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Pagkas-Bather J, Motley DN, Schneider JA. Health equity for Black sexually minoritised men through status-neutral HIV care. Lancet HIV 2024:S2352-3018(24)00032-8. [PMID: 38430923 DOI: 10.1016/s2352-3018(24)00032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 03/05/2024]
Abstract
Current strategies (both biomedical and barrier methods) for HIV elimination in the USA do not best serve those who are most affected by HIV. Improving healthc are for individuals most affected by HIV requires restructuring of care delivery to improve their HIV outcomes. The transformation of clinical care delivery is crucial to address the needs of one of the most affected populations along the HIV care continuum: Black sexually minoritised men (BSMM). Status-neutral HIV care delivery systems might address social determinants of health of BSMM who are stigmatised and disenfranchised within the context of American society. Addressing the needs of BSMM will bring us closer to health-care equity, which benefits us all.
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Affiliation(s)
- Jade Pagkas-Bather
- Section of Infectious Diseases & Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
| | - Darnell N Motley
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Section of Infectious Diseases & Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA; Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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2
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Calabrese SK, Kalwicz DA, Zaheer MA, Dovidio JF, Garner A, Zea MC, Treloar C, Holt M, Smith AKJ, MacGibbon J, Modrakovic DX, Rao S, Eaton LA. The Potential Role of Undetectable = Untransmittable (U = U) in Reducing HIV Stigma among Sexual Minority Men in the US. AIDS Behav 2024; 28:741-757. [PMID: 38285293 DOI: 10.1007/s10461-023-04263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
The Undetectable = Untransmittable (U = U) message and its scientific underpinnings have been widely suggested to reduce HIV stigma. However, misunderstanding and skepticism about U = U may prevent this destigmatizing potential from being fully realized. This cross-sectional study examined associations between U = U belief (belief that someone with a sustained undetectable viral load has zero risk of sexually transmitting HIV) and HIV stigma among US sexual minority men. Differences by serostatus and effects of brief informational messaging were also explored. The survey was completed online by 106 men living with HIV and 351 HIV-negative/status-unknown men (2019-2020). Participants were 18-83 years old (M[SD] = 41[13.0]). Most were non-Hispanic White (70.0%) and gay (82.9%). Although nearly all participants (95.6%) were aware of U = U, only 41.1% believed U = U. A greater percentage of participants living with HIV (66.0%) believed U = U compared with HIV-negative/status-unknown participants (33.6%). Among participants living with HIV, U = U belief was not significantly associated with perceived, internalized, or experienced HIV stigma or with viral load prejudice (prejudice against people who have a detectable HIV viral load). Among HIV-negative/status-unknown participants, U = U belief was associated with less frequently enacted HIV discrimination, more positive feelings toward people with an undetectable viral load, and lower personal endorsement of stigmatizing beliefs. Brief informational messaging about U = U did not affect most stigma dimensions and did not favorably affect any. Interventions are needed to correct commonly held, outdated misconceptions about HIV transmission risk. Such initiatives must not only engage people living with HIV but also engage HIV-negative/status-unknown people to maximize the destigmatizing potential of U = U.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA.
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
| | - David A Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Myra A Zaheer
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA
- MPact Global Action for Gay Men's Health and Rights, West Hollywood, CA, USA
| | - Maria Cecilia Zea
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - James MacGibbon
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Djordje X Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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3
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Kalichman SC, Shkembi B, El-Krab R. Geometric approach to measuring intersectional stigma among black sexual minority men: reliability and validity in an HIV prevention context. Sex Health 2023; 20:441-452. [PMID: 37344210 DOI: 10.1071/sh23021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Stigma and discrimination experiences attributable to multiple intersecting facets of the self (e.g. intersectional stigma) pose substantial challenges to accessing health services, including HIV prevention. While there have been theoretical advances in understanding multiple co-occurring stigmas, there are few psychometric instruments available to assess intersectional stigma. We have developed an approach to assessing intersectional stigma that conceptualises an intersection in geometric terms, defined as the line that connects points on two (or more) stigma dimensions and calculates scores derived from the geometric definition of intersecting lines. METHODS Following pilot studies to derive items and response formats, we administered newly developed enacted stigma (24-items) and anticipated stigma (17-items) scales with attributions to race and sexual minority status for stigma experiences to a sample of 422 Black sexual minority men at risk for HIV recruited through social media platforms. RESULTS The enacted and anticipated intersectional stigma scales, including subscales representing discrimination, interpersonal and felt stigma demonstrated evidence for reliability and construct validity. The enacted stigma scales were associated with medical mistrust, whereas the anticipated stigma scales predicted perceived barriers to using pre-exposure prophylaxis for HIV prevention. CONCLUSIONS The intersectional stigma scales offer greater specificity in measuring stigma experiences attributed to race, sexual minority status and the intersection of racial-sexual minority status.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut, 2006 Hillside Road, Storrs, CT 06269, USA
| | - Bruno Shkembi
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut, 2006 Hillside Road, Storrs, CT 06269, USA
| | - Renee El-Krab
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut, 2006 Hillside Road, Storrs, CT 06269, USA
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4
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Reid R, Madhu A, Gonzalez S, Crosby H, Stjuste M, Dale SK. Burnout Among Service Providers for People Living with HIV: Factors Related to Coping and Resilience. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01784-2. [PMID: 37704906 DOI: 10.1007/s40615-023-01784-2] [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] [Received: 07/12/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023]
Abstract
Individuals who provide services for people living with HIV (PLWH) face numerous work-related challenges, including psychosocial and structural factors affecting the quality of care that they provide. Little is known about the factors that relate to burnout among service providers for PLWH. The current study seeks to examine the factors associated with burnout and the role of resilience and coping in the context of burnout. Via convenience sampling, data was collected from 28 professionals (e.g., peer counselors, HIV testers, case managers/case workers, group facilitators, or social workers) serving PLWH in the USA. Participants completed quantitative measures on sociodemographics, organizational factors, discrimination, trauma, depression, and burnout. A sub-sample of 19 participants provided in-depth qualitative data via semi-structured interviews on burnout, coping, and resilience as a buffer against the effects of burnout. Thematic content analysis revealed themes on the factors related to burnout (e.g., discrimination, limited financial and housing resources, and COVID-19), rejuvenating factors, coping with burnout, and intervention strategies. Additionally, Pearson's product moment correlations revealed significant associations between mental health variables such as depressive and posttraumatic stress disorder symptomology with (a) discrimination and microaggressions and (b) burnout. The current study highlights challenges to providing HIV care, including structural barriers and discrimination that are doubly impactful to the professionals in this sample who share identities with the PLWH whom they serve. These findings may inform the development of an intervention targeting burnout among individuals providing services to PLWH and motivate change to remove structural barriers and improve quality of care for PLWH.
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Affiliation(s)
- Rachelle Reid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Aarti Madhu
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Stephanie Gonzalez
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Hannah Crosby
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Michelle Stjuste
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
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Mireles L, Horvath KJ, Guadamuz TE, Waratworawan W, Kongjareon Y, Meyers-Pantele SA. The Moderating Role of Social Support and HIV Stigma on the Association Between Depression and ART Adherence Among Young Thai Men Who Have Sex with Men. AIDS Behav 2023; 27:2959-2968. [PMID: 37000384 PMCID: PMC10524997 DOI: 10.1007/s10461-023-04018-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 04/01/2023]
Abstract
In Thailand, antiretroviral therapy (ART) programs still have difficulties reaching and promoting adherence among a key population - young men who have sex with men (YMSM) living with HIV. As such, we sought to examine potential psychosocial barriers that may contribute to suboptimal levels of ART adherence for this population. Data were drawn from a study of 214 YMSM living with HIV from Bangkok, Thailand. Linear regression models tested the association between depression and ART adherence, and whether social support and HIV-related stigma moderated that relationship. Multivariable models demonstrated social support was significantly associated with higher levels of ART adherence, and that there was a three-way interaction between depression, social support, and HIV-related stigma on ART adherence. These results further our understanding of the role of depression, stigma, and social support in ART adherence among Thai YMSM living with HIV, and that additional supports for YMSM with depression and HIV-related stigma are needed.
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Affiliation(s)
- Linda Mireles
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Thomas E Guadamuz
- Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand.
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand.
- John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA.
| | - Worawalan Waratworawan
- Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Yamol Kongjareon
- Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Stephanie A Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA, USA
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Dale SK, Nelson CM, Wright IA, Etienne K, Lazarus K, Gardner N, Bolden R, Adeojo L, Patrick J, Wallen C, Liu J, Ironson G, Alcaide ML, Safren S, Feaster D. Structural equation model of intersectional microaggressions, discrimination, resilience, and mental health among black women with hiv. Health Psychol 2023; 42:299-313. [PMID: 37141016 PMCID: PMC10167554 DOI: 10.1037/hea0001275] [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: 05/05/2023]
Abstract
OBJECTIVE Compared to non-Black women, Black women in the United States are more likely to be diagnosed with HIV, living with HIV, and have suboptimal HIV outcomes, disparities largely linked to structural and psychosocial factors that may impact mental health. METHOD 151 Black women living with HIV (BWLWH) enrolled in a longitudinal cohort study completed baseline assessments between October 2019 and January 2020 in the Southeastern United States. Measures captured microaggressions (gendered-racial, HIV, and Lesbian/Gay/Bisexual/Transgender/Queer), "macro" discrimination acts (gender, race, HIV, sexual orientation), resilience factors (self-efficacy, trait resilience, posttraumatic growth, positive religious coping, and social support), and mental health (depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic cognitions). Four structural equation models were estimated with latent discrimination (LD), latent microaggression (LM), and latent resilience (LR) as predictors and depressive symptoms, PTSD symptoms, posttraumatic cognitions, and latent mental health (LH) as outcomes. Indirect pathways from LD and LM via LR and LR as a moderator were estimated. RESULTS Models fit well based on indices. There were significant direct pathways from LM and LR to depressive symptoms, posttraumatic cognitions, and LH and a significant direct pathway from LM to PTSD symptoms, but not from LD to any mental health outcome. Indirect pathways were not significant. However, LR moderated the relationships between both LM and LD with PTSD symptoms. CONCLUSION Intersectional microaggressions and resilience factors may play key roles in BWLWH's mental health. Research is needed to examine these pathways overtime and provide opportunities to improve mental health and HIV outcomes among BWLWH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sannisha K. Dale
- Department of Psychology, University of Miami
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - C. Mindy Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Ian A. Wright
- Department of Economics, University of Miami School of Business
| | | | | | | | | | | | | | | | | | | | - Maria L Alcaide
- Department of Medicine (Infectious Diseases), OB/GYN and Public Health, University of Miami Miller School of Medicine
| | | | - Daniel Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
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7
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Minority stress and sleep: How do stress perception and anxiety symptoms act as mediators for sexual minority men? Sleep Health 2023; 9:136-143. [PMID: 36697318 DOI: 10.1016/j.sleh.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Sexual minority men experience worse sleep than heterosexuals. Little is known about how minority stress may account for these differences. Therefore, the aims of this study are to (1) understand the relationship between minority stress and sleep disturbance in a sample of sexual minority men, and (2) test whether these relationships are mediated by generalized anxiety symptoms and perception of stress. METHODS In 2020, 239 sexual minority men were recruited to complete an online survey. Participants responded to scales assessing minority stress (ie, internalized homophobia, experiences of harassment, microaggressions), perception of stress, generalized anxiety symptoms, and sleep disturbance. Linear regressions were used to test the relationship between minority stress and sleep disturbance and to test generalized anxiety symptoms and perception of stress as mediators. RESULTS The final model was significant (F = 16.916, p < .001) and accounted for 43.5% of the variance in sleep disturbance. Generalized anxiety symptoms and perception of stress fully mediated the relationships between minority stress and sleep disturbance. CONCLUSIONS Findings from this study suggest the need for psychological intervention to improve sleep for sexual minority men. Future research should test this model longitudinally, and include objective measures of stress. Future interventions could target stress perception using mindfulness or cognitive-based interventions.
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8
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Mol MM, Visser MJ, Rai SS, Peters RMH. Measuring health-related stigma: Exploring challenges and research priorities to improve assessment. Glob Public Health 2023; 18:2264960. [PMID: 37801723 DOI: 10.1080/17441692.2023.2264960] [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: 03/10/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
Despite the advances in stigma research, measuring health-related stigma continues to be challenging and knowledge gaps remain. This study gained insight into challenges and research priorities related to the assessment of health-related stigma. Interviews were conducted with 14 stigma researchers, followed by a survey that was completed by 36 respondents. The findings showed a diverse range of research priorities. Among the top ranked priorities were the need for robust measurement properties of existing scales (content validity, responsiveness, validation across settings), exploration and assessment of subtle changes in stigma, and investigation on ways to assess actual behaviour and discrimination. Various challenges with the cross-cultural use of measures were identified, along with a research opportunity to shorten the cross-cultural validation process. Other identified research priorities related to: studying multi-level intersectional stigma; focusing on positive features that counter stigma; rephrasing negative and offending scale items; developing generic measures; and, the further development of practical tools to support researchers with scale implementation. The defined research priorities can guide future studies to advance stigma measurements and, as our ability to measure is critical for our understanding, enhance our knowledge about the complex stigma processes.
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Affiliation(s)
- Marente M Mol
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marlies J Visser
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sarju S Rai
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ruth M H Peters
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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9
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A novel psychometric approach to assessing intersectional hiv stigma: the geometric intersectional stigma scales. J Behav Med 2022; 45:804-811. [PMID: 35687209 PMCID: PMC9510112 DOI: 10.1007/s10865-022-00331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/04/2022] [Indexed: 10/31/2022]
Abstract
Recent advances in stigma theories have emphasized intersectionality, but there are currently few approaches to measuring intersectional HIV stigma. Here we present a novel approach to assessing intersectional HIV stigma. Black/African American sexual minority men living with HIV (N = 437) completed newly developed measures of enacted and anticipated stigma along with a battery of instruments to examine construct validity. For each endorsed stigma item, participants rated three personal attributes ascribed to the stigma experiences, specifically race, same-sex sexual behavior, and HIV status. Based on the notion that intersecting orthogonal dimensions such as attributions for experiencing stigma can be conceptualized geometrically, we used the Pythagorean Theorem to calculate intersectional stigma scores. Results showed that the enacted and anticipated stigma scales and the assessment of intersectional stigma attributes demonstrated acceptable response rates, internal consistency and a pattern of associations with correlates that suggests construct validity. In separate tests of construct validity, regression models predicting medication adherence indicated varied results among stigma measures, demonstrating clear advantages to separating the assessment of stigma experiences from the attributes to which stigma experiences are ascribed. Findings from this geometric approach to assessing intersectional HIV stigma were promising and warrant further investigation.
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10
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Wright IA, Reid R, Shahid N, Ponce A, Nelson CM, Sanders J, Gardner N, Liu J, Simmons E, Phillips A, Pan Y, Alcaide ML, Rodriguez A, Ironson G, Feaster DJ, Safren SA, Dale SK. Neighborhood Characteristics, Intersectional Discrimination, Mental Health, and HIV Outcomes Among Black Women Living With HIV, Southeastern United States, 2019‒2020. Am J Public Health 2022; 112:S433-S443. [PMID: 35763751 PMCID: PMC9241469 DOI: 10.2105/ajph.2021.306675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/14/2022]
Abstract
Objectives. To examine the effects of within-neighborhood and neighboring characteristics on discrimination, stigma, mental health, and HIV outcomes among Black women living with HIV (BWLWH). Methods. A total of 151 BWLWH in a southeastern US city provided baseline data (October 2019‒January 2020) on experienced microaggressions and discrimination (race-, gender-, sexual orientation-, or HIV-related), mental health (e.g., depression, posttraumatic stress disorder), and HIV outcomes (e.g., viral load, antiretroviral therapy adherence). Neighborhood characteristics by census tract were gathered from the American Community Survey and the National Center for Charitable Statistics. Spatial econometrics guided the identification strategy, and we used the maximum likelihood technique to estimate relationships between a number of predictors and outcomes. Results. Within-neighborhood and neighboring characteristics (employment, education, crime, income, number of religious organizations, and low-income housing) were significantly related to intersectional stigma, discrimination, mental health, HIV viral load, and medication adherence. Conclusions. Policy, research, and interventions for BWLWH need to address the role of neighborhood characteristics to improve quality of life and HIV outcomes. (Am J Public Health. 2022;112(S4):S433-S443. https://doi.org/10.2105/AJPH.2021.306675).
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Affiliation(s)
- Ian A Wright
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Rachelle Reid
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Naysha Shahid
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Amanda Ponce
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - C Mindy Nelson
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Jasmyn Sanders
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Nadine Gardner
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Jingxin Liu
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Ervin Simmons
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Arnetta Phillips
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Yue Pan
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Maria L Alcaide
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Allan Rodriguez
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Gail Ironson
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Daniel J Feaster
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Steven A Safren
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Sannisha K Dale
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
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11
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Abstract
Stigma changes over time: it waxes and wanes through history, is manifested within humans who develop over time and is tied to statuses (such as attributes, illnesses and identities) that have varying courses. Despite the inherent fluidity of stigma, theories, research and interventions typically treat associations between stigma and health as stagnant. Consequently, the literature provides little insight into when experiences of stigma are most harmful to health and when stigma interventions should be implemented. In this Perspective, we argue that integrating time into stigma research can accelerate progress towards understanding and intervening in associations between stigma and health inequities. We situate time in relation to key concepts in stigma research, identify three timescales that are relevant for understanding stigma (historical context, human development and status course), and outline a time-based research agenda to improve scientists’ ability to understand and address stigma to improve health. Associations between stigma and health are typically treated as stagnant. In this Perspective, Earnshaw et al. argue that considering stigma in relation to historical, human development and status course timescales can advance progress in understanding and addressing stigma to improve health.
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12
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Skinta M, Torres-Harding S. Confronting microaggressions: Developing innovative strategies to challenge and prevent harm. NEW IDEAS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.newideapsych.2021.100921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Kalichman SC, Shkembi B, Eaton LA. Finding the Right Angle: A Geometric Approach to Measuring Intersectional HIV Stigma. AIDS Behav 2022; 26:27-38. [PMID: 34424389 DOI: 10.1007/s10461-021-03437-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/31/2022]
Abstract
Intersectionality has emerged as theoretically and practically important to advancing HIV stigma research. However, few psychometric measures capture the intricacies of intersectional stigma. Grounded in the HIV stigma framework and contemporary theories of intersectionality, this paper describes a novel approach to conceptualizing the measurement of intersectional stigma. Taking the notion of an intersection literally, that is the point at which two or more lines meet and form a union, we offer a geometric conceptualization for developing a psychometric instrument to measure intersectional stigma. Ratings of stigmatized attributes, such as stigma ascribed to gender, race, sexual orientation, and HIV status are assessed on independent scales to calculate their intersection using the Pythagorean Theorem, c = [Formula: see text] (a2 + b2) and its extension to multiple stigmatized attributes d = [Formula: see text] (a2 + b2 + c2). Data from a sample of Black /African American women living with HIV were used to test the concept of a geometric approach to measuring intersectional enacted stigma and intersectional anticipated stigma. Findings from the test of concept were encouraging and warrant further scale development research.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA.
| | - Bruno Shkembi
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA
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14
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Greenwood GL, Wilson A, Bansal GP, Barnhart C, Barr E, Berzon R, Boyce CA, Elwood W, Gamble-George J, Glenshaw M, Henry R, Iida H, Jenkins RA, Lee S, Malekzadeh A, Morris K, Perrin P, Rice E, Sufian M, Weatherspoon D, Whitaker M, Williams M, Zwerski S, Gaist P. HIV-Related Stigma Research as a Priority at the National Institutes of Health. AIDS Behav 2022; 26:5-26. [PMID: 33886010 PMCID: PMC8060687 DOI: 10.1007/s10461-021-03260-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
The National Institutes of Health (NIH) recognizes that, despite HIV scientific advances, stigma and discrimination continue to be critical barriers to the uptake of evidence-based HIV interventions. Achieving the Ending the HIV Epidemic: A Plan for America (EHE) goals will require eliminating HIV-related stigma. NIH has a significant history of supporting HIV stigma research across its Institutes, Centers, and Offices (ICOs) as a research priority. This article provides an overview of NIH HIV stigma research efforts. Each ICO articulates how their mission shapes their interest in HIV stigma research and provides a summary of ICO-relevant scientific findings. Research gaps and/or future opportunities are identified throughout, with key research themes and approaches noted. Taken together, the collective actions on the part of the NIH, in tandem with a whole of government and whole of society approach, will contribute to achieving EHE's milestones.
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Affiliation(s)
- Gregory L Greenwood
- Division of AIDS Research, National Institute of Mental Health, National Institutes of Health, 5601 Fishers Lane, 9G19, Bethesda, MD, 20852, USA.
| | - Amber Wilson
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Geetha P Bansal
- Division of International Training and Research, Fogarty International Center, Bethesda, MD, 20814, USA
| | - Christopher Barnhart
- Sexual and Gender Minority Research Office, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Elizabeth Barr
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Rick Berzon
- Division of Scientific Programs, National Institute of Minority Health and Health Disparities, Bethesda, MD, 20892, USA
| | - Cheryl Anne Boyce
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, 20892, USA
| | - William Elwood
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, 20814, USA
| | | | - Mary Glenshaw
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Rebecca Henry
- Division of Extramural Science Programs, National Institute of Nursing Research, Bethesda, MD, 20892, USA
| | - Hiroko Iida
- Division of Extramural Research, National Institute of Dental and Craniofacial Research, Bethesda, MD, 20892, USA
| | - Richard A Jenkins
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, 20852, USA
| | - Sonia Lee
- Division of Extramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, 20817, USA
| | - Arianne Malekzadeh
- Division of International Science Policy, Planning and Evaluation, Fogarty International Center, Bethesda, MD, 20814, USA
| | - Kathryn Morris
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Peter Perrin
- Division of Digestive Diseases & Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 20892, USA
| | - Elise Rice
- Division of Extramural Research, National Institute of Dental and Craniofacial Research, Bethesda, MD, 20892, USA
| | - Meryl Sufian
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Darien Weatherspoon
- Division of Extramural Research, National Institute of Dental and Craniofacial Research, Bethesda, MD, 20892, USA
| | - Miya Whitaker
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Makeda Williams
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, 20892, USA
| | - Sheryl Zwerski
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD, 20852, USA
| | - Paul Gaist
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
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15
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Dale SK, Pan Y, Gardner N, Saunders S, Wright IA, Nelson CM, Liu J, Phillips A, Ironson GH, Rodriguez AE, Alcaide ML, Safren SA, Feaster DJ. Daily Microaggressions and Related Distress among Black Women Living with HIV during the Onset of the COVID-19 Pandemic and Black Lives Matter Protests. AIDS Behav 2021; 25:4000-4007. [PMID: 34046762 PMCID: PMC8158077 DOI: 10.1007/s10461-021-03321-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 02/06/2023]
Abstract
Black women living with HIV (BWLWH) in the U.S. face microaggressions based on race, gender, HIV-status, and sexual orientation. We examined changes in daily microaggressions and related distress among 143 BWLWH in Miami, FL. Microaggression-related distress increased from 52% at baseline/October, peaked at 70% during the holidays (November/December), declined to 55% in March when COVID-19 social distancing began, and peaked to 83% in June/July 2020 during widespread Black Lives Matters protests. Baseline viral suppression was associated with lower microaggressions across the 9-months. Microaggression-related distress may change due to social context and research is needed on microaggressions and viral load overtime.
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Affiliation(s)
- Sannisha K Dale
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| | - Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nadine Gardner
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sherence Saunders
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Ian A Wright
- Department of Economics, Miami Herbert Business School, University of Miami, Miami, FL, USA
| | - Cheri M Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jingxin Liu
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Arnetta Phillips
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Gail H Ironson
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Singh RS, Bhambhani Y, Skinta MD, Torres-Harding SR. Measurement of Intersectional Microaggressions: Conceptual Barriers and Recommendations. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 16:956-971. [PMID: 34498531 DOI: 10.1177/1745691621991855] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since Crenshaw coined the term "intersectionality" in 1989, researchers of bias have struggled with how to capture the complexity and intricacies of intersectional identities and microaggressions experienced by individuals holding these identities within the quantitative framework that dominates psychology. Although scholarship has grown in the exploration of experiences such as racialized sexual harassment, or sexual racism within queer and trans communities, there is no strong consensus on how this might be measured systematically in ways that allow for inferences regarding the experiences of populations of interest. With an emphasis on the experiences of queer and trans people of color, this article explores intersectional identities through three main points: First, we define what is meant by intersectionality and the real-world experiences that are important for advancing an understanding of microaggressions; second, we review the existing measures and their ability to capture the breadth and depth of the lived experience of those with intersectional identities; and third, we propose a framework for the development of a more accurate and comprehensive measure of microaggressions.
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Affiliation(s)
- R Sonia Singh
- South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas.,Department of Psychiatry, University of Arkansas for Medical Sciences
| | - Yash Bhambhani
- Department of Family and Social Medicine, Montefiore Medical Center, Bronx, New York
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17
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Berman M, Eaton LA, Watson RJ, Maksut JL, Rucinski KB, Earnshaw VA. Perpetuated HIV Microaggressions: A Novel Scale to Measure Subtle Discrimination Against People Living With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:1-15. [PMID: 33617319 DOI: 10.1521/aeap.2021.33.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
HIV discrimination has served as a barrier to addressing the HIV epidemic and providing effective HIV treatment and care. Measuring HIV discrimination, particularly covert HIV discrimination, has proven to be complex. Adapted from a previous scale, we developed a perpetuated HIV micro-aggressions scale to assess covert forms of discriminatory beliefs among HIV-negative/unknown HIV status individuals. Factor analysis resulted in three subscales, explaining 73.58% of the scale's variance. The new scale demonstrated both convergent validity (HIV prejudice, HIV stereotypes) and discriminant validity (alcohol use, depressive symptomology). Perpetuated HIV microaggressions were significantly associated with HIV conspiracy beliefs, HIV prejudice, and HIV stereotypes. This new scale can serve as an important tool in evaluating perpetuated HIV microaggressions among HIV-negative individuals.
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Affiliation(s)
- Marcie Berman
- Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut, Storrs, Connecticut
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut, Storrs, Connecticut
| | - Ryan J Watson
- Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut, Storrs, Connecticut
| | - Jessica L Maksut
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine B Rucinski
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware
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18
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Kalichman SC, Katner H, Banas E, Hill M, Kalichman MO. Cumulative Effects of Stigma Experiences on Retention in HIV Care Among Men and Women in the Rural Southeastern United States. AIDS Patient Care STDS 2020; 34:484-490. [PMID: 33147086 DOI: 10.1089/apc.2020.0144] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The stigmatization of HIV infection impedes every step along the HIV continuum of care, particularly care engagement and retention. The differential effects of various sources of stigma on retention in HIV care have been the subject of limited research. We examined the accumulation of HIV stigma experiences over 1 year in relationship to treatment retention among 251 men and women marginally engaged in HIV care in the southeastern United States. Results showed that cumulative stigma experiences predicted poorer retention in care, with greater stigma experiences related to less consistency in attending scheduled medical appointments. HIV stigma originating from family members and acts of overt discrimination were the most frequently experienced sources of stigma and were most closely associated with disengagement from HIV care. In addition, analyses by gender indicated that retention in care for men was impacted by stigma to a greater extent than among women. These findings reaffirm the importance of HIV stigma as a barrier to HIV care and provide new directions for interventions to mitigate the negative effects of stigma on patients who are not fully engaged in HIV care. Clinical trials registration NCT104180280.
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Affiliation(s)
- Seth C. Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Ellen Banas
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Moira O. Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
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19
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Berman M, Eaton LA, Watson RJ, Andrepont JL, Kalichman S. Social Distancing to Mitigate COVID-19 Risks Is Associated With COVID-19 Discriminatory Attitudes Among People Living with HIV. Ann Behav Med 2020; 54:728-737. [PMID: 32940326 PMCID: PMC7516104 DOI: 10.1093/abm/kaaa074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2, the virus that causes COVID-19, is an emerging pandemic with heightened concerns for people with compromised immune systems, including people living with HIV. PURPOSE In the absence of a vaccine, public health messaging to mitigate risks for COVID-19 primarily focuses on social distancing. Because people living with HIV commonly experience mistreatment associated with HIV, their response to social distancing may be complicated by psychosocial attitudes associated with COVID-19. METHODS To evaluate these relationships, we conducted a rapid-response, cross-sectional survey with people living with HIV (N = 149) to assess social distancing practices, COVID-19 discriminatory attitudes, COVID-19 xenophobic attitudes, HIV microaggressions, and concern over contracting COVID-19. Data were collected from participants enrolled in a larger ongoing study between March 30, 2020 and April 17, 2020. RESULTS Results indicated that choosing to socially distance to reduce COVID-19 exposure was associated with COVID-19 discriminatory attitudes, concerns of contracting COVID-19, and identifying as transgender. Likewise, social distancing imposed by others (e.g., cancelations and restrictions) was associated with concerns of contracting COVID-19. CONCLUSIONS Findings demonstrate that social distancing measures are related to concerns of contracting the virus and discriminatory attitudes toward those who are presumed to be living with COVID-19. These potentially negative psychosocial attitudes toward people perceived to have COVID-19 echo the discriminatory actions and attitudes that we continue to observe in HIV social sciences research.
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Affiliation(s)
- Marcie Berman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Ryan J Watson
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - J L Andrepont
- School of Public Policy, Oregon State University, Corvallis, OR, USA
| | - Seth Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
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20
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Nobles AL, Leas EC, Latkin CA, Dredze M, Strathdee SA, Ayers JW. #HIV: Alignment of HIV-Related Visual Content on Instagram with Public Health Priorities in the US. AIDS Behav 2020; 24:2045-2053. [PMID: 31916098 PMCID: PMC10712936 DOI: 10.1007/s10461-019-02765-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Instagram, with more than 1 billion monthly users, is the go-to social media platform to chronicle one's life via images, but how are people using the platform to present visual content about HIV? We analyzed public Instagram posts containing the hashtag "#HIV" (because they are self-tagged as related to HIV) between January 2017 and July 2018. We described the prevalence of co-occurring hashtags and explored thematic concepts in the images using automated image recognition and topic modeling. Twenty-eight percent of all #HIV posts included hashtags focused on awareness, followed by LGBTQ (24.5%) and living with HIV (17.9%). However, specific strategies were rarely cited, including testing (10.8%), treatment (10.3%), PrEP (6.2%) and condoms (4.1%). Image analyses revealed 44.5% of posts included infographics followed by people (21.3%) thereby humanizing HIV and stigmatized populations and promoting community mobilization. Novel content such as the handwriting image-theme (3.8%) where posters shared their HIV test results appeared. We discuss how this visual content aligns with public health priorities to reduce HIV in the US and the novel, organic messages that public health could help amplify.
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Affiliation(s)
- Alicia L Nobles
- The Center for Data Driven Health at Qualcomm Institute, California Institute for Telecommunications and Information Technology, University of California San Diego, La Jolla, CA, USA
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Eric C Leas
- The Center for Data Driven Health at Qualcomm Institute, California Institute for Telecommunications and Information Technology, University of California San Diego, La Jolla, CA, USA
- Division of Health Policy, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - John W Ayers
- The Center for Data Driven Health at Qualcomm Institute, California Institute for Telecommunications and Information Technology, University of California San Diego, La Jolla, CA, USA.
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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21
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Kalichman S, Banas E, Kalichman M, Mathews C. Stigmatisation of alcohol use among people receiving antiretroviral therapy for HIV infection, Cape Town, South Africa. Glob Public Health 2020; 15:1040-1049. [PMID: 32053472 DOI: 10.1080/17441692.2020.1724314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Antiretroviral therapy (ART) effectively treats HIV infection, with improved longevity and quality of life among people living with HIV. Alcohol use, however, remains a robust barrier to ART. This study, for the first time, examined the effects of the stigmatisation of alcohol use on ART adherence. Patients receiving ART in Cape Town, South Africa who currently drink alcohol (N = 187) and those who do not drink alcohol (N = 106) completed measures of alcohol use, alcohol-ART adherence, and alcohol-ART stigma. Participants also provided permission to access their most recent HIV viral load from clinic medical records. Results of a mediation model demonstrated significant detrimental effects of alcohol use on ART adherence. In addition, the indirect effects of alcohol use on ART adherence through alcohol-ART stigma was also significant, indicating that alcohol-ART stigma at least in part mediates the association between alcohol use and ART adherence. The same pattern of results was observed in relation to HIV viral load obtained from medical records. Interventions designed to address alcohol use as a barrier to ART adherence should incorporate alcohol-ART stigma as a barrier to adherence as well as a barrier to participating in adherence interventions.
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Affiliation(s)
- Seth Kalichman
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Ellen Banas
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA.,Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
| | - Moira Kalichman
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Catherine Mathews
- Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
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