Stigma Interventions Research Articles

Patient and Provider Perspectives on HIV Stigma in Healthcare Settings in Underserved Areas of the US South: A Mixed Methods Study.

Stigma experienced in healthcare settings is a barrier to ending the HIV epidemic. Using a convergent parallel mixed methods approach, we collected qualitative data from 14 focus groups with People with HIV (PWH) and Healthcare workers (HCW) and quantitative survey data (N = 762 PWH and N = 192 HCW) from seven HIV healthcare clinics outside of major urban areas in the southeastern US. Four key themes emerged: (1) HIV-related stigma and discrimination in healthcare settings; (2) experiences of intersectional stigma; (3) disclosure concerns in healthcare settings; and (4) impact of stigma on HIV-related health behavior. Implications for future stigma interventions in healthcare settings include the importance of engaging PWH in the development of interventions, the need for interventions in settings that do not specialize in HIV care, and the importance of engaging all staff when addressing HIV-related stigma.

POSTER ABSTRACTS: P88 EXAMINING GENDER NORMS AND SEXUAL STEREOTYPING AMONG SOUTHERN FAITH LEADERS

Objectives: Gender norms and stereotyping contribute to religiously based stigma and decrease access to sexual and reproductive health (SRH) services. We explored religious leaders’ beliefs and perceptions to inform a faith based SRH stigma intervention.

Ending intimate partner violence among women living with HIV: How attachment and HIV stigma inform understanding and intervention

ABSTRACT This mixed-methods, exploratory study examined why women living with HIV (WLHIV) stay in intimate partner violence (IPV) relationships and what helps end IPV in their lives. WLHIV (n = 108) who experienced IPV and were patients at two HIV primary care clinics in San Francisco completed quantitative surveys; 15 participants also completed a qualitative interview. Qualitative data showed HIV stigma was the most cited reason for staying in an IPV relationship, followed by substance use, and then by themes of attachment insecurity. Quantitative data indicated that most participants accessed HIV services and rated them as more helpful than other community resources to end IPV in their lives. Enduring attachment relationships with HIV medical and social service providers and their attachment-enhancing actions and attributes were critical to participants addressing IPV and coping with HIV stigma. This study highlights the important role that HIV providers and clinics can play in addressing IPV among WLHIV.

Effectiveness of HIV Stigma Interventions for Men who have Sex with Men (MSM) With and Without HIV in the United States: A Systematic Review and Meta-Analyses.

Stigma may contribute to HIV disparities for men who have sex with men (MSM). This systematic review quantified the effects of HIV stigma interventions for MSM on stigma and sex risk. We conducted a systematic search to identify US-based studies published between 2000 and June 2019 focused on HIV and MSM, and either measured stigma pre-post or included a stigma intervention component. Twenty-nine articles, representing 26 unique studies met inclusion criteria. Random effect models showed no intervention effect for reducing stigma and a non-significant increase in HIV testing. Significant decreases in condomless sex with males, condomless sex with females, and substance-influenced sex were found. Few intervention studies measured stigma pre-post. Findings suggest that including a stigma reduction component in interventions can improve HIV testing and reduce sex risk for MSM. Developing interventions to address stigma may be important in decreasing HIV infection among MSM and ending the HIV epidemic.

Using Positive Empathy Interventions to Reduce Stigma Toward People Who Inject Drugs.

People who inject drugs are often the target of stigma that puts this already at-risk group at greater risk of harm. Past research has shown that holding stigmatizing views of people who inject drugs increases risky behaviors and is a barrier to their engagement in important medical and public health interventions. One explanation is that the negativity surrounding the group causes increased levels of anticipated emotional exhaustion, discouraging positive engagement. However, there has been minimal research focused on addressing this negativity to reduce levels of held stigma against people who inject drugs. We hypothesized that giving people an imagined positive contact exercise about people who inject would lead to a reduction in stigma, since exposure to positive empathy may create new mental associations between stigmatized groups and more positive emotions and experiences. Secondarily, we hypothesized that positive empathy strategies would be more effective than traditional informational or learning based techniques, and that the latter would be more effective than a control condition. Our sample consisted of 375 participants recruited online. Participants were assigned to one of three study conditions: a positive empathy condition, an informational learning condition, or a control condition, and completed a posttest social distance measure. Results demonstrated that subjects exposed to the positive empathy stigma reduction condition experienced a significant reduction in held stigma while participants exposed to traditional informational learning techniques showed no significant reduction in held stigma. Positive empathy-based stigma interventions should be further researched as a promising avenue to reduce the effects of drug-related stigma.

The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health.

Stigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the "stigma system" as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.

Intersectional Stigma Among People Transitioning From Incarceration to Community-Based HIV Care in Gauteng Province, South Africa.

People transitioning from incarceration to community-based HIV care experience HIV stigma, incarceration stigma, and the convergence of these stigmas with social inequities. The objective of this study is to understand intersectional stigma among people returning from incarceration with HIV in Gauteng Province, South Africa. Qualitative interviews were conducted with 42 study participants. We analyzed transcript segments and memos from these interviews. Our results showed that anticipated HIV stigma increased participants' difficulty with disclosure and treatment collection. Incarceration stigma, particularly the mark of a criminal record, decreased socioeconomic stability in ways that negatively affected medication adherence. These stigmas converged with stereotypes that individuals were inherently criminal "bandits." Male participants expressed concerns that disclosing their HIV status would lead others to assume they had engaged in sexual activity with men while incarcerated. AIDS education and prevention efforts will require multilevel stigma interventions to improve HIV care outcomes.

Prevalence of HIV-related stigma in adults living with HIV & disability in Florida, 2015–2016

ABSTRACT Using data collected from the Florida Medical Monitoring Project, we sought to compare the prevalence of overall HIV-related stigma, including its subdimensions among persons with HIV and disability(s) and persons with HIV without disability in Florida. Disability was classified as having difficulty in one or more areas: activity limitations, participation restrictions, and functional or sensory activities. HIV-related stigma was assessed using the HIV Stigma Scale, which measures (1) overall stigma (2) negative self-image, (3) personalized, and (4) anticipated stigma. Multivariate analysis indicates that the crude prevalence ratios of overall stigma, including negative self-image, personalized, and anticipated stigma among persons with HIV and disability(s) were 1.43, 1.24, 1.20, and 1.23 compared to persons with HIV without disability, respectively. After adjusting for confounders, the prevalence ratios of HIV-related stigma ranged from 1.33–1.07 among persons with HIV and disability(s) compared to persons with HIV without disability. The implications of these findings reveal that persons with HIV and disability(s) are more vulnerable to HIV-related stigma. Researchers could consider distinct stigma interventions tailored towards persons with HIV and disability(s) in Florida.

Working toward eradicating weight stigma by combating pathologization: A qualitative pilot study using direct contact and narrative medicine

AbstractStigma against fat people permeates every level of healthcare, yet most attempts to reduce weight stigma among healthcare providers have shown only marginal results. Fat studies, a field that rigorously interrogates negative assumptions about fatness, can help social psychologists understand weight stigma by centering the pathologization of fatness as a major contributor to weight stigma at the structural and interpersonal level. A fat studies approach also reorients the normative goal of weight stigma interventions from reducing stigma to eradicating stigma and calls for methods that reject weight stigma’s roots in medicine and medical discourse. Even nuanced and sympathetic models of “obesity” cannot combat stigma that is structurally based in medical authority. We applied these principles to develop a new method of weight stigma intervention: direct contact structured through narrative medicine. In a qualitative pilot study, four medical students and two fat activist community members met for five 2‐hours narrative medicine workshops over 5 weeks. All participants completed focus group interviews about the experience. Interview transcript analysis revealed that these workshops provided a space for depathologizing, humanizing, empathy‐inducing, and power‐leveling interactions between medical students and fat people, where members of both groups reported benefiting from the experience. We conclude that non‐pathologizing approaches to eradicating weight stigma are not only feasible, but both ethically and methodologically necessary.

Advancing research to eliminate mental illness stigma: an interventional study to improve community attitudes towards depression among University students in Singapore

BackgroundAfter decades of anti-stigma initiatives, the Advancing Research To Eliminate Mental Illness Stigma (ARTEMIS) intervention study is one of the first in Singapore to evaluate the effects of an anti-stigma intervention on attitudes towards depression in university students.Methods390 university students from a local university in Singapore were voluntarily recruited for the study. The ARTEMIS intervention comprises an educational and social contact component, as well as a question and answer (Q&A) session with experts in the area of mental health. The Community Attitudes towards Mental Illness (CAMI) scale was administered at baseline, post-intervention and at 3-months follow-up. A confirmatory factor analysis (CFA) was conducted.ResultsThe CFA identified a 3-factor model for the CAMI with a decent fit (RMSEA = 0.06, CFI = 0.93, TLI = 0.93, SRMR = 0.06). Favourable shifts in attitudes across the factors were observed immediately after the intervention (p < 0.001). Gender (β = − 1.19, 95% CI: − 2.10, − 0.27, p = 0.01) and nationality (β = − 1.23, 95% CI: − 2.35, − 0.11, p = 0.03) were identified as significant correlates for the community mental health ideology (CMHI) factor. Linear effects indicated that having a close social contact with mental illness observed a smaller decrease in authoritarianism scores from pre- to post-intervention (β = 0.85, 95% CI: 0.18, 1.53, p = 0.01); whereas quadratic effects found a greater decrease in scores from post-intervention to after 3-months for benevolence (β = − 0.34, 95% CI: − 0.52, − 0.16, p < 0.001) and CMHI (β = − 0.22, 95% CI: − 0.45, − 0.002, p = 0.048).ConclusionThe anti-stigma intervention shows promising short-term results across the CAMI dimensions even after adjusting for sociodemographic correlates. However, the intervention did not observe the sustained attitude shifts after 3-months. Recommendations for future anti-stigma interventions were also considered.

A Review of the State of the Science of HIV and Stigma: Context, Conceptualization, Measurement, Interventions, Gaps, and Future Priorities.

Stigma is a fundamental cause of health inequities. As such, stigma is a major barrier to HIV prevention, care, and treatment. This review will examine the concept of stigma, explicating the mechanisms of action of HIV-related stigma while also examining intersectional stigma and structural stigma. Instruments to measure HIV-related stigma and its mechanisms of action, as well as stigma enacted and experienced by HIV health care providers, will also be reviewed. This article will conclude with a review of stigma interventions, gaps in the literature, and priorities for future HIV, intersectional, and structural stigma research.

Examining associations among weight stigma, weight bias internalization, body dissatisfaction, and eating disorder symptoms: Does weight status matter?

The present study aimed to expand weight stigma theoretical models by accounting for central tenets of prominent eating disorder (ED) theories and increasing the generalizability of existing models for individuals across the weight spectrum. College students (Sample 1: N = 1228; Sample 2: N = 1368) completed online surveys assessing stigma and ED symptoms. In each sample, separately, multi-group path analyses tested whether body mass index (BMI) classification (underweight/average weight, overweight, obese) moderated a model wherein weight stigma experiences were sequentially associated with weight bias internalization, body dissatisfaction, and five ED symptoms: binge eating, purging, restricting, excessive exercise, muscle building behaviors. Results supported the assessed model overall and for individuals in each BMI class, separately. Although patterns of associations differed for individuals with different BMIs, these variations were limited. The present findings suggest that the adverse impact of weight stigma on distinct ED symptoms is not limited to individuals with elevated BMIs and that these associations are generally explained by the same mechanisms. Weight stigma interventions that focus on decreasing weight bias internalization and body dissatisfaction are recommended for individuals across the weight spectrum. Further examination of associations between weight stigma and multiple ED symptoms, beyond disinhibited eating, is supported.

Bidirectional relationships between weight stigma and pediatric obesity: A systematic review and meta-analysis.

This study for the first time quantified concurrent and bidirectional relationships between weight stigma and weight status in children, with age and gender as moderators. A literature search was conducted in PubMed, Web of Science, and PsycINFO for studies examined associations between weight stigma and weight status among children aged 6-18 years. Twenty-five studies (20 cross-sectional studies and five longitudinal studies) from six countries with 101,036 participants were included in review, and 18 were included in meta-analysis. Weight and height were self-reported in nine studies, otherwise objectively measured. With data from 17 cross-sectional studies and baseline portions of four longitudinal studies, meta-analysis showed weight stigma and overweight/obesity were associated (pooled OR = 3.12, 95% CI: 2.71, 3.60), they were also associated across age and gender. Body mass index (BMI) was associated with greater weight stigma (pooled r = 0.38, 95% CI: 0.32, 0.43). Age modified such association. Weight stigma predicted increased BMI from three longitudinal studies (pooled β = 1.12, 95% CI: 0.78, 1.45); another two longitudinal studies reported BMI predicted greater weight stigma. Data were inadequate for age- or gender-stratified analyses. Findings supported positive concurrent and bidirectional relationships between weight stigma and weight status. Timely obesity and weight stigma interventions to protect children well-being are needed.

Examining HIV-related stigma among African, Caribbean, and Black church congregants from the Black PRAISE study in Ontario, Canada

ABSTRACT HIV-related stigma impedes adoption and implementation of effective HIV prevention and treatment strategies. It may also exacerbate racial/ethnic HIV disparities. Given high levels of religious observance within African, Caribbean, and Black (ACB) communities and the social capital that faith-based organizations hold, these entities may be promising venues for stigma-remediation and effective partners in community-based, HIV-focused programing. However, more research is needed to understand HIV-related stigma in these institutions. This study examines HIV-related stigma among six ACB churches in Ontario, Canada. Surveys were distributed to ACB attendees (N = 316) and linear regressions determined relationships between HIV-related stigma and stigma subdomains with demographics, greater disagreement with same-sex relationships, HIV knowledge, and religiosity. Greater disagreement with same-sex relationships was the only variable associated with the HIV-related stigma scale and all of its subscales. Age, gender, HIV knowledge, religiosity, contact with persons living with HIV, and length of time in Canada were associated with varying aspects of HIV-related stigma. Findings can inform the development of HIV-related stigma interventions and the characteristics of individuals these efforts should target to achieve maximum impact.

Resilience and stigma in mothers of children with emotional and behavioural difficulties

BackgroundMothers of children with intellectual and developmental disabilities (IDD) experience frequent and high levels of stigma from family, friends, and members of the public. This stigma can have a negative impact on mothers’ psychological well-being, their social circle, and their relationship with their child. AimsThe present study aimed to establish if there was a relationship between emotional and behavioural difficulties and stigma, and if resilience, social support and parental adjustment acted as a protective factors in this relationship. Methods108 mothers of children aged between four and 16 years old with IDD participated in a cross-sectional online survey. Mothers were asked about their child’s behavioural difficulties, their experience of stigma, in addition to completing assessments of resilience, social support, and parental adjustment. ResultsOverall child behavioural and emotional difficulties, and the sub domain emotional problems, hyperactivity, and low prosocial behaviour were found to be a significant independent predictors of stigma. Resilience was associated with stigma and moderated the relationship between low prosocial behaviour and stigma. There was no evidence that social support or parental attachment acted as protective factors in the relationship between child behavioural difficulties and stigma. ConclusionsThe results of the present study extend the findings of previous research by providing evidence that families of children with a range of developmental disabilities experience stigma, in particular when children show high levels of emotional problems and hyperactivity, and low levels of prosocial behaviour. The present study also provides evidence that resilience is associated with stigma and resilience-building interventions may be beneficial to reduce the negative impact of stigma.

Award for Distinguished Early Career Contributions to Psychology in the Public Interest: Valerie A. Earnshaw.

The Awards for Distinguished Contributions to Psychology in the Public Interest recognize persons who have advanced psychology as a science and/or profession by a single extraordinary achievement or a lifetime of outstanding contributions in the public interest. Two awards are given: one to a senior psychologist and a second to a psychologist who has made a significant contribution to the public interest in the early stages of his or her career. The 2020 recipients of the APA Awards for Distinguished Contributions in the Public Interest were selected by the 2019 Committee on Psychology in the Public Interest Awards. Valerie A. Earnshaw is recognized for her innovative research on stigma and health inequities, as well as remarkable national and international contributions to advancing theoretical perspectives for understanding how stigma affects health inequities across the life span, particularly in the context of HIV/AIDS and substance use disorders. With this award, the APA recognizes Earnshaw as an emerging leader in the field of stigma intervention research and honors her commitment to addressing multiple forms of stigma, work that is essential for improving the health and well-being of communities most impacted by health inequities globally. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Abstract PO-108: Impact of stigma and stigma-focused interventions on screening and treatment outcomes in cancer patients

Abstract Objective: Stigma is known to negatively influence cancer patients’ treatment outcomes and psychosocial behavior. Previous studies have highlighted specific types of cancer and how stigma was experienced by those patients, families, caregivers, and the general population. The aim of this study is to systematically review the information on: how stigma is experienced by all cancer patients; how stigma affects cancer screening behavior; the influence of cancer-related stigma on psychosocial, behavioral, and health outcomes; and the effectiveness of interventions used to address cancer stigma. Procedure: The protocol, search, appraisal, synthesis, analysis, and reporting (PSALSAR) framework was used for conducting this systematic literature review. CINAHL, PubMed, and PsycINFO databases were searched using the keywords “cancer stigma”, “cancer stigma intervention”, “cancer stigma impact”, “effect of cancer stigma”, and “stigma and cancer screening”. Articles publication period was set for 2010 to 2020. Data extracted from relevant articles included title, author(s), publication year, country of study, study aims, research design, type of population studied, and result. Out of the 957 articles initially found, 49 (29 quantitative, 16 qualitative, 2 mixed methods, and 2 scoping reviews) met inclusion criteria and were reviewed. Quality assessment of included studies revealed the studies had varying levels of methodological quality. Extracted data were organized and narratively analyzed. Results: Stigma levels varied depending on country of study and type of cancer discussed. Developing countries had higher rates of severe stigma reported compared to developed countries with varying experience of stigma often depending on cancer type. Cancer Patients of ethnic minorities in Developed countries experienced higher rates of stigma within their communities. Cancer was associated with imminent death consistently throughout studies. Cancer patients who experienced self-blame were more inclined to conceal their diagnosis from family and friends. While cancer stigma majorly resulted in negative psychosocial outcomes in cancer patients, there were also instances of posttraumatic growth reported in literature emanating from the stigma experienced. Literature on cancer-related stigma interventions for cancer patients and the general public was scant. Conclusions: Stigma affects many aspects of cancer patients’ life both during and after treatment. Future studies and clinical practices should utilize the information provided to empower cancer patients and combat stigma. Interventions should improve public education to help minimize stigma in both developing and developed countries. Citation Format: Elizabeth Akin-Odanye, Anisah Husman. Impact of stigma and stigma-focused interventions on screening and treatment outcomes in cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-108.

Examining Different Strategies for Stigma Reduction and Mental Health Promotion in Asian Men in Toronto.

Mental illness stigma has detrimental effects on health and wellbeing. Approaches to address stigma in racialized populations in Western nations need to emphasize inclusivity, social justice, and sociocultural intersectionality of determinants of health. The current paper evaluates three intervention approaches to reduce stigma of mental illness among Asian men in Toronto, Canada. Participants received one of four group interventions: psychoeducation, Acceptance and Commitment Therapy (ACT), Contact-based Empowerment Education (CEE), and a combination of ACT+CEE. Self-report measures on stigma (CAMI, ISMI) and social change (SJS) were administered before and after the intervention. A total of 535 Asian men completed the interventions. Overall analyses found that all intervention approaches were successful in reducing stigma and promoting social change. Subscale differences suggest that CEE may be more broadly effective in reducing mental illness stigmatizing attitudes while ACT may be more specifically effective in reducing internalized stigma. More work needs to be done to elucidate mechanisms that contribute to socioculturally-informed mental illness stigma interventions for racialized communities and traditionally marginalized populations.

The Fight against Stigma: Multilevel Stigma Interventions in Schizophrenia Patients

Background: Stigma is one of the main factors causing pasung (physical restraint or confinement in Indonesian terms) in schizophrenia patients. It is the main obstacle to reducing the number of pasung throughout the world. Thus, there is a need for appropriate interventions to reduce stigma in schizophrenia patients who go through pasung. This study aims to identify multilevel stigma interventions in people with schizophrenia who go through pasung (physical restraint and confinement). It can be applied and adapted to various cultural contexts.Design and Methods: Quasi-experimental research with pretest and post-test analysis consists of 82 people with schizophrenia who go through pasung. Respondents were divided into the intervention group and the control group. A multilevel stigma intervention was given to the intervention group for three months.Results: There was a significant difference in the average stigma score in the control group (moderate category stigma) and the intervention group (mild category stigma) after multilevel stigma intervention (p-value = 0.04). The average stigma score of schizophrenia patients in the intervention group decreased by 8.2%, while the average stigma score in the control group increase of 20.4%.Conclusions: Multilevel stigma interventions are effective in reducing stigma in people with schizophrenia who go through pasung. We underline that multilevel stigma interventions through collaboration from various parties can provide great opportunities in stigma reduction programs in people with schizophrenia who go through pasung.Significance for public healthSchizophrenia is a chronic mental disorder that is closely related to stigmatization. Stigma and discrimination in patients with schizophrenia lead to poor medication adherence, leading to poor images and low self-esteem in patients. Also, stigma causes patients and families to be reluctant to seek medical treatment for their clinical conditions, so that stigma is closely related to the process of treating patients with schizophrenia. This study illustrates the effect of multilevel stigma interventions on decreasing stigmatization in people with schizophrenia. This study's results are expected to contribute to the provision of interventions to reduce stigmatization in schizophrenia patients throughout the scope of health care.

Estimating the prevalence of autism spectrum disorder in Lebanon

This cross-sectional survey examines the prevalence rate of Autism spectrum disorder (ASD) in 818 children (16–48 months) across all Lebanese regions. Screening was done using the revised form of the Modified-Checklist for Autism in Toddlers. Based on the total score of items failed, children were classified into 3 categories of ASD risk (low, moderate and high). Phone calls follow-up interviews and clinical assessments for diagnosis ascertainment were conducted. Given the caregivers’ reluctance to participate, the prevalence rate was estimated between 49 and 513 per 10,000 with a male predominance. Our prevalence estimation, even under restrictive assumptions, is higher than elsewhere in the Arab region. Anti- stigma interventions adapted to the socio-cultural context are needed prior to future research in the field.