Disclosure and nondisclosure among people newly diagnosed with HIV: an analysis from a stress and coping perspective

The Impact of HIV-Related Stigma on Racial/Ethnic Disparities in Retention in HIV Care Among Adults Living with HIV in Florida

BACKGROUND

Our study examines the effects of distinct HIV stigma subtypes on retention in care and racial-ethnic differences among persons with HIV (PWH).

METHODS

Using Florida Medical Monitoring Project 2015-2017 data, we analyzed patients' clinical and behavioral characteristics. We analyzed 89,889 PWH in Florida (50.0% non-Hispanic Blacks, 20.8% Hispanics, 29.2% non-Hispanic whites). HIV stigma subtypes, negative self-image, anticipated stigma, personalized stigma, and retention in care were examined with logistic regressions.

RESULTS

People with high negative self-image and anticipated stigma were less likely to be retained (CI: 0.84-0.92; 0.47-0.53). The association between HIV-related stigma subtypes and retention in care differed between Black, White, and Hispanic participants. Negative self-image was associated with higher retention rates among Hispanics (CI: 5.64-9.26) and Whites (CI: 1.04-1.27), while low retention rates among Blacks (0.617-0.686). The likelihood of staying in care was lower across all racial-ethnic groups when the anticipated stigma was high or moderate. In contrast, personalized stigma increased retention across all racial-ethnic groups.

CONCLUSION

Results showed that distinct types of HIV stigma differentially impact retention, and these associations differ by race and ethnicity. Future interventions should address the effect HIV stigma subtypes have on racially minoritized PWH retention.

Life and love under criminalization: The experiences of people living with HIV in Canada

Based upon qualitative interviews with 54 women and men living with HIV across Ontario, Canada, this paper examines the impact of HIV criminalization on the sexual and romantic relationships of people living with HIV. This research highlights the navigation strategies people living with HIV create and employ to both navigate and protect themselves from the law. Through a thematic and intersectional analysis, this study shows how adoption of these strategies is unequal, with access to navigation strategies varying along lines of gender, race, and sexual orientation. As a result, women and racialized people living with HIV face more difficulties navigating the impact of the law. HIV criminalization in Canada fuels and validates HIV stigma and produces vulnerability both within and outside of the relationships of people living with HIV. This paper seeks to understand HIV criminalization from the perspective of those governed by the law, in hopes of producing knowledge which will contribute to legal reform, inform policy, and support the development of efficacious secondary prevention initiatives.

Barriers, Facilitators and Opportunities for HIV Status Disclosure Among Young Men Who Have Sex With Men: Qualitative Findings from the Tough Talks Intervention

Disclosing one's HIV status can involve complex individual and interpersonal processes interacting with discriminatory societal norms and institutionalized biases. To support disclosure decision-making among young men who have sex with men (YMSM) living with HIV, we developed Tough Talks™, an mHealth intervention that uses artificially intelligent-facilitated role-playing disclosure scenarios and informational activities that build disclosure skills and self-efficacy. Qualitative interviews were conducted with 30 YMSM living with HIV (mean age 24 years, 50% Black) who were enrolled in a randomized controlled trial assessing Tough Talks™ to understand their experiences with HIV status disclosure. Interviews were recorded, transcribed, and thematically coded. Barriers to disclosure focused on fear, anxiety, stigma, and trauma. Facilitators to disclosure are described in the context of these barriers including how participants built comfort and confidence in disclosure decisions and ways the Tough Talks™ intervention helped them. Participants' narratives identified meaning-making within disclosure conversations including opportunities for educating others and advocacy. Findings revealed ongoing challenges to HIV status disclosure among YMSM and a need for clinical providers and others to support disclosure decision-making and affirm individuals' autonomy over their decisions to disclose. Considering disclosure as a process rather than discrete events could inform future intervention approaches.

The HIV Empowering Adults' Decisions to Share: UK/Uganda (HEADS-UP) Study-A Randomised Feasibility Trial of an HIV Disclosure Intervention for Young Adults with Perinatally Acquired HIV

Young adults with perinatally acquired HIV (PAH) face numerous challenges, including antiretroviral therapy (ART) adherence, managing onward HIV transmission risks and maintaining wellbeing. Sharing one's HIV status with others (onward HIV disclosure) may assist with these challenges but this is difficult. We developed and tested the feasibility of an intervention to help HIV status sharing decision-making for young adults with PAH. The study used a randomised parallel group feasibility design with 18-25-year-olds in Uganda and 18-29 year-olds in the UK. Participants were randomly assigned to intervention or standard of care (SOC) condition. The intervention consisted of four sessions (3 group, 1 individual) with follow-up support, delivered in person in Uganda and remotely in the UK. Assessments were carried out at: Pre-intervention /baseline; Post-intervention (intervention group only); Six-month follow-up. 142 participants were recruited (94 Uganda, 48 UK; 89 female, 53 male). At six-month follow-up, 92/94 (98%) participants were retained in Uganda, 25/48 (52%) in the UK. Multivariate analysis of combined data from both countries, showed a non-significant effect of intervention condition on HIV disclosure cognitions and affect (p = 0.08) and HIV disclosure intention (p = 0.09). There was a significant intervention effect on well-being (p = 0.005). This study addressed important gaps in understanding acceptable and feasible ways of delivering HIV status sharing support for young people living with PAH across two very different settings. The intervention was acceptable in both countries and feasible in Uganda. In the UK, retention may have been affected by its remote delivery.Trial registration: ISRCTN Registry, ISRCTN31852047, Registered on 21 January 2019.

Experiences of stigma and HIV care engagement in the context of Treat All in Rwanda: a qualitative study

BACKGROUND

'Treat All' policies recommending immediate antiretroviral therapy (ART) soon after HIV diagnosis for all people living with HIV (PLHIV) are now ubiquitous in sub-Saharan Africa. While early ART initiation and retention is effective at curtailing disease progression and transmission, evidence suggests that stigma may act as a barrier to engagement in care. This study sought to understand the relationships between HIV stigma and engagement in care for PLHIV in Rwanda in the context of Treat All.

METHODS

Between September 2018 and March 2019, we conducted semi-structured, qualitative interviews with adult PLHIV receiving care at two health centers in Kigali, Rwanda. We used a grounded theory approach to data analysis to develop conceptual framework describing how stigma influences HIV care engagement in the context of early Treat All policy implementation in Rwanda.

RESULTS

Among 37 participants, 27 (73%) were women and the median age was 31 years. Participants described how care engagement under Treat All, including taking medications and attending appointments, increased their visibility as PLHIV. This served to normalize HIV and use of ART but also led to high levels of anticipated stigma in the health center and community at early stages of treatment. Enacted stigma from family and community members and resultant internalized stigma acted as additional barriers to care engagement. Nonetheless, participants described how psychosocial support from care providers and family members helped them cope with stigma and promoted continued engagement in care.

CONCLUSIONS

Treat All policy in Rwanda has heightened the visibility of HIV at the individual and social levels, which has influenced HIV stigma, normalization, psychosocial support and care engagement in complex ways. Leveraging the individual and community support described by PLHIV to deliver evidence-based, peer or provider-delivered stigma reduction interventions may aid in attaining Treat All goals.

Predictors Associated With HIV Status Non-Disclosure in Korea

BACKGROUND

Human immunodeficiency virus (HIV) disclosure provides personal support to people living with HIV/acquired immunodeficiency syndrome (PLWH). In addition, it has important implications for disease prevention and treatment. Research on disclosure has been conducted worldwide; however, data from South Korea are insufficient. The purpose of this study was to examine whether certain demographic, medical, and psychosocial factors act as predictors of HIV serostatus non-disclosure among PLWH in South Korea.

METHODS

Participants consisted of 147 PLWH who visited the outpatient infection clinic between June 2020 and January 2021. Demographics, medical factors, HIV-related stigma, and depressive and anxiety symptoms were measured.

RESULTS

The overall disclosure rate among participants was 61.2%. Logistic regression analysis showed that lower depression (odds ratio [OR], 0.918; P = 0.021) and higher disclosure concerns (OR, 1.133; P = 0.004) were significant predictors of non-disclosure. Further, married state was a major predictor of non-disclosure when single referred (OR, 3.002; P = 0.024); however, divorce, separation, and widowed status had no significant consequences.

CONCLUSION

In South Korea, the rate of HIV disclosure is lower than in other countries. The higher disclosure concerns, lower depression and married state were suggested to be important predictors of HIV non-disclosure. High level of perceived stigma and experienced discrimination of PLWH may have affected the results. The social atmosphere linking sexual promiscuity and disease may also have influenced these results. Nationwide efforts should continue to reduce the overall stigma and create a social environment where PLWH can feel safe to disclose their disease conditions.

Assessing diagnosis disclosure and concealment in multiple sclerosis: Development and initial validation of the DISCO-MS survey

BACKGROUND

Individuals with multiple sclerosis (MS) regularly report making strategic decisions about whether to share their diagnosis or keep it a secret; for many, this represents a key stressor. Surprisingly, the impact of disclosure and concealment are understudied in MS and a formal measurement instrument is lacking. We developed the Diagnosis Disclosure and Concealment in MS (DISCO-MS) survey, a self-assessment tool evaluating (1) frequency of concealment behaviors and (2) expected consequences of diagnosis disclosure in persons with MS.

METHODS

A systematic mixed-methods process was used for the design and initial validation of the DISCO-MS. Associations of DISCO-MS responses to demographics, clinical variables, and mood were examined in 204 participants with MS.

RESULTS

The 39-item DISCO-MS shows good psychometric characteristics. Approximately 25% of respondents conceal their diagnosis, particularly in professional settings. Higher concealment behaviors were associated with younger age, shorter disease duration, and lower physical disability. Nearly 50% of respondents believed that talking openly about their diagnosis might have undesirable professional and interpersonal consequences. Younger age, higher depression, and higher anxiety were associated with greater expectations of negative consequences.

CONCLUSION

Development and validation of the DISCO-MS presents the first step toward systematic study of the impact of DISCO on people with MS.

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

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.

Using decision tree analysis to understand the influence of social networks on disclosure of HIV infection status

Disclosure of human immunodeficiency virus (HIV) infection status improves treatment adherence and HIV prevention. Social networks influence such disclosure by people living with HIV/AIDS (PLWH). This study aimed to investigate the disclosure status of Korean PLWH and determine the social network characteristics associated with disclosure. A cross-sectional study design was used, and 148 Korean PLWH answered self-report questionnaires that included items on the characteristics of social networks and disclosure. Logistic regression and decision tree analysis were performed. In total, 81 participants (54.7%) reported disclosing HIV status to the most important supporter. Five factors were found to influence disclosure: age, self-help group participation, living arrangement, social network relationship, and tie strength; three groups had higher percentages of nondisclosure. The findings suggest that healthcare practitioners should provide adequate counseling by considering the characteristics of social networks and disclosure status of PLWH. Researchers should identify high-risk populations using decision tree analysis.

Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis

BACKGROUND

Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries.

METHODS

A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis.

RESULTS

Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage.

CONCLUSION

WLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.

Structural and intersectional biographical disruption: The case of HIV disclosure among a sample of black gay and bisexual men

HIV disclosure has been considered key to prevention and privileged as a "healthy" behavior for people living with HIV. Although research has documented potential negative outcomes of disclosure, we know little about its potential of these consequences to disrupt one's biography, or the intersectional and structural inequities that shape disclosure/nondisclosure and its outcomes. Exploring HIV disclosure as a discrete, measurable event cannot account for the experience of the self in illness, and how disclosure can fundamentally shift everyday reality and social relationships. To fill this gap, I employed the framework of structural intersectionality, and the medical sociology theory of biographical disruption to explore HIV disclosure among a sample of Black gay and bisexual men living with HIV in the Deep South. Between June 2019 and June 2020, I conducted in-depth qualitative interviews with 30 Black gay and bisexual men living with HIV in the Baton Rouge, Louisiana metropolitan area. Interviews were recorded and transcribed verbatim and analyzed using a grounded theory approach. Disruptions as a result of HIV disclosure included: assaults on self; disturbance to social and familial networks; and socioeconomic impacts. Further, findings illustrate that disruptions were not discrete events, but evolved over time, and that the nature of disruption was constituted by previous traumatic disruptions, social and structural contexts, and men's social location at the intersections of race, class, sexuality, HIV-status, and geography. I highlight that consequences of HIV disclosure among a sample of Black gay and bisexual men, were shaped by their unique social location and the persistence of intersecting structural inequities. Future research should account for preceding and cumulative experiences, how intersecting inequities constitute disclosure experiences, and that disclosure is a complex process occurring in the context of ongoing social relations.

The Impact of Stigmatization on Social Avoidance and Fear of Disclosure among Older People: Implications for Social Policy Preparedness in a Public Health Crisis

This study examined whether older people with epicenter travel experiences in the event of the novel coronavirus disease epidemic suffered from stigmatization, which in turn affected subsequent behavior, including fear of disclosure and social avoidance. A three-wave survey was conducted using a time-lagged design of older people who had travel experiences in Hubei, China on the eve of the outbreak. Results reveal positive associations between stigmatization and stress, social avoidance, and fear of disclosure, in addition to positive associations between stress and social avoidance and fear of disclosure. Findings thus suggest that the effects of stigmatization on social avoidance and fear of disclosure is mediated, in part, by stress. De-stigmatization and psychological supports should be prioritized for epidemic prevention and control among older people in quarantine.

Behavioral Intentions to Use Patient Portals to Disclose HIV and Other Sexually Transmitted Infection Testing Histories with Sexual Partners Among U.S. Sexual Minority Men

Disclosure of HIV and other sexually transmitted infection (HIV/STI) testing history to sexual partners is low among gay, bisexual, and other U.S. sexual minority men (SMM). Patient portals (PP) could increase HIV/STI testing history disclosure. This study estimated the predictive validity of the Enhancing Dyadic Communication (EDC) latent construct for perceived behavioral intentions to use PP for HIV/STI test disclosures. A randomized subset of SMM completed the Patient Portal Sexual Health Instrument as part of the 2018 American Men's Internet Survey. Multivariable logistic regression models estimated associations between EDC and intentions to use PP for test disclosures. Among a sample of 1,509 SMM aged 15 to 77 years, EDC was associated with intentions to use PP to disclose test history with main partners (aOR 2.17; 95% CI 1.90 to 2.47) and non-main partners (aOR 2.39; 95%CI 2.07 to 2.76). Assessing EDC could be useful in clinical settings for interventions encouraging patients to communicate with partners about testing.

To Disclose, Not Disclose, or Conceal: A Qualitative Study of HIV-Positive Men with Multiple Concealable Stigmatized Identities

People living with HIV (PLHW) and other concealable stigmatized identities (CSIs) face continual decisions about the degree of openness they are willing to allow for their identities in different social contexts. Disclosing or concealment of CSIs describes potential stigma management strategies that may have distinct psychosocial consequences. This study aimed to examine disclosure processes in a sample of sexual minority men (SMM) with intersecting CSIs, who use substances and were suboptimally engaged in HIV care. Interviews (N = 33) were initially double coded following thematic analysis, which identified disclosure as a theme. Subsequently, content analysis and additional selective double coding were used to iteratively identify and refine subthemes related to disclosure decisions. Illustrative quotes and frequencies of the invoked subthemes and identities were recorded for each participant. The majority of participants discussed experiences of disclosure and nondisclosure (N = 31, 94%). Among these, a spectrum of related behaviors and preferences emerged, including active disclosure, passive disclosure, passive nondisclosure, and concealment. Across disclosure-related content, in addition to HIV status, the majority of participants also described navigating decisions about disclosure of sexual orientation (71%), substance use (61%), and multiple identities at once (55%). Findings from this study highlight the fluid and multi-dimensional nature of identity-related disclosure processes in SMM with multiple CSIs. Participants in this study possessed interlocking stigmatized identities and described being varying degrees of "out" across identities and time. Moreover, these findings challenge common beliefs that disclosure is a binary construct associated with positive gain.

90 DAYS: An investigation of a short entertainment-education film to improve HIV status disclosure among black women living with HIV in Miami-Dade County

Within Miami-Dade County, Black women experience disproportionate rates of HIV incidence and prevalence. Status disclosure to sexual partners is central to mitigating the HIV epidemic and ensuring a healthier lifestyle for those living with the virus. The disclosure processes model (DPM) posits that barriers such as stigma and negative outcome expectations often facilitate disclosure avoidance. Therefore, this study investigated the utility and acceptability of an entertainment-education (EE) short film, 90 DAYS, for disclosure among Black women living with HIV in Miami-Dade County. Employing photo-elicitation (Harper, 2002), focus groups were conducted with 48 participants. After screening the 90 DAYS film about stigma and disclosure, participants were asked semi-structured questions based upon extant EE and DPM literature. Via inductive and deductive processes, five themes were derived from the data. Participants found the 90 DAYS film to be an empowering counter-narrative that could be used to overcome multiple disclosure-related factors. They felt it provided a social script for how to disclose to their sexual partners. A novel finding of this investigation was that respondents asserted the film could facilitate safer disclosure events. Additional themes included the film being a resource of hope for young and newly diagnosed women; and an educational tool for the community. Altogether, findings lend promise to the use of EE for addressing disclosure avoidance among Black women living with HIV.

A randomised feasibility trial of an intervention to support sharing of HIV status for 18-25-year olds living with perinatally acquired HIV compared with standard care: HIV Empowering Adults' Decisions to Share-UK/Uganda Project (HEADS-UP)

Abstract

Background

Young adults with perinatally acquired HIV (PAH) face several challenges, including adhering to antiretroviral therapy (ART), managing the risk of onward HIV transmission and maintaining positive well-being. Sharing one’s HIV status with others (onward HIV disclosure) may assist with these challenges by facilitating emotional and practical support. Rates of HIV status sharing are, however, low in this population. There are no existing interventions focused on sharing one’s HIV status for young adults living with PAH. The HEADS-UP study is designed to develop and test the feasibility of an intervention to help the sharing of HIV status for young adults with PAH.

Methods

The study is a 30-month multi-site randomised feasibility study across both a high-income/low-HIV prevalence country (UK) and a low-income/high-HIV prevalence country (Uganda). Phase 1 (12 months) will involve developing the intervention using qualitative interviews with 20 young people living with PAH (ten in the UK—18 to 29 years; ten in Uganda—18 to 25 years), 20 of their social network (friends, family, sexual partners as defined by the young person; ten in the UK, ten in Uganda) and ten professionals with experience working with young adults with PAH (five in the UK, five in Uganda). Phase 2 (18 months) involves conducting a randomised feasibility parallel group trial of the intervention alongside current standard of care condition in each country (main study) with 18- to 25-year olds with PAH. A sample size of 94 participants per condition (intervention or standard of care; 188 participants in total: 47 in each condition in each country) with data at both the baseline and 6-month follow-up time points, across UK and Ugandan sites will be recruited. Participants in the intervention condition will also complete measures immediately post-intervention. Face-to-face interviews will be conducted with ten participants in both countries immediately post-intervention and at 6-month follow-up (sub-study).

Discussion

This study will be the first trial that we are aware of to address important gaps in understanding acceptable and feasible ways of delivering HIV status sharing support for young people living with PAH.

Trial registration

ISRCTN Registry, ISRCTN31852047, Registered on 21 January, 2019. Study sponsor: Royal Holloway University of London. Sponsor contact: alicen.nickson@rhul.ac.uk. Date and version: April 2020. Protocol version 3.5.

Disclosure of a communication disorder during a job interview: A theoretical model

With the passage of the Americans with Disabilities Act Amendments Act of 2008 (ADAAA), the definition of disability was expanded and the terms "speaking, hearing, and communicating" were given status as major life activities. Therefore, any communication disorder which substantially limits these major life activities in the workplace can qualify as a disability under the law. This legal protection means that no employer can ever ask about the presence of a communication disorder, and a job applicant is never required to disclose their communication disorder during the hiring process. However, this right to refrain from disclosure potentially places job applicants in a difficult situation. Applicants can choose to remain silent about their disorder and hopefully avoid hiring discrimination, yet the only way that workplace accommodations can be legally requested is if disclosure of the disability takes place. This disclosure decision-making process is likely complex and dependent upon multiple factors. Aspects such as workplace culture, job duties, severity of symptoms, individual motivations, and characteristics of the communication disorder likely all play a role when weighing the decision to disclose. This article proposes a theoretical model which outlines the factors that might influence the disclosure decision-making process for those with communication disorders before a job interview. Each major component of this decision-making process is highlighted, focusing on which factors might inhibit or foster disclosure within a hiring context. Clinical implications are discussed which can allow speech-language pathologists to assist those who are struggling with this important decision. The article also identifies areas in need of future research.

Factors Associated with HIV Disclosure Status Among iENGAGE Cohort of New to HIV Care Patients

HIV disclosure is an important behavior with implications for HIV treatment and prevention but understudied among new to HIV care patients who face unique challenges adjusting to a new diagnosis. This study evaluated the factors associated with HIV disclosure status and patterns of HIV disclosure among new to HIV care patients. A cross-sectional study was conducted evaluating the iENGAGE (integrating ENGagement and Adherence Goals upon Entry) cohort. Participants were enrolled in this randomized behavioral trial between December 2013 and June 2016. The primary and secondary outcomes included HIV disclosure status (Yes/No) and patterns of disclosure (Broad, Selective and Nondisclosure), respectively. Logistic and Multinomial Logistic Regression were used to evaluate the association of participant factors with HIV disclosure and patterns of HIV disclosure, respectively. Of 371 participants, the average age was 37 ± 12 years, 79.3% were males, and 62.3% were African Americans. A majority of participants (78.4%) disclosed their HIV status at baseline, 63.1% were broad disclosers and 15.2% were selective disclosers. In multivariable regression, black race, emotional support, and unmet needs predicted any HIV and broad disclosure, whereas males, emotional support, active coping, and acceptance were associated with selective disclosure. Interventions to promote early disclosure should focus on coping strategies and unmet needs, particularly among black and male people living with HIV initiating care.

Factors associated with hostility among people living with HIV/AIDS in Northeast China: a cross-sectional study

Background

Hostility can result in negative outcomes in people living with HIV/AIDS (PLWHA); however, previous research on this topic is far from adequate. To contribute to existing knowledge on this aspect of PLWHA, the current study examined the prevalence of hostility and its potential influencing factors among PLWHA.

Methods

A cross-sectional questionnaire survey was undertaken on 218 HIV patients in Heilongjiang Province of China between March and August in 2013. A multiple logistic regression analysis was performed to identify factors associated with hostility.

Results

The prevalence of hostility was 17.0% among the participants. The three most alarming types of hostility included desiring to kill the person who infected them, blaming the infection on the society, and abandoning themselves to despair. A multiple logistic regression model identified that depression (OR = 3.845, 95% CI = 1.309–9.229), perceived stigma (OR = 3.281, 95% CI = 1.109–7.711), and fear of dying (OR = 2.710, 95% CI = 1.068–6.881) were the risk factors for hostility, while higher levels of trust-in-doctor (OR = 0.176, 95% CI = 0.060–0.517) and per capita household income (OR = 0.344, 95% CI = 0.119–0.991) were protective factors.

Conclusions

Our findings highlight the prominent influence of psychological, healthcare, and social factors on hostility among PLWHA. Interventions specifically targeted to reduce hostility should be provided, including incorporating psychological service into HIV management guidelines, enhancing PLWHA’s trust-in-doctor, establishing comprehensive services for PLWHA, reducing the social stigma against PLWHA, and paying more attention to PLWHA with financial problems. These interventions may improve the management and control of HIV/AIDS.

Assessment of HIV-related stigma and determinants among people living with HIV/AIDS in Abeokuta, Nigeria: A cross-sectional study

Introduction:

HIV/AIDS-related stigma remains an essential barrier to the formulated care delivery and improved quality of life of people living with HIV/AIDS in sub-Saharan Africa. Only a few studies have evaluated stigma and its determinants as concerns people living with HIV/AIDS in Nigeria.

Methods:

A cross-sectional design study recruited 386 people living with HIV/AIDS attending the government clinic, Federal Medical Centre, Abeokuta, Nigeria, for the assessment of stigma using Berger’s HIV stigma scale and United States Agency International Development-recommended indicators and questions on HIV-related stigma among people living with HIV/AIDS. Data were analyzed using SPSS 21.

Results:

Of the 386 people living with HIV/AIDS, 322 (83.4%) were females and 64 (16.6%) were males, and 96.9% had disclosed their HIV status. Overall, mean perceived stigma score was moderately high at 95.74 (standard deviation = ±16.04). Majority (77.2%) of the participants experienced moderately perceived stigma. Among the subscales, disclosure concerns contributed the most to stigma score at 68.9%. Enacted stigma in the last 12 months was documented in 35.8% (138). There was no association observed between age, gender, marital status and HIV-related stigma. However, low education was associated with higher negative self-image perception (31.83 ± 5.81 vs 29.76 ± 5.74, p < 0.001). Furthermore, higher perceived stigma score was associated with abandonment by spouses (p < 0.001), isolation from household members (p < 0.001) and social exclusion (p < 0.001). We demonstrated a correlation between the domains of enacted stigma and Berger HIV stigma scales except for the loss of resources.

Conclusion:

Perceived HIV-related stigma is moderately high among people living with HIV/AIDS. Low education, disclosure concerns, spousal or household abandonment and social exclusion are the significant contributors. HIV-related stigma preventive interventions at different levels of care are advocated.

Adjustment to acute or early HIV-1 infection diagnosis to prompt linkage to care and ART initiation: qualitative insights from coastal Kenya

Diagnosing and treating patients with acute or early HIV-1 infection (AEHI) is an important strategy to prevent HIV-1 transmission. We used qualitative methods to understand factors that facilitate adjustment to AEHI diagnosis, prompt linkage to care and initiation of antiretroviral treatment (ART). Twenty-three AEHI patients (12 women, 11 men) included 18 participants identified at health facilities, and 5 participants identified in a sex worker cohort. Of these, 17 participants (9 women, 8 men) participated in qualitative interviews about their AEHI status 2 weeks after diagnosis. Thirteen participants (7 women, 6 men) returned for a second interview 12 weeks after diagnosis. Interviews explored participants' experiences at the time of and following their diagnosis, and examined perceptions about ART initiation and behavior change recommendations, including disclosure and partner notification. A grounded theory framework was used for analysis, eliciting three important needs that should be addressed for AEHI patients: 1) the need to better understand AEHI and accept one's status; 2) the need to develop healthy strategies and adjust to the reality of AEHI status; and 3) the need to protect self and others through ART initiation, adherence, safer sex, and disclosure. A preliminary conceptual framework to guide further intervention and research with AEHI populations is proposed.

Ways of coping and HIV disclosure among people living with HIV: mediation of decision self-efficacy and moderation by sex

Individuals living with HIV/AIDS face several stressors and use varying strategies to cope. Disclosure (or nondisclosure) of HIV serostatus is an important consideration among individuals living with HIV. However, studies examining the association between coping and HIV disclosure are lacking, and more research examining potential mediators and moderators is needed. The transactional model of stress and coping and the theory of planned behavior may help in understanding the mediating relationship between coping, decision self-efficacy, and HIV disclosure. Therefore, the aims of this study were to examine the association between coping and HIV disclosure to sexual partners, assess the mediating role of decision self-efficacy, and examine moderation by sex. Baseline data from 262 individuals living with HIV who participated in a disclosure intervention were used for analysis. Descriptive statistics were used to assess sociodemographic characteristics. Principal component analysis was used to operationalize coping. Path analysis was then used to determine the mediating role of decision self-efficacy in the association between overall, adaptive, distancing, and attack/escape avoidance coping and HIV disclosure to sexual partners. After adjusting for age and time since diagnosis, direct associations between coping and decision self-efficacy, and decision self-efficacy and disclosure behavior varied by sex. Among the overall study population, decision self-efficacy mediated the associations between adaptive coping (β = 0.064, p = 0.003), attack/escape avoidance coping (β = -0.052, p = 0.009) and disclosure behavior. Disclosure intervention programs geared towards populations living with HIV should include decision self-efficacy and adaptive coping, and attenuate attack/escape avoidance coping.

Assessing Stigma, Disclosure Regret and Posttraumatic Growth in People Living with HIV

Posttraumatic growth after a diagnosis of HIV is positively associated with adjustment, yet stigma and disclosure regret are negatively associated with adjustment. Research into whether posttraumatic growth is experienced while perceiving stigma and disclosure regret is still growing. This study aimed to determine whether posttraumatic growth maintains a positive relation with life satisfaction after controlling for disclosure regret and perceived stigma. Using a cross-sectional design, a questionnaire measuring life satisfaction, health status, depression, posttraumatic growth, disease severity, perceived stigma, disclosure regret, and demographical information was completed by 73 people living with HIV (PLWH). Results showed that all participants had disclosed to at least one person. Regression results showed that after controlling for other variables, including stigma and disclosure regret, posttraumatic growth was positively associated with life satisfaction. The importance of the relation of posttraumatic growth with subjective measures of adjustment may be important for interventions aimed at supporting PLWH.

Avoidant Coping Mediates the Relationship Between Self-Efficacy for HIV Disclosure and Depression Symptoms Among Men Who Have Sex with Men Newly Diagnosed with HIV

HIV diagnosis presents a critical opportunity to reduce secondary transmission, improve engagement in care, and enhance overall well-being. To develop relevant interventions, research is needed on the psychosocial experiences of newly diagnosed individuals. This study examined avoidant coping, self-efficacy for HIV disclosure decisions, and depression among 92 newly diagnosed men who have sex with men who reported recent sexual risk behavior. It was hypothesized that avoidant coping would mediate the relationship between self-efficacy and depression. Cross-sectional surveys were collected from participants 3 months after HIV diagnosis. To test for mediation, multiple linear regressions were conducted while controlling for HIV disclosure to sexual partners. Self-efficacy for HIV disclosure decisions showed a negative linear relationship to depression symptoms, and 99% of this relationship was mediated by avoidant coping. The index of mediation of self-efficacy on depression indicated a small-to-medium effect. Higher self-efficacy was related to less avoidant coping, and less avoidant coping was related to decreased depression symptoms, all else held constant. These findings highlight the role of avoidant coping in explaining the relationship between self-efficacy for HIV disclosure decisions and depression.

Positive and Negative Self-Conscious Emotion and Transmission Risk Following HIV Diagnosis

While negative emotions are associated with risk behaviors and risk avoidance among people with HIV, emerging evidence indicates that negative self-conscious emotions, those evoked by self-reflection or self-evaluation (e.g., shame, guilt, and embarrassment), may differentially influence health-risk behaviors by producing avoidance or, conversely, pro-social behaviors. Positive emotions are associated with beneficial health behaviors, and may account for inconsistent findings related to negative self-conscious emotions. Using multinomial logistic regression, we tested whether positive emotion moderated the relationships between negative emotion and negative self-conscious emotions and level of condomless sex risk: (1) seroconcordant; (2) serodiscordant with undetectable viral load; and (3) serodiscordant with detectable viral load [potentially amplified transmission (PAT)] among people recently diagnosed with HIV (n = 276). While positive emotion did not moderate the relationship between negative emotion and condomless sex, it did moderate the relationship between negative self-conscious emotion and PAT (AOR = 0.60; 95% CI 0.41, 0.87); high negative self-conscious and high positive emotion were associated with lower PAT risk. Acknowledgment of both positive and negative self-conscious emotion may reduce transmission risk behavior among people with HIV.

Physical and Psychological Abuse among Seropositive African American MSM 50 Aged Years and Older

Little is known about abuse experienced among African American men who have sex with men (MSM) who are 50 years and older. A series of focus groups were conducted to examine perspectives of seropositive African American MSM age 50 years and older who reported experiencing some form of psychological or physical abuse. Thirty African American MSM were divided into four focus groups and four themes emerged: "Fear Being Gay," "No One Else to Love Me," "Nowhere to Turn," and "Sexual Risk & Control." The data suggest there is a need to develop culturally tailored interventions for this population.

Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV

OBJECTIVE

We conducted a randomized controlled trial to determine whether IRISS (Intervention for those Recently Informed of their Seropositive Status), a positive affect skills intervention, improved positive emotion, psychological health, physical health, and health behaviors in people newly diagnosed with HIV.

METHOD

One-hundred and fifty-nine participants who had received an HIV diagnosis in the past 3 months were randomized to a 5-session, in-person, individually delivered positive affect skills intervention or an attention-matched control condition.

RESULTS

For the primary outcome of past-day positive affect, the group difference in change from baseline over time did not reach statistical significance (p = .12, d = .30). Planned secondary analyses within assessment point showed that the intervention led to higher levels of past-day positive affect at 5, 10, and 15 months postdiagnosis compared with an attention control. For antidepressant use, the between group difference in change from baseline was statistically significant (p = .006, d = -.78 baseline to 15 months) and the difference in change over time for intrusive and avoidant thoughts related to HIV was also statistically significant (p = .048, d = .29). Contrary to findings for most health behavior interventions in which effects wane over the follow up period, effect sizes in IRISS seemed to increase over time for most outcomes.

CONCLUSIONS

This comparatively brief positive affect skills intervention achieved modest improvements in psychological health, and may have the potential to support adjustment to a new HIV diagnosis. (PsycINFO Database Record

Living a secret: Disclosure among adolescents and young adults with chronic illnesses

Objectives This qualitative study examines how and why adolescents living with visible and invisible chronic illnesses choose to share their condition with individuals within their social environments. Methods A sample of 25 adolescents were recruited from five subspecialty services: Spina bifida, rheumatology, cardiology, cystic fibrosis, and renal transplant/dialysis. Recruits completed a semi-structured interview designed to explore: (1) to whom adolescents disclose their conditions, (2) motivation and conditions under which they disclose, (3) content of disclosure, and (4) barriers to disclosure. Results Family members closely connected to treatment or management are most likely to be primary targets of disclosure. Regardless of social network size, respondents disclosed their illness to few peers. Common reasons for disclosure were perceived trust and shared experience with illness and disability. Reasons for withholding disclosure include perceived fear of rejection, pity, and perceptions of being seen as vulnerable or different. Discussion Disclosure was found to be influenced by (a) the visibility of a condition, (b) the anticipated response from the recipient, (c) practical needs, and (d) a decision that disclosure is justified. These findings inform clinical practice, warrant the need for further study, and insinuate practical solutions to combat the socio-emotional impact of nondisclosure among adolescents.

HIV Disclosure Anxiety: A Systematic Review and Theoretical Synthesis

HIV disclosure can help people living with HIV to access social support, enhance antiretroviral adherence, facilitate engagement in care and reduce unprotected sex. Given interpersonal risks associated with HIV disclosure, however, anxiety about sharing one's status is common. To investigate anxiety about HIV disclosure in HIV-positive populations, we conducted a systematic review of qualitative and quantitative studies, with 119 studies included. The review demonstrated that perceived interpersonal risks are associated with HIV disclosure and outlined evidence of associations with anxiety, fear and worry. We present a new cognitive model of HIV disclosure anxiety adapted from clinical theories of health and social anxiety, consistent with evidence from the review. The model attempts to explain the development and maintenance of anxiety in individuals whose functioning is most affected by concerns about sharing their status. Implications for helping people living with HIV struggling with significant levels of anxiety about HIV disclosure are discussed.

Community Disclosure by People Living With HIV in Rural China

The decision to disclose HIV serostatus is a complex and a challenging task because of potential stigma, blame, and fear associated with HIV infection. Despite continued research on HIV disclosure, literature on HIV disclosure to community is still scarce. The purpose of the study is to describe patterns of HIV status disclosure to community members in a sample of HIV-infected men and women in rural China. This study used the baseline data of a randomized controlled intervention trial for HIV-affected families in China. The data was collected between late 2011 to early 2013. In addition to demographic and HIV-related clinical characteristics, we collected the extent of HIV disclosure to members within the community. We first calculated descriptive statistics and frequencies to describe the demographics of the sample. We then compared the extents of HIV disclosure to different community members. We performed chi-square tests to determine whether the demographic and socioeconomic variables were associated with the extent of HIV disclosure to community. A total of 522 PLH were included in the study. The results show that age and family income are associated with the extent of disclosure of HIV status to members within the community, including neighbor, village leaders, people in the village, and coworkers. More disclosures were found among older age groups. People with less family income tend to disclose more to the community than those with higher family income. There is a need to explore the association of HIV disclosure to the community to help realize the public health and personal implications of disclosure. Our results underscore the potential benefits of age and socioeconomic status-specific interventions in the efforts to dispel barriers to HIV status disclosure to the community.

Reported Church Attendance at the Time of Entry into HIV Care is Associated with Viral Load Suppression at 12 Months

The Southeast has high rates of church attendance and HIV infection rates. We evaluated the relationship between church attendance and HIV viremia in a Southeastern US, HIV-infected cohort. Viremia (viral load ≥200 copies/ml) was analyzed 12 months after initiation of care. Univariate and multivariable logistic regression models were fit for variables potentially related to viremia. Of 382 patients, 74 % were virally suppressed at 12 months. Protective variables included church attendance (AOR 0.5; 95 % CI 0.2, 0.9), being on antiretroviral therapy (AOR 0.01; 95 % CI 0.004, 0.04), CD4(+) T lymphocyte count 200-350 cells/mm(3) at care entry (AOR 0.3; 95 % 0.1, 0.9), and education (AOR 0.5; 95 % CI 0.2, 0.9). Variables predicting viremia included black race (AOR 3.2; 95 % CI 1.4, 7.4) and selective disclosure of HIV status (AOR 2.7; 95 % CI 1.2, 5.6). Church attendance may provide needed support for patients entering HIV care for the first time.

Family relations in the context of HIV/AIDS in Southwest China

In China, an estimated 780,000 people have been infected with HIV (China AIDS, 2012 ). Even as this stigmatized population rapidly grows, with the majority of reproductive age (20-40 years old), information about their daily experiences in the domestic sphere has been scarce. Because the family remains a central unit of social and ethical organization in China, the current qualitative study examines family relations among people living with HIV (PLWH) with the goal of identifying the effect of HIV on family relations and, conversely, the effect of family relations on those with HIV. We analyzed data from 90 in-depth interviews with PLWH and people around them (i.e., their children, health care providers, other community members) in southwest China (Guangxi province). Through analyzing the families' experiences with illness, three themes emerged: how individuals with HIV interact with their community; how they cope with stigma alongside and against their family; and how families can support those with HIV. Our data ultimately showed the critical role of family in the quality of PLWH's well-being. Because concealment of their serostatus was the primary coping strategy, stigma manifestation was most obvious in the domestic spheres. Yet, when help was received, PLWH regarded family support as the most helpful, as those who received empathy from their families remained more optimistic. Thus, there is an urgent need for developing efficacious intervention programs that could lead to maximize family support, involving the families of PLWH, with a particular attention to family dynamics in daily interactions. Despite our awareness of the significance of family in China, this study reveals a particular kind of role of family that has rarely been considered, namely the role of family in healing and sustaining social bonds within the context of stigmatization, when those bonds might otherwise be broken.

Expression of gp120 in mice evokes anxiety behavior: Co-occurrence with increased dendritic spines and brain-derived neurotrophic factor in the amygdala

Human immunodeficiency virus type 1 (HIV) infection of the brain produces cognitive and motor disorders. In addition, HIV positive individuals exhibit behavioral alterations, such as apathy, and a decrease in spontaneity or emotional responses, typically seen in anxiety disorders. Anxiety can lead to psychological stress, which has been shown to influence HIV disease progression. These considerations underscore the importance of determining if anxiety in HIV is purely psychosocial, or if by contrast, there are the molecular cascades associated directly with HIV infection that may mediate anxiety. The present study had two goals: (1) to determine if chronic exposure to viral proteins would induce anxiety-like behavior in an animal model and (2) to determine if this exposure results in anatomical abnormalities that could explain increased anxiety. We have used gp120 transgenic mice, which display behavior and molecular deficiencies similar to HIV positive subjects with cognitive and motor impairments. In comparison to wild type mice, 6 months old gp120 transgenic mice demonstrated an anxiety like behavior measured by open field, light/dark transition task, and prepulse inhibition tests. Moreover, gp120 transgenic mice have an increased number of spines in the amygdala, as well as higher levels of brain-derived neurotrophic factor and tissue plasminogen activator when compared to age-matched wild type. Our data support the hypothesis that HIV, through gp120, may cause structural changes in the amygdala that lead to maladaptive responses to anxiety.

Disclosure of HIV Serostatus and Sexual Orientation Among HIV-Positive Men Who Have Sex with Men in China

This study addressed the issue of disclosing HIV status and sexual orientation, and explored the consequences of such disclosures among HIV-positive men who have sex with men (MSM) in China. In-depth individual interviews were conducted with 37 HIV-positive MSM. Of these participants, 3 (8.1%) disclosed neither their HIV status nor their sexual orientation to anyone; 24 (64.9%) voluntarily disclosed both their HIV-positive status and their sexual orientation; 7 (18.9%) voluntarily disclosed their HIV status only, and 3 (8.1%) involuntarily disclosed their HIV status and sexual orientation. Parents, partners, siblings and close friends were the most common disclosure targets. HIV-positive MSM were less likely to disclose their sexual orientation than their HIV status. The positive consequences of disclosure included receiving support, acquiring family care, reducing stress, improving mood and developing more positive values and beliefs. The negative consequences included the participants' perception of rejection and stigma toward themselves and their families. However, the stigma mainly comes from "outsiders" rather than family members and close friends. We did not find any differences with respect to consequences between participants who disclosed their HIV status only and those who disclosed both their HIV status and sexual orientation. In conclusion, partners, siblings and friends were main disclosure targets, and HIV positive MSM preferred to disclose their HIV serostatus than their sexual orientation. Voluntarily disclosing one's HIV status to significant others resulted in more positive consequences than negative consequences. Theses results were informative for developing mental health and coping interventions.

HIV-negative children's experiences and opinions towards parental HIV disclosure: a qualitative study in China

In HIV/AIDS research, few studies to date have evaluated ways to improve parental HIV disclosure practices using feedback from HIV negative children who have recently experienced this event. We conducted semi-structured in-depth interviews with 20 children (aged 6-15) who were partially to fully aware of their parents' HIV status in rural Guangxi, China. Of the 20 children, eight children who were of older age (11.38 years in average) endorsed parental HIV disclosure, five discouraged it, and seven expressed uncertainty. Children's different experiences and attitudes towards disclosure were seen to be associated with their family dynamics (especially the parent-child relationship), social support and care, experiences of stigma and discrimination, psychosocial suffering, comprehension of the disease, and the children's age. Our study contributes to building a child centered comprehensive understanding for Chinese parental HIV disclosure. It is imperative that counsellors and community advocates assess and help parents achieve optimal readiness preceding disclosure of their illness to their HIV negative children.

Factors influencing HIV disclosure among people living with HIV/AIDS in Nigeria: a systematic review using narrative synthesis and meta-analysis

OBJECTIVES

To critically review, appraise and evaluate quality of evidence on HIV disclosure among people living with HIV/AIDS (PLWHA) in Nigeria, and to identify a possible gap in knowledge on HIV/AIDS and disclosure.

STUDY DESIGN

A systematic review using narrative synthesis and meta-analysis.

METHODS

MedLine, PsycINFO, PubMed Central, Scopus and CINAHL were searched. Data were extracted with the use of spread sheet. An analysis of heterogeneity was performed for the disclosure rate and the presence of a supportive reaction from partners. A meta-analysis was performed for the disclosure rates to sexual partners, with data available for all ten studies.

RESULTS

Ten studies met the inclusion criteria. The outcomes show that HIV disclosure of sero-positive status is most common between spouses or sexual partners than disclosure to relatives/family members, friends, pastor/Imam or work colleagues/employers. The participants in most of these studies are women, and amongst the most influential factors on disclosure are gender, anticipated outcome, marital status and knowledge of partners' status. Some studies reported non-disclosure as a way of limiting stigma. Almost all of the studies highlighted that there is fear of stigma and social exclusion associated with disclosure.

CONCLUSION

This review discusses the overall experience of HIV disclosure on the management of the disease and barriers to disclosure. We found that PLWHA in Nigeria disclosed to at least one person within their social networks. Stigma is still a major consideration for PLWHA who experience a range of misconceptions around HIV transmission. The findings of this study may inform local policies and plans for improving the PLWHA quality of life. Targeted policies to increase disclosure of sero-positive status and reduce stigma may facilitate disease prevention. The methodological rigour of the included studies was appraised low.

Do People Know I'm Poz?: Factors Associated with Knowledge of Serostatus Among HIV-Positive African Americans' Social Network Members

We examined how functional social support, HIV-related discrimination, internalized HIV stigma, and social network structure and composition were cross-sectionally associated with network members' knowledge of respondents' serostatus among 244 HIV-positive African Americans in Los Angeles. Results of a generalized hierarchical linear model indicated people in respondents' networks who were highly trusted, well-known to others (high degree centrality), HIV-positive, or sex partners were more likely to know respondents' HIV serostatus; African American network members were less likely to know respondents' serostatus, as were drug-using partners. Greater internalized stigma among respondents living with HIV was associated with less knowledge of their seropositivity within their social network whereas greater respondent-level HIV discrimination was associated with more knowledge of seropositivity within the network. Additional research is needed to understand the causal mechanisms and mediating processes associated with serostatus disclosure as well as the long-term consequences of disclosure and network members' knowledge of respondents' serostatus.

Depression and HIV Serostatus Disclosure to Sexual Partners Among Newly HIV-Diagnosed Men Who Have Sex with Men

HIV disclosure to sexual partners facilitates joint decision-making and risk reduction strategies for safer sex behaviors, but disclosure may be impacted by depression symptoms. Disclosure is also associated with disclosure self-efficacy, which in turn may also be influenced by depressive symptoms. This study examined the relationship between depression and HIV disclosure to partners following diagnosis among men who have sex with men (MSM), mediated by disclosure self-efficacy. Newly HIV-diagnosed MSM (n=92) who reported sexual activity after diagnosis completed an assessment soon after diagnosis which measured depressive symptoms, and another assessment within 3 months of diagnosis that measured disclosure self-efficacy and disclosure. Over one-third of the sample reported elevated depressive symptoms soon after diagnosis and equal proportions (one-third each) disclosed to none, some, or all partners in the 3 months after diagnosis. Depressive symptoms were negatively associated with disclosure self-efficacy and disclosure to partners, while disclosure self-efficacy was positively associated with disclosure. Disclosure self-efficacy partially mediated the relationship between depression and disclosure, accounting for 33% of the total effect. These findings highlight the importance of addressing depression that follows diagnosis to enhance subsequent disclosure to sexual partners.

Social Support, Stigma and Disclosure: Examining the Relationship with HIV Medication Adherence among Ryan White Program Clients in the Mid-South USA

Social support from friends and family is positively related to better health outcomes among adults living with HIV. An extension of these networks such as religious communities may be an untapped source of social support for promoting HIV medical adherence. This paper explores the association of HIV medication adherence to satisfaction with support from family, friends and church members, as well as HIV-related stigma, and HIV disclosure. In partnership with the Shelby County Health Department, the Memphis Ryan White Part A Program, and the University of Memphis School of Public Health, a total of 286 interviewer-administered surveys were conducted with Ryan White clients. Seventy-six percent (n = 216) of participants reported being prescribed antiretroviral medication (ARVs). Nearly all participants (n = 202, 94%) prescribed ARVs reported disclosing their HIV status to someone. Almost 20% (n = 40) of those prescribed ARVs reported not being satisfied with support received from his/her church. Interestingly, participants reported rarely experiencing stigma as a result of their HIV status. The extent to which satisfaction with support from personal networks and institutional settings like the church affect medication adherence is yet to be understood. The complexity of HIV disclosure and HIV stigma in relation to these supports warrants further investigation to understand how best to improve HIV health outcomes.

From themes to hypotheses: following up with quantitative methods

One important category of mixed-methods research designs consists of quantitative studies that follow up on qualitative research. In this case, the themes that serve as the results from the qualitative methods generate hypotheses for testing through the quantitative methods. That process requires operationalization to translate the concepts from the qualitative themes into quantitative variables. This article illustrates these procedures with examples that range from simple operationalization to the evaluation of complex models. It concludes with an argument for not only following up qualitative work with quantitative studies but also the reverse, and doing so by going beyond integrating methods within single projects to include broader mutual attention from qualitative and quantitative researchers who work in the same field.

Living with constant suffering: a different life following the diagnosis of HIV

We used grounded theory in semi-structured interviews with 32 persons living with HIV (PLWH) in Barcelona, Spain, and found that PLWH live with constant suffering, a core category combining four realities: I need help; My life is constantly controlled; I have a new imposed life; and I have an uncertain reality. Participants described being constantly controlled by health policies and medications. They thought their lives were in the hands of others and that a new life, characterized by the constant fear of stigma, had been imposed on them. They felt they were losing freedom and vitality, as many questions remained unanswered, causing uncertainty related to health and public life. Emotional help was obtained mainly from peers and social networks. Our emergent theory shows a disruptive experience, with serious consequences to individual and social development. Health care has to focus on the real needs of PLWH to reduce suffering and uncertainty.

Efficacy of Coming Out Proud to reduce stigma's impact among people with mental illness: pilot randomised controlled trial

BACKGROUND

Facing frequent stigma and discrimination, many people with mental illness have to choose between secrecy and disclosure in different settings. Coming Out Proud (COP), a 3-week peer-led group intervention, offers support in this domain in order to reduce stigma's negative impact.

AIMS

To examine COP's efficacy to reduce negative stigma-related outcomes and to promote adaptive coping styles (Current Controlled Trials number: ISRCTN43516734).

METHOD

In a pilot randomised controlled trial, 100 participants with mental illness were assigned to COP or a treatment-as-usual control condition. Outcomes included self-stigma, empowerment, stigma stress, secrecy and perceived benefits of disclosure.

RESULTS

Intention-to-treat analyses found no effect of COP on self-stigma or empowerment, but positive effects on stigma stress, disclosure-related distress, secrecy and perceived benefits of disclosure. Some effects diminished during the 3-week follow-up period.

CONCLUSIONS

Coming Out Proud has immediate positive effects on disclosure- and stigma stress-related variables and may thus alleviate stigma's negative impact.

Coping strategies for HIV-related stigma in Liuzhou, China

This study explores the feelings, experiences, and coping strategies of people living with HIV (PLHIV) in Liuzhou, China. In a southwestern Chinese city with high HIV prevalence, we conducted semi-structured in-depth interviews with 47 PLHIV selected to represent individuals who had acquired HIV via different acquisition routes. Many participants felt severely stigmatized; they commonly reported having very low self-esteem and feelings of despair. Based on style of coping and whether it occurred at the interpersonal or intrapersonal level, four types of coping that participants used to deal with HIV-associated stigma were identified: (1) Compassion (Passive/Avoidant-Interpersonal); (2) Hiding HIV status (Passive/Avoidant-Intrapersonal); (3) Social support (Active/Problem-focused-Interpersonal; and (4) Self-care (Active/Problem-focused-Intrapersonal). Educational and stigma-reduction interventions targeting potential social support networks for PLHIV (e.g., family, close friends, and peers) could strengthen active interpersonal PLHIV coping strategies. Interventions teaching self-care to PLHIV would encourage active intrapersonal coping, both of which may enhance PLHIV quality of life in Liuzhou, China.

Double disclosure bind: complexities of communicating an HIV diagnosis in the context of unintended pregnancy in Durban, South Africa

Disclosure of HIV status is widely promoted in the prevention of mother-to-child transmission (PMTCT), but a number of context-specific factors may mediate disclosure outcomes. To better understand HIV-disclosure dynamics, we conducted in-depth interviews among 62 HIV-positive pregnant women accessing PMTCT services in Durban, South Africa. Transcripts were coded for emergent themes and categories. Thirty-nine women (63 %) had been recently diagnosed with HIV; most (n = 37; 95 %) were diagnosed following routine antenatal HIV testing. Forty-two women (68 %) reported unplanned pregnancies. Overall, 37 women (60 %) reported an unintended pregnancy and recent HIV diagnosis. For them, 2 life-changing diagnoses had resulted in a double-disclosure bind. The timing and stigma surrounding these events strongly influenced disclosure of pregnancy and/or HIV. PMTCT-related counseling must be responsive to the complex personal implications of contemporaneous, life-changing events, especially their effect on HIV-disclosure dynamics and, ultimately, on achieving better maternal mental-health outcomes.

Illness appraisals and depression in the first year after HIV diagnosis

Illness appraisals provide important context to help understand the way individuals cope with chronic illness. In the present study, a qualitative approach to the analysis of HIV diagnosis experience narratives in a sample of 100 people newly diagnosed with HIV revealed five groups that differed in their initial illness appraisals: HIV as Chronic Illness, Concern about Dying, Stigmatization, Threat to Identity, and Other Threats Overshadow HIV. When compared on quantitatively measured depressive mood, the groups differed on level and trajectory over the course of the first year post-diagnosis. Although the experience of living with HIV has changed significantly with the advent of effective Antiretroviral Therapies (ART), there were a number of similarities between the appraisals of this group of participants who were diagnosed post ART and groups who were diagnosed before ART became widely available. Posttest counselors and other HIV service providers should take individual differences in illness appraisals into account in order to help newly HIV-positive clients manage their healthcare and cope adaptively with their diagnosis.

Strategies and outcomes of HIV status disclosure in HIV-positive young women with abuse histories

Young women with HIV and histories of physical and/or sexual abuse in childhood may be vulnerable to difficulties with disclosure to sexual partners. Abuse in childhood is highly prevalent in HIV-positive women, and has been associated with poorer communication, low assertiveness, low self worth, and increased risk for sexual and other risk behaviors that increase the risk of secondary transmission of HIV. HIV disclosure may be an important link between abuse and sexual risk behaviors. Qualitative interviews with 40 HIV-positive young women with childhood physical and/or sexual abuse were conducted; some women had also experienced adult victimization. Results suggest that HIV-positive women with abuse histories use a host of strategies to deal with disclosure of HIV status, including delaying disclosure, assessing hypothetical responses of partners, and determining appropriate stages in a relationship to disclose. Stigma was an important theme related to disclosure. We discuss how these disclosure processes impact sexual behavior and relationships and discuss intervention opportunities based on our findings.