Abstract
The current work evaluates the HIV Stigma Framework in a sample of 95 people living with HIV recruited from an inner-city clinic in the Bronx, NY. To determine the contributions of each HIV stigma mechanism (internalized, enacted, and anticipated) on indicators of health and well-being, we conducted an interviewer-delivered survey and abstracted data from medical records. Results suggest that internalized stigma associates significantly with indicators of affective (i.e., helplessness regarding, acceptance of, and perceived benefits of HIV) and behavioral (i.e., days in medical care gaps and ARV non-adherence) health and well-being. Enacted and anticipated stigma associate with indicators of physical health and well-being (i.e., CD4 count less than 200 and chronic illness comorbidity respectively). By differentiating between HIV stigma mechanisms, researchers may gain a more nuanced understanding of how HIV stigma impacts health and well-being and better inform targeted interventions to improve specific outcomes among people living with HIV.
Resumen
El presente trabajo evalúa el Marco Teórico del Estigma hacia el VIH en una muestra de 95 personas que viven con VIH y que fueron reclutadas en una clínica del centro de la ciudad del Bronx, NY. Para determinar la contribución de cada mecanismo con el que el estigma hacia el VIH (interiorizado, percibido, y anticipado) funciona en relación a indicadores de salud y bienestar, se realizó una encuesta conducida por entrevistadores y se extrajo información de registros médicos. Los resultados sugieren que el estigma internalizado se asocia significativamente con indicadores de salud y bienestar afectivos (es decir desesperanza, aceptación del VIH y beneficios percibidos por tener VIH) y de comportamiento (es decir, días de interrupción en la atención médica y falta de adherencia a medicamentos ARV). El estigma percibido y el anticipado se asocian con indicadores de salud física y bienestar (es decir, recuento de CD4 inferior a 200 y comorbilidad con otras enfermedades crónicas, respectivamente). Al diferenciar entre mecanismos de estigmatización en relación al VIH, los investigadores pueden obtener una comprensión más matizada de cómo el estigma impacta a la salud y al bienestar y pueden utilizar esta información para informar adecuadamente el desarrollo de intervenciones dirigidas a mejorar resultados específicos entre las personas que viven con VIH.
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References
Goffman E. Stigma: notes on the management of spoiled identity. 1st ed. New York: Simon & Schuster; 1963.
Mahajan AP, Sayles JN, Patel VA, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008;22(2):S67–79.
Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med. 2003;57:13–24.
Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742–53.
Deacon H. Towards a sustainable theory of health-related stigma: lessons from the HIV/AIDS literature. J Commun Appl Soc Psychol. 2006;16(6):418–25.
Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.
Quinn DM, Earnshaw VA. Understanding concealable stigmatized identities: the role of identity in psychological, physical, and behavioral outcomes. Soc Issues Policy Rev. 2011;5(1):160–90.
Hatzenbuehler ML, Nolen-Hoeksema S, Erickson SJ. Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: results from a prospective study of bereaved gay men. Health Psychol. 2008;27(4):455–62.
Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29.
Earnshaw VA, Quinn DM. The impact of stigma in healthcare on people living with chronic illnesses. J Health Psychol. 2012;17:157–68.
Mellins CA, Kang E, Leu C-S, Havens JF, Chesney MA. Longitudinal study of mental health and psychosocial predictors of medical treatment adherence in mothers living with HIV disease. AIDS Patient Care STDS. 2003;17(8):407–16.
Safren SA, Kumarasamy N, James R, Raminani S, Solomon S, Mayer KH. ART adherence, demographic variables and CD4 outcome among HIV-positive patients on antiretroviral therapy in Chennai, India. AIDS Care. 2005;17(7):853–62.
Mak WWS, Poon CYM, Pun LYK, Cheung SF. Meta-analysis of stigma and mental health. Soc Sci Med. 2007;65(2):245–61.
Evers AWM, Kraaimaat FW, van Lankveld W, Jongen PJH, Jacobs JWG, Bijlsma JWJ. Beyond unfavorable thinking: the illness cognition questionnaire for chronic diseases. J Consult Clin Psychol. 2001;69(6):1026–36.
Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24(10):1101–8.
Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. (under review).
Cole SW, Kemeny ME, Taylor SE. Social identity and physical health: accelerated HIV progression in rejection-sensitive gay men. J Pers Soc Psychol. 1997;72(2):320–35.
Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367:528–9.
Leserman J. HIV disease progression: depression, stress, and possible mechanisms. Biol Psychiatry. 2003;54(3):295–306.
Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70(5):539–45.
Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. E. Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Annu Rev Psychol. 2002;53(1):83–107.
McEwen B. Allostasis and allostatic load implications for neuropsychopharmacology. Neuropsychopharmacology. 2000;22(2):108–24.
Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2008;98(2):200–8.
Visser MJ, Kershaw T, Makin JD, Forsyth BWC. Development of parallel scales to measure HIV-related stigma. AIDS Behav. 2008;12(5):759–71.
Aberg JA, Kaplan JE, Libman H, et al. Primary care guidelines for the management of persons infected with Human Immunodeficiency Virus: 2009 update by the HIV medicine association of the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(5):651–81.
Glass TR, De Geest S, Weber R, et al. Correlates of self-reported nonadherence to antiretroviral therapy in HIV-infected patients. J Acquir Immune Defic Syndr. 2006;41(3):385–92.
Brown TA. Confirmatory factor analysis for applied research. New York: Guilford Press; 2006.
Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L. On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav. 1997;38(2):177–90.
Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2008;32(1):20–47.
Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006;10(5):473–82.
Alonzo AA, Reynolds NR. Stigma, HIV, and AIDS: an exploration and elaboration of a stigma trajectory. Soc Sci Med. 1991;41(3):303–15.
Earnshaw VA, Kalichman SC. Stigma experienced by people living with HIV/AIDS. In: Liamputtong P, editor. Stigma, discrimination, and living with HIV/AIDS: a cross-cultural perspective. New York: Springer; 2013.
Logie CH, James L, Tharao W, Loutfy MR. HIV, gender, race, sexual orientation, and sex work: a qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada. PLoS Med. 2011;8(11):e1001124.
Roura M, Urassa M, Busza J, Mbata D, Wringe A, Zaba B. Scaling up stigma? The effects of antiretroviral roll-out on stigma and HIV testing. Early evidence from roural Tanzania. Sex Transm Infect. 2009;85:308–12.
Acknowledgments
A seed grant from the University of Connecticut Center for Health Intervention and Prevention partly funded this work. Training grants from the National Institute of Mental Health funded Earnshaw’s (T32 MH020031) and Smith’s (F31 MH093264) efforts. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Center for Health Intervention and Prevention. The authors thank the participants, as well as HIV care providers and clinic staff for their support and contributions towards this project. Further, the authors thank Maria-Cristina Cruza-Guet for her assistance in translating the abstract to Spanish.
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Appendix: HIV Stigma Mechanism Measure
Appendix: HIV Stigma Mechanism Measure
How do you feel about being HIV-positive?
Statement | Strongly disagree | Disagree | Neither disagree nor agree | Agree | Strongly agree |
|---|---|---|---|---|---|
1. Having HIV makes me feel like I’m a bad person | 1 | 2 | 3 | 4 | 5 |
2. I feel I’m not as good as others because I have HIV | 1 | 2 | 3 | 4 | 5 |
3. I feel ashamed of having HIV | 1 | 2 | 3 | 4 | 5 |
4. I think less of myself because I have HIV | 1 | 2 | 3 | 4 | 5 |
5. Having HIV makes me feel unclean | 1 | 2 | 3 | 4 | 5 |
6. Having HIV is disgusting to me | 1 | 2 | 3 | 4 | 5 |
How likely is it that people will treat you in the following ways in the future because of your HIV status?
Statement | Very unlikely | Unlikely | Neither unlikely nor likely | Likely | Very likely |
|---|---|---|---|---|---|
1. Family members will avoid me | 1 | 2 | 3 | 4 | 5 |
2. Family members will look down on me | 1 | 2 | 3 | 4 | 5 |
3. Family members will treat me differently | 1 | 2 | 3 | 4 | 5 |
4. Community/social workers won’t take my needs seriously | 1 | 2 | 3 | 4 | 5 |
5. Community/social workers will discriminate against me | 1 | 2 | 3 | 4 | 5 |
6. Community/social workers will deny me services | 1 | 2 | 3 | 4 | 5 |
7. Healthcare workers will not listen to my concerns | 1 | 2 | 3 | 4 | 5 |
8. Healthcare workers will avoid touching me | 1 | 2 | 3 | 4 | 5 |
9. Healthcare workers will treat me with less respect | 1 | 2 | 3 | 4 | 5 |
How often have people treated you this way in the past because of your HIV status?
Statement | Never | Not often | Somewhat often | Often | Very often |
|---|---|---|---|---|---|
1. Family members have avoided me | 1 | 2 | 3 | 4 | 5 |
2. Family members have looked down on me | 1 | 2 | 3 | 4 | 5 |
3. Family members have treated me differently | 1 | 2 | 3 | 4 | 5 |
4. Community/social workers have not taken my needs seriously | 1 | 2 | 3 | 4 | 5 |
5. Community/social workers have discriminated against me | 1 | 2 | 3 | 4 | 5 |
6. Community/social workers have denied me services | 1 | 2 | 3 | 4 | 5 |
7. Healthcare workers have not listened to my concerns | 1 | 2 | 3 | 4 | 5 |
8. Healthcare workers have avoided touching me | 1 | 2 | 3 | 4 | 5 |
9. Healthcare workers have treated me with less respect | 1 | 2 | 3 | 4 | 5 |
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Earnshaw, V.A., Smith, L.R., Chaudoir, S.R. et al. HIV Stigma Mechanisms and Well-Being Among PLWH: A Test of the HIV Stigma Framework. AIDS Behav 17, 1785–1795 (2013). https://doi.org/10.1007/s10461-013-0437-9
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DOI: https://doi.org/10.1007/s10461-013-0437-9