health 2023; 23:2062. [PMID: 37864144 PMCID: PMC10590010 DOI: 10.1186/s12889-023-16741-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/12/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The stigma associated with human immunodeficiency virus (HIV) is a significant global public health concern. Health care providers and policy makers continue to struggle with understanding and implementing strategies to reduce HIV-related stigma in particular contexts and at the intersections of additional oppressions. Perspectives and direction from people living with HIV are imperative. METHODS In this project we amplified the voices of people living with HIV about their experiences of HIV-related stigma in Manitoba, Canada. We used an arts-based qualitative case study research design using photovoice and narrative interviews. Adults living with HIV participated by taking pictures that represented their stigma experiences. The photos were a catalyst for conversations about HIV and stigma during follow-up individual narrative interviews. Journaling provided opportunities for participants to reflect on their experiences of, and resistance to, stigma. Interviews were audio recorded and transcribed. Photos, journals, and transcribed interviews were analyzed using inductive qualitative methods RESULTS: Through pictures and dialogue, participants (N = 11; 64% women) expressed the emotional and social impacts of stigmas that were created and supported by oppressive structures and interpersonal attitudes and behaviours. These experiences were compounded by intersecting forms of oppression including racism, sexism, and homophobia. Participants also relayed stories of their personal strategies and transitions toward confronting stigma. Strategies were themed as caring for oneself, caring for children and pets, reconstituting social support networks, and resisting and disrupting stigma. Participants made important recommendations for system and policy change. CONCLUSIONS These stories of oppression and resistance can inspire action to reduce HIV-related stigma. People living with HIV can consider the strategies to confront stigma that were shared in these stories. Health care providers and policy makers can take concerted actions to support peoples' transitions to resisting stigmas. They can facilitate supportive and anti-oppressive health and social service systems that address medical care as well as basic needs for food, shelter, income, and positive social and community connections.
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Affiliation(s)
- Gayle Restall
- Department of Occupational Therapy, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada.
| | - Patricia Ukoli
- Faculty of Social Work, University of Manitoba, Winnipeg, MB, Canada
| | - Punam Mehta
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Elizabeth Hydesmith
- Department of Anthropology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Mike Payne
- Nine Circles Community Health Centre, Winnipeg, MB, Canada
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26
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Barozzi S. "Language Is My Second Language": Dangerous Writing and Hiv-Affected Communities in Tom Spanbauer's In the City of Shy Hunters. JOURNAL OF HOMOSEXUALITY 2023; 70:2763-2783. [PMID: 35657201 DOI: 10.1080/00918369.2022.2074336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This paper aims to analyze the U.S. writer and teacher Tom Spanbauer's novel In the City of Shy Hunters by means of theoretical perspectives that embrace both queer and communitarian epistemologies. The novel, set mainly in New York City in the mid-1980s, is narrated in first person by the protagonist and shows how HIV/AIDS, and the elevated social stigma surrounding it, affects different classes and ethnicities, as well as gender, sexual and corporal diversities. It experiments with a particular writing style and teaching method that Spanbauer calls dangerous writing; that is, how to expose our inner life and secrets, which are often related to social taboos. The main objective of this paper is to demonstrate the connection between dangerous writing, queer studies (Judith Butler, Annamarie Jagose) and community theory (Jean-Luc Nancy, Maurice Blanchot and Roberto Esposito) by adopting a multidisciplinary approach to literary critical analysis. The main result of this study demonstrates that the singularities represented in the novel, who are mostly queer and affected by HIV/AIDS, can create inoperative communities and communities of lovers, open to otherness as well as being spontaneous, antisocial and momentary, with a recognition and acceptance of mortality.
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Affiliation(s)
- Stef Barozzi
- Department of Language and Literature Teaching, Faculty of Education, University of Granada, Granada, Spain
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27
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Hidayat J, Chen MY, Maulina R, Nurbaya S. Factors Associated With HIV-Related Stigma Among Indonesian Healthcare Workers: A Cross-Sectional Online Survey. J Nurs Res 2023; 31:e295. [PMID: 37668415 DOI: 10.1097/jnr.0000000000000573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Despite worldwide advances in HIV care and growing scientific knowledge about HIV, stigma and prejudice continue to hinder people living with HIV/AIDS (PLWHA) from seeking treatment and care. HIV-related stigma among healthcare workers in Indonesia has been investigated and measured in only a few empirical studies. PURPOSE This study was developed to identify factors related to holding stigmatizing attitudes toward PLWHA among professional healthcare providers in Indonesia. METHODS A cross-sectional survey approach using convenience and snowball sampling techniques was used. Data were collected in February and March 2022. All of the participants were healthcare workers in Indonesia who had completed an online survey that collected demographic data and measured HIV-related stigma, fear of HIV transmission, and HIV-related knowledge. Bivariate analysis and multiple linear regression were used to investigate the association between the independent and dependent variables. RESULTS The study enrolled 252 participants, including eight physicians (3.2%), 200 nurses (79.4%), and 44 midwives (17.5%). Over two thirds of the participants (65.1%) had no formal HIV training. Stigmatizing attitudes were associated with lower levels of HIV knowledge ( B = -0.480, p < .01), fear of becoming infected with the HIV virus ( B = 0.354, p < .05), and type of HIV care setting ( B = -2.913, p < .05). Of the three participant categories, physicians had the highest levels of both HIV knowledge and PLWHA-related stigma. CONCLUSIONS The findings indicate many healthcare workers in Indonesia receive limited formal training on HIV, have low levels of HIV knowledge, and fear HIV transmission. Therefore, providing comprehensive and up-to-date education about HIV for health workers and proper personal protective equipment should be incorporated into programs aimed at reducing stigmatizing attitudes against patients with HIV among healthcare workers in Indonesia.
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Affiliation(s)
- Jufri Hidayat
- MSN, RN, Doctoral Student, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Miao-Yen Chen
- PhD, RN, Associate Professor, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Rufidah Maulina
- MS, Lecturer, Midwifery Department, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Sitti Nurbaya
- MS, Lecturer, Faculty of Nursing, Stikes Nani Hasanuddin Makassar, Indonesia
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28
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Simo Fotso A, Wright CG, Low A. How does HIV-related stigma correlate with HIV prevalence in African countries? Distinct perspectives from individuals living with and living without HIV. BMC Public Health 2023; 23:1720. [PMID: 37667211 PMCID: PMC10478181 DOI: 10.1186/s12889-023-16545-3] [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: 01/03/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Population-level research evaluating HIV-related stigma among countries with varied national HIV prevalence is scarce. To better understand HIV-related stigma and mitigate its potential negative effects, it is necessary to evaluate its relationship with HIV prevalence, as well as the mechanisms that influence it. This study aimed to analyze how HIV-related stigma correlates with subnational HIV prevalence in three African countries with varied HIV epidemics. METHODS This paper used data from the nationally representative Population-based HIV Impact Assessment (PHIA) surveys conducted from 2015-2017 in Malawi, Zambia, and Tanzania. Each country's sub-national geographic divisions were used to categorize them as low (0-5.4%), middle (5.5-11.2%), and high (11.3-17.1%) HIV prevalence regions in the main analysis. Questions from the survey stigma module were used to measure HIV-related stigma. Logistic regression and multilevel models were performed to assess the associations between the level of sub-national HIV prevalence and HIV-related stigma measures among persons living with, and without, HIV. RESULTS The results show that the odds of people living without HIV expressing stigmatizing behavior towards PLWH was significantly lower in regions of middle (OR = 0.80, 90%CI = (0.68-0.96)) and high (OR = 0.65, 90%CI = (0.53-0.80)) HIV prevalence when compared to low prevalence regions. The odds of reporting discriminatory attitudes were also lower for those in middle (OR = 0.87, 90%CI = (0.78-0.98)) and high (OR = 0.64, 90%CI = (0.56-0.73)) HIV prevalence regions compared to others. Living in middle and high HIV prevalence regions was associated with lower odds of expressing prejudice toward PLWH (OR = 0.84, 90%CI = (0.71-0.99) and OR = 0.60, 90%CI = (0.45-0.80), respectively) among people living without HIV. Notably, PLWH living in high prevalence regions had higher odds of reporting internalized stigma (OR = 1.48, 90%CI = (1.02-2.14)) compared to those living in low prevalence regions. CONCLUSIONS The results indicate that among people not living with HIV, subnational HIV prevalence was negatively associated with discriminatory attitudes and prejudice towards PLWH, but HIV prevalence was positively associated with self-reported internalized stigma among PLWH. These results provide insight on how resources could be invested to reduce HIV related stigma among both PLWH and those not living with HIV.
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Affiliation(s)
- Arlette Simo Fotso
- L'Institut national d'études démographiques (INED), F-93300, Aubervilliers, France.
- Centre Population & Développement, Université Paris-Cité, Inserm, Paris, France.
| | - Connor G Wright
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Andrea Low
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
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29
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Goldstein MH, Moore S, Mohamed M, Byrd R, Curtis MG, Rice WS, Camacho-Gonzalez A, Zanoni BC, Hussen SA. A qualitative analysis examining intersectional stigma among young adults living with HIV in Atlanta, Georgia. PLoS One 2023; 18:e0289821. [PMID: 37561729 PMCID: PMC10414665 DOI: 10.1371/journal.pone.0289821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
HIV-related stigma is a barrier to engagement in care for young adults living with HIV. Other intersecting forms of stigma (e.g., racism, sexism, homophobia), may worsen HIV-related stigma and impact engagement in care. From November 2020 to February 2021, we conducted 20 in-depth qualitative interviews among young adults living with HIV attending a large, comprehensive HIV care center in Atlanta, Georgia. Semi-structured interview guides based on Earnshaw and Chaudoir's HIV Stigma Framework and the theory of intersectionality facilitated discussion around experiences with various forms of stigma and its possible influence on healthcare engagement. Using the social-ecological model, we used thematic analysis to contextualize how young adults living with HIV experienced intersectional stigma and enacted, anticipated, and internalized HIV stigma in both healthcare and non-healthcare settings. Most participants identified as male, Black/African American, and gay. Participants described stigma at intrapersonal, interpersonal, clinic, and community levels. Intrapersonal stigma was associated with delayed care seeking, isolation, and fear of disclosure. Interpersonal stigma included discrimination from family and friends and avoidance of close relationships to elude disclosure. At the clinic level, stigma included negative experiences with staff in HIV and non-HIV healthcare settings, which contributed to decreased engagement in care. Stigma in the community included differential treatment from employers, community leaders, and religious community and was associated with feelings of helplessness related to current societal inequalities. Coping/motivating mechanisms for stigma included prioritizing health, eliciting support from the medical care team and peers. Our findings show different intersecting stigmas are barriers to healthcare at multiple levels for young adults living with HIV, potentially exacerbating existing health and social disparities. To improve engagement in care among young adults living with HIV, future interventions should address the different mechanisms of stigma at community, clinic, interpersonal and intrapersonal levels by enhancing social support and improving healthcare structural competency.
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Affiliation(s)
- Madeleine H. Goldstein
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Shamia Moore
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Munira Mohamed
- College of Arts and Sciences, Emory University, Atlanta, GA, United States of America
| | - Rosalind Byrd
- School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Michael G. Curtis
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Whitney S. Rice
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Andres Camacho-Gonzalez
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Brian C. Zanoni
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Sophia A. Hussen
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Aung S, Hardy N, Hogan J, DeLong A, Kyaw A, Tun MS, Aung KW, Kantor R. Characterization of HIV-Related Stigma in Myanmar. AIDS Behav 2023; 27:2751-2762. [PMID: 36723769 PMCID: PMC9889955 DOI: 10.1007/s10461-023-03998-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/02/2023]
Abstract
Characterizing HIV-related stigma and its impacts are important for interventions toward their elimination. A cross-sectional study was conducted in 2016 to evaluate enacted and internalized stigma among adult people living with HIV (PLWH) across four cities in Myanmar using the India Stigma Index questionnaire. Multivariable regression analyses were performed to determine differences in measured enacted and internalized stigma outcomes. Among 1,006 participants, 89% reported any stigma indicator, 47% enacted stigma, and 87% internalized stigma. In regression analysis, city and duration of illness were associated with higher enacted stigma, and younger age was associated with higher internalized stigma. Those with HIV duration > 7.4 years had mean enacted stigma nearly 2 units higher than the overall mean. Internalized stigma increased with duration of illness and leveled off at 5 years. PLWH from smaller cities experienced lower stigma. In Myanmar, nearly 90% of PLWH experience stigma, results that reflect a unique transition point.
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Affiliation(s)
- Su Aung
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI United States of America
- Division of Infectious Diseases, University of California San Francisco, 513 Parnassus Ave Suite S308, 94143 San Francisco, CA United States of America
| | - Nicole Hardy
- School of Public Health, Brown University, Providence, RI United States of America
| | - Joseph Hogan
- School of Public Health, Brown University, Providence, RI United States of America
| | - Allison DeLong
- School of Public Health, Brown University, Providence, RI United States of America
| | - Aung Kyaw
- National AIDS Programme, Yangon, Myanmar
| | | | | | - Rami Kantor
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI United States of America
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Mokgatle M, Madiba S. Community Perceptions of HIV Stigma, Discriminatory Attitudes, and Disclosure Concerns: A Health Facility-Based Study in Selected Health Districts of South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6389. [PMID: 37510621 PMCID: PMC10379360 DOI: 10.3390/ijerph20146389] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
Research data about HIV stigma perceptions and discriminatory attitudes among the general population are limited. Furthermore, the willingness of HIV-negative individuals to engage with HIV prevention and disclosure interventions has not been established in South Africa. The study investigated community perceptions of stigma as well as discriminatory attitudes towards HIV disclosure to understand if and how these perceptions might influence the uptake of disclosure interventions. This facility-based study used a validated questionnaire to measure the four constructs of HIV stigma among 670 adults recruited from health districts of two provinces of South Africa. Of these, 72% were female, 87% had ever been tested for HIV, and 31% knew someone who has HIV. Stigma towards people living with HIV (PLHIV) is widespread in the general population. A high proportion (75%) endorsed disclosure concerns, 75% perceived stigma to be common, and 56% endorsed negative statements indicating perceived stigma in communities. Fear, moral and social judgement, and rejection underlined their perceptions about PLHIV. Almost half (45.7%) were unwilling to care for family members sick with AIDS, suggesting negative distancing reactions and discriminatory attitudes towards PLHIV. The widespread discriminatory attitudes and the perceived stigma that is evident in the general population might heighten the disclosure concerns endorsed, promote non-disclosure, and increase HIV transmission. To design interventions, it is crucial to be cognisant of disclosure concerns, discriminatory attitudes, and perceived stigma evident in communities. Thus, the findings underscore the need to increase efforts to challenge and reduce community drivers of negative discriminatory attitudes and perceived stigma.
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Affiliation(s)
- Mathildah Mokgatle
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- School of Transdisciplinary Research and Graduate Studies, College of Graduate Studies, University of South Africa (UNISA), Muckleneuk, Pretoria 0001, South Africa
| | - Sphiwe Madiba
- Faculty of Health Sciences, Executive Deans Office, University of Limpopo, Polokwane 0700, South Africa
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Chang DF, Donald J, Whitney J, Miao IY, Sahdra B. Does Mindfulness Improve Intergroup Bias, Internalized Bias, and Anti-Bias Outcomes?: A Meta-Analysis of the Evidence and Agenda for Future Research. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2023:1461672231178518. [PMID: 37382426 DOI: 10.1177/01461672231178518] [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] [Indexed: 06/30/2023]
Abstract
Whereas mindfulness has been shown to enhance personal well-being, studies suggest it may also benefit intergroup dynamics. Using an integrative conceptual model, this meta-analysis examined associations between mindfulness and (a) different manifestations of bias (implicit/explicit attitudes, affect, behavior) directed toward (b) different bias targets (outgroup or ingroup, e.g., internalized bias), by (c) intergroup orientation (toward bias or anti-bias). Of 70 samples, 42 (N = 3,229) assessed mindfulness-based interventions (MBIs) and 30 (N = 6,002) were correlational studies. Results showed a medium-sized negative effect of MBIs on bias outcomes, g = -0.56, 95% confidence interval [-0.72, -0.40]; I(2;3)2: 0.39; 0.48, and a small-to-medium negative effect between mindfulness and bias for correlational studies, r = -0.17 [-0.27, -0.03]; I(2;3)2: 0.11; 0.83. Effects were comparable for intergroup bias and internalized bias. We conclude by identifying gaps in the evidence base to guide future research.
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Affiliation(s)
| | - James Donald
- The University of Sydney, New South Wales, Australia
| | | | | | - Baljinder Sahdra
- Australian Catholic University, North Sydney, New South Wales, Australia
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Wanjala SW, Nyongesa MK, Mapenzi R, Luchters S, Abubakar A. A qualitative inquiry of experiences of HIV-related stigma and its effects among people living with HIV on treatment in rural Kilifi, Kenya. Front Public Health 2023; 11:1188446. [PMID: 37427260 PMCID: PMC10324964 DOI: 10.3389/fpubh.2023.1188446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/25/2023] [Indexed: 07/11/2023] Open
Abstract
Background The pervasiveness of HIV-related stigma and discrimination, and its consequences on HIV prevention and treatment, have been well documented. However, little is known about the lived experiences of HIV-related stigma and its effects among the general adult population living with HIV in rural African settings. This study set out to explore this knowledge gap. Methods From April to June 2018, we conducted in-depth interviews with a convenience sample of 40 adults living with HIV aged 18-58 years in Kilifi, Kenya. A semi-structured interview guide was used to explore experiences of HIV-related stigma and its impact on these adults. A framework approach was used to analyze the data using NVIVO 11 software. Results Participants reported experiences of HIV-related stigma in its various forms (anticipated, perceived, internalised, and enacted), as well as its effects on HIV treatment and social and personal spheres. The internalisation of stigma caused by enacted stigma impacted care-seeking behavior resulting in worse overall health. Anxiety and depression characterized by suicidal ideation were the results of internalised stigma. Anticipated stigma prompted HIV medication concealment, care-seeking in remote healthcare facilities, and care avoidance. Fewer social interactions and marital conflicts resulted from perceived stigma. Overall, HIV-related stigma resulted in partial and non-disclosure of HIV seropositivity and medication non-adherence. At a personal level, mental health issues and diminished sexual or marital prospects (for the unmarried) were reported. Conclusion Despite high awareness of HIV and AIDS among the general population in Kenya, adults living with HIV in rural Kilifi still experience different forms of HIV-related stigma (including self-stigma) that result in a raft of social, personal, and HIV-treatment-related consequences. Our findings underscore the urgent need to reevaluate and adopt more effective strategies for implementing HIV-related anti-stigma programs at the community level. Addressing individual-level stigma will require the design of targeted interventions. To improve the lives of adults living with HIV in Kilifi, the effects of HIV-related stigma, particularly on HIV treatment, must be addressed.
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Affiliation(s)
- Stanley W. Wanjala
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Social Sciences, School of Humanities and Social Sciences, Pwani University, Kilifi, Kenya
| | - Moses K. Nyongesa
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Rachael Mapenzi
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Amina Abubakar
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Gutiérrez-Velilla E, Barrientos-Casarrubias V, Gómez-Palacio Schjetnan M, Perrusquia-Ortiz LE, Cruz-Maycott R, Alvarado-de la Barrera C, Ávila-Ríos S, Caballero-Suárez NP. Mental health and adherence to antiretroviral therapy among Mexican people living with HIV during the COVID-19 pandemic. AIDS Res Ther 2023; 20:34. [PMID: 37287023 PMCID: PMC10245356 DOI: 10.1186/s12981-023-00532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The mental health and medical follow-up of people living with HIV (PLWH) have been disrupted by the COVID-19 pandemic. The objectives of this study were to assess anxiety, depression and substance use in Mexican PLWH during the pandemic; to explore the association of these symptoms with adherence to antiretroviral therapy (ART), and to compare patients with and without vulnerability factors (low socioeconomic level, previous psychological and/or psychiatric treatment). METHODS We studied 1259 participants in a cross-sectional study, PLWH receiving care at the HIV clinic in Mexico City were contacted by telephone and invited to participate in the study. We included PLWH were receiving ART; answered a structured interview on sociodemographic data and adherence to ART; and completed the psychological instruments to assess depressive and anxiety symptoms and substance use risk. Data collection was performed from June 2020 to October 2021. RESULTS 84.7% were men, 8% had inadequate ART adherence, 11% had moderate-severe symptoms of depression, and 13% had moderate-severe symptoms of anxiety. Adherence was related to psychological symptoms (p < 0.001). Vulnerable patients were more likely to be women, with low educational level and unemployed (p < 0.001). CONCLUSIONS It is important to address mental health of PLWH during the COVID-19 pandemic, with special attention to the most vulnerable individuals. Future studies are needed to understand the relationship between mental health and ART adherence.
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Affiliation(s)
- Ester Gutiérrez-Velilla
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Vania Barrientos-Casarrubias
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - María Gómez-Palacio Schjetnan
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Lydia E Perrusquia-Ortiz
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Rosa Cruz-Maycott
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Claudia Alvarado-de la Barrera
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Nancy Patricia Caballero-Suárez
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México.
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Bowles JM, Kolla G, Smith LR, Scheim A, Dodd Z, Werb D. Disease-related stigma among people who inject drugs in Toronto amidst the COVID-19 pandemic. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100167. [PMID: 37273749 PMCID: PMC10199487 DOI: 10.1016/j.dadr.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
Background Stigma overwhelmingly affects people who inject drugs. The COVID-19 pandemic posed unique challenges for people who inject drugs, who are already stigmatized as being "dangerous and spreading disease." The present study explored ways in which stigma was experienced by a sample of people who inject drugs in Toronto, Canada following COVID-related public health precaution measures. Methods Qualitative interviews were conducted with people who inject drugs (n = 24) recruited from supervised consumption sites in Toronto, Canada. The semi-structured interview guide focused on the impact of COVID-19 on participants' health and social well-being. Interviews took place six-months after initial COVID-19 precautions (September-October 2020). We used thematic analysis to examine findings, with stigma being an emergent theme. Results Participants described heightened acts of stigma after COVID-19 restrictions were implemented, including feeling treated as "diseased" and the cause of COVID-19's spread. They reported being less likely to receive emergency care during events such as overdoses. Participants perceived increased disease-related stigma evident through actions of stigma, including amplified dehumanization by the public, others avoiding all contact with them, and more discrimination by police and hospital systems. Conclusion Participants provided specific examples of how stigmatizing behaviors harmed them after COVID-19 precautions began. It is plausible that stigma contributed to the dramatic increase in fatal overdoses, difficulty accessing housing, and further difficulty accessing needed healthcare in our setting. Integrating evidence-based harm reduction approaches in areas where stigma is evident might offset harms stemming from disease-related stigma and mitigate these harms during future public health emergencies.
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Affiliation(s)
- Jeanette M. Bowles
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Gillian Kolla
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- University of Victoria Canadian Institute for Substance Use Research: Victoria, BC, Canada
| | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
| | - Ayden Scheim
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Zoe Dodd
- MAP Centre for Urban Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
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Njuguna I, Moraa H, Mugo C, Mbwayo A, Nyapara F, Aballa C, Wagner AD, Wamalwa D, John-Stewart G, Inwani I, O’Malley G. 'They should show them love even if their status of being HIV positive is known': Youth and caregiver stigma experience and strategies to end HIV stigma in schools. Trop Med Int Health 2023; 28:466-475. [PMID: 37177902 PMCID: PMC10278085 DOI: 10.1111/tmi.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE HIV stigma and discrimination is widespread in sub-Saharan Africa and is associated with poor clinical outcomes. Schools play a critical role in the life of youth and have been identified as a potentially stigmatising environment. We sought to explore school HIV stigma drivers, facilitators, manifestations and outcomes among youth living with HIV (YLH) as well as potential stigma reduction interventions in Kenya. METHODS Semi-structured in-depth qualitative interviews with 28 school-attending YLH aged 14-19 years and 24 caregivers of YLH were analysed using directed content analysis. Results were summarised using the Health and Stigma Framework. RESULTS Drivers and facilitators of HIV stigma in the school environment included misconceptions about HIV transmission, HIV treatment outcomes and long-term overall health of people living with HIV. HIV stigma manifested largely as gossip, isolation and loss of friendships. Fear of HIV stigma or experienced stigma resulted in poor adherence to antiretroviral treatment-particularly among YLH in boarding schools-and poor mental health. Stigma also impacted school choice (boarding vs. day school) and prevented HIV disclosure to schools which was necessary for optimal support for care. Proposed interventions to address HIV stigma in schools included HIV education, psychosocial support for YLH, support for HIV disclosure to schools while ensuring confidentiality and building YLH resilience. CONCLUSION There is an urgent need to develop interventions to address HIV stigma in schools to ensure optimised health and social outcomes for YLH. Future studies to understand the most effective and efficient interventions are needed.
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Affiliation(s)
- Irene Njuguna
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Hellen Moraa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Florence Nyapara
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Calvins Aballa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anjuli D. Wagner
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Grace John-Stewart
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Epidemiology, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Medicine, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Pediatrics, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Irene Inwani
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Gabrielle O’Malley
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
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Bryant JV, Carcioppolo N, Lun D, Potter J. Entertainment-education to reduce internalized stigma, increase intimate partner status disclosure intentions, and increase antiretroviral medical adherence intentions: A randomized controlled trial targeting black women living with HIV in the Southern U.S. Soc Sci Med 2023; 327:115945. [PMID: 37182297 DOI: 10.1016/j.socscimed.2023.115945] [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: 03/30/2022] [Revised: 04/06/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Black women in the Southern U.S. account for 67% of all new HIV diagnoses across women of all races and ethnicities. In comparison to women of other racial and ethnic identities, Black women disproportionately experience internalized stigma, lower levels of disclosure self-efficacy, and lower rates of medical adherence. The disclosure processes model hypothesizes that persons living with HIV can be disclosure avoidance oriented or disclosure approach oriented. Disclosure avoidance is facilitated by various forms of stigma and negative outcome expectations. While disclosure approach orientation is facilitated by factors such as positive disclosure attitudes and disclosure self-efficacy. Despite the important role of disclosure in ending the HIV epidemic, extant interventions are limited. Recent research suggests entertainment-education (EE) may be an effective intervention for HIV status disclosure. Entertainment-education is a persuasive strategy that consists of intentionally embedding health and social messages into entertaining content. METHODS The present study evaluated the comparative efficacy of the 90 DAYS film for improving internalized HIV stigma, disclosure beliefs, positive disclosure attitudes, disclosure self-efficacy, HIV disclosure intentions, and medical adherence intentions. A randomized controlled trial was employed consisting of 130 Black women living with HIV in the Southern U.S. Participants were recruited primarily via a Qualtrics panel and randomly assigned to either view the 90 DAYS film or a standard of care brochure. RESULTS Results indicated the EE condition significantly outperformed the brochure condition on the following outcomes: disclosure beliefs (p = .046), positive disclosure attitudes (p = .008), disclosure self-efficacy (p = .007), and intentions to disclose to an intimate partner (p = .038). Statistically significant differences were not observed for internalized stigma or medical adherence intentions. CONCLUSION Findings suggest that EE is an effective strategy for improving psychosocial influences of disclosure and disclosure intentions. Theoretical and practical implications of this work are discussed.
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Affiliation(s)
- Jazmyne V Bryant
- Division of Health Science, Florida A&M University, 334 Palmer Avenue, Tallahassee, FL, 32307, USA.
| | - Nick Carcioppolo
- Dept of Communication Studies, University of Miami, 5100 Brunson Dr, Coral Gables, FL, 33146, USA
| | - Di Lun
- Dept of Health Disparities Research, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - JoNell Potter
- Dept of Obstetrics and Gynecology, University of Miami, 8932 SW 97th Ave, Miami, FL, 33176, USA
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Kim K, Jang S, Rim HD, Kim SW, Chang HH, Woo J. Attachment Insecurity and Stigma as Predictors of Depression and Anxiety in People Living With HIV. Psychiatry Investig 2023; 20:418-429. [PMID: 37253467 DOI: 10.30773/pi.2022.0271] [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: 09/15/2022] [Accepted: 01/26/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine whether attachment insecurity, stigma, and certain demographic and medical factors predict depression and anxiety in people living with HIV (PLWH). METHODS Participants were 147 PLWH who visited the outpatient infection clinic in Kyungpook National University Hospital (KNUH; Daegu, South Korea) between June 2020 and January 2021. We measured HIV-related stigma, attachment anxiety and avoidance, depressive symptoms, and anxiety symptoms. RESULTS Logistic regression analysis showed that unemployment, longer time receiving antiretroviral therapy, higher attachment avoidance, and higher attachment anxiety were significant predictors of depression. Results also showed that longer time receiving antiretroviral therapy, higher attachment anxiety, and concern with public attitudes were significant predictors of anxiety. CONCLUSION In addition to education to reduce public stigma, interventions to reduce PLWH's self-stigma should continue. We suggest attachment-based psychotherapy as an effective intervention to improve PLWH's mental health.
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Affiliation(s)
- Kyungmin Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seoyoung Jang
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyo-Deog Rim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin-Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jungmin Woo
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Chakrapani V, Gulfam FR, Arumugam V, Aher A, Shaikh S, Prasad R, Safren S, Golub SA, Patel VV. Intersectional stigma and gender non-affirmation hinder HIV care engagement among transgender women living with HIV in India. AIDS Care 2023; 35:572-580. [PMID: 35819879 PMCID: PMC9834431 DOI: 10.1080/09540121.2022.2099511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/04/2022] [Indexed: 01/14/2023]
Abstract
Among transgender women living with HIV (TGWLH) in India, little is understood about the mechanisms through which multiple intersecting stigmas impact HIV care engagement, or intervention strategies that might mitigate this impact. We conducted focus groups with TGWLH (N = 30) in three Indian cities and analysed data using theoretical frameworks related to HIV stigma, gender affirmation, and syndemics. Findings revealed that enacted and anticipated stigma due to transgender identity, HIV, or sex work status, and lack of gender affirmation (e.g., misgendering) in healthcare settings delayed ART initiation and promoted care disengagement. Having supportive physicians and counsellors within ART centres and peer outreach workers facilitated ART initiation, adherence, and retention. Findings also revealed that HIV stigma within TGW communities led to concealment of HIV status or syndemic conditions such as depression and alcohol use, thereby affecting care engagement. However, the TGW community itself was also described as a resilience resource, offering emotional, psychological and tangible support that decreased the impact of discrimination on care engagement. HIV care engagement efforts among Indian TGWLH could be strengthened by reducing intersecting stigmas in healthcare settings and within TGW communities, providing gender-affirming and culturally competent healthcare, addressing psychosocial syndemic conditions, and strengthening support within transgender communities.
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Affiliation(s)
| | | | | | | | | | | | - Steven Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Viraj V. Patel
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA
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Eitel KB, Roberts AJ, D’Agostino R, Barrett CE, Bell RA, Bellatorre A, Cristello A, Dabelea D, Dolan LM, Jensen ET, Liese AD, Mayer-Davis EJ, Reynolds K, Marcovina SM, Pihoker C. Diabetes Stigma and Clinical Outcomes in Adolescents and Young Adults: The SEARCH for Diabetes in Youth Study. Diabetes Care 2023; 46:811-818. [PMID: 36883290 PMCID: PMC10090897 DOI: 10.2337/dc22-1749] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/12/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To examine the association between diabetes stigma and HbA1c, treatment plan and acute and chronic complications in adolescents and young adults (AYAs) with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS The SEARCH for Diabetes in Youth study is a multicenter cohort study that collected questionnaire, laboratory, and physical examination data about AYAs with diabetes diagnosed in childhood. A five-question survey assessed frequency of perceived diabetes-related stigma, generating a total diabetes stigma score. We used multivariable linear modeling, stratified by diabetes type, to examine the association of diabetes stigma with clinical factors, adjusting for sociodemographic characteristics, clinic site, diabetes duration, health insurance, treatment plan, and HbA1c. RESULTS Of 1,608 respondents, 78% had type 1 diabetes, 56% were female, and 48% were non-Hispanic White. The mean (SD) age at study visit was 21.7 (5.1) years (range, 10-24.9). The mean (SD) HbA1c was 9.2% (2.3%; 77 mmol/mol [2.0 mmol/mol]). Higher diabetes stigma scores were associated with female sex and higher HbA1c (P < 0.01) for all participants. No significant association between diabetes stigma score and technology use was observed. In participants with type 2 diabetes, higher diabetes stigma scores were associated with insulin use (P = 0.04). Independent of HbA1c, higher diabetes stigma scores were associated with some acute complications for AYAs with type 1 diabetes and some chronic complications for AYAs with type 1 or type 2 diabetes. CONCLUSIONS Diabetes stigma in AYAs is associated with worse diabetes outcomes and is important to address when providing comprehensive diabetes care.
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Affiliation(s)
- Kelsey B. Eitel
- University of Washington, Department of Pediatrics, Seattle, WA
| | | | | | | | - Ronny A. Bell
- Wake Forest University School of Medicine, Winston-Salem, NC
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41
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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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42
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Yu F, Hsiao YH, Park S, Kambara K, Allan B, Brough G, Hwang TF, Dang N, Young B, Patel R, Maldonado A, Okoli C. The Influence of Anticipated HIV Stigma on Health-related Behaviors, Self-rated Health, and Treatment Preferences Among People Living with HIV in East Asia. AIDS Behav 2023; 27:1287-1303. [PMID: 36348191 PMCID: PMC10036452 DOI: 10.1007/s10461-022-03865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
Abstract
Long-acting injectable regimens for HIV treatment have been developed which are less frequent, more discreet, and more desirable for some people living with HIV (PLHIV) and may help reduce stigma-related barriers to HIV treatment. However, there is little information on the relationship between reported stigma and preference for these newer treatments. We characterized anticipated, experienced, and internalized HIV stigma and examined the associations with treatment preferences among an international sample of PLHIV. Data came from the international, web-based, cross-sectional study called "Positive Perspectives" conducted among PLHIV aged ≥ 18 years in 25 geographic locations during 2019 (n = 2389). Descriptive analyses were stratified among East Asian (n = 230) vs. non-Asian (n = 2159) participants. Results showed that prevalence of anticipated stigma was significantly higher among East Asian than non-Asian participants (72.2%[166/230] vs. 63.8%[1377/2159], p = 0.011). A significantly higher percentage of East Asian (68.7%[158/230]) than non-Asian participants (43.3%[935/2159] indicated that someone finding their HIV pills would cause them much "stress or anxiety" (p < 0.001). Actions taken by some PLHIV to prevent unwanted disclosure included restricting who they shared their HIV status with, hiding their HIV pills, or even skipping a dose altogether because of privacy concerns. Overall, 50.0%[115/230] East Asian participants believed HIV would reduce their lifespan and 43.0%[99/230] no longer planned for their old age because of HIV. Anticipated stigma was strongly associated with receptivity to non-daily regimens. Concerted efforts to reduce stigma and deliver flexible treatment options that address the unmet treatment needs of PLHIV, including confidentiality concerns, may improve their health-related quality of life.
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Affiliation(s)
- Fei Yu
- Danlan Beijing Media Limited, Beijing, China
| | | | | | - Keita Kambara
- Japanese Network of People living with HIV/AIDS, Tokyo, Japan
| | - Brent Allan
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia
- International Council of AIDS Service Organizations (ICASO), Toronto, Canada
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43
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Kim SJ, Ahn A, Hu E, Peterson CE. Qualitative Analysis of Multiple Sources and Dimensions of Stigma Among Older Adults Living With HIV Infection Released From Corrections. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:126-140. [PMID: 37129593 DOI: 10.1521/aeap.2023.35.2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
While sources of stigma associated with HIV, incarceration, and aging have been explored separately, the concurrent effects of these multiple sources have been understudied. We conducted in-depth interviews with 48 older adults over 50 years of age with HIV infection who were returning from correctional settings concerning their experiences of stigma. Participants described HIV-related stigma substantially more often than incarceration-related stigma and a greater number of stigma experiences as time passed from release. Anticipated stigma experiences were frequently associated with HIV. Enacted stigma was often related to incarceration. Internalized stigma was associated with both HIV and incarceration. However, participants often described aging as a positive experience of gaining wisdom and control over their life. The findings indicated that multiple sources of stigma affect different dimensions of stigma. Postrelease interventions may benefit from addressing increasing experiences of stigma in the rapidly growing population of older adults living with HIV with a history of incarceration.
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Affiliation(s)
- Sage J Kim
- Division of Health Policy & Administration, School of Public Health, University of Illinois at Chicago
| | - Anna Ahn
- Division of Health Policy & Administration, School of Public Health, University of Illinois at Chicago
| | - Elise Hu
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois at Chicago
| | - Caryn E Peterson
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois at Chicago
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44
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van der Kooij YL, den Daas C, Bos AER, Willems RA, Stutterheim SE. Correlates of Internalized HIV Stigma: A Comprehensive Systematic Review. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:158-172. [PMID: 37129595 DOI: 10.1521/aeap.2023.35.2.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Internalized HIV stigma is prevalent and research on internalized HIV stigma has increased during the past 10 years. The aim of this systematic review was to synthesize research on internalized HIV stigma and relationships with various health-related variables in order to better inform the development of interventions aimed at reducing internalized HIV stigma. We reviewed 176 studies with a quantitative design reporting correlates that were peer-reviewed, published in English before January 2021, drawn from PubMed, PSYCHINFO, Web of Science, EBSCO, and Scopus. Synthesis showed consistent associations between internalized stigma and negative psychological (e.g., depression, anxiety), social (e.g., lack of social support, discrimination, nondisclosure, and intersecting stigmas), and health (e.g., substance use, treatment nonadherence, negative clinical HIV outcomes) variables. We argue for a more socioecological approach to internalized stigma, with greater attention for intersectional stigmas, and more longitudinal research, if we are to effectively develop interventions that reduce internalized stigma.
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Affiliation(s)
| | - Chantal den Daas
- Institute of Applied Health Sciences, Health Psychology Group, Aberdeen University, Aberdeen, Scotland and the National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | | | - Sarah E Stutterheim
- Sarah E. Stutterheim is affilkiated with the Department of Health Promotion & Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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45
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Wiginton JM, Maksut JL, Scheim AI, Zlotorzynska M, Sanchez TH, Baral SD. Intersecting Sexual Behavior and Gender Identity Stigmas Among Transgender Women in the United States: Burden and Associations with Sexual Health. AIDS Behav 2023:10.1007/s10461-023-04028-w. [PMID: 36952112 PMCID: PMC10034890 DOI: 10.1007/s10461-023-04028-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
In the United States, a context of multiple marginalization shapes sexual health disparities experienced by transgender women. Using data from 396 transgender women with negative or unknown HIV status, we performed exploratory factor analysis on responses to gender identity and sexual behavior stigma items and regressed sexual health outcomes on extracted factors via modified Poisson regression with robust variance estimation. Overall, 97.2% of participants endorsed ≥ 1 gender identity stigma; 67.2% endorsed ≥ 1 sexual behavior stigma; and 66.9% endorsed ≥ 1 of each. Extracted factors included gender-identity social stigma, reflecting experiences related to family, fearfulness in public, and verbal harassment (α = 0.68); gender-identity institutional stigma/violence, reflecting experiences related to healthcare, police interactions, and interpersonal violence (α = 0.73); and global sexual behavior stigma, reflecting experiences related to family, friends, and healthcare, as well as police interactions, fearfulness in public, verbal harassment, and interpersonal violence (α = 0.83). Gender-identity social stigma was significantly, positively associated with testing for HIV and testing for sexually transmitted infections. Gender-identity institutional stigma/violence and global sexual behavior stigma were both significantly, positively associated with condomless anal sex, sex work, testing for HIV, testing for sexually transmitted infections, and use of HIV pre-exposure prophylaxis. Stigma-mitigation remains critical to improve quality of life and sexual health for transgender women in the United States.
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Affiliation(s)
- John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
- San Diego State University, San Diego, CA, USA.
| | - Jessica L Maksut
- Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Ayden I Scheim
- Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Maria Zlotorzynska
- Rollins School of Public Health, Emory University, 1581 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Travis H Sanchez
- Rollins School of Public Health, Emory University, 1581 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Stefan D Baral
- Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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46
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Lo Hog Tian JM, Watson JR, McFarland A, Parsons JA, Maunder RG, McGee A, Boni AR, Cioppa L, Ajiboye ME, Rourke SB. The cost of anticipating stigma: a longitudinal examination of HIV stigma and health. AIDS Care 2023:1-9. [PMID: 36942573 DOI: 10.1080/09540121.2023.2190575] [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: 03/23/2023]
Abstract
Levels of HIV stigma remain high, however there is a limited understanding around how different types of stigma interact to impact health. This study uses data from two time points to examine how enacted and internalized stigma lead to worse health through anticipated stigma as a mediator. We recruited 341 participants in Ontario, Canada to complete the HIV Stigma Index survey at baseline (t1) from September 2018 to August 2019 and follow up (t2) approximately two years later. Mediation models were created with enacted and internalized stigma at t1 as the antecedents, anticipated stigma at t2 as the mediator, and physical health, mental health, and overall health at t2 as the outcomes. Only the model with internalized stigma (t1) as the antecedent had anticipated stigma (t2) as a significant mediator contributing to both decreased mental and overall health. This highlights the need to address internalized stigma and the potential for anticipated stigma interventions to be effective at improving the health and wellbeing of people living with HIV.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Abbey McFarland
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Janet A Parsons
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Department of Physical Therapy and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - A McGee
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Anthony R Boni
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Lynne Cioppa
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Monisola E Ajiboye
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- International Community of Women Living with HIV, Toronto, Canada
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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47
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Bingaman A, Hamilton A, Houpt B, Olivero R, Fair C. “Nothing is ever going to change if we don't start advocating for our child.”: Community-level disclosure and stigma management strategies among parents of internationally adopted children living with PHIV. Front Public Health 2023; 11:1091335. [PMID: 37006538 PMCID: PMC10063915 DOI: 10.3389/fpubh.2023.1091335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundThe number of internationally adopted children living with perinatally-acquired HIV (IACP) in the U.S. is increasing, yet little is known about their families' experiences navigating HIV disclosure within a community context. This paper examines the lived experiences of adoptive parents as they navigate HIV disclosure and manage stigma toward their adopted children within their broader communities.MethodsA purposive sample of parents of IACP was recruited at two pediatric infectious disease clinics and via closed Facebook groups. Parents completed two semi-structured interviews approximately one year apart. Interview questions included strategies parents used to reduce the impact of community level stigma that their child is likely to encounter as they mature. Interviews were analyzed using Sort and Sift, Think and Shift analytic approach. All parents (n = 24) identified as white and most (n = 17) had interracial families, with children adopted from 11 different countries (range: age at adoption 1-15 years; range: age at first interview 2-19 years).ResultsAnalyses revealed that parents serve as advocates for their child by both supporting more public HIV disclosure at times, but also applying indirect strategies such as working to improve outdated sex education material. Knowledge of HIV disclosure laws empowered parents to make informed decisions about who, if anyone, in the community needed to know their child's HIV status.ConclusionFamilies with IACP would benefit from HIV disclosure support/training and community-based HIV stigma reduction interventions.
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Affiliation(s)
- Amanda Bingaman
- Public Health Studies, Elon University, Elon, NC, United States
| | - Alison Hamilton
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Bethany Houpt
- Public Health Studies, Elon University, Elon, NC, United States
| | - Rosemary Olivero
- Department of Pediatric Infectious Disease, Helen Devos Children's Hospital, Grand Rapids, MI, United States
| | - Cynthia Fair
- Public Health Studies, Elon University, Elon, NC, United States
- *Correspondence: Cynthia Fair
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48
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Budhwani H, Yiğit İ, Maragh-Bass AC, Rainer CB, Claude K, Muessig KE, Hightow-Weidman LB. Development and Validation of the Youth Pre-Exposure Prophylaxis (PrEP) Stigma Scale. AIDS Behav 2023; 27:929-938. [PMID: 36029425 PMCID: PMC9968821 DOI: 10.1007/s10461-022-03829-9] [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: 08/21/2022] [Indexed: 01/05/2023]
Abstract
To date, there are no established scales to assess PrEP stigma among youth. We validated the Youth PrEP Stigma Scale within the Adolescent Trials Network P3 study (2019-2021). Data from sexual and gender minority youth (16-24 years) who were prescribed PrEP across nine domestic sites were evaluated (N = 235). Descriptive statistics, exploratory factor analysis, and correlation coefficients are reported. Results yielded a three-factor solution (PrEP Disapproval by Others, Enacted PrEP Stigma, and PrEP User Stereotypes) with strong factor loadings and Cronbach's alphas ranging from 0.83 to 0.90, suggesting excellent internal consistency. Correlations between this Scale, anticipated HIV stigma, perceived HIV risk, and disclosure of sexual identity were significant, indicating potential for robust application. Given the persistence of HIV infections among youth, stigma as a barrier to prevention, and expansion of PrEP modalities, the Youth PrEP Stigma Scale could enhance intervention and mechanistic research among youth at elevated risk for HIV acquisition.
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Affiliation(s)
- Henna Budhwani
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, 32306, Tallahassee, FL, USA.
| | - İbrahim Yiğit
- Department of Psychology, Faculty of Arts and Sciences, TED University, Ankara, Turkey
| | - Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Crissi B Rainer
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Kristina Claude
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Kathryn E Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
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McKinney-Prupis E, Chiu YCJ, Grov C, Tsui EK, Duke SI. Psychosocial and Health-Related Behavioral Outcomes of a Work Readiness HIV Peer Worker Training Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4322. [PMID: 36901333 PMCID: PMC10001842 DOI: 10.3390/ijerph20054322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Targeted work readiness training is an important approach to help people living with HIV (PLHIV) to overcome their unique barriers to work, while addressing social determinants of health needs. This study assesses the psychosocial impacts of a work readiness training and internship program among HIV peer workers in New York City. From 2014 through 2018, 137 PLHIV completed the training program, and 55 individuals completed both the training and the six-month peer internship. Depression, HIV internalized stigma, self-esteem, HIV medication adherence, patient self-advocacy, and safer sex communication apprehension were used as outcome measures. Paired t-tests were performed to determine if significant score changes occurred at the individual level before and after each training. Our results show that participating in the peer worker training program significantly decreased depression and internalized HIV stigma, and significantly increased self-esteem, medication adherence, and patient self-advocacy. The study underscores that peer worker training programs are important tools to improve not only the work readiness of PLHIV, but also psychosocial and health outcomes. Implications for HIV service providers and stakeholders are discussed.
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Affiliation(s)
| | | | - Christian Grov
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10017, USA
| | - Emma K. Tsui
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10017, USA
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Beichler H, Kutalek R, Dorner TE. People Living with HIV and AIDS: Experiences towards Antiretroviral Therapy, Paradigm Changes, Coping, Stigma, and Discrimination-A Grounded Theory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3000. [PMID: 36833695 PMCID: PMC9962544 DOI: 10.3390/ijerph20043000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The experiences in coping with HIV/AIDS from people living with HIV (PLWH) in Austria, Munich, and Berlin regarding adherence, antiretroviral therapy (ART), stigmatization, and discrimination were the main focus of this study. Therapy adherence is the cornerstone for PLWH to reduce disease progression and increase life expectancy combined with a high quality of life. The experience of stigmatization and discrimination in different life situations and settings is still experienced today. AIMS We aimed to examine the subjective perspective of PLWH concerning living with, coping with, and managing HIV/AIDS in daily life. METHODS Grounded Theory Methodology (GTM) was used. Data collection was conducted with semi-structured face-to-face interviews with 25 participants. Data analysis was performed in three steps, open, axial, and selective coding. RESULTS Five categories emerged, which included the following: (1) fast coping with diagnosis, (2) psychosocial burden due to HIV, (3) ART as a necessity, (4) building trust in HIV disclosure, (5) stigmatization and discrimination are still existing. CONCLUSION In conclusion, it can be said that it is not the disease itself that causes the greatest stress, but the process of coping with the diagnosis. Therapy, as well as lifelong adherence, is hardly worth mentioning today. Much more significant is currently still the burden of discrimination and stigmatization.
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Affiliation(s)
- Helmut Beichler
- Nursing School, General Hospital, Medical University Vienna, 1090 Vienna, Austria
| | - Ruth Kutalek
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas E. Dorner
- Academy for Ageing Research, Haus der Barmherzigkeit, 1160 Vienna, Austria
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria
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