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Davtyan M, Kacanek D, Lee J, Berman C, Chadwick EG, Smith R, Salomon L, Frederick T. The role of internalised HIV stigma in disclosure of maternal HIV serostatus to children perinatally HIV-exposed but uninfected: a prospective study in the United States. J Int AIDS Soc 2023; 26 Suppl 4:e26167. [PMID: 37909234 PMCID: PMC10618870 DOI: 10.1002/jia2.26167] [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] [Received: 01/27/2023] [Accepted: 08/23/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Decisions to disclose HIV serostatus may be complicated by internalised HIV stigma. We evaluated the association of internalised HIV stigma in biological mothers living with HIV with disclosure of their serostatus to their children perinatally HIV-exposed but uninfected (CHEU). METHODS Mothers and their CHEU were enrolled in the United States (U.S.)-based Surveillance Monitoring for Antiretroviral Therapy (ART) Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study (PHACS), a longitudinal study of outcomes related to in utero exposure to HIV and ART among CHEU. Mothers completing at least one stigma and disclosure assessment starting at the child's age 11-, 13-, 15- and/or 17-year study visits between 16 August 2016 and 1 October 2020 were eligible. Stigma was measured with the 28-item Internalised HIV Stigma Scale (IHSS). Mean stigma scores were linearly transformed to a range of 0-100, with higher scores indicating greater levels of stigma. At each visit, mothers were asked if their child was aware of their HIV diagnosis and at what age the child became aware. The Kaplan-Meier estimator evaluated the cumulative probability of disclosure at each child age. Logistic regression models with generalised estimating equations to account for repeated measures were fit to examine the association between stigma and disclosure, controlling for relevant socio-demographic variables. RESULTS Included were 438 mothers of 576 children (mean age 41.5 years, 60% U.S.-born, 60% Black/African American and 37% with household income ≤$10,000). The prevalence of disclosure across all visits was 29%. Mothers whose children were aware versus not aware of their serostatus reported lower mean IHSS scores (38.2 vs. 45.6, respectively). The cumulative proportion of disclosure by age 11 was 18.4% (95% CI: 15.5%, 21.8%) and 41% by age 17 (95% CI: 35.2%, 47.4%). At all child ages, disclosure was higher among children of U.S.-born versus non-U.S.-born mothers. After adjusting for age, marital status and years since HIV diagnosis, higher IHSS scores were associated with lower odds of disclosure (OR = 0.985, 95% CI: 0.975, 0.995). CONCLUSIONS Providing support to women as they make decisions about serostatus disclosure to their children may entail addressing internalised HIV stigma and consideration of community-level factors, particularly for non-U.S.-born mothers.
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Affiliation(s)
- Mariam Davtyan
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Deborah Kacanek
- Harvard T.H. Chan School of Public HealthCenter for Biostatistics in AIDS ResearchBostonMassachusettsUSA
| | - Jessica Lee
- Harvard T.H. Chan School of Public HealthCenter for Biostatistics in AIDS ResearchBostonMassachusettsUSA
| | - Claire Berman
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Ellen G. Chadwick
- Department of PediatricsFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Renee Smith
- Department of PediatricsCollege of MedicineUniversity of IllinoisChicagoIllinoisUSA
| | - Liz Salomon
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Toinette Frederick
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Wang Q, Hui KH, Wang A, Wang X, Sun H, Lau STY, Wang C, Mo PKH. Chinese Mothers' Intent to Disclose Their HIV Status to Their Children: The Role of Positive Outcome Expectations and Reward Responsiveness. Int J Public Health 2023; 68:1605559. [PMID: 37228894 PMCID: PMC10204079 DOI: 10.3389/ijph.2023.1605559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/12/2023] [Indexed: 05/27/2023] Open
Abstract
Objective: The current study investigated the role of positive outcome expectations and reward responsiveness in intention to disclose HIV status to children among women living with HIV in China. The moderating role of reward responsiveness was also explored. Method: A 1-year longitudinal survey was conducted. 269 women living with HIV who had at least one child aged >5 years and had not yet disclosed their HIV status to their oldest child were selected from a larger sample of women living with HIV at baseline, with a total of 261 respondents completing the follow-up survey. Results: After adjusting for significant socio-demographic and medical variables, positive outcome expectations positively predicted mothers' intention to disclose HIV, while reward responsiveness had a negative effect. A moderation effect of reward responsiveness was found, with further analysis showing that reward responsiveness has strengthened the relationship between positive outcome expectations and intention to disclose HIV. Conclusion: Findings support the relevance of positive outcome expectations and reward responsiveness to intention of disclosure among women living with HIV in China.
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Affiliation(s)
- Qian Wang
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kam Hei Hui
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ailing Wang
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoyan Wang
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - He Sun
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Stephanie Tsz Yung Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Changhe Wang
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Phoenix Kit Han Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Do Older Adults with HIV Have Distinctive Personal Networks? Stigma, Network Activation, and the Role of Disclosure in South Africa. AIDS Behav 2021; 25:1560-1572. [PMID: 32776180 PMCID: PMC7415327 DOI: 10.1007/s10461-020-02996-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study considers whether the personal networks of older South African people living with HIV (PLHIV) differ from those without HIV. Using recent survey data (N = 5059), results suggest that PLHIV reported more core network members than their peers without HIV (IRR 1.08; 95% CI 1.03, 1.13), but were equally likely to receive emotional support from network members (1.21; 95% CI 0.93, 1.58). PLHIV who had yet to disclose their serostatus were more likely than others to have friends and other non-kin in their core network (B 0.08; 95% CI 0.02, 0.13) and to maintain networks of non-overlapping members (OR 2.11; 95% CI 1.33, 3.34). Even as HIV remains highly stigmatized in South Africa, PLHIV tend to maintain relatively large and supportive networks. Still, a sizeable proportion of PLHIV do not disclose their illness—these individuals disproportionately inhabit networks marked by non-kin and by high bridging potential.
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Wang Q, Wang Z, Ma X, Chan P, Lau JTF, Mo PKH. Chinese mothers' intent to disclose the HIV status to their children: the role of outcome expectations and self-efficacy. AIDS Care 2021; 34:95-104. [PMID: 33563048 DOI: 10.1080/09540121.2021.1882930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The present study examined the association between outcome expectations, self-efficacy, and intention to disclose HIV status to children among HIV-positive women in China, and the moderating and mediating role of self-efficacy on the association between outcome expectations and intention to disclose. A cross-sectional survey was conducted among 179 HIV-positive mothers who had at least one living child aged >5 years and had not yet disclosed their HIV status to her oldest child. Results from hierarchical regressions revealed that after adjusting for socio-demographic and medical variables, negative outcome expectations had a negative association (β = -0.22), while disclosure self-efficacy had a positive association (β = 0.43) with an intention to disclose HIV. The moderation effect of self-efficacy on the association between outcome expectations and intention to disclose HIV was not significant. Results from structural equation modeling showed that self-efficacy mediated the association between negative/positive outcome expectations and intention to disclose HIV. Findings support the importance of outcome expectations and self-efficacy and also the mediating role of self-efficacy in HIV disclosure among HIV-positive mothers in the Chinese context.
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Affiliation(s)
- Qian Wang
- Department of Prevention of Mother to Child Transmission of Disease, National Center for women and children's health, China Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, People's Republic of China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, People's Republic of China
| | - Xiaomeng Ma
- Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Polin Chan
- World Health Organization, Western Pacific Regional Office, Manila, Philippines
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, People's Republic of China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, People's Republic of China
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, People's Republic of China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, People's Republic of China
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Nwankwo B, Oluchukwu J, Usman N. Disclosure of human immune deficiency virus status to infected children at a tertiary hospital in North-western Nigeria. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_119_21] [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] Open
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HIV Sero-Status Non-disclosure Among HIV-Infected Opioid-Dependent Individuals: The Roles of HIV-Related Stigma, Risk Behavior, and Social Support. J Community Health 2020; 44:112-120. [PMID: 30043195 DOI: 10.1007/s10900-018-0560-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV sero-status disclosure among people living with HIV (PLWH) is an important component of preventing HIV transmission to sexual partners. Due to various social, structural, and behavioral challenges, however, many HIV-infected opioid-dependent patients do not disclose their HIV status to all sexual partners. In this analysis, we therefore examined non-disclosure practices and correlates of non-disclosure among high-risk HIV-infected opioid-dependent individuals. HIV-infected opioid-dependent individuals who reported HIV-risk behaviors were enrolled (N = 133) and assessed for HIV disclosure, risk behaviors, health status, antiretroviral therapy (ART) adherence, HIV stigma, social support and other characteristics. Multivariable logistic regression was used to identify significant correlates of non-disclosure. Overall, 23% reported not disclosing their HIV status to sexual partners, who also had high levels of HIV risk: sharing of injection equipment (70.5%) and inconsistent condom use (93.5%). Independent correlates of HIV non-disclosure included: being virally suppressed (aOR 0.19, p = 0.04), high HIV-related stigma (aOR 2.37, p = 0.03), and having multiple sex partners (aOR 5.87, p = 0.04). Furthermore, a significant interaction between HIV-related stigma and living with family/friends suggests that those living with family/friends were more likely to report not disclosing their HIV status when higher levels of perceived stigma was present. Our findings support the need for future interventions to better address the impact of perceived stigma and HIV disclosure as it relates to risk behaviors among opioid-dependents patients in substance abuse treatment settings.
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Domlyn AM, Jiang Y, Harrison S, Qiao S, Li X. Stigma and psychosocial wellbeing among children affected by parental HIV in China. AIDS Care 2019; 32:500-507. [PMID: 31690083 DOI: 10.1080/09540121.2019.1687834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Parental HIV infection presents unique psychosocial challenges for families. Affected children are vulnerable to stigma-related distress from a parent's HIV status and are more likely to experience symptoms of depression and low self-esteem than unaffected peers. This study examined whether HIV-related stigma predicted poorer mental health among children affected by parental HIV and whether psychosocial assets mediated this relationship. METHODS A sample of 790 children (ages 6-17) affected by parental HIV in Henan, China reported on HIV-related stigma, social support, emotional regulation, future outlook, and mental health symptoms. Structural equation modeling was used to examine the direct and indirect effects of stigma on mental health. RESULTS Results indicated that stigma was associated with psychosocial resources, which in turn were associated with mental health symptoms. The indirect pathways from stigma to mental health symptoms through psychosocial resources were consistent across age and gender. CONCLUSION The experience of HIV-related stigma was associated with poorer overall mental health among children affected by parental HIV in China. Children's psychosocial resources, including social support, emotional regulation, and future outlook, mediated the relationship between HIV-related stigma and mental health symptoms. Future interventions may wish to target these modifiable aspects of wellbeing to improve social and behavioral outcomes in this vulnerable population.
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Affiliation(s)
- Ariel M Domlyn
- Department of Psychology, University of South Carolina, Columbia, SC, USA.,South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Yanping Jiang
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sayward Harrison
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Mo PKH, Wang Z, Lau JTF, Li AYC, Wang Q. Disclosure of maternal HIV infection to children among Chinese women with HIV: The application of the Theory of Planned Behaviour and the role of various norms. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1544-1554. [PMID: 31373425 DOI: 10.1111/hsc.12825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 05/10/2019] [Accepted: 07/09/2019] [Indexed: 05/22/2023]
Abstract
Maternal HIV disclosure to children has numerous benefits for both mothers and children. However, the prevalence of maternal HIV disclosure to children remains low in many countries. The present study examined factors associated with intention to disclose maternal HIV status to children among Chinese HIV+ women who have not disclosed their HIV status to their child. Factors from the Theory of Planned Behavior and various norms (injunctive, descriptive and moral norm) were examined. Findings from 179 HIV+ women revealed that only 16.8% intended to disclose their HIV status to their child in the future. Adjusted for significant background variables, all factors from the TPB and various norms (i.e. attitude, injunctive norm, descriptive norm, moral norm, perceived behavioural control) were associated with intention to disclose HIV status (adjusted odds ratios ranged from 3.22, 15.85). Stepwise logistic regression showed that attitude (ORm = 6.96) and injunctive norm (ORm = 6.81) were associated with intention to disclose HIV status. Interventions to promote maternal HIV disclosure were warranted to promote attitude, perceived behavioural control, and various norms associated with HIV disclosure.
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Affiliation(s)
- Phoenix K H Mo
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Zixin Wang
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Joseph T F Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Angela Y C Li
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Qian Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Moseholm E, Fetters MD, Aho I, Mellgren Å, Johansen IS, Storgaard M, Pedersen G, Katzenstein TL, Weis N. Study protocol: becoming and being a mother living with HIV - a multicentre longitudinal mixed methods study among pregnant women living with HIV, non-pregnant women living with HIV and pregnant women not living with HIV in a high-income setting (the 2B MOM study). BMJ Open 2019; 9:e027761. [PMID: 31619417 PMCID: PMC6797316 DOI: 10.1136/bmjopen-2018-027761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The success of combination antiretroviral therapy has decreased the risk of perinatal HIV transmission and normalised pregnancy in women living with HIV (WLWH). Despite these advances, WLWH still face complex medical and psychosocial issues during pregnancy and postpartum, and there is a gap of knowledge on the experiences of becoming and being a mother living with HIV in today's context. The overall aim of this study is to investigate psychosocial outcomes and experiences of WLWH in Scandinavia during pregnancy and early motherhood. METHODS AND ANALYSIS This is a multicentre longitudinal convergent mixed methods study consisting of a quantitative survey study, a qualitative interview study and a mixed methods analysis. The survey study aims to examine psychosocial outcomes of WLWH across the pregnancy - postpartum trajectory. Participants are pregnant WLWH living in Scandinavia. Two control groups of HIV-negative pregnant women and non-pregnant WLWH are also included. Data is collected in the third trimester, 3 and 6 months postpartum using standardised questionnaires. Statistical analysis will assess changes over time and identify predictors of adverse outcomes. The interview study seeks to understand experiences of pregnancy and becoming a mother while living with HIV. Pregnant WLWH who are enrolled in the survey study will be asked to participate in individual interviews in the third trimester and 6 months postpartum. Data will be analysed using narrative analysis. The survey and interview results will be merged in a mixed methods analysis to assess confirmation, expansion or discordance between the data sets. ETHICS AND DISSEMINATION Approval from the Danish Data Protection Agency (VD-2018-253), and the Finnish and Swedish Ethics Committees have been obtained (HUS/1330/2019 and Dnr: 2019-04451, respectively). Study results will be disseminated to patient organisations, through publications in peer-reviewed journals and at scientific conferences.
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Affiliation(s)
- Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Micheal D Fetters
- Mixed Methods Program and Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Inka Aho
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Åsa Mellgren
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isik S Johansen
- Department of Infectious Diseases, Odense Universitetshospital, Odense, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Important Roles of Health Professionals in Maternal HIV Disclosure Among HIV-Infected Women in China. AIDS Behav 2019; 23:2829-2836. [PMID: 31228027 DOI: 10.1007/s10461-019-02566-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Maternal HIV disclosure to children is beneficial for both mothers and children. A cross-sectional survey was conducted to investigate the prevalence of maternal HIV disclosure to at least one living child aged > 5 years among 292 HIV-infected mothers in Guangxi Province, China. Among all participants, 45.2% had self-disclosed their HIV positive sero-status to at least one living child aged > 5 years. After adjusting for the significant background variables, participants self-reported health professionals in governmental antenatal care clinics had discussed with them about maternal HIV disclosure (adjusted odds ratios, aOR: 5.85), had received counseling services (aOR: 7.84) or support (aOR: 8.75) from these health professionals when making decision on maternal HIV, and perceived higher empathy of these health professionals (aOR: 1.09) were more likely to have reported maternal HIV disclosure. Instrumental and affective interactions between health professionals and HIV-infected mothers were important facilitators of maternal HIV disclosure.
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Dalton L, Rapa E, Ziebland S, Rochat T, Kelly B, Hanington L, Bland R, Yousafzai A, Stein A. Communication with children and adolescents about the diagnosis of a life-threatening condition in their parent. Lancet 2019; 393:1164-1176. [PMID: 30894272 DOI: 10.1016/s0140-6736(18)33202-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022]
Abstract
Many adults diagnosed with a life-threatening condition have children living at home; they and their partners face the dual challenge of coping with the diagnosis while trying to maintain a parenting role. Parents are often uncertain about how, when, and what to tell their children about the condition, and are fearful of the effect on their family. There is evidence that children are often aware that something is seriously wrong and want honest information. Health-care professionals have a key role in supporting and guiding parents and caregivers to communicate with their children about the diagnosis. However, the practical and emotional challenges of communicating with families are compounded by a scarcity of evidence-based guidelines. This Review considers children's awareness and understanding of their parents' condition, the effect of communication around parental life-threatening condition on their wellbeing, factors that influence communication, and the challenges to achieving effective communication. Children's and parents' preferences about communication are outlined. An expert workshop was convened to generate principles for health-care professionals, intended as practical guidance in the current absence of empirically derived guidelines.
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Affiliation(s)
- Louise Dalton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tamsen Rochat
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Human Sciences Research Council, Johannesburg, South Africa
| | - Brenda Kelly
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lucy Hanington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ruth Bland
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Institute of Health and Wellbeing, Glasgow, UK; University of Glasgow and Royal Hospital for Children, Glasgow, UK
| | | | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
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Pediatric HIV Disclosure in Northern India: Evaluation of Its Prevalence, Perceptions amongst Caregivers, and Its Impact on CLHIV. AIDS Res Treat 2018; 2018:2840467. [PMID: 30473886 PMCID: PMC6220414 DOI: 10.1155/2018/2840467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/25/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022] Open
Abstract
Background With improving standards of care of children living with HIV (CLHIV), pediatric HIV related mortality rates are declining. New challenges like HIV status disclosure are emerging which need to be addressed to ensure their smooth transition into adulthood. Poor disease disclosure rates are observed in CLHIV globally. Aims This study was done to assess the prevalence of HIV disclosure in North Indian CLHIV, know the perceptions of caregivers regarding disclosure, and evaluate the impact of disclosure on CLHIV. Methods It was a questionnaire based cross-sectional study carried out amongst 144 caregivers of CLHIV aged 6-16 years attending the pediatric HIV clinic of a tertiary care teaching hospital. Results Though the majority (93.8%) caregivers felt that it is important to disclose but only 33% of the children were actually disclosed. Eighty five percent felt that disclosure must be done by one of the family members and correspondingly 73% of the disclosed children were actually disclosed by their parents. Forty seven percent believed that the most appropriate age for disclosure is 10-12 years. The mean age at which disclosure was actually done was 11.06 ± 1.62 years. Comparison of the disclosed and undisclosed CLHIV revealed that the disclosed group had significantly higher age, longer duration of taking ART, and higher proportion of paternal orphans. Age of the CLHIV was the only significant factor for disclosure. Several reasons were cited by the caregivers for nondisclosure. The caregivers observed improved drug adherence in 47.9% of the children following disclosure. Conclusions There is a need to develop region specific pediatric HIV disclosure guidelines keeping in mind the caregivers' perceptions. The guidelines must be age appropriate, systematic, and socioculturally acceptable. The most suitable age for disclosure appears to be 10-12 years. Involvement of caregivers and health care providers in the process is a must.
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Khan S, Ion A, Alyass A, Greene S, Kwaramba G, Smith S, Carvalhal A, Kennedy VL, Walmsley S, Loutfy M. Loneliness and perceived social support in pregnancy and early postpartum of mothers living with HIV in Ontario, Canada. AIDS Care 2018; 31:318-325. [PMID: 30157684 DOI: 10.1080/09540121.2018.1515469] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The HIV Mothering Study (n = 72) was a prospective, observational, cohort study exploring psychosocial experiences and needs of WLWHIV in pregnancy and postpartum. We performed quantitative analysis of determinants of loneliness (UCLA Loneliness Scale) and lower perceived social support (SS) (Medical Outcomes Study-Social Support Survey). The hypothesized determinants included: age, years with HIV, racism (Everyday Discrimination Scale), depression (Edinburgh Postnatal Depression Scale [EPDS]), nadir CD4 (<200 cells/μL), tertiary vs. community HIV care, and marital status. The median age was 33 (IQR = 30-37); 65.3% were African/Caribbean/Black. Multivariable analyses revealed associations between marital status and perceived social support (β = -16.48, p < 0.0001), and this association was also seen with change over time (p = 0.02). Variables associated with SS that did not change over time were: income, EDS racism, EPDS score. Significant associations with loneliness were seen with the same variables associated with SS. Variables associated with loneliness that also changed over time were: EDS Racism (β = 0.22, p = 0.0005, and over time p = 0.003), and EPDS score (β = 0.74, p < 0.0001), and over time (p = 0.0211). Variables associated with loneliness but that did not change over time were: marital status and income. This analysis provides clinicians with prenatal risk factors which may be associated with increase loneliness and lower SS during pregnancy and postpartum: marital status, income, racism and depression.
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Affiliation(s)
- S Khan
- a Pediatric Infectious Diseases , McMaster University , Hamilton , Canada
| | - A Ion
- b Department of Social Work , McMaster University , Hamilton , Canada
| | - A Alyass
- c Department of Clinical Epidemiology , McMaser University , Hamilton , Canada
| | - S Greene
- b Department of Social Work , McMaster University , Hamilton , Canada
| | - G Kwaramba
- d Department of Medicine , University of Toronto, St. Michael's Hospital , Toronto , Canada
| | - S Smith
- d Department of Medicine , University of Toronto, St. Michael's Hospital , Toronto , Canada
| | - A Carvalhal
- e Department of Psychiatry , University of Toronto , Toronto , Canada
| | - V L Kennedy
- f Women's College Research Institute , Women's College Hospital, University of Toronto & Maple Leaf Medical Clinic , Toronto , Canada
| | - S Walmsley
- g Department of Medicine , University of Toronto, University Health Network , Toronto , Canada
| | - M Loutfy
- f Women's College Research Institute , Women's College Hospital, University of Toronto & Maple Leaf Medical Clinic , Toronto , Canada
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Abdulrahman R, Stuard E, Vachon ME, Nicholas C, Neugebauer R, Hagmann SHF, Purswani MU. Predictors of Disclosure of Maternal HIV Status by Caregivers to their Children in an Inner-City Community in the United States. AIDS Behav 2017; 21:141-151. [PMID: 27011379 DOI: 10.1007/s10461-016-1372-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Disclosure of HIV status to children is a challenge parents living with HIV face. To evaluate predictors of maternal HIV disclosure in a low-income clinic in the U.S. that serves an African American, Hispanic and immigrant population with high HIV prevalence, 172 caregivers with 608 children completed a standardized survey. Caregivers were 93 % female, 84 % biological mothers, and 34 % foreign born. Sixty-two (36 %) caregivers had at least one disclosed child, 42 of whom also had other nondisclosed children. Of all children, 581 (96 %) were uninfected and 181 (30 %) were disclosed. Caregiver's U.S. birth (OR: 2.32, 95 % CI 1.20-4.52), child's age (OR: 1.2/year, 95 % CI 1.16-1.24), and increased HIV-stigma perception by caregiver (1.06/point increase, 95 % CI 1.04-1.09) predicted disclosure. Children were more often disclosed if their caregiver was born in the U.S. or reported higher HIV-related stigma. These findings suggest that complex family context may complicate disclosure, particularly among immigrants.
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Affiliation(s)
- Rozan Abdulrahman
- Columbia University, Mailman School of Public Health, Environmental Health Department, New York, NY, USA.
| | - Emma Stuard
- Bronx-Lebanon Hospital Center, Department of Pediatrics, Bronx, NY, USA
| | - Mary E Vachon
- Bronx-Lebanon Hospital Center, Department of Pediatrics, Bronx, NY, USA
| | - Cate Nicholas
- Bronx-Lebanon Hospital Center, Department of Pediatrics, Bronx, NY, USA
| | - Richard Neugebauer
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, USA
| | | | - Murli U Purswani
- Bronx-Lebanon Hospital Center, Department of Pediatrics, Bronx, NY, USA
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A systematic review of measures of HIV/AIDS stigma in paediatric HIV-infected and HIV-affected populations. J Int AIDS Soc 2016; 19:21204. [PMID: 27717409 PMCID: PMC5055615 DOI: 10.7448/ias.19.1.21204] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/14/2016] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION HIV-related stigma impacts the quality of life and care management of HIV-infected and HIV-affected individuals, but how we measure stigma and its impact on children and adolescents has less often been described. METHODS We conducted a systematic review of studies that measured HIV-related stigma with a quantitative tool in paediatric HIV-infected and HIV-affected populations. RESULTS AND DISCUSSION Varying measures have been used to assess stigma in paediatric populations, with most studies utilizing the full or variant form of the HIV Stigma Scale that has been validated in adult populations and utilized with paediatric populations in Africa, Asia and the United States. Other common measures included the Perceived Public Stigma Against Children Affected by HIV, primarily utilized and validated in China. Few studies implored item validation techniques with the population of interest, although scales were used in a different cultural context from the origin of the scale. CONCLUSIONS Many stigma measures have been used to assess HIV stigma in paediatric populations, globally, but few have implored methods for cultural adaptation and content validity.
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Ion A, Wagner AC, Greene S, Loutfy MR. HIV-related stigma in pregnancy and early postpartum of mothers living with HIV in Ontario, Canada. AIDS Care 2016; 29:137-144. [PMID: 27449254 DOI: 10.1080/09540121.2016.1211608] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HIV-related stigma is associated with many psychological challenges; however, minimal research has explored how perceived HIV-related stigma intersects with psychosocial issues that mothers living with HIV may experience including depression, perceived stress and social isolation. The present study aims to describe the correlates and predictors of HIV-related stigma in a cohort of women living with HIV (WLWH) from across Ontario, Canada during pregnancy and early postpartum. From March 2011 to December 2012, WLWH ≥ 18 years (n = 77) completed a study instrument measuring independent variables including sociodemographic characteristics, perceived stress, depression symptoms, social isolation, social support and perceived racism in the third trimester and 3, 6 and 12 months postpartum. Multivariable linear regression was employed to explore the relationship between HIV-related stigma and multiple independent variables. HIV-related stigma generally increased from pregnancy to postpartum; however, there were no significant differences in HIV-related stigma across all study time points. In multivariable regression, depression symptoms and perceived racism were significant predictors of overall HIV-related stigma from pregnancy to postpartum. The present analysis contributes to our understanding of HIV-related stigma throughout the pregnancy-motherhood trajectory for WLWH including the interactional relationship between HIV-related stigma and other psychosocial variables, most notably, depression and racism.
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Affiliation(s)
- Allyson Ion
- a School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Anne C Wagner
- b Department of Psychology , Ryerson University , Toronto , Ontario , Canada
| | - Saara Greene
- a School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Mona R Loutfy
- c Women's College Research Institute, Women's College Hospital , Toronto , Ontario , Canada.,d Department of Medicine , University of Toronto , Toronto , Ontario , Canada
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17
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Exploring the Impact of Childhood Abuse on HIV Social and Attitudinal Factors Among Adults With and Without this History in Sub-Saharan Africa: Findings from NIMH Project Accept (HPTN 043). AIDS Behav 2016; 20:737-45. [PMID: 26271817 DOI: 10.1007/s10461-015-1166-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Using data from four sites in three African countries, this community randomized study examined the association between childhood sexual and/or physical abuse (CSA and/or CPA) and HIV disclosure, HIV-related stigma, stress, and social support among adults with and without a history of abuse. A history of abuse among men was associated with higher levels of adult-reported stress and HIV-related stigma, and with significantly lower rates of HIV test result disclosure to current partners. Women with a history of CSA and/or CPA had significantly higher perceived stigma, discrimination and stress. Although childhood abuse was significantly associated with adult stress and stigmatization, participants with histories of CSA and/or CPA also reported significantly higher perceived social support compared to people without such experiences. These findings may reflect support received in response to disclosure of CSA or CPA or emotional ambivalence in relationships that have been found to be associated with child abuse. We conclude that it is critical for HIV prevention interventions to advocate for the primary prevention of child abuse, for early identification of adolescents and adults who report experiencing childhood abuse, and to address stigma and stress-related attitudinal, behavioral and relationship difficulties experiences as an aftermath of early abuse that increase their risk of HIV.
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18
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Zeligman M, Barden SM, Hagedorn WB. Posttraumatic Growth and HIV: A Study on Associations of Stigma and Social Support. JOURNAL OF COUNSELING AND DEVELOPMENT 2016. [DOI: 10.1002/jcad.12071] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Melissa Zeligman
- Department of Counseling and Psychological Services; Georgia State University
| | - Sejal M. Barden
- Department of Child, Family, and Community Sciences; University of Central Florida
| | - W. Bryce Hagedorn
- Department of Child, Family, and Community Sciences; University of Central Florida
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19
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Fekete EM, Williams SL, Skinta MD, Bogusch LM. Gender differences in disclosure concerns and HIV-related quality of life. AIDS Care 2016; 28:450-4. [PMID: 26850839 DOI: 10.1080/09540121.2015.1114995] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV-related disclosure concerns are associated with higher rates of concealment and poorer well-being, including poorer health related HIV quality of life (HIV-QOL). Little research, however, has examined whether gender differences exist in the links between HIV disclosure concerns and HIV-QOL. We expected that disclosure concerns and gender would be associated with HIV-QOL, such that the relationship between disclosure concerns and poorer HIV-QOL to be stronger in women living with HIV (WLWH) than in men living with HIV (MLWH). One hundred and forty MLWH (n = 102) and WLWH (n = 38) completed an online questionnaire consisting of measures regarding their demographics, disclosure concerns (HIV-stigma scale), and HIV-QOL (HIV-AIDS-Targeted Quality of Life Instrument). Results suggested that more disclosure concerns were associated with poorer HIV-QOL, but in general, men and women did not differ in their levels of HIV-QOL. As expected, interactions emerged between gender and disclosure concerns such that disclosure concerns were associated with increased health worries and poorer sexual functioning for WLWH but not for MLWH. Interventions should acknowledge the differing needs and experiences of WLWH in order to improve HIV-QOL and increase longevity.
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Affiliation(s)
- Erin M Fekete
- a School of Psychological Sciences, University of Indianapolis , Indianapolis , IN , USA
| | - Stacey L Williams
- b Department of Psychology, East Tennessee State University , Johnson City , TN , USA
| | - Matthew D Skinta
- c Pacific Graduate School of Psychology, Palo Alto University , Palo Alto , CA , USA
| | - Leah M Bogusch
- a School of Psychological Sciences, University of Indianapolis , Indianapolis , IN , USA
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20
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Valle A, Treviño AC, Zambrano FF, Urriola KE, Sánchez LA, Elizondo JE. Perceived HIV-Associated Stigma among HIV-Seropositive Men: Psychometric Study of HIV Stigma Scale. Front Public Health 2015; 3:171. [PMID: 26191524 PMCID: PMC4490212 DOI: 10.3389/fpubh.2015.00171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 06/19/2015] [Indexed: 12/03/2022] Open
Abstract
Objectives To assess the internal consistency and factor structure of the abridged Spanish version of the Berger HIV Stigma Scale (HSS-21), to provide evidence for its convergent and discriminant validity, and to describe perceived stigma in an urban population from northeast Mexico. Methods Seventy-five HIV-positive men who have sex with men (MSM) were recruited. Participants answered the Spanish versions of three Likert-type scales: HSS-21, Robsenberg’s self-esteem scale, and the abbreviated version of the Zung’s Depression Scale. Results HSS-21 showed high reliability and validity; its factor structure included four components: concern with public attitudes; negative self-image; disclosure concerns; and enacted stigma. The level of stigma was high in 27 out of 75 (36%) participants; nevertheless, the score found in the component related to disclosure concerns indicated high level of stigma in 68% of participants. The score of HSS-21 was positively correlated with the score of depression and negatively correlated with the score of self-esteem. Conclusion Results demonstrated high reliability for the HSS-21; correlations with other scales supported its validity. This scale demonstrated to be a practical tool for assessing stigma among Mexican HIV-positive MSM. High level of stigma was found only in the factor related to disclosure concerns. Policy implications Identifying HIV-associated stigma through a short, reliable, and validated instrument will allow the development of interventions that cope and manage stigma in HIV-positive MSM. HSS-21 distinguishes between different dimensions of stigma and will contribute to a better understanding of this phenomenon.
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Affiliation(s)
- Adrian Valle
- Medical and Health Sciences Program, Department of Basic Sciences, Instituto Tecnológico de Monterrey , Monterrey , Mexico
| | - Ana Cecilia Treviño
- Medical and Surgical Dentist Program, Instituto Tecnológico de Monterrey , Monterrey , Mexico
| | | | | | - Luis Antonio Sánchez
- Clinical Microbiology and Infectious Diseases, Universidad de Monterrey , San Pedro Garza García , Mexico ; Secretaria de Salud de Nuevo León, Nuevo Leon State Council for AIDS Prevention (COESIDA NL) , Monterrey , Mexico
| | - Jesus Eduardo Elizondo
- Medical and Health Sciences Program, Department of Basic Sciences, Instituto Tecnológico de Monterrey , Monterrey , Mexico ; Doctoral Program in Biotechnology, Biopharmaceuticals and Biopharmaceutical Engineering, Instituto Tecnológico de Monterrey , Monterrey , Mexico ; Doctoral Program in Dentistry, Research in Dentistry, Universitat Internacional de Catalunya , Barcelona , Spain
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21
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Gromadzka O, Santamaria EK, Benavides JM, Dolezal C, Elkington KS, Leu CS, McKay M, Abrams EJ, Wiznia A, Bamji M, Ann Mellins C. Sexual Health Knowledge in a Sample of Perinatally HIV-infected and Perinatally-exposed Uninfected Youth. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2015; 14:277-293. [PMID: 26855617 PMCID: PMC4743908 DOI: 10.1080/15381501.2014.912177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study describes sexual health knowledge in perinatally HIV-infected (PHIV+) and perinatally-exposed uninfected (PHIV-) ethnic-minority youth, ages 9-16 years, residing in NYC (n=316). Data on youth sexual health knowledge (e.g., pregnancy, STDs, birth control) and caregiver-adolescent communication about sexual health were examined. Participants in both groups answered only 35% of the sexual health knowledge questions correctly (mean=6.6/19). Higher scores were found among youth who reported more communication about sex with caregivers (vs. those who did not report talking about sex with caregivers; 8.54 vs. 5.84, p<.001) and among PHIV+ youth who were aware of their status (vs. PHIV+ youth who were not; 7.27 vs. 4.70, p<.001). Age was positively correlated with sexual health knowledge (beta=.489, p<.001). Both PHIV+ and PHIV- youth had poor sexual health knowledge, suggesting a need for sexual health education for both groups. Data suggest that interventions focused on caregiver-child risk communication may be important for prevention.
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Affiliation(s)
- Olga Gromadzka
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY
| | - E. Karina Santamaria
- Doctoral Student, Department of Behavioral and Social Sciences, Brown University, Providence RI, USA
| | - Jessica M. Benavides
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY
| | - Katherine S. Elkington
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY
| | - Mary McKay
- Silver School of Social Work, New York University, New York, NY
| | - Elaine J. Abrams
- ICAP, Mailman School of Public Health and College of Physicians & Surgeons, Columbia University, New York, NY
| | - Andrew Wiznia
- Albert Einstein College of Medicine and Jacobi Medical Center, New York, NY
| | - Mahrukh Bamji
- Metropolitan Hospital Center and New York Medical College, New York, NY
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY
- Mailman School of Public Health, Columbia University, New York, NY
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22
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Medical pluralism predicts non-ART use among parents in need of ART: a community survey in KwaZulu-Natal, South Africa. AIDS Behav 2015; 19:137-44. [PMID: 25034940 DOI: 10.1007/s10461-014-0852-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Despite documented common use of traditional healers and efforts to scale up antiretroviral treatment (ART) in sub-Saharan Africa, evidence on whether medical pluralism predicts ART use is inconclusive and restricted to clinic settings. This study quantitatively assesses whether medical pluralism predicts ART use among parents in need of ART in South Africa. 2,477 parents or primary caregivers of children were interviewed in HIV-endemic communities of KwaZulu-Natal. Analysis used multiple logistic regression on a subsample of 435 respondents in need of ART, who reported either medical pluralism (24.6 %) or exclusive public healthcare use (75.4 %). Of 435 parents needing ART, 60.7 % reported ART use. Medical pluralism emerged as a persistent negative predictor of ART utilization among those needing it (AOR [95 % CI] = .556 [.344 - .899], p = .017). Use of traditional healthcare services by those who need ART may act as a barrier to treatment access. Effective intersectoral collaboration at community level is urgently needed.
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23
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Aljassem K, Raboud JM, Hart TA, Benoit A, Su D, Margolese SL, Rourke SB, Rueda S, Burchell A, Cairney J, Shuper P, Loutfy MR. Gender Differences in Severity and Correlates of Depression Symptoms in People Living with HIV in Ontario, Canada. ACTA ACUST UNITED AC 2014; 15:23-35. [DOI: 10.1177/2325957414536228] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigates the differences in severity and correlates of depression symptoms among 1069 men and 267 women living with HIV in Ontario, Canada, who completed the 20-item Center for Epidemiologic Studies Depression Scale (CES-D). Women had higher CES-D scores than that of men (median [interquartile range]: 13 [5-26] versus 9 [3-20], P = .0004). More women had total CES-D scores >15 (mild-moderate depression; 44% versus 33%, P = .002) and >21 (severe depression; 31% versus 23%, P = .003). Unlike men, at age 40, women’s scores increased yearly (0.4 per increased year, P = .005). The distribution of scores differed by gender: There was no difference in the 10th percentile of depression scores, 0 (95% confidence interval [CI]: 1.0-1.0) but the 75th percentile of depression scores for women was 6 (95% CI: 2.0-10.0) points higher than that of men. Important gender differences exist in depression symptoms and in correlates of symptoms in people living with HIV.
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Affiliation(s)
- Kinda Aljassem
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Janet M. Raboud
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trevor A. Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Ryerson University, Toronto Ontario, Canada
| | - Anita Benoit
- Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - DeSheng Su
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Shari L. Margolese
- Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Sean B. Rourke
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Sergio Rueda
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Ann Burchell
- Department of Psychology, Ryerson University, Toronto Ontario, Canada
| | - John Cairney
- Department of Family Medicine and Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Paul Shuper
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Mona R. Loutfy
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Zhou Y, Zhang L, Li X, Kaljee L. Do Chinese parents with HIV tell their children the truth? A qualitative preliminary study of parental HIV disclosure in China. Child Care Health Dev 2013; 39:816-24. [PMID: 22676417 DOI: 10.1111/j.1365-2214.2012.01394.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND With the extended lifespan of people living with human immunodeficiency virus (HIV) due to the advent of antiretroviral therapy, the disclosure of HIV serostatus to their uninfected children is becoming more critical. However, limited data are available regarding parental HIV disclosure to children in China. We explore patterns of parental HIV disclosure and the reasons for disclosure or non-disclosure to children. METHODS A preliminary study was conducted using open-ended questions in Guangxi, China in 2011 with 39 parents living with HIV. RESULTS A majority of participants (77%) had not disclosed their HIV serostatus to their children. Participants who voluntarily disclosed tended to be older and were more likely to disclose to their adult children. Among parents who disclosed, reasons included a need for emotional and financial support, as well as feelings of obligation to their children. Among non-disclosing parents, primary reasons included concerns that children were too young to understand, fear of being stigmatized, and fear of increased psychological burden to children. CONCLUSIONS Few parents with HIV disclosed their HIV status to their children. These data indicate the need for future research to explore disclosure issues in relation to children's age and the implementation of developmentally appropriate interventions and support systems for parents and children affected by HIV in China.
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Affiliation(s)
- Y Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, China Carman and Ann Adams Department of Pediatrics Prevention Research Center, Wayne State University School of Medicine, Detroit, MI, USA
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25
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Franco LM, Burkhalter B, de Wagt A, Jennings L, Kelley AG, Hammink ME. Evidence base for children affected by HIV and AIDS in low prevalence and concentrated epidemic countries: applicability to programming guidance from high prevalence countries. AIDS Care 2013; 21 Suppl 1:49-59. [PMID: 22380979 PMCID: PMC2903781 DOI: 10.1080/09540120902923089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
As global commitment grows to protect and support children affected by HIV and AIDS, questions remain about how best to meet the needs of these children in low prevalence settings and whether information from high prevalence countries can appropriately guide programming in these settings. A 2007 search for the evidence in low prevalence settings on situational challenges of HIV and AIDS-affected children and interventions to address these challenges identified 413 documents. They were reviewed and judged for quality of documentation and scientific rigor. Information was compiled across eight types of challenges (health and health care, nutrition and food security, education, protection, placement, psychosocial development, socioeconomic status, and stigma/ discrimination); and also assessed was strength of evidence for situational and intervention findings. Results were compared to three programming principles drawn from research in high prevalence countries: family-centered preventive efforts, treatment, and care; family-focused support to ensure capacity to care for and protect these children; and sustaining economic livelihood of HIV and AIDS-affected households. Findings show that children affected by HIV and AIDS in low prevalence settings face increased vulnerabilities similar to those in high prevalence settings. These findings support seeking and testing programmatic directions for interventions identified in high prevalence settings. However, low prevalence settings/countries are extremely diverse, and the strength of the evidence base among them was mixed (strong, moderate, and weak in study design and documentation), geographically limited, and had insufficient evidence on interventions to draw conclusions about how best to reduce additional vulnerabilities of affected children. Information on family, economic, sociocultural, and political factors within local contexts will be vital in the development of appropriate strategies to mitigate vulnerabilities.
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Affiliation(s)
- Lynne Miller Franco
- University Research Company, LLC, 7200 Wisconsin Ave., Suite 600, Bethesda, MD 20814, USA
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26
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Fongkaew W, Viseskul N, Suksatit B, Settheekul S, Chontawan R, Grimes RM, Grimes DE. Verifying quantitative stigma and medication adherence scales using qualitative methods among Thai youth living with HIV/AIDS. J Int Assoc Provid AIDS Care 2013; 13:69-77. [PMID: 23321804 DOI: 10.1177/1545109712463734] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
HIV/AIDS-related stigma has been linked to poor adherence resulting in drug resistance and the failure to control HIV. This study used both quantitative and qualitative methods to examine stigma and its relationship to adherence in 30 HIV-infected Thai youth aged 14 to 21 years. Stigma was measured using the HIV stigma scale and its 4 subscales, and adherence was measured using a visual analog scale. Stigma and adherence were also examined by in-depth interviews. The interviews were to determine whether verbal responses would match the scale's results. The mean score of stigma perception from the overall scale and its 4 subscales ranged from 2.14 to 2.45 on a scale of 1 to 4, indicating moderate levels of stigma. The mean adherence score was .74. The stigma scale and its subscales did not correlate with the adherence. Totally, 17 of the respondents were interviewed. Contrary to the quantitative results, the interviewees reported that the stigma led to poor adherence because the fear of disclosure often caused them to miss medication doses. The differences between the quantitative and the qualitative results highlight the importance of validating psychometric scales when they are translated and used in other cultures.
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27
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John-Stewart GC, Wariua G, Beima-Sofie KM, Richardson BA, Farquhar C, Maleche-Obimbo E, Mbori-Ngacha D, Wamalwa D. Prevalence, perceptions, and correlates of pediatric HIV disclosure in an HIV treatment program in Kenya. AIDS Care 2012; 25:1067-76. [PMID: 23256520 DOI: 10.1080/09540121.2012.749333] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Disclosure to HIV-infected children regarding their diagnosis is important as expanding numbers of HIV-infected children attain adolescence and may become sexually active. In order to define correlates of pediatric disclosure and facilitate development of models for disclosure, we conducted a cross-sectional survey of primary caregivers of HIV-1 infected children aged 6-16 years attending a pediatric HIV treatment program in Nairobi, Kenya. We conducted focus group discussions with a subset of caregivers to further refine perceptions of disclosure. Among 271 caregiver/child dyads in the cross-sectional survey, median child age was 9 years (interquartile range: 7-12 years). Although 79% of caregivers believed children should know their HIV status, the prevalence of disclosure to the child was only 19%. Disclosure had been done primarily by health workers (52%) and caregivers (33%). Caregivers reported that 5 of the 52 (10%) who knew their status were accidentally disclosed to. Caregivers of older children (13 vs. 8 years; p<0.001), who were HIV-infected and had disclosed their own HIV status to the child (36% vs. 4%; p=0.003), or who traveled frequently (29% vs. 16%, p=0.03) were more likely to have disclosed. Children who had been recently hospitalized (25% vs. 44%, p=0.03) were less likely to know their status, and caregivers with HIV were less likely to have disclosed (p=0.03). Reasons for disclosure included medication adherence, curiosity or illness while reasons for nondisclosure included age and fear of inadvertent disclosure. Our study found that disclosure rates in this Kenyan setting are lower than observed rates in the USA and Europe but consistent with rates from other resource-limited settings. Given these low rates of disclosure and the potential benefits of disclosure, strategies promoting health worker trainings and caregiver support systems for disclosure may benefit children with HIV.
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28
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Mkwanazi NB, Rochat TJ, Imrie J, Bland RM. Disclosure of maternal HIV status to children: considerations for research and practice in sub-Saharan Africa. Future Virol 2012. [DOI: 10.2217/fvl.12.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An estimated 2.8 million children are born to HIV-infected mothers each year, 2.5 million of whom are likely to be HIV-exposed but uninfected. In sub-Saharan Africa up to 40% of pregnant women are HIV-infected, resulting in large numbers of HIV-uninfected children living with at least one HIV-infected parent. These parents face many challenges, including the dilemma of when and how to disclose their HIV status to their children, particularly those who are pre-adolescent. This article summarizes the current evidence on maternal HIV disclosure to their HIV-uninfected children, explores the reported benefits of disclosure to children and mothers, highlights the gaps in knowledge and areas for future research, and discusses possible future intervention models focusing on primary school-aged children in sub-Saharan Africa.
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Affiliation(s)
- Ntombizodumo B Mkwanazi
- Africa Centre for Health & Population Studies, University of KwaZulu–Natal, PO Box 198, Somkhele, 3935, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Tamsen J Rochat
- Africa Centre for Health & Population Studies, University of KwaZulu–Natal, PO Box 198, Somkhele, 3935, South Africa
- Department of Psychology, Stellenbosch University, South Africa
| | - John Imrie
- Africa Centre for Health & Population Studies, University of KwaZulu–Natal, PO Box 198, Somkhele, 3935, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Centre for Sexual Health & HIV Research, Faculty of Population Health Sciences, University College London, UK
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Madiba S. The impact of fear, secrecy, and stigma on parental disclosure of HIV status to children: a qualitative exploration with HIV positive parents attending an ART clinic in South Africa. Glob J Health Sci 2012; 5:49-61. [PMID: 23445694 PMCID: PMC4776781 DOI: 10.5539/gjhs.v5n2p49] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 11/12/2012] [Indexed: 11/12/2022] Open
Abstract
South Africa is one of the sub Saharan countries where considerable progress in providing antiretroviral treatment (ART) has been made. The increased access to ART contributes to improvements in the prognosis of HIV and parents are more likely to raise their children than ever before. The study examined the social context influencing disclosure of parental HIV status to children from the perspectives of fathers and mothers accessing ART from an academic hospital in South Africa. Three focus group interviews were conducted with 26 non-disclosed biological parents of children aged between 7 and 18 years. Their ages ranged between 20-60 years and they cared for a total of 60 children. Parental decision not to disclose their HIV status to children was influenced by the fear of death and dying, the influence of television and media, stigma and discrimination. Parents delayed disclosure of their HIV status to children because children believed that AIDS kills. Parents also feared that the child may not be able to keep the parent's HIV status secret and might result in the family being subjected to stigma, discrimination, and isolation. Fear of stigma and discrimination were also responsible for the continuous efforts by parents to protect their HIV status from their children, family and neighbour's. Parents also delayed disclosure to children because they lacked disclosure skills and needed support for disclosure from health care providers. Healthcare providers are in a unique position to provide such support and guidance and assist parents to disclose and children to cope with parental HIV infection.
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Affiliation(s)
- Sphiwe Madiba
- Department of Environmental and Occupational health, University of Limpopo, South Africa.
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30
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Moore AR. Older People Living with HIV/AIDS (OPLWHA) in Lomẻ, Togo: Personal Networks and Disclosure of Serostatus. AGEING INTERNATIONAL 2012. [DOI: 10.1007/s12126-012-9158-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Krauss BJ, Letteney S, De Baets AJ, Baggaley R, Okero FA. Caregiver's HIV disclosure to children 12 years and under: a review and analysis of the evidence. AIDS Care 2012; 25:415-29. [PMID: 22880755 DOI: 10.1080/09540121.2012.712664] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A systematic review and analysis of the empirical evidence through June 2010 on HIV disclosure to children 12 and under was conducted using methods validated by the Cochrane group. Fifteen articles focusing on caregiver disclosure (255 total) were analyzed using GradePro 3 software. Results suggest that there is evidence of health and future care planning benefit for HIV+ and healthy children (12 and under) of HIV+ caregivers if the caregiver discloses his/her HIV status to them. Children of the maturity of school age youth (e.g., beginning at 6 years and continuing through 12) can be told of their caregivers' HIV status, while younger children may be informed partially in an age-appropriate manner.
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Affiliation(s)
- Beatrice J Krauss
- School of Public Health at Hunter College, Center for Community and Urban Health, The City University of New York, New York, NY, USA.
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32
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Risk and protective factors for depression symptoms among children affected by HIV/AIDS in rural China: a structural equation modeling analysis. Soc Sci Med 2012; 74:1435-43. [PMID: 22405505 DOI: 10.1016/j.socscimed.2012.01.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 10/29/2011] [Accepted: 01/05/2012] [Indexed: 02/06/2023]
Abstract
Previous research has revealed a negative impact of orphanhood and HIV-related stigma on the psychological well-being of children affected by HIV/AIDS. Little is known about psychological protective factors that can mitigate the effect of orphanhood and HIV-related stigma on psychological well-being. This research examines the relationships among several risk and protective factors for depression symptoms using structural equation modeling. Cross-sectional data were collected from 755 AIDS orphans and 466 children of HIV-positive parents aged 6-18 years in 2006-2007 in rural central China. Participants reported their experiences of traumatic events, perceived HIV-related stigma, perceived social support, future orientation, trusting relationships with current caregivers, and depression symptoms. We found that the experience of traumatic events and HIV-related stigma had a direct contributory effect on depression among children affected by HIV/AIDS. Trusting relationships together with future orientation and perceived social support mediated the effects of traumatic events and HIV-related stigma on depression. The final model demonstrated a dynamic interplay among future orientation, perceived social support and trusting relationships. Trusting relationships was the most proximate protective factor for depression. Perceived social support and future orientation were positively related to trusting relationships. We conclude that perceived social support, trusting relationships, and future orientation offer multiple levels of protection that can mitigate the effect of traumatic events and HIV-related stigma on depression. Trusting relationships with caregivers provides the most immediate source of psychological support. Future prevention interventions seeking to improve psychological well-being among children affected by HIV/AIDS should attend to these factors.
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Letteney S, Krauss B, Kaplan R. Examining HIV-positive parents' disclosure to their children: a biopsychosocial approach. SOCIAL WORK IN PUBLIC HEALTH 2012; 27:345-360. [PMID: 22657148 DOI: 10.1080/19371918.2010.500881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In the post HAART era, the biopsychosocial issues now facing HIV-positive parents concerning disclosure of their status to their children need to be understood in the context of chronic disease. This article describes the experiences of 101 adult HIV-positive urban in-treatment mothers and fathers of school-age children on disclosure, psychological distress, social support, and symptom severity. Key variables associated with parents' HIV disclosure were the age of parent and of children in the household, parents' HIV-related symptoms, and parent ethnicity. Cultural and maturational, rather than psychological or social factors were significantly related to parents' HIV disclosure.
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Affiliation(s)
- Susan Letteney
- Social Work Program, Department of Social Sciences, York College of The City University of New York, Jamaica, New York, USA.
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Hosek SG, Lemos D, Harper GW, Telander K. Evaluating the acceptability and feasibility of Project ACCEPT: an intervention for youth newly diagnosed with HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2011; 23:128-44. [PMID: 21517662 PMCID: PMC3280923 DOI: 10.1521/aeap.2011.23.2.128] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Given the potential for negative psychosocial and medical outcomes following an HIV diagnosis, Project ACCEPT, a 12-session behavioral intervention, was developed and pilot-tested for youth (aged 16-24) newly diagnosed with HIV. Fifty participants recently diagnosed with HIV were enrolled from 4 sites selected through the Adolescent Medicine Trials Network (ATN). The majority of participants identified as African American (78%). Feasibility and acceptability data demonstrated high rates of participation and high levels of satisfaction with the intervention program from both participants and staff. Exploratory outcome data demonstrated improved levels of HIV knowledge that were sustained over time (Cohen's effect [d] d = .52) and improvements in peer (d = .35) and formal (d = .20) social support immediately postintervention. Gender differences emerged over time in the areas of depressive symptoms, family social support, self-efficacy for sexual discussion, and personalized stigma. Project ACCEPT appears to be an acceptable and feasible intervention to implement in clinical settings for youth newly diagnosed with HIV.
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Affiliation(s)
- Sybil G Hosek
- John H. Stroger Jr. Hospital of Cook County, Department of Psychiatry, Chicago, IL 60612, USA.
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35
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Stutterheim SE, Shiripinda I, Bos AE, Pryor JB, de Bruin M, Nellen JF, Kok G, Prins JM, Schaalma HP. HIV status disclosure among HIV-positive African and Afro-Caribbean people in the Netherlands. AIDS Care 2011; 23:195-205. [DOI: 10.1080/09540121.2010.498873] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sarah E. Stutterheim
- a Department of Work and Social Psychology, Faculty of Psychology and Neuroscience , Maastricht University , PO Box 616, 6200 , MD , Maastricht , the Netherlands
| | | | - Arjan E.R. Bos
- a Department of Work and Social Psychology, Faculty of Psychology and Neuroscience , Maastricht University , PO Box 616, 6200 , MD , Maastricht , the Netherlands
| | - John B. Pryor
- c Department of Psychology , Illinois State University , Normal , IL , USA
| | - Marijn de Bruin
- d Communication Science , Wageningen University , Wageningen , the Netherlands
| | - Jeannine F.J.B. Nellen
- e Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, and Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre , University of Amsterdam , Amsterdam , the Netherlands
| | - Gerjo Kok
- a Department of Work and Social Psychology, Faculty of Psychology and Neuroscience , Maastricht University , PO Box 616, 6200 , MD , Maastricht , the Netherlands
| | - Jan M. Prins
- e Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, and Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre , University of Amsterdam , Amsterdam , the Netherlands
| | - Herman P. Schaalma
- a Department of Work and Social Psychology, Faculty of Psychology and Neuroscience , Maastricht University , PO Box 616, 6200 , MD , Maastricht , the Netherlands
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Wagner AC, Hart TA, Mohammed S, Ivanova E, Wong J, Loutfy MR. Correlates of HIV stigma in HIV-positive women. Arch Womens Ment Health 2010; 13:207-14. [PMID: 20372948 DOI: 10.1007/s00737-010-0158-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 02/06/2010] [Indexed: 12/01/2022]
Abstract
We examined the variables associated with HIV stigma in HIV-positive women currently living in Ontario, Canada. Based on previous literature, we predicted that variables of social marginalization (e.g., ethnicity, income, education), medical variables (e.g., higher CD4 count, lower viral load), and increased psychological distress would be associated with higher perceived HIV stigma among HIV-positive women. One hundred fifty-nine HIV-positive women between the ages of 18 and 52 in Ontario completed self-report measures of the aforementioned variables. Women were recruited through 28 AIDS service organizations, eight HIV clinics, and two community health centers. In multiple regression analyses, for women born in Canada, lower educational level and higher anxiety were associated with higher HIV stigma. For women born outside of Canada, having been judged by a physician in Canada for trying to become pregnant was associated with higher HIV stigma. For HIV-positive women born outside of Canada, negative judgment by a physician regarding intentions to become pregnant should be addressed to reduce perceived HIV stigma and vice versa. Health care providers should be trained in the provision of sensitive and effective health care for women living with HIV, especially when providing reproductive health care.
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Affiliation(s)
- Anne C Wagner
- Department of Psychology, Ryerson University, 105 Bond Street, Toronto, ON M5B 1Y3, Canada.
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37
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Vaz LM, Eng E, Maman S, Tshikandu T, Behets F. Telling children they have HIV: lessons learned from findings of a qualitative study in sub-Saharan Africa. AIDS Patient Care STDS 2010; 24:247-56. [PMID: 20397899 DOI: 10.1089/apc.2009.0217] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV-infected children in developing countries are living longer lives as they gain access to antiretroviral treatment programs. As they grow older, their parents/guardians are faced with the difficult decision of if, when, and how to inform their child of his/her HIV status. Both negative and positive social, psychological, and behavioral impacts of disclosure to children have been reported, including improved adherence to medication regimens. Understanding the disclosure process from the perspective of HIV positive children, therefore, is critical to developing these interventions. Through children's experiences we can learn about what works well, what needs to be strengthened, and what is missing in current disclosure practices. We conducted in-depth interviews with eight caregiver-child dyads in Kinshasa, Democratic Republic of the Congo. The children were in a comprehensive HIV pediatric care and treatment program and had already been told their HIV diagnosis. For the analysis we placed particular emphasis on children's reports of communication with their caregivers and health care providers about their illness. Patterns emerged of limited communication between children and their caregivers as well as their providers, before, during, and after disclosure. From the perspective of children in this study, disclosure was largely a discrete event rather than a process. Sociocultural contexts surrounding HIV/AIDS, as well as health status, variations in parent-child communication and the relationships between health providers and children under their care, should inform psychosocial interventions delivered alongside treatment programs.
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Affiliation(s)
| | - Eugenia Eng
- Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Suzanne Maman
- Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tomi Tshikandu
- School of Public Health, University of Kinshasa, Kinshasa Democratic Republic of the Congo, Kinshasa, The Democratic Republic of the Congo
| | - Frieda Behets
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Campbell T, Beer H, Wilkins R, Sherlock E, Merrett A, Griffiths J. “I look forward. I feel insecure but I am ok with it”. The experience of young HIV+ people attending transition preparation events: a qualitative investigation. AIDS Care 2010; 22:263-9. [DOI: 10.1080/09540120903111460] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tomás Campbell
- a Newham Psychological Services , 10 Vicarage Lane, London , E15 4ES , UK
| | - Hannah Beer
- a Newham Psychological Services , 10 Vicarage Lane, London , E15 4ES , UK
| | | | | | - Anna Merrett
- d Child & Family Consultation Service , East London Foundation NHS Trust , London , UK
| | - Jayne Griffiths
- a Newham Psychological Services , 10 Vicarage Lane, London , E15 4ES , UK
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39
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Gonzalez A, Miller CT, Solomon SE, Bunn JY, Cassidy DG. Size matters: community size, HIV stigma, & gender differences. AIDS Behav 2009; 13:1205-12. [PMID: 18815878 DOI: 10.1007/s10461-008-9465-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 09/12/2008] [Indexed: 11/26/2022]
Abstract
Conclusions regarding HIV stigma in rural areas are hampered by lack of agreement about rural classification. This investigation examined perceptions of HIV stigma among males and females with HIV/AIDS in metropolitan, micropolitan, and rural areas. Two-hundred people with HIV/AIDS completed a measure of perceived HIV stigma. Their county or town of residence was used to classify community size. Results indicated that community size was related to one aspect of perceived stigma, disclosure concerns, differently for men and women. Rural women reported more disclosure concerns than did metropolitan and micropolitan women. They also reported more disclosure concerns than rural men. Men in micropolitan communities reported more disclosure concerns than men in rural areas and tended to report more disclosure concerns than men in metropolitan areas. Understanding the relationship of community size to HIV stigmatization requires acknowledging that many communities are neither urban nor rural, and it requires considering gender differences.
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Affiliation(s)
- Adam Gonzalez
- Department of Psychology, University of Vermont, 2 Colchester Avenue-John Dewey Hall, Burlington, Vermont, 05405, USA.
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40
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Nam SL, Fielding K, Avalos A, Gaolathe T, Dickinson D, Geissler PW. Discussing matters of sexual health with children: what issues relating to disclosure of parental HIV status reveal. AIDS Care 2009; 21:389-95. [PMID: 19280415 DOI: 10.1080/09540120802270276] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Little is published about the disclosure of parents' own HIV status to their children in Africa. Research shows that keeping family secrets from children, including those related to a parent's HIV status, can be detrimental to their psychological well-being and to the structure of the family. Further, children with HIV-positive parents have been shown to be more vulnerable to poorer reproductive health outcomes. This qualitative study in Botswana conducted in-depth interviews among 21 HIV-positive parents on antiretroviral therapy. The data revealed that parents found discussing the issue of HIV with children difficult, including disclosing their own HIV status to them. Reasons for disclosing included: children being HIV positive, the rest of the family knowing, or the parent becoming very sick. Reasons for not disclosing included: believing the child to be too young, not knowing how to address the issue of HIV, that it would be "too painful" for the child/ren. Concern that other people might find out about their status or fear of children experiencing stigmatising behaviour. Interviews elucidated the difficulty that parents have in discussing their own HIV status and more general sexual health issues with their children. Parents and other guardians require support in managing age-appropriate disclosure to their children. This may further enable access to forums that can help children cope with their fears about the future and develop life skills in preparation for dealing with relationships of a sexual nature and sexual health as children move into adulthood. In developing such support mechanisms, changing family roles in Botswana need to be taken into consideration and the role of other family members in the upbringing of children in Tswana society need to be recognised and utilised.
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Affiliation(s)
- Sara Liane Nam
- Infectious Diseases Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK.
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41
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Logie C, Gadalla T. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care 2009; 21:742-53. [DOI: 10.1080/09540120802511877] [Citation(s) in RCA: 284] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- C. Logie
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - T.M. Gadalla
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
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42
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Delaney RO, Serovich JM, Lim JY. Psychological differences between HIV-positive mothers who disclose to all, some, or none of their biological children. JOURNAL OF MARITAL AND FAMILY THERAPY 2009; 35:175-180. [PMID: 19302515 PMCID: PMC2697848 DOI: 10.1111/j.1752-0606.2009.00114.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study explored the psychological differences between HIV-positive women who disclosed their serostatus to all, some, or none of their biological children. Data from this project come from a larger, longitudinal investigation of the disclosure process of HIV-infected women. Data were obtained regarding the disclosure processes and the psychological adjustment of women with children (n = 90) based on measures of depression, anxiety, and stress. Results suggest that women who disclose to all, some, or none of their children are not significantly different with regard to emotional well-being. Implications for marriage and family therapists are provided.
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43
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To say or not to say: a qualitative study on the disclosure of their condition by human immunodeficiency virus-positive adolescents. J Adolesc Health 2009; 44:356-62. [PMID: 19306794 DOI: 10.1016/j.jadohealth.2008.08.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 07/29/2008] [Accepted: 08/06/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE Human immunodeficiency virus (HIV)-positive adolescents face a number of challenges in dealing with their disease, treatment, and developmental tasks. This qualitative study describes some of the reasons why, and the extent to which, adolescents may or may not disclose their condition to others. METHODS A semistructured interview lasting 40-110 minutes was conducted with each of 29 adolescents 12-20 years old, 22 female and seven male) living in Switzerland. Interviews were tape recorded and transcribed verbatim. The analysis of the content of interviews allowed us to identify salient topics (e.g., disclosure), which were then explored in detail. RESULTS Of 29 participants, eight had not disclosed their condition to anyone outside the family, 19 had disclosed it to good friends, and 16 had disclosed it to some teachers. Four participants had engaged in public disclosure, and six of 10 sexually active teenagers disclosed their status to their partners. The attitudes toward disclosure among younger adolescents were mostly related to those of the parents, particularly the mother. Older adolescents, engaged in their search for autonomy, tended to decide independently what to say and to whom. Although foster/adoptive parents would often encourage disclosure, biological parents, especially HIV-positive mothers, insisted on not disclosing the adolescent's status for fear of stigma. CONCLUSION The health care team should systematically address the issue of disclosure with the adolescent and his family (or foster parents), the aim being to balance the right of the adolescent and that adolescent's family to maintain privacy against the concerns of sexual partners, as well as the adolescent's interest in divulging HIV status to relatives, school staff, and friends.
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44
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Sandelowski M, Barroso J, Voils CI. Gender, Race/Ethnicity, and Social Class in Research Reports on Stigma in HIV-Positive Women. Health Care Women Int 2009; 30:273-88. [DOI: 10.1080/07399330802694880] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Sandelowski M, Voils CI, Barroso J, Lee EJ. "Distorted into clarity": a methodological case study illustrating the paradox of systematic review. Res Nurs Health 2008; 31:454-65. [PMID: 18324678 DOI: 10.1002/nur.20278] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systematic review is typically viewed in the health sciences as the most objective--that is, rigorous, transparent, and reproducible--method for summarizing the results of research. Yet, recent scholarship has shown systematic review to involve feats of interpretation producing less certain, albeit valuable, results. We found this to be the case when we tried to overcome the resistance to synthesis of a set of qualitative and quantitative findings on stigma in HIV-positive women. These findings were difficult to combine largely because of fuzzy conceptualizations of stigma and the volume of unique quantitative findings. Our encounter with findings resistant to synthesis heightened our awareness of the extent to which all systematic reviews are accomplished by practices that paradoxically "distort [research findings] into clarity."
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46
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Emlet C. Truth and consequences: a qualitative exploration of HIV disclosure in older adults. AIDS Care 2008; 20:710-7. [DOI: 10.1080/09540120701694014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C.A. Emlet
- a Social Work Program , University of Washington , Tacoma , US
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47
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Solomon P, Wilkins S. Participation among women living with HIV: A rehabilitation perspective. AIDS Care 2008; 20:292-6. [DOI: 10.1080/09540120701660320] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- P. Solomon
- a School of Rehabilitation Science , McMaster University , Hamilton , Canada
| | - S. Wilkins
- a School of Rehabilitation Science , McMaster University , Hamilton , Canada
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48
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Murphy DA. HIV-positive mothers' disclosure of their serostatus to their young children: a review. Clin Child Psychol Psychiatry 2008; 13:105-22. [PMID: 18411869 PMCID: PMC2384146 DOI: 10.1177/1359104507087464] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One challenge faced by mothers living with HIV (MLWHs) is the decision about whether or not to disclose their HIV status to their young children, and how best to carry out the disclosure. Disclosure of their serostatus has emerged as one of the main concerns MLWHs have, and that decision can result in high levels of psychological distress. Concerns are exacerbated among MLWHs with younger children, due to the fact that they face additional worries, such as whether the child is old enough to understand, or will be able to keep the information confidential. A great deal of recent research--within approximately the past decade--has been conducted to investigate maternal disclosure of HIV, and the outcomes on children. This article reviews the current state of the research literature, focusing on factors that appear to influence whether or not mothers chose to disclose; characteristics of children who have been made aware of their mothers' serostatus relative to children who remain unaware; factors that appear to influence children's reactions to maternal disclosure; and implications of this research as well as future research directions.
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Affiliation(s)
- Debra A Murphy
- University of California at Los Angeles, Health Risk Reduction Projects, Department of Psychiatry, 90025-7539, USA.
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49
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Bunn JY, Solomon SE, Miller C, Forehand R. Measurement of stigma in people with HIV: a reexamination of the HIV Stigma Scale. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2007; 19:198-208. [PMID: 17563274 DOI: 10.1521/aeap.2007.19.3.198] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Stigma associated with HIV infection can unfavorably impact the lives and behavior of people living with HIV/AIDS. The HIV Stigma Scale was designed to measure the perception of stigma by those who are HIV infected. Reanalysis of the psychometric properties of this scale was conducted in a new sample of 157 individuals living with HIV/AIDS in rural New England. This resulted in revision of the scale: shortening it from 40 to 32 items and retaining the original four factors but renaming one: Enacted Stigma (formerly Personalized Stigma), Disclosure Concerns, Negative Self-image, and Concern With Public Attitudes. These four subscales have been refined such that each consists of unique items. Cronbach's alphas for the subscales ranged from .90 to .97, and .95 for the overall scale, indicating internal consistency. Correlations with other scales confirmed the validity of the HIV Stigma Scale in another sample of people living with HIV/AIDS.
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Affiliation(s)
- Janice Yanushka Bunn
- Department of Medical Biostatistics, University of Vermont, Burlington, VT 05405, USA.
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50
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Abstract
OBJECTIVE To develop decision rules regarding key ethical dimensions in scientific protocols for the National Institute for Mental Health (NIMH) Collaborative HIV/STD Prevention Trial taking place in five countries (China, India, Peru, Russia, and Zimbabwe). DESIGN Countries had HIV rates from 27 to 0.1%, the standard of care varied from access to antiretroviral drugs to no availability, and the reporting of sexually transmitted diseases (STD) to government agencies was mandatory in some countries and not in others. These variations presented challenges when developing decision rules that could be uniformly adopted across countries and simultaneously follow the ethical principles of beneficence, respect, and justice. METHODS We used several strategies to identify and resolve ethical dilemmas for this international HIV prevention trial. First, we identified key principles, especially those derived for clinical therapeutic, biomedical preventive, or device trials. We convened a 'workgroup on protecting human participants' and charged them with identifying and implementing optimal procedures for ensuring the ethical and equitable treatment of participants and making recommendations to minimize physical, psychological, and social harm to the participants. Each site had a community advisory board, essential in identifying local ethical issues and possible resolutions to them. The NIMH established a data safety and monitoring board with ultimate responsibility for adjudicating ethical dilemmas and decisions. The protocols were deliberated thoroughly by the Trial steering committee, and approved by nine United States and five in-country institutional review boards. RESULTS We summarize the decision rules adopted to resolve the ethical dilemmas identified. Especially important were the translation of clinical trials principles for a behavioral intervention trial, strategies for ensuring confidentiality and informed consent, dilemmas relating to partner notification of sexually transmitted infections including HIV, minimizing the risks of social harm, establishing community partnerships, ensuring equity among United States and in-country principal investigators, and building capacity for additional research. CONCLUSION We document our processes and decisions, and their underlying rationales, and hope they contribute to the development of further thinking and practice regarding the ethics of social and behavioral HIV and STD prevention trials in resource-poor settings.
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