精神分裂症病人及家属受歧视状况

目的：了解精神分裂症病人及其家属受歧视状况，探讨歧视对精神分裂症病人及其家属的影响。方法：应用自编问卷在北京地区对精神分裂症病人(N=225)、精神分裂症病人家属(N=230)、社区居民(N=257)和精神科医护人员(N=283)进行调查。结果：42％的病人报告他们受到了单位不公正对待，受到同事或同学歧视，被邻居看不起，并导致恋爱或婚姻失败。56%的家属报告为避免歧视把病人患精神病的事对外保密。全部4组受试中85％以上的人相信歧视会降低病人的自信心，75％以上的人相信歧视给家属造成很大的心理压力，70％以上的人相信歧视严重影响病人的生活，60％以上的人相信歧视使病人的家庭成员减少了他们应有的社交活动。与其他三组人群比较，精神科医护人员更同意精神病人及其家属受歧视是常见的现象，更相信歧视会给他们的生活带来严重影响。与病人和家属比较，对歧视现象的存在社区居民的认同较低，但他们同样认为歧视对病人和家属有消极影响。结论：精神分裂症病人遭遇到的歧视突出地表现在与个人基本社会生活密切有关的工作、婚姻和人际交往三个方面。社会歧视对病人及其家属的心理和社会生活产生了严重影响。     

Intersecting stigma and HIV testing practices among urban refugee adolescents and youth in Kampala,Uganda: qualitative findings

IntroductionHIV‐related risks may be exacerbated in humanitarian contexts. Uganda hosts 1.3 million refugees, of which 60% are aged under 18. There are knowledge gaps regarding HIV testing facilitators and barriers, including HIV and intersecting stigmas, among urban refugee youth. In response, we explored experiences and perspectives towards HIV testing strategies, including HIV self‐testing, with urban refugee youth in Kampala, Uganda.MethodsWe implemented a qualitative study with refugee cisgender youth aged 16 to 24 living in Kampala''s informal settlements from February‐April 2019. We conducted five focus groups with refugee youth, including two with adolescent boys and young men, two with adolescent girls and young women and one with female sex workers. We also conducted five key informant (KI) interviews with government, non‐government and community refugee agencies and HIV service providers. We conducted thematic analyses to understand HIV testing experiences, perspectives and recommendations.ResultsParticipants (n = 49) included young men (n = 17) and young women (n = 27) originally from the Democratic Republic of Congo [DRC] (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1), in addition to five KI (gender: n = 3 women, n = 2 men; country of origin: n = 2 Rwanda, n = 2 Uganda, n = 1 DRC). Participant narratives revealed stigma drivers included fear of HIV infection; misinformation that HIV is a “Ugandan disease”; and blame and shame for sexual activity. Stigma facilitators included legal precarity regarding sex work, same‐sex practices and immigration status, alongside healthcare mistreatment and confidentiality concerns. Stigma experiences were attributed to the social devaluation of intersecting identities (sex work, youth, refugees, sexual minorities, people living with HIV, women). Participants expressed high interest in HIV self‐testing. They recommended HIV self‐testing implementation strategies to be peer supported and expressed concerns regarding sexual‐ and gender‐based violence with partner testing.ConclusionsIntersecting stigma rooted in fear, misinformation, blame and shame, legal precarity and healthcare mistreatment constrain current HIV testing strategies with urban refugee youth. Findings align with the Health Stigma and Discrimination Framework that conceptualizes stigma drivers and facilitators that devalue intersecting health conditions and social identities. Findings can inform multi‐level strategies to foster enabling HIV testing environments with urban refugee youth, including tackling intersecting stigma and leveraging refugee youth peer support.     

Universal HIV testing and treatment and HIV stigma reduction: a comparative thematic analysis of qualitative data from the HPTN 071 (PopART) trial in South Africa and Zambia

Despite continued development of effective HIV treatment, expanded access to care and advances in prevention modalities, HIV‐related stigma persists. We examine how, in the context of a universal HIV‐testing and treatment trial in South Africa and Zambia, increased availability of HIV services influenced conceptualisations of HIV. Using qualitative data, we explore people’s stigma‐related experiences of living in ‘intervention’ and ‘control’ study communities. We conducted exploratory data analysis from a qualitative cohort of 150 households in 13 study communities, collected between 2016 and 2018. We found that increased availability of HIV‐testing services influenced conceptualisations of HIV as normative (non‐exceptional) and the visibility of people living with HIV (PLHIV) in household and community spaces impacted opportunities for stigma. There was a shift in community narratives towards individual responsibility to take up (assumingly) widely available service – for PLHIV to take care of their own health and to prevent onward transmission. Based on empirical data, we show that, despite a growing acceptance of HIV‐related testing services, anticipated stigma persists through the mechanism of shifting responsibilisation. To mitigate the responsibilisation of PLHIV, heath implementers need to adapt anti‐stigma messaging and especially focus on anticipated stigma.     

Perceptions of social stigma and its effect on interpersonal relationships of young males who experience a psychotic disorder

Background:  People with psychotic disorders experience high levels of disability and impairment as a result of their illness. Difficulty in the area of social relationships poses a substantial problem with the majority of people with psychosis being socially isolated. Many of them experience an unmet need for services.
Methods:  A focus group was conducted with the aim of investigating the perceived experience of six young men who had a psychotic disorder to gain an understanding of the impact this had on interpersonal relationships.
Results:  The major themes identified were: (i) a significant decrease in the internal and external control of one's life at the onset of illness; (ii) the effects of labelling and stigma on interpersonal relationships; and (iii) the change in self perception that these effects bring.
Conclusion:  The implications of the findings for rehabilitation interventions are presented, specifically psychosocial group interventions addressing interpersonal relationships.     

Combining the HYM (Healthy Young Men’s) Cohort Study and the TRUTH (A Trans Youth of Color Study): Protocol for an Expanded Mixed Methods Study Renewal

BackgroundAs we enter the fifth decade of the AIDS epidemic, health researchers and AIDS activists reflect both on the progress that has been made and the importance of continued prevention efforts for those most at risk. As HIV infection rates continue to fluctuate across communities, a trend has emerged with new HIV infections becoming increasingly concentrated—with cascading effects—among people aged <30 years, from marginalized racial and ethnic groups, and who are sexual or gender minorities.ObjectiveIn this paper, we discuss the renewal of the Healthy Young Men’s (HYM) Cohort Study and the addition of a subcohort—TRUTH: A Transgender Youth of Color Study. The overarching aim of our renewed study was to inform new intervention strategies; understand linkage to care; and examine changes over time with respect to minority-related stress and intersectional identities and their relationship with substance use, mental health, and HIV risk. Findings from this study will help to inform the development of new interventions designed to engage African American and Black and Latino young men who have sex with men (YMSM) and transgender and gender minority youth in the HIV prevention and care continua and to reduce risk by addressing pathways of minority-related stress and intersectional stigma.MethodsLongitudinal study (baseline and follow-up assessments every 6 months for a total of 8 waves of data collection) is ongoing with reconsented cohort from the last iteration of HYM Cohort Study. This study protocol includes self-report survey, collection of urine to assess recent use of illicit drugs, and collection of blood and rectal and throat swabs to test for current sexually transmitted infection and HIV infection. An additional sample of blood and plasma (10 mL for 4 aliquots and 1 pellet) is also collected and stored in the HYM Cohort Study biorepository for future studies. This mixed methods study design includes collection of triangulated analysis of quantitative, qualitative, and biological measures (ie, drug use, sexually transmitted infection and HIV testing, and adherence to antiretroviral therapy among participants who are HIV+) at baseline and every 6 months.ResultsAs of February 2022, participants from the past 4 years of the HYM Cohort Study and TRUTH: A Transgender Youth of Color Study Cohort have been reconsented and enrolled into the renewal period of longitudinal data collection, which is projected from summer of 2020 until summer of 2025. Recruitment is ongoing to reach our target enrollment goal of YMSM and transgender minority youth.ConclusionsThe findings from this study are being used to inform the development of new, and adaptation of existing, evidence-based HIV prevention interventions designed to engage populations of transgender and gender minority youth and YMSM in the HIV prevention and care continua.International Registered Report Identifier (IRRID)DERR1-10.2196/39232     

“I'm Going to Shut Down All of Your Tricks”: Depictions of Treatment Professionals in Addiction Entertainment

Background: Previous research on addiction themed reality television shows has focused on the depiction of addiction and treatment and has concluded that these shows reinforce stigma. Existing research has not investigated the depiction of treatment professionals in these series. Objectives: This study fills the gap in existing research by analyzing the representations of treatment professionals in reality television shows, including the ways that the shows are edited, the statements made by treatment professionals, and interactions between treatment professionals and laypersons. Methods: The data for this study was drawn from two popular reality shows Intervention and Celebrity Rehab with Dr. Drew. Using a total of 117 episodes, a qualitative content analysis of the representations of treatment professionals in the two series was conducted. Results: The data reveal the ways that depictions of treatment professionals are carefully controlled compared to those of people with substance use issues. In addition, treatment professionals are granted opportunities to interpret, explain, and diagnose the behaviors and experiences of people with substance use problem. Finally, when confronted with resistance treatment professionals assert their authority and demand compliance with their orders. Conclusions/Importance: In strategically presenting treatment professionals in sharp contrast to people with substance use problems, these portrayals of treatment professionals actually reinforce rather than contradict the stigma of addiction.     

癫(疒间)患儿生活质量研究

目的 研究癫(疒间)息儿生活质量的特点及其影响因素.方法 对神经科门诊的93例癫(疒间)患儿进行生活质量评定,并与在年龄、性别、文化程度等方面严格匹配的93名正常儿童进行对比.生活质量评定工具:抗癫(疒间)药物的不良反应量表(SEP),青少年癫(疒间)患儿的生活质量-48项量表(QOLIE-AD-48),焦虑自评量表(SAS),汉密尔顿抑郁量表(HAMD).结果 患儿常见的药物不良反应有皮疹、注意力不易集中、记忆障碍;患儿生活质量损害的范围广泛(P<0.01),其中社会支持的损害最明显;患儿焦虑抑郁的得分和对照组比较,差异有统计学意义(P<0.01).多因素分析发现抗癫疴药物的不良反应、焦虑、抑郁、羞耻感与生活质量有相关性.且具有统计学意义(P<0.05).结论 除合理的药物治疗外,应对患儿进行包括心理干预的综合治疗以提高患儿的社会功能,全面提高患儿的生活质量.