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09-09-2020

Interpersonal and intrapersonal manifestations of HIV stigma and their impacts on psychological distress and life satisfaction among people living with HIV: Toward a dual-process model

Auteurs: Randolph C. H. Chan, Winnie W. S. Mak, Gloria Y. K. Ma, Mandy Cheung

Gepubliceerd in: Quality of Life Research | Uitgave 1/2021

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Abstract

Purpose

As HIV is one of the most stigmatizing health conditions, people living with HIV (PLHIV) continue to experience multiple forms and sources of stigmatization, which negatively impact their quality of life. The present study proposed a dual-process model to understand the different manifestations of HIV stigma and examine how they relate to each other and affect psychological distress and life satisfaction in PLHIV.

Methods

Two hundred and ninety-one PLHIV in Hong Kong participated in the study and completed a self-report questionnaire on HIV stigma, psychological distress, and life satisfaction. Structural equation modeling was conducted to examine the mechanisms underlying HIV stigma and mental health.

Results

Around one-third of the participants experienced HIV-related avoidance and/or discrimination in different domains of life over the past year. Enacted stigma toward PLHIV was highly pronounced in Hong Kong, especially among general healthcare providers. The results revealed the interpersonal and intrapersonal processes underlying HIV stigma and mental health. While enacted stigma had a direct effect on psychological distress and life satisfaction, PLHIV might also internalize the stigmatizing beliefs associated with HIV identity, which were related to greater psychological distress and poorer life satisfaction.

Conclusion

Stigma reduction programs that target non-HIV healthcare workers are recommended to confront their misconceptions and biases toward PLHIV. Given the high prevalence of self-stigma, psychological interventions that focus on restructuring negative beliefs about PLHIV and reconstructing a self-empowering and positive identity are necessary to promote better mental health and quality of life.
Literatuur
1.
go back to reference Mahajan, A. P., Sayles, J. N., Patel, V. A., Remien, R. H., Ortiz, D., Szekeres, G., et al. (2008). Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS (London, England), 22(Suppl 2), S67–S79.CrossRef Mahajan, A. P., Sayles, J. N., Patel, V. A., Remien, R. H., Ortiz, D., Szekeres, G., et al. (2008). Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS (London, England), 22(Suppl 2), S67–S79.CrossRef
2.
go back to reference Fuster-Ruizdeapodaca, M. J., Molero, F., Holgado, F. P., & Mayordomo, S. (2014). Enacted and internalized stigma and quality of life among people with HIV: The role of group identity. Quality of Life Research, 23(7), 1967–1975.CrossRef Fuster-Ruizdeapodaca, M. J., Molero, F., Holgado, F. P., & Mayordomo, S. (2014). Enacted and internalized stigma and quality of life among people with HIV: The role of group identity. Quality of Life Research, 23(7), 1967–1975.CrossRef
3.
go back to reference Rueda, S., Mitra, S., Chen, S., Gogolishvili, D., Globerman, J., Chambers, L., et al. (2016). Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: A series of meta-analyses. British Medical Journal Open, 6(7), e011453. Rueda, S., Mitra, S., Chen, S., Gogolishvili, D., Globerman, J., Chambers, L., et al. (2016). Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: A series of meta-analyses. British Medical Journal Open, 6(7), e011453.
4.
go back to reference Bos, A. E., Pryor, J. B., Reeder, G. D., & Stutterheim, S. E. (2013). Stigma: Advances in theory and research. Basic and Applied Social Psychology, 35(1), 1–9.CrossRef Bos, A. E., Pryor, J. B., Reeder, G. D., & Stutterheim, S. E. (2013). Stigma: Advances in theory and research. Basic and Applied Social Psychology, 35(1), 1–9.CrossRef
5.
go back to reference Hutton, V. E., Misajon, R., & Collins, F. E. (2013). Subjective wellbeing and ‘felt’ stigma when living with HIV. Quality of Life Research, 22(1), 65–73.CrossRef Hutton, V. E., Misajon, R., & Collins, F. E. (2013). Subjective wellbeing and ‘felt’ stigma when living with HIV. Quality of Life Research, 22(1), 65–73.CrossRef
6.
go back to reference Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science and Medicine, 57(1), 13–24.CrossRef Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science and Medicine, 57(1), 13–24.CrossRef
7.
go back to reference Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13(6), 1160–1177.CrossRef Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13(6), 1160–1177.CrossRef
8.
go back to reference Steward, W. T., Herek, G. M., Ramakrishna, J., Bharat, S., Chandy, S., Wrubel, J., et al. (2008). HIV-related stigma: Adapting a theoretical framework for use in India. Social Science and Medicine, 67(8), 1225–1235.CrossRef Steward, W. T., Herek, G. M., Ramakrishna, J., Bharat, S., Chandy, S., Wrubel, J., et al. (2008). HIV-related stigma: Adapting a theoretical framework for use in India. Social Science and Medicine, 67(8), 1225–1235.CrossRef
9.
go back to reference Dos Santos, M. M., Kruger, P., Mellors, S. E., Wolvaardt, G., & Van Der Ryst, E. (2014). An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa: The People Living with HIV Stigma Index. BMC Public Health, 14(1), 80.CrossRef Dos Santos, M. M., Kruger, P., Mellors, S. E., Wolvaardt, G., & Van Der Ryst, E. (2014). An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa: The People Living with HIV Stigma Index. BMC Public Health, 14(1), 80.CrossRef
10.
go back to reference Paxton, S., Gonzales, G., Uppakaew, K., Abraham, K., Okta, S., Green, C., et al. (2005). AIDS-related discrimination in Asia. AIDS Care, 17(4), 413–424.CrossRef Paxton, S., Gonzales, G., Uppakaew, K., Abraham, K., Okta, S., Green, C., et al. (2005). AIDS-related discrimination in Asia. AIDS Care, 17(4), 413–424.CrossRef
11.
go back to reference Herek, G. M., Saha, S., & Burack, J. (2013). Stigma and psychological distress in people with HIV/AIDS. Basic and Applied Social Psychology, 35(1), 41–54.CrossRef Herek, G. M., Saha, S., & Burack, J. (2013). Stigma and psychological distress in people with HIV/AIDS. Basic and Applied Social Psychology, 35(1), 41–54.CrossRef
12.
go back to reference Quinn, D. M., & Earnshaw, V. A. (2013). Concealable stigmatized identities and psychological well-being. Social and Personality Psychology Compass, 7(1), 40–51.CrossRef Quinn, D. M., & Earnshaw, V. A. (2013). Concealable stigmatized identities and psychological well-being. Social and Personality Psychology Compass, 7(1), 40–51.CrossRef
13.
go back to reference Mak, W. W., Cheung, R. Y., Law, R. W., Woo, J., Li, P. C., & Chung, R. W. (2007). Examining attribution model of self-stigma on social support and psychological well-being among people with HIV+/AIDS. Social Science and Medicine, 64(8), 1549–1559.CrossRef Mak, W. W., Cheung, R. Y., Law, R. W., Woo, J., Li, P. C., & Chung, R. W. (2007). Examining attribution model of self-stigma on social support and psychological well-being among people with HIV+/AIDS. Social Science and Medicine, 64(8), 1549–1559.CrossRef
16.
go back to reference Mo, P. K., & Ng, C. T. (2017). Stigmatization among people living with HIV in Hong Kong: A qualitative study. Health Expectations, 20(5), 943–951.CrossRef Mo, P. K., & Ng, C. T. (2017). Stigmatization among people living with HIV in Hong Kong: A qualitative study. Health Expectations, 20(5), 943–951.CrossRef
17.
go back to reference Davis, C., Noel, M. B., Chan, S.-F. F., & Wing, L. S. (1998). Knowledge, attitudes and behaviours related to HIV and AIDS among Chinese adolescents in Hong Kong. Journal of Adolescence, 21(6), 657–665.CrossRef Davis, C., Noel, M. B., Chan, S.-F. F., & Wing, L. S. (1998). Knowledge, attitudes and behaviours related to HIV and AIDS among Chinese adolescents in Hong Kong. Journal of Adolescence, 21(6), 657–665.CrossRef
18.
go back to reference Mak, W. W., Poon, C. Y., Pun, L. Y., & Cheung, S. F. (2007). Meta-analysis of stigma and mental health. Social Science and Medicine, 65(2), 245–261.CrossRef Mak, W. W., Poon, C. Y., Pun, L. Y., & Cheung, S. F. (2007). Meta-analysis of stigma and mental health. Social Science and Medicine, 65(2), 245–261.CrossRef
19.
go back to reference Logie, C., & Gadalla, T. (2009). Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care, 21(6), 742–753.CrossRef Logie, C., & Gadalla, T. (2009). Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care, 21(6), 742–753.CrossRef
20.
go back to reference Turan, B., Budhwani, H., Fazeli, P. L., Browning, W. R., Raper, J. L., Mugavero, M. J., et al. (2017). 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. AIDS and Behavior, 21(1), 283–291.CrossRef Turan, B., Budhwani, H., Fazeli, P. L., Browning, W. R., Raper, J. L., Mugavero, M. J., et al. (2017). 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. AIDS and Behavior, 21(1), 283–291.CrossRef
21.
go back to reference Keyes, C. L. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539–548.CrossRef Keyes, C. L. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539–548.CrossRef
22.
go back to reference Renshaw, T. L., & Cohen, A. S. (2014). Life satisfaction as a distinguishing indicator of college student functioning: Further validation of the two-continua model of mental health. Social Indicators Research, 117(1), 319–334.CrossRef Renshaw, T. L., & Cohen, A. S. (2014). Life satisfaction as a distinguishing indicator of college student functioning: Further validation of the two-continua model of mental health. Social Indicators Research, 117(1), 319–334.CrossRef
23.
go back to reference Simbayi, L. C., Kalichman, S., Strebel, A., Cloete, A., Henda, N., & Mqeketo, A. (2007). Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Social Science and Medicine, 64(9), 1823–1831.CrossRef Simbayi, L. C., Kalichman, S., Strebel, A., Cloete, A., Henda, N., & Mqeketo, A. (2007). Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Social Science and Medicine, 64(9), 1823–1831.CrossRef
24.
go back to reference Mak, W. W., & Cheung, R. Y. (2010). Self-stigma among concealable minorities in Hong Kong: Conceptualization and unified measurement. American Journal of Orthopsychiatry, 80(2), 267–281.CrossRef Mak, W. W., & Cheung, R. Y. (2010). Self-stigma among concealable minorities in Hong Kong: Conceptualization and unified measurement. American Journal of Orthopsychiatry, 80(2), 267–281.CrossRef
25.
go back to reference Westland, J. C. (2010). Lower bounds on sample size in structural equation modeling. Electronic Commerce Research and Applications, 9(6), 476–487.CrossRef Westland, J. C. (2010). Lower bounds on sample size in structural equation modeling. Electronic Commerce Research and Applications, 9(6), 476–487.CrossRef
26.
go back to reference Szymanski, D. M. (2006). Does internalized heterosexism moderate the link between heterosexist events and lesbians’ psychological distress? Sex Roles, 54(3–4), 227–234.CrossRef Szymanski, D. M. (2006). Does internalized heterosexism moderate the link between heterosexist events and lesbians’ psychological distress? Sex Roles, 54(3–4), 227–234.CrossRef
27.
go back to reference Link, B. G. (1987). Understanding labeling effects in the area of mental disorders: An assessment of the effects of expectations of rejection. American Sociological Review, 52(1), 96–112.CrossRef Link, B. G. (1987). Understanding labeling effects in the area of mental disorders: An assessment of the effects of expectations of rejection. American Sociological Review, 52(1), 96–112.CrossRef
28.
go back to reference Veit, C. T., & Ware, J. E. (1983). The structure of psychological distress and well-being in general populations. Journal of Consulting and Clinical Psychology, 51(5), 730–742.CrossRef Veit, C. T., & Ware, J. E. (1983). The structure of psychological distress and well-being in general populations. Journal of Consulting and Clinical Psychology, 51(5), 730–742.CrossRef
29.
go back to reference Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75.CrossRef Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75.CrossRef
30.
go back to reference Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411–423.CrossRef Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411–423.CrossRef
31.
go back to reference Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.CrossRef Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.CrossRef
32.
go back to reference Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422–445.CrossRef Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422–445.CrossRef
34.
go back to reference Ho, C. Y., & Mak, W. W. (2013). HIV-related stigma across cultures: Adding family into the equation. In P. Liamputtong (Ed.), Stigma, discrimination and living with HIV/AIDS: A cross-cultural perspective (pp. 53–69). Dordrecht: Springer.CrossRef Ho, C. Y., & Mak, W. W. (2013). HIV-related stigma across cultures: Adding family into the equation. In P. Liamputtong (Ed.), Stigma, discrimination and living with HIV/AIDS: A cross-cultural perspective (pp. 53–69). Dordrecht: Springer.CrossRef
35.
go back to reference Rao, D., Angell, B., Lam, C., & Corrigan, P. (2008). Stigma in the workplace: Employer attitudes about people with HIV in Beijing, Hong Kong, and Chicago. Social Science and Medicine, 67(10), 1541–1549.CrossRef Rao, D., Angell, B., Lam, C., & Corrigan, P. (2008). Stigma in the workplace: Employer attitudes about people with HIV in Beijing, Hong Kong, and Chicago. Social Science and Medicine, 67(10), 1541–1549.CrossRef
36.
go back to reference Elliott, R., & Gold, J. (2005). Protection against discrimination based on HIV/AIDS status in Canada: The legal framework. HIV/AIDS Policy and Law Review, 10(1), 20–31. Elliott, R., & Gold, J. (2005). Protection against discrimination based on HIV/AIDS status in Canada: The legal framework. HIV/AIDS Policy and Law Review, 10(1), 20–31.
37.
go back to reference Mak, W. W., Mo, P. K., Ma, G. Y., & Lam, M. Y. (2017). Meta-analysis and systematic review of studies on the effectiveness of HIV stigma reduction programs. Social Science and Medicine, 188, 30–40.CrossRef Mak, W. W., Mo, P. K., Ma, G. Y., & Lam, M. Y. (2017). Meta-analysis and systematic review of studies on the effectiveness of HIV stigma reduction programs. Social Science and Medicine, 188, 30–40.CrossRef
38.
go back to reference Nyblade, L., Stangl, A., Weiss, E., & Ashburn, K. (2009). Combating HIV stigma in health care settings: What works? Journal of the International AIDS Society, 12(1), 15.CrossRef Nyblade, L., Stangl, A., Weiss, E., & Ashburn, K. (2009). Combating HIV stigma in health care settings: What works? Journal of the International AIDS Society, 12(1), 15.CrossRef
39.
go back to reference Chan, R. C. H., & Mak, W. W. S. (2019). Cognitive, regulatory, and interpersonal mechanisms of HIV stigma on the mental and social health of men who have sex with men living with HIV. American Journal of Men’s Health, 13(5), 1557988319873778.CrossRef Chan, R. C. H., & Mak, W. W. S. (2019). Cognitive, regulatory, and interpersonal mechanisms of HIV stigma on the mental and social health of men who have sex with men living with HIV. American Journal of Men’s Health, 13(5), 1557988319873778.CrossRef
40.
go back to reference Mittal, D., Sullivan, G., Chekuri, L., Allee, E., & Corrigan, P. W. (2012). Empirical studies of self-stigma reduction strategies: A critical review of the literature. Psychiatric Services, 63(10), 974–981.CrossRef Mittal, D., Sullivan, G., Chekuri, L., Allee, E., & Corrigan, P. W. (2012). Empirical studies of self-stigma reduction strategies: A critical review of the literature. Psychiatric Services, 63(10), 974–981.CrossRef
41.
go back to reference Heijnders, M., & Van Der Meij, S. (2006). The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychology, Health and Medicine, 11(3), 353–363.CrossRef Heijnders, M., & Van Der Meij, S. (2006). The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychology, Health and Medicine, 11(3), 353–363.CrossRef
42.
go back to reference Yang, X., & Mak, W. W. (2017). The differential moderating roles of self-compassion and mindfulness in self-stigma and well-being among people living with mental illness or HIV. Mindfulness, 8(3), 595–602.CrossRef Yang, X., & Mak, W. W. (2017). The differential moderating roles of self-compassion and mindfulness in self-stigma and well-being among people living with mental illness or HIV. Mindfulness, 8(3), 595–602.CrossRef
Metagegevens
Titel
Interpersonal and intrapersonal manifestations of HIV stigma and their impacts on psychological distress and life satisfaction among people living with HIV: Toward a dual-process model
Auteurs
Randolph C. H. Chan
Winnie W. S. Mak
Gloria Y. K. Ma
Mandy Cheung
Publicatiedatum
09-09-2020
Uitgeverij
Springer International Publishing
Gepubliceerd in
Quality of Life Research / Uitgave 1/2021
Print ISSN: 0962-9343
Elektronisch ISSN: 1573-2649
DOI
https://doi.org/10.1007/s11136-020-02618-y