From Conceptualizing to Measuring HIV Stigma: A Review of HIV Stigma Mechanism Measures
TL;DR: A new framework designed to aid in clarifying the conceptualization and measurement of HIV stigma among individuals is articulate and the utility of using three questions to guide future HIV stigma research is emphasized.
Abstract: Recent analyses suggest that lack of clarity in the conceptualization and measurement of HIV stigma at an individual level is a significant barrier to HIV prevention and treatment efforts. In order to address this concern, we articulate a new framework designed to aid in clarifying the conceptualization and measurement of HIV stigma among individuals. The HIV Stigma Framework explores how the stigma of HIV elicits a series of stigma mechanisms, which in turn lead to deleterious outcomes for HIV uninfected and infected people. We then apply this framework to review measures developed to gauge the effect of HIV stigma since the beginning of the epidemic. Finally, we emphasize the utility of using three questions to guide future HIV stigma research: who is affected by, how are they affected by, and what are the outcomes of HIV stigma?
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TL;DR: The contributions of the syndemics approach for understanding both interacting chronic diseases in social context, and the implications of a Syndemics orientation to the issue of health rights, are examined.
805 citations
TL;DR: The identification of effective interventions to reduce stigma and discrimination that can be integrated into national responses is crucial to the success of the global AIDS response.
Abstract: Introduction : HIV-related stigma and discrimination continue to hamper efforts to prevent new infections and engage people in HIV treatment, care and support programmes. The identification of effective interventions to reduce stigma and discrimination that can be integrated into national responses is crucial to the success of the global AIDS response. Methods : We conducted a systematic review of studies and reports that assessed the effectiveness of interventions to reduce HIV stigma and discrimination between 1 January 2002 and 1 March 2013. Databases searched for peer-reviewed articles included PubMed, Scopus, EBSCO Host -CINAHL Plus, Psycinfo, Ovid, Sociofile and Popline. Reports were obtained from the www.HIVAIDSClearinghouse.eu , USAID Development Experience Clearinghouse, UNESCO HIV and AIDS Education Clearinghouse, Google, WHO and UNAIDS. Ancestry searches for articles included in the systematic review were also conducted. Studies of any design that sought to reduce stigma as a primary or secondary objective and included pre- and post-intervention measures of stigma were included. Results : Of 2368 peer-reviewed articles and reports identified, 48 were included in our review representing 14 different target populations in 28 countries. The majority of interventions utilized two or more strategies to reduce stigma and discrimination, and ten included structural or biomedical components. However, most interventions targeted a single socio-ecological level and a single domain of stigma. Outcome measures lacked uniformity and validity, making both interpretation and comparison of study results difficult. While the majority of studies were effective at reducing the aspects of stigma they measured, none assessed the influence of stigma or discrimination reduction on HIV-related health outcomes. Conclusions : Our review revealed considerable progress in the stigma-reduction field. However, critical challenges and gaps remain which are impeding the identification of effective stigma-reduction strategies that can be implemented by national governments on a larger scale. The development, validation, and consistent use of globally relevant scales of stigma and discrimination are a critical next step for advancing the field of research in this area. Studies comparing the effectiveness of different stigma-reduction strategies and studies assessing the influence of stigma reduction on key behavioural and biomedical outcomes are also needed to maximize biomedical prevention efforts. Keywords : systematic review; HIV; stigma reduction; discrimination reduction; interventions; measurement. (Published: 13 November 2013) To access the supplementary material to this article please see Supplementary Files in the column to the right (under Article Tools). Citation : Stangl AL et al. Journal of the International AIDS Society 2013, 16 (Suppl 2):18734 http://www.jiasociety.org/index.php/jias/article/view/18734 | http://dx.doi.org/10.7448/IAS.16.3.18734
529 citations
TL;DR: Evaluating the HIV Stigma Framework in a sample of 95 people living with HIV recruited from an inner-city clinic in the Bronx, NY suggests that internalized stigma associates significantly with indicators of affective and behavioral health and well-being.
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.
498 citations
Cites background or methods from "From Conceptualizing to Measuring H..."
...Therefore, items for measures of internalized, anticipated, and enacted HIV stigma were adapted from previously validated scales [9, 24] according to the criteria specified by Earnshaw and Chaudoir [6]....
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...In the current study, we explored whether the HIV stigma mechanisms proposed by the HIV Stigma Framework [6] are differentially associated with indicators of health and well-being among PLWH....
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...Therefore, items for measures of internalized, anticipated, and enacted HIV stigma were adapted from previously validated scales [9, 24] according to the criteria specified by Earnshaw and Chaudoir [6]....
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...Earnshaw and Chaudoir [6] hypothesize that differentiating between these individual-level HIV stigma mechanisms within research is important to advance understandings of how HIV stigma impacts specific health and well-being outcomes among PLWH....
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...To address this limitation of the literature and bridge conceptualizations of HIV stigma at the structural and individual levels, Earnshaw and Chaudoir [6] proposed the HIV Stigma Framework....
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TL;DR: Significant associations between HIV-related stigma and higher rates of depression, lower social support and lower levels of adherence to antiretroviral medications and access to and usage of health and social services are found.
Abstract: Objective To conduct a systematic review and series of meta-analyses on the association between HIV-related stigma and health among people living with HIV. Data sources A structured search was conducted on 6 electronic databases for journal articles reporting associations between HIV-related stigma and health-related outcomes published between 1996 and 2013. Study eligibility criteria Controlled studies, cohort studies, case-control studies and cross-sectional studies in people living with HIV were considered for inclusion. Outcome measures Mental health (depressive symptoms, emotional and mental distress, anxiety), quality of life, physical health, social support, adherence to antiretroviral therapy, access to and usage of health/social services and risk behaviours. Results 64 studies were included in our meta-analyses. We found significant associations between HIV-related stigma and higher rates of depression, lower social support and lower levels of adherence to antiretroviral medications and access to and usage of health and social services. Weaker relationships were observed between HIV-related stigma and anxiety, quality of life, physical health, emotional and mental distress and sexual risk practices. While risk of bias assessments revealed overall good quality related to how HIV stigma and health outcomes were measured on the included studies, high risk of bias among individual studies was observed in terms of appropriate control for potential confounders. Additional research should focus on elucidating the mechanisms behind the negative relationship between stigma and health to better inform interventions to reduce the impact of stigma on the health and well-being of people with HIV. Conclusions This systematic review and series of meta-analyses support the notion that HIV-related stigma has a detrimental impact on a variety of health-related outcomes in people with HIV. This review can inform the development of multifaceted, intersectoral interventions to reduce the impact of HIV-related stigma on the health and well-being of people living with HIV.
497 citations
Cites background from "From Conceptualizing to Measuring H..."
...However, the extent to which people who experience a high degree of anticipated stigma may be less likely to disclose their HIV status for fear of social exclusion is unknown.(7) 48 Consequently, as questions surrounding the complex relationship between HIV-related stigma, depression and social support still remain, conducting longitudinal studies and exploring the role of potential moderating factors is warranted....
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...stigma and social support, previous research indicates that disclosure of one’s HIV status to family, friends or healthcare professionals may be a stigmatising social process that can result in fear of rejection,(28) or isolation and exclusion by support networks.(7) 48 Research examining social support as moderating the relationship between HIV-related stigma and depression,(6) 74–76 points to the role of social support in buffering depression among people living with HIV....
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...In other words, for those living with HIV, the knowledge that their HIV status is a socially devalued aspect of themselves may be experienced in a variety of ways, ranging from actually being the object of prejudice and discrimination from others to holding negative beliefs and feelings about themselves.(7) Stigma may arise from misconceptions about HIV transmission and from judg-...
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TL;DR: The Health Stigma and Discrimination Framework is proposed, which is a global, crosscutting framework based on theory, research, and practice, and its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight is demonstrated.
Abstract: Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.
454 citations
Cites background from "From Conceptualizing to Measuring H..."
...The majority of health-related stigma frameworks explore psychological pathways at the individual level, focusing either on the individuals experiencing stigma [10, 11, 14–16, 30, 31], those perpetuating stigma [21, 26], or both [20, 24, 32]....
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References
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TL;DR: In this article, the authors discuss the relationship between information control and personal identity, including the Discredited and the Discreditable Social Information Visibility Personal Identity Biography Biographical Others Passing Techniques of Information Control Covering.
Abstract: CONTENTS 1. Stigma and Social Identity Preliminary Conceptions The Own and the Wise Moral Career 2. Information Control and Personal Identity The Discredited and the Discreditable Social Information Visibility Personal Identity Biography Biographical Others Passing Techniques of Information Control Covering 3. Group Alignment and Ego Identity Ambivalence Professional Presentations In-Group Alignments Out-Group Alignments The Politics of Identity 4. The Self and Its Other Deviations and Norms The Normal Deviant Stigma and Reality 5. Deviations and Deviance
17,631 citations
Book•
01 Jan 1963
TL;DR: In this article, the authors discuss the relationship between information control and personal identity, including the Discredited and the Discreditable Social Information Visibility Personal Identity Biography Biographical Others Passing Techniques of Information Control Covering.
Abstract: CONTENTS 1. Stigma and Social Identity Preliminary Conceptions The Own and the Wise Moral Career 2. Information Control and Personal Identity The Discredited and the Discreditable Social Information Visibility Personal Identity Biography Biographical Others Passing Techniques of Information Control Covering 3. Group Alignment and Ego Identity Ambivalence Professional Presentations In-Group Alignments Out-Group Alignments The Politics of Identity 4. The Self and Its Other Deviations and Norms The Normal Deviant Stigma and Reality 5. Deviations and Deviance
13,742 citations
Book•
01 Jan 1954TL;DR: In this article, the authors describe the dynamics of prejudgment, including: Frustration, Aggression and Hatred, Anxiety, Sex, and Guilt, Demagogy, and Tolerant Personality.
Abstract: Preferential Thinking * What Is the Problem? * The Normality of Prejudgment * Formation of In-Groups * Rejection of Out-Groups * Patterning and Extent of Prejudice Group Differences * The Scientific Study of Group Differences * Racial and Ethnic Differences * Visibility and Strangeness * Traits Due to Victimization Perceiving And Thinking About Group Differences * The Cognitive Process * Linguistic Factors * Stereotypes in Our Culture * Theories of Prejudice Sociocultural Factors * Social Structure And Cultural Pattern * Choice of Scapegoats * The Effect of Contact * Acquiring Prejudice * Conforming * The Young Child * Later Learning * Inner Conflict The Dynamics Of Prejudice * Frustration * Aggression and Hatred * Anxiety, Sex, and Guilt * Projection Character Structure * The Prejudiced Personality * Demagogy * The Tolerant Personality * Religion and Prejudice Reducing Group Tensions * Ought There to Be a Law? * Evaluation of Programs * Limitations and Horizons
13,470 citations
Book•
01 Jan 1935
TL;DR: In this paper, Neuberg and Heine discuss the notion of belonging, acceptance, belonging, and belonging in the social world, and discuss the relationship between friendship, membership, status, power, and subordination.
Abstract: VOLUME 2. Part III: The Social World. 21. EVOLUTIONARY SOCIAL PSYCHOLOGY (Steven L. Neuberg, Douglas T. Kenrick, and Mark Schaller). 22. MORALITY (Jonathan Haidt and Selin Kesebir). 23. AGGRESSION (Brad J. Bushman and L. Rowell Huesmann). 24. AFFILIATION, ACCEPTANCE, AND BELONGING: THE PURSUIT OF INTERPERSONAL CONNECTION (Mark R. Leary). 25. CLOSE RELATIONSHIPS (Margaret S. Clark and Edward P. Lemay, Jr.). 26. INTERPERSONAL STRATIFICATION: STATUS, POWER, AND SUBORDINATION (Susan T. Fiske). 27. SOCIAL CONFLICT: THE EMERGENCE AND CONSEQUENCES OF STRUGGLE AND NEGOTIATION (Carsten K. W. De Dreu). 28. INTERGROUP RELATIONS 1(Vincent Yzerbyt and Stephanie Demoulin). 29. INTERGROUP BIAS (John F. Dovidio and Samuel L. Gaertner). 30. SOCIAL JUSTICE: HISTORY, THEORY, AND RESEARCH (John T. Jost and Aaron C. Kay). 31. INFLUENCE AND LEADERSHIP (Michael A. Hogg). 32. GROUP BEHAVIOR AND PERFORMANCE (J. Richard Hackman and Nancy Katz). 33. ORGANIZATIONAL PREFERENCES AND THEIR CONSEQUENCES (Deborah H. Gruenfeld and Larissa Z. Tiedens). 34. THE PSYCHOLOGICAL UNDERPINNINGS OF POLITICAL BEHAVIOR (Jon A. Krosnick, Penny S. Visser, and Joshua Harder). 35. SOCIAL PSYCHOLOGY AND LAW (Margaret Bull Kovera and Eugene Borgida). 36. SOCIAL PSYCHOLOGY AND LANGUAGE: WORDS, UTTERANCES, AND CONVERSATIONS (Thomas Holtgraves). 37. CULTURAL PSYCHOLOGY (Steven J. Heine). AUTHOR INDEX. SUBJECT INDEX.
13,453 citations
TL;DR: It is shown that LGBs have a higher prevalence of mental disorders than heterosexuals and a conceptual framework is offered for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems.
Abstract: In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications. The study of mental health of lesbian, gay, and bisexual (LGB) populations has been complicated by the debate on the classification of homosexuality as a mental disorder during the 1960s and early 1970s. That debate posited a gay-affirmative perspective, which sought to declassify homosexuality, against a conservative perspective, which sought to retain the classification of homosexuality as a mental disorder (Bayer, 1981). Although the debate on classification ended in 1973 with the removal of homosexuality from the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1973), its heritage has lasted. This heritage has tainted discussion on mental health of lesbians and gay men by associating— even equating— claims that LGB people have higher prevalences of mental disorders than heterosexual people with the historical antigay stance and the stigmatization of LGB persons (Bailey, 1999). However, a fresh look at the issues should make it clear that whether LGB populations have higher prevalences of mental disorders is unrelated to the classification of homosexuality as a mental disorder. A retrospective analysis would suggest that the attempt to find a scientific answer in that debate rested on flawed logic. The debated scientific question was, Is homosexuality a mental disorder? The operationalized research question that pervaded the debate was, Do homosexuals have high prevalences of mental disorders? But the research did not accurately operationalize the scientific question. The question of whether homosexuality should be considered a mental disorder is a question about classification. It can be answered by debating which behaviors, cognitions, or emotions should be considered indicators of a mental
8,696 citations