Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS

The stigma associated with HIV/AIDS poses a psychological challenge to people living with HIV/AIDS. We hypothesized that that the consequences of stigma-related stressors on psychological well-being would depend on how people cope with the stress of HIV/AIDS stigma. Two hundred participants with HIV/AIDS completed a self-report measure of enacted stigma and felt stigma, a measure of how they coped with HIV/AIDS stigma, and measures of depression and anxiety, and self-esteem. In general, increases in felt stigma (concerns with public attitudes, negative self-image, and disclosure concerns) coupled with how participants reported coping with stigma (by disengaging from or engaging with the stigma stressor) predicted self-reported depression, anxiety, and self-esteem. Increases in felt stigma were associated with increases in anxiety and depression among participants who reported relatively high levels of disengagement coping compared to participants who reported relatively low levels of disengagement coping. Increases in felt stigma were associated with decreased self-esteem, but this association was attenuated among participants who reported relatively high levels of engagement control coping. The data also suggested a trend that increases in enacted stigma predicted increases in anxiety, but not depression, among participants who reported using more disengagement coping. Mental health professionals working with people who are HIV positive should consider how their clients cope with HIV/AIDS stigma and consider tailoring current therapies to address the relationship between stigma, coping, and psychological well-being.     

Stigma and Psychological Distress in People With HIV/AIDS

Using a community sample of 197 people living with HIV/AIDS, we examined how awareness of societal stigma (felt stigma) and negative feelings toward oneself as a member of a stigmatized group (self-stigma) are related to psychological well-being. Both felt stigma and self-stigma were significantly correlated with symptoms of depression and anxiety, but controlling for felt stigma reduced self-stigma's association with depressive symptoms to nonsignificance. Global self-esteem and social avoidance fully mediated the associations between self-stigma and distress but only partially mediated the associations between felt stigma and distress. Felt stigma mediated the relationship between distress and HIV-related changes in physical appearance.     

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.     

The Affective Consequences of Minority Stress Among Bisexual,Pansexual, and Queer (Bi+) Adults: A Daily Diary Study

Bisexual, pansexual, and queer (bi+) individuals are at increased risk for depression and anxiety. These disparities are hypothesized to be due to the unique, minority-specific stressors that they experience. Prior research supports that bi+ stressors are associated with depression and anxiety, but nearly all studies have been cross-sectional, limiting our understanding of how experiencing bi+ stress influences individuals’ levels of depression and anxiety as they occur in their day-to-day lives. To address this gap, we examined the daily associations between bi+ stressors (discrimination, internalized stigma, rejection sensitivity, and identity concealment) and depressed/anxious mood in a 28-day diary study. Participants were 208 bi+ individuals who completed daily measures of bi+ stressors and depressed/anxious mood. We tested unlagged (same-day) and lagged (next-day) associations, and we also tested whether internalized stigma, rejection sensitivity, and identity concealment functioned as mechanisms underlying the daily associations between discrimination and depressed/anxious mood. Participants reported higher depressed/anxious mood on days when they reported higher discrimination, internalized stigma, rejection sensitivity, and identity concealment. There were significant unlagged indirect effects of discrimination on depressed and anxious mood via internalized stigma and rejection sensitivity, and there was also a significant unlagged indirect effect of discrimination on anxiety via identity concealment. However, none of the lagged associations were significant. Results suggest that bi+ stress is related to same-day, but not next-day, depressed/anxious mood. The nonsignificant lagged associations could reflect that bi+ individuals are using adaptive coping skills in response to bi+ stress, or that other experiences throughout the day have stronger influences on next-day mood.     

Unable to be a Human Being in Front of Other People: A Qualitative Study of Self-Isolation Among People Living with HIV/AIDS in China

In China, acute stigma accompanying an HIV diagnosis can lead to self-isolation. In a cultural setting where family relationships are highly valued and contribute critically to well-being, such self-isolation can thwart HIV self-management and engagement in medical care, and so heighten risk for health disparities. To understand this phenomenon, we conducted individual in-depth interviews with 34 persons living with HIV/AIDS (PLwHA) in Shanghai and Beijing. Inductive content analysis revealed a range of forms of self-isolation motivation, beliefs, and behaviors influenced by: 1) internalized stigma and desire to avoid discrimination; 2) HIV-related factors such as HIV knowledge and disease progression; and 3) familial factors such as a sense of responsibility and family members’ reactions. Based on a proposed framework centering on dialectical family influences (whereby PLwHA are pushed away from, yet pulled toward the family fold), implications for provision of multidisciplinary care in medical settings are considered, including culturally appropriate strategies to decrease health disparities.     

艾滋病污名的形成机制、负面影响与干预

艾滋病污名主要包括实际污名、感知污名和自我污名, 这些不同形式的污名给艾滋病患者带来了精神上的痛苦、社会资源的剥夺等一系列的负面影响。归因理论、社会文化理论和道德理论分别从社会心理学、社会不平等和文化道德的角度阐述了艾滋病污名的形成机制。从这些机制出发, 减少艾滋病污名可以结合接触假设、知识传播以及认知行为疗法, 并注意改变艾滋病患者的自身观念。未来的艾滋病污名研究应更多地从社会文化以及道德的角度进行跨文化的量化研究。     

The Adolescent HIV Communication Belief Scale: Preliminary Reliability and Validity

Globally, there are nearly 2 million HIV positive children, many of whom are adolescents. The majority have perinatally acquired HIV. A key challenge for this population is communicating about HIV to meet emotional and practical needs. Despite evidence of its benefits, HIV communication in adolescents with HIV is rare. To enhance HIV communication, individuals’ beliefs may need to be taken into account. There is no measure of beliefs about HIV communication for adolescents living with HIV. A seven-item measure of HIV communication beliefs was developed and administered to 66 adolescents with HIV in the UK (39 female; aged 12–16 years). Data were explored using principal component analysis. Preliminary criterion-related validity was assessed by examining relationships between the measure and communication occurrence, frequency and intention. Preliminary construct validity was assessed by examining relationships between the measure and HIV stigma, HIV disclosure cognition and affect, quality of life and self-perception. Two factors were revealed: communication self-efficacy and normative beliefs; and communication attitudes. The full scale and its subscales were internally consistent. The total score showed statistically significant positive relationships with HIV communication intention, HIV disclosure cognitions and affect, and HIV stigma but not with other variables. Preliminary evidence of the measure’s good psychometric properties suggests it may be helpful in outlining relationships between HIV communication beliefs and other constructs. It may also be useful in testing interventions that aim to enhance HIV communication in this population. Further work needs to be done to establish the scale’s psychometric properties.     

Personal Meaning,Social Support,and Perceived Stigma in Individuals Receiving HIV Mental Health Services

Human immunodeficiency virus (HIV) stigma represents a significant source of stress among individuals living with HIV disease, prompting interest in research to identify factors that may help to ameliorate the stress burden associated with HIV stigma. Consistent with this research line, the current study was conducted as a cross-sectional investigation examining associations between positive global personal meaning, social support, and perceived HIV stigma. Global personal meaning refers to beliefs and aspirations through which one ascribes value and purpose in living. The study sample was comprised of individuals living with HIV disease who presented for an initial visit in a specialty HIV mental health services program. In bivariate analyses, social support was negatively correlated with multidimensional aspects of HIV stigma that included distancing, blaming, and discrimination stigma, whereas personal meaning was negatively associated only with blaming stigma. In further analyses using structural equation modeling, social support significantly mediated the association between personal meaning and both distancing and blaming stigma. Interactions between positive personal meaning and social support may be useful to consider in future research on psychological resource factors and HIV stigma. Understanding these interactions may also inform clinical efforts to address HIV stigma concerns.     

Stigma, social context, and mental health: lesbian and gay couples across the transition to adoptive parenthood

This is the first study to examine change in depression and anxiety across the first year of adoptive parenthood in same-sex couples (90 couples: 52 lesbian, 38 gay male). Given that sexual minorities uniquely contend with sexual orientation-related stigma, this study examined how both internalized and enacted forms of stigma affect the mental health of lesbians and gay men during the transition to parenthood. In addition, the role of contextual support was examined. Higher perceived workplace support, family support, and relationship quality were related to lower depressive and anxious symptoms at the time of the adoption, and higher perceived friend support was related to lower anxiety symptoms. Lower internalized homophobia and higher perceived neighborhood gay-friendliness were related to lower depressive symptoms. Finally, individuals with high internalized homophobia who lived in states with unfavorable legal climates regarding gay adoption experienced the steepest increases in depressive and anxious symptoms. Findings have important implications for counselors working with sexual minorities, especially those experiencing the transition to parenthood.     

Experiences of HIV-related discrimination and consequences for internalised stigma,depression and alcohol use

Objective: HIV stigma undermines health and well-being of people living with HIV (PLWH). Conceptual work on stigma mechanisms suggests that experiences of stigma or discrimination increase internalised stigma. However, not all PLWH may internalise the HIV discrimination they experience. We aimed to investigate the role of stress associated with events of HIV-related discrimination on internalised HIV stigma, as well as the downstream effects on depressive symptoms and alcohol use severity.

Design: 199 participants were recruited from an HIV clinic in the southeastern United States.

Main study measures: HIV-related discrimination was assessed using items adapted from measures of enacted HIV stigma and discrimination. Participants rated perceived stress associated with each discrimination item. Internalised HIV stigma was assessed using the internalised stigma subscale of the HIV Stigma Mechanisms Scale. Depressive symptoms were assessed with the Centre for Epidemiological Studies-Depression Index. Alcohol use severity was assessed with the Alcohol Use Disorders Identification Test.

Results: In serial mediation models, HIV-related discrimination was indirectly associated with both depressive symptoms and alcohol use severity through its associations with stress and internalised HIV stigma.

Conclusions: Understanding the mechanisms through which PLWH internalise HIV stigma and lead to poor health outcomes can yield clinical foci for intervention.     

Vicarious Experiences of Major Discrimination and the Life Satisfaction of Black and White Adults from a Community Sample

The racism-related stress framework argues that racism can influence the well-being of individuals through personal and vicarious experiences of discrimination, but studies on racism and health have primarily focused on understanding how personally experienced discrimination shapes these outcomes. Using data from the Nashville Stress and Health Study (N?=?1,252) the present study examines the racial differences in vicarious experiences of major discrimination among Black and non-Hispanic White adults from a community sample. Additionally, given longstanding evidence of racial disparities in life satisfaction, this study assesses whether the effects of vicarious experiences of discrimination influence overall life satisfaction of both Black and White adults. Results reveal significant racial differences in the types of vicarious discrimination that both groups are exposed to, and that Black adults are more exposed to vicarious experiences of major discrimination relative to White adults. Furthermore, findings indicate that vicarious experiences of discrimination, in addition to personal experiences of discrimination, are associated with lower levels of overall life satisfaction among Black adults, but not for White adults. This study extends the broader literature on racism-related stress and offers new insights for understanding racial differences in overall life satisfaction and well-being.

     

AIDS Stigma and Contact With Persons With AIDS: Effects of Direct and Vicarious Contact.1

This paper examines the relationship between AIDS-related stigma and (a) direct, personal contact with people with AIDS (PWAs), and (b) vicarious contact—through mass media—with a public figure with AIDS or HIV. Data are presented from a 2-wave national telephone survey with a probability sample of US. adults (ns = 538 at Wave 1; 382 at Wave 2) and an oversample of Black Americans (ns = 607 and 420, respectively). Direct contact with a PWA was associated with less support for coercive AIDS policies, less blame for PWAs, and less avoidance of PWAs. Vicarious contact–operationalized as the self-reported impact of Earvin “Magic” Johnson's disclosure of his HIV infection–appeared to have its greatest impact among respondents who previously had manifested high levels of stigma. In that group, levels of stigma diminished somewhat to the extent that respondents reported having been strongly influenced by Johnson's announcement.     

Effect of perceived public stigma on internalized homophobia,anticipated stigma,shame, and guilt: Outness as a moderator

Although previous studies found that distal minority stress contributes to proximal minority stress and shame/guilt among the lesbian, gay, and bisexual (LGB) population, it is unclear whether the extent to which LGB individuals' open display and discussion their sexual orientation moderates these relationships. A total of 1,452 Chinese LGB adults provided demographic information and completed measures of outness, perceived public stigma, internalized homophobia, anticipated stigma, shame, and guilt. Structural equation modelling was conducted to test the hypothesized moderation analyses. Perceived public stigma had positive associations with internalized homophobia, anticipated stigma, shame, and guilt. Outness played a moderating role in the associations of perceived public stigma with internalized homophobia, anticipated stigma, shame, and guilt. Specifically, when LGB individuals had higher levels of outness, the effects of perceived public stigma on internalized homophobia, anticipated stigma, shame, and guilt were lower. Moreover, such moderating effect did not differ by sexual orientation. The degree to which sexual minority individuals' sexual orientation is known by and openly discussed with others may lower the extent to which LGB individuals internalize sexual stigma, expect rejection after coming out, and develop shame and guilt as a result of perceived social prejudice and discrimination.     

A Preliminary Examination of Sexual Orientation as a Social Vulnerability for Experiencing HIV/AIDS-related Stigma

This investigation is a preliminary examination of sexual orientation as a social vulnerability for experiencing HIV/AIDS-related stigma, specifically concerns about disclosure and public attitudes. Participants were 36 heterosexual men and 82 gay men with HIV/AIDS. Consistent with prediction, a heterosexual sexual orientation was significantly associated with HIV/AIDS disclosure concerns. This effect was evident after controlling for various demographic variables, CD4 T-cell count, time since HIV diagnosis, self-esteem, and coping styles. Also, as predicted, similar levels of enacted stigma were evident regardless of sexual orientation. Further work is needed to understand the process of HIV/AIDS disclosure for heterosexual men with this illness and to differentiate the experience of HIV/AIDS-related stigma among gay and straight men with HIV/AIDS.     

Predictors of HIV-related stigma among young people living with HIV.

Enacted and perceived HIV stigma was examined among substance-using young people living with HIV (YPLH) in Los Angeles, San Francisco, and New York City (N = 147). Almost all YPLH (89%) reported perceived stigma, and 31% reported enacted experiences in the past 3 months; 64% reported experiences during their lifetime. The HIV stigma questions were characterized by factors of avoidance, social rejection, abuse, and shame. In multivariate models, enacted stigma was associated with gay or bisexual identity, symptomatic HIV or AIDS, and bartering sex. Perceived stigma was associated with female gender, symptomatic HIV or AIDS, bartering sex, lower injection drug use, and fewer friends and family knowing serostatus. Gay or bisexual YPLH who were also HIV symptomatic or AIDS diagnosed experienced more HIV stigma than their heterosexual peers.     

Stigma modifies the association between social support and mental health among sexual violence survivors in the Democratic Republic of Congo: implications for practice

Background and Objectives: The aim of this study was to further understanding of the relationship between social support, internalized and perceived stigma, and mental health among women who experienced sexual violence in the eastern Democratic Republic of Congo (DRC).

Methods: Drawing from baseline survey data collected in eastern DRC, researchers conducted a secondary cross-sectional analysis using data from 744 participants. Regression and moderation analyses were conducted to examine associations between social support variables, felt stigma, and depression, anxiety and posttraumatic stress disorder (PTSD).

Results: Emotional support seeking and felt stigma were positively associated with increased symptom severity across all three mental health variables. Stigma modified associations between emotional support seeking and depression (t?=??2.49, p?=?.013), anxiety (t?=??3.08, p?=?.002), and PTSD (t?=??2.94, p?=?.003). Increased frequency of emotional support seeking was associated with higher mental health symptoms of anxiety and PTSD among women experiencing all levels of stigma.

Conclusions: Enhancing understanding of social support and stigma may inform research and intervention among Congolese forced migrant populations across circumstances and geographic locations. Implications for practice and research are discussed.     

Coping-related expectancies and dispositions as prospective predictors of coping responses and symptoms

We used Rotter's (1954, 1982) social learning theory and Kirsch's (1985, 1999) response expectancy extension thereof to clarify distinctions between coping-related expectancies (beliefs about the outcomes of coping efforts) and coping dispositions (tendencies to use particular coping responses), specifically focusing on the role of generalized expectancies for negative mood regulation (NMR) as a predictor of individual differences in coping and well-being. Two studies using structural equation modeling provided support for direct and indirect associations between NMR expectancies and symptoms of depression. In Study 1 NMR expectancies predicted situational avoidance coping responses and symptoms of depression and anxiety, independent of dispositional avoidance coping tendencies. In Study 2, NMR expectancies were associated with depressive symptoms, concurrently and prospectively, independent of dispositional optimism and pessimism. Both studies indicated that NMR expectancies are more strongly associated with depressive symptoms than with symptoms of anxiety and physical illness. Results underscore the importance of distinguishing between expectancies and other personality variables related to coping.     

The effect of personal and group discrimination on the subjective well-being of people with mental illness: the role of internalized stigma and collective action intention

The goal of this study is to test a model in which personal discrimination predicts internalized stigma, while group discrimination predicts a greater willingness to engage in collective action. Internalized stigma and collective action, in turn, are associated to positive and negative affect. A cross-sectional study with 213 people with mental illness was conducted. The model was tested using path analysis. Although the data supported the model, its fit was not sufficiently good. A respecified model, in which a direct path from collective action to internalized stigma was added, showed a good fit. Personal and group discrimination appear to impact subjective well-being through two different paths: the internalization of stigma and collective action intentions, respectively. These two paths, however, are not completely independent, as collective action predicts a lower internalization of stigma. Thus, collective action appears as an important tool to reduce internalized stigma and improve subjective well-being. Future interventions to reduce the impact of stigma should fight the internalization of stigma and promote collective action are suggested.     

Disentangling the effects of depression symptoms and adult attachment on emotional disclosure

Individuals with high levels of depression symptoms and individuals with insecure attachment orientations have been shown to limit their use of emotional disclosure as a means of emotion regulation. However, little is known about how depression symptoms and insecure attachment orientations might jointly predict whether individuals engage in emotional disclosure. The authors addressed this question using both inter- and intraindividual approaches. College students (N = 121) completed measures of depression symptoms, adult attachment orientation, and generalized disclosure tendencies. To obtain an intraindividual measure of emotional disclosure, participants also completed an online daily diary in which they rated the intensity of the day's most unpleasant event and their disclosure of that event for 7 days. Results indicated that depression symptoms were negatively related to generalized disclosure tendencies and to intraindividual daily intensity-disclosure slopes. Attachment avoidance was negatively related to both generalized disclosure tendencies and to daily disclosure, and attachment anxiety moderated the relation between daily event intensity and disclosure. The authors discuss the implications for theory and counseling psychology practice.     

Neural response to evaluating depression predicts perceivers’ mental health treatment recommendations

Nonstigmatized perceivers’ initial evaluations of stigmatized individuals have profound consequences for the well-being of those stigmatized individuals. However, the mechanism by which this occurs remains underexplored. Specifically, what beliefs about the stigmatized condition (stigma-related beliefs) shape how nonstigmatized perceivers evaluate and behave toward stigmatized individuals? We examined these questions with respect to depression-related stigmatization because depression is highly stigmatized and nondepressed individuals’ behavior (e.g., willingness to recommend treatment) directly relates to removing stigma and increasing well-being. In Study 1, we identified common stigma-related beliefs associated with depression (e.g., not a serious illness, controllable, threatening), and found that only perceptions that depression is a serious condition predicted nondepressed perceivers’ willingness to recommend mental health treatment. Moreover, perceivers’ beliefs that depression is a distressing condition mediated the relationship between perceived seriousness and treatment recommendations (Study 1). In Study 2, we used fMRI to disentangle the potential processes connecting distress to nondepressed perceivers’ self-reported treatment intentions. Heightened activity in the dorsomedial prefrontal cortex (dmPFC)—a region widely implicated in evaluating others—and the ventrolateral prefrontal cortex (vlPFC)—a region widely implicated in regulating negative emotions—emerged when nondepressed perceivers evaluated individuals who were ostensibly depressed. Beliefs that depression is a distressing condition mediated the relationship between dmPFC (but not vlPFC) activity and nondepressed individuals’ self-reported treatment recommendations.