Disclosure Concerns Research Articles

Willingness of joining online support groups among men who have sex with men living with HIV in Shandong Province of China: A mixed methods study.

Online support groups afford new opportunities to help individuals affected by HIV/AIDS to seek social support from peers. The study aimed to understand the willingness and associated factors of joining online support groups among men who have sex with men (MSM) living with HIV. The study followed a mixed method approach, with qualitative in-depth interviews followed by a quantitative cross-sectional survey in three cities of Shandong Province, China from 2019 to 2020. The in-depth interviews were audio-taped, transcribed verbatim and analyzed using thematic approach. In the quantitative analysis, explanatory variables included sociodemographic, behavioral, clinical, psychological, and demand factors. Univariate and multivariable logistic regressions were conducted to examine the associated factors of willing to join online support groups. A total of 576 and 20 participants were included in the quantitative survey and qualitative interviews, respectively. Only 24.7% (142/576) of participants in the quantitative study were willing to join the online support group. Multivariable analysis showed the associated factors included income level, sexual orientation and availability of information. The barriers to joining online support groups included privacy disclosure concern and psychological pressure exposed to HIV-related information. Facilitators included information acquisition, mutual medication reminding, and emotional support. MSM living with HIV in China had relatively low willingness to join the online support groups. This study highlighted the importance of safeguarding privacy, involving professional mental health providers, and providing high-quality information when establishing online support groups for people living with HIV.

The Association Between HIV-Related Stigma and the Uptake of HIV Testing and ART Among Older Adults in Rural South Africa: Findings from the HAALSI Cohort Study

HIV testing and antiretroviral therapy (ART) remain critical for curbing the spread of HIV/AIDS, but stigma can impede access to these services. Using data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we used a multivariable logistic regression to examine the correlation between HIV-related stigma, HIV testing and ART uptake in older adults. We used four questions to measure stigma, with three assessing social stigma (reflecting social distancing preferences) and one assessing anticipated stigma (disclosure concern). We combined the three social stigma questions to generate a social stigma score ranging from 0 to 3, with higher scores indicating higher stigma. Anticipated stigma was prevalent 85% (95% CI 0.84–0.86), and social stigma was also frequent 25% (95% CI 0.24–0.27). Higher social stigma scores correlated with decreased HIV testing for all participants with social stigma. Compared to those with a score of 0, odds of testing decreased with higher stigma scores (OR = 0.66, 95% CI 0.53–0.81, p = 0.000) for a score of 1 and (OR = 0.56, 95% CI 0.38–0.83, p = 0.004) for a score of 3. ART uptake also decreased with higher social stigma scores among people living with HIV (PLWH), although it was significant for those with a score of 2 (OR = 0.41, 95% CI 0.19–0.87, p = 0.020). These findings emphasize that HIV-related stigma hampers testing and ART uptake among older adults in rural South Africa. Addressing stigma is crucial for improving testing rates, early diagnosis, and treatment initiation among the older population and achieving UNAIDS 95–95–95 targets.

Disclosure Concerns and the Correlation Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV Receiving Antiretroviral Therapy in Taiwan.

Gay, bisexual, and other men who have sex with men (GBMSM) are associated with the widespread human immunodeficiency virus (HIV) transmission in Taiwan. Additionally, little is known about disclosure patterns and rates, as well as factors influencing disclosure, among GBMSM living with HIV in the country. HIV prevention for GBMSM is effective when HIV status is disclosed. For instance, GBMSM disclosing their HIV status can result in early pre-exposure prophylaxis with a serodiscordant partner. In this cross-sectional study of 200 GBMSM living with HIV conducted from June to November 2020, we assessed internalized homophobia (IHP Scale) and social support (Multidimensional Scale of Perceived Social Support), as well as self-reported disclosure and non-disclosure. Among the participants, 75.5% revealed their HIV status within 3 months of diagnosis. Younger age, occupation type, and number of sexual partners were some factors associated with disclosure. Those receiving more social support and who experienced less IHP were more likely to reveal their HIV status. On the contrary, older GBMSM and GBMSM living with HIV who worked in educational enterprises still experienced severe IHP. Policymakers and healthcare practitioners should be aware of the problems faced by GBMSM living with HIV and offer practical assistance to improve their mental health.

Can a brief session of the online coronavirus disease 2019 destigmatization program reduce stigma among survivors? A randomized controlled trial.

Stigmatization has taken a heavy toll on the mental health and quality of life of the survivors of coronavirus disease 2019 (COVID-19). To address this issue, we proposed a brief, self-directed, reflective, and practical destigmatization intervention. The current study aimed to investigate the efficacy of the online COVID-19 destigmatization program (OCDP) in mitigating stigma among the survivors of COVID-19. This study was conducted on 142 survivors of COVID-19 before their discharge from Vajra Hospital from July 2022 to November 2022. The participants were randomly assigned between the intervention group (n = 71), who attended the 40-min OCDP, and the control group (n = 71), who received standard mental health care. The primary outcome was the efficacy of OCDP in reducing stigmatization. A COVID-19 stigma questionnaire was administered to assess stigmatization in the intervention and control groups immediately before and after the program during follow-up on days 7, 14, and 28. The secondary outcome was the efficacy of the program in alleviating negative emotions according to the Depression Anxiety Stress Scale 21 questionnaire. Compared with the control group, the intervention group had a more prominent reduction in the overall stigma score on day 7 (p = 0.002) and day 14 (p = 0.028). The intervention group had a more evident reduction in enacted stigma (day 7, p = 0.04), internalized stigma (day 7, p = 0.008; day 14, p < 0.028), and perceived external stigma (day 7, p = 0.002) than the control group. However, there was no significant difference in terms of disclosure concern between the intervention and control groups. Furthermore, the reduction in depression, anxiety, and stress between the two groups did not significantly differ. Online COVID-19 destigmatization program provided prior to hospital discharge is an effective tool in reducing stigmatization, particularly within the first 2 weeks after reintegration into society, among the survivors of COVID-19.

Community Perceptions of HIV Stigma, Discriminatory Attitudes, and Disclosure Concerns: A Health Facility-Based Study in Selected Health Districts of South Africa.

Research data about HIV stigma perceptions and discriminatory attitudes among the general population are limited. Furthermore, the willingness of HIV-negative individuals to engage with HIV prevention and disclosure interventions has not been established in South Africa. The study investigated community perceptions of stigma as well as discriminatory attitudes towards HIV disclosure to understand if and how these perceptions might influence the uptake of disclosure interventions. This facility-based study used a validated questionnaire to measure the four constructs of HIV stigma among 670 adults recruited from health districts of two provinces of South Africa. Of these, 72% were female, 87% had ever been tested for HIV, and 31% knew someone who has HIV. Stigma towards people living with HIV (PLHIV) is widespread in the general population. A high proportion (75%) endorsed disclosure concerns, 75% perceived stigma to be common, and 56% endorsed negative statements indicating perceived stigma in communities. Fear, moral and social judgement, and rejection underlined their perceptions about PLHIV. Almost half (45.7%) were unwilling to care for family members sick with AIDS, suggesting negative distancing reactions and discriminatory attitudes towards PLHIV. The widespread discriminatory attitudes and the perceived stigma that is evident in the general population might heighten the disclosure concerns endorsed, promote non-disclosure, and increase HIV transmission. To design interventions, it is crucial to be cognisant of disclosure concerns, discriminatory attitudes, and perceived stigma evident in communities. Thus, the findings underscore the need to increase efforts to challenge and reduce community drivers of negative discriminatory attitudes and perceived stigma.

Associations between social network characteristics and sexual minority disclosure concern among Black men who have sex with men living with and without HIV.

In addition to the pervasive anti-Black racism faced by Black people in the United States, Black men who have sex with men (BMSM) face sexual minority stigma and, among BMSM living with HIV, HIV-related stigma. These multilevel social forces shape social networks, which are important sources of resources, support, and behavior regulation. This study quantitatively examined the relationship between social network characteristics and sexual minority stigma (e.g., homophobia, biphobia), assessed by reported concerns around disclosing one's sexual minority status, among BMSM in Baltimore, Maryland in 2014 (N = 336). A majority of participants (63.7%) reported experiencing medium or high levels of sexual minority disclosure concern. In a multiple linear regression model, participants with higher sexual minority disclosure concern reported lower network density and having fewer good friends who are gay or bisexual men. Stratifying the same multiple linear regression model by HIV status supports the importance of an intersectional understanding of sexual minority and HIV-related stigma. These findings can help health-related programs address the complex relationships between sexual minority stigma, social networks, and HIV status within this multiply-marginalized and high-priority population.

Dose environmental information disclosure raise public environmental concern? Generalized propensity score evidence from China

This paper assesses the impact of environmental information disclosure on public environmental concern based on data from China General Social Survey 2013 (CGSS2013) and the matched socio-economic indicators and environmental information disclosure data at the city level. Applying a generalized propensity score (GPS) method, we find that the relationship between environmental information disclosure and environmental concern is an inverted U-shaped relationship. Environmental information disclosure appears to have its highest impact on public environmental concern when its intensity is between 65 and 70. Besides, through an instrumental variable (IV) approach, we document that with a 1% increase in environmental information disclosure, public environmental concern can increase by 1.7%. Further mechanism analysis shows that environmental information disclosure affects public environmental concern by enhancing people's environmental risk perception and environmental knowledge.

Psychological flexibility as a moderator of the relationship between HIV-related stigma and resilience among HIV/AIDS patients

HIV-related stigmatisation is common in many parts of the world and is experienced by all categories of people living with HIV and AIDS (PLWHA). Although the negative consequences of HIV-related stigmatisation on the resilience of PLWHA is well documented, little is known about the plausible role of certain personal characteristics in moderating the stigma-resilience relationship. In addition to investigating the direct association of HIV-related stigma (personalised stigma, disclosure concern, concern about public attitude and negative self-image) with resilience, the present study examined whether psychological flexibility (PF) moderates the HIV-related stigmaresilience relationship among PLWHA. Participants included 280 PLWHA (M = 39.48; SD = 9.03) selected from Sacred Heart Catholic Hospital (SHCH), Obudu, Cross River State, Nigeria. Participants completed relevant self-report measures. Results showed that patients reported moderately high levels of resilience (M = 59.13; SD = 13.98). Hierarchical multiple regression analysis showed that HIV-related stigma (personalised stigma, disclosure concern and concern about public attitudes) were not significantly associated with resilience (p = 0.230; p = 0.747; p = 0.528). HIV-related negative self-image and PF were independently and significantly associated with resilience (p = 0.024; p = 0.000). Results of moderation hypothesis revealed that PF did not moderate the relationship between HIV-related disclosure concern and resilience (p = 0.903), and between HIV-related concern about public attitudes and resilience (p = 0.905), but PF moderated the relationship of HIV-related personalised stigma and resilience (p = 0.023), and the relationship of HIV-related negative self-image and resilience (p = 0.004). Therefore, interventions to promote resilience abilities in PLWHA should consider facilitating patients’ psychological flexibility skills as it is critical in decreasing the hazardous effect of HIV-related stigma on the patients.

A longitudinal study of COVID-19 disclosure stigma and COVID-19 testing hesitancy in the United States

ObjectivesThis study examines the relationship between COVID-19 disclosure stigma and COVID-19 testing hesitancy and assesses their changes between November 2020 and 2021. Study designThis was a longitudinal cohort. MethodsA total of 355 participants completed four study waves between November 2020 and November 2021. Factor analyses and Cronbach's alpha assessed the factor structure and internal consistency of the COVID-19 Disclosure Stigma scale. Paired t-tests and McNemar's Chi-squared test assessed change between the study waves. Multivariable logistic regression models examined the relationship between COVID-19 disclosure stigma and testing hesitancy at four study waves. ResultsCOVID-19 disclosure stigma declined significantly between the last study waves (P = 0.030). The greatest disclosure concern was reporting a positive test to close contacts (range: 19%–21%) followed by disclosure to friends (range: 10%–15%) and family (range: 4%–10%). Over the course of the four study waves, COVID-19 testing hesitancy when symptomatic ranged from 23% to 30%. Older age, female gender, and having received a COVID-19 vaccine were associated with decreased odds of testing hesitancy. Greater COVID-19 disclosure stigma and more conservative political ideology showed a consistent relationship with increased odds of COVID-19 testing hesitancy. ConclusionsStudy findings suggest that many people anticipate feeling stigmatized when disclosing positive test results, especially to close contacts. A substantial percentage of study participants reported hesitancy to be tested when symptomatic. This study identifies a need for interventions that normalize COVID-19 testing (e.g. engaging leaders with conservative followings), provide strategies for disclosing positive results, and allow anonymous notification of potential COVID-19 exposure.

Understanding the effects of COVID-19 stigmatisation on job performance: a survey of frontline healthcare workers

The level of stigmatisation among health care providers has increased during the COVID-19 pandemic, and understanding the effect of COVID-19 stigmatisation on job performance has become increasingly important. The study explores the influence of COVID-19 stigmatisation on job performance among frontline health workers via the mediating role of anxiety. Furthermore, the moderating effect of resilience in the association between COVID-19 stigmatisation and anxiety is further examined. Participants were made up of 820 frontline health workers working in the epicentres of the Bono Ahafo, Western, Greater Accra, and Northern regions of Ghana. The hierarchical regression technique was employed in estimating the relationship between the variables. COVID-19 stigmatisation among frontline health workers directly affected anxiety and performance. In addition, the results showed that resilience moderated the relationship between COVID-19 stigmatisation and anxiety. The findings again demonstrated that anxiety partially mediated the association between concern for disclosure and public attitude and negative experience and job performance, whereas personalised stigma was insignificant. The study provides implications for establishing anti-stigma interventions and programs to enhance job performance among health workers. Key messages Many healthcare workers are subject to stigmatisation during the COVID-19 pandemic. The study employs hierarchical regression methods to examine the impacts of COVID-19 stigmatisation on job performance among frontline health workers. The health management team should strengthen interventions to control the stigma experienced by health workers during COVID-19 treatments.

5.17 Psychometric Properties of the ADHD Stigma Questionnaire-Revised Among Parents of Children in Primary Care

Children with ADHD and their families may face stigma as a result of ADHD symptoms, label, or treatment. The ADHD Stigma Questionnaire (ASQ) is an existing measurement tool that has been validated with adolescents. However, it does not include items capturing medication or courtesy stigma (ie, stigma toward parents due to a child’s ADHD). In this study, we worked with an expert panel to add 8 new medication and courtesy stigma items to the ASQ and conducted a psychometric evaluation of the revised version (ASQ-R) completed by parents. A total of 159 English-speaking parents of children between ages 0 and 17 years were recruited from pediatric clinics at an urban safety-net hospital between September 2018 and May 2021 to complete the ASQ-R and a demographic questionnaire. We conducted an exploratory factor analysis on the ASQ-R and calculated average scores to assess the level of ADHD stigma perceived by parents. The ASQ-R supports a new 4-factor model including the following 4 factors: 1) concern for public attitudes; 2) disclosure concerns; 3) medication stigma; and 4) parenting inadequacy. Factors reflecting concern for public attitudes and disclosure concerns are similar to the original factors. The newly added items delineated 2 newly defined factors, and 8 items (7 old, 1 new) were dropped from the final questionnaire due to failure to load or redundancy. The ASQ-R can help to evaluate ADHD stigma perceived by parents of children with ADHD with its 4 factors. More data should evaluate its performance with other populations.

Disclosure Concerns and Viral Suppression in People Newly Initiating HIV Care: The Role of Internalized HIV Stigma.

Research on how disclosure concerns affect health outcomes for people living with HIV (PLWH) has yielded inconsistent results. Theoretically, disclosure concerns could predict either poorer antiretroviral therapy (ART) adherence (PLWH worried about disclosure may not want to take their medication in front of others) or better ART adherence (stronger concerns may enhance treatment adherence to avoid unintentional disclosure). Furthermore, internalized stigma (which is positively associated with disclosure concerns) predicts worse ART adherence (an effect potentially in the opposite direction of the direct effect of disclosure concerns). One hundred eighty-six PLWH initiating HIV care at 4 US clinics completed measures of disclosure concerns, internalized stigma, and ART adherence. Viral load data were obtained from medical records. We examined the indirect effect of disclosure concerns on outcomes, adjusting for the suppressor effect of internalized stigma. That is, we examined whether the association between disclosure concerns and ART adherence/viral suppression is stronger and positive when controlling for the effect of internalized stigma. Disclosure concerns were more strongly associated with better viral suppression and ART adherence when internalized stigma was in the model, suggesting that internalized stigma suppressed this association. Similarly, internalized stigma led to higher disclosure concerns, which in turn led to better ART adherence and higher likelihood of viral suppression. However, internalized stigma also had a direct effect in the opposite direction of this indirect effect. Findings highlight the importance of addressing effects of internalized stigma and disclosure concerns jointly when attempting to understand effects on health outcomes among new-to-care PLWH.

Translation and cross language validation of human immunodeficiency virus stigma scale in a Pakistani context

Objectives: To evaluate the translation and validation of human immunodeficiency virus stigma scale in Urdu language. Methods: The evaluation study was conducted in Lahore, Kasur, Gujranwala and Faisalabad from January 2019 to June 2019. Forward-backward translation method was used to translate the human immunodeficiency virus stigma scale from English to Urdu. Additionally, inter-correlation among variables was assessed by using correlation to determine the psychometric properties. Exploratory factor analysis of the scale was done followed by confirmatory factor analysis for establishing a good model fit. Results: Cronbach’s alpha coefficient was 0.95. There was high correlation among the sub-components of the the scale, ranging from 0.38 to 0.80 (p&lt;0.001). Confirmatory factor analysis depicted good model fit. Conclusion: The Urdu version of the human immunodeficiency virus stigma scale was found to be a valid and reliable tool to measure personal stigma, disclosure concern, concerns about public attitude and negative self-image. Key Words: HIV/AIDS stigma, Translation, Cross-validation. Continuous...

Treatment adherence mediates the relationship between HIV-related stigma and health-related quality of life

ABSTRACT There is a strong association between HIV-related stigma (HS) and health-related quality of life among people living with HIV/AIDS, yet few studies, to date, have examined mediators of this link. This study examined the mediating role of antiretroviral medication adherence (MA) on association between HS and HRQoL. Respondents were 969 people living with HIV/AIDS (PLWH) (628 males and 341 females, Mean age = 35.55, years), conveniently drawn from four hospital facilities in Enugu and Ebonyi States of Nigeria. Data were collected using HIV Stigma Scale, Morisky Medical Adherence Scale, and Patient Reported Outcome Quality of Life-HIV. Data were analysed using the Hayes PROCESS macro for SPSS which uses a regression-based, path-analytical framework. Results showed that HS across dimensions (personalised stigma, disclosure concern, concern about people’s attitude and negative self-image) were negatively associated with MA (r = −.16; p < .001, r = −.13; p < .00, r = −.22; p < .001 and r = −.21; p < .001, respectively) HRQoL. MA was positively associated with HRQoL (r = . 24; p < .001). MA mediated HS-HRQoL association. These findings suggest that stigma associated with HIV/AIDS is associated with poor adherence to active antiretroviral therapy (ART) treatment regimen, which can result in poor health and treatment outcome among PLWH. The findings may be helpful in improving HRQoL among PLWH.

THE RELIABILITY AND VALIDITY OF THE TURKISH FORM OF BERGER HIV STIGMA SCALE

Objective:HIV-related stigma towards people living with HIV/AIDS (PLWHA) creates a barrier in access to quality health care, affects mental health and leads to poor treatment adherence. Assessment of different components of HIV-related stigma is needed to develop appropriate strategies for prevention and intervention. The aim of this study was to translate and adapt Berger HIV Stigma Scale to Turkish and assess its reliability and validity.Method:The Turkish version of the 40 item, 4-point Likert-type self-report HIV Stigma Scale, as well as Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSES) and sociodemographic data form were administered to 95 PLWHA.Results:The items of the scale whose face validity was found to be sufficient, were loaded on four factors in the explanatory factor analysis: Internalised Stigmatization (16 items); Concerns with Public Attitudes (12 items); Negative Self Image (9 items); and Disclosure Concerns (8 items). This structure explained 46.71% of the variance after an item was removed based on the analysis. All subscales had acceptable internal consistency with Cronbach’s alpha coefficients .802-.934. BDE scores had moderate positive correlations with Internalized Stigmatization; Concerns with Public Attitudes; Disclosure Concerns subscale scores (rs=0.214, p=0.047; rs=0.295, p=0.006; rs=0.353, p=0.001), and strong positive correlations with Negative Self Image score (rs=0.617, p<0.001). A moderate positive correlation was found between RSES and Negative Self Image subscale score (rs=0.434; p<0.001).Conclusion:Our findings showed that the Turkish form of Berger HIV Stigma Scale is a reliable and valid tool for measuring HIV-related stigma in PLWHA.

THE IMPACT OF ENVIRONMENTAL, SOCIAL AND GOVERNANCE INDEX ON FIRM VALUE: EVIDENCE FROM MALAYSIA

In this study we investigates the relationship of environmental, social and governance (ESG) practices and the consequences related to their disclosure on the firm's value. Our data is extracted from the final accounts of 122 firms listed on Bursa Malaysia over the period 2011 to 2019 with 1098 observations. We used three instrumental variables in this study in order to find the endogeneity of ESG performance namely, the existence of a CSR committee on the Board of directors, dispersion of forecasted earnings and finally the ownership concentration of the firm. We used three first stage regression models related to ESG disclosure and the interaction between the strength, concern, and disclosure of ESG. Besides that, we also use the second stage regression to investigate the insider effects of ESG activities and ESG disclosure. Our results are consistent with the approach that indicate that ESG strength increases firm value whereas ESG disclosure and ESG concern decreases the firm value. Most importantly, this study finds that ESG disclosures can play the role by which a firm can reduce the negative effect of weakness and improve the positive effect of strength. Keywords: Environmental, Social Governance Practices, ESG Activities, ESG PerformanceJEL Classifications: F64, M14 DOI: https://doi.org/10.32479/ijeep.10217

Correlates of ART Use Among Newly Diagnosed HIV Positive Adolescent Girls and Young Women Enrolled in HPTN 068.

Despite expanded access to HIV treatment worldwide, poor HIV care outcomes persist among adolescent girls and young women (AGYW). This study was conducted among AGYW recruited from the HPTN 068 cohort who had sero-converted to HIV during the main trial between 2011 and 2014. The aim was to examine correlates of anti-retroviral treatment (ART) use. Log binomial regression was used to estimate the crude associations between social support, stigma, and HIV status disclosure and current ART use. Adjusted analyses were also conducted controlling for age and time since diagnosis. Seventy-nine AGYW were included in this analysis. Median age of participants was 20 (range: 17 to 24) and time since diagnosis ranged from 0.5 to 4.8years (median = 2.1). Over 75% of AGYW (n = 60) had sought HIV care at some point, with the same number reporting previous disclosure of their sero-status. However, just 43% (n = 34) of participants were on treatment at the time of the interview. Over half of participants (n = 44; 55.7%) reported social support was available to them most or all of the time, and the median stigma score was 90 (range 80-113). Adjusted analyses found higher current ART use among those who had disclosed their status (adjusted prevalence ratio (aPR): 3.19; 95% confidence interval (CI) 1.09, 9.32; p = 0.0339) and those with lower scores on the disclosure concern sub-scale of the Berger HIV Stigma Scale (aPR: 0.88; 95% CI 0.79, 0.98; p = 0.0236). ART use among AGYW living with HIV and enrolled in HPTN 068 was low despite relatively high linkage to care during the trial. Interventions aimed at minimizing individuals' concerns about disclosure and improving onward disclosure of one's status could further improve ART utilization among AGYW living with HIV in South Africa.

Effect of HIV-Related Stigma and HIV-Related Stress on HIV Disclosure Concerns: a Study of HIV-Positive Persons on Antiretroviral Therapy at Two Urban Hospitals in Ghana

Limited research has examined HIV disclosure concerns and the role that HIV-related stigma and HIV-related stress play in disclosure in HIV care in Ghana. We explored HIV status disclosure concerns among 235 people living with HIV (PLHIV) and attending two general hospitals in the Greater Accra Region of Ghana. Hierarchical multiple regression was used to analyse the data. Our results showed that PLHIV who experienced higher levels of perceived HIV-related stigma reported greater levels of HIV disclosure concerns, and therefore were more likely not to disclose their HIV-positive status. In addition, we found that PLHIV who reported experiencing higher levels of HIV-related emotional stress also reported greater levels of HIV disclosure concerns. HIV-related instrumental stress was negatively associated with HIV disclosure concerns, suggesting that PLHIV who reported having greater access to money, food, transport, healthcare system, treatment, and antiretroviral medication were less likely to experience HIV disclosure concerns. The current data demonstrate that interventions that help to reduce HIV-related stigma and HIV-related stress may increase HIV status disclosure, thereby improving the psychological health of PLHIV in Ghana.

The Convergence of Disclosure Concerns and Poverty Contributes to Loss to HIV Care in India: A Qualitative Study.

In India, there is little evidence on reasons for high rates of loss to HIV care. We conducted a clinic-based qualitative study at the YR Gaitonde Centre for AIDS Research and Education to explore factors that influence loss to care. In all, 17 men and 14 women were interviewed; median age was 42 (interquartile range [IQR], 36-48) and median CD4 count was 448 (IQR, 163-609). A majority reported avoiding treatment freely available at nearby government facilities because of disclosure concerns and perceptions of poor quality. As a result, participants sought care in the private sector where they were subjected to medication and transport costs. Life circumstances causing lost wages or unexpected expenditures therefore prevented participants from attending clinic, resulting in loss to care. Improving perceptions of quality of care in the public sector, addressing disclosure concerns, and reducing economic hardships among people living with HIV may be important in reducing loss to HIV care in India.

Trajectories of HIV-related internalized stigma and disclosure concerns among ART initiators and non-initiators in South Africa.

HIV-related stigma among people living with HIV (PLHIV) is associated with worse health outcomes. We used longitudinal data from a multi-site cohort in South Africa to assess changes over time in stigma after HIV diagnosis and determine whether antiretroviral therapy (ART) initiation is associated with stigma reduction. We administered the Internalized AIDS-Related Stigma Scale (IARSS, a six-item dichotomous scale questionnaire) at baseline, three months, and six months to newly diagnosed ART-eligible participants between 2014-2015. A confirmatory factor analysis indicated that the IARSS contained a four-item internalized stigma factor (α=0.80) and a two-item disclosure concerns factor (α=0.75). We fitted multiple logistic regression models specifying internalized stigma/disclosure concerns at six months as the outcome and ART initiation as the predictor of interest. Of the 500 participants (187 men and 313 women) enrolled, 308 (62%) initiated ART. Internalized stigma declined among people entering care (mean score, 1.0 to 0.7, p<0.01); however, disclosure concerns remained unchanged (percentage endorsing either disclosure concern item, 78% to 77%, p=0.23). These findings were similar between ART initiators and non-initiators. We estimated a statistically significant positive association between ART initiation and disclosure concerns at six months (OR=1.88; 95% CI, 1.20-2.94) but not between ART initiation and internalized stigma at six months (OR=1.15; 95% CI, 0.75-1.78). Among ART-eligible South African PLHIV entering into HIV care, internalized stigma modestly declined over time but disclosure concerns persisted. PLHIV who initiated ART were more likely to have persistent disclosure concerns over time as compared with those who did not start ART.