Social and structural factors including HIV stigma are theorized to drive global disparities in HIV prevalence. This study tests whether HIV self-stigma, or experiences of stigma at the individual level, is associated with engagement in unprotected sex among people living with HIV (PLWH) in KwaZulu-Natal, South Africa, where 37.4% of adults are living with HIV compared with 0.8% worldwide. It further explores whether depressive symptoms, HIV status disclosure to sex partners, and/or condom use attitudes mediate potential associations between HIV self-stigma and unprotected sex. Participants, including 924 PLWH, were recruited from primary care clinics and completed baseline, 6-, 12-, and 18-month survey assessments between 2008 and 2011. Hierarchical linear modeling analyses were used to examine longitudinal within-subjects associations between HIV self-stigma, mediators, and unprotected sex with both HIV-negative/unknown and HIV-positive partners. Results demonstrate that HIV self-stigma was prospectively associated with greater likelihood of unprotected sex with HIV-negative/unknown partners. None of the variables explored significantly mediated this association. HIV self-stigma was also prospectively associated with greater likelihood of unprotected sex with HIV-positive partners via the mediators of greater depressive symptoms and more negative condom use attitudes. The current study suggests that HIV self-stigma undermines HIV secondary prevention and care efforts among PLWH in KwaZulu-Natal. It is therefore critical to address HIV stigma at the social/structural level to reduce HIV self-stigma at the individual level and ultimately curb global disparities in HIV prevalence. In the absence of widespread social/structural change, interventions that treat depressive symptoms and encourage more positive condom use attitudes despite the existence of HIV stigma may buffer associations between HIV self-stigma and unprotected sex with HIV-positive partners among PLWH in KwaZulu-Natal. 相似文献
The aim of this study was to examine relations of emotional variability during mother–adolescent conflict interactions in early adolescence with adolescent disclosure and maternal control in early and late adolescence. Data were used from 92 mother–adolescent dyads (M age T1 = 13.05; 65.20% boys) that were videotaped at T1 while discussing a conflict. Emotional variability was derived from these conflict interactions. Mothers also completed questionnaires at the start of the study (T1) and five years later (T6) on adolescent disclosure and maternal control. Path analysis showed that more emotional variability during conflict interactions in early adolescence was associated with higher levels of adolescent disclosure in early adolescence and with relative decreases in maternal control from early to late adolescence. More emotional variability of mother–adolescent dyads serves an important function in adaptively dealing with relational challenges that arise during adolescence. 相似文献
Living donor guidelines—both national and international—either do not address or are vague about what information can be shared between prospective living donors and transplant candidates, as well as when to make such disclosures and who should make them. This study explored the attitudes of donors and recipients regarding how much information they believe should be shared.
Design, setting, participants, & measurements
Two Email invitations were sent by the National Kidney Foundation (national headquarters) to its Email listservs, inviting members to participate in an online survey to assess the attitudes of kidney transplant stakeholders regarding the disclosure of health and health risk behavior information.
Results
From approximately 4200 unique Email addresses, 392 (9.3%) respondents completed part or all of the survey. The analyses were limited to the 236 respondents who self-identified as either donors (potential and actual, n=160) or recipients (candidates and actual, n=76). Overall, 79% (186 of 234) of respondents supported disclosure of general recipient health information that would affect post-transplant outcome to donors, and 88% (207 of 235) supported disclosure of general donor health information to recipients. Recipients and donors were also supportive of sharing donor and recipient information, particularly information relevant to graft and patient survival. There is some reticence, however, about sharing social information. The closer the relationship, the more information they are willing to share. Both donors and recipients wanted the transplant team involved in the information disclosure. Over three quarters of donors (79%) and recipients (78%) did not think the recipient had a right to know why a donor was excluded from donating.
Conclusions
Both donors and recipients want a significant amount of health information to be disclosed. The opinions of other stakeholders need to be surveyed to determine whether a revision of current policies and practices is warranted. 相似文献
This study examined the main reasons and predictors of HIV disclosure and its relationship to access to care among people living with HIV (PLH) in a rural area of China. A sample of 88 PLH from three counties was interviewed in 2009. In our sample, the rates of disclosure were higher within and outside family. Trust (31%), needing help (28%), and close relationships (26%) were the three main reasons of selecting the person to disclose by a PLH. Using a multivariate analysis, level of HIV disclosure to partners and members within the community was only significantly associated with use of antiretroviral treatment (ART) (β = 2.76; 95% Confidence Interval (CI): 0.77, 4.74). After adjusting for demographics, time since HIV diagnosis and ART, we found HIV disclosure (β = 0.07; 95% CI: 0.01, 0.13) was a significant predictor for access to care. In order to improve PLHs' access to health services and care, future intervention programs should consider both the potential benefits and risks associated with HIV disclosure (intentional and unintentional), and assist PLHs to prepare for HIV disclosure and reduce potential negative impacts that come with it. 相似文献
BACKGROUND There is consensus that patients should be told if they are injured by medical care. However, there is little information
on how they react to different methods of disclosure.
OBJECTIVE To determine if volunteers’ reactions to videos of physicians disclosing adverse events are related to the physician apologizing
and accepting responsibility.
DESIGN Survey of viewers randomized to watch videos of disclosures of three adverse events (missed mammogram, chemotherapy overdose,
delay in surgical therapy) with designed variations in extent of apology (full, non-specific, none) and acceptance of responsibility
(full, none).
PARTICIPANTS Adult volunteer sample from the general community in Baltimore.
MEASUREMENTS Viewer evaluations of physicians in the videos using standardized scales.
RESULTS Of 200 volunteers, 50% were <40 years, 25% were female, 80% were African American, and 50% had completed high school. For
designed variations, scores were non-significantly higher for full apology/responsibility, and lower for no apology/no responsibility.
Perceived apology or responsibility was related to significantly higher ratings (chi-square, 81% vs. 38% trusted; 56% vs. 27% would
refer, p < 0.05), but inclination to sue was unchanged (43% vs. 47%). In logistic regression analyses adjusting for age, gender,
race and education, perceived apology and perceived responsibility were independently related to higher ratings for all measures.
Inclination to sue was reduced non-significantly.
CONCLUSIONS Patients will probably respond more favorably to physicians who apologize and accept responsibility for medical errors than
those who do not apologize or give ambiguous responses. Patient perceptions of what is said may be more important than what
is actually said. Desire to sue may not be affected despite a full apology and acceptance of responsibility.
Presented in part at the 28th Annual Meeting of the Society for General Internal Medicine, New Orleans, LA, May 11–14, 2005 相似文献
Objectives: This research addresses four questions: (1) What role do health care providers play in women's disclosure to others of their HIV-positive status? (2) What are women's concerns and experiences with disclosure? (3) What violence do women living with HIV experience? (4) How is the violence related to their diagnosis and disclosures? Methods: Participants were 310 HIV-positive women enrolled in an HIV primary care clinic in an urban teaching hospital. Women were interviewed once using both quantitative and qualitative methods. Results: Women had known they were HIV-positive for an average of 5.8 years; 22% had an HIV-positive partner; 58% had disclosed their status to more than 10 people; and 68% had experienced physical abuse and 32% sexual abuse as an adult. Fifty-seven percent of the sample reported that a health care provider had told them to disclose to their sex partners. Women who were afraid of disclosure-related violence (29%) were significantly more likely than those who were not to report that a health care provider helped them with disclosure (21% vs. 10%). Although 4% reported physical abuse following a disclosure event, 45% reported experiencing emotional, physical, or sexual abuse at some time after their diagnosis. Risk factors for experiencing abuse after diagnosis were a prior history of abuse, drug use, less income, younger age, length of time since diagnosis, and having a partner whose HIV status was negative or unknown. Conclusions: Identifying women at risk for abuse after an HIV-positive diagnosis is important for those who provide HIV testing and care. Routine screening for interpersonal violence should be incorporated into HIV posttest counseling and continuing primary care services.
Salutary effects of writing about trauma on health are well documented, but little research has directly examined the underlying mechanisms by which these effects occur. The principal study in this article assessed the potential underlying mechanism of meaning-making, defined as changing situational meaning (appraisals of the traumatic experience) and global meaning (world views, personality, and coping styles) in order to reduce the discrepancy between global and situational meaning. Forty-one trauma-writing participants and 21 nontrauma-writing control participants completed 4 days of writing and a 4 month follow-up. Decrements in health were noted for the control group but not for the trauma-writing group. Over time, the trauma-writing group's appraisals changed to reflect less aversive situational meaning (e.g., less stressful, less threatening), and their cognitive processing, reflected by intrusions and avoidance, decreased. Less stressful appraisals and reduced cognitive processing were related to improved health outcomes. Results indicate that writing about trauma facilitates the making of meaning. A second study examined whether scores on several measures used in the first study changed across 4 months without a writing intervention. It was found that these measures did not change across time. 相似文献