HIV-related stigma experiences: Understanding gender disparities in Thailand

This paper assesses the relationship between gender and HIV-related stigma experiences among people living with HIV (PLHIV) – enacted and anticipated stigma – and PLHIV caregivers – courtesy stigma – in Northern Thailand, along with the underlying reasons for stigmatising attitudes towards PLHIV – instrumental and symbolic stigma – expressed in the general population. We used data from the Living With Antiretrovirals (LIWA) study conducted on all PLHIV receiving antiretroviral treatment in four district hospitals in Northern Thailand (n?=?513) and on a community sample of adults from the general population (n?=?500). Women living with HIV and female caregivers of PLHIV reported higher rates of HIV-related stigma experiences than men. Gender interacted with other predictors – the period of HIV diagnosis and age – to increase the level of stigma experienced. Among the general population, attitudes of contact avoidance were infrequent. However, stereotypes depicting PLHIV as blameworthy were highly pervasive, with women perceived as the “victims” of their spouse's irresponsible sexual behaviours. In this context, women were yet more often subjected to HIV-related stigma than men, in particular women diagnosed in the pre-antiretroviral therapy era and younger female caregivers. The role of gender in shaping disparities in HIV-related stigma experiences is discussed.     

结核病相关病耻感量表的研制与评价

目的 研制和评价适用于我国的结核病相关病耻感量表.方法 采用结核病相关病耻感量表对1 342例结核病患者进行测评,利用SAS 9.4和AMOS 17.0对量表的信效度进行分析.结果 结核病相关病耻感量表共有3个维度9个条目,量表的总体Cronbach's α系数为0.88,各维度Cronbach's α系数为0.85、0.60和0.66;结核病相关病耻感量表二阶多因子模型的适配度指标分别为x2/df为4.162,RMSEA为0.049,GFI为0.962,AGFI为0.911,CFI为0.919.结论 结核病相关病耻感量表具有较高的信效度,可以作为我国结核病患者病耻感的测评工具.     

“They were just waiting to die”: Somali Bantu and Karen Experiences with Cancer Screening Pre- and Post-Resettlement in Buffalo,NY

BackgroundLittle is known about how pre-resettlement experiences affect refugees’ uptake of cancer screenings. The objective of this study was to characterize Somali Bantu and Karen experiences with cancer and cancer screenings prior to and subsequent to resettlement in Buffalo, NY in order to inform engagement by health providers.MethodsThe study was grounded in a community-based participatory research approach, with data collection and analysis guided by the Health Belief Model and life course framework. Interviews were transcribed, independently coded by two researchers, and analyzed using an immersion-crystallization approach. We conducted 15 semi-structured interviews and six interview-focus group hybrids with Somali Bantu (n = 15) and Karen (n = 15) individuals who were predominantly female (87%).ResultsCancer awareness was more prevalent among Karen compared to Somali Bantu participants. Prior to resettlement, preventative health care, including cancer screening, and treatment were unavailable or inaccessible to participants and a low priority compared with survival and acute health threats. There, Somali Bantu treated cancer-like diseases with traditional medicine (heated objects, poultices), and Karen reported traditional medicine and even late-stage biomedical treatments were ineffective due to extent of progressed, late-stage ulcerated tumors when care was sought. A fatalistic view of cancer was intertwined with faith (Somali Bantu) and associated with untreated, late-stage cancer (Karen). Karen but not Somali Bantu reported individuals living with cancer were stigmatized pre-resettlement due to the unpleasant manifestations of untreated, ulcerated tumors. Now resettled in the U.S., participants reported obtaining cancer screenings was challenged by transportation and communication barriers and facilitated by having insurance and interpretation services. While Somali Bantu women strongly preferred a female provider for screenings, Karen women felt cancer severity outweighed cultural modesty concerns in terms of provider gender.SignificanceOur findings suggest the need for culturally-relevant cancer education that incorporates the life course experiences and addresses logistical barriers in linking individuals with screening, to be complemented by trauma-informed care approaches by healthcare providers.     

What features of stigma do the public most commonly attribute to Alzheimer's disease dementia? Results of a survey of the U.S. general public

Introduction

Understanding the prevalence of beliefs, attitudes, and expectations about Alzheimer's disease dementia in the public could inform strategies to mitigate stigma.

叙事疗法对永久性肠造口患者病耻感影响的研究

目的 评价叙事疗法对永久性肠造口患者病耻感的影响。 方法 选取2018年4月—11月在某三级甲等医院胃肠外科、结直肠肛门外科行腹会阴联合直肠癌根治术的47例患者,通过一对一、面对面或视频通话的形式,对患者进行每周1次、每次30~45 min、共8次的叙事疗法;采用社会影响量表和造口适应量表评价干预前后的效果。 结果 出院前1 d、干预结束、干预结束后1个月,患者社会影响量表得分分别为（59.64±6.62）分、（53.87±8.78）分、（47.98±8.47）分,不同时间点病耻感差异有统计学意义（F=179.078,P<0.001）;造口适应量表得分分别为（40.49±7.13）分、（45.68±6.87）分、（46.70±7.11）分,不同时间点社会心理适应水平差异有统计学意义（校正后F=75.295,P<0.001）。 结论 叙事疗法有助于降低永久性肠造口患者的病耻感并提高其社会心理适应水平。     

HIV感染者和AIDS患者病耻感的研究进展

从HIV感染者和艾滋病患者病耻感的测评工具、影响因素以及干预措施3个方面进行综述,旨在通过理论依据的总结,以期促进病耻感临床相关干预措施的实施。     

Social-cultural factors of HIV-related stigma among the Chinese general population in Hong Kong

HIV-related stigma in the wider community compounds the suffering of people living with HIV (PLWH) and hampers effective HIV prevention and care. This study examines the level of public stigma toward PLWH in Hong Kong and associated social-cultural factors. A telephone survey was conducted in June–July 2016 with 1080 Chinese adults aged 18–94 randomly selected from the general population. The results indicate substantial degree of public stigma toward PLWH. Overall, 58.1% of the participants endorsed at least one statement indicating negative social judgment of PLWH. Over 40% attributed HIV infections to irresponsible behaviors and nearly 30% perceived most PLWH as promiscuous. About 20% considered HIV to be a punishment for bad behavior and believed that PLWH should feel ashamed of themselves. These statistics indicate that HIV-related stigma among the general Hong Kong population had no noticeable reduction in a decade but is lower than that among rural and urban populations in China. Our findings suggest that the lower stigma in Hong Kong may be linked to higher education levels rather than Hongkongers’ more Westernized outlook. The results of a multiple regression analysis showed that education level (β?=??.19), homophobia (β?=?.30), and conformity to norms (β?=?.14) were independent predictors of HIV-related stigma but not age, income, or cultural orientations. By differentiating between associated social-cultural factors, this study provides a more nuanced understanding of the layered nature of HIV-related stigma: not broadly grounded in religion or Chinese culture but stemming from more specific social-cultural beliefs – perceptions of norm violation and negative attitudes toward homosexuality, which were not mutually exclusive. These findings have implications for HIV-related stigma reduction by providing evidence for the importance of addressing homophobia. Existing HIV publicity activities should be re-examined for inadvertent contribution to the stigmatization process – particularly press conferences and prevention campaigns that reinforce negative stereotypes of gay/bisexual men and PLWH.     

Stigma and disease disclosure among HIV+ individuals: the moderating role of emotion dysregulation

Increased disclosure of HIV status has been shown to reduce disease transmission among persons living with HIV (PLHIV). HIV-related stigma has been shown to reduce HIV disclosure; however, little is known about factors that may underlie the relation between HIV-related stigma and HIV disclosure. The current study examined emotion dysregulation (i.e., maladaptive generation, processing, and modulation of one’s emotions) in the relation between HIV-related stigma, sub-facets of HIV-related stigma, and HIV disclosure among PLHIV seeking psychological treatment (n?=?80; 61.3% male; 56.3% African-American (non-Hispanic); M_age?=?48.25, SD?=?7.39). Results indicated past experiences of rejection due to one’s HIV status (i.e., enacted stigma), as well as subjective beliefs regarding how PLHIV are evaluated by others (i.e., public attitudes stigma), are significantly related to HIV disclosure. Additionally, these relations are moderated by emotion dysregulation. Specifically, greater HIV-related stigma is associated with reduced HIV disclosure for individuals with greater emotion dysregulation. However, emotion dysregulation did not moderate the relations between negative self-image (e.g., shame, guilt) or disclosure concerns and HIV disclosure. Findings suggest emotion dysregulation may play a moderating role for certain types of HIV disclosure.     

玉夏胶囊治疗高血压病526例临床观察

目的以中医证类和血压降低值(达标率)为主要疗效评价指标,观察玉夏胶囊降压疗效和安全性。方法治疗组526例口服玉夏胶囊;对照组528例口服清脑降压片,两组疗程均为8周。观察两组治疗前后血压、心率及生化指标,同时观察中医证候包括头痛、心悸、胸闷、体胖、腰酸,进行中医证候评分;判定降压疗效及中医证候疗效。结果治疗组治疗后收缩压、舒张压、血糖、尿微量蛋白较治疗前差异有统计学意义(P<0.05);对照组治疗后收缩压、舒张压、心率、尿微量蛋白及肌酐水平变化差异有统计学意义(P<0.05)。治疗组对收缩压和舒张压的降压效果优于对照组(P<0.05)。两组治疗后头痛、心悸、胸闷、腰酸、体胖评分均较治疗前降低(P<0.05);两组治疗后比较,除胸闷外,余症状评分差异有统计学意义(P<0.05)。降压疗效:治疗组显效率(41.83%)及总有效率(93.35%)优于对照组(显效率和总有效率分别为26.89%和88.25%)(P<0.05)。中医证候疗效:治疗组总有效率88.78%,对照组为80.49%,两组比较差异有统计学意义(P<0.05)。玉夏胶囊对高血压病痰湿壅盛证疗效(总有效率为95.54%)优于其他证型(P<0.05)。结论玉夏胶囊降压效果明显、且能有效改善头痛、心悸、胸闷等症状,对不同证型的高血压病患者均有疗效,对痰湿壅盛证类高血压疗效更为明显。     

住院精神病患者病耻感水平及相关因素调查

目的探讨住院精神病患者病耻感水平及相关因素。方法采用一般情况调查表及贬低-歧视感知量表对212例住院精神病患者进行问卷调查。结果 60.85%的被调查患者有病耻感;精神分裂症患者病耻感高于情感病患者(χ2=8.843,P<0.01);病程5年及以内的患者病耻感高于5年以上的患者(χ2=5.448,P<0.05)。结论精神病患者病耻感水平高,患者的病耻感与精神疾病诊断及病程有关。