Experiences Of Stigma Research Articles

Barriers to healthcare access and experiences of stigma: Findings from a coproduced Long Covid case-finding study.

Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE-ICP Collaboration. Twenty-three interviews were completed. Participants reported limited awareness of what Long Covid is and the available pathways to management. There was considerable self-doubt among participants, sometimes reinforced by interactions with healthcare professionals (HCPs). Participants questioned their deservedness in seeking healthcare support for their symptoms. Hesitancy to engage with healthcare services was motivated by fear of needing more investigation and concerns regarding judgement about the ability to carry out caregiving responsibilities. It was also motivated by the complexity of the clinical presentation and fear of all symptoms being attributed to poor mental health. Participants also reported trying to avoid overburdening the health system. These difficulties were compounded by experiences of stigma and discrimination. The emerging themes reaffirmed a framework of epistemic injustice in relation to Long Covid, where creating, interpretingand conveying knowledge has varied credibility based on the teller's identity characteristics and/or the level of their interpretive resources. We have codeveloped recommendations based on the findings. These include early signposting to services, dedicating protected time to listening to people with Long Covid, providing a holistic approach in care pathways, and working to mitigate stigma. Regardless of the diagnosis, people experiencing new symptoms must be encouraged to seek timely medical help. Clear public health messaging is needed among communities already disadvantaged by epistemic injustice to raise awareness of Long Covid, and to share stories that encourage seeking care and to illustrate the adverse effects of stigma. This study was coproduced with a CAB made up of 23 members including HCPs, people with lived experience of Long Covid and other stakeholders.

Mental health stigma and its relationship with mental health professionals - A narrative review and practice implications.

The extent and magnitude of the mental health stigma are enormous, with substantial clinical and social implications. There is a complex relationship between mental health stigma and mental health professionals (MHPs); MHPs can be anti-stigma crusaders, victims of stigma, and even a source of stigma. Unfortunately, literature is scarce talking about the relationship between stigma and MHPs. Hence, the current review aims to bridge the existing gap in the literature on various aspects of stigma and the role of MHPs. For the current review, we ran a search in PubMed and Google Scholar databases; we restricted our study to records focusing on the interplay of mental health stigma and the MHPs, published during 2012-2022, in English, and having a full text available. We found that MHPs (psychiatrists, psychologists, and psychiatric nurses) can also be the recipients of the stigma. The stigma faced by the MHPs is determined by the negative stereotypes set by the media, or medical students, or other health professionals; the marginal position of psychiatry in the health system; difficult-to-treat mental disorders; MHPs' own experience of stigma; and the attitude or beliefs of various caders of the MHPs, their professional experience, and expertise in managing various mental health conditions. Notably, MHPs can also be a source of stigma (stigmatizers). MHPs need to be sensitized concerning this, and the anti-stigma interventions must incorporate this aspect of stigma. Novel interventions, such as digital-based programs, should be used instead of traditional anti-stigma programs in order to decrease stigma around mental health issues and make anti-stigma initiatives more appealing and scalable. To address the issues of stigma, there has to be more communication between MHPs, other health professionals, service users, and policymakers.

Exploring Stigma Experience and Coping Strategies Among Women Living with HIV/AIDS in China: A Phenomenological Study.

As of the end of 2022, over 20 million women worldwide, aged 15 and above, are living with HIV. Stigma remains a formidable barrier for women living with HIV/AIDS, hindering their access to healthcare and exacerbating health disparities. Indeed, some women living with HIV/AIDS can successfully confront and overcome stigma. There remains a paucity of qualitative research exploring the stigma coping strategies of women living with HIV/AIDS in China. This study was aimed to gain the deeper understanding of stigma experienced by women living with HIV/AIDS and coping strategies. We recruited diverse participants using snowball sampling and purposive sampling. Semi-structured personal in-depth interviews were conducted with 30 women living with HIV/AIDS from December 2022 to June 2023. The samples were from four HIV/AIDS designated hospitals. The data were analyzed using the Colaizzi seven-step model. The experiences of stigma among women living with HIV/AIDS included family role (wife/mother/grandmother) collapse and disgusted by family, resignation in being shunned by others, helplessness due to social exclusion, grief at being devaluated, and resentment for experiencing injustice. The coping strategies used to deal with stigma included concealing their conditions, avoiding socialization, and attempting to retaliate against society. Healthcare professionals are recommended to offer women living with HIV/AIDS effective emotional support and guidance to cope with stigma. The study highlights the stigma they face, providing valuable evidence for policymakers. Recommendations emphasize the importance of developing services addressing both physical and psychological needs of women living with HIV/AIDS.

Sexual exploitation of male youth: background characteristics and needs from a life-course perspective

IntroductionSexual exploitation is a human rights violation that has a detrimental impact on the psychological-, physical- and social well-being of victims. Sexually exploited male youth are prevalent, yet underrepresented in clinical practice, policy and research. There are multiple barriers that often prevent male youth to disclose and to seek or receive support, such as gender norms, limited awareness of victimization and feelings of guilt and shame.ObjectivesBy gaining more insight into the background and clinical characteristics of male victims and their care and support needs, this study aims to raise awareness and to better inform policymakers, care- and educational professionals on adequate prevention and intervention efforts.MethodsTwenty-six male youth at high-risk or victims of sexual exploitation participated in this qualitative study. By means of semi-structured interviews and case-file analyses, data was collected by to identify risk and protective factors in their life-course and care and support needs.ResultsResults indicate that several vulnerabilities (e.g. previous experiences of abuse and neglect, mental health problems, household dysfunction, social rejection, running away, substance use) and a lack of positive and supportive relationships led male youth into high-risk situations. Among these were involvement in pay dates, survival sex and criminality, which contributed to victimization. Experiences of stigmatization were often a barrier to express vulnerabilities and to disclose victimization. There was a wide variety in care and support needs, including peer-to-peer support, therapy, support with day-to-day practices and anonymous support.ConclusionsThese results will contribute to adequate prevention and intervention strategies and meet the unique needs of male youth at risk for, or victim of sexual exploitation.Disclosure of InterestG. Mercera Grant / Research support from: This research was funded by the Dutch Ministry of Health, Welfare and Sports (grant number: 328604)., S. Leijdesdorff: None Declared, E. Heynen: None Declared, T. van Amelsvoort: None Declared

38 Impacts of Racial Discrimination on Cognitive and Affective Processes and Drug-Cue Reactivity

OBJECTIVES/GOALS: Our overarching aim is to examine, in an African American population, cognitive, affective, and neurophysiological processes, as well as risk-taking behavior, in response to racial stigma cues. While accounting for individual differences, we aim to see how these processes and drug-cue reactivity are impacted or altered by exposure to racial cues. METHODS/STUDY POPULATION: Participants will be African Americans between 18 and 25 years of age, equally distributed across genders. We will recruit 75 participants in order to have adequate power to conduct our intended analyses—particularly pertaining to individual differences in risk behavior outcomes. Participants will be asked to complete demographic and self-report questionnaires. Participants will also be asked to complete computerized tasks while their physiological responses (heart rate, skin conductance, and electroencephalographic (EEG) data) are recorded. The tasks are as follow: resting, gambling, go/no-go, picture viewing (positive, negative, and neutral images), and a drug cue image set. These tasks will be repeated after the participant views a racial stigma image set to evaluate the impact of discrimination. RESULTS/ANTICIPATED RESULTS: Data from 18 participants has been collected. Data will be periodically preprocessed and validated (e.g., 1 participant was removed due to data recording errors, so the current valid Nis 17). Generally, we anticipate that behaviors and neural activity will be modulated across all tasks after viewing the racial stigma image set. Specifically, (a) cognitive and affective processing of singular events of racial stigma may indicate a stress response, (b) modulation from chronic experiences of racial stigma render neural systems increasingly sensitive to stigma cues, and thereby less equipped to regulate stress response, (c) the impact of these processes on altering risk behavior (may increase such behaviors), and (d) the impact of these modulations on altering drug-cue reactivity (may amplify reactivity). DISCUSSION/SIGNIFICANCE: The study will identify factors that contribute to stress and risk behavior among African Americans. A substantial gap continues to exist regarding the nature of risk behavior among African Americans, despite the fact that African Americans represent a health disparity population with unique vulnerabilities to health-relevant risk behavior.

Primary caregivers’ experiences of caring for people living with dementia in Ghana: a phenomenological study

BackgroundDementia is often associated with functional impairments that limit the independence of persons living with dementia (PwD). As such, many PwD often require a higher level of support provided by persons referred to as caregivers. Such caregiving activities tend to strain and stress the caregiver. Nonetheless, Ghana lacks empirical evidence and understanding of the effects of caring for PwD on the lives of primary caregivers. To help narrow this knowledge gap, we explored the perspectives of primary caregivers about the impacts of caring for PwD in Ghana.MethodsUsing a descriptive phenomenological design, we conducted in-depth interviews with primary caregivers in the Ashanti region, Ghana. A semi-structured interview guide was used as the data collection instrument. The data analysis followed Collazi’s thematic analysis framework. All coding and categorization were done in NVivo-12.ResultsFive themes emerged from the analysis. These themes included (a) sacrifice of personal interests, and time commitments; (b) financial strain and negative impact on job; (c) feelings of stress and burnout; (d) experience of abuse and stigma; and (e) perceived blessing of caregiving.ConclusionThe study’s findings resonate with existing literature, highlighting the consistent struggles faced by caregivers. Sacrificing personal interests, navigating financial strains, and grappling with stress and burnout emerged as pervasive themes. We conclude that despite the negative impacts of caring for PwD, caregivers perceived their role as associated with blessings, deriving positive meaning and fulfilment from their caregiving journey. This study underscores a need to build more compassionate communities in rural settings of Ghana.

Experiences of Gender-Based Stigma in Health Care in North America: A Mixed-Methods Scoping Review and Synthesis of the Literature

Experiences of Gender-Based Stigma in Health Care in North America: A Mixed-Methods Scoping Review and Synthesis of the Literature

Community psychiatric care for people with mental disorder and homelessness, with the involvement of peer support. Cooperation of the Awakenings Foundation and BMSZKI

IntroductionA person diagnosed with a psychiatric illness, must face labels and discriminiation most of the time. Fear of these undermines the motivation of people in need to seek help. A special example of this phenomenon is the case of people experiencing homelessness and mental disorder, avoiding the additional stigma of homelessness and therefore do not seek any help for their mental ill-health. Availability of the specific services complicates their problem.Fear of stigma, trauma, and previous bad experiences of using services also keep people experiencing homelessness away from services.In Hungary, the February Third Working Group (F3) Report on the 2020 Homelessness Survey After the Penal Code - Before the Pandemic Homelessness - Services Perspectives by Péter Győri shows in his summary paper that only 29% had received psychiatric treatment.ObjectivesMethodology Center of Social and Its Institutions (BMSZKI), in collaboration with the Awakenings Foundation, developed a complex rehabilitation service for people experiencing homelessness and mental disorder. This presentation aims to present this good practice.MethodsComplex rehabilitation based on the methodology of community psychiatric care with the involvement of peer support.Results-provision of community psychiatric care for people experiencing homelessness and mental disorder,-introduction of screening for effective care of undiagnosed persons with mental disorders,-provision of outpatient and day hospital care-focus of care in accommodation services on persons with mental disorders,-the involvement of peer-support work in the service,-building a network of contact points, organizing case conferences,-developing and organizing training on recovery-based rehabilitation for people with mental disorders in cooperation between the two organizations,-telemedicine, making digital mental health available-presence of resources represented by self-help groups -running a working group to promote improvements based on practical experience homelessness and mental disorder.Conclusionsextra-institutional teamwork multiplies the resources for people experiencing homelessness and mental disorder.Keywordsmental disorder, homelessness, community psychiatric care, peer support, collaborationDisclosure of InterestNone Declared

215 Weight Stigma as an Ongoing Challenge for Mental Health Post-Bariatric Surgery

OBJECTIVES/GOALS: The objective for this study was to evaluate the associations between weight stigma and symptoms of depression, anxiety, and binge eating following bariatric surgery. METHODS/STUDY POPULATION: Bariatric surgery is the leading evidence-based treatment for severe obesity; however, mental health challenges can compromise long-term improvements in quality of life. Weight stigma is a major contributor to mental health challenges for individuals with obesity generally; however, the role of weight stigma post-operatively after significant weight loss is poorly understood.148 patients underwent pre-bariatric surgery psychological evaluation and completed a follow-up study approximately 2 years after. Measures included the Stigmatizing Situations Inventory-Brief, Patient Health Questionnaire, Generalized Anxiety Questionnaire, and Binge Eating Scale. RESULTS/ANTICIPATED RESULTS: In regression models controlling for demographic covariates (sex, age, education, race), body mass index, and baseline measure of each outcome (e.g., depressive symptoms pre-surgery in models predicting depression post-surgery), weight stigma was independently associated with depression (p=.023), anxiety (p <.001), and binge eating (p=.008) symptoms post-surgery.Above and beyond weight, demographics, and pre-surgery measurements of mental health, weight stigma continues to influence mental health outcomes in the years following bariatric surgery. Despite weight loss after bariatric surgery, this data suggests the cumulative experiences of stigma and discrimination continue to negatively impact mental health. DISCUSSION/SIGNIFICANCE: Interventions for bariatric surgery patients must consider the effects of weight stigma, at both the societal and individual levels. Interventions countering stigma could optimize long-term quality of life and associated outcomes.

Perceived stigma evaluation among residents in psychiatry

IntroductionThe nature of psychiatry as a specialty dealing with mental health and emotional well-being may contribute to the perceived stigma. These misconceptions and biases can impact the way psychiatry residents perceive their profession, their own self-esteem, job satisfaction, and overall well-being.ObjectivesOur goal was to evaluate the experience of stigma among psychiatry residents.MethodsA descriptive cross-sectional online survey was conducted in January 2022 among psychiatry residents at Hedi Chaker University Hospital in Sfax, Tunisia.The Clinician Associative Stigma Scale (CASS) was used to assess stigmatization experiences.ResultsA total of 34 residents participated in this survey. Their average age was 27.94 years ± 2.43, with 91.2% being female. Of the participants, 61.8% were adult psychiatry residents, and 39.2% were child psychiatry residents. Additionally, the choice of adult psychiatry or child psychiatry specialty was self-determined in 91.2% of cases. The participants had an average of 2 years of experience in psychiatry. They reported a personal medical or surgical history, a personal psychiatric history, and a family history of psychiatric disorders in 32.4%, 8.8%, and 50%, respectively. The average CASS score was 47.09 ± 8.32.The mean scores for the “discomfort with disclosure” factor, the “stereotypes about mental health professionals” factor, the “negative stereotypes about individuals with serious mental illness” factor, and the “negative stereotypes about effectiveness” factor were respectively 8 ± 3, 9.44 ± 2.57, 15.62 ± 5.7, and 11.35 ± 3.33.ConclusionsOur study highlighted that residents in psychiatry suffered stigma. Special attention should be given to reducing this phenomenon in this population.Disclosure of InterestNone Declared

The COVID-19 Pandemic's Stigma Effects on Chinese International Students' Lives and Mental Health

As COVID-19, which originated in Wuhan, China, spreads globally in 2019, there has been a surge in discrimination against people of Chinese descent. Negative labels such as "disease carrier" and "potential threat" have become closely associated with the Chinese community, resulting in social segregation characterized by exclusion, discrimination, and, in some cases, physical harm. This study aims to explore whether the stigma against Chinese international students still exists today when the epidemic has ended. This study collected 100 questionnaires from Chinese international students in Western countries regarding personally identifiable information, personal experiences of stigma, and reactions to stigma. By analyzing the questionnaire data, the stigmatization experiences of Chinese international students after the epidemic were summarized. Stereotypes such as "virus carriers" that arose during the epidemic still existed and continued to affect the 324dc health of Chinese students who study abroad. At this same time, many Chinese students were able to recover from the trauma quickly, but there are still some students who have difficulty or are unable to fully recover from the trauma. This paper hopes to draw the attention of more overseas universities to this current situation and create a healthier and more inclusive learning environment for international students.

Inadvertent Disclosure of HIV Status to Adolescents Living with HIV and Subsequent Impact on Medico-Social Wellbeing in Kaduna, Nigeria

Background: Inadvertent disclosure of HIV status poses significant challenges for adolescents living with HIV, particularly in settings where stigma and discrimination are prevalent. Objective: This research seeks to delve into the prevalence and ramifications of accidental disclosures of HIV status among adolescents frequenting a Youth Friendly Clinic (YFC) at a major hospital in Kaduna, Nigeria. It further aims to uncover the medical and social repercussions following such incidents. Methods: Employing a comprehensive mixed-methods strategy, this study combined quantitative and qualitative analyses. Initially, a survey was conducted among 217 adolescents aged between 10 and 19 years, who were patients at the YFC of a tertiary care facility. This survey gathered information on demographic factors, experiences related to the disclosure of HIV status, and the effects of accidental disclosures on emotional health and the consistency of antiretroviral treatment adherence. Subsequently, the study engaged in qualitative research through detailed interviews and group discussions with 85 adolescents who had unintentionally disclosed their HIV status. This allowed for an exploration of the experiences surrounding these disclosures, the coping strategies adopted, and their perceptions of available support. Ethical clearance was secured to ensure the confidentiality and integrity of the research process. Results: The initial analysis revealed that a significant portion (39.2%) of the adolescent participants had inadvertently disclosed their HIV status, mostly by overhearing conversations (56%) and through discussions with peers at the clinic (17%). The qualitative exploration identified key themes such as heightened experiences of stigma and discrimination, difficulties in securing social support, and detrimental effects on mental health. Following these unintended disclosures, adolescents reported feelings of social isolation, changed perceptions by family members, and battles with depression and anxiety. The findings highlight the intricate relationship between accidental disclosure and its social and medical impacts, emphasizing the necessity for bespoke interventions aimed at addressing the needs of this at-risk demographic. Conclusion: The confidentiality of adolescent patients must be a top priority for healthcare professionals, alongside the development of preventative measures against accidental disclosures and the provision of comprehensive support services to counteract the adverse outcomes. By enhancing privacy protection and offering individualized support, it is feasible to mitigate the negative effects associated with unintended disclosures, including stigma and mental health challenges. This investigation enriches our comprehension of accidental HIV status disclosure among adolescents and accentuates the critical need for creating interventions that improve their overall well- being and social inclusion.

'My goal was to become normal'-A qualitative investigation of coping with stigma, body image and self-esteem long-term after bariatric surgery.

Improved self-esteem and body image, as well as reduced experiences of weight stigma are important patient-reported obesity treatment outcomes. However, more knowledge is needed about how individuals who have undergone metabolic and bariatric surgery (MBS) perceive themselves and their bodies and use different coping strategies in relation to body image and self-esteem long-term after MBS. In this qualitative study body image, self-esteem, weight stigma and coping strategies were explored among 18 individuals who underwent MBS more than 10 years ago when interviewed. Using reflexive thematic analysis, two primary themes were identified: 'Experiences of living with a stigmatised body' and 'Coping with weight stigma, body image and self-esteem', and eight sub-themes. Findings capture frequent experiences of weight stigma before bariatric surgery, the need for coping with stigma and body dissatisfaction before and after MBS, and how different coping strategies are related to participants' perceptions of their bodies and self-concepts. More adaptive coping strategies, such as confrontation and cognitive restructuring may facilitate more positive body image outcomes, than more ruminative and avoidant strategies. Understanding adaptive coping strategies can be useful to develop interventions to reduce negative consequences of weight stigma on body image and self-esteem.

Persecution as stigma-driven trauma: Social determinants, stigma, and violence in asylum seekers in the United States

ObjectiveExisting literature documents high rates of experienced violence in asylum seekers. Despite this high prevalence, experiences of traumatic stress are neither necessary nor sufficient grounds for claiming asylum, without documented experiences of persecution. The aim of the current study is to better understand the role of co-occurring pre-migratory social determinants, stigma, and trauma on the experiences of persecution among asylum seekers in the United States. MethodWe conducted a retrospective file review of legal declarations submitted by 25 asylum seekers who participated in forensic mental health evaluations at a pro-bono asylum clinic. We coded de-identified data for co-occurring events of trauma, social determinants of health, and components of “discrimination” from the legal definition of persecution - conceptualizing persecution as stigma-driven infliction of violence. Data was analyzed using a tiered deductive and inductive reflexive thematic analysis. ResultsFindings suggest pre-migratory social determinants included demographics, neighborhood, economic, environmental, and social and cultural level disparities across various grounds for seeking asylum, and experiences of stigma were associated with the specific acts of violence and harm. ConclusionsOur findings - specific to asylum seekers who have obtained legal representation and completed applications for asylum in the United States - describe the co-occurrence of social determinants, stigma and traumatic experiences among asylum seekers. To our knowledge, this study is the first of its kind to bridge the existing legal framework of asylum to a psychological construct incorporating trauma, stigma, and social determinants of health, lending support for the conceptualization of persecution as stigma-driven trauma.

The Allegory of the Favela: The Multifaceted Effects of Socioeconomic Mobility

What are the consequences of upward socioeconomic mobility for disenfranchised individuals? This article examines this question in the context of a business training program offered to residents of Brazilian urban slums, known as “favelas.” The study employs a randomized controlled trial complemented by quantile regressions, field visits, and interviews. The results show that training improves favela dwellers’ economic outcomes, such as by increasing income and participation in entrepreneurship, and some socio-psychological outcomes, such as by improving self-efficacy and optimism. However, these income improvements were accompanied by participants’ enhanced experiences of favela stigma, an adverse socio-psychological outcome related to their residential segregation. Both quantitative and qualitative findings demonstrate the multifaceted nature of socioeconomic mobility, through which favela dwellers who prosper economically become more exposed to prejudice from people living outside favelas. The study illustrates, through the “allegory of the favela,” the bittersweet process of socioeconomic mobility. This abductive research contributes to the literature by showing that while interventions designed to enfranchise individuals may effectively achieve economic inclusion in terms of income gains, they may simultaneously lead participants into discriminatory systems that further stigmatize people based on the same characteristics of their prior exclusion.

Experiences of social stigma of people living with Hansen's disease in Brazil: silencing, secrets and exclusion.

Hansen's disease is a chronic, infectious and transmissible disease that is considered a public health problem in Brazil. Hansen's disease is marked by stigma and prejudice, because it carries with it a strong negative social image, reinforced by policies of social isolation in the community. A qualitative study was conducted in Ribeirão Preto, an inland city of the state of São Paulo, Brazil. Eleven patients under treatment for the disease were interviewed. The interviews were audio recorded and transcribed in full, then were analyzed through the stages of transcription, transposition and reconstitution, as informed by concepts proposed by Goffman. The results showed that the marks of stigma are still present in the twenty-first century and were presented in two axes: 'Stigma and work for the person affected by Hansen's disease' and 'The experience of stigma in the family'. The participants refer to fears of losing their jobs and of being ridiculed, which stops them talking about the disease. Regarding their families, the participants reported episodes of discrimination, the creation of family secrets and fear of relatives' reactions. All these aspects interfere in the follow-up and treatment of patients and need to be considered and welcomed by health professionals. It is recommended that these aspects are addressed in the initial training and continuing education of health professionals. La maladie de Hansen est une maladie chronique, infectieuse et transmissible, considérée comme un problème de santé publique au Brésil. La maladie de Hansen est marquée par la stigmatisation et les préjugés, car elle véhicule une image sociale fortement négative, renforcée par des politiques d'isolement social au sein de la communauté. Étude qualitative menée à Ribeirão Preto, une ville intérieure de l'État de São Paulo, au Brésil. Onze patients traités pour la maladie ont été interrogés. Les entretiens ont été enregistrés et transcrits intégralement, et ont été analysés en suivant les étapes de transcription, de transposition et de reconstitution, selon les concepts proposés par Goffman. Les résultats montrent que les marques de la stigmatisation sont toujours présentes au 21ème siècle et ont été présentées selon deux axes : 'La stigmatisation et le travail pour la personne affectée par la maladie de Hansen' et 'L'expérience de la stigmatisation dans la famille'. Les participants évoquent la peur de perdre leur emploi, la peur d'être ridiculisés, ce qui les pousse à ne pas parler de la maladie. En ce qui concerne les familles, les participants ont rapporté des épisodes de discrimination, la création de secrets de famille et la peur des réactions des proches. Tous ces aspects interfèrent dans le suivi et le traitement des patients et doivent être pris en compte et accueillis par les professionnels de la santé. Il est recommandé que ces aspects soient abordés dans la formation initiale et la formation continue des professionnels de la santé. La enfermedad de Hansen es una enfermedad crónica, infecciosa y transmisible, considerada un problema de salud pública en Brasil. La enfermedad de Hansen está marcada por el estigma y el prejuicio, ya que conlleva una fuerte imagen social negativa, reforzada por políticas de aislamiento social en la comunidad. Estudio cualitativo realizado en Ribeirão Preto, una ciudad del interior del estado de São Paulo, Brasil. Se entrevistaron a once pacientes en tratamiento para la enfermedad. Las entrevistas fueron grabadas en audio, transcritas en su totalidad y analizadas a través de etapas de transcripción, transposición y reconstitución, según los conceptos propuestos por Goffman. Los resultados muestran que las marcas del estigma siguen presentes en el siglo XXI y se presentaron en dos ejes: 'Estigma y trabajo para la persona afectada por la enfermedad de Hansen' y 'La experiencia del estigma en la familia'. Los participantes mencionan el miedo a perder sus trabajos, el temor a ser ridiculizados, lo que les impide comentar sobre la enfermedad. En cuanto a las familias, los participantes reportaron episodios de discriminación, la creación de secretos familiares y el miedo a las reacciones de los familiares. Todos estos aspectos interfieren en el seguimiento y tratamiento de los pacientes y deben ser considerados y acogidos por los profesionales sanitarios. Se recomienda abordar estos aspectos en la formación inicial y la educación continua de los profesionales sanitarios.

An ecological model of experienced stigma during the COVID-19 pandemic: A qualitative study in Malaysia

In this paper, we adopted an ecological model and relational cognition framework to decolonize pandemic stigma in a non-WEIRD society. We reconstructed the concept of pandemic stigma in an ex-colonized and multicultural society of Southeast Asia region, by conducting a qualitative study in Malaysia to explore their lived experiences of differential treatment during the COVID-19 Pandemic from 2020 to 2022. We interviewed 30 Malaysians aged 18–64 of diverse ethnicities (Malays, Chinese, Indians, and other minorities) through online semi-structured sessions and coded the transcripts through consensus thematic analysis. Results showed that the interviewees’ lived experiences of stigma could be conceptualized as negative interactions with multiple systems: (1) Kinship, (2) Companionship, (3) Organizations, (4) Societal (5) Political, as well as (6) Internal systems. We found that interviewees attributed their experiences of stigma to (1) Individual (self) reasons, (2) Impact of close relationships, (3) Impact of casual social interactions, and (4) Impact of cultural-political context. Our findings could be translated into culturally responsive and context-specific interventions, which addressed systemic injustice that exacerbated the global polarization during the pandemic.

HIV-related Shame among Women Giving Birth in Tanzania: A Mixed Methods Study.

Women living with HIV (WLHIV) commonly experience HIV-related shame which can interfere with HIV care-seeking behavior and lead to poor clinical outcomes. HIV-related shame may be particularly heightened during the pregnancy and postpartum periods. This study aimed to describe HIV-related shame among WLHIV giving birth, identify associated factors, and qualitatively examine the impacts of HIV-related shame on the childbirth experience. Postpartum WLHIV (n = 103) were enrolled in the study between March and July 2022 at six clinics in the Kilimanjaro Region, Tanzania. Participants completed a survey within 48h after birth, prior to being discharged. The survey included a 13-item measure of HIV-related shame, which assessed levels of HIV-related shame(Range: 0-52). Univariable and multivariable regression models examined factors associated with HIV-related shame. Qualitative in-depth interviews were conducted with pregnant WLHIV (n = 12) and postpartum WLHIV (n = 12). Thematic analysis, including memo writing, coding, and synthesis, was employed to analyze the qualitative data. The survey sample had a mean age of 29.1 (SD = 5.7), and 52% were diagnosed with HIV during the current pregnancy. Nearly all participants (98%) endorsed at least one item reflecting HIV-related shame, with an average endorsement of 9 items (IQR = 6). In the final multivariable model, HIV-related shame was significantly associated with being Muslim vs. Christian (ß = 6.80; 95%CI: 1.51, 12.09), attending less than four antenatal care appointments (ß = 5.30; 95%CI: 0.04, 10.55), and reporting experiences of HIV stigma in the health system (ß = 0.69; 95%CI: 0.27, 1.12). Qualitative discussions revealed three key themes regarding the impact of HIV-related shame on the childbirth experience: reluctance to disclose HIV status, suboptimal adherence to care, and the influence on social support networks. WLHIV giving birth experience high rates of HIV-related shame, and social determinants may contribute to feelings of shame. HIV-related shame impacts the childbirth experience for WLHIV, making the labor and delivery setting an important site for intervention and support.The study is funded by the National Institutes of Health (R21 TW012001) and is registered on clinicaltrials.gov (NCT05271903).

Factors Associated with PrEP Stigma Among Gay, Bisexual, and Other Men Who Have Sex with Men (gbMSM): A Systematic Review

ABSTRACT Gay, bisexual, and other men who have sex with men (gbMSM) are disproportionately affected by HIV. While pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition, uptake of PrEP among gbMSM is low, which may in part be due to stigma associated with PrEP use. This systematic review aimed to explore experiences of PrEP stigma and to identify factors associated with this. Four databases were searched for papers including terms relating to (i) gbMSM, (ii) PrEP, and (iii) stigma, with narrative synthesis used to analyze results. After screening, 70 studies were included in the final analysis. Experiences of PrEP stigma were found to be characterized by a number of stereotypes and came from a range of sources. Five categories of factors were associated with stigma: (i) healthcare-related factors, (ii) cultural and contextual factors, (iii) sociodemographic factors, (iv) peer-discussion, and (v) psychosocial factors. These findings suggest that stigma can be a common experience for gbMSM. However, some are more at risk than others. Interventions aimed at reducing PrEP stigma may be useful in increasing uptake.

Abstract P287: Incorporating Behavioral and Social Determinants of Health Variables Into a Machine Learning Model Predicting Cardiometabolic Disease

Introduction: Machine learning models hold potential for improved cardiometabolic disease prediction and more efficacious prevention and intervention efforts. Current models are limited by use of cross-sectional datasets and variables (features) consisting of diagnostic criteria (such as blood glucose or hemoglobin A1c in type 2 diabetes models) and overlook health behaviors and social determinants of health (HB-SDH). Hypothesis: Machine learning models built with HB-SDH variables will accurately predict type 2 diabetes. Methods: We used data from 2,493 participants without diabetes in the Adolescent to Adult Health study (mean age = 15.5 years at baseline (1994), 40.9% male) who contributed blood samples and anthropometric measures in wave 4 (2008) or 5 (2016-2018). We used an 80/20 split to form separate training and test datasets; the training dataset was used to build random forest and XGBoost models, and performance with respect to classifying diabetes was evaluated in the test dataset. We first built a model using 15 demographic and biomarker features as a comparator for our second model, which included 34 HB-SDH features measured during adulthood but no biomarkers. Results: Five-hundred sixteen participants developed type 2 diabetes. In XGBoost, the comparator model was found to predict diabetes with 92.6% accuracy (95% CI: 89.8%, 94.8%) and area under the curve (AUC) = 0.8165. The HB-SDH model had 88.7% accuracy (95% CI: 85.4, 91.4%) and AUC = 0.7631. Using random forest, the comparator model had 93.0% accuracy (95% CI: 90.3, 95.2%) and AUC = 0.8376, while the HB-SDH model had 89.8% (95% CI: 88.6, 92.4%) accuracy and AUC = 0.7650. The top 10 variables in ascertaining classifications in the random forest model included self-reported general health, waist circumference, self-reported anxiety diagnosis, self-reported hypertension diagnosis, income, BMI, education level, change in weight, financial scarcity, and experienced stigma, while in the XGBoost model these were self-reported general health, experienced stigma, financial scarcity, self-reported anxiety diagnosis, experienced weight stigma, waist circumference, income, self-reported hypertension diagnosis, sugar-sweetened beverage intake, and BMI. Conclusions: Machine learning models built with behavioral and social determinants of health variables perform comparably to models with biomarkers and identify salient features for diabetes risk. The features that factored into classification performance were similar between random forest and XGBoost models. In this population, HB-SDH of relevance included socioeconomic indicators, sugary beverages, anxiety, and experiencing stigma, in addition to adiposity and hypertension. This finding needs to be replicated in diverse cohorts that may experience different HB-SDH.