Associations between perceived HIV stigma and quality of life at the dyadic level: the actor-partner interdependence model

Association between stigma and quality of life among chronic refractory wounds patients and informal caregivers: an actor-partner interdependence model analysis

PURPOSE

The co-occurrence of health impairments in patients and their informal caregivers may be particularly common in intimate care settings in China. Patients with Chronic Refractory Wounds (CRWs) and their informal caregivers constitute a dyad and exhibit dyadic effects during the caring process. Unfortunately, no study has yet explored the dyadic effects of stigma on the QoL of patients with CRWs and their caregivers.

METHODS

We used a convenience sampling method and recruited CRWs patient-caregiver dyads (N = 207) in China between April 2022 and October 2023.

RESULTS

We found that: (i) dyadic members experience varying degrees of stigma; (ii) the actor-partner effect of CRWs patients' stigma on their own and their informal caregivers' QoL was significant (Path A1: β = - 1.27, Path A2: β = - 0.37, Path P1: β = - 0.08, Path P2: β = - 0.18); (iii) informal caregivers' stigma adversely affects both their own and their patients' psychological QoL((Path A4: β = - 0.65, Path P4: β = - 0.52)). Informal caregivers' stigma can negatively impact patients' physical QoL (Path P3: β = - 0.17), whereas it does not significantly affect their own physical QoL.

CONCLUSION

There is a notable actor-partner effect of the CRWs patients' stigma on their own and their informal caregivers' QoL. CRWs patients' stigma should become a priority for the government to improve CRWs patients' and informal caregivers' QoL. Besides, health professionals should be addressing several assessments and interventions to decrease informal caregivers' affiliate stigma symptoms and improve CRWs patients' and informal caregivers' QoL.

Impulsive Decision-Making, Affective Experiences, and Parental History of Self-Injurious Thoughts and Behaviors within Parent-Adolescent Dyads

Impulsive decision-making, particularly during states of affective intensity, is associated with greater risk of engagement in self-injurious thoughts and behaviors (SITBs) during adolescence. The proximal (dyadic parent-adolescent affect and impulsivity) and distal (family history of SITBs) risk factors that occur within the family system could be relevant processes at stake in the intergenerational transmission of risk. The current study tests the interdependence of parent-adolescent factors associated with risk for SITBs and probes the extent to which parent-adolescent affective states influence their own (actor-effects) and each other's (partner-effects) impulsive decision-making, and further whether these relationships are moderated by a parent's history of SITBs. Participants included 212 (106 dyads) community parents and their adolescents who completed self-report and behavioral tasks related to positive and negative affective states, impulsive decision-making, and lifetime history of SITBs. Application of the Actor-Partner Interdependence Model (APIM) revealed a partner-effect where greater parent negative affect in the past week was associated with elevated adolescent impulsive decision-making among families with a history of SITBs (Estimate = 0.66, Standard Error = 0.13, p < 0.001). In addition, a significant actor-effect was observed where greater positive affect was associated with decreased impulsive decision-making among adolescents (Estimate = -0.21, Standard Error = 0.10, p = 0.03), however, moderating effects of parent history of SITBs were not detected. Findings from the present study shed light on the interdependence of affect and impulsivity within parent-adolescent dyads, and the extent to which these interactions may be particularly salient for families with known vulnerabilities for SITBs.

Alcohol Use, HIV Stigma and Quality of Life Among Alcohol Consuming Men Living with HIV in India: A Mediation Analysis

This study examined the hypothesis that HIV-related stigma mediates the effect of alcohol use on health-related quality of life (HRQoL) among alcohol consuming Indian men living with HIV (PLWH). The study used baseline data from a randomized controlled clinical trial entitled 'Alcohol and ART adherence: Assessment, Intervention, and Modeling in India. Participants completed surveys assessing demographic characteristics, alcohol use, HIV-related stigma, HRQoL. Mediation analysis was conducted to establish the mediation effect of HIV-related stigma on the relationship between alcohol use and HRQoL. The final mediation model showed that the effect of alcohol use on HRQoL were partially mediated by overall HIV-related stigma. Specially, 27.1% of the effects of alcohol use on HRQoL was mediated through overall HIV stigma. In the HIV stigma subdomain analyses, negative self-image mediated 14% and concerns with public attitudes (anticipated stigma) mediated 17.3% of the effect of alcohol use on HRQoL respectively. The findings suggest that efforts to reduce the negative impact of alcohol use on HRQoL and improve HRQoL among PLWH should include interventions addressing both alcohol use and specific forms of HIV-related stigma.

A Dyadic Analysis of Criminal Justice Involvement and Sexual HIV Risk Behaviors Among Drug-Involved Men in Community Corrections and Their Intimate Partners in New York City: Implications for Prevention, Treatment and Policies

People in community corrections have rates of HIV and sexual risk behaviors that are much higher than the general population. Prior literature suggests that criminal justice involvement is associated with increased sexual risk behaviors, yet these studies focus on incarceration and use one-sided study designs that only collect data from one partner. To address gaps in the literature, this study used the Actor Partner-Interdependence Model with Structural Equation Modeling (SEM), to perform a dyadic analysis estimating individual (actor-only) partner-only, and dyadic patterns (actor-partner) of criminal justice involvement and greater sexual risks in a sample of 227 men on probation and their intimate partners in New York City, United States. Standard errors were bootstrapped with 10,000 replications to reduce bias in the significance tests. Goodness of fit indices suggested adequate or better model fit for all the models. Significant actor-only relationships included associations between exposures to arrest, misdemeanor convictions, time spent in jail or prison, felony convictions, lifetime number of incarceration events, prior conviction for disorderly conduct and increased sexual risk behaviors. Partner only effects included significant associations between male partners conviction for a violent crime and their female partners' sexual risk behaviors. Men's encounters with police and number of prior misdemeanors were associated with their own and intimate partners' sexual risk behaviors. Women's prior arrest was associated with their own and intimate partners' sexual risk behaviors. The results from the present study suggest that men on probation and their intimate partners' criminal justice involvement are associated with increased engagement in sexual risk behaviors. It is necessary to conduct greater research into developing dyadic sexual risk reduction and HIV/STI prevention interventions for people who are involved in the criminal justice system.

Experiences and needs of family support for HIV-infected Asian Americans: A qualitative dyadic analysis

BACKGROUND

When coping with HIV-related challenges, family support is the first line that Asian Americans living with HIV (AALHIV) lean on; however, few studies have explored the dyadic aspects of family support among AALHIV. We aimed to explore the dyadic aspects of family support among AALHIV and their family caregivers.

METHODS

From September 2017 to January 2020, we recruited 18 dyads among AALHIV and their caregivers in Los Angeles and New York City by the purposive sampling method. Using qualitative dyadic analysis of semi-structured, in-depth interviews, we explored dyadic aspects of family support among participants based on Fitch's Supportive Care Framework.

RESULTS

We found that AALHIV obtained support from family caregivers to cover the domains of their physical, psychological, spiritual, informational, social, and practical supportive care. This dyadic analysis indicated congruence in most supportive care; however, there were also dissimilar in the support perceptions.

CONCLUSIONS

Our findings exemplify the physical, psychological, spiritual, informational, social, and practical support from AALHIV and their family caregivers. When developing a culturally sensitive intervention for AALHIV, we need to consider the different aspects of the support. Especially, family support can enhance patients-providers' relationships as well as health engagement with HIV care.

Application of the actor-partner interdependence model in parent-adolescent emotion regulation and depression

BACKGROUND

The family environment is an important context for the development and maintenance of depressive symptoms within families. In this study, we evaluated whether parent and adolescent self-reports of emotion regulation constructs are linked with their own (actor effects) and each other's (partner effects) depressive symptoms.

METHODS

Participants were 123 adolescent-parent dyads, recruited from adolescent inpatient and partial hospitalization programs, who completed self-report assessments of emotion dysregulation and depression.

RESULTS

Using the Actor-Partner Interdependence Model (APIM), results revealed expected actor effects for emotion regulation strategies, but not impulsiveness. A significant partner effect for parents' impulsiveness and adolescents' depressive symptoms was observed, demonstrating the interdependent nature of these characteristics in the sample. Interpretation of APIM model coefficients indicated that greater parent impulsiveness was associated with less adolescent depression symptom severity.

LIMITATIONS

Limitations include a small sample of primarily Caucasian adolescents who were receiving intensive psychiatric services making generalizability more challenging. The sample also consisted of largely mothers which is important to consider given there are known gender differences in rates of depression and sensitivity to interpersonal processes.

CONCLUSIONS

Overall, findings shed light on the nature of these characteristics within the families of depressed adolescents and the role of emotion regulation in the parent-child relationship. Implications of this work and future studies are discussed.

Quality-of-Life (QoL) of Indonesian Children Living with HIV: The Role of Caregiver Stigma, Burden of Care, and Coping

Background

Treatment of children with HIV infection has increased rapidly by increasing the life span of HIV patients from baby to adult. Improving the quality-of-life (QoL) in children living with HIV is a priority of HIV management in children and caregivers of children living with HIV have important roles. Caregiver stigma, caregiver burden, and caregiver coping affect caregivers in treating children living with HIV.

Objective

Analyzing the association of caregiver stigma, caregiver burden, and caregiver coping on QoL of Indonesian children living with HIV.

Methods

Participants in this study were caregivers of Indonesian children living with HIV. Participants were measured for caregiver stigma, caregiver burden, caregiver coping, and QoL of Indonesian children living with HIV. The instrument used in measuring caregiver stigma was people living with HIV/AIDS and caregiver questionnaire, caregiver burden used Zarit Burden questionnaire, caregiver coping used F-COPES questionnaire, and QoL used PedsQL for children aged 2-18 years old. Measurement data were analyzed using logistic regression and independent t tests with P<0.05.

Results

Indonesian children living with HIV in this study had an average age of 7.7±3.68 years and average participant age of 40.2±11.26 years. All participants stated that Indonesian children living with HIV tend to keep their health status confidential. Most QoL of Indonesian children living with HIV was good (71.7%), caregiver stigma value was 21.7±2.06, and caregiver burden level was moderate, of 50.9%. However, there was no significant association between caregiver stigma (β=0.064; P=0.548) and burden level (β=0.058; P=0.593) on QoL. On the other hand, caregiver coping value was 77.2±7.30, and there was a significant association of caregiver coping on QoL (β=-0.196; P=0.049).

Conclusion

There is an association of caregiver coping on QoL of Indonesian children living with HIV, in which the higher the caregiver coping, the lower the QoL. Meanwhile, there is no significant association of caregiver stigma and burden on QoL of Indonesian children living with HIV.

HIV Disclosure Patterns and Psychosocial Correlates Among People Living with HIV in Nanjing, China: A Latent Class Analysis

Little is known about the patterns of HIV disclosure and the predictors of such group memberships. Therefore, our study aimed to explore the relationship between HIV disclosure patterns and psychosocial factors. From July to August 2016, totally 466 people living with HIV (PLWH) were recruited from a tertiary hospital. Latent class analysis was performed to ascertain HIV disclosure patterns, and multinomial logistic regression was used to examine predictors of HIV disclosure patterns. Four classes were identified and characterized as the systematic disclosure (11.2%), systematic concealment (39.5%), disclosure to spouse (29.0%), and disclosure to parents (20.4%). Relative to the systematic concealment class, respondents of the systematic disclosure and disclosure to spouse classes were more likely to report a high level of social support (adjusted odds ratio (aOR) = 1.112, 95% CI = 1.039-1.189; aOR = 1.144, 95% CI = 1.084-1.208). PLWH in the disclosure to spouse class tended to have increased perceived stigma (aOR = 1.040, 95% CI = 1.008-1.073). These findings provide practical implications for effective intervention targeting the different subgroups. Urgent attention should be paid to perceived stigma and social support to encourage PLWH to disclose their HIV status.

The relationship between stigma, religiosity, and the quality of life of HIV-positive MSM in Medan, Indonesia

OBJECTIVE

This study aims to determine the relationship between stigma, religiosity, and the quality of life of HIV-positive men who have sex with men (MSM) in Medan.

METHODS

This is an analytical observational study with a cross-sectional approach. Data in demographics, stigma, religiosity, and quality of life were obtained directly from the participants. Data were taken from April to May 2018. There were 175 subjects who met the criteria which; (i) HIV-positive MSM; (ii) aged≥18 y.o.; and (iii) able to read and write.

RESULTS

Bivariate analysis found that there is a negative relationship between stigma and quality of life (p-value=0.007), and there is a positive relationship between religiosity and quality of life (p-value=0.000).

CONCLUSION

These findings suggest that stigma is an indicator of poor quality of life, while higher religiosity is associated with better quality of life. An interdisciplinary approach is needed in health care planning and social services, to improve the quality of life of HIV-positive MSM.

The impacts of depression and anxiety on quality of life among patients with HIV/AIDS and their spouses: testing dyadic dynamics using the actor-partner interdependence model

HIV/AIDS not only affects the patients, but also their entire family. This study aimed to assess the impacts of the patients' and their spouses' anxiety and depression on their quality of life (QoL) at the dyadic level. A total of 120 serodiscordant husband-wife dyads from the voluntary counselling and testing center in Shiraz, Iran, were involved in this study from February to June 2015. The WHOQOL-BREEF, CESD-10, and Beck Anxiety Inventory instruments were used, respectively, to assess the QoL, depression, and anxiety scores of the participants. The actor-partner interdependence model (APIM) was used to estimate the effects of depression and anxiety of both the people living with HIV/AIDS (PLWHA) and their spouses on their own QoL (actor effect) as well as their partners' (partner effect). The APIM analysis revealed that both PLWHAs' and their spouses' depression and anxiety showed actor effects on their own QoL. Furthermore, spouses' depression showed a significant partner effect on PLWHAs' QoL and PLWHAs' anxiety had significant partner effects on spouses' QoL. Accordingly, this data can be used to develop targeted interventions aimed at guidance and assistance of PLWHAs and their spouses to find coping strategies that improve their own QoL as well as their partners'.

'We are the change' - An innovative community-based response to address self-stigma: A pilot study focusing on people living with HIV in Zimbabwe

Introduction

Self-stigma–negative self-judgements resulting in shame, worthlessness and self-blame–may play a crucial role in emotional reactions and cause emotional distress among many people living with HIV and other chronic illnesses. Furthermore, self-stigma negatively impacts on self-agency, quality of life, adherence to treatment, and access to services. High levels of self-stigma have been reported across many countries, however few programmes or interventions exist to specifically tackle this phenomenon. This paper reports the findings of a pilot study carried out in Zimbabwe using a programme incorporating “Inquiry-Based Stress Reduction (IBSR): The Work of Byron Katie”–a guided form of self-inquiry which helps users to overcome negative thoughts and beliefs.

Objectives

The primary objective of this uncontrolled pilot study was to examine the potential role of the IBSR intervention in helping people living with HIV to overcome self-stigma and associated states.

Methods

23 people living with HIV (17 Female, 6 male, average age 41 years) were recruited from a local HIV support network, via open call for volunteers. All participants received the intervention, consisting of a 12-week facilitated programme using techniques derived from IBSR: The Work of Byron Katie. Qualitative and quantitative data were collected and analysed pre- and post-programme.

Results

After taking part in the intervention, participants reported significant improvements in factors including self-stigma (1-month follow-up vs baseline Z = 2.1, p = 0.039; 3-month follow-up vs baseline Z = 3.0, p = 0.003, n = 23, Wilcoxon Matched Pairs Signed Rank Test) and depression (1mo vs baseline Z = 3.7, p = <0.001; 3mo vs baseline Z = 3.3, p = 0.001). Qualitatively, participants reported improvements including lessened fears around disclosure of their HIV status, reduced feelings of life limitations due to HIV, and greater positive mentality. Improvements persisted at three-month follow-up.

Conclusion

With further development and larger comparative studies to confirm effects, the IBSR programme could become a novel tool to enable people living with HIV to support themselves in overcoming self-stigma.

Individual and family level factors associated with physical and mental health-related quality of life among people living with HIV in rural China

Background

One of the major challenges faced by people living with HIV (PLH) is the compromised quality of life due to the negative impact of HIV on their health. HIV/AIDS control effort should go beyond laboratory and lay more emphasis on improving the health-related quality of life (HRQoL) for PLH. The objective of this study is to evaluate the physical and mental HRQoL of PLH in rural China, and explore the relationship between HRQoL and individual- and family-level factors.

Methods

A cross-sectional study was conducted among 522 PLH in Anhui, China. Participant’s sociodemographic characteristics, family status, and HIV-related factors were collected. Physical health summary score (PHS) and mental health summary score (MHS) of quality of life were measured. Multiple linear regressions were conducted to estimate the association of the individual- and family-level factors with MHS and PHS.

Results

Male were more likely to report a higher level of PHS and MHS than female (β = 0.123, P = 0.009; β = 0.150, P = 0.002). Age was significantly negatively associated with the PHS (β = − 0.232, P<0.001) when other variables were controlled. Family size remained negatively correlated with PHS (β = − 0.105, P = 0.021). Family annual income was significantly positively associated with PHS and MHS (β = 0.126, P = 0.003; β = 0.135, P = 0.002).

Conclusions

Future intervention should be carefully tailored to the specific needs of sub-populations (such as female and older PLH) considering their physical and mental HRQoL conditions. More attention and care should be provided to PLH with left-behind children in the family.

The experience and management of HIV stigma among HIV-negative adults in heterosexual serodiscordant relationships in New York City

Despite treatment advances that have improved the health and life expectancy of HIV-positive people and contribute to the prevention of HIV transmission, HIV stigma is still frequently experienced by HIV-infected individuals and those close to them. This study investigated the types of HIV-related stigma experienced by HIV-negative adults in serodiscordant heterosexual relationships when their partner's HIV-positive status was revealed to family and friends and their strategies to manage such stigma. In-depth interviews were conducted in New York City with 56 men and 44 women who were HIV negative and had been in a relationship for at least six months with an HIV-positive partner of the opposite sex. Those who had disclosed the HIV status of their partner to family or friends experienced four main types of stigmatizing behaviours: distancing (avoidance of the participant or his/her partner for fear of infection), depreciation of the partner (being told their partner is not worthy of them), violation of privacy (people spreading the information that the partner is HIV positive), or accusations (being told that it was wrong to be in a relationship with HIV-positive people or to try to conceive with them). Participants described four main ways of managing actual or anticipated stigma: secrecy (not disclosing the HIV status of their partner to anyone), avoidance (breaking ties with people who held stigmatizing views), seeking support from their partner or the HIV-positive community (e.g., HIV-related organizations or their partner's family or friends), or education (informing family or friends about HIV treatment and prevention). Findings show that HIV-related "courtesy" stigma is frequently experienced by HIV-negative people in serodiscordant relationships but often can be managed. Offering support to individuals in serodiscordant relationships can improve the quality of life of HIV-positive people and their HIV-negative partners and potentially reduce HIV stigma.

Family Cohesion, Stigma, and Quality of Life in Dyads of Children With Epilepsy and Their Parents

Objective

To examine the mediating role of stigma on the links between family cohesion and quality of life (QoL) in children with epilepsy and their parents. Participants were 192 families attending three Portuguese public hospitals. Children and parents completed self-report measures of family cohesion, stigma, QoL, and health-related QoL (HRQoL). Neurologists assessed clinical variables. Structural equation modeling within the framework of the actor-partner interdependence model was used. The final model showed a good fit to the data, explaining 43% and 35% of the QoL outcomes of children and parents, respectively. Family cohesion was positively linked to QoL outcomes, directly for children and parents, and indirectly for children only, by way of negative links with perceived stigma. At the dyadic level, parents' perceptions of family cohesion were positively associated with children's HRQoL. A routine screening of those patients experiencing poorer HRQoL should include the assessment of family relationships and stigma.

Independent and synergistic effects of self- and public stigmas on quality of life of HIV-infected persons

Stigma has a potential impact on the quality of life of HIV-infected individuals over time. There is little empirical evidence regarding the first appearance and dynamic changes among different types of stigma, self-stigma and public-stigma, and their impacts on quality of life over time in HIV-infected persons. The purpose of this study was to assess the dynamic changes in self-stigma and public-stigma along the time course and determined their independent and synergistic impacts on quality of life. A Cross-sectional study was conducted at Two HIV-designed hospitals and two branches of non-government an-AIDS organizations in Wes Java, Indonesia. Persons diagnosed with HIV completed self-report measures of stigma and the questionnaire of World Health Organization Quality of Life (WHOQOL)-HIV brief version. Kernel smoothing method and multivariate linear regression were applied for statistical analysis. Two hundred fifteen adult HIV-infected persons agreed to participate in this study, with a response rate of 85.3%. The kernel smoothing means showed that one-third of subjects developed self-stigma immediately after HIV diagnosis while a higher public-stigma felt 6 months later, and both seemed to last continually. Beginning at about 48 months after diagnosis, participants with stigma showed consistently lower scores for all domains of quality of life. After control of potential confounding through multiple linear regression analyses, we found scores of all four domains and items of mobility, fatigue, activity of daily living, positive feeling, self-esteem, social support, and physical environment of WHOQOL were independently associated with both self-stigma and public-stigma. While self-stigma also affects items related to personal psychological feelings, public stigma alone associates with lower scores of items related to social and environmental domains. Our findings underscore the need to explore and control the complex structure and possible synergistic effects of multiple stigmatizations.

Complex Problems, Care Demands, and Quality of Life Among People Living With HIV in the Antiretroviral Era in Indonesia

People living with HIV (PLWH) suffer from physical and psychological distress that palliative care could alleviate. Our cross-sectional study identified HIV-related problems and demands for palliative care at different disease stages, and their interactions with quality of life (QOL) in 215 PLWH from a referral hospital and an AIDS nongovernmental organization in Indonesia. A brief survey of demographic information, the Bahasa version of Problems and Needs of Palliative Care, and the World Health Organization Quality of Live in HIV-infected Persons instrument (WHOQOL-HIV BREF; Cronbach's alpha = .89) were used for data collection. Mean age was 33.5 years (SD = 4.7); 66% were male. Fatigue (67%) was the most prevalent symptom, and the symptom sleeping problems (54.9%) was the priority for palliative care. Higher spiritual and financial demands were found in PLWH with stage IV HIV. Multivariable analysis indicated negative associations between QOL and psychosocial problems, and demands for social and financial support. Interventions focused on psychosocial issues would improve the QOL for PLWH.

Stigmatization among people living with HIV in Hong Kong: A qualitative study

Background

HIV/AIDS is one of the most stigmatized medical conditions across the world. Self‐stigma is prevalent among people living with HIV (PLHIV) and a major obstacle to HIV prevention and care.

Objective

This study aimed to describe the experiences of stigmatization and explore the possible factors that might be associated with stigmatization among PLHIV in Hong Kong.

Design

Qualitative in‐depth interviews were conducted.

Setting and participants

15 PLHIV were recruited from two local non‐governmental organizations on HIV prevention.

Main variables studied

Participants were interviewed about their views and feelings towards oneself as a PLHIV and contributing factors, experiences of discriminations, stigmatizing behaviours, issues about disclosure, social relationships and potential impact of HIV.

Results and conclusions

Thematic analyses revealed three levels of factors which might be associated with stigmatization: (i) intrapersonal level (misconceptions about HIV, attribution of self‐responsibility, severe state of illness, side‐effects of medication), (ii) interpersonal level (discrimination, social rejection) and (iii) social level (mass media, public stereotypes). Findings provide important insights into which interventions to reduce stigmatization of PLHIV could be designed.

Stigmas, symptom severity and perceived social support predict quality of life for PLHIV in urban Indian context

Background

Multiple variables have been studied in relation to health-related quality of life (HRQoL), but research has not integrated the contributions of different variables in a single model that allows to compare them. This study, carried out with people living with HIV/AIDS in India, sought to develop a prediction model considering various predictors previously found to be related to HRQoL, namely sociodemographic factors, HIV symptoms, social support, stigmas and avoidant coping.

Methods

A sample of 961 HIV-positive persons from Bengaluru and Mumbai participated in this cross-sectional study, completing a sociodemographic questionnaire along with HRQoL, HIV symptoms, disclosure expectations, disclosure avoidance, social support and internalized, felt, vicarious and enacted stigma scales. Bivariate associations were obtained (correlations, ANOVAs and t tests) and a multiple regression analysis was performed.

Results

Results show that, when all variables are considered together, being married, widowed or deserted, symptom intensity, internalized stigma, disclosure avoidance and enacted stigma contribute negatively to predict HRQoL. On the other hand, being employed, good disclosure expectations and good social support contribute positively to predict HRQoL. Almost half of the variance in HRQoL was explained by this model.

Conclusions

Interventions seeking to increase HRQoL in people living with HIV/AIDS in India would benefit from addressing these aspects.

Ageism, resilience, coping, family support, and quality of life among older people living with HIV/AIDS in Nanning, China

Although the HIV epidemic continues to spread among older adults over 50 years old in China, little empirical research has investigated the interrelationships among ageism, adaptability, family support, and quality of life among older people living with HIV/AIDS (PLWHAs). In this cross-sectional study, among 197 older PLWHAs over 50 years old, path analytic modelling was used to assess the interrelationships among ageism, resilience, coping, family support, and quality of life. Compared with female PLWHAs, male PLWHAs had a higher level of resilience and coping. There were no significant differences in the scores of quality of life, ageism, family support, HIV knowledge, and duration since HIV diagnosis between males and females. The following relationships were statistically significant in the path analysis: (1) family support → resilience [β (standardised coefficient) = 0.18], (2) resilience → ageism (β = -0.29), (3) resilience → coping (β = 0.48), and (4) coping → quality of life (β = 0.24). In addition, male PLWHAs were more resilient than female PLWHAs (β = 0.16). The findings indicate that older PLWHAs do not only negatively accept adversity, but build their adaptability to positively manage the challenges. Family-based interventions need take this adaptability to adversity into consideration.

Dyadic Effects of Stigma and Discrimination on Distress in Chinese HIV Discordant Couples

The present study investigated the dyadic effects of stigma and discrimination on distress in Chinese couples affected by HIV. Chinese people living with HIV (PLHIV) and their seronegative spouses (N = 119 couples) participated in this study. The PLHIV completed measures on stigma beliefs about being better off dead and dignity-related distress. The spouses completed measures on perceived discrimination and exclusion and caregiver distress. The results showed that there was no significant correlation between the PLHIV's stigma beliefs and the spouses' perceived discrimination and exclusion. The couples showed significant associations in their dignity-related distress and caregiver distress. Analyses using the actor-partner interdependence model showed that PLHIV's stigma beliefs and the spouses' perceived discrimination and exclusion both had significant actor and partner effects on distress within the dyad. Psychosocial interventions aiming for distress reduction in the context of HIV should tackle stigma and discrimination and target the couples rather than solely the patient or spouse.

Stigma against People Living with HIV/AIDS in China: Does the Route of Infection Matter?

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.

Network stigma towards people living with HIV/AIDS and their caregivers: An egocentric network study

HIV stigma occurs among peers in social networks. However, the features of social networks that drive HIV stigma are not well understood. The objective of this study is to investigate anticipated HIV stigma within the social networks of people living with HIV/AIDS (PLWHA) (N = 147) and the social networks of PLWHA's caregivers (N = 148). The egocentric social network data were collected in Guangxi, China. More than half of PLWHA (58%) and their caregivers (53%) anticipated HIV stigma from their network peers. Both PLWHA and their caregivers anticipated that spouses or other family members were less likely to stigmatise them, compared to friend peers or other relationships. Married network peers were believed to stigmatise caregivers more than unmarried peers. The association between frequent contacts and anticipated stigma was negative among caregivers. Being in a close relationship with PLWHA or caregivers (e.g., a spouse or other family member) was associated with less anticipated stigma. Lower network density was associated with higher anticipated stigma among PLWHA's alters, but not among caregivers' alters. Findings may shed light on innovative stigma reduction interventions at the social network level and therefore improve HIV/AIDS treatment utilisation.

Selective disclosure of HIV status in egocentric support networks of people living with HIV/AIDS

The objective of this study was to investigate HIV disclosure activities in social support networks of people living with HIV/AIDS (PLWHAs). An egocentric network study was conducted in Nanning, China. A sample of 147 PLWHAs (egos) nominated 922 network members (alters) who would provide egos with social support. All egos disclosed their HIV status to at least one alter in their support networks and 26.5 % disclosed to all alters. Among network alters, 95.7 % of spouse alters, 59.9 % of other family member alters, and 29.7 % of friend alters were aware of egos' HIV status. PLWHA egos were more likely to disclose their HIV status to their spouse and other family members, frequently-contacted alters, and alters who provided more social support. In addition, older egos and unmarried egos were more likely to disclose their HIV status. The findings indicate that network-based HIV intervention programs should take into consideration selective disclosure in social networks.

Actor and partner effects of perceived HIV stigma on social network components among people living with HIV/AIDS and their caregivers

BACKGROUND

Few studies have investigated the relationship between HIV stigma and social network components at the dyadic level. The objective of this study was to examine the actor and partner effects of perceived HIV stigma by people living with HIV/AIDS (PLWHAs) and their caregivers on social network variables at the dyadic level.

METHOD

An egocentric social network study was conducted among 147 dyads consisting of one PLWHA and one caregiver (294 participants) in Nanning, China. The actor-partner interdependence model (APIM) was used to analyze the relationships between perceived HIV stigma and social network components (network relations, network structures, and network functions) at the dyadic level.

RESULTS

We found in this dyadic analysis that: (1) social network components were similar between PLWHAs and their caregivers; (2) HIV stigma perceived by PLWHAs influenced their own social network components, whereas this influence did not exist between caregivers' perceived HIV stigma and their own social network components; (3) a few significant partner effects were observed between HIV stigma and social network components among both PLWHAs and caregivers.

CONCLUSION

The interrelationships between HIV stigma and social network components were complex at the dyadic level. Future interventions programs targeting HIV stigma should focus on the interpersonal relationship at the dyadic level, beyond the intrapersonal factors.

Psychological Impacts among Older and Younger People Living with HIV/AIDS in Nanning, China

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.

Measuring HIV stigma at the family level: psychometric assessment of the Chinese Courtesy Stigma Scales (CCSSs)

Courtesy stigma is the stigmatization a person perceives or experiences due to their association with a stigmatized individual or group. Most HIV-related stigma scales have been developed for people living with HIV/AIDS (PLWHAs), but not for their HIV-uninfected family members. To date, few measurement scales have been designed to measure the degree of stigma among both PLWHAs and their HIV-uninfected family members at the family level. We developed a set of courtesy stigma scales and estimated their reliability and validity from 256 PLWHAs and 256 of their HIV-uninfected family members. Exploratory and confirmatory factor analyses were performed in two independent samples: a development sample (N = 216) and a validation sample (N = 296), respectively. Two factors (“public stigma” and “self-perceived stigma”) had high internal consistency reliability (Cronbach's alpha coefficient between 0.83–0.90) and good construct validity (standardized factor loading range: 0.37–0.95) in both samples. These findings document that the newly developed brief instrument is a psychometrically sound measure of HIV-related stigma among both PLWHAs and their HIV-uninfected family members.