Addressing Disease-Related Stigma During Infectious Disease Outbreaks

The Association Between COVID-19-related Discrimination and Probable Post-traumatic Stress Disorder Among Patients With COVID-19 in Sapporo, Japan

BACKGROUND

Disasters such as earthquakes, terrorism, and pandemics have triggered post-traumatic stress disorder (PTSD), and discrimination against the affected individuals has been linked to the development of PTSD. However, there is limited evidence regarding the association between discrimination against coronavirus disease 2019 (COVID-19) patients and probable PTSD in Japan.

METHODS

We conducted a cross-sectional study utilizing a web-based questionnaire targeting individuals who had contracted the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection in Sapporo City. A total of 4,247 individuals with laboratory-confirmed SARS-CoV-2 infection spanning from February 2020 to February 2022 completed the questionnaire (response rate: 15.9%). Probable PTSD was measured using the three-item Posttraumatic Diagnostic Scale. The stratified exact logistic regression was applied to calculate the odds ratios (ORs) of probable PTSD for COVID-19-related discrimination with adjusted factors.

RESULTS

This study included 3,626 patients who had a history of SARS-CoV-2 infection. Among them, 321 patients (8.9%) experienced COVID-19-related discrimination. The prevalence of probable PTSD was 19.6% (63/321) among the patients who experienced COVID-19-related discrimination, and 4.6% (152/3,305) among those who had not encountered such discrimination. The adjusted OR of COVID-19-related discrimination for probable PTSD was 4.68 (95% confidence interval [CI], 3.36-6.53). The population attributable fraction of probable PTSD attributable to COVID-19-related discrimination among COVID-19 patients was estimated to be 23.4% (95% CI, 21.5-25.3%).

CONCLUSION

The comprehensive epidemiological survey of COVID-19 patients in Japan showed that COVID-19-related discrimination was associated with a higher prevalence of probable PTSD. Mitigating discrimination could be helpful to attenuate PTSD in future pandemics.

The relationship between strong-ties weak-ties rationality and COVID-19 public stigma: A cross-cultural study of Malaysia and Australia

We investigated the relationship between strong-ties versus weak-ties rationality and public stigma (PS) during the COVID-19 pandemic. We also explored the cultural group differences (Malaysians vs. Australians) in this relationship. An online survey was conducted in 2021 with a final sample of 830 eligible Malaysians and 394 eligible Australians. Participants completed the multidimensional strong-ties weak-ties rationality Scale (STWTRS) and an adapted public stigma (PS) scale towards COVID-19 patients. Through multiple regression analysis, we found that the strong-ties rationality, ST-Authoritarian rationality, was positively associated with PS-Blame in both countries. However, the variable Country moderated the relationship between ST-Communal and PS-Rejection, with a negative association found in Malaysia and a positive association in Australia. The findings confirmed the strong-ties weak-ties rationality framework, where ST rationality, especially ST-Authoritarian, could explain the cognitive mechanism behind negative attitudes towards those who pose threat towards the in-group survival. However, ST-Communal could buffer the rejection towards the COVID-19 patients in Malaysia due to its emphasis on social harmony. This study can inform future interventions aimed at mitigating stigma and promoting a more inclusive and supportive society in times of crisis.

Assessing Vaccine Intentions, Knowledge, Self-Efficacy, and Trust: A Cross-Sectional Study on Perceptions of Monkeypox Vaccination and Public Health Risk Awareness in Makurdi, Benue State, Nigeria

Introduction The global emergence of monkeypox has heightened public health concerns, particularly in regions with limited vaccine uptake. In Nigeria, understanding the factors influencing vaccination intentions is essential for developing effective public health strategies. Despite vaccine availability, hesitancy and varying degrees of acceptance persist, driven by factors such as self-efficacy, vaccine trust, and overall attitudes toward vaccination. Previous research highlights the importance of these factors in shaping health behaviors, particularly in vulnerable populations. In Benue State, where distinct health challenges affect key demographic groups such as people living with human immunodeficiency virus (PLHIV) and men who have sex with men (MSM), addressing vaccination intentions is critical for public health efforts. Objectives The objective was to assess the intention to receive the monkeypox vaccine, self-assessed knowledge levels, self-efficacy, and risk perception among the PLHIV, MSM, and the healthcare population in Benue State, Nigeria. Additionally, the study aimed to evaluate public trust in vaccines and health authorities and to understand how these factors influence attitudes toward vaccination and overall perceptions of monkeypox-related health risks. Methodology A cross-sectional survey was conducted among 377 participants in Makurdi, Benue State, Nigeria, focusing on PLHIV, MSM, and healthcare workers. Participants were recruited using a snowball sampling technique, which leveraged social media platforms (WhatsApp, Facebook, and Telegram) and the Federal Medical Center in Makurdi. Data were collected using a structured questionnaire designed to assess self-efficacy, trust in vaccines, vaccination attitudes, and prior vaccination experiences. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY). Descriptive statistics were used to summarize the characteristics of the study population. Bivariate analyses, including chi-square tests and independent t-tests, were employed to explore the relationships between socio-demographic characteristics and vaccination intentions. Statistical significance was set at p < 0.05 for all analyses. Results The study revealed a significant positive relationship between self-efficacy and vaccination intention (p = 0.001). Trust in vaccinations and health authorities was also found to be a significant predictor of vaccination intention (p < 0.05). Furthermore, participants who had previously received the coronavirus disease 2019 (COVID-19) vaccine were more likely to express intention to receive the monkeypox vaccine (p = 0.000). However, the perception that the threat of monkeypox was exaggerated did not significantly impact vaccination intention (p = 0.4). Conclusion This study highlights the critical role of self-efficacy, trust in vaccines, and prior vaccination experiences in shaping the intention to receive the monkeypox vaccine in Benue State, Nigeria. The findings suggest that public health policies should prioritize enhancing trust in vaccines and health authorities, as well as boosting self-efficacy, to improve vaccination uptake. Addressing these factors may lead to more effective public health interventions against monkeypox and other infectious diseases.

An evolutionary concept analysis: stigma among women living with hepatitis C

BACKGROUND

Stigma is a complex social phenomenon that leads to marginalization and influences the course of illness. In the context of hepatitis C virus (HCV), stigma is a well-documented barrier to accessing care, treatment, and cure. In recent years, HCV rates among women have increased, resulting in an urgent need to address stigma and its harmful effects. The purpose of this concept analysis was to investigate stigma in the context of women living with HCV using Rodgers' evolutionary method.

METHODS

PubMed, CINAHL, Scopus, Medline, PsycINFO, and Nursing and Allied Health were used to identify articles describing HCV stigma among women. Articles from peer-reviewed journals and geographic locations, published between 2002-2023, were included in the analysis. As specified in Rodgers' evolutionary method, articles were analyzed with a focus on the concept's context, surrogate and related terms, antecedents, attributes, examples, and consequences.

RESULTS

Following screening, 33 articles were selected for inclusion in the analysis. Discrimination and marginalization were identified as surrogate and related terms to stigma; and antecedents of stigma were identified as limited knowledge, fear of diagnosis, and disclosure. Prevalent attributes of stigma in the literature were described as feelings of decreased self-worth, negative stereotyping, and fear of transmission. Importantly, HCV stigma among women is unique in comparison to other forms of infectious disease-related stigma, primarily due its impact on women's identity as mothers and caregivers. Stigmatization of women living with HCV resulted in negative consequences to personal relationships and healthcare access due to decreased health-seeking behaviours. Although access to HCV treatment has changed considerably over time, a temporal analysis could not be completed due to the limited number of articles.

CONCLUSIONS

Stigma in the context of women living with HCV has its own unique antecedents, attributes, and consequences. This enhanced understanding of stigma among women living with HCV has the potential to inform improved and more effective approaches to care, which will be required to reach HCV elimination. Furthermore, this analysis identifies stigma layering and stigma in the direct-acting antiviral  treatment era as areas for more in-depth future inquiry.

The Chinese version of the tendency to stigmatize epidemic diseases scale: a translation and validation study

Objective

To translate the Tendency to Stigmatize Epidemics Diseases Scale (TSEDS) into Chinese and to evaluate its psychometric properties.

Methods

Translation and cross-cultural adaptation using the Brislin translation model, and pre-testing to form a Chinese version of TSEDS. A total of 434 adults participated in the study and the TSEDS were measured using the critical ratio method, Pearson correlation analysis, retest reliability, content validity, structural validity, and concurrent validity.

Results

The Chinese version of the TSEDS scale contains 27 items in 5 dimensions, including structural stigma, perceived stigma, organizational stigma, internalized stigma, and social stigma. The average content validity index of the scale was 0.975. The goodness of fit index (χ2/df= 1.981, RMSEA = 0.067, CFI= 0.930, IFI = 0.931, TLI = 0.922) indicated a good model fit. The Cronbach's alpha coefficient was 0.962 and the dimensionality ranged from 0.882 to 0.928. The retest reliability was 0.912.

Conclusion

The Chinese version of TSEDS has good reliability and validity, which can be used to assess the epidemiological stigma tendency of Chinese adults.

Receptiveness to monkeypox vaccines and public health communication strategies among gay, bisexual and other men who have sex with men in Singapore: cross-sectional quantitative and qualitative insights

OBJECTIVES

Monkeypox (mpox) was declared as a global health emergency by the WHO, with most reported cases disproportionately involving gay, bisexual and other men who have sex with men (GBMSM). This study explored the willingness of Singaporean GBMSM to receive mpox vaccines and engage in changes to sexual behaviour, and analysed the factors influencing both decisions.

METHODS

An online cross-sectional study was disseminated through community groups and Grindr from September to October 2022 among GBMSM in Singapore, where we surveyed respondents' demographics, stigma associated with mpox, perceived risks of sexually transmitted infections (STIs) and changes to sexual behaviours in response to mpox. Descriptive statistics and multivariable linear and logistics regression analyses, as well as thematic analysis of data, were also conducted.

RESULTS

237 GBMSM community members responded to the survey, with the majority being receptive to vaccine and 67.5% indicating changes to sexual behaviour in view of rising mpox infections. Predictors of vaccine receptivity among GBMSM included self-perceived mpox risk (adjusted OR (aOR)=0.44, 95% CI 0.07, 0.82) and self-perceived STI risk (aOR=0.39, 95% CI 0.03, 0.76). Predictors for changes to sexual behaviour included self-perceived mpox stigma (aOR=1.17, 95% CI 1.08, 1.27), self-perceived mpox risk (aOR=1.22, 95% CI 1.03,1.44), age (aOR=0.96, 95% CI 0.93, 1.00) and race (aOR=0.31, 95% CI 0.10, 0.93). In the thematic analysis, respondents raised concerns about vaccine effectiveness, side effects, cost and privacy.

CONCLUSIONS

Our findings suggest that the rise in mpox infections have prompted changes to GBMSM's sexual practices. In general, GBMSM are willing to receive the mpox vaccine but are concerned about the physical and social consequences of uptake. These concerns should be addressed when vaccines are released.

Survey of staff experiences of potential stigma during the COVID19 pandemic

The impact of COVID-19 on everyone's lives has been significant. However, there is also another factor related to the well-being of healthcare workers (HCWs) and that is how they are perceived by the general public. The aim of this study is to provide insight into the scope of this potential problem and describe how HCWs perceive community views and if this influences provision of patient care. A paper-based survey was conducted within mental health wards and community services as well as medical and surgical wards of a large metropolitan hospital in Queensland. Exploratory Factor Analysis was used to explore the dimensionality of the HCW stigma scale from the staff survey. Confirmatory Factor Analysis was used to assess validity and reliability. A total of 545 staff (67.9% nursing, 6.6% medical, 14.7% Allied Health and 10.8% Administrative) completed the survey between June and July 2020. Exploratory Factor Analysis showed that five factors explained 55% of the variance and represent factors of (i) Alienation, (ii) Social isolation, (iii) Perceived workplace harmony, (iv) Perceived job demands, (v) Clinical self-efficacy. The survey displayed high internal reliability and discriminant validity was observed for all subscales. Australian HCW's reported feeling well supported at work and appreciated by society in general during the pandemic, possibly because Australian healthcare services were better prepared than those countries that first experienced COVID-19.

Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022-2023 UK mpox outbreak

BACKGROUND

Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak.

METHODS

Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework.

RESULTS

Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities.

CONCLUSIONS

The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

Perceived Social Stigma of Cutaneous Leishmaniasis in Hubuna, Saudi Arabia

Background

Cutaneous Leishmaniasis (CL) is a vector-borne skin infection that remains prevalent in regions with poor socioeconomic conditions. Stigmatization occurs when individuals with physical or psychological disorders interact with societal stereotypes. The aim of this study was to explore the perceived social stigma surrounding CL among people residing in Hubuna, Saudi Arabia.

Methods

This cross-sectional community-based survey recruited 618 individuals aged 18 years and above using the snowball sampling technique to reach hidden cases within the target population. Data was collected using a self-administered questionnaire and the Explanatory Model Interview Catalogue for Perceived Social Stigma (EMIC-SS-12) was used to assess the level of perceived social stigma. It includes questions on demographic variables, behaviors, and experiences. The analysis was performed using SPSS.

Results

The study included 618 participants, the majority of whom were women and girls (54.2%), with a mean age of 28 ± 12.7 years. The median score for perceived social stigma was 26.0. Only 2.1% (n = 13) of participants had the highest EMIC-SS-12 score of 36, while 7.6% (n = 47) scored zero. The mean score for overall perceived social stigma was 1.89 ± 0.91, while the mean score for experienced stigma was 1.99 ± 1.02. Univariate analysis showed that sex, employment, location of lesions, and number of lesions were insignificantly associated with stigmatization (P-value < 0.05), because these associations were uncertain because the CI includes or very close to 1.

Conclusion

The study reveals insights into stigmatization associated with CL in the Habuna area of Saudi Arabia. It found that the median of perceived social stigma was 26. Factors such as sex, employment status, and location of the lesion are uncertainly associated with stigma. It is crucial to explore negative behaviors and perceptions and develop suitable health education programs.

COVID-19 Linked Social Stigma Among Arab Survivors: A Cross-Sectional Experiences from the Active Phase of the Pandemic

Objective

This study aimed to explore the magnitude and variability of the disease-linked stigma among COVID-19 survivors and their experiences of social stigma, coping strategies, contextual challenges, and preferences for support.

Methods

An Arabic version of the social stigma survey questionnaire was designed and validated to obtain socio-demographic characteristics and quantitative measures of stigma encountered by the survivors. 482 COVID-19 survivors completed the survey, and the data were analyzed using descriptive statistics and thematic analysis.

Results

The results of this study revealed the prevalence of high levels of both perceived external stigma and enacted stigma among participants. Enacted and Internalized stigma were associated with survivors' educational background/ status. The participants suggested three levels of support: organizational, social, and personal. Establishing an online stigma reduction program and national psychological crisis interventions at the organizational level. It is crucial to assist coping mechanisms and societal reintegration techniques at the social level.

Conclusion

These results provide valuable insights for holistic health policy formation and preparedness strategies for future pandemics, helping survivors promote health and reintegrate into society, where stigma reduction and psychological crisis interventions are underdeveloped.

Stigma and inequality in the management of coronavirus disease-2019 (COVID-19)- patients among healthcare providers in Saudi Arabia and associated beliefs: A cross sectional study

BACKGROUND

Stigma and discrimination (SAD) can greatly impact the management of Coronavirus Disease-19 (COVID-19) patients. Studies examining SAD in managing COVID-19 patients in Saudi Arabia (SA) are limited. This study examined the discrimination and inequality in treating COVID-19 patients and the associated beliefs among healthcare workers (HCWs) during the pandemic.

METHODS

This was a cross sectional study using an online self-administrated questionnaire by 414 HCWs from September 2022 to January 2023.

RESULTS

Of the 414 participants, 53.4% aged 18-30 years, were males (53.4%), mostly Saudi (82.1%), and residents of western SA (90.8%). Almost one-third of the participants (32.1%) were physicians, and 23.7% were pharmacists. 53.1% of the HCWs had work experience < 5 years, 49.3% either had a current/previous COVID-19 infection and 10.1% (n = 42) reported treating ≥ 2000 COVID-19 patients. Most of the participants had not received training on avoiding discrimination against COVID-19 patients (n = 246; 59.4%) and denied receiving any incentives from their institution (n = 294; 71%) or community (n = 248; 59.9%) during the pandemic. Less than 20% of the HCWs had observed some sort of discrimination in providing care for COVID-19 patients. The responses significantly differed by nationality, educational level, specialty, workplace and COVID-19 infection status (P < 0.05). Approximately, 20% of the participants held negative beliefs about COVID-19 patients and these responses varied significantly by nationality, work experience, workplace, gender, and age (p < 0.05). Cross-tabulation and regression analyses showed some differences by gender, workplace, specialty and COVID-19 infection status.

CONCLUSIONS

There was a low prevalence of negative beliefs about COVID-19 patients and a low prevalence of discriminatory behaviors in providing care for these patients in SA. Training and governmental regulations could further lower the prevalence of SAD against COVID-19 patients.

Stigmatization of Ebola virus disease survivors in 2022: A cross-sectional study of survivors in Sierra Leone

BACKGROUND

Evidence has demonstrated a high proportion of Ebola virus disease (EVD) survivors experienced stigma due to the disease. This study sought to understand the longer-term effects of stigma encountered by survivors of the 2014-2016 EVD epidemic living in Sierra Leone.

METHODS

This was a cross-sectional study of 595 EVD survivors and 403 close contacts (n = 998) from Sierra Leone. Assessments were conducted using a three-part survey between November 2021 to March 2022. We explored the socio-demographic factors associated with stigma experienced by EVD survivors.

FINDINGS

50·6 % (n = 301) of EVD survivors reported that they continued to experience at least one aspect of stigma. Females were disproportionately affected by stigma, with 45·2 % of females reporting isolation from friends and family compared to 33·9 % of men (p = 0·005). Multivariable logistic regression models revealed those aged 40-44, living rurally, and reporting an acute infection longer than seven days was associated with EVD-related stigma at the time of survey.

INTERPRETATION

This study demonstrates stigma is still prevalent among people who survived EVD in 2022. It also identified socio-demographic factors associated with stigma that can be used for targeting interventions. Importantly, this highlights the continued need for EVD survivors to access mental healthcare and social support systems well after disease recovery.

FUNDING

This study was funded by the Canadian Institutes for Health Research (Grant no. PJT-175098. JK is funded by a Tier 2 Canada Research Chair in the Molecular Pathogenesis of Emerging and Re-Emerging Viruses. SS is funded by a Tier 2 Canada Research Chair in Program Science and Global Public Health.

The socioeconomic impact of equine epizootic lymphangitis in working equids in low and middle-income countries: A scoping review

Equine epizootic lymphangitis (EEL) is a very infectious and contagious fungal disease that, with its ocular, respiratory and skin forms, causes severe effects on the health and welfare of working equids. Treatment is expensive and rarely available in low and middle-income countries (LMICs). Epidemiological data is lacking in most countries where the disease is known to exist. The purpose of this scoping review is to identify the current knowledge on the socioeconomic impact of EEL in working equids in LMICs, to highlight knowledge gaps and provide recommendations for future research. Seven eligible papers were obtained from the search of four databases and backward citation searching. The review showed that the available research on this subject is very scarce and restricted to Ethiopia. From the results it emerged that EEL causes detrimental socioeconomic effects on working equids' owners, compromising their health and livelihood. Its economic consequences were attributed to the reduced working capacity and loss of sick animals. Among the social impacts, authors highlighted the stigma around sick equids and their owners. Further studies on the socioeconomic impact of EEL conducted in endemic areas are highly required. The integration of epidemiological data with socioeconomic impact studies from LMICs may promote funding allocation for the development of cost-effective treatments and vaccines and for implementing disease prevention and control programmes. Future research would gain from applying the One Health approach to better examine the multiplicity of the disease socioeconomic effects, therefore increasing the potential of research to orientate policy.

Stigma of coronavirus disease 2019 among hospitalized children and their parents: A prospective cohort study

BACKGROUND

The stigma associated with coronavirus disease 2019 (COVID-19) is a global problem that causes psychosomatic distress, including depression, anxiety, and loneliness. However, few studies have investigated the stigma of COVID-19 and the associated mental health impact on children or parents.

METHODS

We conducted a prospective cohort study at the National Center for Child Health and Development in Tokyo, Japan, between November 2021 and October 2022. Children (4-17 years of age) with COVID-19 and parents of hospitalized children (0-17 years of age) with COVID-19 were enrolled in the study. Children with special health-care needs were excluded. The questionnaires on stigma and mental health (depression, anxiety, and loneliness) were administered during hospitalization and at the 1 month follow-up evaluation after discharge.

RESULTS

During the study period, 47 children and 111 parents were included. Thirty-eight children (81%) and 105 parents (95%) answered the questionnaires at the 1 month follow up, respectively. Approximately 70% of participants were categorized as a high-stigma group. In children, subjective stigma was associated with loneliness during hospitalization (mean difference [MD] 2.32; 95% confidence interval [CI], 0.11-4.52) and depression at the 1 month follow up (MD 2.44; 95% CI, 0.40-4.48). In parents, presumed stigma was associated with depression, anxiety, and loneliness at 1 month follow up (MD 2.24, 1.68, and 1.15; 95% CI, 0.58-3.89, 0.11-3.25, and 0.08-2.21).

CONCLUSION

Our findings suggest that the stigma associated with COVID-19 continues to affect mental health for more than a month after discharge, and the effects of stigma on mental health differed between the children and parents.

Stigma and infectious diseases in Africa: examining impact and strategies for reduction

Stigma poses a significant barrier to accessing care, managing, and preventing infectious diseases in Africa. The authors conducted an extensive search across Scopus, PubMed, ScienceDirect, and Google Scholar to identify relevant English-language articles, with no constraints on publication dates, using the keywords "Stigma," and "Infectious Disease," in conjunction with "Africa." This article explores the multifaceted nature of stigma associated with infectious diseases, highlighting its impact on healthcare access and public health outcomes. It delves into the current situation of infectious disease-related stigma in Africa, emphasizing the various diseases and contexts affected. The article identifies drivers of stigma, including negative attitudes, misinformation, and institutional practices, and discusses their role in perpetuating discrimination. Importantly, it provides recommendations for addressing infectious disease stigma in Africa through comprehensive strategies encompassing health education, contact-based interventions, professionalized counselling and peer support services, and community engagement. The article calls for collaboration among governments, healthcare organizations, NGOs, and community leaders to implement holistic strategies that prioritize inclusivity and stigma reduction. Ultimately, it underscores the urgent need to combat stigma to improve healthcare access and outcomes for individuals affected by infectious diseases in Africa.

Families under pressure: A qualitative study of stressors in families of children with congenital heart disease

The objective of this study was to better understand the stressors in families of children with congenital heart disease (CHD) to assist with formulating targeted stress management plans for such families. A descriptive qualitative study was undertaken at a tertiary referral hospital in China. Following purposeful sampling, interviews were conducted with 21 parents of children with CHD regarding the stressors in their families. Following content analysis, 11 themes were generated from the data and categorised into six main domains: the initial stressor and associated hardships, normative transitions, prior strains, the consequences of family efforts to cope, intrafamily and social ambiguity, and sociocultural values. The 11 themes include confusion regarding the disease, hardships encountered during treatment, the heavy financial burden, the unusual growth track of the child due to the disease, normal events becoming abnormal for the family, impaired family functioning, family vulnerability, family resilience, family boundary ambiguity induced by role alteration, a lack of knowledge about community support and family stigma. Various and complex stressors exist for families of children with CHD. Medical personnel should fully evaluate the stressors and take targeted measures before implementing family stress management practices. It is also necessary to focus on the posttraumatic growth of families of children with CHD and strengthen resilience. Moreover, family boundary ambiguity and a lack of knowledge about community support should not be ignored, and further research is needed to explore these variables. Most importantly, policymakers and healthcare providers should adopt a range of strategies to address the stigma of being in a family of a child with CHD.

Social stigma during COVID-19: A systematic review

Objectives

Stigmatization was reported throughout the COVID pandemic for COVID-19 patients and close contacts. The aim of this systematic review was to comprehensively examine the prevalence and impact of stigmatization during COVID-19 pandemic.

Methods

English articles were searched using online databases that included PubMed, Scopus, Embase, and Web of Science up to 24 August 2022. A two-step screening and selection process was followed utilizing an inclusion and exclusion criteria and then data was extracted from eligible articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed, and the risk of bias was assessed using the Newcastle-Ottawa Scale.

Results

Seventy-six studies were eligible for inclusion. Twenty-two studies reported the prevalence of social stigma due to COVID-19 infection with social isolation being the most commonly reported stigma. There were 20 studies that reported the majority of participants experienced stigma due to COVID-19 infection, which was as high as 100% of participants in two studies. Participants in 16 studies reported blaming from others as the second most common type of stigma, with various other types reported such as psychological pressure, verbal violence, avoidance, and labeling. The most common effect of the stigma was anxiety followed by depression, and then reduction of socialization.

Conclusion

Findings from the present review have identified that COVID-19-related stigma studies have generally focused on its prevalence, type, and outcome. Greater awareness of this topic may assist with improving public education during pandemics such as COVID-19 as well as access to support services for individuals impacted by stigmatization.

'We are not here to enforce; we are here for the people' Factors influencing performance of contact tracing during the COVID-19 pandemic: A qualitative study

Background

Provider-initiated contact tracing (CT) is an important measure to slow down the spread of infectious diseases such as COVID-19. However, carrying out effective CT depends on the collaboration between the patient and the contact tracer. To improve CT, it is important to understand which factors influence contact tracers in being able to carry out CT during large pandemics.

Methods

We performed individual semi-structured interviews with nine contact tracers working for the COVID-19 unit of the Public Health Service (PHS) Rotterdam-Rijnmond, the Netherlands, to explore their experiences with carrying out CT. Data were collected between July 2020 and December 2020. The interview protocol was structured based on the CT tasks and guided by the literature and the framework explaining adherence to clinical practice guidelines.

Results

In general, CT seemed to be carried out satisfactorily. Individual factors (interviewing techniques and skills, attitude towards the patient and attitude towards CT), factors related to the patient (cooperativeness and engagement, emotions, language and culture and (mis)information), guideline-related factors (characteristics) and factors related to the organisation (interactions with colleagues, support from management, workload and training) were found to influence the carrying out of CT.

Conclusion

To be well prepared for future pandemics, it is important to explore strategies that can be effective to support the contact tracer in performing CT, support patients in feeling comfortable to be engaged and ways to reach more consistency in policies and protocols.

Disease-Related Stigma, Stigmatizers, Causes, and Consequences: A Systematic Review

Background

Stigma is a sociological concept that is important in medicine and health because it threatens health as much as the disease itself. We aimed to explore the causes, stigmatizers, consequences and coping strategies related to the stigma of diseases by systematically analyzing relevant literature.

Methods

This systematic review examined 65 articles on Disease-Related Stigma by searching Noormags, Magiran, SID, Google Scholar, and PubMed databases. The articles were published in Persian and English between 2001 and 2022 and conducted in Iran. We used a three-step systematic review process to select articles that met the research criteria.

Results

Conflict in society, lack of knowledge, specific characteristics of the disease, and the contagious nature of disease are the main causes of stigma, leading to stigmatization by different groups such as significant others, generalized others, institutional others, and macro others. Patients experiencing stigma face various psychological, physical, and social complications, and they may use concealment as a coping strategy, which can pose a potential threat to society's general health.

Conclusion

By knowing the causes and stigmatizers of disease-related, it is possible to reduce stigma with less cost and time.

Can a brief session of the online coronavirus disease 2019 destigmatization program reduce stigma among survivors? A randomized controlled trial

Background

Stigmatization has taken a heavy toll on the mental health and quality of life of the survivors of coronavirus disease 2019 (COVID-19). To address this issue, we proposed a brief, self-directed, reflective, and practical destigmatization intervention. The current study aimed to investigate the efficacy of the online COVID-19 destigmatization program (OCDP) in mitigating stigma among the survivors of COVID-19.

Methods

This study was conducted on 142 survivors of COVID-19 before their discharge from Vajra Hospital from July 2022 to November 2022. The participants were randomly assigned between the intervention group (n = 71), who attended the 40-min OCDP, and the control group (n = 71), who received standard mental health care. The primary outcome was the efficacy of OCDP in reducing stigmatization. A COVID-19 stigma questionnaire was administered to assess stigmatization in the intervention and control groups immediately before and after the program during follow-up on days 7, 14, and 28. The secondary outcome was the efficacy of the program in alleviating negative emotions according to the Depression Anxiety Stress Scale 21 questionnaire.

Results

Compared with the control group, the intervention group had a more prominent reduction in the overall stigma score on day 7 (p = 0.002) and day 14 (p = 0.028). The intervention group had a more evident reduction in enacted stigma (day 7, p = 0.04), internalized stigma (day 7, p = 0.008; day 14, p < 0.028), and perceived external stigma (day 7, p = 0.002) than the control group. However, there was no significant difference in terms of disclosure concern between the intervention and control groups. Furthermore, the reduction in depression, anxiety, and stress between the two groups did not significantly differ.

Conclusion

Online COVID-19 destigmatization program provided prior to hospital discharge is an effective tool in reducing stigmatization, particularly within the first 2 weeks after reintegration into society, among the survivors of COVID-19.

Academic performance and mental health among Chinese middle and high school students after the lifting of COVID-19 restrictions

Background

Although the COVID-19 pandemic has greatly changed the way students studied, it is still unknown about the impact of the COVID-19 pandemic on students' academic performance and mental health.

Objective

To explore the academic performance and mental health status of middle and high school students after the lifting of COVID-19 restrictions in China.

Methods

An online survey was conducted in Sichuan province, China from Dec 14, 2022 to Feb 28, 2023. All participants were students in middle and high schools, recruited via their teachers. The general information, COVID-19-related information, and academic performance were collected. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Internet Addiction Test (IAT) were used to assess the mental health problems.

Results

Of 60,268 participants, 36,247 (60.2%) middle and high school students reported that their studies were affected by the COVID-19 pandemic, and 24,864 (41.2%) reported that their academic performance had worsened. The prevalence of depression and anxiety symptoms was 38.4 and 32.7%, respectively. There was a significant association between academic performance change and mental health problems. The logistic regression analysis showed that improved academic performance was a protective factor for depression, and declined academic performance was a risk factor for depression and anxiety. Being COVID-19 infected, family members being infected, with quarantine experience, and with COVID-19-related stigma were risk factors for depression and anxiety.

Conclusion

Academic studies and mental health status of middle and high school students in Sichuan, China have been negatively impacted by the COVID-19 pandemic, even after the lifting of COVID-19 restrictions. Students' academic performance, academic concerns, and mental health status should be considered for educational policymakers and institutions to improve students' academic studies and mental well-being.

The victims, villains and heroes of 'panic buying': News media attribution of responsibility for COVID-19 stockpiling

Societies often respond to a crisis by attributing blame to some groups while constructing others as victims and heroes. While it has received scant sociological attention, 'panic buying' is a critical indicator of such public sentiment at the onset of a crisis, and thus a crucial site for analysis. This article traces dynamics of blame in news media representations of an extreme period of panic buying during COVID-19 in Australia. Analysis reveals that lower socio-economic and ethnically diverse consumers were blamed disproportionately. Unlike wealthier consumers who bulk-bought online, shoppers filling trollies in-store were depicted as selfish and shameful, described using dehumanising language, and portrayed as 'villains' who threatened social order. Supermarkets were cast simultaneously as 'victims' of consumer aggression and 'heroes' for their moral leadership, trustworthiness and problem-solving. This portrayal misunderstands the socio-emotional drivers of panic buying, exacerbates stigma towards already disadvantaged groups, and veils the corporate profiteering that encourages stockpiling.

Analyzing U.S. State Governments' COVID-19 Homepages during the Initial Lockdown in March and April 2020: Information Content and Interactivity

During times of a pandemic, government emergency response webpages are an important communication channel and if properly managed, will mitigate pandemic impacts. Guided by the Crisis and Emergency Risk Communication (CERC) framework and web interactivity literature, this study examined the information content and interactivity of U.S. state governments' COVID-19 homepages when many states declared stay-at-home orders in March or April of 2020. Using a web archive service, we retrieved 48 state governments' COVID-19 homepages. Three coders coded these pages for the presence or absence of information content on five dimensions (timely updates, sensemaking information, efficacy information, targeted guidance, and anti-stigma communication) and interactivity on four dimensions (accessibility, navigability, media richness, and engagement). Results revealed that a large proportion of state governments' COVID-19 homepages provided timely information facilitating people's understanding of the pandemic. Yet, there were some information gaps regarding how to cope with the pandemic or its related problems, such as mental stress and social discrimination. While many COVID-19 homepages allowed easy navigation, page engagement and accessibility seemed inadequate. U.S. state governments' COVID-19 homepages could be a good source for sensemaking. Practitioners and researchers should explore how to better harness interactive Internet technologies and present information that fosters people's efficacy to manage through the pandemic.

Visual Learning Equity: A Course Auditing System of Skin Color in Preclinical Medical Education

BACKGROUND AND OBJECTIVES

Visual learning equity is a health justice effort in response to the lack of representation of brown and black skin images in medical education. This paucity creates a knowledge gap and decreases providers' competence in managing skin disease in minoritized populations. Herein, we aimed to create a standardized course auditing system to assess the use of brown and black skin images in medical education.

METHODS

We performed a cross-sectional analysis of the 2020-2021 preclinical curriculum at one US medical school. All human images in the learning material were analyzed. Skin color was categorized as light/white, medium/brown, and dark/black using the Massey-Martin New Immigrant Survey Skin Color Scale.

RESULTS

We included 1,660 unique images in our analysis; 71.3%, (n=1,183) were light/white, 16.1% (n=267) were medium/brown and 12.7% (n=210) were dark/black. Dermatologic images of skin, hair, nails, or mucosal disease made up 62.1% (n=1,031) of the images and 68.1% (n=702) were light/white. The pulmonary course presented the highest proportion of light/white skin (88.0%, n=44/50) and the dermatology course presented the lowest proportion of light/white skin (59.0%, n=301/510). Images of infectious diseases were more frequently presented in darker skin colors (χ2 [2]=15.46, P<.001).

CONCLUSIONS

Light/white skin was the standard used for visual learning images in the medical school curriculum at this institution. The authors outline steps to perform a curriculum audit and diversify medical curricula to ensure the next generation of physicians are educated to care for all patients.

COVID-19 stigmatization after the development of effective vaccines: Vaccination behavior, attitudes, and news sources

OBJECTIVE

To compare COVID-19 stigmatization at two pandemic time points (1) August 2020-during lockdowns and prior to vaccine rollout, and (2) May 2021-during vaccine rollout, when approximately half of U.S. adults were vaccinated.

METHODS

Comparison of COVID19-related stigmatization and associated factors in two national internet surveys conducted in August 2020 (N = 517) and May 2021 (N = 812). Factors associated with endorsing stigmatization were identified using regression analysis. The main outcomes included endorsement of stigmatization and behavioral restrictions towards persons with COVID-19 and towards persons of Chinese descent. A previously developed "stigmatizing attitudes and behavioral restrictions" scale was adapted to measure the intersection of negative attitudes toward COVID-19 disease and negative attitudes toward persons of Chinese descent.

RESULTS

COVID-19 related stigmatization declined significantly from August 2020 to May 2021. Many factors were associated with stigmatizing in both surveys: full time employment, Black race, Hispanic ethnicity, worry about contracting COVID-19, probable depression, and Fox News and social media as sources of information (all positively associated), and self-assessed knowledge about COVID-19, contact with Chinese individuals, and publicly funded news as sources (all negatively associated). Positive attitudes toward vaccination were associated with stigmatization.

CONCLUSIONS

COVID-19 related stigmatization reduced substantially over these two points in the pandemic, with many continuities in the factors associated with stigmatizing. Despite the reduction in stigmatizing, however, some stigmatizing attitudes for both COVID-19 and Chinese individuals remained.

Moral IntuitionsAboutStigmatizing Practices andFeedingStigmatizing Practices: How Haidt’s Moral Foundations Theory Relates to Infectious Disease Stigma

Despite extensive stigma mitigation efforts, infectious disease stigma remains common. So far, little attention has been paid to the moral psychology of stigmatizing practices (i.e. beliefs, attitudes, actions) rather than the experience of being stigmatized. Addressing the moral psychology behind stigmatizing practices seems necessary to explain the persistence of infectious disease stigma and to develop effective mitigation strategies. Our article proposes building on Jonathan Haidt’s moral foundations theory, which states that moral judgements follow from intuitions rather than conscious reasoning. Conceptual analysis was conducted to show how Haidt’s five moral foundations can be connected to (i) moral judgements about stigmatizing practices and (ii) stigmatizing practices themselves. We found that care/harm, fairness/cheating, loyalty/betrayal and sanctity/degradation intuitions can inform moral judgements about stigmatizing practices. Loyalty/betrayal and sanctity/degradation intuitions can sometimes also feed stigmatizing practices. Authority/subversion intuitions can inform moral judgements and stigmatizing practices towards people who disrespect authoritative rules meant to protect public health. Moral dumbfounding and posthoc reasoning might explain the persistence of stigmatizing practices. In conclusion, this study demonstrates the relevance of Haidt’s approach to infectious disease stigma research and mitigation strategies. We hope that this study motivates researchers to further test and assess this approach.

Characteristics of victim blaming related to COVID-19 in South Korea

This study aimed to determine the characteristics of the victim-blaming tendency of patients with coronavirus disease-2019 (COVID-19) and the worry of being blamed because of COVID-19 infection. This study utilized two methodologies based on the theory of defensive attribution and information processing. First, a media analysis was conducted to determine the characteristics of the two representative COVID-19 victim blaming cases (the Itaewon Club case and the Omicron-infected pastor case). The results show that from the viewpoint of defensive attribution theory, the victim blaming of patients infected with COVID-19 is related to social identity and moral violations committed by the patients. The Korean public emphasized their social identity and believed that the patients were different from them from an ego-defensive viewpoint. Second, we conducted three longitudinal online panel surveys (N1 = 1569; N2 = 1037; N3 = 833). The samples were selected by stratified random sampling based on sex, age, and 17 metropolitan regions in Korea. The results showed that as the number of COVID-19 cases increased, the respondents' level of risk perception decreased significantly. As the information processing theory explains, people who are familiar with the frequent risks of COVID-19 are less worried about being blamed by others. Meanwhile, the regression analysis found that victim blaming of the pastor was significantly related to the respondent's religion. We can conclude that the Korean people may blame the victims of COVID-19 because they believe that the victims are very different from an ego-defensive viewpoint. Furthermore, the trust variable appeared to be important: the more the respondents trusted the government, the more they blamed the victims of COVID-19. We term this phenomenon the "trust paradox."

Social stigma and discrimination faced by COVID-19 patients in an industrial unit: Findings of survey from rural Maharashtra

Introduction

Uncertain situation of the coronavirus disease 2019 (COVID-19) pandemic has led to fear, stigma, and discrimination across all strata of society in varying proportions. Stigmatization increases the suffering of people or those who are at risk of getting the disease and make it harder for public health authorities to control the disease.

Material and Methods

The present study is a questionnaire-based cross-sectional survey conducted over a period of four weeks in the month of July 2021 in a food industry in rural region of western Maharashtra among COVID-19 positive patients. A total of 152 participants were included in the study. The data was analyzed using SPSS software (version 20). Descriptive statistics were used which included frequencies and percentages.

Results

64.5% of the participants were males and 35.5% were females. Approx. 85% of the participants were in age group 15-58 years. 100% of them reported to have faced fear on being tested COVID-19 positive. However, only approx. 2-5% individuals hid their illness from family and friends and 7.9% of them were afraid of getting hospitalized.

Conclusion

It was found that fear was prevalent among all survivors but stigma was found to be minimal which is likely due to widespread awareness through media, IEC campaigns, and active involvement of administration in implementing policies.

Estimation of monkeypox spread in a nonendemic country considering contact tracing and self-reporting: A stochastic modeling study

In May 2022, monkeypox started to spread in nonendemic countries. To investigate contact tracing and self-reporting of the primary case in the local community, a stochastic model is developed. An algorithm based on Gillespie's stochastic chemical kinetics is used to quantify the number of infections, contacts, and duration from the arrival of the primary case to the detection of the index case (or until there are no more local infections). Different scenarios were set considering the delay in contact tracing and behavior of infectors. We found that the self-reporting behavior of a primary case is the most significant factor affecting outbreak size and duration. Scenarios with a self-reporting primary case have an 86% reduction in infections (average: 5-7, in a population of 10 000) and contacts (average: 27-72) compared with scenarios with a non-self-reporting primary case (average number of infections and contacts: 27-72 and 197-537, respectively). Doubling the number of close contacts per day is less impactful compared with the self-reporting behavior of the primary case as it could only increase the number of infections by 45%. Our study emphasizes the importance of the prompt detection of the primary case.

Diagnostics of Ebola virus

Ebola is a highly pathogenic virus, which in humans reaches a mortality rate above 50%. Due to a lack of laboratories in territories where Ebola viruses are endemic and the limited number of surveillance programmes, tests for the confirmation of suspected cases of Ebola are often performed in Reference Laboratories. While this provides guarantees regarding the accuracy of results, the shipment of samples to a centralized facility where the diagnostic test can be performed and the time required to achieve the results takes several days, which increases costs and entails delays in the isolation of positive subjects and therapeutic intervention with negative consequences both for patients and the community. Molecular tests have been the most frequently used tool in Ebola diagnosis in recent outbreaks. One of the most commonly used molecular tests is the Real-Star Altona, which targets a conserved area of the L gene. This assay showed different sensitivities depending on the Ebola virus: 471 copies/mL (EBOV) and 2871 copies/ml (SUDAN virus). The Cepheid system also showed good sensitivity (232 copies/mL). The LAMP platform is very promising because, being an isothermal reaction, it does not require high-precision instrumentation and can be considered a Point of Care (PoC) tool. Its analytical sensitivity is 1 copy/reaction. However, since data from real life studies are not yet available, it is premature to give any indications on its feasibility. Moreover, in November 2014, the WHO recommended the development of rapid diagnostic tests (RDT) according to ASSURED criteria. Several RDT assays have since been produced, most of which are rapid tests based on the search for antibody anti-Ebola viral proteins with immunochromatographic methods. Several viral antigens are used for this purpose: VP40, NP and GP. These assays show different sensitivities according to the protein used: VP40 57.4-93.1%, GP 53-88.9% and 85% for NP compared to reference molecular assays. From these results, it can be deduced that no RDT reaches the 99% sensitivity recommended by the WHO and therefore any RDT negative results in suspected cases should be confirmed with a molecular test.

A post-outbreak assessment of exposure proximity and Ebola virus disease-related stigma among community members in Kono District, Sierra Leone: A cross-sectional study

Background

Based on findings from other contexts, informed by intergroup contact theory, that more contact is associated with less stigma, we hypothesized that community members with greater exposure to cases of Ebola virus disease (EVD) were less likely to report EVD-related stigma towards EVD survivors. We assessed personal stigmatizing attitudes towards Ebola survivors, which reflects personal fear and judgement, as well as perceived stigma towards EVD survivors, which reflects an individual's perception of the attitudes of the community towards a stigmatized group.

Methods

From September 2016 to July 2017, we conducted a cross-sectional, community-based study of EVD-related stigma among individuals who did not contract Ebola in four EVD-affected rural communities of Kono District, Sierra Leone. We identified individuals from all quarantined households and obtained a random sample of those who were unexposed. Exposed individuals either lived in a quarantined household or were reported to have been in contact with an EVD case. Our explanatory variable was proximity to an EVD case during the outbreak. Our primary outcome was stigma towards EVD survivors, measured by a 6-item adapted HIV-related stigma index validated in Zambia and South Africa, with 1 item reflecting personal stigmatizing attitudes and 5 items reflecting perceived community stigma. The 6-item EVD stigma index had good internal consistency (Cronbach's alpha=0.82). We used modified Poisson and negative binomial regression models, adjusting for potential confounders, to estimate the association between exposure proximity and EVD stigma.

Results

We interviewed 538 participants aged 12 to 85 years. Most (57%) had been quarantined. Over one-third (39%) reported personal stigmatizing attitudes or perceived community stigma; the most frequently endorsed item was fear and judgment towards EVD survivors. Having contact with someone with EVD was significantly associated with a lower likelihood of perceived community stigma (prevalence ratio [PR], 0.26; 95% CI, 0.13-0.54) and personal stigmatizing attitudes (PR, 0.44; 95% CI, 0.29-0.65). In contrast, being quarantined was significantly associated with a higher likelihood of perceived community stigma (PR, 3.9; 95% CI, 1.5-10.1).

Conclusions

In this cross-sectional study, we found evidence of an inverse relationship between EVD-related stigma and contact with an EVD case. This finding substantiates intergroup contact theory and may form the basis for anti-stigma interventions.

Extending health systems resilience into communities: a qualitative study with community-based actors providing health services during the COVID-19 pandemic in the Philippines

BACKGROUND

Amidst ongoing calls for increased health systems resilience, gaps remain in our understanding of how health systems can reach further into communities to ensure resilient service delivery. Indeed, public health emergencies caused by infectious hazards reveal both the value and vulnerability of the workforce delivering health services in communities. This study explores ways in which a non-governmental organization (NGO) in the Philippines protected their frontline workforce during the first year of the COVID-19 pandemic.

METHODS

Guided by a qualitative descriptive approach, 34 in-depth interviews were conducted with community-based health actors employed by the NGO between June 2020 and February 2021. Data analysis was guided by an iterative deductive and inductive approach.

RESULTS

We identified four key activities that enabled the NGO and their staff to provide health and social services in communities in a safe and consistent manner as part of the organization's pandemic response. These include (1) ensuring adequate personal protective equipment (PPE) and hygiene supplies; (2) providing contextualized and role-specific infection prevention and control (IPC) training; (3) ensuring access to testing for all staff; and (4) providing support during quarantine or isolation.

CONCLUSION

Learning from the implementation of these activities offers a way forward toward health emergency preparedness and response that is crucially needed for NGOs to safely leverage their workforce during pandemics. Further, we describe how community-based health actors employed by NGOs can contribute to broader health systems resilience in the context of health emergency preparedness and response.

Social distancing, community stigma, and implications for psychological distress in the aftermath of Ebola virus disease

BACKGROUND

The 2013-2016 Ebola virus disease (EVD) epidemic resulted in more infections and deaths than all prior outbreaks in the 40-year history of this virus combined. This study examines how experiences of EVD infection, and preventive measures such as social distancing, were linked to experiences of stigma and social exclusion among those reintegrating into their communities.

METHODS

Key informant interviews (n = 42) and focus group discussions (n = 27) were conducted in districts with a high prevalence of EVD and representing geographical and ethnic diversity (n = 228 participants). The final sample was composed of adults (52%) and children (48%) who were EVD-infected (46%) and -affected (42%) individuals, and community leaders (12%). Data were coded using a Grounded Theory approach informed by Thematic Content Analysis, and analyzed using NVivo. Interrater reliability was high, with Cohen's κ = 0.80 or higher.

FINDINGS

Participants described two main sources of EVD-related stress: isolation from the community because of social distancing and other prevention measures such as quarantine, and stigma related to infected or affected status. Participants linked experiences of social isolation and stigma to significant distress and feelings of ostracization. These experiences were particularly pronounced among children. Sources of support included community reintegration over time, and formal community efforts to provide education and establish protection bylaws.

INTERPRETATION

This study found that social distancing and EVD-related stigma were each prominent sources of distress among participants. These results suggest that isolation because of infection, and the enduring stigmatization of infected individuals and their families, demand coordinated responses to prevent and mitigate additional psychosocial harm. Such responses should include close engagement with community leaders to combat misinformation and promote community reintegration.

Addressing Operational Challenges Faced by COVID-19 Public Health Rapid Response Teams in Non-United States Settings

The coronavirus disease 2019 (COVID-19) global response underscores the need for a multidisciplinary approach that integrates and coordinates various public health systems-surveillance, laboratory, and health-care systems/networks, among others-as part of a larger emergency response system. Multidisciplinary public health rapid response teams (RRTs) are one mechanism used within a larger COVID-19 outbreak response strategy. As COVID-19 RRTs are deployed, countries are facing operational challenges in optimizing their RRT's impact, while ensuring the safety of their RRT responders. From March to May 2020, United States Centers for Disease Control and Prevention received requests from 12 countries for technical assistance related to COVID-19 RRTs and emergency operations support. Challenges included: (1) an insufficient number of RRT responders available for COVID-19 deployments; (2) limited capacity to monitor RRT responders' health, safety, and resiliency; (3) difficulty converting critical in-person RRT operational processes to remote information technology platforms; and (4) stigmatization of RRT responders hindering COVID-19 interventions. Although geographically and socioeconomically diverse, these 12 countries experienced similar RRT operational challenges, indicating potential applicability to other countries. As the response has highlighted the critical need for immediate and effective implementation measures, addressing these challenges is essential to ensuring an impactful and sustainable COVID-19 response strategy globally.

"Like a wake-up call for humankind": Views, challenges, and coping strategies related to public health measures during the first COVID-19 lockdown in Thailand

Following the first Thai COVID-19 case in January 2020, the Thai government introduced several non-pharmaceutical interventions (NPIs) in March 2020 (e.g., contact tracing, travel restrictions, closure of businesses, curfews, stay at home orders) to control COVID-19 transmissions. This study aimed to understand the views and experiences of a small number of Thai residents related to public health measures implemented during the first COVID-19 wave in Thailand. A total of 28 remote in-depth interviews with Thai residents (18-74 years old) were conducted between 8 May and 21 July 2020. Interviews were audio recorded, transcribed, and analysed using thematic analysis based on the Framework Method. Our results describe participants' views, challenges, and coping strategies relating to COVID-19 restrictions. Most participants expressed support for the introduction of strict public health measures, while some criticized lacking enforcement or rational of certain measures. Participants identified four major challenges, namely financial hardship; social isolation and loneliness; stigma and shaming; and fear of COVID-19 infection. Strategies adopted to address these challenges included practical coping strategies (e.g., reducing risks and fear of COVID-19 infection; mitigating financial, social, and mental health impacts), and embedded socio-cultural ways of coping (e.g., turning to religion; practicing acceptance; kindness, generosity and sharing ('Namjai'); 'making merit' ('Tham-bun')). The challenges identified from this study, in particular the role of stigma and discrimination, may be relevant to other infectious disease outbreaks beyond COVID-19. Findings from this study underscore the need for policies and interventions that mitigate the negative impacts of NPIs on the public, particularly on vulnerable groups, and highlight the importance of considering socio-cultural context to support community resilience in times of crisis. Our findings remain relevant in light of low COVID-19 vaccine availability and the potential need to implement further public health restrictions in Thailand and elsewhere against COVID-19 or future infectious disease threats.

Operational challenges and considerations for COVID-19 research in humanitarian settings: A qualitative study of a project in Eastern Democratic Republic of the Congo and South Sudan

Since the beginning of the COVID-19 pandemic, much research has been conducted globally, but relatively few studies have been carried out in complex emergency settings that pose numerous operational challenges. We conducted a qualitative study to explore the barriers and enablers of a COVID-19 cohort study conducted in South Sudan and Eastern Democratic Republic of the Congo, to inform future research on COVID-19 and infectious diseases in humanitarian settings. We used a case study design embedded within the original prospective cohort study. Qualitative data was collected through four health facility assessments, 28 key informant interviews, and a focus group discussion. Data were analyzed using a manual thematic analysis approach and summarized against four primary themes: testing challenges and enablers, perceptions and attitudes towards COVID-19, national health system considerations, and study management considerations. Findings suggest most of the challenges affecting the cohort study were not specific to COVID-19 research but have been a feature of previous infectious disease research carried out in complex emergencies. However, the pandemic has exacerbated certain problems. The high proportion of travellers enrolled due to testing mandates, stigmatization of infected individuals linked to the heavy global focus on COVID-19, strained resources during waves of increasing infections, and remote management requirements all negatively impacted the cohort study. Factors that facilitated the research included proactive management, data quality oversight procedures, and strong collaboration with national health stakeholders. The global impact of COVID-19, its high public profile, and specific pandemic policies pose further operational challenges for research in already complex humanitarian settings. Future studies could plan mitigation measures that include flexibility in staffing and budgets, strategies to expand testing, and early partnerships with local organizations and health authorities.

Covid-19, social stigma and changing religious practice in Tablighi Jamaat communities in Lombok, Indonesia

The emergence of Covid-19 has presented serious challenges to people's lives, and as a result many are in the process of reconstructing aspects of what used to be considered 'normal' life. In Indonesia, religious practice in 2020 experienced a kind of disempowerment and disruption in the areas of ritual and proselytization in Muslim communities. Religious people have been challenged to find ways to reconstruct their ritual and worship practices in safe ways that avoid spreading the virus. This article discusses the changes to religious practice and the ability to adapt to new forms of proselytization in Tablighi Jamaat environments where many followers have been infected with Covid-19. In particular, the article aims to explore how Tablighi Jamaat members interpret and define the Covid-19 pandemic, and what discourses have developed in their environments. Research for this article was conducted in Lombok, Indonesia from February till September 2020 and is based on observations and snowball-sampling interviews conducted online and offline with over 50 individuals. When the Indonesian government locked down mosques and large meetings, the Tablighi Jamaat took a position that Covid-19 was not a serious danger-indeed they saw it as an anti-Islamic conspiracy, instead-and they continued to gather and preach as before. This led to a disease cluster from a Tablighi event in Gowa, South Sulawesi, causing a stigma in broader society toward the Tablighi practice of Islam.

Comparisons Between COVID-19 Stigma and Other Stigmas: Distinct in Explicit Attitudes and Similar in Implicit Process

Since the outbreak of COVID-19, the public stigma associated with COVID-19 has emerged. To better understand the COVID-19 stigma, the present research conducted three studies on 1,493 Chinese participants from the outbreak to the recovery period of the COVID-19 pandemic to examine the psychological mechanisms of COVID-19 stigma by comparing it with other disease-related stigmas in terms of their explicit and implicit processes. Study 1 and Study 2 jointly demonstrated that the public endorsed more stigma toward the COVID-19 related people (i.e., the COVID-19 patients) relative to the other disease-related people (i.e., the SARS patients, people with flu) in multiple explicit aspects, including emotional, motivational, cognitive, and social processing. Using the implicit association test (IAT), Study 3 found no significant difference in the implicit measures of the COVID-19 vs. the SARS groups, which further revealed that the pandemic stigmas (i.e., COVID-19 and SARS) were similar at the implicit level. These findings suggest common (implicit level) but distinct (explicit level) psychological processes of the pandemic-related stigmas, which provide reference to policymakers in formulating suitable interventions to deal with COVID-19 stigma and a newly generated potential stigma and provide psychological support for the public in the future.

The Double Bind of Communicating About Zoonotic Origins: Describing Exotic Animal Sources of COVID-19 Increases Both Healthy and Discriminatory Avoidance Intentions

Many novel diseases are of zoonotic origin, likely including COVID-19. Describing diseases as originating from a diverse range of animals is known to increase risk perceptions and intentions to engage in preventative behaviors. However, it is also possible that communications depicting use of exotic animals as food sources may activate stereotypes of cultures at the origin of a disease, increasing discriminatory behaviors and disease stigma. We used general linear modeling and mediation analysis to test experimental data on communications about zoonotic disease origins from the critical first two months leading up to the declaration of a global pandemic. Results suggest that communications about potential familiar food origins (pigs) affected people's risk perceptions, health behaviors, and COVID-19 stigma compared to more exotic food sources (e.g., snakes). Participants (N = 707) who read descriptions of exotic origins viewed the virus as riskier and reported stronger intentions to engage in preventative behaviors than those who read about familiar origins (pigs). However, reading exotic origin descriptions was also associated with stronger intentions to avoid Asian individuals and animal products. These results are critical for both theory and public policy. For theory, they are the first to experimentally demonstrate that zoonotic origin descriptions can impact intentions to engage in discriminatory behaviors for cultures viewed as the origin of a novel infectious disease. For policy, they offer clear, actionable insights on how to communicate about risks associated with a novel zoonosis while managing the potential impact on discriminatory behaviors and stigma.

The Impact of COVID-19 on Americans’ Attitudes toward China: Does Local Incidence Rate Matter?

Linking local COVID-19 and population statistics to a U.S.-based survey we recently conducted, we examine the spatial variation in the impact of COVID-19 on Americans’ attitudes toward China. The research strategy capitalizes on differential local COVID-19 incidence rates as varying dosages of COVID-19 impact across local contexts in the United States. Our results reveal negative yet heterogeneous effects of the ongoing COVID-19 pandemic on Americans’ attitudes toward China. We find that greater local exposure to COVID-19 is associated with a lower level of trust in Chinese and a less favorable attitude toward China. These findings lend consistent support to behavioral immune system theory by bridging the literature on contextual variations in public attitudes, with broader implications for U.S.-China relations.

Resilience and intention of healthcare workers in China to receive a COVID-19 vaccination: The mediating role of life satisfaction and stigma

Aims

The present study investigated the association between resilience, stigma, life satisfaction and the intention to receive a COVID‐19 vaccination among Chinese HCWs. It also explored the mediating role of stigma and life satisfaction on the association between resilience and intention to receive a COVID‐19 vaccination.

Design

An anonymous cross‐sectional survey.

Methods

1733 HCWs from five hospitals in four provinces of mainland China completed a cross‐sectional online survey in October and November 2020.

Results

Among the HCWs, the rate of intention to receive a COVID‐19 vaccination was 73.1%. Results from structural equation modelling showed that resilience was associated both directly, and indirectly with greater intent to receive a COVID‐19 vaccination through two pathways: first by increasing life satisfaction, and second by reducing stigma and increasing life satisfaction.

Conclusion

Promoting the resilience of HCWs has the potential to increase the COVID‐19 vaccination uptake rate among HCWs in China.

Impact

This study tested the relationship between several psychological factors and the COVID‐19 vaccination intention of HCWs in China, finding that resilience played a significant role in improving COVID‐19 vaccination intention rates by reducing stigma and increasing life satisfaction.

Impact of infectious disease epidemics on xenophobia: a systematic review

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Xenophobia has a significant impact on the health of international migrants.

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During an infectious disease outbreak, stigma and prejudice are highly pronounced.

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Migrants, often seen as disease carriers, are socially rejected during epidemics.

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Ensure an equal treatment and healthcare assistance for migrants is imperative.

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Educational interventions are urgently needed to prevent xenophobic tendencies.

Background Globally, xenophobia towards out-groups is frequently increased in times of economic and political instability, such as in infectious disease outbreaks. This systematic review aims to: (1) assess the xenophobic attitudes and behaviors towards migrants during disease outbreaks; and (2) identify adverse health outcomes linked to xenophobia. Methods We searched nine scientific databases to identify studies measuring xenophobic tendencies towards international migrants during disease outbreaks and evaluated the resulting adverse health effects. Results Eighteen articles were included in the review. The findings were grouped into: (1) xenophobia-related outcomes, including social exclusion, out-group avoidance, support for exclusionary health policies, othering, and germ aversion; and (2) mental health problems, such as anxiety and fear. Depending on the disease outbreak, different migrant populations were negatively affected, particularly Asians, Africans, and Latino people. Factors such as perceived vulnerability to disease, disgust sensitivity, medical mistrust individualism, collectivism, disease salience, social representation of disease and beliefs in different origins of disease were associated with xenophobia. Conclusions Overall, migrants can be a vulnerable population frequently blamed for spreading disease, promoting irrational fear, worry and stigma in various forms, thus leading to health inequities worldwide. It is urgent that societies adopt effective support strategies to combat xenophobia and structural forms of discrimination against migrants.

Stigmatizing Attitudes Toward COVID-19 Among Patients, Their Relatives and Healthy Residents in Zhangjiajie

Introduction

In July 2021, Zhangjiajie City became the new epicenter of the COVID-19 outbreak. Aside from the physical manifestations of COVID-19, patients are also victims of severe social stigmatization. Stigma affects not only COVID-19 patients or survivors, but also individuals associated with them. This study aims to describe and assess the COVID-19-related stigma between patients, their relatives, and healthy local residents.

Methods

The study included 43 COVID-19 patients, 68 relatives, and 75 healthy residents from Zhangjiajie. Demographic data was collected, including gender, age, marital status, and educational level. Stigma attitudes toward COVID-19 were measured using the Stigma Scale and Social Distance Scale. Frequencies and percentages were described for each item of the scales, and differences among the three groups were examined using the chi-square test.

Results

With regards to personal and perceived stigma, most participants agreed that patients with COVID-19 "could snap out of the problem" and that "they were dangerous." For social distance, over 30% of participants from the three groups agreed with the item "unwillingness to marry into the family of someone with COVID-19." In all groups, there were significant statistical differences in the belief that "the problem is not a real medical illness" and the desire to "spend the evening socializing."

Conclusion

Although the outbreak was well-contained in Zhangjiajie, stigmatizing attitudes toward COVID-19 and desire for social distance to such patients were common among patients, their relatives and healthy local residents. Our study's results suggest that public education, anti-stigma interventions, and policies are necessary for people living in Zhangjiajie in order to effectively curtail the spread of COVID-19 and provide a useful strategy for a tourist city like Zhangjiajie to recover sooner from economic decline.

COVID-19 transmission flow through the stigmatization process in Bangladesh: A qualitative study

Introduction

Coronavirus disease (COVID-19) patients and survivors face stigma, discrimination, and negligence. The motives for and the different types and consequences of COVID-19-related stigmatization remain underexplored in Bangladesh. Therefore, this study examined how the COVID-19 stigmatization process is interlinked with transmission flow.

Methods

Using a qualitative research design, we conducted 20 in-depth interviews with infected and suspected caregivers and five key informant interviews with physicians, local media representatives, leaders, law enforcement officials, and local administrative officials in three divisional cities of Bangladesh. We performed thematic analysis to analyze the data.

Results

Participants expressed their experiences with multiple subthemes within three themes (stigma related to symptoms, stigma associated with isolation and quarantine, and stigma associated with health services). Participants reportedly faced stigma, for example, exclusion, hesitation to interact, avoidance, bullying, threat, and negligence caused by misinformation, rumors, and fear. Stigmatized individuals reportedly hid their symptoms and refrained from seeking healthcare services, contributing to COVID-19 transmission flow.

Conclusion

Revealed insights may contribute to effective prevention, control, and management of such an emerging pandemic. Further in-depth exploration of such stigmatization process will enrich unexpected outbreaks management effectively.

The impact of COVID-19 on clinical research for Neglected Tropical Diseases (NTDs): A case study of bubonic plague

BACKGROUND

Among the many collaterals of the COVID-19 pandemic is the disruption of health services and vital clinical research. COVID-19 has magnified the challenges faced in research and threatens to slow research for urgently needed therapeutics for Neglected Tropical Diseases (NTDs) and diseases affecting the most vulnerable populations. Here we explore the impact of the pandemic on a clinical trial for plague therapeutics and strategies that have been considered to ensure research efforts continue.

METHODS

To understand the impact of the COVID-19 pandemic on the trial accrual rate, we documented changes in patterns of all-cause consultations that took place before and during the pandemic at health centres in two districts of the Amoron'I Mania region of Madagascar where the trial is underway. We also considered trends in plague reporting and other external factors that may have contributed to slow recruitment.

RESULTS

During the pandemic, we found a 27% decrease in consultations at the referral hospital, compared to an 11% increase at peripheral health centres, as well as an overall drop during the months of lockdown. We also found a nation-wide trend towards reduced number of reported plague cases.

DISCUSSION

COVID-19 outbreaks are unlikely to dissipate in the near future. Declining NTD case numbers recorded during the pandemic period should not be viewed in isolation or taken as a marker of things to come. It is vitally important that researchers are prepared for a rebound in cases and, most importantly, that research continues to avoid NTDs becoming even more neglected.