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Yuan GF, Qiao S, Li X, Shen Z, Zhou Y. How Does Anticipated HIV Stigma Affect Medication Adherence? A Longitudinal Path Analysis Model. AIDS Behav 2024; 28:1684-1693. [PMID: 38340222 DOI: 10.1007/s10461-024-04293-3] [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] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
Prior research has documented that anticipated HIV stigma may play an important predictive role in medication adherence among people living with HIV (PLWH). However, longitudinal data on the mechanisms underlying this linkage are scarce. The current study aimed to explore the longitudinal mediation association among anticipated HIV stigma, medication adherence support, HIV self-management, and medication adherence. A four-wave sample consisting of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20; 63.9% male) with a six-month interval was used in the current study. Participants were asked to complete self-report questionnaires. A path analysis model was analyzed. Results indicate that anticipated HIV stigma at baseline was positively related to medication adherence at Time 4 (T4). Medication adherence support at Time 2 (T2) and HIV self-management at Time 3 (T3) serially mediated the anticipated HIV stigma at Time 1 (T1) and medication adherence at T4. These findings provide critical insights into the mediating roles of medication adherence support and HIV self-management in the relationship between anticipated HIV stigma and medication adherence over time. Such an understanding has important implications for the development of tailored interventions and public health strategies aimed at improving medication adherence among PLWH in the context of HIV-related stigma.
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Affiliation(s)
- Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, Leshan, Sichuan, China.
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Shan Qiao
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
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Quality of Life and Its Association With HIV-Related Stigma Among People Living With HIV in Kerman, Iran: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2022; 33:605-612. [PMID: 36170123 DOI: 10.1097/jnc.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study aimed to evaluate the quality of life (QoL) and its association with HIV-related stigma among people living with HIV (PLHIV) in Kerman province, southeast Iran. A convenience sample of 104 PLHIV was recruited. Data on QoL were collected using the HIV/AIDS-Targeted QoL instrument. Internal and external stigma were measured using an instrument developed by UNAIDS. The average QoL score was 52.5 (SD =13.9). In multivariable model, PLHIV who experienced higher external stigma score (B = -1.9; 95% confidence interval [CI]: -2.6 to -1.1) and higher internal stigma score (B = -1.1; 95% CI: -1.5 to -0.6) had lower level of QoL. The low level of QoL among PLHIV in Iran indicates the need for initiatives to increase QoL among this population. Our data suggest that QoL in PLHIV could be improved by interventions aimed at reducing stigma in both community and health care settings.
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Older People Living with HIV Were Less Physically Active Than Their Uninfected Counterparts in China: A Matched-Sample Mediation Analysis. AIDS Behav 2022; 26:2435-2445. [PMID: 35084614 DOI: 10.1007/s10461-021-03564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/01/2022]
Abstract
The study compared the level of physical activity (PA) between older people living with HIV (PLWH) and their HIV-negative counterparts in China and tested the mediational roles of self-compassion, attitudes toward aging, and perceived stress in the between-group difference in PA. From December 2017 to August 2018, face-to-face interviews were conducted among 337 and 363 HIV-positive and -negative people aged ≥ 50 in Yongzhou City, Hunan, China. Path analysis was performed. The proportions of low, moderate, and high levels of PA in the HIV-positive and -negative groups were 18.9% versus 6.7%, 43.1% versus 32.0%, and 38.0% versus 61.3%, respectively, yielding a statistically significant difference. The path analysis showed that older PLWH reported less self-compassion and positive attitudes toward aging, which was in turn associated with more perceived stress and ultimately associated with less PA. Chinese older PLWH were more sedentary than their HIV-negative counterparts. Future PA interventions may modify the mediators.
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Hsieh E, Polo R, Qian HZ, Fuster-RuizdeApodaca MJ, Del Amo J. Intersectionality of stigmas and health-related quality of life in people ageing with HIV in China, Europe, and Latin America. THE LANCET. HEALTHY LONGEVITY 2022; 3:e206-e215. [PMID: 36098292 DOI: 10.1016/s2666-7568(22)00003-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/19/2021] [Accepted: 01/04/2022] [Indexed: 12/24/2022] Open
Abstract
People ageing with HIV face crucial challenges that can compromise their long-term health, one of which is stigma. HIV-related stigma can interact with other coexistent inequities to create a unique oppression system that results in traumatic experiences. This intersectionality of stigmas represents a new inequality that is greater than the sum of the original component inequalities. In this Series paper we review the literature regarding the intersectionality of HIV-related and ageing-related stigma and health-related quality of life among people ageing with HIV in China, Europe, and Latin America-three regions that represent distinct epidemiological and cultural trends in terms of HIV and ageing. Substantial gaps in the literature were identified, in particular a scarcity of data from Latin America. We also found inconsistencies between countries in terms of definitions and reporting practices related to people ageing with HIV. Research that fully considers the intersectional stigmas faced by this vulnerable population will contribute to advancing the United Nations 2030 Agenda for Sustainable Development.
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Affiliation(s)
- Evelyn Hsieh
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, West Haven VA Medical Center, West Haven, CT, USA
| | - Rosa Polo
- HIV, STIs, Viral Hepatitis and Tuberculosis Control Division, Ministry of Health, Madrid, Spain
| | - Han-Zhu Qian
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Maria J Fuster-RuizdeApodaca
- Departamento de Psicología Social y de las Organizaciones, Universidad Nacional de Educación a Distancia, Madrid, Spain; Spanish AIDS Interdisciplinary Society, Madrid, Spain.
| | - Julia Del Amo
- HIV, STIs, Viral Hepatitis and Tuberculosis Control Division, Ministry of Health, Madrid, Spain; Ciber de Enfermedades Infecciosas, Madrid, Spain
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Ruiz EL, Greene KY, Galea JT, Brown B. From surviving to thriving: the current status of the behavioral, social, and psychological issues of aging with HIV. Curr Opin HIV AIDS 2022; 17:55-64. [PMID: 35102052 DOI: 10.1097/coh.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite significant advances in knowledge regarding the biological and clinical issues related to aging with HIV, significantly less research has centered on related psychological, behavioral, and social issues, which are increasingly recognized as important for successfully aging with HIV. RECENT FINDINGS Barriers to successful aging include physical challenges from a sociobehavioral perspective, psychosocial challenges, and system-level challenges. In contrast, several resiliencies and interventions that help facilitate healthy aging with HIV are also emerging. Comprehensive interventions to address the physical, mental, and psychosocial needs of older people living with HIV (OPLWH) are necessary. CONCLUSION To promote healthy aging with HIV, we must utilize both clinical and biopsychosocial interventions. The lack of data on the needs of OPLWH is an important barrier to healthy aging in this population.
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Affiliation(s)
- Erik L Ruiz
- University of South Florida, College of Public Health
| | - Karah Y Greene
- University of South Florida, School of Social Work, Tampa, Florida
| | - Jerome T Galea
- University of South Florida, College of Public Health
- University of South Florida, School of Social Work, Tampa, Florida
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts
| | - Brandon Brown
- University of California, Riverside School of Medicine, Riverside, California, USA
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Armoon B, Higgs P, Fleury MJ, Bayat AH, Moghaddam LF, Bayani A, Fakhri Y. Socio-demographic, clinical and service use determinants associated with HIV related stigma among people living with HIV/AIDS: a systematic review and meta-analysis. BMC Health Serv Res 2021; 21:1004. [PMID: 34551772 PMCID: PMC8459487 DOI: 10.1186/s12913-021-06980-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 09/02/2021] [Indexed: 01/11/2023] Open
Abstract
Background Defining HIV-related stigma (HRS) can be problematic due to structural inequalities, cultural differences, discrimination by health care providers and the limitations of tools measuring stigma for people living with HIV (PLWH). This meta-analysis aimed to determine self-reported HRS and its association with socio-demographic and clinical determinants. Methods PubMed, Scopus, Web of Science, PsycInfo, SciELO and Cochrane electronic databases were searched and after reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals. Results Thirty-one studies containing 10,475 participants met the eligibility criteria. Among the potential risk factors: age > 30 years (OR = 0.93, 95%CI = 0.86, 1), living with a spouse (OR = 0.07, 95%CI = 0.02, 0.17), CD4 count < 200 (OR = 0.5, 95% CI = 0.31, 0.68), medication adherence (OR = 0.96, 95%CI = 0.94, 0.99), poor access to care (OR = 0.79, 95%CI = 0.65, 0.93), time since diagnosis, and accessibility to care (OR = 0.37, 95%CI = 0.11, 0.86) were all significantly associated with self-reported HIV stigma among PWLH. Conclusion Stigma is correlated with numerous negative consequences in marginalised populations including PLWH. Considering the negative association that stigma has on HIV prevention and treatment targeted evidence-based stigma reduction interventions are recommended. Interventions that are focused on a particular group, such as healthcare professionals are warranted. Rigorously designed studies with specific and validated outcome measures associated with targeted interventions may help to improve the reduction of HRS for PLWH.
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Affiliation(s)
- Bahram Armoon
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Marie-Josée Fleury
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.,Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC, H3A 1A1, Canada.,Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada
| | - Amir-Hossien Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Ladan Fattah Moghaddam
- Department of nursing, faculty of nursing and midwifery, Tehran medical sciences, Islamic Azad University, Tehran, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Fakhri
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Negative attitudes toward aging mediated the association between HIV status and depression among older people in mainland china. J Affect Disord 2020; 277:1005-1012. [PMID: 33065809 DOI: 10.1016/j.jad.2020.09.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/16/2020] [Accepted: 09/07/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND In China, people living with HIV (PLWH) are aging. The study compared prevalence of probable depression between older PLWH and their HIV-negative counterparts, and tested the hypothesis that the between-group difference in depressive symptoms would be mediated by attitudes toward aging. METHODS With informed consent, a cross-sectional survey was conducted via anonymous face-to-face interviews to 337 and 363 HIV-positive and HIV-negative people aged ≥50, respectively, in Yongzhou City, Hunan, China from December 2017 to August 2018. Depression was measured by the Center for Epidemiologic Studies Depression (CES-D) scale. Attitudes toward aging were measured by the Attitudes to Aging Questionnaire (subdomains: psychosocial loss, physical change, psychological growth). Bootstrapping analyses were performed to test the mediation hypothesis. RESULTS The prevalence of probable depression (CES-D ≥ 16) was significantly higher in the HIV-positive group than the HIV-negative group (44.8% versus 20.4%). The HIV-positive participants presented more negative attitudes toward aging (in psychosocial loss and physical change) than their HIV-negative counterparts. Negative attitudes toward aging were associated with more depressive symptoms. Overall attitudes toward aging (effect size=41.3%) and the subdomains of psychosocial loss (effect size=38.5%) and physical change (effect size=16.3%) partially mediated the association between HIV status and depressive symptoms, respectively. LIMITATIONS The cross-sectional design limited the ability of causal inference. Selection bias, information bias, and confounding bias might exist. CONCLUSIONS Older PLWH might be more depressed than their HIV-negative counterparts in mainland China, partially because they possessed more negative attitudes toward aging. Interventions for depression may include components of improving attitudes toward aging.
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Wu D, Huang W, Zhao P, Li C, Cao B, Wang Y, Stoneking S, Tang W, Luo Z, Wei C, Tucker J. A Crowdsourced Physician Finder Prototype Platform for Men Who Have Sex with Men in China: Qualitative Study of Acceptability and Feasibility. JMIR Public Health Surveill 2019; 5:e13027. [PMID: 31596245 PMCID: PMC6913768 DOI: 10.2196/13027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/22/2019] [Accepted: 08/19/2019] [Indexed: 12/31/2022] Open
Abstract
Background Men who have sex with men (MSM), including both gay and bisexual men, have a high prevalence of HIV and sexually transmitted infections (STIs) in China. However, healthcare seeking behaviors and engagement in clinical services among MSM are often suboptimal. Global evidence shows that embedding online HIV or sexual health services into gay social networking applications holds promise for facilitating higher rates of healthcare utilization among MSM. We developed a prototype of a gay-friendly health services platform, designed for integration within a popular gay social networking app (Blued) in China. Objective The purpose of this study was to evaluate the acceptability of the platform and ask for user feedback through focus group interviews with young MSM in Guangzhou and Shenzhen, cities in Southern China. Methods The prototype was developed through an open, national crowdsourcing contest. Open crowdsourcing contests solicit community input on a topic in order to identify potential improvements and implement creative solutions. The prototype included a local, gay-friendly, STI physician finder tool and online psychological consulting services. Semistructured focus group discussions were conducted with MSM to ask for their feedback on the platform, and a short survey was administered following discussions. Thematic analysis was used to analyze the data in NVivo, and we developed a codebook based on the first interview. Double coding was conducted, and discrepancies were discussed with a third individual until consensus was reached. We then carried out descriptive analysis of the survey data. Results A total of 34 participants attended four focus group discussions. The mean age was 27.3 years old (SD 4.6). A total of 32 (94%) participants obtained at least university education, and 29 (85%) men had seen a doctor at least once before. Our survey results showed that 24 (71%) participants had interest in using the online health services platform and 25 (74%) thought that the system was easy to use. Qualitative data also revealed that there was a high demand for gay-friendly healthcare services which could help with care seeking. Men felt that the platform could bridge gaps in the existing HIV or STI service delivery system, specifically by identifying local gay-friendly physicians and counselors, providing access to online physician consultation and psychological counseling services, creating space for peer support, and distributing pre-exposure prophylaxis and sexual health education. Conclusions Crowdsourcing can help develop a community-centered online platform linking MSM to local gay-friendly HIV or STI services. Further research on developing social media–based platforms for MSM and evaluating the effectiveness of such platforms may be useful for improving sexual health outcomes.
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Affiliation(s)
- Dan Wu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Wenting Huang
- School of Public Health, Emory University, Atlanta, GA, United States
| | - Peipei Zhao
- Social Entrepreneurship to Spur Health Global, Guangzhou, China.,Shenzhen Nanshan Canter for Chronic Disease Control, Shenzhen, China
| | - Chunyan Li
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen, China
| | - Yifan Wang
- School of Media and Communication, Shenzhen University, Shenzhen, China
| | - Shelby Stoneking
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Weiming Tang
- Social Entrepreneurship to Spur Health Global, Guangzhou, China.,Project-China, University North Carolina at Chapel Hill, Guangzhou, China.,Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Zhenzhou Luo
- Shenzhen Nanshan Canter for Chronic Disease Control, Shenzhen, China
| | - Chongyi Wei
- Department of Social and Behavior Health Sciences, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Joseph Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Social Entrepreneurship to Spur Health Global, Guangzhou, China.,Project-China, University North Carolina at Chapel Hill, Guangzhou, China
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9
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Sang JM, Matthews DD, Meanley SP, Eaton LA, Stall RD. Assessing HIV Stigma on Prevention Strategies for Black Men Who Have Sex with Men in the United States. AIDS Behav 2018; 22:3879-3886. [PMID: 29860555 DOI: 10.1007/s10461-018-2181-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The deleterious effects of HIV stigma on HIV+ Black MSM care continuum outcomes have been well-documented. How HIV stigma shapes HIV prevention for HIV- persons in this community is poorly understood. We sought to test the relationship of HIV stigma with HIV- Black MSM on HIV testing, pre-exposure prophylaxis (PrEP) awareness, and PrEP use. We recruited 772 participants at Black Pride events across five US cities in 2016. Multivariable logistic regression models assessed the association of external HIV stigma on prevention outcomes adjusting for sociodemographic variables. Stigma was positively associated with PrEP awareness (AOR = 1.34; 95% CI = 1.09, 1.66; p value = 0.005), and not associated with PrEP use or HIV testing in our sample. These findings highlight the complex nature of HIV stigma among BMSM and include results for PrEP, which can affect uptake other prevention methods. We support anti-HIV stigma efforts and advise further exploration on HIV stigma among BMSM and prevention outcomes.
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Affiliation(s)
- Jordan M Sang
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA.
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Derrick D Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven P Meanley
- Program on Sexuality, Technology & Action Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa A Eaton
- Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| | - Ron D Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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10
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Li Z, Morano JP, Khoshnood K, Hsieh E, Sheng Y. HIV-related stigma among people living with HIV/AIDS in rural Central China. BMC Health Serv Res 2018; 18:453. [PMID: 29903006 PMCID: PMC6003113 DOI: 10.1186/s12913-018-3245-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/29/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND HIV-related stigma among people living with HIV/AIDS (PLWHA) has been associated with many negative consequences, including poor adherence to therapy and undue psychological stress. However, the relative influence of specific demographic and situational factors contributing to HIV-related stigma among rural PLWHA in central China remains unknown. The aim of this study was to explore the level of HIV-related stigma among rural PLWHA across specific demographic and situational factors in central China. METHODS A cross-sectional study was conducted among PLWHA receiving care through the Chinese Centers for Disease Control of Zhenping county in Henan Province, China. Participants completed a 55-item questionnaire which included demographic and disease-related factors, HIV-related stigma was measured utilizing the validated Berger HIV Stigma Scale which has good psychometric characteristics in Chinese PLWHA. RESULTS A total of 239 PLWHA completed the survey. The mean total HIV-related stigma score was 105.92 (SD = 12.35, 95% CI: 104.34, 107.49). Multivariable linear regression analysis revealed a higher level of HIV-related stigma in younger PLWHA (β = - 0.57, 95% CI = - 0.78,-0.35, p<0.001) and those who self-reported opportunistic infections (β = 6.26, 95% CI = 1.26, 11.26, p < 0.05). CONCLUSIONS The findings in the current study suggest that rural PLWHA in central China suffer from the burden of HIV-related stigma at a moderate to high level. Younger PLWHA and PLWHA that have opportunistic infections tend to perceive a higher level of HIV stigma.
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Affiliation(s)
- Zhen Li
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Jamie P Morano
- Division of Infectious Diseases and International Medicine, University of South Florida, Tampa, FL, USA.,Yale University Center for Interdisciplinary Research on AIDS (CIRA), New Haven, USA
| | | | - Evelyn Hsieh
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yu Sheng
- Department of Basic Nursing, School of Nursing, Peking Union Medical College, Beijing, China.
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Zhang C, Li X, Liu Y, Zhou Y, Shen Z, Chen Y. Impacts of HIV Stigma on Psychosocial Well-Being and Substance Use Behaviors Among People Living With HIV/AIDS In China: Across the Life Span. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:108-119. [PMID: 29688775 PMCID: PMC6056313 DOI: 10.1521/aeap.2018.30.2.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To date, existing studies have indicated that stigma against people living with HIV/AIDS (PLWHA) negatively affects their psychosocial well-being, and the impact may differ by age. In the current study, we aim to assess the impact of various types of stigma on PLWHA's psychological status and concomitant substance use. We explored different types of HIV stigma with psychosocial well-being and substance use employing mixed effect models among 2,987 Chinese PLWHA. Multivariate analyses revealed that each type of HIV stigma is positively associated with psychosocial distress, but negatively related to resilience and self-esteem across all age groups of PLWHA, with enacted stigma showing the strongest impact. Stigmatized PLWHA are more likely to smoke and use drugs, especially among the < 35 and 35-49-year-old groups. Age-specific interventions should be implemented to enhance PLWHA's stigma coping skill for improving their psychological health and reducing substance use in China and worldwide.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester, Rochester, New York
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Yu Liu
- Division of Public Health Science, School of Medicine and Dentistry, University of Rochester
| | - Yuejiao Zhou
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
| | - Zhiyong Shen
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
| | - Yi Chen
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
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12
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Access to HIV Care and Resilience in a Long-Term Conflict Setting: A Qualitative Assessment of the Experiences of Living with Diagnosed HIV in Mogadishu, Somali. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070721. [PMID: 28678166 PMCID: PMC5551159 DOI: 10.3390/ijerph14070721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 01/22/2023]
Abstract
Background: Human Immunodeficiency Virus (HIV) continues to take a heavy toll on the lives of many people, with the worst impact on health and wellbeing for the affected individuals in fragile states. The HIV situation in Somalia is not clearly known and experiences of the people living with HIV in this war-torn region are often unexpressed. This pilot qualitative study sought to explore the experiences of people diagnosed with HIV living in Mogadishu, and their resilience in access to care and social support. Methods: Participants were recruited through drug dispensers at the HIV clinic in Banadir Hospital. Face-to-face in-depth interviews were conducted in Somali in May 2013 among patients who were receiving antiretroviral therapy (ART) from the HIV clinic in Mogadishu. These were tape-recorded, transcribed, and translated for content analysis. Results: Three women and four men who were living with HIV shared the following narratives. Their perception was that they had either got HIV from their spouses or through health care contamination. They were very knowledgeable about the realities of HIV, how the medication works, nutritional requirements, and drug adherence. They were always willing to go an extra mile to secure a good life for themselves. However, the external HIV stigma impacted their access to care. They faced challenges in their homes and at work which compelled them to seek support from non-governmental organizations (NGOs) or close family members. This stigma often affected their disclosure to the wider community due to the uncertainty of the repercussions, leading to a life of extreme loneliness and financial difficulties. The participants’ coping mechanisms included living together and starting their own NGO for support with very strong optimism about their prognosis. Conclusions: The people diagnosed with HIV living in Mogadishu are highly knowledgeable about HIV transmission, the realities of living with a diagnosed HIV infection, and the efficacy of HIV treatment. Our small sample suggests adequate access to ART through NGOs. However, widespread HIV stigma limits HIV status disclosure to families and communities, which creates a risk of self-isolation and ill health. Still, affected individuals have developed resilient mechanisms for managing the risks. They strive to remain employed for economic security, adhere to HIV treatment, engage in support groups, and maintain the utmost optimism about their prognosis.
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13
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Zhang C, Li X, Liu Y, Qiao S, Zhang L, Zhou Y, Tang Z, Shen Z, Chen Y. Stigma against People Living with HIV/AIDS in China: Does the Route of Infection Matter? PLoS One 2016; 11:e0151078. [PMID: 26981636 PMCID: PMC4794244 DOI: 10.1371/journal.pone.0151078] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/23/2016] [Indexed: 11/19/2022] Open
Abstract
In the current study, we tested the hypothesis that people who contracted HIV from “blameless” routes (e.g., blood transfusion, sex with stable partners) are less stigmatized compared to people who contracted HIV from “blamable” routes (e.g., injection drug use, sex with sex workers). A cross-sectional study was conducted among 2,987 participants in Guangxi province, China, between 2012 and 2013. We employed both explanatory and predictive modeling strategy by using multivariate linear regression models. In the explanatory models, we assessed the association between routes of infection and three types of stigma (perceived, internalized, and enacted). From identified routes of infection that significantly contributed to higher stigma, we employed predictive modeling to explore predictors for the specific type of stigma. Multiple-imputation was employed for sensitivity analyses. Of the total sample, 63% were male and the average age was 42.9 years (ranged between 18 and 88). Multivariate regression models revealed that contraction from commercial sex increased the perceived (β = 0.46, 95%CI = 0.02, 0.90) and internalized stigma (β = 0.60, 95%CI = 0.09, 1.10), while injecting drug use increased the perceived (β = 0.65, 95%CI = 0.07, 1.22) and enacted stigma (β = 0.09, 95%CI = 0.02, 0.16) after controlling for confounders. Among PLWHA who were infected via commercial sex partners, social support was negatively associated with perceived (β = -0.47, 95%CI = -0.79, -0.14) and internalized stigma (β = -0.80, 95%CI = -1.24, -0.35). Among PLWHA who were infected via injecting drugs, no adherence to antiretroviral treatment (β = 0.41, 95%CI = 0.01, 0.82) was positively associated with perceived stigma, and disclosure of serostatus to others was negatively associated with enacted stigma (β = -0.20, 95%CI = -0.34, -0.05). Knowledge of the association between routes of infection and stigma can guide health professionals and policy makers to develop tailored intervention strategies to mitigate the effects of stigma and enhance HIV care utilization among PLWHA in China.
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Affiliation(s)
- Chen Zhang
- Divison of Epidemiology, Vanderbilt University, Nashville, Tennessee, United State of America
- * E-mail:
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United State of America
| | - Yu Liu
- Divison of Epidemiology, Vanderbilt University, Nashville, Tennessee, United State of America
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United State of America
| | - Liying Zhang
- Department of Pediatrics, Wayne State University, Detroit, Michigan, United State of America
| | - Yuejiao Zhou
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
| | - Zhenzhu Tang
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
| | - Zhiyong Shen
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
| | - Yi Chen
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
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De Jesus M, Carrete C, Maine C, Nalls P. Attitudes, perceptions and behaviours towards HIV testing among African-American and East African immigrant women in Washington, DC: implications for targeted HIV testing promotion and communication strategies. Sex Transm Infect 2015; 91:569-75. [PMID: 25897146 DOI: 10.1136/sextrans-2014-051876] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/04/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The objective of the study was to examine and compare the HIV testing attitudes, perceptions and behaviours between African-American and East African immigrant women in the Washington, DC metropolitan area. METHODS Adopting an inductive, qualitative methodological approach, we conducted a total of 40 in-depth, semistructured interviews between October 2012 and March 2013. Qualitative thematic analysis was used to analyse the data. RESULTS Overall, African-American women held more favourable views towards HIV testing than East African immigrant women. Very few East African immigrant women sought HIV testing intentionally. The majority of East African participants were tested inadvertently, while others tested for immigration-related or employment-related purposes. There were many barriers that impede women from seeking an HIV test including negative assumptions (eg, "Getting an HIV test implies that I am HIV positive"), negative emotions (eg, "Fear of being diagnosed with HIV and what this will mean for me") and potential negative reactions from partner or others (eg, "Getting an HIV test can signal distrust, disrespect, or infidelity"). There were nuances in how each group articulated some of these barriers and East African women expressed unique concerns that originated from experiences in their home countries. CONCLUSIONS The study shed light into the complexity of factors that constrain women from presenting themselves voluntarily for an HIV test and highlighted the nuances between African-American and East African perceptions. Implications of findings for effective targeted HIV screening promotion and communication strategies among these groups of women are discussed.
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Affiliation(s)
- Maria De Jesus
- School of International Service, American University, Washington DC, USA Center on Health, Risk, and Society, American University, Washington DC, USA
| | - Claudia Carrete
- School of International Service, American University, Washington DC, USA
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15
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Liu H, He X, Levy JA, Xu Y, Zang C, Lin X. Psychological Impacts among Older and Younger People Living with HIV/AIDS in Nanning, China. J Aging Res 2014; 2014:576592. [PMID: 25132993 PMCID: PMC4123477 DOI: 10.1155/2014/576592] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 07/06/2014] [Indexed: 11/21/2022] Open
Abstract
Objectives. The HIV epidemic has drastically increased among older adults in China, yet little research has examined the psychological impacts among older and younger people living with HIV/AIDS (PLWHAs). This study examined and compared self-efficacy, depression, well-being, and quality of life among older and younger PLWHAs in China. Method. A two-stage sampling procedure was used to recruit a final sample of 148 participants. Older adults were defined as age 50 and older. Result. Compared to younger PLWHAs aged 18-49 years old, older PLWHAs reported lower levels of well-being (7.6 versus 11.4), higher levels of depression (18.6 versus 15.8), and poorer quality of life. Self-efficacy was similar among older (23.9) and younger (24.6) PLWHAs. A higher level of depression among older PLWHAs was associated with much lower levels of subjective well-being and quality of life (physical health and psychological health). Conclusion. The findings suggest that older PLWHAs face psychological problems and mental health challenges beyond those experienced by younger PLWHAs. Intervention programs dedicated to improving mental health and quality of life are greatly needed for HIV infected older adults.
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Affiliation(s)
- Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD 20742, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD 20742, USA
| | - Judith A. Levy
- Health Policy and Administration, School of Public Health, University of Illinois, Chicago, IL 60612, USA
| | - Yongfang Xu
- Nanning Center for Disease Control and Prevention, Nanning 530023, China
| | - Chunpeng Zang
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD 20742, USA
| | - Xinqin Lin
- Nanning Center for Disease Control and Prevention, Nanning 530023, China
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