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Holland A, Freeman TP, Nicholls J, Burke C, Howkins J, Harris M, Hickman M, Attwood A, Carlisle V, Krykant P, Maynard OM. Making sense of drug use and dependence-A scoping review of mass media interventions intended to reduce stigma towards people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 132:104543. [PMID: 39226769 DOI: 10.1016/j.drugpo.2024.104543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND People who use drugs face entrenched stigma, which fosters shame, restricts service access, and exacerbates inequalities. The use of mass media in anti-stigma interventions offers an opportunity to challenge stigmatising attitudes at scale. There are, however, inconsistencies in messaging approaches used in mass media anti-stigma interventions, and how authors conceptualise and measure 'stigma'. METHODS This scoping review maps literature on the development and/or evaluation of mass media interventions intended to reduce stigma towards people who use drugs. We systematically searched seven databases for reports about: (i) people who use drugs, (ii) stigma, (iii) mass media. We charted data about intervention (i) subjects and recipients, (ii) format, (iii) authors, (iv) content; and (v) conceptualisation and measurement of stigma. We narratively synthesised findings with qualitative content analyses. RESULTS From 14,256 records, we included 49 reports about 35 interventions. 25/35 were from the last five years and 19/35 were from the United States. Intended recipients included the public and/or specified sub-populations, often including healthcare workers. Most interventions were intended to reduce stigma towards people with patterns of drug use perceived to be problematic, as opposed to people who use drugs in general. Interventions ranged from single pieces of media to complex multi-format campaigns. People who use(d) drugs contributed to 22/35 interventions. Professionals working in medical disciplines co-authored 29/35 interventions. Intervention content often had a medical focus, describing dependence as a 'disease' or medical issue, and emphasised the benefits of recovery. Other interventions, however, criticised medical framings. In some interventions drug use and people who use drugs were described in markedly negative terms. 'Stigma' was often under-theorised, and measurement approaches were inconsistent, with 42 instruments used to measure phenomena associated with stigma across 19 quantitative evaluations. CONCLUSION We found inconsistencies in approaches to reduce and measure stigma, potentially reflecting different motivations for intervention development. The primary motivation of many interventions was seemingly to promote drug service engagement and recovery.
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Affiliation(s)
- Adam Holland
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK; Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK; London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, UK.
| | - Tom P Freeman
- University of Bath, Department of Psychology, Addiction and Mental Health Group, Bath, UK
| | | | - Chloe Burke
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK; University of Bath, Department of Psychology, Addiction and Mental Health Group, Bath, UK
| | - Joshua Howkins
- Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK
| | - Magdalena Harris
- London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, UK
| | - Matthew Hickman
- Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK
| | - Angela Attwood
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK
| | - Vicky Carlisle
- Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK
| | - Peter Krykant
- Cranstoun, Thames Mews, Portsmouth Road, Esher, Surrey, UK
| | - Olivia M Maynard
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK
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Chu W, Tam CC, Harrison S. Associations between perceived discrimination experiences, treatment adherence self-efficacy, and depressive symptoms among people living with HIV in the Southern United States. AIDS Care 2024; 36:1382-1391. [PMID: 38623601 DOI: 10.1080/09540121.2024.2341231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Abstract
This study examined associations between perceived discrimination, treatment adherence self-efficacy, and depressive symptoms among people living with HIV (PLHIV) in the Southern United States. Cross-sectional survey data were collected from 402 PLHIV who self-reported on interpersonal discrimination experiences based on HIV status, sexuality, gender, income, and living condition. Participants also reported on adherence self-efficacy and depressive symptoms. We employed K-means clustering to identify groups based on discrimination experiences, and logistic regressions to examine group differences on adherence self-efficacy and depressive symptoms. Results suggested three groups: a cluster with high perceived discrimination across all identities/conditions (n = 41; 11%; Cluster 1); a cluster with high perceived discrimination based on HIV status, income, and living condition (n = 49; 13%; Cluster 2); and a cluster with low perceived discrimination across all identities/conditions (n = 288; 76%; Cluster 3). Compared to Cluster 3, Cluster 1 and 2 had 2.22 times (p = .037) and 3.98 times (p<.001) greater odds of reporting depressive symptoms. Compared to Cluster 3, Cluster 2 had 3.40 times (p = .003) greater odds of reporting lower adherence self-efficacy. Findings demonstrate the need for individual-level support for PLHIV with discrimination histories, and broader efforts to end the stigma, discrimination, and marginalization of PLHIV based on HIV status and other characteristics.
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Affiliation(s)
- Wendy Chu
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
| | - Cheuk Chi Tam
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Sayward Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
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Lin C, Diep NB, Nguyen L, Trang NT, Li L, Le MG. Navigating cultural and gender aspects of stigma among women living with HIV in Vietnam. CULTURE, HEALTH & SEXUALITY 2024; 26:1333-1349. [PMID: 38478464 PMCID: PMC11393182 DOI: 10.1080/13691058.2024.2318428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/09/2024] [Indexed: 04/21/2024]
Abstract
Women living with HIV often face intersecting challenges of stigma and gender inequality. In Vietnam, this issue is potentially exacerbated by the patriarchal culture. From December 2021 to March 2022, we conducted in-depth interviews with 30 women living with HIV in Hanoi to better understand their experiences and the coping mechanisms to navigate HIV stigma, cultural beliefs and gender norms. The interviews explored various topics including women's social and family roles in Vietnam, HIV-related beliefs, stigma and its impact on one's health and coping strategies. Participants reported stereotypes that assumed that women living with HIV had either engaged in sex work or behaved promiscuously. These stereotypes render them vulnerable to judgement and discrimination owing to widespread expectations of female virtue. As a result, women living with HIV often enacted non-disclosure and self-isolation to avoid stigma. This self-stigmatisation negatively impacted their healthcare-seeking, employment opportunities and ability to fulfil traditional family-caring roles. Conversely, many participants exhibited resilience with the support of family and peers. Overall, the complex interplay between gender, culture and HIV stigma underscores the importance of developing culturally appropriate, multifaceted approaches to engaging family and peers, modifying gender-based discriminatory social practices and enhancing women's self-efficacy and empowerment in Vietnam.
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Affiliation(s)
- Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California, Center for Community Health, Los Angeles, CA, USA
| | - Nguyen Bich Diep
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Lynn Nguyen
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nguyen Thu Trang
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Li Li
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California, Center for Community Health, Los Angeles, CA, USA
| | - Minh Giang Le
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Krulic T, Brown G, Graham S, McCarthy A, Bourne A. Stepping out of secrecy: heterosexuality, quality of life, and experiences of HIV peer navigation in Australia. CULTURE, HEALTH & SEXUALITY 2024; 26:1285-1300. [PMID: 38349774 DOI: 10.1080/13691058.2024.2308667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
Heterosexual people make up a small, but growing proportion of people living with HIV in Australia. This article draws on semi-structured interviews with thirteen heterosexual men and women living with HIV to examine the bearing that sexual identity had on their participation in a peer navigation programme. Our analyses consider the influence of sexuality and gender on the quality of peer relations and the effects of HIV-related stigma on health service engagement and quality of life. Gender and sexuality were significant factors in establishing understanding, acceptance, and community for participants. Having their heterosexuality mirrored by a peer was affirming for men. Women instead emphasised their gendered experiences of HIV. Otherwise, participants' narratives suggested that an experienced peer could reassure, guide interactions with community and services, and ease treatment-related and nonclinical aspects of life. We see peer navigation as a promising intervention to improve the quality of life for heterosexual people living with HIV. Person-centred support from a peer may be particularly important in HIV service environments adapting to the needs of heterosexual people. Peer navigation programmes should promote choice and employ peers of diverse experiences. Implications for referral and the improvement of social services for heterosexual people living with HIV are discussed.
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Affiliation(s)
- Timothy Krulic
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Living Positive Victoria, Melbourne, Australia
| | - Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Sara Graham
- Living Positive Victoria, Melbourne, Australia
| | - Anthony McCarthy
- Heterosexual Men's Advocacy Network (HetMAN), Melbourne, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Gázquez-López M, Álvarez-Serrano MA, Martín-Salvador A, Pérez-Morente MÁ, García-García I, González-García A, Martínez-García E. Attitudes towards people living with HIV/AIDS through the EAPVVS-E: A descriptive analysis in nursing students. NURSE EDUCATION TODAY 2024; 144:106418. [PMID: 39316862 DOI: 10.1016/j.nedt.2024.106418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 09/09/2024] [Accepted: 09/16/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Despite advances in antiretroviral treatment, stigma towards people with HIV/AIDS continues to exist. Nursing students, as future key players in health care, must advocate for the elimination of stigma through education, empathy and the creation of a supportive environment. This holistic approach is crucial to improving their quality of life and moving towards the eradication of HIV/AIDS. AIM To identify nursing students' attitudes towards people living with HIV or AIDS and their relationship with sociodemographic and academic-cultural variables of the participants. DESIGN A cross-sectional study was performed. SETTINGS The research was carried out in the Nursing Degree of the Faculty of Health Sciences of the Ceuta Campus of the University of Granada. PARTICIPANTS Convenience sampling was used to recruit 284 students of the degree in Nursing. METHODS Data were collected voluntarily and on an anonymous basis, using the "Attitudes Towards People Living with HIV/AIDS Scale in Nursing Students". Bivariate and multivariate analyses were performed. RESULTS Factors 1 (Professional Practice), 2 (Social Integration) and 3 (Partner and Family) exhibited mean scores considered to be favourable attitudes (>4 points). In contrast, Factor 4, called Benevolent Stigma, had a mean score of 3.68 ± 0.97. Religious beliefs, academic year, sexual orientation, academic practices and age are considered influential variables in the different factors. CONCLUSIONS Nursing students present attitudes with favourable scores. However, these results highlight the importance of influencing the different factors, especially in the second year of the Bachelor's Degree in Nursing in our sample. Thus, an educational intervention in this area would be necessary to reinforce the values of humanised care.
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Affiliation(s)
- María Gázquez-López
- Department of Nursing, Faculty of Health Sciences, University of Granada, 51001 Ceuta, Spain
| | | | - Adelina Martín-Salvador
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | | | - Alberto González-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Encarnación Martínez-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; Virgen de las Nieves University Hospital, 18014 Granada, Spain
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Wyrod R, Bravo M. From AIDS to COVID-19: the interplay between dual pandemics in social perceptions of disease. CULTURE, HEALTH & SEXUALITY 2024:1-15. [PMID: 39243172 DOI: 10.1080/13691058.2024.2401006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
This paper is one of the few to examine how people who have lived through both COVID-19 and AIDS understand these pandemics in relation to each other. Data were collected in Uganda, and we found that the AIDS epidemic proved to be a key reference point for people in explaining why COVID-19 was perceived as so worrisome. In addition, AIDS-related stigma was a problematically common frame when discussing responsibility for HIV versus SARS-CoV-2 infection, and there was evidence of some forgetfulness regarding the toll AIDS had taken on the country. More positively, the legacy of AIDS made many people more attentive to social inequalities tied to health risks, and this at times prompted a more nuanced understanding of the socially varied effects of COVID-19. Overall, we argue that how individuals respond to a novel epidemic is shaped not only by their understandings of current threats but also by enduring perceptions of epidemics and pandemics that may have preceded it.
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Affiliation(s)
- Robert Wyrod
- Department of Women and Gender Studies, International Affairs Program, University of Colorado, Boulder, CO, USA
| | - Matthew Bravo
- Department of Sociology, University of Colorado, Boulder, CO, USA
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Yan X. The impact of accent stigma on self-efficacy and acculturation strategy among international students in the United States. Front Psychol 2024; 15:1414282. [PMID: 39301003 PMCID: PMC11410617 DOI: 10.3389/fpsyg.2024.1414282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/26/2024] [Indexed: 09/22/2024] Open
Abstract
Introduction This paper aimed to understand international students' experience of accent stigma during interpersonal interactions, and how it affected their self-efficacy and acculturation strategy during intercultural adjustment. Methods Study 1 conducted in-depth interviews with 15 international students (60% female, 21.6 years old on average), asking for narratives on how they perceived accent stigma was enacted in everyday scenarios. Study 2 distributed a survey to 132 international students (53.5% female, 25.52 years old on average) with scales measuring perceived accent stigma, perceived discrimination, perceived hate, fear, self-efficacy, and integration into the host culture. Results Based on thematic analysis, Study 1 identified verbal disapproval, verbal avoidance, nonverbal disapproval, and nonverbal avoidance as four behavioral markers that signal the enactment of accent stigma during interpersonal interactions. Study 2 assessed a path model and found that accent stigma was associated with more perceived discrimination, perceived hate, and fear. Accent stigma also had negative impacts on self-efficacy, which in turn, resulted in poor integration into the host culture. Conclusion This study examined the negative consequences of accent stigma on international students and highlighted the role of self-efficacy during international students' intercultural adjustment. Findings had important theoretical and practical implications in terms of better supporting and serving international students during their stressful transitional period in a new culture.
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Affiliation(s)
- Xiaodi Yan
- China University of Political Science and Law, Beijing, China
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8
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Burrows K. Psych Unit Gangs: An Autoethnography. Cult Med Psychiatry 2024; 48:663-675. [PMID: 38913276 DOI: 10.1007/s11013-024-09866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 06/25/2024]
Abstract
The stigma against people with mental illness is a well-worn subject; however, stigma between groups of people with different mental illnesses is rarely discussed. Within the context of a psychiatric hospital, hierarchies form among patients based on symptomatology and diagnosis. In this perspectives piece, I explore, how, in my experiences with being on the bottom of this hierarchy as a person with a schizophrenia-spectrum psychotic illness in a psychiatric hospital. I, and my fellow "psychotics," were stigmatized and outcasted by other groups of individuals who were diagnosed with mental illnesses that are considered less serious than psychosis. I explore how one stigmatized, outcasted group (people with substance use and mood disorders) construct power relationships over an even more highly stigmatized, marginalized group (people with psychotic disorders). Utilizing Goffmanian and Tajfel theories, the perspective explores stigma within a total institution, and the formation of in-groups and out-groups. I explore how people, upon entering the psychiatric hospital unit, know almost immediately whether they belong to the dominant group or the subordinate group, and I conclude with recommendations to reduce the stigma of psychotic disorders within popular culture.
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Affiliation(s)
- Kathryn Burrows
- National Coalition of Independent Scholars, Brattleboro, VT, USA.
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Leal AF, Cazeiro CC, Mattos ACE, Hentges B, Teixeira LB, Knauth DR, Magno L, Dourado I, Vera MADSM. Profile and experiences during the incarceration of transgender women and travestis (TGW) in Brazil: a cross-sectional study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27Suppl 1:e240014.supl.1. [PMID: 39166586 PMCID: PMC11338535 DOI: 10.1590/1980-549720240014.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE The objective of the present study is to describe the sociodemographic and behavioral characteristics of a group of transgender women and travestis (TGW) with a history of incarceration and the institutional and social context of this experience in Brazil. METHODS The analyzed data were derived from the TransOdara Study, a cross-sectional study conducted in five Brazilian capitals from December 2019 to July 2021. Participants were recruited using the Respondent-Driven Sampling (RDS) technique, in which, after an initial formative and exploratory stage, the first participants were identified; in turn, these participants recruited up to six other transgender women and travestis for the research. The study's outcome was the experience of incarceration throughout life, captured through the question: "Have you ever been arrested in your life?" RESULTS A total of 1,245 TGW were interviewed, of which 20.3% (n=253) experienced incarceration. Incarceration was more frequent among those aged 33 to 42 years (35.6%), with lower level of education (45.5%, p<0.001), engaged in informal work (30.3%), without a partner (67.2%), and among those who reported illicit drug use (66.4%). The majority (60.9%) of TGW were incarcerated with cisgender men, and the most common reasons for imprisonment were drug trafficking (30.4%) followed by robbery (29.2%). Over a quarter of the interviewees (26.3%) experienced assault, and 13.8% reported experiencing sexual violence during incarceration. CONCLUSION The results emphasize the high prevalence of incarceration among TGW. This incarceration takes place in male wards and in a context of high rates of physical and sexual violence.
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Affiliation(s)
- Andréa Fachel Leal
- Universidade Federal do Rio Grande do Sul, Department of Sociology – Porto Alegre (RS), Brazil
| | - Cristine Coelho Cazeiro
- Universidade Federal do Rio Grande do Sul, Graduate Program in Epidemiology – Porto Alegre (RS), Brazil
| | | | - Bruna Hentges
- Universidade Federal do Rio Grande do Sul, Department of Sociology – Porto Alegre (RS), Brazil
| | | | - Daniela Riva Knauth
- Universidade Federal do Rio Grande do Sul, Department of Social Medicine – Porto Alegre (RS), Brazil
| | - Laio Magno
- Universidade do Estado da Bahia – Salvador (BA), Brazil
- Universidade Federal da Bahia – Salvador (BA), Brazil
| | - Inês Dourado
- Universidade Federal da Bahia – Salvador (BA), Brazil
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Nguyen AL, Polonijo AN, Galea JT, Yoo-Jeong M, Taylor J, Ruiz EL, Greene K, Lopez JL, Christenson C, Brown B. A community-academic partnered approach to designing a Virtual Village to address the needs of older adults living with HIV. AIDS Care 2024:1-9. [PMID: 39088383 DOI: 10.1080/09540121.2024.2383869] [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: 01/13/2024] [Accepted: 07/18/2024] [Indexed: 08/03/2024]
Abstract
ABSTRACTMany older adults living with HIV face unique challenges, including comorbidities, loneliness, and isolation. This community-academic partnered study elicited viewpoints from older adults living with HIV about the characteristics of a digital environment ("Virtual Village") to combat against loneliness and isolation. We utilized Choice-Based Conjoint Analyses to determine preferred attributes of a Virtual Village. We also conducted focus groups and interviews with older adults living with HIV and used an iterative, data-driven approach to systematically identify emergent themes. Participants (N = 82) were aged 50-82 years and racially/ethnically diverse. The majority were men (78%), gay (66%), and lived with HIV for ≥15 years (83%). Cost was the factor that most drove participants' preference for joining a Virtual Village. Thematic concerns included lack of technological confidence, internet access, potential for harassment in digital environments, privacy, and preference for in-person interactions. Praises centered on convenience and making connections across geographic distances. Participants emphasized the need for purposive strategies to form a cohesive and supportive community for older adults living with HIV. A moderated environment was recommneded to create a safe, structured, and comfortable digital environment for older adults living with HIV. A Virtual Village should be viewed as a bridge to in-person interactions.
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Affiliation(s)
- Annie L Nguyen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
| | - Andrea N Polonijo
- Department of Sociology and the Health Sciences Research Institute, University of California, Merced, CA, United States
| | - Jerome T Galea
- College of Behavioral and Community Sciences, School of Social Work, University of South Florida, Tampa, FL, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Moka Yoo-Jeong
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Jeff Taylor
- HIV+Aging Research Project-Palm Springs, Palm Springs, CA, United States
| | - Erik L Ruiz
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Karah Greene
- College of Behavioral and Community Sciences, School of Social Work, University of South Florida, Tampa, FL, United States
| | - Jasmine L Lopez
- Department of Psychology, University of California, Riverside, CA, United States
| | | | - Brandon Brown
- Riverside School of Medicine, Department of Social Medicine, Population and Public Health, University of California, San Diego, CA, United States
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Chong N, Azwa I, Hassan AA, Mousavi ME, Wong PL, Ng RX, Saifi R, Basri S, Omar SFS, Walters SM, Collier ZK, Haddad MS, Altice FL, Kamarulzaman A, Earnshaw VA. HIV Activist Identity, Commitment, and Orientation Scale (HAICOS): Psychometric Evaluation to Assess Clinician's Propensity Towards HIV Activism in Malaysia. AIDS Behav 2024; 28:2780-2792. [PMID: 38806844 DOI: 10.1007/s10461-024-04381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
HIV activism has a long history of advancing HIV treatment and is critical in dismantling HIV-related stigma. This study evaluated the psychometric quality of the HIV Activist Identity, Commitment, and Orientation Scale (HAICOS) to assess clinicians' propensity towards HIV activism in Malaysia. From November 2022 to March 2023, 74 general practitioners and primary care physicians in Malaysia participated in the study. The exploratory factor analysis (EFA) extracted an internally consistent three-factor solution with 13 items: (1) HIV activist identity and commitment, orientation towards (2) day-to-day, and (3) structural activism. The Cronbach's alpha value was 0.91, and intra-class correlation coefficient for test-retest reliability was 0.86. Stigma-related (prejudice and discrimination intent) and clinical practice (comfort in performing clinical tasks with key populations and knowledge about HIV pre-exposure prophylaxis) measures supported the construct validity of the scale. The study provided concise, structurally valid, and reliable measures to evaluate HIV activism among clinicians.
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Affiliation(s)
- Norman Chong
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia.
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Asfarina Amir Hassan
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
| | | | - Pui Li Wong
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rong Xiang Ng
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rumana Saifi
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sazali Basri
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Suzan M Walters
- School of Global Public Health, Department of Epidemiology, New York University, New York, USA
- Center for Drug Use and HIV/HCV Research, New York, USA
| | - Zachary K Collier
- Department of Educational Psychology, University of Connecticut, Connecticut, USA
| | - Marwan S Haddad
- Center for Key Populations, Community Health Center, Inc., Middletown Connecticut, USA
| | - Frederick L Altice
- Yale School of Public Health, Yale University, New Haven, USA
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, USA
| | - Adeeba Kamarulzaman
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, New York, USA
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Freire IM, Minayo MCDS. Trajectories of adolescents living with vertical transmission-HIV virus. CIENCIA & SAUDE COLETIVA 2024; 29:e05172024. [PMID: 39140535 DOI: 10.1590/1413-81232024298.05172024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/27/2024] [Indexed: 08/15/2024] Open
Abstract
This study analyzes the life stories of eight young people living with vertically transmitted HIV in order to understand their perceptions marked by secrecy and silence regarding their experiences with the virus. Conducted at a specialized outpatient clinic in Rio de Janeiro, the study adopted circle dance, a Complementary and Integrative Health Practice, as a care tool. Using a qualitative approach and Life History as a data collection method, the focus was to understand the youth's experiences related to the disease and the crucial aspects of their lives. Three girls and five boys participated in the study, all aware of their diagnosis. The principal emerging themes included family dynamics, school environment connection, challenges in treatment adherence, age at the time of diagnosis disclosure, and time elapsed since then. Analyzing these young people's narratives allowed us to explore individual and social aspects of their experiences, revealing their similarities and differences. The circle dance workshops provided a playful space for expressing emotions and feelings through body movements, expanding young people's perspectives on the future.
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Affiliation(s)
- Imara Moreira Freire
- Instituto Fernandes Figueira (IFF), Fundação Osvaldo Cruz (Fiocruz). Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Maria Cecília de Souza Minayo
- Departamento de Estudos Sobre Violência e Saúde Jorge Careli (Claves), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fiocruz. Rio de Janeiro RJ Brasil
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Zulu JM, Budhwani H, Wang B, Menon A, Kim D, Zulu M, Nyamaruze P, Govender K, Armstrong R. Living a private lie: intersectional stigma, depression and suicidal thoughts for selected young key populations living with HIV in Zambia. BMC Public Health 2024; 24:1937. [PMID: 39030515 PMCID: PMC11264630 DOI: 10.1186/s12889-024-19278-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/26/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Limited research has been conducted on the forms, manifestations and effects of intersectional stigma among young HIV-positive men who have sex with men (MSM) and transgender women (TGW) in Zambia. In this study, we aimed to address this gap by elucidating the experiences of these in a small group of young, HIV + MSM and TGW in Zambia. METHODS We applied a mixed-methods design. Data were collected from January 2022 to May 2022. Qualitative data were collected using in-depth interviews while quantitative data were collected using a questionnaire. Qualitative transcripts were coded using thematic analysis while paper-based questionnaire data were entered into Kobo Connect. Descriptive statistics, using chi-squared tests were calculated using Excel. In this paper, we provide a descriptive profile of the sample and then focus on the qualitative findings on intersectional stigma, depression, and contemplation of suicide. RESULTS We recruited 56 participants from three sites: Lusaka, Chipata, and Solwezi districts. Participants' mean age was 23 years. The study found that 36% of all participants had moderate to significant symptoms of depression, 7% had major depression, 30% had moderate signs of anxiety, 11% had high signs of anxiety, 4% had very high signs of anxiety and 36% had contemplated suicide at least once. A greater proportion of TGW had moderate to significant symptoms of depression (40%) or major depression (10%) compared to MSM, at 33% and 6%, respectively (X2 = 0.65; p = 0.42). Similarly, more TGW (55%) had contemplated suicide than MSM peers (36%, X2=1.87; p = 0.17). In the qualitative data, four emergent themes about the forms, manifestations, and effects of intersectional stigma were (1) HIV, sexual orientation, and gender identity disclosure; (2) Dual identity; (3) Challenges of finding and maintaining sexual partners; (4) Coping and resilience. Overall, having to hide both one's sexuality and HIV status had a compounding effect and was described as living "a private lie." CONCLUSION Effectively addressing stigmas and poor mental health outcomes among young HIV-positive MSM and TGW will require adopting a socio-ecological approach that focuses on structural interventions, more trauma-informed and identity-supportive care for young people with HIV, as well as strengthening of authentic community-informed public health efforts.
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Affiliation(s)
- Joseph Mumba Zulu
- Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
- Center for Community Health Systems and Implementation Research, Lusaka, Zambia.
| | - Henna Budhwani
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, UMass Chan Medical, School 368 Plantation Street, Worcester, MA, 01605, US
| | - Anitha Menon
- Department of Psychology, School of Humanities and Social Sciences, University of Zambia, Box 32379, Lusaka, Zambia
- Psychology Program, School of Liberal Studies, University of Petroleum and Energy Sciences, Dehradun, India
- Liberal Arts Department, Rochester Institute of Technology, Dubai, UAE
| | - Deogwoon Kim
- Department of Population and Quantitative Health Sciences, UMass Chan Medical, School 368 Plantation Street, Worcester, MA, 01605, US
| | - Mirriam Zulu
- Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Patrick Nyamaruze
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Russell Armstrong
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
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14
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Negarandeh R, Shahmari M, Zare L. Stigmatization experiences of healthcare workers in the context of the COVID-19 pandemic: a scoping review. BMC Health Serv Res 2024; 24:823. [PMID: 39020333 PMCID: PMC11253434 DOI: 10.1186/s12913-024-11300-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, healthcare workers face the stigmatization of those caring for COVID-19 patients, creating a significant social problem. Therefore, this study investigated the stigmatization of healthcare workers in the context of the COVID-19 pandemic. METHODS In this scoping review study, searches were conducted from December 2019 to August 2023 in Persian and English using various databases and search engines including PubMed (Medline), Embase, Scopus, ISI Web of Science, ProQuest, Science Direct, Springer, Cochrane Library, Google Scholar, and national databases. The study used English keywords such as Social Stigma, Health Personnel, Healthcare Worker, Medical Staff, Medical Personal, Physicians, doctors, Nurses, nursing staff, COVID-19, and coronavirus disease 2019, and their Persian equivalents, and their Persian equivalents to explore healthcare workers' experiences of COVID-19-related stigma. RESULTS From a total of 12,200 search results, 77 eligible studies were included in this study. stigmatization of healthcare workers caring for COVID-19 patients was evident from the literature because of fear, misinformation, and negative self-image. Manifestations were violence and deprivation of social rights, resulting in adverse biopsychosocial, occupational, and economic consequences. This condition can affect negatively health staff themselves, their families, and society as well. Anti-stigmatization measures include informing society about the realities faced by healthcare workers, presenting an accurate and empathetic image of health workers, providing psychosocial support to health workers, and encouraging them to turn to spirituality as a coping mechanism. There are notable research gaps in comprehending the phenomenon, exploring its variations across diverse healthcare roles and cultural contexts, examining its long-term effects, and monitoring shifts in stigma perceptions over time. CONCLUSION The COVID-19 pandemic has resulted in the stigmatization of healthcare workers, causing mistreatment and rights violations. This stigma persists even post-pandemic, posing a psychological dilemma for caregivers. Addressing this requires comprehensive strategies, including tailored stigma prevention programs and research to understand its psychological impact.
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Affiliation(s)
- Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehraban Shahmari
- Department of Medical-Surgical, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Leily Zare
- Department of Medical Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Dennermalm N, Sjöland CF, Christiansen M, Nilsson Schönnesson L, Laine K, Kanon E, Suarez D, Ekström AM, Mølsted Alvesson H. Growing up in the shadow of HIV: post-AIDS generation of HIV-negative men who have sex with men in Sweden and their perceptions of HIV and stigma. CULTURE, HEALTH & SEXUALITY 2024:1-15. [PMID: 39012361 DOI: 10.1080/13691058.2024.2375608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/29/2024] [Indexed: 07/17/2024]
Abstract
Despite growing understanding and acceptance of the concept of Undetectable = Untransmittable (U = U) among gay men, HIV stigma remains a burden for people living with HIV. This study explored perceptions of HIV among HIV seronegative gay men in Sweden in this new context. Using snowball sampling, 15 gay men born between 1980 and 2000 were recruited to the study. Semi-structured interviews were conducted and data were subjected to reflexive thematic analysis. Men grew up experiencing gay stigma and were repeatedly informed by parents, schools, communities, peers, and popular culture about the dangers of HIV, and that gay men were a high-risk group. As men grew older, and the premise of HIV shifted dramatically due to U = U, some remained emotionally anchored to the pre-U = U era, while others realigned their perceptions, often after a process of reconciling emotional responses (e.g. HIV = death) with the logical-rational claims made about U = U. The study highlights key areas for future efforts, namely establishing a balance between HIV education strategies and stigma reduction initiatives. Study findings underscore the need to care for the memory of those lost during the crisis years, while also addressing the stigma faced by those currently living with HIV.
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Affiliation(s)
- Nicklas Dennermalm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Carl Fredrik Sjöland
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Public Health Agency of Sweden, Solna, Sweden
| | - Mats Christiansen
- Department of Public Health and Care Science, Uppsala University, Uppsala, Sweden
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | | | | | | | | | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease/Venhälsan, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
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Kamila A, Widyawati W, Hasanbasri M, Hakimi M. Capturing the HIV-related social exclusion practices experienced by key populations through photovoice: an interpretative phenomenological study. Reprod Health 2024; 21:107. [PMID: 39004733 PMCID: PMC11247771 DOI: 10.1186/s12978-024-01832-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 06/16/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Key populations are defined as groups that are susceptible to HIV, including Men Sex with Men (MSM), Transgender (TG), Persons who Inject Drug (PID), and Female Sex Worker (FSW). These key populations groups are among the fastest-growing populations in Indonesia. These vulnerable groups are ostracized by society and health services, which makes it difficult to get treatment. This project was carried out to investigate the different experiences and perspectives of these key populations in facing and addressing social and spiritual exclusion. METHODS A qualitative phenomenological study using photovoice was carried out from July to December 2022. Key populations comprising MSM, TG, PID, and FSW were recruited from community-based peer groups in West Bandung Regency using snowball sampling. This was followed by the Photovoice stages, from workshops to focus group discussions and interviews with audio recordings. Furthermore, thematic data analysis was carried out by interpretative participant narratives and photographs supported by Atlas.ti software. RESULT Eighteen participants comprising four MSM, five TG, four PIDs, and five FSWs participated in this research. Among these eighteen participants, six were HIV-negative, including 3 PIDs and 3 FSWs, while the remaining were positive. The analysis of the collected data identified four main themes: 1) limited access like unequal treatment, disadvantage, and harassment, 2) social and spiritual impact, 3) coping mechanisms, and 4) self-reflection through photovoice. These results showed that social exclusion occurred in an environment where community values, beliefs, and norms dehumanised these key populations, and where removal of support and care was prominent. Despite these challenges, participant resilience was evidenced by using internal resources and peer support as coping mechanisms. The participants considered photovoice as a tool to foster self-confidence and self-awareness through a reflective process. CONCLUSIONS The findings of this study highlight the emphasis on participants' openness in sharing their experiences, which can build empathy and promote a more inclusive community in HIV prevention efforts. This research findings can be used to inform HIV policy and practice and inclusion of these key populations in the community. We advocate making the photovoice efforts accessible to a wider audience through exhibitions and various media.
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Affiliation(s)
- Ami Kamila
- Doctoral Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Health Science, Universitas 'Aisyiyah Bandung, Bandung, West Java, Indonesia
| | - Widyawati Widyawati
- Pediatric and Maternity Nursing Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Mubasysyir Hasanbasri
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohammad Hakimi
- Obstetrics and Gynecology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Hanson OR, Weglarz AJ, Barabara ML, Cohen SR, Minja LM, Mlay PS, Stephens MJ, Olomi GA, Mlay J, Mmbaga BT, Watt MH. HIV-related Shame among Women Giving Birth in Tanzania: A Mixed Methods Study. AIDS Behav 2024; 28:2276-2285. [PMID: 38526642 DOI: 10.1007/s10461-024-04322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
Women living with HIV (WLHIV) commonly experience HIV-related shame which can interfere with HIV care-seeking behavior and lead to poor clinical outcomes. HIV-related shame may be particularly heightened during the pregnancy and postpartum periods. This study aimed to describe HIV-related shame among WLHIV giving birth, identify associated factors, and qualitatively examine the impacts of HIV-related shame on the childbirth experience. Postpartum WLHIV (n = 103) were enrolled in the study between March and July 2022 at six clinics in the Kilimanjaro Region, Tanzania. Participants completed a survey within 48 h after birth, prior to being discharged. The survey included a 13-item measure of HIV-related shame, which assessed levels of HIV-related shame (Range: 0-52). Univariable and multivariable regression models examined factors associated with HIV-related shame. Qualitative in-depth interviews were conducted with pregnant WLHIV (n = 12) and postpartum WLHIV (n = 12). Thematic analysis, including memo writing, coding, and synthesis, was employed to analyze the qualitative data. The survey sample had a mean age of 29.1 (SD = 5.7), and 52% were diagnosed with HIV during the current pregnancy. Nearly all participants (98%) endorsed at least one item reflecting HIV-related shame, with an average endorsement of 9 items (IQR = 6). In the final multivariable model, HIV-related shame was significantly associated with being Muslim vs. Christian (ß = 6.80; 95%CI: 1.51, 12.09), attending less than four antenatal care appointments (ß = 5.30; 95%CI: 0.04, 10.55), and reporting experiences of HIV stigma in the health system (ß = 0.69; 95%CI: 0.27, 1.12). Qualitative discussions revealed three key themes regarding the impact of HIV-related shame on the childbirth experience: reluctance to disclose HIV status, suboptimal adherence to care, and the influence on social support networks. WLHIV giving birth experience high rates of HIV-related shame, and social determinants may contribute to feelings of shame. HIV-related shame impacts the childbirth experience for WLHIV, making the labor and delivery setting an important site for intervention and support.The study is funded by the National Institutes of Health (R21 TW012001) and is registered on clinicaltrials.gov (NCT05271903).
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Affiliation(s)
- Olivia R Hanson
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Anya J Weglarz
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | | | - Susanna R Cohen
- Department of Obstetrics and Gynecology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Pendo S Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Maya J Stephens
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Gaudensia A Olomi
- Health Management Department, Kilimanjaro Regional Secretary's Office, Moshi, Tanzania
| | - Janeth Mlay
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Melissa H Watt
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
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Camlin CS, Arunga T, Johnson‐Peretz J, Akatukwasa C, Atwine F, Onyango A, Owino L, Kamya MR, Petersen ML, Chamie G, Kakande E, Kabami J, Balzer LB, Havlir DV, Ayieko J. Client experiences with "Dynamic Choice Prevention," a model for flexible patient-centred HIV prevention delivery in rural Eastern Africa. J Int AIDS Soc 2024; 27:e26336. [PMID: 39020454 PMCID: PMC11254577 DOI: 10.1002/jia2.26336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 07/02/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Identifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients' experiences of this "dynamic choice prevention model" (DCP) and highlight pathways of action to inform HIV prevention delivery models. METHODS In-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes. RESULTS Individuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners' behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure. CONCLUSIONS Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities-but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.
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Affiliation(s)
- Carol S. Camlin
- University of California, San Francisco (UCSF), Obstetrics, Gynecology & Reproductive SciencesSan FranciscoCaliforniaUSA
| | - Titus Arunga
- Kenya Medical Research Institute (KEMRI)KisumuKenya
| | - Jason Johnson‐Peretz
- University of California, San Francisco (UCSF), Obstetrics, Gynecology & Reproductive SciencesSan FranciscoCaliforniaUSA
| | | | | | | | | | - Moses R. Kamya
- Infectious Diseases Research CollaborationKampalaUganda
- Department of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Maya L. Petersen
- University of California, Berkeley, Biostatistics, Epidemiology, and Computational Precision HealthBerkeleyCaliforniaUSA
| | - Gabriel Chamie
- University of California, San Francisco (UCSF), MedicineSan FranciscoCaliforniaUSA
| | | | - Jane Kabami
- Infectious Diseases Research CollaborationKampalaUganda
| | - Laura B. Balzer
- University of California, Berkeley, Biostatistics, Epidemiology, and Computational Precision HealthBerkeleyCaliforniaUSA
| | - Diane V. Havlir
- University of California, San Francisco (UCSF), MedicineSan FranciscoCaliforniaUSA
| | - James Ayieko
- Kenya Medical Research Institute (KEMRI)KisumuKenya
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Brener L, Cama E, Broady T, Harrod ME, Holly C, Caruana T, Beadman K, Treloar C. Experiences of stigma and subsequent reduced access to health care among women who inject drugs. Drug Alcohol Rev 2024; 43:1071-1079. [PMID: 38271084 DOI: 10.1111/dar.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Research into stigma and injecting drug use has typically involved predominantly male participants, with limited research about the unique experience of women who inject drugs. METHODS This study used survey methods to assess reduced access to health care due to stigma among a sample of women who inject drugs. Women (n = 232) completed a survey as part of a broader national study of people who inject drugs. RESULTS Only 46 (19.9%) women reported that they had not experienced any injecting drug use-related stigma in the past year and most commonly noted 'sometimes' experiencing injecting-related stigma (36.8%) with more than 75% of women reporting that health workers had treated them negatively because of their injecting drug use. Most women undertook strategies to prevent experiencing stigma, such as not disclosing drug use to a health worker (81.3%), not attending follow-up appointments (76.7%) and delaying accessing health care (76.8%). Women with lower levels of personal wellbeing, who had experienced poorer treatment by health workers, had engaged in greater past month injecting, were employed and identified as lesbian, gay, bisexual, transgender or queer (LGBTQ) reported more reduced access to health care. DISCUSSION AND CONCLUSIONS Stigma has concerning health care implications for women who inject drugs and this research highlights the importance of understanding the impact of stigma in impeding health care access. Public health interventions should focus on addressing the systemic factors that reduce health care access for women who inject and take account of the impact of stigma in diminishing the quality and accessibility of health care for this group.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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20
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de la Rosa T, Scorza FA. Contextualizing stigma in Parkinson's disease research. Clinics (Sao Paulo) 2024; 79:100425. [PMID: 38943705 PMCID: PMC11261289 DOI: 10.1016/j.clinsp.2024.100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/10/2024] [Indexed: 07/01/2024] Open
Affiliation(s)
- Tomás de la Rosa
- Neuroscience Department, Universidad de Cádiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Fúlvio Alexandre Scorza
- Neurology Department, Escola Paulista de Medicina Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Aggarwal A, Zhang R, Qiao S, Wang B, Lwatula C, Menon A, Ostermann J, Li X, Harper G. Stigmatizing clinical setting erodes physician-patient interaction quality for sexual minority men through perceived HIV stigma and HIV infection concerns in Zambia. AIDS Care 2024; 36:797-806. [PMID: 38437705 DOI: 10.1080/09540121.2024.2324288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
This study investigated whether perceived HIV stigma and HIV infection concerns among healthcare providers (HCPs) mediate the association between stigmatizing clinical setting and their interaction quality with sexual minority men (SMM) patients in Zambia. In 2021, a cross-sectional survey was conducted with 91 HCPs offering HIV-related services to SMM in Zambia. Path analysis was conducted to examine the potential mediation effect of "perceived HIV stigma" and "HIV infection concern" among HCPs in the association between "stigmatizing clinical setting" and their "interaction quality with SMM". Mediators i.e., "perceived HIV stigma" and "HIV infection concern" among HCPs, were associated positively with the stigmatizing clinical setting (β = 0.329, p < .01, β = 0.917, p < 0.01), and negatively with physician-patient interaction quality (β = -0.167, p = 0.051; β = -0.126, p < 0.05). Stigmatizing clinical setting had a significant and negative indirect effect on HCPs interaction quality with SMM through increased perceived HIV stigma (z = -1.966, p < 0.05) and increased HIV infection concern (z = -1.958, p = 0.050). To improve physician-patient interaction quality, stigma reduction interventions among HCPs, who serve SMM in Zambia, should target development of development of inclusive policies and the cultivation of cultural norms that are supportive and respectful to SMM, and protection of HCPs from enacted stigma due to offering care to SMM.
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Affiliation(s)
- Abhishek Aggarwal
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Ran Zhang
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Bo Wang
- Population and Quantitative Health Sciences, University of Massachusetts, Boston, USA
| | | | - Anitha Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Jan Ostermann
- Department of Health Service Policy and Management, University of South Carolina, Columbia, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Gary Harper
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, USA
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França M, Dourado I, Grangeiro A, Greco D, Magno L. Racial HIV Testing Inequalities in Adolescent Men who have Sex with Men and Transgender Women in Three Brazilian Cities. AIDS Behav 2024; 28:1966-1977. [PMID: 38526640 DOI: 10.1007/s10461-024-04297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/27/2024]
Abstract
Many barriers to human immunodeficiency virus (HIV) testing among Black people exist. This study analysed the association between race/skin colour and lifetime HIV testing among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in three Brazilian cities. This cross-sectional study was nested within the PrEP1519 cohort, a multicentre study of AMSM and ATGW aged 15-19 years in Belo Horizonte, Salvador, and São Paulo, Brazil. The outcome variable was the lifetime HIV testing (no or yes). The main exposure variable was self-reported race/skin colour as White and a unique Black group (composed of Pardo-mixed colour and Black, according to the Brazilian classification). Descriptive statistics and bivariate and multiple logistic regression analyses were conducted to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) to determine the association between the main exposure and outcome, adjusted for covariates. White adolescents were tested more frequently than the unique Black group (64.0% vs. 53.7%, respectively; Ρ = 0.001). Multiple logistic regression analysis showed that the unique Black group of AMSM and ATGW had 26% (adjusted OR [aOR], 0.74; 95% CI, 0.55-0.98) and 38% (aOR, 0.62; 95% CI, 0.45-0.87) lower odds of being tested for HIV in a lifetime than Whites in model 1 and 2, respectively. Our findings highlight the role of racism in lifetime HIV testing among AMSM and ATGW. Therefore, an urgent need for advances exists in public policies to combat racism in Brazil.
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Affiliation(s)
- Marcus França
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Alexandre Grangeiro
- Faculdade de Medicina Preventiva, Universidade de São Paulo, São Paulo, Brazil
| | - Dirceu Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
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Nilsson Schönnesson L, Dahlberg M, Reinius M, Zeluf-Andersson G, Ekström AM, Eriksson LE. Prevalence of HIV-related stigma manifestations and their contributing factors among people living with HIV in Sweden - a nationwide study. BMC Public Health 2024; 24:1360. [PMID: 38769531 PMCID: PMC11106865 DOI: 10.1186/s12889-024-18852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND With access to antiretroviral therapy (ART) HIV infection is a chronic manageable condition and non-sexually transmissible. Yet, many people living with HIV still testify about experiencing HIV-related stigma and discrimination. It is well-documented that HIV-related stigma and discrimination continue to be critical barriers to prevention, treatment, care and quality of life. From an individual stigma-reduction intervention perspective, it is essential to identify individual and interpersonal factors associated with HIV-related stigma manifestations. To address this issue and to expand the literature, the aim of this study was to assess the prevalence of HIV-related stigma manifestations and their associated factors among a diverse sample of people living with HIV in Sweden. METHOD Data from 1 096 participants were derived from a nationally representative, anonymous cross-sectional survey "Living with HIV in Sweden". HIV-related stigma manifestations were assessed using the validated Swedish 12-item HIV Stigma Scale encompassing four HIV-related stigma manifestations: personalised stigma, concerns with public attitudes towards people living with HIV, concerns with sharing HIV status, and internalized stigma. Variables potentially associated with the HIV-related stigma manifestations were divided into four categories: demographic characteristics, clinical HIV factors, distress and ART adherence, and available emotional HIV-related support. Four multivariable hierarchical linear regression analyses were employed to explore the associations between multiple contributors and HIV-related stigma manifestations. RESULTS The most dominating stigma feature was anticipation of HIV-related stigma. It was manifested in high scores on concerns with sharing HIV status reported by 78% of the participants and high scores on concerns about public attitudes towards people living with HIV reported by 54% of the participants. High scores on personalised stigma and internalized stigma were reported by around one third of the participants respectively. Between 23 and 31% of the variance of the four reported HIV-related stigma manifestations were explained mainly by the same pattern of associated factors including female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support. CONCLUSION The most dominating stigma feature was anticipation of stigma. Female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support constituted potential vulnerability factors of the four HIV-related stigma manifestations. Our findings highlight the vital necessity to support people living with HIV to increase their resilience to stigma in its different forms. Exploring associated factors of HIV-related stigma manifestations may give an indication of what circumstances may increase the risk of stigma burden and factors amenable to targeted interventions. As individual stigma-reductions interventions cannot be performed isolated from HIV-related stigma and discrimination in society, a key challenge is to intensify anti-stigma interventions also on the societal level.
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Affiliation(s)
| | - Marie Dahlberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna-Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital/Venhälsan, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Psychological Sciences, City, University of London, London, UK
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
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Charlesworth TES, Hatzenbuehler ML. Mechanisms upholding the persistence of stigma across 100 years of historical text. Sci Rep 2024; 14:11069. [PMID: 38744930 PMCID: PMC11094178 DOI: 10.1038/s41598-024-61044-z] [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: 10/03/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024] Open
Abstract
Today, many social groups face negative stereotypes. Is such negativity a stable feature of society and, if so, what mechanisms maintain stability both within and across group targets? Answering these theoretically and practically important questions requires data on dozens of group stereotypes examined simultaneously over historical and societal scales, which is only possible through recent advances in Natural Language Processing. Across two studies, we use word embeddings from millions of English-language books over 100 years (1900-2000) and extract stereotypes for 58 stigmatized groups. Study 1 examines aggregate, societal-level trends in stereotype negativity by averaging across these groups. Results reveal striking persistence in aggregate negativity (no meaningful slope), suggesting that society maintains a stable level of negative stereotypes. Study 2 introduces and tests a new framework identifying potential mechanisms upholding stereotype negativity over time. We find evidence of two key sources of this aggregate persistence: within-group "reproducibility" (e.g., stereotype negativity can be maintained by using different traits with the same underlying meaning) and across-group "replacement" (e.g., negativity from one group is transferred to other related groups). These findings provide novel historical evidence of mechanisms upholding stigmatization in society and raise new questions regarding the possibility of future stigma change.
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Affiliation(s)
- Tessa E S Charlesworth
- Kellogg School of Management, Northwestern University, 2211 Campus Dr, Evanston, IL, 60208, USA.
| | - Mark L Hatzenbuehler
- Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA, 02138, USA
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Weinstein ER, Mendez NA, Jones MA, Safren SA. The impact of syndemic burden, age, and sexual minority status on internalized HIV stigma among people living with HIV in South Florida. J Health Psychol 2024:13591053241249633. [PMID: 38738485 DOI: 10.1177/13591053241249633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Internalized HIV stigma has been associated with several poor mental and physical health outcomes among people living with HIV (PLWH); yet, little research has explored how internalized HIV stigma may be affected by syndemic burden. This study sought to examine the relationship between syndemic conditions and HIV stigma over and above the potential effects of two social determinants of health, age and sexual minority status, using a linear regression approach (N = 1343). Syndemic burden was significantly positively associated with internalized HIV stigma above and beyond the effects of age and sexual minority status (b = 0.23). Additionally, age (b = -0.02) and being a sexually minority (b = -0.31) were significantly negatively associated with internalized HIV stigma. Findings should inform future treatment targets for this population by specifically working to reduce internalized HIV stigma for people with a greater syndemic burden and, potentially, among young adults and heterosexual PLWH.
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Affiliation(s)
| | | | - Megan A Jones
- Milken Institute School of Public Health, George Washington University, USA
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26
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Gittings L, Hodes R, Kom P, Mbula S, Pantelic M. 'Remember there is that thing called confidentiality': experiences of institutional discrimination in the health system among adolescent boys and young men living with HIV in the Eastern Cape province of South Africa. CULTURE, HEALTH & SEXUALITY 2024; 26:575-587. [PMID: 37480578 DOI: 10.1080/13691058.2023.2232023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/28/2023] [Indexed: 07/24/2023]
Abstract
Adolescents and men are two populations that perform poorly within the HIV cascade of care, having worse AIDS-related health outcomes, and experiencing higher levels of HIV-related stigma. This paper explores institutional health system discrimination as experienced by adolescent boys with perinatally-acquired HIV, situating them within the social and gendered contexts of the Eastern Cape Province, South Africa. Life history narratives (n = 36) and in-depth semi-structured interviews (n = 32) with adolescent boys living with HIV aged 13-22 were conducted in 2017-2018. In-depth semi-structured interviews with biomedical and traditional health practitioners (n = 14), analysis of health facility files (n = 41) and clinic observations were also conducted. Together, triangulated sources point to an incongruence between the complex needs of adoelscent boys and young men living with HIV and their experiences within the health system. Two institutional discrimination-related deterrents to retention in care were identified: (1) lack of confidentiality due to health facility layouts and practices that visibilised people living with HIV; and (2) mistreatment in the form of shouting. This article contributes to the limited literature on the experiences of young men within the HIV continuum of care, focusing on how stigma influences how young men experience and engage with the health sector.
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Affiliation(s)
- Lesley Gittings
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Rebecca Hodes
- Department of Anthropology, Archaeology and Social Development, Humanities Faculty, Pretoria University, South Africa
| | - Phakamani Kom
- Oxford Research South Africa, East London, South Africa
| | | | - Marija Pantelic
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Azhar S, Ahmad I, Guzman Herrera MM, Tariq N, Lerner R. "I would prefer to be dead than to live this way": Lived experiences of stigma and discrimination against khwaja sira in Swat, Pakistan. Glob Ment Health (Camb) 2024; 11:e60. [PMID: 38774887 PMCID: PMC11106546 DOI: 10.1017/gmh.2024.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/28/2024] [Accepted: 04/17/2024] [Indexed: 05/24/2024] Open
Abstract
Due to their identification as third gender people, khwaja sira have historically been subjected to experiences of social marginalization. However, the extant literature has not fully explored the lived experiences of stigma and discrimination against khwaja sira in the Swat Valley of Khyber Pakhtunkhwa, Pakistan. To address this gap, we conducted 45 interviews with khwaja sira in Mingora, Swat, Khyber Pakhtunkhwa to better understand their experiences of gender-nonconformity stigma and discrimination in various social contexts, including within their families, in accessing health care, and within education and work contexts. Applying Minority Stress Theory and utilizing thematic content analysis, the present study identified three dimensions of gender-nonconformity stigma: (1) internalized stigma, namely feelings of shame and embarrassment; (2) perceived stigma, namely opinions others had of khwaja sira regarding lack of employability or engagement in sex work; and (3) enacted stigma, namely exclusion from families, in educational settings, in religious spaces, and in healthcare settings. Findings should inform future social intervention and community practice engagements with khwaja sira communities in Pakistan.
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Affiliation(s)
- Sameena Azhar
- Graduate School of Social Service, Fordham University,New York, NY, USA
| | - Imtyaz Ahmad
- Graduate School of Social Service, Fordham University,New York, NY, USA
- Department of Political Science, Hazara University, Mansehra, Pakistan
| | | | - Nadeem Tariq
- Department of Pakistan Studies, National University of Modern Languages (NUML), Islamabad, Pakistan
| | - Riya Lerner
- Graduate School of Social Service, Fordham University,New York, NY, USA
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28
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Guise A. Stigma power in practice: Exploring the contribution of Bourdieu's theory to stigma, discrimination and health research. Soc Sci Med 2024; 347:116774. [PMID: 38537331 DOI: 10.1016/j.socscimed.2024.116774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/08/2024] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
Stigma and discrimination are increasingly understood as shaping health, and in turn conceptualised as social processes shaped by power and structural inequities. A challenge to analysis and implementing interventions is developing theory that can integrate analysis of structure, agency and power. One theoretical framework already promoted by prominent scholars as supporting this need is Bourdieu's social practice theory. This paper explores the application to date of Bourdieu's theory on stigma, discrimination and health. The paper describes how existing health literature has used concepts of symbolic violence, fields, capitals and habitus to develop insight into stigma power. The discussion explores how this theoretical framework is though underutilised and there has been little consideration of new programmatic approaches based on this theory. Directions for future research include the need for integrated approaches to analysis, especially using habitus to explore stigma power, and addressing processes of change. Directions for conceptualising interventions address how a mismatch of field and habitus could foster change and then the role for prophets in fostering symbolic revolutions. All these potential directions must in turn be integrated within the vast scholarship on stigma. In conclusion, further application and development of Bourdieu's social practice theory could help address the theoretical challenges facing the field of stigma, discrimination and health research.
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Affiliation(s)
- Andy Guise
- King's College London, 5(t,h) Floor, Addison House, Guy's Campus, London, SE1 3UL, UK.
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29
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Makki A, Day C, Chaar BB. Professional stigma towards clients with methamphetamine use disorder - a qualitative study. J Pharm Policy Pract 2024; 17:2306869. [PMID: 38456180 PMCID: PMC10919299 DOI: 10.1080/20523211.2024.2306869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background Methamphetamine use disorder (MUD) is associated with poor health outcomes. Pharmacists play a role in delivery of substance use treatment, with several studies having examined their attitudes to people with opioid use disorder, but little is known about their attitude towards people with MUD. This study aimed to explore pharmacists' perspectives on the provision of services to clients with MUD. Methods A convenience sampling strategy was used to recruit community pharmacists across Sydney, Australia. Semi structured interviews examined views and ideas of pharmacists surrounding the treatment and management of MUD, followed by coding of transcribed interview data by all members of the research team. Results Nineteen pharmacists completed the interviews. The main theme identified was stigma held by healthcare professionals. The almost unanimous perception amongst pharmacists was fear and apprehension towards people with MUD, including underlying assumptions of criminality, misinformation regarding people with MUD, and lack of education and knowledge surrounding MUD. Conclusion A substantial amount of stigma towards people with MUD was found in this study. Negative attitudes by healthcare professionals can perpetuate healthcare disparities and impede the accessibility of future treatment programs for people with MUD. Appropriate educational interventions on MUD for pharmacists are needed.
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Affiliation(s)
- Ali Makki
- Faculty of Medicine and Health, The University of Sydney School of Pharmacy, Camperdown, Australia
| | - Carolyn Day
- Faculty of Medicine and Health Addiction Medicine, Central Clinical School, Camperdown, Australia
| | - Betty B. Chaar
- Professionalism Committee School of Pharmacy FMH, Faculty of Medicine and Health, The University of Sydney School of Pharmacy, Camperdown, Australia
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Jung M. Physical Distancing for Gay Men from People Living with HIV During the COVID-19 Pandemic. JOURNAL OF HOMOSEXUALITY 2024:1-19. [PMID: 38319682 DOI: 10.1080/00918369.2024.2314031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The fear of COVID-19 can exacerbate social stigma and prejudice against individuals living with HIV (PLWH). This research delved into the behaviors of MSM (men who have sex with men) who practice physical-distancing from PLWH. Data from 878 respondents were collected through a web survey conducted on Korea's largest LGBT portal site over one month in July 2022. The study examined various independent variables encompassing socioeconomic characteristics, health status, media consumption habits, and homosexual attributes of MSM. The dependent variable assessed was the extent of physical-distancing perceived by MSMs without HIV toward PLWH. The statistical analysis employed nested regression models. In Model I, it was observed that physical-distancing from PLWH decreased as the age and education level of the respondent increased. In Model II, a decrease in physical-distancing was noted among respondents with underlying health conditions. Model III indicated that increased use of traditional media corresponded to greater physical-distancing from PLWH. Lastly, Model IV revealed a reduction in physical-distancing when the respondent was themselves a person living with HIV. This study underscores the existence of physical-distancing toward PLWH within the gay community. Consequently, fostering solidarity and providing support becomes imperative to prevent the isolation of PLWH within this community.
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Affiliation(s)
- Minsoo Jung
- Department of Health Science, Dongduk Women's University, Seoul, South Korea
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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31
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Hatzenbuehler ML, Lattanner MR, McKetta S, Pachankis JE. Structural stigma and LGBTQ+ health: a narrative review of quantitative studies. Lancet Public Health 2024; 9:e109-e127. [PMID: 38307678 DOI: 10.1016/s2468-2667(23)00312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 02/04/2024]
Abstract
Health disparities related to sexual orientation and gender identity exist across multiple outcomes. Scholarship has begun to evaluate whether structural stigma-ie, societal-level conditions, cultural norms, and institutional policies that constrain opportunities, resources, and wellbeing-contributes to health burdens among LGBTQ+ individuals. We conducted a comprehensive review of quantitative studies examining this hypothesis. We found 98 articles that linked objective (ie, non-self-reported) measures of structural stigma to mental (n=57), behavioural (ie, substance use; n=27; HIV/AIDS or sexually transmitted infection; n=20), and physical (n=20) health outcomes. There was generally consistent evidence that structural stigma increases risk of poor health among LGBTQ+ individuals. Several methodological strengths were identified, including the use of multiple measures (eg, laws or policies [59%, 58 of 98]), designs (eg, quasi-experiments [21%, 21 of 98]), and samples (eg, probability-based [56%, 55 of 98]). However, important gaps exist. Just over half of studies included area-level covariates or non-LGBTQ+ comparison groups, which are necessary to address alternative explanations for the observed associations. Additionally, while studies (n=90) have begun to identify candidate mechanisms, only nine (10%) formally tested mediation. We offer suggestions for future research to advance this literature, which has implications not only for the identification of structural determinants of LGBTQ+ health but also for the development of public health interventions that reduce LGBTQ+ health disparities.
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Affiliation(s)
| | - Micah R Lattanner
- Department of Public Health, Santa Clara University, Santa Clara, CA, USA
| | - Sarah McKetta
- Department of Population Medicine, Harvard University, Boston, MA, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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32
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Lu J, Shan Y, Ji M, Low LF, Kim S, Barcenilla-Wong A, Shen S, Chu W. Development of a method and an assessment construct for person-centered translation of dementia public stigma scales. Front Public Health 2024; 11:1233400. [PMID: 38322363 PMCID: PMC10846308 DOI: 10.3389/fpubh.2023.1233400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024] Open
Abstract
Background With the number of people with dementia dramatically increasing over time and dementia becoming a major health concern worldwide, scales have been developed to assess the stigma socially attached to this neurodegenerative disorder. There are, however, almost no available methods and assessment constructs for person-centered translation of dementia public stigma scales. Objective To develop such a method and such an assessment construct by translating the Dementia Public Stigma Scale (DPSS) into standard written Chinese. Methods We translated the DPSS following three major steps: (1) literal translation and mistranslation identification; (2) panel discussions of items with problematic translations; and (3) the final checking of the translated scale. Informed by the translation and adaptation process, we then developed a method for person-centered translation of dementia public stigma scales. Based on this method and our panel discussions, we finally proposed a tripartite assessment construct for quality evaluation of the translation of dementia public stigma scales. Results Forward and backward translation did not work sufficiently in dementia public stigma scale translation. Mistranslations were induced by three major causes, including confusion caused by multiple Chinese meanings of the immediate Chinese direct translation, the lack of immediate Chinese direct translation because of varying positive/negative emotions attached to multiple translations, and the lack of culture-specific idioms in Chinese. Based on these factors, we proposed a tripartite dementia translation assessment construct. Following this assessment tool, we determined the best Chinese version that could further be tested for its psychometric properties among the public. Conclusion A method and an assessment construct for person-centered translation of dementia public stigma scales were developed. Such a method and such an assessment construct could be followed in the translation of dementia public stigma scales and the translation evaluation of such scales.
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Affiliation(s)
- Junfeng Lu
- College of International Studies, Jiaxing University, Jiaxing, China
| | - Yi Shan
- College of International Studies, Jiaxing University, Jiaxing, China
| | - Meng Ji
- School of Languages and Cultures, University of Sydney, Sydney, NSW, Australia
| | - Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sarang Kim
- Australian Institute of Health and Welfare (AIHW), Canberra, ACT, Australia
| | | | - Sam Shen
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Weiwei Chu
- College of Foreign Languages and Literature, Fudan University, Shanghai, China
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Bernard M, Niemann J, Weinhold L, Jepsen D, Miani C, Luck-Sikorski C. Abortion stigma among abortion seekers, healthcare professionals and the public in high-income countries: A mixed-methods systematic review protocol. BMJ Open 2024; 14:e076602. [PMID: 38238049 PMCID: PMC10806672 DOI: 10.1136/bmjopen-2023-076602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Abortion is a crucial sexual and reproductive right. However, the legal situation of pregnancy termination is rather heterogeneous across countries and regions. The political climate and cultural perception may result in abortion-related stigma. This mixed-methods systematic review protocol aims to detail the proposed methods for assessing the current state of research on abortion stigma in high-income countries from an abortion seeker, healthcare provider and public perspective. METHODS AND ANALYSIS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline, we conducted a systematic literature search of peer-reviewed studies from high-income countries in relevant electronic databases: PubMed, CINHAL, PsycINFO, LIVIVO and Cochrane Library. Qualitative, quantitative and mixed-method studies that measured or examined abortion-related stigma in abortion seekers, healthcare professionals and the general public will be included. Assessment of risk of bias, data synthesis and qualitative meta-aggregation will be carried out. ETHICS AND DISSEMINATION The results of the systematic review will be submitted to peer-reviewed journals and presented at relevant conferences.
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Affiliation(s)
- Marie Bernard
- Institute of Medical Sociology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Jana Niemann
- Institute of Medical Sociology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Laura Weinhold
- Institute of Medical Sociology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Dennis Jepsen
- Institute of Medical Sociology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Celine Miani
- Department of Social Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Claudia Luck-Sikorski
- SRH Hochschule fur Gesundheit GmbH, Gera, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig University, Leipzig, Germany
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Luthuli MQ, John-Langba J. The Moderating Role of HIV Stigma on the Relationship between Perceived Social Support and Antiretroviral Therapy Adherence Self-Efficacy among Adult PLHIV in South Africa. J Int Assoc Provid AIDS Care 2024; 23:23259582241228743. [PMID: 38594925 PMCID: PMC11301718 DOI: 10.1177/23259582241228743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/15/2023] [Accepted: 01/06/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND People living with human immune deficiency virus (PLHIV) grapple with distinct challenges, including HIV stigma which affects their antiretroviral therapy (ART) adherence self-efficacy. This study investigates the interaction of HIV stigma and perceived social support on ART adherence self-efficacy among adult PLHIV in South Africa. METHODS This study utilized a cross-sectional design that involved 201 participants selected using time location sampling at a tertiary health facility in Durban. RESULTS HIV stigma was significantly and negatively associated with self-efficacy (β = -7.860, t = -4.654, p = .001), with variations across different stigma levels (β = -5.844, t = -4.003, p = .001). Social support was significantly and positively associated with self-efficacy at lower HIV stigma levels (β = 7.440, t = 3.887, p = .001), in contrast to higher levels (β = -2.825, t = 1.400, p = .163). CONCLUSION Social support significantly influences ART adherence self-efficacy, particularly at lower levels of HIV stigma, but the effect of support weakens as stigma intensifies.
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Affiliation(s)
- Muziwandile Qiniso Luthuli
- Discipline of Social Work, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Johannes John-Langba
- Discipline of Social Work, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
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Magno L, Terto V, Parker R. Stigmatisation and resistance processes: Reflections on the field of HIV research and an agenda for contemporary stigma studies. Glob Public Health 2024; 19:2371390. [PMID: 39016193 DOI: 10.1080/17441692.2024.2371390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/15/2024] [Indexed: 07/18/2024]
Abstract
Stigmatisation processes constitute key barriers to effectively addressing the HIV pandemic. In this article, we provide a critical overview of this field's current state of the art, highlighting some key emerging issues that merit greater research attention in the future to ensure that contemporary research on stigmatisation and resistance processes continues to engage with changing social and political circumstances. We look at how resistance to stigma has developed in the context of HIV and highlight some of the most important programmatic strategies that have emerged over the history of the pandemic. We present the key concepts of 'moral panics' and 'necropolitics', and we articulate them in relation to new global phenomena that deepen the processes of stigmatisation. Moreover, we identify an agenda for investigation which merits greater attention in future research, intervention, and advocacy: 1) changing political environments, neoliberalism, growing political polarisation, and the rise of political extremism; 2) the rise of the information age, technological change, and social media; and 3) rebuilding civil society and governmental responses to stigma.
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Affiliation(s)
- Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Brazil
| | - Veriano Terto
- Associação Brasileira Interdisciplinar de AIDS (ABIA), Rio de Janeiro, Brazil
| | - Richard Parker
- Associação Brasileira Interdisciplinar de AIDS (ABIA), Rio de Janeiro, Brazil
- Sexuality Policy Watch (SPW), Rio de Janeiro, Brazil
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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Parker R. Epidemias de significação e políticas de saúde global: Do fim da AIDS ao fim da ampliação da resposta global da AIDS. Glob Public Health 2024; 19:2386920. [PMID: 39155786 DOI: 10.1080/17441692.2024.2386920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/02/2024] [Indexed: 08/20/2024]
Abstract
RESUMONas últimas quatro décadas e meia, a história da pandemia de HIV passou por várias fases que podem ser pensadas como ondas distintas em termos da resposta social e política que a pandemia gerou. Ao longo dessa história, houve batalhas importantes sobre os significados e interpretações que a resposta à pandemia produziu. Mas, especialmente na última década, parece haver uma crescente desconexão entre as alegações de sucesso feitas por muitas agências globais de saúde e formuladores de políticas e a realidade empírica que essas alegações encobrem. Este comentário argumenta que a 'ampliação' ('scale-up') da resposta à pandemia essencialmente chegou ao fim e enfatiza a importância de um debate político mais honesto sobre o estado atual da resposta global ao HIV. Argumenta que, a fim de melhor definir os rumos que tal resposta deve tomar no futuro, exige que pensemos criticamente sobre as formas como essa resposta se desenvolveu historicamente, que reconheçamos os avanços significativos alcançados nas últimas décadas, mas também que reconheçamos a encruzilhada a que chegou em meados da década de 2020.
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Affiliation(s)
- Richard Parker
- Associação Brasileira Interdisciplinar de AIDS (ABIA), Rio de Janeiro, Brasil
- Sexuality Policy Watch (SPW), Rio de Janeiro, Brasil
- Departamento de Ciências Sociomédicas, Columbia University, Nova York, NY, EUA
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Hatzenbuehler ML, McLaughlin KA, Weissman DG, Cikara M. A research agenda for understanding how social inequality is linked to brain structure and function. Nat Hum Behav 2024; 8:20-31. [PMID: 38172629 PMCID: PMC11112523 DOI: 10.1038/s41562-023-01774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/01/2023] [Indexed: 01/05/2024]
Abstract
Consistent evidence documents powerful effects of social inequality on health, well-being and academic achievement. Yet research on whether social inequality may also be linked to brain structure and function has, until recently, been rare. Here we describe three methodological approaches that can be used to study this question-single site, single study; multi-site, single study; and spatial meta-analysis. We review empirical work that, using these approaches, has observed associations between neural outcomes and structural measures of social inequality-including structural stigma, community-level prejudice, gender inequality, neighbourhood disadvantage and the generosity of the social safety net for low-income families. We evaluate the relative strengths and limitations of these approaches, discuss ethical considerations and outline directions for future research. In doing so, we advocate for a paradigm shift in cognitive neuroscience that explicitly incorporates upstream structural and contextual factors, which we argue holds promise for uncovering the neural correlates of social inequality.
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Affiliation(s)
| | | | - David G Weissman
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Mina Cikara
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Speight J, Holmes-Truscott E, Garza M, Scibilia R, Wagner S, Kato A, Pedrero V, Deschênes S, Guzman SJ, Joiner KL, Liu S, Willaing I, Babbott KM, Cleal B, Dickinson JK, Halliday JA, Morrissey EC, Nefs G, O'Donnell S, Serlachius A, Winterdijk P, Alzubaidi H, Arifin B, Cambron-Kopco L, Santa Ana C, Davidsen E, de Groot M, de Wit M, Deroze P, Haack S, Holt RIG, Jensen W, Khunti K, Kragelund Nielsen K, Lathia T, Lee CJ, McNulty B, Naranjo D, Pearl RL, Prinjha S, Puhl RM, Sabidi A, Selvan C, Sethi J, Seyam M, Sturt J, Subramaniam M, Terkildsen Maindal H, Valentine V, Vallis M, Skinner TC. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol 2024; 12:61-82. [PMID: 38128969 DOI: 10.1016/s2213-8587(23)00347-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
People with diabetes often encounter stigma (ie, negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health; self-care, access to optimal health care; and social and professional opportunities. To accelerate an end to diabetes stigma and discrimination, an international multidisciplinary expert panel (n=51 members, from 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. We achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility, and fear or disgust. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination (ie, unfair and prejudicial treatment) due to diabetes, such as in health care, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, we achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.
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Affiliation(s)
- Jane Speight
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
| | - Elizabeth Holmes-Truscott
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | | | - Renza Scibilia
- Diabetogenic, Melbourne, VIC, Australia; JDRF International, New York, NY, USA
| | - Sabina Wagner
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Asuka Kato
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Victor Pedrero
- Faculty of Nursing, Universidad Andrés Bello, Santiago, Chile
| | - Sonya Deschênes
- School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Kevin L Joiner
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ingrid Willaing
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Institute of Public Health, Department of Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | - Katie M Babbott
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bryan Cleal
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Jane K Dickinson
- Department of Health Studies & Applied Educational Psychology, Teachers College Columbia University, New York, NY, USA
| | - Jennifer A Halliday
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Eimear C Morrissey
- Health Behavior Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Giesje Nefs
- Department of Medical Psychology, Radboudumc, Nijmegen, Netherlands; Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands; Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, Netherlands
| | - Shane O'Donnell
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Per Winterdijk
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, Netherlands
| | - Hamzah Alzubaidi
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
| | | | | | - Emma Davidsen
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Mary de Groot
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maartje de Wit
- Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK; National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Karoline Kragelund Nielsen
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Tejal Lathia
- Department of Endocrinology, Apollo Hospitals, Navi Mumbai, India
| | | | | | - Diana Naranjo
- Department of Pediatrics, Division of Endocrinology, Stanford School of Medicine, Palo Alto, CA, USA
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Suman Prinjha
- Leicester Diabetes Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, College of Liberal Arts & Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Chitra Selvan
- Department of Endocrinology, Ramaiah Medical College, Bengaluru, India
| | - Jazz Sethi
- The Diabesties Foundation, Ahmedabad, India
| | - Mohammed Seyam
- Faculty of Medicine, Al-Quds University, Abu Dis, Palestine
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Mythily Subramaniam
- Institute of Mental Health Singapore, Singapore; Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Helle Terkildsen Maindal
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Timothy C Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia; La Trobe Rural Health School, La Trobe University, Flora Hill, VIC, Australia; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Pring K, Malli M, Hardy BW, Rapp SR, Storch EA, Mink JW, Martindale JM. Reframing stigma in Tourette syndrome: an updated scoping review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02332-3. [PMID: 38159134 DOI: 10.1007/s00787-023-02332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024]
Abstract
Persistent tic disorders (PTD) such as Tourette's syndrome (TS) are common childhood-onset neurodevelopmental disorders. Stigmatization of individuals with these disorders remains an ongoing problem. The purpose of this scoping review is to serve as an updated review of the research regarding stigmatization in youth with PTD since the publication of the original systematic review about this topic in 2016. The electronic databases Embase, Web of Science, PubMed, PsycINFO, and CINAHL were searched. Of the 4751 initial articles screened after removing duplications, 47 studies met the inclusion criteria. The studies were examined under the social-ecological stigmatization model, which helps categorize stigmatization into individual, interpersonal, community, and structural levels and serves as a broader definition of stigmatization than the previous systematic review. On the individual level, youth with PTD had lower self-esteem than peers, often leading to fear of future stigmatization, avoidant behaviors, and self-stigmatization. They also experienced higher rates of bullying and other forms of abuse than peers at the interpersonal level. At the community level, youth with PTD faced discriminatory environments in school and work and limited availability of community services and healthcare access. At the structural level, knowledge about PTD was limited in the general population, often about the limited portrayals of PTD in the media. We hope that the broader scope of this review serves to help inform future efforts to decrease the stigmatization faced by this group.
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Affiliation(s)
- Kelly Pring
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Melina Malli
- Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Brandy W Hardy
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Stephen R Rapp
- Department of Psychology and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Jaclyn M Martindale
- Department of Neurology, Wake Forest University School of Medicine, North Carolina, Winston-Salem, NC, USA.
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40
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Sohn A. Trends in Human Immunodeficiency Virus-Related Knowledge and Stigma among Men Who Have Sex with Men in the Republic of Korea from 2012 to 2022. Healthcare (Basel) 2023; 11:3135. [PMID: 38132025 PMCID: PMC10743135 DOI: 10.3390/healthcare11243135] [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: 09/17/2023] [Revised: 11/16/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
To evaluate the trends in human immunodeficiency virus (HIV)-related knowledge and stigma among men who have sex with men (MSM) in the Republic of Korea between 2012 and 2022, five cross-sectional surveys were conducted. Though general knowledge of HIV infections is high, some misconceptions persist. The initial set of five questions in the survey maintained consistent levels of understanding throughout the five recurring surveys. Notably, the study found a consistent decrease in personal stigma toward people with HIV/AIDS (PWHA) within the MSM community in Korea. The increasing willingness of individuals to engage in social interaction with HIV-positive individuals, ranging from dining to cohabitation, indicated a positive change in societal attitudes. It is crucial to implement active policies such as counseling, testing, education, promotion, and the creation of preventive programs to improve knowledge about HIV and reduce stigma.
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Affiliation(s)
- Aeree Sohn
- Department of Public Health, Sahmyook University, Seoul 01795, Republic of Korea
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41
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Grangeiro A, Ferraz D, Magno L, Zucchi EM, Couto MT, Dourado I. HIV epidemic, prevention technologies, and the new generations: trends and opportunities for epidemic response. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00144223. [PMID: 38088648 DOI: 10.1590/0102-311xpt144223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 12/18/2023] Open
Abstract
The United Nations has underscored the possibility of ending the HIV epidemic as a public health problem. However, an increase in the incidence among adolescents and youth has indicated a greater distance between HIV responses and the specificities of the new generations, which can maintain the epidemic for an extended period. Regards this matter, it is debated that the provision of a range of preventive methods, even if highly effective, and a conservatism that has internalized stigma within government policies, hinder the proper and essential dialogue between current preventive policies and the needs of the new generations. These generations are marked by a social representation of AIDS as a mild disease, by new gender and sexuality performances, and by the search for a more critical role in affective and sexual encounters, which includes frequent use of dating apps and substances. The hierarchy of the delivery of prevention methods is presented as a proposal for a new policy, prioritizing pre-exposure prophylaxis (PrEP) and addressing the social determinants of the HIV epidemic, including strategies to mitigate stigma. The importance of the participation of adolescents and youth in constructing the policy and the need for an intersectoral response are also reinforced.
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Affiliation(s)
| | - Dulce Ferraz
- Diretoria Regional de Brasília, Fundação Oswaldo Cruz, Brasília, Brasil
| | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil
| | - Eliana Miura Zucchi
- Programa de Pós-graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
| | | | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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Gillette E, Nyandiko W, Chory A, Scanlon M, Aluoch J, Choudhury N, Lagat D, Ashimosi C, Biegon W, Munyoro D, Lidweye J, Nyagaya J, Wilets I, DeLong A, Kantor R, Vreeman R, Naanyu V. Ethical Considerations for Engaging Children and Adolescents Living with HIV in Research in African Countries: A Systematic Review. J Empir Res Hum Res Ethics 2023; 18:346-362. [PMID: 37872659 PMCID: PMC11325447 DOI: 10.1177/15562646231208991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Research engaging children and adolescents living with HIV (CALWH) is critical for youth-friendly services and HIV care, and researchers need to ensure that such engagement is ethical. We conducted a systematic review to identify key ethical considerations for the engagement of CALWH in research. The review focused on primary research articles conducted in African countries that examined ethical issues in CALWH engaged in research. Ten studies met the inclusion criteria; the following seven key domains were extracted: 1) justifications for engaging CALWH in research; 2) community involvement; 3) informed consent/assent; 4) caregiver involvement; 5) perceptions of benefits; 6) perception of the risks of involvement; and 7) confidentiality. These domains can inform the ethical engagement of CALWH in research.
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Affiliation(s)
- Emma Gillette
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Winstone Nyandiko
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, Indiana, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Nandini Choudhury
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Lagat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Whitney Biegon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ilene Wilets
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Rachel Vreeman
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Violet Naanyu
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Zhang Y, Chai C, Xiong J, Zhang L, Zheng J, Ning Z, Wang Y. The impact of anxiety, depression, and social support on the relationship between HIV-related stigma and mental health-related quality of life among Chinese patients: a cross-sectional, moderate-mediation study. BMC Psychiatry 2023; 23:818. [PMID: 37940853 PMCID: PMC10634100 DOI: 10.1186/s12888-023-05103-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/10/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND/OBJECTIVE People living with HIV (PLWH) are prone to mental health problems and evidence indicates that HIV-related stigma can negatively impact mental health-related quality of life. This study explored potential mechanisms between HIV-related stigma and mental health-related quality of life, specifically whether anxiety or depression mediates, and whether social support moderates, the relationship. METHOD A total of 1197 Chinese PLWH participated in the study. The Berger HIV Stigma Scale, the Hospital Anxiety and Depression Scale (HADS), the 12-item Brief Health Survey (SF-12), and the Multidimensional Scale of Perceived Social Support (MSPSS) were employed. RESULTS HIV-related stigma was negatively associated with mental health-related quality of life. Anxiety and depression partially mediated the relationship between HIV-related stigma and mental health-related quality of life; social support played a moderating role. CONCLUSIONS The mental health-related quality of life in PLWH was shown to be indirectly affected by HIV-related stigma through anxiety and depression in China. The negative impact of HIV-related stigma decreased with increased social support.
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Affiliation(s)
- Yushu Zhang
- School of Public Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Chengliang Chai
- Department of AIDS/STDs Control and Prevention, Zhejiang Provincial Center for Diseases Control and Prevention, Zhejiang Province, Hangzhou, China
| | - Jianjing Xiong
- Jing'an District Center for Disease Prevention and Control, Shanghai, China
| | - Lin Zhang
- Center for Disease Control and Prevention, 10, East Section of Taihao Road, Henan Province, Zhoukou, 466000, China
| | - Jinlei Zheng
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang Province, Hangzhou, China
| | - Zhen Ning
- Division of Tuberculosis and AIDS Control and Prevent Shanghai Municipal Center for Disease Control and Prevention 1380, Zhongshan Xi Road, Shanghai, 200336, China.
| | - Ying Wang
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, 200032, China.
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Brown CA, Siegler AJ, Zahn RJ, Valencia RK, Sanchez T, Kramer MR, Phaswana-Mafuya NR, Stephenson R, Bekker LG, Baral SD, Sullivan PS. Assessing the association of stigma and HIV service and prevention uptake among men who have sex with men and transgender women in South Africa. AIDS Care 2023; 35:1497-1507. [PMID: 36755403 PMCID: PMC10406969 DOI: 10.1080/09540121.2023.2175770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
HIV prevention for gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) is critical to reducing health disparities and population HIV prevalence. To understand if different types of stigma impact engagement with HIV prevention services, we assessed associations between stigmas and use of HIV prevention services offered through an HIV prevention intervention. This analysis included 201 GBMSM and TGW enrolled in a prospective cohort offering a package of HIV prevention interventions. Participants completed a baseline survey that included four domains of sexual identity/behavior stigma, HIV-related stigma, and healthcare stigma. Impact of stigma on PrEP uptake and the number of drop-in visits was assessed. No domain of stigma was associated with PrEP uptake. In bivariate analysis, increased enacted sexual identity stigma increased number of drop-in visits. In a logistic regression analysis constrained to sexual identity stigma, enacted stigma was associated with increased drop-in visits (aIRR = 1.30, [95% CI: 1.02, 1.65]). Participants reporting higher enacted stigma were modestly more likely to attend additional services and have contact with the study clinics and staff. GBMSM and TGW with higher levels of enacted stigma may seek out sensitized care after negative experiences in their communities or other healthcare settings.
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Affiliation(s)
- Carolyn A Brown
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
- ViiV Healthcare, Durham, NC, USA
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Ryan J Zahn
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Rachel K Valencia
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Travis Sanchez
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Nancy Refilwe Phaswana-Mafuya
- SAMRC/JJ Pan African Centre for Epidemics Research (PACER) Extramural Unit; Department of Environmental Health, University of Johannesburg, Johannesburg, South Africa
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | | | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
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Grieb SM, Platt R, Vazquez MG, Alvarez K, Polk S. Mental Health Stigma Among Spanish-Speaking Latinos in Baltimore, Maryland. J Immigr Minor Health 2023; 25:999-1007. [PMID: 37213041 PMCID: PMC10201042 DOI: 10.1007/s10903-023-01488-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
To assess mental health-related stigma in an emerging Latino immigrant community and explore demographic characteristics associated with stigma. We surveyed 367 Spanish-speaking Latino adults recruited at community-based venues in Baltimore, Maryland. The survey included sociodemographic questions, the Depression Knowledge Measure, Personal Stigma Scale, and the Stigma Concerns about Mental Health Care (SCMHC) assessment. Multiple regression models examining associations between personal stigma and stigma concerns about mental health care, respectively, were constructed using variables that were statistically significant in bivariate analyses. Being male, having less than high school education, reporting high importance of religion, and having lower depression knowledge contributed to higher personal stigma. When controlling for other variables, only depression knowledge contributed unique variance to the prediction of higher SCMHC. Efforts to improve access to and quality of mental health care must be paralleled by ongoing efforts to reduce depression stigma within emergent immigrant Latino communities.
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Affiliation(s)
- Suzanne M Grieb
- Department of Pediatrics Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building - Center Tower Suite 4200, Baltimore, MD, 21205, USA.
| | - Rheanna Platt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Monica Guerrero Vazquez
- Department of Pediatrics Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building - Center Tower Suite 4200, Baltimore, MD, 21205, USA
- Center for Salud/Health and Opportunities for Latinos, Johns Hopkins University, Baltimore, MD, USA
| | - Kiara Alvarez
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sarah Polk
- Department of Pediatrics Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building - Center Tower Suite 4200, Baltimore, MD, 21205, USA
- Center for Salud/Health and Opportunities for Latinos, Johns Hopkins University, Baltimore, MD, USA
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Kutner BA, Vaughn MP, Giguere R, Rodriguez-Hart C, McKinnon K, Kaighobadi F, Felix B, Akakpo A, Cournos F, Mikaelian M, Knox J, Boccher-Lattimore D, Mack KA, LaForest M, Sandfort TGM. A Systematic Review of Intervention Studies That Address HIV-Related Stigmas Among US Healthcare Workers and Health Systems: Applying a Theory-Based Ontology to Link Intervention Types, Techniques, and Mechanisms of Action to Potential Effectiveness. Ann Behav Med 2023; 57:801-816. [PMID: 37318287 PMCID: PMC10498821 DOI: 10.1093/abm/kaad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND To end the HIV epidemic, we need to better understand how to address HIV-related stigmas in healthcare settings, specifically the common theoretical bases across interventions so that we can generalize about their potential effectiveness. PURPOSE We describe theory-based components of stigma interventions by identifying their functions/types, techniques, and purported mechanisms of change. METHODS This systematic review examined studies published by April 2021. We applied a transtheoretical ontology developed by the Human Behaviour Change Project, consisting of 9 intervention types (ITs), 93 behavior change techniques (BCTs), and 26 mechanisms of action (MOAs). We coded the frequency and calculated the potential effectiveness of each IT, BCT, and MOA. We evaluated study quality with a 10-item adapted tool. RESULTS Among the nine highest quality studies, indicated by the use of an experimental design, the highest potentially effective IT was "Persuasion" (i.e. using communication to induce emotions and/or stimulate action; 66.7%, 4/6 studies). The highest potentially effective BCTs were "Behavioral practice/rehearsal" (i.e. to increase habit and skill) and "Salience of consequences" (i.e. to make consequences of behavior more memorable; each 100%, 3/3 studies). The highest potentially effective MOAs were "Knowledge" (i.e. awareness) and "Beliefs about capabilities" (i.e. self-efficacy; each 67%, 2/3 studies). CONCLUSIONS By applying a behavior change ontology across studies, we synthesized theory-based findings on stigma interventions. Interventions typically combined more than one IT, BCT, and MOA. Practitioners and researchers can use our findings to better understand and select theory-based components of interventions, including areas for further evaluation, to expedite ending the HIV epidemic.
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Affiliation(s)
- Bryan A Kutner
- Psychiatry Research Institute at Montefiore Einstein (PRIME), Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael P Vaughn
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristina Rodriguez-Hart
- Division of Disease Control (DIS), New York City Department of Health and Mental Hygiene (DOHMH), New York, NY, USA
| | - Karen McKinnon
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, New York, NY, USA
| | - Farnaz Kaighobadi
- Department of Social Sciences, Bronx Community College, City University New York, Bronx, NY, USA
| | - Bimbla Felix
- Adult Comprehensive Services, Jacobi Medical Center, New York, NY, USA
| | - Attisso Akakpo
- New York State Department of Health, AIDS Institute, New York, NY, USA
| | - Francine Cournos
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, New York, NY, USA
| | - Matt Mikaelian
- The Mental Health Association of Westchester, Tarrytown, NY, USA
| | - Justin Knox
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daria Boccher-Lattimore
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, New York, NY, USA
| | - Kimbirly A Mack
- Division of Disease Control (DIS), New York City Department of Health and Mental Hygiene (DOHMH), New York, NY, USA
| | - Marian LaForest
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, New York, NY, USA
| | - Theodorus G M Sandfort
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Kubátová A, Fialová A, Stupka J, Malý M, Hamplová L, Sedláčková S. Stigmatization and discrimination of people living with HIV in the Czech Republic: a pilot study. Cent Eur J Public Health 2023; 31:210-216. [PMID: 37934485 DOI: 10.21101/cejph.a7782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/11/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES HIV positivity diagnosis is often accompanied by stigmatization and discrimination, even in developed societies. The aim of the study was to obtain current information on the quality of life of people living with HIV in the Czech Republic, to assess the level and perception of stigmatization and discrimination, and to identify existing problems of people living with HIV concerning health services, family and the public. METHODS Data for the pilot study were collected by convenience sampling between 2021 and 2022. Respondents were recruited from residents of Czech nationality and foreigners living with HIV in the Czech Republic who participated in an ECDC online questionnaire study or attended a convalescent stay for people living with HIV. Likert scales were used to capture key opinions, attitudes and beliefs of respondents. Data were processed using descriptive analysis. RESULTS The study involved 42 people living with HIV. A total of 77% of the respondents reported that they had learned to live with their HIV-positive status, but 21% admitted to having low self-esteem due to their status. A total of 81% of the respondents had disclosed their HIV-positive status to someone outside of the healthcare setting, however, 40% of the respondents found it difficult to do so. Assault or threats from a sexual partner were reported by 17% of the respondents. A total of 27% of the respondents admitted having been denied or suspended health care, 44% reported inappropriate comments from healthcare workers, and 32% of the respondents avoided visiting the healthcare facility. Alarmingly, 41% of the respondents had been refused dental care at some point in the past because of their HIV-positive status. CONCLUSIONS Although the study presents only limited findings due to the small number of respondents, it is clear that stigmatization and discrimination of people living with HIV exists in the Czech society. It brings the risk of loss of motivation and involvement of people living with HIV in working together with healthcare providers on their treatment. There is a clear need for a larger study to identify the causes of stigmatization and to find ways to prevent it.
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Affiliation(s)
- Anna Kubátová
- National Institute of Public Health, Prague, Czech Republic
| | - Alena Fialová
- National Institute of Public Health, Prague, Czech Republic
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Stupka
- National Institute of Public Health, Prague, Czech Republic
| | - Marek Malý
- National Institute of Public Health, Prague, Czech Republic
| | | | - Simona Sedláčková
- Faculty of Military Health, University of Defence, Hradec Kralove, Czech Republic
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Rock A, McNaughton Reyes HL, Go V, Maman S, Perez M, Donastorg Y, Kerrigan D, Barrington C. Relationships Between Stigma and Intimate Partner Violence Among Female Sex Workers Living With HIV: Social and Economic Exclusion. Violence Against Women 2023; 29:1971-1997. [PMID: 36344251 PMCID: PMC10387732 DOI: 10.1177/10778012221127722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Violence against female sex workers (FSWs) perpetrated by their intimate (i.e., non-commercial) partners, particularly against FSWs living with HIV, is understudied. Stigma can deplete the economic resources, social relationships, and mental well-being of stigmatized people, which may increase their intimate partner violence (IPV) risk. We quantitatively assessed relationships between HIV stigma and sex work stigma and IPV victimization among FSWs living with HIV in the Dominican Republic (n = 266). Enacted HIV stigma, in the form of job loss, and anticipated HIV stigma, in the form of fear of exclusion by family, were associated with increased IPV risk. Potential association mechanisms, including increased economic vulnerability and social isolation, and programmatic responses are discussed.
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Affiliation(s)
- Amelia Rock
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | | | - Vivian Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | - Suzanne Maman
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | - Martha Perez
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirurgia de Piel Dr. Humberto Bogaert Diaz, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirurgia de Piel Dr. Humberto Bogaert Diaz, Dominican Republic
| | - Deanna Kerrigan
- Department of Prevention and Community Health, GWU Milken Institute School of Public Health, USA
| | - Clare Barrington
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
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Asrina A, Ikhtiar M, Idris FP, Adam A, Alim A. Community stigma and discrimination against the incidence of HIV and AIDS. J Med Life 2023; 16:1327-1334. [PMID: 38107709 PMCID: PMC10719780 DOI: 10.25122/jml-2023-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/04/2023] [Indexed: 12/19/2023] Open
Abstract
The problem of human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome (AIDS) is increasingly complex, including not only health-related concerns problems but also rampant stigma and discrimination, further exacerbating the health and social conditions of the affected individuals. This study aimed to examine the triggers of stigma and discrimination among individuals with HIV/AIDS in Wakatobi, Southeast Sulawesi. We employed a quasi-qualitative design with a case study approach involving data reduction, presentation, and drawing conclusions. Triggers of stigma and discrimination experienced by individuals living with HIV/AIDS encompassed a range of factors. Stigma was rooted in various causes, including fear, perceptions of unattractiveness, anxiety, associations with the disease, and lack of confidentiality. Discrimination, on the other hand, was caused by disappointment, feelings of insecurity, diminished self-esteem, and factors like competition and exploitation. The forms of stigma for people living with HIV/AIDS were public stigma, self-stigma, verbal discrimination, and avoidance. Meanwhile, the impact of stigma and discrimination on individuals living with HIV and AIDS is substantial. They encounter difficulties in finding help, restoring their lives, and discrimination. Stigmatizing attitudes and discriminatory acts of people living with HIV/AIDS worsen the quality of life of people living with HIV/AIDS, which can potentially cause new infections. Therefore, the government should undertake extensive educational initiatives regarding HIV and AIDS. By enhancing public knowledge and awareness, society can work towards eradicating stigma and discrimination from social interactions.
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Affiliation(s)
- Andi Asrina
- Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indonesia
| | - Muhammad Ikhtiar
- Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indonesia
| | | | - Arlin Adam
- Faculty of Public Health, Universitas Pejuang Republik Indonesia, Makassar, Indonesia
| | - Andi Alim
- Faculty of Public Health, Universitas Pejuang Republik Indonesia, Makassar, Indonesia
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MICHAELS ELIK, LAM‐HINE TRACY, NGUYEN THUT, GEE GILBERTC, ALLEN AMANIM. The Water Surrounding the Iceberg: Cultural Racism and Health Inequities. Milbank Q 2023; 101:768-814. [PMID: 37435779 PMCID: PMC10509530 DOI: 10.1111/1468-0009.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
Policy Points Cultural racism-or the widespread values that privilege and protect Whiteness and White social and economic power-permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the "tip of the iceberg," whereas structural and institutional racism represent its base. This paper advances cultural racism as the "water surrounding the iceberg," allowing it to float while obscuring its base. Considering the fundamental role of cultural racism is needed to advance health equity. CONTEXT Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism. METHODS We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities. FINDINGS Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course. CONCLUSIONS More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence-based policy interventions to reduce cultural racism and promote health equity.
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Affiliation(s)
- ELI K. MICHAELS
- Division of Epidemiology, School of Public HealthUniversity of California
| | - TRACY LAM‐HINE
- Division of Epidemiology & Population HealthStanford University School of Medicine
| | | | - GILBERT C. GEE
- Jonathan and Karin Fielding School of Public HealthUniversity of California
| | - AMANI M. ALLEN
- Division of Epidemiology, School of Public HealthUniversity of California
- Division of Community Health Sciences, School of Public HealthUniversity of California
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