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Causevic S, Ekström AM, Orsini N, Kagesten A, Strömdahl S, Salazar M. Prevalence and associated factors for poor mental health among young migrants in Sweden: a cross-sectional study. Glob Health Action 2024; 17:2294592. [PMID: 38180014 PMCID: PMC10773640 DOI: 10.1080/16549716.2023.2294592] [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: 06/21/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Young migrants face multiple challenges that can affect their mental, sexual and reproductive health. OBJECTIVE To assess the prevalence of self-reported poor mental health and its associated demographic, post-migration and sexual risk behaviour factors among young migrants (aged 15-25) in Sweden. METHODS Data were drawn from a cross-sectional survey conducted with migrants aged 15-65 years old in Sweden between December 2018 and November 2019 (n = 6449). Among these, 990 participants aged 15-25 were eligible for the study. Mental health was measured using the Refugee Health Screener-13. Missing data indicator analysis and multivariable logistic regression models were conducted to estimate the association between mental health, sexual risk behaviour, demographic and migration-related variables. RESULTS Of the 990 participants, 59% reported poor mental health. Participants reporting poor mental health were more likely to be female (AOR:1.63, 95% CI:1.18-2.25), to have lived in Sweden more than three years (AOR:2.16, 95% CI:1.17-3.97), to engage in any sexual risk behaviour (AOR:1.99, 95% CI:1.25-3.17), and to live alone (AOR:1.95, 95% CI:1.25-3.03) or with friends they already knew (AOR:1.60, 95% CI:1.37-4.91). People arriving from the Americas (AOR:0.54, 95% CI:0.33-0.88), Asia (AOR:0.44, 95% CI:0.22-0.86), Europe (AOR:0.30, 95% CI:0.14-0.61) and Africa (AOR 0.37, 95% CI: 0.23-0.60) had lower odds of poor mental health than those arriving from Syria. CONCLUSION The prevalence of poor mental health among young migrants in Sweden was high, with specific subgroups (women, asylum seekers, people arriving from Syria, and those residing longer in Sweden) being particularly vulnerable. Our results indicate the interconnectedness between poor mental health and sexual risk behaviour in this population. Thus, policies targeting young migrants should ensure that healthcare services screen for both poor sexual and mental health at the same time.
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Affiliation(s)
- Sara Causevic
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Anna Mia Ekström
- Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Stockholm, Sweden
- Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
| | - Nicola Orsini
- Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Stockholm, Sweden
| | - Anna Kagesten
- Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Stockholm, Sweden
| | - Susanne Strömdahl
- Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Stockholm, Sweden
- Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
- Swedish Public Health Agency, Stockholm, Sweden
| | - Mariano Salazar
- Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Stockholm, Sweden
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Drumright LN, Johnson MO, Mayer KH, Christopoulos K, Cachay E, Crawford TN, Whitney BM, Dai M, Ruderman SA, Mixson LS, Keruly JC, Chander G, Saag MS, Kitahata MM, Moore RD, Willig AL, Eron JJ, Napravnik S, Nance RM, Hahn A, Ma J, Bamford L, Fredericksen RJ, Delaney JAC, Crane HM. Differences in internalized HIV stigma across subpopulations of people with HIV in care across the United States. AIDS 2024; 38:1206-1215. [PMID: 38349228 PMCID: PMC11144440 DOI: 10.1097/qad.0000000000003864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Few studies have examined which subgroups of people with HIV (PWH) carry the greatest burden of internalized HIV stigma (IHS), which may be important to care provision and interventions. METHODS PWH in the CFAR Network of Integrated Clinical Systems (CNICS) longitudinal, US-based, multisite, clinical care cohort completed tablet-based assessments during clinic visits including a four-item, Likert scale (low 1-5 high), IHS instrument. Associations between sociodemographic characteristics and IHS scores were assessed in adjusted linear regression models. RESULTS Twelve thousand six hundred and fifty-six PWH completed the IHS assessment at least once from February 2016 to November 2022, providing 28 559 IHS assessments. At baseline IHS assessment, the mean age was 49 years, 41% reported White, 38% Black/African American, and 16% Latine race/ethnicity, and 80% were cisgender men. The mean IHS score was 2.04, with all subgroups represented among those endorsing IHS. In regression analyses, younger PWH and those in care fewer years had higher IHS scores. In addition, cisgender women vs. cisgender men, PWH residing in the West vs. the Southeast, and those with sexual identities other than gay/lesbian had higher IHS scores. Compared with White-identifying PWH, those who identified with Black/African American or Latine race/ethnicity had lower IHS scores. Age stratification revealed patterns related to age category, including specific age-related differences by gender, geographic region and race/ethnicity. DISCUSSION IHS is prevalent among PWH, with differential burden by subgroups of PWH. These findings highlight the benefits of routine screening for IHS and suggest the need for targeting/tailoring interventions to reduce IHS among PWH.
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Affiliation(s)
| | | | | | | | | | | | | | - Mindy Dai
- University of Washington, Seattle, WA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jimmy Ma
- University of Washington, Seattle, WA
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Eschliman EL, Hoang D, Khoshnam N, Ye V, Kokaze H, Ji Y, Zhong Y, Morumganti A, Xi W, Huang S, Choe K, Poku OB, Alvarez G, Nguyen T, Nguyen NT, Shelley D, Yang LH. A "What Matters Most" approach to investigating intersectional stigma toward HIV and cancer in Hanoi, Vietnam. J Natl Cancer Inst Monogr 2024; 2024:11-19. [PMID: 38836524 PMCID: PMC11151327 DOI: 10.1093/jncimonographs/lgae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/11/2023] [Accepted: 01/04/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Vietnam is experiencing a growing burden of cancer, including among people living with HIV. Stigma acts as a sociocultural barrier to the prevention and treatment of both conditions. This study investigates how cultural notions of "respected personhood" (or "what matters most") influence manifestations of HIV-related stigma and cancer stigma in Hanoi, Vietnam. METHODS Thirty in-depth interviews were conducted with people living with HIV in Hanoi, Vietnam. Transcripts were thematically coded via a directed content analysis using the What Matters Most conceptual framework. Coding was done individually and discussed in pairs, and any discrepancies were reconciled in full-team meetings. RESULTS Analyses elucidated that having chữ tín-a value reflecting social involvement, conscientiousness, and trustworthiness-and being successful (eg, in career, academics, or one's personal life) are characteristics of respected people in this local cultural context. Living with HIV and having cancer were seen as stigmatized and interfering with these values and capabilities. Intersectional stigma toward having both conditions was seen to interplay with these values in some ways that had distinctions compared with stigma toward either condition alone. Participants also articulated how cultural values like chữ tín are broadly protective against stigmatization and how getting treatment and maintaining employment can help individuals resist stigmatization's most acute impacts. CONCLUSIONS HIV-related and cancer stigma each interfere with important cultural values and capabilities in Vietnam. Understanding these cultural manifestations of these stigmas separately and intersectionally can allow for greater ability to measure and respond to these stigmas through culturally tailored intervention.
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Affiliation(s)
- Evan L Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dung Hoang
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Nasim Khoshnam
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Vivian Ye
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Haruka Kokaze
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Yatong Ji
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Yining Zhong
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | | | - Wenyu Xi
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Sijia Huang
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Karen Choe
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Ohemaa B Poku
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Gloria Alvarez
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Trang Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | | | - Donna Shelley
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Lawrence H Yang
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
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Pitt A, Lerigo F, Satherley RM. Health-Related Stigma and Challenges Faced by Men Living with Celiac Disease: A Qualitative Analysis. J Acad Nutr Diet 2024; 124:674-685. [PMID: 38040116 DOI: 10.1016/j.jand.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Celiac disease (CD) is an autoimmune condition managed by strict adherence to a gluten-free diet. Dietary choice has gendered connotations, and men with CD may face judgment from others when following a gluten-free diet. However, little is known about health-related stigma in men with CD. OBJECTIVES The study aim was to explore the health-related stigma and challenges faced by men with CD, and the influence of CD on their lives. METHODS Qualitative semistructured online interviews were conducted with men living with CD. PARTICIPANTS Twenty adults (aged 18 years or older) identifying as men living in the United Kingdom, with self-reported CD, were recruited using social media and opportunistic sampling. STATISTICAL ANALYSES Participants provided rich, detailed discussions about aspects of their experience of living with CD. Reflexive thematic analysis was used, with a critical-realist lens that enabled researchers to connect men's experiences within wider sociocultural constructs such as masculinity and social identity. RESULTS Three themes were identified: CD threatens social inclusion; others' assumptions about CD and microaggressions have a psychological influence, and masculine norms, health-related stigma, and power dynamics influence men's health behaviors and everyday experience. Health-related stigma was found to be interconnected with these men's gendered social environment, suggesting that may be an important social and structural determinant of dietary, health-related, and health support-seeking behaviors in men diagnosed with CD. CONCLUSIONS Contrary to prior assumptions, health-related stigma influences men with CD of all ages, particularly in social settings. The study unveils the complex interplay of individual beliefs, social norms, and power dynamics, in particular with other men, that influence individual beliefs and emphasize the performative aspect of food consumption. Internalized stigma and microaggressions influence men's well-being. To better support men with CD, health providers, charitable organizations, and the food industry should address the social influence of adherence to a gluten-free diet, in particular perceived threats to social status and inclusion, which may cause concern, influence food choice, and influence dietary adherence.
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Affiliation(s)
- Angie Pitt
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, Surrey, United Kingdom
| | - Fiona Lerigo
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Rose-Marie Satherley
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, United Kingdom.
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Baillie J, Gill P, Courtenay M. Perceptions of peritonitis risk, prevention, diagnosis and stigma: Findings from a mixed methods study with patients and relatives using peritoneal dialysis. J Ren Care 2024; 50:138-150. [PMID: 36946307 DOI: 10.1111/jorc.12464] [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: 09/30/2022] [Revised: 01/27/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Peritonitis is the main treatment-related complication of peritoneal dialysis and a primary concern for patients and their relatives. Therefore, understanding their perceptions of peritonitis is important. OBJECTIVES To explore patients' and relatives' perceptions of peritoneal dialysis-associated peritonitis risk, prevention measures and experiences of diagnosis, and experience of perceived stigma. DESIGN A sequential mixed methods study design was used, including a questionnaire and semi-structured interviews. PARTICIPANTS Patients using peritoneal dialysis and relatives (n = 75) from six National Health Service organisations from the United Kingdom. MEASUREMENTS A structured questionnaire was administered with patients and relatives (n = 75) using peritoneal dialysis; data were analysed using descriptive statistics. Thirty questionnaire respondents were then purposively sampled and interviewed in-depth; data were analysed thematically. Data were collected 2017-2018. Ethical and governance approvals were gained. RESULTS Qualitative and quantitative analyses were integrated and three themes presented: • Perceptions of risk: participants assessed their risk of developing peritonitis and possible implications on their health and relatives. Participants felt greatly responsible for preventing infection. • Preventing peritonitis: participants reported similar and some differing measures to minimise their risk of developing peritonitis. Participants wanted to be seen as "clean". • Diagnosis of peritonitis: peritonitis diagnosis was embarrassing and stigmatising for many individuals. This was influenced by the response of healthcare professionals and the cause of peritonitis. CONCLUSIONS It is important that healthcare professionals are aware of how responsible patients and relatives feel about preventing peritonitis, the emotional effect of this responsibility and crucially the impact this may have on seeking help.
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Affiliation(s)
- Jessica Baillie
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Paul Gill
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Pulerwitz J, Gottert A, Tun W, Eromhonsele AF, Oladimeji PL, Shoyemi E, Akoro M, Ndeloa C, Adedimeji A. Reducing stigma and promoting HIV wellness/mental health of sexual and gender minorities: RCT results from a group-based programme in Nigeria. J Int AIDS Soc 2024; 27:e26256. [PMID: 38837614 DOI: 10.1002/jia2.26256] [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: 07/16/2023] [Accepted: 04/15/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION High levels of HIV stigma as well as stigma directed towards sexual and/or gender minorities (SGMs) are well documented in the African setting. These intersecting stigmas impede psychosocial wellbeing and HIV prevention and care. Yet, there are few if any evidence-based interventions that focus on reducing internalized stigma and promoting mental health and HIV wellness for SGMs in Africa. We developed and evaluated a group-based intervention drawing on cognitive behavioural therapy (CBT) strategies for men who have sex with men (MSM) and transgender women (TGW) at risk for or living with HIV in Lagos, Nigeria. METHODS The intervention comprised four weekly in-person group sessions facilitated by community health workers. We conducted a delayed intervention group randomized controlled trial (April-September 2022), with pre-post surveys plus 3-month follow-up (immediate group only), as well as qualitative research with participants and programme staff. Outcomes included internalized stigma related to SGM and HIV status, depression, resiliency/coping and pre-exposure prophylaxis (PrEP)/HIV treatment use. RESULTS Mean age of the 240 participants was 26 years (range 18-42). Seventy-seven percent self-identified as MSM and 23% TGW; 27% were people with HIV. Most (88%) participants attended all four sessions, and 98% expressed high intervention satisfaction. There was significant pre-post improvement in each psychosocial outcome, in both the immediate and delayed arms. There were further positive changes for the immediate intervention group by 3-month follow-up (e.g. in intersectional internalized stigma, depression). While baseline levels of ever-PrEP use were the same, 75% of immediate-group participants reported currently using PrEP at 3 months post-intervention versus 53% of delayed-group participants right after the intervention (p<0.01). Participants post-intervention described (in qualitative interviews) less self-blame, and enhanced social support and resilience when facing stigma, as well as motivation to use PrEP, and indicated that positive pre-intervention changes in psychosocial factors found in the delayed group mainly reflected perceived support from the study interviewers. CONCLUSIONS This study demonstrated the feasibility and acceptability of a group-based CBT model for MSM and TGW in Nigeria. There were also some indications of positive shifts related to stigma, mental health and PrEP, despite issues with maintaining the randomized design in this challenging environment.
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Affiliation(s)
- Julie Pulerwitz
- Social and Behavioural Science Research Division, Population Council, Washington, DC, USA
| | - Ann Gottert
- Social and Behavioural Science Research Division, Population Council, Washington, DC, USA
| | - Waimar Tun
- Social and Behavioural Science Research Division, Population Council, Washington, DC, USA
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Nabunya P, Ssewamala FM, Kizito S, Mugisha J, Brathwaite R, Neilands TB, Migadde H, Namuwonge F, Ssentumbwe V, Najjuuko C, Sensoy Bahar O, Mwebembezi A, McKay MM. Preliminary Impact of Group-Based Interventions on Stigma, Mental Health, and Treatment Adherence Among Adolescents Living with Human Immunodeficiency Virus in Uganda. J Pediatr 2024; 269:113983. [PMID: 38401789 PMCID: PMC11095998 DOI: 10.1016/j.jpeds.2024.113983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/13/2024] [Accepted: 02/18/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To examine the preliminary impact of group cognitive behavioral therapy and multiple family group-based family strengthening to address HIV stigma and improve the mental health functioning of adolescents living with HIV in Uganda. STUDY DESIGN We analyzed data from the Suubi4Stigma study, a 2-year pilot randomized clinical trial that recruited adolescents living with HIV (10-14 years) and their caregivers (n = 89 dyads), from 9 health clinics. We fitted separate three-level mixed-effects linear regression models to test the effect of the interventions on adolescent outcomes at 3 and 6 months post intervention initiation. RESULTS The average age was 12.2 years and 56% of participants were females. Participants in the multiple family group-based family strengthening intervention reported lower levels of internalized stigma (mean difference = -0.008, 95% CI = -0.015, -0.001, P = .025) and depressive symptoms at 3 months (mean difference = -0.34, 95% CI = -0.53, -0.14, P < .001), compared with usual care. On the other hand, participants in the group cognitive behavioral therapy intervention reported lower levels of anticipated stigma at 3 months (mean difference = -0.039, 95% CI = -0.072, -0.006), P = .013) and improved self-concept at 6 months follow-up (mean difference = 0.04, 95% CI = 0.01, 0.01, P = .025). CONCLUSION Outcome trends from this pilot study provide compelling evidence to support testing the efficacy of these group-based interventions on a larger scale. TRIAL REGISTRATION The study is registered in the Clinical trials.gov database (Identifier #: NCT04528732).
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO.
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rachel Brathwaite
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Torsten B Neilands
- Division of Prevention Science, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Herbert Migadde
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Claire Najjuuko
- Division of Computational & Data Sciences, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | | | - Mary M McKay
- Vice Provost Office, Washington University in St. Louis, St. Louis, MO
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Filiatreau LM, Ebasone PV, Dzudie A, Wainberg M, Yotebieng M, Anastos K, Parcesepe AM. Intersectional HIV- and Depression-Related Stigma Among People with HIV Entering HIV Care in Cameroon. AIDS Behav 2024:10.1007/s10461-024-04375-2. [PMID: 38767726 DOI: 10.1007/s10461-024-04375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Mental health-related stigma is a prominent barrier to improved mental health outcomes globally and may be particularly harmful to populations with other stigmatized identities. We aimed to understand intersectional depression- and HIV-related stigma among people with HIV (PWH) entering HIV care in Cameroon. Using baseline data from a cohort of PWH entering HIV care in Cameroon between 2019 and 2020, we characterized depression- and HIV-related stigma in the population overall and by sociodemographic sub-group. We also explored substantively meaningful variation in stigma endorsement by depressive symptom severity (Patient Health Questionnaire-9 [PHQ-9]) and causal attribution of depression. Among those with elevated depressive symptoms (PHQ-9 scores > 4), we estimated the association between stigma type and depressive symptom severity using binomial regression. Among 398 participants, 49% endorsed low HIV- and depression-related stigma (N = 195), 10% endorsed high HIV- and depression-related stigma (N = 38), 29% endorsed high depression-related stigma only (N = 116), and 12% endorsed high HIV-related stigma only (N = 49). Respondents with and without heightened depressive symptoms commonly believed depressive symptoms were caused by HIV (N = 140; 32.9%). Among those with elevated depressive symptoms, the prevalence of moderate to severe symptoms was higher among those endorsing high HIV-related stigma only (prevalence ratio 1.55; 95% confidence interval: 1.01, 2.37) compared to those reporting low HIV- and depression-related stigma. HIV- and depression-related stigma are both common among PWH entering HIV care in Cameroon. The consistent association between HIV-related stigma and poor psychosocial well-being among people with HIV necessitates the urgent scale-up of evidence-based HIV-related stigma interventions specifically.
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Affiliation(s)
- Lindsey M Filiatreau
- School of Medicine, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Rotejanaprasert C, Thanutchapat P, Phoncharoenwirot C, Mekchaiporn O, Chienwichai P, Maude RJ. Investigating the spatiotemporal patterns and clustering of attendances for mental health services to inform policy and resource allocation in Thailand. Int J Ment Health Syst 2024; 18:19. [PMID: 38725054 PMCID: PMC11080131 DOI: 10.1186/s13033-024-00639-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Mental illness poses a substantial global public health challenge, including in Thailand, where exploration of access to mental health services is limited. The spatial and temporal dimensions of mental illness in the country are not extensively studied, despite the recognized association between poor mental health and socioeconomic inequalities. Gaining insights into these dimensions is crucial for effective public health interventions and resource allocation. METHODS This retrospective study analyzed mental health service utilization data in Thailand from 2015 to 2023. Temporal trends in annual numbers of individuals visiting mental health services by diagnosis were examined, while spatial pattern analysis employed Moran's I statistics to assess autocorrelation, identify small-area clustering, and hotspots. The implications of our findings for mental health resource allocation and policy were discussed. RESULTS Between 2015 and 2023, mental health facilities documented a total of 13,793,884 visits. The study found anxiety, schizophrenia, and depression emerged as the top three illnesses for mental health visits, with an increase in patient attendance following the onset of the COVID-19 outbreak. Spatial analysis identified areas of significance for various disorders across different regions of Thailand. Positive correlations between certain disorder pairs were found in specific regions, suggesting shared risk factors or comorbidities. CONCLUSIONS This study highlights spatial and temporal variations in individuals visiting services for different mental disorders in Thailand, shedding light on service gaps and socioeconomic issues. Addressing these disparities requires increased attention to mental health, the development of appropriate interventions, and overcoming barriers to accessibility. The findings provide a baseline for policymakers and stakeholders to allocate resources and implement culturally responsive interventions to improve mental health outcomes.
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Affiliation(s)
- Chawarat Rotejanaprasert
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Papin Thanutchapat
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
- Department of Computer Engineering, Faculty of Engineering, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Chiraphat Phoncharoenwirot
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
- Department of Computer Engineering, Faculty of Engineering, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Ornrakorn Mekchaiporn
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
- Department of Computer Engineering, Faculty of Engineering, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Peerut Chienwichai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The Open University, Milton Keynes, UK
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Nabunya P, Migadde H, Namuwonge F, Mugisha J, Kirabo W, Ssentumbwe V, Claire N, Raymond A, Bahar OS, Mwebembezi A, McKay MM, Ssewamala FM. Feasibility and Acceptability of Group-Based Stigma Reduction Interventions for Adolescents Living with HIV and Their Caregivers: The Suubi4Stigma Randomized Clinical Trial (2020-2022). AIDS Behav 2024; 28:1630-1641. [PMID: 38308772 PMCID: PMC11070307 DOI: 10.1007/s10461-024-04284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
This study examined the feasibility and acceptability of two group-based interventions: group-cognitive behavioral therapy (G-CBT) and a family-strengthening intervention delivered via multiple family group (MFG-FS), to address HIV stigma among adolescents living with HIV (ALHIV) and their caregivers. A total of 147 adolescent -caregiver dyads from 9 health clinics situated within 7 political districts in Uganda were screened for eligibility. Of these, 89 dyads met the inclusion criteria and provided consent to participate in the study. Participants were randomized, at the clinic level, to one of three study conditions: Usual care, G-CBT or MFG-FS. The interventions were delivered over a 3-month period. While both adolescents and their caregivers attended the MFG-FS sessions, G-CBT sessions were only attended by adolescents. Data were collected at baseline, 3 and 6-months post intervention initiation. The retention rate was 94% over the study period. Across groups, intervention session attendance ranged between 85 and 92%, for all sessions. Fidelity of the intervention was between 85 and 100%, and both children and caregivers rated highly their satisfaction with the intervention sessions. ALHIV in Uganda, and most of sub-Saharan Africa, are still underrepresented in stigma reduction interventions. The Suubi4Stigma study was feasible and acceptable to adolescents and their caregivers -supporting testing the efficacy of the interventions in a larger trial.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA.
| | - Herbert Migadde
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Winnie Kirabo
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - Najjuuko Claire
- Division of Computational & Data Sciences, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, USA
| | - Atwebembere Raymond
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | | | - Mary M McKay
- Office of the Vice Provost, Washington University in St. Louis, St. Louis, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
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11
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Djordjevic M, Farhang S, Shirzadi M, Mousavi SB, Bruggeman R, Malek A, Mohagheghi A, Ranjbar F, Shafiee-Kandjani AR, Jongsma HE, Veling W. Self-stigma, religiosity, and perceived social support in people with recent-onset psychosis in the Islamic Republic of Iran: Associations with symptom severity and psychosocial functioning. Int J Soc Psychiatry 2024; 70:542-553. [PMID: 38312047 PMCID: PMC11067409 DOI: 10.1177/00207640231221090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
AIMS Most evidence on psychosocial factors in recent-onset psychosis comes from high-income countries in Europe, Australia, Canada and the USA, while these factors are likely to differ under varying sociocultural and economic circumstances. In this study, we aimed to investigate associations of self-stigma, religiosity and perceived social support with symptom severity and psychosocial functioning in an Iranian cohort of people with recent-onset psychosis (i.e. illness duration of <2 years). METHODS We used baseline data of 361 participants (N = 286 [74%] male, mean age = 34 years [Standard Deviation = 10.0]) from the Iranian Azeri Recent-onset Acute Phase Psychosis Survey (ARAS). We included assessments of self-stigma (Internalized Stigma of Mental Illness, ISMI), religiosity (based on Stark & Glock), perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS), symptom severity (Positive And Negative Syndrome Scale, PANSS) and psychosocial functioning (clinician-rated Global Assessment of Functioning Scale, GAF, and self-reported World Health Organization Disability Assessment Schedule 2.0, WHODAS 2.0). Descriptive analyses were employed to characterize the study sample. Covariate-adjusted ordinal and multivariable linear regression analyses were performed to investigate cross-sectional associations of baseline ISMI, religiosity and MSPSS with concurrent PANSS, GAF and WHODAS 2.0. RESULTS Higher self-stigma was associated with poorer self-reported functioning (B = 0.375 [95% Confidence Interval (CI): 0.186, 0.564]) and more severe concurrent symptoms (B = 0.436 [95% CI: 0.275, 0.597]). Being more religious was associated with poorer clinician-rated functioning (OR = 0.967 [95% CI: 0.944, 0.991]), but with less severe symptoms (B = -0.258 [95% CI: -0.427, -0.088]). Stronger social support was associated with poorer clinician-rated (OR = 0.956 [95% CI: 0.935, 0.978]) and self-reported functioning (B = 0.337 [95% CI: 0.168, 0.507]). CONCLUSION This study shows that self-stigma, religiosity and perceived social support were associated with symptom severity and clinician-rated as well as self-reported psychosocial functioning in an Iranian cohort of people with recent-onset psychosis. The findings extend previous evidence on these psychosocial factors to one of the largest countries in the Middle East, and suggest that it may be worthwhile to develop strategies aimed at tackling stigma around psychosis and integrate the role of religiosity and social support in mental ill-health prevention and therapy.
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Affiliation(s)
- M Djordjevic
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - S Farhang
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - M Shirzadi
- Clinical Research Development Center, Imam Khomeini, Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical
Sciences, Kermanshah, Iran
| | - SB Mousavi
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - R Bruggeman
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - A Malek
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - A Mohagheghi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - F Ranjbar
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - AR Shafiee-Kandjani
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - HE Jongsma
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - W Veling
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
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12
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Akyirem S, Ekpor E. Experience of stigma among persons with type 2 diabetes in Africa: a systematic review. Int Health 2024; 16:231-239. [PMID: 37366652 PMCID: PMC11062194 DOI: 10.1093/inthealth/ihad045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/27/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Diabetes stigma is a pervasive social phenomenon with significant impacts on individuals living with type 2 diabetes mellitus (T2DM). Despite the negative health impact of diabetes stigma, little is known about the experience of this phenomenon in Africa. This review aimed to synthesize existing quantitative and qualitative studies that examine the experiences and outcomes of T2DM stigma in Africa. A mixed studies review methodology was utilized to conduct this research. Relevant articles were identified by searching the Cumulative Index to Nursing and Allied Health Literature, PubMed, MEDLINE and PsycINFO databases. The mixed method appraisal tool was used to assess the quality of included studies. Of 2626 records identified, 10 articles met the inclusion criteria. The prevalence of diabetes stigma was as high as 70%. The results of the review indicate that individuals with T2DM in Africa are labelled as 'having HIV', 'nearing their death' and 'wasting resources'. These experiences were associated with low quality of life, disease concealment and avoidance of self-management behaviours. The findings highlight the urgent need for further stigma-centric studies to fully understand how T2DM stigma is experienced in Africa. The evidence from such studies would inform the development and evaluation of effective interventions to address this social consequence of T2DM.
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Affiliation(s)
- Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, Connecticut, 06511, USA
| | - Emmanuel Ekpor
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
- Christian Health Association of Ghana, University of Ghana, Legon, Accra, Ghana
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13
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AlHamawi R, Khader Y, Abaza H, Satyanarayana S, Wilson N, Saleh Abu Rumman A, Okkah K. Tuberculosis-related knowledge, practices, perceived stigma and discrimination among patients with tuberculosis: a cross-sectional study in Jordan. Infect Dis (Lond) 2024; 56:359-375. [PMID: 38329456 DOI: 10.1080/23744235.2024.2311292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Tuberculosis knowledge, practices, and perceived stigma and discrimination among patients with tuberculosis are key factors for the management of the disease. OBJECTIVES The objectives of the study were to assess knowledge, practices, perceived stigma and discrimination, perceived family and health workers support, perceived level of satisfaction with healthcare services, delay in diagnosis/treatment and reasons for delay among patients with tuberculosis in Jordan. METHODS A cross-sectional study was conducted among patients who were under treatment for tuberculosis in Jordan in 2021. RESULTS This study included a total of 452 patients with tuberculosis. About 91.4% of patients had low to moderate overall tuberculosis-related knowledge score and 8.6% had high knowledge score. Almost two-thirds of patients (67.5%) had perceived a low level of stigma, 61 (13.5%) perceived a moderate level of stigma, and 86 (19.0%) perceived a high level of stigma. The majority (84.5%) of patients with tuberculosis thought that there was a delay in diagnosis and/or treatment of tuberculosis. CONCLUSION Our study showed gaps in tuberculosis knowledge and practices, high perceived stigma and discrimination, and perceived delay in diagnosis and treatment initiation,. Efforts within the national tuberculosis control program should be made to increase public awareness about the symptoms of tuberculosis and the importance of seeking early care.
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Affiliation(s)
- Rana AlHamawi
- Research and policy Global Health Development|Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Yousef Khader
- Professor of Epidemiology, Medical Education and Biostatistics, Department of Community Medicine, Public Health, and Family Medicine/, Jordan University of Science & Technology, Irbid, Jordan
| | - Hiba Abaza
- Migration Health Division, International Organization for Migration (IOM) Amman, Jordan
| | - Srinath Satyanarayana
- Migration Health Division, International Organization for Migration (IOM) Amman, Jordan
| | - Nevin Wilson
- Migration Health Division, International Organization for Migration (IOM) Amman, Jordan
| | | | - Khaled Okkah
- Department of Chest Disease and Foreigners, Jordan Ministry of health, Jordan
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14
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O'Donnell AT, Foran AM. The link between anticipated and internalized stigma and depression: A systematic review. Soc Sci Med 2024; 349:116869. [PMID: 38678910 DOI: 10.1016/j.socscimed.2024.116869] [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: 01/19/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
Stigmatized groups may experience psychological distress. Yet, some studies show no significant relation between stigma and mental health outcomes. This systematic review investigates the link between anticipated and internalized stigma, and one mental health outcome, depression. We aimed to (1) determine whether anticipated and internalized stigma predict levels of depression, and (2) review the quality of evidence for this link. We searched PsycInfo, PubMed and EMBASE databases. Eighty-three studies (N = 34,705) met our inclusion criteria, across five stigma categories: Sexual and gender minorities; HIV/AIDS; Illness or disability-related (non-HIV); Weight, and Other. We reviewed evidence within each category and study design and developed a narrative synthesis. Sixty studies (72.3%) supported the proposed link, which varied across categories from 53.6% to 100%. Using the NIH quality assessment tool, most studies were of fair quality. Most cross-sectional studies (76.7%) straightforwardly supported the positive relation between internalized and/or anticipated stigma and depression, while only 40% of longitudinal studies did. Implications for the study of stigma and mental health outcomes are discussed.
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Affiliation(s)
- Aisling T O'Donnell
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Aoife-Marie Foran
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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15
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Baynam G, Gomez R, Jain R. Stigma associated with genetic testing for rare diseases-causes and recommendations. Front Genet 2024; 15:1335768. [PMID: 38638122 PMCID: PMC11024281 DOI: 10.3389/fgene.2024.1335768] [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: 12/04/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Rare disease (RD) is a term used to describe numerous, heterogeneous diseases that are geographically disparate. Approximately 400 million people worldwide live with an RD equating to roughly 1 in 10 people, with 71.9% of RDs having a genetic origin. RDs present a distinctive set of challenges to people living with rare diseases (PLWRDs), their families, healthcare professionals (HCPs), healthcare system, and societies at large. The possibility of inheriting a genetic disease has a substantial social and psychological impact on affected families. In addition to other concerns, PLWRDs and their families may feel stigmatized, experience guilt, feel blamed, and stress about passing the disease to future generations. Stigma can affect all stages of the journey of PLWRDs and their families, from pre-diagnosis to treatment access, care and support, and compliance. It adversely impacts the quality of life of RD patients. To better explore the impact of stigma associated with genetic testing for RDs, we conducted a literature search on PubMed and Embase databases to identify articles published on stigma and RDs from January 2013 to February 2023. There is a dearth of literature investigating the dynamics of stigma and RD genetic testing. The authors observed that the research into the implications of stigma for patient outcomes in low- and middle-income countries (LMICs) and potential interventions is limited. Herein, the authors present a review of published literature on stigma with a focus on RD genetic testing, the associated challenges, and possible ways to address these.
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Affiliation(s)
- Gareth Baynam
- Undiagnosed Diseases Program -WA, Genetic Services of WA, King Edward Memorial Hospital, Subiaco, WA, Australia
- Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Subiaco, WA, Australia
- Rare Care Centre, Perth Children’s Hospital, Subiaco, WA, Australia
| | - Roy Gomez
- Emerging Asia Medical Lead–Specialty Care, Pfizer, Singapore, Singapore
| | - Ritu Jain
- Nanyang Technological University, Singapore, Singapore
- DEBRA International, Asia Pacific Alliance of Rare Disease Organizations, Singapore, Singapore
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16
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Hill SE, Zhang C, Remera E, Ingabire C, Umwiza F, Munyaneza A, Muhoza B, Rwibasira G, Yotebieng M, Anastos K, Murenzi G, Ross J. Association Between Clinical Encounter Frequency and HIV-Related Stigma Among Newly-Diagnosed People Living with HIV in Rwanda. AIDS Behav 2024; 28:1390-1400. [PMID: 38112826 PMCID: PMC10947825 DOI: 10.1007/s10461-023-04226-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
HIV-related stigma in healthcare settings remains a key barrier to engaging people living with HIV (PLHIV) in care. This study investigated the association between clinical encounter frequency and HIV-related anticipated, enacted, and internalized stigma among newly-diagnosed PLHIV in Rwanda. From October 2020 to May 2022, we collected data from adult PLHIV on antiretroviral therapy (ART) in Kigali, Rwanda who were participating in a randomized, controlled trial testing early entry into differentiated care at 6 months after ART initiation. We measured anticipated HIV stigma with five-point Likert HIV Stigma Framework measures, enacted stigma with the four-point Likert HIV/AIDS Stigma Instrument, and internalized stigma with the four-point Likert HIV/AIDS Stigma Instrument. We used multivariable linear regression to test the associations between clinical encounter frequency (average inter-visit interval ≥ 50 days vs. < 50 days) and change in mean anticipated, enacted and internalized HIV stigma over the first 12 months in care. Among 93 individuals enrolled, 76 had complete data on encounter frequency and stigma measurements and were included in the present analysis. Mean internalized stigma scores of all participants decreased over the first 12 months in care. Anticipated and enacted stigma scores were low and did not change significantly over time. There was no association between encounter frequency and change in internalized stigma. In this pilot study of newly-diagnosed Rwandan PLHIV with relatively low levels of HIV-related stigma, clinical encounter frequency was not associated with change in stigma. Additional research in diverse settings and with larger samples is necessary to further explore this relationship.
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Affiliation(s)
- Sarah E Hill
- Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Chenshu Zhang
- Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Eric Remera
- HIV/AIDS and STIs Diseases Division, Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda
| | - Charles Ingabire
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development, Kigali, Rwanda
| | - Francine Umwiza
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development, Kigali, Rwanda
| | - Athanase Munyaneza
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development, Kigali, Rwanda
| | - Benjamin Muhoza
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development, Kigali, Rwanda
| | - Gallican Rwibasira
- HIV/AIDS and STIs Diseases Division, Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda
| | - Marcel Yotebieng
- Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Kathryn Anastos
- Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Gad Murenzi
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development, Kigali, Rwanda
| | - Jonathan Ross
- Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
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17
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Brown C, Nkemjika S, Ratto J, Dube SR, Gilbert L, Chiang L, Picchetti V, Coomer R, Kambona C, McOwen J, Akani B, Kamagate MF, Low A, Manuel P, Agusto A, Annor FB. Adverse Childhood Experiences and Associations with Mental Health, Substance Use, and Violence Perpetration among Young Adults in sub-Saharan Africa. CHILD ABUSE & NEGLECT 2024; 150:106524. [PMID: 38854869 PMCID: PMC11160582 DOI: 10.1016/j.chiabu.2023.106524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Adverse childhood experiences (ACEs) can have debilitating effects on child well-being, with consequences persisting into adulthood. Most ACE studies have been conducted in high-income countries and show a graded relationship between multiple ACE exposures and adverse health outcomes. Less is known about the types and burden of ACEs in sub-Saharan Africa (SSA). Objective To estimate the pooled prevalence of six individual and cumulative ACE exposures (physical, sexual, and emotional violence; orphanhood; witnessing interparental and community violence) and assess their association with mental health outcomes, substance use, and violence perpetration among young adults in SSA. Participants and setting Aggregate data from the Violence Against Children and Youth Survey (VACS) in Cote d'Ivoire 2018, Kenya 2019, Lesotho 2018, Mozambique 2019, and Namibia 2019 included a sample of 11,498 young adults aged 18-24 years. Methods Cumulative ACEs were defined by an integer count of the total number of individual ACEs (0 to 6). Weighted prevalence and adjusted odds ratios were estimated. Result ACEs prevalence ranged from 7.8% (emotional violence) to 55.0% (witnessing community violence). Strong graded relationships between cumulative ACE exposure and all study outcomes for both males and females were observed. Among females, witnessing interparental violence was the only individual ACE risk factor significantly associated with increased odds of substance use; among males, emotional violence was significantly associated with all outcomes. Conclusion ACEs are associated with adverse mental health, substance use, and violence perpetration in SSA. Gender-specific and culturally sensitive intervention strategies are needed to effectively mitigate ACEs in this population.
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Affiliation(s)
- Colvette Brown
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Stanley Nkemjika
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Jeffrey Ratto
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Shanta R. Dube
- Levine College of Health Sciences, Wingate University, Wingate, North Carolina
| | - Leah Gilbert
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Laura Chiang
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Viani Picchetti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Rachel Coomer
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Namibia
| | - Caroline Kambona
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Kenya
| | - Jordan McOwen
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Mozambique
| | - Bangaman Akani
- Department of Public Health, Felix Houphouet Boigny University, Abidjan, Cote d’ Ivoire
| | - Maman Fathim Kamagate
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Cote d’ Ivoire
| | - Andrea Low
- International Center for AIDS Care and Treatment Program (ICAP)at Columbia University, NY
| | - Pedro Manuel
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Mozambique
| | | | - Francis B. Annor
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
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18
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Fisk-Hoffman RJ, Parisi CE, Siuluta N, Ding DD, Widmeyer M, Somboonwit C, Cook RL. Antiretroviral Therapy Concealment Behaviors and their Association with Antiretroviral Therapy Adherence among People with HIV: Findings from the Florida Cohort Study. AIDS Behav 2024; 28:1047-1057. [PMID: 37861924 PMCID: PMC10922241 DOI: 10.1007/s10461-023-04214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
Little is known about HIV medication concealment behaviors and the effect of medication concealment on antiretroviral therapy (ART) adherence among people with HIV (PWH). This study aims to (1) to describe medication concealment behaviors and factors associated with these behaviors, and (2) assess the association between medication concealment and suboptimal ART adherence. The Florida Cohort Study enrolled adult PWH from community-based clinics around the state from October 2020 to September 2022 (n = 416, 62% aged 50+, 56% male, 44% non-Hispanic Black, 18% Hispanic). Participants responded to questions about sociodemographics, stigma, ART adherence (≥ 85%), symptoms of depression, social networks and disclosure to their networks, and actions to conceal ART to avoid inadvertent disclosure of their HIV status. Analyses were conducted using multivariable logistic regressions models. The most common concealment behavior was hiding ART while having guests over (32%), followed by removing ART labels (26%), and putting ART into a different bottle (16%). Overall, 43% reported ≥ 1 behavior. In multivariable models, depressive symptoms, incomplete disclosure of HIV to close social networks, and not having a close social network were associated with ART concealment. After adjusting for risk factors for suboptimal ART adherence, endorsing hiding medication while having guests was associated with suboptimal ART adherence (aOR 2.87, 95% CI 1.15-7.55). Taking any action and other individual behaviors were not associated. ART concealment behaviors were common but did not consistently negatively influence adherence when accounting for other factors. PWH may want to receive ART medications in ways that ensure privacy and reduce the risk of inadvertent disclosure.
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Affiliation(s)
- Rebecca J Fisk-Hoffman
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christina E Parisi
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nanyangwe Siuluta
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Delaney D Ding
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Charurut Somboonwit
- Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA.
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19
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Madkhali NAB, Ameri A, Al-Naamani ZY, Alshammari B, Madkhali MAB, Jawed A, Alfaifi F, Kappi AA, Haque S. COVID-19 Linked Social Stigma Among Arab Survivors: A Cross-Sectional Experiences from the Active Phase of the Pandemic. J Multidiscip Healthc 2024; 17:805-823. [PMID: 38434483 PMCID: PMC10906728 DOI: 10.2147/jmdh.s450611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Objective This study aimed to explore the magnitude and variability of the disease-linked stigma among COVID-19 survivors and their experiences of social stigma, coping strategies, contextual challenges, and preferences for support. Methods An Arabic version of the social stigma survey questionnaire was designed and validated to obtain socio-demographic characteristics and quantitative measures of stigma encountered by the survivors. 482 COVID-19 survivors completed the survey, and the data were analyzed using descriptive statistics and thematic analysis. Results The results of this study revealed the prevalence of high levels of both perceived external stigma and enacted stigma among participants. Enacted and Internalized stigma were associated with survivors' educational background/ status. The participants suggested three levels of support: organizational, social, and personal. Establishing an online stigma reduction program and national psychological crisis interventions at the organizational level. It is crucial to assist coping mechanisms and societal reintegration techniques at the social level. Conclusion These results provide valuable insights for holistic health policy formation and preparedness strategies for future pandemics, helping survivors promote health and reintegrate into society, where stigma reduction and psychological crisis interventions are underdeveloped.
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Affiliation(s)
| | | | | | - Bushra Alshammari
- Department of Medical-Surgical Nursing, College of Nursing, University of Hail, Hail, Saudi Arabia
| | | | - Arshad Jawed
- Department of Nursing, College of Nursing, Jazan University, Jazan, 45142, Saudi Arabia
| | - Faten Alfaifi
- Department of Nursing, College of Nursing, Jazan University, Jazan, 45142, Saudi Arabia
| | - Amani Ali Kappi
- Department of Nursing, College of Nursing, Jazan University, Jazan, 45142, Saudi Arabia
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan, 45142, Saudi Arabia
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Mah SS, Teare GF, Law J, Adhikari K. Facilitators and barriers for implementing screening brief intervention and referral for health promotion in a rural hospital in Alberta: using consolidated framework for implementation research. BMC Health Serv Res 2024; 24:228. [PMID: 38383382 PMCID: PMC10882928 DOI: 10.1186/s12913-024-10676-y] [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: 05/30/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Screening, brief intervention, and referral (SBIR) is an evidence-based, comprehensive health promotion approach commonly implemented to reduce alcohol and substance use. Implementation research on SBIR demonstrate that patients find it acceptable, reduces hospital costs, and it is effective. However, SBIR implementation in hospital settings for multiple risk factors (fruit and vegetable consumption, physical activity, alcohol and tobacco use) is still emergent. More evidence is needed to guide SBIR implementation for multiple risk factors in hospital settings. OBJECTIVE To explore the facilitators and barriers of SBIR implementation in a rural hospital using the Consolidated Framework for Implementation Research (CFIR). METHODS We conducted a descriptive qualitative investigation consisting of both inductive and deductive analyses. We conducted virtual, semi-structured interviews, guided by the CFIR framework. All interviews were audio-recorded, and transcribed verbatim. NVivo 12 Pro was used to organize and code the raw data. RESULTS A total of six key informant semi-structured interviews, ranging from 45 to 60 min, were carried out with members of the implementation support team and clinical implementers. Implementation support members reported that collaborating with health departments facilitated SBIR implementation by helping (a) align health promotion risk factors with existing guidelines; (b) develop training and educational resources for clinicians and patients; and (c) foster leadership buy-in. Conversely, clinical implementers reported several barriers to SBIR implementation including, increased and disrupted workflow due to SBIR-related documentation, a lack of knowledge on patients' readiness and motivation to change, as well as perceived patient stigma in relation to SBIR risk factors. CONCLUSION The CFIR provided a comprehensive framework to gauge facilitators and barriers relating to SBIR implementation. Our pilot investigation revealed that future SBIR implementation must address organizational, clinical implementer, and patient readiness to implement SBIR at all phases of the implementation process in a hospital.
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Affiliation(s)
- Sharon S Mah
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population & Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Gary F Teare
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population & Public Health, Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jessica Law
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population & Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Kamala Adhikari
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population & Public Health, Alberta Health Services, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Bromberg DJ, Machavariani E, Madden LM, Dumchev K, LaMonaca K, Earnshaw VA, Pykalo I, Filippovych M, Haddad MS, Dvoriak S, Altice FL. Integrating methadone into primary care settings in Ukraine: effects on provider stigma and knowledge. J Int AIDS Soc 2024; 27:e26202. [PMID: 38379179 PMCID: PMC10879646 DOI: 10.1002/jia2.26202] [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: 03/20/2023] [Accepted: 12/08/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Stigma has undermined the scale-up of evidence-based HIV prevention and treatment. Negative beliefs influence clinicians' discriminatory behaviour and ultimately have wide-ranging effects across the HIV prevention and treatment continuum. Stigma among clinicians can be mitigated in several ways, including through interpersonal contact. In this study, we test whether interactions with people who inject drugs (PWID) influence attitudes of both direct and indirect providers of opioid agonist therapies (OATs) within the same primary care clinics (PCCs) where OAT is newly introduced. METHODS In a cluster randomized controlled trial integrating OAT and HIV care into PCCs in Ukraine, clinicians at 24 integrated care sites (two sites in 12 regions) from January 2018 to August 2022 completed a structured survey at baseline, 12 and 24 months. The survey included feeling thermometers and standardized scales related to clinician attitudes towards patients and evidence-based care. Nested linear mixed-effects models were used to examine changes in mean scores over three timepoints for both direct and indirect clinicians. RESULTS There were fewer significant changes in any of the scales for direct providers (n = 87) than for indirect providers (n = 155). Direct providers became less tough-minded about substance use disorders (p = 0.002), had less negative opinions about PWID (p = 0.006) and improved their beliefs regarding OAT maintenance (p<0.001) and medical information (p = 0.004). Indirect providers reported improvements in most stigma constructs, including a significant decrease in prejudice (p<0.001), discrimination (p = 0.001), shame (p = 0.007) and fear (p = 0.001) towards PWID. CONCLUSIONS Integrating OAT services within primary settings was associated with significantly reduced stigma constructs and improved attitudes towards PWID, possibly through increased intergroup contact between PWID and general clinical staff. Unlike most stigma reduction interventions, re-engineering clinical processes so that PWID receive their care in PCCs emerges as a multilevel stigma reduction intervention through the integration of specialized services in PCCs. Integration influences different types of stigma, and has positive effects not only on health outcomes, but also improves clinician attitudes and efficiently reduces clinician stigma.
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Affiliation(s)
- Daniel J. Bromberg
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
| | | | - Lynn M. Madden
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- APT FoundationNew HavenConnecticutUSA
| | | | | | | | - Iryna Pykalo
- Ukrainian Institute on Public Health PolicyKyivUkraine
| | | | - Marwan S. Haddad
- Center for Key Populations, Community Health Center, Inc.MiddletownConnecticutUSA
| | | | - Frederick L. Altice
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- University of DelawareNewarkDelawareUSA
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22
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King DD, Gill CJ, Cadieux CS, Singh N. The role of stigma in cannabis use disclosure: an exploratory study. Harm Reduct J 2024; 21:21. [PMID: 38273362 PMCID: PMC10811895 DOI: 10.1186/s12954-024-00929-8] [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: 04/04/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Although cannabis use incidence, societal acceptance, and legislation all trend positively, cannabis remains federally illegal in the USA. Prior studies have revealed that patients are reluctant to disclose their cannabis use history in the healthcare system, which can negatively impact patient care. This study reports the frequency of cannabis use disclosure with special considerations for stigmatization. To better understand the limitations, providers face in providing collaborative, comprehensive, and informed care, this study evaluated four domains of stigma: perceived, anticipated, enacted, and internalized. METHODS This study used a descriptive exploratory design. Data collection occurred using an anonymous, online national survey with a convenience sample in the USA. Recruitment relied on electronic media and occurred between July and December 2022. Participants were adults older than 21 years and self-identified as having used cannabis and accessed the healthcare system within the last five years. The survey measured demographic characteristics, cannabis use, and disclosure patterns. Stigma was measured using the Stigma Use Stigma Mechanism Scale (SU-SMS) and Substance Abuse Use Self-Stigma Scale (SASSS) with language modifications for cannabis. Ordinal logistic regression models were performed to evaluate associations between the frequency of cannabis use disclosure patterns and each stigma category. Associations were assessed using Chi-squared or Fisher's exact tests. RESULTS Data were available for 249 respondents. Most participants (57.1%) reported initiating a conversation about cannabis with their healthcare provider; 27.8% of the time, cannabis is never discussed, and healthcare providers initiate only 15.1% of related discussions. Anticipated stigma [95% CI 1.045-1.164] and total stigma [95% CI 1.001-1.039] had statistically significant associations with nondisclosure. Annual household income (p = .04), chronicity of cannabis use (p = .03), frequency of cannabis use (p = .02), and a known amount of CBD in products consumed (p = .01) had statistically significant associations with the frequency of cannabis use disclosure. CONCLUSIONS Patients who use cannabis experience stigmatization in the healthcare setting that may limit disclosure of cannabis use history. Future studies would be well served to explore anticipated stigma more deeply. Healthcare providers should be knowledgeable to lead such conversations relating to cannabis while maintaining an unbiased perspective.
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Affiliation(s)
- Daniel D King
- College of Nursing, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA.
| | - Christopher J Gill
- National Board of Certification and Recertification for Nurse Anesthetists, 8725 West Higgins Road, Suite 525, Chicago, IL, 60631, USA
| | - Carey S Cadieux
- Pacific College of Health and Science, 7445 Mission Valley Road #105, San Diego, CA, 92108, USA
| | - Neha Singh
- Bouvé College of Health Sciences, School of Nursing, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
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Susanti H, Brooks H, Keliat BA, Bradshaw T, Wulandari D, Fadilah R, Diorarta R, Suherman, Bee P, Lovell K, Renwick L. Stakeholder perspectives of family interventions for schizophrenia in Indonesia: a qualitative study. BMC Psychiatry 2024; 24:59. [PMID: 38254095 PMCID: PMC10804701 DOI: 10.1186/s12888-024-05504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Mental illnesses comprise the single largest source of health-related economic burden globally and low-and middle-income countries (LMICs) are disproportionately affected. Many individuals with schizophrenia do not receive evidence-based, psychosocial interventions as these are largely unavailable, undeveloped, and under-researched in LMICs. Involving service-users and carers in the design of interventions is crucial to ensure stakeholder needs are adequately addressed by the intervention and to aid successful implementation. We aimed to explore the views and perspectives of different stakeholder groups about the delivery, format, and content of family interventions for people living with schizophrenia in Indonesia as a first step towards developing evidence-based, acceptable family interventions. This study used a qualitative design comprising single stakeholder focus groups. Data were analysed separately using the framework approach incorporating deductive and inductive coding within an existing heuristic framework. 51 participants consented to take part in this study comprising six stakeholder consultation groups including service-users (n = 15), caregivers (n = 15) and healthcare professionals (n = 21). Service users were diagnosed with schizophrenia. Caregivers comprised parents (n = 10, 67%), brothers (n = 2, 13%), sister (n = 1, 7%) and husbands (n = 2, 13%). Healthcare professionals were working as nurses (n = 6, 29%), doctors (n = 5, 23%) or cadre's (n = 10, 48%). Caregiver and service-user respondents had limited knowledge or experience of structured family interventions. There was strong support for such interventions, however, for effective delivery a number of challenges exist in terms of widespread stigmatised views, low expectations for involvement in sharing decisions about care and treatment, views that healthcare professionals are expert and have the authority to delegate tasks to families such as responsibility for ensuring medication adherence and understanding the need to balance the needs of both service-users and families when there are conflicting agendas for treatment. These findings can support the development of evidence-based family interventions for families of those with schizophrenia in Indonesia, as user-informed interventions enhance engagement, satisfaction, and adherence to family interventions.
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Affiliation(s)
- Herni Susanti
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Budi-Anna Keliat
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Tim Bradshaw
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Dewi Wulandari
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Rizky Fadilah
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Raphita Diorarta
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Suherman
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Laoise Renwick
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK.
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Fuady A, Arifin B, Yunita F, Rauf S, Fitriangga A, Sugiharto A, Yani FF, Nasution HS, Putra IWGAE, Mansyur M, Wingfield T. Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002489. [PMID: 38190416 PMCID: PMC10773931 DOI: 10.1371/journal.pgph.0002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
Stigma towards people with tuberculosis (TB-Stigma) is associated with other psychosocial consequences of TB including mental illness and reduced quality of life (QoL). We evaluated TB-Stigma, depression, QoL, and the need for psychosocial support among adults with TB in Indonesia, a high TB burden country. In this primary health facility-based survey in seven provinces of Indonesia, from February to November 2022, we interviewed adults receiving (a) intensive phase treatment for drug-susceptible (DS) TB at public facilities, (b) treatment at private facilities, (c) those lost to follow up (LTFU) to treatment, and (d) those receiving TB retreatment. We used our previously validated Indonesian TB-Stigma Scale, Patient Health Questionnaire-9, and EQ-5D-5L to measure TB-Stigma, depression, and QoL. Additional questions assessed what psychosocial support was received or needed by participants. We recruited and interviewed 612 people, of whom 60.6% (96%CI 59.6-64.5%) experienced moderate TB-Stigma. The average TB-Stigma scores were 19.0 (SD 6.9; min-max 0-50; Form A-Patient Perspective) and 23.4 (SD 8.4, min-max 0-50; Form B-Community Perspective). The scores were higher among people receiving treatment at private facilities (adjusted B [aB] 2.48; 0.94-4.03), those LTFU (aB 2.86; 0.85-4.87), males (aB 1.73; 0.59-2.87), those losing or changing job due to TB (aB 2.09; 0.31-3.88) and those living in a rural area (aB 1.41; 0.19-2.63). Depression was identified in 41.5% (95% CI 37.7-45.3%) of participants. Experiencing TB-Stigma was associated with moderately severe to severe depression (adjusted odds ratio [aOR] 1.23; 1.15-1.32) and both stigma and depression were associated with lower QoL (aB -0.013; [-0.016]-[-0.010]). Informational (20.8%), emotional (25.9%) and instrumental (10.6%) support received from peers or peer-groups was limited, and unmet need for such support was high. There is a sizeable and intersecting burden of TB-Stigma and depression among adults with TB in Indonesia, which is associated with lower QoL. Participants reported a substantial unmet need for psychosocial support including peer-led mutual support groups. A community-based peer-led psychosocial support intervention is critical to defray the psychosocial impact of TB in Indonesia.
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Affiliation(s)
- Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Sulawesi Selatan, Indonesia
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Ferdiana Yunita
- Department of Community Medicine, Faculty of Medicine, Universitas Gunadarma, Depok, Indonesia
| | - Saidah Rauf
- Department of Nursing, Politeknik Kesehatan Kemenkes Ambon, Maluku, Indonesia
| | - Agus Fitriangga
- Department of Community Medicine, Faculty of Medicine, Universitas Tanjungpura, Pontianak, West Kalimantan, Indonesia
| | - Agus Sugiharto
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Finny Fitry Yani
- Department of Child Health, Faculty of Medicine, Universitas Andalas, Padang, West Sumatera, Indonesia
- Department of Paediatric, Dr. M. Djamil General Hospital, Padang, West Sumatera, Indonesia
| | - Helmi Suryani Nasution
- Department of Public Health, Faculty of Medicine and Health Sciences, Universitas Jambi, Jambi, Indonesia
| | - I. Wayan Gede Artawan Eka Putra
- Department of Public Health and Prevention Medicine, Faculty of Medicine, Universitas Udayana, Kota Denpasar, Bali, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tom Wingfield
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
- Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, Liverpool, United Kingdom
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Bogart LM, Phaladze N, Kgotlaetsile K, Goggin K, Mosepele M. Qualitative Evaluation of Treatment Partners for People With HIV in Botswana: Current Healthcare Provider Practices and Recommendations for Improvement. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X231225809. [PMID: 38171536 DOI: 10.1177/2752535x231225809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Botswana has an adult HIV prevalence of 20.8% and annual incidence of 0.2%. We aimed to evaluate current practices and advance recommendations for treatment partners (informal adherence supporters) for people with HIV in Botswana. In January-February 2020, we conducted seven focus groups with 36 healthcare providers at seven HIV clinics in Gaborone, Botswana. Providers perceived treatment partners to be critical for quality patient care. They shared that in the new era of universal antiretroviral therapy (ART) initiation immediately after diagnosis ("test-and-treat"), providers no longer require patients to select treatment partners at ART initiation. Providers suggested a renewed emphasis on treatment partners. They believed that standard guidance for providers around treatment partner selection would ensure that providers cover similar topics across patients and endorsed implementation of workshops to educate treatment partners on how to support patients. However, streamlined ART initiation policies require innovative strategies, including eHealth interventions, to engage treatment partners.
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, Santa Monica, CA, USA
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Keonayang Kgotlaetsile
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Boitekanelo College, Gaborone, Botswana
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
- Kansas City Schools of Medicine and Pharmacy, University of Missouri, Kansas City, MO, USA
| | - Mosepele Mosepele
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
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Umar TP, Jain N, Sayad R, Tandarto K, Jain S, Reinis A. Overcoming Stigma: The Human Side of Monkeypox Virus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:383-397. [PMID: 38801592 DOI: 10.1007/978-3-031-57165-7_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Monkeypox (Mpox) virus is a zoonotic disease that was recently declared a public health emergency of international concern (PHEIC) by the World Health Organization (WHO). Symptoms of Mpox include fever, headache, muscle pain, and a rash which starts on the face and spreads to the rest of the body. The stigma surrounding the Mpox virus has been one of the greatest challenges in dealing with the disease. People with Mpox have been often shunned by their communities, and many are afraid to seek medical care for fear of ostracism. For those affected by the virus, this stigma can significantly impact their mental health and quality of life. It is further fueled by misinformation and societal norms. Hence, a multifaceted approach that includes education, awareness campaigns, and community engagement is needed to overcome the stigma associated with Mpox. Effective communication strategies are critical to the dispelling of rumors and the reduction of fear. Interventional measures need to be shaped according to the needs of those affected.
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Affiliation(s)
- Tungki Pratama Umar
- Faculty of Medicine, Sriwijaya University, Dr. Mohammad Ali Street-RSMH Complex, Palembang, 30126, Indonesia.
| | - Nityanand Jain
- Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, Riga, 1007, Latvia.
- Joint Microbiology Laboratory, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, 1002, Latvia.
| | - Reem Sayad
- Faculty of Medicine, Assiut University, Saad Zaghloul, Assiut, 71515, Egypt
| | - Kevin Tandarto
- Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya Street No.2, North Jakarta, Special Capital Region of Jakarta, 14440, Indonesia
| | - Shivani Jain
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Genesis Institute of Dental Sciences and Research, Ferozepur - Moga Rd, Firozpur, Punjab, 152002, India
| | - Aigars Reinis
- Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, Riga, 1007, Latvia
- Joint Microbiology Laboratory, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, 1002, Latvia
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Squires K. Sex Workers in Canada Face Unequal Access to Healthcare: A Systems Thinking Approach. J Prim Care Community Health 2024; 15:21501319241233173. [PMID: 38504526 PMCID: PMC10953055 DOI: 10.1177/21501319241233173] [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: 10/24/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Despite Canada's universal health system, sex workers across the country face an alarmingly high number of barriers when they seek to healthcare services. This has resulted in unmet healthcare needs and substantially poorer health outcomes than the general Canadian population. The objective of this study was to use a systems thinking approach to gain an in-depth understanding of the barriers sex workers face and how access could be improved. METHODS The analysis was conducted using a systems thinking methodology, which incorporates systems tools and inquiry processes. The methodology comprised 2 domains of inquiry: (1) Problem Landscape, (2) Solutions Landscape. Systems tools and methods, such as causal loop diagrams, iceberg diagram, and systems mapping, investigated the problem landscape for understanding the interconnected nature of the issue, alongside review of both published and gray literature. An environmental scan explored the current solutions landscape. These methods connected through systemic inquiry processes, including ongoing review and application of diverse perspectives, boundary judgments, interrelationships; enabled gaps and levers of change to be determined. RESULTS The main barriers sex workers face are stigma, criminalization, accessibility, and cost of healthcare. The stigma of sex work stems from otherization, paternalism, and moralistic, faith-based beliefs. The barriers unique to sex work are stigma and criminalization; both of which surface as avoidance, dislike, and/or fear of medical professionals. Five gaps each with a lever of change to improve access were identified: (1) Stigma - Collectivization and external collaboration, (2) Criminal status of sex work - Decriminalization, (3) Lack of adequate education - Improved healthcare professional training and anti-discriminatory health policies, (4) Lack of support - Increased community-based healthcare services, (5) Cost of healthcare - Universal coverage of "secondary" healthcare components. CONCLUSION Through reducing the stigma surrounding sex work, making changes that improve the healthcare services that sex workers receive, and collaboration between involved parties, sex workers can be prevented from falling through the cracks of the Canadian healthcare system; lessening the health inequities sex workers face and improving their health outcomes.
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Agarwal A, Nayak PK, van Brakel WH, van Wijk R, Jain A, Broekkamp H, Mol MM, Mishra CP. Impact of basic psychological support on stigma and mental well-being of people with disabilities due to leprosy and lymphatic filariasis: a proof-of-concept study. Int Health 2023; 15:iii59-iii69. [PMID: 38118159 PMCID: PMC10732683 DOI: 10.1093/inthealth/ihad096] [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: 05/31/2023] [Revised: 08/09/2023] [Accepted: 09/29/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND People with leprosy and lymphatic filariasis (LF)-related disabilities experience higher levels of poor mental well-being compared with the general community. Mental health services are often not available. This study was conducted to provide proof of concept that basic psychological support for people affected by neglected tropical diseases (BPS-N) can be given by peer supporters to reduce stigma, improve mental well-being and participation among clients. METHODS The BPS-N approach was tested in a quasi-experimental design using mixed methods. To provide psychological support using the BPS-N, peer supporters were selected and trained. They supported people with leprosy- and LF-related disabilities. Preintervention and postintervention, stigma, mental well-being, depression and participation were measured through standard scales within 4 wk of the intervention; differences were tested using standard tests of significance. RESULTS After 3 mo of intervention, the mean level of stigma had decreased (30.3 to 24, p<0.001); high mental well-being increased (0% to 13.3%, p<0.001); and moderate to severe depression decreased (88% to 47%, p<0.001). No significant change occurred in participation restrictions (87% to 92%, p=0.497). CONCLUSIONS Psychological peer support using the BPS-N guideline appears effective in reducing stigma and improving mental well-being and can be operationalised. However, this should be confirmed through a randomised controlled trial. CONTEXTE Les personnes atteintes de lèpre et de handicaps liés à la filariose lymphatique (FL) souffrent davantage d'un manque de bien-être mental que le reste de la population. Les services de santé mentale ne sont souvent pas disponibles hors des zones urbaines. Cette étude a été menée pour démontrer que le soutien psychologique de base pour les personnes atteintes de MTN (BPS-N) peut être dispensé par des pairs (dans une logique de transfert de tâches) afin de réduire la stigmatisation et d'améliorer le bien-être mental et la participation des clients. MÉTHODES L'approche du BPS-N a été testée dans le cadre d'un modèle quasi-expérimental utilisant des méthodes mixtes. Pour fournir un soutien psychologique à l'aide du BPS-N, des pairs ont été sélectionnés et formés. Ils sont venus en aide aux personnes atteintes de lèpre et de déficiences liées à la FL. Avant et après l'intervention, les éléments suivants ont été mesurés à l'aide d'échelles standardisées: niveau de stigmatisation, bien-être mental, symptômes dépressifs, et enfin, la participation sociale. Les différences ont été testées à l'aide de tests de signification standardisés. RÉSULTATS Après 3 mois d'intervention, le niveau moyen de stigmatisation a diminué (30,3 à 24, p<0 001) ; le niveau de bien-être mental a augmenté (0% à 13,3%, p<0 001) et la dépression modérée à sévère a diminué (88% à 47%, p<0 001). Aucun changement significatif n'a été observé en ce qui concerne les restrictions de participation (87% contre 92%, p=0 497). CONCLUSIONS Le soutien psychologique par les pairs utilisant la ligne directrice BPS-N semble efficace pour réduire la stigmatisation et améliorer le bien-être mental. Toutefois, cette efficacité doit être confirmée par un essai contrôlé randomisé. ANTECEDENTES Las personas con lepra y discapacidades relacionadas con la filariasis linfática (FL) sufren niveles más altos de malestar mental en comparación con la comunidad en general. Los servicios de salud mental no suelen estar disponibles a nivel periférico. Este estudio se llevó a cabo para proporcionar una prueba de concepto de que el Apoyo Psicológico Básico para personas afectadas por NTDs (BPS-N) puede ser dado por compañeros de apoyo (rotación de tareas) para reducir el estigma, mejorar el bienestar mental y la participación entre los clientes. MÉTODOS El enfoque BPS-N se probó en un diseño cuasi-experimental utilizando métodos mixtos. Para proporcionar apoyo psicológico con el BPS-N, se seleccionaron y formaron compañeros de apoyo. Apoyaron a personas con lepra y discapacidades relacionadas con la FL. El estigma, el bienestar mental, la depresión y la participación se midieron antes y después de la intervención, mediante escalas estándar; las diferencias se comprobaron mediante pruebas estándar de significación. RESULTADOS Después de 3 meses de intervención, el nivel medio de estigma disminuyó (30,3 a 24, p<0 001); el bienestar mental alto aumentó (0% a 13,3%, p<0 001) y la depresión moderada a grave disminuyó (88% a 47%, p<0 001). No se produjeron cambios significativos en las restricciones de participación (87% frente a 92%, p=0 497)). CONCLUSIONES El apoyo psicológico entre iguales, utilizando la guía BPS-N, parece eficaz para reducir el estigma y mejorar el bienestar mental. Sin embargo, esto debe confirmarse mediante un ensayo controlado aleatorizado.
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Affiliation(s)
- Ashok Agarwal
- NLR, Safdarjung Development Area, New Delhi-110016, India
| | | | | | - Robin van Wijk
- NLR, 1090HA Amsterdam, The Netherlands
- Erasmus Medical Center, 3015 GD Rotterdam, Netherlands
| | - Amit Jain
- NLR, Safdarjung Development Area, New Delhi-110016, India
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Martei YM, Obasohan M, Mokokwe L, Ralefala T, Mosepele M, Gross R, Barg FK. Stigma and Social Determinants of Health Associated With Fidelity to Guideline-Concordant Therapy in Patients With Breast Cancer Living With and Without HIV in Botswana. Oncologist 2023; 28:e1230-e1238. [PMID: 37405697 PMCID: PMC10712728 DOI: 10.1093/oncolo/oyad183] [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: 11/07/2022] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Patients with breast cancer in sub-Saharan Africa (SSA) experience a disproportionate burden of mortality. Fidelity to treatment guidelines, defined as receiving optimal dose and frequency of prescribed treatments, improves survival. We sought to identify patient factors associated with treatment fidelity and how this may differ for people with HIV (PWH) and breast cancer. METHODS We conducted a qualitative study of women who initiated outpatient treatment for stages I-III breast cancer in Botswana, with deviance sampling of high- and low-fidelity patients. One-on-one interviews were conducted using semi-structured guides informed by the Theory of Planned Behavior. The sample size was determined by thematic saturation. Transcribed interviews were double coded with an integrated analytic approach. RESULTS We enrolled 15 high- and 15 low-fidelity participants from August 25, 2020 to December 15, 2020, including 10 PWH (4 high, 6 low fidelity). Ninety-three percent had stage III disease. Barriers to treatment fidelity included stigma, social determinants of health (SDOH), and health system barriers. Acceptance and de-stigmatization, peer and other social support, increased knowledge and self-efficacy were identified as facilitators. The COVID-19 pandemic amplified existing socioeconomic stressors. Unique barriers and facilitators identified by PWH included intersectional stigma, and HIV and cancer care integration, respectively. CONCLUSION We identified multilevel modifiable patient and health system factors associated with fidelity. The facilitators provide opportunities for leveraging existing strengths within the Botswana context to design implementation strategies to increase treatment fidelity to guideline-concordant breast cancer therapy. However, PWH experienced unique barriers, suggesting that interventions to address fidelity may need to be tailored to specific comorbidities.
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Affiliation(s)
- Yehoda M Martei
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia, PA, USA
| | - Modesty Obasohan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lebogang Mokokwe
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | | | - Robert Gross
- Department of Medicine (Infectious Diseases), University of Pennsylvania, Philadelphia, PA, USA
| | - Frances K Barg
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
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Tuck CZ, Cooper R, Aryeetey R, Gray LA, Akparibo R. A critical review and analysis of the context, current burden, and application of policy to improve cancer equity in Ghana. Int J Equity Health 2023; 22:254. [PMID: 38066530 PMCID: PMC10709985 DOI: 10.1186/s12939-023-02067-2] [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: 06/20/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Cancer causes a major disease burden worldwide. This is increasingly being realised in low and middle-income countries, which account disproportionately for preventable cancer deaths. Despite the World Health Organization calling for governments to develop policies to address this and alleviate cancer inequality, numerous challenges in executing effective cancer policies remain, which require consideration of the country-specific context. As this has not yet been considered in Ghana, the aim of this review was to bring together and critique the social-environmental, health policy and system factors to identifying opportunities for future health policies to reduce cancer burden in the Ghanian context. A critical policy-focused review was conducted to bring together and critique the current health systems context relating to cancer in Ghana, considering the unmet policy need, health system and social factors contributing to the burden and policy advances related to cancer. CONCLUSION The findings highlight the changing burden of cancer in Ghana and the contextual factors within the socio-ecosystem that contribute to this. Policies around expanding access to and coverage of services, as well as the harmonization with medical pluralism have potential to improve outcomes and increase equity but their implementation and robust data to monitor their impact pose significant barriers.
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Affiliation(s)
- Chloe Zabrina Tuck
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
- School of Public Health, University of Ghana, Accra, Ghana.
| | - Richard Cooper
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | | | - Laura A Gray
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Robert Akparibo
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
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Pham TAM, Forse R, Codlin AJ, Phan THY, Nguyen TT, Nguyen N, Vo LNQ, Dat PT, Minh HDT, Nguyen LH, Nguyen HB, Nguyen NV, Bodfish M, Lönnroth K, Wingfield T, Annerstedt KS. Determinants of catastrophic costs among households affected by multi-drug resistant tuberculosis in Ho Chi Minh City, Viet Nam: a prospective cohort study. BMC Public Health 2023; 23:2372. [PMID: 38042797 PMCID: PMC10693707 DOI: 10.1186/s12889-023-17078-5] [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: 01/23/2023] [Accepted: 10/26/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Globally, most people with multidrug-resistant tuberculosis (MDR-TB) and their households experience catastrophic costs of illness, diagnosis, and care. However, the factors associated with experiencing catastrophic costs are poorly understood. This study aimed to identify risk factors associated with catastrophic costs incurrence among MDR-TB-affected households in Ho Chi Minh City (HCMC), Viet Nam. METHODS Between October 2020 and April 2022, data were collected using a locally-adapted, longitudinal WHO TB Patient Cost Survey in ten districts of HCMC. Ninety-four people with MDR-TB being treated with a nine-month TB regimen were surveyed at three time points: after two weeks of treatment initiation, completion of the intensive phase and the end of the treatment (approximately five and 10 months post-treatment initiation respectively). The catastrophic costs threshold was defined as total TB-related costs exceeding 20% of annual pre-TB household income. Logistic regression was used to identify variables associated with experiencing catastrophic costs. A sensitivity analysis examined the prevalence of catastrophic costs using alternative thresholds and cost estimation approaches. RESULTS Most participants (81/93 [87%]) experienced catastrophic costs despite the majority 86/93 (93%) receiving economic support through existing social protection schemes. Among participant households experiencing and not experiencing catastrophic costs, median household income was similar before MDR-TB treatment. However, by the end of MDR-TB treatment, median household income was lower (258 [IQR: 0-516] USD vs. 656 [IQR: 462-989] USD; p = 0.003), and median income loss was higher (2838 [IQR: 1548-5418] USD vs. 301 [IQR: 0-824] USD; p < 0.001) amongst the participant households who experienced catastrophic costs. Being the household's primary income earner before MDR-TB treatment (aOR = 11.2 [95% CI: 1.6-80.5]), having a lower educational level (aOR = 22.3 [95% CI: 1.5-344.1]) and becoming unemployed at the beginning of MDR-TB treatment (aOR = 35.6 [95% CI: 2.7-470.3]) were associated with experiencing catastrophic costs. CONCLUSION Despite good social protection coverage, most people with MDR-TB in HCMC experienced catastrophic costs. Incurrence of catastrophic costs was independently associated with being the household's primary income earner or being unemployed. Revision and expansion of strategies to mitigate TB-related catastrophic costs, in particular avoiding unemployment and income loss, are urgently required.
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Affiliation(s)
- Thi Anh Mai Pham
- WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Rachel Forse
- WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
- Friends for International TB Relief, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, Ha Noi, Viet Nam.
| | - Andrew J Codlin
- WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden
- Friends for International TB Relief, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, Ha Noi, Viet Nam
| | - Thi Hoang Yen Phan
- Centre for Development of Community Health Initiatives, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, Ha Noi, Viet Nam
| | - Thanh Thi Nguyen
- Centre for Development of Community Health Initiatives, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, Ha Noi, Viet Nam
| | - Nga Nguyen
- Friends for International TB Relief, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, Ha Noi, Viet Nam
| | - Luan Nguyen Quang Vo
- Centre for Development of Community Health Initiatives, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, Ha Noi, Viet Nam
| | - Phan Thuong Dat
- Pham Ngoc Thach Hospital, 120 Hong Bang, Ward12, District 5, Ho Chi Minh City, Viet Nam
| | - Ha Dang Thi Minh
- Pham Ngoc Thach Hospital, 120 Hong Bang, Ward12, District 5, Ho Chi Minh City, Viet Nam
| | - Lan Huu Nguyen
- Pham Ngoc Thach Hospital, 120 Hong Bang, Ward12, District 5, Ho Chi Minh City, Viet Nam
| | - Hoa Binh Nguyen
- National Lung Hospital/National TB Control Programme, 463 Hoang Hoa Tham, Vinh Phu, Ba Dinh, Ha Noi, Viet Nam
| | - Nhung Viet Nguyen
- National Lung Hospital/National TB Control Programme, 463 Hoang Hoa Tham, Vinh Phu, Ba Dinh, Ha Noi, Viet Nam
- University of Medicine and Pharmacy, Vietnam National University, Ha Noi, Viet Nam
| | - Miranda Bodfish
- CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, USA
| | - Knut Lönnroth
- WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Tom Wingfield
- WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden
- Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, Merseyside, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, L7 8XP, Merseyside, UK
| | - Kristi Sidney Annerstedt
- WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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McDaniels B, Pontone GM, Mathur S, Subramanian I. Staying hidden: The burden of stigma in PD. Parkinsonism Relat Disord 2023; 116:105838. [PMID: 37689498 DOI: 10.1016/j.parkreldis.2023.105838] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Despite the myriad motor and non-motor challenges associated with Parkinson's disease (PD) diagnosis, the hidden issue of stigma may be among the most influential factors negatively affecting quality of life. A number of qualitative studies have been published assessing various aspects of stigma in PD, and quantitative studies assert that most people with PD experience stigma during the course of their disease. Stigma is associated with poorer mental and physical health, poorer quality of life, decreased levels of hope, self-esteem and self-efficacy. The resulting stigma can lead to social anxiety and isolation, reluctance to seek medical care, loneliness, depression and anxiety. Therefore, understanding what stigma is, where it comes from, and how it affects people living with PD may offer clinicians and care partners tools to help mitigate the negative effects. FOCUS Over the past few decades, we have seen a move away from simply focusing on the effects of a disease (medical model) toward a holistic biopsychosocial approach that considers the role of environmental factors (stigma) when assessing overall well-being. We review some proactive practical suggestions to help people living with PD effectively combat the negative effects of stigma. CONCLUSION The additional hidden burden of stigma from PD affects quality of life. Having a better understanding of the role of stigma and its impact may allow clinicians to provide proactive care and greater empathy for those living with the challenges of this disease.
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Affiliation(s)
- Bradley McDaniels
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA.
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA; Parkinson's Disease Research, Education and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA
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Hidayat J, Chen MY, Maulina R, Nurbaya S. Factors Associated With HIV-Related Stigma Among Indonesian Healthcare Workers: A Cross-Sectional Online Survey. J Nurs Res 2023; 31:e295. [PMID: 37668415 DOI: 10.1097/jnr.0000000000000573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Despite worldwide advances in HIV care and growing scientific knowledge about HIV, stigma and prejudice continue to hinder people living with HIV/AIDS (PLWHA) from seeking treatment and care. HIV-related stigma among healthcare workers in Indonesia has been investigated and measured in only a few empirical studies. PURPOSE This study was developed to identify factors related to holding stigmatizing attitudes toward PLWHA among professional healthcare providers in Indonesia. METHODS A cross-sectional survey approach using convenience and snowball sampling techniques was used. Data were collected in February and March 2022. All of the participants were healthcare workers in Indonesia who had completed an online survey that collected demographic data and measured HIV-related stigma, fear of HIV transmission, and HIV-related knowledge. Bivariate analysis and multiple linear regression were used to investigate the association between the independent and dependent variables. RESULTS The study enrolled 252 participants, including eight physicians (3.2%), 200 nurses (79.4%), and 44 midwives (17.5%). Over two thirds of the participants (65.1%) had no formal HIV training. Stigmatizing attitudes were associated with lower levels of HIV knowledge ( B = -0.480, p < .01), fear of becoming infected with the HIV virus ( B = 0.354, p < .05), and type of HIV care setting ( B = -2.913, p < .05). Of the three participant categories, physicians had the highest levels of both HIV knowledge and PLWHA-related stigma. CONCLUSIONS The findings indicate many healthcare workers in Indonesia receive limited formal training on HIV, have low levels of HIV knowledge, and fear HIV transmission. Therefore, providing comprehensive and up-to-date education about HIV for health workers and proper personal protective equipment should be incorporated into programs aimed at reducing stigmatizing attitudes against patients with HIV among healthcare workers in Indonesia.
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Affiliation(s)
- Jufri Hidayat
- MSN, RN, Doctoral Student, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Miao-Yen Chen
- PhD, RN, Associate Professor, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Rufidah Maulina
- MS, Lecturer, Midwifery Department, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Sitti Nurbaya
- MS, Lecturer, Faculty of Nursing, Stikes Nani Hasanuddin Makassar, Indonesia
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Malli IA, Hamdan D, Aljahdali A, Almutairi A, Jar R, Alzahrani R, Khan MA. Medical Interns' Knowledge, Attitude, and Practice Toward People Living with HIV: Multicenter Experience from Saudi Arabia. HIV AIDS (Auckl) 2023; 15:571-582. [PMID: 37744212 PMCID: PMC10516208 DOI: 10.2147/hiv.s418948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Background Discrimination by some healthcare providers toward people living with HIV/AIDS has been documented. Differences in cultural backgrounds make it harder for future doctors, who need a lot of knowledge and a positive attitude to treat patients. In conservative countries like Saudi Arabia, not enough is known about how much medical interns know about HIV and how they feel about people living with HIV/AIDS. Methods From April to September 2021, this cross-sectional study use non-probability random sampling and utilized a self-administered questionnaire to collected the data from 346 medical interns who had graduated from five different medical schools. Results Most of the subjects correctly identified the main transmission routes, such as unprotected sex (94.57%), blood and body fluid exchange (94.19%), and sharing needles or syringes (91.47%). But they did not know what the most common co-infections were for HIV patients or how to protect themselves after exposure. This paper showed that medical interns have some stigmatizing behaviors toward patients living with HIV, as 31.1% and 22.9% agreed, respectively, that they would feel more sympathetic toward people who get AIDS from blood transfusions compared to IV drug users (IDU). Conclusion Medical interns also showed some positive attitudes, as more than half of the sample (56.2%) would not isolate beds for people living with HIV/AIDS. The study's conclusion is that HIV education and training programs should be added for medical interns, which might have a significant positive impact on their attitude.
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Affiliation(s)
- Israa Abdullah Malli
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, 22384, Saudi Arabia
- Ministry of the National Guard - Health Affairs, Jeddah, 22384, Saudi Arabia
| | - Dalia Hamdan
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, 22384, Saudi Arabia
| | - Alhanoof Aljahdali
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, 22384, Saudi Arabia
| | - Amal Almutairi
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, 22384, Saudi Arabia
| | - Raghad Jar
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, 22384, Saudi Arabia
| | - Reham Alzahrani
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, 22384, Saudi Arabia
| | - Muhammad Anwar Khan
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, 22384, Saudi Arabia
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Simo Fotso A, Wright CG, Low A. How does HIV-related stigma correlate with HIV prevalence in African countries? Distinct perspectives from individuals living with and living without HIV. BMC Public Health 2023; 23:1720. [PMID: 37667211 PMCID: PMC10478181 DOI: 10.1186/s12889-023-16545-3] [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: 01/03/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Population-level research evaluating HIV-related stigma among countries with varied national HIV prevalence is scarce. To better understand HIV-related stigma and mitigate its potential negative effects, it is necessary to evaluate its relationship with HIV prevalence, as well as the mechanisms that influence it. This study aimed to analyze how HIV-related stigma correlates with subnational HIV prevalence in three African countries with varied HIV epidemics. METHODS This paper used data from the nationally representative Population-based HIV Impact Assessment (PHIA) surveys conducted from 2015-2017 in Malawi, Zambia, and Tanzania. Each country's sub-national geographic divisions were used to categorize them as low (0-5.4%), middle (5.5-11.2%), and high (11.3-17.1%) HIV prevalence regions in the main analysis. Questions from the survey stigma module were used to measure HIV-related stigma. Logistic regression and multilevel models were performed to assess the associations between the level of sub-national HIV prevalence and HIV-related stigma measures among persons living with, and without, HIV. RESULTS The results show that the odds of people living without HIV expressing stigmatizing behavior towards PLWH was significantly lower in regions of middle (OR = 0.80, 90%CI = (0.68-0.96)) and high (OR = 0.65, 90%CI = (0.53-0.80)) HIV prevalence when compared to low prevalence regions. The odds of reporting discriminatory attitudes were also lower for those in middle (OR = 0.87, 90%CI = (0.78-0.98)) and high (OR = 0.64, 90%CI = (0.56-0.73)) HIV prevalence regions compared to others. Living in middle and high HIV prevalence regions was associated with lower odds of expressing prejudice toward PLWH (OR = 0.84, 90%CI = (0.71-0.99) and OR = 0.60, 90%CI = (0.45-0.80), respectively) among people living without HIV. Notably, PLWH living in high prevalence regions had higher odds of reporting internalized stigma (OR = 1.48, 90%CI = (1.02-2.14)) compared to those living in low prevalence regions. CONCLUSIONS The results indicate that among people not living with HIV, subnational HIV prevalence was negatively associated with discriminatory attitudes and prejudice towards PLWH, but HIV prevalence was positively associated with self-reported internalized stigma among PLWH. These results provide insight on how resources could be invested to reduce HIV related stigma among both PLWH and those not living with HIV.
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Affiliation(s)
- Arlette Simo Fotso
- L'Institut national d'études démographiques (INED), F-93300, Aubervilliers, France.
- Centre Population & Développement, Université Paris-Cité, Inserm, Paris, France.
| | - Connor G Wright
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Andrea Low
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
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Celeste-Villalvir A, Payan DD, Armenta G, Palar K, Then-Paulino A, Acevedo R, Fulcar MA, Derose KP. Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic. PLoS One 2023; 18:e0290228. [PMID: 37616218 PMCID: PMC10449144 DOI: 10.1371/journal.pone.0290228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men's experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women's experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to "move on" and "look ahead." Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.
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Affiliation(s)
- Alane Celeste-Villalvir
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Denise D. Payan
- Department of Health, Society and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, United States of America
| | - Gabriela Armenta
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, United States of America
| | - Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Amarilis Then-Paulino
- Facultad de Ciencia de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Maria Altagracia Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Kathryn P. Derose
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, California, United States of America
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Poku OB, Eschliman EL, Entaile P, Rampa S, Mehta H, Tal D, Silvert L, Li T, Becker TD, Govindasamy D, Stockton MA, Adedimeji A, Ho-Foster A, Blank MB, Dangerfield DT, Yang LH, Murray SM. "It's Better If I Die Because Even in the Hospital, There is a Stigma, People Still Gossip": Gossip as a Culturally Shaped Labeling Process and Its Implications for HIV-Related Stigma in Botswana. AIDS Behav 2023; 27:2535-2547. [PMID: 36646928 PMCID: PMC10350478 DOI: 10.1007/s10461-023-03980-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] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
This study qualitatively explores HIV-related gossip as both a manifestation and driver of HIV-related stigma, which is a known barrier to HIV testing and treatment in Botswana. Data were elicited from 5 focus group discussions and 46 semi-structured in-depth interviews with individuals living with HIV and community members with undisclosed serostatus in Gaborone, Botswana in 2017 (n = 84). Directed content analysis using the 'What Matters Most' theoretical framework identified culturally salient manifestations of HIV-related stigma; simultaneous use of Modified Labeling Theory allowed interpretation and stepwise organization of how the social phenomenon of gossip leads to adverse HIV outcomes. Results indicated that HIV-related gossip can diminish community standing through culturally influenced mechanisms, in turn precipitating poor psychosocial well-being and worsened HIV-related outcomes. These harms may be offset by protective factors, such as appearing healthy, accepting one's HIV status, and community education about the harms of gossip.
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Affiliation(s)
- Ohemaa B Poku
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Evan L Eschliman
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Shathani Rampa
- Department of Psychology, Queens College, City University of New York, New York, NY, USA
| | - Haitisha Mehta
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Danielle Tal
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Lea Silvert
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Tingyu Li
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Melissa A Stockton
- Department of Psychiatry, Vagelos College of Physicians and Surgeons Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Lawrence H Yang
- School of Global Public Health, New York University, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Barnwell PV, Ingate MR, Sagar A, Contrada RJ. College students' perceptions of concussion: Illness beliefs and masculinity norms predict stigma and willingness to seek treatment. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-16. [PMID: 37487191 DOI: 10.1080/07448481.2023.2222845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 04/19/2023] [Accepted: 05/19/2023] [Indexed: 07/26/2023]
Abstract
College students' beliefs and attitudes concerning concussion, and masculinity norms, were examined in relation to stigma and willingness to seek treatment for possible concussion. Beliefs were measured using a revised Illness Perception Questionnaire (IPQ). Participants: Participants were 631 undergraduates at a Northeastern university, most of whom were nonathletes with no concussion. Methods: Data were collected online. Regression analysis were performed to identify predictors of stigma and treatment willingness. Results: Beliefs that concussion symptoms reflect malingering, are controllable, and have psychological causes were related to more stigmatizing attitudes, as was endorsement of masculinity norms regarding winning and risk-taking. Believing that concussion symptoms are long-lasting and endorsing competitiveness, pain discounting, and self-reliance predicted willingness to seek treatment. Preliminary structural models showed adequate fit. Conclusions: In addition to beliefs assessed by the IPQ, traditional conceptions of masculinity warrant greater attention in the study of concussion-related stigma and willingness to seek treatment.
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Affiliation(s)
- Patrick V Barnwell
- Psychology Department, Rutgers University, New Brunswick, New Jersy, USA
| | - Margaret R Ingate
- Psychology Department, Rutgers University, New Brunswick, New Jersy, USA
| | - Anushka Sagar
- Psychology Department, Rutgers University, New Brunswick, New Jersy, USA
| | - Richard J Contrada
- Psychology Department, Rutgers University, New Brunswick, New Jersy, USA
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Helmert C, Fleischer T, Speerforck S, Ulke C, Altweck L, Hahm S, Muehlan H, Schmidt S, Grabe HJ, Völzke H, Schomerus G. An explorative cross-sectional analysis of mental health shame and help-seeking intentions in different lifestyles. Sci Rep 2023; 13:10825. [PMID: 37402843 PMCID: PMC10319876 DOI: 10.1038/s41598-023-37955-8] [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: 11/23/2022] [Accepted: 06/30/2023] [Indexed: 07/06/2023] Open
Abstract
To identify und support particular target groups for mental health prevention, we explore the links between shame and help-seeking intentions concerning mental health in different lifestyles (based on socioeconomic status as well as health-related behaviors). Lifestyles were operationalized by nine confirmatory, homogenous clusters of the sample. These clusters are based on individuals' similarities in sociodemographic aspects and health behavior. Analyses included t tests, Chi-square, ANOVA, regressions investigating in sociodemographic characteristics. Hierarchical linear models examining cross-sectional associations of shame and willingness to seek help for different lifestyles of participants of the Study of Health in Pomerania (SHIP-START-1 and SHIP-START-3, data collected 2002-2006 and 2014-2016; n = 1630). Hierarchical linear models showed small context effects for lifestyle-related associations of shame and willingness to seek help. For younger as well as male participants, lifestyles indicated different associations of shame and help-seeking intentions: Especially the lifestyles with unhealthy behaviors and high as well as low socioeconomic status resulted in higher shame being associated with low help-seeking intentions in case of mental illness. Lifestyle clusters might be a useful tool to identify marginalized groups with unhealthy behaviors, which should be addressed by interventions and prevention programs.
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Affiliation(s)
- Claudia Helmert
- Department of Psychiatry and Psychotherapy, University of Leipzig, Medical Center, Leipzig, Germany.
| | - Toni Fleischer
- Department of Psychiatry and Psychotherapy, University of Leipzig, Medical Center, Leipzig, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University of Leipzig, Medical Center, Leipzig, Germany
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, University of Leipzig, Medical Center, Leipzig, Germany
| | - Laura Altweck
- Department of Health and Prevention, Greifswald University, Greifswald, Germany
| | - Stefanie Hahm
- Department of Health and Prevention, Greifswald University, Greifswald, Germany
| | - Holger Muehlan
- Department of Health and Prevention, Greifswald University, Greifswald, Germany
| | - Silke Schmidt
- Department of Health and Prevention, Greifswald University, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, Greifswald University, Medical Center, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, Greifswald University, Medical Center, Greifswald, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig, Medical Center, Leipzig, Germany
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40
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Nardell MF, Sindelo S, Rousseau E, Siko N, Fuzile P, Julies R, Bassett IV, Mellins CA, Bekker LG, Butler LM, Katz IT. Development of "Yima Nkqo," a community-based, peer group intervention to support treatment initiation for young adults with HIV in South Africa. PLoS One 2023; 18:e0280895. [PMID: 37319250 PMCID: PMC10270624 DOI: 10.1371/journal.pone.0280895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/11/2023] [Indexed: 06/17/2023] Open
Abstract
AIMS Half of young adults diagnosed with HIV in South Africa start antiretroviral therapy (ART). We developed and field tested a facilitator-guided peer support group called Yima Nkqo ("Standing Tall" in isiXhosa) to promote treatment initiation for young adults newly diagnosed with HIV in communities around Cape Town. METHODS Following an adapted version of the UK Medical Research Council's framework for developing complex interventions, we 1) identified evidence on previous interventions to improve ART uptake in sub-Saharan Africa; 2) collected and analyzed qualitative data on the acceptability of our proposed intervention; 3) proposed a theoretical understanding of the process of behavior change; and 4) developed an intervention manual and feedback tools. During field-testing, participant feedback on intervention acceptability, and team feedback on consistency of content delivery and facilitation quality, were analyzed using an iterative, rapid-feedback evaluation approach. In-depth written and verbal summaries were shared in weekly team meetings. Team members interpreted feedback, identified areas for improvement, and proposed suggestions for intervention modifications. RESULTS Based on our formative research, we developed three, 90-minute sessions with content including HIV and ART education, reflection on personal resources and strengths, practice disclosing one's status, strategies to overcome stressors, and goal setting to start treatment. A lay facilitator was trained to deliver intervention content. Two field testing groups (five and four participants, respectively) completed the intervention. Participants highlighted that strengths of Yima Nkqo included peer support, motivation, and education about HIV and ART. Team feedback to the facilitator ensured optimal consistency of intervention content delivery. CONCLUSIONS Iteratively developed in collaboration with youth and healthcare providers, Yima Nkqo is a promising new intervention to improve treatment uptake among young adults with HIV in South Africa. The next phase will be a pilot randomized controlled trial of Yima Nkqo (ClinicalTrials.gov Identifier: NCT04568460).
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Affiliation(s)
- Maria F. Nardell
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Siyaxolisa Sindelo
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Elzette Rousseau
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Nomakaziwe Siko
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Pamela Fuzile
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Robin Julies
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Ingrid V. Bassett
- Harvard Medical School, Boston, MA, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States of America
| | - Linda-Gail Bekker
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
- Department of Medicine, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Republic of South Africa
- Governing Council, International AIDS Society, Geneva, Switzerland
| | - Lisa M. Butler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, United States of America
| | - Ingrid T. Katz
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Global Health Institute, Harvard University, Cambridge, MA, United States of America
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, United States of America
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41
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Rose AL, Feng Y, Rai S, Shrestha P, Magidson JF, Kohrt BA. Pretraining Skills as Predictors of Competence of Nonspecialists in Delivery of Mental Health Services. Psychiatr Serv 2023; 74:614-621. [PMID: 36625138 PMCID: PMC10238614 DOI: 10.1176/appi.ps.202100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Task-shared delivery of mental health care, which includes training people who are not mental health specialists to deliver components of care, has been identified as a core strategy for increasing access to mental health care globally. However, after standard training, nonspecialists attain variable and sometimes poor competence in task-shared mental health care. This study examined whether pretraining interpersonal skills (nonverbal communication, verbal communication, rapport building, and empathy-warmth) are related to posttraining competence in task-shared mental health care among nonspecialists in Nepal. METHODS Nonspecialists (e.g., auxiliary health workers and health assistants) (N=185) were assessed at pretraining and posttraining (4 months after training and supervision) in a task-shared mental health care program in Nepal. This study employed both a classification algorithm and a logistic regression model to examine the relationship between pretraining interpersonal skills and posttraining competence. RESULTS The classification model predicted posttraining competence at above-chance levels on the basis of pretraining interpersonal skills. In particular, pretraining nonverbal communication skill distinguished participants whose posttraining competence was rated as acceptable from those whose rating was not acceptable. Nonverbal communication was also a significant predictor in the regression model. No other interpersonal skills were significantly related to posttraining competence outcomes in the regression model. CONCLUSIONS Some pretraining interpersonal skills of nonspecialists may predict overall competence outcomes in task-shared mental health care. Future studies confirming the relationship between pretraining interpersonal skills and posttraining competence in care delivery could improve staff selection and training strategies in task-shared mental health care programs.
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Affiliation(s)
- Alexandra L Rose
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
| | - Yi Feng
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
| | - Sauharda Rai
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
| | - Pragya Shrestha
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
| | - Jessica F Magidson
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
| | - Brandon A Kohrt
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
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Njuguna I, Moraa H, Mugo C, Mbwayo A, Nyapara F, Aballa C, Wagner AD, Wamalwa D, John-Stewart G, Inwani I, O’Malley G. 'They should show them love even if their status of being HIV positive is known': Youth and caregiver stigma experience and strategies to end HIV stigma in schools. Trop Med Int Health 2023; 28:466-475. [PMID: 37177902 PMCID: PMC10278085 DOI: 10.1111/tmi.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE HIV stigma and discrimination is widespread in sub-Saharan Africa and is associated with poor clinical outcomes. Schools play a critical role in the life of youth and have been identified as a potentially stigmatising environment. We sought to explore school HIV stigma drivers, facilitators, manifestations and outcomes among youth living with HIV (YLH) as well as potential stigma reduction interventions in Kenya. METHODS Semi-structured in-depth qualitative interviews with 28 school-attending YLH aged 14-19 years and 24 caregivers of YLH were analysed using directed content analysis. Results were summarised using the Health and Stigma Framework. RESULTS Drivers and facilitators of HIV stigma in the school environment included misconceptions about HIV transmission, HIV treatment outcomes and long-term overall health of people living with HIV. HIV stigma manifested largely as gossip, isolation and loss of friendships. Fear of HIV stigma or experienced stigma resulted in poor adherence to antiretroviral treatment-particularly among YLH in boarding schools-and poor mental health. Stigma also impacted school choice (boarding vs. day school) and prevented HIV disclosure to schools which was necessary for optimal support for care. Proposed interventions to address HIV stigma in schools included HIV education, psychosocial support for YLH, support for HIV disclosure to schools while ensuring confidentiality and building YLH resilience. CONCLUSION There is an urgent need to develop interventions to address HIV stigma in schools to ensure optimised health and social outcomes for YLH. Future studies to understand the most effective and efficient interventions are needed.
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Affiliation(s)
- Irene Njuguna
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Hellen Moraa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Florence Nyapara
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Calvins Aballa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anjuli D. Wagner
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Grace John-Stewart
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Epidemiology, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Medicine, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Pediatrics, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Irene Inwani
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Gabrielle O’Malley
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
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Nabunya P, Namuwonge F, Sensoy Bahar O, Ssentumbwe V, Migadde H, Mugisha J, Ssewamala FM. Stigma by Association, Parenting Stress, and the Mental Health of Caregivers of Adolescents Living With HIV in Uganda. J Adolesc Health 2023; 72:S18-S23. [PMID: 37062579 PMCID: PMC10151126 DOI: 10.1016/j.jadohealth.2022.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/14/2022] [Accepted: 08/26/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE This study examined the relationship between stigma by association-defined as prejudice and discrimination against individuals who are associated with stigmatized individuals, parenting stress, and the mental health of caregivers of adolescents living with HIV. METHODS Multivariate regression analyses were conducted using baseline data from the Suubi4Stigma study (2020-2022), a pilot study addressing HIV-related stigma among adolescents and their caregivers in southern Uganda. RESULTS The average age was 47 years, 77.5% were female, and 49% identified as the child's biological parent. Stigma by association was associated with poor caregiver mental health (b = 1.346, 95% confidence interval = 0.49, 2.21) and parenting stress (b = 1.431, 95% confidence interval = 0.79, 2.08). Caregiver's gender, biological relatedness, household composition, and family cohesion were uniquely associated with caregiver mental health and parenting stress. DISCUSSION Findings point to the need to incorporate stigma reduction components, not only for adolescents living with HIV, but also their caregivers, to counteract the effects of stigma on their mental health.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri.
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Herbert Migadde
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri
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Turney K, Testa A, Jackson DB. Stigma Arising from Youth Police Contact: The Protective Role of Mother-Youth Closeness. JOURNAL OF MARRIAGE AND THE FAMILY 2023; 85:477-493. [PMID: 38106990 PMCID: PMC10723111 DOI: 10.1111/jomf.12886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 09/12/2022] [Indexed: 12/19/2023]
Abstract
Objective The purpose of this article is to examine the relationship between mother-youth closeness and stigma stemming from police contact. Background Research increasingly indicates that stigma stemming from police-youth encounters links police contact to compromised outcomes among youth, though less is known about the correlates of stigma stemming from this criminal legal contact. Close mother-youth relationships, commonly understood to be protective for youth outcomes, may be one factor that buffers against stop-related stigma, especially the anticipation of stigma. Method We use data from the Fragile Families and Child Wellbeing Study, a sample of youth born in urban areas around the turn of the 21st century, to examine the relationship between mother-youth closeness and stop-related stigma. Results We find that mother-youth closeness is negatively associated with stop-related anticipated stigma but not stop-related experienced stigma. We also find that the relationship between mother-youth closeness and stop-related anticipated stigma is concentrated among youth experiencing a non-intrusive stop. Conclusion Close mother-youth relationships may protect against stigma stemming from criminal legal contact.
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Affiliation(s)
- Kristin Turney
- University of California, Irvine, 3151 Social Science Plaza, Irvine, CA 92697
| | - Alexander Testa
- The University of Texas Health Science Center at Houston, 7411 John Smith Drive, Suite 1100, San Antonio, TX 78229
| | - Dylan B Jackson
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore MD, 21205
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Carol Matthews-Mthembu J, Khan G. Implications of Social Stigma on the Health Outcomes of Marginalised Groups. Infect Dis (Lond) 2023. [DOI: 10.5772/intechopen.104423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Research Focus: Stigma is a longstanding issue for South Africa as it is influenced by a history of typification. Social marginalisation is influenced by a myriad of socially structured norms and those who experience stigma, are often faced with social devaluation within their society. In addition, experiences of discrimination may lead to internalised stigma that may lower the self-esteem and agency as well as negatively affect the well-being of many. Methods: This chapter uses current literature to propose that stigma, remain a public health concern. Recommendations: The findings suggest recommendations that are likely to enhance programme and policy interventions aimed to decrease stigma. Overview Stigma has been a longstanding issue for South Africa as it is influenced by a history of typification. Social marginalisation is influenced by a myriad of socially structured norms and those who experience stigma, are often faced with social devaluation within their society. This policy brief proposes that stigma, and in particular its association with certain marginalised groups, remain a public health concern. It further discusses possible recommendations that are likely to enhance both programme and policy interventions aimed to decrease stigma or at the least, make individuals aware of their complicity in reproducing and maintaining social stigmatisation.
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Gronholm PC, Bakolis I, Cherian AV, Davies K, Evans-Lacko S, Girma E, Gurung D, Hanlon C, Hanna F, Henderson C, Kohrt BA, Lempp H, Li J, Loganathan S, Maulik PK, Ma N, Ouali U, Romeo R, Rüsch N, Semrau M, Taylor Salisbury T, Votruba N, Wahid SS, Zhang W, Thornicroft G. Toward a multi-level strategy to reduce stigma in global mental health: overview protocol of the Indigo Partnership to develop and test interventions in low- and middle-income countries. Int J Ment Health Syst 2023; 17:2. [PMID: 36732828 PMCID: PMC9896727 DOI: 10.1186/s13033-022-00564-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/31/2022] [Indexed: 02/04/2023] Open
Abstract
There is increasing attention to the impacts of stigma and discrimination related to mental health on quality of life and access to and quality of healthcare. Effective strategies for stigma reduction exist, but most evidence comes from high-income settings. Recent reviews of stigma research have identified gaps in the field, including limited cultural and contextual adaptation of interventions, a lack of contextual psychometric information on evaluation tools, and, most notably, a lack of multi-level strategies for stigma reduction. The Indigo Partnership research programme will address these knowledge gaps through a multi-country, multi-site collaboration for anti-stigma interventions in low- and middle-income countries (LMICs) (China, Ethiopia, India, Nepal, and Tunisia). The Indigo Partnership aims to: (1) carry out research to strengthen the understanding of mechanisms of stigma processes and reduce stigma and discrimination against people with mental health conditions in LMICs; and (2) establish a strong collaborative research consortium through the conduct of this programme. Specifically, the Indigo Partnership involves developing and pilot testing anti-stigma interventions at the community, primary care, and mental health specialist care levels, with a systematic approach to cultural and contextual adaptation across the sites. This work also involves transcultural translation and adaptation of stigma and discrimination measurement tools. The Indigo Partnership operates with the key principle of partnering with people with lived experience of mental health conditions for the development and implementation of the pilot interventions, as well as capacity building and cross-site learning to actively develop a more globally representative and equitable mental health research community. This work is envisioned to have a long-lasting impact, both in terms of the capacity building provided to participating institutions and researchers, and the foundation it provides for future research to extend the evidence base of what works to reduce and ultimately end stigma and discrimination in mental health.
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Affiliation(s)
- Petra C Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anish V Cherian
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Kelly Davies
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, UK
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dristy Gurung
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fahmy Hanna
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Claire Henderson
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jie Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Santosh Loganathan
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ning Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Uta Ouali
- Department Psychiatry A, Razi University Hospital, La Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Renee Romeo
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicolas Rüsch
- Section of Public Mental Health, Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany
| | - Maya Semrau
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicole Votruba
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Imperial College London, London, UK
| | - Syed Shabab Wahid
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
- Department of Global Health, School of Health, Georgetown University, Washington, DC, USA
| | - Wufang Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Lim S, Lee S, Cohen L, Chin JJ, Trinh-Shevrin C, Islam NS. Factors Influencing Recovery and Well-Being Among Asian Survivors of International Criminal Sex Trafficking in an Urban U.S. City. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:2360-2386. [PMID: 35548928 DOI: 10.1177/08862605221101187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex trafficking is serious form of gender-based violence that results in profound adverse health outcomes, yet one that is poorly understood. New York City is a major hub for sex trafficking, with a significant but unquantified number of victims originating from East Asian countries and trafficked via illicit massage businesses. Peer-reviewed studies among Asian survivors of international criminal sex trafficking do not exist. The aim of this study is to qualitatively examine the factors at various levels of influence that impact the recovery and reintegration process of Asian criminal sex trafficking survivors in the United States from the perspective of survivors and front-line service providers. The study was guided by community-based participatory research and trauma-informed approaches, leveraging a collaboration with a well-established service provider organization. Ten in-depth interviews were conducted between 2018 and 2019 with three Korean survivors and seven key informants who were anti-trafficking service providers working with East Asian clients. Data were analyzed using a grounded theory approach. Survivors and service providers vocalized factors at multiple levels that either facilitate or impede recovery and well-being. Levels of influence included structural (e.g., poverty/debt bondage, immigration status, limited English proficiency), cultural (e.g., fatalism, collectivism), institutional (e.g., lack of culturally appropriate, trauma-informed care), interpersonal (e.g., exploitation, social support), and individual (e.g., resilience). Stigma was a crosscutting factor that spanned all levels of influence. This study highlights the voices of survivors and front-line service providers to understand the lives of an under-researched population of Asian sex trafficking survivors. Ultimately, the root, structural causes of survivor marginalization need to be addressed, which stem from the intersection of class-, gender-, and race-related inequities. While survivors continue to experience exploitation and marginalization post-trafficking, they also carry an enormous amount of resilience that must be leveraged in their path to recovery from trauma.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine, NY, USA
| | - Seunggun Lee
- Department of Population Health, New York University Grossman School of Medicine, NY, USA
| | - Lori Cohen
- Anti-Trafficking Initiative, Sanctuary for Families, New York, NY, USA
| | - John J Chin
- Hunter College, 5924The City University of New York, NY, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University Grossman School of Medicine, NY, USA
| | - Nadia S Islam
- Department of Population Health, New York University Grossman School of Medicine, NY, USA
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Zabihi Poursaadati M, Maarefvand M, Bolhari J, Hosseinzadeh S, Songhori N, Derakhshan L, Khubchandani J. Caregivers' experiences and perspectives of factors associated with relapse in Iranian people living with schizophrenia: A qualitative study. Int J Soc Psychiatry 2023; 69:86-100. [PMID: 34971526 DOI: 10.1177/00207640211068977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relapse in People Living with Schizophrenia (PLS) has several reasons and recognizing these can increase the effectiveness of treatment interventions. Formal and informal caregivers are an informed source to reduce relapse in PLS. AIM This study explores the caregivers' perspective in Iran on the factors affecting relapse in PLS. METHOD A total of 28 caregivers (16 formal caregivers and 12 informal caregivers) of PLS were enrolled in our qualitative study. A content analysis was conducted using individual and group, semi-structured in-depth interviews with informal and formal caregivers of PLS. This study was conducted in a hospital, three universities, and a non-governmental organization in Tehran, Iran. RESULTS The majority (69%) of the participants were females. About half of the informal caregivers were over 60 years old and about 40% of the formal caregivers were in the age range of 30 to 40 years. The average number of years of work for informal caregivers was 17.6 years and the average of work experience among the formal caregivers was 14.1 years. Seven key dual themes were identified from data: 'awareness-stigma', 'social support-social exclusion', 'treatment adherence-treatment discontinuation', 'holistic approach - one-dimensional approach', 'supported employment-social dysfunction', 'emotional management in family - family with high emotional expression', and 'access to treatment-treatment gap'. CONCLUSION The results of this research can help practitioners and policymakers to enable evidence-based practices to reduce relapse in PLS by emphasizing and acting on factors identified in our analyses.
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Affiliation(s)
| | - Masoomeh Maarefvand
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Biostatistics department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nahid Songhori
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Leili Derakhshan
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jagdish Khubchandani
- Department of Public Health Sciences, New Mexico University, Las Cruces, NM, USA
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Lodi S, Rossi SL, Bendiks S, Gnatienko N, Lloyd-Travaglini C, Vetrova M, Toussova O, Bushara N, Blokhina E, Krupitsky E, Ekstrand ML, Lioznov D, Samet JH, Lunze K. Correlates of Intersectional HIV and Substance Use Stigma Affecting People with HIV and Substance Use in St. Petersburg, Russia. AIDS Behav 2023; 27:462-472. [PMID: 35916947 PMCID: PMC9892353 DOI: 10.1007/s10461-022-03781-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 02/04/2023]
Abstract
People with HIV (PWH) who inject drugs often experience coexisting HIV- and substance use-related stigma manifestations. We assessed correlates of HIV stigma (Berger HIV stigma scale), substance use stigma (Substance Abuse Self-stigma scale) and intersectional HIV and substance use stigma in a cohort of PWH with a lifetime history of drug use in St. Petersburg, Russia. Intersectional stigma was defined as having a score greater than the median for both forms of stigma. Of the 208 participants, 56 (27%) had intersectional stigma. Depressive symptoms and alcohol dependence were significantly associated with a higher HIV and substance stigma score, but not with intersectional stigma. Individual and community interventions to reduce the impact of HIV stigma and substance use stigma affecting PWH who inject drugs should consider assessing and addressing mental health and unhealthy substance use. Further work with longitudinal data is needed to understand mechanisms leading to intersectional stigma.
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Affiliation(s)
- Sara Lodi
- Boston University School of Public Health, Boston, MA, USA.
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Sarah L Rossi
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sally Bendiks
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | | | | | - Marina Vetrova
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Olga Toussova
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Natalia Bushara
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Elena Blokhina
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Evgeny Krupitsky
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
- Department of Addiction, Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Maria L Ekstrand
- Center for AIDS Prevention Studies, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | - Dmitry Lioznov
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Jeffrey H Samet
- Boston University School of Public Health, Boston, MA, USA
- Department of Medicine, Boston Medical Center, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Karsten Lunze
- Department of Medicine, Boston Medical Center, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
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Amazue LO, Eze JE, Essien NF, Nnadozie EE, Onu DU. Health disclosure mediates stigma-psychological well-being link among Vesico-Vaginal fistula patients. PSYCHOL HEALTH MED 2023; 28:336-343. [PMID: 35164625 DOI: 10.1080/13548506.2022.2041206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There is strong link between health stigma and poor psychological wellbeing among Vesico-Vaginal fistula (V.V.F.) patients, yet no study to date has investigated the variables mediating this link. This study investigated the mediating role of health disclosure on the relationship between health stigma and psychological wellbeing among V.V.F. patients in Nigeria. Participants were 183 women (aged 14-70 years; mean age 22.88 years, SD = 5.64) conveniently drawn from a National Obstetric Fistula Hospital facility in south-east Nigeria. Participants completed measures of health stigma, health disclosure and psychological wellbeing. Results showed that health disclosure mediated the association between health stigma and psychological wellbeing. The results indicated that increased health stigma would lead to decreased health disclosure which in turn, would lead to poor psychological wellbeing. Our findings highlighted the relevance of health disclosure in the management of stigma impacts on health and wellbeing of V.V.F. patients.
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Affiliation(s)
| | - John Eze Eze
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
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