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Delle Donne V, Massaroni V, Lombardi F, Dusina A, Salvo PF, Borghetti A, Ciccullo A, Visconti E, Di Giambenedetto S. The association between stigma and wellbeing in an Italian cohort of PLWH: The role of social support and personal factors. Int J STD AIDS 2024; 35:176-187. [PMID: 37956698 DOI: 10.1177/09564624231213115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Our aim was to assess the association between different types of stigma and physical, behavioural and emotional wellbeing, and to evaluate whether these associations were mediated by the level of social support, age, education, sex and time from HIV diagnosis in an Italian cohort of people living with HIV (PLWH). We enrolled 96 PLWH and had them complete a cross-sectional online survey that included the "HSS-12", the "SF-12" and the "DASS-21". We performed linear regression analyses to explore the associations between the HSS-12 scores and cART adherence, viral load, SF-12 and DASS-21 scores, and a mediation analysis to identify mediators in the significant associations. We showed that higher level of depression and worse perception of mental health were significantly associated with higher HSS-12 "personalised stigma" (p = .009, p = .020) "disclosure concerns" (p = .012, p = .039), "concerns about public attitudes" (p =.007, p = .005) and "negative self-image" scores; (p < .001, p = .001); worse perception of physical health status was associated with higher HSS-12 "personalised stigma" scores (p = .018); higher level of anxiety and stress were associated with higher "negative self-image" scores (0.001 and p < .001). The association between higher HSS-12 "negative self-image" and higher levels of depression, anxiety and stress were mediated by lower age (a*b = +0.10; a*b = +0.12; a*b = +0.11). This study may have important implications for clinical practice as it contributes to understanding the characteristics and consequences of HIV-related stigma in a population of PLWH with excellent viroimmunological status and therapeutic adherence.
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Affiliation(s)
- Valentina Delle Donne
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Valentina Massaroni
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Francesca Lombardi
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alex Dusina
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Alberto Borghetti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arturo Ciccullo
- UOC Infectious Diseases, Ospedale S. Salvatore, L'Aquila, Italy
| | - Elena Visconti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Di Giambenedetto
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Nguyen NT, Nguyen T, Vu GV, Truong N, Pham Y, Guevara Alvarez G, Armstrong-Hough M, Shelley D. Depression and associated factors among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam: a cross-sectional analysis. BMJ Open 2024; 14:e077015. [PMID: 38355191 PMCID: PMC10868293 DOI: 10.1136/bmjopen-2023-077015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES To assess the prevalence of depressive symptoms and associated factors among people living with HIV (PLWH) who were current cigarette smokers and receiving treatment at HIV outpatient clinics (OPCs) in Vietnam. DESIGN A cross-sectional survey of smokers living with HIV. SETTING The study was carried out in 13 HIV OPCs located in Ha Noi, Vietnam. PARTICIPANTS The study included 527 PLWH aged 18 and above who were smokers and were receiving treatment at HIV OPCs. OUTCOME MEASURES The study used the Centre for Epidemiology Scale for Depression to assess depressive symptoms. The associations between depressive symptoms, tobacco dependence and other characteristics were explored using bivariate and Poisson regression analyses. RESULTS The prevalence of depressive symptoms among smokers living with HIV was 38.3%. HIV-positive smokers who were female (prevalence ratio, PR 1.51, 95% CI 1.02 to 2.22), unmarried (PR 2.06, 95% CI 1.54 to 2.76), had a higher level of tobacco dependence (PR 1.06, 95% CI 1.01 to 1.11) and reported their health as fair or poor (PR 1.66, 95% CI 1.22 to 2.26) were more likely to have depression symptoms compared with HIV-positive smokers who were male, married, had a lower level of tobacco dependence and self-reported their health as good, very good or excellent. CONCLUSION The prevalence of depressive symptoms among smokers receiving HIV care at HIV OPCs was high. Both depression and tobacco use screening and treatment should be included as part of ongoing care treatment plans at HIV OPCs.
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Affiliation(s)
| | - Trang Nguyen
- Institute of Social and Medical Studies, Ha Noi, Vietnam
| | | | - Nga Truong
- Institute of Social and Medical Studies, Ha Noi, Vietnam
| | - Yen Pham
- Institute of Social and Medical Studies, Ha Noi, Vietnam
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Brown MJ, Gao C, Kaur A, Qiao S, Li X. Social Support, Internalized HIV Stigma, Resilience and Depression Among People Living with HIV: A Moderated Mediation Analysis. AIDS Behav 2023; 27:1106-1115. [PMID: 36094638 PMCID: PMC10115436 DOI: 10.1007/s10461-022-03847-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/30/2022]
Abstract
Internalized HIV stigma has been associated with depression among people living with HIV (PLWH). However, it is still unclear whether resilience would mediate the association between internalized HIV stigma and depression and how this indirect effect would be moderated by social support. Data were collected from 402 PLWH in South Carolina using a cross-sectional survey. Data were fitted using a path model that specified the extent to which internalized HIV stigma and depression were related through resilience and how this effect was moderated by social support. Sociodemographic characteristics were included in the model as covariates. The indirect effect of internalized HIV stigma on depression through resilience was statistically significant for high social support but not for low social support. To mitigate negative impacts of internalized HIV stigma on mental health of PLWH, intervention efforts should integrate multilevel components for promoting both resilience and social support.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States.
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, United States.
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, United States.
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, United States.
| | - Chuanji Gao
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Shan Qiao
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Xiaoming Li
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
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Brown MJ, Amoatika D, Kaur A, Addo PNO, Yoo-Jeong M. Psychosocial Protective and Risk Factors of Quality of Life Outcomes Among Older Adults Living With HIV. AIDS Behav 2023:10.1007/s10461-023-03989-2. [PMID: 36717423 DOI: 10.1007/s10461-023-03989-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
HIV continues to be a public health issue for older adults. Previous studies have examined predictors of quality of life (QoL) among people living with HIV (PLWH), but the majority have been in international settings and have not focused on older adults living with HIV (OALH). The aim of this study was to examine the associations between psychosocial protective and risk factors (resilience, internalized HIV-related stigma, and depression), and overall and domains (physical, psychological, independence, social, environmental, and spiritual) of QoL among OALH. Data were obtained from 156 OALH living in South Carolina. Resilience was positively associated with all QoL domains except the spiritual domain. Internalized HIV-related stigma was associated with all QoL domains except the psychological and environmental domains. Depression was associated with the overall QoL measure and all domains. Interventions aimed at increasing resilience, attenuating internalized HIV-related stigma and depressive symptoms may be warranted for OALH, which may improve overall and varying domains of QoL.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, 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. .,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, SC, Columbia, USA. .,Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, SC, Columbia, USA.
| | - Daniel Amoatika
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Prince Nii Ossah Addo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Moka Yoo-Jeong
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, MA, Boston, USA
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Armoon B, Fleury MJ, Bayat AH, Fakhri Y, Higgs P, Moghaddam LF, Gonabadi-Nezhad L. HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis. Int J Ment Health Syst 2022; 16:17. [PMID: 35246211 PMCID: PMC8896327 DOI: 10.1186/s13033-022-00527-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 02/17/2022] [Indexed: 12/16/2022] Open
Abstract
Background Stigma is a social phenomenon known to have a negative impact on the lives of people living with HIV (PLWH). However, defining HIV-related stigma (HRS) is difficult because of the intersection it has with structural inequalities, and cultural differences, discrimination by health care providers that measure stigma among PLWH. HIV/AIDS has been characterized as a traumatic experience and PLWH may experience stigma which can cause negative mental health disorders and experiences, including emotional distress, shame, depression, anxiety, suicidal ideation. A systematic review of the evidence on the mental disorders of PLWH is currently lacking. This study aimed to analyze the association between HRS and social support, alcohol use disorders and mental health disorders and experiences (depression, anxiety, and suicidal ideation) among PLWH. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) this study searched PubMed, Scopus, Web of sciences, PsycInfo, SciELO and Cochrane library electronic databases to identify publications between January 1992 and August 2020 that discussed social support, alcohol use disorders, mental health disorders and experiences (i.e., depression and anxiety and suicidal ideation) associated with HRS. Pooled Odds Ratios (ORs) were utilized at a 95% confidence level, and as sampling methods differed between articles pooled estimates used a random effects model. Results Twenty-two studies with 9548 participants met the eligibility criteria. No association was observed between HRS and alcohol use disorders. PLWH who had higher levels of social supports were less likely to report HRS. Participants who had been diagnosed with anxiety were 1.89 times more likely to report HRS, while those diagnosed with depression were 1.61 times more. Respondents who reported suicidal ideation also were 1.83 times more likely to report HRS. Conclusions This meta-analysis supports that HRS has a detrimental association with anxiety, depression and suicidal ideation, but social support protects again HRS in PLWH. Applying interventions which focus on the mental health disorders of PLWH may decrease HRS. Provision of social support by practitioners, combined with mental health treatment and assessments, and designing methods to identify stigma at different stages of illness are warranted.
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Affiliation(s)
- Bahram Armoon
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 33 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.,Department of Psychiatry, McGill University, 33 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Yadollah Fakhri
- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia.,Burnet Institute, Melbourne, Victoria, Australia
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Leila Gonabadi-Nezhad
- Department of Psychiatry, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
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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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Ncitakalo N, Mabaso M, Joska J, Simbayi L. Factors associated with external HIV-related stigma and psychological distress among people living with HIV in South Africa. SSM Popul Health 2021; 14:100809. [PMID: 34027011 PMCID: PMC8121694 DOI: 10.1016/j.ssmph.2021.100809] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND HIV-related stigma and psychological distress among people living with HIV (PLHIV) pose a public health challenge in most African countries. This study aims to investigate the association between HIV-related stigmatizing attitudes and psychological distress amongst PLHIV in South Africa using the 2012 nationally representative population-based household survey. METHODS The data used in the analysis were collected using a multi-stage stratified cluster sampling design. Bivariate and multivariate logistic regression models were used to identify factors associated with stigma among PLHIV with psychological distress. A total of 2521 HIV positive individuals that responded to the question on psychological distress, 34.3% had psychological distress and 37.9% experienced high levels of HIV related stigmatizing attitudes. Stigmatizing attitudes among PLHIV with psychological distress were significantly less likely among those with secondary level education [aOR = 0.67 (95% CI: 0.44-1.01), p = 0.050], those with correct knowledge about HIV and rejection of myths about HIV [aOR = 0.58 (95% CI: 0.38-0.89), p = 0.013], and those who ever tested for HIV [aOR = 0.65 (95% CI: 0.42-1.01), p = 0.054]. CONCLUSION The findings suggest a need to reinvigorate stigma-reduction interventions in the national HIV response with emphasis on HIV awareness and education campaigns. In addition, HIV testing services should be reinforced through communication strategies targeted against HIV stigmatization, discrimination and fear. There is also a need to continuously engage PLHIV in programs through counselling and support interventions for acceptance of HIV positive status and to help them cope with HIV-related stigma.
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Affiliation(s)
| | - Musawenkosi Mabaso
- Human and Social Capabilities Research Division, Human Sciences Research Council, Durban, South Africa
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry & Mental Health, University of Cape Town, South Africa
| | - Leickness Simbayi
- Office of the Deputy Chief Executive Officer for Research, Human Sciences Research Council, Cape Town, South Africa
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Nursalam N, Sukartini T, Arifin H, Pradipta RO, Mafula D, Ubudiyah M. Determinants of the Discriminatory Behavior Experienced by People Living with HIV in Indonesia: A Cross-sectional Study of the Demographic Health Survey. Open AIDS J 2021. [DOI: 10.2174/1874613602115010001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
The discriminatory behavior experienced by People Living With HIV (PLWH) remains an unresolved problem in Indonesia. The aims of this research were to determine the factors associated with the discriminatory behavior experienced by PLWH in Indonesia.
Methods:
This study used cross-sectional design data by processing secondary data from the Indonesian Demographic Health Survey (IDHS) conducted in 2017. The total sample in this study was 15,413 records obtained via the two-stage stratified cluster sampling technique. The variables in this study were knowledge, information, socioeconomic and demographic details and the discriminatory behavior experienced by PLWH. The instrument refers to IDHS 2017. The data were analyzed using a chi-squared test and multinomial logistic regression.
Results:
The results obtained show that approximately 78.87% of respondents exhibited discriminatory behavior against PLWH in Indonesia. Respondents who had more knowledge about HIV [RRR: 25.35; CI: 2.85, 225.18] and who had earnings [RRR: 2.15; CI: 1.18, 3.92] were more at risk of discriminatory behavior than others. Respondents who lived in a rural area were less likely to engage in discriminatory behavior against PLWH than those who lived in urban areas [RRR: 0.51; CI: 0.29, 0.91].
Conclusion:
An increased understanding of HIV-AIDS and Indonesian people's acceptance of PLWH can occur through the provision of accurate information that is designed to prevent discriminatory behavior against PLWH. The government can consider this problem and further related policies so that PLWH can coexist in society and enjoy the same rights as those living without discrimination.
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Chen WT, Shiu C, Yang JP, Chuang P, Berg K, Chen LC, Chi PC. Tobacco, Alcohol, Drug Use, and Intimate Partner Violence Among MSM Living With HIV. J Assoc Nurses AIDS Care 2019; 30:610-618. [PMID: 31633629 PMCID: PMC7609996 DOI: 10.1097/jnc.0000000000000090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Men who have sex with men (MSM) and are living with HIV have reported high rates of intimate partner violence (IPV) and substance use. We examined relationships between accumulative IPV, incidents of IPV, and numbers of substances used. One hundred twenty Taiwanese MSM living with HIV completed a cross-sectional survey. Accumulative IPV was assessed by summing the number of 15 types of IPV experienced in the previous year; substance use was measured by any use of alcohol, tobacco, or other drugs during the previous week. In multivariate analysis, IPV was not associated with tobacco use but was positively associated with alcohol and other drug use and significantly associated with the probability of using multiple substances. MSM living with HIV who experienced greater IPV were more likely to use alcohol and other drugs and were more likely to use more than one substance. Health care providers screening for IPV should also screen for substance use.
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Affiliation(s)
- Wei-Ti Chen
- University of California Los Angeles, School of Nursing, Los Angeles, California, USA
| | - Chengshi Shiu
- University of California Los Angeles, School of Nursing, Los Angeles, California, USA
| | - Joyce P. Yang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Los Altos, California, USA
| | - Peing Chuang
- Taipei Union Hospital, Kunming Branch, Center of Disease Prevention and Control, Taipei, Taiwan
| | - Kristin Berg
- Center for Disabilities and Associate Professor of Pediatrics, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Li-Chen Chen
- School of Nursing, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chun Chi
- Taipei Union Hospital, Kunming Branch, Center of Disease Prevention and Control, Taipei, Taiwan
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A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019; 17:17. [PMID: 30764819 PMCID: PMC6376728 DOI: 10.1186/s12916-019-1250-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/02/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. METHODS We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. RESULTS Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. CONCLUSIONS Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.
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Chen WT, Shiu C, Yang JP, Li CSR, Wang K, Zhang L, Zhang J, Bao M, Aung MN, Chen LC, Zhao H, Lu H. Substance use, anxiety, and self-management efficacy in HIV-positive individuals: A mediation analysis. JOURNAL OF SUBSTANCE USE 2018; 23:408-414. [PMID: 30906222 DOI: 10.1080/14659891.2018.1436603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Context In China, the social stigma of both substance use and HIV remains major barriers. HIV+ individuals have been demonstrated to have higher psychosocial distress in the literature. To ensure quality of life among HIV+ Chinese individuals, self-efficacy in HIV-related management including substance use and anxiety is the key to suppress viral load and maintain healthy lives. Objectives We examine the mediation relationship among substance use, anxiety, and self-management efficacy. Method A cross-sectional study design was used. 137 HIV+ individuals were recruited from two premier Chinese hospitals: Beijing's Ditan Hospital and Shanghai's Public Health Clinic Center (SPHCC). Results HIV+ substance users had significantly lower HIV-management efficacy and higher anxiety scores. About a third of the relations between substance use and anxiety was mediated by HIV-management self-efficacy. Those who used substances in the previous week had higher anxiety levels suggesting the presence of a recent effect. Their higher levels of anxiety could be largely explained by their lower HIV-management efficacy. Conclusion It is useful for healthcare providers to assess substance use behaviors in HIV+ individuals as well as provide support in managing anxiety in this population. Meanwhile, enhancing self-management efficacy to ensure healthy lifestyles may support achieving optimal lives with HIV.
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Affiliation(s)
- Wei-Ti Chen
- School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Chengshi Shiu
- School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Joyce P Yang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Chiang-Shan Ray Li
- Psychiatry and of Neuroscience, School of Medicine, Yale University, New Haven, CT
| | - Kerong Wang
- Ditan Hospital, Capital Medical University, Beijing, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jing Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Meijuan Bao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | | | - Li-Chen Chen
- National Cheng Kung University, School of Nursing, Tainan, Taiwan
| | - Hongxin Zhao
- Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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