羞辱与歧视对艾滋病传播机制的影响及对策

艾滋病的流行已成为一个严重影响全球卫生和社会经济发展的重要问题,而中国也已经面临艾滋病流行的高峰期。在艾滋病流行过程中,羞辱和歧视是一个非常重要的社会影响因素。从传染病流行病学方面进行剖析,讨论了羞辱与歧视对艾滋病传播机制的影响及对策。     

羞辱与歧视对艾滋病传播机制的影响及对策

艾滋病的流行已成为一个严重影响全球卫生和社会经济发展的重要问题,而中国也已经面临艾滋病流行的高峰期.在艾滋病流行过程中,羞辱和歧视是一个非常重要的社会影响因素.从传染病流行病学方面进行剖析,讨论了羞辱与歧视对艾滋病传播机制的影响及对策.     

医务人员对艾滋病人态度及其相关因素分析——以北京两所综合医院为例

为了解医务人员对艾滋病人及病毒携带者的态度,选取北京市两所三级甲等医院392名医务人员进行自填式问卷调查.结果显示,医务人员对艾滋病感染者及病人的歧视严重,同时医务人员对经性途径感染患者的歧视高于其它途径感染患者,也高于乙肝或梅毒病人.道德化评价和对于艾滋病的认识有限是产生艾滋病相关羞辱和歧视的重要原因.     

IV/AIDS防治:中国MDGs/全面小康的困境与出路

联合国千年发展目标(MDGs)与全面小康目标的一致性使其从独特角度审视当代中国小康进程。中国MDGs实施状况表明,艾滋病病毒/艾滋病(HIV/AIDS)防治是发展薄弱环节,这将对中国小康进程带来诸如贫困等问题。歧视和羞辱是艾滋病病毒/艾滋病防治目标的最大社会障碍,而现存法律因素更无意识强化了这种歧视。建立有效的沟通策略与法律支持、“让艾滋病人群更大地参入到目标中来”(GIPA)可能是当前的出路。关注艾滋病病毒/艾滋病防治,实现中国MDGs ,是中国全面小康社会的必经之路     

HIV/AIDS防治:中国MDGs/全面小康的困境与出路

联合国千年发展目标(MDGs)与全面小康目标的一致性使其从独特角度审视当代中国小康进程.中国MDGs实施状况表明,艾滋病病毒/艾滋病(HIV/AIDS)防治是发展薄弱环节,这将对中国小康进程带来诸如贫困等问题.歧视和羞辱是艾滋病病毒/艾滋病防治目标的最大社会障碍,而现存法律因素更无意识强化了这种歧视.建立有效的沟通策略与法律支持、"让艾滋病人群更大地参入到目标中来"(GIPA)可能是当前的出路.关注艾滋病病毒/艾滋病防治,实现中国MDGs,是中国全面小康社会的必经之路.     

自我与他者之间:艾滋病患者的“双重”歧视问题——基于云南L艾滋病防治中心的实证调查

艾滋病歧视是全球面临的共性问题。对云南L艾滋病防治中心进行实证调查,结果显示,艾滋病患者所承受的歧视不仅来自他者,还来自患者自身。他者的歧视是艾滋病歧视的根源,艾滋病患者的自我歧视进一步加固了艾滋病歧视。艾滋病歧视还存在差异性,这种差异共存于艾滋病患者的自我歧视和他者歧视之中。调查结果同时显示,感染途径和性别分别是与艾滋病歧视差异关联度最大的两个因素,在艾滋病歧视消除的研究与工作开展方面,必须重视艾滋病歧视的差异问题。     

大学生地域歧视现象态度量表的编制及信效度检验

地域歧视现象的存在是违背和谐社会理念的,人们对此现象是什么态度?研究以费施贝因和阿扎吉提出的理性行为模型理论为基础,选取网络上最活跃的大学生为样本,编制了大学生地域歧视现象态度量表,构建了对地域歧视现象态度、对地域歧视者态度和对被歧视者态度3个维度。通过整理访谈资料、参考相关量表、专家讨论等方法编制条目。选取358名被试进行预测试,617名被试正式测试。研究结果表明,大学生地域歧视现象态度量表建构的3个维度结构合理,量表的项目分析、探索性分析和验证性分析符合心理测量学要求,是测量中国大学生地域歧视现象态度的有效工具。     

受艾滋病影响儿童的歧视知觉在歧视经历和心理健康之间的作用分析

本研究旨在考察中国农村地区受艾滋病影响儿童(包括双孤儿童、单孤儿童和非孤儿童)在经历了父母感染艾滋病、父母因为艾滋病丧亡后的歧视经历和歧视知觉状况,及其对心理健康的影响.采用问卷调查了1221名被试,测查了他们的歧视经历、歧视知觉、心理健康(抑郁、孤独、自尊).经过数据分析发现:(1)歧视经历和歧视知觉存在显著的年龄段和儿童类别的差异,12岁及以下的儿童得分显著高于13岁及以上的,双孤儿童得分显著高于单孤儿童和非孤儿童;抑郁、孤独和自尊存在显著的儿童类别差异,双孤儿童、单孤儿童差于非孤儿童;且孤独和自尊还存在显著的年龄段差异,12岁以下的儿童差于13岁以上的;(2)不同歧视经历和歧视知觉的儿童在抑郁、孤独和自尊上存在显著差异,均是歧视经历、歧视知觉多的儿童抑郁和孤独严重、自尊低;(3)歧视经历对抑郁、孤独和自尊都有显著的预测作用,歧视知觉在其中起到了部分中介作用.     

艾滋病防控中获取患者信息的伦理问题刍议

当前艾滋病获取患者信息中,存在公私观念上的摩擦、相关规定与环节存在疏漏、对信息弱势群体关照不足的伦理难题。问题背后包含着患者为了公共健康的伦理目的却又失去伦理关系的风险,"失德"名声带来的耻感与歧视,遵守政策规范却缺少应有的尊重与保护等矛盾。问题的解决需要在文化背景和利益关系下思量个人身心秩序与社会整体秩序间如何权衡,结合历史、理论与现实维度提出路径。"信"的建立是关键所在,包括公共卫生部门公信力的树立和相应制度措施建设,同时在信息活动中需要给"私"以合理地位,并注重艾滋病治疗相关医学信息的宣传。     

服务提供者交际活动与顾客忠诚的关系

对Koermer的"服务提供者交际活动量表"(Service Provider Sociality Scale)修订以形成适合中国文化背景的服务提供者交际活动量表,根据顾客忠诚的研究编制了顾客忠诚量表,顾客忠诚包括对服务提供者的个人忠诚及与服务提供者所在组织的组织忠诚。先后对684名被试进行调查,探索性因素分析和验证性因素分析结果表明,服务提供者交际活动有三个因素构成——礼节性交际活动、社会性交际活动、私密性交际活动。回归分析表明,社会性交际活动是顾客忠诚的最重要预测变量。     

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.     

Measuring HIV stigma: existing knowledge and gaps

The growing recognition of the reduction of HIV stigma as central to effective programs across the HIV/AIDS prevention to care and treatment continuum is leading to an increasing number of programs focused on stigma reduction. Correctly evaluating the impact of these programs depends on having a good set of measures that effectively capture and distinguish the complexities of HIV stigma. This paper reviews the existing literature on HIV stigma measurement and identifies key gaps that remain. There is a need for measures at the general population level that are unambiguous about the cause of the stigmatizing behavior, that capture enacted stigma (discrimination), and that can distinguish compound (layered) stigma. In addition, studies are needed in a wider variety of contexts and on a larger scale that include a comprehensive set of measures to capture the complexity of HIV-related stigma and ensure appropriate evaluation of stigma-reduction programs.     

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。     

The Multilevel Relationships of HIV‐Related Stigma to Child and Caregiver Mental Health among HIV‐Affected Households in South Africa

HIV/AIDS‐related (HAR) stigma is still a prevalent problem in Sub‐Saharan Africa, and has been found to be related to mental health of HIV‐positive individuals. However, no studies in the Sub‐Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV‐negative, HIV‐affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra‐individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community‐representative sample of 508 HIV‐affected households nested within 24 communities in KwaZulu‐Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual‐level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV‐affected adults; and that community‐level HAR stigma significantly predicts both individual‐level mental health outcomes (anxiety) among HIV‐affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV‐affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context.     

AIDS‐Related Stigma in Individuals With Other Stigmatized Identities in the USA: A Review of Layered Stigmas

AIDS‐related stigmas have profound negative impacts on people living with and those affected by HIV/AIDS. While a considerable body of work examines AIDS‐related stigma, it is less clear how AIDS stigmas affect individuals in relation to other stigmatized identities, particularly ethnic minorities. This review examines the literature on AIDS‐related stigma among these groups. The limited available research indicates that AIDS stigmas can seriously interfere with HIV testing, treatment, and care. In addition, prevention studies conducted with incarcerated adolescents, a group characterized by stigmatized identities and high risks for HIV, indicate that interventions for this population do not address stigmatized identities and demonstrate limited effects on risk reduction outcomes. Research is needed to examine stigma in primary prevention of HIV with an at‐risk stigmatized group.     

Stigma and social participation in Southern India: differences and commonalities among persons affected by leprosy and persons living with HIV/AIDS

Stigma is a common phenomenon worldwide and infectious diseases like HIV/AIDS and leprosy are often associated with high levels of stigma. Several studies have been conducted concerning the effects of stigma and the impact on social participation, but comparative studies are rare. The objective of this study was to identify differences and similarities between HIV/AIDS and leprosy-related stigma. From April till July 2009, 190 questionnaire-based interviews were conducted to assess the levels of internalized stigma (Internalized Stigma of Mental Illness scale), perceived stigma (Explanatory Model Interview Catalogue stigma scale) and social participation (Participation scale) in a cross-sectional sample of people affected by leprosy (PL) and people living with HIV/AIDS (PLHA). Respondents were selected from several hospitals, charity projects and during home visits in Vellore district, Tamil Nadu. Our results showed that both PLHA (n?=?95) and leprosy-affected respondents (n?=?95) faced a substantial burden of internalized and perceived stigma, with the former reporting a significantly higher level of stigma. As a result, PLHA faced more frequent and also more severe participation restrictions than PL. Especially, restrictions in work-related areas were reported by the majority of the respondents. In conclusion, PLHA faced a significantly higher level of stigma and participation restriction than PL. However, the latter also reported a substantial burden of stigma and participation restrictions. The study suggests that it may be possible to develop joint interventions based on the commonalities found. More research is needed to define these more precisely and to test the effectiveness of such joint interventions in reducing stigma and improving social participation.     

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。     

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.     

Responsibility judgments and responses to people living with AIDS in China: testing an attributional perspective

With one in five individuals in the world living in China, there is an urgent need for HIV prevention and understanding HIV/AIDS stigma in China. This study applies an attributional analysis to Chinese students' responses to AIDS, examining effects of attributions of causal controllability for HIV infection on reactions to people living with HIV/AIDS. Students (n = 309) read one of two scenarios describing an AIDS patient and manipulating controllability of AIDS onset. Controllability of AIDS onset contributed to responsibility judgments, less positive affect, and lower desires to personally interact with the patient. Responsibility judgments predicted interaction wishes directly and indirectly through positive affect. Results provide support for Weiner's interpersonal attributional model. Implications for responses to AIDS in China are discussed.     

The fight against stigma: an overview of stigma-reduction strategies and interventions

In many health conditions, people are severely affected by health-related stigma and discrimination. A literature review was conducted to identify stigma-reduction strategies and interventions in the field of HIV/AIDS, mental illness, leprosy, TB and epilepsy. The review identified several levels at which interventions and strategies are being implemented. These are the intrapersonal, interpersonal, organizational/institutional, community and governmental/structural level. Although a lot of work has been carried out on stigma and stigma reduction, far less work has been done on assessing the effectiveness of stigma-reduction strategies. The effective strategies identified mainly concentrated on the individual and the community level. In order to reduce health-related stigma and discrimination significantly, single-level and single-target group approaches are not enough. What is required is a patient-centred approach, which starts with interventions targeting the intrapersonal level, to empower affected persons to assist in the development and implementation of stigma-reduction programmes at other levels.