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Alzahrani NS, Almarwani AM. The effect of HIV on patients' lives: a phenomenological qualitative study. Int J Qual Stud Health Well-being 2024; 19:2315634. [PMID: 38340013 PMCID: PMC10860465 DOI: 10.1080/17482631.2024.2315634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Human immunodeficiency virus (HIV) infection poses a significant threat to the immune system, compromising the body's ability to combat diseases and infections. The Ministry of Health in Saudi Arabia reported an HIV incidence rate of 3 cases per 10,000 individuals. This study aimed to gain insight into the lived experience of Saudi patients living with HIV. METHODS Employing a qualitative phenomenological approach, this study conducted in-depth interviews with 16 HIV patients (10 men, 6 women) between January 2023 and May 2023. RESULTS Thematic data analysis highlighted three overarching themes and four subthemes. "Fear of the Future" encompassed subthemes including the fear of infecting a family member, fear of marriage, fear of employment recruitment, and fear of scandals. "Hopelessness" reflected the profound emotional state experienced by patients. "Overcoming Adversity" captured the resilience and strength demonstrated by individuals facing the challenges of living with HIV. CONCLUSION Saudi patients diagnosed with HIV encounter numerous obstacles in their daily lives. The fear of the future, including concerns such as infecting family members, marriage prospects, employment opportunities, and potential social repercussions, significantly impacts their overall well-being. By understanding the lived experience of HIV patients in Saudi Arabia, healthcare providers and policymakers can better support and enhance the quality of life for this population.
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Affiliation(s)
- Naif S. Alzahrani
- Department of Medical Surgical Nursing, College of Nursing, Taibah University, Medina, Saudi Arabia
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2
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Jordans CCE, Vliegenthart-Jongbloed KJ, van Bruggen AW, van Holten N, van Beek JEA, Vriesde M, van der Sluis D, Verbon A, Roukens AHE, Stutterheim SE, Rokx C. Unmasking Individual and Institutional HIV Stigma in Hospitals: Perspectives of Dutch Healthcare Providers. AIDS Behav 2024:10.1007/s10461-024-04404-0. [PMID: 38869755 DOI: 10.1007/s10461-024-04404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/14/2024]
Abstract
People with HIV continue to experience HIV stigma. Quantitative data on HIV stigma perpetrated by healthcare providers of hospitals providing HIV care in high-income countries are limited. The aim of this study is to investigate factors associated with HIV stigma in Dutch healthcare settings from the healthcare providers' perspective. We conducted a cross-sectional study using the questionnaire 'Measuring HIV Stigma and Discrimination Among Health Facility Staff - Monitoring Tool for Global Indicators' to assess HIV stigma among healthcare providers (n = 405) in two academic hospitals. Healthcare providers licensed to provide medical care were eligible for inclusion. The primary outcome was the self-reported prevalence of at least one manifestation of HIV stigma measured by six stigma indicators (four individual, two institutional). Secondary outcomes were the prevalence of HIV stigma per indicator, per occupation, per department, and factors associated with individual stigma indicators. HIV stigma was prevalent among 88.1% (95%CI 84.5% - 91.2%) of participants. Stigma was mostly driven by negative attitudes towards people with HIV and worry to acquire HIV. Multivariate analysis showed that several factors were associated with HIV stigma, including younger age, male sex, working at one of the surgical departments, and working as a nurse. Having received any training on HIV stigma and/or discrimination was associated with less HIV stigma among all indicators. In conclusion, HIV stigma is highly prevalent among Dutch healthcare providers. Targeted approaches, including training on HIV stigma and discrimination, are needed to reduce HIV stigma in healthcare and should, among others, focus on younger healthcare providers.
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Affiliation(s)
- C C E Jordans
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3015 CN, The Netherlands
| | - K J Vliegenthart-Jongbloed
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands
| | - A W van Bruggen
- Master student Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N van Holten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - J E A van Beek
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands
| | - M Vriesde
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands
| | - D van der Sluis
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - A Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3015 CN, The Netherlands
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A H E Roukens
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - S E Stutterheim
- Department of Health Promotion & Care and Public Health Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands
| | - C Rokx
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3015 CN, The Netherlands.
- Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center, Rotterdam, 3015 CN, The Netherlands.
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3
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Johnson SE, Samson M. Cancer stigma: the need for policy and programmatic action. J Natl Cancer Inst Monogr 2024; 2024:45-50. [PMID: 38836525 DOI: 10.1093/jncimonographs/lgae014] [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: 10/27/2023] [Revised: 01/08/2024] [Accepted: 03/20/2024] [Indexed: 06/06/2024] Open
Abstract
Cancer is a stigmatized disease in many countries that impacts the quality of life and mental health of people affected by cancer. This commentary examines some dimensions of cancer stigma and has been developed based on insights from participants in a Union for International Cancer Control program dedicated to cancer patient organizations in low- and middle-income countries. Aimed at program managers and policy makers, this commentary highlights the importance of developing strategies to reduce cancer stigma in cancer control programs in different contexts, working closely with community-based civil society organizations and those with lived experience of cancer to understand, evaluate, and take action regarding the impact of cancer stigma on health-seeking behavior and patients' quality of life.
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Affiliation(s)
| | - Mélanie Samson
- Capacity Building, Union for International Cancer Control, Geneva, Switzerland
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Nilsson Schönnesson L, Dahlberg M, Reinius M, Zeluf-Andersson G, Ekström AM, Eriksson LE. Prevalence of HIV-related stigma manifestations and their contributing factors among people living with HIV in Sweden - a nationwide study. BMC Public Health 2024; 24:1360. [PMID: 38769531 PMCID: PMC11106865 DOI: 10.1186/s12889-024-18852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND With access to antiretroviral therapy (ART) HIV infection is a chronic manageable condition and non-sexually transmissible. Yet, many people living with HIV still testify about experiencing HIV-related stigma and discrimination. It is well-documented that HIV-related stigma and discrimination continue to be critical barriers to prevention, treatment, care and quality of life. From an individual stigma-reduction intervention perspective, it is essential to identify individual and interpersonal factors associated with HIV-related stigma manifestations. To address this issue and to expand the literature, the aim of this study was to assess the prevalence of HIV-related stigma manifestations and their associated factors among a diverse sample of people living with HIV in Sweden. METHOD Data from 1 096 participants were derived from a nationally representative, anonymous cross-sectional survey "Living with HIV in Sweden". HIV-related stigma manifestations were assessed using the validated Swedish 12-item HIV Stigma Scale encompassing four HIV-related stigma manifestations: personalised stigma, concerns with public attitudes towards people living with HIV, concerns with sharing HIV status, and internalized stigma. Variables potentially associated with the HIV-related stigma manifestations were divided into four categories: demographic characteristics, clinical HIV factors, distress and ART adherence, and available emotional HIV-related support. Four multivariable hierarchical linear regression analyses were employed to explore the associations between multiple contributors and HIV-related stigma manifestations. RESULTS The most dominating stigma feature was anticipation of HIV-related stigma. It was manifested in high scores on concerns with sharing HIV status reported by 78% of the participants and high scores on concerns about public attitudes towards people living with HIV reported by 54% of the participants. High scores on personalised stigma and internalized stigma were reported by around one third of the participants respectively. Between 23 and 31% of the variance of the four reported HIV-related stigma manifestations were explained mainly by the same pattern of associated factors including female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support. CONCLUSION The most dominating stigma feature was anticipation of stigma. Female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support constituted potential vulnerability factors of the four HIV-related stigma manifestations. Our findings highlight the vital necessity to support people living with HIV to increase their resilience to stigma in its different forms. Exploring associated factors of HIV-related stigma manifestations may give an indication of what circumstances may increase the risk of stigma burden and factors amenable to targeted interventions. As individual stigma-reductions interventions cannot be performed isolated from HIV-related stigma and discrimination in society, a key challenge is to intensify anti-stigma interventions also on the societal level.
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Affiliation(s)
| | - Marie Dahlberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna-Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital/Venhälsan, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Psychological Sciences, City, University of London, London, UK
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
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5
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Birch L, Bindert A, Macias S, Luo E, Nwanah P, Green N, Stamps J, Crooks N, Singer RM, Johnson R, Singer RB. When Stigma, Disclosure, and Access to Care Collide: An Ethical Reflection of mpox Vaccination Outreach. Public Health Rep 2024; 139:379-384. [PMID: 37846098 PMCID: PMC11037228 DOI: 10.1177/00333549231201617] [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: 10/18/2023] Open
Abstract
Experiences of stigma in health care encounters among LGBTQ+ populations (lesbian, gay, bisexual, transgender, and queer and questioning) have long been a barrier to care. Marginalization and historically grounded fears of stigmatization have contributed to a reluctance to disclose sexual behavior and/or gender identity to health care providers. We reflect on how student nurses grappled with the ethics of patient disclosure while providing mobile outreach in Chicago for mpox (formerly monkeypox) from fall 2022 to spring 2023. Student nurses addressed how requiring disclosure of sexual behavior or sexual orientation may serve as a barrier to accessing preventive care, such as mpox vaccination. Accounts of stigma and criminalization experienced by LGBTQ+ people provide insight on challenges historically associated with disclosure in health care.
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Affiliation(s)
- Lane Birch
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Adam Bindert
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Susy Macias
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Ellis Luo
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Patrick Nwanah
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Noel Green
- Department of Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Jahari Stamps
- Southside Health Advocacy Resource Partnership, Chicago, IL, USA
| | - Natasha Crooks
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Rebecca M. Singer
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Robin Johnson
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Randi Beth Singer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Endalamaw A, Gilks CF, Ambaw F, Assefa Y. Socioeconomic inequality and contributors in accepting attitudes toward people living with HIV among adults in Ethiopia from 2005 to 2016: a population-based cross-sectional study. BMJ Open 2023; 13:e074694. [PMID: 38040424 PMCID: PMC10693865 DOI: 10.1136/bmjopen-2023-074694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/03/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION The public's accepting attitude toward people living with HIV is crucial in reducing HIV-related stigma and discrimination, increasing people's access to HIV service. This study examines the inequalities in accepting attitudes toward people living with HIV in Ethiopia from 2005 to 2016. METHODS This cross-sectional study was based on the 2005, 2011 and 2016 Ethiopian Demographic Health Surveys. A total of 17 075, 28 478 and 25 542 adults were included in the 2005, 2011 and 2016 surveys, respectively. Socioeconomic inequality was investigated using the concentration curve and Erreygers' concentration index (ECI), which is scaled from -1 (pro-poor) to +1 (pro-rich). The ECI was decomposed to identify the contributors to socioeconomic inequality using generalised linear regression with the logit link function. RESULTS Accepting attitude toward people living with HIV was 17.9% (95% CI: 16.6%, 19.3%) in 2005, which increased to 33.5% (95% CI: 31.8%, 35.3%) in 2011 and 39.6% (95% CI: 37.6%, 41.9%) in 2016. ECI was 0.342 (p<0.001), 0.436 (p<0.001) and 0.388 (p<0.001), respectively, for 2005, 2011 and 2016. The trend line illustrates socioeconomic inequality seems diverging over time, with an increasing ECI of 0.005 every year (r=0.53; p=0.642; slope=0.005). CONCLUSIONS The current study found that there was pro-rich inequality from 2005 to 2016. People with higher socioeconomic status had a better attitude toward people living with HIV. Comprehensive knowledge about HIV/AIDS, education status, residence, and access to electronic and paper-based media, as well as HIV testing, contribute to a better accepting attitude toward people living with HIV. It is of utmost importance for the country to enhance accepting attitude toward people living with HIV to reduce stigma and discrimination. This requires whole-system response according to the primary healthcare approach toward ending the epidemic of HIV/AIDS in the country.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, the University of Queensland, Brisbane, Queensland, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
| | - Charles F Gilks
- School of Public Health, the University of Queensland, Brisbane, Queensland, Australia
| | - Fentie Ambaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Queensland, Australia
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Marks LR, Hayes LR, Amos ATM, Moore KL, Dark T. 'Don't judge me 'til you walk through my shoes': A qualitative investigation of the experiences of women living with HIV. ETHNICITY & HEALTH 2023; 28:1128-1144. [PMID: 37439581 DOI: 10.1080/13557858.2023.2231667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Women living with the human immunodeficiency virus (HIV) are less of a focus in the HIV literature, which tends to focus on the HIV experiences of men who have sex with men (MSMs). Hence, we conducted a qualitative study that examined: (a) the type of stigma and discrimination that women living with HIV experience related to their HIV status, (b) the source of this stigma and discrimination, (c) their responses related to this stigma and discrimination, and (d) the ways in which women living with HIV cope with these experiences of stigma and discrimination. DESIGN Participants consisted of 14 self-identified women living with HIV that were recruited at a community organization in the Southern United States that provides services to individuals living with HIV. The participants ranged in age from 27 to 65 (M = 47.92, SD = 13.08). The sample primarily identified as Black (N = 12), followed by White (N = 1) and Multiracial (N = 1). Most women were cisgender (N = 13) with one woman identifying as transgender (N = 1). RESULTS Fourteen women participated in one of two focus groups (seven in each focus group), which were audio recorded and transcribed. We identified 24 categories across five domains (Stigma and Discrimination, Source of Stigma and Discrimination, Response to Stigma and Discrimination, Coping with Stigma and Discrimination, and Support). CONCLUSIONS This study identified that women living with HIV experience stigma and discrimination in a multitude of ways from different sources. Moreover, women with HIV responded to and coped in negative and positive ways. Multidimensional approaches including personal and community education may help alleviate the stigma and discrimination faced by women living with HIV.
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Affiliation(s)
- Laura Reid Marks
- Department of Educational Psychology and Leaning Systems, College of Education, Florida State University, Tallahassee, FL, USA
| | - Lauren R Hayes
- Department of Counseling, Educational Psychology, and Research, College of Education, University of Memphis, Memphis, TN, USA
| | - Asia T M Amos
- Department of Counseling, Educational Psychology, and Research, College of Education, University of Memphis, Memphis, TN, USA
| | - Kanesha L Moore
- Department of Counseling, Educational Psychology, and Research, College of Education, University of Memphis, Memphis, TN, USA
| | - Tyra Dark
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
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Dācus JD, Wood CV, Ward D. Partnering and Programming for a Black, Indigenous, and People of Color Sexual and Gender Minority Pathway to HIV Research. J Acquir Immune Defic Syndr 2023; 94:S73-S79. [PMID: 37707852 PMCID: PMC10503272 DOI: 10.1097/qai.0000000000003264] [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] [Indexed: 09/15/2023]
Abstract
BACKGROUND There is an urgent need to conduct innovative research on the health needs of populations whose intersecting identities, such as being Black, Indigenous, and other People of Color (BIPOC) and sexual and gender identity (SGM) persons, put them at greater risk of HIV infection. More so, as important as it is to train on the best practices, it is as important to train aspiring BIPOC SGM scholars in intersectional HIV science so that they can address the HIV-related issues of BIPOC SGM populations. METHODS In line with guidelines to increase diversity in the HIV workforce, we sought to (1) solidify the interest of BIPOC SGM trainees engaging in intersectional HIV science by piloting a 2-week Summer Intensive Program, (2) leverage the relationships and resources of our community partner to enhance our recruitment from HBCUs and MSIs, and (3) identify opportunities for postprogram training and mentoring activities. RESULTS Our data suggest that participants gained a great deal from the instructional sessions. Participants commented on the quality of the sessions, effectiveness of the instructional faculty, and a confirmed interest in HIV science. CONCLUSIONS We succeeded in promoting interest in and commitment to HIV science among early career BIPOC SGM scholars. An instructional program of this intensity is best suited to those with some experience in graduate school and existing interest in HIV science. As a program serving multiply minoritized populations, clarification of host institution policies and procedures, as well as administrative support, are essential for ensuring a smooth experience for scholars visiting from outside institutions.
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Affiliation(s)
- Jagadīśa-devaśrī Dācus
- The Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern Feinberg School of Medicine, 625 N. Michigan Avenue, Room 14-055, Chicago, IL 60611
| | - Christine V. Wood
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, 303 E. Chicago Avenue, Room 18-134, Chicago, IL 60611
| | - Dafina Ward
- Southern AIDS Coalition, P.O. Box 2490, Spring Powder, GA 30127
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Esen İ, Kaya S, Günay E, Özol D. Variability in Stigma Severity During the COVID-19 Pandemic. Cureus 2023; 15:e46508. [PMID: 37927764 PMCID: PMC10625036 DOI: 10.7759/cureus.46508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Objective The aim of this study was to investigate change in the stigma that emerged during the COVID-19 pandemic over time and the factors responsible for the change. Methods Individuals with COVID-19 who presented to Ankara Medicalpark and VM Medicalpark Hospitals' Internal Diseases and Chest Diseases polyclinic between May 2021 and April 2022 were examined. The volunteers were divided into two groups: those who had COVID-19 within the first six months of the pandemic (group 1) and those who had it in the second six months (group 2). The questionnaire assessing stigma consisted of 29 propositions that participants could mark whether they agreed with them or not. Results The median age of the volunteers was 38 years. Eighty-eight (69.3%) had the disease in the first six months of the pandemic and 39 (30.7%) in the second six months. Moreover, 76.1% of the participants in the first group and 94.9% of those in the second group did not agree with the statement "I thought COVID-19 was a punishment for me" (p=0.011). Further, 56.8% of the participants in the first group and 97.4% of those in the second group stated that they did not agree with the statement "Employers may terminate the employment of employees who they find out have contracted COVID-19" (p<0.001). 80.7% of the participants in the first group and 38.5% of those in the second group agreed with the statement "There was social discrimination against people who caught COVID-19" (p<0.001). Conclusions At the beginning of the pandemic, the participants had concerns about losing their status and jobs, but this anxiety decreased over time. Stigma in the first six months of the pandemic was greater than that in the second six months, and discrimination related to stigma decreased with recognition of the disease and the increase in experience.
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Affiliation(s)
- İrfan Esen
- Internal Medicine, Yüksek İhtisas University, Ankara, TUR
| | - Selda Kaya
- Pulmonary Diseases, Yüksek İhtisas University, Ankara, TUR
| | - Ersin Günay
- Pulmonary Diseases, Ankara Etlik City Hospital, Ankara, TUR
| | - Duygu Özol
- Pulmonary Diseases, Süreyyapaşa Chest Diseases And Thoracic Surgery Training And Research Hospital, Ankara, TUR
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Sommer S, Barroso J. A qualitative metasynthesis of stigma in women living with HIV in the United States. Int J Equity Health 2023; 22:158. [PMID: 37605194 PMCID: PMC10441719 DOI: 10.1186/s12939-023-01969-5] [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] [Received: 06/08/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
Our goal was to synthesize qualitative studies on HIV-related stigma as experienced by women living with HIV (WLWH) in the U.S. Qualitative metasynthesis techniques as developed by Sandelowski et al. (Res Nurs Health 30(1):99-111, 2007) were used to integrate and update findings on stigma in WLWH in the U.S. in 43 reports of qualitative studies conducted between 2004 and 2023 with 1118 participants. Developed themes explored a collective narrative of women first surviving the intersectionality of multiple sources of stigma, discovering non-linear pathways to transcend their stigma, and finally experiencing resilience through their transcendence of stigma. While this metasynthesis revealed similarities to an earlier metasynthesis in the ubiquity and persistence of stigma, they differ primarily in women's abilities to find agency in managing and opposing their stigma. This cognitive reframing of their stigma helped women to redefine stigma as ignorance and move towards a more positive assessment of the self. In doing so, they separated themselves from their stigma and the damaging effects of it. Findings from this metasynthesis may serve as a useful tool for the development of stigma reduction interventions specific to the needs and experiences of WLWH in the U.S.
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Affiliation(s)
- Sadie Sommer
- School of Nursing, Vanderbilt University, 461 21st Ave, S, Nashville, TN, 37240, USA.
| | - Julie Barroso
- School of Nursing, Vanderbilt University, 461 21st Ave, S, Nashville, TN, 37240, USA
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Chandler CJ, Liu Q, Brown AL, Matthews DD, Tsai AC, Bukowski LA, Eaton LA, Stall RD, Friedman MR. Associations of past-year stigma and psychosocial syndemic conditions: Considerations for intersectional stigma measures among Black Sexual Minority Men. STIGMA AND HEALTH 2023; 8:372-380. [PMID: 37789829 PMCID: PMC10545331 DOI: 10.1037/sah0000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
This secondary analysis of a mixed serostatus sample of Black sexual minority men (BSMM) used conditional inference tree methods to explore associations of past-year experienced stigma and psychosocial syndemic conditions. Experienced stigmas were attributed to race, sexuality, socioeconomic status, HIV status or some "other" reason. Psychosocial syndemic conditions studied included physical assault, intimate partner violence, polysubstance use, and depression symptomology. Data are from Promoting Our Worth, Equality and Resilience (POWER), a serial, cross-sectional study conducted between 2014-2017 (N=4430). Experiences of multiple stigmas were reported by n=938 (22.1%) of BSMM. Conditional inference tree results revealed that HIV-related stigma and its intersection with "other" stigma showed the greatest variance in psychosocial condition prevalence. Our findings suggest that when developing intercategorical intersectional analyses with BSMM, there are important stigmas for BSMM beyond those attributed to race, sexuality, and SES, particularly intersecting with HIV-related stigma. Conditional inference tree analysis shows promise in quantitative explorations of intersectional stigma with BSMM, but will benefit from the inclusion of additional forms of stigma, which should be considered by the field moving forward.
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Affiliation(s)
- Cristian J. Chandler
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - Qimin Liu
- Psychological Sciences, Vanderbilt University 2301 Vanderbilt Place · Nashville, TN 37240-7817, USA
| | - Andre L. Brown
- Behavioral and Community Health Science, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - Derrick D. Matthews
- Health Behavior, Gillings School of Public Health, University of North Carolina, 361 Rosenau Hall, Chapel Hill, NC 27599, USA
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital 100 Cambridge St Suite 1600, Boston, MA 02114, USA
| | - Leigh A. Bukowski
- Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street Scaife Hall, Suite 600 Pittsburgh, PA 15213, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Rd, Storrs, CT 06269-1248, USA
| | - Ronald D. Stall
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - M. Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
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Jain JP, Hill M, Gamarel KE, Santos GM, Johnson MO, Neilands TB, Dilworth SE, Reback CJ, Sevelius J. Socio-ecological Barriers to Viral Suppression Among Transgender Women Living with HIV in San Francisco and Los Angeles, California. AIDS Behav 2023; 27:2523-2534. [PMID: 36682008 PMCID: PMC10362091 DOI: 10.1007/s10461-023-03979-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/23/2023]
Abstract
Troubling disparities in viral suppression persist among transgender (trans) women living with HIV in the US. We utilized baseline data from a randomized controlled trial of a behavioral intervention among trans women living with HIV in San Francisco and Los Angeles, to identify the socio-ecological correlates of biologically confirmed viral suppression (< 200 HIV-1 RNA copies/mL). Among 253 participants, the mean age was 43 (SD = 11), 46% identified as Black or African American and 35% were virally non-suppressed. In adjusted Poisson regression models, the following barriers to viral suppression were identified: injection drug use [adjusted risk ratio (aRR) 0.78, 95% CI 0.65-0.93, Z = - 2.64, p = 0.008], methamphetamine use (aRR 0.65, 95% CI 0.51-0.83, Z = - 3.45, p = 0.001), amphetamine use (aRR 0.62, 95% CI 0.44-0.87, Z = - 2.75, p = 0.006), homelessness (aRR 0.79, 95% CI 0.63-0.98, Z = - 2.06, p = 0.039), and sex work (aRR 0.60, 95% CI 0.41-0.86, Z = - 2.77, p = 0.009). These findings underscore the importance of interventions that address the socio-ecological barriers to viral suppression among trans women in urban settings.
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Affiliation(s)
- Jennifer P Jain
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Miranda Hill
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, USA
| | - Glenn-Milo Santos
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Samantha E Dilworth
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Cathy J Reback
- Friends Research Institute, Los Angeles, CA, USA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, USA
| | - Jae Sevelius
- Department of Medicine, University of California, San Francisco, San Francisco, USA
- Department of Psychiatry, Columbia University, New York, USA
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13
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Parcesepe AM, Filiatreau LM, Gomez A, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. HIV-Related Stigma, Social Support, and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon. AIDS Patient Care STDS 2023; 37:146-154. [PMID: 36802206 PMCID: PMC10024262 DOI: 10.1089/apc.2022.0187] [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] [Indexed: 02/23/2023] Open
Abstract
HIV-related stigma has been associated with poor mental health among people with HIV (PWH). Social support is a potentially modifiable factor that may buffer negative mental health sequelae of HIV-related stigma. Little is known about the extent to which the modifying effect of social support differs across mental health disorders. Interviews were conducted with 426 PWH in Cameroon. Log binomial regression analyses were used to estimate the association between high anticipated HIV-related stigma and low social support from family or friends and symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and harmful alcohol use, separately. Anticipated HIV-related stigma was commonly endorsed with ∼80% endorsing at least 1 of 12 stigma-related concerns. In multivariable analyses, high anticipated HIV-related stigma was associated with greater prevalence of symptoms of depression {adjusted prevalence ratio (aPR) 1.6 [95% confidence interval (CI) 1.1-2.2]} and anxiety [aPR 2.0 (95% CI 1.4-2.9)]. Low social support was associated with greater prevalence of symptoms of depression [aPR 1.5 (95% CI 1.1-2.2)], anxiety [aPR 1.7 (95% CI 1.2-2.5)], and PTSD [aPR 1.6 (95% CI 1.0-2.4)]. However, social support did not meaningfully modify the relationship between HIV-related stigma and symptoms of any mental health disorders explored. Anticipated HIV-related stigma was commonly reported among this group of PWH initiating HIV care in Cameroon. Social concerns related to gossip or losing friends were of the greatest concern. Interventions focused on reducing stigma and strengthening support systems may be particularly beneficial and have the potential to improve the mental health of PWH in Cameroon.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amanda Gomez
- Department of Maternal and Child Health and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Milton Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Marcel Yotebieng
- Department of Medicine and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Department of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
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14
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Beichler H, Kutalek R, Dorner TE. People Living with HIV and AIDS: Experiences towards Antiretroviral Therapy, Paradigm Changes, Coping, Stigma, and Discrimination-A Grounded Theory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3000. [PMID: 36833695 PMCID: PMC9962544 DOI: 10.3390/ijerph20043000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The experiences in coping with HIV/AIDS from people living with HIV (PLWH) in Austria, Munich, and Berlin regarding adherence, antiretroviral therapy (ART), stigmatization, and discrimination were the main focus of this study. Therapy adherence is the cornerstone for PLWH to reduce disease progression and increase life expectancy combined with a high quality of life. The experience of stigmatization and discrimination in different life situations and settings is still experienced today. AIMS We aimed to examine the subjective perspective of PLWH concerning living with, coping with, and managing HIV/AIDS in daily life. METHODS Grounded Theory Methodology (GTM) was used. Data collection was conducted with semi-structured face-to-face interviews with 25 participants. Data analysis was performed in three steps, open, axial, and selective coding. RESULTS Five categories emerged, which included the following: (1) fast coping with diagnosis, (2) psychosocial burden due to HIV, (3) ART as a necessity, (4) building trust in HIV disclosure, (5) stigmatization and discrimination are still existing. CONCLUSION In conclusion, it can be said that it is not the disease itself that causes the greatest stress, but the process of coping with the diagnosis. Therapy, as well as lifelong adherence, is hardly worth mentioning today. Much more significant is currently still the burden of discrimination and stigmatization.
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Affiliation(s)
- Helmut Beichler
- Nursing School, General Hospital, Medical University Vienna, 1090 Vienna, Austria
| | - Ruth Kutalek
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas E. Dorner
- Academy for Ageing Research, Haus der Barmherzigkeit, 1160 Vienna, Austria
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria
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15
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Derose KP, Berkley-Patton J, Hamilton-Burgess C, Thompson CB, Williams ED, Simon S, Allsworth JE. Correlates of HIV-Related Stigmas Among African American Church-Affiliated Populations in Kansas City. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:54-68. [PMID: 36735231 PMCID: PMC9907009 DOI: 10.1521/aeap.2023.35.1.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
HIV-related stigmas contribute to disparities, and contact with HIV-positive individuals has been suggested to reduce stigma. Faith-based organizations have been recognized as important to stigma reduction efforts among African American populations; however, relatively few church-based studies have measured HIV-related stigma. This study uses baseline data (N = 1,448) from a study with 14 African American churches in Kansas City, Missouri and Kansas, to examine correlates of HIV-related stigmas among church members and community members accessing church social services using two previously validated scales that measure discomfort interacting with individuals with HIV and anticipated stigma or rejection. Knowing someone with HIV was associated with lower discomfort, even after adjusting for sociodemographic characteristics and sexual risk, HIV knowledge, previous communication about HIV at church, and mean drug and homosexuality stigmas. Knowing someone with HIV was not associated with anticipated stigma or rejection after adjustment. Contact-based interventions hold promise for reducing discomfort around people with HIV among church-affiliated populations.
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Affiliation(s)
- Kathryn P. Derose
- University of Massachusetts Amherst, Department of Health Promotion & Policy
- RAND Corporation
| | | | | | | | | | - Stephen Simon
- University of Missouri - Kansas City, School of Medicine
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16
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Public health services and intersectional stigma: a social sciences perspective with implications for HIV service design and delivery. Curr Opin HIV AIDS 2023; 18:18-26. [PMID: 36444656 DOI: 10.1097/coh.0000000000000769] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
PURPOSE OF REVIEW Understanding stigma is important for improving HIV care services and gaps in HIV service delivery have been attributed to stigma. This review article synthesizes recent evidence on stigma and its implications for HIV service design and delivery. Given the intersectional nature of stigma, we will focus on HIV stigma as well as related forms of stigma based on one's race, sexual identity, gender identity and other identities. RECENT FINDINGS Stigma remains a barrier to achieving equity in HIV services. Individualistic measures of stigma remain influential and are associated with barriers to accessing HIV health services. Recent work also highlights stigma measured at a structural level and its impact on HIV services contexts. Individuals situated at intersections of marginalized identities continue to face greatest injustices, and although intersectional approaches have been adapted to design services at a micro level, few focus on structural change. Recent evidence for mitigating stigma indicates some success for psychosocial interventions that target internalized stigma. Furthermore, community-led approaches show promise in addressing stigma that manifests in HIV health services settings. SUMMARY Interventions that address individual-level stigma and structural stigma are needed. Theoretical and applied antistigma research is needed to make HIV services more equitable.
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17
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Shea L, Bushen J, Ahmad N, Geonnotti G, LaMori J, Terrey S, Gonzalez P, Shuman J. Development and implementation of an online community as a strategy for mixed methods research during a pandemic. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:47. [PMID: 36064454 PMCID: PMC9442570 DOI: 10.1186/s40900-022-00383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
Conducting mixed methods research is critical for healthcare researchers to understand attitudes, behaviors, and experiences on health-related topics, such as vaccine acceptance. As the COVID-19 pandemic has made it difficult to employ traditional, face-to-face qualitative methodologies, this paper describes the use of a virtual platform to conduct person-centered research. To overcome these challenges and better understand the attitudes and behaviors of vaccine-eligible individuals in the United States, an online health community called the Virtual Engagement Research Community (VERC) was designed and implemented. Using the Health Belief Model as a framework, the VERC employed a mixed methods approach to elicit insights, which included discussion topics, rapid polls, and surveys. Throughout the initial enrollment period of April-October 2021, continuous improvement efforts were made to bolster recruitment and member engagement. This agile research strategy was successful in utilizing mixed methods to capture community sentiments regarding vaccines. While this community focused on vaccination, the methodology holds promise for other areas of health research such as obesity, HIV, mental health disorders, and diabetes.
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Affiliation(s)
- Lisa Shea
- Janssen Scientific Affairs, LLC, 800 Ridgeview Drive, Horsham, PA, 19044, USA.
| | | | - Nina Ahmad
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Gabrielle Geonnotti
- Janssen Scientific Affairs, LLC, 800 Ridgeview Drive, Horsham, PA, 19044, USA
| | - Joy LaMori
- Janssen Scientific Affairs, LLC, 800 Ridgeview Drive, Horsham, PA, 19044, USA
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18
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Chandler CJ, Adams BJ, Eaton LA, Meunier É, Andrade E, Bukowski LA, Stall RD, Friedman MR. Intersectional Experienced Stigma and Psychosocial Syndemic Conditions in a Sample of Black Men Who Have Sex with Men Engaged in Sex Work (BMSM-SW) from Six US Cities. JOURNAL OF SEX RESEARCH 2022; 59:920-930. [PMID: 35580257 PMCID: PMC9835797 DOI: 10.1080/00224499.2022.2072799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Black men who have sex with men (BMSM) in the United States experience a disproportionate burden of violence, substance use, physical and mental health conditions relative to other racial groups. BMSM who engage in sex work (BMSM-SW) experience a high burden of psychosocial conditions, sexually transmitted infections, including HIV, and intersectional stigma. This analysis characterizes remuneration and client typologies for BMSM-SW, documents intersectional stigma experienced by BMSM-SW relative to other BMSM, and explores the impact of experienced intersectional stigma on the relationship between sex work engagement and psychosocial syndemic conditions (violence, polydrug use, and depression symptoms). Results show that a majority of BMSM-SW in the sample had female clients and that sex workers were more likely than other BMSM to hire another sex worker. BMSM-SW were more likely than other BMSM to report stigma attributed to race; sexuality; HIV status; socioeconomic status; and "other" attributes, and were more likely to report experiencing stigma across all settings assessed (schools; healthcare; employment; housing; police/courts; and in public/community). Intersectional stigma mediated the relationship between sex work engagement and psychosocial syndemic conditions, accounting for 49% (95% CI: 47.6-50.0%) of the relationship. Interventions for BMSM-SW should include resilience-building components to counteract the effects of intersectional stigma.
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Affiliation(s)
- Cristian J. Chandler
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, USA 37203
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Brian J. Adams
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032
| | - Elí Andrade
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Leigh A. Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Ronald D. Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - M. Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
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19
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Chen YT, Duncan DT, Del Vecchio N, Timmins L, Pagkas-Bather J, Knox J, Lacap S, Hanson H, Schneider JA. COVID-19 Conspiracy Beliefs are not Barriers to HIV Status Neutral Care Among Black Cisgender Sexual Minority Men and Black Transgender Women at the Initial Peak of the COVID-19 Pandemic in Chicago, USA. AIDS Behav 2022; 26:3939-3949. [PMID: 35731308 PMCID: PMC9214465 DOI: 10.1007/s10461-022-03720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/24/2022]
Abstract
We examined associations between COVID-19 conspiracy beliefs and HIV status neutral care engagement among Black cisgender sexual minority men (BCSMM) and Black transgender women (BTW). Throughout April–July 2020, a total of 226 (222 in the current analysis: 196 BCSMM, 20 BTW, and 6 other) participants in Chicago’s Neighborhoods and Networks (N2) cohort study completed virtual assessments. Participants reported their HIV status, changes in the frequency of PrEP/ART use, and COVID-19 conspiracy beliefs. Three-quarters of the sample believed at least one conspiracy theory that COVID-19 was either government-created or lab-created accidentally or purposefully. Believing one or more COVID-19 conspiracy theories was significantly associated with better PrEP or ART engagement (using PrEP more frequently or continuously using PrEP/Missing ART less or continuously using ART) (aPR = 0.75 [95% CI 0.56–0.99], p < 0.05). Believing COVID-19 came about naturally was strongly associated with worse PrEP engagement (i.e., use PrEP less or not on PrEP) or worse ART engagement (i.e., missed ART more or not on ART) (aPR = 1.56 [95% CI 1.23, 1.98], p < 0.001). Findings suggested substantial COVID-19 conspiracies among BCSMM and BTW, and this was associated with HIV care engagement.
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Affiliation(s)
- Yen-Tyng Chen
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA. .,Department of Public Health, William Paterson University of New Jersey, Wayne, NJ, USA. .,Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Natascha Del Vecchio
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Liadh Timmins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,School of Psychology, Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, Wales, UK
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Shaina Lacap
- Department of Public Health, William Paterson University of New Jersey, Wayne, NJ, USA
| | | | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA.,Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.,Crown School of Social Work, University of Chicago, Chicago, IL, USA
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20
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Goodenow MM, Rausch DM. Recent Key Efforts to Improve HIV-Related Intersectional Stigma and Discrimination Research. Am J Public Health 2022; 112:S393-S394. [PMID: 35763741 DOI: 10.2105/ajph.2022.306712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Maureen M Goodenow
- Maureen M. Goodenow is with the Office of AIDS Research, National Institutes of Health (NIH), Rockville, MD. Dianne M. Rausch is with the Division of AIDS Research, National Institute of Mental Health, NIH
| | - Dianne M Rausch
- Maureen M. Goodenow is with the Office of AIDS Research, National Institutes of Health (NIH), Rockville, MD. Dianne M. Rausch is with the Division of AIDS Research, National Institute of Mental Health, NIH
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21
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Friedman MR, Liu Q, Meanley S, Haberlen SA, Brown AL, Turan B, Turan JM, Brennan-Ing M, Stosor V, Mimiaga MJ, Ware D, Egan JE, Plankey MW. Biopsychosocial Health Outcomes and Experienced Intersectional Stigma in a Mixed HIV Serostatus Longitudinal Cohort of Aging Sexual Minority Men, United States, 2008‒2019. Am J Public Health 2022; 112:S452-S462. [PMID: 35763737 PMCID: PMC9241468 DOI: 10.2105/ajph.2022.306735] [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] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Objectives. To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. Methods. We measured experienced intersectional stigma (EIS; ≥ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008‒2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008‒2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. Results. The mean age (n = 1806) was 51.8 years (range = 22-84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Conclusions. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. Public Health Implications. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts. (Am J Public Health. 2022;112(S4):S452-S462. https://doi.org/10.2105/AJPH.2022.306735).
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Affiliation(s)
- M Reuel Friedman
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Qimin Liu
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Steven Meanley
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Sabina A Haberlen
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Andre L Brown
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Bulent Turan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Janet M Turan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Mark Brennan-Ing
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Valentina Stosor
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Matthew J Mimiaga
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Deanna Ware
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - James E Egan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Michael W Plankey
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
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Primary Care of the Person Living with HIV. Pathogens 2022; 11:pathogens11040380. [PMID: 35456055 PMCID: PMC9025375 DOI: 10.3390/pathogens11040380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 02/05/2023] Open
Abstract
Life-changing progress has been made over the past 30 years in the treatment of HIV infection. HIV has transformed from an illness that resulted in one complication after another and nearly always resulted in death to a chronic illness that for most patients is more easily managed than diabetes or heart disease. Antiretroviral therapy (ART) is now simple and well-tolerated. The most important priority of HIV treatment is ensuring that people living with HIV stay on continuous, effective ART. ART, although not curative, suppresses the virus and allows the immune system to recover. Even when the CD4 count remains low, suppressive ART helps prevent opportunistic infections and other HIV related complications. (1) Suppressive ART is important not only to the individual living with HIV health but is an important public health goal since people living with HIV will not transmit HIV to their sexual partners if their viral load is undetectable. (2) A respectful, culturally appropriate patient–provider relationship is one of the most important factors in keeping people living with HIV engaged in care. (3) Persons living with HIV deserve both excellent HIV and primary care. Some communities have providers that are experts in both, but often people living with HIV receive the best care by collaboration between their primary care provider and an HIV expert. This article is written to help primary care givers who are not HIV experts provide appropriate primary care to their patients who are living with HIV and emphasizes issues that deserve additional attention in people living with HIV compared to the general population
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Iott BE, Loveluck J, Benton A, Golson L, Kahle E, Lam J, Bauermeister JA, Veinot TC. The impact of stigma on HIV testing decisions for gay, bisexual, queer and other men who have sex with men: a qualitative study. BMC Public Health 2022; 22:471. [PMID: 35264132 PMCID: PMC8908600 DOI: 10.1186/s12889-022-12761-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Stigmatization may prompt gay, bisexual, queer and other men who have sex with men (GBQMSM) to avoid or delay HIV testing. There has been little attention to GBQMSMs’ perspectives about how stigma may influence their decisions about whether, where, and how often to get tested for HIV. Methods We conducted nine focus groups with 64 adult GBQMSM in Metropolitan Detroit, including HIV-negative men and people living with HIV (PLWH). Data were thematically analyzed deductively and inductively in three rounds. Results Three themes emerged regarding whether to get tested: (1) Perceived promiscuity, risk perceptions and HIV testing; (2) Fearing sexual rejection; and (3) Fearing friend and family member distancing and rejection. Themes concerning where to get tested included: (4) Conflating HIV testing and diagnosis; and (5) Seeking privacy and safety at specialized services. As for how often to get tested, themes included: (6) Reducing contact with healthcare providers due to intersectional stigma; (7) Responsibility and regular testing; and (8) HIV stigma and testing as routine care. Black participants articulated themes (3), (4), and (6) with greater frequency than other participants. Framing HIV testing as a personal responsibility may have created a “new stigma,” with unintended consequences not observed with “routine healthcare” messaging. Conclusions GBQMSMs’ perspectives indicate the potential for new foci for HIV testing promotion interventions based on stigma-related issues that they deem important. There is a need for interventions to challenge the “promiscuity” stereotype, and to reduce the sexual stigmatization of GBQMSM living with HIV/AIDS—especially online. Provider stigma requires both intervention and continued availability of specialized services. Future stigma-reduction interventions for Black GBQMSM could focus on building family support/acceptance, awareness of multiple testing options, and integrating LGBTQ-related issues into initiatives for racial justice in health care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12761-5.
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Affiliation(s)
- Bradley E Iott
- School of Information, University of Michigan, Ann Arbor, MI, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Akilah Benton
- Detroit Health Department, City of Detroit, Detroit, MI, USA
| | - Leon Golson
- Unified - HIV Health and Beyond, Ypsilanti, MI, USA
| | - Erin Kahle
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Jason Lam
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | | | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI, USA. .,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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HIV Knowledge and Stigmatizing Attitude towards People Living with HIV/AIDS among Medical Students in Jordan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020745. [PMID: 35055566 PMCID: PMC8775845 DOI: 10.3390/ijerph19020745] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
The stigmatizing attitude towards people living with HIV/AIDS (PLWHA) can be a major barrier to effective patient care. As future physicians, medical students represent a core group that should be targeted with focused knowledge and adequate training to provide patient care without prejudice. The aim of the current study was to examine HIV/AIDS knowledge, and the stigmatizing attitude towards PLWHA, among medical students in Jordan. The current study was based on a self-administered online questionnaire, which was distributed during March–May 2021, involving students at the six medical schools in Jordan, with items assessing demographics, HIV/AIDS knowledge, and HIV/AIDS stigmatizing attitude, which was evaluated using the validated HIV-stigma scale. The total number of respondents was 1362, with predominance of females (n = 780, 57.3%). Lack of HIV/AIDS knowledge among the study participants was notable for the following items: HIV transmission through breastfeeding (40.8% correct responses), HIV is not transmitted through saliva (42.6% correct responses), and vertical transmission of HIV can be prevented (48.8% correct responses). Approximately two-thirds of the respondents displayed a positive attitude towards PLWHA. For six out of the 14 HIV/AIDS knowledge items, lack of knowledge was significantly correlated with a more negative attitude towards PLWHA. Multinomial regression analysis showed that a significantly more negative attitude towards PLWHA was found among the pre-clinical students compared to the clinical students (odds ratio (OR): 0.65, 95% confidence interval (CI): 0.43–0.97, p = 0.036); and that affiliation to medical schools that were founded before 2000 was associated with a more positive attitude towards PLWHA compared to affiliation to recently founded medical schools in the country (OR: 1.85, 95% CI: 1.42–2.42, p < 0.001). About one-third of medical students who participated in the study displayed a negative attitude towards PLWHA. Defects in HIV/AIDS knowledge were detected for aspects involving HIV transmission and prevention, and such defects were correlated with a more negative attitude towards PLWHA. It is recommended to revise the current medical training curricula, and to tailor improvements in the overall HIV/AIDS knowledge, which can be reflected in a more positive attitude towards PLWHA, particularly for the recently established medical schools in the country.
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Increased Work Experience Associated with Less Stigmatizing Attitudes towards People Living with HIV among Thai Healthcare Personnel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189830. [PMID: 34574754 PMCID: PMC8465955 DOI: 10.3390/ijerph18189830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
Abstract
HIV-related stigma in health facilities has been suggested as a primary target for HIV-related stigma reduction. The objective of this study was to describe negative attitudes among Thai healthcare personnel (HCP) toward PLHIV. This nationwide probability sampled survey was conducted in 2019 in 12 provinces in Thailand and Bangkok, the capital. Participants were considered to have stigmatizing attitudes toward PLHIV if they had a stigmatizing view in response to at least one of the four questions. Eighty-two percent of the 3056 respondents had at least one stigmatizing attitude. Younger HCP, ages < 30 (AOR = 1.60; 95%CI: 1.18–2.18) and 30–39 (AOR = 1.60; 95%CI: 1.21–2.12) were more likely to have stigmatizing attitudes towards PLHIV compared to those aged 50 and older. Being support staff, support-clinical (AOR = 1.89; 95%CI: 1.44–2.49) and support-nonclinical (AOR = 1.71; 95%CI: 1.24–2.36) as opposed to professional staff also increased the likelihood of having stigmatizing attitudes. Stigma was also more likely to be present in HCPs who did not work at HIV-focused clinics (AOR = 1.97; 95%CI: 1.57–2.48). HCP who had more work experience, especially related to PLHIV care, were less likely to have stigmatizing attitudes. These personnel could be good peer educators or role models for a stigma reduction campaign within their healthcare facilities.
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Amutah-Onukagha N, Ibeziako N, Tibbitt C, Louis L, Amarnath A. Wisdom Matters: Honoring the Wisdom and Assessing the Health Literacy of Black Women Living with HIV. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2021; 11:204-224. [PMID: 36818219 PMCID: PMC9930510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Low literacy levels in Black women with HIV (WWH) have been shown to amplify pre-existing health disparities and sequelae of non-adherence to health-related guidance. Wisdom Matters is a community-based participatory research program with an aim of improving health literacy in populations of Black WWH and assessing the existing knowledge, attitudes, and beliefs surrounding HIV care delivery and psychosocial barriers in these populations. Our research was conducted in Boston, MA, where 17 Black WWH were recruited to complete a 6-week curriculum designed to provide a thorough and cohesive path to empowerment, both individually and collectively, pertaining to living with HIV. Data collection was augmented through pre- and posttest data as well as qualitative data collected via focus groups. Content and narrative analyses of these qualitative data demonstrate individual and group improvement in the areas of nutrition, medication adherence, stress management, and disclosure of HIV status after participation in the Wisdom Matters program. The study demonstrates the feasibility and acceptability of health literacy interventions based within community settings and addresses gaps in literacy that healthcare workers can prioritize in the education of their patients.
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