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Dennermalm N, Sjöland CF, Christiansen M, Nilsson Schönnesson L, Laine K, Kanon E, Suarez D, Ekström AM, Mølsted Alvesson H. Growing up in the shadow of HIV: post-AIDS generation of HIV-negative men who have sex with men in Sweden and their perceptions of HIV and stigma. CULTURE, HEALTH & SEXUALITY 2024:1-15. [PMID: 39012361 DOI: 10.1080/13691058.2024.2375608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/29/2024] [Indexed: 07/17/2024]
Abstract
Despite growing understanding and acceptance of the concept of Undetectable = Untransmittable (U = U) among gay men, HIV stigma remains a burden for people living with HIV. This study explored perceptions of HIV among HIV seronegative gay men in Sweden in this new context. Using snowball sampling, 15 gay men born between 1980 and 2000 were recruited to the study. Semi-structured interviews were conducted and data were subjected to reflexive thematic analysis. Men grew up experiencing gay stigma and were repeatedly informed by parents, schools, communities, peers, and popular culture about the dangers of HIV, and that gay men were a high-risk group. As men grew older, and the premise of HIV shifted dramatically due to U = U, some remained emotionally anchored to the pre-U = U era, while others realigned their perceptions, often after a process of reconciling emotional responses (e.g. HIV = death) with the logical-rational claims made about U = U. The study highlights key areas for future efforts, namely establishing a balance between HIV education strategies and stigma reduction initiatives. Study findings underscore the need to care for the memory of those lost during the crisis years, while also addressing the stigma faced by those currently living with HIV.
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Affiliation(s)
- Nicklas Dennermalm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Carl Fredrik Sjöland
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Public Health Agency of Sweden, Solna, Sweden
| | - Mats Christiansen
- Department of Public Health and Care Science, Uppsala University, Uppsala, Sweden
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | | | | | | | | | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease/Venhälsan, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
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Bhor N, Nadh PO. Interfaces of 'being healthy and being Ill': how is health being perceived by individuals with non-communicable chronic conditions? Int J Equity Health 2024; 23:108. [PMID: 38797834 PMCID: PMC11129416 DOI: 10.1186/s12939-024-02188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/12/2023] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Accommodating chronic care into the everyday lives of individuals diagnosed with non-communicable chronic conditions often poses significant challenges. Several studies in public health literature that addressed the question of non-adherence to treatment by turning their gaze towards individual's perception of their own health restricted the use of perception exploration to visceral states and corporeality without adequately acknowledging the mutual permeance of socio-biological worlds. This study explored the socio-economic genealogies of individuals, to understand the role of structural and intermediate factors that determine health perceptions, by attempting to answer the question 'how do individuals with non-communicable chronic conditions perceive their health as healthy or ill'?. METHODS This study was conducted in a low-income neighbourhood called Kadugondanahalli in India using qualitative research methods. A total of 20 in-depth interviews were conducted with individuals diagnosed with non-communicable chronic conditions. Individuals were recruited through purposive and snowball sampling. RESULTS The participants predominantly perceived their health as being healthy and ill in an episodic manner while adhering to their treatment and medications for chronic conditions. This was strongly determined by the factors such as presence of family support and caregiving, changes in work and occupation, changes in lifestyle, psychological stress from being diagnosed, and care-seeking practices. This episodic perception of illness led to the non-adherence of prescribed chronic care. CONCLUSIONS Due to the episodic manner in which the participants experienced their illness, the paper recommends considering health and illness as two different entities while researching chronic conditions. It is important for the health system to understand and fix the healthy and ill episodes, which often lead to switching between controlled and uncontrolled states of diabetes and hypertension. To do so, it is important to consider the social, economic, behavioural and psychological factors in an individual's health outcome. The interplay between these factors has socialized health perception and various related practices from the individual to the community level. Therefore, the health system needs to re-strategize its focus from individual to community level interventions to address the determinants of health and NCD risk factors by strengthening the NCD prevention approach.
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Affiliation(s)
- Nilanjan Bhor
- Indian Institute for Human Settlements, Bangalore (Bengaluru), India.
| | - P Omkar Nadh
- Indian Institute for Human Settlements, Bangalore (Bengaluru), India
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Beer L, Williams D, Tie Y, McManus T, Yuan A(X, Crim SM, Demeke HB, Creel D, Blackwell AD, Craw JA, Weiser J. The Capacity of HIV Care Facilities to Implement Strategies Recommended by the Ending the HIV Epidemic Initiative: The Medical Monitoring Project Facility Survey. J Acquir Immune Defic Syndr 2023; 94:290-300. [PMID: 37643411 PMCID: PMC10615730 DOI: 10.1097/qai.0000000000003290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic activities. SETTING US HIV care facilities. METHODS We analyzed 2021 survey data from 514 facilities that were recruited from a census of facilities providing care to a national probability sample of US adults with HIV. We present weighted estimates of facility characteristics, services, and policies and estimates of the proportion of all US HIV patients attending these facilities. RESULTS Among HIV care facilities, 37% were private practices, 72% were in areas with population >1 million, and 21% had more than 1000 HIV patients. Most provided preexposure prophylaxis (83%) and postexposure prophylaxis (84%). More than 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/sexually transmitted infection (STI) transmission risk reduction counseling (89%); fewer had on-site access to treatment for substance use disorders (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups. CONCLUSION Results indicate some strengths that support Ending the HIV Epidemic-recommended strategies among HIV care facilities, such as high availability of preexposure prophylaxis/postexposure prophylaxis, as well as areas for improvement, such as provision of staff antistigma trainings and adherence supports.
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Affiliation(s)
- Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Yunfeng Tie
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Timothy McManus
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Stacy M. Crim
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hanna B. Demeke
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Angela D. Blackwell
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jason A. Craw
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Montgomery C, Atkinson A, Jones A, Sumnall H. Little Evidence for the Role of Disgust Sensitivity in Implicit Disgust to Images of White People Engaged in Injecting Drug Use (IDU). Subst Use Misuse 2023; 58:1722-1733. [PMID: 37602746 DOI: 10.1080/10826084.2023.2247054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Background: Previous research has shown that People Who Inject Drugs (PWID) are subject to public stigma, which affects access to, and provision and quality of, treatment and support services. Less is known about the socio-cognitive processes that support the development and maintenance of public stigma toward PWID. The present study investigated the role of disgust sensitivity in implicit disgust to injecting drug use. Methods: 126 participants took part in an online Implicit Association Task (IAT) measuring implicit disgust to pictorial stimuli of injecting drug use or medical injecting. Participants also completed The Disgust Scale Revised, Injecting Phobia Scale (Short Form), Attitudes to People Who Use Drugs (PWUD) scale and a substance use inventory. Results: Average IAT score was negative indicating significantly higher implicit disgust to injecting drug use. Hierarchical linear regression found that injecting phobia predicted implicit disgust to injecting drug use. Questionnaire measures of disgust did not predict implicit disgust. While animal reminder disgust and injecting phobia were significantly correlated with each other, animal reminder disgust did not predict implicit disgust scores. Conclusions: On the basis of our findings, stigma toward PWID may not be a result of feelings of disgust toward injecting drug use. We discuss findings in the context of the underlying cortical processes supporting implicit and explicit representations of disgust. Future research should seek to investigate neurophysiological evidence for disgust to and stigmatization of injecting drug use and the potential role of domains of disgust in this.
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Affiliation(s)
| | - Amanda Atkinson
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Andrew Jones
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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Derose KP, Berkley-Patton J, Hamilton-Burgess C, Thompson CB, Williams ED, Simon S, Allsworth JE. Correlates of HIV-Related Stigmas Among African American Church-Affiliated Populations in Kansas City. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:54-68. [PMID: 36735231 PMCID: PMC9907009 DOI: 10.1521/aeap.2023.35.1.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
HIV-related stigmas contribute to disparities, and contact with HIV-positive individuals has been suggested to reduce stigma. Faith-based organizations have been recognized as important to stigma reduction efforts among African American populations; however, relatively few church-based studies have measured HIV-related stigma. This study uses baseline data (N = 1,448) from a study with 14 African American churches in Kansas City, Missouri and Kansas, to examine correlates of HIV-related stigmas among church members and community members accessing church social services using two previously validated scales that measure discomfort interacting with individuals with HIV and anticipated stigma or rejection. Knowing someone with HIV was associated with lower discomfort, even after adjusting for sociodemographic characteristics and sexual risk, HIV knowledge, previous communication about HIV at church, and mean drug and homosexuality stigmas. Knowing someone with HIV was not associated with anticipated stigma or rejection after adjustment. Contact-based interventions hold promise for reducing discomfort around people with HIV among church-affiliated populations.
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Affiliation(s)
- Kathryn P. Derose
- University of Massachusetts Amherst, Department of Health Promotion & Policy
- RAND Corporation
| | | | | | | | | | - Stephen Simon
- University of Missouri - Kansas City, School of Medicine
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6
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Boo HI, Choi Y. Effects of scenario-based attribution on collective emotions and stigma toward persons with COVID-19: A cross-sectional survey. Health Sci Rep 2023; 6:e1039. [PMID: 36628107 PMCID: PMC9827543 DOI: 10.1002/hsr2.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/27/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Background and Aims During this COVID-19 pandemic, many people experience and share emotions such as fear, anxiety, sadness, anger, and disgust, which can be regarded as collective emotions. This study investigated the effects of scenario-based attribution for serious diseases on collective emotions and social stigma. Methods Participants were 297 healthy adults who met two conditions: (1) not having tested positive for COVID-19 (including their family members or close friends) and no experience of self-quarantine; and (2) not having been diagnosed with lung cancer, and not having family members or close friends diagnosed with it. Three hundred participants were recruited, through a company conducting online surveys. A total of 297 data sets were analyzed, excluding data supplied by three participants who might have responded unreliably to the filler question. Scenarios were recorded according to attribution type (internal vs. external) and disease (COVID-19 vs. lung cancer). A 2 × 2 factorial design was used, whereby participants were randomly assigned to one of four conditions. Results The COVID-19 condition showed higher scores on the perceived risk and fear of the disease compared to the lung cancer one. The COVID-19/internal attribution condition showed the highest scores for fear and anger toward scenario characters, and the lung cancer/external attribution condition showed higher sympathy scores than other conditions. Although attribution to COVID-19 was not directly related to social stigma, it could evoke negative emotions toward infected people. Conclusion The findings suggest that attributions of serious diseases such as COVID-19 to infected persons can influence collective emotions and the level of social stigma associated with the disease. Attention to the collective emotions and stigma associated with disease is a key component for communities and countries to recover from and respond to its impacts.
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Affiliation(s)
- Hye In Boo
- Department of Psychology, BK21 Education & Research Team for Disaster and Trauma InterventionKeimyung UniversityDaeguKorea
| | - Yun‐Kyeung Choi
- Department of Psychology, BK21 Education & Research Team for Disaster and Trauma InterventionKeimyung UniversityDaeguKorea
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Li Y, Guo Y, Chen L. Predicting Social Support Exchanging Among Male Homosexuals Who are HIV-Positive in Social Media Context: The Role of Online Self-Disclosure. JOURNAL OF HOMOSEXUALITY 2022; 69:2233-2249. [PMID: 34110274 DOI: 10.1080/00918369.2021.1935623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study investigated social support exchanges on social media among male homosexuals who are HIV-positive (MHHP) in China and explored how online self-disclosure relates to such activity. Analyses were based on 9,459 Weibo messages posted by 188 targeted users.Results showed that the informational and emotional support messages were prevalent in the Chinese context, and esteem social support was first found to be the most salient by the current investigation. Results of independent samples t-tests suggested that MHHP who engaged in significant self-disclosure on Weibo tended to have more frequent social support exchanges than those who did not. In particular, MHHP who expressed sex-seeking intentions and companionship seeking intentions were likely to post more supportive messages than those who did not express such intentions. Moreover, MHHP who disclosed their concerns over discrimination tended to post more emotional, informational, and esteem support messages than those who did not express discrimination concerns.
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Affiliation(s)
- Yiwei Li
- Division of Humanities and Social Sciences, Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, China
| | - Yu Guo
- Faculty of Humanities and Arts, Macau University of Science and Technology, Macau, China
| | - Liang Chen
- School of Journalism and Communication, Tsinghua University, Beijing, China
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8
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Purtle J, Nelson KL, Gollust SE. Public Opinion About Adverse Childhood Experiences: Social Stigma, Attribution of Blame, and Government Intervention. CHILD MALTREATMENT 2022; 27:344-355. [PMID: 33769126 DOI: 10.1177/10775595211004783] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Adverse childhood experiences (ACEs) are receiving increasing attention in academic, policy, and media discourses. However, no public opinion research has focused on ACEs. We conducted a nationally representative survey of U.S. adults to address this knowledge gap. A web-based survey was conducted using the Ipsos KnowledgePanel (N = 503, completion rate = 60.5%) in fall 2019. We found that inter-personal stigma and parental blame related to ACEs were prevalent, with 25.0% of respondents unwilling to have a person with "a lot of ACEs" as a close co-worker and 65.2% believing that parents were very much to blame for the consequences of ACEs. Fifty percent of respondents believed that government intervention to prevent ACEs was very important. After adjustment for demographic characteristics, inter-personal stigma toward people with ACEs and conservative ideology were significantly associated with lower perceived importance of government intervention to prevent ACEs. Black race, Hispanic ethnicity, and female gender were significantly associated with higher perceived importance of government intervention. These findings provide an empirical foundation to inform strategies to communicate ACE science to public and policymaker audiences.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Katherine L Nelson
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Zeng X, Xu L, Xiao X. Negative implicit in-group stereotypes of Chinese male drug abusers: evidence from ERP. CURRENT PSYCHOLOGY 2022; 42:1-13. [PMID: 35967507 PMCID: PMC9362483 DOI: 10.1007/s12144-022-03424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/24/2022]
Abstract
Psychological dependence is the most important factor leading to relapse, few studies have examined whether in-group stereotypes exist in drug abusers, while it's helpful for drug abusers in getting rid of psychological dependence. To investigate the presence of in-group stereotypes and the neural mechanisms in drug abusers, two experiments were designed in this study. Experiment 1 used a classification-verification paradigm and Experiment 2 used The Extrinsic Affect Simon Task (EAST), simultaneous collection of EEG data from China. 18 and 17 males were analyzed respectively in Experiment 1 and 2. The results in Experiment 1 showed that (1) there was no significant difference in reaction times or N400 amplitude between the condition "Drug abusers-Negative words" and the condition "Drug abusers-Positive words". In Experiment 2, we found that (2) participants in the condition "Drug abusers-Negative words" scored higher in accuracy rates than in the condition "Drug abusers-Positive words". (3) Participants in the condition "Drug abusers-Negative words" were shorter than "Drug abusers-Positive words" in reaction times (RTs). (4) Participants in the condition "Drug abusers-Negative words" were lower than "Drug abusers-Positive words" in the peak of N400. The conclusion is that there are significant negative implicit in-group stereotypes among Chinese male drug abusers. The experimental results and the uniqueness of Chinese male drug abusers in this study were discussed.
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Affiliation(s)
- Xiaoqing Zeng
- School of Psychology, Jiangxi Normal University, Nanchang, China
- Institute of Psychology, Jiangxi Normal University, Nanchang, 330022 China
| | - Lingling Xu
- School of Psychology, Jiangxi Normal University, Nanchang, China
- Institute of Psychology, Jiangxi Normal University, Nanchang, 330022 China
| | - Xiang Xiao
- School of Psychology, Jiangxi Normal University, Nanchang, China
- ShiMen Middle School, Shunde, Foshan, 323999 China
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Adequacy of Existing Surveillance Systems to Monitor Racism, Social Stigma and COVID Inequities: A Detailed Assessment and Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413099. [PMID: 34948709 PMCID: PMC8701783 DOI: 10.3390/ijerph182413099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 12/02/2022]
Abstract
The populations impacted most by COVID are also impacted by racism and related social stigma; however, traditional surveillance tools may not capture the intersectionality of these relationships. We conducted a detailed assessment of diverse surveillance systems and databases to identify characteristics, constraints and best practices that might inform the development of a novel COVID surveillance system that achieves these aims. We used subject area expertise, an expert panel and CDC guidance to generate an initial list of N > 50 existing surveillance systems as of 29 October 2020, and systematically excluded those not advancing the project aims. This yielded a final reduced group (n = 10) of COVID surveillance systems (n = 3), other public health systems (4) and systems tracking racism and/or social stigma (n = 3, which we evaluated by using CDC evaluation criteria and Critical Race Theory. Overall, the most important contribution of COVID-19 surveillance systems is their real-time (e.g., daily) or near-real-time (e.g., weekly) reporting; however, they are severely constrained by the lack of complete data on race/ethnicity, making it difficult to monitor racial/ethnic inequities. Other public health systems have validated measures of psychosocial and behavioral factors and some racism or stigma-related factors but lack the timeliness needed in a pandemic. Systems that monitor racism report historical data on, for instance, hate crimes, but do not capture current patterns, and it is unclear how representativeness the findings are. Though existing surveillance systems offer important strengths for monitoring health conditions or racism and related stigma, new surveillance strategies are needed to monitor their intersecting relationships more rigorously.
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11
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Power J, Amir S, Lea T, Brown G, Lyons A, Carman M, Rule J, Bourne A. Bisexual Men Living with HIV: Wellbeing, Connectedness and the Impact of Stigma. AIDS Behav 2021; 25:4085-4093. [PMID: 33768382 PMCID: PMC7994180 DOI: 10.1007/s10461-021-03236-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
Social research with people living with HIV (PLHIV) rarely distinguishes between gay men and bisexual men. However, bisexual men may have unique experiences of HIV-related stigma and distinct support needs. In this paper, findings are presented from a cross-sectional survey of Australian PLHIV, which included the Berger (HIV) stigma scale. A total of 872 PLHIV completed the survey, of which 48 (6.0%) were bisexual men. Bisexual men reported higher levels of internalised HIV-related stigma, greater negative self-image and poorer emotional wellbeing than gay men. Bisexual men also reported less social support, less connection with lesbian, gay, bisexual, transgender and queer (LGBTQ) communities, and less connection with other PLHIV. Analysis of data from an open-text question revealed feelings of social isolation and fear of rejection was associated with participant's HIV diagnosis. Study findings suggest that existing social supports for PLHIV may not adequately address the unique support needs of bisexual men.
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Affiliation(s)
- Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, Melbourne, VIC, 3086, Australia.
| | - Stephanie Amir
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, Melbourne, VIC, 3086, Australia
| | - Toby Lea
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, Melbourne, VIC, 3086, Australia
- Centre for Social Research in Health, UNSW Sydney, John Goodsell Building, Sydney, NSW, Australia
| | - Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, Melbourne, VIC, 3086, Australia
- Centre for Social Impact, UNSW Sydney, Science Engineering Building, Sydney, NSW, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, Melbourne, VIC, 3086, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, Melbourne, VIC, 3086, Australia
- Rainbow Health Victoria, La Trobe University, Building NR6, Bundoora, Melbourne, Australia
| | - John Rule
- National Association of People with HIV Australia, Sydney, NSW, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, Melbourne, VIC, 3086, Australia
- Kirby Institute UNSW, UNSW, Wallace Wurth Building, Sydney, Australia
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12
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Carter G, Meyerson B, Rivers P, Crosby R, Lawrence C, Cope SD, DeBruicker D, Levin S, Meeks W, Thomas C, Turner B, Abert C, Coles H, Allen A, Gonzalez-Fagoaga E, Grivois-Shah R. Living at the Confluence of Stigmas: PrEP Awareness and Feasibility Among People Who Inject Drugs in Two Predominantly Rural States. AIDS Behav 2021; 25:3085-3096. [PMID: 34003385 DOI: 10.1007/s10461-021-03304-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
We explored knowledge, beliefs, and acceptability of pre-exposure prophylaxis (PrEP) for HIV prevention with reference to stigma among people who inject drugs (PWID) in two predominately rural U.S. states. We conducted interviews with 65 current or former PWID aged 18 years or older and living in Arizona or Indiana. Most (63%) of the interviewees were not aware of PrEP. They often confused PrEP with HIV treatment, and many believed that PrEP was only for sexual risk or gay sexual risk. Once they understood that PrEP was recommended for PWID, the participants held a positive view of PrEP and felt that a once-daily pill was feasible. Experiences of stigma about drug use remained a crucial barrier to accessing healthcare and PrEP. This was often linked with anticipated or expressed homophobia. PrEP interventions among PWID must focus on education and the confluence of stigmas in which PWID find themselves when considering PrEP.
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13
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Thomas M, McCoy T, Jeffries I, Haverkate R, Naswood E, Leston J, Platero L. Native American Two Spirit and LGBTQ health: a systematic review of the literature. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2021. [DOI: 10.1080/19359705.2021.1913462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Morgan Thomas
- Northwest Portland Area Indian Health Board, Portland, USA
| | | | | | | | | | - Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, USA
| | - Laura Platero
- Northwest Portland Area Indian Health Board, Portland, USA
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14
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Brener L, Broady T, Cama E, Hopwood M, Byrne J, Treloar C. Positive effects of community attachment on internalised stigma and wellbeing among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103323. [PMID: 34146790 DOI: 10.1016/j.drugpo.2021.103323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Internalised stigma experienced by people who inject drugs (PWID) is known to have negative health consequences. Research has explored factors that may protect or buffer individuals from the negative consequences of internalised stigma. Community attachment, or perceived connection to a community of like people, can have numerous health-related benefits. However, this relationship may be complex for PWID; being part of a social network of PWID may provide opportunity for more frequent drug use and equipment sharing. This study investigated the relationships between community attachment, internalised stigma, and wellbeing among PWID, while also addressing potential health risks associated with PWID community attachment. METHODS PWID (n=603) were recruited through nine peer-based drug user organisations across Australia with assistance from the peak consumer organisation. Participants completed a survey measuring community attachment, internalised stigma, personal wellbeing, injecting frequency, and equipment sharing. RESULTS Greater attachment to a PWID community was associated with lower internalised stigma, but also with sharing of injecting equipment and increased frequency of injecting behaviour. The relationship between community attachment and personal wellbeing was mediated by internalised stigma, however this was only the case for PWID who reported no sharing of injecting equipment. CONCLUSIONS This research highlights the significance of community attachment for PWID while also noting the complexity of this relationship and the potential negative consequences. It is important to view networks of PWID communities as sources of positive social capital, where norms about health behaviours and harm reduction can be promoted and which can buffer community members from the harms associated with stigma.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW, Sydney, Australia.
| | - Timothy Broady
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Jude Byrne
- Australian Injecting & Illicit Drug Users League (AIVL), Canberra, ACT, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, Australia
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15
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Bogart LM, Barreras JL, Gonzalez A, Klein DJ, Marsh T, Agniel D, Pantalone DW. Pilot Randomized Controlled Trial of an Intervention to Improve Coping with Intersectional Stigma and Medication Adherence Among HIV-Positive Latinx Sexual Minority Men. AIDS Behav 2021; 25:1647-1660. [PMID: 33231847 PMCID: PMC8084890 DOI: 10.1007/s10461-020-03081-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
We developed and pilot-tested an eight-session community-based cognitive behavior therapy group intervention to improve coping with intersectional stigma, address medical mistrust, and improve antiretroviral treatment adherence. Seventy-six HIV-positive Latinx sexual minority men (SMM; 38 intervention, 38 wait-list control) completed surveys at baseline, and 4- and 7-months post-baseline. Adherence was electronically monitored. Intention-to-treat, repeated-measures regressions showed improved adherence in the intervention vs. control group from baseline to follow-up [electronically monitored: b (95% CI) 9.24 (- 0.55, 19.03), p = 0.06; self-reported: b (95% CI) 4.50 (0.70, 8.30), p = .02]. Intervention participants showed marginally decreased negative religious coping beliefs in response to stigma [b (95% CI) = - 0.18 (- 0.37, 0.01), p = .06], and significantly lower medical mistrust [b (95% CI) = - 0.47 (- 0.84, - 0.09), p = .02]. Our intervention holds promise for improving HIV outcomes by empowering Latinx SMM to leverage innate resilience resources when faced with stigma.ClinicalTrials.gov ID (TRN): NCT03432819, 01/31/2018.
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA.
| | - Joanna L Barreras
- Bienestar Human Services Inc, Los Angeles, CA, USA
- California State University Long Beach, Long Beach, CA, USA
| | - Ana Gonzalez
- Bienestar Human Services Inc, Los Angeles, CA, USA
| | - David J Klein
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Terry Marsh
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Denis Agniel
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - David W Pantalone
- University of Massachusetts Boston, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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16
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Broady TR, Brener L, Vuong T, Cama E, Treloar C. Online interventions to reduce stigma towards population groups affected by blood borne viruses in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103292. [PMID: 34053824 DOI: 10.1016/j.drugpo.2021.103292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stigmatising attitudes and behaviours by others can have a range of negative effects for population groups and individual people affected by blood borne viruses. The reduction of stigma is a major goal within current Australian national health strategies, however, there is a lack of evidence regarding effective interventions to achieve this goal. Drawing on Allport's (1954) intergroup contact theory, this study aimed to evaluate the effectiveness of an online stigma reduction intervention implemented with the Australian public. METHODS The study was conducted between February and May 2020. Australian adults recruited via Facebook advertising were randomly allocated to a control group (n=316) or one of five intervention groups: people living with HIV (n=320), people living with hepatitis C (n=347), people living with hepatitis B (n=333), people who inject drugs (n=316), or sex workers (n=296). Participants viewed a short video depicting lived experiences of their assigned group. Participants completed attitudinal measures about the group before and immediately after the video, and then at three-month follow-up. These measures related to overall attitudes towards the group, controllability of the stigmatised condition/behaviour, desire to maintain personal distance from the group, and opinions regarding treatment of the group in health care and public policy. Longitudinal changes in attitudes were analysed using a mixed effects regression model with maximum likelihood estimation. RESULTS Across each of the intervention groups, reductions in negative attitudes were found immediately after watching the videos on almost all outcome measures. By three-month follow-up, the HIV intervention group demonstrated long-term improvements in relation to personal distance compared to the control group, and the hepatitis B intervention group demonstrated long-term improvements in relation to attitudes and personal distance compared to the control group. Across intervention and control groups, long-term reductions in negative attitudes were found in relation to HIV controllability, hepatitis B controllability and opinions, hepatitis C controllability and opinions, and injecting drug use attitudes and opinions. CONCLUSION Brief online videos depicting priority populations groups demonstrated positive results in terms of reducing some stigmatising attitudes towards those groups amongst members of the Australian public. Online contact interventions have the potential to be scaled up and rolled out across jurisdictions at national and international levels. These findings suggest that these interventions could be an effective way to contribute to the reduction of stigma and discrimination towards populations affected by blood borne viruses.
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Affiliation(s)
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Thu Vuong
- Social Policy Research Centre, UNSW Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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17
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Jacobi CA, Atanga PN, Bin LK, Fru AJC, Eppel G, Mbome VN, Etonde HEM, Bogner JR, Malfertheiner P. "My Friend with HIV Remains a Friend": HIV/AIDS Stigma Reduction through Education in Secondary Schools-A Pilot Project in Buea, Cameroon. J Int Assoc Provid AIDS Care 2021; 19:2325958219900713. [PMID: 32036732 PMCID: PMC7011319 DOI: 10.1177/2325958219900713] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The universal access to treatment and care for people living with HIV (PLWHIV) is still a
major problem, especially in sub-Saharan Africa, where 70% of HIV-infected people live.
Equally important is the fact that HIV/AIDS-related stigma is recognized to be a major
obstacle to successfully control the spread of this disease. We devised a pilot project
(titled “My friend with HIV remains a friend”) to fight the HIV/AIDS stigmatization
through educating secondary school students by openly HIV-positive teachers. In a first
step, we have measured the amount and type of stigma felt by the PLWHIV in Buea/Cameroon
using the “The people living with HIV Stigma Index” from Joint United Nations Programme on
HIV/AIDS. Gossiping and verbal insults were experienced by 90% of the interviewees, while
9% have experienced physical assaults. Using these data and material from the “Toolkit for
action” from the “International Centre for the Research on Women,” the teachers educated
the students on multiple aspects of HIV/AIDS and stigma. The teaching curriculum included
role-plays, picture visualizations, drawing, and other forms of interactions like visits
to HIV and AIDS treatment units. Before and after this intervention, the students
undertook “True/False” examinations on HIV/AIDS and stigma. We compared these results with
results from students from another school, who did not participate in this intervention.
We were able to show that the students taking part in the intervention improved by almost
20% points in comparison to the other students. Their results did not change.
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Affiliation(s)
- Christoph Arnim Jacobi
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany.,Department of Gastroenterology and Internal Medicine, KKH Prignitz, Perleberg, Germany
| | - Pascal Nji Atanga
- Cameroon Baptist Convention Health Services, Tiko, SW Region, Cameroon
| | - Leonard Kum Bin
- Cameroon Baptist Convention Health Services, Tiko, SW Region, Cameroon
| | | | - Gerd Eppel
- GIZ health program (PGCSS), Yaounde, Cameroon
| | | | | | - Johannes Richard Bogner
- Division of Infectious Diseases, Medizinische Poliklinik-Innenstadt, University of Munich, Munich, Germany
| | - Peter Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
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18
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Li M, Long J, Wang X, Liao Y, Liu Y, Hao Y, Wu Q, Zhou Y, Wang Y, Wang Y, Wang Q, Ma Y, Chen S, Liu T. A Comparison of COVID-19 Stigma and AIDS Stigma During the COVID-19 Pandemic: A Cross-Sectional Study in China. Front Psychiatry 2021; 12:782501. [PMID: 34925108 PMCID: PMC8671734 DOI: 10.3389/fpsyt.2021.782501] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/02/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: To understand the current situation of stigmatizing attitudes toward Coronavirus Disease 2019 (COVID-19) in China and compare it with acquired immunodeficiency syndrome (AIDS). Methods: Convenient sampling and vignette-based methods were used to recruit participants on WeChat. A demographic form and adopted stigma scale were used to collect participants' demographic information and stigmatizing attitudes toward COVID-19 and AIDS. Results: A total of 13,994 questionnaires were included in this study. A high portion of participants tend to avoid contact with individuals affected with COVID-19 (74.3%) or AIDS (59.0%), as well as their family members (70.4% for COVID-19 and 47.9% for AIDS). About half of the participants agreed that affected persons could not only cause problems to their own family but also have adverse effects on others (59.6% and 55.6% for COVID-19, 56.9 and 47.0% for AIDS). The agreements with statements about perceived stigma were similar but slightly higher than those about personal stigma in both COVID-19 and AIDS. Participants' agreements with all statements regarding personal and perceived stigma attitudes between COVID-19 and AIDS were all statistically significant (p < 0.001). Participants obtained COVID-19-related information mainly from social media (91.3%) and newspaper or television (77.1%) during the epidemic, and 61.0% of them thought information from newspapers or television was the most reliable. Conclusion: Several similarities and differences of people's attitude toward COVID-19 and AIDS were found. Avoidance, blame, and secondary discrimination to diagnosed persons and their surrounding persons were the main representations of COVID-19-related stigma. Stigma of COVID-19 had less moral link but more public panic. Experience from HIV-related stigma reduction and prevention can be applied to reduce COVID-19-related stigma.
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Affiliation(s)
- Manyun Li
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiang Long
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuyi Wang
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanhui Liao
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yueheng Liu
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuzhu Hao
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qiuxia Wu
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Yingying Wang
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yunfei Wang
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qianjin Wang
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuejiao Ma
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shubao Chen
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tieqiao Liu
- National Clinical Research Center for Mental Disorders, Changsha, China.,Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
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19
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Yuvaraj A, Mahendra VS, Chakrapani V, Yunihastuti E, Santella AJ, Ranauta A, Doughty J. HIV and stigma in the healthcare setting. Oral Dis 2020; 26 Suppl 1:103-111. [PMID: 32862542 DOI: 10.1111/odi.13585] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
People living with HIV (PLHIV) continue to endure stigma and discrimination in the context of health care despite global improvements in health outcomes. HIV stigma persists within healthcare settings, including dental settings, manifesting itself in myriad, intersecting ways, and has been shown to be damaging in the healthcare setting. Stigmatising practices may include excessive personal protective equipment, delaying the provision of care or unnecessary referral of PLHIV to specialist services in order to access care. The workshop entitled "HIV and Stigma in the Healthcare Setting" provided an overview of the concept and manifestation of HIV stigma and explored the disproportionate burden it places on groups that face additional disadvantages in accessing care. The final part of the workshop concluded with a review of institutional and community-based interventions that worked to reduce HIV stigma and group discussion of the ways in which these strategies might be adapted to the dental workforce.
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Affiliation(s)
- Anandi Yuvaraj
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | - Evy Yunihastuti
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Indonesia
| | | | - Amitha Ranauta
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India.,DBT/Wellcome Trust India Alliance, The Humsafar Trust, Mumbai, India
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20
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Poku OB, Ho-Foster AR, Entaile P, Misra S, Mehta H, Rampa S, Goodman M, Arscott-Mills T, Eschliman E, Jackson V, Melese T, Becker TD, Eisenberg M, Link B, Go V, Opondo PR, Blank MB, Yang LH. 'Mothers moving towards empowerment' intervention to reduce stigma and improve treatment adherence in pregnant women living with HIV in Botswana: study protocol for a pragmatic clinical trial. Trials 2020; 21:832. [PMID: 33028387 PMCID: PMC7542742 DOI: 10.1186/s13063-020-04676-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND With high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children's lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the "What Matters Most" stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the "Mothers Moving towards Empowerment" (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period. METHODS This study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at < 16 weeks), birth weight, vaccination record, and HIV status). DISCUSSION Our trial will evaluate MME, a culturally based HIV stigma reduction intervention using the "What Matters Most" framework, to reduce stigma and improve treatment adherence among pregnant women and their infants. This study will help inform further refinement of MME and preparation for a future large-scale, multisite, randomized controlled trial (RCT) in Botswana. TRIAL REGISTRATION ClinicalTrials.gov NCT03698981 . Registered on October 8, 2018.
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Affiliation(s)
- Ohemaa B Poku
- Johns Hopkins University, Baltimore, MD, United States.
| | - Ari R Ho-Foster
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- University of Botswana, Gaborone, Botswana
| | | | | | | | | | | | - Tonya Arscott-Mills
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- University of Botswana, Gaborone, Botswana
| | | | - Valerie Jackson
- University of California San Francisco, San Francisco, CA, United States
| | | | - Timothy D Becker
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Bruce Link
- University of California Riverside, Riverside, CA, USA
| | - Vivian Go
- University of North Carolina at Chapel Hill, Chapel Hil, NC, USA
| | | | | | - Lawrence H Yang
- New York University, New York, NY, United States
- Columbia University Mailman School of Public Health, New York, NY, USA
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21
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Evangeli M, Collins J. What is the best way to share an HIV diagnosis with an intimate partner? An experimental study of assertive disclosure communication. AIDS Care 2020; 32:1078-1081. [PMID: 32062983 DOI: 10.1080/09540121.2020.1728216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Living with HIV presents challenges to wellbeing and managing one's own and others' health. Sharing an HIV positive diagnosis can increase social support and antiretroviral adherence and reduce onward HIV transmission. However, HIV disclosure anxiety is common with concerns about partner responses. There is limited research on whether the way HIV is shared affects partners' responses. We assessed whether communication style influences hypothetical partner responses in intimate relationships. Two hundred and four participants (83% female; median age 20, IQR 19-23) were shown four vignettes (high assertion regular partner, low assertion regular partner, high assertion casual partner, low assertion casual partner). Participants responded as the intimate partner to questions addressing affective and cognitive reactions to HIV diagnosis sharing. Assertive compared to non-assertive communication led to intimate partner responses with lower negative affect, warmer feelings toward the character and greater intentions to provide support and to continue a sexual relationship. Participants responded with more global negative affect and shock, and greater intention to provide support and to continue a sexual relationship if the character was a regular compared to a causal partner. Future work could explore whether people with HIV should be assisted to share their diagnosis assertively for greater benefits.
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Affiliation(s)
- Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, UK
| | - Jodie Collins
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, UK
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22
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Tuppal CP, Ninobla MMG, Reñosa MDC, Ruiz MGD, Loresco RC, Tuppal SMP, Panes II. Living with HIV/AIDS among men having sex with men (MSM) in the Philippines: Internet ethnography of HIV life stages. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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23
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Stangl AL, Lilleston P, Mathema H, Pliakas T, Krishnaratne S, Sievwright K, Bell‐Mandla N, Vermaak R, Mainga T, Steinhaus M, Donnell D, Schaap A, Bock P, Ayles H, Hayes R, Hoddinott G, Bond V, Hargreaves JR. Development of parallel measures to assess HIV stigma and discrimination among people living with HIV, community members and health workers in the HPTN 071 (PopART) trial in Zambia and South Africa. J Int AIDS Soc 2019; 22:e25421. [PMID: 31840400 PMCID: PMC6912047 DOI: 10.1002/jia2.25421] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Integrating standardized measures of HIV stigma and discrimination into research studies of emerging HIV prevention approaches could enhance uptake and retention of these approaches, and care and treatment for people living with HIV (PLHIV), by informing stigma mitigation strategies. We sought to develop a succinct set of measures to capture key domains of stigma for use in research on HIV prevention technologies. METHODS From 2013 to 2015, we collected baseline data on HIV stigma from three populations (PLHIV (N = 4053), community members (N = 5782) and health workers (N = 1560)) in 21 study communities in South Africa and Zambia participating in the HPTN 071 (PopART) cluster-randomized trial. Forty questions were adapted from a harmonized set of measures developed in a consultative, global process. Informed by theory and factor analysis, we developed seven scales, with values ranging from 0 to 3, based on a 4-point agreement Likert, and calculated means to assess different aspects of stigma. Higher means reflected more stigma. We developed two measures capturing percentages of PLHIV who reported experiencing any stigma in communities or healthcare settings in the past 12 months. We validated our measures by examining reliability using Cronbach's alpha and comparing the distribution of responses across characteristics previously associated with HIV stigma. RESULTS Thirty-five questions ultimately contributed to seven scales and two experience measures. All scales demonstrated acceptable to very good internal consistency. Among PLHIV, a scale captured internalized stigma, and experience measures demonstrated that 22.0% of PLHIV experienced stigma in the community and 7.1% in healthcare settings. Three scales for community members assessed fear and judgement, perceived stigma in the community and perceived stigma in healthcare settings. Similarly, health worker scales assessed fear and judgement, perceived stigma in the community and perceived co-worker stigma in healthcare settings. A higher proportion of community members and health workers reported perceived stigma than the proportion of PLHIV who reported experiences of stigma. CONCLUSIONS We developed novel, valid measures that allowed for triangulation of HIV stigma across three populations in a large-scale study. Such comparisons will illuminate how stigma influences and is influenced by programmatic changes to HIV service delivery over time.
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Affiliation(s)
- Anne L Stangl
- International Center for Research on WomenWashingtonDCUSA
| | | | - Hlengani Mathema
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
- Division of Public Health Surveillance and ResponseNational Institute for Communicable DiseasesNational Health Laboratory ServiceJohannesburgSouth Africa
| | | | | | | | - Nomhle Bell‐Mandla
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Redwaan Vermaak
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Tila Mainga
- ZambartSchool of MedicineUniversity of ZambiaLusakaZambia
| | - Mara Steinhaus
- International Center for Research on WomenWashingtonDCUSA
| | | | - Ab Schaap
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
- ZambartSchool of MedicineUniversity of ZambiaLusakaZambia
| | - Peter Bock
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Helen Ayles
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
- ZambartSchool of MedicineUniversity of ZambiaLusakaZambia
| | - Richard Hayes
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Graeme Hoddinott
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Virginia Bond
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
- ZambartSchool of MedicineUniversity of ZambiaLusakaZambia
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24
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Reluga TC, Smith RA, Hughes DP. Dynamic and game theory of infectious disease stigmas. J Theor Biol 2019; 476:95-107. [PMID: 31153888 DOI: 10.1016/j.jtbi.2019.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 05/16/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
Stigmas are a primal phenomena, ubiquitous in human societies past and present. Some evolutionary anthropologists have argued that stigmatization in response to disease is an adaptive behavior because stigmatization may help people and communities reduce the risks they face from infectious diseases and increase reproductive success. On the other hand, some cultural anthropologists and social critics argue that stigmatization has strong negative impacts on community health. One recent analysis resolved this conflict by hypothesizing that stigmas had individual and group-evolutionary benefits in the past but are now maladaptive because of intervening societal transitions. Here, we present a quantitative theory of infectious disease stigmatization. Using a four-compartment model of stigmatization against a chronic disease, we show a stigma ratio, being the ratio of net transmissions by stigmatized people to net transmissions by unstigmatized people, predicts the impact of stigmatization on lifetime infection risk. When stigmatized people are segregated from the rest of the population and there are no alternative interventions that reduce transmission, stigmatization can reduce prevalence and infection risk. When stigmas do not lead to segregation but do discourage behavior change and reduce access to medical interventions, stigmatization acts to increases the lifetime risk of infection in the community. We further show that fear of stigmas can create policy resistance to healthcare access. The societal consequences of fear are worse when effective medical treatment is available. We conclude that stigma's can be adaptive, but good healthcare and leaky ostracism can make stigmas against chronic infectious disease maladaptive, and that the deprecation of stigmas is a natural transition in the modern urban societies.
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Affiliation(s)
- Timothy C Reluga
- Department of Mathematics, Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park, PA 16802, United States.
| | - Rachel A Smith
- Department of Communication Arts and Sciences, Center for Infectious Disease Dynamics, and The Methodology Center, Pennsylvania State University, University Park, PA 16802, United States
| | - David P Hughes
- Departments of Entomology and Department of Biology, Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA 16802, United States
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25
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Willis E, Painter C. The Needle and the Damage Done: Framing the Heroin Epidemic in the Cincinnati Enquirer. HEALTH COMMUNICATION 2019; 34:661-671. [PMID: 29388799 DOI: 10.1080/10410236.2018.1431023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This case study focuses on the Cincinnati Enquirer's coverage of the heroin epidemic. The Enquirer started the first heroin beat in January 2016, and it could serve as a model for other news organizations. Reporters used combinations of episodic, thematic, public health, and crime and law enforcement frames in their coverage. These news frames are discussed in terms of how individualism-collectivism, geographic location, available resources, and social determinants inform journalistic and societal discussions of the heroin epidemic in terms of solutions instead of responsibility or blame.
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Affiliation(s)
- Erin Willis
- a Advertising, Public Relations & Media Design , University of Colorado , Boulder
| | - Chad Painter
- b Department of Communication , University of Dayton
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Wirz CD, Xenos MA, Brossard D, Scheufele D, Chung JH, Massarani L. Rethinking Social Amplification of Risk: Social Media and Zika in Three Languages. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:2599-2624. [PMID: 30408201 DOI: 10.1111/risa.13228] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/23/2018] [Accepted: 10/15/2018] [Indexed: 06/08/2023]
Abstract
Using the Zika outbreak as a context of inquiry, this study examines how assigning blame on social media relates to the social amplification of risk framework (SARF). Past research has discussed the relationship between the SARF and traditional mass media, but the role of social media platforms in amplification or attenuation of risk perceptions remains understudied. Moreover, the communication and perceptions of Zika-related risk are not limited to discussions in English. To capture conversations in languages spoken by affected countries, this study combines data in English, Spanish, and Portuguese. To better understand the assignment of blame and perceptions of risk in new media environments, we looked at three different facets of conversations surrounding Zika on Facebook and Twitter: the prominence of blame in each language, how specific groups were discussed throughout the Zika outbreak, and the sentiment expressed about genetically engineered (GE) mosquitoes. We combined machine learning with human coding to analyze public discourse in all three languages. We found differences between languages and platforms in the amount of blame assigned to different groups. We also found more negative sentiments expressed about GE mosquitoes on Facebook than on Twitter. These meaningful differences only emerge from analyses across the three different languages and platforms, pointing to the importance of multilingual approaches for risk communication research. Specific recommendations for outbreak and risk communication practitioners are also discussed.
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Affiliation(s)
- Christopher D Wirz
- Department of Life Sciences Communication, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael A Xenos
- Department of Life Sciences Communication, University of Wisconsin-Madison, Madison, WI, USA
| | - Dominique Brossard
- Department of Life Sciences Communication, University of Wisconsin-Madison, Madison, WI, USA
- Morgridge Institute for Research, Madison, WI, USA
| | - Dietram Scheufele
- Department of Life Sciences Communication, University of Wisconsin-Madison, Madison, WI, USA
- Morgridge Institute for Research, Madison, WI, USA
| | - Jennifer H Chung
- Department of Life Sciences Communication, University of Wisconsin-Madison, Madison, WI, USA
| | - Luisa Massarani
- National Institute of Public Communication of Science and Technology and Master of Communication of Science, Technology and Health, Fiocruz, Rio de Janeiro, Brazil
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Broady TR, Cama E, Brener L, Hopwood M, de Wit J, Treloar C. Responding to a national policy need: development of a stigma indicator for bloodborne viruses and sexually transmissible infections. Aust N Z J Public Health 2018; 42:513-515. [DOI: 10.1111/1753-6405.12809] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Elena Cama
- Centre for Social Research in Health; UNSW; New South Wales
| | - Loren Brener
- Centre for Social Research in Health; UNSW; New South Wales
| | - Max Hopwood
- Centre for Social Research in Health; UNSW; New South Wales
| | - John de Wit
- Centre for Social Research in Health; UNSW; New South Wales
| | - Carla Treloar
- Centre for Social Research in Health; UNSW; New South Wales
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Ophir Y. Coverage of Epidemics in American Newspapers Through the Lens of the Crisis and Emergency Risk Communication Framework. Health Secur 2018; 16:147-157. [PMID: 29870279 DOI: 10.1089/hs.2017.0106] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Centers for Disease Control and Prevention (CDC) Crisis and Emergency Risk Communication (CERC) framework has been used by the organization during recent outbreaks of infectious diseases. However, the dissemination of the organization's crisis messages depends largely on mass media coverage. This study analyzed 5,006 articles from leading American newspapers covering 3 epidemics: H1N1, Ebola, and Zika. Using a mixed method of automated and manual content analysis, it identified 3 distinct themes used to cover the diseases: pandemic, scientific, and social. Analysis of the themes based on CERC guidelines demonstrated substantial discrepancies between what CDC aims to communicate during epidemics and what the media actually disseminated to the public. Implications for public health organizations and communicators are discussed.
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Affiliation(s)
- Yotam Ophir
- Yotam Ophir, PhD, is a postdoctoral fellow, Annenberg School for Communication, University of Pennsylvania , Philadelphia
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Hofmann B, Svenaeus F. How medical technologies shape the experience of illness. LIFE SCIENCES, SOCIETY AND POLICY 2018; 14:3. [PMID: 29397458 PMCID: PMC5797484 DOI: 10.1186/s40504-018-0069-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/26/2018] [Indexed: 05/21/2023]
Abstract
In this article we explore how diagnostic and therapeutic technologies shape the lived experiences of illness for patients. By analysing a wide range of examples, we identify six ways that technology can (trans)form the experience of illness (and health). First, technology may create awareness of disease by revealing asymptomatic signs or markers (imaging techniques, blood tests). Second, the technology can reveal risk factors for developing diseases (e.g., high blood pressure or genetic tests that reveal risks of falling ill in the future). Third, the technology can affect and change an already present illness experience (e.g., the way blood sugar measurement affects the perceived symptoms of diabetes). Fourth, therapeutic technologies may redefine our experiences of a certain condition as diseased rather than unfortunate (e.g. assisted reproductive technologies or symptom based diagnoses in psychiatry). Fifth, technology influences illness experiences through altering social-cultural norms and values regarding various diagnoses. Sixth, technology influences and changes our experiences of being healthy in contrast and relation to being diseased and ill. This typology of how technology forms illness and related conditions calls for reflection regarding the phenomenology of technology and health. How are medical technologies and their outcomes perceived and understood by patients? The phenomenological way of approaching illness as a lived, bodily being-in-the-world is an important approach for better understanding and evaluating the effects that medical technologies may have on our health, not only in defining, diagnosing, or treating diseases, but also in making us feel more vulnerable and less healthy in different regards.
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Affiliation(s)
- Bjørn Hofmann
- Institute for the health sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Centre of Medical Ethics, University of Oslo, PO Box 1130, Blindern, N-0318 Oslo, Norway
| | - Fredrik Svenaeus
- Centre for Studies in Practical Knowledge, School of Culture and Learning, Södertörn University, 141 89 Huddinge, Sweden
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McGinty E, Pescosolido B, Kennedy-Hendricks A, Barry CL. Communication Strategies to Counter Stigma and Improve Mental Illness and Substance Use Disorder Policy. Psychiatr Serv 2018; 69:136-146. [PMID: 28967320 PMCID: PMC5794622 DOI: 10.1176/appi.ps.201700076] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Despite the high burden and poor rates of treatment associated with mental illness and substance use disorders, public support for allocating resources to improving treatment for these disorders is low. A growing body of research suggests that effective policy communication strategies can increase public support for policies benefiting people with these conditions. In October 2015, the Center for Mental Health and Addiction Policy Research at Johns Hopkins University convened an expert forum to identify what is currently known about the effectiveness of such policy communication strategies and produce recommendations for future research. One of the key conclusions of the forum was that communication strategies using personal narratives to engage audiences have the potential to increase public support for policies benefiting persons with mental illness or substance use disorders. Specifically, narratives combining personal stories with depictions of structural barriers to mental illness and substance use disorder treatment can increase the public's willingness to invest in the treatment system. Depictions of mental illness and violence significantly increase public stigma toward people with mental illness and are no more effective in increasing willingness to invest in mental health services than nonstigmatizing messages about structural barriers to treatment. Future research should prioritize development and evaluation of communication strategies to increase public support for evidence-based substance use disorder policies, including harm reduction policies-such as needle exchange programs-and policies expanding treatment.
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Affiliation(s)
- Emma McGinty
- Dr. McGinty and Dr. Barry are with the Department of Health Policy and Management, where Dr. Kennedy-Hendricks is affiliated, and with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Pescosolido is with the Department of Sociology, Indiana University, Bloomington
| | - Bernice Pescosolido
- Dr. McGinty and Dr. Barry are with the Department of Health Policy and Management, where Dr. Kennedy-Hendricks is affiliated, and with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Pescosolido is with the Department of Sociology, Indiana University, Bloomington
| | - Alene Kennedy-Hendricks
- Dr. McGinty and Dr. Barry are with the Department of Health Policy and Management, where Dr. Kennedy-Hendricks is affiliated, and with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Pescosolido is with the Department of Sociology, Indiana University, Bloomington
| | - Colleen L Barry
- Dr. McGinty and Dr. Barry are with the Department of Health Policy and Management, where Dr. Kennedy-Hendricks is affiliated, and with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Pescosolido is with the Department of Sociology, Indiana University, Bloomington
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Safarnejad A, Groot W, Pavlova M. Study design and the estimation of the size of key populations at risk of HIV: lessons from Viet Nam. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:7. [PMID: 29382390 PMCID: PMC5791336 DOI: 10.1186/s12914-018-0141-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/03/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Estimation of the size of populations at risk of HIV is a key activity in the surveillance of the HIV epidemic. The existing framework for considering future research needs may provide decision-makers with a basis for a fair process of deciding on the methods of the estimation of the size of key populations at risk of HIV. This study explores the extent to which stakeholders involved with population size estimation agree with this framework, and thus, the study updates the framework. METHODS We conducted 16 in-depth interviews with key informants from city and provincial governments, NGOs, research institutes, and the community of people at risk of HIV. Transcripts were analyzed and reviewed for significant statements pertaining to criteria. Variations and agreement around criteria were analyzed, and emerging criteria were validated against the existing framework. RESULTS Eleven themes emerged which are relevant to the estimation of the size of populations at risk of HIV in Viet Nam. Findings on missing criteria, inclusive participation, community perspectives and conflicting weight and direction of criteria provide insights for an improved framework for the prioritization of population size estimation methods. CONCLUSIONS The findings suggest that the exclusion of community members from decision-making on population size estimation methods in Viet Nam may affect the validity, use, and efficiency of the evidence generated. However, a wider group of decision-makers, including community members among others, may introduce diverse definitions, weight and direction of criteria. Although findings here may not apply to every country with a transitioning economy or to every emerging epidemic, the principles of fair decision-making, value of community participation in decision-making and the expected challenges faced, merit consideration in every situation.
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Affiliation(s)
- Ali Safarnejad
- Maastricht University, Maastricht Graduate School of Governance, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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von Hippel C, Brener L, Horwitz R. Implicit and explicit internalized stigma: Relationship with risky behaviors, psychosocial functioning and healthcare access among people who inject drugs. Addict Behav 2018; 76:305-311. [PMID: 28889059 DOI: 10.1016/j.addbeh.2017.08.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION People who inject drugs (PWID) are stigmatized by society. Over time people may begin to internalize the stigma about their group. This research examines how implicit and explicit internalized stigma among PWID relates to health care and treatment access, psychosocial functioning, and engagement in risky behaviors. METHODS PWID were recruited from a needle and syringe program (NSP) located in Sydney, Australia. Participants completed a survey examining explicit and implicit internalized stigma, risky behaviors (e.g., sharing injecting equipment, unprotected sex), health care and treatment access (e.g., comfort attending NSPs), and psychosocial functioning (e.g., mental health). Detailed demographic variables were also collected. RESULTS A total of 115 clients completed the measures. To the degree that participants had internalized the stigma about their group (measured explicitly), they felt less comfortable attending NSPs, had greater severity of dependence, and experienced more depressive symptoms. The implicit measure of internalized stigma was related to treatment engagement and needle sharing, although the direction of these effects was unexpected. CONCLUSIONS This research highlights the importance of ongoing research into the implications of internalized stigma for PWID. Assessing both explicit and implicit internalized stigma appears to be beneficial as these are related to different health and behavioral outcomes.
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Affiliation(s)
- Courtney von Hippel
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia.
| | - Loren Brener
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Robyn Horwitz
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia
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Soltan EM, Salama HM, Aboelmagd MA. Assessment of stigma among patients infected with hepatitis C virus in Suez City, Egypt. J Public Health (Oxf) 2017. [DOI: 10.1007/s10389-017-0872-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Mesenburg MA, Wehrmeister FC, Silveira MFD. [Voluntary versus health professional-initiated HIV testing: a population-based study in women in a city in Southern Brazil]. CAD SAUDE PUBLICA 2017; 33:e00074415. [PMID: 29091172 DOI: 10.1590/0102-311x00074415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 12/13/2016] [Indexed: 05/29/2023] Open
Abstract
This was a cross-sectional population-based study that aimed to describe the prevalence of HIV testing and associated factors in women in Pelotas, Rio Grande do Sul State, Brazil. A total of 1,222 women were interviewed. We estimated the overall testing prevalence (yes/no) and prevalence disaggregated by testing ordered by a health professional versus voluntary testing. Test prevalence was 66.1% (95%CI: 63.4-68.8): 52.4% for testing ordered by a health professional (95%CI: 49.6-55.2) and 13.6% for spontaneous testing (95%CI: 11.6-15.5). The principal reason for testing was prenatal screening (52%). Age, age at sexual initiation, and having children were associated statistically with both voluntary and health professional-initiated testing. Sexual risk score, conjugal status, and condom use were only associated statistically with testing ordered by a health professional, while history of anal sex was only associated with spontaneous testing. The results indicate that HIV testing is closely related to prenatal care and that risk perception by the attending health professional appears to be more accurate than the patient's own perception.
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Affiliation(s)
- Marilia Arndt Mesenburg
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
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Abstract
PURPOSE OF REVIEW To collect and update published information on the stigma associated with substance abuse in nonclinical samples, which has not been recently reviewed. RECENT FINDINGS Searching large databases, a total of only 17 articles were published since 1999, with the majority of studies conducted outside the United States. Using major stigma concepts from a sociological framework (stereotyping, devaluation in terms of status loss, discrimination, and negative emotional reactions), the studies reviewed predominantly indicated that the public holds very stigmatized views toward individuals with substance use disorders (SUDs), and that the level of stigma was higher toward individuals with SUDs than toward those with other psychiatric disorders. SUMMARY The prevalence of SUDs is increasing in the US general population, but these disorders remain seriously undertreated. Stigma can reduce willingness of policymakers to allocate resources, reduce willingness of providers in nonspecialty settings to screen for and address substance abuse problems, and may limit willingness of individuals with such problems to seek treatment. All of these factors may help explain why so few individuals with SUDs receive treatment. Public education that reduces stigma and provides information about treatment is needed.
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Ganju D, Saggurti N. Stigma, violence and HIV vulnerability among transgender persons in sex work in Maharashtra, India. CULTURE, HEALTH & SEXUALITY 2017; 19:903-917. [PMID: 28132601 PMCID: PMC6176758 DOI: 10.1080/13691058.2016.1271141] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 12/07/2016] [Indexed: 05/23/2023]
Abstract
Among marginalised groups in India, HIV prevalence is highest among transgender persons; however, little is known about their HIV vulnerability. This study describes transgender sex workers' experiences of stigma and violence, a key driver of the HIV epidemic, and explores their coping responses. In-depth interviews were conducted with 68 respondents in Maharashtra state, India. Findings show that respondents face pervasive stigma and violence due to multiple marginalised social identities (transgender status, sex work, gender non-conformity), which reinforce and intersect with social inequities (economic and housing insecurity, employment discrimination, poverty), fuelling HIV vulnerability at the micro, meso and macro levels. Several factors, such as felt and internalised stigma associated with psycho-social distress and low self-efficacy to challenge abuse and negotiate condom use; clients' power in sexual transactions; establishing trust in regular partnerships through condomless sex; norms condoning violence against gender non-conforming persons; lack of community support; police harassment; health provider discrimination and the sex work environment create a context for HIV vulnerability. In the face of such adversity, respondents adopt coping strategies to shift power relations and mobilise against abuse. Community mobilisation interventions, as discussed in the paper, offer a promising vulnerability reduction strategy to safeguard transgender sex workers' rights and reduce HIV vulnerability.
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Affiliation(s)
- Deepika Ganju
- HIV and AIDS Program, Population Council, New Delhi, India
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Mak WWS, Mo PKH, Ma GYK, Lam MYY. Meta-analysis and systematic review of studies on the effectiveness of HIV stigma reduction programs. Soc Sci Med 2017; 188:30-40. [PMID: 28704645 DOI: 10.1016/j.socscimed.2017.06.045] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 06/17/2017] [Accepted: 06/30/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The present study conducted a meta-analysis and systematic review on studies evaluating the effectiveness of stigma reduction programs in improving knowledge and reducing negative attitudes towards people living with HIV (PLHIV). RESULTS Meta-analysis (k = 42 studies) found significant and small effect sizes in the improvement of the participants' knowledge of HIV/AIDS from interventions with (Cohen's d = 0.48, 95% CI [0.30, 0.66]) and without control groups (Cohen's d = 0.42, 95% CI [0.28, 0.57]). Significant and small effect sizes were found in the improvement of the participants' attitudes toward PLHIV from interventions with (Cohen's d = 0.39, 95% CI [0.23, 0.55]) and without control groups (Cohen's d = 0.25, 95% CI [0.11, 0.39]). Significant and small effect sizes were sustained at the follow-up assessments. Subgroup analysis showed that number of intervention sessions, intervention settings, and sample type significantly moderated the effect sizes in the meta-analysis. Findings from the systematic review of 35 studies indicated that most of the included studies showed positive results in reducing negative attitudes toward PLHIV and improving HIV-related knowledge. Most of the included studies tended to have low methodological quality. CONCLUSION The present meta-analysis and systematic review indicated that the studies generally found small improvement in HIV-related knowledge and reduction in negative attitudes towards PLHIV among the stigma reduction programs being evaluated. High-quality stigma reduction programs with multidimensional stigma indicators and psychometrically sound outcome measures are highly warranted.
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Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Phoenix K H Mo
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Gloria Y K Ma
- Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Maggie Y Y Lam
- Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
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Carpiano RM, Fitz NS. Public attitudes toward child undervaccination: A randomized experiment on evaluations, stigmatizing orientations, and support for policies. Soc Sci Med 2017; 185:127-136. [PMID: 28578210 DOI: 10.1016/j.socscimed.2017.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
Child undervaccination is a complex public health problem and a contentious social and political issue. Efforts to increase vaccination coverage require understanding how the public evaluates different reasons for child undervaccination, which may influence attitudes, stigmatizing behaviors, and support for vaccination policies. We conducted a vignette experiment with a United States national online sample (n = 1469) to investigate how and why different undervaccination actions shape evaluations (blame, anger, sympathy, differentness, credibility, dangerousness), stigmatizing orientations (social distance, discrimination), and support for particular policies (e.g., research funding, belief exemptions, fines). Each participant was randomly assigned to read one of four vignettes that described a mother who either refused vaccines, delayed vaccines, encountered social barriers to obtaining vaccines, or was up-to-date on vaccines for her child. Compared to the up-to-date condition, each undervaccination action predicted significantly more negative evaluations and stigmatizing orientations. Vaccine refusal was the most negatively appraised. Differences in social distance and discrimination were explained by negative evaluations about the parent. These evaluations and orientations predicted support for a range of policies. Negative parental evaluations were associated with increased support for more severe policies. We discuss the implications of these findings for addressing undervaccination and informing health scholarship on stigma.
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Affiliation(s)
| | - Nicholas S Fitz
- National Core for Neuroethics, University of British Columbia, Canada
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Parker CM, Garcia J, Philbin MM, Wilson PA, Parker RG, Hirsch JS. Social risk, stigma and space: key concepts for understanding HIV vulnerability among black men who have sex with men in New York City. CULTURE, HEALTH & SEXUALITY 2017; 19:323-337. [PMID: 27550415 PMCID: PMC5415078 DOI: 10.1080/13691058.2016.1216604] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Black men who have sex with men in the USA face disproportionate incidence rates of HIV. This paper presents findings from an ethnographic study conducted in New York City that explored the structural and socio-cultural factors shaping men's sexual relationships with the goal of furthering understandings of their HIV-related vulnerability. Methods included participant observation and in-depth interviews with 31 Black men who have sex with men (three times each) and 17 key informants. We found that HIV vulnerability is perceived as produced through structural inequalities including economic insecurity, housing instability, and stigma and discrimination. The theoretical concepts of social risk, intersectional stigma, and the social production of space are offered as lenses through which to analyse how structural inequalities shape HIV vulnerability. We found that social risk shaped HIV vulnerability by influencing men's decisions in four domains: 1) where to find sexual partners, 2) where to engage in sexual relationships, 3) what kinds of relationships to seek, and 4) whether to carry and to use condoms. Advancing conceptualisations of social risk, we show that intersectional stigma and the social production of space are key processes through which social risk generates HIV vulnerability among Black men who have sex with men.
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Affiliation(s)
- Caroline M. Parker
- Department of Sociomedical Sciences, Mailman School of Public
Health, Columbia University, New York, USA
| | - Jonathan Garcia
- College of Public Health and Human Sciences, Oregon State
University, Corvallis, OR, USA
| | - Morgan M. Philbin
- HIV Center for Clinical and Behavioral Studies, New York State
Psychiatric Institute and Columbia University, New York, USA
| | - Patrick A. Wilson
- Department of Sociomedical Sciences, Mailman School of Public
Health, Columbia University, New York, USA
| | - Richard G. Parker
- Department of Sociomedical Sciences, Mailman School of Public
Health, Columbia University, New York, USA
| | - Jennifer S. Hirsch
- Department of Sociomedical Sciences, Mailman School of Public
Health, Columbia University, New York, USA
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Vorasane S, Jimba M, Kikuchi K, Yasuoka J, Nanishi K, Durham J, Sychareun V. An investigation of stigmatizing attitudes towards people living with HIV/AIDS by doctors and nurses in Vientiane, Lao PDR. BMC Health Serv Res 2017; 17:125. [PMID: 28183300 PMCID: PMC5301416 DOI: 10.1186/s12913-017-2068-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 02/01/2017] [Indexed: 11/14/2022] Open
Abstract
Background Despite global efforts, HIV-related stigma continues to negatively impact the health and well-being of people living with HIV/AIDS. Even in healthcare settings, people with HIV/AIDS experience discrimination. Anecdotal evidence suggests that healthcare professionals in the Lao People's Democratic Republic, a lower-middle income country situated in Southeast Asia, stigmatize HIV/AID patients. The purpose of this study was to assess HIV stigmatizing attitudes within Laotian healthcare service providers and examine some of the factors associated with HIV/AIDS-related stigma among doctors and nurses. Methods A structured questionnaire, which included a HIV-related stigma scale consisting of 17 items, was self-completed by 558 healthcare workers from 12 of the 17 hospitals in Vientiane. Five hospitals were excluded because they had less than 10 staff and these staff were not always present. The questionnaire was pre-tested with 40 healthcare workers. Descriptive statistical analysis was performed and comparisons between groups undertaken using chi-square test and t-test. Bivariate and multiple linear regression analyses were carried out to examine the associations between stigmatizing attitudes and independent variables. Results Out of the 558 participating healthcare workers, 277 (49.7%) were doctors and 281 (50.3%) were nurses. Nearly 50% of doctors and nurses included in the study had high levels of stigmatizing attitudes towards people living with HIV/AIDS. Across the different health professionals included in this study, lower levels of HIV/AIDS knowledge were associated with higher levels of stigmatizing attitudes towards people living with HIV/AIDS. Stigmatizing attitudes, including discrimination at work, fear of AIDS, and prejudice, were lower in healthcare workers with more experience in treating HIV/AIDS patients. Conclusions This study is the first to report on HIV/AIDS-related stigmatization among healthcare workers in Lao PDR. Stigmatizing attitudes contribute to missed opportunities for prevention, education and treatment, undermining efforts to manage and prevent HIV. Reversing stigmatizing attitudes and practices requires interventions that address affective, cognitive and behavioral aspects of stigma. Alongside this, health professionals need to be enabled to enact universal precautions and prevent occupational transmission of HIV. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2068-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Savina Vorasane
- Department of Radiology, Mahosoth hospital, Vientiane, Lao PDR.
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiko Nanishi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jo Durham
- School of Public Health, The University of Queensland , Brisbane, Australia
| | - Vanphanom Sychareun
- Dean of the Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
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Beckman AL, Wilson MM, Prabhu V, Soekoe N, Mata H, Grau LE. A qualitative view of the HIV epidemic in coastal Ecuador. PeerJ 2016; 4:e2726. [PMID: 27904814 PMCID: PMC5126616 DOI: 10.7717/peerj.2726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/27/2016] [Indexed: 11/25/2022] Open
Abstract
In 2013 approximately 37,000 people were living with HIV in Ecuador (prevalence 0.4%), representing a generalized epidemic where most new infections arise from sexual interactions in the general population. Studies that examine attitudes towards people living with HIV (PLWH), individual risk perception of acquiring HIV amongst Ecuadorians, and the ways in which levels of risk perception may affect risk behaviors are lacking. This qualitative study aimed to fill this gap in the literature by investigating these issues in the rural, coastal community of Manglaralto, Ecuador, which has among the highest incidence of HIV in Ecuador. We conducted interviews with 15 patients at Manglaralto Hospital. Analysis of interview transcripts revealed widespread negative attitudes towards PLWH, prevalent risk behaviors such as multiple sex partners and lack of condom use, and low individual risk-perception of contracting HIV. These findings underscore the need for increased efforts to prevent further growth of the HIV epidemic in Ecuador.
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Affiliation(s)
| | - Magdalena M Wilson
- Department of Social and Behavioral Sciences, Yale School of Public Health , New Haven , CT , United States
| | | | - Nicola Soekoe
- Department of Ethics, Politics and Economics, Yale University , New Haven , CT , United States
| | | | - Lauretta E Grau
- Center for Interdisciplinary Research on AIDS and the Department of Epidemiology of Microbial Disease, Yale School of Public Health , New Haven , CT , United States
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42
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Stigmatisation et impact sur le soin : l’exemple des IST/VIH. SEXOLOGIES 2016. [DOI: 10.1016/j.sexol.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
BACKGROUND Perceived experiences of stigma have been found to be associated with poorer psychosocial outcomes and engagement in risk practices among people who inject drugs. Yet the extent to which people internalize or accept the stigma surrounding their injecting drug use, and whether this is associated with risky injecting practices, is not well known. OBJECTIVES The aim of this study was to assess the extent of internalized stigma among a sample of people who inject drugs in Australia and identify socio-demographic, injecting risk, and mental health correlates. METHODS People who inject drugs were recruited from a needle and syringe program located in Sydney, Australia to complete a brief survey. The survey included measures of internalized stigma, severity of drug dependence, self-esteem, depression, and shared use of injecting equipment. RESULTS The sample comprised 102 people who inject drugs. Internalized stigma was higher among participants who reported being depressed in the past month, and was also associated with greater severity of drug dependence and diminished self-esteem. There was no relationship between internalized stigma and shared use of needles or other injecting equipment in the past month. Conclusions/Importance: Findings underscore the need for further investigation of internalized stigma among people who inject drugs. In particular, future research should assess the impact of implicit (i.e., subconscious) internalized stigma on mental health.
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Affiliation(s)
- Elena Cama
- a Centre for Social Research in Health , University of New South Wales , Sydney , Australia
| | - Loren Brener
- a Centre for Social Research in Health , University of New South Wales , Sydney , Australia
| | - Hannah Wilson
- a Centre for Social Research in Health , University of New South Wales , Sydney , Australia
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Wagner GJ, Bogart LM, Klein DJ, Green HD, Mutchler MG, McDavitt B, Hilliard C. Association of Internalized and Social Network Level HIV Stigma With High-Risk Condomless Sex Among HIV-Positive African American Men. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1347-55. [PMID: 26718361 PMCID: PMC4929056 DOI: 10.1007/s10508-015-0641-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 05/26/2023]
Abstract
We examined whether internalized HIV stigma and perceived HIV stigma from social network members (alters), including the most popular and most similar alter, predicted condomless intercourse with negative or unknown HIV status partners among 125 African American HIV-positive men. In a prospective, observational study, participants were administered surveys at baseline and months 6 and 12, with measures including sexual behavior, internalized HIV stigma, and an egocentric social network assessment that included several measures of perceived HIV stigma among alters. In longitudinal multivariable models comparing the relative predictive value of internalized stigma versus various measures of alter stigma, significant predictors of having had condomless intercourse included greater internalized HIV stigma (in all models), the perception that a popular (well-connected) alter or alter most like the participant agrees with an HIV stigma belief, and the interaction of network density with having any alter that agrees with a stigma belief. The interaction indicated that the protective effect of greater density (connectedness between alters) in terms of reduced risk behavior dissipated in the presence of perceived alter stigma. These findings call for interventions that help people living with HIV to cope with their diagnosis and reduce stigma, and inform the targets of social network-based and peer-driven HIV prevention interventions.
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Affiliation(s)
- Glenn J Wagner
- Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
| | - Laura M Bogart
- Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - David J Klein
- Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Harold D Green
- Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA
| | - Matt G Mutchler
- Department of Sociology, California State University, Dominguez Hills, Carson, CA, USA
- Community-Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA
| | - Bryce McDavitt
- Department of Sociology, California State University, Dominguez Hills, Carson, CA, USA
- Community-Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA
- Clinical Psychology, Pacifica Graduate Institute, Carpinteria, CA, USA
| | - Charles Hilliard
- Department of Psychiatry & Human Behavior, Charles Drew University of Medicine and Science, Los Angeles, CA, USA
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Mogobe KD, Shaibu S, Matshediso E, Sabone M, Ntsayagae E, Nicholas PK, Portillo CJ, Corless IB, Rose CD, Johnson MO, Webel A, Cuca Y, Rivero-Méndez M, Solís Báez SS, Nokes K, Reyes D, Kemppainen J, Reid P, Sanzero Eller L, Lindgren T, Holzemer WL, Wantland D. Language and Culture in Health Literacy for People Living with HIV: Perspectives of Health Care Providers and Professional Care Team Members. AIDS Res Treat 2016; 2016:5015707. [PMID: 27340564 PMCID: PMC4909894 DOI: 10.1155/2016/5015707] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/17/2016] [Accepted: 04/12/2016] [Indexed: 11/17/2022] Open
Abstract
Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs), and 39 HIV professional care team members (PCTMs). SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.
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Affiliation(s)
| | - Sheila Shaibu
- School of Nursing, University of Botswana, Gaborone, Botswana
| | - Ellah Matshediso
- HIV and AIDS Coordination Office, University of Botswana, Gaborone, Botswana
| | | | | | - Patrice K. Nicholas
- Global Health and Academic Partnerships, Brigham and Women's Hospital and MGH Institute of Health Professions, Boston, MA 02120, USA
| | | | | | | | | | - Allison Webel
- Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44122, USA
| | | | | | - Solymar S. Solís Báez
- Center for Nursing Research, University of Puerto Rico-Recinto de Ciencias Medicas, San Juan, PR, USA
| | | | | | | | - Paula Reid
- School of Nursing, University of North Carolina Wilmington, Wilmington, NC 28403-5995, USA
| | | | - Teri Lindgren
- Rutgers University School of Nursing, Newark, NJ 07102, USA
| | | | - Dean Wantland
- Rutgers University School of Nursing, Newark, NJ 07102, USA
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Smith LR, Earnshaw VA, Copenhaver MM, Cunningham CO. Substance use stigma: Reliability and validity of a theory-based scale for substance-using populations. Drug Alcohol Depend 2016; 162:34-43. [PMID: 26972790 PMCID: PMC5293183 DOI: 10.1016/j.drugalcdep.2016.02.019] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 12/21/2015] [Accepted: 02/02/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Substance use disorders consistently rank among the most stigmatized conditions worldwide. Thus, substance use stigma fosters health inequities among persons with substance use disorders and remains a key barrier to successful screening and treatment efforts. Current efforts to measure substance use stigma are limited. This study aims to advance measurement efforts by drawing on stigma theory to develop and evaluate the Substance Use Stigma Mechanisms Scale (SU-SMS). The SU-SMS was designed to capture enacted, anticipated, and internalized Substance Use Stigma Mechanisms among persons with current and past substance use disorders, and distinguish between key stigma sources most likely to impact this target population. METHODS This study was a cross-sectional evaluation of the validity, reliability, and generalizability of the SU-SMS across two independent samples with diverse substance use and treatment histories. RESULTS Findings support the structural and construct validity of the SU-SMS, suggesting the scale was able to capture enacted, anticipated, and internalized stigma as distinct stigma experiences. It also further differentiated between two distinct stigma sources (family and healthcare providers). Analysis of these mechanisms and psychosocial metrics suggests that the scale is also associated with other health-related outcomes. Furthermore, the SU-SMS demonstrated high levels of internal reliability and generalizability across two independent samples of persons with diverse substance use disorders and treatment histories. CONCLUSION The SU-SMS may serve as a valuable tool for better understanding the processes through which substance use stigma serves to undermine key health behaviors and outcomes among persons with substance use disorders.
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Affiliation(s)
- Laramie R. Smith
- Center for Health, Intervention & Prevention, University of Connecticut; 2006 Hillside Rd. U-1248, Storrs, CT 06269, USA,Corresponding author at: Division of Global Public Health, University of California San Diego, 9500 Gilman Dr. #0507, La Jolla, CA 92093, USA
| | - Valerie A. Earnshaw
- Department of Psychology, University of Connecticut, 406 Babbidge Rd. U-1020, Storrs, CT 06269, USA
| | - Michael M. Copenhaver
- Center for Health, Intervention & Prevention, University of Connecticut; 2006 Hillside Rd. U-1248, Storrs, CT 06269, USA
| | - Chinazo O. Cunningham
- Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10461, USA
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Boone MR, Cook SH, Wilson PA. Sexual identity and HIV status influence the relationship between internalized stigma and psychological distress in black gay and bisexual men. AIDS Care 2016; 28:764-70. [PMID: 27017893 DOI: 10.1080/09540121.2016.1164801] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Experiences of internalized homophobia and HIV stigma in young Black gay and bisexual men (GBM) may lead to psychological distress, but levels of distress may be dependent upon their sexual identity or HIV status. In this study, we set out to explore the associations between psychological distress, sexual identity, and HIV status in young Black GBM. Participants were 228 young Black GBM who reported on their psychological distress, their HIV status, and their sexual identity. Results indicated that internalized homophobia was significantly related to psychological distress for gay men, but not for bisexual men. HIV stigma was related to psychological stress for HIV-positive men, but not for HIV-negative men. Results indicate a need for more nuanced examinations of the role of identity in the health and well-being of men who have sex with men.
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Affiliation(s)
- Melissa R Boone
- a The Methodology Center, The Pennsylvania State University , University Park , PA , USA
| | - Stephanie H Cook
- b Department of Health Behavior & Health Education and Department of Psychology , The University of Michigan , Ann Arbor , MI , USA
| | - Patrick A Wilson
- c Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
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49
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Brent RJ. The value of reducing HIV stigma. Soc Sci Med 2016; 151:233-40. [PMID: 26820574 DOI: 10.1016/j.socscimed.2016.01.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 01/06/2016] [Accepted: 01/09/2016] [Indexed: 10/22/2022]
Abstract
HIV-stigma is a major reason why HIV continues to be a global epidemic. Interventions targeting HIV-stigma are therefore necessary. To find an intervention that is worthwhile, a Cost-Benefit Analysis is needed which compares costs and benefits. There are many documented costs of HIV-stigma. What is missing is a valuation of the benefits of reducing HIV-stigma. The purpose of this paper is to present a general method that can be used to value the benefits of stigma reduction programs. The method involves estimating the marginal rate of substitution (MRS) between stigma and income in the utility function of older people with HIV. To illustrate how our framework can be used, we applied it to a sample of just over 900 people coming from the 2005-06 ROAH study (Research on Older Adults with HIV) in New York City.
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Affiliation(s)
- Robert J Brent
- Department of Economics, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA.
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Ballester-Arnal R, Ruiz-Palomino E, Gil-Llario MD. HIV Testing Among Spanish Youth: Analysis of the Mediating Role of the Big Five Personality and Other Psychological Factors. AIDS Behav 2015; 19:2001-11. [PMID: 25969179 DOI: 10.1007/s10461-015-1084-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early diagnosis of HIV improves the effectiveness of treatments and stops the progression of the disease. The influence of personality and other psychological variables in testing for HIV is analyzed. The first part of the study is composed of 4,929 young people (M age = 20.45, SD = 2.16). For the second part, young heterosexuals who participated in a broader project on HIV prevention were selected (n = 240, M age = 20.78, SD = 2.29). Only 23.3 % of the total sample have ever been tested for HIV antibodies. The main reason for not testing was fear of positive result (25.4 %). Statistically significant differences in Agreeableness (p = .027), Trust (p = .022) and Straightforwardness (p = .024) were found between HIV-tested and not HIV-tested youth. Trust explained 3.3 % of variance of HIV-test. Knowing barriers to testing and individual differences could be useful in developing preventive campaigns.
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Affiliation(s)
- Rafael Ballester-Arnal
- Department of Clinical and Basic Psychology and Psychobiology, School of Health Sciences, University Jaume I, Avda. Vicent Sos Baynat s/n, 12071, Castellón de la Plana, Spain.
| | - Estefanía Ruiz-Palomino
- Department of Clinical and Basic Psychology and Psychobiology, School of Health Sciences, University Jaume I, Avda. Vicent Sos Baynat s/n, 12071, Castellón de la Plana, Spain.
| | - María Dolores Gil-Llario
- Department of Developmental and Educational Psychology, University of Valencia, Estudi General, Valencia, Spain
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