Prevalence of, and factors associated with, HIV/AIDS-related stigma and discriminatory attitudes in Botswana

Botswana has the highest prevalence of HIV in the world. The epidemic of HIV/AIDS is often accompanied by stigma and discrimination that create the circumstances for spreading HIV. To facilitate the design of effective programmes to fight the high prevalence of HIV/AIDS-related stigma and discriminatory attitudes, this study examined survey data on the prevalence of, and factors associated with, such attitudes in Botswana. While most respondents showed discriminatory attitudes towards a teacher or a shopkeeper with HIV/AIDS, only 11% of 4,147 respondents reported unwillingness to care for a family member with HIV/AIDS. The more tolerant attitudes towards a family member with HIV/AIDS appeared to be promoted by the fact that family members have been and continue to care for their sick members through a government project called Community Home-based Care aimed at relieving public hospitals of HIV/AIDS patients. Since the burden of caring for sick relatives rests on the shoulders of women, they portrayed more tolerant attitudes towards HIV/AIDS patients. Young people and those who believed a person could get HIV infection by sharing a meal with an HIV/AIDS patient had discriminatory attitudes towards people with HIV/AIDS. The national information, education and communication programme needs to be strengthened to reach more people for HIV/AIDS education. Finally, programmes that aim to promote more tolerant attitudes towards people with HIV/AIDS may be more effective if the human rights of those with HIV/AIDS are promoted and respected.     

A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS

HIV/AIDS-related stigma and discrimination have a substantial impact on people living with HIV/AIDS (PLHA). The objectives of this study were: (1) to determine the associations of two constructs of HIV/AIDS-related stigma and discrimination (negative attitudes towards PLHA and perceived acts of discrimination towards PLHA) with previous history of HIV testing, knowledge of antiretroviral therapies (ARVs) and communication regarding HIV/AIDS and (2) to compare these two constructs across the five research sites with respect to differing levels of HIV prevalence and ARV coverage, using data presented from the baseline survey of U.S. National Institute of Mental Health (NIMH) Project Accept, a four-country HIV prevention trial in Sub-Saharan Africa (Tanzania, Zimbabwe and South Africa) and northern Thailand. A household probability sample of 14,203 participants completed a survey including a scale measuring HIV/AIDS-related stigma and discrimination. Logistic regression models determined the associations between negative attitudes and perceived discrimination with individual history of HIV testing, knowledge of ARVs and communication regarding HIV/AIDS. Spearman's correlation coefficients determined the relationships between negative attitudes and perceived discrimination and HIV prevalence and ARV coverage at the site-level. Negative attitudes were related to never having tested for HIV, lacking knowledge of ARVs, and never having discussed HIV/AIDS. More negative attitudes were found in sites with the lowest HIV prevalence (i.e., Tanzania and Thailand) and more perceived discrimination against PLHA was found in sites with the lowest ARV coverage (i.e., Tanzania and Zimbabwe). Programs that promote widespread HIV testing and discussion of HIV/AIDS, as well as education regarding and universal access to ARVs, may reduce HIV/AIDS-related stigma and discrimination.     

HIV/AIDS-related stigma in Kumasi, Ghana

ObjectiveTo assess HIV/AIDS-related stigma and discrimination of people living with HIV/AIDS (PLWHA) in Kumasi, Ghana.MethodsA cross-sectional survey of 104 adults from the four sub-districts in Kumasi was conducted.ResultsFour stigma constructs, employment-based discrimination, screening and identification of HIV positive people, revelation of HIV status and social contact stigma were determined based on reliability measures from responses to the questionnaire. Regression analysis showed that participants with higher educational attainment were more likely to favor policies denying employment to PLWHA (p<0.05), but disapproved of revealing HIV sero-status (p<0.05). Muslims were more likely than Christians to agree with identifying PLWHA (p<0.05) and more likely to advocate revealing HIV sero-status (p<0.05). Males were more likely to favor revealing HIV status (p<0.05). Employed persons were more likely to have social contact with PLWHA (p<0.05).ConclusionsThese findings are useful in guiding the design of interventions against HIV/AIDS-related stigma in Kumasi.     

AIDS-related stigma and social interaction: Puerto Ricans living with HIV/AIDS

People living with HIV/AIDS are stigmatized. Although personal and social consequences of this stigmatization have been documented, research regarding its impact on social interactions is scarce. Latinos, and Puerto Ricans in particular, have voiced concern regarding AIDS stigma. The authors investigated the key role of social interaction in the process of stigmatization through in-depth, semistructured interviews in a sample of 30 Puerto Ricans living with HIV/AIDS. Participants reported instances in which AIDS stigma negatively influenced social interactions with family, friends, sexual partners, coworkers, and health professionals. Some of the consequences they described were loss of social support, persecution, isolation, job loss, and problems accessing health services. Findings support the need for interventions to address AIDS stigma and its consequences.     

某地既往有偿供血人群艾滋病歧视状况研究

目的 了解因既往有偿供血造成艾滋病流行地区艾滋病歧视现象及其产生原因和影响因素.方法 在安徽省某地利用目的抽样法从人类免疫缺陷病毒(HIV)感染者、家庭成员、村民及卫生工作者中各选择20名共80名作为调查对象.采用一对一深入访谈的方法,了解艾滋病歧视现象,分析产生原因与影响因素.结果 80名调查对象中,1名未完成调查,在完成调查的79名中,歧视的主要表现形式是扩大的歧视[81.0%(64/79)],嫌弃、回避及抛弁,看病时受到歧视[47.4%(28/59)],失去社会支持[33.3%(13/39)]等.艾滋病流行严重的村庄歧视相对较轻,艾滋病流行较轻的村庄歧视较严重.对艾滋病存在错误认识[57.5%(23/40)]、恐惧[32.5%(13/40)]及道德判断是歧视产生的主要原因.为了避免家人和孩子的正常生活受到影响,多数HIV感染者不愿暴露身份.结论 由于对艾滋病的错误认识等,导致歧视现象严重,亟须开展减少歧视相关工作.     

安徽省MSM社群内艾滋病相关羞辱和歧视的差序格局研究

目的 了解安徽省男男性行为人群(men who have sex with men,MSM)社群内不同关系层同伴(男友/固定性伴、同性偶然性伴、MSM社群普通朋友、MSM社群一般人员)对人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者和获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)病人艾滋病相关羞辱和歧视的差序格局特征及其主要表现形式.方法 采用面对面的问卷调查方式,匿名调查安徽省184名HIV阳性MSM和202名HIV阴性MSM.结果 HIV阴性MSM对不同关系层的HIV/AIDS患者的羞辱和歧视评分差异存在统计学意义(F=7.76,P＜0.001),且这种差异呈现出关系越亲近,羞辱和歧视情况越严重的趋势.同性性伴关系层主要表现在对性要求的拒绝和排斥,而社群普通朋友和一般人员则主要表现为议论、言语羞辱和嘲笑.结论 MSM社群中普遍存在对HIV/AIDS患者的羞辱和歧视,且具有一定的差序格局特征,因此应针对这些特点采取行之有效的干预策略和措施.     

Prevalence of sexual activity and associated factors in hypertensive males and females in China: A cross-sectional study

ABSTRACT: BACKGROUND: Hypertension is an important factor contributing to sexual dysfunction. The number of people with hypertension is increasing in China, but research into sexual life, which has implications for quality of life, is limited. We aimed to compare sexual activity and the influence of daily behaviors and sexual domain of hypertensive males and females in south China. METHODS: A cross-sectional study was conducted at the health care center of a university-affiliated hospital from 2007 to 2008. We enrolled 502 subjects with hypertension (225 males, 48.79+/-7.39 years old; 277 females, 48.26+/-6.93 years old) and 173 with normotension (82 males, 45.69+/-6.58 years old; 91 females, 46.14+/-7.03 years old), all sexually active. All subjects completed a self-administered questionnaire on sexual activity before a routine physical check-up. Data were collected on sociodemographic and clinical characteristics, use of cigarettes and intake of beverages (including alcohol). RESULTS: Hypertensive and normotensive subjects differed in frequency of orgasms and of sexual satisfaction, as well as duration of sexual activity. For hypertensive men, low frequency of sexual activity, orgasms and satisfaction were associated with unemployed or retired status than physical labor work (odds ratio [OR] 0.28 [95% confidence interval (95% CI) 0.12-0.69], 0.32 [0.12-0.86], 0.33 [0.19-0.88], respectively; p<0.05), and long sexual duration was associated with never drinking alcohol than heavy drinking (OR 4.49 [1.28-6.41]). For hypertensive women, low frequency and duration of sexual activity and low satisfaction were associated with never drinking tea than heavy tea drinking (OR 0.42 [0.18-0.96], 0.49 [0.24-0.98], 0.29 [0.14-0.64], respectively; p<0.05). Medication use and electrocardiography results were not associated with sexual activity for hypertensive patients. CONCLUSIONS: For hypertensive people in China, lifestyle factors are associated with sexual dysfunction, which differs by the sex of the person. Further research needs to examine serum hormone levels to validate the result.     

HIV/AIDS-related stigma and discrimination: accounts of HIV-positive Caribbean people in the United Kingdom

This paper explores the effects of HIV/AIDS-related stigma and discrimination (HASD) on HIV-positive Caribbean people in the Caribbean and the UK. In-depth, semi-structured interviews were held with a purposively selected group of 25 HIV-positive people of Caribbean origin, using primary selection criteria of sex, age, sexuality and country of birth. Interviews with respondents revealed that they are keenly aware of the stigma surrounding HIV/AIDS, which some attribute to a particularly Caribbean combination of fear of contamination, homophobia, and ignorance, reinforced by religious beliefs. In fact, religion serves a double role: underpinning stigma and assisting in coping with HIV. HASD has usually occurred where respondents have lost or do not have control over disclosure. Compared to UK-born respondents, the accounts of Caribbean-born respondents, most of whom were born in Jamaica, include more reports of severe HASD, particularly violence and employment discrimination. All respondents mobilise a variety of strategies in order to avoid HASD, which have implications for their social interactions and emotional well being. While some manage to avoid the "spoiled identity" of the stigmatised, thereby creating their own understandings of HIV infection, these may remain individual-level negotiations. HASD affects HIV-positive Caribbean people at home and in the diaspora in a variety of ways: emotionally, mentally, financially, socially and physically. Interventions specifically addressing stigma and discrimination must be formulated for the UK's Caribbean population. Tackling stigma and discrimination requires more than education; it requires "cultural work" to address deeply entrenched notions of sexuality.     

Internalized HIV/AIDS-related stigma in a sample of HIV-positive people in Bangladesh

Internalized stigma among people living with HIV/AIDS (PLHA) is prevalent in Bangladesh. A better understanding of the effects of stigma on PLHA is required to reduce this and to minimize its harmful effects. This study employed a quantitative approach by conducting a survey with an aim to know the prevalence of internalized stigma and to identify the factors associated with internalized stigma among a sample of 238 PLHA (male=152 and female=86) in Bangladesh. The findings suggest that there is a significant difference between groups with the low- and the high-internalized HIV/AIDS stigma in terms of both age and gender. The prevalence of internalized stigma varied according to the poverty status of PLHA. An exploratory factor analysis (EFA) found 10 of 15 items loaded highly on the three factors labelled self-acceptance, self-exclusion, and social withdrawal. About 68% of the PLHA felt ashamed, and 54% felt guilty because of their HIV status. More than half (87.5% male and 19.8% female) of the PLHA blamed themselves for their HIV status while many of them (38.2% male and 8.1% female) felt that they should be punished. The male PLHA more frequently chose to withdraw themselves from family and social gatherings compared to the female PLHA. They also experienced a higher level of internalized stigma compared to the female PLHA. The results suggest that the prevalence of internalized stigma is high in Bangladesh, and much needs to be done by different organizations working for and with the PLHA to reduce internalized stigma among this vulnerable group.     

农村地区HIV感染者艾滋病相关知识、态度、行为及流动情况研究

目的 了解农村地区HIV感染者的流动情况以及他们的艾滋病相关知识、态度及行为，并为采取针对性措施，预防HIV的传播提供依据。方法 对安徽省阜阳市农村地区16～49岁已婚HIV感染者采用统一的调查表用匿名的方式进行断面调查。结果 共调查了84名HIV感染者，其中45．2％没有外出打工，16．7％在本地打工，38．1％到外地打工；28．6％的感染者答对65％以上的艾滋病相关知识题目，男性、文化程度在初中及以上者的正确率较高，认为艾滋病可怕及希望了解艾滋病知识的感染者正确率较高，艾滋病传播途径知识正确率为45．2％，而非传播途径知识的正确率仅为13．1％；仅14．3％的感染者上个月使用过避孕套，但每次性生活都使用避孕套者只有2．4％；3．6％承认过去6个月曾有过婚外性行为而且没有使用避孕套。结论 HIV感染者中高的流动率、低水平的艾滋病知识、低的避孕套使用率提示：急需对农村感染者家庭进行艾滋病相关的健康教育。     

Pyschosocial factors associated with children's cycling for transport: A cross-sectional moderation study

Promoting children's cycling for transport is a useful strategy to increase their physical activity levels. No studies have examined to which extent children's psychosocial characteristics play a role in their transportation cycling. Furthermore, insights into the association between children's independent mobility (IM) and transportation cycling is lacking in Europe. This study examined (1) the association of children's psychosocial characteristics with transportation cycling and its moderating effect of child's gender, parents' educational attainment and IM, and (2) the association between children's IM and transportation cycling.Children (n = 1232, aged 10–12 yrs) completed an online questionnaire at school assessing their psychosocial characteristics related with transportation cycling. Parents reported child's usual transportation cycling and the distance their child is allowed to cycle unsupervised (IM). Hurdle models were used to estimate associations between independent variables and odds of being a cyclist and with minutes of transportation cycling among those cycling. Data were collected during November–December 2014 across Flanders, Belgium.Children's perceived parental modeling, parental norm, peers' co-participation, self-efficacy and IM were positively related to the odds of being a cyclist, perceived benefits were negatively associated. Parental modeling, siblings' modeling, self-efficacy and parental norm were more strongly related to the odds of being a cyclist among children with a low IM. Friends' modeling was significantly related with odds of being a cyclist among boys. IM and parental norm (only among boys) were positively related to the time spent cycling. Targeting children, their friends and parents seems therefore most appropriate when aiming to increase children's transportation cycling.     

Sexual stigma and sympathy: attitudes toward persons living with HIV in Jamaica

As the number of persons living with HIV continues to increase in Jamaica, attitudes and values become more important. This study aimed to examine the attitudes of university students in Jamaica toward persons living with HIV, including homosexual men, heterosexual men, women sex workers, other women, and children. One thousand two hundred and fifty-two students were surveyed between June 2001 and February 2002 using a 193-item questionnaire measuring a variety of HIV-related knowledge, attitudinal and behavioural items. Less than half of students reported sympathetic attitudes toward homosexual men or women sex workers living with HIV while a majority reported generally sympathetic attitudes toward heterosexual men and non-sex worker women living with the disease. Predictors of sympathy varied by target group. Male students were significantly less likely to report sympathy for homosexual men than for any other group. Spirituality was associated with sympathy for homosexual men and women sex workers, but not for the remaining two groups. Findings suggest that levels of negative attitudes are high in Jamaica and warrant attention to both individual and societal-level actions and interventions. In addition, messages and interventions must be targeted, recognizing both the differences in level of sympathy expressed toward different groups and predictors of sympathy across the groups.     

广西医护人员对艾滋病认识程度和接受态度的初步研究

  目的  了解中国医务人员（HCPs）艾滋病污名现状,为向HCPs开展减少艾滋病污名干预活动提供科学依据。  方法  检索中国知网数据库、万方数据库和PubMed数据库,并辅以文献追溯法收集2001年1月 — 2017年6月公开发表的关于中国HCPs艾滋病污名现状的相关文献,应用R 3.3.1软件对纳入的文献行meta分析。  结果  共纳入43篇中、英文文献（中文文献40篇和英文文献3篇）,累计研究对象21 335人。meta分析结果显示,有37.59 %（95 % CI = 22.55 %～53.96 %）和47.02 %（95 % CI = 34.41 %～59.83 %）的HCPs分别对艾滋病感染者/患者（PLWHA）存在负性刻板印象和恐惧心理;有31.43 %（95 % CI = 18.72 %～45.73 %）的HCPs认为有权拒绝为PLWHA提供医疗服务;有22.20 %（95 % CI = 12.23 %～34.11 %）的HCPs拒绝为PLWHA提供一般诊疗/护理服务;有37.96 %（95 % CI = 20.64 %～57.01 %）的HCPs拒绝提供侵入性诊疗/护理服务;有54.44 %（95 % CI = 45.05 %～63.67 %）的HCPs赞成对PLWHA实行就医隔离;有59.39 %（95 % CI = 32.13 %～83.85 %）的HCPs认为应对PLWHA实行强制检测;有37.40 %（95 % CI = 20.08 %～56.57 %）的HCPs认为可未经PLWHA同意擅自将其病情告知他人。敏感性分析结果显示,本研究结果较为稳定;Egger’s检验和漏斗图结果均显示,除“拒绝提供侵入性诊疗/护理工作”指标外,其余指标存在发表偏倚的可能性均较小。  结论  中国HCPs艾滋病污名严重,亟需针对此人群开展干预工作。     

HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action

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.     

Rural children's attitudes to people with HIV/AIDS in Mali: the causes of stigma

Qualitative research among young people and other community members in rural Mali elicited knowledge and attitudes with regard to HIV/AIDS. Findings indicated that rumours concerning methods of infection are likely to increase the stigmatization of those with the disease. The most frequently stated mode of transmission involved urinating in a place where someone with AIDS had already urinated. Shared clothes, food and water were seen as sources of infection. Both children and teachers recommended that people with AIDS be isolated. Even talking to them would lead to a risk of infection. Discriminatory views were likely to have been reinforced by parents and community elders who possessed the same misinformation. The notion that AIDS results from sexual encounters between young women and dogs belonging to white people in C?te d'Ivoire was also widespread. These discourses may reflect perceived xenophobia and risk to migrants associated with current tensions between the two countries, together with misgivings about Western sexual liberalism. A holistic educational programme is proposed to address not simply HIV/AIDS, but the social context in which infection occurs, with view to combating stigma and discrimination associated with not just HIV but also with migration in this setting.     

大学生HIV/AIDS知识、态度与依恋模式的关系

目的了解医学院校大学生的人类免疫缺陷病毒/艾滋病（HIV/AIDS）相关知识、态度,并探讨其与依恋模式之间的关系.方法采用分层整群抽样的方法抽取1277名在校大学生进行了自填式问卷调查.结果调查对象的依恋模式为安全型占59.3%,沉溺型占18.3%,漠视型占13.1%,恐惧型占9.3%.HIV/AIDS相关知识与安全型得分呈正相关,与沉溺型、漠视型呈负相关.调查对象接纳感染者的态度与安全型呈正相关,与沉溺型、恐惧型呈负相关;对高危行为的反对程度与安全型呈正相关,与漠视型、恐惧型呈负相关;对感染的影响担心程度与沉溺型呈正相关,与漠视型呈负相关,与恐惧型呈正相关;对感染风险意识与安全型呈负相关,与恐惧型呈正相关.结论依恋模式对HIV/AIDS相关知识、态度有重要影响.     

HIV/AIDS stigma attitudes among educators in KwaZulu-Natal, South Africa

BACKGROUND: One hundred and twenty educators from KwaZulu-Natal, South Africa, underwent HIV/AIDS training. The educators were surveyed about their attitudes toward people with HIV. METHODS: The educators completed self-administered survey questionnaires both before and after 2 interventions. Measures included demographic characteristics, teachers' knowledge about HIV/AIDS, self-efficacy in handling HIV/AIDS situations, and attitudes (stigma and otherwise) toward HIV-related issues. The first intervention was a CD-ROM and the second intervention involved educators receiving a 2-day workshop on HIV transmission, risk factors, and actions that educators should know and undertake. The first step entailed testing the stigma instrument for its internal consistency and developing and testing potential subscales from the instrument. The second step entailed testing for the statistical associations between stigma (as measured by the stigma instrument and its subscales) and various demographic and HIV knowledge-related variables. RESULTS: The overall stigma scale had a Cronbach α coefficient of .66. Educators in the workshop generally had lower baseline levels of stigma than those in the CD-ROM intervention. Following both interventions, the stigma levels of both groups of educators were significantly reduced. Improvements in the general knowledge about HIV as a disease and in the specific knowledge about HIV transmission risks were both statistically significantly associated with reductions in stigma attitudes, having controlled for educators' baseline stigma levels and demographic profiles. CONCLUSIONS: The levels of teachers' stigma attitudes were statistically significantly lower after both types of HIV/AIDS training and were also statistically significantly associated with improvements in HIV knowledge.     

Hyperuricemia and associated factors: a cross-sectional study of Japanese-Brazilians

This cross-sectional study aimed to estimate the prevalence of hyperuricemia and associated risk factors among Japanese-Brazilians. We obtained data on demographic, health history, food intake, and laboratory variables. Chi-square and prevalence ratios were used as measures of association. 35.3% of the subjects presented hyperuricemia, which was more frequent in smokers, males, age > 55 years, with co-morbidities, individuals on uric acid-increasing medication, serum creatinine > 1.4 mg/dL, high alcohol consumption, and low consumption of milk and dairy products. In the multivariate analysis, the associations remained significant with gender, overweight, central obesity, hypertriglyceridemia, and use of specific drugs. Among males, low intake of saturated fat was associated with hyperuricemia. Individuals with hypertension showed a negative association with dairy product consumption. The high hyperuricemia prevalence suggests that changes in nutritional profile and control of associated co-morbidities could help minimize occurrence of this condition.     

建筑业劳务输出人员性病艾滋病影响因素定性研究

目的了解建筑业劳务输出人员性病艾滋病相关危险行为及其影响因素,为该人群的性病艾滋病防治工作提供依据。方法采用半结构式访谈方法,对劳务输出人员、劳务公司负责人、中介公司老板、南通市对外贸易经济合作局、当地疾病预防控制中心的相关工作人员等26名关键知情人进行访谈。结果商业性行为是建筑劳务输出人员感染性病艾滋病的主要高危行为,其影响因素包括劳务输出地的性服务市场情况、企业管理制度的执行力度、同伴影响、经济收入、艾滋病知识认知不足以及工人的自身素质等。结论应重视劳务输出人员性病艾滋病的防制,并采取适当的干预措施减少高危行为的发生。