Perceived HIV-Associated Stigma among HIV-Seropositive Men: Psychometric Study of HIV Stigma Scale (original) (raw)
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UNDERSTANDING HIV-RELATED STIGMA: SOCIAL AND PSYCHOLOGICAL PROCESSES
Few modern illnesses have been as extensively stigmatized as HIV. The consequences of HIV-related stigma are substantial and include hampered HIV prevention, testing delays, poor treatment adherence, psychological distress in people living with HIV (PLWH), and disrupted social interactions. This dissertation reports on the social and psychological processes involved in the production and experience of HIV-related stigma. The first part of this dissertation describes the results of comprehensive qualitative research conducted with African, Dutch Antillean, and Surinamese diaspora in the Netherlands. In Chapter 2, the beliefs that underlie and contribute to HIV-related stigma in these communities are investigated. Interviews with both HIV-positive and HIV-negative community members established that beliefs that HIV is highly contagious, that HIV is a very severe disease, and that PLWH are personally responsible for acquiring their HIV infection contribute to HIV-related stigma, as does the belief that PLWH are HIV-positive because they engage in norm-violating behavior such as promiscuity, commercial sex work, and, for Afro-Caribbean diaspora, also homosexuality. These beliefs were found to be exacerbated and perpetuated by cultural taboos on talking about HIV and sexuality. Chapter 3 describes the manifestations and consequences of HIV-related stigma in African, Dutch Antillean, and Surinamese communities, and delineates the coping strategies employed by PLWH to mitigate the negative social and psychological consequences of HIV-related stigma. In this study, HIV-related stigma was found to manifest as social distance, physical distance, words, and silence, and to have substantial psychological, social, and health-related consequences. The psychological consequences of HIV-related stigma were emotional pain, sadness, loneliness, anger, frustration, and internalized stigma. The social consequences included decreased social network size, limited social support, and social isolation, and were found to result from not only enacted stigma but also self-imposed social withdrawal. Also, poor treatment adherence was found to be a health-related consequence. In terms of coping strategies, this study established that PLWH employ both problem-focused and emotion-focused coping strategies to mitigate the negative consequences of stigma. Problem-focused coping strategies reported were selective disclosure, disengagement, affiliating with similar others, seeking social support and, to a lesser extent, activism. Emotion-focused strategies included distraction, positive reappraisal, religious coping, external attributions, disidentification, and acceptance. Chapter 4 investigates how African, Dutch Antillean, and Surinamese PLWH approach disclosure. Previous research has shown that HIV status disclosure is a reasoned process whereby the costs and benefits to oneself and to others are weighed. As such, understanding disclosure requires understanding the reasons for and against disclosure employed by PLWH. In this study, reasons for nondisclosure and disclosure were established. Reasons for nondisclosure were fear of stigmatization, having had previous negative experiences with disclosure, having observed the stigmatization of other PLWH, feeling shame, and wanting to protect others – particularly one’s children and family – from stigmatization-by-association and/or worrying, and believing that one’s HIV status is a private matter. Participants reported disclosing because they were in a close and supportive relationship, disclosure led to emotional release, disclosure could lead to emotional or financial support, they felt a perceived duty to inform, and they had a desire to educate others about sexual risk-taking. The findings suggest that stigma plays an important role in disclosure decisions among these populations. Together, the three chapters in the first part of this dissertation follow the process of stigmatization in African and Afro-Caribbean diaspora communities from the beliefs underlying stigma to the manifestations and consequences of HIV-related stigma and subsequent coping while also considering how African and Afro-Caribbean PLWH decide whether or not to disclose their HIV status. The second part of this dissertation explores some aspects of HIV-related stigma in more detail and expands the study population and sample to include all PLWH living in the Netherlands. The findings reported in this section are also, in contrast to the first part of this dissertation, quantitative in nature. Chapter 5 investigates, using a cross-sectional survey, which specific stigma experiences are most strongly related to psychological distress across a number of social settings, something that has not previously been done. Most studies investigating the psychological impact of HIV-related stigma employ an aggregate measure of stigma and, although this approach provides useful information about the psychological implications of HIV-related stigma in general, it neglects to acknowledge the possibility that some manifestations in specific settings may be psychologically more detrimental than others. As a result, this study examined participants’ experiences of 11 manifestations of HIV-related stigma in 6 social settings. Linear regression analyses were conducted to determine which setting-specific manifestations best predict psychological distress. The results showed that three manifestations in family settings, namely receiving advice to conceal one’s status, being avoided, and being treated with exaggerated kindness, and one manifestation in health care settings, namely awkward social interaction, best predicted psychological distress in PLWH, thus demonstrating that manifestations of HIV-related stigma do vary according to setting. Chapter 6 returns to the issue of disclosure and, in particular, to the debate on whether a visible or concealable stigma is more detrimental to PLWH’s psychological well-being and social lives. The study reported in this chapter investigated HIV-related stigma, psychological distress, self esteem, and social support in a sample comprising people who have concealed their HIV status to all but a selected few (limited disclosers), people who can conceal but chose to be open (full disclosers), and people who had visible symptoms that made concealing difficult (visibly stigmatized). The findings indicate that while visibly stigmatized participants and full disclosers both reported significantly more stigma experiences than limited disclosers, only the visibly stigmatized reported more psychological distress, lower self esteem, and less social support than limited disclosers. This suggests that having a visible stigma is more detrimental than having a concealable stigma. Differences in psychological distress and self esteem between the visibly stigmatized and full disclosers were mediated by social support while differences between the visibly stigmatized and limited disclosers were mediated by both social support and stigma. These findings clearly suggest that social support buffers psychological distress in PLWH. The final chapter of this dissertation, Chapter 7, is a general discussion of all research findings, both the qualitative findings acquired through research with African, Dutch Antillean, and Surinamese diaspora communities and the quantitative findings gathered through cross-sectional research with the general PLWH population in the Netherlands. This chapter not only summarizes the findings of the studies reported in this dissertation and discusses them in the context of the current literature; it also discusses the role of culture in understanding stigma, claiming that HIV-related stigma is a relatively ubiquitous phenomenon. Before concluding, this chapter reflects on the methods used to conduct the research reported in this dissertation, outlines implications of the research findings, and provides recommendations for future research.
Factors Related to the Stigma Associated with HIV / Aids Patient
International Journal of Science and Research (IJSR)
HIV/AIDS related stigma (H/A stigma) is invoked as a persistent and pernicious problem. The manifestation of H/A stigma not only varies by cultural/national setting, but also by whether one is considering intrapersonal versus societal levels of stigma. Objectives-To assess the factor related to the personal & perceived community stigma.and to find the association between the factors related to stigma associated with HIV / AIDS patient and selected demographic variable.Methods: descriptive research approach with Single group non experimental research design was used for 30-HIV / AIDS samples from tertiary care hospital. Results: Majority (73.33 %) were in the age group 20-45yrs.Most of the patients were Male (70%) and (96.7%) were married as well as (90%) patients were illiterate. community stigma according to blame and judgment people were affected with this factor i.e,83.3%Maximum& ,interpersonal distance factors also affected with 86.7% ,and value items 60%was affected. community ...
2006
People's attitudes towards people living with HIV/AIDS remain a major community challenge. There is a need to generate a climate of understanding, compassion and dignity in which people living with HIV/AIDS (PLWHA) will be able to voluntarily disclose their status and receive the support and respect all people deserve. However, many people experience discrimination because they have HIV/AIDS. In a certain area in Khayelitsha, a township in Cape Town, a young woman was killed after disclosing the HIV status after being raped by five men. This has become a barrier to testing, treatment, on quality of life and social responses to HIV/AIDS. While many previous studies have focused on the external stigma in the general population, there is a dearth of studies on stigma among PLWHA themselves and hence the aim of the present study was to investigate stigma attached to HIV/AIDS from the perspective of PLWHA. The focus group research method was used to collect the data. Six focus groups consisting of 8-10 people in each group were held in Khayelitsha drawn from organizations working with PLWHA and Treatment Action Campaign (TAC). Data was analyzed using discourse analysis and the PEN-3 Model was used to explain the themes that emerged from the data. Results showed that PLWHA are affected by both enacted and internal stigma related to HIV/AIDS. It was found that the experiences of discrimination and stigma often originate from the fear and perceptions of PLWHA as immoral or living dead. They suffer rejection at home, work, school and in the health care centres. Results also showed that PLWHA felt shame, guilt, hopelessness and useless. This internalized stigma leads to withdrawal, depression, not to disclose the HIV status and prevent people for testing for HIV and also affect health-seeking behaviour. However, participants who were well informed and those who were members of the support groups reported that they are coping with the illness and they are open about their HIV-status. This suggests that education efforts have been remarkably successful in changing attitudes. It is recommended that stigma reduction programmes should involve PLWHA, community leaders and the community members to be part of the planning and implementation. It is also important to look at the successful programmes already existing in the area and adapt them and also to evaluate the effectiveness. Prof. Leickness Simbayi for your support, encouragement and being patient with me until the end of this process. The Penn-State University and Human Science Research Council for providing me fellowship and the facilities which made it possible for me to finish my thesis. Chelsea Morroni for support, friendship, motivation and containment which kept me going. My husband, children and family for the inspiration, encouragement and providing me space to finish this thesis. PLWHA who participated in this study for sharing your experiences with me. Thank you for trusting me with your sensitive life stories, without you this project was not going to be possible.
Factors related to the perceived stigmatization of people living with HIV
Revista da Escola de Enfermagem da U S P, 2017
Analyzing the factors related to perceived stigmatization of people living with HIV. A cross-sectional study conducted from September of 2014 to December 2015 with users from a specialized service in Minas Gerais. Data were collected through individual instrument application, organized in Microsoft Office Excel(r) 2010 spreadsheets and processed on IBM(r) SPSS 23.0. Descriptive statistics and multiple linear regression method were used for data analysis, adopting statistical significance set at 5.0% (p≤0.05). The study development met research ethics standards. 258 users participated in the study. Most were males between 40 and 49 years of age, single, with low educational level and income. Being between 40 and 49 years of age and having been hospitalized for complications related to HIV were positively associated predictors to increased stigmatization; while not having comorbidities and not being aware of exposure to HIV were predictors associated to reduced stigmatization. Given t...
Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale¶
Research in Nursing & Health, 2001
An instrument to measure the stigma perceived by people with HIV was developed based on the literature on stigma and psychosocial aspects of having HIV. Items surviving two rounds of content review were assembled in a booklet and distributed through HIV‐related organizations across the United States. Psychometric analysis was performed on 318 questionnaires returned by people with HIV (19% women, 21% African American, 8% Hispanic). Four factors emerged from exploratory factor analysis: personalized stigma, disclosure concerns, negative self‐image, and concern with public attitudes toward people with HIV. Extraction of one higher‐order factor provided evidence of a single overall construct. Construct validity also was supported by relationships with related constructs: self‐esteem, depression, social support, and social conflict. Coefficient alphas between .90 and .93 for the subscales and .96 for the 40‐item instrument provided evidence of internal consistency reliability. The HIV S...
AIDS, 2009
"Objectives: Recent research has shown that experiences of stigmatization have an adverse impact on the psychological well-being of people living with HIV/AIDS (PLWHA). Most studies investigating this relationship employ an aggregate measure of stigma. Although this approach provides useful information about the psychological implications of HIV-related stigma in general, it neglects to acknowledge the possibility that some manifestations in specific settings may be psychologically more detrimental than others. The present study examines which specific stigma experiences are most strongly related to psychological distress across a number of social settings. Methods: A cross-sectional survey was administered to 667 PLWHA in the Netherlands. We examined participants’ experiences of 11 manifestations of HIV-related stigma in 6 social settings. Linear regression analyses were conducted to determine which setting-specific manifestations best predict psychological distress after controlling for marital status, education and health status. Results: Three manifestations in family settings, namely receiving advice to conceal one’s status, being avoided and being treated with exaggerated kindness, and one manifestation in health care settings, namely awkward social interaction, best predicted psychological distress in PLWHA. Conclusions: Manifestations of HIV-related stigma vary according to setting. Certain manifestations in specific social settings impact the psychological well-being of PLWHA more than others. In this study, certain experiences of stigmatization with PLWHA’s families and in health care settings were more strongly related to psychological distress than experiences occurring in other social settings. These findings suggest that stigma reduction interventions focusing on these influential settings may benefit the psychological well-being of PLWHA."
STIGMA OF PEOPLE LIVING WITH HIV/AIDS
NurseLine Journal, 2019
People living with HIV have many complex problems in their lives. Internal problems concern bio-psycho-socio-spiritual, while external problems concern the views and attitudes of others towards themselves. Negative views from other people formed long ago will give a bad stigma to people with HIV. The stigma of society has a great influence, not only affecting citizens but also health workers. This study aims to review the results of research related to stigma inherent in the community, especially nurses to people with HIV. The researcher sought the results of other studies through several databases including ProQuest, Scopus, Science Direct, PubMed, Medline, Springer link and Elsevier. Keywords to search literature include" stigma"," nurse" and" people with HIV". The results obtained were as many as 14 journals. Many studies have been carried out for prevention, treatment, and support for people with HIV/AIDS. But along with advances in the field of health need to continue to do problems related to people with HIV/AIDS