Articles tagged as "Stigma and social exclusion"

Stigma and Discrimination

Norman LR, Carr R, et al. Sexual stigma and sympathy: attitudes toward persons living with HIV in Jamaica. Cult Health Sex 2006;8:423-33.

As the number of persons living with HIV continues to increase in Jamaica, attitudes and values become more important. This study examined the attitudes of university students in Jamaica toward persons living with HIV, including homosexual men, heterosexual men, women sex workers, other women, and children. One thousand two hundred and fifty-two students were surveyed between June 2001 and February 2002 using a 193-item questionnaire measuring a variety of HIV-related knowledge, attitudinal and behavioural items. Less than half of students reported sympathetic attitudes toward homosexual men or women sex workers living with HIV while a majority reported generally sympathetic attitudes toward heterosexual men and non-sex worker women living with the disease. Predictors of sympathy varied by target group. Male students were significantly less likely to report sympathy for homosexual men than for any other group. Spirituality was associated with sympathy for homosexual men and women sex workers, but not for the remaining two groups. Findings suggest that levels of negative attitudes are high in Jamaica and warrant attention to both individual and societal-level actions and interventions. In addition, the authors conclude, messages and interventions must be targeted, recognizing both the differences in level of sympathy expressed toward different groups and predictors of sympathy across the groups.

Editors’ note: Stigma is a critical barrier in the response to AIDS. There is a clear need for much better understanding in all countries of the origin and nature of stigma towards people living with HIV, and those at risk of HIV, to inform active, intensive and effective programming at every level to counter it.

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Mental Health and HIV

Murray LK, Haworth A, et al. Violence and abuse among HIV-Infected women and their children in Zambia: a qualitative study. J Nerv Ment Dis 2006;194:610-15

HIV and violence are two major public health problems increasingly shown to be connected. Qualitative research is needed due to the dearth of literature on this association in developing countries, cultural influences on mental health syndromes and presentations, and the sensitive nature of the topic. This study sought to investigate the mental health issues of an HIV-affected population of women and children in Lusaka, Zambia, through a systematic qualitative approach. The two qualitative methods used identified three major problems for women: domestic violence, depression-like syndrome, and alcohol abuse; and three major problems for children: defilement, domestic violence, and behaviour problems. Domestic violence and sexual abuse were found to be closely linked to HIV and alcohol abuse. Drawing on this local perspective of the overlap between violence and HIV, the authors highlight the need for violence and abuse to be addressed as HIV services are implemented in sub-Saharan Africa.

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HIV in the Workplace

Tarantola A, Golliot F, et al. Assessment of preventive measures for accidental blood exposure in operating theaters: A survey of 20 hospitals in Northern France. Am J Infect Control 2006;34:376-82. http://www.sciencedirect.com/

Accidental exposures to blood (ABE) expose health care workers (HCW) to the risk of occupational infection. Tarantola and colleagues aimed to assess the prevention equipment available in the operating theatre with reference to guidelines or recommendations and its use by the staff in that operating theatre on that day and past history of ABE. Correspondents of the Centre de Coordination de la Lutte contre les Infections Nosocomiales (CCLIN) Paris-Nord ABE Surveillance Taskforce carried out an observational multi-centre survey in 20 volunteer French hospitals. Forty-nine of the 260 (18.8%) staff surveyed said they double-gloved for all patients and procedures, changing gloves hourly. Blunt-tipped suture needles were available in 49.1% of operating theatres; 42 of 76 (55.3%) of the surgeons in these operating theatres said they never used them. Overall, 60% and 64% of surgeons had never self-tested for HIV and hepatitis C virus, respectively. Fifty-five surgeons said they had sustained a total of 96 needle stick injuries during the month preceding the survey. Ten of these surgeons had notified of 1 needle stick injury each to the occupational health department of their hospital (notification rate, 10.4%). The authors conclude that the occurrence of needle stick injury remained high in operating personnel in France in 2000. Although hospitals may improve access to protective devices, operating staff mindful of safety in the operating theatre should increase their use of available devices, their knowledge of their own serostatus, and their ABE notification rate to guide well-targeted prevention efforts.

Editors’ note: more qualitative research is needed to understand why the majority of surgeons in this study have not had an HIV or hepatitis C virus test (what are the occupational implications for French surgeons who test positive?), why the needlestick incident notification rate is so low (which would mean less uptake of post-exposure prophylaxis) and why available protection is not being used routinely.

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Misconceptions

Ritieni A, Moskowitz J, Tholandi M. HIV/AIDS Misconceptions Among Latinos: Findings From a Population-Based Survey of California Adults. Health Educ Behav 2006 Jul 21; [Epub ahead of print].

Ritieni and colleagues examined misconceptions about HIV among 454 Latino adults in California using data from a population-based telephone survey conducted in 2000. Common misconceptions concerning modes of HIV transmission included transmission via mosquito or animal bite (64.1%), public facilities (48.3%), or kissing someone on the cheek (24.8%). A composite misconceptions score was constructed. Correlations between the composite measure and other HIV-related beliefs were examined. Latinos with a higher level of misconceptions were more likely to report higher self-perceived risk of HIV infection, and discomfort with infected individuals in a school and in a food setting. Results from multiple linear regression analysis indicated that individuals 45 years and older, those who were interviewed in Spanish, and those with lower education or income levels had a higher degree of misconceptions. The results suggest the need for targeted education efforts to reduce HIV misconceptions among Latino adults in California.

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Stigma and Discrimination

Kohi TW, Makoae L, et al. HIV and AIDS stigma violates human rights in five African countries. Nurs Ethics 2006;13:404-15

Kohi and colleagues explored the situation and human rights of people living with HIV through focus groups in five African countries (Lesotho, Malawi, South Africa, Swaziland and Tanzania). They interviewed 251 informants who included people living with HIV, nurse managers, and nurse clinicians from urban and rural settings. The authors used the NVivo software to identify specific incidents related to human rights, which were compared with the Universal Declaration of Human Rights. The findings revealed that the human rights of people living with HIV were violated in a variety of ways, including denial of access to adequate or no health care/services, and denial of home care, termination or refusal of employment, and denial of the right to earn an income, produce food or obtain loans. The informants living with HIV were also abused verbally and physically. Kohi and colleagues conclude by recommending that country governments and health professionals need to address these issues to ensure the human rights of all people.

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HIV in the Workplace

Corbett EL, Dauya E, et al. Uptake of workplace HIV counselling and testing: A cluster-randomised trial in Zimbabwe. PLoS Med 2006;3:e238. http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030238

HIV counselling and testing is a key component of both HIV care and HIV prevention, but uptake is currently low. Corbett and colleagues investigated the impact of rapid HIV testing at the workplace on uptake of voluntary counselling and testing. Business occupational health clinics were randomly allocated to either one or the other of two counselling and testing strategies. HIV counselling and testing was directly offered to all employees, followed by two years of open access to testing and counselling and basic HIV care. Businesses were randomised to either on-site rapid HIV testing at their occupational clinic (11 businesses) or to vouchers for off-site testing and counselling at a chain of free-standing centres also using rapid tests (11 businesses). Baseline anonymous HIV serology was requested from all employees. Corbett and colleagues found that HIV prevalence was 19.8% and 18.4% at businesses randomised to on-site and off-site testing and counselling, respectively. In total, 1957 of 3950 employees at clinics randomised to on-site testing had testing and counselling (mean uptake by site 51.1%) compared to 586 of 3532 employees taking vouchers at clinics randomised to off-site testing (mean uptake by site 19.2%). The risk ratio for on-site testing compared to voucher uptake was 2.8 (95% CI 1.8-3.8) after adjustment for potential confounders. The authors conclude that HIV counselling and testing at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care. Convenience and accessibility appear to have critical roles in the acceptability of community-based HIV counselling and testing.

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Education and HIV

Mathews C, Boon H, et al. Factors associated with teachers' implementation of HIV/AIDS education in secondary schools in Cape Town, South Africa. AIDS Care 2006;18:388-97.

Mathews and colleagues investigated the factors influencing high school teachers’ implementation of HIV education. The independent variables included constructs derived from expectancy value theories, teachers' generic dispositions, their training experience, characteristics of their interactive context and the school climate. The authors conducted a postal survey of 579 teachers responsible for AIDS education in all 193 public high schools in Cape Town. Questionnaires were completed and returned by 324 teachers (56% response rate) from 125 schools. Many teachers (222; 70%) had implemented HIV education during 2003, and female teachers were more likely to have implemented than males (74% vs. 58%). The teacher characteristics associated with teaching about HIV were previous training, self-efficacy, student-centeredness, beliefs about controllability and the outcome of HIV education, and their responsibility. The existence of a school HIV policy, a climate of equity and fairness, and good school-community relations were the school characteristics associated with teaching about HIV. Mathews and colleagues conclude that these findings demonstrate the value of teacher training and school policy formulation. They go further to say that the findings also demonstrate the value and importance of interventions that go beyond a sexual health agenda, focussing on broader school development to improve school functioning and school climate.

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Psychosocial Distress

Corona R, Beckett MK, et al. Do Children Know Their Parent's HIV Status? Parental Reports of Child Awareness in a Nationally Representative Sample. Ambul Pediatr 2006;6:138-44. http://www.sciencedirect.com/science/journal/15301567

Corona and colleagues aimed to determine the rates and predictors of child awareness of parental HIV status and the effect of that knowledge on children. The authors conducted interviews with 274 parents from a nationally representative sample of HIV-infected adults receiving health care for HIV in the United States. HIV-infected parents reported that 44% of their children (5-17 years old) were aware of their parent's HIV status, and parents had discussed with 90% of those children the possibility that HIV or AIDS might lead to their parent's death. Multivariate analyses revealed that parents with higher income, with an HIV risk group of heterosexual intercourse, with higher CD4 counts, with greater social isolation, and with younger children were less likely to report that their child knew the parent was HIV positive. Parents reported that 11% of children worried they could catch HIV from their parent. Reasons children did not know their parent's HIV status included that the parent was worried about the emotional consequences of disclosure (67%), was worried the child would tell other people (36%), and did not know how to tell their child (28%). The authors conclude that clinicians may be able to support and guide HIV-infected parents in deciding whether, when, and how to disclose their infection to their children.


Persson A, Newman C. Potency and vulnerability: Troubled 'selves' in the context of antiretroviral therapy. Soc Sci Med 2006 May 17; [Epub ahead of print]. http://www.sciencedirect.com/science/journal/02779536

The concepts of health and self have become intimately entangled in contemporary western society. Health is figured as a marker of identity, as a vehicle of self-production and self-actualisation, while the individual is also made increasingly responsible for his or her health. Persson and Newman explore how "self" is constituted in discourses that shape the ways in which people understand and do health and medicine, particularly discourses of neo-liberalism and of the immune system. They situate the discussion in the context the antiretroviral drug efavirenz. This drug, commonly described as "potent", can have a number of troubling effects on a person's everyday sense of self, including insomnia, confusion, cognitive disorders, depression, de-personalisation, psychosis, and suicidal ideation. While efavirenz may be clinically effective in its capacity to suppress the virus, these effects are at odds with the implicit aim of HIV medicine to restore and secure the self by way of immunological integrity and strength. These effects also bring into focus the predicament of choice under the contemporary political conditions of neo-liberalism with its emphasis on health as an enterprise of the autonomous, rational self. In exploring first-person accounts, the paper unpacks a number of the binary concepts on which contemporary discourses of health and medicine rely, such as immunity and vulnerability, potency and fragility, rationality and madness, self and non-self, and asks whether the individual under neo-liberalism is being asked the impossible.

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Stigma and Social Exclusion

Rintamaki LS, Davis TC, et al. Social Stigma Concerns and HIV Medication Adherence. AIDS Patient Care STDS. 2006;20:359-68. http://www.liebertonline.com/doi/abs/10.1089/apc.2006.20.359

The threat of social stigma may prevent people living with HIV from revealing their status to others and serves as a barrier to HIV treatment adherence. Rintamaki and colleagues evaluated the effect of such concerns on self-reported treatment adherence using a short, three-item measure among 204 people living with HIV in Chicago. Overall, the mean age of participants was 40.1 years, 45% were African American, and 80% were men. People with high HIV stigma concerns were 2.5 times less likely to define and interpret the meaning of CD4 count correctly and 3.3 times more likely to be non-adherent to their medication regimen than those with low concerns. Concern over revealing HIV status was the only statistically significant, independent predictor of adherence in multivariate analysis. The authors conclude that clinical care directed to individuals living with HIV should include considerations for patient sensitivity to social stigma, such as modifications to medication schedules and referrals for counselling prior to enrolment in ART.


Poku KA, Linn JG, et al. A comparative analysis of perceived stigma among HIV-positive Ghanaian and African American males. Sahara 2005;2:344-51. http://thor.sabinet.co.za/sama/m_sahara.html

The purpose of this paper was to address two questions: (i) Do Ghanaian and African American males with HIV experience different types and degrees of stigma? and (ii) Is the impact of stigma associated with HIV on the self different for Ghanaian and African American males? A quantitative method was used, and the four dimensions of stigma (social rejection, financial insecurity, internalised shame, and social interaction) were identified and measured using combination Likert-type questionnaires. Data regarding positive feelings of self worth and self-deprecation, stress related to body image, and personal control were also collected in Ghana (55 men) and the southeastern USA (55 men). The authors found that values for the scales measuring stigma and self-perception were significantly higher for the Ghanaian men than for the African American men and concluded that the Ghanaian men living with HIV experienced a greater amount of negative self-perception and stigma-related strife than the African American men.

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Workplace

Dickinson D, Stevens M. Understanding the response of large South African companies to HIV/AIDS. Sahara 2005;2:286-95. http://thor.sabinet.co.za/sama/m_sahara.html

This paper provides a framework analysing the response of South African companies to AIDS. Drawing on three case studies of companies, each with over 20 000 South African-based employees, the authors identify six ‘drivers’ that influence corporate behaviour regarding HIV: legal requirements, voluntary regulation, business costs, social pressures, visibility of the disease, and individuals within companies. Dickinson and Stevens suggest that costs calculations, while possibly underestimating indirect and macro-implications, are not key in driving company responses to HIV. The law and voluntary regulation have influenced, but not determined, the response of companies to HIV. Social pressures on companies are of importance, but the scale and complexity of need in South Africa has seen the deflecting of this driver. Of greater reference in determining responses has been the social pressure of other companies' responses. The general visibility of the AIDS epidemic is also a significant factor in explaining companies' responses to AIDS. Moreover, the visibility of HIV and AIDS within companies has influenced the responses of often relatively weak, internal agents who have been attempting to drive companies’ HIV programmes. The authors conclude that external drivers — legal requirements, economic performance, and social pressures — have framed corporate responses to AIDS to a degree, but have generally been weak. Moreover, there has been relatively little synergy between these external drivers and the internal drivers – voluntary regulation, visibility, and company HIV 'champions' – that could propel companies into pro-active, bold responses to AIDS.

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