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Relative Importance of Various Measures of HIV-Related Stigma in Predicting Psychological Outcomes Among Children Affected by HIV

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Abstract

To assess the relative importance of four different measures of HIV-related stigma in predicting psychological problems among children affected by HIV in rural China. Cross-sectional data were collected from 755 orphans (i.e., children who lost one or both of their parents to HIV), 466 vulnerable children (children who were living with HIV-infected parents), and 404 comparison children who were from the same community and did not have HIV-related illness or death in their families. Four HIV-related stigma measures include perceived public stigma against people living with HIV/AIDS (PLWHA), perceived public stigma against children affected by HIV (orphans and vulnerable children), personal stigmatizing attitudes against PLWHA, and enacted stigma among children affected by HIV. Psychological problems included depression and adjustment problems. Various measures of HIV-related stigma independently and differentially contribute to children’s psychological problems. Enacted stigma and children’s perceived public stigma against PLWHA or children affected by HIV are generally stronger predictors of psychological problems than their own feelings or attitudes towards PLWHA. Various aspects of HIV-related stigma are important for us to understand the perception, attitudes, and experience of children affected by HIV, including both children experiencing HIV-related parental illness and death in their own family and children who were living in the communities hardly hit by HIV. Future health promotion and psychological care efforts for children affected by HIV need to consider the effect of various forms of HIV-related stigma on these children’s psychosocial well-being and mobilize the community resources to mitigate the negative effect of HIV-related stigma on PLWHA and their children.

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References

  • Bell, C. C., Bhana, A., Petersen, I., McKay, M. M., Gibbons, R., Bannon, W., et al. (2008). Building protective factors to offset sexually risky behaviors among black youths: A randomized control trial. Journal of the National Medical Association, 100(8), 936–944.

    PubMed  Google Scholar 

  • Bird, S., Bogart, L., & Delahanty, D. (2004). Health-related correlates of perceived discrimination in HIV care. AIDS Patient Care and STDs, 18, 19–26.

    Article  PubMed  Google Scholar 

  • Bond, V., Chaseb, E., & Aggleton, P. (2002). Stigma, HIV/AIDS and prevention of mother-to-child transmission in Zambia. Evaluation and Program Planning, 25, 347–356.

    Article  Google Scholar 

  • Campbell, C., Foulis, C. A., Maimane, S., & Sibiya, Z. (2005). “I have an evil child at my house”: Stigma and HIV/AIDS management in a South African community. American Journal of Public Health, 95, 808–815.

    Article  PubMed  Google Scholar 

  • Campbell, C., Nair, Y., Maimane, S., & Nicholson, J. (2007). ‘Dying twice’: A multi-level model of the roots of AIDS stigma in two South African communities. Journal of Health Psychology, 12, 403–416.

    Article  PubMed  Google Scholar 

  • Chesney, M. A., & Smith, A. W. (1999). Critical delays in HIV testing and care. American Behavioral Scientist, 42, 1162–1174.

    Article  Google Scholar 

  • Deng, R., Li, J., Sringernyuang, L., & Zhang, K. (2007). Drug abuse, HIV/AIDS and stigmatisation in a Dai community in Yunnan, China. Social Science and Medicine, 64, 1560–1571.

    Article  PubMed  Google Scholar 

  • Duffy, L. (2005). Suffering, shame, and silence: The stigma of HIV/AIDS. Journal of the Association of Nurses in AIDS Care, 16, 13–20.

    Article  PubMed  Google Scholar 

  • Fang, X., Li, X., Stanton, B., Hong, Y., Zhang, L., Zhao, G., et al. (2009). Parental HIV/AIDS on psychosocial adjustment of rural Chinese children. Journal of Pediatric Psychology, 34(10), 1053–1062.

    Article  PubMed  Google Scholar 

  • Fendrich, M., Weissman, M. M., & Warner, V. (1990). Screening for depressive disorder in children and adolescents: Validating the center for epidemiologic studies depression scale for children. American Journal of Epidemiology, 131, 538–551.

    PubMed  CAS  Google Scholar 

  • Herek, G. M. (1999). AIDS and stigma. Am Behav Scientist, 42(7), 1106–1116.

    Google Scholar 

  • Herek, G. M. (2002). Thinking about AIDS and stigma: a psychologist’s perspective. The Journal of Law, Medicine & Ethics, 30, 594–607.

    Article  Google Scholar 

  • Herek, G. M., & Capitanio, J. P. (1997). AIDS stigma and contact with persons with AIDS: Effects of direct and vicarious contact. Journal of Applied Social Psychology, 27(1), 1–36.

    Article  Google Scholar 

  • Herek, G. M., & Capitanio, J. P. (1998). Symbolic prejudice or fear of infection? A functional analysis of AIDS-related stigma among heterosexual adults. Basic and Applied Social Psychology, 20, 230–241.

    Article  Google Scholar 

  • Herek, G. M., Capitanio, J. P., & Widaman, K. F. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92, 371–377.

    Article  PubMed  Google Scholar 

  • Hightower, A. D., Cowen, E. L., Spinell, A. P., Lotyczewski, B. S., Guare, J. C., Rohrbeck, C. A., et al. (1987). The child rating scale: The development of a socioemotional self-rating scale for elementary school children. School Psychology Review, 16, 239–255.

    Google Scholar 

  • Holzemer, W. L., Uys, L. R., Chirwa, M. L., Greeff, M., Makoae, L. N., Kohi, T. W., et al. (2007). Validation of the HIV/AIDS-related stigma instrument—PLWA (HASI-P). AIDS Care, 19, 1002–1012.

    Article  PubMed  Google Scholar 

  • Jacoby, A. (1994). Felt versus enacted stigma: A concept revisited. Evidence from a study of people with epilepsy in remission. Social Science and Medicine, 38, 269–274.

    Article  PubMed  CAS  Google Scholar 

  • Kopacz, D. R., Grossman, L. S., & Klamen, D. L. (1999). Medical students and AIDS: Knowledge, attitudes and implications for education. Health Education Research, 14, 1–6.

    Article  PubMed  CAS  Google Scholar 

  • Lee, R. S., Kochman, A., & Sikkema, K. J. (2002). Internalized stigma among people living with HIV/AIDS. AIDS and Behavior, 6, 309–319.

    Article  Google Scholar 

  • Letamo, G. (2003). Prevalence of, and factors associated with, HIV/AIDS-related stigma and discriminatory attitudes in Botswana. Journal of Health, Population and Nutrition, 21, 347–357.

    Google Scholar 

  • Li, L., Wu, Z., Zhao, Y., Lin, C., Detels, R., & Wu, S. (2007). Using case vignettes to measure HIV-related stigma among health professionals in China. International Journal of Epidemiology, 36(1), 178–184.

    Article  PubMed  CAS  Google Scholar 

  • Lieber, E., Li, L., Wu, Z., Rotheram-Borus, M. J., & Guan, J. (2006). HIV/STD stigmatization fears as health-seeking barriers in China. AIDS and Behavior, 10, 463–471.

    Article  PubMed  Google Scholar 

  • Malcolm, A., Aggleton, P., Bronfman, M., Galvão, J., Mane, P., & Verrall, J. (1998). HIV-related stigmatization and discrimination: Its forms and contexts. Critical Public Health, 8, 347–370.

    Article  Google Scholar 

  • Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science and Medicine, 57, 13–24.

    Article  PubMed  Google Scholar 

  • Petersen, I., Bhana, A., Myeza, N., Alicea, S., John, S., Holst, H., et al. (2010). Psychosocial challenges and protective influences for socio-emotional coping of HIV+ adolescents in South Africa: A qualitative investigation. AIDS Care, 22(8), 970–978.

    Article  PubMed  CAS  Google Scholar 

  • Pomeroy, E. C., Rubin, A., & Walker, R. J. (1995). Effectiveness of a psychoeducational and task-centered group intervention for family members of people with AIDS. Social Work Research, 19, 142–152.

    PubMed  CAS  Google Scholar 

  • Reidpath, D. D., Brijnath, B., & Chan, K. Y. (2005). An Asia Pacific six-country study on HIV-related discrimination: Introduction. AIDS Care, 17, S117–S127.

    Article  PubMed  Google Scholar 

  • Roeloffs, C., Sherbourne, C., Unützer, J., Fink, A., Tang, L., & Wells, K. (2003). Stigma and depression among primary care patients. General Hospital Psychiatry, 25, 311–315.

    Article  PubMed  Google Scholar 

  • Rosenthal, E. (2002). AIDS scourge in rural China leaves villages of orphans. New York: New York Times.

    Google Scholar 

  • Scrambler, G. (1998). Stigma and disease: Changing paradigms. The Lancet, 352, 1054–1055.

    Article  Google Scholar 

  • Thomas, F. (2006). Stigma, fatigue and social breakdown: Exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region, Namibia. Social Science and Medicine, 63, 3174–3187.

    Article  PubMed  Google Scholar 

  • Valdiserri, R. O. (2002). HIV/AIDS stigma: An impediment to public health. American Journal of Public Health, 92, 341–342.

    Article  PubMed  Google Scholar 

  • Varas-Díaz, N., Serrano-García, I., & Toro-Alfonso, J. (2005). AIDS-related stigma and social interaction: Puerto Ricans living with HIV/AIDS. Qualitative Health Research, 15, 169–187.

    Article  PubMed  Google Scholar 

  • Visser, M. J., Kershaw, T., Makin, J. D., & Forsyth, B. W. C. (2008). Development of parallel scales to measure HIV-related stigma. AIDS and Behavior, 12, 759–771.

    Article  PubMed  Google Scholar 

  • Wright, E. R., Gronfein, W. P., & Owens, T. J. (2000). Deinstitutionalization, social rejection, and the self-esteem of former mental patients. Journal of Health and Social Behavior, 41, 68–90.

    Article  PubMed  CAS  Google Scholar 

  • Zhao, J., Li, X., Fang, X., Hong, Y., Zhao, G., Lin, D., et al. (2010). Stigma against children affected by AIDS (SACAA): Reliability and validity of a brief measurement scale. AIDS and Behavior, 14, 1302–1312.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the National Institute of Mental Health and the National Institute of Nursing Research (R01MH76488). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institute of Nursing Research. The authors wish to thank Drs. Xiaoyi Fang, Xiuyun Lin, Yunfei Lv, and other members of the investigative team for their contribution in the scale development and field data collection. The authors also want to thank Ms. Joanne Zwemer for assistance with manuscript preparation.

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Correspondence to Xiaoming Li.

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Zhao, G., Li, X., Zhao, J. et al. Relative Importance of Various Measures of HIV-Related Stigma in Predicting Psychological Outcomes Among Children Affected by HIV. Community Ment Health J 48, 275–283 (2012). https://doi.org/10.1007/s10597-011-9424-7

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  • DOI: https://doi.org/10.1007/s10597-011-9424-7

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