High Levels Of Stigma Research Articles

Validity and reliability of the Persian version of Recce stigma scale in people with multiple sclerosis and its impact on quality of life.

There is often a fear of social stigma experienced by people with multiple sclerosis (pwMS), which negatively impacts the quality of their lives (QoL). Currently, no Persian-validated questionnaire is available to assess this issue in pwMS. This study aimed to assess the validaty and reliability of the Persian version of Reece Stigma Scale Multiple Sclerosis (RSS-MS) questionnaire for pwMS. This cross-sectional was conducted between January and February 2023 in Isfahan, Iran. The demographic and clinical information and the RSS-MS and Multiple Sclerosis Impact Scale-29 (MSIS-29) questionnaires were recorded from pwMS. The content validity index (CVI) and content validity ratio (CVR) have been used to evaluate validity. To identify the factors supporting the MS-related stigma, an exploratory factor analysis (EFA) was conducted. The present study recruited 194 pwMS. Based on factor analysis, only two factors had eigenvalues ≥ 1.0 and exhibited high internal consistency. The Cronbach's α coefficient for internal consistency of the RSS-MS scale was 0.822. More evidence for the construct validity suggested that having higher levels of stigma is significantly correlated with psychological (r = 0.468, p-value < 0.001) and physical dimensions (r = 0.585, p-value < 0.001) of MSIS-29. Expanded Disability Status Scale, disease duration, and treatment duration did not show a significant correlation with stigma (p-value > 0.05). This study indicated that the modified version of the RSS-MS scale in the Persian language showed acceptable validity and reliability for evaluating the stigma among Persian pwMS. Furthermore, this study emphasizes the cruciality of monitoring and addressing stigma among pwMS, as it can potentially enhance medical, psychological, physical, and QoL outcomes.

Factors influencing the implementation of integrated screening for HIV, syphilis, and hepatitis B for pregnant women in Nepal: A qualitative study.

In Nepal, national guidelines recommend free HIV and syphilis screening for pregnant women at their first antenatal visit, using an opt-out approach. However, screening uptake is low and the guidelines do not include hepatitis B screening. It is essential to understand the factors influencing the implementation of integrated screening for HIV, syphilis, and hepatitis B, as recommended by WHO, to improve uptake and prevent vertical transmission. This study explored the knowledge, attitudes, and perceptions of pregnant women, their families, healthcare providers and policymakers on integrated prenatal screening. We conducted 12 in-depth interviews with pregnant women, 10 with their husbands and 4 with mothers-in-law in Kapilvastu and Kathmandu. In addition, we interviewed 7 health workers and 4 decision-makers. These interviews were sufficient to reach saturation. Data were analysed using a thematic content analysis. A combination of the social-ecological model and the WHO building blocks provided a theoretical framework for interpreting data. The analysis showed that antenatal screening in Nepal involved many stakeholders and was influenced by various factors. Implementation issues were found in the building blocks service delivery, health workforce and medical products. Husbands and in-laws play an important role in the acceptance of screening by pregnant women, especially in rural areas. High levels of stigma and discrimination against people with sexually transmitted diseases were reported, and knowledge of hepatitis B and syphilis was low. Access and uptake of screening could be improved through rapid testing, by strengthening the health system and by integrating hepatitis B screening through an opt-out approach like that for HIV and syphilis. Effective community involvement through awareness campaigns and investment in lower-level health facilities is essential to improve screening rates. This study provides information for decision-makers about challenges in implementing integrated screening to guide the design of targeted interventions to reduce vertical transmission.

Implementing a scoping review to explore sport officials' mental health.

Sport officials are tasked with applying rules, maintaining fairness, and ensuring athlete safety. However, sport officials experience anxiety, burnout, and non-accidental violence, with the incidence of these events increasing worldwide. This has led to rising attrition rates among sport officials, with many sport organizations concerned for their operational capacity. The effects of anxiety, burnout, and non-accidental violence might contribute to or be indicative of sport officials' negative mental health outcomes. To develop a clear understanding of how sport officials' mental health is affected by their occupation, it is necessary to identify the mental health outcomes and predictors they experience, and to what extent. The purpose of this scoping review was to identify and examine the empirical research and policy documents surrounding sport officials' mental health. One thousand, two hundred six articles were identified across four databases: PubMed, Web of Science, SportDiscus, and PsycINFO. Next, a policy search was conducted on the respective international governing body websites from English-speaking countries for the 60 included sports. Following screening, 18 studies and one policy document met the inclusion criteria for exploring sport officials' mental health. Participants (N = 7,941) in the studies were mainly European male soccer and basketball referees. Most studies utilized quantitative inquiry (n = 15) rather than qualitative methods (n = 2) or framework development (n = 1). The research demonstrated that sport officials frequently experienced negative mental health outcomes and predictors including anxiety, depression, burnout, lower mental health literacy, and high levels of stigmatization towards mental health. These outcomes were influenced by gender/sex, age, and experience. There is a need to explore personal and environmental (including occupational) factors that cause or contribute to sport officials' mental health symptoms and disorders.

Self-stigma of leprosy affected persons in Jaffna District

Leprosy new case detections are stagnant over the past 20 years and continue to be stigmatized in socially marginalized groups and the urban poor are less likely to seek care. There is a big gap in studies related to leprosy stigma in Sri Lanka. This study aimed to measure the stigma among leprosy affected persons in Jaffna District.This was a cross sectional descriptive study done in dermatology clinic, teaching hospital, Jaffna using all 109 leprosy patients. The validated interviewer administered questionnaire with the tool (Internalized Scale of Mental Illness (ISMI) adapted for leprosyaffected persons) was used to measure the stigma. Average of mean scores (with SD) was calculated to demonstrate the level of stigma. The level of stigma to different domains/item responses were described by presenting compound bar diagrams/charts.Mean age of the participants was 40.3±18.6yrs. Most of the participants were males (53.2%), Sri Lankan Tamils (97.2%), Hindus (77.1%), married (65.1%), from MOH Chankanai area (50.5%) and affected by MB type of leprosy (68.8%). Only 44% completed secondary education, 36.7% had no job and 32.1% were manual workers. The mean score of (ISMI) leprosy patients was 2.43 which mean high level of stigma. The response pattern to different components of ISMI was heterogeneous.

Stigma-Generating Mechanisms in Families Enrolled in a Pediatric Weight Management Program: A Qualitative Study of Health Identities and Healthcare Authenticity.

In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma.

The Voter Next Door: Stigma Effects on Advance Voting for Radical Right Parties

Despite the influence of stigmatization on vote choices, little attention has been given to the impact of social stigma on voters’ selection of voting procedures. To bridge this gap, our study focuses on Sweden, where the open-display ballot system at polling stations potentially compromises vote secrecy. Using survey data from the Swedish National Election Studies in 2014 and 2018, we examine the relationship between citizens’ voting procedure choices and their support for a highly stigmatized radical right party, the Sweden Democrats. Our findings reveal that voters of the Sweden Democrats are more inclined to vote in advance, particularly in districts with low general party support, indicating a high level of stigma. We argue that advance voting can be seen as a strategy to safeguard vote secrecy when voting for stigmatized parties within an institutional context featuring public displays of ballots. In addition, our research sheds light on the importance of electoral integrity in maintaining the confidentiality of voters’ choices.

Stigma and Discrimination of family care giver's (FCG) – A Barrier in mental illness: Scoping Review

Mental disorders are considered as invisible disorders as they are overlooked by patients, caregivers, health professionals, and policymakers yet cause significant health burdens. People with mental illness are subjected to high levels of stigma and discrimination because of widely held misconceptions about the causes and nature of mental illness. varies from 43% to 83%. Stigma and discrimination can occur in one or the other form. The co-occurrence of five components of stigma includes labelling, stereotyping, separation, status loss, and discrimination”. Literature identifies different types of mental health-related stigma, including self-stigma, public stigma, professional stigma, and institutional stigma. Stigma in mental illness is a serious social problem that has a multitude of consequences on the individual concerned and his or her family. This paper throws light on the extent, problems associated, consequence and strategies to overcome stigma and burden among family caregivers so that the family members consider mental illness as disease which requires treatment.

Internalized Stigma and its Correlates Among Opioid Agonist Treatment Service Users in Nepal

Opioid use disorder is associated with high levels of stigma and discrimination, which impact treatment seeking and compliance. Despite extensive evidence as an optimal intervention for opioid use disorder, enrollment in Opioid Agonist Treatment (OAT) in settings like Nepal, is accompanied by moral judgements and stigma with a broad narrative of it being merely a replacement of ‘one addiction with another’. Stigma is eventually internalized by many service users impacting enrollment and maintenance in OAT, and quality of life. This study aimed to assess internalized stigma among OAT service users in Nepal and to explore its association with sociodemographic characteristics, lifetime mental disorders and quality of life. A cross-sectional study was conducted among 231 OAT service users, the survey instrument included the Mini-International Neuropsychiatric Interview for DSM-5, Internalized Stigma of Mental Illness Inventory (ISMI) and the World Health Organization Quality of Life –BREF. Factors associated with quality of life and internalized stigma were investigated using bivariate and multivariate analyses. More than half (56.28%) of respondents reported having high internalized stigma with a mean ISMI score of 2.71 ± 0.64. All 29 ISMI items were found to have a mean score greater than 2.5 indicating a high burden of internalized stigma. Service users reporting higher internalized stigma had significantly lower quality of life across all domains, greater medical co-morbidity, lifetime anxiety and depressive disorder and alcohol use disorder. To lessen stigma and its impacts, our findings recommend a national initiative targeting stigma reduction interventions for existing OAT services and beneficiaries.

Human immunodeficiency virus care and management in incarcerated populations in Sub-Saharan Africa between 2010 and 2022: A narrative review.

Different countries in sub-Saharan Africa (SSA) have established guidelines to reduce HIV transmission and improve its management in prisons. This narrative review aimed to examine established literature on HIV care and management among incarcerated persons in SSA to identify successful interventions that could inform improved guidelines, policies, and practices related to the clinical care of this population. We searched PubMed, Scopus, Web of Science, Embase, and TRIP Medical Databases in August 2022 for articles published between 1st January 2010 and 30th June 2022. We identified 27 eligible articles based on the Population/Concept/Context framework. HIV screening primarily involved mass campaigns rather than formal prison programmes, with limited implementation of universal testing and treatment. Although a few studies reported on access to antiretrovirals (ARVs), prisoners in urban areas and females had disproportionate access. Barriers identified include poor living conditions, high levels of stigma, and resource constraints. Inter-prison transfers, release from prison, and lack of established programmes hindered follow-up and linkage to care. The implementation of strategies such as universal testing and treatment, human resource strengthening, financing plans for testing, ARV care, and frequent assessment of risk could improve HIV care and management in prisons in SSA.

Avoidance and empowerment: How do sex workers navigate stigma?

It is well known that sex workers experience high levels of stigma. This research examined the techniques sex workers use to ameliorate the emotional and practical impacts of that stigma. Twenty female sex workers with varying roles of escorts, porn actresses, camgirls and content creators were interviewed. Our participants revealed that they used avoidance techniques, such as selective disclosure and the construction of alternate personas. Interestingly, they also reported that they employed positive techniques, such as being unapologetic and deriving confidence from their profession. We suggest that teaching stigma management techniques could be an important tool for sex work organisations to support both established and newer sex workers.

Distribution of perceived weight stigma and its psychological impact on obese people in Saudi Arabia

BackgroundWorldwide, obesity prevalence has nearly tripled since 1975, with about 13% of adults being obese and about 39% overweight. Overweight and obese persons are vulnerable to frequent stigmatization and discrimination because of their weight, an issue that is barely discussed in the medical literature. In Saudi Arabia, the prevalence of obesity is 36%. However, there is no available data on the prevalence of perceived weight stigma among obese people. Therefore, this study aims to (a) determine the Distribution of perceived weight stigma among obese people, (b) identify the major sources of stigma, and (c) determine the psychological impact of perceived weight-based stigma on obese people in Saudi Arabia. MethodsThis is a cross-sectional study conducted in Saudi Arabia using an online questionnaire that includes Stigmatizing Situations Inventory Scale (SSI) and Perceived Stress Scale (PSS). Results1341 people participated in the study, of which 819 (61%) were females and 522 (39%) were male. Of all, 62 (5%) were underweight, 357 (27%) were normal weight, and 922 (69%) were overweight or obese. Participants in the overweight/obese category scored higher on average in every SSI item than did their counterparts in the underweight and normal weight categories, indicating higher levels of stigma among overweight and obese participants. The major sources of stigma for overweight and obese participants were identified based on the mean of participant responses to each item. These were: assumption about overeating or binge eating (mean response ± SD 2.80 ± 3.01), children's comments (2.22 ± 2.58), being stared at in public (2.18 ± 2.83) and being singled out as a child (2.05 ± 2.67). ConclusionParallel with the literature, our findings indicate a high prevalence of weight stigma in Saudi Arabia which can have negative psychological implications on obese people.

The associations between public stigma and support for others’ help-seeking for alcohol use disorder: a cross sectional study in the general Danish population

BackgroundA minority of all individuals with alcohol use disorders (AUD) seek treatment, where stigma is one prominent barrier. Social support is important to facilitate health and increase treatment-seeking. Whether there is an association between stigma and attitudes towards others’ help-seeking for AUD is unknown. The aim of this study was to investigate the associations between stigma and support towards others’ help-seeking for AUD, also to explore possible gender differences.MethodCross-sectional study, n = 2895, including Danish adults aged 30–65 in the general population. Year 2020, an online questionnaire was administrated, which covered demographics, attitudes towards others’ help-seeking for AUD, and stigma measured with the Difference, Disdain & Blame Scales. Analyses were performed with Restricted Cubic Spline models, and odds ratios were calculated.ResultsLower level of stigma was associated with a higher probability for endorsing an “active support strategy”. Level of stigma was not associated with “not knowing what to say or do” or “sharing my concern with others”. There were few gender differences: among men, higher level of stigma was associated with a higher probability of “avoidance”. Among women, lower level of stigma was associated with a lower probability of “avoidance”.ConclusionThere is a clear association between stigma and attitudes towards supporting others’ help-seeking for AUD. The results highlight the need to reduce stigma and promote engagement towards others’ treatment-seeking.

Parent's Stigma Towards Childhood Tuberculosis: A Multicenter Survey from Eastern Bandung Regency

Aims: Tuberculosis-related stigma negatively influences tuberculosis prevention programs such as delayed diagnoses, poor treatment adherence, and decreased quality of life of patients. This descriptive quantitative study aimed to describe the stigma towards tuberculosis among parents. Method: A total of 30 samples taken through accidental sampling were parents who had children (0-14 years) with tuberculosis who had been treated at the public health centers. A questionnaire adapted from Van Rie TB Stigma Scale (VTSS) was used and analyzed using descriptive analysis. Result: Most parents (76.6%) had lower levels of stigma, while the others scored higher levels. Lower stigma levels can be caused by a mature mindset, good knowledge of TB information, and indicates higher hopes from parents to increase their care level for children’s development, health-seeking behavior, and support for children’s TB treatment until it is completed. Accordingly, higher stigma levels from parents might be a result of several external factors that can increase the lack of motivation for health-seeking behavior in their children’s TB treatment. Conclusion: The role of health workers is very important in reducing stigma. Health education about prevention and treatment of childhood tuberculosis is still needed because it is a source of fear and high stigma against childhood tuberculosis in society.

Stigma and its correlates among patients with Crohn’s disease: A cross-sectional study in China

ObjectivesCrohn’s disease is an incurable disease characterized by unpredictable intestinal symptoms, which unavoidably affect patients’ lives and contribute to feelings of stigma. This study aimed to explore the status and its correlates of stigma among patients with Crohn’s disease. MethodsUsing a convenience sampling, 146 hospitalized patients with Crohn’s disease were recruited in a tertiary hospital in Southern China from October 2020 to March 2021. The participants were assessed by demographic and disease-related questionnaires, the Social Impact Scale (SIS), Inflammatory Bowel Disease-Self-Efficacy Scale (IBD-SES), and Social Support Rating Scale (SSRS). Multivariate linear regression analysis was conducted to explore the influencing factors of stigma among patients with Crohn’s disease. ResultsThe mean SIS score was 58.14 ± 10.74, representing a moderate effect of stigma, and 85.6% (125/146) of the patients experienced moderate to high levels of stigma. The multiple linear regression analysis showed that perceived public awareness of the disease, family income, age, and self-efficacy were the main influencing factors of stigma, which could explain 52% of the total variation of stigma among patients with Crohn’s disease. ConclusionStigma among patients with Crohn’s disease is influenced by perceived public awareness of the disease, family income, age, and self-efficacy. Interventions aimed at improving self-efficacy and public awareness should be considered to alleviate the level of stigma, especially for those aged 40 years or older or low-income patients.

624-P: Portrayal of Perceived Stigma across Ages in Type 1 Diabetes—A BETTER Registry Analysis

Background: People with type 1 diabetes (PWT1D) perceiving high diabetes-related stigma are less likely to report in-target A1c levels. We hypothesized that people with higher levels of stigma have suboptimal psychosocial outcomes and that stigma would be perceived differently across age groups. Methods: Cross-sectional analysis of 709 PWT1D aged ≥14 years in the BETTER T1D registry (Quebec, Canada) who completed the T1D Stigma Assessment Scale (DSAS-1). The DSAS-1 (/95) includes 3 subscales; Blame &amp; Judgment (6 items), Identity Concern (7 items), and Treated Differently (6 items). Individuals who perceived more stigma compared to the total cohort (DSAS-1 mean score +1 standard deviation), were stratified into groups by age to determine associations with diabetes self-management behaviours and outcomes. Results: Across groups, youth (n=105; 14-24 years) had the highest stigma perception (20%), followed by 18% in middle-aged adults (n=401; 35-64 years), then 15% for both young adults (n=130; 25-34 years) and seniors (n=73; 65+ years). The majority of youth, young and middle-aged adults, and seniors perceived stigma as Blame &amp; Judgment (51%, 44%, 33%, and 19%, respectively). Stigma related to Identity Concern was highest among seniors (15%). In an age- and diabetes duration-adjusted models, 40% of adjusted variance in stigma score was explained by increased diabetes distress (p&amp;lt;0.001), depression (p=0.005), hyperglycemia avoidance behaviours (p&amp;lt;0.001), fear of hypoglycemia (p&amp;lt;0.001) and decreased social support (p&amp;lt;0.001). Conclusion: Interventions targeting diabetes-related stigma need to be tailored for different age groups to target suboptimal diabetes self-management behaviours and improve psychosocial outcomes. Disclosure A.Housni: None. A.Katz: None. J.C.Kichler: None. M.Nakhla: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé. Funding JDRF (4-SRA-2018-651-Q-R); Canadian Institutes of Health Research (JT1-157204)

Correlates of Suicidal Ideation Among Sexual Minority Male Students in a Nigerian University

Sexual minority men report higher suicidal ideation compared to heterosexual men. As a consequence of the high levels of stigma in Nigeria and most of sub-Saharan Africa, few studies have investigated psychosocial risk factors for suicidal ideation in these settings. The present study aimed to fill this research gap by identifying factors associated with suicidal ideation among Nigerian sexual minority men. Eighty-one sexual minority men were assessed for suicidal ideation, sociodemographic and family background, sexuality-related, minority stress, and psychosocial factors. Childhood adversity, minority-stress factors, and all three psychosocial (intimate partner violence, alcohol use problems and depressive symptoms) variables were significantly associated with increased suicidal ideation (ΔR2= 11%, 15% and 20%, respectively). Our findings highlight the importance of known risk factors for suicidal ideation as well as factors specific to sexual minority men. Recognising these factors may help in identifying young sexual minority men who may require further support in high-stigma settings such as Nigeria.

Exploring relationships between HIV programme outcomes and the societal enabling environment: A structural equation modeling statistical analysis in 138 low- and middle-income countries.

Countries worldwide have attempted to reduce the incidence of HIV and AIDS associated deaths with varying success, despite significant progress in antiretroviral treatment (ART) and condom use. A chief obstacles is that key populations affected face high levels of stigma, discrimination and exclusion, limiting the successful response to HIV. However, a gap exists in studies demonstrating the moderation effects of societal enablers on overall programme effectiveness and HIV outcomes using quantitative methods.Structural Equation Modeling was used for 138 countries covering a 12-year period to examine how the unfavorable societal enabling environment, including stigma and discrimination, unfavorable legal environment and lack of access to societal justice, gender inequality and other unfavorable development situations affect the effectiveness of HIV programmes and HIV outcomes, while controlling for potentially confounding variables. The results only showed statistical significance when all four societal enablers were modeled as a composite. The findings show the direct and indirect standardized effects of unfavorable societal enabling environments to AIDS-related mortality among PLHIV are statistically significant and positive (0.26 and 0.08, respectively). We hypothesize that this may be because an unfavorable societal enabling environment can negatively affect adherence to ART, quality of healthcare and health seeking behavior. Higher ranked societal environments increase the effect of ART coverage on AIDS related mortality by about 50% in absolute value, that is -0.61 as against -0.39 for lower ranked societal environments. However, mixed results were obtained on the impact of societal enablers on changes in HIV incidence through condom use. Results indicate that countries with better societal enabling environments had fewer estimated new HIV infections and fewer AIDS-related deaths. The failure to include societal enabling environments in HIV response undermines efforts to achieve the 2025 HIV targets, and the related 2030 Sustainable Development indicator to end AIDS, even if sufficient resources are mobilized.

Examining mental health knowledge, stigma, and service use intentions among Royal Canadian Mounted Police cadets.

Royal Canadian Mounted Police (RCMP) officers experience an elevated risk for mental health disorders due to inherent work-related exposures to potentially psychologically traumatic events and occupational stressors. RCMP officers also report high levels of stigma and low levels of intentions to seek mental health services. In contrast, very little is known about the levels of mental health knowledge and stigma of RCMP cadets starting the Cadet Training Program (CTP). The current study was designed to: (1) obtain baseline levels of mental health knowledge, stigma against peers in the workplace, and service use intentions in RCMP cadets; (2) determine the relationship among mental health knowledge, stigma against peers in the workplace, and service use intentions among RCMP cadets; (3) examine differences across sociodemographic characteristics; and (4) compare cadets to a sample of previously surveyed serving RCMP. Participants were RCMP cadets (n = 772) starting the 26-week CTP. Cadets completed questionnaires assessing mental health knowledge, stigma against coworkers with mental health challenges, and mental health service use intentions. RCMP cadets reported statistically significantly lower levels of mental health knowledge (d = 0.233) and stigma (d = 0.127), and higher service use intentions (d = 0.148) than serving RCMP (all ps < 0.001). Female cadets reported statistically significantly higher scores on mental health knowledge and service use and lower scores on stigma compared to male cadets. Mental health knowledge and service use intentions were statistically significantly positively associated. For the total sample, stigma was inversely statistically significantly associated with mental health knowledge and service use intentions. The current results indicate that higher levels of mental health knowledge were associated with lower stigma and higher intention to use professional mental health services. Differences between cadets and serving RCMP highlight the need for regular ongoing training starting from the CTP, designed to reduce stigma and increase mental health knowledge. Differences between male and female cadets suggest differential barriers to help-seeking behaviors. The current results provide a baseline to monitor cadet mental health knowledge and service use intentions and stigma as they progress throughout their careers.

Violence, women, blood(line): Hong Kong films of severe mental illness

ABSTRACT Hong Kong has commendably progressive mental health care for local people with a severe mental illness. Social stigma towards these people, however, remains unyieldingly intense and widespread. This occurs despite Hong Kong’s well-regarded community psychoeducation regime. This study analyses how popular local films contribute to an apparent paradox, whereby a society with innovative mental health care and community psychoeducation retains conspicuously high levels of stigma towards people with a severe mental illness. The study employs a well-tested narrative-cum-discourse analytic approach to reveal how four contemporary local films construct and make sense of the illness, and why they do so in the ways that they do. The analysis finds that, regardless of a film’s social intent or commercial status, it casts local men with severe mental illness as dangerous and macabrely violent. Women are assigned blame for this. The films further justify the removal of people with the illness from everyday society, in line with longstanding Chinese cultural scripts. As a result, the filmic portrayals discursively align with local newspaper reporting on severe mental illness, disregarding the humane principles espoused and embraced by local mental health care and community psychoeducation.

Structural Equation Modeling of Stigma and HIV Prevention Clinical Services Among Transgender and Gender Diverse Adults: The Mediating Role of Substance Use and HIV Sexual Risk.

Transgender and gender diverse (TGD) adults experience high levels of stigma that contributes to elevated substance use and HIV sexual risk behaviors. Despite higher burdens of substance use and HIV compared to cisgender adults, TGD individuals may be less likely to engage in health care to avoid further discrimination. This analysis included 529 TGD adults in Massachusetts and Rhode Island who were HIV negative or had an unknown HIV serostatus and were purposively sampled between March and August 2019. We used structural equation modeling to test whether substance use, HIV sexual risk behaviors (ie, condom use, sex work, and multiple partners), and receiving gender-affirming hormone therapy mediate any observed association between TGD-related stigma and utilization of HIV prevention clinical services (ie, HIV prevention programs, PrEP use, and HIV testing). Substance use and HIV sexual risk mediated the relationship between TGD-related stigma and utilization of HIV prevention clinical services (β = 0.08; 95% CI = 0.05, 0.17; P = 0.03 and β = 0.26; 95% CI = 0.14 to 0.37; P < 0.001). Having a hormone therapy prescription was not a mediator between TGD-related stigma and HIV prevention clinical services. Future interventions that aim to improve HIV prevention clinical services among TGD adults should consider the impact of TGD-related stigma on participants' substance use and sexual risk behaviors. These efforts require that health care organizations and community organizations make a deliberate investment in the reach and success of interventions and programs.