INTRODUCTION: HIV disproportionately affects African Americans, Latinos, and gay and bisexual men of all racial and ethnicity groups. People living with HIV/AIDS experience stigma related to their disease. HIV/AIDS stigma can have detrimental effects on HIV prevention, testing and treatment. Entertainment-education is a health communication strategy that can be used to influence behavioral and social change in the population. AIM: The purpose of this study is to evaluate whether a Motion Comic intervention, an EE strategy, can decrease H/A stigma in a sample of MSM adolescents aged 15-24. METHODS: Participants were recruited from GA, FL, NY and CA using convenience sampling. A sample of MSM adolescents aged 15-24 (n=24) was used for this study. The study design is a one-group pretest-posttest intervention. Participants were shown the Motion Comic episodes. Participants completed pre- and post-viewing surveys to assess HIV/AIDS stigma. A summed variable was used as the outcome for total HIV/AIDS stigma. A paired samples t-test was used to measure a statistically significant difference in HIV/AIDS stigma from pretest to posttest. RESULTS: There was a statistically significant decrease in HIV stigma from pre-viewing survey (M = 9.87, SD = 3.49) to post-viewing survey (M = 8.65, SD = 2.48), t (22) = 2.01, p < .0285 (one-tailed). The mean decrease in HIV stigma scores was 1.22 with a 95% confidence interval ranging from 0.177 to 2.248. The eta squared statistic (.16) indicated a large effect size. DISCUSSION: Results from this study show that viewing the Motion Comic may reduce HIV/AIDS stigma related to casual transmission of HIV and values, such as blame, shame and judgment, in MSM adolescents.

Over the years, growing concerns were raised about the serious effect that HIV stigma has on the global HIV and AIDS-prevention response, with appeals to regard HIV stigma reduction as one of the most important factors that need to be addressed in any HIV-prevention strategy. Studies have found scant evidence of comprehensive community-based approaches to reduce stigma, as few of the existing strategies address the community, but maintain the focus mainly on behaviour change in the individual. This research study is a follow-up study to two other studies. The first study focused on people living with HIV (PLWH) and nurses in health care settings; and the second was a trans-disciplinary, comprehensive, community-based HIV stigma reduction and wellness-enhancement intervention that involved PLWH and people living close to them (PLC). This HIV stigma-reduction community “hub” network intervention was specifically planned as an intervention for the community, targeting PLWH and their community members who live in the same ward in the Tlokwe municipality in the North West Province of South Africa. The objectives of the study were to explore, describe and determine whether an HIV stigma-reduction community “hub” network intervention in a South African urban area will make a difference in the HIV stigma experiences of PLWH, as well as related stigmatisation by their community; to describe the implementation of this intervention; and to determine the change in depression and psychosocial well-being of PLWH and their community before and after the intervention. The HIV stigma-reduction community “hub” network intervention defines a “hub” as a two-person mobiliser team consisting of a PLWH and a non-infected PLC who are inhabitants of the same community and functions from a “hub” in the community. The strategy is based upon the involvement of PLWH and PLC, as community mobilisers, who share their knowledge and who mobilise and empower their own community to reduce HIV stigma. A convergent parallel mixed-method design with a single case pre-test post-test design for the quantitative data, and an interpretive description approach for the qualitative data were utilised. The sample for this study included PLWH recruited through accessibility sampling as well as community members living in the same municipal ward through random voluntary sampling. Valid measures were used to determine and describe whether the HIV stigma-reduction community “hub” network intervention will affect change in the HIV stigma experiences of PLWH, the perceived stigmatisation by their community, as well as the depression and psychosocial well-being of both PLWH and the community. A sub-sample of both groups was selected by means of purposive voluntary sampling for the qualitative part of the study, consisting of in-depth interviews about stigma experiences of PLWH, as well as stigmatisation of the community toward PLWH. For the description of the HIV stigma-reduction community “hub” network intervention, a holistic single-case study design was used. Participants were recruited according to accessibility, during the various community activities, with no differentiation between PLWH and people of unknown HIV status residing in that community. Findings indicate that the HIV stigma-reduction community “hub” network intervention, as planned and implemented, was successful in initiating the onset of changes in a community through the PLWH and PLC, as community mobilisers were active in the community “hub” network to mobilise their own communities towards HIV stigma reduction, sharing their knowledge and mobilising and empowering their own community. Changes were observed on an individual and social level. Recommendations focus on using and strengthening the present community intervention, adjusting some of the scales used in this study and ensuring stronger collaboration between health and social disciplines to address the various manifestations and to change the contexts of HIV stigma. It is furthermore recommended that future HIV stigma-reduction interventions give special attention to addressing aspects of psychosocial well-being. / PhD (Psychology), North-West University, Potchefstroom Campus, 2015

Over the years, growing concerns were raised about the serious effect that HIV stigma has on the global HIV and AIDS-prevention response, with appeals to regard HIV stigma reduction as one of the most important factors that need to be addressed in any HIV-prevention strategy. Studies have found scant evidence of comprehensive community-based approaches to reduce stigma, as few of the existing strategies address the community, but maintain the focus mainly on behaviour change in the individual. This research study is a follow-up study to two other studies. The first study focused on people living with HIV (PLWH) and nurses in health care settings; and the second was a trans-disciplinary, comprehensive, community-based HIV stigma reduction and wellness-enhancement intervention that involved PLWH and people living close to them (PLC). This HIV stigma-reduction community “hub” network intervention was specifically planned as an intervention for the community, targeting PLWH and their community members who live in the same ward in the Tlokwe municipality in the North West Province of South Africa. The objectives of the study were to explore, describe and determine whether an HIV stigma-reduction community “hub” network intervention in a South African urban area will make a difference in the HIV stigma experiences of PLWH, as well as related stigmatisation by their community; to describe the implementation of this intervention; and to determine the change in depression and psychosocial well-being of PLWH and their community before and after the intervention. The HIV stigma-reduction community “hub” network intervention defines a “hub” as a two-person mobiliser team consisting of a PLWH and a non-infected PLC who are inhabitants of the same community and functions from a “hub” in the community. The strategy is based upon the involvement of PLWH and PLC, as community mobilisers, who share their knowledge and who mobilise and empower their own community to reduce HIV stigma. A convergent parallel mixed-method design with a single case pre-test post-test design for the quantitative data, and an interpretive description approach for the qualitative data were utilised. The sample for this study included PLWH recruited through accessibility sampling as well as community members living in the same municipal ward through random voluntary sampling. Valid measures were used to determine and describe whether the HIV stigma-reduction community “hub” network intervention will affect change in the HIV stigma experiences of PLWH, the perceived stigmatisation by their community, as well as the depression and psychosocial well-being of both PLWH and the community. A sub-sample of both groups was selected by means of purposive voluntary sampling for the qualitative part of the study, consisting of in-depth interviews about stigma experiences of PLWH, as well as stigmatisation of the community toward PLWH. For the description of the HIV stigma-reduction community “hub” network intervention, a holistic single-case study design was used. Participants were recruited according to accessibility, during the various community activities, with no differentiation between PLWH and people of unknown HIV status residing in that community. Findings indicate that the HIV stigma-reduction community “hub” network intervention, as planned and implemented, was successful in initiating the onset of changes in a community through the PLWH and PLC, as community mobilisers were active in the community “hub” network to mobilise their own communities towards HIV stigma reduction, sharing their knowledge and mobilising and empowering their own community. Changes were observed on an individual and social level. Recommendations focus on using and strengthening the present community intervention, adjusting some of the scales used in this study and ensuring stronger collaboration between health and social disciplines to address the various manifestations and to change the contexts of HIV stigma. It is furthermore recommended that future HIV stigma-reduction interventions give special attention to addressing aspects of psychosocial well-being. / PhD (Psychology), North-West University, Potchefstroom Campus, 2015

<p>Individer som smittas av Human Immunodeficiency Virus (HIV) och utvecklar Acquired Immune Deficiency Syndrome (AIDS) ställs inte bara inför en livshotande sjukdom utan drabbas dessutom av stigma som är relaterat till fruktan för HIV/AIDS. Stigmatisering är ett globalt problem som kan leda till diskriminering och försämrad livskvalitet för personen i såväl den privata som den offentliga sfären. Orsaken till stigmatiseringen är komplex och problematiken existentiell. Syftet med denna litteraturstudie var att jämföra påverkan på individen vid sjukdomen HIV i Europa respektive Afrika söder om Sahara. Resultaten i studien baseras på 17 vetenskapliga artiklar där fokus ligger på anledningar till att berätta om eller dölja sin HIV-status och vilka konsekvenser detta val kan få för individens liv. Studien visar att stigmat relaterat till sjukdomen HIV/AIDS skiljer sig något i Europa och Afrika. Vissa likheter mellan de båda världsdelarna kunde skönjas, såsom att valet att berätta om sin sjukdom ofta föll på någon som den smittade individen ansåg sig ha en nära och förtroendefull relation till. Resultaten visar också att stigmatiseringens effekter kan slå hårdare mot den enskilda individen i Afrika än i Europa. I Afrika sker en omfattande forskning kring ämnet, till skillnad mot Europa.</p>

Individer som smittas av Human Immunodeficiency Virus (HIV) och utvecklar Acquired Immune Deficiency Syndrome (AIDS) ställs inte bara inför en livshotande sjukdom utan drabbas dessutom av stigma som är relaterat till fruktan för HIV/AIDS. Stigmatisering är ett globalt problem som kan leda till diskriminering och försämrad livskvalitet för personen i såväl den privata som den offentliga sfären. Orsaken till stigmatiseringen är komplex och problematiken existentiell. Syftet med denna litteraturstudie var att jämföra påverkan på individen vid sjukdomen HIV i Europa respektive Afrika söder om Sahara. Resultaten i studien baseras på 17 vetenskapliga artiklar där fokus ligger på anledningar till att berätta om eller dölja sin HIV-status och vilka konsekvenser detta val kan få för individens liv. Studien visar att stigmat relaterat till sjukdomen HIV/AIDS skiljer sig något i Europa och Afrika. Vissa likheter mellan de båda världsdelarna kunde skönjas, såsom att valet att berätta om sin sjukdom ofta föll på någon som den smittade individen ansåg sig ha en nära och förtroendefull relation till. Resultaten visar också att stigmatiseringens effekter kan slå hårdare mot den enskilda individen i Afrika än i Europa. I Afrika sker en omfattande forskning kring ämnet, till skillnad mot Europa.

This dissertation is composed of three studies that examined illness-related stigma, depressive symptoms and attachment style among patients living with HIV and Hepatitis C (HCV). The first study examined the psychometric properties of a brief HIV Stigma Scale (B-HSS) in a sample of adult patients living with HIV (PHA) (n=94). The second study developed and explored the psychometric properties of the HCV Stigma Scale in a sample of adult patients living with HCV (PHC) (n =92). Psychometric properties were evaluated with classical test theory and item response theory methodology. The third study explored whether illness-related stigma mediated the relationship between insecure attachment styles (anxious attachment or avoidant attachment) and depressive symptoms among PHA (n =72) and PHC (n=83). From June to December 2008, patients were recruited to participate in a questionnaire study at the outpatient clinics in The Ottawa Hospital. Findings indicated that the 9-item B-HSS is a reliable and valid measure of HIV stigma with items that are highly discriminatory, which indicates that items are highly effective at discriminating patients with different levels of stigma. The 9-item HCV Stigma Scale was also found to be reliable and valid with highly discriminatory items that effectively differentiate PHC. Construct validity for both scales was supported by relationships with theoretically related constructs: depression and quality of life. Among PHA, when HIV stigma was controlled the relationship between anxious attachment style and depression was not significant. However, the relationship between avoidant attachment style and depressive symptoms decreased but remained significant. Among PHC when HCV stigma was controlled the relationship between insecure attachment styles and depressive symptoms was not significant. Dissertation results emphasize the importance of identifying patients experiencing illness-related stigma and the relevance of addressing stigma and attachment style when treating depressive symptoms among PHA and PHC.

This dissertation is composed of three studies that examined illness-related stigma, depressive symptoms and attachment style among patients living with HIV and Hepatitis C (HCV). The first study examined the psychometric properties of a brief HIV Stigma Scale (B-HSS) in a sample of adult patients living with HIV (PHA) (n=94). The second study developed and explored the psychometric properties of the HCV Stigma Scale in a sample of adult patients living with HCV (PHC) (n =92). Psychometric properties were evaluated with classical test theory and item response theory methodology. The third study explored whether illness-related stigma mediated the relationship between insecure attachment styles (anxious attachment or avoidant attachment) and depressive symptoms among PHA (n =72) and PHC (n=83). From June to December 2008, patients were recruited to participate in a questionnaire study at the outpatient clinics in The Ottawa Hospital. Findings indicated that the 9-item B-HSS is a reliable and valid measure of HIV stigma with items that are highly discriminatory, which indicates that items are highly effective at discriminating patients with different levels of stigma. The 9-item HCV Stigma Scale was also found to be reliable and valid with highly discriminatory items that effectively differentiate PHC. Construct validity for both scales was supported by relationships with theoretically related constructs: depression and quality of life. Among PHA, when HIV stigma was controlled the relationship between anxious attachment style and depression was not significant. However, the relationship between avoidant attachment style and depressive symptoms decreased but remained significant. Among PHC when HCV stigma was controlled the relationship between insecure attachment styles and depressive symptoms was not significant. Dissertation results emphasize the importance of identifying patients experiencing illness-related stigma and the relevance of addressing stigma and attachment style when treating depressive symptoms among PHA and PHC.

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.

Infant Feeding in HIV in Canada is an increasingly challenging and confusing aspect of clinical care for providers and patients due to differences in recommendations in Canada compared to low income countries. The frequency of breastfeeding occurring in Canada is not documented or known, and is shrouded in stigma because of fear of criminalization or child apprehension in the midst of a culture where ‘breast is best’ messaging dominates. Breastmilk transmission data comes from observational and randomized controlled trials completed in low resource settings, which may not be generalizable to Canadian clinical settings. Previous literature has not explored provider perspectives on this issue, especially in high resource settings. We developed a survey to explore the knowledge, attitudes and practices of adult and pediatric HIV care providers in Canada. This survey explores the provider knowledge levels, risk tolerance and perceived stigma pertaining to infant feeding in HIV. Using exploratory analysis including descriptive statistics and regression modelling, we developed scales on the above listed three subject areas. The overall opinions of providers were that formula feeding should remain the recommendation due to the potential risk to the infant; and that women should be supported to access formula and resources to overcome barriers to formula feeding. Providers varied in their risk tolerance and the degree of stigma they perceived associated with infant feeding for their patients. Providers did not feel that breastfeeding is a criminal matter, but in some circumstances they would consider involving child protection services. Focus group consultation with women living with HIV, provided insight into the experiences, and clinical and research priorities for women living with HIV on infant feeding. A provider meeting was organized to discuss the challenges and resources pertaining to infant feeding in Canada across the provinces. Providers described diverse patient populations with differing needs. Using a World Café model for discussion, priority needs were decided through consensus including the need for knowledge translational resources to convey information to women living with HIV on infant feeding, and the need for evidence based consensus clinical management guidelines was evident. Quantifying the frequency of breastfeeding occurring in Canada by women living with HIV will help to understand how often this issue is encountered. A preliminary qualitative approach to understanding infant feeding issues for women living with HIV using focus groups is described. However, further exploration in a community based approached is needed to explore the needs and challenges faced by families affected by HIV around infant feeding. / Thesis / Master of Science (MSc) / Infant Feeding in HIV in Canada is an increasingly challenging aspect of clinical care. Information on breastmilk transmission comes from studies completed in lower income countries, and this may not be applicable to the Canadian HIV setting. Previous literature has not explored provider perspectives on this issue, especially in high-income countries like Canada. In this knowledge, attitudes and practices survey of HIV care providers in Canada, the main findings were that formula feeding should remain the recommendation due to the potential risk of HIV infection occurring in the baby, however women should be supported to access formula and resources to overcome barriers to formula feeding. Providers do not feel that breastfeeding is a criminal matter, but in some circumstances may consider involving child protection services. We performed community consultation using focus groups to understand some of the issues women face with infant feeding, some of the clinical solutions they would support, and research questions and knowledge translation they would want undertaken. A provider meeting to discuss the challenges pertaining to infant feeding in Canada demonstrated that although populations differ, the need for knowledge translational resources to convey information to women living with HIV on infant feeding was universal. Furthermore, the need for evidence based consensus clinical management guidelines would improve the quality of care provided.

High levels of HIV stigma are reported for people living with HIV or AIDS (PLHA) and PLHA have to cope with this. These experiences may differ in a rural and urban setting. Obtaining a true reflection of the level of HIV stigma experienced by PLHA in a rural and urban setting and their level of coping self-efficacy, while dealing with this stigma, will be helpful in planning future intervention strategies. The study aims to compare qualitative expressed experiences with quantitative measures of levels of HIV stigma and coping self-efficacy of PLHA in a rural and urban setting. Secondly the aim is to establish the relationship between the levels of HIV stigma experiences of PLHA and coping self-efficacy of PLHA. The study took place in the North West Province, in both a rural (n=12) and urban (n=11) setting. Participants were selected by means of purposive sampling. A convergent parallel design was used within a mixed method approach. In-depth interviews provided qualitative data. Quantitative data came from two scales, the HIV and AIDS stigma scale-PLWA (HASI-P) (Holzemer et al., 2007a) and the Coping self-efficacy scale (CSE) (Chesney, Neilands, Chambers, Taylor, & Folkman, 2006). The study revealed that HIV stigma does exist, and is experienced by PLHA in the North West province in both a rural and an urban setting with no significant difference. Qualitative data confirmed the results of the HIV stigma measure, and also provided a rich understanding of the differences in contexts between the two settings. Additional types of stigma found to those included in the HASI-P point to shifts in the way people and communities experience HIV stigma. Results of the CSE scale showed that PLHA from both rural and urban settings employed the three types of coping self-efficacy as described by Chesney et al. (2006), with no significant difference between the two groups. Statistical correlations within the HASI-P revealed correlations between certain types of stigma experienced, indicating that HIV stigma is not experienced in a single dimension but can extend to more than one area of the lives of PLHA. Correlations within the CSE scale illustrate that ways PLHA cope may be related to each other Recommendations focus on further research options, policy development and implementation in practice. The goals of the research were reached in that it was confirmed that HIV stigma and coping self-efficacy of PLHA in rural and urban settings, using qualitative and quantitative methods, does exist. The relationship between HIV stigma and coping self-efficacy of PLHA was established through the correlation of scales and through the evidence found during in-depth interviews; that HIV stigma exists and that PLHA develop coping self-efficacy to deal with it. / Thesis (MA (Research Psychology))--North-West University, Potchefstroom Campus, 2013