Higher Stigma Research Articles

Barriers to HIV care in Uganda and implications for universal test-and-treat: a qualitative study

ABSTRACT Achieving universal HIV test-and-treat will require targeted interventions for those with worse outcomes, including advanced HIV. We conducted qualitative, semi-structured interviews with healthcare workers (HCWs) and people living with HIV (PLWH) at 5 HIV clinics in Kampala, Uganda, to understand barriers to care. PLWH enrolled started/restarted on HIV treatment ≤3 months prior. PLWH were grouped as 1) “ART-experienced” or those restarted therapy after ≥12 months off, 2) ART naïve CD4 count <100 cells/uL “late presenters” or 3) ART naïve CD4 count >350 cells/uL “early presenters”. In-depth interviews were conducted in Luganda, translated, and transcribed verbatim. Between May and August 2017, 58 PLWH and 20 HCWs were interviewed. High stigma and low social support emerged as themes among all as barriers to care. Alcohol abuse was a barrier for men. Fear of domestic violence and abandonment were barriers for women, limiting disclosure of their HIV status to their male partners. Clinic factors such as rapport with staff, distance, efficiency, and privacy impacted care. Future interventions to decrease delayed ART initiation should target stigma and social support. Assisted disclosure, contact tracing, and alcohol abuse treatment should be implemented. Strengthening client support, reducing wait times, and increasing privacy assurances would improve care-seeking behaviors.

Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky

BackgroundEnrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study’s purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky.MethodsWe conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017–2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory.ResultsStigma, a feature of IREF’s meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID’s individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment.ConclusionsFeatures of the social and healthcare environments operating at the meso-level, as well as PWID’s individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.

Suicide literacy, suicide stigma, and psychological help seeking attitudes among Arab youth.

To date, very little is known about the current situation of suicide and its effects on psychological help-seeking attitudes in Arab countries. Therefore, this study aimed to assess the levels of suicide literacy and suicide stigma and their relationships with attitudes towards seeking psychological help among a sample of Arab youth in Jordan. A descriptive, correlational, cross-sectional study was conducted using an anonymous online self-report survey to collect data. This study included a total of 707 Arab youth aged 16–24 years (mean = 18.60, SD = 1.95). Most of the participants were male (n = 398, 56.3%). The participants were found to have very low suicide literacy levels, relatively high suicide stigma levels, and negative attitudes towards seeking psychological help. Family members, relatives, and friends were the most frequently reported sources of psychological help, while mental healthcare professionals were the least frequently reported sources. A significant negative correlation was found between attitudes towards seeking psychological help and both stigmatization and glorification subscales of suicide stigma. While a significant positive correlation was found between attitudes towards seeking psychological help and suicide literacy. The predictors of attitudes towards seeking psychological help were gender, suicide literacy, and glorification of suicide stigma among Arab youth. The results of this study confirm the presence of an urgent need for designing and implementing educational programs and awareness campaigns on suicide and mental health among youth in schools and universities. Such interventions may increase knowledge, decrease stigma, change psychological help-seeking attitudes, and hence improve the use of mental health services and may prevent suicide among this age group.

Internalized Stigma in Persons With Mental Illness in Qatar: A Cross-Sectional Study.

Stigma impacts persons with mental illness (PWMI), their families and network of friends, the public and health care professionals. Stigma is a major barrier for PWMI to seeking treatment, which contributes to the burden of disease, disability, and mortality. Research on stigma is relatively scant in the Middle East region and particularly in Qatar. To address stigma effectively in each culture, it is essential to study its nature in the context where the PWMI experience stigma. The purpose of this study was to assess the prevalence of internalized stigma in PWMI in Qatar. A cross-sectional study of PWMI receiving outpatient mental health services in Qatar was done. We interviewed 417 PWMI using a modified 18-item version of the short form of the Internalized Stigma of Mental Illness (ISMI) Scale. Descriptive and regression models were used to analyze the data. The Cronbach alpha for the modified 18-items ISMI was 0.87. Participants' average score on this scale was 2.07 ± 0.38 with 41 (9.8%) of them scoring more than 2.5 which is considered “high” stigma score. In multivariate logistic regression, high stigma (modified ISMI score >2.5) was significantly higher among PWMI with no formal education and among those who reported lower levels of social support. The reported levels of internalized stigma in this vulnerable population of Qatar fall at the lower spectrum reported worldwide. An anti-stigma education program designed for the context of Qatar emphasizing on education and support for PWMI may be conducive to creating an all-inclusive society.

Stigma toward individuals with mental disorders among Brazilian psychiatrists: a latent class analysis

Objective:The stigma toward individuals with mental disorders is highly prevalent, not only in the general population but among health care providers as well. The aim of this study was to identify subgroups based on stigmatizing beliefs related to psychiatric disorders among Brazilian psychiatrists, as well as to investigate their association with clinical and personality characteristics.Methods:Latent cluster analysis was used to find subgroups of cases in multivariate data according to a psychotic (schizophrenia) and a nonpsychotic disorder (attention-deficit hyperactivity disorder). The clusters for each psychiatric disorder were compared according to sociodemographic, emotional traits, and personality characteristics.Results:A total of 779 psychiatrists answered the questionnaire. Three different subgroups of stigma levels were identified regarding schizophrenia: the highest (n=202 [51.7%]), intermediate (108 [27.6%]), and the lowest (81 [20.7%]). Participants from the highest stigma group had a significantly longer time since graduation, higher anxiety-state scores, and lower positive affect. Two subgroups were identified with respect to attention-deficit hyperactivity disorder, although there were no differences between them in sociodemographic or clinical variables.Conclusion:There were more subgroups of stigmatizing beliefs regarding psychotic disorders. Individual characteristics, such as those related to trait anxiety and affect, can be associated with high stigma toward schizophrenia.

ANALISIS HUBUNGAN FAKTOR DEMOGRAFI, FAKTOR PENYAKIT, DAN FAKTOR PSIKOLOGIS DENGAN MAKNA SPIRITUAL PENGALAMAN SAKIT

The prevalence of HIV/AIDS is increasing in almost all over the world, the most incidence is in productive age. High community stigma and discrimination, has a negative impact on people living with HIV/AIDS (PLWHA) and the wider life. Objective: Identify the relationship between demographic factors (age, gender, latest education, occupation, religion, economic status, marital status), disease factors (initial diagnosis, opportunistic infections, medication adherence), and psychological factors (anxiety and depression) with meaning, spiritual experience of illness in PLHIV in East Jakarta. This study used a cross sectional study design with consecutive sampling involving 225 respondents at the Bhayangkara Hospital Level I R. Said Sukanto, Jakarta. The independent t test obtained the age factor with a p value of 0.043, meaning that there was a relationship between age and the spiritual meaning of the experience of illness. Chi square test on the factors of gender, recent education, employment, religion, economic status, marital status, early diagnosis, opportunistic infections, adherence to taking medication, anxiety and depression obtained p value&gt; 0.05 means that there is no relationship between these factors and meaning, spiritual experience of illness. Opportunistic infection is a dominant factor related to the spiritual meaning of the experience of illness. There is a relationship between age and the spiritual meaning of the experience of illness, and opportunistic infections are the dominant factor related to the spiritual meaning of the experience of pain. Suggestion: It is necessary to do further research based on initial diagnosis or duration of HIV infection.

Sociodemographic correlates of public stigma about mental illness: a population study on Hong Kong\u2019s Chinese population

BackgroundIndividuals with psychiatric disorders are often unwilling to seek help or often follow treatment regimens, fearing public stigma. This study identified the sociodemographic correlates of public stigma while accounting for mental health literacy and life satisfaction.MethodsThis study analysed data for 1514 individuals who participated in a population-based random telephone survey conducted in 2018. Sociodemographic characteristics included gender, age, education level, and occupation. Data on public stigma, mental health literacy, and life satisfaction were also collected. Multiple linear regression was conducted to examine the effects of sociodemographic characteristics on public stigma. A moderation analysis was performed to investigate the role of age and education in the relationship between mental health literacy and public stigma.ResultsSociodemographic characteristics, such as female gender, older age, lower education, and occupation (particularly retired and homemakers), were associated with a higher public stigma. The association between public stigma and mental health literacy was the most significant among individuals aged 50 years and above with lower education levels.ConclusionsThis study showed that certain population subgroups, based on their sociodemographic profile, have a higher stigma about mental illnesses. Understanding the differential effects of sociodemographic factors on public stigma is imperative to developing effective anti-stigma campaigns.

The Influence of Stigmatizing Messages on Danger Appraisal: Examining the Model of Stigma Communication for Opioid-Related Stigma, Policy Support, and Related Outcomes

ABSTRACT Drug overdose is a leading cause of injury and death in the United States, and opioids are among the most significant of causes. For people with opioid use disorders (OUDs), opioid stigma can lead to devastating consequences, including anxiety and depression. Still, mass media may stigmatize people with OUDs by ascribing stigmatizing labels (e.g., “opioid addict”) and other stigma features to those individuals. However, it is unclear how these stigmatizing messages influence public perceptions of people with OUDs and public support for rehabilitation and Naloxone administration policies. The model of stigma communication (MSC) provides a framework for understanding these relationships. This study used the MSC in two online factorial experiments, the first among college undergraduates (N = 231) and the second among Amazon Mechanical Turk workers (N = 245), to examine how stigmatizing messages about people with OUDs influence stigma-related outcomes. Results reveal that opioid stigma messages influence different outcomes depending on the content of those messages. Classification messages with a stigmatizing mark (e.g., “Alex appears unkempt”) and label (e.g., “opioid addict”) led to greater perceptions of dangerousness and threat in both studies. High stigma classification messages also led to an increased desire for behavioral regulation and social distance in Study 2. Structural equation modeling in Study 1 also supported the applicability of the MSC in the opioid context. Implications for health communication theory development and practice are discussed.

Understanding and addressing privacy and confidentiality concerns associated with the provision of mobile HIV care: a qualitative study

ABSTRACT Less than half the people with HIV (PLWH) in the United States (US) are retained in HIV care, underscoring the importance of novel reengagement and retention strategies. Mobile HIV clinics (MHCs) are one such strategy, but privacy and confidentiality concerns have limited their use. As part of a larger mixed-methods study in Atlanta, Georgia, from June 2019- July 2020, we conducted 41 qualitative interviews with key stakeholders to explore confidentiality, privacy and stigma concerns and strategies to address them. Interviews were recorded, transcribed and coded thematically. Four key themes emerged: 1) the need to understand MHC acceptance in the context of high HIV stigma in the South, 2) the multidimensionality of confidentiality and stigma concerns (e.g., related to exterior labeling, layout, location attracting unwanted attention), 3) the counter perspective: potential for MHCs to positively reframe HIV and reduce stigma, and 4) strategies to overcome stigma and confidentiality concerns, including co-delivery of non-HIV services, unidirectional flow, and non-HIV exterior labeling. In furthering understanding of the breadth of privacy and confidentiality concerns associated with an MHC and strategies for addressing them, this exploratory study lays a critical foundation for the development of an MHC to reengage and retain PLWH in the US.

Diagnostic efficacy for predicting intraductal papillary mucinous neoplasms of the pancreas with high grade dysplasia or invasive carcinoma based on the surgery indications in different guidelines

Objective: To evaluate the performance of the European Evidence-based Guidelines on Pancreatic Cystic Neoplasms (EEGPCN)(2018) and International Association of Pancreatology(IAP) Guideline(Version 2017) in predicting high grade dysplasia/invasive carcinoma-intraductal papillary mucinous neoplasm(HGD/INV-IPMN). Methods: A retrospective analysis of 363 patients,who underwent surgical resection in Changhai Hospital affiliated to Navy Medical University from January 2012 to December 2018 and were pathologically identified as (intraductal papillary mucinous neoplasm, IPMN),was performed. The patients,including 230 males and 133 females,aging (61.7±10.1) years(range:19 to 83 years). The proportion of HGD/INV-IPMN who met with the absolute indication(AI) of EEGPCN and high risk stigma(HRS) of IAP were compared. The binary Logistic regression analysis was used to find the independent risk factors of HGD/INV-IPMN.Eight combinations of risk factors derived from relative indication/worrisome feature or risk factors in this study,were made to evaluate the diagnostic efficacy. The area under curve(AUC) of receiver operating characteristics was used to evaluate the the cutoff value of risk factors(①CA19-9≥37 U/ml,②diameter of main pancreatic duct 5.0-9.9 mm,③enhancing mural nodule<5 mm,④(acute) pancreatiti,⑤acyst diameter ≥40 mm,⑤bcyst diameter ≥30 mm, ⑥thickened or enhancing cyst walls,⑦neutrophile granulocyte to lymphocyte ratio(NLR)≥2, ⑧cyst located in head, uncinate or neck,⑨carcinoembryonic antigen(CEA) ≥5 μg/L) number for predicting HGD/INV-IPMN.The accuracy,sensitivity,specificity,positive predictive value,negative predictive value,true positive,true negative,false positive,false negative,positive likelihood ratio,negative likelihood ratio,Youden index and F1 score were calculated. Results: Ninety-two patients(49.5%) of 186 ones who met AI and 85 patients(48.3%) of 176 ones who met HRS were respectively confirmed as HGD/INV-IPMN. In those patients who were not met AI,tumor location,thickened/enhancing cyst wall,CA19-9 elevated,NLR≥2 and CEA elevated were significantly (P<0.05) correlated with HGD/INV-IPMN. And tumor location(head/uncinate/neck vs. body/tail,OR=3.284,95%CI:1.268-8.503,P=0.014),thickened/enhancement cyst wall (with vs.without,OR=2.713,95%CI:1.177-6.252,P=0.019),CA19-9(≥37 U/L vs.<37 U/L, OR=5.086,95%CI:2.05-12.62,P<0.01) and NLR(≥2 vs.<2,OR=2.380,95%CI:1.043-5.434,P=0.039) were the independent risk factors of HGD/INV-IPMN. Patients with ≥4 risk factors of 9 in combination Ⅷ(①②③④⑤b⑥⑦⑧⑨) were diagnosed as HGD/INV-IPMN with the moderate accuracy(71.0%),moderate sensitivity (62.0%) and moderate specificity (73.0%). Patients with ≥4 risk factors of 9 in Combination Ⅶ(①②③④⑤a⑥⑦⑧⑨) were diagnosed as HGD/INV-IPMN with the highest specificity(83.0%) and patients with ≥3 risk factors of 8 in combination Ⅵ(①②③④⑤b⑥⑧⑨) were diagnosed as HGD/INV-IPMN with the highest sensitivity(74.0%). The AUC for diagnosis of HGD/INV-IPMN in combination Ⅵ,Ⅶ and Ⅷ were 0.72,0.75 and 0.75,respectively. Older patients and younger patients could respectively refer to combination Ⅶ and combination Ⅵ to improve the management of IPMN. Conclusions: Patients who meet AI of EEGPCN should undertake resection, otherwise the method we explored is recommended. The method of improvement for diagnosis of HGD/INV-IPMN is relatively applicable and efficient for decision-making of surgery, especially for younger patients with decreasing of missed diagnosis and elder patients with decreasing of misdiagnosis.

A clinical study of new cases of Hansen’s disease at a tertiary health care centre in post elimination era

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Leprosy, in 2016, globally a total of 214,783 new cases were reported over half of them were from India (135,485) alone. However, 16 other countries with pockets of high endemicity were reported. On the other hand, actual numbers of people affected by the disease is likely to be far higher than statistics show as there still prevails lack of awareness about the disease, lack of skills of general health staff in leprosy diagnosis, inadequate active case findings, lack of inclusion of cases from private sector and presence of high stigma in the community. Aims and objectives were to study the number of increasing new cases of Hansen’s disease in post elimination era.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;&lt;strong&gt;:&lt;/strong&gt; A prospective observational study of number of new cases of leprosy presented at a department of DVL, BMCH, Chitradurga, Karnataka, from 2017 April-2018 September. A total of 91 cases were detected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Series of 91 cases were detected, and based on WHO classification were classified as multibacillary (MB)-72 cases and paucibacillary (PB)-19 cases. The maximum number of cases were detected between 20-29 years of age. The male to female ratio was 1.2:1. 46 (50.54%) cases were diagnosed to have borderline tuberculoid (BT). Patients mainly belonged to low socioeconomic status (89.1%). Deformities were seen in 21 (23.07%)) cases. 7 patients presented with type-I reaction and 13 patients with type-II reactions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Even with MB-MDT and monitoring, some high endemic pockets of leprosy may continue to persists in India. Every year new cases are increasing and causing morbidity from neglected cases. We should not be complacent at this stage because it may become a serious health problem again.&lt;/p&gt;

The roles of weight stigma, emotion dysregulation, and eating pathology in suicide risk

Using an interpersonal theory of suicide and affect regulation framework, we investigated the relationships between perceived burdensomeness, thwarted belongingness, weight stigmatization, emotion dysregulation, eating pathology, and suicide risk. Three main hypotheses were investigated. First, we predicted a positive linear relationship between weight stigmatization and risk. Second, an indirect effect of weight stigmatization on risk via perceived burdensomeness and thwarted belongingness was posited. Third, we hypothesized that weight stigmatization would indirectly affect suicide risk via emotion dysregulation and eating pathology. Undergraduates (N = 156) completed online surveys. Linear regressions and indirect effect analyses were performed. Weight stigmatization was directly, positively associated with increased suicide risk. Weight stigmatization indirectly affected suicide risk via perceived burdensomeness but not thwarted belongingness. Higher stigmatization was associated with higher levels of perceived burdensomeness, which was associated with higher risk. An indirect effect of weight stigmatization on suicide risk through emotional dysregulation emerged. Higher weight stigmatization was associated with higher emotional dysregulation, which was associated with higher suicide risk. When all models were combined, only an indirect effect via perceived burdensomeness remained. Our findings may have clinical and public health implications for suicide prevention among people with weight stigma-related risk factors.

Black men who have sex with men living in states with HIV criminalization laws report high stigma, 23 U.S. cities, 2017.

To examine the association between HIV laws, perceived community stigma, and behaviors and to compare differences between and within Black and White men who have sex with men (MSM). National HIV Behavioral Surveillance conducted interviews and HIV testing with MSM in 23 U.S. cities in 2017 using venue-based sampling methods. We used weighted cross-sectional data to compare MSM living in states with versus without HIV laws using Rao-Scott chi-square tests. We modeled the association between stigma and state HIV laws within racial groups to obtain adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs). Among 7392 MSM, 56% lived in a state with HIV laws. In law states, Black MSM were more likely than White MSM to report their community would discriminate against persons with HIV (PWH) (59 versus 34%), not support the rights of PWH (20 versus 9%), not be friends with PWH (19 versus 10%), believe PWH 'got what they deserved' (27 versus 16%), and be intolerant of MSM (14 versus 5%). Adjusted for confounders, Black MSM in HIV law states were more likely to think their community would discriminate against PWH (aPR, 1.14; 95% CI, 1.02-1.29; P = 0.02) and be intolerant toward MSM (aPR, 2.02; 95% CI, 1.43-2.86; P < 0.001) than Black MSM in states without such laws. HIV laws were related to higher stigma, but only for Black MSM. Future research regarding HIV-related laws should account for racial/ethnic disparities. Modernizing laws can delegitimize stigma and promote focusing on effective HIV prevention strategies.

Mental health literacy among adolescents: Evidence from a community-based study in Delhi.

Mental Health Literacy (MHL) is the ability to recognize mental disorders, along with knowledge of professional help available, effective self-help strategies, skills to give support to others, and knowledge of how to prevent mental disorders. Adequate MHL is linked to better health-seeking behavior and management of mental illness. To assess the MHL related to depression and anxiety among adolescents of age 15 to 19 years residing in Delhi. A survey was conducted among adolescents in southeast Delhi. MHL was assessed using sex-matched vignettes of Common Mental Disorders (CMDs) like depression and anxiety. MHL was assessed under domains of identifications of disorders, help-seeking behavior, knowledge about prevention, and stigmatizing attitude toward the respective illness. Statistical analysis was done in STATA and percentage of participants with adequate MHL in various domains was calculated, and difference between various groups was examined using chi-square test. A total of 491 adolescents participated (response rate of 87.2%) of whom a 50.3% were girls and 57.8% were 15 to 17 years of age. Only 50 (10.2%) participants identified depression vignette as that of depression and 51 (10.4%) identified vignette of anxiety disorder as the same. No statistically significant gender differential in MHL was seen (p value = .8). The stigmatizing attitude, assessed by asking a series of questions suggesting stigma toward the particular illness, was observed among almost all participants (depression -99.4%, and anxiety disorders -96.1%). 18.3% and 18.7% of participants reported correct knowledge about the prevention of depression and anxiety respectively. Four hundred and twenty-two (86%) identified the need to seek help for symptoms reported in vignettes. Of these, 234 (55%) preferred parents, and 62 (14.7%) look after friends for any help. Adolescents residing in Delhi reported poor MHL for Common Mental Disorders. High stigma and poor help-seeking behavior was also observed among the participants toward CMDs.

Prevalence and factors associated with behavioural problems in children with epilepsy attending Mulago hospital, Uganda: A cross-sectional study

Purpose: To determine the prevalence of behavioural problems and the associated factors in children with epilepsy (CWE). Methods: This was a cross-sectional study conducted at Mulago National Referral Hospital, Kampala, Uganda, from December 2019 to May 2020. A total of 300 CWE aged 6 to 17 years were consecutively enrolled and assessed for behavioural problems using the Strengths and Difficulties Questionnaire. We obtained data on the associated factors by using pretested structured questionnaires, the Rosenberg Self-Esteem Scale, the Kilifi Stigma Scale of Epilepsy, the Morisky medication adherence scale and the Tumaini Child Health Screener for childhood disabilities. Simple logistic regression and multivariate analysis was done to determine the associated factors while adjusting for the presence of neurodevelopmental disorders and childhood disabilities. Results: Behavioural problems were detected in 108/300 CWE (36%) with more internalizing (28%) than externalizing (21%) behaviour scores noted. The odds of behavioural problems increased with the presence of co-morbid neurodevelopmental disorders or childhood disabilities (cOR: 5.42, p-value < 0.001). Factors associated with occurrence of behavioural problems were high stigma perception (aOR: 4.06, p-value < 0.001) and being seizure-free in the last six months (aOR: 3.43, p-value =0.031) while being an adolescent (aOR: 0.33, p=0.001) lessened the risk. Conclusions: Behavioural problems occur in more than a third of CWE. They are more in the internalizing domain than in the externalizing domain. Their odds increase with high perceived stigma and in the first six months of seizure control.

Spatial pattern and associated factors of HIV testing and counselling among youths (15\u201324\u2009years) in Ethiopia

BackgroundHIV testing and counseling (HTC) services are key for HIV prevention, treatment, care, and support. Although the prevalence of HIV infection is high among adolescents and young adults, evidence suggests the utilization of HTC service among youth is very low in Ethiopia. Identifying factors and the geographic variation of HTC uptake is important to prioritize and design targeted prevention programs to increase its utilization and reduce HIV infection in hot spot areas.MethodsData from the 2016 Ethiopian Demographic and Health Survey were used to analyze 10,781 youth aged 15–24 years. The spatial analysis was performed in ArcGIS 10.1. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyze the purely spatial clusters of HTC uptake. A multilevel logistic regression analysis was used to identify the associated individual and community-level factors of HTC uptake and estimate between community variance. All models were fitted in Stata version 14.0 and finally, the adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) were reported.ResultsIn this study, the spatial patterns of HTC uptake were found to be non-random (Global Moran’s I = 0.074, p value< 0.001). Forty-seven primary clusters were identified that were located in the entire Somali region with a relative likelihood of 1.50 and the Log-Likelihood Ratio of 135.57. Youth who were ever married (AOR = 4.65; 95% CI; 4.05, 5.34), those attended higher education (AOR = 3.97; 95% CI; 3.10,5.08), those from richest household (AOR = 1.86; 95% CI; 1.44, 2.39), aged 20–24 years (AOR = 2.25; 95% CI; 2.02,2.51), having compressive HIV related knowledge (AOR = 2.05; 95% CI; 1.75,2.41), and exposed to media (AOR = 1.38; 95% CI; 1.22,1.57) were positive association with HTC uptake. However, being male (AOR = 0.81; 95% CI; 0.73,0.91) and having high HIV related stigma (AOR = 0.53; 95% CI; 0.42,0.67) were negatively associated with HTC uptake. At the community-level, youth from communities with a high percentage of educated (AOR = 1.45; 95% CI; 1.17,1.80) were more likely to utilize HTC compared with those from communities with low percentages of educated.ConclusionThe current study indicated differences in HTC uptake in the country. Both individual and community-level factors affected HTC uptake in Ethiopia. Multifaceted intervention approaches that consider individual and community factors are required to improve HTC uptake.

Direct-to-consumer marketing (DTC) of internet-based cognitive behavioral therapy (iCBT) using brief promotional video: Mapping modifiable mechanisms in pre-treatment acceptance

IntroductionGiven the suboptimal acceptance of iCBT for depression, finding ways to increase the acceptance and uptake is crucial for its dissemination. Moreover, it remains unknown to what extend the Unified Theory of Acceptance and Use of Technology (UTAUT) could aid the design of DTC in psychological service.ObjectivesTo explore whether the regulatory processes theorized in the UTAUT (Performance Expectancy, Effort Expectancy, Social Influence, and Facilitating Condition) could be modified and mediate the change of acceptance of iCBT.MethodsThis randomized controlled trial recruited 219 individuals with at least mild level of depression. Upon completion of pre-assessment, participants were randomly allocated to an intervention (IG) and a control group (CG). The IG received a 7-minute UTAUT-driven promotion video, while the CG received a video of same length on general psychoeducation. Both groups completed a post-assessment.ResultsRepeated measures ANOVA revealed a significant time by group effect on treatment acceptance. The video in IG was perceived to be clearer and more persuasive. Mediation analysis showed that the intervention effect was mediated by increase in perceived performance expectancy of iCBT, and the indirect effect was conditional on dispositional help seeking stigma.ConclusionsPre-treatment acceptance of iCBT can be improved by brief DTC promotion video. The finding casts light that performance expectancy was the most modifiable and mediatable regulatory process on iCBT acceptance, although such relation could be attenuated by high help-seeking stigma. In sum, DTC marketing could aid implementation of Internet-based interventions, effort in stigma reduction should continue to encourage uptake of effective treatment.DisclosureNo significant relationships.

Stigma, insight and social anxiety in first episode patients with psychosis

IntroductionPeople with schizophrenia are considered to be within the most stigmatized social groups. Accurate and efficient detection of stigma and its correlates is essential in patients with psychosis.ObjectivesThe purpose of this study was to assess illness insight, stigma, social anxiety and quality of life in patients with a first episode of psychosis and their possible correlationsMethodsThe sample of this study consisted of 90 patients with a first episode of psychosis that fulfilled inclusion and exclusion criteria. Tools used for the purpose of this study were Schedule for the assessment of insight-Expanded version, Internalized Stigma for Mental Illness Scale, World Health Organization Quality of Life Assessment - Greek version, Liebowitz Social Anxiety Scale - Greek version. Data were collected and analyzed with SPSS v26.ResultsThe study group had good insight (SAI-E score: 20.33±4.449), medium to high stigma values (ISMI score 50.93±7.854), a good enough quality of life (WHOQOL-BREF score: 86.08±10.010) and low levels of social anxiety (LSAS-Gr Fear score: 3.26±8.653; Anxiety score: 2,93±7,596). The results of this study show significant at the 0.01 level 2-tailed correlations as such: (i) a positive and significant relationship between ISMI and LSAS-Gr, (ii) a negative and significant relationship between ISMI and WHOQOL-BREF, and (iii) a negative and moderate relationship between WHOQOL-BREF and LSAS-Gr.ConclusionsWe report medium to high stigma levels, good insight and a good enough quality of life in a sample of first-episode patients with psychosis.DisclosureNo significant relationships.

THE RELATIONSHIP BETWEEN NURSES 'JOB STRESS AND STIGMA TENDENCY

Nurses are among the occupational groups that experience the most intense work stress since they provide care to a stressful group that is sick or at risk of illness. Stigmatization is one of the factors that negatively affect the working life and the functioning of the environment. A high tendency to stigmatize can further increase work stress on employees. The study was conducted in a descriptive and relationship-seeking manner in order to determine the levels of nurses' job stress and tendency to stigmatize, and the relationship between job stress and stigma tendency. The study was carried out with 245 nurses working in a university hospital. The study data were obtained using the personal information form, the Work Stress Scale and the Stigmatization Scale. It was determined that the average score of the nurses' Work Stress Scale is 2.44 ± 0.54 and 75.9% of them have a stress level that creates a stimulus effect and increases success. It was found that the levels of nurses' psychological stigma tendency (49.11 ± 12.00) were below the average; It was found that 31.8% of them had high stigma tendency levels. It has been determined that the Stigmatization Scale of nurses gives the highest scores to the items "Employees with more seniority like to establish authority over young people", "I do not meet with a person whose lifestyle does not suit me outside of work" and "The efficiency of the elderly personnel in the work environment is very low". When the relationship between the nurses' Job Stress Scale and the Stigmatization Tendency Scale general point average is examined; It was determined that there is a weakly significant positive correlation (r = 0.276; p &lt;0.01). In addition, it was found that the job stress levels of nurses with a high stigma tendency were statistically significantly higher (p &lt;0.01). It is recommended to provide training and information on the stigma tendency and coping with work stress with in-service trainings.

Characterizing community-level abortion stigma in the United States

ObjectiveEstimate community-level abortion stigma among U.S. adults and characterize factors associated with high stigma and less favorable opinions toward policies supportive of abortion care. Study DesignWe recruited respondents (U.S. adults, English-speaking) from a nationally representative, probability-based online panel in December 2018. We used multivariable logistic regression to identify factors associated with high abortion stigma using the Community Attitudes Abortion Scale (CAAS), a Reproductive Events and Experiences Scale (REES) subscale, and a Community Level Abortion Stigma Scale (CLASS) subscale. We measured favorability toward policies supportive of abortion care using widely used polling questions. ResultsOf 1800 eligible individuals contacted, 984 opened the invitation (54.6%) and 886 (90%) completed the survey. The majority demonstrated midrange stigma scores on all three scales. Increased likelihood of high stigma measured by CAAS was demonstrated among individuals reporting Catholic (OR 2.97, 95%CI 1.49–5.91) and Evangelical or Protestant religion (OR 4.78, 95%CI 2.53–9.00) compared to no religion, and Republican (OR 11.56, 95%CI 6.21–21.52) and Independent political affiliation (5.80, 95%CI, 3.17–10.60) compared to Democratic. Similar trends were seen with REES. Measured by CLASS, we found high stigma in Catholics compared to those with no religion (OR 1.91, 95%CI 1.09–3.32) and Blacks compared to Whites (OR 1.66, 95%CI 1.02–2.68). Identifying as Catholic, Evangelical or Protestant, and Republican were associated with holding less favorable opinions toward policies supportive of abortion care. Identifying as Catholic was the only characteristic associated with high stigma across all measures. ConclusionsAcross multiple measurement tools, factors associated with high stigma and less favorable opinions toward policies supportive of abortion care include Catholic, Evangelical or Protestant religion and Republican political affiliation. ImplicationsMultiple measures are needed to fully understand the extent of and characteristics associated with community-level abortion stigma. Religion and political identity are frequently associated with high stigma. Understanding these relationships may aid in developing interventions to decrease stigma and in turn reduce barriers to abortion care.