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Chen WT, Sun W, Huang F, Shiu CS, Kim B, Candelario J, Toma L, Wu G, Ah-Yune J. Lost in Translation: Impact of Language Barriers and Facilitators on the Health Care of Asian Americans Living with HIV. J Racial Ethn Health Disparities 2024; 11:2064-2072. [PMID: 37306920 PMCID: PMC10713860 DOI: 10.1007/s40615-023-01674-7] [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] [Received: 03/11/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
Language barriers are major obstacles that Asian American immigrants face when accessing health care in the USA. This study was conducted to explore the impact of language barriers and facilitators on the health care of Asian Americans. Qualitative, in-depth interviews and quantitative surveys were conducted with 69 Asian Americans (Chinese, Filipino, Japanese, Malaysian, Indonesian, Vietnamese, and mixed Asian backgrounds) living with HIV (AALWH) in three urban areas (New York, San Francisco, and Los Angeles) in 2013 and from 2017 to 2020. The quantitative data indicate that language ability is negatively associated with stigma. Major themes emerged related to communication, including the impact of language barriers on HIV care and the positive impact of language facilitators-family members/friends, case managers, or interpreters-who can communicate with healthcare providers in the AALWH's native language. Language barriers negatively impact access to HIV-related services and thus result in decreased adherence to antiretroviral therapy, increased unmet healthcare needs, and increased HIV-related stigma. Language facilitators enhanced the connection between AALWH and the healthcare system by facilitating their engagement with health care providers. Language barriers experienced by AALWH not only impact their healthcare decisions and treatment choices but also increase levels of external stigma which may influence the process of acculturation to the host country. Language facilitators and barriers to health services for AALWH represent a target for future interventions in this population.
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Affiliation(s)
- Wei-Ti Chen
- School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Wenxiu Sun
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Feifei Huang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Cheng-Shi Shiu
- School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA
- National Taiwan University, Department of Social Work, Taipei, Taiwan
| | - Boram Kim
- School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Jury Candelario
- APAIT- A division of Special Service for Groups, Inc., Los Angeles, CA, USA
| | - Lance Toma
- San Francisco Community Health Center, San Francisco, CA, USA
| | - Gilbert Wu
- Chinese-American Planning Council, Inc., New York, NY, USA
| | - Judy Ah-Yune
- Chinese-American Planning Council, Inc., New York, NY, USA
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Jaimes YAP, Lozada-Martínez ID, Tosàs MR, Tiraboschi J. Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review. LE INFEZIONI IN MEDICINA 2024; 32:168-182. [PMID: 38827831 PMCID: PMC11142417 DOI: 10.53854/liim-3202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024]
Abstract
The aim of the present study was to explore the stigma and fear of getting sick in health professionals who treat people living with HIV. An exploratory systematic review was conducted. The search was limited to the presence of stigma and fear of getting sick on the part of healthcare workers who treat people living with HIV, documented by the health workers or patients themselves. No language restriction was made and systematic reviews, comments or communications were excluded. The sources of information were Scopus, PubMed/MEDLINE, Science Direct, and the CENTRAL Registry, from the last 5 years. The quality of the evidence was assessed with an adapted tool and the synthesis of the results was carried out using a narrative synthesis approach. Twenty-three articles were included, which related structural stigma, stigma by health professionals and fear of getting sick. Among the findings, data stood out such as that more than 50% of patients reported having experienced discrimination due to HIV and even accumulated stigma for other additional causes. Stigma enacted in healthcare settings was related to suboptimal adherence to treatment (OR 1.38; 95% CI: 1.03-1.84; p=0.028). Stigma is a structural barrier in the care of people living with HIV and generates a psychological, physical, and social health impact for these people. Some limitations of the present study are that, despite searching the major databases, important manuscripts may have been left out. Additionally, there are regions that are not represented in this review because no manuscripts from those areas were found.
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Affiliation(s)
| | | | - Mar Rosàs Tosàs
- Blanquerna-Faculty of Health Sciences- Ramon Llull University, Barcelona, Spain
| | - Juan Tiraboschi
- Infectious Diseases Service-Bellvitge-IDIBELL-University Hospital-University of Barcelona. Hospitalet de Llobregat, Spain
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Poku OB, Becker TD, Rampa S, Misra S, Ho-Foster AR, Entaile P, Tay C, Choe K, Arscott-Mills T, Blank MB, Opondo PR, Yang LH. Theory-Driven, Multi-Stage Process to Develop a Culturally-Informed Anti-Stigma Intervention for Pregnant Women Living with HIV in Botswana. Int J MCH AIDS 2022; 11:e569. [PMID: 36320928 PMCID: PMC9617017 DOI: 10.21106/ijma.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite a well-established universal HIV diagnosis and treatment program, Botswana continues to face a high HIV prevalence, in large part due to persistent stigma, which particularly affects pregnant women and interferes with healthcare engagement. Tackling stigma as a fundamental cause of HIV disparities is an important but understudied aspect of current HIV interventions. Our multinational and multicultural team used a theory-driven, multi-stage iterative process to develop measures and interventions to first identify and then target the most culturally-salient aspects of stigma for mothers living with HIV in Botswana. This methodology report examines the stage-by-stage application of the "What Matters Most" (WMM) theory and lessons learned, sharing a replicable template for developing culturally-shaped anti-stigma interventions. METHODS First, we conducted initial qualitative work based on the WMM theory to identify key structural and cultural factors shaping stigma for women living with HIV in Botswana. Second, we developed a psychometrically validated scale measuring how "what matters most" contributes to and protects against stigma for this population. Third, we designed an anti-stigma intervention, "Mothers Moving towards Empowerment" (MME), centered on the local values identified using WMM theory that underly empowerment and motherhood by adapting a cognitive behavioral therapy (CBT)-informed, group-based, and peer-co-led anti-stigma intervention specifically for pregnant women living with HIV. Fourth, we conducted a pilot study of MME in which participants were allocated to two trial arms: intervention or treatment-as-usual control. RESULTS Our qualitative research identified that bearing and caring for children are capabilities essential to the concept of respected womanhood, which can be threatened by a real or perceived HIV diagnosis. These values informed the development and validation of a scale to measure these culturally-salient aspects of stigma for women living with HIV in Botswana. These findings further informed our intervention adaptation and pilot evaluation, in which the intervention group showed significant decreases in HIV stigma and depressive symptoms compared to the control group. Participants reported overcoming reluctance to disclose their HIV status to family, leading to improved social support. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Previous studies have not utilized culturally-based approaches to assess, resist, and intervene with HIV-related stigma. By applying WMM in each stage, we identified cultural and gendered differences that enabled participants to resist HIV stigma. Focusing on these capabilities that enable full personhood, we developed an effective culturally-tailored anti-stigma intervention for pregnant women living with HIV in Botswana. This theory-driven, multi-stage approach can be replicated to achieve stigma reduction for other outcomes, populations, and contexts.
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Affiliation(s)
- Ohemaa B Poku
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health Columbia University & the New York State Psychiatric Institute, New York, NY, United States
| | - Timothy D Becker
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA, United States
| | - Ari R Ho-Foster
- Faculty of Medicine, University of Botswana, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Charisse Tay
- Teachers College, Columbia University, New York, NY, United States
| | - Karen Choe
- New York University, Teachers College, Columbia University, New York, NY, United States
| | - Tonya Arscott-Mills
- Department of Pediatrics, Levine Children's Hospital, Charlotte, NC, United States
| | | | | | - Lawrence H Yang
- New York University, New York, NY, United States, Columbia University Mailman, School of Public Health, New York, NY, United States
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Yang LH, Ho-Foster AR, Becker TD, Misra S, Rampa S, Poku OB, Entaile P, Goodman M, Blank MB. Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging "What Matters Most" to Resist Stigma. AIDS Behav 2021; 25:459-474. [PMID: 32839870 PMCID: PMC8530255 DOI: 10.1007/s10461-020-03012-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Perceived stigma deters engagement in HIV care and is powerfully shaped by culture. Yet few stigma measures consider how cultural capabilities that signify "full personhood" could be engaged to resist stigma. By applying a theory conceptualizing how culturally-salient mechanisms can worsen or mitigate HIV stigma in relation to "what matters most" (WMM), we developed the WMM Cultural Stigma Scale for Women Living with HIV in Botswana (WMM-WLHIV-BW) and psychometrically evaluated it among 201 respondents with known and unknown HIV status. The two subscales, Cultural Factors Shape Stigma (CFSS) and Cultural Capabilities Protect against Stigma (CCPS) were reliable (both [Formula: see text]). Among WLHIV, the CFSS Subscale showed initial construct validity with depressive symptoms (r = .39, p = .005), similar to an established HIV stigma scale, whereas the CCPS Subscale showed initial construct validity with self-esteem (r = .32, p = .026) and social support number (r = .29, p = .047), suggesting that achieving local cultural capabilities mitigates stigma and is linked with positive psychosocial outcomes. This culturally-derived scale could help WLHIV in Botswana experience improved stigma-related outcomes.
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Affiliation(s)
- Lawrence H Yang
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA.
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Ari R Ho-Foster
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Supriya Misra
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA
| | - Shathani Rampa
- Department of Psychology, University of Botswana, Gaborone, Botswana
| | - Ohemaa B Poku
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Melody Goodman
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA
| | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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