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Kampouri E, Damas J, Kusejko K, Ledergerber B, Braun D, Nawej Tshikung O, Hachfeld A, Weisser M, Wissel K, Bernasconi E, Cobos Manuel I, Jackson-Perry D, Eriksson LE, Reinius M, Cavassini M, Darling KEA. Prevalence of HIV-related stigma among people with HIV in Switzerland: addressing the elephant in the room. AIDS 2024; 38:1874-1884. [PMID: 39051627 PMCID: PMC11424058 DOI: 10.1097/qad.0000000000003983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES We aimed to determine the prevalence of HIV-related stigma among people with HIV (PWH) in Switzerland. DESIGN A cross-sectional multicenter study nested within the Swiss HIV Cohort Study (SHCS). METHODS We included adult PWH enrolled in the SHCS, attending follow-up between March 1, 2020, and January 31, 2021. Inability to speak English, French, German, or Italian was the only exclusion criterion. Participants were invited to complete a validated 12-item HIV-stigma questionnaire comprising four stigma subscales (negative self-image, personalized stigma, disclosure concerns, and concerns regarding public attitudes), plus two healthcare-related stigma items. Questionnaire responses were graded using a four-point Likert-type scale, higher scores indicating higher stigma. "Non-applicable," inferring HIV-status non-disclosure, was possible for personalized stigma; stigma scores from participants answering "non-applicable" to at least one item were analyzed separately. Factors associated with HIV-stigma were identified through multivariable linear models. RESULTS Of 9643 PWH with a SHCS visit, 5563 participated in the study: 26% were female, 13% Black, and 37% heterosexual; median age was 53 years (interquartile range 44-59); 2067 participants (37%) gave at least one "non-applicable" response. Disclosure concerns had the highest stigma scores and were reported by 4656/5563 (84%). HIV-stigma was reported across all demographic groups. However, being female, Black, and heterosexual were independently associated with higher scores. Higher education and longer follow-up duration were associated with lower scores. Healthcare-related stigma was reported in 37% of participants. CONCLUSION HIV-stigma was prevalent across all demographic groups. The association with being female and Black suggests that HIV-stigma accentuates preexisting sex and race inequalities.
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Affiliation(s)
- Eleftheria Kampouri
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - José Damas
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich
| | - Dominique Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich
| | | | - Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel
| | - Kerstin Wissel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, Lugano
- University of Geneva, Geneva
- University of Southern Switzerland, Lugano, Switzerland
| | - Isabel Cobos Manuel
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - David Jackson-Perry
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - Lars E Eriksson
- Karolinska Institutet, Division of Nursing, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Maria Reinius
- Karolinska Institutet, Division for Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden
| | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - Katharine E A Darling
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne
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Chu W, Tam CC, Harrison S. Associations between perceived discrimination experiences, treatment adherence self-efficacy, and depressive symptoms among people living with HIV in the Southern United States. AIDS Care 2024; 36:1382-1391. [PMID: 38623601 DOI: 10.1080/09540121.2024.2341231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Abstract
This study examined associations between perceived discrimination, treatment adherence self-efficacy, and depressive symptoms among people living with HIV (PLHIV) in the Southern United States. Cross-sectional survey data were collected from 402 PLHIV who self-reported on interpersonal discrimination experiences based on HIV status, sexuality, gender, income, and living condition. Participants also reported on adherence self-efficacy and depressive symptoms. We employed K-means clustering to identify groups based on discrimination experiences, and logistic regressions to examine group differences on adherence self-efficacy and depressive symptoms. Results suggested three groups: a cluster with high perceived discrimination across all identities/conditions (n = 41; 11%; Cluster 1); a cluster with high perceived discrimination based on HIV status, income, and living condition (n = 49; 13%; Cluster 2); and a cluster with low perceived discrimination across all identities/conditions (n = 288; 76%; Cluster 3). Compared to Cluster 3, Cluster 1 and 2 had 2.22 times (p = .037) and 3.98 times (p<.001) greater odds of reporting depressive symptoms. Compared to Cluster 3, Cluster 2 had 3.40 times (p = .003) greater odds of reporting lower adherence self-efficacy. Findings demonstrate the need for individual-level support for PLHIV with discrimination histories, and broader efforts to end the stigma, discrimination, and marginalization of PLHIV based on HIV status and other characteristics.
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Affiliation(s)
- Wendy Chu
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
| | - Cheuk Chi Tam
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Sayward Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
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Lo Hog Tian JM, Watson JR, Cioppa L, Murphy M, Boni AR, Parsons JA, Maunder RG, Rourke SB. The Role of Dimensions of Social Support in the Relationship Between Stigma and Mental Health: A Moderation Analysis. AIDS Behav 2024:10.1007/s10461-024-04506-9. [PMID: 39325117 DOI: 10.1007/s10461-024-04506-9] [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: 09/07/2024] [Indexed: 09/27/2024]
Abstract
HIV stigma remains a barrier to good health and understanding how social support may reduce the negative impact of stigma on health may help with designing stigma interventions. This study aims to understand how different types of social support may moderate or change the nature of the relationship between stigma and mental health. We recruited 327 participants to complete the People Living with HIV Stigma Index at baseline (t1) between August 2018 and September 2019 and at follow-up (t2) between February 2021 and October 2021. Separate moderation models were created with different types of social support (emotional/informational, tangible, affectionate, positive social interaction) as moderators, baseline stigma (internalized, enacted, anticipated) as the antecedent, and mental health (t2) as the outcome. Emotional/informational support was a significant moderator for the relationship between enacted (b = -2.12, 95% CI: -3.73, -0.51), internalized (b = -1.72, 95% CI: -3.24, -0.20), and anticipated (b = -2.59, 95% CI: -4.59, -0.60) stigma at t1 and mental health at t2. Tangible support was a significant moderator for internalized stigma (b = -1.54, 95% CI: -2.74, -0.35). Lastly, positive social interaction was a significant moderator for internalized (b = -1.38, 95% CI: -2.71, -0.04) and anticipated stigma (b = -2.14, 95% CI: -3.93, -0.36). In general, the relationship between social support and better mental health was stronger for participants with low stigma. Intervention strategies aimed at both stigma reduction and boosting social supports with different functions may be important for improving the mental health of people living with HIV.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Lynne Cioppa
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Michael Murphy
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Anthony R Boni
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Janet A Parsons
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
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4
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Gasik RE, Madkour AS, Skeen SJ, Clum G, Francis T, Felker-Kantor E, Ferguson T, Welsh DA, Molina PE, Theall KP. The Impact of Childhood Adversity on Life Course Alcohol Use Patterns and Health Status Among People Living with HIV. AIDS Behav 2024; 28:2887-2898. [PMID: 38907764 PMCID: PMC11390825 DOI: 10.1007/s10461-024-04368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/24/2024]
Abstract
Adverse childhood experiences (ACEs) and financial hardship are associated with increased likelihood of heavier alcohol use and health challenges in adulthood among persons living with HIV (PWH). We examined whether retrospectively captured lifetime drinking trajectories are a pathway through which childhood hardships affect current health in a sample of 365 adult PWH. Childhood economic hardship and ACEs were used as main predictors. Measures of alcohol use included age at first drink and lifetime drinking trajectories. Health indicators included health-related quality of life, frailty, number of comorbidities, and symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD). Structural equation modeling (SEM) was applied to estimate both direct and indirect pathways between childhood hardship and physical and mental health. Participants were mostly male; Black (84%); and averaged 48 years of age. SEM results supported both direct and indirect pathways between childhood experiences and adult health. ACEs were connected to physical health directly and mental health both directly and indirectly through age at first drink and drinking heaviness during ages 10-20. Childhood economic hardship related to mental health indirectly through higher drinking levels during ages 10-20. Childhood adverse experiences, economic hardship, and early drinking patterns appear to accumulate, resulting in later life physical and mental health concerns for PWH. Findings support taking a life course approach to health. This includes considering individual trauma histories in HIV care engagement and taking preventative approaches which support the economic and social well-being of vulnerable children to improve health in subsequent decades.
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Affiliation(s)
- Rayna E Gasik
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | | | - Simone J Skeen
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
| | - Gretchen Clum
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | - Erica Felker-Kantor
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Tekeda Ferguson
- Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - David A Welsh
- Section of Pulmonary/Critical Care, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Patricia E Molina
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Katherine P Theall
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Filiatreau LM, Ebasone PV, Dzudie A, Wainberg M, Yotebieng M, Anastos K, Parcesepe AM. Intersectional HIV- and Depression-Related Stigma Among People with HIV Entering HIV Care in Cameroon. AIDS Behav 2024; 28:2950-2960. [PMID: 38767726 DOI: 10.1007/s10461-024-04375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Mental health-related stigma is a prominent barrier to improved mental health outcomes globally and may be particularly harmful to populations with other stigmatized identities. We aimed to understand intersectional depression- and HIV-related stigma among people with HIV (PWH) entering HIV care in Cameroon. Using baseline data from a cohort of PWH entering HIV care in Cameroon between 2019 and 2020, we characterized depression- and HIV-related stigma in the population overall and by sociodemographic sub-group. We also explored substantively meaningful variation in stigma endorsement by depressive symptom severity (Patient Health Questionnaire-9 [PHQ-9]) and causal attribution of depression. Among those with elevated depressive symptoms (PHQ-9 scores > 4), we estimated the association between stigma type and depressive symptom severity using binomial regression. Among 398 participants, 49% endorsed low HIV- and depression-related stigma (N = 195), 10% endorsed high HIV- and depression-related stigma (N = 38), 29% endorsed high depression-related stigma only (N = 116), and 12% endorsed high HIV-related stigma only (N = 49). Respondents with and without heightened depressive symptoms commonly believed depressive symptoms were caused by HIV (N = 140; 32.9%). Among those with elevated depressive symptoms, the prevalence of moderate to severe symptoms was higher among those endorsing high HIV-related stigma only (prevalence ratio 1.55; 95% confidence interval: 1.01, 2.37) compared to those reporting low HIV- and depression-related stigma. HIV- and depression-related stigma are both common among PWH entering HIV care in Cameroon. The consistent association between HIV-related stigma and poor psychosocial well-being among people with HIV necessitates the urgent scale-up of evidence-based HIV-related stigma interventions specifically.
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Affiliation(s)
- Lindsey M Filiatreau
- School of Medicine, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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6
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Tam CC, Harrison SE, Benotsch EG, Litwin AH, Zhou Y, Shen Z, Li X. Psychological Distress Mediates the Relationship Between HIV-Related Stigma and Prescription Opioid Misuse Among Chinese People Living with HIV. AIDS Behav 2024; 28:1673-1683. [PMID: 38334862 DOI: 10.1007/s10461-024-04288-0] [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: 01/31/2024] [Indexed: 02/10/2024]
Abstract
Prescription opioid misuse (POM) among people living with HIV (PLWH) is a serious concern due to risks related to dependence and overdose, and PLWH may be at higher risk for POM due to psychosocial stressors including psychological distress. However, scant POM research has examined the role of HIV-related stigma (e.g., internalized stigma, enacted stigma) in POM among PLWH. Guided by minority stress theory, this study examined a hypothesized serial mediation among enacted stigma, internalized stigma, psychological distress, and POM within a sample of Chinese PLWH with pain symptoms enrolled in a wave (between November 2017 and February 2018) of a longitudinal cohort study in Guangxi (n = 116). Models were tested individually for six enacted stigma experiences, controlling for key demographic and health-related variables (e.g., CD4 + count). Results showed HIV-related workplace discrimination was the most common stigma experience (12%,) and 10.3% of PLWH reported POM. Indirect effect analyses showed that internalized stigma was indirectly associated with POM through psychological distress. Internalized stigma and psychological distress mediated the association between workplace discrimination and POM. Family discrimination, gossip, and healthcare discrimination were directly associated with POM. This study suggests that Chinese PLWH may engage in POM to cope with psychological distress that is rooted in HIV-related stigma and highlights the important context of workplace discrimination for PLWH. Implications for interventions to reduce POM among PLWH are discussed.
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Affiliation(s)
- Cheuk Chi Tam
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Discovery I, 915 Greene Street, Columbia, SC, 29208, USA.
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Sayward E Harrison
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Discovery I, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Psychology, College of Arts and Sciences, University of South Carolina, 1512 Pendleton St., Columbia, SC, 29208, USA
| | - Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, PO Box 842018, Richmond, VA, 23284, USA
| | - Alain H Litwin
- School of Health Research, Clemson University, 605 Grove Road, Greenville, SC, 29605, USA
- Department of Medicine, School of Medicine Greenville, University of South Carolina, 876 W Faris Rd, Greenville, SC, 29605, USA
| | - Yuejiao Zhou
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Xiaoming Li
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Discovery I, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Ahmed M, Nijhawan AE, Gao A, Ahn C, Chow JY. Association Between Substance Abuse and Mental Illness Symptoms Screener (SAMISS) Scores and HIV Care Continuum Outcomes in People Newly Diagnosed with HIV in the US South. AIDS Behav 2024; 28:1731-1740. [PMID: 38361170 DOI: 10.1007/s10461-024-04287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
Mental illness (MI) and substance use (SU) are highly prevalent among people with HIV (PWH) and impact care outcomes. The Substance Abuse and Mental Illness Symptoms Screener (SAMISS) is a validated screener for MI and SU, but it is unknown how screening results at entry to care correlate with subsequent HIV outcomes. This is a retrospective chart review of individuals newly diagnosed with HIV between 2016 and 2019 in a Southern US, safety-net clinic. Baseline demographics, HIV risk factors, socioeconomic variables, and SAMISS screening scores were collected. Outcomes included retention in care, achieving virologic suppression (VS), and continuous VS. Data analyses included stepwise Cox and logistic multivariate regression modeling. Among the 544 newly diagnosed PWH, mean age was 35, 76% were male, 46% non-Hispanic Black, 40% Hispanic/other. Overall, 35% screened positive for SU and 41% for MI. A positive SU (odds ratio (OR) 0.66, p = 0.04) or MI (OR 0.65, p = 0.03) SAMISS screening was associated with lower retention in care in univariate analysis, but was not statistically significant after adjusting for other variables. Positive SAMISS screening for SU and MI were both associated with reduced continuous VS in univariate and multivariate analyses (SU: adjusted OR (aOR) 0.67, p = 0.05; MI: aOR 0.66, p = 0.03). SAMISS is a useful tool for prospectively identifying individuals at risk for low retention in care and for not achieving sustained VS. Future interventions guided by SAMISS may improve HIV care continuum outcomes.
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Affiliation(s)
- Manal Ahmed
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ang Gao
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chul Ahn
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeremy Y Chow
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Ramos SD, Vincent W, Siconolfi DE, Pollack LM, Horvath KJ, Campbell CK, Tebbetts S, Kegeles SM, Storholm ED. Differential Associations of Depressive Symptomology to HIV Care Engagement Among Young Black Sexual Minority Men with HIV (YBSMM+) in the US South: A Multi-Group Analysis of Mood, Intimate Partner Violence, and Alcohol Use. AIDS Behav 2024; 28:774-785. [PMID: 37796375 DOI: 10.1007/s10461-023-04186-x] [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] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Abstract
Young Black Sexual Minority Men with HIV (YBSMM+) in the US South encounter multiple socio-structural challenges that contribute to disproportionately poor HIV-related outcomes across the care continuum. Depression, anxiety, intimate partner violence (IPV), and alcohol use are prominent factors that negatively impact engagement with HIV care. Syndemic theory posits that these multiple factors interact synergistically to promote poor outcomes; however, depression itself is highly heterogeneous in presentation, which may pose issues when examining associations to HIV care engagement. This study sought to better understand the associations of specific depressive symptomology subtypes, generalized anxiety, experienced IPV, and alcohol use on HIV care engagement for YBSMM+. Results showed that interpersonally oriented depressive symptomatology was associated with increased HIV care engagement among YBSMM + who abstained from alcohol. On the other hand, among YBSMM + who frequently binge drank, combined negative affect and somatic components of depressive symptomatology and frequency of IPV experiences were associated with decreased HIV care engagement while generalized anxiety was associated with increased HIV care engagement. The findings suggest that the negative affect and somatic components of depression may be particularly salient for HIV care engagement among YBSMM + who binge drink frequently. Developing targeted interventions that address these specific conditions while accounting for the nuances of mood-based symptomatology could improve intervention efforts geared towards improving HIV care engagement among YBSMM+.
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Affiliation(s)
- Stephen D Ramos
- Department of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, 6475 Alvarado Road, Suite 118, San Diego, CA, 92120, USA.
- SDSU Research Foundation, San Diego State University, San Diego, CA, USA.
| | - Wilson Vincent
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | | | - Lance M Pollack
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | | | - Scott Tebbetts
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Susan M Kegeles
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erik D Storholm
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA, USA
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Wang D, Scherffius A, Ouyang X, Deng Q. Family Functioning and Depressive Symptoms Among HIV-Positive Men Who Have Sex with Men: Mediating Roles of Stigma and Resilience. Psychol Res Behav Manag 2024; 17:755-764. [PMID: 38434956 PMCID: PMC10906277 DOI: 10.2147/prbm.s449825] [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: 11/14/2023] [Accepted: 02/08/2024] [Indexed: 03/05/2024] Open
Abstract
Background Depressive symptoms are common among HIV-positive men who have sex with men (MSM). This study aims to explore (1) the relationship between family functioning and depressive symptoms and (2) the mediating roles of stigma and resilience in the relationship among HIV-positive MSM. Methods We used data from a cross-sectional study of a convenience sample in Hunan Province, China, conducted in 2019. The data analysis included 191 HIV-positive MSM with an average age of 26.98 years. All participants completed self-report questionnaires on demographic variables, family functioning, stigma, resilience, and depressive symptoms. Results Better family functioning was significantly associated with lower depressive symptoms. Both stigma (Indirect effect = -0.04, 95% CI, -0.10 ~ -0.001) and resilience (Indirect effect = -0.06, 95% CI, -0.12 ~ -0.01) were significant partial mediators in the relationship between family functioning and depressive symptoms. A parallel and chain mediating role of stigma and resilience in the relationship between family functioning and depressive symptoms was also supported (Indirect effect = -0.03, 95% CI, -0.08 ~ -0.01). Conclusion Improving family functioning is crucial for alleviating depressive symptoms among HIV-positive MSM in China. Depression assessment and reduction should be an integral part of prevention and treatment programs targeting stigma and resilience.
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Affiliation(s)
- Dongfang Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, People’s Republic of China
| | - Andrew Scherffius
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xuan Ouyang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Qijian Deng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China
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10
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Ha T, Shi H, Singh RJ, Gaikwad SS, Joshi K, Padiyar R, Schensul JJ, Schensul SL. Alcohol Use, HIV Stigma and Quality of Life Among Alcohol Consuming Men Living with HIV in India: A Mediation Analysis. AIDS Behav 2023; 27:3272-3284. [PMID: 37031311 DOI: 10.1007/s10461-023-04047-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/10/2023]
Abstract
This study examined the hypothesis that HIV-related stigma mediates the effect of alcohol use on health-related quality of life (HRQoL) among alcohol consuming Indian men living with HIV (PLWH). The study used baseline data from a randomized controlled clinical trial entitled 'Alcohol and ART adherence: Assessment, Intervention, and Modeling in India. Participants completed surveys assessing demographic characteristics, alcohol use, HIV-related stigma, HRQoL. Mediation analysis was conducted to establish the mediation effect of HIV-related stigma on the relationship between alcohol use and HRQoL. The final mediation model showed that the effect of alcohol use on HRQoL were partially mediated by overall HIV-related stigma. Specially, 27.1% of the effects of alcohol use on HRQoL was mediated through overall HIV stigma. In the HIV stigma subdomain analyses, negative self-image mediated 14% and concerns with public attitudes (anticipated stigma) mediated 17.3% of the effect of alcohol use on HRQoL respectively. The findings suggest that efforts to reduce the negative impact of alcohol use on HRQoL and improve HRQoL among PLWH should include interventions addressing both alcohol use and specific forms of HIV-related stigma.
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Affiliation(s)
- Toan Ha
- Department of Infectious Diseases and Virology, School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Hui Shi
- Department of Infectious Diseases and Virology, School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | - Rupal Padiyar
- Lokmanya Tilak Municipal Medical College, Mumbai, India
| | | | - Stephen L Schensul
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
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11
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Skuban-Eiseler T, Orzechowski M, Steger F. Access to healthcare for people living with HIV: an analysis of judgments of the European Court of Human Rights from an ethical perspective. Front Public Health 2023; 11:1193236. [PMID: 37377554 PMCID: PMC10292927 DOI: 10.3389/fpubh.2023.1193236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Although HIV has been part of our reality for over 30 years, people living with HIV (PLHIV) still experience restrictions regarding their access to healthcare. This poses a significant ethical problem, especially as it endangers achieving the goal of ending the HIV epidemic worldwide. The aim of this paper is to analyze the rulings of the European Court of Human Rights (ECtHR) regarding cases where PLHIV experienced restrictions on their access to healthcare. Methods We conducted an analysis of the ECtHR database and were able to identify N = 28 cases dealing with restricted access to healthcare for PLHIV. A descriptive and thematic analysis was conducted to identify ways in which access to healthcare for PLHIV was restricted. Results We were able to identify a total of four main categories, with denial of adequate therapeutic support as the main category with N = 22 cases (78.57%). Most of the judgments examined were filed against Russia (N = 12, 42.86%) and Ukraine (N = 9, 32.14%). A large proportion of PLHIV in the cases studied (N = 57, 85.07%) were detainees. Discussion The analysis shows a clear condemnation of limited access to healthcare for PLHIV by the ECtHR. Ethical implications of the analyzed cases are discussed in detail.
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Affiliation(s)
- Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
- kbo-Isar-Amper-Klinikum Region München, Munich, Germany
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
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12
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Pytell JD, Li X, Thompson C, Lesko CR, McCaul ME, Hutton H, Batey DS, Cachay E, Mayer KH, Napravnik S, Christopoulos K, Yang C, Crane HM, Chander G, Lau B. The temporal relationship of alcohol use and subsequent self-reported health status among people with HIV. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 9:100020. [PMID: 37476695 PMCID: PMC10357948 DOI: 10.1016/j.ajmo.2022.100020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 07/22/2023]
Abstract
Background Alcohol use among people with HIV is associated with worse HIV treatment outcomes. Its impact on self-reported health status is unclear. Setting Longitudinal cohort of people with HIV engaged in care across 7 clinics participating in the Centers for AIDS Research Network of Integrated Care Systems between January 2011 and June 2014. Methods A total of 5046 participants were studied. A quantile regression model estimated the association of alcohol use levels with subsequent self-reported health status score, accounting for multiple covariates including depressive symptoms. Women, men who have sex with women, and men who have sex with men were analyzed separately. Results Prevalence of heavy alcohol use was 21%, 31%, and 37% among women, men who have sex with women, and men who have sex with men, respectively. Women with heavy alcohol use had a subsequently decreased median self-reported health status score compared to women with no or moderate alcohol use (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.58-0.99); this association was not explained by the presence of depressive symptoms. There was no observed association of alcohol use level on subsequent self-reported health status among men who have sex with women. Men who have sex with men reporting no alcohol use had a subsequently decreased median self-reported health status compared to moderate alcohol use (OR: 0.88; 95% CI: 0.80-0.97). Conclusion Heavy alcohol use is associated with worsened self-reported health status at subsequent visits among women with HIV and not men with HIV.
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Affiliation(s)
- Jarratt D. Pytell
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
| | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carol Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E. McCaul
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA
| | - Heidi Hutton
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA
| | - D. Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Cachay
- Department of Medicine, University of California, San Diego, CA, USA
| | - Kenneth H. Mayer
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katerina Christopoulos
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Cui Yang
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi M. Crane
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan Lau
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Lo Hog Tian JM, Watson JR, McFarland A, Parsons JA, Maunder RG, McGee A, Boni AR, Cioppa L, Ajiboye ME, Rourke SB. The cost of anticipating stigma: a longitudinal examination of HIV stigma and health. AIDS Care 2023:1-9. [PMID: 36942573 DOI: 10.1080/09540121.2023.2190575] [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: 03/23/2023]
Abstract
Levels of HIV stigma remain high, however there is a limited understanding around how different types of stigma interact to impact health. This study uses data from two time points to examine how enacted and internalized stigma lead to worse health through anticipated stigma as a mediator. We recruited 341 participants in Ontario, Canada to complete the HIV Stigma Index survey at baseline (t1) from September 2018 to August 2019 and follow up (t2) approximately two years later. Mediation models were created with enacted and internalized stigma at t1 as the antecedents, anticipated stigma at t2 as the mediator, and physical health, mental health, and overall health at t2 as the outcomes. Only the model with internalized stigma (t1) as the antecedent had anticipated stigma (t2) as a significant mediator contributing to both decreased mental and overall health. This highlights the need to address internalized stigma and the potential for anticipated stigma interventions to be effective at improving the health and wellbeing of people living with HIV.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Abbey McFarland
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Janet A Parsons
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Department of Physical Therapy and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - A McGee
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Anthony R Boni
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Lynne Cioppa
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Monisola E Ajiboye
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- International Community of Women Living with HIV, Toronto, Canada
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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14
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Zhang H. Intersectional stigma and coping strategies of single mothers living with HIV in Thailand. CULTURE, HEALTH & SEXUALITY 2023; 25:336-351. [PMID: 35209801 DOI: 10.1080/13691058.2022.2042393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
Stigma and discrimination are barriers to the prevention and treatment of HIV, and have serious biomedical, psycho-social and socio-cultural consequences, especially for marginalised groups such as sex workers, transgender people and sexual minorities. There has been little research to date on single mothers living with HIV to situate the stigma they experience within the context of gender, class, ethnicity and other intersecting social inequalities. Drawing on participant observation and in-depth interviews with 28 single mothers living with HIV in Thailand in 2020-21, this article finds that single mothers living with HIV experience intersectional stigma based on their class, ethnicity, religious status and gender, which manifests at the self, family, community and societal levels. In response to this stigmatisation, single mothers have developed four different coping strategies: self-presentation, identity talk, self-exclusion (through distancing and selective association), and empowerment. Findings from the research indicate that an intersectional approach is needed if academics, health workers, policy makers - and even the individuals concerned - are to understand and respond effectively to the HIV-related stigma experienced by specific socio-demographic groups.
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Affiliation(s)
- Herbary Zhang
- Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong
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15
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Walsh JL, John SA, Quinn KG, Hirshfield S, O’Neil A, Petroll AE. Factors associated with quality of life, depressive symptoms, and perceived stress among rural older adults living with HIV in the United States. J Rural Health 2023; 39:488-498. [PMID: 36510755 PMCID: PMC10038895 DOI: 10.1111/jrh.12730] [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] [Indexed: 12/14/2022]
Abstract
PURPOSE Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions. METHODS Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (Mage = 56, 67% male, 67% White, and 23% Black). Associations between social support, HIV stigma, satisfaction with medical care, discrimination in health care settings, and structural barriers and health-related QOL, depressive symptoms, and perceived stress were assessed using multiple linear regressions. FINDINGS Controlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress. CONCLUSIONS In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.
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Affiliation(s)
- Jennifer L. Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Andrew O’Neil
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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16
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Mugo C, Kohler P, Kumar M, Badia J, Kibugi J, Wamalwa DC, Agot K, John-Stewart GC. Individual-, Interpersonal- and Institutional-Level Factors Associated with HIV Stigma Among Youth in Kenya. AIDS Behav 2023:10.1007/s10461-023-03982-9. [PMID: 36646929 PMCID: PMC9843110 DOI: 10.1007/s10461-023-03982-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
HIV stigma remains a barrier in achieving optimal HIV treatment. We studied the prevalence and predictors of HIV stigma among adolescents and youth with HIV (AYWHIV) ages 15-24 years in Western Kenya. Of 1011 AYWHIV, 69% were female with a median age of 18 years. Most (59%) attended adolescent clinic days, and 40% attended support groups. One-quarter (27%) had experienced physical, 18% emotional, and 7% sexual violence. The majority of AYWHIV (88%) reported disclosure concerns, 48% reported perceived community stigma, 36% experienced, and 24% internalized stigma. Compared to AYWHIV attending adolescent clinics, those in general/adult clinics had higher internalized stigma. Similarly, having dropped out of school was associated with higher internalized stigma. AYWHIV in sexual relationships had higher experienced stigma and disclosure concerns. Lastly, exposure to violence was associated with higher experienced, internalized, perceived community stigma and disclosure concerns. These risk factors can be targeted when developing stigma-prevention interventions.
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Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Hospital Road, P.O. Box 00202, Nairobi, Kenya.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Pamela Kohler
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Manasi Kumar
- Department of Research and Programs, Kenyatta National Hospital, Hospital Road, P.O. Box 00202, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Jacinta Badia
- Impact Research and Development Organization, Kisumu, Kenya
| | - James Kibugi
- Impact Research and Development Organization, Kisumu, Kenya
| | - Dalton C Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Grace C John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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17
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Significant Others and Not Family or Friend Support Mediate Between Stigma and Discrimination Among People Living With HIV in Lagos State, Nigeria: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:96-104. [PMID: 36198119 DOI: 10.1097/jnc.0000000000000366] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
ABSTRACT Approximately 70% of the 37.7 million people living with HIV (PLWH) globally reside in sub-Saharan Africa and 10% of the global HIV burden is in Nigeria. PLWH encounter stigma and discrimination. Limited support from family, friends, and significant others increases stigma and discrimination among PLWH. This study sought to understand how support from family, friends, and significant others mediates stigma and discrimination in the Nigerian context. This descriptive cross-sectional study enrolled 396 PLWH from six health facilities between June and July 2021 in Lagos State, Nigeria. Stigma, discrimination, and social support were assessed. On average, participants were 32 years of age and female. Increased social support was associated with reduced stigma and discrimination. Support from participants' significant others was found to mediate the relationship between stigma and discrimination.
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18
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Brittain K, Pellowski J, Noholoza S, Mellins CA, Bekker LG, Kagee A, Remien RH, Abrams EJ, Myer L. Perinatal alcohol use among young women living with HIV in South Africa: Context, experiences, and implications for interventions. Glob Public Health 2023; 18:2221732. [PMID: 37302089 PMCID: PMC10413958 DOI: 10.1080/17441692.2023.2221732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
Perinatal alcohol use is common in South Africa, including among young women living with HIV (WLHIV), but there are few insights into the drivers of alcohol use in this population. Following the completion of a pilot trial of a peer support intervention for WLHIV aged 16-24 years in Cape Town, we purposively selected participants who had reported perinatal alcohol use at ≥1 study visits to complete a qualitative in-depth interview exploring their experiences of substance use. Of 119 women enrolled, 28 reported alcohol use, and 24 were interviewed, with ≥1/3 reporting drinking throughout their pregnancy. Women described living in a community where heavy perinatal alcohol consumption is normalised, including among their peers, leading to social pressure. Despite being aware of the risks of perinatal alcohol use, women described a disconnect between public health messaging and their experiences. Although most acknowledged the negative effects of alcohol in their lives, self-efficacy to reduce consumption was diminished by peer influences and the lack of formal employment and opportunities for recreation. These findings provide insights into the drivers of perinatal alcohol use in this setting, and suggest that without meaningful community-level changes, including employment opportunities and alternatives for socialising, interventions may have limited impact.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Pellowski
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
- International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | - Sandisiwe Noholoza
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude A. Mellins
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Robert H. Remien
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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19
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Chakrapani V, Kershaw T, Kaur J, Shunmugam M, Nelson R, Vijin PP, Rajan M, Subramanian T. Associations between sexual stigma, enacted HIV stigma, internalized HIV stigma and homonegativity, and depression: testing an extended minority stress model among men who have sex with men living with HIV in India. AIDS Care 2022; 34:1586-1594. [PMID: 36062378 DOI: 10.1080/09540121.2022.2119467] [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: 11/30/2022]
Abstract
Limited data is available on the associations between intersectional stigmas and mental health outcomes among men who have sex with men living with HIV (MSMLH) in India. The minority stress model postulates that sexual stigma contributes to depression through proximal stressors like internalized homonegativity (IHN). Using cross-sectional survey data from 119 MSMLH in 2015/16, we tested whether: (1) sexual stigma and enacted HIV stigma (EHS) are associated with depression; (2) their effects on depression are mediated through IHN and internalized HIV stigma (IHS); and (3) their effects on IHN are mediated through IHS. Significant direct associations were observed between scores on sexual stigma and IHS (β = .49, 95% CI .27, .70), EHS and IHN (β = .19, 95% CI .03, .36), and IHS and IHN (β = .07, 95% CI .03, .12). IHS scores mediated the associations of sexual stigma with depression (β = .17, 95% CI .07, .27) and IHN scores (β = .04, 95% CI .004, .07). EHS was not found to be significantly associated with depression or IHN. The findings partially support the minority stress model among MSMLH and highlight the importance of addressing both sexual and HIV-related stigmas to improve mental health of MSMLH, especially by screening for and reducing IHS, IHN and depression.
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Affiliation(s)
| | - Trace Kershaw
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Jasvir Kaur
- Department of Nursing, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Ruban Nelson
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | | | - Magesh Rajan
- ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai, India
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20
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Jolle J, Kabunga A, Okello TO, Kadito EO, Aloka J, Otiti G, Aluku AA, Kumakech E, Udho S. HIV-related stigma experiences and coping strategies among pregnant women in rural Uganda: A qualitative descriptive study. PLoS One 2022; 17:e0272931. [PMID: 36206276 PMCID: PMC9543605 DOI: 10.1371/journal.pone.0272931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 08/01/2022] [Indexed: 11/05/2022] Open
Abstract
Background HIV-related stigma is a global problem among HIV clients with far-reaching effects including increased rates of mother-to-child transmission of HIV. However, HIV-related stigma experiences and coping strategies have received little attention, especially among pregnant women in rural settings. We explored the HIV-related stigma experiences and coping strategies among pregnant women in rural northern Uganda. Methods This was a qualitative descriptive study conducted among HIV-positive pregnant women seeking care at Aboke Health Center IV, Kole district, northern Uganda. We conducted 12 in-depth interviews using a semi-structured interview guide. Data were analyzed using the inductive thematic approach of Braun and Clarke. Results The age range of the 12 participants was 17 to 35 years while the average duration with HIV since diagnosis was five years. The majority of the participants were subsistence farmers who had attained a primary level of education. Social rejection and public ridicule were identified as HIV-related stigma experiences while ignoring, social support, and prayers were identified as HIV-related coping strategies among the study participants. Conclusion Enacted HIV-related stigma is common among pregnant women in rural northern Uganda. Healthcare providers should work closely with HIV-positive women and other stakeholders to identify and strengthen HIV-related stigma coping strategies among pregnant women in rural settings.
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Affiliation(s)
- Judith Jolle
- Department of Public Health, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Amir Kabunga
- Department of Community Psychology & Psychotherapy, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Tonny Owili Okello
- Department of Community Psychology & Psychotherapy, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Esther Oloi Kadito
- Department of Public Health, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Jimmy Aloka
- Department of Public Health, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Geoffrey Otiti
- Department of Public Health, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Agnes Adong Aluku
- Department of Nursing & Midwifery, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Edward Kumakech
- Department of Nursing & Midwifery, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Samson Udho
- Department of Nursing & Midwifery, Faculty of Health Sciences, Lira University, Lira, Uganda
- * E-mail:
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21
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Zeng Y, Han L, Cheng Y, Jia CX. How Anti-Substance Abuse Campaigns Influence Substance Abusers' Psychological Health in Chinese Communities: The Mediating Role of Perceived Stigma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116687. [PMID: 35682271 PMCID: PMC9180135 DOI: 10.3390/ijerph19116687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 02/04/2023]
Abstract
The current study explored how anti-substance abuse campaigns influence substance abusers' psychological health through the perception of stigma. The study is based on a sample of substance abusers who received community-based treatments (n = 3457) and used structural equation modeling to estimate the role of perceived stigma in mediating between perceptions of overstatement of harm conveyed in anti-substance abuse campaigns and psychological outcomes. The results revealed that substance abusers' perception of overstatement of the harm caused by the substances and substance abusers enhanced their perceived stigma and impaired their psychological health in terms of anxiety, depression, and somatization, through both direct and indirect pathways. The results advocate for proper strategies in the design of anti-substance abuse campaigns. Possible initiatives to reduce substance abusers' perceived stigma are recommended.
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Affiliation(s)
- Yonghui Zeng
- School of Economics and Statistics, Guangzhou University, Guangzhou 510006, China;
- Department of Social Work, School of Public Administration, South China Agricultural University, Guangzhou 510640, China;
| | - Li Han
- Department of Social Work, School of Public Administration, South China Agricultural University, Guangzhou 510640, China;
| | - Yu Cheng
- School of Education Science and Law, Xiangnan University, Chenzhou 423043, China
- School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou 510275, China
- Correspondence: (Y.C.); (C.X.J.)
| | - Cindy Xinshan Jia
- Department of Social Work, School of Public Administration, South China Agricultural University, Guangzhou 510640, China;
- Correspondence: (Y.C.); (C.X.J.)
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22
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Daubert E, French AL, Burgess HJ, Sharma A, Gustafson D, Cribbs SK, Weiss DJ, Ramirez C, Konkle-Parker D, Kassaye S, Weber KM. Association of Poor Sleep With Depressive and Anxiety Symptoms by HIV Disease Status: Women's Interagency HIV Study. J Acquir Immune Defic Syndr 2022; 89:222-230. [PMID: 34732681 PMCID: PMC8740603 DOI: 10.1097/qai.0000000000002847] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/04/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Sleep disturbances are prevalent in women living with HIV (WLWH) and can affect mental health and overall quality of life. We examined the prevalence and predictors of poor sleep quality in a US cohort of WLWH and HIV-uninfected controls and the relationship between sleep quality and mental health symptom burden stratified by HIV disease status (viremic WLWH, aviremic WLWH, and HIV-uninfected women). METHODS Sleep quality was assessed using the Pittsburgh Sleep Quality Index in 1583 (400 viremic WLWH, 723 aviremic WLWH, and 460 HIV-uninfected women) Women's Interagency HIV Study participants. Depressive and anxiety symptoms were concurrently assessed using the Center for Epidemiological Studies-Depression (CES-D) scale and General Anxiety Disorder (GAD-7) scale. Associations between poor sleep quality (global Pittsburgh Sleep Quality Index >5) and both high depressive (CES-D ≥16) and anxiety (GAD-7 ≥10) symptoms were each assessed by HIV disease status using multivariable logistic regression models. RESULTS Prevalence of poor sleep quality in the overall sample was 52%, differed by HIV disease status (P = 0.045), and was significantly associated with high depressive and anxiety symptoms in (1) viremic WLWH, (2) aviremic WLWH, and (3) HIV-uninfected women [CES-D: (1) adjusted odds ratio (aOR) = 7.50, 95% confidence interval (CI): 4.10 to 13.7; (2) aOR = 4.54, 95% CI: 3.07 to 6.73; and (3) aOR = 6.03, 95% CI: 3.50 to 10.4; GAD-7: (1) aOR = 5.20; 95% CI: 2.60 to 10.4, (2) aOR = 6.03; 95% CI: 3.67 to 9.91, and (3) aOR = 6.24; 95% CI: 3.11 to 12.6]. CONCLUSIONS Poor sleep quality is highly prevalent, as is mental health symptom burden, among WLWH and HIV-uninfected controls. Future longitudinal studies are necessary to clarify the directionality of the relationship.
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Affiliation(s)
| | - Audrey L. French
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL
| | | | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences Medical Center, Brooklyn, NY
| | - Sushma K. Cribbs
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care & Sleep, Emory University, Department of Veterans Affairs, Atlanta, GA
| | - Deborah Jones Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Catalina Ramirez
- Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Deborah Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS; and
| | - Seble Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC
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23
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Treatments, Perceived Stigma, and Employment Outcomes among Substance Abusers in China. Healthcare (Basel) 2022; 10:healthcare10010130. [PMID: 35052293 PMCID: PMC8776030 DOI: 10.3390/healthcare10010130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 12/23/2022] Open
Abstract
Employment is a vital component of a substance abuser's recovery, but little is known about how stigma affects employment for substance abusers receiving treatment. The current study investigates the effects of stigma and treatment on employment in the Chinese context. Using a sample of substance abusers (N = 3.978), multiple logistics regressions with moderation effects were employed. The findings show that treatments positively reduce confirmative experiences of anticipated stigma, and promote employment only when respondents do not perceive stigma. The findings highlight the impact of perceived stigma on limiting substance abusers' chances of being employed, implying that eliminating stigma is the foundation for recovery. Possible strategies that can be explored for reducing stigma are discussed.
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24
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Meyers-Pantele SA, Lammert S, Rendina HJ, Shalhav O, Talan AJ, Smith LR, Pitpitan EV, Horvath KJ. Examining HIV Stigma, Depression, Stress, and Recent Stimulant Use in a Sample of Sexual Minority Men Living with HIV: An Application of the Stigma and Substance Use Process Model. AIDS Behav 2022; 26:138-148. [PMID: 34741690 PMCID: PMC8900724 DOI: 10.1007/s10461-021-03517-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 01/03/2023]
Abstract
Sexual minority men (SMM) with HIV are disproportionately impacted by stigma and mental health disorders. Guided by the Stigma and Substance Use Process Model, we evaluated how HIV stigma impacts mental health outcomes among SMM with HIV. Data were drawn from Thrive With Me, an RCT of an mHealth intervention targeting ART adherence among SMM with HIV. Path analyses tested the relationships between HIV stigma, depression, stress, and recent stimulant use. Overall, 49.1% (194/401) had depression symptoms, 68.8% (276/401) had moderate-to-high stress, and 28.1% (111/401) had detectable stimulant use in urine samples at baseline. In path analyses, baseline internalized HIV stigma was associated with depression and stress 5-months post-baseline and enacted stigma was associated with recent stimulant use 11-months post-baseline. We identified internalized and enacted HIV stigma, but not anticipated stigma, as potentially important intervention targets for stimulant use, depression, and stress among SMM with HIV.
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Affiliation(s)
- S A Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, CA, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
| | - S Lammert
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - H J Rendina
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Whitman-Walker Institute, Washington, DC, USA
| | - O Shalhav
- Whitman-Walker Institute, Washington, DC, USA
| | - A J Talan
- Whitman-Walker Institute, Washington, DC, USA
| | - L R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - E V Pitpitan
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - K J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
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25
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Shuper PA. The Role of Alcohol-Related Behavioral Research in the Design of HIV Secondary Prevention Interventions in the Era of Antiretroviral Therapy: Targeted Research Priorities Moving Forward. AIDS Behav 2021; 25:365-380. [PMID: 33987783 DOI: 10.1007/s10461-021-03302-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
HIV secondary prevention focuses on averting onward HIV transmission, which can be realized when people living with HIV enact requisite HIV care continuum-related behaviors to achieve viral suppression, and engage in condom-protected sex when virally unsuppressed. Alcohol has been detrimentally linked to all aspects of HIV secondary prevention, and although a growing number of behavioral interventions account for and address alcohol use within this realm, further efforts are needed to fully realize the potential of such initiatives. The present article proposes a series of targeted priorities to inform the future design, implementation, and evaluation of alcohol-related behavioral intervention research within the scope of HIV secondary prevention. These priorities and corresponding approaches account for the challenges of resource-constrained clinic environments; capitalize on technology; and address key comorbidities. This framework provides the foundation for a range of alcohol-related behavioral interventions that could potentially enhance global HIV secondary prevention efforts in the years ahead.
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Affiliation(s)
- Paul A Shuper
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Institute for Collaboration On Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa.
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26
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Budhwani H, Yigit I, Ofotokun I, Konkle-Parker DJ, Cohen MH, Wingood GM, Metsch LR, Adimora AA, Taylor TN, Wilson TE, Weiser SD, Kempf MC, Sosanya O, Gange S, Kassaye S, Turan B, Turan JM. Examining the Relationships Between Experienced and Anticipated Stigma in Health Care Settings, Patient-Provider Race Concordance, and Trust in Providers Among Women Living with HIV. AIDS Patient Care STDS 2021; 35:441-448. [PMID: 34739336 PMCID: PMC8817693 DOI: 10.1089/apc.2021.0096] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Stigma in health care settings can have negative consequences on women living with HIV, such as increasing the likelihood of missed visits and reducing trust in their clinical providers. Informed by prior stigma research and considering knowledge gaps related to the effect of patient-provider race concordance, we conducted this study to assess if patient-provider race concordance moderates the expected association between HIV-related stigma in health care settings and patients' trust in their providers. Moderation analyses were conducted using Women's Interagency HIV Study data (N = 931). We found significant main effects for patient-provider race concordance. Higher experienced stigma was associated with lower trust in providers in all patient-provider race combinations [White-White: B = -0.89, standard error (SE) = 0.14, p = 0.000, 95% confidence interval, CI (-1.161 to -0.624); Black patient-White provider: B = -0.19, SE = 0.06, p = 0.003, 95% CI (-0.309 to -0.062); and Black-Black: B = -0.30, SE = 0.14, p = 0.037, 95% CI (-0.575 to -0.017)]. Higher anticipated stigma was also associated with lower trust in providers [White-White: B = -0.42, SE = 0.07, p = 0.000, 95% CI (-0.552 to -0.289); Black patient-White provider: B = -0.17, SE = 0.03, p = 0.000, 95% CI (-0.232 to -0.106); and Black-Black: B = -0.18, SE = 0.06, p = 0.002, 95% CI (-0.293 to -0.066)]. Significant interaction effects indicated that the negative associations between experienced and anticipated HIV-related stigma and trust in providers were stronger for the White-White combination compared with the others. Thus, we found that significant relationships between HIV-related experienced and anticipated stigma in health care settings and trust in providers exist and that these associations vary across different patient-provider race combinations. Given that reduced trust in providers is associated with antiretroviral medication nonadherence and higher rates of missed clinical visits, interventions to address HIV-related stigma in health care settings may improve continuum of care outcomes.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | | | - Igho Ofotokun
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | | | | - Adaora A Adimora
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tonya N Taylor
- Downstate Health Sciences University, Brooklyn, New York, USA
| | - Tracey E Wilson
- Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sheri D Weiser
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Seble Kassaye
- Georgetown University, Washington, District of Columbia, USA
| | | | - Janet M Turan
- University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
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27
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Fisher CB, Tao X, Liu T, Giorgi S, Curtis B. COVID-Related Victimization, Racial Bias and Employment and Housing Disruption Increase Mental Health Risk Among U.S. Asian, Black and Latinx Adults. Front Public Health 2021; 9:772236. [PMID: 34778197 PMCID: PMC8585986 DOI: 10.3389/fpubh.2021.772236] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The mental health of racial/ethnic minorities in the U.S. has been disproportionately impacted by the COVID-19 pandemic. This study examined the extent to which disruptions in employment and housing, coronavirus-specific forms of victimization and racial bias independently and conjointly contributed to mental health risk among Asian, Black, and Latinx adults in the United States during the pandemic. Methods: This study reports on data from 401 Asian, Black, and Latinx adults (age 18-72) who participated in a larger national online survey conducted from October 2020-June 2021, Measures included financial and health information, housing disruptions and distress in response to employment changes, coronavirus related victimization distress and perceived increases in racial bias, depression and anxiety. Results: Asian participants had significantly higher levels of COVID-related victimization distress and perceived increases in racial bias than Black and Latinx. Young adults (<26 years old) were more vulnerable to depression, anxiety, and coronavirus victimization distress than older respondents. Having at least one COVID-related health risk, distress in response to changes in employment and housing disruptions, pandemic related victimization distress and perceived increases in racial bias were positively and significantly related to depression and anxiety. Structural equation modeling indicated COVID-related increases in racial bias mediated the effect of COVID-19 related victimization distress on depression and anxiety. Conclusions: COVID-19 has created new pathways to mental health disparities among racial/ethnic minorities in the U.S. by exacerbating existing structural and societal inequities linked to race. Findings highlight the necessity of mental health services sensitive to specific challenges in employment and housing and social bias experienced by people of color during the current and future health crises.
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Affiliation(s)
- Celia B. Fisher
- Department of Psychology, Fordham University, Bronx, NY, United States
- Center for Ethics Education, Fordham University, Bronx, NY, United States
| | - Xiangyu Tao
- Department of Psychology, Fordham University, Bronx, NY, United States
| | - Tingting Liu
- National Institutes of Health, National Institute on Drug Abuse, Baltimore, MD, United States
- Positive Psychology Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Salvatore Giorgi
- National Institutes of Health, National Institute on Drug Abuse, Baltimore, MD, United States
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Brenda Curtis
- National Institutes of Health, National Institute on Drug Abuse, Baltimore, MD, United States
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28
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Lo Hog Tian JM, Watson JR, Ibáñez-Carrasco F, Tran B, Parsons JA, Maunder RG, Card KG, Baral S, Hui C, Boni AR, Ajiboye M, Lindsay JD, Rourke SB. Impact of experienced HIV stigma on health is mediated by internalized stigma and depression: results from the people living with HIV stigma index in Ontario. BMC Public Health 2021; 21:1595. [PMID: 34496825 PMCID: PMC8427956 DOI: 10.1186/s12889-021-11596-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background Experiences of HIV stigma remain prevalent across Canada, causing significant stress and negatively affecting the health and wellbeing of people living with HIV. While studies have consistently demonstrated that stigma negatively impacts health, there has been limited research on the mechanisms behind these effects. This study aims to identify which dimensions of stigma have significant relationships with self-rated health and examine the mechanisms by which those types of stigma impact self-rated health. Methods We recruited 724 participants to complete the People Living with HIV Stigma Index in Ontario, designed by people living with HIV to measure nuanced changes in stigma and discrimination. The present study utilizes data from externally validated measures of stigma and health risks that were included in the survey. First, we conducted multiple regression analyses to examine which variables had a significant impact on self-rated health. Results from the multiple regression guided the mediation analysis. A parallel mediation model was created with enacted stigma as the antecedent, internalized stigma and depression as the mediators, and self-rated health as the outcome. Results In the multiple regression analysis, internalized stigma (coefficient = −0.20, p < 0.01) and depression (coefficient = −0.07, p < 0.01) were both significant and independent predictors of health. Mediation analyses demonstrated that the relationship between enacted stigma and self-rated health is mediated in parallel by both internalized stigma [coefficient = −0.08, se = 0.03, 95% CI (−0.14, −0.02)] and depression [coefficient = −0.16, se = 0.03, 95% CI (−0.22, −0.11)]. Conclusions We developed a mediation model to explain how HIV-related stigma negatively impacts health. We found that that enacted stigma, or experiences of prejudice or discrimination, can lead to internalized stigma, or internalization of negative thoughts regarding one’s HIV status and/or increased depressive symptoms which then may lead to worse overall health. Highlighting the importance of internalized stigma and depression has the potential to shape the development of targeted intervention strategies aimed at reducing the burden of stigma and improving the health and wellbeing of people living with HIV.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | | | - Billy Tran
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Janet A Parsons
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada.,Department of Physical Therapy and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - Kiffer G Card
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Faculty of Health Sciences, Simon Frasier University, Burnaby, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - Christian Hui
- Canadian HIV Stigma Index Steering Committee, Toronto, Canada.,Ontario Positive Asians, Toronto, Canada.,Ryerson University, Toronto, Canada
| | - Anthony R Boni
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Monisola Ajiboye
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,International Community of Women Living with HIV, London, UK
| | - Joanne D Lindsay
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada.
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29
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van der Kooij YL, Kupková A, den Daas C, van den Berk GE, Kleene MJT, Jansen HS, Elsenburg LJ, Schenk LG, Verboon P, Brinkman K, Bos AE, Stutterheim SE. Role of Self-Stigma in Pathways from HIV-Related Stigma to Quality of Life Among People Living with HIV. AIDS Patient Care STDS 2021; 35:231-238. [PMID: 34097466 PMCID: PMC8215416 DOI: 10.1089/apc.2020.0236] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This study examined the relationships between perceived public stigma, experienced stigma, and quality of life in people living with HIV (PLHIV), and whether self-stigma mediates these relationships. Cross-sectional data were analyzed from 1704 PLHIV in care at OLVG hospital in the Netherlands. We measured different types of stigma (perceived public stigma, experienced stigma, and self-stigma), and various quality-of-life outcomes (disclosure concerns, depression, anxiety, sexual problems, sleeping difficulties, self-esteem, general health, and social support). Structural equation modeling was used to test the paths from different types of stigma to quality-of-life outcomes. All direct effects of self-stigma on quality-of-life outcomes were significant. The final mediation model showed that the effects of both perceived public and experienced stigma on quality-of-life outcomes were mediated by self-stigma. These findings highlight the importance of addressing self-stigma in PLHIV, and call for (psychosocial) interventions that reduce the harmful effects of HIV-related stigma.
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Affiliation(s)
| | - Alžběta Kupková
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Chantal den Daas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | | | | | | | | | - Leo G. Schenk
- Hello Gorgeous Foundation, Amsterdam, the Netherlands
| | - Peter Verboon
- Faculty of Psychology, Open University, Heerlen, the Netherlands
| | - Kees Brinkman
- Internal Medicine, OLVG Hospital, Amsterdam, the Netherlands
| | - Arjan E.R. Bos
- Faculty of Psychology, Open University, Heerlen, the Netherlands
| | - Sarah E. Stutterheim
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
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30
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Ziersch A, Walsh M, Baak M, Rowley G, Oudih E, Mwanri L. "It is not an acceptable disease": A qualitative study of HIV-related stigma and discrimination and impacts on health and wellbeing for people from ethnically diverse backgrounds in Australia. BMC Public Health 2021; 21:779. [PMID: 33892683 PMCID: PMC8063420 DOI: 10.1186/s12889-021-10679-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/22/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND People from ethnically diverse backgrounds living with HIV are susceptible to adverse health and wellbeing outcomes, particularly as a consequence of HIV-related stigma and discrimination (HSD), though relatively little is known about experiences in Australia. METHODS This paper reports on HSD in ethnically diverse communities in South Australia and impacts on health and wellbeing. Interviews and focus groups were conducted with 10 individuals living with HIV from ethnically diverse backgrounds, 14 ethnically diverse community leaders, and 50 service providers. Data were analysed thematically. RESULTS Findings indicated that HIV is a highly stigmatised condition in ethnically diverse communities due to fear of moral judgment and social isolation, and was experienced at the intersections of gender, sexual orientation, religion, culture, and immigration status. Experiences of HSD were damaging to health and wellbeing through non-disclosure, reduced social support, delayed testing, service access barriers, impacts on treatment adherence, and directly to mental health. CONCLUSIONS Actions addressing the impacts of HSD on people from ethnically diverse backgrounds are crucial.
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Affiliation(s)
- Anna Ziersch
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Moira Walsh
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Melanie Baak
- School of Education, University of South Australia, Adelaide, Australia
| | - Georgia Rowley
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Enaam Oudih
- Relationships Australia South Australia, Adelaide, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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31
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Algarin AB, Sheehan DM, Varas-Diaz N, Fennie K, Zhou Z, Spencer EC, Cook CL, Cook RL, Ibanez GE. Enacted HIV-Related Stigma's Association with Anxiety & Depression Among People Living with HIV (PLWH) in Florida. AIDS Behav 2021; 25:93-103. [PMID: 32564164 DOI: 10.1007/s10461-020-02948-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Research has shown that HIV-related stigma contributes to people living with HIV having a higher risk of mental health disorders. Our study examines the association between enacted HIV-related stigma and symptoms of anxiety and depression among PLWH. We used baseline data from 932 PLWH collected from the Florida Cohort study between 2014 and 2018. The sample was majority 45 + years of age (63.5%), male (66.0%), and Black (58.1%). The majority had previously experienced enacted HIV-related stigma (53.1%). Additionally, 56.6% and 65.2% showed mild to moderate/severe levels of anxiety and depression, respectively. Those who experienced any levels of enacted HIV-related stigma (vs none) had significantly greater odds of mild and moderate/severe levels of anxiety (vs no/minimal) (AOR[CI] 1.54[1.13, 2.10], p = 0.006; AOR[CI] 3.36[2.14, 5.26], p < 0.001, respectively) and depression (AOR[CI] 1.61[1.19, 2.18], p = 0.002; AOR[CI] 3.66[2.32, 5.77], p < 0.001, respectively). Findings suggest a need to evaluate interventions for PLWH to reduce the deleterious effects of enacted HIV-related stigma on mental health.
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32
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Hojilla JC, Santiago-Rodriguez EI, Sterling S, Williams EC, Leyden W, Hare CB, Silverberg MJ, Satre DD. HIV Stigma and Its Associations with Longitudinal Health Outcomes Among Persons Living with HIV with a History of Unhealthy Alcohol Use. AIDS Behav 2021; 25:215-224. [PMID: 32632497 PMCID: PMC7785626 DOI: 10.1007/s10461-020-02963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined the demographic and clinical correlates of HIV stigma and evaluated how HIV stigma was associated with physical and mental health outcomes one year later in a primary-care based cohort of persons living with HIV (PLHIV; N = 584). HIV stigma was measured using a modified Berger HIV stigma scale, which includes four subscales: (1) personalized stigma; (2) disclosure concerns; (3) negative self-image; and (4) concerns around public attitudes towards PLHIV. Physical and mental health were assessed using the 12-item short form survey (SF-12). Compared to whites, African Americans were more likely to have higher personalized stigma scores (adjusted prevalence ratio [aPR] 1.54 [95% confidence interval 1.10-2.15]), disclosure concerns (aPR 1.40 [1.03-1.92]), and concerns with public attitudes about PLHIV (aPR 1.61 [1.11-2.34]). Hispanic/Latinx participants were more likely to have concerns around public attitudes towards PLHIV (aPR 1.50 [1.11-2.02]) than whites. Compared to men, women were more likely to have higher negative self-image scores (aPR 1.50 [1.08-2.08]). Higher stigma scores were associated with poorer subsequent self-reported physical and mental health functional status. Our findings highlight the substantial need for addressing HIV stigma, particularly among minority subgroups.
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Affiliation(s)
- J Carlo Hojilla
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
| | - Edda I Santiago-Rodriguez
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily C Williams
- Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - C Bradley Hare
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | | | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Leyva-Moral JM, Gómez-Ibáñez R, San Rafael S, Guevara-Vásquez G, Aguayo-González M. Nursing students' satisfaction with narrative photography as a method to develop empathy towards people with Hiv: A mixed-design study. NURSE EDUCATION TODAY 2021; 96:104646. [PMID: 33160157 DOI: 10.1016/j.nedt.2020.104646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/29/2020] [Accepted: 10/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A major concern for people living with HIV during their lifetime is stigma and discrimination. It is therefore crucial to improve new generations of nurses' empathetic attitude towards these patients to eliminate fear and reduce discrimination using new educational interventions. OBJECTIVE To analyze nursing students' satisfaction with narrative photography as a method to develop empathy towards people living with HIV. DESIGN Concurrent mixed-method design. PARTICIPANTS Seventeen first-year nursing students from a public university in Barcelona, Spain. METHODS A 32-item questionnaire was administered at the end of the narrative photography training activity to determine nursing students' satisfaction with the methodology. Sociodemographic, attitudinal, skills, and satisfaction data were collected. Qualitative data were collected using a reflective open-ended question. RESULTS Of the participants, 82.4% stated that narrative photography helped them to develop reflective thinking and perceive how people living with HIV may feel. Further, 88.2% said that the new method helped them to eliminate some of their prejudices about HIV/AIDS, consider different points of view, understand the importance of providing humanized care, and identify discriminatory behaviors when caring for people living with HIV. Finally, 70.6% stated that narrative photography taught them more than traditional lectures. CONCLUSIONS Nursing students' satisfaction with narrative photography as a teaching strategy is very high; as a result, empathy is advanced in an academic and professional way during the nursing degree. However, more research is needed to demonstrate its efficacy in different scenarios.
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Affiliation(s)
- Juan M Leyva-Moral
- Universitat Autònoma de Barcelona, Faculty of Medicine, Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Barcelona, Spain.
| | - Rebeca Gómez-Ibáñez
- Universitat Autònoma de Barcelona, Faculty of Medicine, Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Barcelona, Spain
| | - Sabiniana San Rafael
- Universitat Autònoma de Barcelona, Faculty of Medicine, Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Barcelona, Spain
| | | | - Mariela Aguayo-González
- Universitat Autònoma de Barcelona, Faculty of Medicine, Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Barcelona, Spain
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Crockett KB, Esensoy TA, Johnson MO, Neilands TB, Kempf MC, Konkle-Parker D, Wingood G, Tien PC, Cohen M, Wilson TE, Logie CH, Sosanya O, Plankey M, Golub E, Adimora AA, Parish C, D Weiser S, Turan JM, Turan B. Internalized HIV Stigma and Pain among Women with HIV in the United States: The Mediating Role of Depressive Symptoms. AIDS Behav 2020; 24:3482-3490. [PMID: 32418165 PMCID: PMC7669722 DOI: 10.1007/s10461-020-02919-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pain is common in women with HIV, though little research has focused on psychosocial experiences contributing to pain in this population. In the present study we examined whether internalized HIV stigma predicts pain, and whether depressive symptoms mediate this relationship among women with HIV. Data were drawn from the Women's Interagency HIV Study (WIHS), for 1,364 women with HIV who completed three study visits between 2015 and 2016. We used a sequential longitudinal design to assess the relationship between internalized HIV stigma at time 1 on pain at time 3 through depressive symptoms at time 2. Analyses revealed internalized HIV stigma was prospectively associated with greater pain, B = 5.30, 95% CI [2.84, 7.60]. The indirect effect through depressive symptoms supported mediation, B = 3.68, 95% CI [2.69, 4.79]. Depression is a modifiable risk factor that can be addressed to improve pain prevention and intervention for women with HIV.
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Affiliation(s)
- Kaylee B Crockett
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35294-0022, USA.
| | - T Alinea Esensoy
- School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mirjam-Colette Kempf
- School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
- Schools of Nursing and Public Health, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Deborah Konkle-Parker
- Department of Medicine/Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Phyllis C Tien
- Department of Medicine, Department of Veterans Affairs Medical Center, San Francisco and Medical Service, University of California, San Francisco, CA, USA
| | - Mardge Cohen
- Department of Medicine, Stroger Hospital of Cook County Bureau of Health and Hospital Systems, Chicago, IL, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Elizabeth Golub
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carrigan Parish
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University Miami Research Center, Miami, FL, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35294-0022, USA
| | - Bulent Turan
- Department of Psychology, University of Alabama At Birmingham, Birmingham, AL, USA
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HIV-related stigma and life goals among people living with HIV (PLWH) in Florida. Qual Life Res 2020; 30:781-789. [PMID: 33131019 DOI: 10.1007/s11136-020-02687-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Goals are an important component of quality of life (QoL) as they provide motivation to accomplish tasks we strive to achieve. Stigma has been identified as a factor that may be deleterious to achieving personal goals. People living with HIV(PLWH) continue to face HIV-related stigma. As HIV prevalence continues to grow in the U.S., it is important to focus on factors that can help improve the health and QoL of PLWH. This study aims to examine the association between HIV-related stigma and goal-setting behaviors among PLWH in Florida. METHODS We used baseline data collected from the Marijuana and Potential Long-term Effects (MAPLE) observational cohort study. We collected life goals data using an abbreviated version of the Personal Projects Analysis inventory. Participants listed up to three goals in five domains and were asked about each goal's difficulty and importance. HIV-related stigma was measured using an abbreviated version of the Herek HIV-related stigma scale. Relative risk estimates and 95% confidence intervals were estimated using multivariate linear regression models. RESULTS The overall sample (n = 232) was majority male (52.4%), Black (72.4%), and non-Latino (84.9%). HIV-related stigma was positively associated with the total number of listed goals (β = 0.042[0.003, 0.082]; p = 0.037) and perceived goal difficulty (β = 0.010[0.003, 0.017]; p = 0.004), but not significantly associated with perceived goal importance (β = 0.001[- 0.002, 0.004]; p = 0.562). CONCLUSION The results suggest that HIV-related stigma may be affecting the pursuit of goals among PLWH. There is a need to develop and evaluate QoL interventions that are tailored to PLWH and focused on achieving goals in the face of HIV-related stigma.
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Kang NE, Kim HY, Kim JY, Kim SR. Relationship between cancer stigma, social support, coping strategies and psychosocial adjustment among breast cancer survivors. J Clin Nurs 2020; 29:4368-4378. [DOI: 10.1111/jocn.15475] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 12/22/2022]
Affiliation(s)
- No Eul Kang
- College of Nursing Jeonbuk National University Jeonju South Korea
| | - Hye Young Kim
- College of Nursing Research Institute of Nursing ScienceJeonbuk National University Jeonju South Korea
| | - Ji Young Kim
- College of Nursing Research Institute of Nursing ScienceJeonbuk National University Jeonju South Korea
| | - Sung Reul Kim
- College of Nursing Korea University Seoul South Korea
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Stephenson R, Chavanduka TMD, Rosso MT, Sullivan SP, Pitter RA, Hunter AS, Rogers E. Contrasting the Perceived Severity of COVID-19 and HIV Infection in an Online Survey of Gay, Bisexual, and Other Men Who Have Sex With Men During the U.S. COVID-19 Epidemic. Am J Mens Health 2020; 14:1557988320957545. [PMID: 32938298 PMCID: PMC7503026 DOI: 10.1177/1557988320957545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
While there is evidence of variations in the risk perceptions of COVID-19 and that they are linked to both engagement in health-protective behaviors and poor mental health outcomes, there has been a lack of attention to how individuals perceive the risk of COVID-19 relative to other infectious diseases. This paper examines the relative perceptions of the severity of COVID-19 and HIV among a sample of U.S. gay, bisexual, and other men who have sex with men (GBMSMs). The "Love and Sex in the Time of COVID-19" survey was conducted online from April 2020 to May 2020. GBMSMs were recruited through paid banner advertisements featured on social networking platforms, resulting in a sample size of 696. The analysis considers differences in responses to two scales: the Perceived Severity of HIV Infection and the Perceived Severity of COVID-19 Infection. Participants perceived greater seriousness for HIV infection (mean 46.67, range 17-65) than for COVID-19 infection (mean 38.81, range 13-62). Some items reflecting more proximal impacts of infection (anxiety, loss of sleep, and impact on employment) were similar for HIV and COVID-19. Those aged over 25 and those who perceived higher prevalence of COVID-19 in the United States or their state were more likely to report COVID-19 as more severe than HIV. There is a need to develop nuanced public health messages for GBMSMs that convey the ongoing simultaneous health threats of both HIV and COVID-19.
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Affiliation(s)
- Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | | | - Matthew T. Rosso
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Stephen P. Sullivan
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Renée A. Pitter
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Alexis S. Hunter
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Erin Rogers
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
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Carey MP, Dunne EM, Norris A, Dunsiger S, Rich C, Rosen RK, Chan P, Salmoirago-Blotcher E. Telephone-Delivered Mindfulness Training to Promote Medication Adherence and Reduce Sexual Risk Behavior Among Persons Living with HIV: An Exploratory Clinical Trial. AIDS Behav 2020; 24:1912-1928. [PMID: 31848765 PMCID: PMC9707639 DOI: 10.1007/s10461-019-02768-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study explored whether telephone-delivered mindfulness training (MT) to promote medication adherence and reduce sexual risk behavior was feasible for and acceptable to people living with HIV. Participants (N = 42; 50% female; M age = 47.5 years) were randomized to MT or health coaching (HC). Pre- and post-intervention, and at 3-month follow-up, we assessed adherence to ART, sexual risk behavior, and hypothesized mediators; we also conducted individual interviews to obtain qualitative data. Results showed that 55% of patients assigned to MT completed ≥ 50% of the training calls compared with 86% of HC patients (p < .05). Most patients reported satisfaction with their intervention (MT = 88%, HC = 87%). Patients in MT and HC reported improvements in medication adherence, mindfulness, and sexual risk reduction as well as reductions in anxiety, depressive symptoms, perceived stress, and impulsivity over time; however, no between-groups differences were observed.
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Affiliation(s)
- Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA.
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, USA.
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, USA.
| | - Eugene M Dunne
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, USA
| | - Alyssa Norris
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, USA
| | - Shira Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, USA
| | - Carla Rich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, USA
| | - Philip Chan
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
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The Role of Depression Screening and Treatment in Achieving the UNAIDS 90-90-90 Goals in Sub-Saharan Africa. AIDS Behav 2019; 23:153-161. [PMID: 31317365 PMCID: PMC6773678 DOI: 10.1007/s10461-019-02593-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite widespread HIV screening and treatment programs across sub-Saharan Africa, many countries are not on course to meet the Joint United Nations Program on HIV/AIDS 90–90–90 targets. As mental health disorders such as depression are prevalent among people living with HIV, investment in understanding and addressing comorbid depression is increasing. This manuscript aims to assess depression and HIV management in sub-Saharan Africa using a 90–90–90 lens through a discussion of: depression and the HIV care continuum; the state of depression screening and treatment; and innovations such as task-shifting strategies for depression management. Due to the lack of mental health infrastructure and human resources, task-shifting approaches that integrate mental health management into existing primary and community health programs are increasingly being piloted and adopted across the region. Greater integration of such mental health care task-shifting into HIV programs will be critical to realizing the 90–90–90 goals and ending the HIV epidemic.
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40
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Glynn TR, Llabre MM, Lee JS, Bedoya CA, Pinkston MM, O'Cleirigh C, Safren SA. Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use. Int J Behav Med 2019; 26:286-296. [PMID: 31065930 PMCID: PMC6563607 DOI: 10.1007/s12529-019-09786-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic non-terminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA. METHODS The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV. RESULTS Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use. CONCLUSION It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease progression risk factors beyond ART adherence is important to be able to design adjuvant interventions, particularly because treatment means that people living with HIV have markedly improved life expectancy and that successful treatment means that HIV is not transmittable to others.
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Affiliation(s)
- Tiffany R Glynn
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Maria M Llabre
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jasper S Lee
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - C Andres Bedoya
- Department of Psychiatry, The Fenway Institute, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Megan M Pinkston
- Department of Psychiatry and Human Behavior, The Miriam Hospital, Clinical Behavioral Medicine Service of the Immunology Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Conall O'Cleirigh
- Department of Psychiatry, The Fenway Institute, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
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