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

Bisexual Behaviors, HIV Knowledge, and Stigmatizing/Discriminatory Attitudes among Men Who Have Sex with Men

OBJECTIVE

To assess the correlates for bisexual behaviors, HIV knowledge, and HIV/AIDS-related stigmatizing/discriminatory attitudes among men who have sex with men (MSM).

METHODS

A cross-sectional survey among MSM was conducted in 2011 to provide demographics, sexual behaviors, HIV knowledge, HIV/AIDS-related stigmatizing/discriminatory attitudes, and services in Jinan, Qingdao, and Yantai of Shandong Province of China.

RESULTS

Of 1230 participants, 82.8% were single, 85.7% aged <35 years, and 47.2% received college or higher education. There were 28.6% MSM who reported to be married or cohabitating or ever had sex with woman in the past 6 months (P6M). 74.5% had ≥6 HIV-related knowledge score. The average total score of stigmatizing/discriminatory attitude was 37.4±4.4(standard deviation). Bisexual behavior was independently associated with higher levels of HIV/AIDS-related stigma/discrimination(AOR = 1.1, 95% CI:1.0-1.1), older age(AOR = 1.2, 95%CI:1.1-1.2), and lower HIV-related knowledge score(AOR = 1.6, 95%CI:1.2-2.2). HIV knowledge score ≥6 was independently associated with lower levels of HIV/AIDS-related stigma/discrimination(AOR = 1.3, 95%CI:1.2-1.3), less bisexual behaviors(AOR = 0.6, 95%CI:0.5-0.9), ever received a test for HIV in the past 12 months (P12M)(AOR = 3.2, 95%CI:2.3-4.5), college or higher level education(AOR = 1.9, 95%CI:1.4-2.6), consistent condom use with men in P6M(AOR=6.9, 95%CI:4.6-10.6), recruited from internet or HIV testing sites(AOR = 11.2, 95%CI:8.0-16.1) and bars, night clubs, or tea houses(AOR = 2.5, 95%CI:1.7-4.8). Expressing higher levels of HIV/AIDS-related stigmatizing/discriminatory attitudes was independently associated with bisexual behaviors(Aβ = 0.9, 95%CI:0.4-1.4), lower HIV-related knowledge score(Aβ = 3.6, 95%CI:3.0-4.1), the number of male sex partners in the past week ≥2(Aβ = 1.4, 95%CI:1.0-1.9), unprotected male anal sex in P6M(Aβ = 1.0, 95%CI:0.5-1.6), and inversely associated with ever received HIV test(Aβ = 1.4, 95%CI:0.8-2.0) and peer education in P12M(Aβ = 1.4, 95%CI:0.9-1.9).

CONCLUSION

HIV/AIDS-related stigmatizing/discriminatory attitudes were associated with bisexual behaviors, low HIV testing rate, lower HIV-related knowledge and risk behaviors. This study called for innovative programs that would reduce HIV/AIDS-related stigmatizing/discriminatory attitudes and bisexual behaviors and improve the uptake of prevention service among MSM.

Gender-based attitudes, HIV misconceptions and feelings towards marginalized groups are associated with stigmatization in Mumbai, India

Summary This study examined the association of gender-based attitudes, HIV misconceptions and community feelings for marginalized groups with stigmatizing responses towards people with HIV/AIDS in Mumbai, India. Participants included 546 men and women sampled in hospital settings during 2007-2008. Structured measures were used to assess avoidance intentions and denial of rights of people with HIV/AIDS. Mean age of participants was 32 years; 42% had less than 10 years of education. Higher HIV transmission misconceptions (β=0.47; p<0.001), more traditional gender attitudes (β=0.11; p<0.01) and more negative feelings towards HIV-positive people (β=0.23; p<0.001) were related to higher avoidance intentions. Endorsement of denial of rights was also significantly associated with higher transmission misconceptions (β=0.20; p<0.001), more traditional gender attitudes (β=0.33; p<0.001) and greater negative feelings towards HIV-positive people (β=0.12; p<0.05), as well as with a lower education level (β=-0.10; p<0.05). The feelings respondents had towards people with HIV/AIDS were more strongly correlated with their feelings towards those with other diseases (tuberculosis, leprosy) than with feelings they had towards those associated with 'immoral' behaviour (e.g. sex workers). Eliminating HIV transmission misconceptions and addressing traditional gender attitudes are critical for reducing HIV stigma in Indian society.

Inhibitions and implications associated with celebrity participation in health-related social marketing: an exploratory research focused on HIV prevention in Portugal

This article discusses motivations and inhibitions among celebrities to participate in health-related social marketing. The research identifies the implications that this involvement may have upon their lives. Results from in-depth interviews with 27 Portuguese celebrities show that they expect a fee for endorsements of commercial and government social marketing, despite the positive image they may gain from endorsing public health. The results demonstrate an absence of celebrity prejudice against HIV because of its serious nature and the social stigma attached to AIDS. This research suggests there is a positive bias and presents helpful information for negotiations between institutions and celebrities.

HIV/AIDS-related stigmatizing and discriminatory attitudes and recent HIV testing among men who have sex with men in Beijing

This study assessed the correlates of recent HIV testing and HIV/AIDS-related stigmatizing and discriminatory attitudes among men who have sex with men (MSM) in Beijing, China. A cross-sectional study probed demographics, sexual and drug use behaviors, HIV testing, and prevention services. Of 500 participants, 39.3% recently received a test for HIV. Recent testing was independently associated with expressing lower levels of HIV/AIDS-related stigmatizing and discriminatory attitudes, more male sex partners, no female sexual partners and knowing HIV status of their last male partner. Expressing lower levels of HIV/AIDS-related stigmatizing and discriminatory attitudes was independently associated with recent testing, younger age, and knowing HIV status of their last male partner. This study revealed that HIV/AIDS-related stigmatizing and discriminatory attitudes were common and inversely associated with recent HIV testing. Low levels of testing highlighted the urgent needs to reduce HIV/AIDS-related stigma and discrimination and expand HIV testing among MSM in Beijing.

Duty and destiny: psychometric properties and correlates of HIV-related stigma among youth NGO workers in Delhi, India

Nongovernmental organizations (NGOs) are increasingly providing critical health-related services to hard-to-reach populations. In India, stigma has been cited as a barrier to NGO participation in HIV-prevention activities with high-risk populations. Our study undertook to characterize and contextualize HIV-related stigma within HIV NGOs in Delhi, India. We investigated psychometric characteristics and correlates of HIV-related stigma in a sample of youth NGO practitioners (N=122) working on peer HIV prevention. Factor analyses revealed a "cultural inflection" of stigma in this population: assignment of blame on people living with HIV (PLWH) factored along with individual behaviors and care-taking (Dharma, or Duty), distinct from the perception of HIV as God's punishment, which was connected to ostracism from society (Karma, or Destiny). Exposure to HIV-related messages in newspapers was associated with 55.7% lower levels of Dharma-related stigma (p=0.07) and 58% lower levels of Karma-related stigma scores (p=0.01), respectively, while recall of HIV-related messages on the radio was associated with 57.3% lower Dharma-related (p=0.03) and 34.1% lower Karma-related stigma scores (p=0.06), respectively. The strongest correlate of lower HIV-related stigma was social proximity to PLWH (~76% reduction on both stigma factors, p<0.03). Future research on HIV-related stigma should consider the unique cultural properties and correlates of stigma among young NGO practitioners.

Facilitating HIV disclosure across diverse settings: a review

HIV status disclosure is central to debates about HIV because of its potential for HIV prevention and its links to privacy and confidentiality as human-rights issues. Our review of the HIV-disclosure literature found that few people keep their status completely secret; disclosure tends to be iterative and to be higher in high-income countries; gender shapes disclosure motivations and reactions; involuntary disclosure and low levels of partner disclosure highlight the difficulties faced by health workers; the meaning and process of disclosure differ across settings; stigmatization increases fears of disclosure; and the ethical dilemmas resulting from competing values concerning confidentiality influence the extent to which disclosure can be facilitated. Our results suggest that structural changes, including making more services available, could facilitate HIV disclosure as much as individual approaches and counseling do.

Challenges Faced by People Living with HIV/AIDS in Cape Town, South Africa: Issues for Group Risk Reduction Interventions

This paper presents the findings of an exploratory study to investigate the challenges faced by people living with HIV/AIDS (PLWHA) in communities in Cape Town, South Africa. The primary goal of the study was to gather data to inform the adaptation of a group risk reduction intervention to the South African context. Qualitative methods were used to examine the experiences of PLWHA. Eight focus group discussions (FGDs) were conducted with 83 HIV-positive participants and 14 key informants (KIs) involved in work with PLWHA were interviewed. Findings revealed that AIDS-related stigma was still pervasive in local communities. This was associated with the difficulty of disclosure of their status for fear of rejection. Also notable was the role of risky behaviours such as lack of condom use and that PLWHA considered their HIV/AIDS status as secondary to daily life stressors like poverty, unemployment, and gender-based violence. These findings have implications for the adaptation or development of behavioural risk reduction interventions for PLWHA.

Conhecimentos sobre o uso de contraceptivos e prevenção de DST: a percepção de mulheres imigrantes

A saúde sexual e reprodutiva representa uma das principais preocupações da Saúde Pública, pois afeta a saúde e o bem-estar dos indivíduos e compromete o nível social e econômico das sociedades. Muitos problemas relacionados à saúde sexual e reprodutiva são acentuados em grupos socialmente desfavorecidos, como os imigrantes. Esta investigação aprofunda o conhecimento de alguns aspectos sobre a saúde sexual e reprodutiva de imigrantes brasileiras e africanas em Portugal, particularmente em relação ao uso de métodos contraceptivos, infecções sexualmente transmissíveis e uso do preservativo. A coleta de dados se deu a partir da realização de grupos focais com mulheres imigrantes, em idade fértil, residentes em Portugal e provenientes do Brasil ou de Países Africanos de Língua Oficial Portuguesa. Os resultados permitem compreender as percepções e conhecimentos das participantes em relação às temáticas abordadas e determinar os aspectos a serem levados em conta para melhor atender suas necessidades de saúde sexual e reprodutiva.

Stigma rises despite antiretroviral roll-out: a longitudinal analysis in South Africa

Stigma is a recognised problem for effective prevention, treatment, and care of HIV/AIDS. However, few studies have measured changes in the magnitude and character of stigma over time. This paper provides the first quantitative evaluation in Africa of the changing nature of stigma and the potential determinants of these changes. More specifically, it evaluates the dynamic relationship between stigma and (1) increased personal contact with people living with HIV/AIDS and (2) knowing people who died of AIDS. Panel survey data collected in Cape town 2003 and 2006 for 1074 young adults aged 14-22 years were used to evaluate changes in three distinct dimensions of stigma: behavioural intentions towards people living with HIV/AIDS; instrumental stigma; and symbolic stigma. Individual fixed effects regression models are used to evaluate factors that influence stigma over time. Each dimension of stigma increased in the population as a whole, and for all racial and gender sub-groups. Symbolic stigma increased the most, followed by instrumental stigma, while negative behavioural intentions showed a modest increase. Knowing someone who died of AIDS was significantly associated with an increase in instrumental stigma and symbolic stigma, while increased personal contact with people living with HIV/AIDS was not significantly associated with any changes in stigma. Despite interventions, such as public-sector provision of antiretroviral treatment (which some hoped would have reduced stigma), stigma increased among a sample highly targeted with HIV-prevention messages. These findings emphasise that changes in stigma are difficult to predict and thus important to monitor. They also indicate the imperative for renewed efforts to reduce stigma, perhaps through interventions to weaken the association between HIV/AIDS and death, to reduce fear of HIV/AIDS, and to recast HIV as a chronic manageable disease.

Community factors shaping HIV-related stigma among young people in three African countries

Despite the high prevalence of HIV/AIDS that exists in many sub-Saharan African countries, very little is known of the prevalence and context of HIV-related stigma in these settings. This paper seeks to understand the community-level factors associated with HIV-related stigma among young people in three culturally contrasting African countries: Burkina Faso, Ghana and Zambia. Using nationally representative data on young people (15-24) from Burkina Faso, Ghana and Zambia, the analysis examines the economic, demographic and behavioral dimensions of community environments that shape HIV-related stigma among young people. The results demonstrate a clear influence of the community environment on shaping HIV-related stigma among young people. The elements of the community that were significantly associated with HIV-related stigma were the economic and behavioral aspects of the community environment, and there was no evidence of relationships between demographic patterns and HIV-related stigma. Behavioral change interventions must address HIV-related stigma in order to encourage behavior change, and must take into account the social, economic and cultural environments in which young people exist.

Suicide attempts among people living with HIV in France

This study examined the prevalence and characteristics of attempted suicide among a representative sample of French Human Immunodeficiency virus (HIV) infected individuals. In 2003, a face-to-face survey was conducted among people living with HIV/AIDS (PLWHA) selected in a random, stratified sample of French hospital departments. Among solicited individuals, 2,932 agreed to participate and were asked if they had ever AS. Among the respondents, 23% had AS. Female gender, younger age, native French citizenship, reporting household financial difficulties, having been HIV-contaminated through homosexual contact or through injection drug use and suffering from lipodystrophy-related symptoms were all independently associated with AS. HIV-discrimination and the lack of social support from family remained independently associated with AS. Our findings indicate a high level of AS among PLWHA and emphasize the multiple roles of factors associated with living with HIV, together with sociodemographic factors. The results enable the possibility for vulnerable groups to be targeted for specific future interventions in order to prevent attempted suicide.

The Greater Involvement of People Living with AIDS principle: theory versus practice in Ontario's HIV/AIDS community-based research sector

Drawing on the Greater Involvement of People with HIV/AIDS (GIPA) principle, the HIV/AIDS movement began to "democratize" research in Canada in the mid-1990s. To date, there is little evidence about the success of the community-based research (CBR) movement in relation to the implementation of GIPA. We draw on findings from a larger study examining barriers and facilitating factors in relation to HIV-related CBR in Ontario, Canada. An online survey was completed by 39 senior managers in Ontario AIDS service organizations (ASOs). Twenty-five in-depth, semi-structured interviews were then conducted to further explore the survey findings. Survey respondents reported that, compared to researchers and frontline service providers, people living with HIV/AIDS (PLWHA) tended to be the least involved in all stages (input, process and outcome) of CBR projects. AIDS service organizations with a mandate that included serving rural and urban communities reported even lower levels of PLWHA involvement in CBR. Qualitative data reveal complex barriers that make meaningful PLWHA engagement in CBR difficult, including: HIV-related stigma; health-related challenges; "credentialism"; lack of capacity to engage in research; other issues taking priority; and mistrust of researchers. Facilitating factors included valuing lived experience; training and mentoring opportunities; financial compensation; trust building; and accommodating PLWHA's needs. While there is strong support for the GIPA principles in theory, practice lags far behind.

Applying social marketing principles to understand the effects of the radio diaries program in reducing HIV/AIDS stigma in Malawi

Relatively little is known about the extent to which health campaigns can play a constructive role in reducing HIV/AIDS-related stigma. The Malawi Radio Diaries is a program in which HIV-positive men and women openly discuss day-to-day events in their lives with the goal of reducing stigma in the population. Adopting a social marketing perspective, we analyze the various components of the Radio Diaries program in terms of three of the "Four P's": product (stigma reduction), place (radio), and promotion (the program itself). We first investigated the important dimensions of stigma and then developed a model to test the demographic and psychosocial correlates of these dimensions. A midterm household survey was then used to determine the relationship between exposure to the Radio Diaries program and stigma. In multivariate analyses, lower education and knowledge were associated with stronger beliefs that persons living with HIV should be isolated from others. Exposure to the Radio Diaries program did not have a main-effect on stigma, but there was a significant interaction between exposure and efficacy to reduce number of partners such that there was little difference in stigma by exposure level for those with low efficacy, but a significant difference by exposure level for those with high efficacy. Findings are discussed in terms of social marketing principles.

Sexual difficulties in people living with HIV in France--results from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA)

We analysed sexual difficulties in a nationally representative sample of HIV-infected outpatients in France. Analyses were restricted to the 1,812 HIV-treated participants who reported at least one sexual partner during the 12 months prior to the study. The sample included 40.6% homosexual men and 24.4% women; 68.1% had a steady partner and 48.2% reported casual partners. Sexual difficulties were reported by 33.3% of the selected individuals and were more frequent in those with low sexual activity. Immuno-virological outcomes were not associated with sexual difficulties. After multiple adjustment for sexual frequency and antidepressant consumption, it was found that a larger HIV-network, reporting HIV-discrimination from friends and/or sexual partners, suffering from lipodystrophy and reporting very disturbing HIV-related symptoms were all significantly associated with sexual difficulties. HIV and HIV-treatment experience are associated with sexual difficulties. Psychological support focused on HIV-experience should be tested as a possible tool for improving sexual quality of life.

African American Adolescent Perceptions of Vulnerability and Resilience to HIV

HIV/AIDS is growing at a disproportional rate among African American adolescents. This trend has occurred despite the fact that 89% of schools have educational programs on HIV/AIDS. Barriers to effective HIV prevention may be related to a failure to develop educational programs based on the cultural competencies of vulnerable populations such as adolescents who are at risk for HIV. The purpose of this qualitative study was to explore African American adolescent perceptions of vulnerability and resilience to HIV/AIDS within a cultural competency paradigm. A group of 8 adolescents at an African American church participated in a focus group to discuss vulnerability and resilience to HIV. To facilitate discussion, the adolescents developed collages from pictures in African American magazines. Content analysis was used to identify themes. The themes revealed were confidence, safe social activities, innocence, image, music/drug culture, and peer pressure.