HIV/STD Stigmatization Fears as Health-Seeking Barriers in China

Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, Los Ángeles, California, United States
AIDS and Behavior (Impact Factor: 3.49). 10/2006; 10(5):463-71. DOI: 10.1007/s10461-005-9047-5
Source: PubMed


Internationally, stigma prohibits effective HIV/STD identification, prevention, and care. Interviews with 106 persons in an urban center in Eastern China, some known to have engaged in stigmatized risk acts (sex workers, STD clinic patients) and some vulnerable for stigmatization fears to influence health-seeking behaviors (market employees, rural-to-urban migrants). Interviews focused on community norms, values, beliefs, and emotional and behavioral reactions to HIV/STD stigmatization related events. Attributions for infection were found to mark individual's failure to adhere to sexuality norms; define a condition warranting the avoidance of infected persons and dismissal by medical professionals; and promote anticipation of negative emotions (i.e., shame, fear, and embarrassment) and devalued social roles and status. Strategies reported to avoid stigmatization include avoiding HIV/STD knowledge; avoiding health care professionals, particularly in public settings; and conforming to community norms of shunning those suspected of risky behaviors. Results have direct implications for community marketing campaigns in China.

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Available from: Mary Jane Rotheram-Borus
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    • "Despite the fact that the risk of transmission of HIV through contact is very low, feelings of fear and avoidance of infected people have prevailed since the discovery of the infection [1]. HIV-related stigmas–defined as prejudice, discounting, discrediting and discrimination directed at people with HIV/AIDS [2]–deter individuals from undergoing HIV testing, cause HIV positive people to avoid disclosure and subsequently lead to delays in them receiving optimal care; stigmas have thus been described as barriers to HIV prevention and treatment efforts [3]. "
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    ABSTRACT: The stigma of and discrimination because of HIV has been described as the most important obstacle to prevention and treatment efforts. The purpose of this study was to investigate negative attitudes and prejudice toward HIV among the Japanese non-medical working population and to explore contributing factors. An online anonymous nationwide survey involving approximately 3,000 individuals was conducted in Japan. Questions ranged from background information and HIV knowledge to individuals' attitudes towards HIV infection in the workplace. Descriptive statistics and logistic regression were applied for analysis. Thirty-three percent of participants feared transmission of HIV from infected colleagues, 34% tended to avoid contact with them and 40% had prejudiced opinions about HIV infection. Despite a relatively high level of knowledge of HIV/AIDS overall (11.9±3.3 from 15 points), only 50% of individuals were aware of some issues. Greater knowledge was associated with less negative attitudes towards HIV infection (OR 0.39, 95% CI 0.31-0.48 for prejudiced opinion, high compared with low level of knowledge), whereas greater health consciousness was inversely related to attitude (OR 1.97, 95% CI 1.50-2.58 for prejudiced opinion, high compared with low health consciousness). Knowledge neutralizes peoples' negative attitudes towards HIV infection, whereas greater health consciousness may worsen them. Educational programs should balance knowledge with health consciousness to improve the efficacy of HIV interventions.
    Full-text · Article · Jul 2013 · PLoS ONE
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    • "Based on the Kelly POL model, and related ethnographic research (Lieber et al., 2009), the social norms goals for the Community Popular Opinion Leader (CPOL) component of the NIMH program included increasing seeking treatment at STD clinics, engaging in conversations about sexual behavior among partners, using condoms in extramarital relationships, and developing nonstigmatizing attitudes about those with STDs (Li et al., 2010). For more details and analyses from this project, also see Caceres et al. (2007); Detels et al. (2003); Guan et al. (2009); Li, Liang et al. (2009); Li et al. (2010); Lieber et al. (2006); NIMH (2007, 2010); Rotheram-Borus, Li, Liang, Wen, Qu, and NIMH Collaborative HIV Prevention Trial Group (2011); and Wu et al. (2007). This study analyses only the popular opinion leader, intervention messages, and stigmatizing attitudes portion of the China data. "
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    ABSTRACT: Reducing STDs and HIV/AIDS incidence requires campaigns designed to change knowledge, attitudes and practices of risky sexual behavior and its consequences. In China, a significant obstacle to such changes is the stigma associated with these diseases. Thus one campaign intervention strategy is to train credible community popular opinion leaders to discuss these issues in everyday social venues. This study tested the effectiveness of such an approach on reducing HIV/AIDS stigma, across two years, from a sample of over 4500 market vendors, in three conditions. Results showed an increasing growth in market communication about intervention messages, and concomitant declines in stigmatizing attitudes, across time, with the greatest changes in community popular opinion leaders, significant changes in intervention non-opinion leaders, and little change in the control markets.
    Full-text · Article · Oct 2012 · Human Communication Research
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    • "Peer-led education in promoting health has become increasingly popular in colleges and universities (Klein & Sondag, 1994). Sex education must not only ensure that awareness and knowledge are imparted, but also include life skills training (Kalichman and Simbayi, 2004; Lieber et al., 2006). Local preventive measures lack emphasis on life skills behavior such as negotiating sex, condom use and wise decision making pertaining to risk behavior practices related to HIV/AIDS (MOH, 2001). "
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    ABSTRACT: OBJECTIVE: Develop, implement and evaluate the effectiveness of a peer-led education program related to HIV/AIDS among university students. METHOD: Design: randomized controlled trial with 276 university students at Faculty of Medicine and Health Sciences University Putra Malaysia (UPM), Serdang in 2011. Intervention: A peer-led education program on HIV prevention by university students. Outcome: differences in knowledge, attitude and risk behavior practices related to HIV between baselines, immediate follow-up after intervention and after three months. RESULTS: Significant improvement in sound knowledge in the intervention group as compared to the control group (Odds ratio, 1.75; 95% CI 1.01, 3.00; p=0.04) and improvement in good attitude related to HIV (Odds ratio 2.22; 95% CI 1.37, 3.61; p=0.01). The odds of high substance risk behavior was significantly reduced in the intervention group as compared to the control group (Odds ratio 0.07; 95% CI 0.02, 0.34; p=0.01). The association between good knowledge and intervention was modified by the different time points (baseline, immediately after intervention and 3months after intervention), ethnicity and gender. CONCLUSION: Peer-led education program in HIV prevention improves knowledge, attitude and substance risk behavior. Changes in sexual risk behavior may require a longer follow-up.
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