HIV/AIDS-related beliefs among Israeli Arab-Palestinian women

Measuring public attitudes towards people living with chronic diseases in Arabic-speaking populations: adaptation and development of the Social Stigma Scale of Chronic Diseases (SSS-CD)

BACKGROUND

A large proportion of the population in Arab countries suffer from chronic diseases. According to the statistics by the Global Health Estimates, chronic illnesses contribute by 71% to total deaths in the Arab region. While chronic illnesses have been demonstrated to carry high levels of social stigma, it is only recently that little research attention has been given to this topic in the Arab world. It is well-established that the social stigma construct is culturally-dependent. Therefore, the lack of an Arabic measure highlighted the urgent need for developing a culturally adapted and valid instrument to assess social stigma toward people living with chronic diseases. In this study, we aimed to examine the psychometric properties of the Arabic translation, adaptation and development of "the Social Stigma Scale of Chronic Diseases" (SSS-CD).

METHOD

Fifteen items derived from the literature and assessing social stigma towards chronic diseases have been administered to 570 Arabic-speaking adults from the Lebanese general population (aged 24.59 ± 6.75years; 68.6% women). Items were translated into Arabic using a forward-backward translation method. Exploratory factor analysis (EFA) using a principal-axis EFA on the first split-half subsample, followed by a confirmatory factor analysis (CFA) tested on the model extracted from the EFA on the second split-half subsample, were conducted to examine the construct validity of the SSS-CD. Fit indices were deemed adequate if the normed model chi-square (χ²/df) ≤ 3, the Steiger-Lind root mean square error of approximation (RMSEA) ≤ 0.08, the Tucker-Lewis Index (TLI) and the comparative fit index (CFI) ≥ 0.90.

RESULTS

Findings revealed that the 10-item SSS-CD has a unidimensional factor structure, with the following fit indices: χ²/df = 92.95/34 = 2.73, RMSEA = 0.077 (90% CI 0.059, 0.096), SRMR = 0.062, CFI = 0.939, TLI = 0.919. A good internal consistency was demonstrated by a McDonald's omega value of 0.73 for the total score. Findings also supported invariance across gender, with men exhibiting higher levels of social stigma attached to chronic diseases than women. All three dimensions of stigmatization (social, psychological and evolutionary stigmatization) were positively correlated with SSS-CD scores (Social self-interest [r = .40; p < .001], Evolutionary self-interest [r = .37; p < .001], Psychological self-interest [r = .42; p < .001]), demonstrating relatively strong convergent validity.

CONCLUSION

Our findings suggest that the SSS-CD has robust psychometric qualities. We thus preliminarily suggest that the scale is valid, reliable and suitable for use among Arabic-speaking people from the general population to measure public attitudes towards people living with chronic diseases. Providing this psychometrically sound measure will hopefully enable to foster research in this area in order to draw a clear overview of the prevalence and characteristics of social stigma attached to chronic diseases in Arabic-speaking communities. However, given that this was the first study to examine the psychometric properties of the SSS-CD, the present findings and conclusions should be considered tentative pending future cross-national validation studies.

“We are experiencing pain on our own”: mental health care to prevail over impacts of cultural silence on HIV

Purpose

This qualitative case study aims to investigate how current services meet the emotional needs of young women growing up with perinatally acquired human immunodeficiency virus (HIV). Young women (15–19 years old), caregivers and service providers were recruited through three multidisciplinary HIV management centres in Malawi.

Design/methodology/approach

In-depth interviews were used to collect data for 14 “cases” (each “case” involved a young woman, a caregiver and a service provider, for a total of 42 participants). The interviews with adolescents were conducted using an innovative visual method known as the “my story” book.

Findings

Thematic analysis revealed that young women experienced traumatic experiences and emotional neglect after being diagnosed as HIV positive. Lack of adult support networks and social isolation were identified as intersecting factors contributing to their mental distress. According to the findings of this study, HIV care should more explicitly include comprehensive mental health-care services. This provision should include ongoing individualised counselling sessions, supplemented by communication skills training to help break the prevalent cultural silence on HIV issues. Young people living with HIV, in general, and young women, are more likely to experience mental health issues than their non-infected peers. Integrating comprehensive mental health evaluation and treatment into HIV care for young people can be beneficial.

Practical implications

Mental health issues are critical and underserved challenges among young people living with perinatally acquired HIV. Women experience a higher prevalence of mental challenges than men. Integrating comprehensive mental health evaluation and treatment into HIV care for young people can be beneficial. Therefore, interventions to assist young people with mental health issues are needed within the context of HIV management in Malawi.

Originality/value

Many studies on mental health and HIV/AIDS have been conducted. However, there is very little information as regards the emotional needs of young women growing up with perinatally acquired HIV. This study fills the void.

The social construction of HIV: A narrative study of Israeli Arabs

"Social determinants of health"-that is, nonmedical care-related factors, forces, and structures that have a strong influence on health-play a vital role in HIV prevention and treatment. In this study, we focused on one such key factor: culture. Israeli Arabs, the largest minority group in Israel, share a unique culture. Although the incidence of HIV/AIDS is lower among Israeli Arabs than among Jews, Arabs account for only 1% of HIV tests in Israel and report poorer HIV-related knowledge, whereas the majority of newly diagnosed Arabs are usually diagnosed with full-blown AIDS. This study explored how HIV/AIDS is socially constructed in Israeli Arab society. A sample of 31 HIV-negative Israeli Arab participants wrote stories about a man living with HIV. Thematic analysis was used to analyze the data. The analysis identified two themes. The first, "HIV and 'forbidden' sexual practices," constructed HIV/AIDS as a sexually transmitted disease associated primarily with premarital sex (a norm transgression in Arab culture). The second theme, "living with HIV," involved two opposing subthemes: "life goes on" and "a ruined life." The former portrayed the life of men with HIV as moving on, at times into a successful future. The latter depicted the point of diagnosis as signifying a turn for the worst-a bleak and hopeless future. The findings suggest that HIV/AIDS is stigmatized among Israeli Arabs and the nature and extent of the stigma corresponds with cultural norms, stressing the importance of designing culturally informed interventions for HIV/AIDS prevention and treatment.