污名应对策略的研究现状与展望

应激与应对的理论发展构建了污名应对研究的基本框架。污名应对策略是指被污名者在具体污名情境中为减少压力的消极影响而有目的地采用的情绪、认知和行为反应。目前, 关于被污名者应对污名策略的研究, 特别是艾滋病污名应对策略的研究日趋增多。根据不同的划分标准, 可以区分出问题聚焦性与情绪聚焦性策略、卷入与摆脱策略以及前摄性与反应性策略; 对于可隐藏污名而言, 还涉及到表露/隐藏策略。在研究方法上, 质性研究范式日益发挥重要作用。未来应该注重污名应对策略的情境性, 加强不同污名领域的专题研究, 关注对应对策略的评价并构建污名应对策略的层次模型。     

Stigmatizing attitudes of the community towards people living with HIV/AIDS

This research involved an exploratory study in which a questionnaire was used to investigate the personal stigma and perceived community stigma regarding HIV/AIDS in a South African community. Student fieldworkers interviewed a convenient sample of 901 respondents from different races, gender and age groups, and found that respondents tended towards stigmatizing persons with HIV/AIDS. Yet, this degree of stigmatization was significantly less severe than the degree of stigmatization that respondents attributed to the community at large. Altogether 17% of the respondents had high stigmatizing attitudes, while 42% perceived the stigmatization by others in the community to be high. Race group, personal knowledge of someone with HIV, area of residence, gender and age group impacted on the respondents' personal tendency to stigmatize those with HIV/AIDS. The article discusses the difference between the level of personal stigma attached by the respondents and that perceived by them to be attached by the community. Attention is also paid to the possible implications of stigmatizing behaviour patterns and interventions on a community level. Copyright © 2006 John Wiley & Sons, Ltd.     

Predictors of anxiety and depression among newly diagnosed people living with HIV: A longitudinal study

This longitudinal study examined whether past resilience and internalized stigma predicted anxiety and depression among newly diagnosed Spanish-speaking people living with HIV (PLWH). We also analyzed whether coping strategies mediated this relationship. Data were collected at two time points from 119 PLWH. Approximately a third of participants had scores indicative of anxiety symptoms, the same result was found for depressive symptoms. Structural equations modeling revealed that 61% of the variance of anxiety and 48% of the variance of depression 8 months after diagnosis was explained by the proposed model, which yielded a good fit to data. Anxiety and depressive symptoms were significantly and negatively predicted by positive thinking, thinking avoidance, and past resilience, and positively predicted by self-blame. Additionally, anxiety was positively predicted by internalized stigma. Past resilience negatively predicted internalized stigma, self-blame, and thinking avoidance and it positively predicted positive thinking. Internalized stigma positively predicted self-blame. Moreover, internalized stigma had a significant indirect effect on anxiety symptoms through self-blame, and past resilience had significant indirect effects on anxiety symptoms and depressive symptoms through internalized stigma and coping. The results point to the need for clinicians and policy makers to conduct systematic assessments and implement interventions to reduce internalized stigma and train people living with HIV to identify and use certain coping behaviors.     

Prevalence,Predictors, and Implications of Religious/Spiritual Struggles Among Muslims

The current investigation explored prevalence, predictors, and psychological implications of religious and spiritual (r/s) struggles among an Israeli‐Palestinian, Muslim sample. R/s struggle was assessed by the Religious and Spiritual Struggles Scale (Exline et al. 2014), a newly developed scale that assesses a wide array of r/s struggles. Factor analysis of the scale in this study revealed five factors of struggle: Divine and Doubt, Punitive Entities, Interpersonal, Moral, and Ultimate Meaning. Of the 139 Muslim participants, between 1.4 percent and 40.2 percent experienced various r/s struggles. Positive God image and fundamentalism predicted lower levels of struggle, whereas negative God image and universality predicted higher levels of struggle. After controlling for religious variables, we found that both depressive symptoms and generalized anxiety were predicted by Punitive Entities and Ultimate Meaning struggles, while satisfaction with life was predicted by Interpersonal struggle. Possible explanations and implications of the findings are offered, and the limitations of the study are discussed.     

Individual attitudes and perceived social norms: Reports on HIV/AIDS‐related stigma among service providers in China

This study examined HIV/AIDS‐related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals, 18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor–nurse ratio of each hospital or clinic. Lab technicians were over‐sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary, anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV‐related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs.     

Methodological considerations in developing measures of HIV risk-relevant behaviors and attitudes: An empirical illustration

Abstract

This paper describes the pilot testing of a survey designed to assess the prevalence of HIV exposure risk-relevant behaviors and associated attitudes, beliefs and knowledge in a heterogeneous, ethnically diverse, sexually active population (the US Army). The specific objectives for the pilot test were to: (1) define optimal survey question formats for behavioral and attitude items; (2) identify questions that were poorly worded or that would not contribute to the overall objectives of the survey; (3) assess the extent to which respondents could accurately follow instructions; (4) identify appropriate and culturally relevant terminology for sensitive items; (5) determine the appropriate timeframe for recall of simple and complex sexual behaviors; (6) assess the degree of respondent honesty and belief in the anonymity of the survey results.     

A Review of Faith-Based HIV Prevention Programs

HIV disproportionately affects people of color, suggesting a need for innovative prevention programs and collaborations as part of prevention efforts. African Americans have close ties to the church and faith-based organizations. African American faith communities were slow to address HIV prevention, but in recent years, they have become more involved in such activities. This study reviews the empirical literature on faith-based HIV prevention programs among African American populations. Several successful faith-based/public health collaborations are identified, and the limitations and strengths of faith-based prevention programs are discussed. Recommendations are provided for developing effective faith-based/public health collaborations.

Religious coping,stigma, and psychological functioning among HIV-positive African American women

The present study examined the role of religious coping in psychological distress and adjustment both cross-sectionally and longitudinally among 141 HIV-positive African American women. Cross-sectional analyses showed that negative religious coping was associated with poorer mental health and functioning, and greater perceptions of stigma and discrimination. Longitudinal analyses revealed that greater negative religious coping at baseline significantly predicted greater changes in mental health in a negative direction 12 months later. Positive religious coping was not associated with any measures of psychological well-being, nor did it predict any mental health outcomes at 12 months. However, participants who experienced high levels of HIV-related stigma and reported high levels of positive religious coping were less depressed than those who reported lower levels of positive religious coping. These results suggest that for this population, negative religious coping was a more salient determinant of psychological distress than positive religious coping was of psychological health.     

Neuropsychological Functioning and Antiretroviral Treatment in HIV/AIDS: A Review

This article presents a review of studies that have investigated the neuropsychological effects of antiretroviral treatment (ART) for HIV-1 infection. It provides a brief overview of the era of monotherapy, dual-therapy, and an extended overview of the current era of combination antiretroviral therapy (CART). This review highlights that while CART has had a dramatic effect on the incidence and the severity of HIV-associated neurocognitive disorders (HAND), HAND, in its mild form, still remains prevalent. New causes of this sustained prevalence are poor CNS penetration of some antiretroviral agents, drug resistance, poor adherence, potential neurotoxicity, co-morbidities such as the long-term CART side effects in relation to cardio-vascular disease, and chronic HIV brain infection that may facilitate the expression of new forms of neurodegenerative processes. The review emphasizes the need to address methodological limitations of published studies and the need for large and representative cross-disciplinary longitudinal investigations across the HIV illness span.     

基于未感染者与感染者双重视角的艾滋病污名

艾滋病污名由公众污名和自我污名两部分构成。前者指公众所持有的对艾滋病和艾滋病感染者的偏见、刻板印象和歧视; 后者指艾滋病感染者感知到的来自公众的偏见、刻板印象和歧视, 并由此产生的负面自我认知。测量主要从未感染者和感染者两个层面展开。艾滋病的公众污名与自我污名广泛存在于个人、家庭、医疗、媒体等诸多领域, 阻碍艾滋病的有效防治并损害社会平等。减少艾滋病污名的干预既需要消除公众的偏见、刻板印象和歧视, 改善社会环境; 也需要感染者自我的心理健康和治疗意愿, 提升生活质量。未来应该从未感染者和感染者的双重视角出发, 对其相互作用机制、测量工具、干预措施及连带污名等进行深入研究。     

Sufism and Gerotranscendence: The Impact of Way of Thinking, Culture, and Aging on Spiritual Maturity

This essay examines the similarities and dissimilarities between a gerotranscendental person's and a Sufi's view of ontological questions, of self and of social and individual relationships. Using the Life History Approach followed up by thematic semi-structured interviews, I studied thirteen Iranian Sufis residing in Sweden, dividing the interviewees into two groups according to the stage of their life in which they became familiar with the Sufi ideas: those who became familiar with Sufi ideas early in their life (30 years) are called early Sufis, and those whose familiarity with Sufi ideas came about in their later life (>30) are called later Sufis. The study posits that the existence of a cosmic view of self and the surrounding world can be observed among early Sufis due to their intemalization of the Sufi ideas in early life. Regarding later Sufis, we can hypothesize that the existence of such a cosmic view is not only due to the intemalization of Sufi ideas, but also to aging.     

Religious/Spiritual Well-Being,Personality and Mental Health: A Review of Results and Conceptual Issues

The current paper provides background to the development of the Multidimensional Inventory for Religious/Spiritual Well-being and then summarises findings derived from its use with other measures of health and personality. There is substantial evidence for religiosity/spirituality being positively related to a variety of indicators of mental health, including subjective well-being and personality dimensions. Furthermore, religiosity/spirituality can play an important role in the process of recovering from mental illness as well as providing a protective function against addictive or suicidal behaviours. However, further research is needed to examine the mechanisms through which religiosity/spirituality have an impact on health-related conditions.     

Poverty and HIV/AIDS in Sub-Saharan Africa: Implications for Psychological Well-being

The study examines the literature on poverty and HIV/AIDS in an effort to explore the various psychological resources available for affected individuals. Poverty is an increased risk for HIV and AIDS for a majority of the citizens of sub-Saharan Africa, and also lowered their subjective well-being. Furthermore, research evidence revealed that the relationship between poverty and subjective well-being is mediated by the intervention of such psychological variables as locus of control, self esteem, depression and coping strategies among others. Psychological resources for positive well-being that could ameliorate the potentially devastating combined effects of HIV and poverty are suggested.     

Repeat HIV Testing and HIV Transmission Risk Behaviors Among Sexually Transmitted Infection Clinic Patients

HIV testing and counseling expends considerable HIV prevention resources and offers great opportunities for HIV risk reduction. Individuals who are at risk for HIV and have not been HIV tested are the focus of current targeted testing campaigns and yet persons who are repeatedly tested for HIV often continue engaging in high-risk practices. This study examined HIV testing, risk behaviors, and other medical diagnostic testing practices of men (N = 231) and women (N = 86) attending an inner-city sexually transmitted infections (STI) clinic. Results showed that 75 (23%) participants had not yet been tested for HIV, 45 (14%) had been tested once, and 197 (63%) had been tested two or more times. Patients that had not been tested and those who were repeatedly tested were similar in their risk behaviors; both demonstrated significantly greater risks for HIV than persons tested just once, although repeat testers were more likely to have had a past STI. HIV testing history was minimally associated with other medical testing and health protective practices, such as testicular self-examination, mammography, and having had PAP tests. Results support targeting high-risk untested persons for HIV testing and suggest an urgent need for interventions to reduce risk behaviors among STI clinic patients who repeatedly test for HIV.     

Unheard Voices: Experiences of Families Living with HIV/AIDS in India*

This study was aimed at understanding the impact of HIV on the family system in the Indian context. A sample of 20 families caring for a relative living with HIV/AIDS (PLWHAs) was recruited from a HIV counseling clinic at the National Institute for Mental Health and Neuro Sciences and a respite home for PLWHAs in Bangalore City in southern India. Qualitative data were collected from these families using a semi-structured interview guide and recorded in the form of narratives. Analysis of these data revealed the following themes: Stigma and discrimination; disclosure; changes in family functioning; financial difficulties; fears of the family; and helplessness. Each theme was presented in detail and implications for intervention to help these families and their PLWHAs discussed. V.A.S. Krishna, PhD, MPE, Fogarty Funded Post Doctoral Fellow, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108 (krishnavas@epi.wustl.edu). Ranbir S. Bhatti, PhD, Professor of Family Therapy, Montfort College, Bangalore, Former Professor and Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (ranbirbhatti@yahoo.com). Prabha S. Chandra, MD, Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (prabhachandra@rediffmail.com). Srilatha Juvva, PhD, Reader, Department of Family and Child Welfare, Tata Institute of Social Sciences (TISS), Mumbai, India 400088 (juvvas@tiss.edu). *The authors would like to thank all the PLWHAs and their family members for volunteering to be part of this study. Post-doctoral Fellowship support for Dr. V.A.S. Krishna from Fogarty Grant—TW05811 (LB Cottler, PI).     

Congruence in Satir's Model: Its Spiritual and Religious Significance

This article casts into relief the essentialist-existential philosophy implicit in Satir's model of healing using Paul Tillich's systematic philosophical framework. Parallels between Satir's model of the person are drawn with Tillich's ontological categories of essence and existence, individualization and participation, and destiny and freedom. Congruence as the integration of elements in three vital human dimensions: the interpersonal, intrapsychic, and spiritual-universal, is correlated with Tillich's philosophical understanding of salvation. The religious quest is understood as a systemic, multidimensional process that brings the interactive and interdependent personal, interpersonal and spiritual dimensions into a restored unity. Thus Satir's rehumanization project and Tillich's religious quest are shown to coincide.     

Understanding the Relationships Among HIV/AIDS-Related Stigma,Health Service Utilization,and HIV Prevalence and Incidence in Sub-Saharan Africa: A Multi-level Theoretical Perspective

HIV-positive individuals often face community-wide discrimination or public shame and humiliation as a result of their HIV-status. In Sub-Saharan Africa, high HIV incidence coupled with unique cultural contexts make HIV-positive individuals particularly likely to experience this kind of HIV/AIDS-related (HAR) stigma. To date, there is a relatively small amount of high-quality empirical literature specific to HAR stigma in this context, supporting the notion that a better understanding of this phenomenon is needed to inform potential interventions. This paper provides a thorough review of the literature specific to HAR stigma in Sub-Saharan Africa, finding (a) qualitative support for the existence of important relationships between HAR stigma and health service utilization and barriers; (b) a need for more quantitative study of stigma and its relationships both to health service utilization and to HIV outcomes directly; and (c) a disconnect between methodological techniques used in this context-specific literature and well-known theories about stigma as a general phenomenon. This paper then draws from its empirical literature review, as well as from well-known theoretical frameworks from multiple disciplines, to propose a theoretical framework for the ecological and multilevel relationships among HAR stigma, health service utilization, and HIV outcomes in this context.     

Risk perception and victim perception: The judgment of HIV cases

There is a vast literature confirming that reactions to different risks are strongly affected by characteristics other than scientific risk estimates; most of this research has concentrated on mapping people's representations of sets of widely varying dangers (e.g. diseases, natural disasters, accidents). This study explored a potentially vital component of risk that cannot be studied by eliciting general reactions to many hazards: the extent to which who is at risk contributes to perceptions and judgments of a risk. While it may be preferable to assume that misfortunes affect the population uniformly, of course the truth is not so egalitarian. Thus, for both theoretical and policy reasons, it is worth exploring psychometrically representations of a particular risk as it affects different people. Using multidimensional scaling and hierarchical cluster analysis, we constructed models of respondents' representations of a disease assumed to be particularly affected by victim perception: Human Immunodeficiency Virus (HIV). Subjects rated the similarity of all possible pairs among 16 scenarios involving HIV infection; the scenarios contained information about both the victim and the method of contraction. A set of attribute scales as well as political/demographic information allowed us both to interpret the structures and to predict individual differences. The results confirmed that reactions to HIV infection are greatly affected by reactions to the victim. In particular, the perceived distastefulness and riskiness of the method of infection loomed larger than did either the overall likability of the victim or the general riskiness of the victim's behavior. Further, the salience of the most statistically influential dimension, ‘deservedness’, depended significantly on demographic and political characteristics of the respondents, suggesting that the relationship between personal values and risk perception is in part mediated by victim perception. Implications for risk perception work and public policy are discussed.