Article

Relationships Between Stigma, Social Support, and Depression in HIV-Infected African American Women Living in the Rural Southeastern United States

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Abstract

This cross-sectional study examined relationships between HIV-related stigma, social support, and depression in a sample of 340 HIV-infected African American women living in rural areas of the Southeastern United States. Three aspects of social support (availability of different types of support, sources of support, and satisfaction with support) and two aspects of HIV-related stigma (perceived stigma and internalized stigma) were measured. Perceived availability of support (p < .0001), sources of support (p = .03), satisfaction with support (p = .003), perceived stigma (p < .0001), and internalized stigma (p < .0001) were all significantly correlated with depression. Social support variables were negatively correlated and stigma variables were positively correlated with depression. HIV-related perceived stigma and internalized stigma were found to mediate the effect of sources of available support on depression. Study findings have implications for designing and implementing interventions to increase social support and decrease HIV-related stigma in order to decrease depression among African American women with HIV disease.

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... For example, internalized HIV/AIDS stigma is a common stressor for PLH, and the effect of stigma on depression might vary by gender [11]. Similarly, access to and use of social support resources can modify the relationship between gender and depression [12]. ...
... Responses on a Likert-scale range from 0 "Not at all" to 3 "Most of the time" and reverse coded for negatively-framed items. The HADS-D has four recommended scoring levels based on the sum of the responses: none (0-7), mild (8-10), moderate (11)(12)(13)(14), severe (15+). In this study, the HADS-D score was treated as a continuous variable indicating severity of depressive symptoms for linear regression analyses. ...
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People living with HIV/AIDS (PLH) experience high rates of depression and related psychosocial risk factors that vary by gender. This study examines gender differences in depression severity among antiretroviral therapy (ART) patients (n = 362) from a large government ART clinic in Kolkata, India. Hypotheses for multiple linear regression models were guided by an integrated gendered stress process model focusing on variables reflecting social status (age, partner status), stressors (stigma), and resources (income, social support). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS); 22% of the sample reached the cutoff for severe depression, 56% moderate, and 13% mild depression. Compared to men, women reported lower income, education (50% no formal education vs. 20% men), availability of emotional and instrumental support, and were less likely to be married or cohabiting (53% women vs. 72% of men). However, more women had partners who were HIV-positive (78% women vs. 46% men). Overall, depression severity was negatively associated with availability of emotional support and self-distraction coping, and positively associated with internalized HIV/AIDS stigma, availability of instrumental support, and behavioral disengagement coping. Interactions for instrumental support by income and partner status by age varied significantly by gender. Analyses stratified by gender indicated that: 1) Frequently seeking instrumental support from others was protective for men at all income levels, but only for high-income women; and 2) having a partner was protective for men as they aged, but not for women. These results suggest that gender disparities in depression severity are created and maintained by women's lower social status and limited access to resources. The effect of stigma on depression severity did not vary by gender. These findings may inform the tailoring of future interventions to address mental health needs of PLH in India, particularly gender disparities in access to material and social resources for coping with HIV. Trial Registration: ClinicalTrials.gov registration #NCT02118454, registered April 2014.
... Several studies from Asia, Africa, Australia, the Caribbean, and the United States have shown a correlation between internalized stigma and depression among PLHIV [16,[21][22][23][24][25][26][27][28][29][30]. From a cognitive theory perspective, depression is defined by people's dysfunctional negative beliefs about themselves, their life experience, their future, and the world in general [31], while internalized stigma entails accepting society's negative attitudes and feelings regarding PLHIV and applying them to oneself [32]. ...
... Several research studies have indicated a link between internalized stigma and depression in PLHIV. The phenomenon was consistently found in general adults living with HIV [16,22,23,26,38], women living with HIV [21], older adults living with HIV (aged ≥ 50 years old) [24], and MSM [25]. However, these studies only examined overall internalized HIV stigma. ...
Article
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Internalized stigma and depression are among the most common mental health problems in people living with HIV (PLHIV). This study aimed to examine the association between depression and overall internalized stigma, as well as different aspects of internalized stigma in PLHIV. The study included 400 PLHIV receiving care in Bangkok and Chiang Mai, Thailand. Data were analyzed using descriptive statistics, Mann-Whitney U test, and Spearman correlation coefficients. The results indicated the PLHIV with mild depression had lower median scores for the social relationship internalized stigma subscale than PLHIV with major depressive disorder (p = 0.009). Total HIV internalized stigma scores were significantly correlated with PHQ-9 scores in the mild depression group (r = 0.327, p = 0.004). Depression and internalized stigma were prevalent and associated, especially in the area of social relationships. Health personnel should be aware of possible depression in PLHIV who have internalized stigma. Intervention to promote understanding and social support for PLHIV is warranted.
... Women living with HIV report fears and experiences of HIV-related stigma in health care settings as a hinderance to engagement in HIV care [21]. HIV-related stigma may also hinder one's ability to disclose their HIV status and prevent women from seeking social support [25][26][27]. ...
... Study findings show that fear, anxiety and the HIV stigma can impede HIV protective behaviors such as inquiring about a partner's HIV status and disclosing one's HIV status. These findings correspond to other research that has shown that HIV stigma plays an important role in how women go about seeking prevention and care services, disclosing HIV status, seeking family support, and ancillary services [25][26][27]. While almost all the study participants reported testing for HIV, it is important to recognize that stigma can have a negative effect on the health and health outcomes of those at risk and PLWHA. ...
Article
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The HIV/AIDS epidemic disproportionately affects Black and African American women in the United States. This study examined the extent of HIV related knowledge, HIV testing decision-making, and perceptions of alcohol use as a risk factor for HIV among Black and African American women in urban and suburban communities. Seven focus groups were conducted with 37 women aged 18 to 49 residing in the Commonwealth of Massachusetts. Women participating in focus groups had a wide breadth of HIV related knowledge. Findings suggest the influence of interpersonal relationships and provider-patient interactions on HIV testing, the need for building community capacity and leveraging community resources towards HIV prevention, and the influence of alcohol outlet density on HIV vulnerability and exposure in communities of color. Comprehensive multifaceted evidence informed interventions that are culturally relevant and gender responsive are needed to reduce HIV/AIDS disparities.
... It has been widely reported that social support can be used as a predictor of depressive symptoms and stigma [14,15,31,70,71]. A study in a population of women infected with Acquired immunodeficiency syndrome (AIDS) found that stigma could mediate the relationship between social support and depressive symptoms [72]. Similar results were also found in substance abuse patients [44]. ...
... We also consider the Wang et al. BMC Psychiatry (2022) 22:117 moderating effect of self-efficacy in the mediation model, which was ignored in previous studies [44,72]. Second, our research established a mediation model and chose a more reliable statistic-1000 bootstrapping, to get robust results. ...
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Background Although some psychological processes, such as stigma and self-efficacy, affect the complicated relationship between social support and depressive symptoms, few studies explored a similar psychological mechanism among individuals with substance use disorders (SUDs). Hence, this research investigates the mediating effects of stigma and the moderating effects of self-efficacy among the psychological mechanism that social support affects depressive symptoms. Methods The study included 1040 Chinese participants with SUDs and completed a series of self-report questionnaires. R software was used to organize and clean up data sets and analyze mediation and moderation effects. Results The result showed that stigma partially mediated depressive symptoms, while self-efficacy moderated this relationship. More specifically, less social support increased depression symptoms by bringing about higher stigma. Besides, subjects with higher self-efficacy are less susceptible to stigma and therefore have mild depressive symptoms. Furthermore, clinical and theoretical implications are discussed in our study. Conclusions Chinese SUDs patients’ depressive symptoms were indirectly affected by perceived social support via stigma and less affected by stigma with improved self-efficacy. The theoretical and practical implications of these results are discussed.
... It generates self-depreciation (MacDougall et al., 2015), a sense of being incapable and unproductive (Farrelly et al., 2015), low self-esteem (Bobo et al., 2018;Carpiniello and Pinna, 2017), guilt for the psychiatric condition, lower self-efficacy, and a lack of empowerment (Hanafiah and Bortel, 2015;Kalisova et al., 2018;Livingston and Boyd, 2010). This type of stigma is also associated with emotional distress, hopelessness, anguish (Bobo et al., 2018;Carpiniello and Pinna, 2017), self-depreciation, pessimism (MacDougall et al., 2015), alienation, nonbelonging (Farrelly et al., 2015), lower adherence to treatment (Howland et al., 2016;Kamaradova et al., 2016;Uhlmann et al., 2014), unemployment (Kamaradova et al., 2016;Mascayano et al., 2016;Pal et al., 2017), lower self-functioning (Berry and Greenwood, 2018;Vyavaharkar et al., 2010), aggressive behavior, psychiatric symptoms (Hayward et al., 2002;Livingston and Boyd, 2010;Oexle et al., 2017;Oliveira et al., 2015), psychiatric hospitalizations (Chang et al., 2016;Picco et al., 2016), and increased risk of suicidal behavior (Touriño, 2018). ...
... The association between depressive symptoms and self-stigma may be related with some characteristics of depressive symptoms that include selfdepreciation, hopelessness, and pessimism (MacDougall et al., 2015)aspects closely linked to self-stigma. Studies have indicated that stigma can intensify depressive symptoms and hopelessness and worsen an individual's functioning (Berry and Greenwood, 2018;Vyavaharkar et al., 2010), and it is also associated with guilt for the mental condition, lower self-efficacy and self-esteem, and lack of empowerment in control of their lives (Hanafiah and Bortel, 2015;Kalisova et al., 2018;Livingston and Boyd, 2010). ...
Article
To analyze the predictors of internalized stigma among people with mood disorders, we conducted an analytical observational cross-sectional study with 108 people with mood disorders in a public service setting in Sao Paulo, Brazil. We applied a sociodemographic and clinical questionnaire, the Internalized Stigma of Mental Illness Scale, the Medication Adherence Scale, the Brief Psychiatric Rating Scale-Anchored, and the Herth Hope Index. We analyzed the data using descriptive statistics, average comparison tests, a correlation test, and multiple linear regression. Internalized stigma was associated with symptomatology, history of aggressive behavior, psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to psychotropic medications, and unemployment. The predictors of internalized stigma were unemployment, more psychiatric symptoms, history of previous suicide attempts, and less hope. Clinical interventions and investigations for stigma reduction and psychosocial rehabilitation should incorporate the factors associated with self-stigma (aggressive behavior, history of psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to medication, and unemployment).
... Fifteen quantitative studies were included in the synthesis Blake Helms et al., 2017;Chaudoir et al., 2012;Costelloe et al., 2015;De La Cruz, Davies, & Stewart, 2011;DiIorio et al., 2009;Hernandez et al., 2018;Kalichman, Katner, Banas, & Kalichman, 2017;McCoy, Higgins, Zuniga, & Holstad, 2015;Overstreet, Earnshaw, Kalichman, & Quinn, 2013;Pichon, Rossi, Ogg, Krull, & Griffin, 2015;Relf & Rollins, 2015;Vyavaharkar et al., 2010;Vyavaharkar, Moneyham, Murdaugh, & Tavakoli, 2012;White et al., 2012). All of the studies were conducted in the southeastern region of the United States with publication dates ranging from 2009 to 2017. ...
... Additionally, the longer participants experienced stigma, the more likely they were able to cope with it and integrate it as a part of their lives (White et al., 2012). Vyavaharkar et al. (2010) had similar findings in a sample of African American women in a rural southeastern region, suggesting that social support was negatively correlated with depression, and internalized stigma was significantly and positively associated with depression. ...
Article
The role of stigma on psychological wellness and treatment outcomes in people living with HIV and AIDS has been well documented among existing empirical evidence. However, within the context of the South, the intersections between HIV-related stigma and social ecological factors has been understudied. The current results-based convergent, mixed-methods synthesis identified how HIV-related stigma manifested and presented itself in PLWHA in the Southern Region of the U.S. The mixed synthesis also highlighted coping strategies for HIV stigma that have the ability to reduce HIV stigma while promoting positive health-behavior change. The findings of the review underscored the uniqueness of people living with HIV/AIDS and demonstrates the crucial role of intersectionality in investigating HIV stigma and treating and preventing HIV. Key words: social ecological factors, HIV stigma, people living with HIV and AIDS, intersectionality, HIV
... The 19-item Medical Outcomes Study-Social Support Survey (MOS-SSS) [25] was used to measure perceived social support. This scale has been validated for use among people with chronic illnesses [25] and has demonstrated good reliability (Cronbach's alpha = 0.96) among Black women living with HIV [26]. It includes questions related to availability of emotional support (e.g., "Someone you can count on to listen to you if you need to talk") as well as physical support (e.g., "Someone to take you to the doctor if you needed it"), affectionate support (e.g., "Someone who hugs you"), and positive social interaction (e.g., "Someone to have a good time with"). ...
Article
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African American women experience higher rates of HIV than other women in the United States, and stigma has been identified as an important determinant of engagement in HIV care. Our study examined whether key variables moderated the effect of an anti-stigma intervention on outcomes among African American women receiving treatment for HIV. Twelve potential moderators included: age, years lived with HIV, marital status, employment status, education level, PTSD diagnosis, alcohol use, social support, baseline CD4 count, baseline viral load, and number of children. Outcomes included changes in: HIV-related stigma, social support, depressive symptoms, PTSD symptoms, alcohol use, viral load, and engagement in HIV care. Results suggest that the intervention is associated with greater improvement in engagement in care among participants with PTSD or depression at baseline, and may help maintain engagement in care among participants experiencing certain mental health conditions. This provides opportunities to address discriminatory structural barriers that lead to stigma and drop-offs in HIV care.
... Research has shown that stigma can contribute to fear of disclosure, leading to underreporting of cases and an increase in transmission of the disease [11][12][13][14]. Stigma is also a barrier to seeking and receiving HIV care, which is necessary to successfully manage HIV infections [15,16]. As such, combating stigma is essential for primary as well as secondary prevention of HIV. ...
Article
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This project established a faith-based, university–community partnership with the African Methodist Episcopal (AME) church in Alabama to develop a statewide training model to address HIV knowledge and stigma, promote discussion and generate action plans to address HIV in the Deep South. A community-engaged research team consisting of church leadership and university researchers developed and implemented the model, “Love with No Exceptions.” Mixed methods were used to evaluate the model delivered in 3-h sessions in five state regions (N = 146 clergy and laity). The majority of participants reported feeling better prepared to serve those living with or affected by HIV and would implement education and awareness activities in their churches. Participants’ HIV knowledge increased from pre- to post-training. Stigma-related attitudes showed minor changes from baseline. These results reflect that partnerships between academic institutions and churches can deliver promising steps towards impactful HIV education in the Deep South.
... Further, by participating in the exhibits and presentations women gained the experience of advocating, acting and speaking on their own behalf. These positive experiences can build women's self-esteem and self-efficacy while reducing psychological distress including depression (Vyavaharkar et al., 2010). ...
Article
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Twenty-three women living with HIV participated in a photovoice-based group research study aimed at increasing their self-esteem, self-efficacy and decreasing depression. The intervention method, photovoice, was specifically chosen to put the power and authority of representing their experiences in the control of the participants. Taking action through sharing their photographs and stories with the public via community exhibits is part of the empowerment process where participants combine a sense of personal control with the ability to actively influence their environment and affect the behavior of others. There was a promising trend on the outcome measures from baseline to posttest moving in the direction expected.
... HIV stigma and discrimination has also been linked to factors that have been identified as antecedents to HIV treatment and care outcomes (e.g., ART adherence), including social support, self-rated health [5,6], physical health, mental health [6,7] and quality of life [8]. Growing research has contributed toward understanding the negative health consequences of HIV stigma among WLWH [6,[9][10][11][12]. ...
Article
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This study elucidated the prevalence and correlates of four types of HIV stigma among women living with HIV (WLWH). Data were drawn from 2 years (September 1/15 to August 31/17) of follow-up from a longitudinal community-based open cohort of 215 cisgender or transgender WLWH who lived and/or accessed care in Metro Vancouver, Canada (2014-present). Bivariate and multivariable cumulative logistic regression using generalized estimating equations for repeated measures were used to examine correlates of HIV stigma, including: (1) anticipated; (2) enacted; (3) internalized; and (4) perceived stigma. In multivariable analysis, disclosure of HIV status without consent was significantly associated with heightened: anticipated; enacted; and perceived stigma. Verbal and/or physical violence related to HIV status was significantly associated with heightened enacted, internalized and perceived stigma. Negative physical effects/symptoms of HIV was significantly associated with all stigma outcomes. Results suggest a need to support safe disclosure of HIV status and address social and structural violence against WLWH.
... Generally, perceived social support has been shown to act as a coping resource or a protective factor against adverse health outcomes, including social stigma (Galvin, Davis, Banks, & Bing, 2008;Walsh, Harel-Fisch, & Fogel-Grinvald, 2010). Specifically, perceived social support buffers the effect of psychological distress such as social stigma on well-being (Łakuta, Marcinkiewicz, Bergler-Czop, & Brzezińska-Wcisło, 2017;Li, Lee, Thammawijaya, Jiraphongsa, & Rotheram-Borus, 2009;Vyavaharkar et al., 2014). Consequently, there is increasing research interest in understanding the intervening role of perceived social support in psychological well-being (Eather, Morgan, & Lubans, 2013;Kerr, Preuss, & King, 2006;Zhao, Wang, & Kong, 2014). ...
Article
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Previous studies have shown that social stigma adversely affects quality of life. However, little research has assessed the influence of social stigma on subjective well‐being (SWB) of persons with albinism (PWA) in Ghana, and the role that perceived social support plays in this relationship. This study investigated the SWB of PWA in Ghana. Participants (N = 105) completed a survey questionnaire on social stigma, social support, and SWB. Results from structural equation modelling showed a significant negative association between social stigma and SWB. Perceived social support partially mediated the negative effect that social stigma has on SWB, with significant other support emerging as a reliable predictor of SWB in this sample. Results suggest that the population with albinism in Ghana is experiencing high levels of social stigma, which is adversely affecting its SWB. Social stigma seems to be preventing PWA from being accorded the needed social support by family and friends. The results highlight the importance of designing stigma‐reduction educational interventions that target social stigma at family, community, and societal levels.
... characteristics. Social characteristics included characteristics hypothesized to be negatively (HIV-related stigma) or positively (religiosity, social support, and attachment and belonging to one's ethnic identity) associated with patterns of alcohol use (Brome et al., 2000;Cotton et al., 2006;Lehavot et al., 2011;Liao et al., 2014;Mannes et al., 2016;Martin et al., 2003;Mulia et al., 2008;Peirce et al., 2000;Serovich et al., 2001;Vyavaharkar et al., 2010). HIV-related stigma was measured continuously using the 14-item Stigma Scale for Chronic Illness (SSCI), a measure validated for use with African Americans living with HIV (Rao et al., 2009(Rao et al., , 2016. ...
Article
Background: Alcohol use is common among people living with HIV and negatively impacts care and outcomes. African-American women living with HIV are subject to vulnerabilities that may increase risk for alcohol use and associated HIV-related outcomes. Methods: We used baseline data from a randomized controlled trial of an HIV-related stigma-reduction intervention among African-American women living with HIV in Chicago and Birmingham (2013-2015). Patterns of alcohol use [any use, unhealthy alcohol use (UAU), heavy episodic drinking (HED)] were measured using the AUDIT-C. We assessed demographic, social, and clinical characteristics which may influence alcohol use and HIV-related outcomes which may be influenced by patterns of alcohol use in bivariate and multivariable analyses. Results: Among 220 African-American women living with HIV, 54 % reported any alcohol use, 24 % reported UAU, and 27 % reported HED. In bivariate analysis, greater depressive symptoms, lower religiosity, lower social support, marijuana, and crack/cocaine use were associated with patterns of alcohol use (p < 0.05). Marijuana and cocaine/crack use were associated with patterns of alcohol use in adjusted analysis (p < 0.05). In adjusted analysis, any alcohol use and HED were associated with lower likelihood of ART adherence (ARR = 0.72, 95 % CI: 0.53-0.97 and ARR = 0.65, 95 % CI: 0.44-0.96, respectively), and UAU was associated with lack of viral suppression (ARR = 0.78, 95 % CI: 0.63-0.96). Conclusions: Findings suggest any and unhealthy alcohol use is common and associated with poor HIV-related outcomes in this population. Regular alcohol screening and intervention should be offered, potentially targeted to subgroups (e.g., those with other substance use).
... This seemed to be one of the cultural factors that contributed to anticipated stigma among the study participants, leading to participants concealing their HIV status [74][75][76]. Concealment of HIV status from other community members may also lead to the lack of social support for PLHIV, which has been reported to lead to HIV stigma and discrimination against PLHIV [77,78] and poor access to HIV healthcare services [79], a vicious cycle. ...
Article
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It is well acknowledged that human immunodeficiency virus stigma (HIV stigma) challenges people living with HIV globally. There is a scarcity of information about determinants of HIV stigma and discrimination among married men in the Indonesian context. This study aimed to explore factors that contribute to stigma and discrimination against HIV-positive men married to women in Yogyakarta, Indonesia. Face-to-face in-depth interviews were conducted to collect data from participants using a snowball sampling technique. A framework analysis was used to guide the analysis of the data. HIV stigma framework was also applied in the conceptualisation and the discussion of the findings. The findings indicate that participants experienced external stigma within healthcare facilities, communities and families. This external stigma was expressed in various discriminatory attitudes and behaviours by healthcare professionals and community and family members. Similarly, participants experienced anticipated stigma as a result of HIV stigma and discrimination experienced by other people living with HIV. Individual moral judgement associating HIV status with amoral behaviours and participants’ negative self-judgement were determinants of perceived stigma. The current findings indicate the need for training programs about HIV stigma issues for healthcare professionals. There is also a need to disseminate HIV information and to improve HIV stigma knowledge among families and communities.
... In addition, disclosure can pose a significant risk in light of the stigma that surrounds HIV. Although ART is more widely available, HIV-related stigma remains, often having a profound effect on PLH and can serve as an additional risk factor for depression [57,58]. ...
Article
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Background: Perinatal women accessing prevention of mother-to-child transmission of HIV (PMTCT) services are at an increased risk of depression; however, in Tanzania there is limited access to services provided by mental health professionals. This paper presents a protocol and baseline characteristics for a study evaluating a psychosocial support group intervention facilitated by lay community-based health workers (CBHWs) for perinatal women living with HIV and depression in Dar es Salaam. Methods: A cluster randomized controlled trial (RCT) is conducted comparing: 1) a psychosocial support group intervention; and 2) improved standard of mental health care. The study is implemented in reproductive and child health (RCH) centers providing PMTCT services. Baseline characteristics are presented by comparing sociodemographic characteristics and primary as well as secondary outcomes for the trial for intervention and control groups. The trial is registered under clinicaltrials.gov (NCT02039973). Results: Among 742 women enrolled, baseline characteristics were comparable for intervention and control groups, although more women in the control group had completed secondary school (25.2% versus 18.2%). Overall, findings suggest that the population is highly vulnerable with over 45% demonstrating food insecurity and 17% reporting intimate partner violence in the past 6 months. Conclusions: Baseline characteristics for the cluster RCT were comparable for intervention and control groups. The trial will examine the effectiveness of a psychosocial support group intervention for the treatment of depression among women living with HIV accessing PMTCT services. A reduction in the burden of depression in this vulnerable population has implications in the short-term for improved HIV-related outcomes and for potential long-term effects on child growth and development. Trial registration: The trial is registered under clinicaltrials.gov (NCT02039973). Retrospectively registered on January 20, 2014.
... A significant body of research suggests that internalized HIV-related stigma is associated with poor engagement in HIV treatment and care, sub-optimal medication adherence, missed clinic visits, and lower access to medical care [12][13][14][15]. In addition to these adverse health behaviors and outcomes, internalized HIV-related stigma has been linked with affective, cognitive, and mental health outcomes, such as depression [5,8,[16][17][18][19][20][21], anxiety [22,23], hopelessness [22], low medication adherence self-efficacy [24], dysfunctional coping styles (i.e. self-blame, avoidance, denial) [5,25], and low quality of life [22,[26][27][28][29]. ...
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Objective: Considering the association between internalized HIV-related stigma and treatment adherence, an intervention addressing HIV treatment adherence may have the added benefit of reducing internalized stigma. The ‘integrating ENGagement and Adherence Goals upon Entry’ (iENGAGE) intervention was developed to facilitate adjustment to living with HIV among individuals newly engaged in HIV care. We evaluated the effects of this intervention on internalized stigma and examined whether the effect is moderated by depressive symptoms and coping styles. Design: The iENGAGE intervention was tailored individually to improve information, motivation, and behavioral skills to promote treatment adherence and viral suppression. Three hundred and seventy-one participants initiating HIV care at four sites in the United States were randomly assigned to either the intervention receiving four face-to face sessions or standard of care control arm. Methods: Baseline and 48-week follow-up assessments were conducted, which included validated measures of internalized HIV-related stigma, depressive symptoms, and coping mechanisms (behavioral disengagement and self-blame) as secondary outcomes. ArepeatedmeasuresANOVAevaluated the effect of the intervention on change in internalized HIV stigma. Furthermore, the moderating effects of depressive symptoms and coping mechanisms on the decrease in internalized stigma were examined. Results: The decrease in internalized stigma from baseline to 48 weeks was significantly larger in the intervention arm compared with the control arm. This effect was significantly moderated by baseline levels of depressive symptoms and self-blame. Conclusion: The multifaceted iENGAGE intervention is effective in reducing internalized stigma for new-to-HIV care individuals, especially with higher depressive symptoms or when using higher levels of self-blame coping.
... Despite differences in beliefs about health and disease in different cultural contexts, illness-related stigma is a common phenomenon in many countries, such as Iran (Hassanpour Dehkordi, Mohammadi, & Nikbakhat Nasrabadi, 2016), the United States (Stites, Rubright, & Karlawish, 2018;Whittle et al., 2017), Germany (Angermeyer & Matschinger, 2003), Russia (Angermeyer, Buyantugs, Kenzine, & Matschinger, 2004), Ireland (Golden et al., 2006), Nigeria (Leger et al., 2018), New Zealand (Kearns et al., 2012) and China (Fu et al., 2015). This illness-related public stigma not only creates tremendous psychological pressure and negative emotions for patients, but also results in the rejection of social interactions and social relations, unemployment and low income, a poor quality of life and poor psychological well-being (Cheng et al., 2013;Corrigan, Tsang, Shi, Lam, & Larson, 2010;Vyavaharkar et al., 2010). ...
Article
This study focused on the stigmatisation of an emerging wellness tourism destination due to patient travel for tourism. The concept of spatial stigma was adopted to explore how local residents perceive, experience and manage the particular negative effects of wellness tourism. The study investigated Bama Yao Autonomous County, colloquially known as ‘Bama’, in China, to which many tourists with cancer and other chronic diseases travel. The results showed that the influx of wellness tourists brought significant challenges in this area. The residents reported ambivalent experiences of and feelings about wellness tourism in local communities, and disagreed with the vilification of wellness tourists. However, they were concerned about the potential consequences of wellness tourism. To manage and resist spatial stigma, the residents deliberately separated themselves from the places occupied by wellness tourists. The theoretical contributions and managerial implications of the study are discussed.
... This is consistent with the studies of Lee et al. (2007) and Tian et al. (2013) that involved ALWH from the USA and China respectively, and Sung et al.'s (2012) study with a South Korean sample of PLWH. High social support has been linked to low CD4 lymphocyte count and reduced HIV progression (Persson et al., 1994), lower depression levels (Mavandadi et al., 2009;Schrimshaw & Siegel, 2003;Vyavaharkar et al., 2009), more positive moods (r ¼ .374), less negative moods (r ¼ À.276; Fleishman et al., 2000) and higher medication adherence practices-all of which are indicative of the better psychological well-being of PLWH. ...
Chapter
Harmony is recognized as fundamental to being and functioning well in philosophical traditions and empirical research globally and in Africa. The aim of this study was to explore and describe harmony as a quality of happiness in South Africa (N = 585) and Ghana (N = 420). Using a qualitative descriptive research design, participants’ responses to an open-ended question from the Eudaimonic-Hedonic Happiness Investigation (EHHI, Delle Fave et al., Soc Indic Res 100:185–207, 2011) on what happiness meant to them were coded according to the formalized EHHI coding manual. Responses that were assigned any of the following codes were considered: codes from the “harmony/balance” category in the “psychological definitions” life domain; and codes from any other life domain containing the words “harmony”, “balance”, or “peace”. This resulted in 222 verbatim responses from South Africa and 80 from Ghana that were analyzed using content analysis to get a sense of the experiential texture of harmony as a quality of happiness. Findings showed that happiness was often expressed as harmony and balance within and between intrapersonal, interpersonal, transcendental, and universal levels of functioning, with wholeness, interconnectedness, and synergy implied. These findings, resonating with philosophical reflections on harmony from Africa and elsewhere, suggest that harmony as a quality of happiness is essentially holistic and contextually embedded and that context-sensitive interdisciplinary approaches to theory building and intervention development pertaining to harmony are needed locally and globally.
... The results further demonstrated that the odds of health care utilization were significantly increased among MSM who screened positive for depression. Importantly, the relationships between depression and health care use held after adjusting for health [59], with those who have visited a health care facility to seek care more likely to experience health care stigma and are also more likely to screen positive for depression. Stigma is known to decrease the coverage of evidence-based services for MSM by both limiting the provision of these services and ultimately, the uptake of available services [33]. ...
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Background In Cote D’Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. Methods 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d’Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. Results Depression (aOR:1.40, 95% CI: 1.07–1.84), being aged 25–29 years (aOR:1.84, 95% CI: 1.11–3.03),unemployed (aOR:0.64, 95% CI: 0.42–0.98), being a student (aOR:0.67, 95% CI: 0.48–0.96), being identified as male (aOR:0.44, 95% CI: 0.29–0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56–0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03–2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. Conclusion Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D’Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d’Ivoire.
... Only two of the 13 women described overcoming the barriers to establishing an intimate relationship and ultimately revealing their HIV status to their partners. Disclosure challenges may be heightened among African American women, as HIV-related stigma is reportedly higher in this group compared to other populations of older adults living with HIV [46]. ...
Article
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Purpose of Review Sexual well-being and intimacy are critical to overall quality of life and retain a high degree of significance for aging individuals, even though these considerations are often overlooked in older populations. Sexual health may be particularly impacted in older individuals living with HIV, especially women, as a result of both physical and psychosocial disease-specific factors. Despite this, sexuality research related to HIV has traditionally focused on risk reduction, rather than on other elements of sexual wellness. In this review, we examine several aspects of sexual well-being that may be important to older women living with HIV (OWLH). Recent Findings This review summarizes existing literature on sexuality in OWLH over the age of 50 and explores five themes related to sexual health: physical and emotional intimacy, desire/interest, satisfaction/pleasure, frequency of sexual activity, and abstinence. Reduced intimacy among OWLH was reported across most studies, due to stigma and disclosure concerns, lack of opportunity for relationships, and difficulty communicating sexual preferences. Data on sexual desire/interest and satisfaction/pleasure among OWLH were mixed. Frequency of sexual activity varied widely across studies, and abstinence emerged as both an intentional and inadvertent decision for OWLH. Factors related to menopause as it relates to sexuality and HIV are also discussed. Summary Sexual health and well-being are important to women living with HIV over 50, though key components such as intimacy, desire, and pleasure remain poorly understood. As this population continues to grow, comprehensive and age-specific interventions are needed to examine positive aspects of sexuality and promote sexual wellness among OWLH.
... One challenge encountered among PLWH is HIV-related stigma. Previous studies among PLWH in the U.S. have found that HIV-related stigma is an important factor in mental health outcomes such as anxiety and depression [5,[7][8][9][10][11][12][13][14][15][16][17][18][19]. HIV-related stigma can be broken down into 4 main factors: enacted, community, internalized, and anticipated [20]. ...
Article
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Research has shown that HIV-related stigma contributes to people living with HIV having a higher risk of mental health disorders. Our study examines the association between enacted HIV-related stigma and symptoms of anxiety and depression among PLWH. We used baseline data from 932 PLWH collected from the Florida Cohort study between 2014 and 2018. The sample was majority 45 + years of age (63.5%), male (66.0%), and Black (58.1%). The majority had previously experienced enacted HIV-related stigma (53.1%). Additionally, 56.6% and 65.2% showed mild to moderate/severe levels of anxiety and depression, respectively. Those who experienced any levels of enacted HIV-related stigma (vs none) had significantly greater odds of mild and moderate/severe levels of anxiety (vs no/minimal) (AOR[CI] 1.54[1.13, 2.10], p = 0.006; AOR[CI] 3.36[2.14, 5.26], p < 0.001, respectively) and depression (AOR[CI] 1.61[1.19, 2.18], p = 0.002; AOR[CI] 3.66[2.32, 5.77], p < 0.001, respectively). Findings suggest a need to evaluate interventions for PLWH to reduce the deleterious effects of enacted HIV-related stigma on mental health.
... Unstable housing disproportionately affects racial/ethnic minorities with HIV and is associated with lack of viral suppression [47,48]. In addition, societal and structural challenges that impede access to and affect the quality of HIV treatment services [49], including HIV-related stigma [50], perceived high racial discrimination [51,52], and medical mistrust [53,54] may underlie the observed racial and ethnic disparities. These factors may contribute to the differences in magnitudes of the measures of viral suppression definitions that disproportionately affect minority groups, particularly non-Hispanic Blacks and Haitians. ...
Article
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The study’s objective was to examine variations in viral load (VL) suppression definitions among clients in the Ryan White Program (RWP). Data from clients enrolled in the RWP during 2017 were examined to calculate the proportion of virally suppressed clients using three definitions: recent viral suppression, defined as having a suppressed VL (< 200 copies/mL) in the last test in 2017; maintained viral suppression, having a suppressed VL for both the first and last tests in 2017; and sustained viral suppression, having all tests in 2017 showing suppression. Relative differences across all three definitions were computed. Recent viral suppression measures were higher than maintained and sustained viral suppression measures by 7.0% and 10.1%, respectively. Significant relative differences in definitions by demographic, socioeconomic and clinical status were observed. It may be beneficial for care planning to report not only estimates of recent viral suppression but maintained and sustained viral suppression as well.
... This is consistent with the studies of Lee et al. (2007) and Tian et al. (2013) that involved ALWH from the USA and China respectively, and Sung et al.'s (2012) study with a South Korean sample of PLWH. High social support has been linked to low CD4 lymphocyte count and reduced HIV progression (Persson et al., 1994), lower depression levels (Mavandadi et al., 2009;Schrimshaw & Siegel, 2003;Vyavaharkar et al., 2009), more positive moods (r ¼ .374), less negative moods (r ¼ À.276; Fleishman et al., 2000) and higher medication adherence practices-all of which are indicative of the better psychological well-being of PLWH. ...
Chapter
Child marriage has been identified as a violation of human rights and an obstacle to promoting the development goals concerning gender, health and education. All these impacts undermine the development of the girl child. Despite the potential for negative outcomes, the presence of intrinsic and extrinsic resources can buffer the adverse effects (e.g., psychological, physical and economic impact) of early marriage. This study employed a qualitative exploratory, descriptive design to explore and describe protective resources utilised by married girls in the Northern region of Ghana to cope with the challenges in their marriage and to promote positive outcomes. Using semi-structured interviews, data was collected from 21 married girls who were aged between 12 and 19 years. Findings, from a thematic analysis of data, showed that intrinsic resources that promoted positive outcomes included possession of resilience attitudes, the use of help-seeking and active coping, and in some instances avoidance coping for problems they perceived as unsolvable. Extrinsic resources included interpersonal support networks, however, participants reported limited access to community and NGO support, which were also identified as protective resources. Policy makers and clinicians should consider a social justice approach in evaluating and recommending protective resources to girls in early marriages when working to promote their well-being. In so doing, attention should be placed on making external support systems accessible to married girls.
... This is consistent with the studies of Lee et al. (2007) and Tian et al. (2013) that involved ALWH from the USA and China respectively, and Sung et al.'s (2012) study with a South Korean sample of PLWH. High social support has been linked to low CD4 lymphocyte count and reduced HIV progression (Persson et al., 1994), lower depression levels (Mavandadi et al., 2009;Schrimshaw & Siegel, 2003;Vyavaharkar et al., 2009), more positive moods (r ¼ .374), less negative moods (r ¼ À.276; Fleishman et al., 2000) and higher medication adherence practices-all of which are indicative of the better psychological well-being of PLWH. ...
Chapter
Psychology is concerned with human behaviour, therefore all psychologies are contextually-embedded and culturally informed. A movement towards globalising psychology would invariably diminish the localised socio-cultural situatedness of psychology, and instead seek to advance a dominant Euro-American centred psychology even in regions where such applications do not fit. The emergence of strong voices, and theoretically grounded and empirically supported positions from the global South in general and sub-Saharan Africa in particular, in studies of well-being allows for the opportunity to explore and describe an Africa(n) centred positive psychology. Acknowledging the limitations of cross-cultural psychological approaches, which have encouraged the uncritical transportation of Euro-American centred concepts and values, in this chapter we utilise assumptions from critical, cultural and African psychology to present our initial thoughts about a culturally embedded, socially relevant and responsive, and context respecting Africa(n) centred positive psychology. This challenge warrants consideration of early contributions to the study of well-being, its current data-driven positivist tendency, as well as African worldviews grounded in interdependence, collectivism, relatedness, harmony with nature, and spirituality. For an Africa(n) centred positive psychology, it is also essential to consider questions of epistemology, ways of knowing about the world and the human condition, context respecting knowledge, and theory building. Drawing on current scholarly evidence in sub-Saharan Africa, which emphasises relationality and societal values and norms shaping experiences of well-being, we propose future directions and discuss implications for empirical research and theory building within positive psychology which seeks to centre Africa and African experiences.
... Likewise, because social support is a protective factor against depressive symptoms, it is imperative to ensure that practitioners design interventions to include social support efforts in the overall mental health trajectory for young people living with HIV. In addition, there is a great need to educate teachers, caregivers, religious clergy and family members of youth and young adults living with HIV on ways to create supportive, accepting environments that enhance resilience, self-worth, self-esteem and self-efficacy while reducing psychological distress, including depressive symptoms (Vyavaharkar et al., 2010;Gentz et al., 2018). ...
Article
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Background: : Namibia has one of the highest HIV prevalence rates among young people living with HIV and AIDS. The study of mental well-being among this vulnerable population is emerging as an important area of public health research. Methods: : This study examined how gender, social support, food insecurity, HIV-related stigma, HIV treatment adherence and HIV transmission knowledge are related to depressive symptoms among young people living with HIV in rural northern Namibia. Data were collected from 188 participants from the Zambezi region. Results: : The hierarchical regression analysis revealed that being a female infected with HIV, having perceived food insecurity, experiencing more HIV-related stigma and having low levels of social support can exacerbate the severity of depressive symptoms in this sample of Namibian youth. Discussion: : Our findings point to the need to expand social support interventions, enhance socio-economic programmes and reduce HIV-related stigma among young people living with HIV, especially those residing in rural, HIV endemic, resource-limited communities in developing countries.
... 34 In contrast, social support may mitigate the impact of socio-structural barriers on HIV care outcomes among Black WLHA. Higher perceived social support is associated with fewer depressive symptoms as well as ART adherence, 37-39 fewer HIV-related health symptoms, 40 less HIV stigma, 41,42 and greater perceived ability to engage in HIV care 29 and HIV self-management. 43 Peer navigation has been highlighted as a successful model of care in improving outcomes along the HIV care continuum. ...
Article
In the U.S., Black women living with HIV/AIDS (WLHA) are affected disproportionately by interpersonal violence, which often co-occurs with adverse mental health and/or substance use, and exacerbates existing poor HIV care outcomes. Peer navigation has been successful in improving HIV care; however, HIV clinics often lack resources for sustainability and may not account for socio-structural barriers unique to Black WLHA. To address this gap, we developed LinkPositively, a culturally-tailored, trauma-informed WebApp for Black WLHA affected by interpersonal violence to improve HIV care outcomes. Using focus group data from nine Black WLHA and peer navigators, we developed LinkPositively. Core components include: virtual peer navigation to facilitate skill-building to cope with barriers and navigate care; social networking platform for peer support; educational and self-care tips; GPS-enabled resource locator for HIV care and support service agencies; and medication self-monitoring/reminder system. If efficacious, LinkPositively will shift the HIV prevention and care paradigm for Black WLHA.
... Worse, SUDs commonly co-occurs with depressive symptoms [3]. Depressive symptoms among people with SUDs can lead to more severe dysfunction, poor treatment results, higher morbidity, mortality, and more treatment costs [4][5][6][7][8][9]. ...
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Background: Although some psychological processes, such as stigma and self-efficacy, affect the complicated relationship between social support and depressive symptoms, few studies explored a similar psychological mechanism among individuals with substance use disorders. Hence, this research investigates the mediating effects of stigma and the moderating effects of self-efficacy among the psychological mechanism that social support affects depressive symptoms. Methods: The study included 1040 Chinese participants with substance abuse disorders (SUDs) and completed a series of self-report questionnaires. R software was used to organize and clean up data sets and analyze mediation and moderation effects. Results: The result showed that stigma had a partial mediating effect on depressive symptoms, while self-efficacy moderated this relationship. More specifically, less social support increased depression symptoms by bringing about higher stigma. Besides, subjects with higher self-efficacy are less susceptible to stigma and therefore have mild depressive symptoms. Furthermore, clinical and theoretical implications are discussed in our study. Conclusions: Chinese SUDs patients’ depressive symptoms were indirectly affected by perceived social support via stigma and less affected by stigma with improved self-efficacy. The theoretical and practical implications of these results are discussed.
... Concerning depression, two separate meta-analyses concluded that depression is significantly associated with treatment non-adherence [69,72]. Other studies reported a positive association between HIVrelated stigma and depression [70,71,[73][74][75][76]. Regarding time since diagnosis, some studies report that HIV-related stigma is higher among those most recently diagnosed and decreases with time since diagnosis [74,77]. ...
Article
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Adherence to antiretroviral therapy (ART) is associated with reduced HIV-related morbidity/mortality and ongoing transmission; however, the extent to which this association is modified by perceived HIV treatment norms is unknown. 270 PLWH completed a survey to assess demographics, risk behaviors, stigma, ART adherence, and perceived HIV treatment norms (Baltimore, 2014–2017). We used modified Poisson regression to examine effect modification by perceived HIV treatment norms. The association between HIV-related stigma and ART adherence was modified by perceived HIV treatment norms. Among individuals who perceived that friends/family were sub-optimally adherent, HIV-related stigma was negatively associated with ART adherence (Adjusted Risk Ratio [ARR] = 0.36; 95%CI 0.15–0.87). Among those who perceived optimal adherence among friends/family, the relationship between HIV-related stigma and ART adherence was not statistically significant (ARR = 1.07; 95%CI 0.65–1.76). Interventions to improve ART adherence among those who are sub-optimally adherent could focus on increasing perceptions of ART adherence among their friends/family.
... This is consistent with the studies of Lee et al. (2007) and Tian et al. (2013) that involved ALWH from the USA and China respectively, and Sung et al.'s (2012) study with a South Korean sample of PLWH. High social support has been linked to low CD4 lymphocyte count and reduced HIV progression (Persson et al., 1994), lower depression levels (Mavandadi et al., 2009;Schrimshaw & Siegel, 2003;Vyavaharkar et al., 2009), more positive moods (r ¼ .374), less negative moods (r ¼ À.276; Fleishman et al., 2000) and higher medication adherence practices-all of which are indicative of the better psychological well-being of PLWH. ...
Chapter
The focus of the present study was two-fold: (a) to examine the relations between demographic characteristics and the psychological well-being of Young People Living with HIV (YPLWH) and (b) to assess the extent to which self-esteem mediated the relationship between social support and psychological well-being of YPLWH. The sample consisted of 181 YPLWH selected from four Primary Health Care clinics in South-Western Uganda who responded to anonymous self-administered questionnaires. Data were analyzed using t-tests, ANOVA, and path analysis. We noted that females had significantly higher purpose in life scores than males (p < .05). General family support exerted direct effects on purpose in life (β = .40, p < .001) and positive relations (β = .15, p < .001). The effects of general family support on personal growth were mediated by self-esteem (β = .14, p < .001). Conversely, the total contributions of support from friends on personal growth and positive relations were mostly direct rather than being mediated by self-esteem. The study highlights a need to enhance the social support networks as a way of enhancing self-esteem and ensuring psychological well-being among YPLWH in Uganda.
... This is consistent with the studies of Lee et al. (2007) and Tian et al. (2013) that involved ALWH from the USA and China respectively, and Sung et al.'s (2012) study with a South Korean sample of PLWH. High social support has been linked to low CD4 lymphocyte count and reduced HIV progression (Persson et al., 1994), lower depression levels (Mavandadi et al., 2009;Schrimshaw & Siegel, 2003;Vyavaharkar et al., 2009), more positive moods (r ¼ .374), less negative moods (r ¼ À.276; Fleishman et al., 2000) and higher medication adherence practices-all of which are indicative of the better psychological well-being of PLWH. ...
Chapter
Positive mental health, and the validity of its assessment instruments, are largely unexplored in the Ghanaian context. This study examined the factor structure of the Twi version of the Mental Health Continuum-Short Form and explored the prevalence of positive mental health in a sample of rural Ghanaian adults (N = 444). A bifactor exploratory structural equation modelling (ESEM) model fit the data better than competing models (confirmatory factor analysis [CFA], bifactor CFA, and ESEM models). We found a high omega reliability coefficient for the general positive mental health factor (ω = .97) and marginal reliability scores for the emotional (ω = .51) and social well-being (ω = .57) subscales, but a low reliability score for the psychological well-being subscale (ω = .41). Findings support the existence of a general mental health factor, and confirm the underlying three-dimensional structure of mental health, but suggest that caution should be applied when interpreting subscale scores, especially for the psychological well-being subscale. Based on Keyes’s criteria for the categorical diagnosis of the presence of positive mental health, 25.5% of the sample were flourishing, with 74.5% functioning at suboptimal levels (31.1% languishing, 41.4% with moderate mental health) and may benefit from contextually relevant positive psychological interventions, which may also buffer against psychopathology.
... Additionally, past research has not investigated these constructs in conjunction with multiple constructs of stigma [48,49]. Research exploring discrimination and internalized stigmas among MSM in relation to key demographic variables has yet to adequately disentangle conflicting results, including assessing whether demographic differences in perceived discrimination and internalized stigma are accounted for by broader impressions of community-level stigma [22,50,51]. ...
Article
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Discrimination and internalized stigma are barriers to engagement in HIV self-care among men who have sex with men (MSM) living with HIV. However, differences in perceptions of discrimination and internalized stigmas by age, year of HIV-diagnosis, and race are poorly understood. We assessed differences in reported discrimination related to HIV, race, sexual orientation, and substance use and internalized stigmas among 202 MSM living with HIV who use substances. Younger participants reported higher levels of all types of discrimination and internalized stigmas (p-values < 0.001–0.030). Those diagnosed after the advent of antiretrovirals reported higher levels of discrimination related to HIV, sexual orientation, and substance use, as well as internalized stigma related to HIV and substance use (p-values 0.001–0.049). We explored perceived community HIV stigma, which accounted for associations involving age and year of diagnosis. Age, year of diagnosis, and race should be considered when assessing and intervening with stigma.
... Similarly, internalized stigma had a significant negative relationship with social support. Previous research suggests that PWH who internalize stigma report lower social support (Vyavaharkar et al., 2010), possibly via greater social avoidance and isolation as well as through impaired close relationship functioning (Pachankis, 2007). The overall HIV Stigma Scale-ES and the enacted and anticipated stigma subscales were not statistically associated with social support. ...
Article
Introduction: African-American women living with HIV report substantial HIV-related stigma and depression. Resilience resources are strength-based resources that may moderate the effects of HIV-related stigma on poor psychosocial outcomes such as depression. Objective: To evaluate whether religiosity, social support, and ethnic identity moderate the effects of HIV-related stigma on depression among African-American women living with HIV. Methods: We used baseline data (May 2013-October 2015) from a randomized controlled trial testing the efficacy of an HIV-related stigma-reduction intervention among African-American women living with HIV in Chicago, IL, and Birmingham, AL, who were older than 18 years and currently receiving HIV services. To assess whether religiosity (7-item Religious Beliefs and Behaviors survey), social support (select subscales from the Medical Outcomes Study Social Support Survey), and ethnic identity (Commitment subscale from the Multigroup Ethnic Identity Measure) modified the relationship between HIV-related stigma (Stigma Scale for Chronic Illness) and depression (8-item Patient Health Questionnaire), we conducted 3 separate moderation analyses using linear regression with interactions between HIV-related stigma and each moderator of interest, adjusted for study site, age, time since diagnosis, and education. Results: Among 226 African-American women living with HIV, greater levels of HIV-related stigma were associated with greater depression in all 3 models (P < 0.05). Only religiosity modified this association (P = 0.04), with a weaker association among women reporting higher levels of religiosity. Conclusions: The protective effects of religiosity may be leveraged in interventions for African-American women living with HIV struggling with HIV-related stigma.
Article
Discrimination of people living with HIV/AIDS (PLWHA) is a persistent issue in China, which affects their psychological health. However, the association between psychological factors and adherence to highly active antiretroviral therapy (HAART) has not been systematically investigated before. Therefore, this study examined the impact of social support, depression, and medication-taking self-efficacy on ART adherence among PLWHA based on Cha et al.’s model, and included “stigma” to the original model to explain the psychological mechanism. Of the 504 participants receiving HAART, 37.8% had mild-to-severe depression. According to structural equation modeling, social support was directly associated with depression, stigma, and adherence; depression partially mediated the positive relationship between social support and adherence self-efficacy and the negative association between stigma and self-efficacy. The modified and extended Cha et al.’s model had a satisfactory fit. Interventions to improve mental health through mental health services, social support, and enhancement of adherence self-efficacy beliefs are required.
Article
Depression can result in poor adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV), and social support can help mitigate the negative relationship. However, little is known about how depression and social support synergistically influence ART adherence over time. The current study aims to explore longitudinal associations between them and examine which sources of social support can play a mediating role between depression and ART adherence over time. A randomized controlled clinical trial was conducted between 2013 and 2016 in Guangxi, China. The study sample was composed of 319 PLHIV who were randomized into control condition and provided data at baseline and at least one of the six follow-ups. The results revealed negative associations of depression with ART adherence over time, and a mediating effect of perceived support from spouse/partner or children. Interventions to promote ART adherence should focus on strengthening PLHIV's relationships with their spouse/partner and children, promoting collaborative provider-patient relationships, and enhancing peer support among PLHIV.
Article
Aims: To examine child outcomes over time among mothers with perinatally depressed mood in rural South Africa (SA). Methods: A representative sample of consecutive births (470/493) in the OR Tambo District of the Eastern Cape of South Africa (SA) were recruited and were reassessed at five points over the course of the next two years: 85% were reassessed at 3 months, 92% at 6 months, 88% at 9 months, 91% at 12 months, and 88% at 2 years post-birth. Over time, the children of mothers with perinatally depressed mood (16%) were compared to children of mothers without depressed mood using multiple linear and logistic regressions. Results: Mothers with perinatal depressed mood are significantly less likely to live with the child's father or their in-laws (23% vs 35%), have household incomes above 2000 ZAR (154 USD) (31% vs 51%), and significantly more likely to have experienced IPV prior (19% vs 9%) and during (32% vs 20%) pregnancy compared to mothers without depressed mood. There are no differences in age, education, primipara, HIV status (29% seropositive), or alcohol use. Growth and developmental delays and motor and speech milestones through 24 months post-birth are similar for mothers with and without perinatal depressed mood. Conclusions: Despite increased economic and partner difficulties associated with perinatal depressed mood, infant outcomes are similar in mothers with and without depressed mood in rural South Africa.
Article
Objective: African-American women are more likely than other women in the United States to experience poor HIV-related health; HIV stigma may contribute to these outcomes. This study assessed the relationship between HIV stigma and viral load, over time, among a sample of African-American women receiving treatment for HIV, and explored social support and depressive symptoms as mediators. Design: Secondary analysis of longitudinal data. Methods: Data came from a randomized trial of an intervention to reduce HIV stigma among African-American women in HIV care in Chicago, Illinois and Birmingham, Alabama. Sociodemographic and psychosocial data were collected at up to six study visits over 14 months. Viral loads were extracted from medical records during the study period. Generalized linear mixed effects models were used to estimate associations between overall, internalized, and enacted HIV stigma and viral load over time. Mediation analyses were used to estimate indirect effects via social support and depressive symptoms. Results: Data from 234 women were analyzed. Overall HIV stigma was significantly associated with subsequent viral load (adjusted β = 0.24, p = 0.005). Both between-subject (adjusted β = 0.74, p < 0.001) and within-subject (adjusted β = 0.34, p = 0.005) differences in enacted stigma were associated with viral load. Neither social support nor depressive symptoms were statistically significant mediators. Conclusions: Ongoing experiences of HIV stigmatization may contribute to increased viral load among African-American women in primary HIV care. Interventions should aim to alleviate the consequences of stigma experienced by patients and prevent future stigmatization.
Article
Entering HIV care is a vulnerable time for newly diagnosed individuals often exacerbating psychosocial difficulties, which may contribute to poor health-related quality of life (HRQOL) ultimately influencing health behaviors including ART adherence, the driver of viral load suppression. Understanding HRQOL in people newly entering HIV care is critical and has the potential to guide practice and research. This exploratory cross-sectional study examined demographic, clinical, and psychosocial factors associated with limitations in four specific domains of HRQOL among persons initially entering outpatient HIV care at four sites in the United States (n = 335). In the unadjusted analysis, female gender was significantly associated with sub-optimal HRQOL with women having increased odds of reporting HRQOL challenges with pain, mood, mobility, and usual activity when compared to men. The adjusted models demonstrated attenuation of parameter estimates and loss of statistical significance for the associations with impaired HRQOL observed among women in unadjusted analyses, suggesting psychosocial factors related to HRQOL are complex and interrelated. Findings are consistent with a robust literature documenting gender-related health disparities. Programs aimed at improving HRQOL for persons initially entering HIV care are warranted generally, and specifically for women, and must address modifiable psychosocial factors via mechanisms including coping and social support.
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Introduction The discriminatory behavior experienced by People Living With HIV (PLWH) remains an unresolved problem in Indonesia. The aims of this research were to determine the factors associated with the discriminatory behavior experienced by PLWH in Indonesia. Methods This study used cross-sectional design data by processing secondary data from the Indonesian Demographic Health Survey (IDHS) conducted in 2017. The total sample in this study was 15,413 records obtained via the two-stage stratified cluster sampling technique. The variables in this study were knowledge, information, socioeconomic and demographic details and the discriminatory behavior experienced by PLWH. The instrument refers to IDHS 2017. The data were analyzed using a chi-squared test and multinomial logistic regression. Results The results obtained show that approximately 78.87% of respondents exhibited discriminatory behavior against PLWH in Indonesia. Respondents who had more knowledge about HIV [ RRR: 25.35; CI: 2.85, 225.18] and who had earnings [ RRR: 2.15; CI: 1.18, 3.92] were more at risk of discriminatory behavior than others. Respondents who lived in a rural area were less likely to engage in discriminatory behavior against PLWH than those who lived in urban areas [ RRR: 0.51; CI: 0.29, 0.91]. Conclusion An increased understanding of HIV-AIDS and Indonesian people's acceptance of PLWH can occur through the provision of accurate information that is designed to prevent discriminatory behavior against PLWH. The government can consider this problem and further related policies so that PLWH can coexist in society and enjoy the same rights as those living without discrimination.
Article
Background Sexual satisfaction is one of the issues faced by breast cancer survivors (BCSs). Aim This study aims to explore the mediation of stigma in the relationship between perceived social support (PSS) and sexual satisfaction among breast cancer survivors. Methods A cross-sectional study was conducted among 918 BCSs in Shanghai Cancer Rehabilitation Club. Data were collected using an online questionnaire including questions on sociodemographic characteristics, health status, PSS, stigma and sexual satisfaction of participants. The bootstrap method was used to test the significance of the simple mediation model. Outcomes The simple mediation of stigma was found significant in the relationship between PSS and sexual satisfaction. Results Stigma plays an intermediary role in the relationship between 2 dimensions of PSS (family and friends) and sexual satisfaction, but not in the relationship between the dimension of other significant people of PSS and sexual satisfaction. Clinical Translation It is important to reduce stigma when improving the sexual satisfaction of BCSs from the perspective of PSS. Strengths & Limitations The mediating role of stigma in the relationship between PSS and sexual satisfaction among BCSs has been shown for the first time. Study limitations include limitations in the representativeness of population by the study sample and the cross-sectional study design. Conclusions Stigma mediates the relationship between PSS and sexual satisfaction, which needs to be eliminated in intervention practice. Yuxin Zhang, Jie Zhao, Nan Jiang, et al. Effects of Stigma on the Relationship Between Perceived Social Support and Sexual Satisfaction Among Breast Cancer Survivors. J Sex Med 2022;XX:XXX–XXX.
Article
Background: Women represent 23% of all Americans living with HIV. By 2020, more than 70% of Americans living with HIV are expected to be 50 years and older. Setting: This study was conducted in the Southern United States-a geographic region with the highest number of new HIV infections and deaths. Objective: To explore the moderating effect of age on everyday discrimination (EVD); group-based medical (GBM) distrust; enacted, anticipated, internalized HIV stigma; depressive symptoms; HIV disclosure; engagement in care; antiretroviral medication adherence; and quality of life (QOL) among women living with HIV. Methods: We used multigroup structural equation modeling to analyze baseline data from 123 participants enrolled at the University of North Carolina at Chapel Hill site of the Women's Interagency HIV Study during October 2013-May 2015. Results: Although age did not moderate the pathways hypothesized, age had a direct effect on internalized stigma and QOL. EVD had a direct effect on anticipated stigma and depressive symptoms. GBM distrust had a direct effect on depressive symptoms and a mediated effect through internalized stigma. Internalized stigma was the only form of stigma directly related to disclosure. Depressive symptoms were a significant mediator between GBM, EVD, and internalized stigma reducing antiretroviral therapy medication adherence, engagement in care, and QOL. Conclusions: EVD, GBM, and internalized stigma adversely affect depressive symptoms, antiretroviral therapy medication adherence, and engagement in care, which collectively influence the QOL of women living with HIV.
Article
Although community cohesion has been identified as a protective factor associated with positive health outcomes, less is known about factors that increase community cohesion for women living with HIV (WLWH). We examined risk/protective factors associated with community cohesion in WLWH (N = 56) in the US Mid-South (Mage = 41.2 years, SD = 9.01). Participants completed hour-long interviews. Hierarchical linear regression modeling was used to examine factors associated with community cohesion. The final model was significant, F(5, 50) = 6.42, p < .001, adj. R = 33%; greater social support (b = .38, p < .01) and resilience (b = .27, p < .05) were significantly associated with better community cohesion. Given the protective benefits of community connectedness, findings suggest that nurses and community providers work with WLWH to harness friend- and family-support networks. In addition, strategies to enhance access to resilience resources would enable WLWH to recover from adversity.
Article
Background People living with HIV/AIDS (PLWHA) are at increased risk of stigma and mental illness, and this appears to be a particular issue in South Africa, which is home to 19% of the world's HIV-positive population. This paper aims to systematically review the literature investigating the relationship between HIV-stigma and depressive symptoms amongst PLWHA in South Africa. Methods A keyword search of four bibliographic databases (CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science) and two grey literature websites was conducted. The quality of eligible studies was assessed using established criteria. Results Fourteen quantitative studies were included in the review. PLWHA in South Africa experience high levels of HIV-stigma and depressive symptoms. All forms of stigma were found to be associated with depressive symptoms amongst PLWHA. Prospective findings were mixed, with one study finding that stigma did not predict depressive symptoms over 36 months, and another that depressive symptoms predicted stigma 12 months later, suggesting a potentially bidirectional relationship. Females and young adults may be particularly vulnerable to HIV-stigma and its negative psychological effects. Some support was found for the moderating role of social support in the relationship between stigma and depressive symptoms across different sub-populations. Limitations Few studies conducted prospective analyses or tested mediation/moderation. Conclusions Despite limitations, this study highlights the importance of understanding the mechanisms underlying HIV-stigma across different sub-populations in South Africa. This may lead to more effective and context-specific interventions to combat adverse mental health outcomes.
Article
We investigated attitudes toward 10 specific groups of individuals with disabilities among students in college settings. These groups comprised major depression, substance use disorder (SUD), anxiety disorder, autism spectrum disorder (ASD), cerebral palsy, hearing impairment, learning disability, visual impairment, spinal cord injury, and cancer survivor. The multidimensional scaling (MDS) analysis revealed a two-dimension space representing participants’ attitudes toward those disabilities. The MDS biplot further indicated higher levels of perceived dangerousness from the groups with SUD, major depression, anxiety disorder, and ASD. The hierarchical cluster analysis revealed that cluster A (SUD and major depression) was rated as having the highest level of social distance (i.e., negative attitudes). The implications for research and practice in rehabilitation counseling were discussed.
Article
Women living with HIV (WLWH) are more likely to suffer from depression than seronegative women and are also more likely to suffer from depression than men living with HIV. There is limited depression research with WLWH in Vietnam. Twenty in-depth interviews with WLWH were conducted to identify pathways leading to depression and coping strategies for depression. Participants were recruited from an antiretroviral treatment clinic in northern Vietnam. Audio-recorded interviews were transcribed, translated, and analysed to identify key themes. All participants reported sudden loss of social support, debilitating depression, and suicidal ideation in the first six months after HIV diagnosis. While some were able to cope with their status after several months, others continued to struggle due to HIV-related stigma that was perceived as more isolating for WLWH than for men. Women who were able to effectively cope with depression found ways to re-establish connections to family and community. Interventions to improve mental wellbeing should link WLWH to mental health services immediately after diagnosis and address loss of support and stigma, as they contributed to the onset and persistence of depression after HIV diagnosis. Community-level HIV stigma reduction interventions may also help repair broken social bonds and foster new ones.
Article
Black women are disproportionately impacted by HIV and depression has been linked to negative HIV outcomes. Little attention has been given to social/structural factors that may drive depression among Black women living with HIV (BWLWH), including discrimination and gendered racial microaggressions (GRM). One hundred BWLWH completed measures on GRM, race- and HIV-related discrimination, and depressive symptoms, as well as a clinical interview for major depressive episode (MDE). GRM and race- and HIV-related discrimination were significantly associated with depressive symptoms and increased likelihood of MDE, but only GRM contributed uniquely in associations with both. Interventions targeting depression among BWLWH should address GRM and race- and HIV-related discrimination.
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Background: Psychological distress and burden among family caregivers of patients with schizophrenia can be mediated by resilience and perceived social support from family members, friends, and other significant caregivers. These are integral to bring positive changes in recovery and adaptation of family caregivers. Those reduce stress characteristics, also improve quality of life and quality of care provided for patients by family caregivers. Aim: This study aimed to determine the relationship between level of resilience and type of perceived social support among family caregivers of patients with schizophrenia. Design: A descriptive correlational design was used in this study. Setting: The study was conducted at Elmaamoura Hospital for Psychiatric Medicine in Alexandria, Egypt. Subjects: Subjects of this study consisted of 200 family caregivers of patients with schizophrenia. Tools: Three tools were used to collect necessary data namely a socio-demographic structured interview schedule, Connor-Davidson Resilience Scale (CD-RISC-10) and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: Among the studied caregivers 76% had low level of resilience and most of the caregivers 82.5% had moderate perceived social support. A statistically significant positive relationship was found between resilience and total score of perceived social support & its three subscales (family social support, important people social support and friends social support). On further analysis using stepwise multiple regression, the study revealed that family social support emerged as the first predictor of resilience. Conclusion: It can be concluded that most of the studied patients had low level of resilience and moderate perceived social support. Moreover, perceived social support is related to and can predict more resilience among family caregivers.
Chapter
In this chapter, we provide an overview of the overlapping epidemics of Incarceration and HIV and how they impact communities of color. First, we provide a brief overview of the epidemiology of incarceration itself – the epidemiology of HIV within the criminal justice (CJ) system – and review some of the interpersonal-, community-, and system-level factors that contribute to high rates of HIV among CJ-involved individuals. Second, we review HIV prevention in jails and prisons, including the evidence for behavioral and biomedical HIV prevention interventions. Third, we examine the HIV care cascade, extending from diagnosis to linkage to care, retention in care, antiretroviral therapy (ART), and virologic suppression in CJ-involved individuals, including key gaps in the cascade and differences in outcomes by race and ethnicity. Fourth, we examine the issue of re-entry, including the multiple barriers people living with HIV (PLWH) face after incarceration which impact continuity of HIV care and treatment. Lastly, we discuss the issue of stigma for CJ-involved PLWH, which may occur during and after incarceration, including the intersectional stigma and discrimination associated with being a racial or ethnic minority, sexual minority, and someone who has been incarcerated. Finally, we conclude with future directions, including national policies which aim to decrease overall incarceration in the USA and promising partnerships and interventions to address health disparities in this vulnerable population.
Article
Despite its effectiveness at preventing HIV, uptake of PrEP has been slow. PrEP-related stigma is a potential barrier to uptake. Social support has been found to buffer against some PrEP stigma. Unfortunately, little research has investigated the relationship between social support and PrEP-related care. In 2018, we conducted 20 semistructured interviews with MSM who use PrEP (ages 22-70). Interview questions explored social support and PrEP-related stigma, and how these and other psychosocial factors affected PrEP use and continuation. Data were analyzed using grounded theory. Social support was important in PrEP-related care and promoted adaptive behavioral responses, such as adherence to PrEP-related medical care and enhancing resilience to stress. Participants described psychosocial benefits of PrEP, such as reduced HIV-related anxiety, but some also reported that PrEP-related stigma was an additional stressor. Findings suggest that social support has significant impacts within PrEP-related care and may help buffer against stigma.
Chapter
Facebook has become an important part of building and maintaining relationships and an increasingly integral part of our lives at all developmental stages. Using Facebook to connect with friends and family can provide greater perceptions of social support, providing a buffer between life stress and physical and mental health outcomes. It has been hypothesised that geographically diverse communities may use Facebook to compensate for limited opportunities to access face-to-face social support. This study examines the role of Facebook-based social support on physical and mental health concerns (mental distress, dissatisfaction with life, and physical illness) across two samples of Australian adult Facebook users (209 living in metropolitan areas, 158 living regionally). Greater levels of Facebook-based social support predicted lower levels of health concerns in a metropolitan-based sample. No association between Facebook-based social support and health concerns was found in the regional sample. This result shows that the use of Facebook as a mechanism for social support, and its effects on health, vary across geographical locations, and appears to be mainly found in a metropolitan population.
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In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
Article
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Depressive symptoms are a common response to HIV disease and evidence suggests that women may be at particular risk. Very little of the research on depressive symptoms within the context of HIV disease has included women, however, and even fewer studies have targeted African American women. In a beginning effort to address this gap, the authors performed a secondary analysis of data collected from 1992-1995 in a sample of 264 HIV+ women. The purpose of the secondary analysis was to describe the levels of depressive symptoms for a subsample of 152 African American subjects and to identify significant covariates. The original analysis was based on a stress and coping framework and was designed to provide a description of stressors, resistance factors, and adaptational outcomes of HIV+ women. It included various measures of psychological distress and quality of life. Depressive symptoms were not examined in the original analysis as an outcome of HIV disease, however. In the secondary analysis, depressive symptoms were operationalized using a depression subscale of the Brief Symptom Inventory (BSI) (Deragotis, 1993). Major categories of correlates examined included person resources, environmental resources, coping responses, and disease-related stressors. The data used in the analysis were collected during the fourth and fifth interviews of the longitudinal study, with 152 of the African American women having completed both interviews. Variance in depressive symptoms was analyzed using ANOVA, zero-order correlations, and multiple regression analysis. The mean depressive symptoms score for the subsample of African American women was considerably higher than published means for female and male normative samples, respectively. The regression model accounted for over half of the variance in depressive symptoms (R2 = .515). Significant correlates included self-esteem, family cohesion, HIV symptoms and quality of life. The findings support personal and social resources and disease-related factors as important correlates of HIV+ African American women's depressive symptoms and suggest the need for interventions to address such factors.
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This study assessed the prevalence of AIDS stigma and misinformation about HIV transmission in 1997 and 1999 and examined trends in stigma in the United States during the 1990s. Telephone surveys with national probability samples of English-speaking adults were conducted in the period 1996 to 1997 (n = 1309) and in 1998 to 1999 (n = 669). Findings were compared with results from a similar 1991 survey. Overt expressions of stigma declined throughout the 1990s, with support for its most extreme and coercive forms (e.g., quarantine) at very low levels by 1999. However, inaccurate beliefs about the risks posed by casual social contact increased, as did the belief that people with AIDS (PWAs) deserve their illness. In 1999, approximately one third of respondents expressed discomfort and negative feelings toward PWAs. Although support for extremely punitive policies toward PWAs has declined, AIDS remains a stigmatized condition in the United States. The persistence of discomfort with PWAs, blame directed at PWAs for their condition, and misapprehensions about casual social contact are cause for continuing concern and should be addressed in HIV prevention and education programs.
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This study examined whether there were differences in the rate of depressive and anxiety disorders between HIV-infected women (N=93) and a comparison group of uninfected women (N=62). Secondary objectives were to examine correlates of depression in HIV-infected women-including HIV disease stage and protease inhibitor use-and the associations between symptoms of depression or anxiety and other potential predictor variables. Subjects underwent extensive semiannual clinical, psychiatric, neuropsychological, and immunological evaluations. Depressive and anxiety disorder diagnoses were assessed by using the Structured Clinical Interview for DSM-IV. Symptoms of depression and anxiety were evaluated with the Hamilton Depression Rating Scale (the 17-item version and a modified 11-item version) and the Hamilton Anxiety Rating Scale, respectively. The rate of current major depressive disorder was four times higher in HIV-seropositive women (19.4%) than in HIV-seronegative women (4.8%). Mean depressive symptom scores on the 17-item Hamilton depression scale also were significantly higher, overall, in the HIV-infected women (mean=8.7, SD=8.0) relative to comparison subjects (mean=3.3, SD=5.8). There was no significant between-group difference in the rate of anxiety disorders. However, HIV-seropositive women had significantly higher anxiety symptom scores (mean=8.8, SD=8.9) than did HIV-seronegative women (mean=3.6, SD=5.5). Both groups had similar substance abuse/dependence histories, but adjusting for this factor had little impact on the relationship of HIV status to current major depressive disorder. HIV-seropositive women without current substance abuse exhibited a significantly higher rate of major depressive disorder and more symptoms of depression and anxiety than did a group of HIV-seronegative women with similar demographic characteristics. These controlled, clinical findings extend recent epidemiologic findings and underscore the importance of adequate assessment and treatment of depression and anxiety in HIV-infected women.
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Stigma profoundly affects the lives of people with HIV/AIDS. Fear of being identified as having HIV or AIDS may discourage a person from getting tested, from accessing medical services and medications, and from disclosing their HIV status to family and friends. In the present study, we use focus groups to identify the most salient domains of stigma and the coping strategies that may be common to a group of diverse, low-income women and men living with HIV in Los Angeles, CA (n = 48). We also explore the impact of stigma on health and healthcare among HIV positive persons in our sample. Results indicate that the most salient domains of stigma include: blame and stereotypes of HIV, fear of contagion, disclosure of a stigmatized role, and renegotiating social contracts. We use the analysis to develop a framework where stigma is viewed as a social process composed of the struggle for both internal change (self-acceptance) and reintegration into the community. We discuss implications of HIV-related stigma for the mental and physical health of HIV-positive women and men and suggestions for possible interventions to address stigma in the healthcare setting.
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Older adults are increasingly becoming impacted by HIV disease, both as newly infected individuals and as long-term survivors of HIV/AIDS living into older age. HIV-related stigma impacts the quality of life of all persons with HIV/AIDS. However, little is know about HIV-related stigma in older adults because many studies do not include older subjects or ignore age as a variable. This mixed methods study examined the experiences of HIV-related stigma in a sample of 25 older adults with HIV/AIDS from the Pacific Northwest. Quantitative methods measured HIV-stigma and depression, while in-depth qualitative interviews captured the lived experiences of these individuals. Stigma was positively and significantly correlated with depression (r = 0.627, p = 0.001) and stigma was found to be significantly higher in African American, as compared to white informants (chi (2) = 4.16, p = 0.041). Qualitative interviews yielded 11 themes that correspond to the four categories constructed in the stigma instrument. Rejection, disclosure concerns, stereotyping, protective silence and feeling "other" were all common experiences of these individuals. HIV stigma should be routinely assessed when working with older, HIV infected clients and interventions should be tailored to the individual experiences of stigma.
Article
Two studies leading to the development of a short form of the Social Support Questionnaire (SSQ) are reported. In Study 1 three items selected for high correlations with the total score (SSQ3) were administered to 182 university students together with several personality measures. SSQ3 had acceptable test-retest reliability and correlations with personality variables similar to those of the SSQ. Internal reliability was marginal although acceptable for an instrument with so few items. Study 2 employed three sets of data in developing a six-item instrument (SSQ6). The SSQ6 had high internal reliability and correlated highly with the SSQ and similarly to it with personality variables. The research findings accompanying the development of the short form social support measure suggest that perceived social support in adults may be a reflection of early attachment experience.
Article
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Article
Abstract A growing number of cases of HIV infection are being diagnosed in rural communities especially among women. Although HIV-specific education and care delivery programs have been focused on rural areas in recent years, limited data are available on the impact of such initiatives on the lives of women with HIV infection. The purpose of this study was to examine characteristics of women with HIV disease living in rural communities. The study used a cross-sectional sample of rural women in Georgia. Data analysis indicated that although a majority of the women reported adequate resources, there was a group of women for whom resources for basic needs were not always adequate. Additionally, women with HIV who had not progressed to AIDS had greater difficulty in obtaining a number
Article
This paper describes the development and evaluation of a brief, multidimensional, self-administered, social support survey that was developed for patients in the Medical Outcomes Study (MOS), a two-year study of patients with chronic conditions. This survey was designed to be comprehensive in terms of recent thinking about the various dimensions of social support. In addition, it was designed to be distinct from other related measures. We present a summary of the major conceptual issues considered when choosing items for the social support battery, describe the items, and present findings based on data from 2987 patients (ages 18 and older). Multitrait scaling analyses supported the dimensionality of four functional support scales (emotional/informational, tangible, affectionate, and positive social interaction) and the construction of an overall functional social support index. These support measures are distinct from structural measures of social support and from related health measures. They are reliable (all Alphas greater than 0.91), and are fairly stable over time. Selected construct validity hypotheses were supported.
Article
A growing number of cases of HIV infection are being diagnosed in rural communities especially among women. Although HIV-specific education and care delivery programs have been focused on rural areas in recent years, limited data are available on the impact of such initiatives on the lives of women with HIV infection. The purpose of this study was to examine characteristics of women with HIV disease living in rural communities. The study used a cross-sectional sample of rural women in Georgia. Data analysis indicated that although a majority of the women reported adequate resources, there was a group of women for whom resources for basic needs were not always adequate. Additionally, women with HIV who had not progressed to AIDS had greater difficulty in obtaining a number of resources. Almost half of the women felt stigmatized due to having HIV. Yet, a high percentage of these women had disclosed their HIV status to health care workers, sexual partners, and family. Study results provide insight into the needs of HIV-infected rural women from their perspective. This information can be important to nurses working in public health and community settings as they face the challenge of developing effective health care services for this population.
Article
Each of 10 published studies investigating the relationship between HIV infection and risk for depressive disorders concluded that HIV-positive individuals are at no greater risk for depression than comparable HIV-negative individuals. This study used meta-analytic techniques to further examine the relationship between depressive disorders and HIV infection. Meta-analytic techniques were used to aggregate and reanalyze the data from 10 studies that compared HIV-positive and HIV-negative individuals for rates of major depressive disorder (N=2,596) or dysthymic disorder (N=1,822). The frequency of major depressive disorder was nearly two times higher in HIV-positive subjects than in HIV-negative comparison subjects. On the other hand, findings were inconclusive with regard to dysthymic disorder. Rates of depression do not appear to be related to the sexual orientation or disease stage of infected individuals. Although the majority of HIV-positive individuals appear to be psychologically resilient, this meta-analysis provides strong evidence that HIV infection is associated with a greater risk for major depressive disorder. Future research should focus on identifying pathways of risk and resilience for depression within this population.
Article
This qualitative focus group study explored perceptions of stigma in HIV-seropositive women. The sample included 19 HIV-positive women who participated in one of four focus group sessions. Participants were asked to talk about and describe their perceptions of how others think about and respond to them and other HIV-infected individuals. Content analysis was used to code the data and identify participant perceptions. Four themes representing distinctly different perceptions of stigma were identified: distancing, overgeneralizing stereotypes, social discomfort, and pity. The implications of the findings for intervention and future research are discussed.
Article
Social networks and social support have been found to be beneficial to the health of individuals in a variety of ways--reducing mortality rates, improving recovery from serious illness, and increasing use of preventive health practices. Social relationships appear to be particularly important to women. Suggestions for health promotion and disease prevention activities include the use of buddy systems, feminist pedagogical techniques, group activities, and linkage to natural supports. Health promotion with women is an underdeveloped area of social work practice with great potential to increase the health of client populations.
Article
Although powerful pharmacological therapies are helping women with HIV infection live longer, women continue to experience the stressors of chronic illness. This study used a person-environment systems framework to describe social interactions, perceived social support, and psychological distress in HIV-positive women. A convenience sample of 104 HIV-positive women living in the San Francisco Bay Area completed a questionnaire on social interactions, perceived social support, and distress. Women reported limited social interactions with family and friends and a low level of perceived social support. Social support and level of distress did not differ by ethnicity. Limited perceived social support was a significant predictor of distress in this sample of women. Supportive interactions from health care providers can be useful in mediating the relationship between the stressor of HIV disease and distress in HIV-positive women. Community-based nurses can enhance HIV-positive women's support network by providing positive and supportive interactions as they intervene with women in symptom management, case management, and other health care services.
Article
The growing incidence of HIV infection among low-income and minority women makes it important to investigate how these women adjust to living with HIV and AIDS. Psychological distress associated with HIV infection may compound the adjustment difficulties and increase the barriers to care associated with living in poverty. The authors surveyed 100 women who were receiving HIV care at a public hospital in the southeastern United States on measures of depression, anxiety, life stress, social support, and coping; they also assessed demographic and medical characteristics of the sample. Participants' annual incomes were low (87% < $10,000), and most participants were minorities (84% African American). Their levels of depression, stress, and anxiety symptoms were elevated relative to community norms. Greater anxiety and depression symptoms were associated with women who reported higher stress, using fewer active coping strategies, and perceiving less social support (ps < .001).
Article
Internationally, there has been a recent resurgence of interest in HIV and AIDS-related stigma and discrimination, triggered at least in part by growing recognition that negative social responses to the epidemic remain pervasive even in seriously affected communities. Yet, rarely are existing notions of stigma and discrimination interrogated for their conceptual adequacy and their usefulness in leading to the design of effective programmes and interventions. Taking as its starting point, the classic formulation of stigma as a 'significantly discrediting' attribute, but moving beyond this to conceptualize stigma and stigmatization as intimately linked to the reproduction of social difference, this paper offers a new framework by which to understand HIV and AIDS-related stigma and its effects. It so doing, it highlights the manner in which stigma feeds upon, strengthens and reproduces existing inequalities of class, race, gender and sexuality. It highlights the limitations of individualistic modes of stigma alleviation and calls instead for new programmatic approaches in which the resistance of stigmatized individuals and communities is utilized as a resource for social change.
Article
HIV is on the rise among African-American women. AIDS-related stigma plays an important role in the lives of HIV-infected and non-infected African-American women. Among HIV-infected women, the decision to disclose HIV seropositive status is likely affected by perceived stigma. The first purpose of the study is to examine perceived AIDS-related stigma over a six year period and across two groups of African-American women: HIV-infected and non-infected. The second purpose of the study examines whether disclosure of HIV seropositive status moderates the relationship between stigma and psychological functioning. Participants were 98 HIV-infected and 146 non-infected African-American women, between the ages of 18 and 50. Data were collected at four points across six years. Results indicated that HIV-infected women perceived a significantly higher level of AIDS-related stigma than non-infected women at all four assessments. Perceptions of stigma did not significantly change over time for the entire sample or within either HIV group. Among HIV-infected women, as the level of perceived stigma increased, the level of disclosure and psychological functioning decreased. Regarding the hypothesized moderating relationship, at high, but not low, levels of disclosure, the relationship between stigma and distress was significant. Implications for health professionals' work with HIV-infected African-American women around the issue of disclosure and stigma are discussed.
Article
To present a metasynthesis of qualitative findings on stigma in HIV-positive women. Metasummary and metasynthesis techniques were used to integrate findings on stigma in 93 reports of qualitative studies conducted between 1991 and 2002 with a total of 1,780 women, mostly from minority groups. Both perceived and enacted stigma were pervasive in the lives of HIV-positive women. HIV-related stigma was intensified in women because they were women. Stigma management largely involved efforts to control information in the service of preserving social relations and maintaining moral identity. This metasynthesis reprises and clarifies the connections between recurring themes in primary quantitative studies and metastudies of HIV-positive people and of stigmatizing diseases and conditions. This work also shows how affected people's location on key axes of difference can both facilitate and complicate efforts to manage stigma. HIV-positive women experience stigmatization in relationships with others. HIV-related stigma is as much a reflection of these others as it is central to the experience of HIV-positive people themselves. Even those not infected with HIV are still affected by it and are thus appropriate targets for interventions to reduce its negative effects.
Article
To determine the sociodemographic and service delivery correlates of depression underdiagnosis in HIV. Cross-sectional survey. National probability sample of HIV-infected persons in care in the contiguous United States who have available medical record data. We interviewed patients using the Composite International Diagnostic Interview (CIDI) survey from the Mental Health Supplement. Patients also provided information regarding demographics, socioeconomic status, and HIV disease severity. We extracted patient medical record data between July 1995 and December 1997, and we defined depression underdiagnosis as a diagnosis of major depressive disorder based on the CIDI and no recorded depression diagnosis by their principal health care provider in their medical records between July 1995 and December 1997. Of the 1140 HIV Cost and Services Utilization Study patients with medical record data who completed the CIDI, 448 (37%) had CIDI-defined major depression, and of these, 203 (45%) did not have a diagnosis of depression documented in their medical record. Multiple logistic regression analysis revealed that patients who had less than a high school education (P <.05) were less likely to have their depression documented in the medical record compared to those with at least a college education. Patients with Medicare insurance coverage compared to those with private health insurance (P <.01) and those with >or=3 outpatient visits (P <.05) compared to <3 visits were less likely to have their depression diagnosis missed by providers. Our results suggest that providers should be more attentive to diagnosing comorbid depression in HIV-infected patients.
Article
This study identified factors associated with emotional distress in 109 African American women with HIV. The relationship of personal factors (demographic, social conflict, social support, and spirituality), health-related factors (perception of health, physical and mental health problems, and years diagnosed), and cognitive/coping responses (stigma, worry, and emotion focused coping) on depressive symptoms and mood state was examined. Younger age, more social conflict, less social support, lower perception of health, and more HIV worry were associated with higher depressive symptom scores. Variables most often affecting various mood states included personal factors (public housing, unemployment, and social conflict) and worry about having HIV worry.
Article
This cross-sectional exploratory study examined relationships among functional social support, HIV-related stigma, social problem solving, and depressive symptoms in a convenience sample of 30 men and nonpregnant women who sought care at two HIV outpatient clinics in the southeastern United States. Participants completed a set of self-report questionnaires at these clinics during scheduled regular visits. Data were analyzed using descriptive statistics. Consistent with other HIV studies, participants in this sample were at high risk for depression. Depressive symptoms were associated with more perceived HIV-related stigma, less social support provided by others, and dysfunctional social problem solving. These results are preliminary but important in identifying potential components for effective interventions to reduce the risk of depressive symptoms in persons with HIV.
Article
The purpose of this paper is to compare the ways in which perceived and actual social support affect the mental health of gay men, straight or bisexual men, and women living with HIV/AIDS. Participants included 125 women and 232 men with an HIV-positive or AIDS diagnosis involved in three larger investigations of HIV, disclosure and mental health. Results suggest each sub-group experienced perceived social support as significantly predictive of better mental health while the effect of actual social support was minimal.
A closer look: The internalization of stigma related to HIV United States Agency for International Devel-opment (USAID) Publication Psycho-logical distress among minority and low-income women living with HIV
  • P Brouard
Brouard, P., (2006). A closer look: The internalization of stigma related to HIV. United States Agency for International Devel-opment (USAID) Publication. Retrieved January 15, 2007, from http://www.policyproject.com Catz, S. L., Gore-Felton, C., & McClure, J. B. (2002). Psycho-logical distress among minority and low-income women living with HIV. Behavioral Medicine, 28(2), 53-60.
Breaking the cycle: Stigma, discrimina-tion, internal stigma, and HIV. United States Agency for International Development (USAID) Publication Depressive and anxiety disorders in women with HIV infection
  • K M F Morrison
  • J M Petitto
  • H T Ten
  • D R Gettes
  • M S Chiappini
  • A L Weber
Morrison, K., (2006). Breaking the cycle: Stigma, discrimina-tion, internal stigma, and HIV. United States Agency for International Development (USAID) Publication. Retrieved January 15, 2007, from http://www.policyproject.com Morrison, M. F., Petitto, J. M., Ten, H. T., Gettes, D. R., Chiappini, M. S., Weber, A. L., et al. (2002). Depressive and anxiety disorders in women with HIV infection. Amer-ican Journal of Psychiatry, 159(5), 789-796.
A telephone intervention for rural women with HIV National Institutes of Health Perceptions of stigma in women infected with HIV
  • L Moneyham
  • L Moneyham
  • B Seals
  • A Demi
  • R Sowell
  • L Cohen
  • J Guillory
Moneyham, L. (2003). A telephone intervention for rural women with HIV. National Institutes of Nursing Research, National Institutes of Health. Moneyham, L., Seals, B., Demi, A., Sowell, R., Cohen, L., & Guillory, J. (1996). Perceptions of stigma in women infected with HIV. AIDS Patient Care & STDS, 10(3), 162-167.
Breaking the cycle: Stigma, discrimination, internal stigma, and HIV. United States Agency for International Development (USAID) Publication
  • K Morrison
Morrison, K., (2006). Breaking the cycle: Stigma, discrimination, internal stigma, and HIV. United States Agency for International Development (USAID) Publication. Retrieved January 15, 2007, from http://www.policyproject.com
A telephone intervention for rural women with HIV. National Institutes of Nursing Research
  • L Moneyham
Moneyham, L. (2003). A telephone intervention for rural women with HIV. National Institutes of Nursing Research, National Institutes of Health.
A closer look: The internalization of stigma related to HIV. United States Agency for International Development (USAID) Publication
  • P Brouard
Brouard, P., (2006). A closer look: The internalization of stigma related to HIV. United States Agency for International Development (USAID) Publication. Retrieved January 15, 2007, from http://www.policyproject.com
Perceptions of stigma in women infected with HIV
  • L Moneyham
  • B Seals
  • A Demi
  • R Sowell
  • L Cohen
  • J Guillory
Moneyham L, Seals B, Demi A, Sowell R, Cohen L, Guillory J. Perceptions of stigma in women infected with HIV. AIDS Patient Care & STDS 1996;10(3):162-167. [PubMed: 11361616]