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.     

Correlates of adolescent assertiveness with HIV avoidance in a four-nation sample

Adolescents are frequently admonished to be socially assertive in order to confront negative interpersonal peer influences. Since the advent of HIV/AIDS in human social chemistry, the admonition has become more critical than ever. But the warning is often proffered in the misguided presumption that social assertiveness is the all-required psycho-structure against risk. The present cross-national study examines social and sexual assertiveness in four-country adolescent samples of Nigerian, Thai, Chinese, and Japanese college students. The findings reveal that sexual rather than social assertiveness was the sine qua non against risk, cross-culturally.     

Personality functioning in people living with HIV

This investigation adopted a multiple case study approach to determine the personality functioning in people living with HIV/ AIDS (PLWHA). Participants comprised a convenience sample of four PLWHA (male?=?3, female?=?1). The majority of the participants were white (n?=?3) and one was black African. Only one participant was married at the time of participation. Data on aspects such as their suicidal ideation, affect, problem solving styles, ego functioning, self-perception, and interpersonal functioning were collected using the Rorschach inkblot test and clinical interview. The data were actuarially analysed and organised under themes, namely; dominant personality style, capacity for control and stress, situational related stress, affect, interpersonal relations and self-perception. Findings revealed that participants had high levels of potential mood disorders and interpersonal difficulties for which targeted psychological services may be needed.     

An examination of attachment,religiousness, spirituality and well-being in a Baptist faith sample

The purpose of this research was to examine a mediational model of attachment, religiousness and spirituality in predicting well-being in people of Christian faith. One hundred and eighty-five participants were recruited from Baptist churches and 19 from a Baptist-based university. Whereas no support was found for a mediational model of attachment, religiousness and spirituality in predicting well-being, support was found for a path model whereby greater levels of insecure attachment to God were associated with lower levels of religious spirituality (RS). In turn, lower levels of RS were associated with greater levels of emotional distress (ED). Therefore, for this sample of Baptists, having a secure attachment to God was related to an increase in religious behaviours, fulfilment with one's prayer life and belief in a purpose for life. It seems that increases in these religious and spiritual variables are related to less ED. This suggests that heightened connection with God, both through religious behaviours and heightened spirituality, is a beneficial pursuit for people of Christian faith.     

Presence of meaning and search for meaning as mediators between spirituality and psychological well-being in a South African sample

Spirituality and meaning in life are important pathways to well-being. Research has conceptually and empirically linked spirituality, religiousness and meaning in life. The present study was concerned with investigating presence of meaning (MLQ-P) and search for meaning (MLQ-S) as mediators between spirituality (religious and existential well-being) and hedonic and eudaimonic well-being. A multi-cultural sample of 326 South African students completed the Meaning in Life Questionnaire (MLQ), Spiritual Well-Being Scale (SWBS), Questionnaire for Eudaimonic Well-Being (QEWB) and the Mental Health Continuum Short-Form (MHC-SF). Structural equation modelling in Mplus was used to study direct and indirect effects. Findings show that the presence of meaning in life explains more paths between spirituality and psychological well-being than search for meaning. MLQ-P mediated the paths between existential well-being and four of the five indices of psychological well-being. MLQ-S did not mediate any path between spirituality (existential and religious well-being) and psychological well-being outcomes.     

Othering,blame and shame when working with people living with HIV

Significant advances in HIV treatment has meant that for the majority of patients with HIV, they are able to live a normal lifespan. However, HIV remains a highly stigmatizing disease with the potential to significantly impact on one’s social identity and sense of self. This paper draws on data from a qualitative study of interviews with five gay men, to explore the experiences of shame in relation to living with HIV. The paper adopts a psychoanalytic lens to highlight the mechanisms of splitting that may be involved at both a social and individual level, and the experience of shame among the participants. The paper aims to use this research data to supplement our understanding of what may be occurring ‘on the couch’ with patients who are living with HIV.     

Conscientiousness predicts disease progression (CD4 number and viral load) in people living with HIV.

OBJECTIVE: Psychosocial factors (e.g., depression, avoidant coping, life stress) have been related to disease progression in HIV. This study examined the relationship between the Big Five Conscientiousness factor and HIV disease progression (CD4 cell and viral load) over 1 year in 119 seropositive participants. The study also examined whether Conscientiousness effects were mediated by adherence, perceived stress, depression, or coping measures. DESIGN: In a 1-year longitudinal design, participants completed the NEO Five-Factor Inventory Conscientiousness scale (P. T. Costa & R. R. McCrae, 1992). Participants also completed psychosocial assessments and underwent blood draws at initial assessments and 1-year follow-up. MAIN OUTCOME MEASURES: Multiple hierarchical regression models were used to predict change in CD4 cell numbers and viral load log 10, controlling for demographic variables, initial disease status, and antiretroviral medications. RESULTS: Conscientiousness predicted significant increases in CD4 number and significant decreases in viral load at 1 year. Conscientiousness was related positively to medication adherence and active coping and negatively to depression and perceived stress. Only perceived stress emerged as a possible mediator. CONCLUSION: The significant relationship between Conscientiousness and medication adherence, distress, and coping suggests that an assessment of Conscientiousness in patients with HIV may help specify or target behavioral interventions to promote optimal disease management.     

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.     

Adolescents,well-being and spirituality: insights from a spiritual program

This paper is a study of adolescents, well-being and spirituality. I have looked at the All Round Training in Excellence (ART-Excel) program for adolescents developed by an international spiritual organisation called the Art of Living Foundation (AOL Foundation). Adolescents participants (n = 396) of this program from four cities – Vancouver, London, Johannesburg and Mumbai – comprised of the sample. An equal number comprised of the control group. The findings suggest that spirituality is generally perceived as having positive mental health and well-being influences for program participants. Logistic regression analyses showed that girls, Hindus (homeland and Diaspora), adolescents in higher monthly expenses brackets, with a better health status, that is no self-declared ailments saw a higher efficacy to the ART-Excel program. The program was in general seen to contribute to well-being, social participation, sense of social duty, relationships, future vision and educational attainment. It is important to recognise the role of spirituality in early adolescents’ psychological well-being and include discussion of such coping mechanisms in working with this population. Moving this further it is also important for helping professionals to be cognisant of the possible presence and importance of spiritual beliefs in the lives of troubled adolescents such as runaway and homeless youth.     

Psychological distress and quality of life of people living with HIV/AIDS in a Nigerian teaching hospital

Presence of psychological distress and poor quality of life (QoL) may affect the outcome of HIV/AIDS. One hundred and seventeen consecutive and consenting participants were interviewed using a Socio-demographic questionnaire, Kessler Psychological Distress Scale (K10) and World Health Organization Quality of Life-HIV Bref. Fifty-six (47.9%) participants scored 20 and above on K10 Scale. QoL was significantly higher in married participants, those who perceived their state of health as being good, asymptomatic participants and those who scored well–mild on K10. The older age group scored higher on QoL Scale than the younger age group in the physical health domain while the married participants scored higher in the domains of physical health, psychological health, environment and spiritual/religion. The participants who perceived their state of health as being good scored higher than those who perceived their health as poor in all domains. There is a high level of psychological distress and poor QoL in people living with HIV/AIDS.     

Self‐esteem,stigma and community participation amongst people with learning difficulties living in the community

A cross‐sectional study examined the relationship between self‐esteem, community participation, age, perceived stigma and social support amongst a sample of 50 people with mild to moderate learning difficulties attending two day centres. Respondent‐paced, structured interviews following ethical and assessment guidelines were used to gather data. Retest interviews were conducted with 20% of the sample 3 months subsequently and only those measures with good test–retest reliability were used to test hypotheses. The results showed fairly high levels of community participation and self‐esteem. Self‐esteem was negatively correlated with stigma and a sub‐group with high concerns regarding meeting strangers was identified. In accordance with studies of non‐disabled samples, self‐esteem was positively associated with age. Social support was comparable to, or higher than, that observed in non‐disabled samples. High social support was observed for staff going out with respondents and for practical help from liked persons and friends. Community participation appeared to be related to higher self‐esteem in older participants but lower self‐esteem in younger participants. Implications for future research and practice are discussed. Copyright © 2002 John Wiley & Sons, Ltd.     

Enacting support within church communities for people living with HIV or AIDS

Social support is important in managing HIV and AIDS. Some people living with HIV or AIDS (PLWHA) have sought support from churches, despite their reputation for stigmatising PLWHA. Semi-structured interviews were conducted with 21 PLWHA and 21 church leaders to identify ways that churches can effectively enact support for PLWHA through improved communication about HIV, AIDS, and related issues. Church leaders also were asked about the institutional barriers to enacting support for PLWHA. Implementing these strategies consistently and holistically will require intentional efforts to address the barriers within church organisations to create environments that are welcoming to and supportive of PLWHA.     

Reducing the serious behavior problems of people with developmental disabilities living in the community

Trends and issues regarding the community-based support of people with developmental disabilities who exhibit severe behavior problems are discussed. Living in the community provides a unique framework within which behavior change programs are developed, implemented, and monitored. Support models for people with challenging behavior need to: (a) program for diversity across people, settings, and activities; (b) plan for high levels of integration in community settings among typical community members; and (c) meet guidelines regarding restrictions in intervention typologies. Increasingly, behavior analysts are conducting analog and in vivo assessments prior to intervening in order to develop an understanding of why behavior problems are occurring. Along with the increase in assessing the functions of behavior, is a greater attention to the contexts in which interventions are applied. The rearranging of contexts, communication training, choice-making, matching people's competence to their settings, the use of novelty, and proactive programing reflect these concerns.     

Internalised HIV-stigma,loneliness, depressive symptoms and sleep quality in people living with HIV

Objective: People living with HIV (PLWH) commonly report sleep disturbances which are associated with long-term health consequences, including disease progression. PLWH also experience internalised stigma as a result of their HIV status, which can be associated with increased loneliness and depression. Little attention focuses on the impact of these factors on sleep. Therefore, we examined whether internalised HIV-stigma was indirectly related to poorer sleep quality through higher levels of loneliness and depressive symptoms.

Design: 181 PLWH from across the United States completed an online survey.

Main Study Measures: Internalised HIV-stigma was assessed using the HIV-Stigma Scale, loneliness was assessed using the UCLA-Loneliness Scale-Short Form, depressive symptoms were assessed with the Center for Epidemiologic Studies–Depression Index, and Sleep Quality was assessed using the Pittsburgh Sleep Quality Index.

Results: Internalised HIV-stigma was indirectly associated with poorer global sleep quality and daytime sleep dysfunction through both loneliness and depressive symptoms.

Conclusions: PLWH who experience HIV-related stigma may experience greater feelings of loneliness, which are related to increased depressive symptoms and poorer sleep quality. Interventions focused on improving sleep in PLWH should focus on multiple factors that influence sleep, including psychosocial factors such as stigma, social isolation and depressive symptoms.     

Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: preliminary results from a community survey.

Widespread Internet use has revolutionized health information and patient education for persons with chronic illnesses. The authors surveyed 147 HIV-positive persons to examine factors associated with Internet use and associations between Internet use and health. Information, motivation, and behavioral skills associated with using the Internet were related to Internet use. The authors found that health-related Internet use was associated with HIV disease knowledge, active coping, information seeking coping, and social support among persons who were using the Internet. These preliminary findings suggest an association between using the Internet for health-related information and health benefits among people living with HIV/AIDS, supporting the development of interventions to close the digital divide in HIV/AIDS care.     

Medication beliefs and structural barriers to treatment adherence among people living with HIV infection

Background: People living in poverty face multiple structural challenges to medication adherence including lack of transportation, inadequate housing and food insecurity. The degree to which individuals’ motivations to remain adherent may overcome structural barriers has received limited attention.

Purpose: To examine whether medication necessity and concerns beliefs predict antiretroviral therapy (ART) adherence over and above structural adherence barriers associated with poverty.

Methods: People living with HIV in a southern US city (N = 942) completed computerised interviews, an objective measure of adherence and HIV viral suppression obtained from medical records. Hierarchical logistic regression models were constructed to examine demographic and illness characteristics, structural barriers, mental health, substance use and medication necessity and concerns beliefs as predictors of ART adherence.

Results: In multivariable models, current drug use and medication necessity and concerns beliefs predicted treatment adherence over and above demographic, health, mental health and structural factors.

Conclusions: Medication beliefs are proximal and powerful motivating factors that predict adherence. Adherence interventions should directly address medication beliefs in developing strategies to manage barriers facing people with HIV living in poverty.     

The chronic illness quality of life (CIQOL) model: explaining life satisfaction in people living with HIV disease.

The chronic illness quality of life (CIQOL) model theorizes that life satisfaction in persons living with a chronic illness such as HIV disease is a function of illness-related discrimination, barriers to health care and social services, physical well-being, social support, and coping. The CIQOL model was evaluated using data from 275 persons living with HIV disease. Women reported less life satisfaction and confronted more barriers to health care and social services than men, and White participants reported higher perceptions of AIDS-related discrimination than non-White participants. The CIQOL model provided an excellent fit to study data (root-mean-square error of approximation = .03) and accounted for almost a third of the variance in life satisfaction scores. Barriers to health care and social services played a particularly prominent role in the model.     

Counsellor-delivered HIV risk reduction intervention addresses safer sex barriers of people living with HIV in KwaZulu-Natal,South Africa

This study developed an HIV risk reduction intervention for people living with HIV (PLWH) obtaining care at primary healthcare clinics in KwaZulu-Natal, South Africa by (1) conducting elicitation research to understand the dynamics of risk behaviour among PLWH, (2) modifying an existing HIV risk reduction intervention based on research findings and (3) conducting a pilot study to evaluate feasibility, acceptability and fidelity of the modified intervention implemented by trained lay counsellors at a rural clinic in KwaZulu-Natal. A total of 61 healthcare providers and 77 HIV+ patients from four primary healthcare clinics participated in 14 focus groups and 20 individual interviews to identify informational, motivational and behavioural skills (IMB) factors contributing to PLWH's sexual risk behaviour. Elicitation research findings were incorporated into a revised version of Options for Health, an evidence-based risk reduction intervention for PLWH in clinical care. In a 5-day training, lay counsellors learned strategies to address IMB barriers to safer sex identified in elicitation research. The revised intervention, which was implemented by six counsellors with 39 patients, was feasible to implement, acceptable to patients and counsellors, and implemented with good fidelity. This study makes an important contribution towards development of a theory-based HIV risk reduction intervention for PLWH linking prevention with treatment in South Africa.     

Counsellor-delivered HIV risk reduction intervention addresses safer sex barriers of people living with HIV in KwaZulu-Natal, South Africa

This study developed an HIV risk reduction intervention for people living with HIV (PLWH) obtaining care at primary healthcare clinics in KwaZulu-Natal, South Africa by (1) conducting elicitation research to understand the dynamics of risk behaviour among PLWH, (2) modifying an existing HIV risk reduction intervention based on research findings and (3) conducting a pilot study to evaluate feasibility, acceptability and fidelity of the modified intervention implemented by trained lay counsellors at a rural clinic in KwaZulu-Natal. A total of 61 healthcare providers and 77 HIV+ patients from four primary healthcare clinics participated in 14 focus groups and 20 individual interviews to identify informational, motivational and behavioural skills (IMB) factors contributing to PLWH's sexual risk behaviour. Elicitation research findings were incorporated into a revised version of Options for Health, an evidence-based risk reduction intervention for PLWH in clinical care. In a 5-day training, lay counsellors learned strategies to address IMB barriers to safer sex identified in elicitation research. The revised intervention, which was implemented by six counsellors with 39 patients, was feasible to implement, acceptable to patients and counsellors, and implemented with good fidelity. This study makes an important contribution towards development of a theory-based HIV risk reduction intervention for PLWH linking prevention with treatment in South Africa.