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Konkle-Parker D, Cleveland JD, Long D, Nair V, Fischl M, Wingood G, Edmonds A. Population Density and Health Outcomes in Women with HIV in the Southern United States: A Retrospective Longitudinal Analysis. J Womens Health (Larchmt) 2024; 33:1111-1119. [PMID: 38864119 DOI: 10.1089/jwh.2023.0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Purpose: Published studies have revealed challenges for people with human immunodeficiency virus (HIV) living in rural areas compared to those in urban areas, such as poor access to HIV care, insufficient transportation, and isolation. The purpose of this study was to examine associations between population density and multiple psychosocial and clinical outcomes in the largest cohort of women with HIV (WWH) in the United States. Methods: Women's Interagency HIV Study (WIHS) participants from Southern sites (n = 561) in 2013-2018 were categorized and compared by population density quartiles. The most urban quartile was compared with the most rural quartile in several psychosocial and clinical variables, including HIV viral load suppression, HIV medication adherence, HIV care attendance, depression, internalized HIV stigma, and perceived discrimination in healthcare settings. Results: Although women in the lowest density quartile were unexpectedly more highly resourced, women in that quartile had greater odds of not attending an HIV care visit in the last six months (odds ratio [OR] = 0.64, 95% confidence interval [CI] [0.43-0.95]), yet higher odds for having fully suppressed HIV when compared to women in the highest density quartile (OR = 1.64, 95% CI [1.13-2.38]). Highly urban WWH had greater likelihood of unsuppressed HIV, even after controlling for income, employment, and health insurance, despite reporting greater HIV care adherence and similar medication adherence. Discussion: Further investigation into the reasons for these disparities by population density is needed, and particular clinical attention should be focused on individuals from high population density areas to help maximize their health outcomes.
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Affiliation(s)
- D Konkle-Parker
- Schools of Medicine, Nursing, Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - J D Cleveland
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - V Nair
- School of Population Health, Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - M Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - G Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - A Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mashinini DP, Kelly NK, Mataboge P, Hill F, Nair H, Palattiyil G, Kahn K, Pettifor A. COVID-19-related stigma within a rural South African community: A mixed methods analysis. PLoS One 2024; 19:e0306821. [PMID: 39024376 PMCID: PMC11257259 DOI: 10.1371/journal.pone.0306821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Infectious disease-related stigma is a pervasive global issue that impedes disease control efforts by increasing reluctance to seek treatment or engagement in prevention behaviors for fear of ostracism. Despite this, there is limited research on COVID-19 stigma in Africa, specifically rural South Africa, which has faced infectious disease-related stigma throughout the HIV epidemic. METHODS Population-based surveys were conducted among 1,662 adults living in the Agincourt Health and Socio-Demographic Surveillance System (AHDSS) area in Mpumalanga, South Africa, in August-October 2020 and August-October 2021. Surveys measured anticipated COVID-19-related stigma from low to high levels. Changes in stigma between surveys were compared using Wilcoxon ranked sign tests, and log-binomial models estimated the association between socio-demographic factors and anticipated stigma at both intervals. Qualitative interviews were conducted in 2022 among 31 adults who completed the original surveys, and the data were analyzed thematically to describe anticipated, perceived, and enacted stigma. RESULTS Anticipated stigma significantly decreased from the first to the second survey (p-value:<0.0001). Stigma was significantly higher among older age groups. In 2020, those less knowledgeable about COVID-19 were 2.24 times as likely to have higher levels of anticipated stigma compared to those who were more knowledgeable (RR:2.24, 95% CI: 1.90,2.64). Fear of being stigmatized influenced willingness to disclose infection. Participants perceived COVID-19 stigma as similar to HIV/AIDS stigma, but concern and fear reduced over time, with differences observed across generations and sexes. For some, fear of death and mistrust of others endorsed enacting stigma toward others. CONCLUSION While COVID-19 stigma decreased over time in rural South Africa, different forms of stigma persisted and influenced participants' willingness to reveal their COVID-19 infection status. Given South Africa's history with infectious disease-related stigma hindering public health efforts, it is crucial that government bodies prioritize strategies to mitigate stigma in rural communities.
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Affiliation(s)
- Duduzile P. Mashinini
- Carolina Population Center, Biosocial Training Program, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Nicole K. Kelly
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Palesa Mataboge
- MRC/Wits Rural Public Health Transitions Research Unit, School of Public Health, Faculty of Health Science University of the Witwatersrand, Johannesburg, South Africa
| | - Frantasia Hill
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Harish Nair
- MRC/Wits Rural Public Health Transitions Research Unit, School of Public Health, Faculty of Health Science University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - George Palattiyil
- Social Work, School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
- Department of Social Work and Community Development, University of Johannesburg, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health Transitions Research Unit, School of Public Health, Faculty of Health Science University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Carolina Population Center, Biosocial Training Program, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- MRC/Wits Rural Public Health Transitions Research Unit, School of Public Health, Faculty of Health Science University of the Witwatersrand, Johannesburg, South Africa
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Saaka SA, Antabe R. Endorsement of HIV-related stigma among men in Ghana: What are the determinants? PLoS One 2024; 19:e0305811. [PMID: 38950016 PMCID: PMC11216618 DOI: 10.1371/journal.pone.0305811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION Stigma and discrimination against people living with HIV (PLHIV) remain a major barrier to effective HIV prevention. Despite the understanding that the creation of a socially inclusive environment for PLHIV is crucial for the promotion of testing, status disclosure, and treatment uptake, HIV stigma persists. Additionally, evidence suggests the endorsement of HIV stigma may be gender specific. Nonetheless, very little is known about the factors influencing men's discrimination against PLHIV in the Ghanaian context. Guided by the theory of planned behavior, our study fills this void by exploring the factors associated with the endorsement of HIV stigma in Ghana. METHODS Utilizing a nationally representative data from the 2022 Ghana Demographic and Health Survey (DHS) (N = 7044 men with ages ranging from 15-49 years), and applying logistic regression models, this study examined the factors associated with the endorsement of HIV-related stigma in Ghana. RESULTS The notion that HIV can be transmitted through the sharing of food with PLHIV was significantly associated with increased odds of stigma endorsement against children with HIV (OR = 3.381; P<0.001) and vendors with HIV (OR = 3.00; P<0.001). On the contrary, knowing that a healthy-looking person can have HIV was significantly associated with decreased odds of endorsement of stigma against children living with HIV (OR = 0.505; P<0.001), and vendors living with HIV (OR = 0.573; P<0.001). Likewise, having knowledge of drugs that help PLHIV to live longer, was significantly associated with decreased odds of stigma endorsement against children living with HIV (OR = 0.768; P<0.001), and vendors living with HIV (OR = 0.719; P<0.001). Moreover, participants with higher educational attainment reported lower odds of stigma endorsement against children living with HIV (OR = 0.255; P<0.01), and vendors living with HIV (OR = 0.327; P<0.01). Furthermore, age was significant and inversely associated with the endorsement of HIV stigma against children living with HIV (OR = 0.951; P<0.05), and vendors living with HIV (OR = 0.961; P<0.05). Also, wealth, ethnicity, and the region of residence significantly predicted endorsement of HIV stigma. CONCLUSION For Ghana to achieve UNAIDS target 95-95-95 by 2030, targeted educational campaigns are necessary to dispel misconceptions about HIV and to promote social inclusion for reducing HIV-related stigma and discrimination in the country.
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Affiliation(s)
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
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Gillot M, Gant Z, Hu X, Satcher Johnson A. Linkage to HIV Medical Care and Social Determinants of Health Among Adults With Diagnosed HIV Infection in 41 States and the District of Columbia, 2017. Public Health Rep 2022; 137:888-900. [PMID: 34318733 PMCID: PMC9379827 DOI: 10.1177/00333549211029971] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To reduce the number of new HIV infections and improve HIV health care outcomes, the social conditions in which people live and work should be assessed. The objective of this study was to describe linkage to HIV medical care by selected demographic characteristics and social determinants of health (SDH) among US adults with HIV at the county level. METHODS We used National HIV Surveillance System data from 42 US jurisdictions and data from the American Community Survey to describe differences in linkage to HIV medical care among adults aged ≥18 with HIV infection diagnosed in 2017. We categorized SDH variables into higher or lower levels of poverty (where <13% or ≥13% of the population lived below the federal poverty level), education (where <13% or ≥13% of the population had RESULTS Of 33 204 adults with HIV infection diagnosed in 2017, 78.4% were linked to HIV medical care ≤1 month after diagnosis. Overall, rates of linkage to care were significantly lower among men and women living in counties with higher versus lower poverty (PR = 0.96; 95% CI, 0.94-0.97), with lower versus higher health insurance coverage (PR = 0.93; 95% CI, 0.92-0.94), and with lower versus higher education levels (PR = 0.97; 95% CI, 0.96-0.98). CONCLUSIONS Increasing health insurance coverage and addressing economic and educational disparities would likely lead to better HIV care outcomes in these areas.
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Affiliation(s)
- Myrline Gillot
- Oak Ridge Institute for Science and Education, Oak Ridge, TN,
USA
| | - Zanetta Gant
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention,
Atlanta, GA, USA
| | - Xiaohong Hu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention,
Atlanta, GA, USA
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention,
Atlanta, GA, USA
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Hosseini H, Kubavat A. Why Do People of Asian Descent Not Utilize Mental Health Treatments Compared to Other Ethnic Groups in the United States? Hosp Top 2022; 101:260-265. [PMID: 35152845 DOI: 10.1080/00185868.2022.2038748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Racial and ethnic minorities like Asians in the United States are significantly less likely to receive mental health treatment than Caucasians. Using 2012 Behavioral Risk Factor Surveillance System data, we examined the underutilization of mental health treatment in the US and find that being over 65 or 35-44, being unmarried, and being insured were positively associated with mental health treatment utilization, and as mentally unhealthy days increased, the utilization of treatment also increased. The paper offers a discussion on why there is this underutilization of mental health services amongst Asians and what steps can be taken to improve utilization.
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Affiliation(s)
- Hengameh Hosseini
- Department of Healthcare Administration and Human Resources, The University of Scranton, Scranton, PA, USA
| | - Aayush Kubavat
- Department of Healthcare Administration and Human Resources, The University of Scranton, Scranton, PA, USA
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Sajadipour M, Rezaei S, Irandoost SF, Ghaumzadeh M, Salmani Nadushan M, Gholami M, Salimi Y, Jorjoran Shushtari Z. What explains gender inequality in HIV infection among high-risk people? A Blinder-Oaxaca decomposition. Arch Public Health 2022; 80:2. [PMID: 34983632 PMCID: PMC8725256 DOI: 10.1186/s13690-021-00758-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/11/2021] [Indexed: 11/15/2022] Open
Abstract
Background Despite clear evidence on role of gender in vulnerability and exposure to HIV infection, information on gender-related inequalities in HIV and related factors are rarely documented. The aim of this study was to measure gender inequality in HIV infection and its determinates in Tehran city, the capital of Iran. Methods The study used the data of 20,156 medical records of high-risk people who were admitted to Imam Khomeini Voluntary Counseling and Testing site in Tehran from 2004 to 2018. The Blinder-Oaxaca decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of HIV infection between female and male. Results The age-adjusted proportion of HIV infection was 9.45% (95%Cl: 9.02, 9.87). The absolute gap in the prevalence of HIV infection between male and female was 4.50% (95% CI: − 5.33, − 3.70%). The Blinder-Oaxaca decomposition indicated that most explanatory factors affecting the differences in HIV infection were job exposure, drug abuse, history of imprisonment, injection drug, heterosexual unsafe sex, and having an HIV-positive spouse. Conclusion The results can provide evidence for health policymakers to better planning and conducting gender-based preventive and screening programs. Policies aiming at promoting HIV preventive behaviors among male may reduce the gap in HIV infection between female and male in Iran.
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Affiliation(s)
- Mansour Sajadipour
- Department of Health, South Tehran health center, Tehran University of Medical Sciences, Tehran, Iran
| | - Satar Rezaei
- Social Determinants of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Seyed Fahim Irandoost
- Social Determinants of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammadreza Ghaumzadeh
- Department of Health, South Tehran health center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Gholami
- Department of Medical Microbiology, Aja University of Medical Sciences, Tehran, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Wanjala SW, Too EK, Luchters S, Abubakar A. Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13074. [PMID: 34948690 PMCID: PMC8701211 DOI: 10.3390/ijerph182413074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
Addressing HIV-related stigma requires the use of psychometrically sound measures. However, despite the Berger HIV stigma scale (HSS) being among the most widely used measures for assessing HIV-related stigma, no study has systematically summarised its psychometric properties. This review investigated the psychometric properties of the HSS. A systematic review of articles published between 2001 and August 2021 was undertaken (CRD42020220305) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additionally, we searched the grey literature and screened the reference lists of the included studies. Of the total 1241 studies that were screened, 166 were included in the review, of which 24 were development and/or validation studies. The rest were observational or experimental studies. All the studies except two reported some aspect of the scale's reliability. The reported internal consistency ranged from acceptable to excellent (Cronbach's alpha ≥ 0.70) in 93.2% of the studies. Only eight studies reported test-retest reliability, and the reported reliability was adequate, except for one study. Only 36 studies assessed and established the HSS's validity. The HSS appears to be a reliable and valid measure of HIV-related stigma. However, the validity evidence came from only 36 studies, most of which were conducted in North America and Europe. Consequently, more validation work is necessary for more precise insights.
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Affiliation(s)
- Stanley W. Wanjala
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Department of Social Sciences, Pwani University, Kilifi P.O. Box 195-80108, Kenya
| | - Ezra K. Too
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
| | - Stanley Luchters
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Public Health, Pwani University, Kilifi P.O. Box 195-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi P.O. Box 230-80108, Kenya
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Prevalence and Correlates of HIV Stigma Among Women Living with HIV in Metro Vancouver, Canada. AIDS Behav 2021; 25:1688-1698. [PMID: 33389325 DOI: 10.1007/s10461-020-03084-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/22/2022]
Abstract
This study elucidated the prevalence and correlates of four types of HIV stigma among women living with HIV (WLWH). Data were drawn from 2 years (September 1/15 to August 31/17) of follow-up from a longitudinal community-based open cohort of 215 cisgender or transgender WLWH who lived and/or accessed care in Metro Vancouver, Canada (2014-present). Bivariate and multivariable cumulative logistic regression using generalized estimating equations for repeated measures were used to examine correlates of HIV stigma, including: (1) anticipated; (2) enacted; (3) internalized; and (4) perceived stigma. In multivariable analysis, disclosure of HIV status without consent was significantly associated with heightened: anticipated; enacted; and perceived stigma. Verbal and/or physical violence related to HIV status was significantly associated with heightened enacted, internalized and perceived stigma. Negative physical effects/symptoms of HIV was significantly associated with all stigma outcomes. Results suggest a need to support safe disclosure of HIV status and address social and structural violence against WLWH.
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Edmonds A, Haley DF, Tong W, Kempf MC, Rahangdale L, Adimora AA, Anastos K, Cohen MH, Fischl M, Wilson TE, Wingood G, Konkle-Parker D. Associations between population density and clinical and sociodemographic factors in women living with HIV in the Southern United States. AIDS Care 2021; 33:229-238. [PMID: 32449377 PMCID: PMC7686024 DOI: 10.1080/09540121.2020.1769829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
To explore the associations of urbanicity with clinical/behavioral outcomes and sociodemographic factors among women living with HIV in the Southern United States, 523 participants of the Women's Interagency HIV Study were classified into population density quartiles. Rural-Urban Commuting Area codes revealed that 7% resided in areas where >30% commute to urban areas, 2% resided in small towns or rural areas, and 91% resided in varying densities of urban areas. Although women in lower density, mostly suburban areas reported higher socioeconomic indicators such as advanced education and greater annual household income, larger proportions of women in the lowest density quartile perceived discrimination in health care settings and agreed with several internalized HIV stigma scale items. Women in the lower quartiles had higher CD4 counts, while those in the lowest quartile were more likely to have a suppressed HIV viral load, report being employed, and not report a history of drug use or current heavy alcohol use. More research is needed to understand the interplay between population density and mechanisms contributing to HIV control as well as increased internalized stigma and perceived discrimination, along with how to target interventions to improve outcomes for individuals with HIV across urban, suburban, and rural areas.
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Affiliation(s)
- Andrew Edmonds
- The University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC
| | - Danielle F Haley
- Northeastern University, Department of Health Sciences, Institute for Health Equity and Social Justice Research, Bouvé College of Health Sciences, Boston, MA
| | | | | | - Lisa Rahangdale
- The University of North Carolina at Chapel Hill, Department of Obstetrics & Gynecology, School of Medicine, Chapel Hill, NC
| | - Adaora A Adimora
- The University of North Carolina at Chapel Hill, School of Medicine, Division of Infectious Diseases, Chapel Hill, NC
| | - Kathryn Anastos
- Albert Einstein College of Medicine/Montefiore Medical Center, Departments of Medicine, Epidemiology, and Population Health, Bronx, NY
| | - Mardge H Cohen
- Departments of Medicine, Stroger Hospital of Cook County and Rush University, Chicago, IL
| | - Margaret Fischl
- University of Miami School of Medicine, Department of Medicine, Division of Infectious Diseases, Miami, FL
| | - Tracey E Wilson
- SUNY Downstate Health Sciences University, Department of Community Health Sciences
| | - Gina Wingood
- Columbia University, Mailman School of Public Health, New York, NY
| | - Deborah Konkle-Parker
- University of Mississippi Medical Center, Department of Medicine, Division of Infectious Diseases, Jackson, MS
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Rai SS, Peters RMH, Syurina EV, Irwanto I, Naniche D, Zweekhorst MBM. Intersectionality and health-related stigma: insights from experiences of people living with stigmatized health conditions in Indonesia. Int J Equity Health 2020; 19:206. [PMID: 33176809 PMCID: PMC7661268 DOI: 10.1186/s12939-020-01318-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022] Open
Abstract
Background Health-related stigma is a complex phenomenon, the experience of which intersects with those of other adversities arising from a diversity of social inequalities and oppressive identities like gender, sexuality, and poverty – a concept called “intersectionality”. Understanding this intersectionality between health-related stigma and other forms of social marginalization can provide a fuller and more comprehensive picture of stigma associated with health conditions. The main objective of this paper is to build upon the concept of intersectionality in health-related stigma by exploring the convergence of experiences of stigma and other adversities across the intersections of health and other forms of social oppressions among people living with stigmatized health conditions in Indonesia. Methods This qualitative study interviewed 40 people affected by either of four stigmatizing health conditions (HIV, leprosy, schizophrenia, and diabetes) in Jakarta and West Java, Indonesia between March and June 2018. Data was analyzed thematically using an integrative inductive-deductive framework approach. Results The main intersectional inequalities identified by the participants were gender and socioeconomic status (n = 21), followed by religion (n = 13), age (n = 11), co-morbidity (n = 9), disability (n = 6), and sexuality (n = 4). Based on these inequalities/identities, the participants reported of experiencing oppression because of prevailing social norms, systems, and policies (macro-level), exclusion and discrimination from societal actors (meso-level), and self-shame and stigma (micro-level). While religion and age posed adversities that negatively affected participants in macro and meso levels, they helped mitigate the negative experiences of stigma in micro level by improving self-acceptance and self-confidence. Conclusion This study uncovered how the experience of health-related stigma intersects with other oppressions originating from the various social inequalities in an individual’s life. The findings highlight the importance of acknowledging and understanding the multi-dimensional aspect of lives of people living with stigmatized health conditions, and warrant integrated multi-level and cross-cutting stigma reduction interventions to address the intersectional oppressions they experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-020-01318-w.
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Affiliation(s)
- Sarju Sing Rai
- Athena Institute, Faculty of Science, Vrije University Amsterdam, VU Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands. .,Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain.
| | - Ruth M H Peters
- Athena Institute, Faculty of Science, Vrije University Amsterdam, VU Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands
| | - Elena V Syurina
- Athena Institute, Faculty of Science, Vrije University Amsterdam, VU Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands
| | - Irwanto Irwanto
- Faculty of Psychology, Atma Jaya Catholic University, Jakarta, Indonesia
| | - Denise Naniche
- Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Marjolein B M Zweekhorst
- Athena Institute, Faculty of Science, Vrije University Amsterdam, VU Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands
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Kalichman SC, Katner H, Banas E, Hill M, Kalichman MO. Cumulative Effects of Stigma Experiences on Retention in HIV Care Among Men and Women in the Rural Southeastern United States. AIDS Patient Care STDS 2020; 34:484-490. [PMID: 33147086 DOI: 10.1089/apc.2020.0144] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The stigmatization of HIV infection impedes every step along the HIV continuum of care, particularly care engagement and retention. The differential effects of various sources of stigma on retention in HIV care have been the subject of limited research. We examined the accumulation of HIV stigma experiences over 1 year in relationship to treatment retention among 251 men and women marginally engaged in HIV care in the southeastern United States. Results showed that cumulative stigma experiences predicted poorer retention in care, with greater stigma experiences related to less consistency in attending scheduled medical appointments. HIV stigma originating from family members and acts of overt discrimination were the most frequently experienced sources of stigma and were most closely associated with disengagement from HIV care. In addition, analyses by gender indicated that retention in care for men was impacted by stigma to a greater extent than among women. These findings reaffirm the importance of HIV stigma as a barrier to HIV care and provide new directions for interventions to mitigate the negative effects of stigma on patients who are not fully engaged in HIV care. Clinical trials registration NCT104180280.
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Affiliation(s)
- Seth C. Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Ellen Banas
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Moira O. Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
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HIV-related stigma and non-adherence to antiretroviral medications among people living with HIV in a rural setting. Soc Sci Med 2020; 258:113092. [PMID: 32585544 DOI: 10.1016/j.socscimed.2020.113092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023]
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Discrimination, Medical Distrust, Stigma, Depressive Symptoms, Antiretroviral Medication Adherence, Engagement in Care, and Quality of Life Among Women Living With HIV in North Carolina: A Mediated Structural Equation Model. J Acquir Immune Defic Syndr 2020; 81:328-335. [PMID: 30893124 DOI: 10.1097/qai.0000000000002033] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women represent 23% of all Americans living with HIV. By 2020, more than 70% of Americans living with HIV are expected to be 50 years and older. SETTING This study was conducted in the Southern United States-a geographic region with the highest number of new HIV infections and deaths. OBJECTIVE To explore the moderating effect of age on everyday discrimination (EVD); group-based medical (GBM) distrust; enacted, anticipated, internalized HIV stigma; depressive symptoms; HIV disclosure; engagement in care; antiretroviral medication adherence; and quality of life (QOL) among women living with HIV. METHODS We used multigroup structural equation modeling to analyze baseline data from 123 participants enrolled at the University of North Carolina at Chapel Hill site of the Women's Interagency HIV Study during October 2013-May 2015. RESULTS Although age did not moderate the pathways hypothesized, age had a direct effect on internalized stigma and QOL. EVD had a direct effect on anticipated stigma and depressive symptoms. GBM distrust had a direct effect on depressive symptoms and a mediated effect through internalized stigma. Internalized stigma was the only form of stigma directly related to disclosure. Depressive symptoms were a significant mediator between GBM, EVD, and internalized stigma reducing antiretroviral therapy medication adherence, engagement in care, and QOL. CONCLUSIONS EVD, GBM, and internalized stigma adversely affect depressive symptoms, antiretroviral therapy medication adherence, and engagement in care, which collectively influence the QOL of women living with HIV.
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Gao MX, Gao MX, Guo L, Sun F, Zhang A. Perceived threat of Alzheimer's disease and related dementias in Chinese older adults: The role of knowledge and perceived stigma. Int J Geriatr Psychiatry 2020; 35:223-229. [PMID: 31755119 DOI: 10.1002/gps.5240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/07/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study focused on perceived threat of Alzheimer's disease and related dementias (ADRD) in Chinese older adults and investigated its associations with their perceived stigma and knowledge of ADRD. METHODS We examined Chinese older adults' perceived threat of ADRD and its associations with perceived stigma, knowledge of ADRD, family variables and health variables. Data for this cross-sectional study were collected by student interviewers in 2016. The participants (N = 754) were recruited from two urban communities in mainland China and their ages ranged from 60 to 89 (M = 69.54, SD = 7.35). RESULTS Hierarchical regression analyses indicated that those who are younger, have more depressive symptoms and lower levels of family cohesion are more likely to worry about ADRD. More ADRD knowledge and higher levels of perceived stigma are significantly associated with perceived threat of ADRD. Community site moderated the relationship between stigma and perceived threat of ADRD. CONCLUSIONS Intervention or service programs need to promote ADRD knowledge and awareness in a culturally sensitive way as well as address stigma and fear toward ADRD in the older population. Future studies are needed to incorporate more cultural and environmental factors to fully understand Chinese older adults' attitudes toward and literacy of ADRD.
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Affiliation(s)
- Ms Xiang Gao
- School of Sociology, Huazhong University of Science and Technology, Wuhan, China.,Elder Service Research Center at Huazhong University of Science and Technology, China
| | - Mr Xiang Gao
- School of Sociology, Huazhong University of Science and Technology, Wuhan, China.,Elder Service Research Center at Huazhong University of Science and Technology, China
| | - Lin Guo
- School of Sociology, Huazhong University of Science and Technology, Wuhan, China.,Elder Service Research Center at Huazhong University of Science and Technology, China
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing, MI
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, MI
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Kalichman S, Shkembi B, Hernandez D, Katner H, Thorson KR. Income Inequality, HIV Stigma, and Preventing HIV Disease Progression in Rural Communities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1066-1073. [PMID: 30955136 PMCID: PMC7000177 DOI: 10.1007/s11121-019-01013-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Antiretroviral therapies (ART) suppress HIV replication, thereby preventing HIV disease progression and potentially preventing HIV transmission. However, there remain significant health disparities among people living with HIV, particularly for women living in impoverished rural areas. A significant contributing factor to HIV-related disparities is a stigma. And yet, the relative contributions of stigma, gender, socio-economics, and geography in relation to health outcomes are understudied. We examined the associations of internalized stigma and enacted stigma with community-level income inequality and HIV viral suppression-the hallmark of successful ART-among 124 men and 74 women receiving care from a publicly funded HIV clinic serving rural areas with high-HIV prevalence in the southeastern US. Participants provided informed consent, completed computerized interviews, and provided access to their medical records. Gini index was collected at the census tract level to estimate community-level income inequality. Individual-level and multilevel models controlled for point distance that patients lived from the clinic and quality of life, and included participant gender as a moderator. We found that for women, income inequality, internalized stigma, and enacted stigma were significantly associated with HIV suppression. For men, there were no significant associations between viral suppression and model variables. The null findings for men are consistent with gender-based health disparities and suggest the need for gender-tailored prevention interventions to improve the health of people living with HIV in rural areas. Results confirm and help to explain previous research on the impact of HIV stigma and income inequality among people living with HIV in rural settings.
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Affiliation(s)
- Seth Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Bruno Shkembi
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Dominica Hernandez
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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Repeat Human Immunodeficiency Virus Testing by Transmission Risk Group and Rurality of Residence in North Carolina. Sex Transm Dis 2019; 45:684-689. [PMID: 29771865 DOI: 10.1097/olq.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Understanding of repeat human immunodeficiency virus (HIV) testing (RHT) is limited and the impact of rural residence as a potential barrier to RHT is unknown. Rural populations are of particular interest in the Southeastern United States because of their disproportionate HIV burden. METHODS We used HIV surveillance data from publicly funded HIV testing sites in North Carolina to assess repeat testing by transmission risk group and residential rurality in a retrospective cohort study. Linear binomial regression models were used to estimate adjusted, 1-year cumulative incidences and cumulative incidence differences comparing RHT within transmission risk populations by level of rurality. RESULTS In our total study population of 600,613 persons, 19,275 (3.2%) and 9567 (1.6%) self-identified as men who have sex with men (MSM) and persons who inject drugs (PWID), respectively. A small minority, 13,723 (2.3%) resided in rural ZIP codes. Men who have sex with men were most likely to repeat test (unadjusted, 1-year cumulative incidence after an initial negative test, 16.4%) compared with PWID (13.2%) and persons who did not identify as either MSM or PWID (13.6%). The greatest effect of rurality was within PWID; the adjusted, 1-year cumulative incidence of RHT was 6.4 (95% confidence interval, 1.4-11.4) percentage points higher among metropolitan versus rural PWID. CONCLUSIONS One-year cumulative incidence of RHT was low among all clients of publicly funded HIV testing sites in North Carolina, including MSM and PWID for whom annual testing is recommended. Our findings suggest a need for public health efforts to increase access to and support for RHT, particularly among rural PWID.
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Choi SW, Ramos C, Kim K, Azim SF. The Association of Racial and Ethnic Social Networks with Mental Health Service Utilization Across Minority Groups in the USA. J Racial Ethn Health Disparities 2019; 6:836-850. [DOI: 10.1007/s40615-019-00583-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/21/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
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Kalichman S, Katner H, Banas E, Kalichman M. Population Density and AIDS-Related Stigma in Large-Urban, Small-Urban, and Rural Communities of the Southeastern USA. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:517-525. [PMID: 28190136 DOI: 10.1007/s11121-017-0761-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIDS stigmas delay HIV diagnosis, interfere with health care, and contribute to mental health problems among people living with HIV. While there are few studies of the geographical distribution of AIDS stigma, research suggests that AIDS stigmas are differentially experienced in rural and urban areas. We conducted computerized interviews with 696 men and women living with HIV in 113 different zip code areas that were classified as large-urban, small-urban, and rural areas in a southeast US state with high-HIV prevalence. Analyses conducted at the individual level (N = 696) accounting for clustering at the zip code level showed that internalized AIDS-related stigma (e.g., the sense of being inferior to others because of HIV) was experienced with greater magnitude in less densely populated communities. Multilevel models indicated that after adjusting for potential confounding factors, rural communities reported greater internalized AIDS-related stigma compared to large-urban areas and that small-urban areas indicated greater experiences of enacted stigma (e.g., discrimination) than large-urban areas. The associations between anticipated AIDS-related stigma (e.g., expecting discrimination) and population density at the community-level were not significant. Results suggest that people living in rural and small-urban settings experience greater AIDS-related internalized and enacted stigma than their counterparts living in large-urban centers. Research is needed to determine whether low-density population areas contribute to or are sought out by people who experienced greater AIDS-related stigma. Regardless of causal directions, interventions are needed to address AIDS-related stigma, especially among people in sparsely populated areas with limited resources.
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Affiliation(s)
- Seth Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | | | - Ellen Banas
- Mercer University Medical School, Macon, GA, USA
| | - Moira Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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Pourmarzi D, Khoramirad A, Gaeeni M. Perceived Stigma in People Living With HIV in Qom. J Family Reprod Health 2017; 11:202-210. [PMID: 30288167 PMCID: PMC6168756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aimed to report on perceived stigma by PLWH and factors that affect it. Materials and methods: A cross-sectional study was carried out on 120 PLWH in Qom, Iran from November 2015 to April 2016. Persian version of Fife and Wright's scale was used to measure perceived stigma. Results: The mean score of stigma was 73.19 ± 12.23 (range: 48-97). The means of external stigma and internal stigma were 43.70 ± 8.61 (range: 19-60), and 29.49 ± 5.32 (range: 17-40), respectively. Living in a rural areas (β = 10.341, p = 0.006), unemployment status (β = 6.910, p = 0.006), and poor support from family members (β = 4.772, p = 0.028) significantly increased the level of perceived stigma. PLWH experience a considerable level of stigma in their daily life. Mass media involvement to increase public awareness and reduce HIV related stigma need be more highlighted. Conclusion: Working with the patients' families, interventions in the rural areas and workplaces, and providing social supports is necessary to minimize the HIV related stigma.
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Affiliation(s)
- Davoud Pourmarzi
- Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ashraf Khoramirad
- Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Mina Gaeeni
- Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
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Muralidharan S, Acharya AK, Margabandu S, Purushotaman S, Kannan R, Mahendrakar S, Kulkarni D. Stigma and Discrimination faced by HIV-infected Adults on Antiretroviral Therapy for more than 1 Year in Raichur Taluk, Karnataka, India. J Contemp Dent Pract 2017; 18:765-770. [PMID: 28874638 DOI: 10.5005/jp-journals-10024-2123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The aim of this study was to evaluate the stress and discrimination faced by human immunodeficiency virus (HIV)-affected adult patients on antiretroviral therapy (ART) for more than 1 year. MATERIALS AND METHODS A cross-sectional study was carried out among 170 adults on ART, reporting to the ART center of the District Civil Hospital, for more than 1 year in Raichur Taluk, Karnataka, India. Convenience sampling technique was followed. Descriptive statistics was performed (Chi-square test) using Statistical Package for the Social Sciences version 16.0. RESULTS A total of 156 (91.8%) patients' families had knowledge about their seropositive status. Seventeen (10.9%) HIV-positive patients reported of change in the attitude of their family members. The main reasons for not revealing the HIV status were the internalized stigma and fear of rejection. Women faced greater discrimination from family, friends, and neighbors than men. CONCLUSION It is necessary to not undermine the effect of rejection due to HIV. It is the only infection that has so many associated social and psychological norms which we need to tend at the earnest. Till date, there is an existence of condescendence toward treatment approach. CLINICAL SIGNIFICANCE The presence of stigma and the fear of being discriminated could be a major hurdle in the rehabilitation of these patients into the mainstream society. Furthermore, it serves as an existing challenge to ascertain these individuals to achieve overall health.
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Affiliation(s)
- Shrikanth Muralidharan
- Department of Public Health Dentistry, M.A. Rangoonwala College of Dental Sciences & Research Centre, Pune Maharashtra, India, Phone: +918308008831, e-mail:
| | - Arun Kumar Acharya
- Department of Public Health Dentistry, Navodaya Dental College, Raichur, Karnataka, India
| | - Shanthi Margabandu
- Department of Public Health Dentistry, Mathrushri Ramabai Ambedkar Dental College and Hospital, Bengaluru, Karnataka India
| | - Shalini Purushotaman
- Department of Public Health Dentistry, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
| | - Ranjit Kannan
- Department of Public Health Dentistry, Asan Memorial Dental College and Hospital, Chengalpet, Tamil Nadu, India
| | - Sangeeta Mahendrakar
- Department of Public Health Dentistry, Navodaya Dental College, Raichur, Karnataka, India
| | - Dinraj Kulkarni
- Department of Oral Pathology and Microbiology, M.A. Rangoonwala College of Dental Sciences & Research Centre Pune, Maharashtra, India
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Wilkinson B, Arora KS. A Systematic Review on Confidentiality, Disclosure, and Stigma in the United States: Lessons for HIV Care in Pregnancy From Reproductive Genetics. New Bioeth 2016; 21:142-54. [PMID: 27124962 DOI: 10.1179/2050287715z.00000000067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The fields of HIV care in pregnancy and reproductive genetics have always been 'exceptional' in that patients are highly concerned about the potential for stigma and the corresponding need for privacy and confidentiality. However, the two fields have diverged in how they have addressed these concerns. The systematic review analyzed 61 manuscripts for similarities and differences between the fields of HIV care in pregnancy and reproductive genetics in the United States, with respect to privacy, confidentiality, disclosure, and stigma. The systematic review revealed that the field of HIV care in pregnancy has insufficiently addressed patient concerns about privacy, confidentiality, and stigma compared to the field of reproductive genetics. Failure to adequately protect confidentiality of HIV-positive patients, and failure to reduce stigma associated with HIV testing and treatment are deficiencies in the delivery of care to HIV-positive pregnant woman and barriers to reducing vertical transmission of HIV. Improvements in care and policy should mirror the field of reproductive genetics.
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Relf MV, Williams M, Barroso J. Voices of Women Facing HIV-Related Stigma in the Deep South. J Psychosoc Nurs Ment Health Serv 2015; 53:38-47. [PMID: 26505522 DOI: 10.3928/02793695-20151020-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/05/2015] [Indexed: 11/20/2022]
Abstract
One in 139 women will be diagnosed with HIV in their lifetime. Thirty-four years into the epidemic, stigma remains part of the trajectory of the disease process for all individuals with HIV. Stigma associated with HIV makes it difficult for women to access HIV testing and counseling, disclose HIV status to sexual partners and health care providers, seek and remain actively engaged in medical care, effectively self-manage the disease after diagnosis, and adhere to antiretroviral therapy. The current article reports the qualitative results from a study designed to test the feasibility and acceptability of a technologically delivered stigma intervention for women with HIV in the Southeastern United States. Qualitative analysis revealed women with HIV uniformly experience, anticipate, and/or internalize stigma associated with HIV. Consequently, women with HIV experience isolation and a threat to self-concept as they make decisions about disclosure, work to maintain the secrecy of their HIV status, and contemplate a future.
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Hutson SP. Climbing Back Up the Mountain: Reflections From an Exploration of End-of-Life Needs of Persons Living With HIV/AIDS in Appalachian Tennessee. Am J Hosp Palliat Care 2015; 33:972-976. [PMID: 26290520 DOI: 10.1177/1049909115600857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Little is known about the health access and end-of-life (EOL) concerns of persons living with HIV/AIDS (PLWHA) in Appalachia, where religious and cultural values are largely traditional. A qualitative, descriptive study with 9 participants was undertaken to assess EOL care needs among those from South Central Appalachian PLWHA. The focus of the study was to examine subjective data regarding EOL needs assessment related to advanced care planning. Five men and 4 women self-acknowledged a diagnosis of HIV/AIDS and completed a 2-hour face-to-face interview with the nurse researcher. Data were analyzed using qualitative descriptive content analysis methods, including data coding for emergent themes and metaphors. A common metaphor tied content to both struggle and triumph as well as the beauty and ruggedness of the Appalachian region: "Climbing Back up the Mountain." Rich descriptions of the significance of the metaphor match with stigma as the greatest hurdle to overcome in planning and interacting with others, including health care providers and significant others, about EOL care needs and advanced planning preferences. Further, the metaphor was derived directly from quotes offered by participants. Sources of stigma were often intersecting: the disease itself, associations with "promiscuity," sexual minority status, illicit drug use, and so on. Strong spiritual images were contrasted with a common avoidance and disdain of organized religion. Findings were used in refining plans for a larger study of EOL care needs and concerns on the population of PLWHA in 2 Southern Appalachian states. Comparison with other research and insights for providers is included.
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Affiliation(s)
- Sadie P Hutson
- College of Nursing, University of Tennessee, Knoxville, TN, USA
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Okello ES, Wagner GJ, Ghosh-Dastidar B, Garnett J, Akena D, Nakasujja N, Musisi S. Depression, Internalized HIV Stigma and HIV Disclosure. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/wja.2015.51004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wagner AC, Ivanova EL, Hart TA, Loutfy MR. Examining the Traits-Desires-Intentions-Behavior (TDIB) model for fertility planning in women living with HIV in Ontario, Canada. AIDS Patient Care STDS 2014; 28:594-601. [PMID: 25291213 DOI: 10.1089/apc.2014.0075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of this study was to determine the predictors of fertility behavior (i.e., trying to become pregnant) in a large representative sample of women living with HIV of reproductive age in Ontario, Canada. The Traits-Desires-Intentions-Behavior model was used to examine the key predictors of reproductive decision making and behavior. A total of 320 women living with HIV were included in the current analysis. The women living with HIV were between the ages of 18 and 52 (mean=37.23, SD=7.53), 56.4% had at least one child living in the home, over 40% identified as being of African ethnicity, and the average time since HIV diagnosis was 10.49 years (SD=5.71). In hierarchical multilevel analysis, perceived family support for trying to become pregnant, living in a large metropolitan city (i.e., Toronto), women's fertility desires, and fertility intentions were associated with fertility behavior (χ(2)9=59.97, p<0.001). As only 10.6% of participants reported engaging in fertility-related behavior, while 57.5% intended a pregnancy in the future, identifying barriers to fertility and discrepancies between intentions and behaviors can support policy programs and assist health care providers to better facilitate the fertility goals of women living with HIV.
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Affiliation(s)
- Anne C. Wagner
- Department of Psychology, Ryerson University, Toronto, Canada
| | | | - Trevor A. Hart
- Department of Psychology, Ryerson University, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mona R. Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Barroso J, Relf MV, Williams MS, Arscott J, Moore ED, Caiola C, Silva SG. A randomized controlled trial of the efficacy of a stigma reduction intervention for HIV-infected women in the Deep South. AIDS Patient Care STDS 2014; 28:489-98. [PMID: 25084499 DOI: 10.1089/apc.2014.0014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to compare outcomes (self-esteem, coping self-efficacy, and internalized stigma) across time in HIV-infected women living in the Deep South who received a stigma reduction intervention (n=51) with those of a control group (n=49) who received the usual care at baseline, and at 30 and 90 days. We recruited 99 women from clinics and an AIDS service organization; they were randomized by recruitment site. A video developed from the results of a qualitative metasynthesis study of women with HIV infection was loaded onto iPod Touch devices. Participants were asked to watch the video weekly for 4 weeks, and to record the number of times they viewed it over a 12-week period. We examined the trajectory model results for efficacy outcomes for the intent-to-treat and the supplemental completers groups. There was a treatment-by-time effect for improved self-esteem (intent-to-treat: p=0.0308; completers: p=0.0284) and decreases in internalized stigma (intent-to-treat: p=0.0036; completers: p=0.0060), and a treatment-by-time-by-time effect for improved coping self-efficacy (intent-to-treat: p=0.0414; completers: p=0.0321). A medium effect of the intervention in terms of improving self-esteem was observed when compared with the control condition in those who completed the study. The magnitude of the intervention effect, however, was large with regard to reducing overall stigma, improving social relationships, and decreasing stereotypes in both groups.
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Affiliation(s)
- Julie Barroso
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida
| | | | | | - Joyell Arscott
- Duke University School of Nursing, Durham, North Carolina
| | | | | | - Susan G. Silva
- Duke University School of Nursing, Durham, North Carolina
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Individual-level socioeconomic status and community-level inequality as determinants of stigma towards persons living with HIV who inject drugs in Thai Nguyen, Vietnam. J Int AIDS Soc 2013; 16:18637. [PMID: 24242257 PMCID: PMC3833190 DOI: 10.7448/ias.16.3.18637] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/22/2013] [Accepted: 08/29/2013] [Indexed: 11/08/2022] Open
Abstract
Introduction HIV infection may be affected by multiple complex socioeconomic status (SES) factors, especially individual socioeconomic disadvantage and community-level inequality. At the same time, stigma towards HIV and marginalized groups has exacerbated persistent concentrated epidemics among key populations, such as persons who inject drugs (PWID) in Vietnam. Stigma researchers argue that stigma fundamentally depends on the existence of economic power differences in a community. In rapidly growing economies like Vietnam, the increasing gap in income and education levels, as well as an individual's absolute income and education, may create social conditions that facilitate stigma related to injecting drug use and HIV. Methods A cross-sectional baseline survey assessing different types of stigma and key socioeconomic characteristics was administered to 1674 PWID and 1349 community members living in physical proximity throughout the 32 communes in Thai Nguyen province, Vietnam. We created four stigma scales, including HIV-related and drug-related stigma reported by both PWID and community members. We then used ecologic Spearman's correlation, ordinary least-squares regression and multi-level generalized estimating equations to examine community-level inequality associations, individual-level SES associations and multi-level SES associations with different types of stigma, respectively. Results There was little urban–rural difference in stigma among communes. Higher income inequality was marginally associated with drug-related stigma reported by community members (p=0.087), and higher education inequality was significantly associated with higher HIV-related stigma reported by both PWID and community members (p<0.05). For individuals, higher education was significantly associated with lower stigma (HIV and drug related) reported by both PWID and community members. Part-time employed PWID reported more experiences and perceptions of drug-related stigma, while conversely unemployed community members reported enacting lower drug-related stigma. Multi-level analysis revealed that the relationship between education inequality and HIV-related stigma is superseded by the effect of individual-level education. Conclusions The results of the study confirm that socioeconomic factors at both the individual level and community level affect different types of stigma in different ways. Attention should be paid to these differences when planning structural or educational interventions to reduce stigma, and additional research should investigate the mechanisms with which SES and inequality affect social relationships and, in turn, stigma.
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Monteiro SS, Villela WV, Soares PS. The interaction between axes of inequality in studies on discrimination, stigma and HIV/AIDS: Contributions to the recent international literature. Glob Public Health 2013; 8:519-33. [DOI: 10.1080/17441692.2013.779738] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Varni SE, Miller CT, Solomon SE. Sexual behavior as a function of stigma and coping with stigma among people with HIV/AIDS in rural New England. AIDS Behav 2012; 16:2330-9. [PMID: 22782789 PMCID: PMC3482285 DOI: 10.1007/s10461-012-0239-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The relationship between coping with HIV/AIDS stigma and engaging in risky sexual behavior (i.e., inconsistent condom use) was examined in HIV-positive adults living in rural areas. Participants answered questions about their experiences with HIV/AIDS prejudice and discrimination (enacted stigma) and their perceptions of felt HIV/AIDS stigma (disclosure concerns, negative self-image, and concern with public attitudes). They were also asked about how they coped with HIV/AIDS stigma, and about their sexual activity during the past 90 days. We hypothesized that using disengagement coping to manage the stress of HIV/AIDS stigma would be related to risky sexual behavior. Multinomial logistic regression results showed that using disengagement coping (avoidance, denial, and wishful thinking) coupled with high levels of enacted stigma was associated with less risky rather than more risky sexual behavior. That is, disengagement coping coupled with high stigma increased the odds of not having vaginal or anal sex versus inconsistently using condoms. Implications for people with HIV/AIDS who use disengagement coping to manage stress to deal with HIV/AIDS stigma are discussed.
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Affiliation(s)
- Susan E. Varni
- Psychology Department, University of Vermont, John Dewey Hall, 2 Colchester Ave, Burlington, VT 05405, USA
| | - Carol T. Miller
- Psychology Department, University of Vermont, John Dewey Hall, 2 Colchester Ave, Burlington, VT 05405, USA
| | - Sondra E. Solomon
- Psychology Department, University of Vermont, John Dewey Hall, 2 Colchester Ave, Burlington, VT 05405, USA
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Swank E, Frost DM, Fahs B. Rural location and exposure to minority stress among sexual minorities in the United States. PSYCHOLOGY & SEXUALITY 2012. [DOI: 10.1080/19419899.2012.700026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Miller CT, Bunn JY, Grover KW, Solomon SE. Perceptions of Behavioral Norms Related to HIV Transmission by People with HIV and by Residents of Their Communities. SOCIAL INFLUENCE 2012; 9:1-19. [PMID: 26167138 DOI: 10.1080/15534510.2012.712548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We examined how people with HIV are both part of and apart from the communities in which they live. We compared perceptions of behavioral norms of 203 people with HIV living in 33 different communities with community-level normative perceptions assessed by surveys of 2,444 randomly selected residents of these communities. Participants with HIV perceived behavior that risks the transmission of HIV as injunctively and descriptively more normative than did other community residents. Participants with HIV living in communities in which community residents perceived relatively widespread approval of condom use to prevent HIV and other sexually transmitted diseases also perceived these behaviors as injunctively normative, and they perceived relatively low levels of HIV stigmatization. Discussion focuses on how perceptions about "deviant" behaviors may affect the experiences of people whose stigmatized status is assumed to be the result of such behavior.
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Miller CT, Grover KW, Bunn JY, Solomon SE. Community norms about suppression of AIDS-related prejudice and perceptions of stigma by people with HIV or AIDS. Psychol Sci 2011; 22:579-83. [PMID: 21478473 PMCID: PMC3433166 DOI: 10.1177/0956797611404898] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We investigated the relationship between community motivations to control AIDS-related prejudice and the experience of stigma by community members with HIV or AIDS, using self-reports from 203 New England residents with HIV or AIDS and 2,444 randomly selected residents of the same New England communities. Multilevel regression analyses revealed that the disclosure concerns of participants with HIV or AIDS were lower in communities where residents were motivated by personal values to control AIDS-related prejudice, and were higher in communities where residents were motivated by social pressure to control AIDS-related prejudice. Reported experiences with discrimination and exclusion were unrelated to community motivations. The results of our study suggest that external and internal pressures to control prejudice shape the experience of stigmatization.
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Affiliation(s)
- Carol T Miller
- Department of Psychology, University of Vermont, 2 Colchester Ave, Burlington, VT 05405, USA.
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Hosek SG, Lemos D, Harper GW, Telander K. Evaluating the acceptability and feasibility of Project ACCEPT: an intervention for youth newly diagnosed with HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2011; 23:128-44. [PMID: 21517662 PMCID: PMC3280923 DOI: 10.1521/aeap.2011.23.2.128] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Given the potential for negative psychosocial and medical outcomes following an HIV diagnosis, Project ACCEPT, a 12-session behavioral intervention, was developed and pilot-tested for youth (aged 16-24) newly diagnosed with HIV. Fifty participants recently diagnosed with HIV were enrolled from 4 sites selected through the Adolescent Medicine Trials Network (ATN). The majority of participants identified as African American (78%). Feasibility and acceptability data demonstrated high rates of participation and high levels of satisfaction with the intervention program from both participants and staff. Exploratory outcome data demonstrated improved levels of HIV knowledge that were sustained over time (Cohen's effect [d] d = .52) and improvements in peer (d = .35) and formal (d = .20) social support immediately postintervention. Gender differences emerged over time in the areas of depressive symptoms, family social support, self-efficacy for sexual discussion, and personalized stigma. Project ACCEPT appears to be an acceptable and feasible intervention to implement in clinical settings for youth newly diagnosed with HIV.
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Affiliation(s)
- Sybil G Hosek
- John H. Stroger Jr. Hospital of Cook County, Department of Psychiatry, Chicago, IL 60612, USA.
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Nacher M, Adriouch L, Godard Sebillotte C, Hanf M, Vantilcke V, El Guedj M, Vaz T, Leconte C, Simart G, Djossou ML, Couppie P. Predictive factors and incidence of anxiety and depression in a cohort of HIV-positive patients in French Guiana. AIDS Care 2011; 22:1086-92. [PMID: 20824561 DOI: 10.1080/09540121003599232] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A retrospective cohort study was conducted to determine the predictive factors and the incidence of anxiety and depression in a cohort of patients followed in French Guiana. A total of 2315 patients were followed for a total of 9116 years of follow-up. The incidence rate of first observed depression was 1.89 per 100 person years. The incidence rate of first observed generalized anxiety was 1.27 per 100 person years. A single failure Cox proportional hazards model showed that patients diagnosed <1 year (Hazard ratio (HR)=4.15; 95% CI=1.15-14.9; P=0.029), patients treated <one year (HR=3.2; 95% CI=1.7-6.2; P<0.001), patients with anxiety (HR=37; 95% CI=19-72; P<0.001), females (HR=2.5; 95% CI=1.5-4; P<0.001), French citizens (HR=1.6; 95% CI=1.05-2.5; P=0.029), and patients with severe immunodeficiency (HR=3.7; 95% CI=1.7-7.8; P=0.001) were at increased risk of depression. For anxiety, recently diagnosed patients (HR=11.7; 95% CI=3.2-42; P<0.001) and females (HR=3; 95% CI=1.6-5.8; P=0.001) were at increased risk. The hazard function showed that there were three peaks for anxiety (2, 6, and 11 years) and depression (2, 7, and 14 years). Incidence of anxiety and depression in this HIV cohort is high. Knowledge of this pattern may help physicians be more vigilant to psychological distress at certain phases of life with HIV.
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Affiliation(s)
- Mathieu Nacher
- Cayenne General Hospital, Centre d'Investigation Clinique Epidemiologie Clinique CIC EC Antilles Guyane CIE, Cayenne, French Guiana.
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Phillips KD, Moneyham L, Thomas SP, Gunther M, Vyavaharkar M. Social context of rural Women with HIV/AIDS. Issues Ment Health Nurs 2011; 32:374-81. [PMID: 21692576 DOI: 10.3109/01612840.2011.568273] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The South has more AIDS cases than any other region of the US, with most new diagnoses among African American women (56%). In a previous study, a peer counseling intervention for rural women with HIV/AIDS was developed and tested. The purpose of this analysis was to describe, from the peer counselors' perspective, the predominant concerns of the women, contextualized by living in isolated, impoverished circumstances in the rural Deep South. Following home visits, peer counselors recorded a description of the encounter. A multidisciplinary qualitative research group extracted, coded, and thematized the chief concerns and context of the women's lives. Findings provide a vivid portrait of HIV-infected women experiencing deeply troubling psychological and physiological symptoms of HIV/AIDS against the contextual ground of poverty and isolation. Themes include: (1) struggle/effort; (2) stigma/hiding; (3) loss/depression; and (4) independence/ dependence. These women lived in extremely difficult life circumstances that reflected not only a devastating chronic illness, but a life of poverty and abuse. Appropriate care for HIV-infected women living in the rural Deep South will need to address the whole context of their lives.
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Affiliation(s)
- Kenneth D Phillips
- The University of Tennessee, College of Nursing, Knoxville, Tennessee 37996-4180, USA.
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