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Evangeli M, Kaleva I, Agyemang A, Williams I, Chawatama T, Jackson R, Keakantse M, Morake B, Seipone K, Busang L. Cultural adaption, translation, preliminary reliability and validity of psychological and behavioural measures for adolescents living with HIV in Botswana: A multi-stage approach. J Health Psychol 2024:13591053241248944. [PMID: 38807436 DOI: 10.1177/13591053241248944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
Human immunodeficiency virus (HIV) remains a significant public health issue among young people living in Botswana. There is a need for reliable and valid psychological and behavioural measures of causally important constructs for this population. We developed a new HIV knowledge measure for use with 10-19-year-olds living with HIV and translated and adapted additional tools measuring HIV adjustment, HIV disclosure cognitions and affect, HIV communication beliefs, antiretroviral (ART) adherence, and self-esteem, using a multi-step process. This included (1) item generation for the HIV knowledge questionnaire, (2) translation including back-translation and expert review, (3) cognitive interviewing, (4) reliability testing (5) preliminary validity analysis. The HIV Knowledge Questionnaire for Adolescents living with HIV, the Illness Cognition Questionnaire, the Adolescent HIV Disclosure Cognition and Affect Scale, the HIV Communication Beliefs Scale, and the Rosenberg Self-Esteem Scale showed acceptable or good reliability and some evidence of validity for adolescents living with HIV in Botswana.
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Affiliation(s)
| | | | | | - Ivor Williams
- African Comprehensive HIV/AIDS Partnerships (ACHAP), Botswana
| | | | - Rachel Jackson
- African Comprehensive HIV/AIDS Partnerships (ACHAP), Botswana
| | | | | | - Khumo Seipone
- African Comprehensive HIV/AIDS Partnerships (ACHAP), Botswana
| | - Lesego Busang
- African Comprehensive HIV/AIDS Partnerships (ACHAP), Botswana
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Maheu-Giroux M, Mishra S. Evidence with 95-95-95 that ambitious is feasible. Lancet HIV 2024:S2352-3018(24)00028-6. [PMID: 38467134 DOI: 10.1016/s2352-3018(24)00028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, McGill University, Montréal H3A 1G1, QC, Canada.
| | - Sharmistha Mishra
- University of Toronto, Toronto, ON, Canada; Unity Health Toronto, Toronto, ON, Canada
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Mine M, Stafford KA, Laws RL, Marima R, Lekone P, Ramaabya D, Makhaola K, Patel HK, Mapondera P, Wray-Gordon F, Agbakwuru C, Okui L, Matroos S, Onyadile E, Ngidi J, Abimiku A, Bagapi K, Nkomo B, Bodika SM, Kim KJ, Moloney M, Mitchell A, Ehoche A, Ussery FL, Hong SY, Keipeile S, Matlhaga M, Mathumo R, Selato R, Charurat ME, Voetsch AC. Progress towards the UNAIDS 95-95-95 targets in the Fifth Botswana AIDS Impact Survey (BAIS V 2021): a nationally representative survey. Lancet HIV 2024:S2352-3018(24)00003-1. [PMID: 38467135 DOI: 10.1016/s2352-3018(24)00003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND In 2014, UNAIDS set a goal to end the AIDS epidemic by achieving targets for the percentage of people living with HIV who were aware of their status, on antiretroviral therapy (ART), and virally suppressed. In 2020, these targets were revised to 95% for each measure (known as 95-95-95), to be reached among people living with HIV by 2025. We used data from the Fifth Botswana AIDS Impact Survey (BAIS V) to measure progress towards these testing and treatment targets in Botswana. METHODS BAIS V used a two-stage cluster design to obtain a nationally representative sample of people aged 15-64 years in Botswana. During March-August, 2021, 14 763 consenting participants were interviewed and tested for HIV in their households by survey teams. HIV-positive specimens were tested for viral load, presence of antiretroviral drugs, and recency of infection using the HIV-1 limiting antigen avidity enzyme immunoassay. Estimates of HIV-positive status and use of ART were based on self-report and the analysis of blood specimens for antiretroviral drugs. Viral load suppression was defined as an HIV RNA concentration of less than 1000 copies per mL. HIV incidence was calculated using the recent infection testing algorithm. Data were weighted to account for the complex survey design. FINDINGS The national HIV prevalence in Botswana among people aged 15-64 years was 20·8% and the annual incidence of HIV infection was 0·2%. 95·1% (men 93·0%, women 96·4%) of people living with HIV aged 15-64 years were aware of their status, 98·0% (men 97·2%, women 98·4%) of those aware were on ART, and 97·9% (men 96·6%, women 98·6%) of those on ART had viral load suppression. Among young people (aged 15-24 years) living with HIV, 84·5% were aware of their status, 98·5% of those aware were on ART, and 91·6% of those on ART had viral load suppression. The prevalance of viral load suppression among all people living with HIV was 91·8%, and varied by district-ranging from 85·3% in Gaborone to 100·0% in Selibe Phikwe. INTERPRETATION BAIS V is the first population-based survey worldwide to report the achievement of the UNAIDS 95-95-95 goals, both overall and among women. Strategies to reach undiagnosed men and young people, including young women, are needed. FUNDING US President's Emergency Plan for AIDS Relief.
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Affiliation(s)
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rebecca L Laws
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reson Marima
- Botswana University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Phenyo Lekone
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | | | - Kgomotso Makhaola
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Hetal K Patel
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Prichard Mapondera
- Botswana University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Floris Wray-Gordon
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chinedu Agbakwuru
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lillian Okui
- Botswana University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | | | | | | | - Alash'le Abimiku
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Khuteletso Bagapi
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | | | - Stephane M Bodika
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kaylee J Kim
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Mirna Moloney
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Mitchell
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Akipu Ehoche
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Faith L Ussery
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven Y Hong
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Stella Keipeile
- National AIDS and Health Promotion Agency, Gaborone, Botswana
| | | | - Rapetse Mathumo
- National AIDS and Health Promotion Agency, Gaborone, Botswana
| | - Robert Selato
- National AIDS and Health Promotion Agency, Gaborone, Botswana
| | - Manhattan E Charurat
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew C Voetsch
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Poku OB, Eschliman EL, Entaile P, Rampa S, Mehta H, Tal D, Silvert L, Li T, Becker TD, Govindasamy D, Stockton MA, Adedimeji A, Ho-Foster A, Blank MB, Dangerfield DT, Yang LH, Murray SM. "It's Better If I Die Because Even in the Hospital, There is a Stigma, People Still Gossip": Gossip as a Culturally Shaped Labeling Process and Its Implications for HIV-Related Stigma in Botswana. AIDS Behav 2023; 27:2535-2547. [PMID: 36646928 PMCID: PMC10350478 DOI: 10.1007/s10461-023-03980-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
This study qualitatively explores HIV-related gossip as both a manifestation and driver of HIV-related stigma, which is a known barrier to HIV testing and treatment in Botswana. Data were elicited from 5 focus group discussions and 46 semi-structured in-depth interviews with individuals living with HIV and community members with undisclosed serostatus in Gaborone, Botswana in 2017 (n = 84). Directed content analysis using the 'What Matters Most' theoretical framework identified culturally salient manifestations of HIV-related stigma; simultaneous use of Modified Labeling Theory allowed interpretation and stepwise organization of how the social phenomenon of gossip leads to adverse HIV outcomes. Results indicated that HIV-related gossip can diminish community standing through culturally influenced mechanisms, in turn precipitating poor psychosocial well-being and worsened HIV-related outcomes. These harms may be offset by protective factors, such as appearing healthy, accepting one's HIV status, and community education about the harms of gossip.
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Affiliation(s)
- Ohemaa B Poku
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Evan L Eschliman
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Shathani Rampa
- Department of Psychology, Queens College, City University of New York, New York, NY, USA
| | - Haitisha Mehta
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Danielle Tal
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Lea Silvert
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Tingyu Li
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Melissa A Stockton
- Department of Psychiatry, Vagelos College of Physicians and Surgeons Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Lawrence H Yang
- School of Global Public Health, New York University, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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5
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Poku OB, Becker TD, Rampa S, Misra S, Ho-Foster AR, Entaile P, Tay C, Choe K, Arscott-Mills T, Blank MB, Opondo PR, Yang LH. Theory-Driven, Multi-Stage Process to Develop a Culturally-Informed Anti-Stigma Intervention for Pregnant Women Living with HIV in Botswana. Int J MCH AIDS 2022; 11:e569. [PMID: 36320928 PMCID: PMC9617017 DOI: 10.21106/ijma.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite a well-established universal HIV diagnosis and treatment program, Botswana continues to face a high HIV prevalence, in large part due to persistent stigma, which particularly affects pregnant women and interferes with healthcare engagement. Tackling stigma as a fundamental cause of HIV disparities is an important but understudied aspect of current HIV interventions. Our multinational and multicultural team used a theory-driven, multi-stage iterative process to develop measures and interventions to first identify and then target the most culturally-salient aspects of stigma for mothers living with HIV in Botswana. This methodology report examines the stage-by-stage application of the "What Matters Most" (WMM) theory and lessons learned, sharing a replicable template for developing culturally-shaped anti-stigma interventions. METHODS First, we conducted initial qualitative work based on the WMM theory to identify key structural and cultural factors shaping stigma for women living with HIV in Botswana. Second, we developed a psychometrically validated scale measuring how "what matters most" contributes to and protects against stigma for this population. Third, we designed an anti-stigma intervention, "Mothers Moving towards Empowerment" (MME), centered on the local values identified using WMM theory that underly empowerment and motherhood by adapting a cognitive behavioral therapy (CBT)-informed, group-based, and peer-co-led anti-stigma intervention specifically for pregnant women living with HIV. Fourth, we conducted a pilot study of MME in which participants were allocated to two trial arms: intervention or treatment-as-usual control. RESULTS Our qualitative research identified that bearing and caring for children are capabilities essential to the concept of respected womanhood, which can be threatened by a real or perceived HIV diagnosis. These values informed the development and validation of a scale to measure these culturally-salient aspects of stigma for women living with HIV in Botswana. These findings further informed our intervention adaptation and pilot evaluation, in which the intervention group showed significant decreases in HIV stigma and depressive symptoms compared to the control group. Participants reported overcoming reluctance to disclose their HIV status to family, leading to improved social support. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Previous studies have not utilized culturally-based approaches to assess, resist, and intervene with HIV-related stigma. By applying WMM in each stage, we identified cultural and gendered differences that enabled participants to resist HIV stigma. Focusing on these capabilities that enable full personhood, we developed an effective culturally-tailored anti-stigma intervention for pregnant women living with HIV in Botswana. This theory-driven, multi-stage approach can be replicated to achieve stigma reduction for other outcomes, populations, and contexts.
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Affiliation(s)
- Ohemaa B Poku
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health Columbia University & the New York State Psychiatric Institute, New York, NY, United States
| | - Timothy D Becker
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA, United States
| | - Ari R Ho-Foster
- Faculty of Medicine, University of Botswana, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Charisse Tay
- Teachers College, Columbia University, New York, NY, United States
| | - Karen Choe
- New York University, Teachers College, Columbia University, New York, NY, United States
| | - Tonya Arscott-Mills
- Department of Pediatrics, Levine Children's Hospital, Charlotte, NC, United States
| | | | | | - Lawrence H Yang
- New York University, New York, NY, United States, Columbia University Mailman, School of Public Health, New York, NY, United States
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6
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Yang LH, Poku OB, Misra S, Mehta HT, Rampa S, Eisenberg MM, Yang LS, Dai Cao TX, Blank LI, Becker TD, Link BG, Entaile P, Opondo PR, Arscott-Mills T, Ho-Foster AR, Blank MB. Stigma, Structural Vulnerability, and "What Matters Most" Among Women Living With HIV in Botswana, 2017. Am J Public Health 2021; 111:1309-1317. [PMID: 34110916 PMCID: PMC8493151 DOI: 10.2105/ajph.2021.306274] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives. To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from "what matters most" in local culture. Methods. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Results. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners'. National HIV policies have therefore unintentionally reinforced disadvantage among women with HIV, whereby men delay or avoid testing by using their partner's status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as "promiscuous" and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Conclusions. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual- and structural-level interventions can address stigma unintentionally reinforced by health care policies.
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Affiliation(s)
- Lawrence H. Yang
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Ohemaa B. Poku
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Supriya Misra
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Haitisha T. Mehta
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Shathani Rampa
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Marlene M. Eisenberg
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Lyla S. Yang
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Thi Xuan Dai Cao
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Lilo I. Blank
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Timothy D. Becker
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Bruce G. Link
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Patlo Entaile
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Philip R. Opondo
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Tonya Arscott-Mills
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Ari R. Ho-Foster
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Michael B. Blank
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
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7
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Misra S, Mehta HT, Eschliman EL, Rampa S, Poku OB, Wang WQ, Ho-Foster AR, Mosepele M, Becker TD, Entaile P, Arscott-Mills T, Opondo PR, Blank MB, Yang LH. Identifying "What Matters Most" to Men in Botswana to Promote Resistance to HIV-Related Stigma. QUALITATIVE HEALTH RESEARCH 2021; 31:1680-1696. [PMID: 33764233 PMCID: PMC9287436 DOI: 10.1177/10497323211001361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite a comprehensive national program of free HIV services, men living with HIV in Botswana participate at lower rates and have worse outcomes than women. Directed content analysis of five focus groups (n = 38) and 50 in-depth interviews with men and women with known and unknown HIV status in Gaborone, Botswana in 2017 used the "what matters most" (WMM) and "structural vulnerability" frameworks to examine how the most valued cultural aspects of manhood interact with HIV-related stigma. WMM for manhood in Botswana included fulfilling male responsibilities by being a capable provider and maintaining social status. Being identified with HIV threatened WMM, which fear of employment discrimination could further exacerbate. Our findings indicate how cultural and structural forces interact to worsen or mitigate HIV-related stigma for urban men in Botswana. These threats to manhood deter HIV testing and treatment, but interventions could capitalize on cultural capabilities for manhood to promote stigma resistance.
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Affiliation(s)
- Supriya Misra
- Department of Public Health, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, United States
| | - Haitisha T. Mehta
- Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
| | - Evan L. Eschliman
- Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032, United States
| | - Shathani Rampa
- Department of Psychology, University of Botswana, Private Bag UB 00705, Gaborone, Botswana
| | - Ohemaa B. Poku
- Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, United States
| | - Wei-Qian Wang
- Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
| | - Ari R. Ho-Foster
- Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Mosepele Mosepele
- Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Timothy D. Becker
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States
| | - Patlo Entaile
- Botswana-UPenn Partnership, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Tonya Arscott-Mills
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Phillip R. Opondo
- Department of Psychiatry, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Michael B. Blank
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, 715 Broadway 12 Floor, New York, NY 10003, United States; Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032, United States
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Yang LH, Ho-Foster AR, Becker TD, Misra S, Rampa S, Poku OB, Entaile P, Goodman M, Blank MB. Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging "What Matters Most" to Resist Stigma. AIDS Behav 2021; 25:459-474. [PMID: 32839870 PMCID: PMC8530255 DOI: 10.1007/s10461-020-03012-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Perceived stigma deters engagement in HIV care and is powerfully shaped by culture. Yet few stigma measures consider how cultural capabilities that signify "full personhood" could be engaged to resist stigma. By applying a theory conceptualizing how culturally-salient mechanisms can worsen or mitigate HIV stigma in relation to "what matters most" (WMM), we developed the WMM Cultural Stigma Scale for Women Living with HIV in Botswana (WMM-WLHIV-BW) and psychometrically evaluated it among 201 respondents with known and unknown HIV status. The two subscales, Cultural Factors Shape Stigma (CFSS) and Cultural Capabilities Protect against Stigma (CCPS) were reliable (both [Formula: see text]). Among WLHIV, the CFSS Subscale showed initial construct validity with depressive symptoms (r = .39, p = .005), similar to an established HIV stigma scale, whereas the CCPS Subscale showed initial construct validity with self-esteem (r = .32, p = .026) and social support number (r = .29, p = .047), suggesting that achieving local cultural capabilities mitigates stigma and is linked with positive psychosocial outcomes. This culturally-derived scale could help WLHIV in Botswana experience improved stigma-related outcomes.
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Affiliation(s)
- Lawrence H Yang
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA.
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Ari R Ho-Foster
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Supriya Misra
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA
| | - Shathani Rampa
- Department of Psychology, University of Botswana, Gaborone, Botswana
| | - Ohemaa B Poku
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Melody Goodman
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA
| | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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