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Ha T, Shi H, Givens D, Nguyen T, Nguyen N. Factors impacting HIV testing among young sexually active women migrant workers in Vietnamese industrial zones. BMC Public Health 2023; 23:1938. [PMID: 37803339 PMCID: PMC10559500 DOI: 10.1186/s12889-023-16841-y] [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] [Received: 07/25/2022] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Young migrant workers living in low- and middle-income countries often experience barriers and inadequate access to HIV prevention and treatment services. This study examines the prevalence of HIV testing, associated factors, and reasons for obtaining and not obtaining HIV testing among young sexually active women migrant workers in an industrial zone in Hanoi, Vietnam. METHODS A cross-sectional study was conducted among 512 sexually active young women migrant workers (aged 18 to 29) working in the Thang Long industrial zone in Hanoi, Vietnam. Data was collected via a face-to-face interview from January 2020 to June 2021. Multivariable logistic regression analysis was used to explore factors associated with ever-testing for HIV among sexually active participants. RESULTS The study found a low level of HIV testing and high rates of unprotected sex. Among those who reported being sexually active, only 23.7% of participants (n = 126) reported having ever been tested for HIV. Among those who reported never having tested for HIV, 38.2% reported not using condoms during their most recent sexual encounter. Factors associated with engaging in HIV testing included being older (25-29 years), having greater knowledge about HIV, past use of sexual and reproductive health and HIV services, and familiarity with HIV testing locations. CONCLUSIONS Overall, a low level of HIV testing, high rates of unprotected sex, and low perceived risks regarding HIV among the study participants point to a need to implement targeted HIV interventions that can improve both safe sex practices and perceptions of and knowledge about risky sexual behaviors. Such interventions should use insights from this study to address factors facilitating HIV testing among industrial zones' women migrant workers.
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Affiliation(s)
- Toan Ha
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Hui Shi
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Givens
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Trang Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | - Nam Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
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Stigmatizing Attitudes toward People Living with HIV among Young Women Migrant Workers in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116366. [PMID: 35681951 PMCID: PMC9180544 DOI: 10.3390/ijerph19116366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 01/19/2023]
Abstract
Despite intensive HIV education and prevention efforts in the past few years, stigmatizing attitudes toward people living with HIV (PLWH) remain a major barrier to HIV prevention and treatment efforts in Vietnam. The purpose of this study was to examine the prevalence of stigmatizing attitudes regarding HIV and identify correlative factors that impact the perceptions of PLWH among a heretofore overlooked demographic in Vietnamese society: women who are migrant workers in designated industrial zones (IZs). A cross-sectional study was conducted among 1061 women migrant workers aged 18 to 29 from January 2020 to November 2020 in Hanoi, Vietnam. Stigmatizing attitudes toward PLWH were measured using a four-item scale. Multiple logistic regression was conducted to examine the factors associated with stigmatizing attitudes. Our findings indicate both substantial levels of stigma persisting among this demographic group as well as the influence of important mitigating factors on the expression of HIV-related stigma. Over seventy-six percent (76.2%) of the participants reported having at least one of the four stigmatizing attitudes. Greater levels of stigmatizing attitudes toward PLWH were significantly associated with lower HIV knowledge, lower levels of education, and identifying as Kinh (the ethnic majority in Vietnam). Additionally, this study found that questions framing HIV infection through a familial lens were significantly associated with lower rates of stigmatizing responses. The high overall levels of stigmatizing attitudes toward PLWH among the study participants suggests that there is an urgent need for the development of culturally appropriate interventions and outreach education activities to reduce stigmatizing attitudes toward PLWH among women who are migrant workers working in the IZs in Vietnam. This study adds to both the existing literature and current efforts and policies around HIV in Vietnam by empirically suggesting that familial-based messaging may be a powerful potential narrative for interventions addressing HIV-related issues such as stigma.
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Li X, Qiao S, Yang X, Harrison SE, Tam CC, Shen Z, Zhou Y. A Resilience-Based Intervention to Mitigate the Effect of HIV-Related Stigma: Protocol for a Stepped Wedge Cluster Randomized Trial. Front Public Health 2022; 10:857635. [PMID: 35425746 PMCID: PMC9001957 DOI: 10.3389/fpubh.2022.857635] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Despite decades of global efforts to tackle HIV-related stigma, previous interventions designed to reduce stigma have had limited effects that were typically in the small- to-moderate range. The knowledge gaps and challenges for combating HIV-related stigma are rooted both in the complexity of the stigma and in the limitations of current conceptualizations of stigma reduction efforts. Recent research has shown the promise of resilience-based approaches that focus on the development of strengths, competencies, resources, and capacities of people living with HIV (PLWH) and their key supporting systems (e.g., family members and healthcare providers) to prevent, reduce, and mitigate the negative effects of stigma. However, the resilience-based approach, while hypothesized, has rarely been empirically tested in large intervention trials, especially in resource-limited settings. Methods In this study, we propose to develop, implement, and evaluate a theory-guided, multilevel, multimodal resilience-based intervention via a stepped wedge cluster randomized trial among 800 PLWH and their biological or surrogate family members, as well as 320 healthcare providers in Guangxi, China with a longitudinal follow-up period of 36 months at 6-month intervals. The primary outcome will be viral suppression and the intermediate outcomes will include perceived stress and medication adherence of PLWH as well as resilience measures at the level of the individual, the family, and the healthcare system. Discussion The proposed study will be one of the first large scale efforts to examine whether resilience among PLWH can be fostered and sustained through a multilevel and multi-component HIV-related stigma intervention and whether a resilience-based intervention can improve clinical outcomes and quality of HIV care among PLWH in a low-resource setting. If efficacious, the intervention components could be tailored to other groups of PLWH and adapted for other low- and middle-income countries. Trial Registration This trial is registered at ClinicalTrials.gov, registration number NCT05174936, registered 13 December 2021. https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=3&cx=-jg9qo2.
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Affiliation(s)
- Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sayward E Harrison
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, United States
| | - Cheuk Chi Tam
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi, China
| | - Yuejiao Zhou
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi, China
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dela Cruz AM, Maposa S, Patten S, Abdulmalik I, Magagula P, Mapfumo S, Abate TD, Carter A, Spies P, Harrowing J, Hall M, Afzal AR, Caine V. “I die silently inside”. Qualitative findings from a Study of People living with HIV who Migrate to and Settle in Canada. J Migr Health 2022; 5:100088. [PMID: 35341065 PMCID: PMC8941335 DOI: 10.1016/j.jmh.2022.100088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/02/2022] Open
Abstract
This study presents compelling accounts of African, Caribbean, and black (ACB) 2 immigrants who feel excluded, isolated, and distanced by others because of their positive 3 HIV status. 4. Among ACB immigration applicants living with HIV in Canada, a positive HIV status 5 had significant consequences on a person's ability to access health and social care, stable 6 housing, meaningful employment, as well as movement within society. 7. It is important to understand the experiences of racialized immigration applicants and 8 HIV screening processes during immigration from an intersectionality lens. 9. Health and social care providers of ACB immigrants living with HIV must consider the 10 interaction of race, legal status, institutional laws and structures, gender, culture, trauma, 11 and intergenerational contexts in providing adequate and appropriate health and social 12 care to this population.
We report on qualitative findings from a mixed methods study, examining enacted and internalized stigma during mandatory HIV screening among immigration applicants living with HIV in Canada. Qualitative findings show alignment with characteristics of internalized HIV stigma. We conducted 34 semi-structured interviews, and analyzed the data through thematic analysis, using Intersectionality and the Internalized HIV Stigma Scale as our theoretical and analytical frameworks. Participants described experiences of enacted and internalized HIV stigma in ways that were consistent with the four main domains of stereotypes, disclosure concerns, social relationships, and self-acceptance, but also extended the description of HIV stigma beyond these domains. Experiences of internalized HIV stigma and enacted stigma during the Canadian Immigration Medical Examination could potentially influence individuals’ long-term engagement in the HIV care cascade during the process of migration to, and settlement in, Canada. We present recommendations for the broader migrant health research agenda, health and social care providers, and public health policies.
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Affiliation(s)
- Aniela M. dela Cruz
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Corresponding author.
| | - Sithokozile Maposa
- College of Nursing, University of Saskatchewan, Prince Albert, Saskatchewan, Canada
| | - San Patten
- San Patten and Associates, Halifax, Nova Scotia, Canada
| | - Inusa Abdulmalik
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | - Jean Harrowing
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Arfan R. Afzal
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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5
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Yu Y, Chen Z, Huang S, Chen Z, Zhang K. What determines employment quality among people living with HIV: An empirical study in China. PLoS One 2020; 15:e0243069. [PMID: 33259563 PMCID: PMC7707494 DOI: 10.1371/journal.pone.0243069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/14/2020] [Indexed: 11/18/2022] Open
Abstract
At the intersection of research areas on health and employment, little attention has been paid on employment quality among people living with HIV (PLWH). The objective of the current study is to identify critical factors and empirically examine their effects on employment quality among PLWH. Based on the social-ecological perspective, we identified negative self-image, workplace discrimination, social support, and policy support as critical factors associated with employment quality among PLWH. Thereafter, a questionnaire survey was conducted to gather information from 339 employed PLWH in China. Hierarchical regression analyses were further performed to analyze the effects of the identified factors on employment quality among PLWH. We obtained three main findings. First, negative self-image and workplace discrimination are detrimental to employment quality among PLWH; whereas social support and policy support are conducive to their employment quality. Second, older, male, and highly educated PLWH can better leverage the undesirable effects of negative self-image and workplace discrimination on employment quality compared with their peers. Third, male, and highly educated PLWH can better utilize social support and policy support to advance employment quality compared with their peers. However, the employment quality effects of the identified factors did not differ by marital status. Our findings provided some useful implications for PLWH, employers, community service providers, and policy makers to promote employment quality among PLWH.
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Affiliation(s)
- Yunjiang Yu
- School of International Economics and Trade, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Zhi Chen
- School of Business Administration, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Shenglan Huang
- School of Business Administration, Shanghai Lixin University of Accounting and Finance, Shanghai, China
- * E-mail:
| | - Zhicheng Chen
- School of Business Administration, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Kailin Zhang
- School of Finance, Shanghai Lixin University of Accounting and Finance, Shanghai, China
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6
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Sweileh WM. Bibliometric analysis of literature in AIDS-related stigma and discrimination. Transl Behav Med 2020; 9:617-628. [PMID: 29982818 DOI: 10.1093/tbm/iby072] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Stigma and discrimination are major barriers in the global fight against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The aim of this study was to create an analytical inventory of worldwide research output in AIDS-related stigma and discrimination. SciVerse Scopus was used for the study period from 1980 to 2017 to retrieve literature in AIDS-related stigma and discrimination. Results were presented as bibliometric tables and maps. In total, 2,509 documents were retrieved. Approximately 40% (n = 990) of the retrieved documents were published in the last 5 years (2013-2017). Retrieved documents received an average of 19.8 citations per article and had an average of 3.2 authors per article. The Hirsh index of the retrieved documents was 94. Most frequently encountered topics were mental health, adherence, adolescents, women, disclosure, and Africa. The USA contributed to 1,226 (48.9%) documents while the African region contributed to 531 (21.2%) documents. Research collaboration among most active countries was relatively low. Authors and institutions from the USA dominated this field. AIDS Care was the most active journal in publishing documents in this field with 307 (13.4%) documents while documents published in Social Medicine journal received the highest citations. Research in AIDS-related stigma and discrimination had witnessed a noticeable increase in the past decade, but the overall number of publications is considered insignificant relative to the size of the problem and the global number of infected people. There was a relative underpresentation of literature from African region despite the fact that more than two-thirds of HIV-infected people in the world are living in Africa.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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HIV-Related Knowledge and Stigma Among the General Population in the Southeast of Iran. SHIRAZ E-MEDICAL JOURNAL 2020. [DOI: 10.5812/semj.96311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: HIV-related stigma is a barrier to effective HIV responses among people living with HIV (PLHIV). Objectives: The current study aimed at measuring HIV-related stigma, and its associated factors among the general population in the Southeast of Iran. Methods: The current cross-sectional study was conducted on a convenience sample of 900 individuals in Kerman, Southeast of Iran, from July to September 2016. Data was collected using a self-administered questionnaire, including (I) demographic and background characteristics; (II) HIV-related stigma; and (III) HIV-related knowledge. Data were analyzed with SPSS version 20 using descriptive statistics, as well as bivariable and multivariable linear regressions. Results: Low, moderate, and high levels of stigmatizing attitudes toward PLHIV were reported by 39.1%, 57.8%, and 3.1% of the participants, respectively. Female sex(beta = 0.33, P value = 0.01) and those not having a history of HIV testing (beta = 0.45, P value < 0.001) had, on average, higher levels of stigmatizing attitudes, while those with a higher level of education (beta = -0.97, P value < 0.001) had, on average, lower levels of stigmatizing attitudes. Conclusions: Gender-sensitive educational interventions need to be developed to reduce the negative attitude towards PLHIV in Iran.
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Zhang Y, Tang S, Li K, Tso LS, Bayus BL, Glidden D, Yang B, Zheng H, Wei C, Tucker J, Tang W. Quantitative evaluation of an innovation contest to enhance a sexual health campaign in China. BMC Infect Dis 2019; 19:112. [PMID: 30717678 PMCID: PMC6360679 DOI: 10.1186/s12879-019-3746-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/25/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Crowdsourcing method is an excellent tool for developing tailored interventions to improve sexual health. We evaluated the implementation of an innovation contest for sexual health promotion in China. METHODS We organized an innovation contest over three months in 2014 for Chinese individuals < 30 years old to submit images for a sexual health promotion campaign. We solicited entries via social media and in-person events. The winning entry was adapted into a poster and distributed to STD clinics across Guangdong Province. In this study, we evaluated factors associated with images that received higher scores, described the themes of the top five finalists, and evaluated the acceptability of the winning entry using an online survey tool. RESULTS We received 96 image submissions from 76 participants in 10 Chinese provinces. Most participants were youth (< 25 years, 85%) and non-professionals (without expertise in medicine, public health, or media, 88%). Youth were more likely to submit high-scoring entries. Images from professionals in medicine, public health, or media did not have higher scores compared to images from non-professionals. Participants were twice as likely to have learned about the contest through in-person events compared to social media. We adapted and distributed the winning entry to 300 STD clinics in 22 cities over 2 weeks. A total of 8338 people responded to an acceptability survey of the finalist entry. Among them, 79.8% endorsed or strongly endorsed being more willing to undergo STD testing after seeing the poster. CONCLUSIONS Innovation contests may be useful for soliciting images as a part of comprehensive sexual health campaigns in low- and middle-income countries.
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Affiliation(s)
- Ye Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510095, China
- Kirby institute, University of New South Wales, Sydney, Australia
| | - Songyuan Tang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Katherine Li
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510095, China
- Weill Cornell Medical College, New York, NY, USA
| | - Lai Sze Tso
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510095, China
| | - Barry L Bayus
- Kenan-Flagler Business School, University of North Carolina, Chapel Hill, NC, USA
| | - David Glidden
- Department of Epidemiology and Biostatistics & Global Health Sciences, University of California, San Francisco, CA, USA
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics & Global Health Sciences, University of California, San Francisco, CA, USA
| | - Joseph Tucker
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510095, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China.
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510095, China.
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Gao M, Xiao C, Zhang X, Li S, Yan H. Social capital and PTSD among PLWHA in China: the mediating role of resilience and internalized stigma. PSYCHOL HEALTH MED 2018; 23:698-706. [PMID: 29334231 DOI: 10.1080/13548506.2018.1426869] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Post-traumatic Stress Disorder (PTSD) is frequent among people living with HIV/AIDS (PLWHA). Few studies have investigated social-psychological predictors of PTSD in China. This study aimed to examine relationships between social capital, stigma, resilience and PTSD among PLWHA in China, and to provide effective suggestions for PTSD intervention. A cross-sectional study of 520 PLWHA was conducted from November 2015 to January 2016. Survey data were collected using anonymous self-reported questionnaire. Multivariable analyses were used to examine related factors of PTSD, and causal mediation analyses were conducted to assess whether stigma and resilience were mediators. Results indicated that higher risk of PTSD was independent associated with stronger stigma, decreasing social capital and lower resilience. There was an indirect relationship of social capital on PTSD mediated through resilience and HIV-related stigma. Therefore, PTSD intervention programs should not only pay attention to the role of social capital on PTSD, but also attach importance to stigma and resilience on PTSD symptoms.
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Affiliation(s)
- Mengting Gao
- a Information Center , Renmin Hospital of Wuhan University , Wuhan , China.,b School of Health Science , Wuhan University , Wuhan , China
| | - Chenchang Xiao
- b School of Health Science , Wuhan University , Wuhan , China
| | - Xuan Zhang
- c Department of nosocomial infection management , The Second People's Hospital of Shanxi Province , Taiyuan , China
| | - Shiyue Li
- b School of Health Science , Wuhan University , Wuhan , China
| | - Hong Yan
- b School of Health Science , Wuhan University , Wuhan , China
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Li X, Yuan L, Li X, Shi J, Jiang L, Zhang C, Yang X, Zhang Y, Zhao D, Zhao Y. Factors associated with stigma attitude towards people living with HIV among general individuals in Heilongjiang, Northeast China. BMC Infect Dis 2017; 17:154. [PMID: 28212610 PMCID: PMC5316215 DOI: 10.1186/s12879-017-2216-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/20/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND HIV-related stigma always is major obstacles to an effective HIV response worldwide. The effect of HIV-related stigma on HIV prevention and treatment is particularly serious in China. This study was to examine stigma attitude towards people living with HIV/AIDS (PLWHA) among general individuals in Heilongjiang Province, Northeast China and the factors associated with stigma attitude, including socio-demographic factors and HIV/AIDS Knowledge. METHODS A cross-sectional survey was carried out in Heilongjiang Province, China. A total of 4050 general individuals with age 15-69 years in four villages in rural areas and two communities in urban areas were drawn using stratified cluster sampling. Standardized questionnaire interviews were administered. Univariate and multivariate log-binomial regression were performed to assess factors affecting stigma attitude towards PLWHA. RESULTS The proportions of participants holding stigma attitude towards PLWHA were 49.6% among rural respondents and 37.0% among urban respondents (P < 0.001). Multivariate log binomial regression analysis among both rural participants (RR = 0.89, 95% CI: 0.87-0.91, P < 0.001) and urban participants (RR = 0.89, 95% CI: 0.87-0.91, P < 0.001) showed that greater knowledge of HIV transmission misconceptions was significantly associated with lower stigma attitude towards people living with HIV. And among urban participants, higher education level (high school vs. primary school or less: RR = 0.73, 95%CI: 0.62-0.87, P < 0.001; middle school vs. primary school or less: RR = 0.83, 95%CI: 0.71-0.97, P = 0.018) were also significantly associated with lower stigma attitude towards PLWHA. CONCLUSIONS The level of stigma attitude towards PLWHA is higher in rural areas than in urban areas in Heilongjiang. Meanwhile, individuals who better were aware of HIV/AIDS transmission misconceptions may hold lower stigma attitude toward PLWHA whether among rural or urban residents.
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Affiliation(s)
- Xin Li
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Lili Yuan
- Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Medical Science Institute, Harbin, Heilongjiang Province, China
| | - Xiaoxia Li
- Department of Public Health, Mudanjiang Medical College, Mudanjiang, Heilongjiang Province, China
| | - Jingli Shi
- Qiqihaer Center for Disease Control and Prevention, Qiqihaer, Heilongjiang Province, China
| | - Liying Jiang
- Department of Epidemiology, Public Health College, Nantong University, Nantong, Jiangsu Province, China
| | - Chundi Zhang
- Qiqihaer Medical University, Qiqihaer, Heilongjiang Province, China
| | - Xiujing Yang
- Clinical Laboratory, Third Affiliated Clinical Hospital of Qiqihaer Medical University, Qiqihaer, Heilongjiang Province, China
| | - Yeli Zhang
- Disease Control Office, Health Department of Heilongjiang Province, Harbin, Heilongjiang Province, China
| | - Donghui Zhao
- Heilongjiang Center for Disease Control and Prevention, Harbin, Heilongjiang Province, China
| | - Yashuang Zhao
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, China.
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Mo PKH, Ng CTY. Stigmatization among people living with HIV in Hong Kong: A qualitative study. Health Expect 2017; 20:943-951. [PMID: 28195685 PMCID: PMC5600241 DOI: 10.1111/hex.12535] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Phoenix K H Mo
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Charlson T Y Ng
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Yeo TED, Chu TH. Social-cultural factors of HIV-related stigma among the Chinese general population in Hong Kong. AIDS Care 2017; 29:1255-1259. [PMID: 28110546 DOI: 10.1080/09540121.2017.1282601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
HIV-related stigma in the wider community compounds the suffering of people living with HIV (PLWH) and hampers effective HIV prevention and care. This study examines the level of public stigma toward PLWH in Hong Kong and associated social-cultural factors. A telephone survey was conducted in June-July 2016 with 1080 Chinese adults aged 18-94 randomly selected from the general population. The results indicate substantial degree of public stigma toward PLWH. Overall, 58.1% of the participants endorsed at least one statement indicating negative social judgment of PLWH. Over 40% attributed HIV infections to irresponsible behaviors and nearly 30% perceived most PLWH as promiscuous. About 20% considered HIV to be a punishment for bad behavior and believed that PLWH should feel ashamed of themselves. These statistics indicate that HIV-related stigma among the general Hong Kong population had no noticeable reduction in a decade but is lower than that among rural and urban populations in China. Our findings suggest that the lower stigma in Hong Kong may be linked to higher education levels rather than Hongkongers' more Westernized outlook. The results of a multiple regression analysis showed that education level (β = -.19), homophobia (β = .30), and conformity to norms (β = .14) were independent predictors of HIV-related stigma but not age, income, or cultural orientations. By differentiating between associated social-cultural factors, this study provides a more nuanced understanding of the layered nature of HIV-related stigma: not broadly grounded in religion or Chinese culture but stemming from more specific social-cultural beliefs - perceptions of norm violation and negative attitudes toward homosexuality, which were not mutually exclusive. These findings have implications for HIV-related stigma reduction by providing evidence for the importance of addressing homophobia. Existing HIV publicity activities should be re-examined for inadvertent contribution to the stigmatization process - particularly press conferences and prevention campaigns that reinforce negative stereotypes of gay/bisexual men and PLWH.
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Affiliation(s)
- Tien Ee Dominic Yeo
- a Department of Communication Studies , Hong Kong Baptist University , Kowloon Tong , Hong Kong
| | - Tsz Hang Chu
- a Department of Communication Studies , Hong Kong Baptist University , Kowloon Tong , Hong Kong
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Zeng H, Zhang L, Zhao Y, Liu H, Guo H, Wang Y, Zhang Z, Mao L. HIV prevention among street-based sex workers (SSWs) in Chongqing, China: interviews with SSWs, clients and healthcare providers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:e173-e180. [PMID: 26294326 DOI: 10.1111/hsc.12266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 06/04/2023]
Abstract
Street-based female sex workers (SSWs) are subjected to a relatively high risk of HIV transmission, even higher than establishment-based female sex workers in China. However, very few HIV intervention programmes have targeted this particular group to date. Based in Southwest China, this study aims to identify perceived barriers, demands and suggestions on HIV prevention from the perspectives of SSWs, clients and healthcare providers in Chongqing. Face-to-face, in-depth interviews were conducted in July 2008 with 23 participants. They were recruited by purposive, convenience sampling and included 12 SSWs, 5 male clients, 4 government healthcare providers and 2 outreach workers from a community-based non-governmental organisation. Thematic analysis was used. SSWs were largely rural-to-urban migrants with a low socioeconomic status. Most of their clients shared a similar background. Both SSWs and their clients demonstrated a low awareness of HIV infection and a lack of understanding of effective preventive strategies. Financial hardships, lack of family support, fear of police arrest and stigma in relation to sex work were identified as SSWs' major barriers for accessing healthcare services. Both SSWs and their clients indicated an urgent demand for accessing adequate HIV prevention and care programmes. On the other hand, government organisations trying to provide services to this group have also encountered obstacles, specifically their limited ability to establish mutual trust. Programmes provided by community-based non-governmental organisation, however, were perceived to be more attractive. In conclusion, there remains a substantial gap between the need of adequate HIV prevention services for SSWs and their clients and what is currently available. Strengthening inter-sectoral collaboration, providing specifically tailored health services, actively involving SSW peers and their clients, and reducing stigma in the society are keys to meet this urgent demand by SSWs in China.
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Affiliation(s)
- Huan Zeng
- School of Public Health and Management, Chongqing Medical University, Chongqing, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.
| | - Lei Zhang
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Hui Liu
- Centre for Disease Control and Prevention, Yubei District, Chongqing, China
| | - Hang Guo
- Institute of Health Policy, College of Human Medicine, Michigan State University, Lansing, Michigan, USA
| | - Yang Wang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Zhen Zhang
- Centre for Disease Control and Prevention, Yuzhong District, Chongqing, China
| | - Limin Mao
- Center for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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Li L, Lin C, Ji G. Gendered aspects of perceived and internalized HIV-related stigma in China. Women Health 2016; 57:1031-1043. [PMID: 27629916 DOI: 10.1080/03630242.2016.1235075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although studies have demonstrated that females experience more HIV-related stigma than males do, questions remain regarding the different dimensions of the stigma (i.e., perceived versus internalized) in China. The present study investigated gender differences in perceived and internalized HIV-related stigma, taking into account the potential influence of education. The study was conducted between October 2011 and March 2013. A total of 522 people living with HIV (PLH) were recruited from Anhui Province, China. The PLH participated in a survey using the Computer Assisted Personal Interview (CAPI) method. The gender differences in perceived and internalized HIV-related stigma were calculated with and without stratifying by education level. Female participants had significantly less education than the male participants. No significant difference was observed between females and males with respect to perceived stigma. However, females reported significantly higher internalized stigma than males did (p < .001). When socio-demographic characteristics were controlled, the gender difference in internalized stigma remained significant among educated participants (p = .038). The findings suggested that gender differences in HIV-related stigma were primarily found for internalized stigma. Heightened intervention efforts are encouraged to reduce internalized HIV-related stigma, particularly among female PLH in China and other regions with similar gender dynamics.
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Affiliation(s)
- Li Li
- a Semel Institute for Neuroscience and Human Behavior, Center for Community Health , University of California, Los Angeles , Los Angeles , California , USA
| | - Chunqing Lin
- a Semel Institute for Neuroscience and Human Behavior, Center for Community Health , University of California, Los Angeles , Los Angeles , California , USA
| | - Guoping Ji
- b Anhui Provincial Center for Women and Child Health , Hefei , China
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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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Zhang C, Li X, Liu Y, Qiao S, Zhang L, Zhou Y, Shen Z, Tang Z. Emotional, physical and financial burdens of stigma against people living with HIV/AIDS in China. AIDS Care 2016; 28 Suppl 1:124-31. [PMID: 26886415 PMCID: PMC4828606 DOI: 10.1080/09540121.2016.1146206] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Numerous researches have shown pernicious effects of stigma against people living with HIV/AIDS (PLWHA). However, no available studies have reported these negative effects including emotional, physical to financial burdens to PLWHA. In the current study, we aim to explore different types of stigma (e.g., perceived, internalized and enacted) and the relevant consequences among PLWHA in China. A cross-sectional study was conducted from 2012 to 2013 in the Guangxi Autonomous Region in China. The validated Berger HIV Stigma Scale was used to measure various types of stigma. We employed a series of linear, logistic and polytomous regression models to assess the association between stigma and different consequences while accounting for potential confounders for each specific model. Of the total sample, 2987 PLWHA provided valid responses with 63% being male and having an average age of 42.9 years. Perceived, internalized and enacted HIV stigma were prevalent among participants, and resulted in various burdens with different magnitudes in their life contexts. Specially, PLWHA who reported higher perceived and internalized stigma were more likely to be imposed on emotional and physical burdens (p < .05). People who reported higher enacted stigma had heavier financial burden compared to their peers (p < .05). Our findings revealed that devastating consequences of HIV-related stigma in China. The prevalent stigmatizing attitudes have pushed PLWHA to the fringes of society and affected them at multiple aspects in their life context. We call for tailored efforts to overcome stigma and discrimination against PLWHA.
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Affiliation(s)
- Chen Zhang
- a Vanderbilt Institute of Global Health , Vanderbilt University , Nashville , TN , USA
| | - Xiaoming Li
- b Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
| | - Yu Liu
- a Vanderbilt Institute of Global Health , Vanderbilt University , Nashville , TN , USA
| | - Shan Qiao
- b Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
| | - Liying Zhang
- c Department of Pediatrics , Wayne State University , Detroit , MI , USA
| | - Yuejiao Zhou
- d Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
| | - Zhiyong Shen
- d Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
| | - Zhengzhu Tang
- d Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
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Yang Y, Wang J, Lin F, Zhang T, Yu F, Zhao Y, Zhang T. Stigma against HIV/AIDS among female sex workers and general migrant women in eastern China. BMC WOMENS HEALTH 2015; 15:2. [PMID: 25608866 PMCID: PMC4316807 DOI: 10.1186/s12905-014-0160-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 12/17/2014] [Indexed: 11/16/2022]
Abstract
Background HIV related stigma is a recognized barrier to early detection of HIV and causes great suffering for those affected. However, data regarding HIV related stigma among female sex workers (FSW) in China was limited, with none for comparison between FSW and general migrant women (GMW). Therefore, the aim of this study was to examine HIV related stigma among FSW and GMW in Shanghai, China. Methods A community based cross-sectional study with face-to-face interviews was conducted in Shanghai (September 2011 through December 2012), using a structured questionnaire.HIV related stigma scores were examined graphically using boxplot. A logistic regression analysis with the proportional odds model was employed to identify factors affecting HIV related stigma scores. Results A total of 1,396 subjects, including 721 FSW and 675 GMW, were recruited in the present study. Both groups had substantial misconceptions about HIV/AIDS, although FSW had slightly higher scores on average. Both groups showed a medium level of HIV related stigma (38.34 ± 6.21 and 38.35 ± 6.86 for FSW and GMW, respectively). For the FSW, higher levels of stigma were observed for those who were in the older age groups (age 26-35 years, OR, 2.06, 95% CI 1.06-4.01), those who were married (OR, 1.62, 95% CI 1.03-2.54), and those who were working at lower-level sex service sites (OR, 1.60, 95% CI 1.06-2.43). Conversely, HIV knowledge was inversely associated with the level of HIV related stigma (OR, 0.93, 95% CI 0.87-0.98).Among GMW participating in the study, those age in the 26-35 years were more likely to show higher level of stigma (OR, 2.61, 95% CI 1.03-2.54), and HIV knowledge was found to be inversely associated with the HIV related stigma level as well (OR, 0.89, 95% CI 0.84-0.95). Conclusions The present study suggests that there is an urgent need for the development of appropriate education strategies to reduce HIV related stigma among FSW and GMW in Shanghai, China. In particular, older women, less educated women, and women that have lived in Shanghai a relatively long time should be targeted in future stigma reduction programs. Electronic supplementary material The online version of this article (doi:10.1186/s12905-014-0160-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Yang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China. .,Minhang District Center for Diseases Control and Prevention, Shanghai, China.
| | - Jun Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China.
| | - Feifei Lin
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China.
| | - Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China.
| | - Feng Yu
- Minhang District Center for Diseases Control and Prevention, Shanghai, China.
| | - Yanping Zhao
- Minhang District Center for Diseases Control and Prevention, Shanghai, China.
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China.
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Fuster-RuizdeApodaca MJ, Molero F, Gil de Montes L, Agirrezabal A, Toledo J, Jaen A. Evolution of HIV-related stigma in Spain between 2008 and 2012. AIDS Care 2014; 26 Suppl 1:S41-5. [PMID: 24720687 DOI: 10.1080/09540121.2014.906557] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To analyze the temporal evolution of HIV-related stigma in Spain between 2008 and 2012. We interviewed a representative sample of the Spanish population (N = 1619) through computer-assisted telephone interviews. The survey measures diverse facets of stigma and other-related variables. We compared the data of the 2012 survey with the result of the survey carried out in 2008. The degree of discomfort concerning people with HIV decreased significantly in 2012. Avoidance intention, negative feelings, the number of people who agreed with the implementation of harsh discriminatory policies, and the number of people who blame people with HIV were also lower in 2012. However, there are still misconceptions about HIV transmission. Attitudes of the Spanish population toward people with HIV have improved in the last four years. However, some attitudes and beliefs still need to be changed.
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Abler L, Henderson G, Wang X, Avery M, Zhang YX, Pan S. Affected by HIV stigma: interpreting results from a population survey of an urban center in Guangxi, China. AIDS Behav 2014; 18 Suppl 2:S192-201. [PMID: 23892728 DOI: 10.1007/s10461-013-0556-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We aimed to identify factors related to HIV stigma in Liuzhou, Guangxi province, a city in southwest China with high HIV prevalence. We used a multi-stage cluster randomized sample of the general population to survey 852 adults. We conducted ordinal logistic regression analyses to test factors associated with punishment and isolation stigma. Eighteen percent of respondents agreed that people with HIV should be punished, and 40% agreed that people living with HIV (PLHIV) should be isolated. Punishment stigma was associated with age, having three or more sexual partners, and TV watching. Isolation stigma was associated with age, urban residence and a history of STI. HIV transmission knowledge was low, and having correct knowledge attenuated the association with punishment and isolation stigma. Despite programs in China to provide care and treatment for PLHIV, HIV stigma is common in this region. Targeted interventions need to focus on fears related to HIV and PLHIV.
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Affiliation(s)
- Laurie Abler
- Duke Global Health Institute, Box 90519, Durham, NC, 27708, USA,
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Muessig KE, Smith MK, Maman S, Huang Y, Chen XS. Advancing the prevention agenda for HIV and other sexually transmitted infections in south China: social science research to inform effective public health interventions. AIDS Behav 2014; 18 Suppl 2:S222-31. [PMID: 24443101 PMCID: PMC3982310 DOI: 10.1007/s10461-014-0695-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite widespread biomedical advances in treatment and prevention, HIV and other sexually transmitted infections (STI) continue to affect a large portion of the world's population. The profoundly social nature of behaviorally driven epidemics and disparities across socioeconomic divides in the distribution of HIV/STI and care outcomes emphasize the need for innovative, multilevel interventions. Interdisciplinary approaches to HIV/STI control are needed to combine insights from the social and biological sciences and public health fields. In this concluding essay to a Special Issue on HIV/STI in south China, we describe the evolution of the region's HIV/STI epidemics and the government response, then synthesize findings from the 11 studies presented in this issue to extend seven recommendations for future HIV/STI prevention and care research in China. We discuss lessons learned from forging international collaborations between the social and biological sciences and public health to inform a shared research agenda to better meet the needs of those most affected by HIV and other STI.
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Affiliation(s)
- Kathryn E. Muessig
- Department of Health Behavior, 306 Rosenau Hall, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7440 USA. Phone: 1-443-320-3152
| | - M. Kumi Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, 306 Rosenau Hall, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7440 USA. Phone: 1-443-320-3152
| | - Yingying Huang
- Department of Sociology, Renmin University, Beijing, China
| | - Xiang-sheng Chen
- National Center for STD Control and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing, Jiangsu 210042, China (Tel: 86-25-845478901. Fax: 86-25-85424903)
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Ahmedani BK, Kubiak SP, Kessler RC, de Graaf R, Alonso J, Bruffaerts R, Zarkov Z, Viana MC, Huang YQ, Hu C, Posada-Villa JA, Lepine JP, Angermeyer MC, de Girolamo G, Karam AN, Medina-Mora ME, Gureje O, Ferry F, Sagar R, Anthony JC. Embarrassment when illness strikes a close relative: a World Mental Health Survey Consortium Multi-Site Study. Psychol Med 2013; 43:2191-2202. [PMID: 23298443 PMCID: PMC4013530 DOI: 10.1017/s003329171200298x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study. METHOD In 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions. RESULTS There was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p<0.001), even with covariate adjustments for age and sex. CONCLUSIONS . The pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC.
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Affiliation(s)
- B K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA.
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Kunstadter P. Ethnicity, socioeconomic characteristics and knowledge, beliefs and attitudes about HIV among Yunnanese Chinese, Hmong, Lahu and Northern Thai in a north-western Thailand border district. CULTURE, HEALTH & SEXUALITY 2013; 15 Suppl 3:S383-S400. [PMID: 23930982 PMCID: PMC3809573 DOI: 10.1080/13691058.2013.814807] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 06/10/2013] [Indexed: 06/02/2023]
Abstract
Data from ethnically diverse north-western Thailand with recent migrants from Myanmar (Burma) and China allow testing of hypotheses concerning between- and within-community differences in predominantly Yunnanese Chinese, Hmong and Lahu ethnic minority villages versus ethnic majority Thai villages. Topics include knowledge of HIV transmission, prevention and treatment, avoidance of people infected with HIV and constraints to use of health services. Respondents include women with one or more children under age five and their husbands/partners. Ethnicity is consistently associated with socioeconomic characteristics, knowledge of HIV transmission, prevention and treatment, avoidance of people living with HIV and AIDS, and constraints to use of services. Chinese community residents had the lowest levels of knowledge of HIV, especially with regard to mother-to-child transmission, the most intent to avoid contact with people living with HIV and AIDS, and the highest levels of constraints to using services, including ineligibility for government healthcare and limited Thai language ability. Associations of counselling with Thai language ability, and more knowledge and less avoidance of people living with HIV and AIDS, suggest that language-appropriate health education may help overcome disparities.
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Affiliation(s)
- Peter Kunstadter
- Social Science Department, Program for HIV Prevention and Treatment (PHPT), Institut de Recherche pour le Développement (IRD), France, and Chiang Mai University, Chiang Mai, Thailand (UMI 174-PHPT)
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HIV- and AIDS-Related Stigma: Psychosocial Aspects in a Representative Spanish Sample. SPANISH JOURNAL OF PSYCHOLOGY 2013; 16:E30. [DOI: 10.1017/sjp.2013.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis study evaluates the prevalence of HIV stigma in Spain and analyzes some variables that may affect its existence. In 2008, we conducted a computer-assisted telephone survey of 1607 people, representative of the Spanish population. Two-wave random stratified sampling was performed, first selecting the home and then the person, depending on the rates of age and sex. About 50% of the population feels discomfort about potential contact with people with HIV and tries to avoid it and 20% advocate discriminatory policies involving physical or social segregation of people with HIV. The belief that HIV is easily transmitted through social contact (15%) and blaming people with HIV for their disease (19.3%) are associated with stigmatization. Degree of proximity to people with HIV, political ideology, educational level, and age are also associated with the degree of stigmatization. According to these results, we suggest that, in order to reduce stigma, we need to modify the erroneous beliefs about the transmission pathways, decrease attributions of blame to people with HIV, and increase contact with them. These interventions should particularly target older people, people with a low educational level, and people with a more conservative political ideology.
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Wong LP. Prevalence and factors associated with HIV/AIDS-related stigma and discriminatory attitudes: a cross-sectional nationwide study. Prev Med 2013; 57 Suppl:S60-3. [PMID: 23583477 DOI: 10.1016/j.ypmed.2013.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 03/26/2013] [Accepted: 03/27/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The prime purpose of this study is to assess HIV/AIDS-related self-stigma and discrimination (S&D) attitudes and associated factors using multivariate analysis of data from the 2010-11 National Survey of Understanding the Root of HIV/AIDS Related Stigma and Discrimination. METHOD A national telephone survey was carried out with 2271 of the Malaysian public aged 18-60 years. The sample was contacted by random digit dialing covering the whole of Peninsular Malaysia from December 2010 to May 2011. The HIV-transmission knowledge, HIV-related self-stigma, and public stigma were investigated. RESULTS Despite high level of HIV-transmission knowledge [mean (SD)=10.56 (2.42), mean score at 70th percentile] the respondents in this study had moderate levels (mean scores near midpoints) of self-stigma and public stigma attitudes. HIV-transmission knowledge score was not significantly correlated with self-stigma score, but showed a significantly small positive effect (r<0.2) for public stigma scores. Ethnicity is the strongest correlate of HIV-transmission knowledge, self-stigma, and public stigma attitudes in the multivariate analyses. Other significant correlates were age, socioeconomic group, and urban-rural setting. CONCLUSIONS The root causes of HIV stigma and discriminatory attitudes were not associated with knowledge deficiency. Interventions should be oriented towards promoting de-stigmatization of HIV/AIDS, and tailored socio-culturally.
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Affiliation(s)
- Li Ping Wong
- Epidemiology and Biostatistics Unit, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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25
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Reda AA, Biadgilign S, Deribe K, Deribew A. HIV-positive status disclosure among men and women receiving antiretroviral treatment in eastern Ethiopia. AIDS Care 2012; 25:956-60. [DOI: 10.1080/09540121.2012.748868] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ayalu A. Reda
- Population Studies and Training Center, Brown University, Providence, RI, USA
- Department of Sociology, Brown University, Providence, RI, USA
| | - Sibhatu Biadgilign
- Departments of Epidemiology and Biostatistics, College of Medical and Health Sciences, Jimma University, Jimma, Ethiopia
| | - Kebede Deribe
- Department of General Public Health, College of Medical and Health Science, Jimma University, Jimma, Ethiopia
| | - Amare Deribew
- Departments of Epidemiology and Biostatistics, College of Medical and Health Sciences, Jimma University, Jimma, Ethiopia
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26
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Rice RE, Wu Z, Li L, Detels R, Rotheram-Borus MJ. Reducing STD/HIV stigmatizing attitudes through community popular opinion leaders in Chinese markets. HUMAN COMMUNICATION RESEARCH 2012; 38:379-405. [PMID: 24944433 PMCID: PMC4059367 DOI: 10.1111/j.1468-2958.2012.01436.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Reducing STDs and HIV/AIDS incidence requires campaigns designed to change knowledge, attitudes and practices of risky sexual behavior and its consequences. In China, a significant obstacle to such changes is the stigma associated with these diseases. Thus one campaign intervention strategy is to train credible community popular opinion leaders to discuss these issues in everyday social venues. This study tested the effectiveness of such an approach on reducing HIV/AIDS stigma, across two years, from a sample of over 4500 market vendors, in three conditions. Results showed an increasing growth in market communication about intervention messages, and concomitant declines in stigmatizing attitudes, across time, with the greatest changes in community popular opinion leaders, significant changes in intervention non-opinion leaders, and little change in the control markets.
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Affiliation(s)
- Ronald E Rice
- Dept. of Communication, University of California, Santa Barbara
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China;
| | - Li Li
- Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, Center for Community Health, University of California, Los Angeles;
| | - Roger Detels
- Department of Epidemiology, School of Public Health, University of California, Los Angeles,
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, Center for Community Health, University of California, Los Angeles;
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27
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Jia Z, Wang L, Chen RY, Li D, Wang L, Qin Q, Ding Z, Ding G, Zang C, Wang N. Tracking the evolution of HIV/AIDS in China from 1989-2009 to inform future prevention and control efforts. PLoS One 2011; 6:e25671. [PMID: 21998679 PMCID: PMC3187780 DOI: 10.1371/journal.pone.0025671] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 09/08/2011] [Indexed: 11/18/2022] Open
Abstract
Background To determine policy implications, this analysis tracks the evolution of HIV/AIDS infection across China to understand current trends and potential risk factors. Methods and Principal Findings A retrospective study with spatial analytical model and multilevel spatial models was conducted among 326,157 HIV/AIDS cases reported from 1989–2009. The results indicate that the distribution of HIV/AIDS was clustered at the county level with different directional distributions across China from 2003 to 2009. Compared to 2003, by 2009 there was a 122% increase in HIV cases among rural residents, 294% increase among urban residents, 211% increase among migrants, and 237% increase among permanent residents. The overall proportion of HIV by different routes of transmission showed dramatic changes with a 504% increase in sexual transmission of HIV, 90% decrease in blood/plasma transmission, and 35% decrease in injecting drug user transmission. Sexual transmission was the major transmission route among women (44%) and the elderly (59% in men, 44% in women) as well as among permanent (36%) and urban residents (33%). Among those <65 years old, women increased more than men, but among those ≥65 years, men increased more than women. Migrants contributed to the variance of HIV infection between counties but not within counties. The length of highway and urbanization combined with illiteracy were risk factors for HIV/AIDS. Conclusions/Significance Rates of HIV/AIDS among permanent urban residents, particularly women and elderly men, have increased significantly in recent years. To prevent HIV from spreading further among the general population, additional attention should be paid to these populations as well as to migrants.
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Affiliation(s)
- Zhongwei Jia
- National Institute on Drug Dependence, Peking University, Beijing, China
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Lu Wang
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Ray Y. Chen
- National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, based at the U.S. Embassy, Beijing, China
| | - Dongmin Li
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Lan Wang
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Qianqian Qin
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Zhengwei Ding
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Guowei Ding
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Chunpeng Zang
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
- * E-mail:
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