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Population Density and AIDS-Related Stigma in Large-Urban, Small-Urban, and Rural Communities of the Southeastern USA

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Abstract

AIDS stigmas delay HIV diagnosis, interfere with health care, and contribute to mental health problems among people living with HIV. While there are few studies of the geographical distribution of AIDS stigma, research suggests that AIDS stigmas are differentially experienced in rural and urban areas. We conducted computerized interviews with 696 men and women living with HIV in 113 different zip code areas that were classified as large-urban, small-urban, and rural areas in a southeast US state with high-HIV prevalence. Analyses conducted at the individual level (N = 696) accounting for clustering at the zip code level showed that internalized AIDS-related stigma (e.g., the sense of being inferior to others because of HIV) was experienced with greater magnitude in less densely populated communities. Multilevel models indicated that after adjusting for potential confounding factors, rural communities reported greater internalized AIDS-related stigma compared to large-urban areas and that small-urban areas indicated greater experiences of enacted stigma (e.g., discrimination) than large-urban areas. The associations between anticipated AIDS-related stigma (e.g., expecting discrimination) and population density at the community-level were not significant. Results suggest that people living in rural and small-urban settings experience greater AIDS-related internalized and enacted stigma than their counterparts living in large-urban centers. Research is needed to determine whether low-density population areas contribute to or are sought out by people who experienced greater AIDS-related stigma. Regardless of causal directions, interventions are needed to address AIDS-related stigma, especially among people in sparsely populated areas with limited resources.

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References

  • Barroso, J., Relf, M. V., Williams, M. S., Arscott, J., Moore, E. D., Caiola, C., & Silva, S. G. (2014). A randomized controlled trial of the efficacy of a stigma reduction intervention for HIV-infected women in the Deep South. AIDS Patient Care and STDs, 28, 489–498.

    Article  PubMed  PubMed Central  Google Scholar 

  • Data, G. (2015). Rural urban suburban data. Retrieved from http://greatdata.com/rural–urban-data.

  • Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13, 1160–1177.

    Article  PubMed  PubMed Central  Google Scholar 

  • Earnshaw, V. A., Smith, L. R., Chaudoir, S. R., Amico, K. R., & Copenhaver, M. M. (2013). HIV stigma mechanisms and well-being among PLWH: A test of the HIV stigma framework. AIDS and Behavior, 17, 1785–1795.

    Article  PubMed  PubMed Central  Google Scholar 

  • Eaton, L. A., Driffin, D. D., Kegler, C., Smith, H., Conway-Washington, C., White, D., & Cherry, C. (2015). The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. American Journal of Public Health, 105, e75–82.

    Article  PubMed  PubMed Central  Google Scholar 

  • Friedman, A. S., Terras, A., Zhu, W., & McCallum, J. (2004). Depression, negative self-image, and suicidal attempts as effects of substance use and substance dependence. Journal of Addictive Disorders, 23, 55–71.

    Article  Google Scholar 

  • Georgia Departmemnt of Public Health. o. P. (2013). HIV Surveillance Summary Georgia, 2013. Available at https://dph.georgia.gov/georgias-hivaids-epidemiology-surveillance-section.

  • Gonzalez, A., Miller, C. T., Solomon, S. E., Bunn, J. Y., & Cassidy, D. G. (2009). Size matters: Community size, HIV stigma, & gender differences. AIDS and Behavior, 13, 1205–1212.

    Article  PubMed  Google Scholar 

  • Heckman, T. G., Somlai, A. M., Kalichman, S. C., Franzoi, S. L., & Kelly, J. A. (1998). Psychosocial differences between urban and rural people living with HIV/AIDS. Journal of Rural Health, 14, 138–145.

    Article  CAS  PubMed  Google Scholar 

  • Kalichman, S. C., Rompa, D., & Cage, M. (2000). Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. Journal of Nervous and Mental Disorders, 188, 662–670.

    Article  CAS  Google Scholar 

  • Kalichman, S. C., Simbayi, L. C., Cloete, A., Ginindza, T., Mthembu, P., Cherry, C., & Cain, D. (2009). Measuring AIDS stigmas in people living with HIV/AIDS: The Internalized AIDS-Related Stigma Scale. AIDS Care, 21, 87–93.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C., Pellowski, J., Kalichman, M. O., Cherry, C., Detorio, M., Caliendo, A. M., & Schinazi, R. F. (2011). Food insufficiency and medication adherence among people living with HIV/AIDS in urban and peri-urban settings. Prevention Science, 12, 324–332.

    Article  PubMed  Google Scholar 

  • Katz, I. T., Ryu, A. E., Onuegbu, A. G., Psaros, C., Weiser, S. D., Bangsberg, D. R., & Tsai, A. C. (2013). Impact of HIV-related stigma on treatment adherence: Systematic review and meta-synthesis. Journal of the International AIDS Society, 16, 18640.

    Article  PubMed  PubMed Central  Google Scholar 

  • LaVeist, T. A., Isaac, L. A., & Williams, K. P. (2009). Mistrust of health care organizations is associated with underutilization of health services. Health Services Research, 44, 2093–2105.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lester, R. T., Ritvo, P., Mills, E. J., Kariri, A., Karanja, S., Chung, M. H., et al. (2010). Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): A randomised trial. Lancet, 376, 1838–1845.

    Article  PubMed  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  PubMed Central  Google Scholar 

  • Marhefka, S., Fuhrmann, H., Gilliam, P., Lopez, B., & Baldwin, J. (2012). Interest in, concerns about, and preferences for potential video-group delivery of an effective behavioral intervention among women living with HIV. AIDS and Behavior, 16, 1961–1969.

    Article  PubMed  Google Scholar 

  • Niyonsenga, T., Trepka, M. J., Lieb, S., & Maddox, L. M. (2013). Measuring socioeconomic inequality in the incidence of AIDS: Rural-urban considerations. AIDS and Behavior, 17, 700–709.

    Article  PubMed  PubMed Central  Google Scholar 

  • Patton, W. (1991). Relationship between self-image and depression in adolescents. Psychological Reports, 68, 867–870.

    Article  CAS  PubMed  Google Scholar 

  • Pellowski, J. A. (2013). Barriers to care for rural people living with HIV: A review of domestic research and health care models. Journal of the Association of Nurses in AIDS Care, 24, 422–437.

    Article  PubMed  PubMed Central  Google Scholar 

  • Peugh, J. L., & Enders, C. (2005). Using the SPSS mixed procedure to fit cross-sectional and longitudinal multilevel models. Educational and Psychological Measurement, 65, 717–741.

    Article  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • Rao, D., Feldman, B. J., Fredericksen, R. J., Crane, P. K., Simoni, J. M., Kitahata, M. M., & Crane, H. M. (2011). A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS and Behavior, 16, 711–716.

    Article  Google Scholar 

  • Reif, S., Golin, C. E., & Smith, S. R. (2005). Barriers to accessing HIV/AIDS care in North Carolina: Rural and urban differences. AIDS Care, 17, 558–565.

    Article  CAS  PubMed  Google Scholar 

  • Sheehan, D. M., Trepka, M. J., Fennie, K. P., Dillon, F. R., Madhivanan, P., & Maddox, L. M. (2015). Neighborhood Latino ethnic density and mortality among HIV-positive Latinos by birth country/region, Florida, 2005–2008. Ethnicity and Health, 21, 268–283.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sweeney, S. M., & Vanable, P. A. (2015). The association of HIV-related stigma to HIV medication adherence: A systematic review and synthesis of the literature. AIDS and Behavior, 20, 29–50.

    Article  Google Scholar 

  • Trepka, M. J., Fennie, K. P., Sheehan, D. M., Lutfi, K., Maddox, L., & Lieb, S. (2014). Late HIV diagnosis: Differences by rural/urban residence, Florida, 2007–2011. AIDS Patient Care and STDs, 28, 188–197.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tsai, A.C., Bangsberg, D.R., Kegeles, S.M., Katz, I.T., Haberer, J.E., Muzoora, C., . . . Weiser, S.D. (2013). Internalized stigma, social distance, and disclosure of HIV seropositivity in rural Uganda. Annals of Behavioral Medicine, 46, 285–294.

  • Vanable, P. A., Carey, M. P., Blair, D. C., & Littlewood, R. A. (2006). Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS and Behavior, 10, 473–482.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vyavaharkar, M., Moneyham, L., Corwin, S., Saunders, R., Annang, L., & Tavakoli, A. (2010). Relationships between stigma, social support, and depression in HIV-infected African American women living in the rural Southeastern United States. Journal of the Association of Nurses in AIDS Care, 21, 144–152.

    Article  PubMed  Google Scholar 

  • Weis, K. E., Liese, A. D., Hussey, J., Gibson, J. J., & Duffus, W. A. (2010). Associations of rural residence with timing of HIV diagnosis and stage of disease at diagnosis, South Carolina 2001–2005. Journal of Rural Health, 26, 105–112.

    Article  PubMed  Google Scholar 

  • Whetten-Goldstein, K., Nguyen, T. Q., & Heald, A. E. (2001). Characteristics of individuals infected with the human immunodeficiency virus and provider interaction in the predominantly rural Southeast. Southern Medical Journal, 94, 212–222.

    Article  CAS  PubMed  Google Scholar 

  • White, H. (1994). Estimation, inference, and specification analysis. New York: Cambridge Press.

    Book  Google Scholar 

  • Williams, R. L. (2000). A note on robust variance estimation for cluster-correlated data. Biometrics, 56, 645–646.

    Article  CAS  PubMed  Google Scholar 

  • Wong, L. P. (2013). Prevalence and factors associated with HIV/AIDS-related stigma and discriminatory attitudes: A cross-sectional nationwide study. Preventive Medicine, 57, S60–63.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA

    Seth Kalichman & Moira Kalichman

  2. Mercer University Medical School, Macon, GA, USA

    Harold Katner & Ellen Banas

Authors
  1. Seth Kalichman
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  2. Harold Katner
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  3. Ellen Banas
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  4. Moira Kalichman
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Corresponding author

Correspondence to Seth Kalichman.

Ethics declarations

The University of Connecticut and Mercer University Institutional Review Boards approved all of the study procedures. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

This research was supported by National Institute of Alcohol Abuse and Alcoholism Grants R01-AA021471 and R01-AA023727.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

All participants provided informed consent in compliance with conducting self-administered anonymous surveys.

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Kalichman, S., Katner, H., Banas, E. et al. Population Density and AIDS-Related Stigma in Large-Urban, Small-Urban, and Rural Communities of the Southeastern USA. Prev Sci 18, 517–525 (2017). https://doi.org/10.1007/s11121-017-0761-9

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  • DOI: https://doi.org/10.1007/s11121-017-0761-9

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