Prejudice and AIDS: the views and experiences of people with HIV infection

Perceived HIV Treatment Norms Modify the Association Between HIV-Related Stigma and Adherence to Antiretroviral Therapy Among Persons Living with HIV in Baltimore, Maryland

Adherence to antiretroviral therapy (ART) is associated with reduced HIV-related morbidity/mortality and ongoing transmission; however, the extent to which this association is modified by perceived HIV treatment norms is unknown. 270 PLWH completed a survey to assess demographics, risk behaviors, stigma, ART adherence, and perceived HIV treatment norms (Baltimore, 2014-2017). We used modified Poisson regression to examine effect modification by perceived HIV treatment norms. The association between HIV-related stigma and ART adherence was modified by perceived HIV treatment norms. Among individuals who perceived that friends/family were sub-optimally adherent, HIV-related stigma was negatively associated with ART adherence (Adjusted Risk Ratio [ARR] = 0.36; 95%CI 0.15-0.87). Among those who perceived optimal adherence among friends/family, the relationship between HIV-related stigma and ART adherence was not statistically significant (ARR = 1.07; 95%CI 0.65-1.76). Interventions to improve ART adherence among those who are sub-optimally adherent could focus on increasing perceptions of ART adherence among their friends/family.

Public perceptions about HIV/AIDS and discriminatory attitudes toward people living with acquired immunodeficiency syndrome in Iran

Negative and discriminatory attitudes towards people living with HIV/AIDS (PLWHA) are one of the biggest experienced challenges by people suffering from HIV, and these attitudes have been regarded as a serious threat to the fundamental rights of all infected people who are affected or associated with this disease in Iran. This study aimed to determine the relationship between public perception about HIV/AIDS and discriminatory attitudes toward PLWHA . The present study was conducted using a descriptive and survey design. Data were collected from 450 patients (236 male and 214 female) in Tehran and Yazd cities. The research instruments were modified HIV-related knowledge/attitude and perception questions about PLWHA, and discriminatory attitudes toward PLWHA. The results showed that prevalence of discriminatory attitudes toward PLWHA in the studied population was 60.0%. There was a significant negative correlation between citizens' awareness about HIV/AIDS, HIV-related attitudes, negative perception toward people with HIV/AIDS symptoms and their discriminatory attitudes toward PLWHA (p < .01). The hierarchical multiple regression analysis showed that components of public perception about HIV/AIDS explained for 23.7% of the variance of discriminatory attitudes toward PLWHA. Negative public perceptions about HIV/AIDS in Iran associated with discriminatory attitudes toward PLWHA and cultural beliefs in Iran tend to stigmatize and discriminate against the LWHA.

'Now and Again It Really Hits Me'

Quantitative and qualitative data were gathered from a sample of 66 seropositive and 67 seronegative men and women about the impact of an HIV diagnosis upon psychosocial well-being. No significant differences between seropositives and seronegatives were found on any of the psychosocial measures except hopelessness. Nor was there significant variation by disease progression (but this may be due to the restricted size of the sample). The qualitative data are used to illustrate these findings and explore their meaning. It is concluded that, with the exception of a hopeless future orientation, psychosocial disturbance of seropositives tends to be episodic and short-lived and thereby difficult to measure.

Bullying, internalized hepatitis (Hepatitis C virus) stigma, and self-esteem: Does spirituality curtail the relationship in the workplace

The objective of this study was to examine the impact of workplace bullying on self-esteem, including the mediating effect of internalized stigma and the moderating effect of spirituality, among hepatitis C virus patients. Data were collected from 228 employed hepatitis C virus patients who had been admitted to Gastroenterology and Hepatology wards in Pakistani hospitals. We found support for the hypothesis that workplace bullying is associated with low self-esteem via internalized stigma. In addition, spirituality moderated the association such that participants with greater spirituality were buffered from the impact of stigma on self-esteem.

Influence of Perceived Secondary Stigma and Family on the Response to HIV Infection Among Injection Drug Users in Vietnam

The full impact of secondary stigma (stigma directed at family) on an HIV-positive individual is unknown. This qualitative research explores perceptions of secondary stigma in the Vietnamese context and its influence on the ways in which an injection drug user (IDU) copes with HIV infection. Data on experiences learning one's HIV status, disclosure decisions, family reactions, and stigma from family and community were collected through in-depth interviews with 25 HIV-positive IDUs recruited through a health center in Thai Nguyen, Vietnam. Participants felt despair when learning they were HIV-positive and expressed concerns focused on the emotional burden and the consequences of HIV stigma that extended to family. Many participants engaged in self-isolating behaviors to prevent transmission and minimize secondary stigma. Data illustrated the strong value given to family in Vietnam and underscored the importance of secondary stigma in the coping process including gaining social support and engaging in risk reduction.

Reducing discriminatory attitudes toward people living with HIV/AIDS (PLWHA) in Hong Kong: an intervention study using an integrated knowledge-based PLWHA participation and cognitive approach

The present paper describes the development and evaluation of an intervention programme aiming to reduce adolescents' discriminatory attitudes toward people living with HIV/AIDS (PLWHA). The intervention programme integrates components of 'virtual interaction' with PLWHA (watching a documentary), knowledge enhancement and a simple cognitive exercise. To evaluate its effectiveness, the programme was implemented to about 600 form 3-4 (grade 9-10) students of three secondary schools in Hong Kong. Using a structured questionnaire, the level of discriminatory attitudes toward PLWHA, knowledge about HIV/AIDS and perceptions about PLWHA, etc. were measured before and after the implementation of the programme. A notable improvement on the level of acceptance of PLWHA and knowledge about HIV/AIDS was found after the implementation of the programme. Negative perceptions about PLWHA also reduced substantially. For instance, before the programme, over one-third (35.7%) of all respondents believed that the majority of PLWHA were promiscuous; the figure dropped to 15.8% after exposure to the programme (adjusted odds ratio = 0.35, p < 0.001). Further, some gender differences were observed. Female respondents tended to be less discriminatory toward PLWHA and responded more favourably to the programme than their male counterparts.

HIV-positive patients and the doctor-patient relationship: perspectives from the margins

The doctor-patient relationship and the medical consultation are important resources for the health work of people living with chronic illness. In this article, the author examines physician-based outpatient health care from the standpoint of women and men who live with HIV in conditions of economic and social marginality. She draws on focus group and interview conversations with 79 HIV-positive individuals in southern Ontario. Using the approach of institutional ethnography, she offers a close reading of patients' descriptions of what they consider good doctoring. Areas of best practice that enhance access to health care examined here include doctors' interactional styles, ways of providing treatment options and treatment information, and ways of addressing the specific needs and life circumstances of patients living in poverty and social marginality.

Discriminatory attitudes towards people living with HIV/AIDS and associated factors: a population based study in the Chinese general population

OBJECTIVES

To examine the level of discriminatory attitudes towards people living with HIV/AIDS (PLWHA) and factors in association with such attitudes.

METHODS

A population based cross sectional telephone survey was conducted. A total of 808 Hong Kong Chinese aged 18-50 randomly selected from the general population participated in the study.

RESULTS

Around 42% of the respondents exhibited discriminatory attitudes in at least five out of the 20 relevant items. For instance, about 42% would avoid making physical contact with PLWHA; 35% believed that all infected medical staff should be dismissed and about 47% would agree with enacting a law to prohibit PLWHA from visiting Hong Kong. A sizeable proportion of the respondents also hold negative perceptions about PLWHA (for example, 43.7% agreed that the majority of PLWHA are promiscuous, 20.7% thought that PLWHA are merely receiving the punishment they deserve, etc). Multiple regression analysis found that age, HIV related knowledge, the above mentioned negative perceptions about PLWHA, fear related to AIDS, and exposure to HIV related information were independent predictors of discriminatory attitudes towards PLWHA. About 30% would give PLWHA the lowest priority in resource allocation among five groups of patients with chronic diseases.

CONCLUSIONS

The general public in Hong Kong has formed some negative perceptions of PLWHA. Discriminatory attitudes towards PLWHA are common and cover different aspects of their life. Intervention programmes are warranted and an integrated approach is required.

Interventions to reduce HIV/AIDS stigma: what have we learned?

This article reviews 22 studies that test a variety of interventions to decrease AIDS stigma in developed and developing countries. This article assesses published studies that met stringent evaluation criteria in order to draw lessons for future development of interventions to combat stigma. The target group, setting, type of intervention, measures, and scale of these studies varied tremendously. The majority (14) of the studies aimed to increase tolerance of persons living with HIV/AIDS (PLHA) among the general population. The remaining studies tested interventions to increase willingness to treat PLHA among health care providers or improve coping strategies for dealing with AIDS stigma among PLHA or at-risk groups. Results suggest some stigma reduction interventions appear to work, at least on a small scale and in the short term, but many gaps remain especially in relation to scale and duration of impact and in terms of gendered impact of stigma reduction interventions.

Social support and unsupportive social interactions: their association with depression among people living with HIV

Although numerous studies of people living with HIV have focused on positive social support, researchers have directed surprisingly little attention to the nature and effects of negative social interactions in this population. Based on data from a diverse sample of people with HIV (N = 271), we conducted a factor analysis to develop the HIV version of the Unsupportive Social Interactions Inventory (USII). Four types of unsupportive or upsetting responses that an HIV-positive person might receive from others were identified: insensitivity, disconnecting, forced optimism and blaming. In analysis with a sub-sample of 96 people with HIV, unsupportive social interactions were only moderately correlated with social support, suggesting that these constructs are relatively independent. Using hierarchical regression analysis, we found that unsupportive social interactions predicted a significant amount of the variance in depression, beyond the variance accounted for by physical functioning and positive social support. Partial correlations indicated that the relationship between unsupportive social interactions and depression was not an artifact of trait negative affectivity. Favourable evidence of the USII's reliability and validity suggests that the instrument provides a useful tool for assessing unsupportive social interactions experienced by people with HIV. Practical implications of the findings and directions for future research are discussed.

Do people with HIV/AIDS disclose their HIV-positivity to dentists?

This study documents behaviours of people with HIV/AIDS regarding the disclosure of their HIV-positivity when seeking dental care. An anonymous survey was conducted in Québec, Canada, from 1993 to 1995, using a sample of 463 people with HIV/AIDS recruited from different sources. Over 80% of respondents reported having sought dental care since becoming aware of their positivity. Of these, 54% reported having always disclosed their HIV-positivity to dentists, while 25% reported never having disclosed this information to dentists. However, 83% of all respondents preferred that the dentist be aware of their HIV status. Respondents gave reasons related to the sociopathological impact of HIV infection to explain their behaviours. The predictors of disclosure of HIV-positivity to the dentist were: gender, main source of payment for dental care, prior disclosure of HIV status to family members, prior disclosure of HIV status to co-workers, and trust in the maintenance of confidentiality by the dentist. These results emphasize the need to use universal precautions in the dental office and to promote dentist-patient relations free of discrimination, so that people with HIV/AIDS are not reluctant to disclose their health status and are confident that such disclosure will lead to care best adapted to their condition.

Attitudes towards people with HIV: are they as stigmatizing as people with HIV perceive them to be?

Stigma is a feature of HIV disease and many people who are HIV-positive report that their lives are affected by fear of discrimination (felt stigma). Although opinions do not necessarily predict behaviour, this article examines whether the public's avowed attitudes to people with HIV are as punitive and stigmatizing as those infected think they are, and the extent to which public attitudes may contribute to felt stigma. A street survey was conducted in Glasgow and Edinburgh, Scotland, asking a stratified quota sample of 300 men and women of all ages to complete a short questionnaire about their attitudes toward people with HIV. The same questionnaire was also completed by 42 men and women with HIV. One in five respondents in the street survey, and all of those with HIV, were also asked to complete the questionnaire imagining that they were a typical member of the public, to find out whether both groups attributed more hostile attitudes to generalized others than they themselves professed. Overall, the general public had relatively liberal views about people with HIV although a majority felt that some restrictions should be placed upon their freedom. Controlling for age, sex, socioeconomic status and city, people with HIV had more liberal attitudes than the general public, but perceived public attitudes to be far less liberal than were reported in the street survey. Respondents in the street survey also perceived generalized others to be less liberal than themselves. These results provide evidence of felt stigma among people with HIV and the policy implications are discussed. The findings are also set within a theoretical framework concerning the nature of attitudes, their relationship to behaviours, and the pervasiveness of negative images associated with AIDS.

Mood and psychiatric disturbance in HIV and AIDS: changes over time

A sample of 26 HIV seronegative, 59 HIV seropositive asymptomatic and 7 HIV seropositive symptomatic homosexual and bisexual men were assessed over two visits, a mean of 11 months apart, using the BDI, STAI, and CIS. Significant differences emerged between the symptomatic group and the other two groups. Past psychiatric history and the somatic items in the assessments accounted for some of these differences. The seropositive asymptomatic and the seronegative groups did not differ on any of the mood or psychiatric assessments, suggesting minimal effect on psychological well-being of seroconversion in the absence of symptoms.

Social support and HIV

This paper reviews research about the relationship between social support and health for people with HIV. Current studies linking social support and HIV are described and the major findings summarized in order to identify gaps in the literature. It is argued that, to date, research in this area has focused primarily upon gay white men in the USA at a symptomatic stage of the illness. There are few studies which have considered the impact of social position on the relationship between social support and health, and few which have included HIV-negative controls. Whilst there is evidence of a link between social support and the psychological well-being of people with HIV, research is still in its infancy. Much information is required about which particular aspects of social support and health are associated, how this association changes over time according to the stage of the disease, and with the socio-economic and cultural characteristics of those with HIV.