"They Kept Away": Social Isolation of Cisgender Women Living with HIV in Hyderabad, India (original) (raw)
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HIV STIGMA AND GENDER: A MIXED METHODS STUDY OF PEOPLE LIVING WITH HIV IN HYDERABAD, INDIA
Dissertation, 2018
The goal of this dissertation study is to explore how HIV stigma and gender interact in the lives of people living with HIV in Hyderabad, India. This study pays particular attention to gendered experiences of depression and medical care utilization. The theoretical framework for the study integrates gender role theory with an adapted version of Goffman’s conceptualization of stigma. The study utilizes mixed methods in two interrelated phases. In Phase 1, 150 individuals living with HIV (51 cisgender women, 49 cisgender men and 50 hijra/transgender women) were recruited to complete a survey that investigated associations between HIV stigma and two outcomes: depression and medical care utilization. The mean age of participants was 38.03 years (SD=7.62); mean income was 8,8083 Rupees (SD=5,917); and mean self-reported CD4 count was 447 (SD=258). The majority of participants were Hindu (85%), spoke Telugu as their native language (89%), and were members of scheduled castes or tribes (79%). HIV stigma was found to be positively associated with both depression and medical care utilization. In phase 2, 32 individuals (16 cisgender heterosexual women and 16 hijra/transgender women), scoring on the high and low ends of the stigma scales, were recruited to participate in in-depth interviews, exploring their experiences with HIV, gender roles, and gender nonconformity. For cisgender women in India, HIV stigma was found to be impacted by restrictive gender roles, a limited ability to refuse or delay sex or marriage, and the prioritization of male partners’ health over females’ health. For hijra/transgender women in India, sex work, gender nonconformity, and the multiplicity of gender identity were found to be important factors in influencing HIV stigma. These findings emphasize the importance of tailoring HIV policies and programs to fit the specific mental and physical health needs of hijra/transgender people and cisgender women in Hyderabad, India.
Diversity and Equality in Health Care, 2017
For women living with HIV infection in India, stigma is a pervasive reality and the greatest barrier to accessing treatment, quality of life and survival. Defining stigma according to Goffman as a socially conceived abnormality, this paper then draws on Engel’s biopsychosocial model for chronic disease to show the pervasive nature of stigma as a continuum affecting all dimensions of life for married, monogamous Indian women with positive HIV sero-status. Two distinct perspectives were identified in the literature: 1) Public: social and relational stigma, or 2) Private: internalised psychological stigma. Only four of the twenty published works reviewed noted interrelationships between these public and private spheres. Only one of those employed an ethnographic methodology to understand stigma from the perspective of the women themselves. While concepts associated with stigma among women living with HIV are diversely employed in research, by considering them as a whole through an intersectional biopsychosocial lens, this paper attempts to provide a basis for implementing integrated and tailored responses. Once the manifestations and interconnected causes of particular groups of HIV-positive women’s marginalisation are identified from their perspective, corresponding HIV-care programs and research activities can be designed. Such programs can be tailored with dual objectives: 1) to respond in a coordinated manner to the particular women’s own identified and prioritised daily needs across biomedical treatment and social and psychological support, and 2) to work to promote change in social constructions of stigma that form barriers to care.
PLOS ONE
People living with HIV/AIDS (PLH) experience high rates of depression and related psychosocial risk factors that vary by gender. This study examines gender differences in depression severity among antiretroviral therapy (ART) patients (n = 362) from a large government ART clinic in Kolkata, India. Hypotheses for multiple linear regression models were guided by an integrated gendered stress process model focusing on variables reflecting social status (age, partner status), stressors (stigma), and resources (income, social support). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS); 22% of the sample reached the cutoff for severe depression, 56% moderate, and 13% mild depression. Compared to men, women reported lower income, education (50% no formal education vs. 20% men), availability of emotional and instrumental support, and were less likely to be married or cohabiting (53% women vs. 72% of men). However, more women had partners who were HIV-positive (78% women vs. 46% men). Overall, depression severity was negatively associated with availability of emotional support and self-distraction coping, and positively associated with internalized HIV/AIDS stigma, availability of instrumental support, and behavioral disengagement coping. Interactions for instrumental support by income and partner status by age varied significantly by gender. Analyses stratified by gender indicated that: 1) Frequently seeking instrumental support from others was protective for men at all income levels, but only for high-income women; and 2) having a partner was protective for men as they aged, but not for women. These results suggest that gender disparities in depression severity are created and maintained by women's lower social status and limited access to resources. The effect of stigma on depression severity did not vary by gender. These findings may inform the tailoring of future interventions to address mental health needs of PLH in India, particularly gender disparities in access to material and social resources for coping with HIV. Trial Registration: ClinicalTrials.gov registration #NCT02118454, registered April 2014.
Women Living with HIV/AIDS: Psychosocial Challenges in the Indian Context
The main aim of this review article is to outline the factors linked to vulnerability of women to HIV infection and to understand the challenges and possible management of HIV among women. The review is a theoretical endeavour to understand women's experiences of living with HIV. This review primarily focuses on studies in the Indian setup , but to further substantiate the arguments and describe the relevant concepts it also takes into account literature from other cultures. On the basis of studies included in this article, it can be surmised that women are more susceptible to HIV due to cultural barriers, health vulnerabilities and social structures. They show less awareness about the treatment facilities, prevention strategies and perceived risk of infection. Women have to face numerous challenges after the infection, such as lack of social support, a higher level of stigma and discrimination, decreased quality of life, mental health issues and adverse coping. To prevent the spread of HIV among women as well as men, it is necessary to plan strategies which deal with empowerment of women, education and awareness regarding the vulnerabilities and knowledge and challenges of HIV infection. There is also a need to address the management of HIV among the infected and even those at risk. This article describes the possible interventions based on existing literature. The review also attempts to suggest certain future directions for the research.
Social Science & Medicine, 2012
Marginalization and stigmatization heighten the vulnerability of sexual minorities to inequitable mental health outcomes. There is a dearth of information regarding stigma and mental health among men who have sex with men (MSM) in India. We adapted Meyer's minority stress model to explore associations between stigma and depression among MSM in South India. The study objective was to examine the influence of sexual stigma, gender non-conformity stigma (GNS) and HIV-related stigma (HIV-S) on depression among MSM in South India. A cross-sectional survey was administered to MSM in urban (Chennai) (n ¼ 100) and semi-urban (Kumbakonam) (n ¼ 100) locations in Tamil Nadu. The majority of participants reported moderate/severe depression scores. Participants in Chennai reported significantly higher levels of GNS, social support and resilient coping, and lower levels of HIV-S and depression, than participants in Kumbakonam. Hierarchical block regression analyses were conducted to measure associations between independent (GNS, HIV-S), moderator (social support, resilient coping) and dependent (depression) variables. Sexual stigma was not included in regression analyses due to multicollinearity with GNS. The first regression analyses assessed associations between depression and stigma subtypes. In Chennai, perceived GNS was associated with depression; in Kumbakonam enacted/perceived GNS and vicarious HIV-S were associated with depression. In the moderation analyses, overall GNS and HIV-S scores (subtypes combined) accounted for a significant amount of variability in depression in both locations, although HIV-S was only a significant predictor in Kumbakonam. Social support and resilient coping were associated with lower depression but did not moderate the influence of HIV-S or GNS on depression. Differences in stigma, coping, social support and depression between locations highlight the salience of considering geographical context in stigma analyses. Associations between HIV-S and depression among HIV-negative MSM emphasize the significance of symbolic stigma. Findings may inform multi-level stigma reduction and health promotion interventions with MSM in South India.
Correlates of Stigma among Rural Indian Women Living with HIV/AIDS
AIDS and Behavior, 2013
AIDS-related stigma has received increasing attention in the literature; however, little is known about the devastating impact it has on rural women living with AIDS (WLA) in India. This crosssectional study (N = 68), analyzed from complete baseline data, identified a number of correlates of stigma among rural WLA in South India. Structured instruments were used to capture sociodemographic history, stigma, knowledge of HIV, depressive symptoms along with the recording of CD4 data. A higher level of felt stigma and more AIDS symptoms were related to avoidant coping, while fewer adherence strategies and lower support for ART adherence were also associated with avoidant coping. These findings promote the need for support and resources for rural India WLA.
BMC Public Health, 2012
Background India has around 2.27 million adults living with HIV/AIDS who face several challenges in the medical management of their disease. Stigma, discrimination and psychosocial issues are prevalent. The objective of the study was to determine the prevalence of severe stigma and to study the association between this, depression and the quality of life (QOL) of people living with HIV/AIDS (PLHA) in Tamil Nadu. Methods This was a community based cross sectional study carried out in seven districts of Tamil Nadu, India, among 400 PLHA in the year 2009. The following scales were used for stigma, depression and quality of life, Berger scale, Major Depression Inventory (MDI) scale and the WHO BREF scale. Both Stigma and QOL were classified as none, moderate or severe/poor based on the tertile cut off values of the scale scores. Depression was classified as none, mild, moderate and severe. Logistic regression analyses were performed to study the risk factors. Results Twenty seven per ce...
Journal of HIV/AIDS & Social Services, 2016
To examine HIV/AIDS-related stigma and discrimination in a high-HIV-prevalence district in India, we used data from a crosssectional survey conducted recently among randomly selected married HIV-positive women, 15-29 years of age. Overall, 88% of respondents experienced stigma and discrimination from family and community. Factors associated with stigma and discrimination differed in the family and community contexts. Higher age gap between spouses and poor household status were significant in explaining the stigma and discrimination from husbands. Older age of the husband and lower household economic status significantly increased the stigma and discrimination from husbands' family as well as from friends and neighbors. Different interventions should be developed for family and community contexts focusing on counseling for husbands, couples, family, and educational programs at the community level to reduce stigma and discrimination.
HIV-related stigma: Adapting a theoretical framework for use in India
Social science & …, 2008
Stigma complicates the treatment of HIV worldwide. We examined whether a multi-component framework, initially consisting of enacted, felt normative, and internalized forms of individual stigma experiences, could be used to understand HIV-related stigma in Southern India. In Study 1, qualitative interviews with a convenience sample of 16 people living with HIV revealed instances of all three types of stigma. Experiences of discrimination (enacted stigma) were reported relatively infrequently. Rather, perceptions of high levels of stigma (felt normative stigma) motivated people to avoid disclosing their HIV status. These perceptions often were shaped by stories of discrimination against others HIV-infected individuals, which we adapted as an additional component of our framework (vicarious stigma). Participants also varied in their acceptance of HIV stigma as legitimate (internalized stigma). In Study 2, newly-developed measures of the stigma components were administered in a survey to 229 people living with HIV. Findings suggested that enacted and vicarious stigma influenced felt normative stigma; that enacted, felt normative, and internalized stigma were associated with higher levels of depression; and that the associations of depression with felt normative
Secret Lives and Gender Fluidity of People Living with HIV in Hyderabad, India
Journal of Community Psychology, 2021
This mixed-methods study sought to explore gender fluidity among people living with human immunodeficiency virus (HIV) in Hyderabad, India, almost all of whom did not identify as hijra. Sixteen gender-nonconforming people living with HIV completed both surveys and in-depth interviews , exploring their experiences with HIV and gender nonconformity stigma. Interviews were conducted in Hindi and Telugu, digitally audio-recorded, then subsequently translated and analyzed in English, using interpretative phenomenological analysis. Our study highlighted three categories of gender expression: (1) "We have to maintain secrecy about our hijra life": Living secret lives; (2) "What happens if my neighbor sees me here?": Contextual disclosure ; (3) "Twenty-four hours a day I will wear a sari": Being fully out. Analysis revealed that many gender-nonconforming people reported identifying with two distinct gender identities: one in the daylight, where they identified as men and fulfilled a role of husband and father with their family, and another at night where they identified otherwise-as women, as third gender, as kothis, hijra, transgender. Themes reinforce a phenomenological interpretation of gender identity and expression in the south Indian context, which is grounded in practices regarding identity's embodiment in clothing, vocal intonation, make-up, and context.