Health Stigma Research Articles

AIDS- and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study

AIDS-related stigma is a major hurdle to care and it hinders people from accessing HIV prevention methods, such as post-exposure prophylaxis. This study was designed to explore how AIDS-related stigma impacts the experience of using non-occupational post-exposure prophylaxis (nPEP) for HIV after sexual contact. Data were gathered in in-depth interviews with 59 people who voluntarily sought out nPEP in five public healthcare facilities in Brazil between 2015 and 2016. Data were analysed into three thematic categories: fear of being mistaken for a person living with HIV and AIDS (PLWHA); desire to hide particular features of one’s sexual life; and experiences of stigmatising behaviour due to nPEP use. Based on the Health Stigma and Discrimination Framework, predominant manifestations of AIDS-related stigma in each category were analysed, as well as their intersections with gender- and sexuality-related stigmas. Results show that experiences of using nPEP are permeated by AIDS-related stigma, intersecting with sexuality- and gender-related stigmas. Stigma experiences are mainly perceived, anticipated and internalised; stigma practices include prejudice and stigmatising behaviours. Taking antiretrovirals (ARVs) led participants to the fear of being discriminated against as a PLWHA and having particular features of their sexual identities disclosed. Thus, hiding nPEP was strategic to protect from stigmatising behaviour. As ARV-based prevention technologies are scaled-up, interventions designed to tackle AIDS- and sexuality-related stigmas must be expanded in Brazil. Required interventions include public campaigns about nPEP, educational programmes in healthcare settings to offer adequate support to nPEP users and investments in stigma research and monitoring.

Canadian men's health stigma, masculine role norms and lifestyle behaviors.

Men are at high risk for both morbidity and premature mortality from several of the most common serious diseases. Although numerous factors have been identified to explain men's risk, this study focused on the relationship between lifestyle behaviors, health-related self-stigma and masculine role norms. An age and location stratified sample of 2000 Canadian men completed measures assessing five lifestyle behaviors (smoking, alcohol use, sleep, diet and exercise), a screen for depression, and measures of self-stigma and masculine role norms. The results showed that elements of both health-related self-stigma and masculine role norms were associated with increased risk for being above the clinical threshold for four of the lifestyle behaviors and depression. The most frequent and largest relationships were associated with exercise and depression. The total number of lifestyle behaviors for which participants were above the clinical cut-points was also associated with self-stigma and masculine role norms. These findings demonstrate the importance of health-related self-stigma and masculine role norms as potential barriers to men's health and well-being.

Is Smoking Queer? Implications of California Tobacco Denormalization Strategies for Queer Current and Former Smokers

ABSTRACT This article is concerned with normative conceptions of health structuring tobacco control strategies designed to “denormalize” tobacco use. Analysis of 201 interviews with non-heterosexual and/or non-cisgender adults in California revealed that participants implicated tobacco use in exacerbating health inequities and perpetuating harmful narratives of queer suffering, but also regarded smoking as a critical tool for self-care and symbol of resistance. Participant narratives suggest that using stigma in health promotion efforts which reinforce normative conceptions of health may be harmful to queer people whose social identities exist within ongoing legacies of pathology, health stigma, and deviance from hegemonic structural norms.

Stigma doesn\u2019t discriminate: physical and mental health and stigma in Canadian military personnel and Canadian civilians

BackgroundIllness-related stigma has been identified as an important public health concern. Past research suggests there is a disproportionate risk of mental-health stigma in the military, but this same finding has not yet been established for physical-health stigma. The current study aimed to assess the independent contribution of mental and physical health on both enacted stigma (discriminatory behaviour) and felt stigma (feelings of embarrassment) and to determine whether these associations were stronger for military personnel than civilians.MethodsData were obtained from the 2002 Canadian Community Health Survey - Mental Health and Well-being and its corresponding Canadian Forces Supplement. Logistic regressions were used to examine a potential interaction between population (military [N = 1900] versus civilian [N = 2960]), mental health, and physical health in predicting both enacted and felt stigma, with adjustments made for socio-demographic information, mental health characteristics, and disability.ResultsMental health did not predict enacted or felt stigma as a main effect nor in an interaction. There was a strong link between physical health and enacted and felt stigma, where worse physical health was associated with an increased likelihood of experiencing both facets of stigma. The link between physical health and enacted stigma was significantly stronger for military personnel than for civilians.ConclusionsPhysical health stigma appears to be present for both civilians and military personnel, but more so for military personnel. Elements of military culture (e.g., the way care is sought, culture of toughness, strict fitness requirements) as well as the physical demands of the job could be potential predictors of group differences.

Adolescent mental health education InSciEd Out: a case study of an alternative middle school population

BackgroundMental illness contributes substantially to global disease burden, particularly when illness onset occurs during youth and help-seeking is delayed and/or limited. Yet, few mental health promotion interventions target youth, particularly those with or at high risk of developing mental illness (“at-risk” youth). Community-based translational research has the capacity to identify and intervene upon barriers to positive health outcomes. This is especially important for integrated care in at-risk youth populations.MethodsHere the Integrated Science Education Outreach (InSciEd Out) program delivered a novel school-based anti-stigma intervention in mental health to a cohort of seventh and eighth grade at-risk students. These students were assessed for changes in mental health knowledge, stigmatization, and help-seeking intentions via a classroom activity, surveys, and teacher interviews. Descriptive statistics and Cohen’s d effect sizes were employed to assess pre–post changes. Inferential statistical analyses were also conducted on pilot results to provide a benchmark to inform future studies.ResultsElimination of mental health misconceptions (substance weakness p = 0.00; recovery p = 0.05; prevention p = 0.05; violent p = 0.05) was accompanied by slight gains in mental health literacy (d = 0.18) and small to medium improvements in help-seeking intentions (anxiety d = 0.24; depression d = 0.48; substance d = 0.43; psychosis d = 0.53). Within this particular cohort of students, stigma was exceptionally low at baseline and remained largely unchanged. Teacher narratives revealed positive teacher views of programming, increased student openness to talk about mental illness, and higher peer and self-acceptance of mental health diagnoses and help-seeking.ConclusionsCurricular-based efforts focused on mental illness in an alternative school setting are feasible and integrated well into general curricula under the InSciEd Out framework. Preliminary data suggest the existence of unique help-seeking barriers in at-risk youth. Increased focus upon community-based programming has potential to bridge gaps in translation, bringing this critical population to clinical care in pursuit of improved mental health for all.Trial registration ClinicalTrials.gov, ID:NCT02680899. Registered 12 February 2016, https://clinicaltrials.gov/ct2/show/NCT02680899

Intrigues of Accessing Mental Health Services Among Urban Refugees Living in Kenya: The Case of Somali Refugees Living in Eastleigh, Nairobi

ABSTRACTThis article explores the perceived mental-health-care access barriers affecting the resettled refugee population in Eastleigh, Kenya. Findings suggest that the main barriers to accessing mental health care are cultural and religious beliefs, inadequate health services, culture-insensitive mental health services, poverty, language barriers, stigma, and discrimination. This study recommends that it is important to integrate Somalis' indigenous methods of treatment of mental illnesses into Western methods of treatment in Kenya to provide a wide spectrum of mental help to refugees.

Resources to address stigma related to sexuality, substance use and sexually transmitted and blood-borne infections.

Stigma is widely recognized as a significant barrier to the prevention, management and treatment of sexually transmitted and blood-borne infections (STBBIs) in Canada. Despite major advances in STBBI prevention and treatment, and global efforts to reduce stigma, people living with or affected by STBBIs continue to experience stigma within health and social service settings in Canada. To describe the development, content and evaluation of knowledge translation resources and training workshops designed to equip health and social service professionals with the knowledge and skills needed to provide more respectful and inclusive sexual health, harm reduction and STBBI services. After conducting a literature review, environmental scan and key informant interviews, and developing a conceptual framework, the Canadian Public Health Association (CPHA) developed four knowledge translation resources and three training workshops in partnership with a number of community-based organizations and experts. The resources were drafted and reviewed by both service providers and individuals affected by STBBIs. The workshops were developed, piloted and then evaluated using post-workshop questionnaires. The four resources developed were a self-assessment tool related to STBBIs and stigma; a service provider discussion guide to facilitate respectful and inclusive discussions on issues related to sexuality, substance use and STBBIs; a toolkit focused on stigma reduction, privacy, confidentiality and the criminalization of HIV non-disclosure; and an organizational assessment tool related to STBBIs and stigma for health and social service settings. These knowledge translation resources were subsequently integrated into the content of three face-to-face trainings that were piloted and evaluated across the country. Post-workshop evaluation had an overall 85% response rate; 88% of participants noted increased awareness of various forms of stigma, 87% noted increased comfort discussing sexuality, substance use and harm reduction with their clients/patients, 90% reported increased awareness of organizational strategies to reduce stigma, and 93% reported being able to integrate workshop learnings into practice. In addition, there was strong support for professional development on issues related to STBBI stigma reduction. These knowledge translation resources and training workshops represent a comprehensive set of tools developed in Canada that service providers can use to help reduce stigma when caring for clients/patients with STBBIs and related conditions. Evaluation indicates there is a strong willingness among health and social service providers to engage in educational opportunities in this area and that participation in the training workshops led to increased awareness and a willingness to adopt best practices.

The Promises and Challenges of Preexposure Prophylaxis (PrEP) in Mississippi

Mississippi is ranked sixth in the nation in the number of HIV/AIDS cases, and the City of Jackson, ranks 4th highest in the rate of new HIV infections in the nation. A review of the literature and personal communications with health providers reveals that public health policy, stigma, cost, and distrust of the healthcare system, are significant barriers to managing the spread of HIV. Education of elected officials and the general public as well as policy advocacy are desperately needed to curb the rising HIV epidemic in Mississippi.

Our Biggest Hurdle Yet: Caregivers' Encounters with Structural Stigma in Child and Youth Mental Health

The aim of this article explores structural stigma in child and youth mental health. The focus is on the experiences of caregivers with children between 12 and 22 years old in their encounters with the systems involved with their families for their children's mental health. The outcomes are presented of a study based on analysis of 10 transcripts—two focus group and eight interview transcripts—with 15 caregivers with children involved with mental health services. Two main themes emerged: (a) structural stigma as denigrating encounters within and across service systems (i.e., child and youth mental health, education, child protection, and criminal justice) and (b) fragmentation of the service delivery system as a significant factor exacerbating stigmatizing encounters. The implications for mental health practice with families are considered.

Coping with stigma and discrimination: evidence from mental health service users in England.

Mental health stigma and discrimination are significant problems. Common coping orientations include: concealing mental health problems, challenging others and educating others. We describe the use of common stigma coping orientations and explain variations within a sample of English mental health service users. Cross-sectional survey data were collected as part of the Viewpoint survey of mental health service users' experiences of discrimination (n = 3005). Linear regression analyses were carried out to identify factors associated with the three stigma coping orientations. The most common coping orientation was to conceal mental health problems (73%), which was strongly associated with anticipated discrimination. Only 51% ever challenged others because of discriminating behaviour, this being related to experienced discrimination, but also to higher confidence to tackle stigma. Although stigma coping orientations vary by context, individuals often choose to conceal problems, which is associated with greater anticipated and experienced discrimination and less confidence to challenge stigma. The direction of this association requires further investigation.

The needs of women users of mental health services and their families

AimUnderstand the needs of women users of mental health services and their families and discuss consequences.MethodNon-systematic review of concepts and data regarding the needs of women users of mental health services and their families.Resultsnequity and inefficiency of mental health resources affect men and women all around the globe. Some important mental health needs as well as barriers to care are gender-specific. Women have specific needs in specific phases of life, e.g. the perinatal period, as well as specific risk factors, e.g. interpersonal violence and sexual abuse. Developments of women only services as well as the implementation of gender-specific approaches in routine care are underway and need to be evaluated, amended and expanded. Training as well as research requirements are numerous and urgent. Family carers are an essential mental health resource. A majority is female with significant unmet needs. Family advocacy in mental health is prominently supported by female activists as is the psychiatric user movement. Because of the cumulation and the interaction of gender-based and other forms of discrimination, legislations such as those following the UN-Convention on the rights of persons with disabilities include specific provisions for women and girls with psychosocial disabilities.ConclusionsMental health stigma and discrimination interact with gender inequality and the discrimination of women and girls to their mental health detriment. Clinical and scientific responsibilities in mental health essentially include gender-specific attention to the needs of women and girls and their families.Disclosure of interestThe author has not supplied his declaration of competing interest.

Bulimia nervosa in Singapore: Clinical profile, comorbidity and gender comparisons

IntroductionThough eating disorder cases have been on the rise in Asia, little is known about them. Bulimia nervosa (BN) has been associated with poor treatment outcome and high mortality risk, and is the second most commonly diagnosed eating disorders in Singapore, after anorexia nervosa (AN), yet no report thus far has explored this condition.ObjectivesThe current study seeks to describe the clinical population diagnosed with BN in our hospital treatment program, as well as to compare their clinical characteristics with a previously published local study on patients with AN.MethodRetrospective medical records review was carried out for patients diagnosed with BN in our hospital's eating disorders treatment program. Patient records from 2003 to 2013 were retrieved and analyzed. We also further compared presenting characteristics across genders and with AN patients.ResultsBetween 2003 and 2013, 348 patients were diagnosed with BN by psychiatrists based on the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR). BN patients presented with high rate of self-harm behaviors (37.1%), previous suicide attempts (19.0%) and psychiatric comorbidities (67.5%), many of which require inpatient treatment. Significant differences were found between genders and in comparison with the AN patients.ConclusionOur results suggest that many patients with BN present with severe psychiatric comorbidities, in some aspects more severe than the AN population. The current study appeals for the development of more effective detection and treatment of vulnerable populations in Singapore. We further discuss about the potential roles of mental health literacy and stigmatization in influencing treatment-seeking behaviors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Community orientation of services for persons with a psychiatric disability. Comparison between Estonia, Hungary and the Netherlands

ABSTRACTThis article explores the way mental health services and social services are orientated on assisting people with a psychiatric disability to participate in different areas of community life. A large research project about community participation in three different countries (Estonia, Hungary and the Netherlands) confirms the findings of other studies that – regardless of geographical location – people with a psychiatric disability have difficulty fulfilling social roles in the community. They are often faced with fewer opportunities than other citizens, due to their health problems, stigma, discrimination and poverty [World Health Organisation. (2011). World report on disability. Geneva: WHO]. An important objective of social work is to help people find their way in society. Surprisingly enough, in all three countries, most social workers are mainly focused on solving individual problems, and not on community participation. Shifting the focus starts by having a clear awareness of the notion of community participation. Social workers have to work both on supporting individuals to find their way in the community (individual support), and on supporting social networks in the community to accommodate persons with a disability on the basis of equal and valued citizenship (community support).

Help for the Helper: Mental Health Concerns, Supports, and Stigma in School Counselors

Self-stigma prohibits many from seeking mental health support, and those in helping professions are not immune to this phenomenon. In this study, we investigated types of mental health concerns, frequencies and types of professional supports, and the relationship between stigma and help seeking in a sample of 330 school counselors. We found significant differences related to gender and familiarity with mental health concerns, as well as differences related to personal experience with mental health concerns. There was no significant difference in stigma for participants who had few personal and professional experiences with mental health concerns and participants who had many professional experiences with mental health concerns.

Obesity Stigma and Negative Perceptions of Political Leadership Competence

This study investigated whether the leadership competence of an overweight candidate is affected by exposure to weight-stigmatizing and nonstigmatizing messages. Participants read one of four messages—a weight stigma, a health stigma, a competence, or a stigma-reducing message. Fat phobia, weight controllability, partisanship, political activism, and voting behaviors were also measured. Weight controllability bias interacted with the weight stigma message to produce lower evaluations of political leadership competence. Weight controllability also correlated with higher levels of fat phobia regardless of message exposure. The evidence suggests making stigmatizing comments in print/online against a candidate based on a physical characteristic like large size negatively biases public perceptions of political leadership competence. This study of negative competence evaluation directed toward a real politician confirms the findings of earlier experimental studies with fictitious fat politicians.

Nurses’ perceptions of mental healthcare in primary-care settings in Kenya

ABSTRACTKenya maintains an extraordinary treatment gap for mental health services because the need for and availability of mental health services are extraordinarily misaligned. One way to narrow the treatment gap is task-sharing, where specialists rationally distribute tasks across the health system, with many responsibilities falling upon frontline health workers, including nurses. Yet, little is known about how nurses perceive task-sharing mental health services. This article investigates nurses’ perceptions of mental healthcare delivery within primary-care settings in Kenya. We conducted a cross-sectional study of 60 nurses from a public urban (n = 20), private urban (n = 20), and public rural (n = 20) hospitals. Nurses participated in a one-hour interview about their perceptions of mental healthcare delivery. Nurses viewed mental health services as a priority and believed integrating it into a basic package of primary care would protect it from competing health priorities, financial barriers, stigma, and social problems. Many nurses believed that integrating mental healthcare into primary care was acceptable and feasible, but low levels of knowledge of healthcare providers, especially in rural areas, and few specialists, would be barriers. These data underscore the need for task-sharing mental health services into existing primary healthcare in Kenya.

Abstract A59: Providing care for LGBTQ individuals with cancer: A call for education and training

Abstract Background: Lesbian, gay, bisexual, transsexual/transgender, and queer/questioning (LGBTQ) individuals comprise a minority and underserved group with unique and often-unrecognized health needs. The LGBTQ community faces barriers to healthcare such as problems accessing health insurance coverage and stigmatization by some healthcare providers based on sexual orientation or gender identity. Additionally, the LGBTQ community has increased cancer risks due to lower screening rates, less use of regular health care, and an elevated prevalence of cancer risk factors, compared with heterosexual and gender-aligned populations. A recent review by Quinn et al. noted that anal, breast, cervical, colorectal, endometrial, lung, and prostate cancers may disproportionally affect the LGBTQ population. The goal of this project was to identify the attitudes, knowledge, and practice behaviors of healthcare providers specializing in these seven cancer types. Methods: A 33-item web-based survey was sent by e-mail to oncology healthcare providers at a National Cancer Institute-Designated Comprehensive Cancer Center. The survey included five sections: demographics, attitudes, knowledge, practice behaviors, and open comments. Summary responses were examined only for providers who identified as specialists in breast, gastrointestinal (GI), genitourinary (GU), gynecologic (GYN), and thoracic cancers. Results: Of the 108 oncology healthcare providers who completed the survey, 36 (33.3%) identified as specialists in breast, GI, GU, GYN, and thoracic cancers. Among this subgroup of clinicians, almost all (91.7%) stated they were comfortable treating LGBTQ patients and agreed the LGBTQ population has unique health risks and needs. However, less than half (49.5%) correctly answered knowledge questions related to health behaviors and cancer risks of LGBTQ individuals. As for practice behaviors, 33.3% actively inquire about a patient's sexual orientation when taking a history, 38.9% agree it is important to know their patients' sexual orientation to provide the best care, and 27.8% believe they are well-informed on the health needs of LGBTQ patients. Nearly 80% believe there should be more education in health professional schools on LGBTQ health needs and 41.7% agree there should be mandatory educational events in the workplace on these needs. Open-ended comments indicated that oncologists in the five highlighted specialties lack awareness of unique LGBTQ health concerns: for example, one thoracic oncology specialist stated that because he treats lung cancer patients, he was “not sure these questions are relevant to my specific area of focus.” Conclusions: Survey results indicate that oncology providers in specialties where LGBTQ patients may be disproportionately affected are accepting of LGBTQ individuals and acknowledge the existence of unique needs for this population, yet are largely unaware of specific health behaviors and risk factors of, and best practices regarding, this population. This study also highlights the potential need for improved LGBTQ-related content in health professional school curricula, as well as for continuing education and training for providers that addresses the care of LGBTQ patient populations. Citation Format: Christina Tamargo, Julian A. Sanchez, Steven K. Sutton, Peter A. Kanetsky, Vani N. Simmons, Susan T. Vadaparampil, Matthew B. Schabath, Gwendolyn P. Quinn. Providing care for LGBTQ individuals with cancer: A call for education and training. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A59.

The intersection of policing and stigma in shaping violence and poor health among sex workers

The intersection of policing and stigma in shaping violence and poor health among sex workers

A qualitative analysis of physician assistant students' mental health bias and stigma constructs before and after a psychiatry rotation

A qualitative analysis of physician assistant students' mental health bias and stigma constructs before and after a psychiatry rotation

Child Aware Practice in Adult Social Services: A Scoping Review

The development of “child aware” practice is about the capacity and capability of adult health and social service providers to identify and respond to the needs of children. A scoping review of the literature considered five adult adversities associated with family stress and reduced parenting capacity: mental illness, alcohol and substance abuse, homelessness, intellectual disability, and domestic violence. Although there are specific needs for children pertaining to particular adversities, there was substantial commonality of potential effects. These included emotional and psychological difficulties, physical and mental health problems, academic difficulties, language delays, peer difficulties, stigma, trauma reactions, loss and grief, instability, and social exclusion. How children react to difficulties in their family depends upon various protective factors, a child's frame of reference, and other dynamics within the family that can offset risks. The findings aim to inform policy, program development, and practice in adult social services, enhancing their responsiveness to children.