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Sibley AL, Klein E, Cooper HLF, Livingston MD, Baker R, Walters SM, Gicquelais RE, Ruderman SA, Friedmann PD, Jenkins WD, Go VF, Miller WC, Westergaard RP, Crane HM. The relationship between felt stigma and non-fatal overdose among rural people who use drugs. Harm Reduct J 2024; 21:77. [PMID: 38582851 PMCID: PMC10998326 DOI: 10.1186/s12954-024-00988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, especially in rural areas. We aimed to characterize the association between felt stigma and non-fatal overdose in a multi-state sample of rural-dwelling people who use drugs. METHODS Between January 2018 and March 2020, 2,608 people reporting past 30-day opioid use were recruited via modified chain-referral sampling in rural areas across 10 states. Participants completed a computer-assisted survey of substance use and substance-related attitudes, behaviors, and experiences. We used multivariable logistic regression with generalized estimating equations to test the association between felt stigma and recent non-fatal overdose. RESULTS 6.6% of participants (n = 173) reported an overdose in the past 30 days. Recent non-fatal overdose was significantly associated with felt stigma after adjusting for demographic and substance use-related covariates (aOR: 1.47, 95% CI: 1.20-1.81). The association remained significant in sensitivity analyses on component fear of enacted stigma items (aOR: 1.48, 95% CI: 1.20-1.83) and an internalized stigma item (aOR: 1.51, 95% CI: 1.07-2.14). CONCLUSIONS Felt stigma related to substance use is associated with higher risk of non-fatal overdose in rural-dwelling people who use drugs. Stigma reduction interventions and tailored services for those experiencing high stigma are underutilized approaches that may mitigate overdose risk.
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Affiliation(s)
- Adams L Sibley
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Emma Klein
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Robin Baker
- OHSU-PSU School of Public Health, Oregon Health & Science University, 1810 SW 5th Ave, Suite 510, Portland, OR, 97201, USA
| | - Suzan M Walters
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, 180 Madison, New York, NY, 10016, USA
| | - Rachel E Gicquelais
- School of Nursing, University of Wisconsin-Madison, 4257 Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI, 53705, USA
| | - Stephanie A Ruderman
- Department of Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main St, Springfield, MA, 01199, USA
| | - Wiley D Jenkins
- Southern Illinois University School of Medicine, 201 E Madison Street, Springfield, IL, 62702, USA
| | - Vivian F Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - William C Miller
- Department of Epidemiology, UNC Gillings School of Global Public Health, CB#8050, 3rd Floor Carolina Square, Chapel Hill, NC, 27516, USA
| | - Ryan P Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI, 53705-2281, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Mail Stop 359931, Seattle, WA, 98104, USA
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Nice J, Saltzman L, Thurman TR, Zani B. AIDSImpact special issue: latent class analysis of ART barriers among adolescents and young adults living with HIV in South Africa. AIDS Care 2024:1-9. [PMID: 38422434 DOI: 10.1080/09540121.2024.2307389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024]
Abstract
This study examined adherence to antiretroviral therapy (ART) among adolescents and young adults living with HIV in South Africa. Using survey data from 857 youth on ART, the study employed latent class analysis to identify subgroups based on self-reported reasons for missed ART doses. Three distinct classes emerged: the largest class (85%) occasionally forgot to take their medication or missed a dose because others were around, the second class (9%) missed doses only due to feeling sick, and the third class (6%) faced multiple barriers such as forgetting, feeling sick, worrying about side effects, or doubting the effectiveness of ART. Youth who reported multiple barriers to adherence had significantly lower adjusted odds (AOR = 0.35, 95% CI = 0.16-0.78) of reporting 90% past month adherence compared to those who occasionally forgot their medication. Additionally, contextual factors such as food security, being treated well at the clinic, and being accompanied to the clinic were associated with higher odds of adherence. The findings highlight the importance of considering co-occurring barriers to adherence and tailoring interventions accordingly. Addressing contextual factors, such as ensuring food security and providing supportive clinic environments, is also crucial for promoting optimal adherence among adolescents and young adults living with HIV.
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Affiliation(s)
- Johanna Nice
- Highly Vulnerable Children Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- International Health and Sustainable Development department, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Leia Saltzman
- Tulane University School of Social Work, New Orleans, LA, USA
| | - Tonya R Thurman
- Highly Vulnerable Children Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- International Health and Sustainable Development department, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Tulane International LLC, Cape Town, South Africa
| | - Babalwa Zani
- Highly Vulnerable Children Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Tulane International LLC, Cape Town, South Africa
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Hartmann M, Nyblade L, Otticha S, Marton T, Agot K, Roberts ST. The development of a conceptual framework on PrEP stigma among adolescent girls and young women in sub-Saharan Africa. J Int AIDS Soc 2024; 27:e26213. [PMID: 38379129 PMCID: PMC10879468 DOI: 10.1002/jia2.26213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Stigma is a well-known barrier to HIV testing and treatment and is an emerging barrier to pre-exposure prophylaxis (PrEP) use. To guide future research, measurement and interventions, we developed a conceptual framework for PrEP stigma among adolescent girls and young women (AGYW) in sub-Saharan Africa, a priority population for PrEP. METHODS A literature review, expert consultations and focus group discussions (FGDs) were conducted to adapt the Health Stigma and Discrimination Framework, describing the stigmatization process nested within the socio-ecological framework. We reviewed all articles on PrEP stigma and on HIV, contraceptive or sexuality stigma among AGYW from 2009 to 2019. Expert consultations were conducted with 10 stigma or PrEP researchers and two Kenyan youth advisory boards to revise the framework. Finally, FGDs were conducted with AGYW PrEP users (4 FGDs; n = 20) and key influencers (14 FGDs; n = 72) in Kenya with the help of a Youth Research Team who aided in FGD conduct and results interpretation. Results from each phase were reviewed and the framework was updated to incorporate new and divergent findings. This was validated against an updated literature search from 2020 to 2023. RESULTS The conceptual framework identifies potential drivers, facilitators and manifestations of PrEP stigma, its outcomes and health impacts, and relevant intersecting stigmas. The main findings include: (1) PrEP stigma is driven by HIV, gender and sexuality stigmas, and low PrEP community awareness. (2) Stigma is facilitated by factors at multiple levels: policy (e.g. targeting of PrEP to high-risk populations), health systems (e.g. youth-friendly service availability), community (e.g. social capital) and individual (e.g. empowerment). (3) Similar to other stigmas, manifestations include labelling, violence and shame. (4) PrEP stigma results in decreased access to and acceptability of PrEP, limited social support and community resistance, which can impact mental health and decrease PrEP uptake and adherence. (5) Stigma may engender resilience by motivating AGYW to think of PrEP as an exercise in personal agency. CONCLUSIONS Our PrEP stigma conceptual framework highlights potential intervention targets at multiple levels in the stigmatization process. Its adoption would enable researchers to develop standardized measures and compare stigma across timepoints and populations as well as design and evaluate interventions.
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Affiliation(s)
- Miriam Hartmann
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Laura Nyblade
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
| | | | - Tozoe Marton
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
| | - Kawango Agot
- Impact Research Development OrganizationKisumuKenya
| | - Sarah T. Roberts
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
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Nawfal ES, Gray A, Sheehan DM, Ibañez GE, Trepka MJ. A Systematic Review of the Impact of HIV-Related Stigma and Serostatus Disclosure on Retention in Care and Antiretroviral Therapy Adherence Among Women with HIV in the United States/Canada. AIDS Patient Care STDS 2024; 38:23-49. [PMID: 38150524 PMCID: PMC10794841 DOI: 10.1089/apc.2023.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
This systematic review explores the roles of HIV stigma and disclosure of HIV serostatus in antiretroviral therapy (ART) adherence and retention in care (RIC) among women with HIV (WHIV) in the United States and Canada. We conducted a systematic search of electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Google scholar) to identify peer-reviewed articles published between January 1996 and December 2022. The search yielded 1120 articles after duplicates were removed. Of these, 27 articles met the inclusion criteria. The majority (89%) of the studies were conducted in the United States. The studies included WHIV from diverse racial/ethnic groups, residing in both urban and rural areas. Most of the studies suggested that internalized stigma, perceived community stigma, and fear of disclosure were important barriers to ART adherence and RIC among WHIV. HIV-related stigma experienced within the health care setting was also reported as a factor impacting health care utilization. A few studies identified mental health distress as a potential mechanism accounting for the association and suggested that social support and resilience may buffer the negative effects of stigma and disclosure on ART adherence and RIC among WHIV. Our review indicates that stigma and concerns about disclosure continue to significantly affect HIV health outcomes for WHIV in high-income countries. It underscores the importance of integrated HIV care services and interventions targeting mental health, resilience building, and improved patient-provider relationships for WHIV to enhance ART adherence and RIC. Longitudinal studies and investigations into additional mechanisms are needed to advance understanding and inform women-centered interventions.
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Affiliation(s)
- Ekpereka Sandra Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
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Ncitakalo N, Sigwadhi LN, Mabaso M, Joska J, Simbayi L. Exploring HIV status as a mediator in the relationship of psychological distress with socio-demographic and health related factors in South Africa: findings from the 2012 nationally representative population-based household survey. AIDS Res Ther 2023; 20:6. [PMID: 36747255 PMCID: PMC9901137 DOI: 10.1186/s12981-022-00498-5] [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: 01/16/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Psychological distress as measured by mental disorders like depression and anxiety is more prevalent in people living with HIV (PLHIV) than in the general population. However, the relationship between mental disorders and HIV is complex and bidirectional. Improved understanding of the relationship between mental disorders and HIV is important for designing interventions for this group. This paper explores the interrelationships of psychological distress with HIV and associated socio-demographic and health-related factors. METHODS This secondary data analysis used the 2012 South African population-based household survey on HIV collected using a cross-sectional multi-stage stratified cluster sampling design. Generalized structural equation modelling (G-SEM) path analysis was used to explore the direct and indirect relationships of socio-demographic, health and HIV-related factors with psychological distress as measured by Kessler 10 scale using HIV status as a moderator variable. RESULTS A total of 20,083 participants were included in the study, 21.7% reported psychological distress, of whom (32.6%) were HIV positive. In the final path model with HIV status as a moderator, psychological distress was significantly more likely among age group 25-49 years (AOR: 1.4 [95% CI 1.3-1.6]), age 50 years and older, (AOR: 1.4 [95% CI 1.2-1.6]), females (AOR: 1.6 [95% CI 1.4-1.8]), high risk drinkers (AOR: 1.9 [1.6-2.2]) hazardous drinkers (AOR: 4.4 [95% CI 3.1-6.3]), ever tested for HIV (AOR: 1.2 [95% CI 1.1-1.3]). Psychological distress was significantly less likely among the married [AOR: 0.8 (0.7-0.9)], other race groups [AOR: 0.5 (0.5-0.6)], those with secondary level education (AOR: 0.9 [95% CI 0.8-0.9]), and tertiary level education (AOR: 0.7 [95% CI 0.6-0.9]), those from rural informal [AOR: 0.8 (0.7-0.9)], and rural formal [AOR: 0.8 (0.7-0.9)] areas and those who rated their health as excellent/good [AOR: 0.4 (0.4-0.5)]. CONCLUSION The findings highlight the importance of designing tailored interventions targeted at psychological distress among PLHIV especially the elderly, females, those with no education and / or low education attainment and those residing in informal urban areas.
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Affiliation(s)
| | - Lovemore Nyasha Sigwadhi
- grid.11956.3a0000 0001 2214 904XDivision of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Musawenkosi Mabaso
- grid.417715.10000 0001 0071 1142Human and Social Capabilities Research Division, Human Sciences Research Council, Durban, South Africa
| | - John Joska
- grid.7836.a0000 0004 1937 1151HIV Mental Health Research Unit, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Leickness Simbayi
- grid.7836.a0000 0004 1937 1151HIV Mental Health Research Unit, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa ,grid.417715.10000 0001 0071 1142Human Sciences Research Council, Cape Town, South Africa ,grid.7836.a0000 0004 1937 1151Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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Cort DA, Reynolds K, Chakraborty D. HIV stigma beliefs and unprotected sex among teenagers and young adults in sub-Saharan Africa: The moderating role of mass media exposure. Soc Sci Med 2023; 317:115615. [PMID: 36527896 DOI: 10.1016/j.socscimed.2022.115615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/31/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Despite significant advances in the fight against HIV in sub-Saharan Africa, health experts remain concerned about new infections and risky sexual behavior among teenagers & young adults (T&YAs). These concerns have spurred efforts to buttress a voluminous literature on the social determinants of risky sexual behavior in Africa. Absent from this flurry of new scholarship is a consistent focus on associations between HIV stigma beliefs and risky sexual behavior, especially among T&YAs. Alongside health professionals' concerns about sexual behaviors is growing alarm about a dramatic expansion of sexual content in African mass media markets, which experts suspect may lead to T&YA risky sexual behavior. Yet, little work using multi-country data has confirmed whether mass media exposure increases the likelihood of risky sexual behavior. We fill these two gaps in the literature using a Demographic and Health Survey sample of unpartnered sub-Saharan African people, ages 15-24, in 30 countries. With this sample, we examine the direct relationships between HIV stigma beliefs, mass media exposure, and unprotected sex. We also explore whether the effect of stigma beliefs on unprotected sex is moderated by individual and regional-level exposure to mass media content. We first find that the effect of HIV stigma beliefs is harmful or associated with increases in the probability of unprotected sex. Second, contrary to past findings, individual-level mass media exposure is protective, or associated with declines in the likelihood of unprotected sex. Third, the harmful effect of stigma attitudes is weakest when individual and regional-level mass media exposure are low, but strongest when individual and regional-level mass media exposure are high. These findings suggest that stigma beliefs can shape the sexual behaviors of African T&YAs in counterintuitive ways. They also show that mass media exposure can be simultaneously protective and harmful for this population.
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Affiliation(s)
- David A Cort
- 838 Thompson Hall, Department of Sociology, University of Massachusetts, Amherst, Amherst, MA, 01003, USA.
| | - Kathryn Reynolds
- 738 Thompson Hall, Department of Sociology, University of Massachusetts, Amherst, Amherst, MA, 01003, USA.
| | - Debadatta Chakraborty
- 902 Thompson Hall, Department of Sociolog, University of Massachusetts, Amherst, Amherst, MA, 01003, USA.
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Lata S, Singh V, Anupriya. HIV/acquired immune deficiency syndrome stigma, perceived social support, and medical adherence among HIV/acquired immune deficiency syndrome children: A mediation analysis. INDIAN JOURNAL OF HEALTH SCIENCES AND BIOMEDICAL RESEARCH (KLEU) 2023. [DOI: 10.4103/kleuhsj.kleuhsj_128_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Wanjala SW, Too EK, Luchters S, Abubakar A. Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13074. [PMID: 34948690 PMCID: PMC8701211 DOI: 10.3390/ijerph182413074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
Addressing HIV-related stigma requires the use of psychometrically sound measures. However, despite the Berger HIV stigma scale (HSS) being among the most widely used measures for assessing HIV-related stigma, no study has systematically summarised its psychometric properties. This review investigated the psychometric properties of the HSS. A systematic review of articles published between 2001 and August 2021 was undertaken (CRD42020220305) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additionally, we searched the grey literature and screened the reference lists of the included studies. Of the total 1241 studies that were screened, 166 were included in the review, of which 24 were development and/or validation studies. The rest were observational or experimental studies. All the studies except two reported some aspect of the scale's reliability. The reported internal consistency ranged from acceptable to excellent (Cronbach's alpha ≥ 0.70) in 93.2% of the studies. Only eight studies reported test-retest reliability, and the reported reliability was adequate, except for one study. Only 36 studies assessed and established the HSS's validity. The HSS appears to be a reliable and valid measure of HIV-related stigma. However, the validity evidence came from only 36 studies, most of which were conducted in North America and Europe. Consequently, more validation work is necessary for more precise insights.
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Affiliation(s)
- Stanley W. Wanjala
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Department of Social Sciences, Pwani University, Kilifi P.O. Box 195-80108, Kenya
| | - Ezra K. Too
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
| | - Stanley Luchters
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Public Health, Pwani University, Kilifi P.O. Box 195-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi P.O. Box 230-80108, Kenya
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Pond RA, Collins LF, Lahiri CD. Sex Differences in Non-AIDS Comorbidities Among People With Human Immunodeficiency Virus. Open Forum Infect Dis 2021; 8:ofab558. [PMID: 34888399 PMCID: PMC8651163 DOI: 10.1093/ofid/ofab558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022] Open
Abstract
Women are grossly underrepresented in human immunodeficiency virus (HIV) clinical and translational research. This is concerning given that people with HIV (PWH) are living longer, and thus accumulating aging-related non-AIDS comorbidities (NACMs); emerging evidence suggests that women are at higher risk of NACM development and progression compared with men. It is widely recognized that women vs men have greater immune activation in response to many viruses, including HIV-1; this likely influences sex-differential NACM development related to differences in HIV-associated chronic inflammation. Furthermore, many sociobehavioral factors that contribute to aging-related NACMs are known to differ by sex. The objectives of this review were to (1) synthesize sex-stratified data on 4 NACMs among PWH: bone disease, cardiovascular disease, metabolic dysfunction, and neurocognitive impairment; (2) evaluate the characteristics of key studies assessing sex differences in NACMs; and (3) introduce potential biological and psychosocial mechanisms contributing to emerging trends in sex-differential NACM risk and outcomes among PWH.
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Affiliation(s)
- Renee A Pond
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cecile D Lahiri
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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Zhang F, Chung L. HIV/AIDS Awareness Among Young Adults in Hong Kong: The Roles of Knowledge, Acceptance and Stigma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7473. [PMID: 34299919 PMCID: PMC8304163 DOI: 10.3390/ijerph18147473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 11/23/2022]
Abstract
In the past decade, HIV (Human Immunodeficiency Virus) infection risk and the prevalence of infected cases in the younger generation have increased in Hong Kong. To promote HIV prevention and control, it is critical to understand the situation of HIV-related knowledge, stigma, and awareness among the younger adults, especially college students. 810 college students (mean age = 20.63 ± 2.05) have participated in the current survey. In mediation pathway analysis, the results show that participants' greater knowledge about HIV is associated with higher awareness, and this relationship is partially mediated by the knowledge-related increase in accepting attitudes toward the people with HIV, but not via reducing stigma. Our findings provide an updated profile of HIV-related knowledge, attitude and awareness among college students in Hong Kong. In addition, we have clarified the mediating role of acceptance in the relationship between knowledge and awareness and pinpointed the importance of knowledge education and workshops to promote acceptance of people with HIV. Insights were provided for tailoring health-promotion programs to reduce risky sex and prevent HIV infection on college campuses.
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Affiliation(s)
- Fan Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China;
| | - Louisa Chung
- The Department of Health and Physical Education, The Education University of Hong Kong, Taipo, Hong Kong
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Ncitakalo N, Mabaso M, Joska J, Simbayi L. Factors associated with external HIV-related stigma and psychological distress among people living with HIV in South Africa. SSM Popul Health 2021; 14:100809. [PMID: 34027011 PMCID: PMC8121694 DOI: 10.1016/j.ssmph.2021.100809] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND HIV-related stigma and psychological distress among people living with HIV (PLHIV) pose a public health challenge in most African countries. This study aims to investigate the association between HIV-related stigmatizing attitudes and psychological distress amongst PLHIV in South Africa using the 2012 nationally representative population-based household survey. METHODS The data used in the analysis were collected using a multi-stage stratified cluster sampling design. Bivariate and multivariate logistic regression models were used to identify factors associated with stigma among PLHIV with psychological distress. A total of 2521 HIV positive individuals that responded to the question on psychological distress, 34.3% had psychological distress and 37.9% experienced high levels of HIV related stigmatizing attitudes. Stigmatizing attitudes among PLHIV with psychological distress were significantly less likely among those with secondary level education [aOR = 0.67 (95% CI: 0.44-1.01), p = 0.050], those with correct knowledge about HIV and rejection of myths about HIV [aOR = 0.58 (95% CI: 0.38-0.89), p = 0.013], and those who ever tested for HIV [aOR = 0.65 (95% CI: 0.42-1.01), p = 0.054]. CONCLUSION The findings suggest a need to reinvigorate stigma-reduction interventions in the national HIV response with emphasis on HIV awareness and education campaigns. In addition, HIV testing services should be reinforced through communication strategies targeted against HIV stigmatization, discrimination and fear. There is also a need to continuously engage PLHIV in programs through counselling and support interventions for acceptance of HIV positive status and to help them cope with HIV-related stigma.
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Affiliation(s)
| | - Musawenkosi Mabaso
- Human and Social Capabilities Research Division, Human Sciences Research Council, Durban, South Africa
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry & Mental Health, University of Cape Town, South Africa
| | - Leickness Simbayi
- Office of the Deputy Chief Executive Officer for Research, Human Sciences Research Council, Cape Town, South Africa
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Aurpibul L, Sophonphan J, Malee K, Kerr SJ, Sun LP, Ounchanum P, Kosalaraksa P, Ngampiyaskul C, Kanjanavanit S, Chettra K, Suwanlerk T, Mellins CA, Paul R, Robbins RN, Ananworanich J, Puthanakit T. HIV-related enacted stigma and increase frequency of depressive symptoms among Thai and Cambodian adolescents and young adults with perinatal HIV. Int J STD AIDS 2021; 32:246-256. [PMID: 33334266 PMCID: PMC10849772 DOI: 10.1177/0956462420960602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
HIV-related enacted stigma and social problems may increase risk for depression and/or behavioral problems among adolescents and young adults with perinatal HIV(AYA-PHIV), yet few studies have explored stigma in AYA-PHIV residing in low-to-middle income regions, including Southeast Asia. We assessed HIV-related enacted stigma and social problems in AYA-PHIV who participated in the RESILIENCE study (clinicaltrials.gov identification: U19AI53741) in Thailand and Cambodia using specific questions during structured in-person interviews. Depression was measured by the Child Depression Inventory for children <15 years, or the Center for Epidemiologic Studies Depression Scales for youth ≥15 years); behavioral problems were measured by the Child Behavior Checklist (CBCL-caregiver report). Among 195 AYA-PHIV (median age 16.9 years), 25.6% reported a lifetime experience of enacted stigma, while 10.8% experienced social problems due to HIV infection. The frequency of depressive symptoms was nearly two-fold higher among AYA-PHIV with compared to those without HIV-related enacted stigma (34.7% vs. 16.0%, p = 0.005). Caregiver-reported behavioral problems were detected in 14.6% of all AYA-PHIV, with no differences between those with and without HIV-related enacted stigma. Low household income and caregiver mental health problems were independent risk factors for depressive symptoms; HIV-related enacted stigma was also associated with increased risk, warranting targeted services to support AYA-PHIV.
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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Jiratchaya Sophonphan
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - Kathleen Malee
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen J Kerr
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ly Penh Sun
- National Center for HIV/AIDS Dermatology and STDs, Phnom Penh, Cambodia
| | | | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Kea Chettra
- National Center for HIV/AIDS Dermatology and STDs, Phnom Penh, Cambodia
| | - Tulathip Suwanlerk
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute, and Columbia University, New York, NY, USA
| | - Robert Paul
- Missouri Institute of Mental Health, University of Missouri-St. Louis, MO, USA
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute, and Columbia University, New York, NY, USA
| | - Jintanat Ananworanich
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Thanyawee Puthanakit
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Cody SL. Influence of Spirituality, HIV Stigma and Education on HIV Knowledge in Rural African American Congregants in the Deep South: Additional Findings from Project FAITHH. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2021; 11:259-274. [PMID: 36818217 PMCID: PMC9930515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
HIV incidence has shifted racially and geographically in the United States and now represents higher proportions of African Americans living in the Rural South. Lower levels of HIV knowledge may be the culprit behind the increasing HIV rates observed in the Rural South. The purpose of this study was to investigate the individual and joint correlates of HIV knowledge in a sample of rural African Americans. Baseline data from a faith-based anti-stigma intervention (Project FAITHH, N= 210) was used to assess associations between sociodemographic characteristics, spirituality, stigma, and HIV knowledge scores. Associations were examined with recursive partitioning. Statistical significance was determined at P< 0.05 with a two-sided test. Recursive partitioning revealed five distinct groups based on the data. HIV knowledge scores were highest among participants who attended some college (P < 0.001) with lower levels of individual stigma (P < 0.001). HIV knowledge scores were lowest among less educated individuals (P < 0.001) who had lower levels of perceived community stigma (P = 0.002). Future interventions designed to improve HIV knowledge in rural African Americans should consider tailoring content to those who have the greatest deficits in HIV knowledge, which may be based on perceived community stigma and education levels.
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Billings KR, Cort DA, Rozario TD, Siegel DP. HIV stigma beliefs in context: Country and regional variation in the effects of instrumental stigma beliefs on protective sexual behaviors in Latin America, the Caribbean, and Southern Africa. Soc Sci Med 2020; 269:113565. [PMID: 33303293 DOI: 10.1016/j.socscimed.2020.113565] [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] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
Does the relationship between the expression of HIV stigma beliefs and the practice of protective sexual behaviors vary by social context? To answer this question, we apply multilevel techniques to Demographic and Health Survey data from seven low HIV prevalence Latin American and Caribbean countries and seven high HIV prevalence Southern African countries to examine contextual variation in this relationship. We examine whether the relationship between stigma beliefs and sexual behaviors differs across these two sets of countries and across regions within each set of countries. We first find that in high prevalence Southern African countries, one unit increases in HIV stigma beliefs are associated with 8% declines in the odds of practicing protective sexual behaviors. Conversely, in low prevalence Latin American and Caribbean countries, unit increases in HIV stigma beliefs are associated with 8% increases in the odds of those same sexual behaviors. Second, the relationship between stigma beliefs and protective sexual behaviors varies across regions within each set of countries, with a wider variance in regional stigma effects located in Southern Africa than in Latin America and the Caribbean. Third, in Southern Africa, the negative effect of stigma beliefs is even more negative in regions where conservative stigma beliefs are pronounced. Overall, our findings demonstrate the importance of taking country and regional context into account when examining the degree to which HIV beliefs affect personal sexual behaviors, which in turn, can contribute to the spread of HIV. Importantly, the implications of our results offer potential guidance to experts who wish to design policies and programs aimed at reducing the expression of negative HIV beliefs towards those infected with HIV.
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Affiliation(s)
- Katie R Billings
- Department of Sociology, University of Massachusetts - Amherst, 918 Thompson Hall, Amherst, MA, 01003, USA.
| | - David A Cort
- Department of Sociology, University of Massachusetts - Amherst, 838 Thompson Hall, Amherst, MA, 01003, USA.
| | - Tannuja D Rozario
- Department of Sociology, University of Massachusetts - Amherst, 808 Thompson Hall, Amherst, MA, 01003, USA.
| | - Derek P Siegel
- Department of Sociology, University of Massachusetts - Amherst, 704 Thompson Hall, Amherst, MA, 01003, USA.
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15
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Saine ME, Szymczak JE, Moore TM, Bamford LP, Barg FK, Schnittker J, Holmes JH, Mitra N, Re VL. Determinants of stigma among patients with hepatitis C virus infection. J Viral Hepat 2020; 27:1179-1189. [PMID: 32500618 PMCID: PMC9390068 DOI: 10.1111/jvh.13343] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022]
Abstract
Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV treatment and elimination. The determinants of HCV-related stigma, including the impacts of stage of HCV treatment (ie spontaneously cleared; diagnosed, untreated; previously treated, not cured; currently being treated; and treated, cured) and coinfection with human immunodeficiency virus (HIV), remain unknown. To address these gaps, we conducted a cross-sectional study among patients with a history of HCV infection (n = 270) at outpatient clinics in Philadelphia from July 2018 to May 2019. We evaluated stigma using the validated HCV Stigma Scale, adapted from the Berger HIV Stigma Scale. Associations among HCV-related stigma and hypothesized demographic, behavioural, and clinical risk factors were evaluated by multivariable linear regression. Most participants (95.5%) experienced HCV-related stigma. Mean stigma scores did not differ significantly between HCV-monoinfected and HIV/HCV-coinfected participants (P = .574). However, we observed significant interactions between HIV status and multiple determinants; therefore, we stratified analyses by HIV status. Among HIV/HCV-coinfected participants, previous HCV treatment without cure, female gender, Hispanic/Latinx ethnicity and some college education were significantly associated with higher HCV-stigma scores. An annual income of $10 000-$40 000 was associated with significantly lower stigma scores. No significant associations were observed among HCV-monoinfected participants. We found that most participants experienced stigma associated with HCV diagnosis. While stigma scores were similar between HCV-monoinfected and HIV/HCV-coinfected participants, the determinants associated with HCV stigma differed by HIV status. Understanding how experiences of stigma differ between HCV-monoinfected and HIV/HCV-coinfected patients may aid in the development of targeted interventions to address the HCV epidemic.
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Affiliation(s)
- M. Elle Saine
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia E. Szymczak
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tyler M. Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura P. Bamford
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA
| | - Frances K. Barg
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jason Schnittker
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA,Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | - John H. Holmes
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Lo Re
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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16
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Saine ME, Moore TM, Szymczak JE, Bamford LP, Barg FK, Mitra N, Schnittker J, Holmes JH, Lo Re V. Validation of a modified Berger HIV stigma scale for use among patients with hepatitis C virus (HCV) infection. PLoS One 2020; 15:e0228471. [PMID: 32023310 PMCID: PMC7001940 DOI: 10.1371/journal.pone.0228471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/15/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV prevention, treatment, and elimination. To date, no validated instrument exists to measure patients' experiences of HCV stigma. This study aimed to revise the Berger (2001) HIV stigma scale and evaluate its psychometric properties among patients with HCV infection. METHODS The Berger HIV stigma scale was revised to ask about HCV and administered to patients with HCV (n = 270) in Philadelphia, Pennsylvania. Scale reliability was evaluated as internal consistency by calculating Cronbach's alpha. Exploratory factor analysis was performed to evaluate construct validity by comparing item clustering to the Berger HIV stigma scale subscales. Item response theory was employed to further evaluate individual items and to calibrate items for simulated computer adaptive testing sessions in order to identify potential shortened instruments. RESULTS The revised HCV Stigma Scale was found to have good reliability (α = 0.957). After excluding items for low loadings, the exploratory factor analysis indicated good construct validity with 85% of items loading on pre-defined factors. Analyses strongly suggested the predominance of an underlying unidimensional factor solution, which yielded a 33-item scale after items were removed for low loading and differential item functioning. Adaptive simulations indicated that the scale could be substantially shortened without detectable information loss. CONCLUSIONS The 33-item HCV Stigma Scale showed sufficient reliability and construct validity. We also conducted computer adaptive testing simulations and identified shortened six- and three-item scale alternatives that performed comparably to the original 40-item scale.
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Affiliation(s)
- M. Elle Saine
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Tyler M. Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Julia E. Szymczak
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Laura P. Bamford
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA, United States of America
| | - Frances K. Barg
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Nandita Mitra
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jason Schnittker
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - John H. Holmes
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Vincent Lo Re
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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17
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Abstract
Depression and human immunodeficiency virus disease are common co-occurring conditions among youth living with human immunodeficiency virus/AIDS. Depression serves as a risk factor for contracting the disease and for nonadherence to medications and adherence to safe sex practices. Although new infections are decreasing nationally, subpopulations of youths continue to have the highest rates of new infections, specifically ethnic and sexual minority youths. Depression contributes to poor health outcomes for youths with human immunodeficiency virus disease. Evidence-based psychotherapy and pharmacotherapy for depression are effective treatments. Integrated care with medical and mental health provides the best care for this population of youth.
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Affiliation(s)
- Tami D Benton
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3440 Market Street, Suite 400, Philadelphia, PA 19104, USA.
| | - Warren Yiu Kee Ng
- Division of Child and Adolescent Psychiatry, Columbia University Irving Medical Center, New York Presbyterian Hospital/Columbia University Medical Center, 635 W 165th St, #EI 610, New York, NY 10032, USA
| | - Denise Leung
- Child and Adolescent Pediatric Psychiatry Community Services, Division of Child and Adolescent Psychiatry, Columbia University Irving Medical Center, 3959 Broadway, MSCH 6N 615A, New York, NY 10032, USA
| | - Alexandra Canetti
- Special Needs Clinic and School Based Mental Health Program, Columbia University Irving Medical Center, 622 West 168th St, VC4 East, New York, NY 10032, USA
| | - Niranjan Karnik
- Department of Psychiatry & Behavioral Sciences, Rush Medical College, Rush University Medical Center, 1645 West Jackson Blvd., Suite 600, Chicago, IL 60612, USA
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18
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Smith Fawzi MC, Siril H, Liu Y, McAdam K, Ainebyona D, McAdam E, Somba M, Oljemark K, Mleli N, Lienert J, Andrew I, Haberlen S, Simwinga A, Todd J, Makongwa S, Li N, Kaaya S. Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of the NAMWEZA intervention in Dar es Salaam, Tanzania. BMJ Glob Health 2019; 4:e000946. [PMID: 31179027 PMCID: PMC6528754 DOI: 10.1136/bmjgh-2018-000946] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION NAMWEZA is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the NAMWEZA intervention on risk behaviour as well as factors potentially contributing to this vulnerability for people living with HIV and their network members. METHODS A stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the NAMWEZA intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview. Intention-to-treat analysis was performed, including primary outcomes of uptake of HIV services, self-efficacy, self-esteem, HIV risk behaviour and IPV. RESULTS For people living with HIV, a number of outcomes improved with the NAMWEZA intervention, including higher self-efficacy and related factors, as well as lower levels of depression and stigma. IPV reduced by 40% among women. Although reductions in HIV risk behaviour were not observed, an increase in access to HIV treatment was reported for network members (72% vs 94%, p=0.002). CONCLUSION These results demonstrate the complexity of behavioural interventions in reducing the vulnerability of acquiring HIV, since it is possible to observe a broad range of different outcomes. This study indicates the importance of formally evaluating interventions so that policymakers can build on evidence-based approaches to advance the effectiveness of HIV prevention interventions. TRIAL REGISTRATION NUMBER NCT01693458.
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Affiliation(s)
- Mary C Smith Fawzi
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Hellen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Yuanyuan Liu
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Donald Ainebyona
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Magreat Somba
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Neema Mleli
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jeffrey Lienert
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Irene Andrew
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jim Todd
- Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Samwel Makongwa
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nan Li
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Carter A, Greene S, Money D, Sanchez M, Webster K, Nicholson V, Brotto LA, Hankins C, Kestler M, Pick N, Salters K, Proulx-Boucher K, O'Brien N, Patterson S, de Pokomandy A, Loutfy M, Kaida A. Love with HIV: A Latent Class Analysis of Sexual and Intimate Relationship Experiences Among Women Living with HIV in Canada. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1015-1040. [PMID: 30891711 DOI: 10.1007/s10508-019-1418-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 06/09/2023]
Abstract
Love remains hidden in HIV research in favor of a focus on risk. Among 1424 women living with HIV in Canada, we explored (1) whether eight facets of sex and intimacy (marital status, sexual activity, physical intimacy, emotional closeness, power equity, sexual exclusivity, relationship duration, and couple HIV serostatus) may coalesce into distinct relationship types, and (2) how these relationship types may be linked to love as well as various social, psychological, and structural factors. Five latent classes were identified: no relationship (46.5%), relationships without sex (8.6%), and three types of sexual relationships-short term (15.4%), long term/unhappy (6.4%), and long term/happy (23.2%, characterized by equitable power, high levels of physical and emotional closeness, and mainly HIV-negative partners). While women in long-term/happy relationships were most likely to report feeling love for and wanted by someone "all of the time," love was not exclusive to sexual or romantic partners and a sizeable proportion of women reported affection across latent classes. Factors independently associated with latent class membership included age, children living at home, sexism/genderism, income, sex work, violence, trauma, depression, HIV treatment, awareness of treatment's prevention benefits, and HIV-related stigma. Findings reveal the diversity of women's experiences with respect to love, sex, and relationships and draw attention to the sociostructural factors shaping intimate partnering in the context of HIV. A nuanced focus on promoting healthy relationships and supportive social environments may offer a more comprehensive approach to supporting women's overall sexual health and well-being than programs focused solely on sexual risk reduction.
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Affiliation(s)
- Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margarite Sanchez
- ViVA, Positive Living Society of British Columbia, Vancouver, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Hankins
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Mary Kestler
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Neora Pick
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Kate Salters
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Karène Proulx-Boucher
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia O'Brien
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Sophie Patterson
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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20
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Wang W, Yang N, Li X, Xiao H, Gao M, Yan H, Li S. A pathway analysis of exploring how HIV-related stigma affects social capital among people living with HIV/AIDS in China. PSYCHOL HEALTH MED 2019; 24:1100-1110. [PMID: 30892925 DOI: 10.1080/13548506.2019.1595677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV-related stigma is the most common and serious social problem which people living with HIV/AIDS (PLWHA) have to face. However, the impact of HIV stigma on social capital is not yet clear. Therefore, this study aims to understand the relationship between HIV stigma and social capital, and explore the mechanism of how HIV stigma influences social capital among Chinese PLWHA on this basis. An institutional based cross-sectional study was conducted from Nov 2015 to Jan 2016 in Wuhan, China, using a self-reporting questionnaire. A total of 552 PLWHA participated, and 520 valid questionnaires were included. Multiple linear regression analysis showed that lower education level, lower monthly income, higher internalized stigma, and anticipated stigma were significantly associated with lower social capital. Results of path analysis showed that although perceived community stigma has no direct effect on social capital, but it can affect social capital through internalized stigma and anticipated stigma. In conclusion, increased HIV stigma and reduced social capital are frequent among PLWHA in China. Perceived community stigma may cause PLWHA to internalize stigma and anticipate stigmatizing experiences, resulting in the reduction of social capital. These findings suggest that perceived community stigma should become the target of stigma intervention strategy among Chinese PLWHA.
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Affiliation(s)
- Wei Wang
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china.,b Department of Epidemiology , University of Florida , Gainesville , FL , USA
| | - Ningxi Yang
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Xiaoyan Li
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Han Xiao
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Mengting Gao
- c Information Center , Renmin Hospital of Wuhan University , Wuhan , P.R. China
| | - Hong Yan
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Shiyue Li
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
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Prevalence of HIV Viral Load Suppression Among Psychiatric Inpatients with Comorbid Substance Use Disorders. Community Ment Health J 2018; 54:1146-1153. [PMID: 29752639 PMCID: PMC6230497 DOI: 10.1007/s10597-018-0284-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/05/2018] [Indexed: 02/05/2023]
Abstract
A consistently suppressed viral load enables HIV (+) patients to live longer, healthier lives and reduces the probability of transmitting the virus. Since the prevalence of HIV is four times higher among those with psychiatric disorders than in the general population, it is likely that this group would also have greater difficulty remaining in care and achieving viral suppression. A secondary data analysis utilizing screening data from the Preventing AIDS Through Health (PATH) for Triples (PFT) Study were examined to assess HIV load suppression among 254 psychiatric inpatients with comorbid substance use disorders in Philadelphia. Viral load results from the past 12 months were obtained from medical records for 63 inpatients identified as HIV (+). The sample was predominately African American (76%), male (56%), and the average age was 43 years. Psychiatric disorders included depression (64%), schizophrenia (21%), and bipolar disorder (13%) with patients reporting use of alcohol (73%), cocaine (64%), cannabis (29%) and opioids (16%) prior to admission. Among this high risk sample of HIV (+) patients, about one-half (52%) achieved viral suppression, with recent opioid users six times more likely to have a detectable viral load than non-opioid users (OR 6.0; CI 1.1-31.7, p = .035). The 52% viral load suppression rate among psychiatric inpatient was higher than expected, given that the CDC's national suppression rate among those diagnosed with HIV in the general population is 58%. However, individuals with mental illness and substance use disorders require constant surveillance, monitoring, and supportive services to achieve viral suppression. Many of those who were virally suppressed were engaged in Philadelphia's extensive treatment network, whereas those who were detectable and enrolled in the PFT intervention were often homeless with unstable psychiatric symptoms and current substance use disorders, particularly opioid abuse.
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Du M, Zhao J, Zhang J, Lau JTF, Mo PKH, Li J. Depression and social support mediate the effect of HIV self-stigma on condom use intentions among Chinese HIV-infected men who have sex with men. AIDS Care 2018; 30:1197-1206. [PMID: 29911428 DOI: 10.1080/09540121.2018.1487916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
HIV self-stigma in HIV positive men who have sex with men (HIVMSM) has been identified as one of the largest challenges of HIV prevention, and associates with numerous negative outcomes, including depression, decreased social support, and less condom use intentions. In the present study, 321 HIVMSM in Chengdu, China were recruited to examine the prevalence of condom use in the past months and intentions to use condoms in next six months; we also identify pathways between HIV self-stigma and intentions to use condoms by the structural equation modeling approach. Results showed that Chinese HIVMSM had the suboptimal prevalence of consistent condom use and low intentions to use condoms consistently. Additionally, depression and decreased social support were significant mediators between HIV self-stigma and condom use intentions. The complex pathways between HIV self-stigma and intentions to use condoms should be taken into account in the HIV prevention and intervention programs.
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Affiliation(s)
- Mengran Du
- a Department of Health and Social Behaviors, West China School of Public Health , Sichuan University , Chengdu , People's Republic of China
| | - Jian Zhao
- b Department of Epidemiology and Biostatistics, School of Public Health , Curtin University , Perth , Australia
| | - Jianxin Zhang
- a Department of Health and Social Behaviors, West China School of Public Health , Sichuan University , Chengdu , People's Republic of China
| | - Joseph T F Lau
- c School of Public Health , Zhejiang University School of Medicine , Hangzhou , Zhejiang , People's Republic of China.,d The Jockey Club School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong, Shatin , Hong Kong , People's Republic of China
| | - Phoenix K H Mo
- e Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , People's Republic of China.,f Department of Social Science and Health Management, School of Public Health , Sun Yat-sen University , Guangzhou , People's Republic of China
| | - Jinghua Li
- g School of Public Health , Sun Yat-sen University , Guangzhou , People's Republic of China.,h Sun Yat-sen Global Health Institute , Sun Yat-sen University , Guangzhou , People's Republic of China
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Babowitch JD, Vanable PA, Carey MP. Gender Moderates the Association of Depressive Symptoms to Sexual Risk Behavior Among HIV-Positive African-American Outpatients. AIDS Behav 2018; 22:1430-1434. [PMID: 29185079 DOI: 10.1007/s10461-017-1981-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous research has reported an association between depressive symptoms and sexual risk behavior. The purpose of this study was to explore whether gender moderates this association in a sample of HIV-positive African-Americans. Participants (N = 93) self-reported depressive symptoms (Center for Epidemiological Studies-Depression Scale; CES-D), and sexual risk behavior for the past 4 months. Analyses revealed that the depressive symptoms-by-gender interaction was associated with condomless sex and substance use proximal to sex. When analyses were stratified by gender, depressive symptoms were associated with condomless sex and frequency of substance use only for women. We conclude that depressive symptoms may be a more powerful sexual risk factor among women relative to men.
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Affiliation(s)
- Jacklyn D Babowitch
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224, USA.
| | - Peter A Vanable
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University, Providence, RI, USA
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Rice WS, Turan B, White K, Turan JM. Norms and stigma around unintended pregnancy in Alabama: Associations with recent contraceptive use and dual method use among young women. Women Health 2018; 58:1151-1166. [PMID: 29240532 DOI: 10.1080/03630242.2017.1414099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The role of unintended pregnancy norms and stigma in contraceptive use among young women is understudied. This study investigated relationships between anticipated reactions from others, perceived stigma, and endorsed stigma concerning unintended pregnancy, with any and dual contraceptive use in this population. From November 2014 to October 2015, young women aged 18-24 years (n = 390) and at risk for unintended pregnancy and sexually transmitted infections participated in a survey at a university and public health clinics in Alabama. Multivariable regression models examined associations of unintended pregnancy norms and stigma with contraceptive use, adjusted for demographic and psychosocial characteristics. Compared to nonusers, more any and dual method users, were White, nulliparous, and from the university and had higher income. In adjusted models, anticipated disapproval of unintended pregnancy by close others was associated with greater contraceptive use (adjusted Odds Ratio [aOR] = 1.54, 95 percent confidence interval [CI] = 1.03-2.30), and endorsement of stigma concerning unintended pregnancy was associated with lower odds of dual method use (aOR = 0.71, 95 percent CI = 0.51-1.00). Unintended pregnancy norms and stigma were associated with contraceptive behavior among young women in Alabama. Findings suggest the potential to promote effective contraceptive use in this population by leveraging close relationships and addressing endorsed stigma.
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Affiliation(s)
- Whitney S Rice
- a Department of Psychology, College of Arts and Sciences , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Bulent Turan
- a Department of Psychology, College of Arts and Sciences , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Kari White
- b Department of Health Care Organization and Policy, School of Public Health , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Janet M Turan
- b Department of Health Care Organization and Policy, School of Public Health , University of Alabama at Birmingham , Birmingham , Alabama , USA
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Cort DA, Tu HF. Safety in stigmatizing? Instrumental stigma beliefs and protective sexual behavior in Sub-Saharan Africa. Soc Sci Med 2017; 197:144-152. [PMID: 29245081 DOI: 10.1016/j.socscimed.2017.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/24/2022]
Abstract
How are people's expression of HIV stigma beliefs connected to their own personal decisions concerning safe sexual practices? Does this relationship vary across countries and by the national context in which people reside? To answer these questions, we develop and test individual, contextual, and cross-level interactional hypotheses of the impact of instrumental HIV stigma attitudes on several measures of protective sexual behavior. Using Demographic and Health Survey data from 467,656 unpartnered individuals across 34 sub-Saharan African countries, we first find that counterintuitively, conservative HIV stigma attitudes are associated with lower likelihoods of participating in all types of protective sexual behaviors. Second, this negative relationship is most pronounced in the Southern and Eastern regions of Africa, where HIV prevalence is highest. Together, these findings suggest that stigma beliefs can shape private behaviors in counterintuitive yet important ways that have profound implications for current epidemiological and public health approaches to slowing the spread of HIV.
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Affiliation(s)
- David A Cort
- University of Massachusetts, Department of Sociology, 838 Thompson Hall, Amherst, MA 01003, USA.
| | - Hsin Fei Tu
- University of Massachusetts, Department of Sociology, 314 Machmer Hall, Amherst, MA 01003, USA.
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Majeed Z, van Wijngaarden E, Dolan JG, Shah KN. Depression partially mediated the relationship between basic psychological needs and quality of life among people living with HIV. AIDS Care 2017; 29:1399-1403. [PMID: 28278562 DOI: 10.1080/09540121.2017.1300627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Few studies have examined the relationship between basic psychological needs (BPN), depression and quality of life (QOL) in people living with HIV (PLWH). This cross-sectional study (N = 65; 37% females, 37% Caucasian, mean age = 55 ± 6 years, mean CD4 count = 668 ± 368 cells/mm3, average duration of HIV = 18 ± 4 years) found that BPN frustration was related with lower QOL. The strength of this relationship was reduced after controlling for depression. This suggests that depression partially mediated the relationship between BPN and QOL. BPN and depression may be specific targets for psychosocial interventions aimed at improving QOL in PLWH to promote successful aging.
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Affiliation(s)
- Zahraa Majeed
- a Department of Medicine, Division of Geriatrics and Aging , University of Rochester , Rochester , USA
| | - Edwin van Wijngaarden
- b Department of Public Health Sciences, School of Medicine and Dentistry , University of Rochester , Rochester , USA
| | - James G Dolan
- b Department of Public Health Sciences, School of Medicine and Dentistry , University of Rochester , Rochester , USA
| | - Krupa N Shah
- a Department of Medicine, Division of Geriatrics and Aging , University of Rochester , Rochester , USA
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Darlington CK, Hutson SP. Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review. AIDS Behav 2017; 21:12-26. [PMID: 27492025 DOI: 10.1007/s10461-016-1504-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Societal stigmatization of HIV/AIDS due to assumptions about transmission and associated behaviors plays a substantial role in the psychosocial well-being of people living with this chronic illness, particularly for women in traditionally conservative geographic regions. Known for social conservatism, the Southern United States (US) holds the highest incidence rate of HIV infection in the US. A systematic search of four databases was used to identify 27 relevant scientific articles pertaining to HIV-related stigma among women living with HIV/AIDS in the Southern US. These studies revealed a rudimentary understanding of stigma sources, effects, and stigma-reduction interventions in this population. Due to the cultural specificity of stigma, further differentiation of stigma in discrete sectors of the South as well as a dialogue about the moral implications of stigma is necessary to lay the groundwork for patient-centered interventions to mitigate the destructive effects of stigma experienced by women in this region.
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Affiliation(s)
- Caroline K Darlington
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Room 337, Knoxville, TN, 37996, USA.
| | - Sadie P Hutson
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Room 337, Knoxville, TN, 37996, 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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Depressive symptoms and substance use as mediators of stigma affecting men who have sex with men in Lesotho: a structural equation modeling approach. Ann Epidemiol 2016; 26:551-556. [PMID: 27425206 DOI: 10.1016/j.annepidem.2016.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 03/30/2016] [Accepted: 06/03/2016] [Indexed: 01/25/2023]
Abstract
PURPOSE Research on the relationship between sexual orientation-related stigma and risks for HIV among men who have sex with men (MSM) is limited. This study tests a hypothesis that substance use and depressive symptoms mediate the relationship between stigma in the health care system and HIV-related risk practices among MSM in Maseru, Lesotho. METHODS In 2014, we conducted a cross-sectional study among MSM in Lesotho accrued via respondent-driven sampling including a survey and biological testing for HIV. The hypothesis was tested using structural equation modeling. RESULTS Of the 318 participants, 22.3% had experienced stigma in the health care system. Stigma in the health care system was associated with depression (β = 0.329, P = .018) and alcohol use (β = 1.417, P = .001). Noninjection illicit drug use (β = 0.837, P = .039) and alcohol use (β = 0.282, P = .000) significantly predicted number of sex partners. Stigma was directly associated with condomless anal sex (β = 0.441, P = .036), and no indirect association was found. CONCLUSIONS Alcohol use and depressive symptoms mediate the relationship between MSM stigma in the health care system and reported number of sex partners. The implications are significant with a focus on the need for comprehensive interventions addressing stigma and mental health when aiming to improve more proximal HIV-related risk practices for MSM.
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Abstract
The primary goal of this study was to adapt Berger, Ferrans, & Lahley (2001) HIV Stigma Scale in Spain, using Bunn, Solomon, Miller, & Forehand (2007) version. A second goal assessed whether the four-factor structure of the adapted scale could be explained by two higher-order dimensions, perceived external stigma and internalized stigma. A first qualitative study (N = 40 people with HIV, aged 28-59) was used to adapt the items and test content validity. A second quantitative study analyzed construct and criterion validity. In this study participants were 557 people with HIV, aged 18-76. The adapted HIV Stigma Scale for use in Spain (HSSS) showed a good internal consistency (α = .88) and good construct validity. Confirmatory Factor Analyses yielded a first-order, four-factor structure and a higher-order, bidimensional structure with the two expected factors (RMSEA = .051, 90% CI [.046, .056]; RMR = .073; GFI = .96; AGFI = .96; CFI = .98). Negative relations were found between stigma and quality of life (r = -.39; p < .01), self-efficacy to cope with stigma (r = -.50; p < .01) and the degree of HIV status disclosure (r = -.35; p < .01). Moreover, the people who had suffered AIDS-related opportunistic infections had a higher score in the Perceived External Stigma dimension than those who had not suffered them, t (493) = 3.02, p = .003, d = 0.26.
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31
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Lee S, Yamazaki M, Harris DR, Harper GW, Ellen J. Social Support and Human Immunodeficiency Virus-Status Disclosure to Friends and Family: Implications for Human Immunodeficiency Virus-Positive Youth. J Adolesc Health 2015; 57:73-80. [PMID: 25940217 PMCID: PMC4478132 DOI: 10.1016/j.jadohealth.2015.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/26/2015] [Accepted: 03/03/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE The fear of negative reactions from friends and family members affects many human immunodeficiency virus (HIV)-positive adolescents' decisions regarding disclosure of their HIV status. The complex relationships and interplay among social support, fear of stigma, and disclosure of HIV status need to be better understood among youth living with HIV (YLHIV). METHODS Social support from friends and family members and HIV status disclosure were examined among 402 youth, aged 12-24 years, living with HIV. RESULTS In separate analyses, (1) HIV-positive youth who reported more than one close friend and (2) HIV-positive youth who reported that friends and family members continued to socialize with them after disclosure of their HIV diagnosis, had higher levels of perceived social support overall (both p < .05). Furthermore, perceived social support did not differ significantly between those participants for whom no family member knew their HIV status and those for whom at least one family member knew their status (p = .13). Race/ethnicity, sexual orientation, education level, and current living situation were not associated with family's knowledge of the participants' HIV infection status (p > .07). CONCLUSION This investigation adds important information concerning YLHIV, whose early disclosure experiences may influence their resilience and future coping mechanisms regarding experienced stigma, and thus influence the length of time they conceal their HIV status, their decision to disclose their status, and potentially their decisions regarding treatment. Interventions and support systems to assist YLHIV with disclosure, as well as medical care, may improve their overall quality of life.
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Affiliation(s)
- Sonia Lee
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
| | - Michiyo Yamazaki
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI
| | - Jonathan Ellen
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL
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Brown LK, Whiteley L, Harper GW, Nichols S, Nieves A. Psychological symptoms among 2032 youth living with HIV: a multisite study. AIDS Patient Care STDS 2015; 29:212-9. [PMID: 25585049 PMCID: PMC4378856 DOI: 10.1089/apc.2014.0113] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study determined the prevalence and patterns of psychological symptoms in adolescents and young adults living with HIV (YLWH) in medical care and relationships between psychological symptoms, route and duration of infection, and antiretroviral treatment (ART). A clinic-based sample of 2032 YLWH (mean age 20.3 years), recruited from 20 adolescent medicine HIV clinics, completed a cross-sectional survey of health behaviors and psychological symptoms using the Brief Symptom Inventory (BSI). Overall, 17.5% of youth reported psychological symptoms greater than the normative threshold on the Global Severity Index. A wide variety of symptoms were reported. The prevalence of clinical symptoms was significantly greater in youth with behaviorally acquired HIV compared to those with perinatally acquired infection (20.6% vs. 10.8%, OR=2.06 in Multiple Logistic Regression (MLR)), and in those not taking ART that had been prescribed (29. 2% vs. 18.8%, OR=1.68 in MLR). Knowing one's HIV status for more than one year and disclosure of HIV status were not associated with fewer symptoms. A large proportion of YLWH have psychological symptoms and the prevalence is greatest among those with behaviorally acquired infection. The high rate of psychological symptoms for youth not taking ART that is prescribed is a cause for concern. Symptoms do not appear to be a transient reaction to diagnosis of HIV.
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Affiliation(s)
- Larry K. Brown
- Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Laura Whiteley
- Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, California
| | - Amethys Nieves
- Rhode Island Hospital, Brown University, Providence, Rhode Island
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Closson EF, Mimiaga MJ, Sherman SG, Tangmunkongvorakul A, Friedman RK, Limbada M, Moore AT, Srithanaviboonchai K, Alves CA, Roberts S, Oldenburg CE, Elharrar V, Mayer KH, Safren SA. Intimacy versus isolation: a qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia. PLoS One 2015; 10:e0120957. [PMID: 25793283 PMCID: PMC4368566 DOI: 10.1371/journal.pone.0120957] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 02/07/2015] [Indexed: 12/21/2022] Open
Abstract
The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010–2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that similar intervention content may be effective for a range of settings.
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Affiliation(s)
- Elizabeth F. Closson
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Susan G. Sherman
- Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | | | - Ruth K. Friedman
- Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Mohammed Limbada
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ayana T. Moore
- FHI360, Durham, North Carolina, United States of America
| | - Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Carla A. Alves
- Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Sarah Roberts
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Catherine E. Oldenburg
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Vanessa Elharrar
- National Institute of Allergy and Infectious Disease, Bethesda, Maryland, United States of America
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard School of Public Health, Boston, Massachusetts, United States of America
- Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Lanier L, DeMarco R. A synthesis of the theory of silencing the self and the social ecological model: understanding gender, race, and depression in African American women living with HIV infection. AIDS Patient Care STDS 2015; 29:142-9. [PMID: 25614997 DOI: 10.1089/apc.2014.0116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The challenges that face African American women living with HIV are immense. African American women continue to be disproportionately infected and affected by this chronic and life-threatening infection in a complex context of individual experience, interactions with the environment, formal and informal support systems, and cultural belief systems. This article identifies the Theory of Silencing the Self (STS) and a widely known model, the Social Ecological Model (SEM), as a synthesized explanatory framework in helping nurses understand how to address research questions and clinical care that is congruent with the experience of African American women living with HIV infection. In synthesizing the components of these two frameworks, an explanation of the relationship between disempowerment and depression in this population will be uncovered as a key component to making relationships at the individual, family, and community level better. Helping African American women living with HIV infection to explore and address how choosing to be silent across their life systems will advance healthcare adherence as we currently know it to improved self-management of a chronic, gender-specific, culturally-bound experience of depression.
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Affiliation(s)
- Latrona Lanier
- Department of Nursing, Darton State College, Albany, Georgia
| | - Rosanna DeMarco
- Department of Nursing, College of Nursing and Health Sciences, University Massachusetts Boston, Boston, Massachusetts
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Wu X, Chen J, Huang H, Liu Z, Li X, Wang H. Perceived stigma, medical social support and quality of life among people living with HIV/AIDS in Hunan, China. Appl Nurs Res 2014; 28:169-74. [PMID: 25315140 DOI: 10.1016/j.apnr.2014.09.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/26/2014] [Accepted: 09/26/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The present study aimed at examining the relationships among perceived stigma, social support, and quality of life (QOL) in people living with HIV (PLWH). METHODS We recruited 190 participants meeting the inclusion criteria from two HIV clinics in Hunan, China. HIV-related Stigma Scale, the Chinese Version of the Medical Outcomes Study - Social Support Survey (MOS-SSS-C), and the Medical Outcomes Study-HIV (MOS-HIV) were used to measure the perceived stigma, social support and QOL in PLWH. RESULTS The mean scores of the perceived stigma, social support, and QOL were 104.32, 53.63, and 61.97 respectively, which were in moderate range. Stepwise multivariate regression analysis showed (R(2)=.49, p<.01) a low score of internalized stigma and family stigma, a high score of tangible support for non-drug use and antiretroviral treatment, and high CD4 count predicted better QOL. CONCLUSION Perceived stigma and social support are correlated with the QOL in PLWH. Interventions designed to decrease perceived stigma and strengthen social support from family are necessary to improve the QOL in PLWH.
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Affiliation(s)
- Xiaohua Wu
- Guangdong General Hospital, 510080, Guangzhou, China
| | - Jia Chen
- School of Nursing of Central South University, 410013, Changsha, China.
| | - Huigen Huang
- Guangdong General Hospital, 510080, Guangzhou, China
| | - Ziping Liu
- The First Hospital of Li Wan, 510370, Guangzhou, China
| | - Xianhong Li
- School of Nursing of Central South University, 410013, Changsha, China
| | - Honghong Wang
- School of Nursing of Central South University, 410013, Changsha, China
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Harper GW, Lemos D, Hosek SG. Stigma reduction in adolescents and young adults newly diagnosed with HIV: findings from the Project ACCEPT intervention. AIDS Patient Care STDS 2014; 28:543-54. [PMID: 25216106 DOI: 10.1089/apc.2013.0331] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This article describes the influence of a group-based behavioral intervention for adolescents and young adults newly diagnosed with HIV (Project ACCEPT) on four dimensions of HIV-related stigma-personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes about people with HIV-as measured by the Berger HIV Stigma Scale. Stigma was addressed in a holistic manner during the intervention by providing HIV/AIDS-related information, facilitating the acquisition of coping skills, and providing contact with other youth living with HIV in order to improve social support. Fifty youth (28 male, 22 female; mean age=19.24 years) newly diagnosed with HIV from four geographically diverse clinics participated in a one-group pretest-posttest design study whereby they received the intervention over a 12-week period, and completed assessments at baseline, post-intervention, and 3-month follow-up. Results from the combined sample (males and females) revealed overall reductions in stigma in three dimensions: personalized stigma, disclosure concerns, and negative self-image, although only the combined-sample effects for negative self-image were maintained at 3-month follow-up. Gender-specific analyses revealed that the intervention reduced stigma for males across all four dimensions of stigma, with all effects being maintained to some degree at the 3-month follow-up. Only personalized stigma demonstrated a decrease for females, although this effect was not maintained at the 3-month follow-up; while the other three types of stigma increased at post-intervention and 3-month follow-up. Findings are discussed in terms of gender specific outcomes and the need for a different type of intervention to reduce stigma for young women.
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Affiliation(s)
- Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Diana Lemos
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois
| | - Sybil G. Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois
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HIV- and AIDS-Related Stigma: Psychosocial Aspects in a Representative Spanish Sample. SPANISH JOURNAL OF PSYCHOLOGY 2013; 16:E30. [DOI: 10.1017/sjp.2013.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis study evaluates the prevalence of HIV stigma in Spain and analyzes some variables that may affect its existence. In 2008, we conducted a computer-assisted telephone survey of 1607 people, representative of the Spanish population. Two-wave random stratified sampling was performed, first selecting the home and then the person, depending on the rates of age and sex. About 50% of the population feels discomfort about potential contact with people with HIV and tries to avoid it and 20% advocate discriminatory policies involving physical or social segregation of people with HIV. The belief that HIV is easily transmitted through social contact (15%) and blaming people with HIV for their disease (19.3%) are associated with stigmatization. Degree of proximity to people with HIV, political ideology, educational level, and age are also associated with the degree of stigmatization. According to these results, we suggest that, in order to reduce stigma, we need to modify the erroneous beliefs about the transmission pathways, decrease attributions of blame to people with HIV, and increase contact with them. These interventions should particularly target older people, people with a low educational level, and people with a more conservative political ideology.
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Fendrich M, Avci O, Johnson TP, Mackesy-Amiti ME. Depression, substance use and HIV risk in a probability sample of men who have sex with men. Addict Behav 2013; 38:1715-8. [PMID: 23254224 PMCID: PMC3619198 DOI: 10.1016/j.addbeh.2012.09.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 09/05/2012] [Accepted: 09/05/2012] [Indexed: 11/20/2022]
Abstract
The persistent HIV epidemic among men who have sex with men (MSM) suggests that continued research on factors associated with risky sexual behavior is necessary. Drawing on prior literature, the role of depression and substance use in HIV risk is also inconclusive. Generalizability of past findings may also be limited to the extent that research has not employed probability samples. Here we report on one of the few probability samples of MSM to examine the role of depressive symptoms and substance use on risky sexual behavior (RSB). Multinomial logistic regression analysis suggested that depression and substance use are independently linked to our risk measure, such that those reporting high levels of depressive symptoms or substance use were more likely to report both unprotected receptive anal intercourse and unprotected insertive anal intercourse, and sex with a risky partner. Implications for prevention and treatment are discussed.
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Affiliation(s)
- Michael Fendrich
- Center for Applied Behavioral Health Research, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, United States.
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Greifinger R, Batchelor M, Fair C. Improving Engagement and Retention in Adult Care Settings for Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) Youth Living with HIV: Recommendations for Health Care Providers. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2013. [DOI: 10.1080/19359705.2013.739533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE With wide-reaching harmful effects of depression, and the absence of psychiatric treatment in most HIV care programs in sub-Saharan Africa, we examined the effects of antiretroviral therapy (ART) on depression and other mental health indicators. METHODS 602 patients (302 non-ART, 300 ART) were followed for the first 12 months of HIV care in Uganda, with assessments at entry into care and Months 6 and 12. Mental health was assessed with measures of depression, hopelessness, and internalized HIV stigma; physical health functioning was assessed as an explanatory variable. RESULTS Thirteen percent had clinical depression, 57% had elevated depressive symptoms, and CD4 cell count was negatively correlated with measures of depression at baseline. Significant reductions in elevated depressive symptoms (time: odds ratio [95% confidence interval] = 0.53 [0.43-0.64]) and hopelessness (time: β = -0.12, p < .001) were observed in both the ART and non-ART groups, but the drop in depression was greater among ART patients in intention-to-treat multivariate analysis (ART × time: p < .001). When added to the regression models, change in physical health functioning predicted positive longitudinal change on measures of depression, hopelessness, and internalized stigma (all p values < .001), yet ART status remained a significant independent predictor of each (ART × time: p values ranged from < .05 to < .001). Most mental health benefits of ART were experienced in the first 6 months of care. CONCLUSIONS These findings demonstrate the mental health benefits of HIV care and ART. However, in some people, mental health problems persist once physical health is stabilized, in which case mental health treatment may be needed.
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Martinez J, Harper G, Carleton RA, Hosek S, Bojan K, Clum G, Ellen, and the Adolescent Medicine J, Ellen J. The impact of stigma on medication adherence among HIV-positive adolescent and young adult females and the moderating effects of coping and satisfaction with health care. AIDS Patient Care STDS 2012; 26:108-15. [PMID: 22149767 DOI: 10.1089/apc.2011.0178] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To explore whether HIV stigma negatively impacts adherence to antiviral medications in HIV-infected adolescent women, moderational analysis was conducted and factors identified that could alter said relationship. Study participants were 178 adolescent females age 15-24, enrolled between 2003-2005, from 5 different cities and 60 provided adherence information. Findings reported by this cohort of 60 adolescent women included: medication adherence, 64.3% reporting adherence at baseline and 45.0% at 12 months; HIV stigma score of 57.60 (standard deviation [SD], 11.83; range, 25-86). HIV stigma was not found to be a significant predictor when binary logit regression was run with medication adherence at 1 year. Using moderational analysis, factors that could moderate stigma's effect on medication adherence was still pursued and identified the following to be significant at 12 months: health care satisfaction (B = -0.020, standard error [SE] = 0.010, p < .05); and Coping (proactive coping strategies [B = 0.012, SE = 0.005, p < .05]; turning to family [B = 0.012, SE = 0.016, p < 0.05]; spiritual coping [B = 0.021, SE = 0.010, p < 0.05]; professional help [B = 0.021, SE = 0.010, p < 0.05]; physical diversions [B = 0.016, SE = 0.007, p < 0.05]). Factors that had no significant moderating effects included: social support measures (mean = 74.9; median = 74.0) and depression score greater than 16 = 43%. We conclude that HIV-infected adolescent women experience HIV stigma and poor adherence over time. Factors like health care satisfaction and coping may minimize stigma's effect on medication adherence. Our findings are tempered by a small sample size and lack of a direct relationship between stigma and adherence on binary logit regression analysis.
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Affiliation(s)
- Jaime Martinez
- Division of Adolescent and Young Adult Medicine, Stroger Hospital of Cook County, Chicago, Illinois
| | - Gary Harper
- Department of Psychology, DePaul University, Chicago Illinois
| | | | - Sybil Hosek
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois
| | - Kelly Bojan
- Ruth Rothstein CORE Center/John Stroger Jr. Hospital, Chicago, Illinois
| | - Gretchen Clum
- Tulane University School of Public Health and Tropical Medicine; Department of Community Health Sciences; New Orleans, Louisian
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