Related Stigma Research Articles

Systematic Review of Religiosity's Relationship with Suicidality, Suicide Related Stigma, and Formal Mental Health Service Utilization among Black Americans.

Rates of suicide have increased among Black Americans. Suicide is now the 3rd leading cause of death for Black Americans between the ages of 1-19 and the 4th leading cause of death for Black Americans aged 20-44. Due to the increasing need in the community, a marked increase in literature focusing on suicide in the Black community has been published since 2018. To build a better understanding of the current state of the literature on suicidality among Black Americans and to offer suggestions for further areas of research, a systematic review was conducted. Spirituality and religious beliefs are often an important cultural focus in the Black community. Some religious beliefs pose potential unintended regarding the sanctity of life among Black Americans. The focus of this systematic review was religiosity's effect on suicidality among Black Americans. Religiosity was found to have a protective effect against suicidality among Black Americans while discouraging formal mental health services utilization. This systematic review also reveals a dearth of research on the relationship between religiosity and suicide related stigma. Areas for further research are mentioned, and religious institutions as mental health intervention centers are encouraged.

Intersectional Stigma and Prevention Among Gay, Bisexual, and Same Gender-Loving Men in New York City, 2020: System Dynamics Models.

Objectives. To create causal loop diagrams that characterize intersectional stigma experiences among Black, gay, bisexual, same gender-loving, and other men who have sex with men and to identify intervention targets to reduce stigma and increase testing and prevention access. Methods. Between January and July 2020, we conducted focus groups and in-depth interviews with 80 expert informants in New York City, which were transcribed, coded, and analyzed. These qualitative insights were developed iteratively, visualized, and validated in a causal loop diagram (CLD) using Vensim software. Results. The CLD revealed 3 key feedback loops-medical mistrust and HIV transmission, serosorting and marginalization of Black and gay individuals, and family support and internalized homophobia-that contribute to intersectional HIV and related stigmas, homophobia, and systemic racism. On the basis of these results, we designed 2 novel intervention components to integrate into an existing community-level anti-HIV stigma and homophobia intervention. Conclusions. HIV stigma, systemic racism, and homophobia work via feedback loops to reduce access to and uptake of HIV testing, prevention, and treatment. Public Health Implications. The CLD method yielded unique insights into reciprocal feedback structures that, if broken, could interrupt stigmatization and discrimination cycles that impede testing and prevention uptake. (Am J Public Health. 2022;112(S4):S444-S451. https://doi.org/10.2105/AJPH.2022.306725).

Does perceived stigma or shame affect stage of presentation in Iraqi Kurdish women diagnosed with breast cancer?

e18680 Background: The concept of breast cancer related stigma and its effect on stage at presentation has been understudied in the Iraqi context. We sought to determine the extent to which perceived stigma or shame affected stage at presentation in Iraqi women diagnosed with breast cancer. Methods: A survey was conducted of 100 cancer patients seen at the Breast Center in Erbil, Kurdistan. Patients were asked subjectively whether they felt a sense of shame with the diagnosis of breast cancer and whether this delayed them in being diagnosed. In addition, a breast cancer stigma scale (BCSS) that has been validated in Arab women was fielded, and objective data regarding stage at presentation was collected. The BCSS has a possible score of 12-60, with lower scores indicating higher levels of stigma. Results: : Of the 100 women surveyed; only 7% were diagnosed at stage 1. While only 6% of women stated that they felt shame when diagnosed with breast cancer, 48% felt that some sense of shame delayed them getting diagnosed. The median BCSS score was 43 (range; 16-60). While marital status (p = 0.360), rural vs. urban setting (p = 0.380), working outside the home (p = 0.669), educational level (p = 0.203) and monthly household income (p = 0.642) were not associated with whether women presented with stage 1 breast cancer at diagnosis, there was a trend towards higher BCSS among those with stage 1 disease (p = 0.076). Further, patients who reported that feelings of shame either “somewhat” or “very much” delayed them being diagnosed were more likely to present with higher stage disease than those who felt this did “not at all” cause a delay (100% vs. 87.8%, p = 0.016). Indeed, all six patients diagnosed with stage 1 disease reported that feelings of shame did “not at all” delay them from being diagnosed. Conclusions: Most patients in the Iraqi Kurdistan context are diagnosed with later stage disease. Feelings of stigma or shame may contribute to later diagnosis in this context.

Junior Doctor Mentors: Enhancing Medical Student Psychiatry Training

AimsIncreased clinical contact during undergraduate psychiatry placements has been shown to both increase the likelihood of students considering a career in psychiatry and reduce mental-health related stigma. It can be challenging to provide medical students with a valuable clinical experience, a problem which has been further exacerbated by the coronavirus pandemic. We aimed to develop a junior doctor mentoring scheme to increase clinical exposure and teaching for students.MethodsWithin NHS Lanarkshire, groups of 4–6 University of Glasgow medical students are accommodated for their five-week clinical psychiatry blocks, during which they have a varied structured timetable, providing an overview of different psychiatric specialties. As such, students meet a wide range of clinicians, which can unfortunately mean there is little continuity in their training throughout the block.We developed a mentoring scheme to help address this issue. Enthusiastic trainee doctors – including foundation year two doctors, GP trainees and psychiatry core trainees – were invited to participate. Medical students are paired with a mentor for the duration of their block, during which they meet informally on a weekly basis. Mentors provide students with ward shadowing opportunities and bedside teaching, as well as completing work-place based assessments (WPBAs), discussing case reports and providing an additional perspective for end-of-block reports.ResultsThe mentoring scheme has been running successfully for every five-week student placement since October 2020. Student feedback has been collected via an anonymous electronic questionnaire. Students were asked what they enjoyed the most about their placement, with students frequently highlighting the support from their mentor.Examples from free-text comments included, “having an assigned mentor was really useful as someone to touch base with and go through clinical cases” and, “having a mentor was invaluable – it is crucial to have a friendly face on the wards and a contact to complete WPBAs”.Informal feedback from mentors has also been positive with trainees enjoying the opportunity to develop their teaching skills and support student training. Mentors also highlighted the role's benefit for their portfolios and specialty applications.ConclusionThis simple and cost-free intervention has had resoundingly positive feedback from medical students and trainees. Medical students enjoy having consistent informal teaching, support and feedback. Our mentoring scheme will continue for all medical students in NHS Lanarkshire and we would encourage other areas to consider a similar project. By increasing clinical exposure we hope to further reduce mental health stigma amongst students and inspire the psychiatrists of tomorrow.

Mental distress before and during the COVID-19 pandemic: A longitudinal study among communities affected by Ebola virus disease in the DR Congo

BackgroundAssociated with high mortality rate, fear, and anxiety, Ebola Virus Disease (EVD) is a significant risk factor for mental distress. This longitudinal study aims to investigate the prevalence and predictors associated with mental distress among populations affected by EVD outbreaks in the Province of Equateur in DR Congo. MethodsSurveys were administered in zones affected by the 2018 EVD outbreak in Equateur Province with a 16-month interval. Measures assessed sociodemographic characteristics, mental distress (GHQ-12), COVID-19 and EVD exposure and related stigmatization, and Resilience. Models of logistic regression and path analysis were used to estimate factors related to mental distress outcomes. ResultsPrevalence of mental distress decreased from Wave 1 to Wave 2 (Mental distressT1= 57.04%, Mental distressT2= 40.29%, x2= 23.981, p<.001). Clinical mental distress score at follow-up was predicted by greater levels of exposure to Ebola at baseline (B= .412, p<.001) and at Wave 2 (B= .453, p<.001) as well as Ebola stigmatization at baseline (B= .752, p<.001), and Protestant religion (B= .474, p=.038). Clinical mental distress score at follow-up was significantly associated with higher levels of exposure to COVID-19 (B= .389, p=.002) and COVID-19 related stigmatization (B= .480, p<.001). COVID-19 related stigmatization partially mediated the association between exposure to EVD (Time 1) and mental distress (B= .409, p<.001). ConclusionsAlthough a decrease in mental distress symptoms was observed, its prevalence remains high. The results show that mental health programs need to develop better health and education communication strategies to reduce stigmatization.

The relationship between stigma and mental health in a population of individuals with COVID-19.

Illness stigma has been observed across previous outbreaks including Ebola, SARS, HIV/AIDS, and now COVID-19. Although both the stigma of having COVID-19 as well as mental health impacts of COVID-19 have been studied, limited research exists regarding the relationship of stigma and mental health in this population. Thus, the primary purpose of the present study was to examine the relationship between stigma and mental health in adults with COVID-19. Adult respondents with a diagnosis of COVID-19 (N = 632) completed an online questionnaire distributed between April 17, 2020, and April 18, 2021. The study measures included the Patient Health Questionnaire 8 (PHQ-8), the Generalized Anxiety Disorder 7-item (GAD-7), and the 8-Item Stigma Scale for Chronic Illness (SSCI-8) tailored to measure perceived stigmatization from a COVID-19 diagnosis. Participants (mean age = 51) were mostly female (71%), White (73%), married (70%), obese (56%), and had a chronic health condition (56%). Female sex, education status, working from home or not working owing to COVID-19, previous mental health diagnosis, history of chronic illness, and being a current/former smoker were associated with higher stigma scores, whereas older age and Black race were associated with lower stigma scores. Greater stigma and psychological distress was observed in females with a previously diagnosed psychiatric illness and/or chronic health condition. Our findings suggest a disproportionate burden of mental health/psychiatric symptoms/sequelae, including stigma and PTSD, among COVID-19 survivors with a history of mental illness. Further studies are needed to fully characterize COVID-19 related stigma and subsequent mental health experiences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Divide to Conquer: Early Diagnosis Enhances Intervention in Cerebral Palsy

Divide to Conquer: Early Diagnosis Enhances Intervention in Cerebral Palsy

COVID-19 İle İlgili Sosyal Damgalama İçin Bir Ölçek Önerisi: COVID-19 Damgalama Ölçeğinin Psikometrik Özellikleri

Background: Social stigmatization is one of the most important results of the COVID-19 pandemic. The aim of the present study is to develop a measurement tool for assessing COVID-19-related stigma. Materials and Methods: The sample of the study consisted of 324 participants who were formerly diagnosed with COVID-19. Measurement regarding the validity of the COVID-19 Stigmatization Scale was evaluated with exploratory analysis. Results: Females accounted for 50.3% (n = 163) of the participants, and the mean age of the participants was 35.35  11.23 . The internal consistency coefficient of the scale was 0.95. The internal consistency coefficients of the subscales were .92 for “anticipatory anxiety”, .90 for “external stigmatization,” .89 for “negative self-image,” .84 for “contagion anxiety,” .90 for “disclosure anxiety,” and .87 for “internal stigmatization.” The total variance explained by the scale was 61.96%. Conclusions: The findings indicated that the COVID-19 Stigmatization Scale, consisting of 44 items in six subscales, is a valid measurement tool for COVID-19 related social stigma.

HIV testing uptake and its association with behavior related stigma among key populations in western province, Sri Lanka: a cross-sectional study

Introduction: Key populations are at the highest risk of acquiring and transmission of HIV. They are female sex workers, men who have sex with men, drug users, and the transgender community. Since these groups are hard to reach, they have a low HIV testing uptake. A probable reason for this could be the stigma and discrimination vested upon them. Objective: The objective of this study was to assess the HIV testing uptake among the KP groups in the Western province in Sri Lanka and their association with behavior related stigma. Methods: Four hundred and ninety-eight drug users, 508 female sex workers, 564 men who have sex with men, and 40 transgender people from Colombo, Gampaha, and Kalutara districts were included in the study using respondent-driven sampling. HIV testing uptake was assessed as ever being tested for HIV which was included in the questionnaire to assess factors associated with stigma among key populations. The level of stigma was evaluated by using the behaviour related stigma tool developed and validated by the same researchers. Statistical analysis was done using RDS-A version 7 and SPSS version 22. Results: HIV testing uptake among female sex workers was 85.6% (95% CI: 82.3– 88.6) in the sample and the population proportion was 87.1% (95% CI: 84.4 – 89.7). The sample proportion among drug users was 43.0% (95% CI: 38.6 – 47.5) and was 38.6% (95% CI: 31.2 – 46.0) among their estimated total population. High level of behaviour related stigma was negatively associated with HIV testing uptake. It was statistically significant only among men who have sex with men (p= 0.04). Conclusion: Highest HIV testing uptake was reported from female sex workers and the lowest was reported from drug users. Association between the level of behaviour-related stigma and the HIV testing uptake was significant only among men who have sex with men.

Assessment of validity and reliability of the tuberculosis related stigma scale in Colombian patients

Objective To know the dimensionality and internal consistency of the Tuberculosis-Related Stigma Scale in patients living with tuberculosis in Santa Marta, Colombia. Method One hundred and twenty-two patients between the ages of 18 and 75 participated (M = 40.3, SD = 14.9), 63.9% were men, 44.3% were single, 69.7% had low income, 80.3% had pulmonary tuberculosis, and 13.1% had co-infection with HIV. The Tuberculosis-Related Stigma Scale was applied; it comprises perceived and internalised stigma subscales. The internal structure was explored by confirmatory factor analysis (EFA). Internal consistency was measured with Cronbach's alpha and McDonald's omega. Besides, the differential functioning of the scales according to gender was explored with Kendall's tau-b coefficient. Results CFA did not show excellent goodness-of-fit indicators for the perceived stigma scale (Satorra-Bentler's chi-square of 184.48, degree of freedom of 44, p = .001, RMSEA of 0.16, 95%CI 0.14–0.19, CFI of 0.77, TLI of 0.72, and SRMR of 0.08) and internalised (Satorra-Bentler's chi-square of 189.14, degree of freedom of 54, p = .001; RMSEA of 0.14, 95%CI 0.12–0.17, CFI of 0.82, TLI of 0.78, and SRMR of 0.07). The alpha and omega coefficients were 0.89 and 0.91 for both scales. Non-gender differential functioning was observed; Kendall's tau-b was between 0.00 and 0.15. Conclusions The Tuberculosis-Related Stigma Scale has an excellent internal consistency but poor goodness-of-fit indicators of unidimensionality. Evaluating the scale's psychometric performance is recommenced in future research.

Social stigma of suicide in South Korea: A cultural perspective

This study examined suicide stigma in relation to Korean cultural characteristics, such as Collectivism, Chemyon sensitivity (concern about losing a socially acceptable face), the tendency toward conformity, and the emphasis on the interdependent self. We found that these characteristics were connected to suicide stigma in Korea. Those with high Chemyon sensitivity tended to perceive that suicidal people were incompetent, immoral, selfish, and deviated from society. Conformity tendency was positively associated with five stigma factors: incompetence, glorification, immorality, selfishness, and social exclusion. Those who perceived themselves as interdependent tended to consider suicidal people incompetent, lacking morality, self-centered, and deviant.

TB related stigma and gender disparity among unaffected population in central Kerala, a survey

BackgroundTB continues to ravage high burden countries despite aggressive TB control measures. Poverty and adverse socioeconomic and cultural factors play a significant role in stigmatization, causing delayed health care seeking, non-compliance to treatment and spread of disease in the community. Women are more vulnerable to stigmatization, posing the risk of gender inequality in health care. The objectives of this study were to ascertain the degree of stigmatization and gender disparity in TB related stigma in the community. MethodsStudy was conducted among TB unaffected persons, using consecutive sampling from bystanders of patients attending the hospital for diseases other than TB. Closed structured questionnaire was used for measuring socio-demographic, knowledge and stigma variables. Stigma scoring was done using TB vignette. ResultsMajority subjects (119 males and 102 females) were from rural area and low socioeconomic status; more than 60% of males and females having college education. Half the subjects answered more than half the TB knowledge questions correctly. Knowledge score was significantly lower among females compared with males (p < 0.002) despite high literacy. Overall stigma scoring was low (mean score = 15.9; total 75). Stigma was higher among females compared with males (p < 0.002); more profound among females receiving female vignettes (Chi-square = 14.1, p < 0.0001). The association was significant even after adjusting for co-variables (OR = 3.323, P = 0.005). Low knowledge showed minimal (statistically insignificant) association with stigma. ConclusionsPerceived stigma though low, was more among females and much higher with female vignette, indicating significant gender disparity in stigma towards TB.

The Mediating Role of Stigma, Internalized Shame, and Autonomous Motivation in the Relationship Between Depression, Anxiety, and Psychological Help-Seeking Attitudes in Multiple Sclerosis

BackgroundDepression and anxiety are commonly experienced in individuals with multiple sclerosis (MS) yet little is known about factors associated with psychological help-seeking attitudes in those with MS.MethodThe current study investigated whether increased stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationship between depressive and anxiety symptoms and psychological help-seeking attitudes in individuals with MS. Two hundred fifty-four participants with MS completed an online questionnaire assessing depressive and anxiety symptoms, stigma related to chronic illness, internalized shame, autonomous motivation, and psychological help-seeking attitudes.ResultsStigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationships between increased depressive symptoms and anxiety symptoms and psychological help-seeking attitudes. The study also found that higher levels of chronic illness–related stigma and internalized shame were associated with more negative psychological help-seeking attitudes and higher autonomous motivation was associated with more positive psychological help-seeking attitudes. There were no direct effects of depressive or anxiety symptoms on psychological help-seeking attitudes.ConclusionThe significant mediating roles of stigma-related chronic illness, internalized shame, and autonomous motivation indicate that these factors may be useful to include in future depression and anxiety intervention studies targeting MS populations.

'We've come a very, very, long way' Overcoming stigma of autism: An interpretative phenomenological analysis within the UK Jewish community.

Autistic people contend with high levels of stigma in many cultures worldwide. There is a scarcity of literature on stigma in relation to autism in faith communities and virtually no research focussing on this topic in Jewish communities. In this study, we aimed to explore experiences of stigma towards autism and sought views on what steps have and can be taken to reduce such stigma. Using an interpretative phenomenological analysis approach, we conducted semi-structured interviews with 10 participants within the UK Jewish community, in both mainstream and specialist autistic schools. Interviews were conducted over 2 months in 2020. During analysis, 5 superordinate (central) themes and 13 subordinate themes were abstracted. Superordinate themes included ‘Stigma not specific to the Jewish community’; ‘Considerable strides made’; ‘More a lack of knowledge or denial than stigma’; ‘Fear of stigma is a real concern but not widely prevalent’; and ‘Potent factors that reduce stigma in the Jewish community’. We recommend workshops for greater awareness and training for teachers and parents on autism and autistic children’s experiences. We also recommend the formation of specialist autism schools in other communities and promotion of positive narratives concerning autistic people, as this successfully reduced stigma within the Jewish community.Lay abstractAutistic people contend with high levels of stigma in a wide array of cultures worldwide. There is a scarcity of literature on stigma in relation to autism in faith communities, with some limited research on this issue in Christian, Muslim and Hindu populations. There is virtually no research focussing on this topic in Jewish communities and to our knowledge, none at all within UK Jewish contexts. In this study, we aimed to explore experiences of stigma towards autism and sought views on what steps have and can be taken to reduce such stigma. Using an interpretative phenomenological analysis approach, we conducted semi-structured interviews with 10 participants within the UK Jewish community, including parents, rabbis, SENDCos, teachers, and headmasters of autistic children in both mainstream and specialist autistic schools. Interviews were conducted over 2 months in 2020. During analysis, 5 superordinate (central) themes and 13 subordinate themes were abstracted from the data. Superordinate themes included ‘Stigma not specific to the Jewish community’; ‘Considerable strides made’; ‘More a lack of knowledge or denial than stigma’; ‘Fear of stigma is a real concern but not widely prevalent’; and ‘Potent factors that reduce stigma in the Jewish community’. We recommend workshops for greater awareness and training for teachers and parents on autism and autistic children’s experiences. We also recommend the formation of specialist autism schools in other communities and promotion of positive narratives concerning autistic people, as this successfully reduced stigma within the Jewish community.

“The most hurtful thing I've ever experienced”: A qualitative examination of the nature of experiences of weight stigma by family members

Family members are some of the most common sources of weight stigma reported by youth and adults with higher body weight; however, little is known about the ways in which weight stigma manifests from different family members. To better understand the nature of weight stigma by family members, the current study qualitatively examined women's retrospective accounts of these experiences. Participants were 410 U.S. adult women engaged in a commercial weight management program who described an experience of weight stigma by a family member in response to an open-ended survey question. Using an inductive qualitative coding approach, we identified 11 forms of weight stigma experienced across 15 family sources. For childhood experiences of stigma from family members, weight teasing was most common. In adulthood, participants most commonly described critical weight comments from family members. Overall, mothers were the most common source of weight stigma, followed by spouses/romantic partners, and references to ‘family’ generally. Across diverse family sources, participants described these stigmatizing experiences as having lasting negative ramifications. Together, these findings can inform interventions to reduce weight stigma in familial relationships.

Exposure to medical education and its role in Covid19 pandemic associated anxiety among medical students in South Kerala

Medical students have varying levels of understanding about Covid19 based on their level of exposure to medical education. This influences their mental health status. There is no clear cut idea about whether Covid19 related anxiety among medical students increases or decreases with increase in scientific knowledge. This study aims to find out the proportion of anxiety related to COVID19 among medical students in South Kerala and assess the role of medical education on anxiety. Analytical cross-sectional study was conducted among 500 medical students in South Kerala. Anxiety was assessed using Generalized Anxiety Disorder7 (GAD-7) scores. Univariate and Bivariate analysis were performed. P value &amp;#60; 0.05 was considered as statistically significant. The median GAD-7 score obtained was three (IQR 5.75). GAD-7 score &amp;#62;10 were reported among 9.8% participants. Anxiety level was found to be significantly associated with the year of admission (p=0.021). Among those who were tested Covid19 positive, 11.9 % hadGAD7 score &amp;#62;10 and among those who faced Covid related stigma, 28.6% had GAD-7 score &amp;#62;10. Association between anxiety and stigma related to Covid19 was found to be statistically significant (p=0.017). Proportion of students with moderately severe or severe anxiety was more among preclinical students and among students who faced Covid19 related stigma. Better knowledge about preventive measures, symptoms, treatment, complications and prognosis of Covid19 can lessen pandemic induced anxiety. Government initiated programs are required to counter the rising levels of stigmatizing attitudes associated with Covid19

Analysis of Stigma in Relation to Behaviour and Attitudes towards Mental Health as Influenced by Social Desirability in Nursing Students.

The training undergraduate nursing students receive, both in terms of theoretical input and clinical practice, may help to instil a less stigmatising perception of mental health. To analyse the perceived evolution of attitudes and expected behaviours, a longitudinal repeated measures study was conducted in a population of student nurses during their undergraduate mental health education. The Mental Illness: Clinicians’ Attitudes Scale, a Scale for measuring attitudes to the mentally ill among future Health workers, and the Reported and Intended Behaviour Scale were completed. A mixed linear model was used to assess the effect of each factor in the questionnaires before and after the various stages of the students’ training in mental health. The overall effect of each factor was assessed by testing the interaction between factor and group, both with and without adjustment with the Social Desirability Scale. The results showed that the clinical practice stage, due to the proximity to care for people with mental health problems, improves attitudes and behaviours towards mental health in students who have not had mental health problems, and also in younger students. In conclusion, integrated, holistic training during the period of clinical practice was associated with positive changes in the attitudes and intended behaviour.

HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis

BackgroundStigma is a social phenomenon known to have a negative impact on the lives of people living with HIV (PLWH). However, defining HIV-related stigma (HRS) is difficult because of the intersection it has with structural inequalities, and cultural differences, discrimination by health care providers that measure stigma among PLWH. HIV/AIDS has been characterized as a traumatic experience and PLWH may experience stigma which can cause negative mental health disorders and experiences, including emotional distress, shame, depression, anxiety, suicidal ideation. A systematic review of the evidence on the mental disorders of PLWH is currently lacking. This study aimed to analyze the association between HRS and social support, alcohol use disorders and mental health disorders and experiences (depression, anxiety, and suicidal ideation) among PLWH.MethodsIn accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) this study searched PubMed, Scopus, Web of sciences, PsycInfo, SciELO and Cochrane library electronic databases to identify publications between January 1992 and August 2020 that discussed social support, alcohol use disorders, mental health disorders and experiences (i.e., depression and anxiety and suicidal ideation) associated with HRS. Pooled Odds Ratios (ORs) were utilized at a 95% confidence level, and as sampling methods differed between articles pooled estimates used a random effects model.ResultsTwenty-two studies with 9548 participants met the eligibility criteria. No association was observed between HRS and alcohol use disorders. PLWH who had higher levels of social supports were less likely to report HRS. Participants who had been diagnosed with anxiety were 1.89 times more likely to report HRS, while those diagnosed with depression were 1.61 times more. Respondents who reported suicidal ideation also were 1.83 times more likely to report HRS.ConclusionsThis meta-analysis supports that HRS has a detrimental association with anxiety, depression and suicidal ideation, but social support protects again HRS in PLWH. Applying interventions which focus on the mental health disorders of PLWH may decrease HRS. Provision of social support by practitioners, combined with mental health treatment and assessments, and designing methods to identify stigma at different stages of illness are warranted.

Community perspectives on leprosy and related stigma in northern Nigeria: a qualitative study

Aim This study explored community perceptions about leprosy and the extent, root causes, and drivers of stigma in Kano State, northern Nigeria. Methodology The study used a cross-sectional design with a qualitative approach. Semi-structured in-depth interviews were conducted with community members unaffected by leprosy. Participants were selected using stratified purposive sampling. Thematic analysis was performed based on the “Framework Approach”. Results A total of 21 community members were included in this study. We found that the majority of the participants perceived persons affected by leprosy negatively, they were considered dirty, incurable, and inferior. Participants indicated that they avoid touching, social interactions, and sharing meals with persons affected by leprosy. In addition, leprosy was said to negatively impact employment opportunities and the marriage prospects of persons affected and their family members. Marriage prospects were considered worse for women affected by leprosy. We identified four main drivers of stigmatization: (1) local beliefs and misconceptions about leprosy (e.g. the belief that leprosy is hereditary, incurable, or highly infectious), (2) fear of disability and deformity, (3) fear of infection, and (4) perceived poor personal hygiene of persons affected. Conclusion This study revealed negative perceptions regarding leprosy, including misconceptions about etiology, fear and desire to keep social distance towards persons affected. Our findings underscore the importance of community education and behavior change as key to transforming perceptions and behavior towards persons affected.

Women's Perceptions of HIV- and Sexuality-Related Stigma in Relation to PrEP: Qualitative Findings from the Masibambane Study, Durban, South Africa.

Daily oral pre-exposure prophylaxis (PrEP) offers effective HIV prevention. In South Africa, PrEP is publicly available, but use among young women remains low. We explored young women's perceptions of PrEP to inform a gender-focused intervention to promote PrEP uptake. Six focus group discussions and eight in-depth interviews exploring perceptions of PrEP were conducted with forty-six women not using PrEP, ages 18-25, from central Durban. Data were thematically analyzed using a team-based consensus approach. The study was conducted among likely PrEP users: women were highly-educated, with 84.8% enrolled in post-secondary education. Qualitative data revealed intersecting social stigmas related to HIV and women's sexuality. Women feared that daily PrEP pills would be confused with anti-retroviral treatment, creating vulnerability to misplaced HIV stigma. Women also anticipated that taking PrEP could expose them to assumptions of promiscuity from the community. To address these anticipated community-level reactions, women suggested community-facing interventions to reduce the burden on young women considering PrEP. Concerns around PrEP use in this group of urban, educated women reflects layered stigmas that may inhibit future PrEP use. Stigma-reducing strategies, such as media campaigns and educational interventions directed at communities who could benefit from PrEP, should re-frame PrEP as an empowering and responsible choice for young women.