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Luo T, Xu S, Zhang K. Policies for recovery from drug use: Differences between public stigma and perceived stigma and associated factors. Drug Alcohol Rev 2024. [PMID: 38326226 DOI: 10.1111/dar.13818] [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: 07/07/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Public stigma towards people who use drugs is widespread and places obstacles in way of their recovery. Previous studies have used different approaches to measure public stigma, resulting in a notable gap in the understanding of the relationship between it and its associated factors. Some studies measure public stigma by assessing stigma perceived by those who use drugs, while others investigate attitudes towards them among the general public. This study aimed to compare perceived and public stigma, and factors related to these two variables. METHODS The study comprised a cross-sectional survey in China of two samples: males who used drugs (N = 257) and the general public (N = 376). The survey assessed demographic variables, social distance, public stigma and perceived stigma of those who use drugs. The data were analysed using t-tests and linear regression. RESULTS Public stigma was significantly higher than perceived stigma. The findings indicated that gender, knowledge of drugs, family relationships with people who use drugs, attributions of drug use and social distance were significantly related to levels of public stigma. Among those who use drugs, perceived stigma was significantly correlated with age, marital status, duration of drug abstinence and social distance. DISCUSSION AND CONCLUSIONS Findings indicate that public stigma undermines the recovery of people who use drugs and highlight the importance of interaction between them and the social environment. The study also underscores the necessity of developing policies to enhance their integration into mainstream culture and provide access to social support and life activities.
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Affiliation(s)
- Tingyu Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shuping Xu
- Department of Social Work, East China University of Political Science & Law, Shanghai, China
| | - Kun Zhang
- Department of Social Work, East China University of Political Science & Law, Shanghai, China
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2
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Leggett AN, Robinson-Lane SG, Oxford G, Leonard N, Carmichael AG, Baker E, Paratore J, Blok AC, Prescott HC, Iwashyna TJ, Gonzalez R. Barriers to and Facilitators of Family Caregiving of Patients With COVID-19 Early in the Pandemic. Am J Crit Care 2023; 32:431-439. [PMID: 37907378 DOI: 10.4037/ajcc2023364] [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] [Indexed: 11/02/2023]
Abstract
BACKGROUND In 2020, many family members were thrust into the role of caregiving for a relative with COVID-19 with little preparation, training, or understanding of the disease and its symptoms. OBJECTIVES To explore the barriers to and facilitators of caregiving experienced by family caregivers of patients with COVID-19 who had been in intensive care in the pandemic's earliest months. METHODS In-depth qualitative interviews were conducted by web conference with 16 adults recovering at home after intubation for COVID-19 in an intensive care unit at a major academic medical center and their primary caregivers from March to August 2020 (N = 32). Thematic qualitative analysis was done using Watkins' rigorous and accelerated data reduction technique with MAXQDA software. RESULTS Seven themes emerged regarding factors that facilitated or posed barriers to care: other health conditions that increased complexity of care, interactions and experiences in the health care system, COVID-19's proliferation into other areas of life, the psychological well-being of the patient-caregiver dyad, experience of support from the dyad's network, the role of caregiving in the dyad, and contextual circumstances of the dyad. The themes often included both barriers and facilitators, depending on the experience of the dyad (eg, feeling encouraged vs fatigued by their support network). CONCLUSIONS Understanding how patients with COVID-19 and their caregivers experience illness management across the recovery journey can help clarify the COVID-19 care-giving process and identify intervention targets to improve overall health and well-being of the care dyad.
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Affiliation(s)
- Amanda N Leggett
- Amanda N. Leggett is an assistant professor in the Institute of Gerontology at Wayne State University, Detroit, Michigan, and an adjunct assistant professor, Department of Psychiatry, School of Medicine, University of Michigan Ann Arbor
| | - Sheria G Robinson-Lane
- Sheria G. Robinson-Lane is an assistant professor, Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan Ann Arbor
| | - Grace Oxford
- Grace Oxford is a research assistant, Biosocial Methods Collaborative, University of Michigan Ann Arbor
| | - Natalie Leonard
- Natalie Leonard is a research technician, Research Center for Group Dynamics, Institute for Social Research, University of Michigan Ann Arbor
| | - Alicia G Carmichael
- Alicia G. Carmichael is a research process manager, Research Center for Group Dynamics, Institute for Social Research, University of Michigan Ann Arbor
| | - Elaina Baker
- Elaina Baker is a research assistant, Department of Psychiatry, School of Medicine, University of Michigan Ann Arbor
| | - Janeann Paratore
- Janeann Paratore is a research assistant, Biosocial Methods Collaborative, University of Michigan Ann Arbor
| | - Amanda C Blok
- Amanda C. Blok is a research assistant professor, Department of Systems, Populations and Leadership, School of Nursing, University of Michigan and a research health scientist, VA Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, Michigan
| | - Hallie C Prescott
- Hallie C. Prescott is an associate professor, Pulmonary and Critical Care, Department of Internal Medicine, School of Medicine, University of Michigan and a research investigator, VA Center for Clinical Management Research, Ann Arbor VA Healthcare System
| | - Theodore J Iwashyna
- Theodore J. Iwashyna is the Bloomberg Distinguished Professor of Social Science and Justice in Medicine and professor of medicine, Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Richard Gonzalez
- Richard Gonzalez is the Amos N. Tversky Professor, Psychology and Statistics and director, Research Center for Group Dynamics, University of Michigan
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Parish CL, Feaster DJ, Pollack HA, Horigian VE, Wang X, Jacobs P, Pereyra MR, Drymon C, Allen E, Gooden LK, Del Rio C, Metsch LR. Health Care Provider Stigma Toward Patients With Substance Use Disorders: Protocol for a Nationally Representative Survey. JMIR Res Protoc 2023; 12:e47548. [PMID: 37751236 PMCID: PMC10565625 DOI: 10.2196/47548] [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: 05/19/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment. OBJECTIVE To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers' clinical practices in caring for their patients. The survey also queried providers' stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders. METHODS Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants' views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations. RESULTS Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers. CONCLUSIONS Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47548.
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Affiliation(s)
- Carrigan Leigh Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Daniel J Feaster
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Xiaoming Wang
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Petra Jacobs
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | | | - Elizabeth Allen
- National Opinion Research Center, Chicago, IL, United States
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- School of General Studies, Columbia University, New York, NY, United States
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4
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Wu D, Zhong X, Deng R, Pan H, Gao Y, Lin B, Tang X, Dai J, Liang H, Huang A. Study on anxiety and depression of men who have sex with men: An application of group-based trajectory model. Front Psychol 2023; 13:857203. [PMID: 36660287 PMCID: PMC9842664 DOI: 10.3389/fpsyg.2022.857203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/30/2022] [Indexed: 01/04/2023] Open
Abstract
The prevalence of anxiety and depression is high among men who have sex with men (MSM), but limited studies focus on their development trends. This study examined the prevalence and influencing factors of anxiety and depression in HIV-negative MSM. In this study, 711 subjects were followed up every 24 weeks for 96 weeks. A group-based trajectory model was used to identify different development trends and a logistic regression model was used to explore the influencing factors of different trajectories. Low, moderate, and high anxiety groups accounted for 32.56, 56.12, and 11.32%; and low and high depression groups accounted for 73.90 and 26.10%. High anxiety was associated with a lower education degree, little HIV-related knowledge, and other characteristics (more agreed that "HIV is a threat to me/my family," had high frequency of seeking sexual partners via the Internet, had a history of sexually transmitted disease (STD), and a sense of discrimination by doctors). High depression was associated with a lower education degree, little HIV-related knowledge, being bisexual and the following characteristics: they felt that HIV infection rate of MSM around them was high, and more agreed that "HIV is a threat to me/my family," had a high frequency of seeking sexual partners through the Internet and alcohol drinking, had a history of STD, and felt being discriminated against by doctors and others. There is heterogeneity in the development trends of anxiety and depression. We need to improve intervention in the mental health of MSM, especially those with high anxiety and depression development trends. Clinical Trial Registration [http://www.chictr.org.cn/showproj.aspx?proj=5716], identifier [ChiCTR-TRC-13003849].
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Affiliation(s)
- Dan Wu
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China,Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Xiaoni Zhong
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China,*Correspondence: Xiaoni Zhong,
| | - Ruibin Deng
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Hong Pan
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Yuwen Gao
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Bing Lin
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Xian Tang
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Jianghong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Hao Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Ailong Huang
- Key Laboratory of Molecular Biology, Ministry of Molecular Biology, Chongqing, China
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5
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MacLean JR, Wetherall K. The Association between HIV-Stigma and Depressive Symptoms among People Living with HIV/AIDS: A Systematic Review of Studies Conducted in South Africa. J Affect Disord 2021; 287:125-137. [PMID: 33780828 DOI: 10.1016/j.jad.2021.03.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND People living with HIV/AIDS (PLWHA) are at increased risk of stigma and mental illness, and this appears to be a particular issue in South Africa, which is home to 19% of the world's HIV-positive population. This paper aims to systematically review the literature investigating the relationship between HIV-stigma and depressive symptoms among PLWHA in South Africa. METHODS A keyword search of four bibliographic databases (CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science) and two grey literature websites was conducted. The quality of eligible studies was assessed using established criteria. RESULTS Fourteen quantitative studies were included in the review. PLWHA in South Africa experience high levels of HIV-stigma and depressive symptoms. All forms of stigma were found to be associated with depressive symptoms amongst PLWHA. Prospective findings were mixed, with one study finding that stigma did not predict depressive symptoms over 36 months, and another that depressive symptoms predicted stigma 12 months later, suggesting a potentially bidirectional relationship. Females and young adults may be particularly vulnerable to HIV-stigma and its negative psychological effects. Some support was found for the moderating role of social support in the relationship between stigma and depressive symptoms across different sub-populations. LIMITATIONS Few studies conducted prospective analyses or tested mediation/moderation. CONCLUSIONS Despite limitations, this study highlights the importance of understanding the mechanisms underlying HIV-stigma across different sub-populations in South Africa. This may lead to more effective and context-specific interventions to combat adverse mental health outcomes.
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Affiliation(s)
- Jack R MacLean
- Institute of Health and Wellbeing, University of Glasgow, 1055 Great Western Road, Glasgow G12 0XH, UK
| | - Karen Wetherall
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, 1055 Great Western Road, University of Glasgow, G12 0XH, UK.
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6
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Knowlton AR, Nguyen TQ, Isenberg S, Tseng TY, Catanzarite Z, Mitchell MM, Cruz-Oliver D. Quality of Life Among Caregivers of a Vulnerable Population Living with HIV: Caregiving and Relationship Factors. AIDS Behav 2021; 25:360-376. [PMID: 32715410 PMCID: PMC10696639 DOI: 10.1007/s10461-020-02975-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Literature on health-related quality of life (HRQOL) has focused on people living with chronic conditions, with less attention given to HRQOL among informal caregivers. We used cross-sectional dyadic data from both care recipients (CR) living with HIV and the person they identified as their primary informal (unpaid) caregiver (CG) to identify psychosocial and caregiving relationship factors (including, CG role ambivalence and caregiving-related stress) associated with CG HRQOL. We conducted confirmatory factor analysis and structural equation modeling testing. The results highlight interdependent effects of the CG-CR relationship and reveal pathways whereby relationship interactions positively and negatively impact CGs' HRQOL. Affiliative stigma, CG-CR communication, CRs' reciprocity of support and other psychosocial factors indirectly and differentially affected physical and mental HRQOL through effects on secondary stress and role ambivalence. Dyad-focused intervention on interpersonal communication and support exchange may improve HRQOL and resilience of CGs of vulnerable people living with HIV.
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Affiliation(s)
- Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Trang Q Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarina Isenberg
- Temmy Latner Centre for Palliative Care, Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, USA
| | - Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zachary Catanzarite
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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7
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Li M, Long J, Wang X, Liao Y, Liu Y, Hao Y, Wu Q, Zhou Y, Wang Y, Wang Y, Wang Q, Ma Y, Chen S, Liu T. A Comparison of COVID-19 Stigma and AIDS Stigma During the COVID-19 Pandemic: A Cross-Sectional Study in China. Front Psychiatry 2021; 12:782501. [PMID: 34925108 PMCID: PMC8671734 DOI: 10.3389/fpsyt.2021.782501] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/02/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: To understand the current situation of stigmatizing attitudes toward Coronavirus Disease 2019 (COVID-19) in China and compare it with acquired immunodeficiency syndrome (AIDS). Methods: Convenient sampling and vignette-based methods were used to recruit participants on WeChat. A demographic form and adopted stigma scale were used to collect participants' demographic information and stigmatizing attitudes toward COVID-19 and AIDS. Results: A total of 13,994 questionnaires were included in this study. A high portion of participants tend to avoid contact with individuals affected with COVID-19 (74.3%) or AIDS (59.0%), as well as their family members (70.4% for COVID-19 and 47.9% for AIDS). About half of the participants agreed that affected persons could not only cause problems to their own family but also have adverse effects on others (59.6% and 55.6% for COVID-19, 56.9 and 47.0% for AIDS). The agreements with statements about perceived stigma were similar but slightly higher than those about personal stigma in both COVID-19 and AIDS. Participants' agreements with all statements regarding personal and perceived stigma attitudes between COVID-19 and AIDS were all statistically significant (p < 0.001). Participants obtained COVID-19-related information mainly from social media (91.3%) and newspaper or television (77.1%) during the epidemic, and 61.0% of them thought information from newspapers or television was the most reliable. Conclusion: Several similarities and differences of people's attitude toward COVID-19 and AIDS were found. Avoidance, blame, and secondary discrimination to diagnosed persons and their surrounding persons were the main representations of COVID-19-related stigma. Stigma of COVID-19 had less moral link but more public panic. Experience from HIV-related stigma reduction and prevention can be applied to reduce COVID-19-related stigma.
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Affiliation(s)
- Manyun Li
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiang Long
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuyi Wang
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanhui Liao
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yueheng Liu
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuzhu Hao
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qiuxia Wu
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Yingying Wang
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yunfei Wang
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qianjin Wang
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuejiao Ma
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shubao Chen
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tieqiao Liu
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
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8
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Maragh-Bass AC, Sloan DH, Alghanim F, Knowlton AR. A mixed-methods exploration of faith, spirituality, and health program interest among older African Americans with HIV. Qual Life Res 2020; 30:507-519. [PMID: 33052513 DOI: 10.1007/s11136-020-02656-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Persons living with HIV (PLWH) are living into old age with more complex care needs that non-PLWH. Promoting quality of life should include advance care planning (ACP) education, particularly among African Americans. We explored faith/spirituality-related correlates of interest in a future quality of life program among African American PLWH. METHODS Data were from the AFFIRM study. Participants were recruited from an HIV clinic and completed surveys, interviews, and focus groups. Quantitative analyses included Logistic regression. Qualitative data were coded using grounded theory. RESULTS Nearly half of participants had less than a high school education (47.9%), and roughly 90% had heard of at least one ACP-related topic (86.6%; N = 315). Qualitative themes related to quality of life and faith/spirituality were: (1) Coping with life challenges; (2) Motivation to improve health for loved ones; and (3) Support programs for people with HIV (N = 39). Satisfaction with religion/spirituality was associated with greater interest in a future program (p < .05); discussing ACP before getting sick was associated with less interest (p < .05). CONCLUSIONS/PRACTICE IMPLICATIONS Prioritizing skill-building and grounding in spirituality with input from faith leaders can reduce ACP inequities and improve health outcomes among African Americans.
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Affiliation(s)
- Allysha C Maragh-Bass
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA. .,FHI 360, Behavioral, Epidemiological, and Clinical Sciences Division, Durham, NC, USA.
| | - Danetta Hendricks Sloan
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA
| | - Fahid Alghanim
- Internal Medicine Residency Program, Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy R Knowlton
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA
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9
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Abstract
OBJECTIVE The negative effects of HIV stigma may extend beyond those who are HIV-positive, to people who are perceived to be at risk of HIV. This article examines HIV stigma by association among Australian gay and bisexual men (GBM). DESIGN Cross-sectional, online survey of 1280 Australian gay and bisexual men. This article focuses on HIV stigma from within a larger study that investigated stigma related to sexual identity. METHODS Bivariate and multivariable comparisons were made between men who experienced HIV stigma by association and those who did not. A serial mediation model was tested to investigate relationships between GBM community attachment, sexual identity stigma, HIV testing frequency, HIV stigma by association, psychological distress, and rejection of sex partners. RESULTS Results found that 5% of participants were HIV-positive, yet over 70% reported that they had been stigmatized by others for their perceived risk of acquiring HIV. Multivariable analysis indicated that HIV stigma by association was associated with more frequent HIV testing, greater GBM community attachment, experiencing stigma related to sexual identity and psychological distress. Our results suggest flow-on effects of HIV stigma by association, such as being more likely to reject other GBM on the basis of their HIV status or not testing for HIV. CONCLUSION Our results underscore the notion that HIV stigma can have broader, negative effects on HIV-affected populations. There is a need to address HIV stigma within GBM communities and society more broadly in order to encourage HIV testing and prevention among GBM.
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10
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Chang EJ, Fleming M, Nunez A, Dombrowski JC. Predictors of Successful HIV Care Re-engagement Among Persons Poorly Engaged in HIV Care. AIDS Behav 2019; 23:2490-2497. [PMID: 30980279 DOI: 10.1007/s10461-019-02491-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Data to Care (D2C) strategy uses HIV surveillance data to identify persons living with HIV (PLWH) who are poorly engaged in care and offers assistance with care re-engagement. We evaluated HIV care re-engagement among PLWH in Seattle & King County, Washington after participation in a D2C program and determined whether variables available at the time of the D2C interview predicted subsequent re-engagement in care. We defined successful re-engagement as surveillance evidence of either continuous care engagement (≥ 2 CD4 counts or HIV RNA results ≥ 60 days apart) or viral suppression (≥ 1 HIV RNA < 200 copies/mL) in the year following the D2C interview. Predictor variables included client characteristics, beliefs about HIV care, and scores on psychosocial assessment scales. Half of participants successfully re-engaged in care. We did not find any significant predictors of re-engagement except viral suppression at the time of the D2C interview. Close follow-up is needed to identify which D2C participants need additional assistance re-engaging in care.
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Affiliation(s)
| | - Mark Fleming
- Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
| | - Angela Nunez
- Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
| | - Julia C Dombrowski
- Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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11
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Huang J, Lin D, Yu NX. Variations in Dyadic Adjustment Among Heterosexual HIV-Discordant Couples in Rural China: A Latent Profile Analysis. AIDS Patient Care STDS 2019; 33:323-335. [PMID: 31194573 DOI: 10.1089/apc.2019.0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The systemic framework of resilience and dyadic perspective of couple coping suggests that HIV-discordant couples may show heterogeneous profiles of dyadic adjustment, shaped by contextual risks and resources. This study aimed to identify heterogeneous profiles of dyadic adjustment and thus investigate the expression of resilience among 159 heterosexual HIV-discordant couples in rural China. We hypothesized that the couples could be grouped into distinct profiles: both members showing poor well-being, both members showing good well-being, and discrepant well-being across the two members. A latent profile analysis classified the couples into three subgroups based on well-being, which was measured using the World Health Organization Well-Being Index. As expected, one subgroup, labeled Maladapted Couples (n = 58, 36.5%), reported poor well-being in both people living with HIV/AIDS (PLWHA) and the seronegative spouse. The second subgroup, labeled Resilient Couples (n = 50, 31.4%), was characterized by relatively good well-being in both partners. In the third subgroup, labeled Maladapted PLWHA and Resilient Spouses (n = 51, 32.1%), the PLWHA showed poor well-being, while the seronegative spouses demonstrated good well-being. The identified subgroups were validated against external well-being measures, including depression and self-rated health measures. Exploratory analyses identified distinct patterns of contextual risks (including HIV stigma and financial difficulties) and resource factors (including individual resources and relational resources) across the subgroups. These findings underscore the heterogeneity of adjustment among heterosexual HIV-discordant couples in rural China and suggest the potential usefulness of services tailored to specific subgroups.
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Affiliation(s)
- Jiasheng Huang
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Danhua Lin
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
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12
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Gamarel KE, Sevelius JM, Reisner SL, Coats CS, Nemoto T, Operario D. Commitment, interpersonal stigma, and mental health in romantic relationships between transgender women and cisgender male partners. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2019; 36:2180-2201. [PMID: 31086428 PMCID: PMC6510026 DOI: 10.1177/0265407518785768] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The goals of this study were to: (a) examine associations between interpersonal stigma and psychological distress among a sample of transgender women and their cisgender male partners; and (b) identify whether commitment moderates the association between interpersonal stigma and psychological distress. To address these aims, 191 couples consisting of transgender women and their cisgender male partners completed a one-time survey. Actor-partner interdependence models (APIM) were fit to examine stigma, commitment, and their interaction on psychological distress. More frequent experiences of interpersonal stigma were associated with elevated psychological distress for both partners. For transgender women, higher commitment was associated with lower psychological distress. There was a significant interaction effect such that the association between interpersonal stigma and psychological distress was attenuated by greater commitment for transgender women, but not for their cisgender male partners. Findings provide preliminary support for associations between interpersonal stigma and mental health of both partners, and identify commitment as a potential stress buffer for transgender women.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Jae M. Sevelius
- Department of Family & Community Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Sari L. Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
- The Fenway Institute, Fenway Health, Boston, MA USA
| | - Cassandra Sutten Coats
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
| | | | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
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13
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Bagheri Z, Taheri M, Motazedian N. The impacts of depression and anxiety on quality of life among patients with HIV/AIDS and their spouses: testing dyadic dynamics using the actor-partner interdependence model. AIDS Care 2019; 31:1500-1508. [PMID: 30884955 DOI: 10.1080/09540121.2019.1595676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
HIV/AIDS not only affects the patients, but also their entire family. This study aimed to assess the impacts of the patients' and their spouses' anxiety and depression on their quality of life (QoL) at the dyadic level. A total of 120 serodiscordant husband-wife dyads from the voluntary counselling and testing center in Shiraz, Iran, were involved in this study from February to June 2015. The WHOQOL-BREEF, CESD-10, and Beck Anxiety Inventory instruments were used, respectively, to assess the QoL, depression, and anxiety scores of the participants. The actor-partner interdependence model (APIM) was used to estimate the effects of depression and anxiety of both the people living with HIV/AIDS (PLWHA) and their spouses on their own QoL (actor effect) as well as their partners' (partner effect). The APIM analysis revealed that both PLWHAs' and their spouses' depression and anxiety showed actor effects on their own QoL. Furthermore, spouses' depression showed a significant partner effect on PLWHAs' QoL and PLWHAs' anxiety had significant partner effects on spouses' QoL. Accordingly, this data can be used to develop targeted interventions aimed at guidance and assistance of PLWHAs and their spouses to find coping strategies that improve their own QoL as well as their partners'.
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Affiliation(s)
- Zahra Bagheri
- Department of Biostatistics, Faculty of Medicine, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Marjan Taheri
- Department of Biostatistics, Faculty of Medicine, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Nasrin Motazedian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences , Shiraz , Iran.,Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences , Shiraz , Iran
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14
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Ma PHX, Chan ZCY, Loke AY. Self-Stigma Reduction Interventions for People Living with HIV/AIDS and Their Families: A Systematic Review. AIDS Behav 2019; 23:707-741. [PMID: 30298241 DOI: 10.1007/s10461-018-2304-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Stigma is a primary concern for people living with human immunodeficiency virus (HIV)/AIDS (PLWHA), and has great impact on their and their family members' health. While previous reviews have largely focused on the public stigma, this systematic review aims to evaluate the impact of HIV/acquired immunodeficiency syndrome (AIDS)-related self-stigma reduction interventions among PLWHA and their families. A literature search using eight databases found 23 studies meeting the inclusion criteria. Five types of intervention approaches were identified: (1) psycho-educational intervention, (2) supportive intervention for treatment adherence (antiretroviral therapy), (3) psychotherapy intervention, (4) narrative intervention, and (5) community participation intervention. Overall, the reviewed articles suggested a general trend of promising effectiveness of these interventions for PLWHA and their family members. Psycho-educational interventions were the main approach. The results highlighted the need for more interventions targeting family members of PLWHA, and mixed-methods intervention studies.
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Affiliation(s)
- Polly H X Ma
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, GH 525, Kowloon, Hong Kong, China
| | - Zenobia C Y Chan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, GH 525, Kowloon, Hong Kong, China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, GH 525, Kowloon, Hong Kong, China.
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15
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Li M, Fu R, Xue H, Wang Y. Intergenerational Association of Maternal Obesity and Child Peer Victimization in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:69-83. [PMID: 30694074 DOI: 10.1177/0022146518824566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Drawing on the intergenerational stress proliferation theory, the courtesy stigma thesis, and the buffering ethnic culture thesis, this study examines the association between maternal obesity and child's peer victimization and whether this association varies for white and black children. Based on longitudinal data from a nationally representative sample of mother-child pairs in the U.S. Panel Study of Income Dynamics Child Development Supplement, negative binomial models show that maternal obesity is associated with increased frequency of peer victimization, even after controlling for family socioeconomic status, child weight status, health status, self-esteem, and demographic characteristics. The association was significant only for white children. Given the developmental significance of child peer relations and the social disparities in obesity, future studies need to explicitly test causal mechanisms underlying the association to decide whether obesity may function as a family stressor (versus an individual stressor) that contributes to the intergenerational reproduction of inequality.
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Affiliation(s)
- Miao Li
- 1 Clemson University, Clemson, SC, USA
| | - Rong Fu
- 2 Siena College, Loudonville, NY, USA
| | - Hong Xue
- 3 Virginia Commonwealth University, Richmond, VA, USA
| | - Youfa Wang
- 4 Ball State University, Muncie, IN, USA
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16
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Huang J, Zhang J, Yu NX. Couple identity and well-being in Chinese HIV serodiscordant couples: resilience under the risk of stigma. AIDS Care 2019; 30:S58-S66. [PMID: 30632776 DOI: 10.1080/09540121.2018.1510105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Resilience literature has suggested the context-specific nature of resilience while such framework has yet to be expanded to health psychology research among HIV serodiscordant couples. Conceptualizing a couple affected by chronic diseases using a "we-ness" framework rather than two separate individuals is important for stress coping of the couple. Considering this social-cognitive context of couple coping would be helpful to facilitate resilience of both the patient and the spouse. It is not clear whether couple identity serves as a protective factor for HIV serodiscordant couples and whether stigma, a prevalent contextual risk in this population, will alter the strength of such a protective effect on well-being. This longitudinal study examined the protective effect of couple identity in predicting the psychological and physical well-being of HIV discordant couples and the moderating role of stigma in such associations. A total of 160 Chinese HIV serodiscordant couples completed the baseline survey and follow-up one year later. Results showed that couple identity predicted fewer depressive symptoms at both the within- and between-couple level and better self-rated physical health at the between-couple level one year later. These protective effects were diminished when HIV stigma was high. This study highlights the importance of examining resources with consideration of contextual factors. It also calls for the sensitivity of stigma in developing a couple-based intervention for HIV serodiscordant couples.
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Affiliation(s)
- Jiasheng Huang
- a Department of Social and Behavioural Sciences , City University of Hong Kong , Hong Kong , People's Republic of China
| | - Jianxin Zhang
- b Institute of Psychology, Chinese Academy of Sciences , Beijing , People's Republic of China
| | - Nancy Xiaonan Yu
- a Department of Social and Behavioural Sciences , City University of Hong Kong , Hong Kong , People's Republic of China
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17
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Vreeman RC, Scanlon ML, Tu W, Slaven J, McAteer C, Aluoch J, Ayaya S, Nyandiko WM. Validation of an HIV/AIDS Stigma Measure for Children Living with HIV and Their Families. J Int Assoc Provid AIDS Care 2019; 18:2325958219880570. [PMID: 31581890 PMCID: PMC6900619 DOI: 10.1177/2325958219880570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/04/2019] [Accepted: 09/13/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There are few validated tools to measure stigma, particularly among children living with HIV and their families. METHODS This study was nested within a larger study that followed 240 child-caregiver dyads (children aged 10-15 years) at 8 clinics in western Kenya. The stigma instrument was administered to all child-caregiver dyads at 2 time points 6 months apart. The primary end point was to construct validity assessed by comparison to criterion constructs using generalized estimating equation models. RESULTS Mean age of child participants was 12.3 years and 52% were female. Generally, caregivers reported experiencing higher levels of HIV stigma compared to their children. Children (9%) and caregivers (14%) reported that HIV stigma made them feel stressed, anxious, and depressed. Child and caregiver stigma items showed high construct validity by emotional and behavioral outcomes. CONCLUSIONS The stigma instrument showed high validity when compared to emotional and behavioral outcomes.
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Affiliation(s)
- Rachel Christine Vreeman
- Department of Health Systems Design and Global Health, Icahn School of
Medicine at Mount Sinai, NY, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of
Health Sciences, Moi University, Eldoret, Kenya
| | - Michael Lawrence Scanlon
- Department of Health Systems Design and Global Health, Icahn School of
Medicine at Mount Sinai, NY, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- John W. McCormack Graduate School of Policy and Global Studies, University
of Massachusetts, Boston, MA, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine,
Indianapolis, IN, USA
| | - James Slaven
- Department of Biostatistics, Indiana University School of Medicine,
Indianapolis, IN, USA
| | - Carole McAteer
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of
Health Sciences, Moi University, Eldoret, Kenya
| | - Winstone Mokaya Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of
Health Sciences, Moi University, Eldoret, Kenya
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18
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Maragh-Bass AC, Denison JA, Thorpe RJ, Knowlton AR. The interactive effects of social support and physical functioning on HIV medical outcomes among African Americans whom inject drugs. J Ethn Subst Abuse 2017. [PMID: 28632094 DOI: 10.1080/15332640.2016.1264337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research suggests a syndemic of substance use, mental illness, and familial conflict is associated with poor HIV medical outcomes among African American persons living with HIV (PLHIV). Social support may facilitate positive health outcomes. This study explores psychosocial correlates of HIV medical outcomes, defined as undetectable viral load (UVL) and acute care minimization. Data were from baseline of the BEACON study (N = 351). UVL was ≤40 copies/mL. Acute care minimization was defined as no ER visits and/or hospitalizations in 6 months. Descriptive statistics and Poisson regression were implemented (N = 351). Moderate syndemic burden was associated with viral suppression. Individuals with main partner caregivers had 35% higher likelihood of viral suppression than individuals whose main supporters were neither kin nor main partners (adjusted point-prevalence rate ratio [APR] = 1.35; 95% CI [1.05, 1.74]). Surprisingly, individuals with more health-related support were more likely to use acute care than individuals with less health-related support (p<.05). Interaction analyses showed that physical function modified the relationship between main supporter type and acute care minimization. Results suggest that social support receipt was not consistently associated with HIV medical outcomes. Conversely, higher syndemic burden may have facilitated positive outcomes through necessitating increased rates of health care engagement. Health care professionals should elicit discussion of social support to strengthen PLHIVs' and their supporters' relationships to improve their health. Results highlight the need for culturally tailored interventions to improve HIV medical outcomes among African American PLHIV substance users.
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Affiliation(s)
| | - Julie A Denison
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Roland J Thorpe
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Amy R Knowlton
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
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19
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Gamarel KE, Kuo C, Boyes ME, Cluver LD. The dyadic effects of HIV stigma on the mental health of children and their parents in South Africa. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2017; 16:351-366. [PMID: 29238272 PMCID: PMC5724576 DOI: 10.1080/15381501.2017.1320619] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
HIV stigma - both 'self-stigma' towards positive individuals and 'stigma by association' towards their families - is linked with adverse mental health. This study examined how stigma was associated with the mental health of parents and children in South Africa. Parent-child dyads (n=2477 dyads) in South Africa participated in a cross-sectional survey. For both parents and children, greater stigma was associated with their own reports of greater anxious and depressive symptoms. Parents reports of stigma was associated with children's greater anxious and depressive symptoms. Children's reports of stigma was related to parents greater anxious and depressive symptoms. There was a significant interaction, such that the association between parent stigma and depression was stronger when children also reported high levels of stigma. Findings provide support the effect of HIV stigma on the mental health of families and illustrate the importance of taking a family-based approach to stigma-reduction interventions to alleviate mental health problems.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Behavioral and Social Sciences, Brown University School of Public, 121 South Main Street, Providence, RI 02130
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI 02130
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public, 121 South Main Street, Providence, RI 02130
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI 02130
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Mark E. Boyes
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, United Kingdom
- Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, United Kingdom
| | - Lucie D. Cluver
- Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, United Kingdom
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, Western Australia
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20
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McHenry MS, Nyandiko WM, Scanlon ML, Fischer LJ, McAteer CI, Aluoch J, Naanyu V, Vreeman RC. HIV Stigma: Perspectives from Kenyan Child Caregivers and Adolescents Living with HIV. J Int Assoc Provid AIDS Care 2016; 16:215-225. [PMID: 27655835 DOI: 10.1177/2325957416668995] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Stigma shapes all aspects of HIV prevention and treatment, yet there are limited data on how HIV-infected youth and their families are affected by stigma in sub-Saharan Africa. The authors conducted a qualitative study using focus group discussions among 39 HIV-infected adolescents receiving care at HIV clinics in western Kenya and 53 caregivers of HIV-infected children. Participants felt that while knowledge and access to treatment were increasing, many community members still held negative and inaccurate views about HIV, including associating it with immorality and believing in transmission by casual interactions. Stigma was closely related to a loss of social and economic support but also included internalized negative feelings about oneself. Participants identified treatment-related impacts of stigma, including nonadherence, nondisclosure of status to child or others, and increased mental health problems. Qualitative inquiry also provided insights into how to measure and reduce stigma among affected individuals and families.
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Affiliation(s)
- Megan Song McHenry
- 1 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.,2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Winstone M Nyandiko
- 2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,3 Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Michael L Scanlon
- 1 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.,2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Lydia J Fischer
- 1 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.,2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Carole I McAteer
- 1 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.,2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- 2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Violet Naanyu
- 2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,4 Department of Behavioural Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Rachel C Vreeman
- 1 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.,2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,3 Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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21
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Yu NX, Chan CLW, Zhang J. Dyadic Effects of Stigma and Discrimination on Distress in Chinese HIV Discordant Couples. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:277-286. [PMID: 27427923 DOI: 10.1521/aeap.2016.28.4.277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The present study investigated the dyadic effects of stigma and discrimination on distress in Chinese couples affected by HIV. Chinese people living with HIV (PLHIV) and their seronegative spouses (N = 119 couples) participated in this study. The PLHIV completed measures on stigma beliefs about being better off dead and dignity-related distress. The spouses completed measures on perceived discrimination and exclusion and caregiver distress. The results showed that there was no significant correlation between the PLHIV's stigma beliefs and the spouses' perceived discrimination and exclusion. The couples showed significant associations in their dignity-related distress and caregiver distress. Analyses using the actor-partner interdependence model showed that PLHIV's stigma beliefs and the spouses' perceived discrimination and exclusion both had significant actor and partner effects on distress within the dyad. Psychosocial interventions aiming for distress reduction in the context of HIV should tackle stigma and discrimination and target the couples rather than solely the patient or spouse.
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Affiliation(s)
- Nancy Xiaonan Yu
- Department of Applied Social Sciences, City University of Hong Kong, Hong Kong, China
| | - Cecilia L W Chan
- Department of Social Work and Social Administration and Center on Behavioral Health, The University of Hong Kong, Hong Kong, China
| | - Jianxin Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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22
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Wu F, He X, Guida J, Xu Y, Liu H. Network stigma towards people living with HIV/AIDS and their caregivers: An egocentric network study. Glob Public Health 2015; 10:1032-45. [PMID: 25642919 DOI: 10.1080/17441692.2014.1003572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
HIV stigma occurs among peers in social networks. However, the features of social networks that drive HIV stigma are not well understood. The objective of this study is to investigate anticipated HIV stigma within the social networks of people living with HIV/AIDS (PLWHA) (N = 147) and the social networks of PLWHA's caregivers (N = 148). The egocentric social network data were collected in Guangxi, China. More than half of PLWHA (58%) and their caregivers (53%) anticipated HIV stigma from their network peers. Both PLWHA and their caregivers anticipated that spouses or other family members were less likely to stigmatise them, compared to friend peers or other relationships. Married network peers were believed to stigmatise caregivers more than unmarried peers. The association between frequent contacts and anticipated stigma was negative among caregivers. Being in a close relationship with PLWHA or caregivers (e.g., a spouse or other family member) was associated with less anticipated stigma. Lower network density was associated with higher anticipated stigma among PLWHA's alters, but not among caregivers' alters. Findings may shed light on innovative stigma reduction interventions at the social network level and therefore improve HIV/AIDS treatment utilisation.
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Affiliation(s)
- Fei Wu
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
| | - Xin He
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
| | - Jennifer Guida
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
| | - Yongfang Xu
- b Department of HIV/AIDS Control and Prevention , Nanning Center for Disease Control and Prevention , Nanning , China
| | - Hongjie Liu
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
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23
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LeBlanc AJ, Frost DM, Wight RG. Minority Stress and Stress Proliferation Among Same-Sex and Other Marginalized Couples. JOURNAL OF MARRIAGE AND THE FAMILY 2015; 77:40-59. [PMID: 25663713 PMCID: PMC4316376 DOI: 10.1111/jomf.12160] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Drawing from 2 largely isolated approaches to the study of social stress-stress proliferation and minority stress-the authors theorize about stress and mental health among same-sex couples. With this integrated stress framework, they hypothesized that couple-level minority stressors may be experienced by individual partners and jointly by couples as a result of the stigmatized status of their same-sex relationship-a novel concept. They also consider dyadic minority stress processes, which result from the relational experience of individual-level minority stressors between partners. Because this framework includes stressors emanating from both status- (e.g., sexual minority) and role-based (e.g., partner) stress domains, it facilitates the study of stress proliferation linking minority stress (e.g., discrimination), more commonly experienced relational stress (e.g., conflict), and mental health. This framework can be applied to the study of stress and health among other marginalized couples, such as interracial/ethnic, interfaith, and age-discrepant couples.
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Affiliation(s)
| | - David M. Frost
- Department of Population and Family Health, Columbia University, 60 Haven Ave., B2, New York, NY 10032
| | - Richard G. Wight
- UCLA Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Dr. South, 36-071 CHS, Box 951772, Los Angeles, CA 90095-1772
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24
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Moore H, Gillespie A. The caregiving bind: Concealing the demands of informal care can undermine the caregiving identity. Soc Sci Med 2014; 116:102-9. [DOI: 10.1016/j.socscimed.2014.06.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 05/14/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
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25
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Liu H, Xu Y, Sun Y, Dumenci L. Measuring HIV stigma at the family level: psychometric assessment of the Chinese Courtesy Stigma Scales (CCSSs). PLoS One 2014; 9:e92855. [PMID: 24658364 PMCID: PMC3962465 DOI: 10.1371/journal.pone.0092855] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/27/2014] [Indexed: 02/06/2023] Open
Abstract
Courtesy stigma is the stigmatization a person perceives or experiences due to their association with a stigmatized individual or group. Most HIV-related stigma scales have been developed for people living with HIV/AIDS (PLWHAs), but not for their HIV-uninfected family members. To date, few measurement scales have been designed to measure the degree of stigma among both PLWHAs and their HIV-uninfected family members at the family level. We developed a set of courtesy stigma scales and estimated their reliability and validity from 256 PLWHAs and 256 of their HIV-uninfected family members. Exploratory and confirmatory factor analyses were performed in two independent samples: a development sample (N = 216) and a validation sample (N = 296), respectively. Two factors (“public stigma” and “self-perceived stigma”) had high internal consistency reliability (Cronbach's alpha coefficient between 0.83–0.90) and good construct validity (standardized factor loading range: 0.37–0.95) in both samples. These findings document that the newly developed brief instrument is a psychometrically sound measure of HIV-related stigma among both PLWHAs and their HIV-uninfected family members.
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Affiliation(s)
- Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, United States of America
- * E-mail:
| | - Yongfang Xu
- Department of HIV/AIDS Control, Nanning Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Yehuan Sun
- Department of Epidemiology, Anhui Medical University, Hefei, Anhui, China
| | - Levent Dumenci
- Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, Virginia, United States of America
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Liu H, Xu Y, Lin X, Shi J, Chen S. Associations between perceived HIV stigma and quality of life at the dyadic level: the actor-partner interdependence model. PLoS One 2013; 8:e55680. [PMID: 23383343 PMCID: PMC3562178 DOI: 10.1371/journal.pone.0055680] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/28/2012] [Indexed: 11/18/2022] Open
Abstract
Background Few studies have investigated the relationship between HIV-related stigma and quality life at the dyadic level. The objective of this study was to examine the actor and partner effects of stigma that was perceived by people living with HIV/AIDS (PLWHAs) and caregivers on quality of life at the dyadic level. Method A survey was conducted among 148 dyads consisting of one PLWHA and one caregiver (296 participants) in Nanning, China. The interdependent relationship between a pair of dyadic members that influences the associations between stigma and quality of life was analyzed, using an innovative dyadic analysis technique: the Actor-Partner Interdependence Model (APIM). Results We found in this dyadic analysis that (1) PLWHAs compared to their caregivers exhibited a higher level of perceived HIV stigma and lower level of quality of life measured in four domains; (2) both PLWHAs' and caregivers' perceived HIV stigma influenced their own quality of life; (3) The quality of life was not substantially influenced by their partners' perceived stigma; and (4) Both actor and partner effects of stigma on quality of life were similar among PLWHAs and their caregivers. Conclusion As HIV stigma and quality of life are complex phenomena rooted in cultures, intervention programs should be carefully planned based on social or cognitive theories and should be culturally adopted.
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Affiliation(s)
- Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, United States of America.
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Wight RG, LeBlanc AJ, de Vries B, Detels R. Stress and mental health among midlife and older gay-identified men. Am J Public Health 2012; 102:503-10. [PMID: 22390515 DOI: 10.2105/ajph.2011.300384] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated associations between stress and mental health (positive affect, depressive symptoms) among HIV-negative and HIV-positive midlife and older gay-identified men, along with the mediating and moderating effects of mastery and emotional support. We also studied the mental health effects of same-sex marriage. METHODS We obtained data from self-administered questionnaires completed in 2009 or 2010 by a subsample (n = 202; average age = 56.91 years; age range = 44-75 years) of participants in the University of California, Los Angeles component of the Multicenter AIDS Cohort Study, one of the largest and longest-running natural-history studies of HIV/AIDS in the United States. RESULTS Both sexual minority stress (perceived gay-related stigma, excessive HIV bereavements) and aging-related stress (independence and fiscal concerns) appeared to have been detrimental to mental health. Sense of mastery partially mediated these associations. Being legally married was significantly protective net of all covariates, including having a domestic partner but not being married. Education, HIV status, and race/ethnicity had no significant effects. CONCLUSIONS Sexual minority and aging-related stress significantly affected the emotional lives of these men. Personal sense of mastery may help to sustain them as they age. We observed specific mental health benefits of same-sex legal marriage.
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Affiliation(s)
- Richard G Wight
- Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, CA 90095-1772, USA.
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Rutledge SE, Whyte J, Abell N, Brown KM, Cesnales NI. Measuring stigma among health care and social service providers: The HIV/AIDS Provider Stigma Inventory. AIDS Patient Care STDS 2011; 25:673-82. [PMID: 21967495 DOI: 10.1089/apc.2011.0008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV/AIDS (PLHA). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHA that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients α for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed.
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Affiliation(s)
| | - James Whyte
- College of Nursing, Florida State University, Tallahassee, Florida
| | - Neil Abell
- College of Social Work, Florida State University, Tallahassee, Florida
| | - Kristin M. Brown
- College of Social Work, Florida State University, Tallahassee, Florida
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Haber DB, Roby JL, High-George LD. Stigma by association: the effects of caring for HIV/AIDS patients in South Africa. HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:541-549. [PMID: 21545359 DOI: 10.1111/j.1365-2524.2011.01002.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The shortage of healthcare workers caring for South Africa's 5-6 million persons living with HIV/AIDS (PLHA) calls for inquiry into workers' challenges and experiences. This exploratory study examines one little-studied challenge: stigmatisation of HIV/AIDS healthcare workers based on their association with PLHA. The authors tested the hypotheses that HIV/AIDS healthcare workers experience stigmatisation due to their association with PLHA, and that such association stigma is correlated with thoughts of leaving the HIV/AIDS field. A sample of 100 participants who provided direct care to PLHA was recruited from a variety of public and private HIV/AIDS care centres in Eastern Cape province, South Africa. Participants attended one of 12 focus groups held between June and August, 2008. They completed a 17-item questionnaire and discussed each item. Findings exhibit the presence of an adverse differentiation and labelling of HIV/AIDS healthcare workers, leading to status loss and discrimination, creating an impetus for HIV/AIDS healthcare workers to leave AIDS work altogether. A significant relationship (χ(2) (TREND) = 3.86, df = 1, P = 0.049) was found between contemplation of leaving AIDS work and perception of others' responses to their work with PLHA. In addition, associations emerged between type of AIDS worker and contemplation of working in AIDS care outside of South Africa (Kruskal-Wallis χ(2) = 6.96, df = 2, P = 0.031), with doctors and nurses reporting higher frequency of contemplating leaving South Africa to work with PLHA elsewhere (Mann-Whitney z = -2.53, P = 0.011). The study lays the foundation for additional research on the effects of association stigma. In turn, increased efforts to retain and recruit new HIV/AIDS healthcare workers will expand the pool of healthcare personnel to PLHA.
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HIV and AIDS Related Stigma: A Necessary Protective Mechanism for Children in High Exposure Areas? SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2011. [DOI: 10.1177/008124631104100207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Much research conducted within the context of stigma related to HIV and AIDS focuses on the effects of stigma without reflecting on the complex social processes which contribute to its construction. In order to render HIV and AIDS interventions and treatment strategies more effective, it is important to consider the function of stigma. This study reflects on the complex social processes underlying children's understandings and construction of stigma related to HIV and AIDS. The study used qualitative interview and focus group data generated in a project on barriers to learning. The findings suggest that the process of stigma construction functions as a protective othering response that may provide a necessary psychological defence in the often overwhelming context of HIV and AIDS. A focus on how children make sense of stigma is at the heart of changing future health behaviours in this context.
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Hassan ZM, Wahsheh MA. Knowledge and attitudes of Jordanian nurses towards patients with HIV/AIDS: findings from a nationwide survey. Issues Ment Health Nurs 2011; 32:774-84. [PMID: 22077750 DOI: 10.3109/01612840.2011.610562] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study explored the knowledge and attitudes of Jordanian nurses toward patients with HIV/AIDS, particularly in regards to their sources of information and education. This survey utilized a cross-sectional design. A self-administered questionnaire developed by Eckstein was used in collecting the data. A total of 922 nurses completed the questionnaire. Overall, Jordanian nurses expressed negative attitudes toward patients with HIV/AIDS, and their level of HIV/AIDS knowledge was weak. Weak knowledge level was recorded among nurses in the following subsections: agent and immunology; course and manifestation; transmission and incidence; and precaution and prevention. Only in one subsection (risk group), did nurses show a good level of knowledge about HIV/AIDS. More than two-thirds of nurses (84%) refused to provide care to patients who tested positive for HIV/AIDS. Most of the nurse participants believed that currently provided HIV/AIDS information resources were inadequate (81.4 %). The majority of nurses were interested in support groups for staff nurses (96.5%). The major source of HIV/AIDS information obtained by Jordanian nurses was through Internet web sites (52.7%). The majority of nurses (96.2%) ranked their fear of getting AIDS from their nursing practice as overwhelming. The total attitude of participants towards patients with HIV/AIDS in all five subsections (i.e., fear of contagion, social stigma, fatal outcome of the disease, direct care, and education and counseling) was negative (84.3%). Accurate knowledge about HIV/AIDS along with an in-depth understanding of patients? needs can help alleviate much of the fear, anxiety, and stigma associated with caring for patients with HIV/AIDS.
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Affiliation(s)
- Zeinab M Hassan
- Hashemite University, School of Nursing, Zarqa, Jordan. hassan
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Yiu JW, Mak WWS, Ho WS, Chui YY. Effectiveness of a knowledge-contact program in improving nursing students' attitudes and emotional competence in serving people living with HIV/AIDS. Soc Sci Med 2010; 71:38-44. [PMID: 20430503 DOI: 10.1016/j.socscimed.2010.02.045] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 12/10/2009] [Accepted: 02/09/2010] [Indexed: 11/16/2022]
Abstract
This study compared the effectiveness of an AIDS knowledge-only program (knowledge) with a combined program of AIDS knowledge and contact with people having HIV/AIDS (PHA) (knowledge-contact) in reducing nursing students' stigma and discrimination towards PHA and in enhancing their emotional competence to serve PHA. Eighty-nine nursing students from two universities in Hong Kong were randomly assigned to either the knowledge or the knowledge-contact condition. All participants completed measures of AIDS knowledge, stigmatizing attitudes, fear of contagion, willingness to treat, positive affect, and negative affect at pre-test, post-test, and six-week follow-up. Findings showed that in both groups, significant improvement in AIDS knowledge, stigmatizing attitudes, fear of contagion, willingness to treat, and negative affect were found at post-test. The effects on AIDS knowledge, fear of contagion, willingness to treat, and negative affect were sustained at follow-up for both groups. Intergroup comparisons at post-test showed that the effectiveness of knowledge-contact program was significantly greater than knowledge program in improving stigmatizing attitudes. No significant difference between the two groups was found at follow-up. Findings showed the short-term effect of contact in improving nursing students' attitudes and emotional competence in serving PHA. Implications for research and training of nursing staff were discussed.
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Affiliation(s)
- Jessie W Yiu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Vijayan T, Benin AL, Wagner K, Romano S, Andiman WA. We never thought this would happen: transitioning care of adolescents with perinatally acquired HIV infection from pediatrics to internal medicine. AIDS Care 2010; 21:1222-9. [PMID: 20024697 DOI: 10.1080/09540120902730054] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Transitioning the medical care of children with perinatally acquired HIV from pediatric care to internal medicine practices has become increasingly important as newer therapies prolong survival. The study aims to describe challenges to caring for these adolescents and the potential barriers to transitioning them to internal medicine-based care. METHODS Qualitative study in which data were gathered from open-ended interviews conducted from November 2005 to April 2006 with 18 adolescents with HIV, 15 of their parents, and 9 pediatric health care providers from the Yale Pediatric AIDS Care Program, New Haven, Connecticut. RESULTS Issues of stigma played a prominent role in both the challenges to care and barriers to transitioning care. Challenges to care were: (1) poor adherence to medication regimens; (2) adolescent sexuality; and (3) disorganized social environments. Potential barriers to transitioning care were: (1) families' negative perceptions of and experiences with stigma of HIV disease - which undermined the desire to meet new providers; (2) perceived and actual lack of autonomy - pediatric providers feared that staff in adult clinics would demand a level of independence that adolescents did not have; and (3) difficulty letting go of relationships - adolescents, guardians, and providers described a familial relationship and expressed anxiety about terminating their relationships. CONCLUSION Understanding these challenges and barriers can inform both pediatric and adult HIV care providers and enable them to create successful transition programs, with the goal of improving retention and follow-up to care.
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Affiliation(s)
- Tara Vijayan
- Department of Medicine, University of California, San Francisco, CA, USA.
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Bar-Lev S. ‘Do you feel sorry for him?’: Gift relations in an HIV/AIDS on-line support forum. Health (London) 2010; 14:147-61. [DOI: 10.1177/1363459309353296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sociologists have debated whether meaningful emotional relationships can be formed on-line. Drawing on Mauss’ concept of the gift, I explore how caregivers who participate in Hope, an on-line support forum dedicated to HIV/AIDS, incorporate moral percepts and understandings about ethics into their caregiving experiences. Their intense discussions on the essence of familial loyalties give rise to emotionally vibrant, empathic communities in which a socio-emotional economy is formulated. Can the Internet act as a moral space? How are concepts such as reciprocity, obligation, and commitment talked about and practiced in an on-line forum that exists in the ever present?
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Quinn DM, Chaudoir SR. Living with a concealable stigmatized identity: the impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. J Pers Soc Psychol 2009; 97:634-51. [PMID: 19785483 PMCID: PMC4511710 DOI: 10.1037/a0015815] [Citation(s) in RCA: 389] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current research provides a framework for understanding how concealable stigmatized identities impact people's psychological well-being and health. The authors hypothesize that increased anticipated stigma, greater centrality of the stigmatized identity to the self, increased salience of the identity, and possession of a stigma that is more strongly culturally devalued all predict heightened psychological distress. In Study 1, the hypotheses were supported with a sample of 300 participants who possessed 13 different concealable stigmatized identities. Analyses comparing people with an associative stigma to those with a personal stigma showed that people with an associative stigma report less distress and that this difference is fully mediated by decreased anticipated stigma, centrality, and salience. Study 2 sought to replicate the findings of Study 1 with a sample of 235 participants possessing concealable stigmatized identities and to extend the model to predicting health outcomes. Structural equation modeling showed that anticipated stigma and cultural stigma were directly related to self-reported health outcomes. Discussion centers on understanding the implications of intraindividual processes (anticipated stigma, identity centrality, and identity salience) and an external process (cultural devaluation of stigmatized identities) for mental and physical health among people living with a concealable stigmatized identity.
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Affiliation(s)
- Diane M Quinn
- Department of Psychology, University of Connecticut.
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Mitchell MM, Knowlton A. Stigma, disclosure, and depressive symptoms among informal caregivers of people living with HIV/AIDS. AIDS Patient Care STDS 2009; 23:611-7. [PMID: 19591607 PMCID: PMC6463991 DOI: 10.1089/apc.2008.0279] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Informal care receipt is associated with better HIV treatment outcomes among patients vulnerable to treatment failure. Yet, informal caregiving can be highly stressful, leading to distress and cessation of caregiving. Research on factors contributing to informal caregivers' psychological distress may advance our understanding of how to improve caregivers' well-being and sustained HIV caregiving for a vulnerable population. We examined relationships among caregiver stigma, disclosure, and depressive symptoms in a cross-sectional sample of 207 informal caregivers of people living with HIV/AIDS (PLWHAs) in Baltimore, Maryland. Caregivers were primarily African American, low-income, urban adults participating in the Action, Resources, and Knowledge (ARK) study (2003-2005), which recruited urban PLWHAs and their main supporters. Results indicated that among caregivers, HIV caregiving-related stigma was associated with more depressive symptoms, while disclosure of caregiving status was associated with fewer symptoms. We also explored the buffering effect of disclosure in the relationship between stigma and depressive symptoms. Results indicated that among those who reported greater stigma, there was a significant decrease in depressive symptoms as the number of disclosures increased. In contrast, participants who indicated lower stigma had consistently fewer depressive symptoms regardless of number of disclosures. These results suggest the need for interventions to address high levels of depressive symptoms among informal HIV caregivers, particularly those who report greater caregiving stigma and less disclosure of their caregiver status. In addition, future research should examine these relationships further using longitudinal data from informal caregivers and their care recipients.
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Affiliation(s)
- Mary M Mitchell
- Department of Mental Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
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Sayles JN, Hays RD, Sarkisian CA, Mahajan AP, Spritzer KL, Cunningham WE. Development and psychometric assessment of a multidimensional measure of internalized HIV stigma in a sample of HIV-positive adults. AIDS Behav 2008; 12:748-58. [PMID: 18389363 DOI: 10.1007/s10461-008-9375-3] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 03/10/2008] [Indexed: 02/06/2023]
Abstract
There is a need for a psychometrically sound measure of the stigma experienced by diverse persons living with HIV/AIDS (PLHA). The goal of this study was to develop and evaluate a multidimentional measure of internalized HIV stigma that captures stigma related to treatment and other aspects of the disease among sociodemographically diverse PLHA. We developed a 28-item measure of internalized HIV stigma composed of four scales based on previous qualitative work. Internal consistency reliability estimates in a sample of 202 PLHA was 0.93 for the overall measure, and exceeded 0.85 for three of the four stigma scales. Items discriminated well across scales, and correlations of the scales with shame, social support, and mental health supported construct validity. This measure should prove useful to investigators examining in the role of stigma in HIV treatment and health outcomes, and evaluating interventions designed to mitigate the impacts of stigma on PLHA.
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Affiliation(s)
- Jennifer N Sayles
- Division of General Internal Medicine and Health Services Research, UCLA, 911 Broxton Ave., Los Angeles, CA 90024, USA.
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Green DA, Devi S, Paulraj LS. Care centre visits to married people living with HIV: an indicator for measuring AIDS-related stigma & discrimination. AIDS Care 2008; 19:910-5. [PMID: 17712695 DOI: 10.1080/09540120701203253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We tested whether observation of the presence and relationship of attendants (i.e. those that accompany upon admission) and visitors to a sample of 230 (128 male, 102 female) married HIV-positive people in an HIV care centre provides an indicator of caregiving, AIDS-related stigma and discrimination. Sensitivity to gender, location (urban vs. rural), age (<35 yrs vs. >35) and source of infection (spouse vs. non-spouse) were factors considered to modulate AIDS-related stigma and assess discrimination. HIV-positive people were accompanied by their spouse (53%), mother (14%), father (7%), with only 7% attending alone. Immediate family most commonly accompanied on admission (80%), but visitors were mainly from the 'extended' family (32%) with many receiving no visitors (48%). Females (11%) were more likely than males to attend alone (11% vs. 4%; p<0.05). No effect of location, age or infector was obtained. Females were more likely to be visited by their mother (14% vs. 6%; p<0.01) and non-immediate family (39% vs. 27%; p<0.05) than males were. In contrast, fathers (0% vs. 6%; p <0.05) and spouses were less likely (3% vs. 10%; p<0.05) to visit females than males. No effect of location or age upon visitation was obtained. Non-spouse infected persons were less likely than spouse-infected to be visited by their spouse (3% vs. 10%; p<0.05) but more likely to receive 'extended' family visitation (43% vs. 24%; p<0.01). Spouse-infected persons had a higher rate of no visitors than persons not infected by their spouse (54% vs. 40%; p<0.05). Observation of the presence and relationship of attendants and visitors to HIV-positive people has potential as an indicator of caregiving AIDS-related stigma and discrimination. The measure appears particularly sensitive to the gender of the HIV-positive person. Such a measure may aid healthcare professionals to focus resources such as relational counselling upon the family and close friends of people experiencing AIDS-related stigma and discrimination, with the aim of improving the provision of care within the community.
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Affiliation(s)
- D A Green
- Department of Clinical Neuroscience, Imperial College London.
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Wight RG, Beals KP, Miller-Martinez D, Murphy DA, Aneshensel CS. HIV-related traumatic stress symptoms in AIDS caregiving family dyads. AIDS Care 2007; 19:901-9. [PMID: 17712694 DOI: 10.1080/09540120601163292] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study assesses HIV-related traumatic stress symptoms in 135 AIDS caregiving family dyads in which the caregiver is a midlife or older mother or wife, and the care-recipient is her HIV-infected adult son or husband. Symptoms of HIV-related traumatic stress can be reliably measured in these dyads, with both caregivers and care-recipients reporting avoidant and intrusive thoughts. Among care-recipients, high symptoms are associated with high daily living assistance requirements, low dyadic adjustment, and high constriction of social activities. Among caregivers, high symptoms of traumatic stress are associated with being HIV positive, feeling overloaded by caregiving demands, and perceiving high levels of HIV stigma. Caregiving mothers and wives may feel traumatized 'courtesy' of their loved one's HIV infection, the caregiving scenario, or the resultant caregiving stress.
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Affiliation(s)
- R G Wight
- Department of Community Health Sciences, University of California, Los Angeles School of Public Health, Los Angeles, CA 90095-1772, USA.
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Swendeman D, Rotheram-Borus MJ, Comulada S, Weiss R, Ramos ME. Predictors of HIV-related stigma among young people living with HIV. Health Psychol 2006; 25:501-9. [PMID: 16846325 PMCID: PMC2392891 DOI: 10.1037/0278-6133.25.4.501] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Enacted and perceived HIV stigma was examined among substance-using young people living with HIV (YPLH) in Los Angeles, San Francisco, and New York City (N = 147). Almost all YPLH (89%) reported perceived stigma, and 31% reported enacted experiences in the past 3 months; 64% reported experiences during their lifetime. The HIV stigma questions were characterized by factors of avoidance, social rejection, abuse, and shame. In multivariate models, enacted stigma was associated with gay or bisexual identity, symptomatic HIV or AIDS, and bartering sex. Perceived stigma was associated with female gender, symptomatic HIV or AIDS, bartering sex, lower injection drug use, and fewer friends and family knowing serostatus. Gay or bisexual YPLH who were also HIV symptomatic or AIDS diagnosed experienced more HIV stigma than their heterosexual peers.
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Affiliation(s)
- Dallas Swendeman
- University of California, Los Angeles AIDS Institute and Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, California, USA.
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