The role of personal contact with HIV-infected people in explaining urban, African American preadolescents' attitudes toward peers with HIV/AIDS

The Development and Psychometric Evaluation of the HIV Stigmatizing Attitudes Scale (HSAS) in Tanzania

HIV stigmatizing attitudes are embedded in social context, making it important to develop culturally specific tools for accurate measurement. The goal of this study was to develop and evaluate the psychometric properties of the HIV Stigmatizing Attitudes Scale (HSAS) in Moshi, Tanzania. Items were adapted based on a scale developed by Visser et al. which was one of the first to measure HIV stigmatizing attitudes in the general population (i.e., people not living with HIV). Items were translated into Swahili and modified with iterative feedback. The HSAS was administered to participants (N = 1494) in an HIV stigma reduction intervention study at two antenatal care clinics in Moshi, Tanzania. The HSAS was found to have strong domain coherence and high reliability based on Cronbach’s alpha, Omega 6 coefficient values, and the composite reliability coefficient, and high validity based on content-oriented evidence, relations to other variables, and response process. Factor analysis revealed a two-factor structure (Moral Judgment and Interpersonal Distancing), consistent with the original Visser scale. The HSAS provides a robust way to measure HIV stigma in the Tanzanian context and can be culturally adapted to other settings.

The Disclosure Dilemma: Willingness to Disclose a Positive HIV Status Among Individuals Preparing for HIV Testing During Antenatal Care in Tanzania

HIV status disclosure can reduce transmission risks and improve care engagement. Individuals may have strong feelings about HIV disclosure even prior to diagnosis. We assessed willingness to disclose a positive HIV status among pregnant women and their male partners awaiting routine HIV testing during antenatal care in Tanzania (n = 939). Logistic regression models were used to examine factors associated with willingness to disclose to one's inner circle (partner/family member) and outer circle (friend/neighbor) in the event of an HIV diagnosis. Almost all (93%) were willing to disclose to at least one person; participants were more willing to disclose to their inner circle (91%) vs outer circle (52%). Individuals with some form of employment, more stigmatizing attitudes of social distancing of PLWH, greater anticipated HIV stigma, more perceived social support, and prior contact with someone living with HIV were more likely to disclose to their inner circles. Individuals who were older, male, and who had higher levels of perceived social support were more willing to disclose to their outer circle. These findings increase the understanding of the intra- and interpersonal factors that influence HIV disclosure decisions. Tailored pre- and post- HIV test counseling are needed to facilitate social support and overcome barriers to disclosure if they test positive for HIV.

Correlates of Homophobic Attitudes in Lebanon: Results of a Cross-Sectional Study

To assess homophobic attitudes toward gay and lesbian persons and examine how those negative attitudes contributed to risk factors that may impact gay and lesbian persons among a sample of Lebanese individuals. A cross-sectional study, conducted between March and July 2017, enrolled 400 participants aged between 15 and 80 years. 129 (32.3%) of the participants had severe homophobic attitudes. An increase in intense homophobia would significantly increase the odds of emotion focused engagement and decrease the problem focused engagement (Beta = 1.05 and Beta = -1.19, respectively). A stepwise linear regression, using the total homophobia score as the dependent variable showed that knowing someone gay (Beta = -12.97), university education level (Beta = -14.93), high monthly income (Beta = -4.33), and higher problem-focused engagement subscale (Beta = -0.54) would significantly decrease the total homophobic score. Our study supports the prevalence of homophobia among people in Lebanon. Understanding the correlation factors and predict discriminative attitudes can be of great help for policymakers when it comes to approaching the problem of homophobia with evidence-based solutions.

Adults’ perceptions about whether children should disclose their mental illness

Purpose

Disclosure of mental illness is a key ingredient in contact-based public stigma change strategies. Adults who disclose their personal recovery story experience greater empowerment and heightened quality of life. Qualitative research suggests youth may similarly benefit, but also have unique benefits and costs associated with disclosure. The purpose of this paper is to examine adults’ perceived costs and benefits of mental illness disclosure for middle and high school students with a new measure, the Coming Out with Mental Illness Scale for Children (COMIS-Child).

Design/methodology/approach

In total, 300 adult participants from Amazon’s MTurk completed the COMIS-Child, the Beliefs about Disclosure Scale (BDS), assessing perceptions about child disclosure, and the Attribution Questionnaire, assessing public stigma.

Findings

Principal component analyses of the COMIS-Child yielded one factor representing disclosure costs and two factors for benefits (changing pubic stigma; person-defined benefits). Internal consistencies of the COMIS-Child factors were strong. Parents with children with mental illness endorsed more costs and fewer benefits from the changing public stigma factor than other respondents. Regression analyses showed decisions about youth disclosing mental illness from the BDS were associated with perceived costs, perceived benefits as personally defined, and public stigma. Disclosure beliefs were also inversely associated with public stigma.

Social implications

Adults who identify more costs and fewer benefits were less likely to believe youth should disclose, favoring a more conservative approach to youth disclosure. This highlights the importance of participating in self-stigma interventions that guide an individual’s decision making about disclosure.

Originality/value

To the author’s knowledge, this is the first study examining adults’ perceptions of youth disclosure of mental illness.

Should youth disclose their mental health challenges? Perspectives from students, parents, and school professionals

Purpose

– Disclosure seems to be a useful strategy for adults to deal with both the public and self-stigma of mental illness. However, youth may face a different set of risks when coming out with their experiences. The purpose of this paper is to examine youth, parent, and teacher perspectives on the costs and benefits of disclosure by middle- and high school-aged youth to better understand these risks.

Design/methodology/approach

– Focus groups were conducted with questions framed to elicit the different ways mental health challenges are discussed in schools and families.

Findings

– Surprisingly, the benefits of disclosure seemed to far outweigh the costs across groups. Benefits included ways to deal with stigma, reducing isolation, and “differentness,” as well as the pursuit of mental health services if needed. Costs included harsh responses to disclosure by peers and family members. Participants shared strategies used to minimize risk, including where and with whom youth might share their stories.

Social implications

– The results suggest many youth have disclosed their experiences with mental health challenges and have received mixed responses; these reactions often serve as the barometer for future disclosure decisions. Other youth are considering disclosure in a variety of settings, but are unsure how to go about it safely. Implications for addressing stigma are discussed.

Originality/value

– To our knowledge, this is the first qualitative research study conducted with youth about disclosure of mental illness experiences. These results will help guide modification of programming that could be beneficial in aiding disclosure decisions and reducing disclosure-related risks for youth who come out.

Demographic and social factors associated with homophobia and fear of AIDS in a community sample

Examinations of demographic and social factors associated with homophobia and fear of AIDS are limited by the frequent use of homogeneous, college student samples and limited examination of interrelationships among variables. The present study examined community attitudes toward homosexuality and fear of HIV/AIDS as a function of age, education, race/ethnicity, religious affiliation, political party affiliation, and personal contact with homosexual individuals and persons living with HIV/AIDS. A community sample of 463 adults completed standardized measures of homophobia and fear of AIDS as well as demographic and social background items. When examined separately, each demographic and social factor assessed, with the exception of race/ethnicity, was associated with homophobia and all but race/ethnicity and political party affiliation were associated with fear of AIDS. However, when entered into multiple regression analyses, 24% of the variance in homophobia was predicted by a single variable, including only personal contact with homosexual individuals, while 18% of the variance in fear of AIDS was accounted for by five variables, including personal contact with homosexual individuals, religious affiliation, political affiliation, education, and personal contact with someone living with HIV/AIDS. Findings suggest that it is important to consider intercorrelations among social and demographic factors, particularly when considering homophobia.

Care centre visits to married people living with HIV: an indicator for measuring AIDS-related stigma & discrimination

We tested whether observation of the presence and relationship of attendants (i.e. those that accompany upon admission) and visitors to a sample of 230 (128 male, 102 female) married HIV-positive people in an HIV care centre provides an indicator of caregiving, AIDS-related stigma and discrimination. Sensitivity to gender, location (urban vs. rural), age (<35 yrs vs. >35) and source of infection (spouse vs. non-spouse) were factors considered to modulate AIDS-related stigma and assess discrimination. HIV-positive people were accompanied by their spouse (53%), mother (14%), father (7%), with only 7% attending alone. Immediate family most commonly accompanied on admission (80%), but visitors were mainly from the 'extended' family (32%) with many receiving no visitors (48%). Females (11%) were more likely than males to attend alone (11% vs. 4%; p<0.05). No effect of location, age or infector was obtained. Females were more likely to be visited by their mother (14% vs. 6%; p<0.01) and non-immediate family (39% vs. 27%; p<0.05) than males were. In contrast, fathers (0% vs. 6%; p <0.05) and spouses were less likely (3% vs. 10%; p<0.05) to visit females than males. No effect of location or age upon visitation was obtained. Non-spouse infected persons were less likely than spouse-infected to be visited by their spouse (3% vs. 10%; p<0.05) but more likely to receive 'extended' family visitation (43% vs. 24%; p<0.01). Spouse-infected persons had a higher rate of no visitors than persons not infected by their spouse (54% vs. 40%; p<0.05). Observation of the presence and relationship of attendants and visitors to HIV-positive people has potential as an indicator of caregiving AIDS-related stigma and discrimination. The measure appears particularly sensitive to the gender of the HIV-positive person. Such a measure may aid healthcare professionals to focus resources such as relational counselling upon the family and close friends of people experiencing AIDS-related stigma and discrimination, with the aim of improving the provision of care within the community.

Children's attitudes toward people with AIDS in Puerto Rico: exploring stigma through drawings and stories

AIDS stigma refers to prejudice and discrimination directed at people or groups perceived to have HIV/AIDS (Herek, 1999). Although AIDS stigma has been found in adolescent and adult populations, few researchers have explored it among children. Misconceptions about people with AIDS (PWA) might lead to negative attitudes toward PWA and obstruct HIV prevention efforts. The authors assessed 110 Puerto Rican children's attitudes toward PWA using drawings (n=65) and stories (n=45). Although participants held stigmatizing attitudes toward PWA across both methods, the approaches captured different beliefs and attitudes. Drawings depicted PWA as physically deteriorated and performing socially condemned behaviors, whereas stories describing PWA highlighted children's fear of contagion and death. Stigma toward PWA was more pronounced than toward other illnesses (e.g., cancer). The study highlights the importance of assessing children's attitudes through creative data collection procedures.

AIDS-related stigma and attitudes towards AIDS-infected people among adolescents

This research examined the co-occurrence of accurate and inaccurate knowledge about HIV transmission among adolescents. Analyses were also conducted to examine the way in which variables related to demographic factors, personal characteristics, parent and peer relationships, and school involvement are associated with attitudes towards HIV/AIDS-infected people. Social and psychological processes that contribute to AIDS-related stigma are also described.

METHODS

Data were collected from the Portuguese sample of the 'Health Behaviour in School-Aged Children - 2002 - a collaborative WHO study'. The study provided data representative of 6137 Portuguese adolescents at national level. Based on these results, we conducted 14 focus groups discussions.

RESULTS

Adolescents presented high levels of knowledge about HIV transmission. However, the proportion of young people who hold misperceptions is also high. A multiple regression analysis identified several associations with attitudes towards HIV-infected persons. The focus groups showed that adolescents believe that people with AIDS experienced discrimination and social exclusion. Adolescents' opinions for HIV-infected persons were mostly positive and tolerant, although some adolescents showed an ambivalent attitude and undefined fears.

CONCLUSION

These findings have significant implications to implement and design comprehensive interventions with impact in adolescents' attitudes towards people with HIV/AIDS.