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Logie CH, Nyblade L. Recognizing and responding to stigma-related barriers in health care. Nat Rev Dis Primers 2024; 10:70. [PMID: 39327459 DOI: 10.1038/s41572-024-00554-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, Ontario, Canada.
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
| | - Laura Nyblade
- Social, Statistical and Environmental Sciences, Research Triangle Institute, Washington DC, USA
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Zhao J, Li S, Zhang N, Cui C, Wang T, Fan M, Zeng J, Xie Y. Felt stigma and associated factors in children and adolescents with epilepsy: a multicenter cross-sectional study in China. Front Neurol 2024; 15:1459392. [PMID: 39206293 PMCID: PMC11349658 DOI: 10.3389/fneur.2024.1459392] [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: 07/04/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
Objective Epilepsy-related stigma is a global problem, yet there has been an inadequate focus on children and adolescents. The purpose of this study was to determine the status quo of stigma and its determinants among children and adolescents with epilepsy in China. Methods A multicenter cross-sectional study was conducted across nine hospitals in eight cities within six provinces in China from 10 October 2023 to 15 June 2024. Participants included patients aged 8 to 18 years with epilepsy and their caregivers. Felt stigma was assessed with the Kilifi Stigma Scale for Epilepsy (KSSE). Social support and self-efficacy were collected through the Social Support Rating Scale (SSRS) and the Generalized Self-Efficacy Scale (GSES). The data were analyzed using t-tests, analysis of variance (ANOVA), Spearman correlation analysis, and multiple linear regression analysis. Results The study enrolled 281 children and adolescents, with a mean age of 12.25 years (SD = 2.56), including 46.6% females. A total of 35.6% participants had self-reported felt stigma. The mean KSSE score is 9.58 (SD = 7.11). Meanwhile, stigma scores correlated strongly with reduced social support (r = -0.55, p < 0.01) and self-efficacy (r = -0.43, p < 0.01). Place of residence (rural vs. non-rural), academic performance (average and above vs. fair or poor), region (western region vs. non-western region), duration of epilepsy (≤5 years vs. >5 years), drug-resistant epilepsy (yes vs. no), comorbidities (yes vs. no), social support and self-efficacy are major influencing factors among the complex factors influencing the felt stigma among children and adolescents. Conclusion Medical staff should be more aware of stigma among children and adolescents with epilepsy, especially those who live in rural and western areas, have poor academic performance, have epilepsy duration of more than 5 years, have drug-resistant epilepsy, and have comorbidities, who are at higher risk of stigma. It is recommended that effective measures be taken to alleviate stigma by improving children and adolescents' self-efficacy and providing more social support for them and their families.
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Affiliation(s)
- Jing Zhao
- Department of Nursing, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Shuangzi Li
- Department of Neurology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Ni Zhang
- Department of Traditional Chinese Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Cui Cui
- Department of Nursing, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ting Wang
- Department of Neurology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Mingping Fan
- Department of Neurology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Junqi Zeng
- Department of Nursing, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuan Xie
- Department of Nursing, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Kaufman TML, Kiekens WJ, Baams L, Bos HMW, De Looze ME. Gender Sexuality Alliances and School Safety: Who Benefits Most, and Do Additive School-Led Practices Strengthen the Link? J Youth Adolesc 2024; 53:1499-1512. [PMID: 38418749 PMCID: PMC11136706 DOI: 10.1007/s10964-024-01957-0] [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: 08/18/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
While Gender and Sexuality Alliances (GSAs) are associated with higher acceptance of sexual diversity and lower bullying-victimization, it is unclear which individual and school-level attributes strengthen these associations. Nationally representative data (N = 1,567 students; Mage = 15.4, SD = 0.16; 34% boys, 66% girls, 51% heterosexual, 49% sexually-diverse after propensity score matching) in 139 Dutch secondary schools were used. Multilevel regression analyses revealed that GSA presence was linked to more inclusive attitudes about sexual diversity and a safer disclosure climate among sexually-diverse students, and lower general bullying-victimization when the school had a GSA combined with school practices to tackle bullying. School professionals and researchers are recommended to recognize the significance of individual and school-level factors that affect GSA correlates.
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Affiliation(s)
- T M L Kaufman
- Department of Pedagogy and Education, Utrecht University, Utrecht, Netherlands.
| | - W J Kiekens
- Department of Sociology/Interuniversity Center for Social Science Theory and Methodology, University of Groningen, Groningen, Netherlands
| | - L Baams
- Department of Pedagogy and Educational Sciences, University of Groningen, Groningen, Netherlands
| | - H M W Bos
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - M E De Looze
- Department of Interdisciplinary Social Sciences, Utrecht University, Groningen, Netherlands
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Valerio H, Alavi M, Marshall AD, Hajarizadeh B, Amin J, Law M, Tillakeratne S, George J, Degenhardt L, Grebely J, Matthews GV, Dore GJ. Factors associated with hepatitis C treatment uptake among females of childbearing age in New South Wales, Australia: A population-based study. Drug Alcohol Rev 2024; 43:1080-1092. [PMID: 37254644 DOI: 10.1111/dar.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/15/2023] [Accepted: 05/09/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Females of childbearing age with hepatitis C virus (HCV) face increased marginalisation with intersecting, sex-specific barriers to direct acting antiviral (DAA) therapy. We assessed the factors associated with uptake of DAA therapy among females of childbearing age, including those with evidence of recent drug dependence. METHODS HCV notifications in New South Wales, Australia (1995-2017) were linked to opioid agonist therapy (OAT), hospitalisations, incarcerations, perinatal, HIV notifications, deaths and prescription databases. Recent drug dependence was defined as hospitalisation due to injectable drugs or receipt of OAT occurring in the DAA era (2016-2018). Logistic regression was used to analyse factors associated with DAA uptake among females of childbearing age (18-44), including those with recent drug dependence. RESULTS Among 57,467 people with evidence of chronic HCV in the DAA era (2016-2018), 20,161 (35%) were female, including 33% (n = 6563/20,161) of childbearing age (18-44). Among all females of childbearing age (n = 6563) and those with evidence of recent drug dependence (n = 2278/6563, 35%), DAA uptake was lower among those who had given birth in the DAA era (vs. no birth record, all females of childbearing age; aOR: 0.74, 95% CI 0.61, 0.89; those with recent drug dependence; aOR 0.69, 95% CI 0.51, 0.93) and Aboriginal and Torres Strait Islander peoples (all females of childbearing age; aOR 0.81, 95% CI 0.71, 0.93; those with recent drug dependence aOR 0.75, 95% CI 0.62, 0.90). CONCLUSION Females of childbearing age should be considered a key population for DAA therapy. Enhancing antenatal and postnatal HCV care may be critical in the pursuit towards elimination.
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Affiliation(s)
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Department of Health Systems and Population Sciences, Macquarie University, Sydney, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Marshall AD, Rance J, Dore GJ, Grebely J, Treloar C. Applying a stigma and time framework to facilitate equitable access to hepatitis C care among women who inject drugs: The ETHOS Engage Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104477. [PMID: 38861842 DOI: 10.1016/j.drugpo.2024.104477] [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: 02/23/2024] [Revised: 05/02/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Women who inject drugs are significantly less likely to initiate hepatitis C virus (HCV) treatment than men. Concerted efforts are needed to minimise gender-based inequalities in care. The study aim was to use a stigma and time framework to investigate how women who inject drugs experienced HCV care in healthcare settings. METHODS Semi-structured, in-depth interviews were conducted with 34 participants from the ETHOS Engage Cohort (n = 1,443) in Australia. Inclusion criteria were aged ≥18 years, history of injection drug use, and persons who injected in the prior six months or were currently receiving opioid agonist treatment. Drawing on the original qualitative dataset (n = 34), we conducted a secondary analysis focused on women participants' experiences of receiving HCV related care (n = 21/34). Utilising thematic analysis, we applied Earnshaw's theoretical framework, which incorporates time into stigma and health research via three "timescales" - historical context, human development, and status course. RESULTS Among the 21 women interviewed (mean age 42 years, 5 are Aboriginal, 11 received HCV treatment), the majority were currently receiving opioid agonist treatment and over half injected drugs in the past month. For historical context, most participants were diagnosed with HCV during the interferon era (1990s-2014). Participants had to navigate a sociomedical landscape not only largely bereft of adequate HCV medical knowledge, appropriate support, and adequate treatments, but were also generally assessed as "unsuitable" for treatment based on their perceived personhood as people who inject drugs. For human development, many participants reported encountering overlapping stigmatizing experiences (layered stigma) while receiving their HCV diagnosis in prenatal care and early postpartum. Under status course, participants acutely recognised the intersection of HCV infection, injection drug use, and gender, and reported concerns about being judged more harshly from healthcare providers as a result. CONCLUSION A stigma and time framework illuminated multiple overlapping stigmatizing experiences for women who inject drugs in HCV care and in turn, can help to inform tools and interventions to counter their impact.
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Affiliation(s)
- Alison D Marshall
- The Kirby Institute, University of New South Wales, Sydney, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
| | - Jake Rance
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
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Nicoloro-SantaBarbara J, Lobel M. Loneliness and Its Predictors in Rare Versus Common Chronic Illnesses. Int J Behav Med 2024; 31:422-432. [PMID: 37845486 DOI: 10.1007/s12529-023-10231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Loneliness is a growing public health concern associated with substantial negative mental and physical health outcomes. Loneliness is especially relevant for individuals with a chronic illness, perhaps more so if their illness is rare. Little is known about the psychosocial experience of individuals with a rare chronic illness, and whether and how it may differ from the experience of individuals with common chronic illnesses. We compared the magnitude of loneliness in persons with a rare or common chronic illness and examined theoretically guided predictors of loneliness as follows: stigma, illness intrusiveness, social comparison, social support, support from healthcare providers, and self-efficacy. METHOD Individuals with a chronic illness (common or rare) completed an anonymous online survey (N = 952). RESULTS Individuals with common chronic illnesses were as lonely as those with a rare chronic illness. Loneliness in both groups was higher than that in population norms. Regression analyses reveal that independent of other predictors, loneliness was especially high among people who feel stigmatized by others, those who have less social support available, and people whose functioning is more disrupted by their illness (all p values < 0.01). CONCLUSION The similarity of loneliness in these groups reinforces the value of further systematic research to identify the needs of individuals with any type of chronic illness. Study findings highlight the importance of examining internalized stigma and social support as possible targets of intervention to reduce loneliness among individuals with a chronic illness, recognizing some of the unique features and challenges of their disorders, whether common or rare.
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Affiliation(s)
- Jennifer Nicoloro-SantaBarbara
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
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Beccia AL, Agénor M, Baek J, Ding EY, Lapane KL, Austin SB. Methods for structural sexism and population health research: Introducing a novel analytic framework to capture life-course and intersectional effects. Soc Sci Med 2024; 351 Suppl 1:116804. [PMID: 38825380 DOI: 10.1016/j.socscimed.2024.116804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 01/19/2024] [Accepted: 03/19/2024] [Indexed: 06/04/2024]
Abstract
Accumulating evidence links structural sexism to gendered health inequities, yet methodological challenges have precluded comprehensive examinations into life-course and/or intersectional effects. To help address this gap, we introduce an analytic framework that uses sequential conditional mean models (SCMMs) to jointly account for longitudinal exposure trajectories and moderation by multiple dimensions of social identity/position, which we then apply to study how early life-course exposure to U.S. state-level structural sexism shapes mental health outcomes within and between gender groups. Data came from the Growing Up Today Study, a cohort of 16,875 children aged 9-14 years in 1996 who we followed through 2016. Using a composite index of relevant public policies and societal conditions (e.g., abortion bans, wage gaps), we assigned each U.S. state a year-specific structural sexism score and calculated participants' cumulative exposure by averaging the scores associated with states they had lived in during the study period, weighted according to duration of time spent in each. We then fit a series of SCMMs to estimate overall and group-specific associations between cumulative exposure from baseline through a given study wave and subsequent depressive symptomology; we also fit models using simplified (i.e., non-cumulative) exposure variables for comparison purposes. Analyses revealed that cumulative exposure to structural sexism: (1) was associated with significantly increased odds of experiencing depressive symptoms by the subsequent wave; (2) disproportionately impacted multiply marginalized groups (e.g., sexual minority girls/women); and (3) was more strongly associated with depressive symptomology compared to static or point-in-time exposure operationalizations (e.g., exposure in a single year). Substantively, these findings suggest that long-term exposure to structural sexism may contribute to the inequitable social patterning of mental distress among young people living in the U.S. More broadly, the proposed analytic framework represents a promising approach to examining the complex links between structural sexism and health across the life course and for diverse social groups.
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Affiliation(s)
- Ariel L Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA.
| | - Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA.
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Eric Y Ding
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
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Janoušková M, Pekara J, Kučera M, Kearns PB, Šeblová J, Wolfová K, Kuklová M, Šeblová D. Experiences of stigma, discrimination and violence and their impact on the mental health of health care workers during the COVID-19 pandemic. Sci Rep 2024; 14:10534. [PMID: 38720009 PMCID: PMC11078939 DOI: 10.1038/s41598-024-59700-5] [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: 12/20/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Health care workers have been exposed to COVID-19 more than people in other professions, which may have led to stigmatization, discrimination, and violence toward them, possibly impacting their mental health. We investigated (1) factors associated with stigma, discrimination, and violence, (2) the association of stigma, discrimination, and violence with mental health, (3) everyday experiences of stigmatization, discrimination, and violence. We chose a combination of a quantitative approach and qualitative content analysis to analyze data collected at three time points: in 2020, 2021 and 2022. A higher age was associated with lower odds of experiencing stigma, discrimination, and violence, whereas female gender was related to more negative experiences. The intensity of exposure to COVID-19 was associated with greater experience with stigmatization, discrimination, and violence across all three years (for example in 2022: odds ratio, 95% confidence interval: 1.74, 1.18-2.55 for mild exposure; 2.82, 1.95-4.09 for moderate exposure; and 5.74, 3.55-9.26 for severe exposure, when compared to no exposure). Stigma, discrimination, and violence were most strongly associated with psychological distress in 2020 (odds ratio = 2.97, 95% confidence interval 2.27-3.88) and with depressive symptoms in 2021 (odds ratio = 2.78, 95% confidence interval 2.12-3.64). Attention should be given to the destigmatization of contagious diseases and the prevention of discrimination, violence, and mental health problems, both within workplaces and among the public.
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Affiliation(s)
- Miroslava Janoušková
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia.
- Division of Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czechia.
| | - Jaroslav Pekara
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia.
- Medical College, Prague, Czechia.
| | - Matěj Kučera
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
- National Institute of Mental Health, Klecany, Czechia
- Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pavla Brennan Kearns
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Jana Šeblová
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
- Paediatric Emergency Department, Motol University Hospital, Prague, Czechia
| | - Katrin Wolfová
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Marie Kuklová
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
- Faculty of Science, Charles University, Prague, Czechia
| | - Dominika Šeblová
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
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Eaton LA, Huedo-Medina T, Earnshaw VA, Kalichman M, Watson RJ, Driver R, Chandler CJ, Kalinowski J, Kalichman SC. Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:650-660. [PMID: 37898978 DOI: 10.1007/s11121-023-01603-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.
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Affiliation(s)
- Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA.
| | | | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | | | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristian J Chandler
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Seth C Kalichman
- Psychological Sciences, University of Connecticut, Storrs, CT, USA
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O'Donnell AT, Foran AM. The link between anticipated and internalized stigma and depression: A systematic review. Soc Sci Med 2024; 349:116869. [PMID: 38678910 DOI: 10.1016/j.socscimed.2024.116869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
Stigmatized groups may experience psychological distress. Yet, some studies show no significant relation between stigma and mental health outcomes. This systematic review investigates the link between anticipated and internalized stigma, and one mental health outcome, depression. We aimed to (1) determine whether anticipated and internalized stigma predict levels of depression, and (2) review the quality of evidence for this link. We searched PsycInfo, PubMed and EMBASE databases. Eighty-three studies (N = 34,705) met our inclusion criteria, across five stigma categories: Sexual and gender minorities; HIV/AIDS; Illness or disability-related (non-HIV); Weight, and Other. We reviewed evidence within each category and study design and developed a narrative synthesis. Sixty studies (72.3%) supported the proposed link, which varied across categories from 53.6% to 100%. Using the NIH quality assessment tool, most studies were of fair quality. Most cross-sectional studies (76.7%) straightforwardly supported the positive relation between internalized and/or anticipated stigma and depression, while only 40% of longitudinal studies did. Implications for the study of stigma and mental health outcomes are discussed.
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Affiliation(s)
- Aisling T O'Donnell
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Aoife-Marie Foran
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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Bondarchuk C, Lemon T, Earnshaw V, Rousseau E, Sindelo S, Bekker LG, Butler L, Katz I. Disclosure Events and Psychosocial Well-Being Among Young South African Adults Living with HIV. Int J Behav Med 2024:10.1007/s12529-024-10291-5. [PMID: 38658438 DOI: 10.1007/s12529-024-10291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Poor psychological well-being is both prevalent among South Africans living with HIV and has been associated with poor HIV clinical outcomes. However, the relationship between disclosure and psychological well-being remains unclear. This analysis sought to examine the relationship between two disclosure-related variables, disclosure status and reaction received, and psychosocial well-being among a sample of young adults living with HIV (YALWH) in urban South Africa. METHOD This was a secondary analysis using observational data from Standing Tall, a randomized controlled trial that recruited 100 participants ages 18-24 who tested positive for HIV after initially presenting to two well-established mobile clinics for HIV testing. Interviews investigating primary and secondary outcomes of interest were done at baseline and 6 months following recruitment. RESULTS About half (51%) of participants disclosed their HIV status within 6 months after recruitment. Simple linear regression analyses revealed that disclosure of HIV status within 6 months after study enrollment predicted significantly lower levels of disclosure concerns and internalized stigma (p < 0.05). Reactions to disclosure were not significantly associated with any of the measures of psychosocial well-being considered in this analysis (p > 0.05). CONCLUSION The results suggest that the act of disclosure among newly diagnosed YALWH may be associated with reductions in internalized stigma. In addition, the finding that the act of disclosure may be a more important determinant of psychosocial well-being than the reaction to disclosure has important implications for interventions designed to promote disclosure and psychosocial well-being in YALWH.
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Affiliation(s)
| | - Tiffany Lemon
- Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
| | - Valerie Earnshaw
- Department of Human Development and Family Services, University of Delaware, Newark, DE, USA
| | - Elzette Rousseau
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Siyaxolisa Sindelo
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Lisa Butler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Ingrid Katz
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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12
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Jones A, Sharples D, Burton S, Montgomery C, Rose AK. The Associations among Perceived Courtesy Stigma, Health and Social Behaviours in Family Members and Friends of People Who Use Substances: An Ecological Momentary Assessment Study. Subst Use Misuse 2024; 59:1440-1445. [PMID: 38629645 DOI: 10.1080/10826084.2024.2340971] [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: 06/05/2024]
Abstract
Background: The stigma and discrimination experienced by individuals with an alcohol/substance use disorder often extends to the family members and friends who provide care, which is known as courtesy stigma. This courtesy stigma can lead to isolation, poor mental health and might impact the quality-of-care these individuals provide. The aim of this study was to examine the frequency of experienced courtesy stigma/discrimination in individuals in a family support service for a loved one's substance use, and to examine any cross-sectional associations with changes in mood, health- and social-related outcomes. Methods: Thirty-six individuals (25 female) with a mean age of 51.91 years took part in an ecological momentary assessment study in which the experience of courtesy stigma/discrimination and measures of mood, health (e.g. alcohol use, nicotine use, healthy eating, sleep, physical activity) and social connections were taken 3 times per day for fourteen days. Results: Across 1029 competed assessments (compliance ∼68%), there were 122 (∼11%) reports of courtesy stigma/discrimination. The most common sources of stigma/discrimination were from family members (∼43% of occurrences) and friends (∼31% of occurrences). Experiencing this stigma/discrimination was associated with increases in alcohol and nicotine use, as well as reductions in healthy eating, physical activity, sleep, social connections, and mood. Conclusions: The experience of courtesy stigma/discrimination was common in a sample of individual's who support a loved one with alcohol or substance use disorder. These experiences are associated with changes in health and social behaviors and may lead to a poorer quality of care.
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Affiliation(s)
- Andrew Jones
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Diane Sharples
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Sam Burton
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | | | - Abigail K Rose
- School of Psychology, Liverpool John Moores University, Liverpool, UK
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13
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Eschliman EL, Patel EU, Murray SM, German D, Kirk GD, Mehta SH, Kaufman MR, Genberg BL. Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use. Subst Use Misuse 2024; 59:1210-1220. [PMID: 38519443 PMCID: PMC11194036 DOI: 10.1080/10826084.2024.2330906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
BACKGROUND People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population. METHODS This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland. Logistic regressions with generalized estimating equations were used to estimate associations between drug use-related discrimination in healthcare settings and subsequent ED utilization for the sample overall and six subgroups based on race, sex, and HIV status. RESULTS 1,342 participants contributed data from 7,289 semiannual study visits. Participants were predominately Black (82%), mostly male (66%), and 33% were living with HIV. Drug use-related discrimination in healthcare settings (reported at 6% of study visits) was positively associated with any subsequent ED use (OR = 1.40, 95% CI: 1.15-1.72). Positive associations persisted after adjusting for covariates, including past sixth-month ED use and drug use, among the overall sample (aOR = 1.28, 95% CI: 1.04-1.59) and among some subgroups. CONCLUSIONS Drug use-related discrimination in healthcare settings was associated with greater subsequent ED utilization in this sample. Further exploration of mechanisms driving this relationship may help improve care and optimize healthcare engagement for people with a history of injection drug use.
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Affiliation(s)
- Evan L. Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Michelle R. Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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14
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Logie CH, Okumu M, Admassu Z, MacKenzie F, Tailor L, Kortenaar JL, Perez-Brumer A, Ahmed R, Batte S, Hakiza R, Kibuuka Musoke D, Katisi B, Nakitende A, Juster RP, Marin MF, Kyambadde P. Exploring ecosocial contexts of alcohol use and misuse during the COVID-19 pandemic among urban refugee youth in Kampala, Uganda: Multi-method findings. J Migr Health 2024; 9:100215. [PMID: 38375158 PMCID: PMC10875238 DOI: 10.1016/j.jmh.2024.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/16/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
Urban refugees may be disproportionately affected by socio-environmental stressors that shape alcohol use, and this may have been exacerbated by additional stressors in the COVID-19 pandemic. This multi-method study aimed to understand experiences of, and contextual factors associated with, alcohol use during the pandemic among urban refugee youth in Kampala, Uganda. We conducted a cross-sectional survey (n = 335), in-depth individual interviews (IDI) (n = 24), and focus groups (n = 4) with urban refugee youth in Kampala. We also conducted key informant interviews (n = 15) with a range of stakeholders in Kampala. We conducted multivariable logistic regression analyses with survey data to examine socio-demographic and ecosocial (structural, community, interpersonal) factors associated with ever using alcohol and alcohol misuse. We applied thematic analyses across qualitative data to explore lived experiences, and perceived impacts, of alcohol use. Among survey participants (n = 335, mean age= 20.8, standard deviation: 3.01), half of men and one-fifth of women reported ever using alcohol. Among those reporting any alcohol use, half (n = 66, 51.2 %) can be classified as alcohol misuse. In multivariable analyses, older age, gender (men vs. women), higher education, and perceived increased pandemic community violence against women and children were associated with significantly higher likelihood of ever using alcohol. In multivariable analyses, very low food security, relationship status, transactional sex, and lower social support were associated with increased likelihood of alcohol misuse. Qualitative findings revealed: (1) alcohol use as a coping mechanism for stressors (e.g., financial insecurity, refugee-related stigma); and (2) perceived impacts of alcohol use on refugee youth health (e.g., physical, mental). Together findings provide insight into multi-level contexts that shape vulnerability to alcohol mis/use among urban refugee youth in Kampala and signal the need for gender-tailored strategies to reduce socio-environmental stressors.
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Affiliation(s)
- Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA
- School of Social Sciences, Uganda Christian University, Mukono, Uganda
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lauren Tailor
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jean-Luc Kortenaar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rushdia Ahmed
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Shamilah Batte
- Organization for Gender Empowerment and Rights Advocacy- OGERA Uganda, Kampala, Uganda
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | - Brenda Katisi
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | - Robert-Paul Juster
- Department of Psychiatry & Addiction, University of Montreal, Montreal, Canada
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Peter Kyambadde
- Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
- National AIDS Control Program, Ministry of Health, Kampala, Uganda
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15
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Fannin A, Hooley C, Reeves CJ, Marçal K, Treglown R, Woerner R. Occupational burnout and public stigma associated with employee mental well-being: A multi-industry, cross-sectional study during COVID-19. Work 2024; 77:49-59. [PMID: 37483050 DOI: 10.3233/wor-220507] [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] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND While mental illness (e.g., depression, anxiety) has been examined frequently in the workplace, the COVID-19 pandemic has only increased the attention towards mental illness. Mental well-being views mental health as a continuum from ill health to thriving. Few studies have examined factors associated with mental well-being in the workplace. Public stigma for mental illness, the general population's negative attitude towards mental illness, and occupational burnout are examined. OBJECTIVE The purpose of this study was to examine the relationship between burnout and public stigma on mental well-being in a sample of employees across industries in the United States. METHODS Employees surveyed from 16 companies from various industries were assessed. Room Here, a non-profit organization whose goal is to improve employee mental fitness, gathered data from these companies located in the western mountain region of the U.S. Data were collected during the pandemic. Across this portfolio of companies, 259 employees were included in the sample. Survey assesses respondents' mental well-being, stigma towards mental illness, and occupational burnout. Ordinary least squares (OLS) regression was used in this cross-sectional study on secondary data. RESULTS Results suggested occupational burnout was associated with a decrease in mental well-being, while public stigma was associated with an improvement in mental well-being. CONCLUSION This study sought to examine the relationship between mental well-being, burnout, and public stigma. Employee burnout and public stigma were related to mental well-being. Implications for burnout and stigma reduction programs are discussed as well as future research.
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Affiliation(s)
- Austin Fannin
- Industrial/Organizational Psychology, University of Tulsa, Tulsa, OK, USA
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, UT, USA
| | - Cody J Reeves
- Marriott School of Business, Brigham Young University, Provo, UT, USA
| | - Katherine Marçal
- School of Social Work, Rutgers University, NewBrunswick, NJ, USA
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16
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Blyth SH, Cowie K, Jurinsky J, Hennessy EA. A qualitative examination of social identity and stigma among adolescents recovering from alcohol or drug use. Addict Behav Rep 2023; 18:100505. [PMID: 37415909 PMCID: PMC10319988 DOI: 10.1016/j.abrep.2023.100505] [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] [Received: 01/22/2023] [Revised: 05/18/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Alcohol and other drug (AOD) use disorders are stigmatized conditions, but little is known about youth's experience of this stigma, which may threaten their developing social identity and recovery process. This study investigates youth's perceptions of AOD use-related stigma in the context of their social identity. Methods This study uses data from 12 youth (ages 17-19) who were in recovery from problematic AOD use. Participants completed a Social Identity Mapping in Addiction Recovery (SIM-AR) exercise, in which they created a visual map of their social groups, and semi-structured interview, in which participants were asked about their experience creating their SIM-AR and reflections on their social network. SIM-AR data were descriptively analyzed, and interviews were thematically analyzed for instances of stigma. Results Using stigmatizing terminology, participants expressed some stigmatizing attitudes towards themselves and others in their network who used substances and perceived both positive and negative reactions from those who knew about their disorder. Findings suggest that youth may experience some internalized stigma and perceive stigma from others in their social networks, which may be a barrier to the development of a healthy social identity and engagement in recovery supports. Conclusions These findings should be considered when seeking to engage youth in treatment and recovery programming. Despite the small sample, the findings suggest the importance of considering how stigma may influence adolescents' treatment and recovery experience in the context of their social environment.
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Affiliation(s)
| | - Kiefer Cowie
- The Wright Institute Clinical Psychology Program, Berkeley, CA 94704, USA
| | - Jordan Jurinsky
- Vanderbilt University, Peabody College of Education and Human Development, Nashville, TN 37203-5721, USA
| | - Emily A. Hennessy
- Massachusetts General Hospital, Psychiatry, Recovery Research Institute, 151 Merrimac Road, Boston, MA 02114-2696, USA
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17
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Guilamo-Ramos V, Johnson C, Thimm-Kaiser M, Benzekri A. Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications. Nurs Outlook 2023; 71:101996. [PMID: 37349232 DOI: 10.1016/j.outlook.2023.101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity. PURPOSE Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce. METHODS We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles. FINDINGS To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic. DISCUSSION Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC; School of Medicine, Department of Family Medicine and Community Health, Department of Infectious Diseases, Duke University, Durham, NC; Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, DC.
| | - Celia Johnson
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
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18
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Logie CH, Shannon K, Braschel M, Krüsi A, Norris C, Zhu H, Deering K. Brief Report: Social Factors Associated With Trajectories of HIV-Related Stigma and Everyday Discrimination Among Women Living With HIV in Vancouver, Canada: Longitudinal Cohort Findings. J Acquir Immune Defic Syndr 2023; 94:190-195. [PMID: 37850977 PMCID: PMC10730092 DOI: 10.1097/qai.0000000000003247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/26/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Women living with HIV (WLHIV) experience stigma rooted in social inequities. We examined associations between social factors (food insecurity, housing insecurity, violence, sexual minority identity, and substance use) and HIV-related stigma and Everyday Discrimination trajectories among WLHIV. METHODS This community-based open longitudinal cohort study with WLHIV living in and/or accessing HIV care in Metro Vancouver, Canada, plotted semiannual averages (2015-2019) of recent (past 6-month) HIV-related stigma and Everyday Discrimination. We examined distinct trajectories of HIV-related stigma and Everyday Discrimination using latent class growth analysis (LCGA) and baseline correlates of each trajectory using multinomial logistic regression. FINDINGS Among participants (HIV-related stigma sample: n = 197 participants with n = 985 observations; Everyday Discrimination sample: n = 203 participants with n = 1096 observations), LCGA identified 2 distinct HIV-related stigma and Everyday Discrimination trajectories: sustained low and consistently high. In multivariable analysis, concurrent food and housing insecurity (adjusted odds ratio [AOR]: 2.15, 95% confidence interval [CI] 1.12-4.12) and physical/sexual violence (AOR: 2.57, 95% CI: 1.22-5.42) were associated with higher odds of the consistently high (vs. sustained low) HIV-related stigma trajectory. Sexual minority identity (AOR: 2.84, 95% CI: 1.49-5.45), concurrent food and housing insecurity (AOR: 2.65, 95% CI: 1.38-5.08), and noninjection substance use (less than daily vs. none) (AOR: 2.04, 95% CI: 1.03-4.07) were associated with higher odds of the consistently high (vs. sustained low) Everyday Discrimination trajectory. CONCLUSIONS Social inequities were associated with consistently high HIV-related stigma and Everyday Discrimination among WLHIV. Multilevel strategies can address violence, economic insecurity, intersecting stigma, and discrimination to optimize health and rights among WLHIV.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Candice Norris
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Haoxuan Zhu
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Kathleen Deering
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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19
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Favre S, Richard-Lepouriel H. A Commentary on Changes in Mental Illness Stigma Over 30 Years-Improvement, Persistence, or Deterioration? (Schomerus et al, 2022). J Nerv Ment Dis 2023; 211:726-727. [PMID: 37639460 DOI: 10.1097/nmd.0000000000001685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Sophie Favre
- Mood Disorder Unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
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20
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Hosaka KRJ, Mandewo D, Mmbaga BT, Ngowi H, Dow DE, Stewart KA. "I am not alone with tears": embodying stigma and longing among youth living with perinatally acquired HIV in Tanzania through a collaborative arts-based approach. MEDICAL HUMANITIES 2023; 49:396-406. [PMID: 36526410 PMCID: PMC10827326 DOI: 10.1136/medhum-2022-012477] [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] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
It is estimated that 4 million youth aged 15-24 years live with HIV globally, 85% of whom live in sub-Saharan Africa. For youth living with perinatally acquired HIV (YPHIV), stigma is frequently linked with negative health outcomes. YPHIV face distinct HIV stigma experiences across the lifespan, particularly because of the centrality of the family context in their HIV experience and the reality that they have lived with HIV since birth. Nevertheless, our understanding and measurement of stigma remains limited. One way to improve our understanding of HIV stigma for YPHIV is through in-depth exploration of embodied narratives of HIV experience. This paper is based on fieldwork that incorporated a collaborative arts-based approach with a group of six YPHIV in Tanzania. Using artwork and a theoretical framework of embodiment, this paper phenomenologically describes their narratives of HIV experience, perceptions of stigma over time and imaginations of the future. This paper highlights that collective solidarity, habitus and participants' desire to reframe others' perceptions about them and relieve the suffering of others shape the embodied experience with HIV. Moreover, this paper argues that stigma experiences for YPHIV are temporal and have changed over time with increased age, interventions and biomedical advances. Broadly, while HIV stigma continues to exist, participants report responding to stigma with agency by creating alternative solidarities and pushing boundaries of possibility, reframing others' perceptions of them and acting on dreams for better futures.
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Affiliation(s)
- Kalei Richard James Hosaka
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
- Division of Internal Medicine-Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, United Republic of Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, United Republic of Tanzania
| | - Happyness Ngowi
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, United Republic of Tanzania
| | - Dorothy E Dow
- Duke Global Health Institute, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Kearsley Alison Stewart
- Duke Global Health Institute, Durham, North Carolina, USA
- Department of Cultural Anthropology, Duke University, Durham, North Carolina, USA
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21
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Pachankis JE, Jackson SD. A Developmental Model of the Sexual Minority Closet: Structural Sensitization, Psychological Adaptations, and Post-closet Growth. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1869-1895. [PMID: 35978203 PMCID: PMC9935753 DOI: 10.1007/s10508-022-02381-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/11/2022] [Accepted: 07/11/2022] [Indexed: 05/15/2023]
Abstract
Across the lifespan, most sexual minority individuals experience the closet-a typically prolonged period in which no significant others know their sexual identity. This paper positions the closet as distinct from stigma concealment given its typical duration in years and absolute removal from sources of support for an often-central identity typically during a developmentally sensitive period. The Developmental Model of the Closet proposed here delineates the vicarious learning that takes place before sexual orientation awareness to shape one's eventual experience of the closet; the stressors that take place after one has become aware of their sexual orientation but has not yet disclosed it, which often takes place during adolescence; and potential lifespan-persistent mental health effects of the closet, as moderated by the structural, interpersonal, cultural, and temporal context of disclosure. The paper outlines the ways in which the model both draws upon and is distinct from earlier models of sexual minority identity formation and proposes several testable hypotheses and future research directions, including tests of multilevel interventions.
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Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, Suite 316, New Haven, CT, 06510, USA.
| | - Skyler D Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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22
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Shepherd BF, Maki JL, Zelaya DG, Warner Ş, Wilson A, Brochu PM. Development and Validation of the Gay-Specific Intraminority Stigma Inventory (G-SISI): Initial Evidence Underpinned by Intraminority Stress Theory. Eur J Investig Health Psychol Educ 2023; 13:170-186. [PMID: 36661763 PMCID: PMC9858161 DOI: 10.3390/ejihpe13010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
There is currently a lack of measures testing intraminority stress within gay men. Therefore, the current study sought to develop and psychometrically test the Gay-Specific Intraminority Stigma Inventory (G-SISI). Based on a content review of the literature and a panel of experts, a pool of items assessing gay men's perceived exposure to a range of discriminatory attitudes from other gay men was generated. Utilizing a randomly split sample of 1723 gay men between the ages of 19 and 79 years, an exploratory factor analysis was first performed (n = 861). The remaining unexamined data were then used to conduct a confirmatory factor analysis (n = 862). The results support a six-factor model: (1) Age Stigma, (2) Socioeconomic Stigma, (3) Gay Non-Conformity Stigma, (4) Racial Stigma, (5) Gender Expression Stigma, and (6) Body Stigma. Cronbach's alpha for the total scale was 0.90 and for the subscales ranged from 0.60 to 0.85. Sociodemographic factors and measures of community involvement were differentially associated with the G-SISI subscales, providing evidence of construct validity. The findings demonstrate initial support for the dimensionality and validity of the G-SISI, which targets modifiable factors (e.g., identity-based stigma) that may increase stress and reduce community coping resources among gay men with diverse identities.
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Affiliation(s)
- Benjamin F. Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Justin L. Maki
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - David G. Zelaya
- School of Public Health, Brown University, Providence, RI 02903, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Şeniz Warner
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Adriana Wilson
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Paula M. Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
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Public health services and intersectional stigma: a social sciences perspective with implications for HIV service design and delivery. Curr Opin HIV AIDS 2023; 18:18-26. [PMID: 36444656 DOI: 10.1097/coh.0000000000000769] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
PURPOSE OF REVIEW Understanding stigma is important for improving HIV care services and gaps in HIV service delivery have been attributed to stigma. This review article synthesizes recent evidence on stigma and its implications for HIV service design and delivery. Given the intersectional nature of stigma, we will focus on HIV stigma as well as related forms of stigma based on one's race, sexual identity, gender identity and other identities. RECENT FINDINGS Stigma remains a barrier to achieving equity in HIV services. Individualistic measures of stigma remain influential and are associated with barriers to accessing HIV health services. Recent work also highlights stigma measured at a structural level and its impact on HIV services contexts. Individuals situated at intersections of marginalized identities continue to face greatest injustices, and although intersectional approaches have been adapted to design services at a micro level, few focus on structural change. Recent evidence for mitigating stigma indicates some success for psychosocial interventions that target internalized stigma. Furthermore, community-led approaches show promise in addressing stigma that manifests in HIV health services settings. SUMMARY Interventions that address individual-level stigma and structural stigma are needed. Theoretical and applied antistigma research is needed to make HIV services more equitable.
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Movahedi Nia Z, Bragazzi N, Asgary A, Orbinski J, Wu J, Kong J. Mpox panic, infodemic, and stigmatization of the 2SLGBTQIAP+ community: geospatial analysis, topic modeling, and sentiment analysis of a large, multilingual social media database (Preprint). J Med Internet Res 2022; 25:e45108. [PMID: 37126377 DOI: 10.2196/45108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The global Mpox (formerly, Monkeypox) outbreak is disproportionately affecting the gay and bisexual men having sex with men community. OBJECTIVE The aim of this study is to use social media to study country-level variations in topics and sentiments toward Mpox and Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, Asexual (2SLGBTQIAP+)-related topics. Previous infectious outbreaks have shown that stigma intensifies an outbreak. This work helps health officials control fear and stop discrimination. METHODS In total, 125,424 Twitter and Facebook posts related to Mpox and the 2SLGBTQIAP+ community were extracted from May 1 to December 25, 2022, using Twitter application programming interface academic accounts and Facebook-scraper tools. The tweets' main topics were discovered using Latent Dirichlet Allocation in the sklearn library. The pysentimiento package was used to find the sentiments of English and Spanish posts, and the CamemBERT package was used to recognize the sentiments of French posts. The tweets' and Facebook posts' languages were understood using the Twitter application programming interface platform and pycld3 library, respectively. Using ArcGis Online, the hot spots of the geotagged tweets were identified. Mann-Whitney U, ANOVA, and Dunn tests were used to compare the sentiment polarity of different topics and countries. RESULTS The number of Mpox posts and the number of posts with Mpox and 2SLGBTQIAP+ keywords were 85% correlated (P<.001). Interestingly, the number of posts with Mpox and 2SLGBTQIAP+ keywords had a higher correlation with the number of Mpox cases (correlation=0.36, P<.001) than the number of posts on Mpox (correlation=0.24, P<.001). Of the 10 topics, 8 were aimed at stigmatizing the 2SLGBTQIAP+ community, 3 of which had a significantly lower sentiment score than other topics (ANOVA P<.001). The Mann-Whitney U test shows that negative sentiments have a lower intensity than neutral and positive sentiments (P<.001) and neutral sentiments have a lower intensity than positive sentiments (P<.001). In addition, English sentiments have a higher negative and lower neutral and positive intensities than Spanish and French sentiments (P<.001), and Spanish sentiments have a higher negative and lower positive intensities than French sentiments (P<.001). The hot spots of the tweets with Mpox and 2SLGBTQIAP+ keywords were recognized as the United States, the United Kingdom, Canada, Spain, Portugal, India, Ireland, and Italy. Canada was identified as having more tweets with negative polarity and a lower sentiment score (P<.04). CONCLUSIONS The 2SLGBTQIAP+ community is being widely stigmatized for spreading the Mpox virus on social media. This turns the community into a highly vulnerable population, widens the disparities, increases discrimination, and accelerates the spread of the virus. By identifying the hot spots and key topics of the related tweets, this work helps decision makers and health officials inform more targeted policies.
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Affiliation(s)
- Zahra Movahedi Nia
- Africa-Canada Artificial Intelligence and Data Innovation Consortium, York University, North York, ON, Canada
- Laboratory for Industrial and Applied Mathematics, York University, North York, ON, Canada
| | - Nicola Bragazzi
- Africa-Canada Artificial Intelligence and Data Innovation Consortium, York University, North York, ON, Canada
- Laboratory for Industrial and Applied Mathematics, York University, North York, ON, Canada
| | - Ali Asgary
- Africa-Canada Artificial Intelligence and Data Innovation Consortium, York University, North York, ON, Canada
- Advanced Disaster, Emergency and Rapid-response Simulation, York University, North York, ON, Canada
| | - James Orbinski
- Africa-Canada Artificial Intelligence and Data Innovation Consortium, York University, North York, ON, Canada
- Dahdaleh Institute for Global Health Research, York University, North York, ON, Canada
| | - Jianhong Wu
- Africa-Canada Artificial Intelligence and Data Innovation Consortium, York University, North York, ON, Canada
- Laboratory for Industrial and Applied Mathematics, York University, North York, ON, Canada
| | - Jude Kong
- Africa-Canada Artificial Intelligence and Data Innovation Consortium, York University, North York, ON, Canada
- Laboratory for Industrial and Applied Mathematics, York University, North York, ON, Canada
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Dayton L, Song W, Kaloustian I, Eschliman EL, Strickland JC, Latkin C. A longitudinal study of COVID-19 disclosure stigma and COVID-19 testing hesitancy in the United States. Public Health 2022; 212:14-21. [PMID: 36182746 PMCID: PMC9411141 DOI: 10.1016/j.puhe.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/21/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examines the relationship between COVID-19 disclosure stigma and COVID-19 testing hesitancy and assesses their changes between November 2020 and 2021. STUDY DESIGN This was a longitudinal cohort. METHODS A total of 355 participants completed four study waves between November 2020 and November 2021. Factor analyses and Cronbach's alpha assessed the factor structure and internal consistency of the COVID-19 Disclosure Stigma scale. Paired t-tests and McNemar's Chi-squared test assessed change between the study waves. Multivariable logistic regression models examined the relationship between COVID-19 disclosure stigma and testing hesitancy at four study waves. RESULTS COVID-19 disclosure stigma declined significantly between the last study waves (P = 0.030). The greatest disclosure concern was reporting a positive test to close contacts (range: 19%-21%) followed by disclosure to friends (range: 10%-15%) and family (range: 4%-10%). Over the course of the four study waves, COVID-19 testing hesitancy when symptomatic ranged from 23% to 30%. Older age, female gender, and having received a COVID-19 vaccine were associated with decreased odds of testing hesitancy. Greater COVID-19 disclosure stigma and more conservative political ideology showed a consistent relationship with increased odds of COVID-19 testing hesitancy. CONCLUSIONS Study findings suggest that many people anticipate feeling stigmatized when disclosing positive test results, especially to close contacts. A substantial percentage of study participants reported hesitancy to be tested when symptomatic. This study identifies a need for interventions that normalize COVID-19 testing (e.g. engaging leaders with conservative followings), provide strategies for disclosing positive results, and allow anonymous notification of potential COVID-19 exposure.
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Affiliation(s)
- L Dayton
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA.
| | - W Song
- Department of Applied Mathematics and Statistics, Johns Hopkins University, USA
| | - I Kaloustian
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - E L Eschliman
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - J C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, USA
| | - C Latkin
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
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Logie CH, Sokolovic N, Kazemi M, Islam S, Frank P, Gormley R, Kaida A, de Pokomandy A, Loutfy M. Does resource insecurity drive HIV-related stigma? Associations between food and housing insecurity with HIV-related stigma in cohort of women living with HIV in Canada. J Int AIDS Soc 2022; 25 Suppl 1:e25913. [PMID: 35818863 PMCID: PMC9274209 DOI: 10.1002/jia2.25913] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Women living with HIV across global contexts are disproportionately impacted by food insecurity and housing insecurity. Food and housing insecurity are resource insecurities associated with poorer health outcomes among people living with HIV. Poverty, a deeply stigmatized phenomenon, is a contributing factor towards food and housing insecurity. HIV-related stigma-the devaluation, mistreatment and constrained access to power and opportunities experienced by people living with HIV-intersects with structural inequities. Few studies, however, have examined food and housing insecurity as drivers of HIV-related stigma. This study aimed to estimate the associations between food and housing insecurity with HIV-related stigma among women living with HIV in Canada. METHODS This prospective cohort study of women living with HIV (≥16 years old) in three provinces in Canada involved three waves of surveys collected at 18-month intervals between 2013 and 2018. To understand associations between food and housing security and HIV-related stigma, we conducted linear mixed effects regression models. We adjusted for socio-demographic characteristics associated with HIV-related stigma. RESULTS AND DISCUSSION Among participants (n = 1422), more than one-third (n = 509; 36%) reported baseline food insecurity and approximately one-tenth (n = 152, 11%) housing insecurity. Mean HIV-related stigma scores were consistent across waves 1 (mean [M] = 57.2, standard deviation [SD] = 20.0, N = 1401) and 2 (M = 57.4, SD = 19.0, N = 1227) but lower at wave 3 (M = 52.8, SD = 18.7, N = 918). On average, across time, food insecure participants reported HIV-related stigma scores that were 8.6 points higher (95% confidence interval [CI]: 6.4, 10.8) compared with food secure individuals. Similarly, participants reporting insecure housing at wave 1 tended to experience greater HIV-related stigma (6.2 points, 95% CI: 2.7, 9.6) over time compared to stably housed participants. There was an interaction between time and housing insecurity, whereby baseline housing insecurity was no longer associated with higher HIV-related stigma at the third wave. CONCLUSIONS Among women living with HIV in Canada, experiencing food and housing insecurity was associated with consistently higher levels of HIV-related stigma. In addition to the urgent need to tackle food and housing insecurity among people living with HIV to optimize wellbeing, getting to the heart of HIV-related stigma requires identifying and dismantling resource insecurity-related stigma drivers.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Nina Sokolovic
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Alliance for South Asian AIDS Prevention, Toronto, Ontario, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mona Loutfy
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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