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Nilsson Schönnesson L, Dahlberg M, Reinius M, Zeluf-Andersson G, Ekström AM, Eriksson LE. Prevalence of HIV-related stigma manifestations and their contributing factors among people living with HIV in Sweden - a nationwide study. BMC Public Health 2024; 24:1360. [PMID: 38769531 PMCID: PMC11106865 DOI: 10.1186/s12889-024-18852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND With access to antiretroviral therapy (ART) HIV infection is a chronic manageable condition and non-sexually transmissible. Yet, many people living with HIV still testify about experiencing HIV-related stigma and discrimination. It is well-documented that HIV-related stigma and discrimination continue to be critical barriers to prevention, treatment, care and quality of life. From an individual stigma-reduction intervention perspective, it is essential to identify individual and interpersonal factors associated with HIV-related stigma manifestations. To address this issue and to expand the literature, the aim of this study was to assess the prevalence of HIV-related stigma manifestations and their associated factors among a diverse sample of people living with HIV in Sweden. METHOD Data from 1 096 participants were derived from a nationally representative, anonymous cross-sectional survey "Living with HIV in Sweden". HIV-related stigma manifestations were assessed using the validated Swedish 12-item HIV Stigma Scale encompassing four HIV-related stigma manifestations: personalised stigma, concerns with public attitudes towards people living with HIV, concerns with sharing HIV status, and internalized stigma. Variables potentially associated with the HIV-related stigma manifestations were divided into four categories: demographic characteristics, clinical HIV factors, distress and ART adherence, and available emotional HIV-related support. Four multivariable hierarchical linear regression analyses were employed to explore the associations between multiple contributors and HIV-related stigma manifestations. RESULTS The most dominating stigma feature was anticipation of HIV-related stigma. It was manifested in high scores on concerns with sharing HIV status reported by 78% of the participants and high scores on concerns about public attitudes towards people living with HIV reported by 54% of the participants. High scores on personalised stigma and internalized stigma were reported by around one third of the participants respectively. Between 23 and 31% of the variance of the four reported HIV-related stigma manifestations were explained mainly by the same pattern of associated factors including female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support. CONCLUSION The most dominating stigma feature was anticipation of stigma. Female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support constituted potential vulnerability factors of the four HIV-related stigma manifestations. Our findings highlight the vital necessity to support people living with HIV to increase their resilience to stigma in its different forms. Exploring associated factors of HIV-related stigma manifestations may give an indication of what circumstances may increase the risk of stigma burden and factors amenable to targeted interventions. As individual stigma-reductions interventions cannot be performed isolated from HIV-related stigma and discrimination in society, a key challenge is to intensify anti-stigma interventions also on the societal level.
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Affiliation(s)
| | - Marie Dahlberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna-Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital/Venhälsan, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Psychological Sciences, City, University of London, London, UK
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
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Amirkhanian YA, Meylakhs AY, Kuznetsova AV, Kelly JA, Quinn KG. AIDSimpact special issue: stigma, serostatus disclosure, coping strategies, and the role of social capital resources among HIV care-nonadherent MSM in Russia: a qualitative analysis. AIDS Care 2024:1-9. [PMID: 38289620 DOI: 10.1080/09540121.2024.2305785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/10/2024] [Indexed: 02/13/2024]
Abstract
The HIV epidemic continues to expand in Russia, with suboptimal levels of care uptake. This qualitative study aimed to characterize social capital resources and lived stigma experiences, coping, and disclosure among care-nonadherent men who have sex with men (MSM) living with HIV in Russia. Twenty-five HIV-positive MSM - recruited online - completed in-depth interviews over Zoom, with data analyzed using MAXQDA software. Stigma was more likely to be encountered in interactions with persons with whom social ties were weaker such as medical providers and relatives, particularly males. Close friends - often other HIV-positive MSM and female relatives - were the most supportive and least stigmatizing. Similar persons were most often considered for HIV serostatus disclosure. Coping strategies to reduce the impact of stigma included ignoring stigmatizing experiences, seeking support from members of one's social circle, minimizing contact with stigmatizing persons, seeking new relationships with persons who are also HIV-positive, proactively reducing stigma through involvement in advocacy roles, and correcting myths and educating others about HIV infection. These findings underscore the need for interventions to assist HIV-positive MSM in building accepting social capital resources to reduce the impact of stigma and to build support within their social networks, often with other HIV-positive MSM.
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Affiliation(s)
- Yuri A Amirkhanian
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anastasia Y Meylakhs
- Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia
| | - Anna V Kuznetsova
- Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia
| | - Jeffrey A Kelly
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
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Meza-Rodríguez MDP, Farfan-Labonne B, Avila-García M, Figueroa-Damian R, Plazola-Camacho N, Pellón-Díaz G, Ríos-Flores BA, Olivas-Peña E, Leff-Gelman P, Camacho-Arroyo I. Psychological distress, anxiety, depression, stress level, and coping style in HIV-pregnant women in Mexico. BMC Psychol 2023; 11:366. [PMID: 37915068 PMCID: PMC10621089 DOI: 10.1186/s40359-023-01416-8] [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: 05/24/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE To evaluate the presence of psychological distress (PD) and its association with the mental health and coping styles of pregnant women living with HIV (PWLWH). METHOD An observational, cross-sectional descriptive study was performed. Seventy-three PWLWH were included. Patients responded to a psychometric battery for PD, depression, anxiety, stress, and coping style evaluation. The scales used in the study were: Goldberg's 30-item General Health Questionnaire (GHQ-30), State-Trait Anxiety Inventory (STAI), Zung Depression Self-Measurement Scale (ZDS), Nowack Stress Profile, Lazarus and Folkman's Coping Styles Questionnaire. RESULTS PD was observed in 31.5% of the participants. PD-positive patients showed a higher probability of presenting traits of depression and anxiety and medium/high stress levels. Besides, they preferentially used emotion-focused coping styles. CONCLUSION PD is associated with a higher probability of presenting anxiety and depression in PWLWH. Emotion-focused coping style could be a factor in decision-making associated with risk behaviors in PWLWH.
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Affiliation(s)
- María Del Pilar Meza-Rodríguez
- Coordinación de Investigación en Psicología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Blanca Farfan-Labonne
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Miroslava Avila-García
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Ricardo Figueroa-Damian
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Noemí Plazola-Camacho
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Gabriela Pellón-Díaz
- Departamento de Neurociencias, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Braulio Alfonso Ríos-Flores
- Departamento de Neurociencias, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Efraín Olivas-Peña
- Departamento de Neurociencias, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Phillipe Leff-Gelman
- Departamento de Investigación en Salud Reproductiva y Perinatal, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Ignacio Camacho-Arroyo
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, Montes Urales 800, Lomas de Chapultepec Miguel Hidalgo, Ciudad de México, C.P. 11000, México.
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Sianturi EI, Latifah E, Gunawan E, Sihombing RB, Parut AA, Perwitasari DA. Adaptive Stigma Coping Among Papuans Living with HIV: a Qualitative Study in One of the Indigenous People, Indonesia. J Racial Ethn Health Disparities 2023; 10:2244-2251. [PMID: 36042114 DOI: 10.1007/s40615-022-01403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The indigenous Papuans of Indonesia's Tanah Papua Island have been a distinct cultural and racial entity from the rest of the country's inhabitants. Furthermore, antiretroviral therapy's inability to reduce mortality and incidence rates in this region has sparked public interest in HIV issues, which has resulted in increased stigma. Papuans were more interested in memorizing the symptoms than using antiretroviral as an effective therapy. This study aimed to analyze the coping level of HIV-infected Papuans to overcome related stigma. METHODS A qualitative study was conducted with data collected through semi-structured interviews in 2018, and 13 Papuans who had experiences with antiretroviral therapy (ART) participated in audio-recorded interviews. The discussions were focused on the ways to deal with stigma after the HIV diagnosis. Furthermore, data were transcribed verbatim using the framework analysis for qualitative study. RESULTS According to the study results, Papuans were shown to have effectively used self-distancing, self-blame, and self-stigmatization coping mechanisms, according to the results. The people temporarily utilize ART until their health returns to normal. CONCLUSIONS This study indicates that ART has been used to cope with stigma. However, the use was temporary since the misunderstanding regarding use of ART remains high. ART education should be addressed since Papuans are willing to adopt the method provided the benefits are fully comprehended. In addition, the participation of healthcare workers such as pharmacies should be increased since they can explain antiretroviral terms.
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Affiliation(s)
- E I Sianturi
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Cenderawasih, Abepura, Indonesia.
| | - E Latifah
- Department of Pharmacy, Faculty of Health Science, Universitas Muhammadiyah Magelang, Magelang, Indonesia
| | - E Gunawan
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Cenderawasih, Abepura, Indonesia
| | | | | | - D A Perwitasari
- Faculty of Pharmacy, University of Ahmad Dahlan, Yogyakarta, Indonesia
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Wei L, Yan H, Guo M, Tian J, Jiang Q, Zhai M, Zhu B, Yin X, Liao Y, Yu B. Perceived HIV Stigma, Depressive Symptoms, Self-esteem, and Suicidal Ideation Among People Living with HIV/AIDS in China: a Moderated Mediation Modeling Analysis. J Racial Ethn Health Disparities 2023; 10:671-679. [PMID: 35165837 PMCID: PMC8853186 DOI: 10.1007/s40615-022-01255-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Suicidal ideation is an important public health challenge among people living with HIV (PLWH) across the world and in China. HIV stigma, depression, and self-esteem have been associated with suicidal ideation. However, the underlying mechanisms remain not fully understood. METHODS Study data were derived from a sample of 465 PLWH in China. Suicidal ideation after HIV diagnosis was used as outcome variable. HIV stigma, depressive symptoms, and self-esteem were measured using reliable instruments and used as predictor, mediator, and moderator, respectively. Mediation and moderated mediation model were used for data analysis. RESULTS 31.6% of PLWH in China had suicidal ideation after HIV diagnosis. The association between perceived HIV stigma and suicidal ideation was partially mediated by depression (indirect effect = 0.02, 95% CI = [0.02, 0.03]) with the path from perceived HIV stigma to depressive symptoms being moderated by self-esteem (interaction effect = - 0.02, 95% CI [- 0.03, - 0.01]). CONCLUSIONS Study findings suggested a mediation mechanism of HIV stigma on suicidal ideation through depressive symptoms, and self-esteem might weaken the mediation mechanism by moderating the perceived HIV stigma-depressive symptoms pathway.
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Affiliation(s)
- Liqing Wei
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Hong Yan
- School of Public Health, Wuhan University, Wuhan, 430072, China.
| | - Menglan Guo
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Jiawei Tian
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Qingqing Jiang
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Mengxi Zhai
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Biao Zhu
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Xiaohong Yin
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Yu Liao
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Bin Yu
- School of Public Health, Wuhan University, Wuhan, 430072, China
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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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Gendered Experiences of Living with HIV in Australia. SEXES 2021. [DOI: 10.3390/sexes2030020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Globally, women represent more than half the people living with HIV. This proportion varies by country, with an over-representation of HIV among men who have sex with men (MSM) in some regions. For example, in Australia, MSM account for over 60% of transmissions, with heterosexual sex accounting for almost a quarter of transmissions. Irrespective of geographic region, there is evidence that women can have a different lived experience of HIV due to their unequal social and economic status in society, while MSM can have a different lived experience depending on the laws and customs of their geographic location. Gender differences related to risk factors, stigma, access to services, mental health, health-related quality of life and economic consequences have been consistently reported globally. This paper explores the subjective lived experience of gender and sexuality disparities among three individuals living with HIV in Australia: a male who identified as gay, and a male and female who each identified as heterosexual. Analysis of themes from these three case reports indicated discernible differences by gender and sexuality in four areas: access to medical services, social support, stigma and mental health. It is argued that knowledge and understanding of potential gender and sexuality disparities must be factored into supportive interventions for people living with HIV in Australia.
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