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Maragh-Bass AC, Hucks-Ortiz C, Beyrer C, Remien RH, Mayer K, del Rio C, Batey DS, Farley JE, Gamble T, Tolley EE. Multilevel Stigma and Its Associations with Medical Care Ratings Among Men Who Have Sex With Men in HPTN 078. J Prim Care Community Health 2023; 14:21501319231175362. [PMID: 37243342 PMCID: PMC10226292 DOI: 10.1177/21501319231175362] [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: 02/13/2023] [Revised: 03/31/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Our research assessed associations between stigma-related variables and medical care ratings among clients with HIV in HIV Prevention Trials Network (HPTN) 078 who were men who have sex with men (MSM). METHODS Logistic regression explored care ratings, stigma, socio-demographics (N = 637). Qualitative thematic coding and themes explored stigmatizing experiences in different settings (N = 111). RESULTS Whites were twice as likely as African-Americans to report high care ratings (P < .05). Clients who reported familial exclusion due to having sex with men were 40% less likely to report high medical care ratings (P < .05). Clients who agreed healthcare providers think people with HIV "sleep around" were half as likely to report high care ratings (P < .08). Stigmatization included "treating me like they'll catch HIV from my hand," and care avoidance so others didn't "know I was having sex with men". CONCLUSIONS Providers can promote African American MSM client retention with more affirming healthcare provision, namely minimizing assumptions and addressing identities and client needs beyond just HIV care.
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Affiliation(s)
| | - Christopher Hucks-Ortiz
- Black AIDS Institute, Los Angeles, CA,
USA
- HIV Prevention Trials Network Black
Caucus, Los Angeles, CA, USA
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
| | | | - Kenneth Mayer
- The Fenway Institute and Harvard
Medical School, Boston, MA, USA
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Madiba S, Ralebona E, Lowane M. Perceived Stigma as a Contextual Barrier to Early Uptake of HIV Testing, Treatment Initiation, and Disclosure; the Case of Patients Admitted with AIDS-Related Illness in a Rural Hospital in South Africa. Healthcare (Basel) 2021; 9:healthcare9080962. [PMID: 34442099 PMCID: PMC8395026 DOI: 10.3390/healthcare9080962] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
We explored the extent to which perceived HIV-related stigma influences the disclosure and concealment of HIV status to family among adult patients hospitalised for AIDS-related illness, and described reports of negative responses and enacted stigma following disclosure. We conducted interviews with a purposeful sample of 28 adult patients in a rural South African hospital. Data analysis was deductive and inductive and followed the thematic approach. We found evidence of delayed HIV diagnosis and initiation of treatment. There was delayed and selective disclosure as well as concealment of the HIV-positive status. The disclosure was delayed for months or even years. During that time, there was active concealment of the HIV status to avoid stigma from family, friends, and community. When disclosure occurred, there was selective disclosure to close family members who would keep the secret and respond favorably. Although the participants disclosed mostly to close family, some of their post-disclosure experiences included incidents of enacted stigma and discrimination. The fear of perceived stigma and self-stigma influenced the active concealment of their HIV status from others. Continuous concealment of one's HIV status and delayed disclosure limit the opportunities for support and care. There is a need to take into consideration the interaction between HIV-related stigma and disclosure to develop disclosure-counselling strategies in primary health care settings.
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Affiliation(s)
- Sphiwe Madiba
- Department of Environmental and Occupational Health, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa;
- Correspondence:
| | - Evelyn Ralebona
- Department of Environmental and Occupational Health, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa;
| | - Mygirl Lowane
- Department of Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa;
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Yin Y, Chen ACC, Wan S, Chen H. Factors Associated With HIV-Related Stigma Toward People Living With HIV Among Nurses in Liangshan Yi Autonomous Prefecture, China: A Cross-Sectional Study. Front Psychiatry 2021; 12:714597. [PMID: 34497545 PMCID: PMC8419247 DOI: 10.3389/fpsyt.2021.714597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background: The Liangshan Yi Autonomous Prefecture has one of the most serious human immunodeficiency virus (HIV) epidemics in China. Evidence shows HIV-related stigma toward people living with HIV (PLWH) among nurses impedes HIV prevention and treatment. However, only limited research about HIV-related stigma toward PLWH from the perspective of nurses in Liangshan has been conducted. Objective: This study aimed to assess HIV-related stigma toward PLWH among nurses and determine factors associated with it in Liangshan, China. Design: We conducted a cross-sectional survey using a stratified, random cluster sampling method. Participants: Registered nurses (N = 1,248; primary hospitals = 102, secondary hospitals = 592, tertiary hospitals = 554) who were aged 18 or older, worked in the selected hospitals for at least 6 months, and consented to participate were recruited. Methods: All participants completed an anonymous online survey measuring sociodemographic characteristics, HIV-related stigma and HIV knowledge. We used multiple stepwise regression analysis to examine factors associated with HIV-related stigma toward PLWH among these nurses. Results: The mean score of HIV-related stigma among nurses was 50.7 (SD = 8.3; range 25-78). Nurses who were more experienced, had higher levels of education, and were working in tertiary hospitals reported higher level of HIV-related stigma. Those who had better HIV knowledge, reported a willingness to receive HIV-related training, were working in areas that had a high prevalence of HIV, had prior experience working in AIDS specialized hospitals, and worked in hospitals that had policies to protect PLWH showed a lower level of HIV-related stigma toward PLWH. Conclusions: Our findings suggested that providing culturally congruent education and training about HIV and care, and having hospitals that promoted policies protecting PLWH, may reduce HIV-related stigma toward PLWH among nurses in China.
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Affiliation(s)
- Yao Yin
- Department of Neurology/West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Angela Chia-Chen Chen
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Shaoping Wan
- School of Medicine, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Hong Chen
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Hampton CJ, Gillum TL. 'Today I feel strong': African American women overcoming HIV-related stigma. Psychol Health 2020; 35:1440-1458. [PMID: 32372665 DOI: 10.1080/08870446.2020.1761978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: African American account for more than 60% of women living with HIV/AIDS in the United States. This population is disproportionately affected in areas of diagnosis, treatment, and morbidity. HIV-related stigma has been found to play a pivotal role in the experiences of African American women living with HIV/AIDS (WLWHA) impacting self-perception, treatment adherence, depression, interpersonal relationships, and overall quality of life. Limited studies have explored the ways in which HIV-related stigma impacts the self-perceptions of African American WLWHA. To explore these experiences, this study examined the ways in which HIV-related stigma impacts the intrapersonal experiences of African American WLWHA.Design: A phenomenological investigation was conducted to explore the experiences of African American WLWHA.Main Outcome Measure: In-depth, semi-structured qualitative interviews.Results: Interpretive phenomenological analysis revealed four emergent themes: (1) increased vulnerability; (2) processing the diagnosis of HIV/AIDS; (3) surviving HIV/AIDS; and (4) quality of life.Conclusion: Findings of this study contribute to existing literature by highlighting the intricacies of the lived experiences of African American WLWHA from initial diagnosis to present day. Exploring the trajectory of the illness among this population allows for a deeper understanding of the ways in which HIV/AIDS impacts the intrapersonal experiences and self-perceptions of WLWHA.
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Affiliation(s)
| | - Tameka L Gillum
- Department of Psychology, Russell Sage College, Troy, NY, USA
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Fargnoli V, Burton-Jeangros C. [Ageing and HIV, the experience of HIV-positive women in French-speaking Switzerland]. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2019; 64:25-27. [PMID: 31023463 DOI: 10.1016/j.soin.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Thanks to a burdensome lifelong treatment, it is now possible to lead an almost 'normal' life while being HIV-positive. The status of people living with the human immunodeficiency virus (HIV) is rarely questioned. The image of the 'dying contagious patient' has been replaced by that of the 'classic chronically ill patient'. However, their HIV-positive status still leads to discrimination. A sociological study based on the accounts of 30 HIV-positive women in French-speaking Switzerland reveals how they feel faced with the prospect of ageing with HIV.
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Affiliation(s)
- Vanessa Fargnoli
- Institut de recherches sociologiques & Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives", Université de Genève, bd du Pont d'Arve 40, 1211 Genève 4, Suisse
| | - Claudine Burton-Jeangros
- Institut de recherches sociologiques & Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives", Université de Genève, bd du Pont d'Arve 40, 1211 Genève 4, Suisse.
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Tang Q, Lu H. Immediate antiviral therapy for HIV-infected persons faces with various obstacles. Drug Discov Ther 2019; 13:172-174. [PMID: 31217365 DOI: 10.5582/ddt.2019.01028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) ranks eighth in the global burden of disease, making seriously threatens to global health. Given there is not yet a cure for HIV infection, antiretroviral therapy (ART) holds a key role not only in improving the prognosis of the patients, but also reducing the risk of HIV transmission. The immediate initiation of ART has been recommended in domestic and foreign policies and guidelines, yet the implementation of this strategy is not satisfactory. In developing countries and even in some developed countries, it still takes a long time for patients to go from the diagnosis of HIV infection to the acceptance of ART. Clarifying the obstacles to the implementation of immediate ART and finding strategies to cope with them have emerged as key problems in response to HIV/AIDS.
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Affiliation(s)
- Qi Tang
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University.,Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
| | - Hongzhou Lu
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University.,Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University.,Department of Infectious Disease, Huashan Hospital Affiliated to Fudan University
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Lan Y, Yang Z, Liu H, Cheng H, Liu S, Tan S. [PSB0739 inhibits formation of semen-derived amyloid fibril]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 38:1338-1343. [PMID: 30514682 DOI: 10.12122/j.issn.1673-4254.2018.11.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the inhibitory effect of PSB0739 on the formation of semen-derived amyloid fibrils. METHODS PAP248-286 (440 μmol/L) was incubated with PSB0739 at different concentrations, and at different time points of incubation, aliquots were taken from each sample for Congo red staining to detect the formation of amyloid fibers. The morphology of amyloid fibrils incubated in the presence or absence of PSB0739 was visualized using transmission electron microscope. The effect of PSB0739 on amyloid fibril formation was determined using virus infection assays at different time points, and the surface charges of amyloid fibril incubated with PSB0739 were calculated using a Zeta potentiometer. The cytotoxicity of PSB0739 in Hela cells was determined using MTT assay. The antiviral effect of PSB0738 against HIV- 1 was evaluated by infection assay. RESULTS PSB0739 inhibited SEVI fibril formation in a dose-dependent manner in vitro. At 48 h of incubation, 220 μmol/L of PSB0739 obviously inhibited the formation of amyloid fibrils in 440 μmol/L of SEVI. Transmission electron microscopy revealed that 220 μmol/L PSB0739 prevented PAP248- 286 (440 μmol/L) from forming amyloid fibrils. PSB0739 antagonized SEVI-mediated enhancement of HIV-1 infection, and 1760 μmol/L of PSB0739 completely reversed the positive charge of SEVI (P < 0.05). PSB0739 below the concentration of 62.5 μmol/L showed no obvious cytotoxicity in Hela cells in vitro (P>0.05). PSB0739 showed a direct anti-HIV activity with an IC50 of 21.77±5.15 μmol/L. CONCLUSIONS PSB0739 can inhibit the formation of semen-derived amyloid fibrils in vitro.
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Affiliation(s)
- Yan Lan
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Zichao Yang
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Han Liu
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Hongyan Cheng
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Shuwen Liu
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Suiyi Tan
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
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Lowther K, Harding R, Simms V, Gikaara N, Ahmed A, Ali Z, Kariuki H, Sherr L, Higginson IJ, Selman L. Effect of participation in a randomised controlled trial of an integrated palliative care intervention on HIV-associated stigma. AIDS Care 2018; 30:1180-1188. [PMID: 29663828 DOI: 10.1080/09540121.2018.1465176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We conducted in Kenya a mixed-methods randomised controlled trial (RCT) of a nurse-led palliative care intervention integrated with anti-retroviral therapy (ART) provision for the management of HIV. Here we report qualitative findings showing increased resistance to HIV-associated stigma among trial participants. A mixed method design was chosen to enable identification of the active ingredients of the intervention and exploration of participants' experiences of receiving the intervention. The RCT was conducted from July 2011 to November 2012 in a community hospital in the city of Mombasa, Kenya, with a sample of 120 adults with HIV on ART. Thirty participants were purposively selected to take part in a qualitative exit interview, based on study arm and mental health outcome. Inductive thematic analysis revealed increased resistance to HIV-associated stigma in both the intervention and control groups. Specifically, patients in both groups described benefit from the social support, compassionate care, and open and respectful communication they received through study participation. Participants described improved self-image, increased access to social agency, and increased resistance to HIV-associated stigma. Our findings suggest that there is potential to increase resistance to stigma through simple mechanisms of support, compassion, and improved communication in routine care. The self-reported impact of trial participation on stigma also has implications for future trials in populations in resource-constrained settings where stigma is common.
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Affiliation(s)
- Keira Lowther
- a Department of Palliative Care and Rehabilitation , King's College London, Cicely Saunders Institute , London , UK
| | - Richard Harding
- b King's College London, Cicely Saunders Institute , Department of Palliative Care and Rehabilitation , London , UK
| | - Victoria Simms
- c London School of Hygiene and Tropical Medicine , London , UK
| | - Nancy Gikaara
- d Kenyan Hospice Palliative Care Association , Nairobi , Kenya
| | - Aabid Ahmed
- e Bomu Hospital, Off Airport Road , Mombasa , Kenya
| | - Zipporah Ali
- f Kenya Hospices and Palliative Care Association , Nairobi , Kenya
| | - Hellen Kariuki
- g University of Nairobi , Department of Medical Physiology , Nairobi , Kenya
| | - Lorraine Sherr
- h University College London , Department of Infection and Population Health , London , UK
| | - Irene J Higginson
- i King's College London, Cicely Saunders Institute , Department of Palliative Care and Rehabilitation , London , UK
| | - Lucy Selman
- j Population Health Sciences , Bristol Medical School, University of Bristol , Bristol , UK
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Abel G, Thompson L. "I don't want to look like an AIDS victim": A New Zealand case study of facial lipoatrophy. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:41-47. [PMID: 28557181 DOI: 10.1111/hsc.12459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
The development of antiretroviral (ARV) drugs to treat HIV has turned what was once a death sentence into a chronic disorder. However, a focus on absence of disease in the form of an undetectable viral load and the dismissal of the so-called "cosmetic" complications of the disease ignores perceptions of health and well-being of those living with HIV. Facial lipoatrophy is a stigmatising side effect of treatment for HIV as it betrays the presence of the virus within the body. The study took a longitudinal qualitative approach, interviewing 11 people twice over a period of 1 year on their experience of living with HIV. Two participants were given cameras and asked to take photos which represented what it was like for them to live with this condition and were interviewed four times at four monthly intervals. This paper looks at one man's struggle to conceal or veil his facial lipoatrophy. His story is presented in the form of "selfies" and extracts from in-depth interviews. It tells of an emotional (ongoing) journey of frustration, anger, excitement, depression and resignation which had a profound effect on his sense of social and psychological well-being. This suggests a more holistic approach to treating people living with HIV is needed. While an undetectable viral load is indeed vital, it should not be seen as the only essential outcome of treatment.
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Affiliation(s)
- Gillian Abel
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Lee Thompson
- Department of Population Health, University of Otago, Christchurch, New Zealand
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Cama E, Brener L, Slavin S, de Wit J. The relationship between negative responses to HIV status disclosure and psychosocial outcomes among people living with HIV. J Health Psychol 2017; 25:538-544. [PMID: 28810499 DOI: 10.1177/1359105317722404] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This report examines rates of HIV status disclosure and negative responses to disclosure among people living with HIV in Australia. Among 697 people living with HIV, most (>90%) had disclosed their status to friends, sexual partners and health providers. Almost a third had not disclosed to family, and half had not told any work colleagues. Negative responses to disclosure (e.g. blame, rejection) by all groups were associated with increased HIV-related stigma, psychological distress and diminished social support and health satisfaction. These results shed light on rates of disclosure among people living with HIV in Australia and the adverse health impacts of negative responses to disclosure.
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Affiliation(s)
- Elena Cama
- University of New South Wales, Australia
| | | | | | - John de Wit
- University of New South Wales, Australia.,Utrecht University, The Netherlands
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