Perceived Community Stigma Research Articles

A pathway analysis of exploring how HIV-related stigma affects social capital among people living with HIV/AIDS in China

ABSTRACTHIV-related stigma is the most common and serious social problem which people living with HIV/AIDS (PLWHA) have to face. However, the impact of HIV stigma on social capital is not yet clear. Therefore, this study aims to understand the relationship between HIV stigma and social capital, and explore the mechanism of how HIV stigma influences social capital among Chinese PLWHA on this basis. An institutional based cross-sectional study was conducted from Nov 2015 to Jan 2016 in Wuhan, China, using a self-reporting questionnaire. A total of 552 PLWHA participated, and 520 valid questionnaires were included. Multiple linear regression analysis showed that lower education level, lower monthly income, higher internalized stigma, and anticipated stigma were significantly associated with lower social capital. Results of path analysis showed that although perceived community stigma has no direct effect on social capital, but it can affect social capital through internalized stigma and anticipated stigma. In conclusion, increased HIV stigma and reduced social capital are frequent among PLWHA in China. Perceived community stigma may cause PLWHA to internalize stigma and anticipate stigmatizing experiences, resulting in the reduction of social capital. These findings suggest that perceived community stigma should become the target of stigma intervention strategy among Chinese PLWHA.

Change in HIV-related stigma in South Africa between 2004 and 2016: a cross-sectional community study

ABSTRACTA critical component of an AIDS-free generation is to reduce HIV-related stigma. Previous research predicted that stigma would decline over time with increased contact with PLWH, understanding of the disease and availability of treatment. The aim of the research was to explore change in stigma over a 12-year period, by comparing data collected from two large cross-sectional samples from South African communities in 2004 (before the roll-out of antiretroviral treatment (ART)) and in 2016. Students recruited respondents according to criteria related to age, gender, race and area of living. A survey assessing moral judgement and interpersonal distance was used to assess personal and perceived community stigma. Responses to ten identical items used in the 2004 and 2016 data collection were compared. Personal stigma attached to HIV decreased significantly over time, except in respect of having close contact with PLWH, such as dating and befriending. Perceived community stigma remained high in all subgroups. It is argued that perceived community stigma contributes to high levels of internalised stigma among PLWH. Interventions should focus on helping PLWH to cope with perceived stigma and strategies to address stereotyping, which contributes to perceived community stigma.

Moment-to-moment within-person associations between acts of discrimination and internalized stigma in people living with HIV: An experience sampling study.

Internalized stigma related to HIV is associated with poorer outcomes for people living with HIV (PLWH). However, little is known about the association between experiences of daily acts of discrimination by others and the activation of internalized stigma, including factors that may moderate this association. One hundred nine men living with HIV responded to experience sampling method (ESM) questions 3 times a day for 7 days via smart-phones. ESM questions included experiences of recent acts of discrimination, internalized HIV stigma, avoidance coping with HIV, and recent social support. We also administered several traditional questionnaire measures assessing psychosocial constructs. In Hierarchical Linear Modeling analyses controlling for age, race, socioeconomic status, and time on antiretroviral therapy, experiencing discrimination predicted internalized stigma within-persons. Individuals higher on attachment-related avoidance, attachment-related anxiety, avoidance coping, perceived community stigma, and helplessness, and individuals lower on social support, had stronger associations between discrimination and current internalized stigma. Similarly, results from two state moderator variables supported our trait analyses: State-level (ESM) social support and avoidance coping were significant moderators. Thus, when PLWH experience incidents of discrimination due to HIV, this may lead to increased feelings of internalized stigma. We extend the literature by demonstrating that the associations between experienced and internalized stigma are not just at the generalized trait level, but also occur at the state-level, accounting for within person variability. Results provide implications for interventions aiming to modify maladaptive interpersonal traits as well as interventions to increase social support to reduce the impact of discrimination on PLWH.

Framing Mechanisms Linking HIV-Related Stigma, Adherence to Treatment, and Health Outcomes.

We present a conceptual framework that highlights how unique dimensions of individual-level HIV-related stigma (perceived community stigma, experienced stigma, internalized stigma, and anticipated stigma) might differently affect the health of those living with HIV. HIV-related stigma is recognized as a barrier to both HIV prevention and engagement in HIV care, but little is known about the mechanisms through which stigma leads to worse health behaviors or outcomes. Our conceptual framework posits that, in the context of intersectional and structural stigmas, individual-level dimensions of HIV-related stigma operate through interpersonal factors, mental health, psychological resources, and biological stress pathways. A conceptual framework that encompasses recent advances in stigma science can inform future research and interventions aiming to address stigma as a driver of HIV-related health.

Effects of state nondiscrimination laws on transgender and gender-nonconforming individuals' perceived community stigma and mental health

ABSTRACTIn this study, we investigated the potential effects of statewide nondiscrimination laws on community stigma, as well as its relationship with psychosocial stressors and mental health outcomes. Gender minority individuals (N = 120) completed an online survey containing psychosocial and mental health outcome measures. The experiences of participants who resided in states with and without nondiscrimination laws were compared in regard to perceived community stigma. Hierarchical and logistic regression were used to test the hypothesized relationships between community stigma and lifetime discrimination and victimization; current depression, anxiety, and substance use; and lifetime suicide attempts. Approximately 60% of participants reported residing in a state without nondiscrimination laws (n = 74). These participants reported higher levels of perceived community stigma, and stigma was positively associated with reports of lifetime discrimination and victimization. The observed relationship between stigma and current anxiety symptoms was marginally significant. Logistic regression results indicate that stigma was positively related to the odds of reporting a lifetime suicide attempt. Analyses suggest that statewide nondiscrimination laws are associated with lower rates of perceived stigma at the community level, which, in turn, is associated with lower rates of discrimination, victimization, anxiety, and risk for attempted suicide.

How Does Stigma Affect People Living with HIV? The Mediating Roles of Internalized and Anticipated HIV Stigma in the Effects of Perceived Community Stigma on Health and Psychosocial Outcomes.

Few researchers have attempted to examine the mechanisms through which HIV-related stigma in the community is processed and experienced at an individual level by people living with HIV. We examined how the effects of perceived HIV stigma in the community on health outcomes for people living with HIV are mediated by internalized stigma and anticipated stigma. Participants (N=203) from an HIV clinic completed self-report measures and their clinical data were obtained from medical records. Results suggested that the association between perceived community stigma and affective, cognitive, and mental health outcomes (self-esteem, depressive symptoms, avoidance coping, self-blame) are mediated by internalized stigma. Furthermore, a serial mediation model suggested that perceived community stigma leads to internalized stigma, which leads to anticipated community stigma, which in turn leads to lower medication adherence. The associations between perceived community stigma and interpersonal outcomes (social support, trust in physicians) were mediated by internalized stigma and anticipated stigma, again in a serial fashion (perceived community stigma leads to internalized stigma, which leads to anticipated stigma, which in turn leads to interpersonal outcomes). These results suggest that perceived HIV-related stigma in the community may cause people living with HIV to internalize stigma and anticipate stigmatizing experiences, resulting in adverse health and psychosocial outcomes-information that can be used to shape interventions.

Safer Conception Methods and Counseling: Psychometric Evaluation of New Measures of Attitudes and Beliefs Among HIV Clients and Providers.

With data from 400 HIV clients with fertility intentions and 57 HIV providers in Uganda, we evaluated the psychometrics of new client and provider scales measuring constructs related to safer conception methods (SCM) and safer conception counselling (SCC). Several forms of validity (i.e., content, face, and construct validity) were examined using standard methods including exploratory and confirmatory factor analysis. Internal consistency was established using Cronbach's alpha correlation coefficient. The final scales consisted of measures of attitudes towards use of SCM and delivery of SCC, including measures of self-efficacy and motivation to use SCM, and perceived community stigma towards childbearing. Most client and all provider measures had moderate to high internal consistency (alphas 0.60-0.94), most had convergent validity (associations with other SCM or SCC-related measures), and client measures had divergent validity (poor associations with depression). These findings establish preliminary psychometric properties of these scales and should facilitate future studies of SCM and SCC.

Re-Validation of the Van Rie HIV/AIDS-Related Stigma Scale for Use with People Living with HIV in the United States

There is little consensus about which of the many validated human immunodeficiency virus (HIV) stigma scales should be regularly used, with few being re-validated in different contexts or evaluated for how they compare to other, existing HIV stigma scales. The purpose of this exploratory study was to re-validate the Van Rie HIV/AIDS-Related Stigma Scale, originally validated in Thailand and using a third-person wording structure, for use with people living with HIV in the United States. Adult HIV clinic patients completed a survey including the Berger and Van Rie scales, and measures of social support and depression. Eighty-five of 211 (40%) eligible participants provided data for both stigma scales. Exploratory factor analyses identified three factors to the Van Rie scale: Loss of Social Relationships (new subscale), Managing HIV Concealment (new subscale), and Perceived Community Stigma (original subscale). These subscales were moderately inter-related (r = 0.51 to 0.58) with acceptable to excellent reliability (Cronbach’s alpha = 0.69 to 0.90). The Van Rie subscales were also moderately inter-correlated with the Berger subscales (r = 0.44 to 0.76), had similar construct validity, and tended to have higher mean stigma scores when compared with Berger subscales that were conceptually most similar. The revised Van Rie HIV-related Stigma Scale demonstrates good validity and internal consistency, offering a valid measure of HIV stigma with a three-factor structure. The third-person wording may be particularly suitable for measuring stigmatizing attitudes during an individual’s transition from at-risk and undergoing HIV testing to newly diagnosed, a time when experiences of discrimination and processing issues of disclosure have not yet occurred. The stigma mechanisms for individuals making this transition have not been well explored. These scenarios, combined with the observed non-response to the Berger Enacted Stigma subscale items (a surprise finding), highlight gaps in our understanding of HIV stigma and how best to measure it.

The role of stigmas in mental health: A comparative study

HIV (Human immunodeficiency Virus), AIDS and cancer are feared terminal diseases. HIV sufferers are known to be stigmatized. The stigma surrounding cancer, unfortunately, is hardly the focus of psychological investigations, and hence this provoked the need to compare the stigma suffered by both groups, and how these have impacted on the psychological functioning of the disease sufferer. The study had two main objectives, firstly, to explore whether HIV patients suffer more stigma than cancer patients or not, and secondly, to understand the most common type of stigma and if stigma is associated with psychopathology. Psychopathology is measured with GHQ-28 which evaluates somatic complaints, anxiety, depression and social dysfunction. The study was a survey, and descriptive in nature, and anchored on two hypotheses: Firstly, that HIV patients will experience more stigmas than cancer patients and consequently report more psychological dysfunctions. Secondly that there will be a significant difference between types of stigma and the symptoms reported about them. Data were collected from a conveniently sampled group of 50 HIV positive patients and another 50 patients diagnosed with cancer, in two clinics and a hospital around the Gauteng Province. The majority of the participants were females, numbering 62 (62, 0%), whilst 38 (38.0%) were males. The age of the respondents ranged from 20-73 years with a mean age of 44.4 years (s.d. = 11.6). Results revealed a significant main effect for enacted stigma F = (1.98), = 17.629, p < .001 and anxiety F = (1.98) = 5.750, p < .001. A post hoc Bonferroni also showed that HIV patients had a higher mean score of enacted stigma (X-bar = 4.22) than cancer patients (X-bar = 1.28) and also HIV patients reported more anxiety (X-bar = 8.81) than cancer patients (X-bar = 6.42). Enacted stigma significantly influenced the GHQ Total (F = (98) = 1.700, p < .05); anxiety (F = (97) = 2.578, p < .004); and depression (F = (97) = 3.390 p < .001). The perceived community stigma had one main effect for depression (F = (1.98) = 1.452, p < .05). There were no significant main effects for internally felt stigma and psychological dysfunctions. Both hypotheses were partially supported. Recommendations included tailoring interventions to meet the cultural needs of patients. Other recommendations were made in accordance with the findings of the study.

Stigmatizing attitudes of the community towards people living with HIV/AIDS

This research involved an exploratory study in which a questionnaire was used to investigate the personal stigma and perceived community stigma regarding HIV/AIDS in a South African community. Student fieldworkers interviewed a convenient sample of 901 respondents from different races, gender and age groups, and found that respondents tended towards stigmatizing persons with HIV/ AIDS. Yet, this degree of stigmatization was significantly less severe than the degree of stigmatization that respondents attributed to the community at large. Altogether 17% of the respondents had high stigmatizing attitudes, while 42% perceived the stigmatization by others in the community to be high. Race group, personal knowledge of someone with HIV, area of residence, gender and age group impacted on the respondents’ personal tendency to stigmatize those with HIV/AIDS. The article discusses the difference between the level of personal stigma attached by the respondents and that perceived by them to be attached by the community. Attention is also paid to the possible implications of stigmatizing behaviour patterns and interventions on a community level. Copyright # 2006 John Wiley & Sons, Ltd.