AIDS stigma combinations in a sample of Puerto Rican health professionals: qualitative and quantitative evidence

The HIV/AIDS epidemic continues to impact Puerto Rico and the Caribbean region with growing numbers of cases each year. The stigma that surrounds the epidemic has harmful implications on the health of people living with the disease and public health in general, fostering health deterioration and new infections. When this stigma emanates from health professionals it can severely hinder access to health services, which are crucial for those living with the virus. Still, AIDS stigma has been previously explored among this population as a separate phenomenon from other pre-existing stigmas. This has yielded a limited perspective on the complexity of how AIDS stigma is manifested. In light of this limitation, the main objectives of this study were: 1) to document AIDS stigma among a sample of Puerto Rican health professionals and health professionals in training and 2) to explore the combination of other stigmas (sexism, homophobia, and negative attitudes towards drug users) with that associated to HIV/AIDS. Through an exploratory design, using a mixed method approach (qualitative in-depth interviews and quantitative questionnaires), we explored the objectives in a sample of 501 health professionals and health professionals in training. The results evidenced the combinations of other stigmas with that of HIV/AIDS. Homophobia yielded the strongest correlation and was the best predictor of AIDS stigma. These results evidence the need to develop interventions to reduce AIDS stigma and its combinations among this population.     

Response of religious groups to HIV/AIDS as a sexually transmitted infection in Trinidad

Background  

HIV/AIDS-related stigma and discrimination are significant determinants of HIV transmission in the Caribbean island nation of Trinidad and Tobago (T&T), where the adult HIV/AIDS prevalence is 2.5%. T&T is a spiritually-aware society and over 104 religious groups are represented. This religious diversity creates a complex social environment for the transmission of a sexually transmitted infection like HIV/AIDS. Religious leaders are esteemed in T&T's society and may use their position and frequent interactions with the public to promote HIV/AIDS awareness, fight stigma and discrimination, and exercise compassion for people living with HIV/AIDS (PWHA). Some religious groups have initiated HIV/AIDS education programs within their membership, but previous studies suggest that HIV/AIDS remains a stigmatized infection in many religious organizations. The present study investigates how the perception of HIV/AIDS as a sexually transmitted infection impacts religious representatives' incentives to respond to HIV/AIDS in their congregations and communities. In correlation, the study explores how the experiences of PWHA in religious gatherings impact healing and coping with HIV/AIDS.     

Disentangling the stigma of HIV/AIDS from the stigmas of drugs use,commercial sex and commercial blood donation – a factorial survey of medical students in China

Background  

HIV/AIDS related stigma interferes with the provision of appropriate care and support for people living with HIV/AIDS. Currently, programs to address the stigma approach it as if it occurs in isolation, separate from the co-stigmas related to the various modes of disease transmission including injection drug use (IDU) and commercial sex (CS). In order to develop better programs to address HIV/AIDS related stigma, the inter-relationship (or 'layering') between HIV/AIDS stigma and the co-stigmas needs to be better understood. This paper describes an experimental study for disentangling the layering of HIV/AIDS related stigmas.     

Drug abuse, HIV/AIDS and stigmatisation in a Dai community in Yunnan, China

The latest data indicate that between 540,000 and 760,000 people are infected with HIV in China. Although minority nationalities represent 8.1% of China's total population, they account for more than 30% of the reported HIV/AIDS cases. This study examined stigma and discrimination against drug abusers and people living with HIV/AIDS (PLHA) in a Dai minority nationality community in Yunnan, China. The study used qualitative research methods, which included participatory observations, in-depth interviews, focus-group discussions, transect walking and community mapping. A combination of different sampling strategies was used to maximise diversity of the initially selected sample. The data revealed deeply entrenched stigma and overt discrimination against drug abusers and PLHA that manifested in familial, work, civil and institutional contexts. The stigma reflected pre-existing cultural, religious sanctions against "deviant behaviours". Intervention programmes that were insensitive to the local culture and religion may have also contributed in part to the stigmatisation of drug abusers and PLHA. The major impact of stigma was that it created a vicious cycle of social isolation, marginalisation and thus addiction relapse. This in turn reinforced the stigmatisation and discrimination against drug abusers and thus hindered efforts towards prevention and control of HIV/AIDS.     

医学生艾滋病歧视研究现状

艾滋病及对HIV感染者/AIDS患者的耻辱和歧视是一个全球性的社会公共问题。其中医务人员是影响社会公众心理感受的权威性人群,他们对HIV感染者/AIDS患者的认识具有社会舆论导向性,直接关系到社会大众对HIV感染者/AIDS患者的态度与行为。工作、教育、医疗卫生和社区4个领域是最有可能发生因艾滋病而导致社会歧视的领域,而医疗卫生或卫生保健领域最为突出,在医疗保健服务过程中存在的歧视会对求医的HIV感染者/AIDS患者生理、心理产生严重影响。因此很有必要在医学院校开展艾滋病反歧视教育,使医学生树立反歧视正确态度。     

Reducing Susceptibility to Courtesy Stigma

In light of the chronic shortage of health professionals willing to care for HIV/AIDS patients, and rising epidemics in many Muslim countries, this qualitative study examined susceptibility and resistance to courtesy stigma as experienced by nurses, doctors, and social workers in Morocco. Forty-nine in-depth interviews provided rich insights into the process of courtesy stigma and how it is managed, within the context of interactions with Islam, interactions within the workplace (patients, other health professionals), and interactions outside the workplace (the general public, friends, and family). Theoretically, the findings extend understanding of courtesy stigma and the dirty work literature. The findings also offer practical suggestions for the development of culturally appropriate strategies to reduce susceptibility to courtesy stigmatization. This study represents the first to explore courtesy stigma as a process experienced by health professionals providing HIV/AIDS care in an Islamic country.     

Discrimination, stigma, and AIDS: a review of academic literature produced in Brazil (2005-2010)

Given the implications of stigma for HIV/AIDS prevention and control of the epidemic, as emphasized by UNAIDS, this study analyzes the Brazilian academic production on health, AIDS, stigma, and discrimination, available in the SciELO database from 2005 to 2010. Brazilian research on the theme is modest as compared to the international literature, but the studies follow the same trend of focusing on individual experiences of discrimination as opposed to analysis of stigma and discrimination as social processes associated with power relations and domination (macro-social structures) and the characteristics of individuals and social groups that shape social interactions. The current study seeks to analyze the reasons for the scarcity of studies on the social perspective towards stigma and discrimination in the field of public health and the implications for the development of proposals to deal with HIV/AIDS-related discrimination.     

Country watch: Mexico

This article describes the program activities of the Mexican National Commission on Human Rights (CNDH), which in 1994 created a program to address human rights issues of HIV-infected victims. The aim was to answer complaints of discrimination against HIV-infected persons and to modify confrontational attitudes of groups that feel infringed upon by the rights of HIV-infected persons. CNDH formed a task force of HIV/AIDS medical experts, which recommended actions for three types of discriminatory practices. Persons with HIV/AIDS (PWHA) who were confined in prison filed complaints about the lack of necessary medications or medical attention. The Official Mexican Norm for the Prevention and Control of HIV stipulates, in its Manual for the Attention of Complaints Regarding HIV/AIDS, protocols for treatment of PWHA. This manual was distributed to 31 State Human Rights Commissions in Mexico. CNDH implemented an outreach program to educate the public about HIV/AIDS, to offer training courses, and to publish written materials about discrimination against PWHA. The CNDH conducted conferences and training sessions for workers in the health services, where most violations of human rights take place. CNDH works closely with the National Board for the Prevention and Control of AIDS to assess clinical records, train staff handling complaints, and channel complaints that require CNDH intervention. CNDH conducts training workshops for nongovernmental organizations. CNDH is constrained by bureaucratic procedures that slow the process of resolving complaints and by the small CNDH staff responsible for handling the more complex cases. However, CNDH has successfully resolved a number of complaints and improved the prison conditions of PWHA.     

Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa

AIDS stigmas interfere with HIV prevention, diagnosis, and treatment and can become internalized by people living with HIV/AIDS. However, the effects of internalized AIDS stigmas have not been investigated in Africa, home to two-thirds of the more than 40 million people living with AIDS in the world. The current study examined the prevalence of discrimination experiences and internalized stigmas among 420 HIV-positive men and 643 HIV-positive women recruited from AIDS services in Cape Town, South Africa. The anonymous surveys found that 40% of persons with HIV/AIDS had experienced discrimination resulting from having HIV infection and one in five had lost a place to stay or a job because of their HIV status. More than one in three participants indicated feeling dirty, ashamed, or guilty because of their HIV status. A hierarchical regression model that included demographic characteristics, health and treatment status, social support, substance use, and internalized stigma significantly predicted cognitive-affective depression. Internalized stigma accounted for 4.8% of the variance in cognitive-affective depression scores over and above the other variables. These results indicate an urgent need for social reform to reduce AIDS stigmas and the design of interventions to assist people living with HIV/AIDS to adjust and adapt to the social conditions of AIDS in South Africa.     

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.     

Felt and enacted stigma among HIV/HCV-coinfected adults: the impact of stigma layering

The realization that many persons with HIV/AIDS are subjected to multiple layers of stigmatization because they belong to socially deviant and disenfranchised groups (e.g., injection drug users, racial/ethnic and sexual minorities) accounts for an increasing interest in the phenomenon of stigma layering. The stigma associated with hepatitis C virus (HCV) has also been conceptualized as layered. However, researchers have overlooked the fact that HCV adds a layer to the HIV stigma and vice versa. Qualitative interviews with 132 HIV/HCV-coinfected patients were analyzed to explore how they experience the two layers of stigma. Most participants hierarchically ordered the stigmas associated with each disease and regarded HIV as the more stigmatizing of the two. A small number perceived HIV and HCV as equally stigmatizing. The impact of the hierarchical and nonhierarchical ordering of the two stigmas on coinfected patients' felt and enacted stigmatization is explored and implications for interventions are discussed.     

北京市卫校师生艾滋病相关知识及态度调查

目的了解卫校师生艾滋病相关知识、态度现状。方法利用整群抽样的方法,对北京市某卫生学校574名全日制在校2、3年级学生及教职员工进行自填式问卷调查,对10名师生进行了个人访谈。结果卫校师生艾滋病相关知识总体知晓率为80.07%,传播途径知识知晓率达84.97%,非传播途径知识知晓率偏低,仅69.63%;53.1%的教职工及61.5%的学生感到害怕艾滋病;17.6%的调查对象认为艾滋病患者不应该享有上学权利,25.6%认为艾滋病患者不应该享有就业权利,59.0%认为经性途径感染艾滋病的人不值得同情,87.5%认为经吸毒途径感染艾滋病的人不值得同情。结论卫校师生对艾滋病相关知识具有较高的认识,但对某些非传播途径仍然存在认识不足;有一定比例的师生对艾滋病病毒感染者和艾滋病病人有恐惧和歧视态度。     

Fear and loathing in health care settings reported by people with HIV

Abstract People with chronic or terminal diseases not only have to face the biophysical consequences but also the social impact of illness. The social impact or stigma associated with HIV/AIDS is high due to its infectivity and association with deviant behaviour. Social interaction with health professionals is critical for subsequent social adjustment to possession of a discreditable disease, including HIV. This paper examines the subjective reports of 61 people with HIV within this context and identifies processes of stigmatisation in health care settings. In agreement with surveys of health care workers, fear of contagion is identified as the principal source of negative reactions towards people with HIV in health care settings. Issues of confidentiality and the response of people with HIV to stigma in health care settings are also discussed. It is concluded that, although the biomedical model in which health professionals are trained ignores the social impact of disease, HIV-related stigma in health care settings in Scotland is declining as health professionals become familiar with treating people with HIV.     

Examining attribution model of self-stigma on social support and psychological well-being among people with HIV+/AIDS

Among various infectious diseases, HIV/AIDS is considered to be one of the most stigmatizing conditions. Using a prospective design, the present study attempted to test the attributional pathway from perceived control to responsibility to self-blame and finally to self-stigmatization, and to examine the social and psychological sequelae of stigma among a sample of 119 people with HIV/AIDS (PWHA) in Hong Kong. Structural equation modeling findings showed that the model had good fit to the data. Although the linkage between the attributions of control, responsibility, and blame was confirmed, the relationship of blame to self-stigma was not significant. Self-stigma was found to dampen social support and lead to psychological distress half a year later. The present study challenged the adequacy of attributional factors in understanding self-stigmatization and demonstrated the impact of stigma on psychological adjustment among PWHA.     

Empowerment and sustainability -- whose responsibility?

Many different bodies are involved in ensuring empowerment and sustainability in the context of HIV/AIDS. International donor agencies and other funders can begin by helping the community groups which they support financially to build capacity and skills. Such action can be taken together with other community-based organizations or networks. Donors can also involve, support, and facilitate the involvement of people with HIV/AIDS (PWHA) in the community, organizations, and various structures. Rather than demanding to be involved simply because they are infected with HIV, PWHA need to demand assistance and expertise which will improve their effectiveness as collaborators in future strategies. Furthermore, nongovernmental organizations should stop trying to control PWHA by speaking on their behalf. Churches and religious bodies must stop using religion as an excuse to do nothing about HIV/AIDS, and the media needs to stop reporting that the epidemic has ended and stop using sensational reporting to sell publications.     

柳州市不同途径发现的HIV/AIDS的晚发现状况及其相关因素

目的 了解柳州市不同途径发现的艾滋病病毒（human immunodeficiency virus,HIV）感染者和艾滋病（acquired immune deficiency syndrome,AIDS）病人（简称HIV/AIDS）的晚发现状况及其相关因素。方法 采用横断面调查方法对2009年1月~2010年6月柳州市新报告的HIV/AIDS进行问卷调查。采用Logistic回归方法分别分析不同途径发现的HIV/AIDS晚发现的危险因素。结果 调查的839例研究对象中,通过医院就诊途径和通过其他途径发现的HIV/AIDS的晚发现率分别为83.8%和62.7%,差异有统计学意义（χ2=48.765,P<0.001）。医院就诊途径发现的HIV/AIDS中,年龄在16~39岁、女性、未婚以及注射吸毒传播途径所占比例分别为37.3%、22.8%、15.3%和5.0%,均低于其他途径发现的HIV/AIDS（均有P<0.05）。多因素结果显示,医院就诊途径发现的HIV/AIDS中,异性性接触传播者、查出感染HIV之前有异性固定性伴性行为和非固定异性性行为者发生晚发现的危险性增加,而家庭年收入 ≥ 15 000元发生晚发现的危险性降低;其他途径发现的HIV/AIDS中,年龄越大发生晚发现的危险性越高。结论 医院就诊途径和其他途径发现的HIV/AIDS中晚发现状况均较严重,两者的人口学特征及其晚发现的危险因素不尽相同,提示今后在促进HIV/AIDS早期发现时应根据不同途径发现的HIV/AIDS的人群特点开展针对性干预措施。     

Position of the American Dietetic Association and Dietitians of Canada: nutrition intervention in the care of persons with human immunodeficiency virus infection

Infection with the human immunodeficiency virus (HIV) and the development of acquired immunodeficiency syndrome (AIDS) have had a significant impact on domestic and global health, social, political, and economic outcomes. Prevention and treatment efforts to control HIV infection are more demanding than in previous decades. Achieving food and nutrition security, and managing nutrition-related complications of HIV infection and the multiple aspects of disease initiated by or surrounding HIV infection, referred to as HIV disease, remain challenges for patients and for those involved with HIV/AIDS prevention, care, and treatment efforts. Confounding clinical issues include medication interactions, coinfection with other infections and diseases, wasting, lipodystrophy, and others. Dietetics professionals, other health care professionals, and people infected with HIV will need to understand and address multiple complex aspects of HIV infection and treatment to improve survival, body functions, and overall quality of life. Individualized nutrition care plans will be an essential feature of the medical management of persons with HIV infection and AIDS.     

医学院校大学生HIV/AIDS知识、态度调查

目的了解医学院校学生的艾滋病知识和态度,为开展艾滋病防治工作提供依据。方法以某医科大学大二学生为调查对象,随机抽取10个班级进行调查,共计341人进行横断面现场调查。结果医学生对艾滋病的传播途径问题回答的正确率较高,超过90%,对非传播途径、艾滋病的早期临床症状问题回答的正确率较低。生源地为城市的学生得分高于农村的学生,差异有统计学意义（P〈0.05）。学校课程教育、互联网、电视、报纸杂志是学生获得艾滋病相关知识的主要途径。在对待艾滋病患者的问题上,该人群的态度较好,生源地为城市的学生得分高于农村的学生,差异有统计学意义（P〈0.05）。艾滋病相关知识得分和态度得分之间无相关性（r=0.06,P〉0.05）。结论医学生的艾滋病知识、态度较好,但仍存在不足,需要进一步开展艾滋病健康教育,尤其是农村学生的艾滋病防治知识的健康教育需进一步加强。     

广州市大中学生预防艾滋病健康教育行动效果评估

目的 评价大、中学生预防艾滋病健康教育效果，为开展相关研究提供依据。方法 采取整群随机抽样的方法，以无记名自填式答卷方式，对广州市大学生2071名、高中生2589名、职中学生2796名预防艾滋病健康教育前后情况进行对比分析。结果 大、中学生在预防艾滋病健康教育后。对20项艾滋病相关知识知晓率显高于教育前；对12项艾滋病相关行为的态度，教育后亦有了不同程度的改变:结论 安全性行为教育、反吸毒教育是对大、中学生进行预防艾滋病健康教育的重点内容；参观图并茂的展览。发放健康教育处方，观看VCD，是预防艾滋病健康教育的较好形式；在传播预防艾滋病知识的同时，更要注重大、中学生对艾滋病相关态度的转变；预防艾滋病健康教育还应与性伦理、性道德、法制教育相结合，效果会更明显。     

AIDS awareness among undergraduate students,Maharashtra

Total 313 undergraduate students (132 males and 181 females) of the colleges of Nashik and Talegaon of Maharashtra were surveyed regard awareness about AIDS. Most of the students knew about AIDs and tests available. They were aware that people indulging sexually promiscuous relations are at risk of AIDS. But the fact that it is transmitted by infected blood and from infected mother to child was not widely known, particularly among Arts students. Some misconceptions regarding modes of transmission were observed among few students, like social kissing, sharing utensils/personal items, using common swimming pools and insect bite spread infection. Attitude towards HIV infected/AIDS patients were not sympathetic. Overall knowledge of Science students were better compared to commerce and Arts students. Confusion about mode of transmission and prevention of the disease exist. Scope of health education for these students was well felt.