<b>Background:</b> This is the first epidemiological study of internalised stigma among adolescents living with the human immunodeficiency virus (HIV) in Sub-Saharan Africa. It aims to establish predictors of internalized HIV-stigma among people living with HIV in Sub-Saharan Africa (Paper 1), develop an HIV-stigma scale for use with adolescents (Paper 2) and build and test a model of risk pathways for internalised stigma (Paper 3). The data used for papers 2 and 3 is part of the world's largest social science study of adolescents living with HIV (n=1060). <b>Paper One</b> systematically reviews evidence on the prevalence and predictors of internalised HIV stigma amongst people living with HIV in Sub-Saharan Africa. PRISMA guidelines were followed. An adapted version of the Cambridge Quality Checklist was used to assess the quality of the findings. A total of 18 papers were included. The prevalence of internalised stigma among adults living with HIV was 27% - 66%. The longitudinal predictors for internalised HIV stigma were poor HIV-related health and psychological distress. The review identifies two critical limitations of the literature. First, no studies on adolescents were found. One of the reasons for this may be the lack of a scale for measuring internalised HIV stigma in this population. Second, only individual-level risk factors for internalised stigma were examined. Papers 2 and 3 aim to address these limitations. <b>Paper Two</b> develops an HIV stigma scale with and for adolescents living with HIV. First, a multidimensional stigma scale previously used with adolescents in the US was cross-culturally adapted using semi-structured cognitive interviews with nine South African adolescents living with HIV. These data were interpreted through thematic analysis, and items were adapted in consultation with interviewees. Second, the revised version of the scale was administered to 1060 adolescents living with HIV. Confirmatory factor analysis confirmed the predicted 3-factor structure, and associations with hypothesised correlates provided evidence of validity. <b>Paper Three</b> develops and tests a model of risk pathways to internalised HIV stigma among adolescents living with HIV. Drawing on findings from the systematic review (Paper 1) and using the scale developed in Paper 2, both inter and intrapersonal pathways of risk from HIV-related disability to internalised HIV stigma were hypothesized. Following from modified labelling theory, interpersonal mechanisms were hypothesized to occur through maltreatment within power-unequal relationships, i.e. enacted HIV stigma and violence victimization. Hypothesized intrapersonal risks were anticipated HIV stigma and depression. Structural equation modelling enabled the grouping of theoretically related constructs and assessment of multiple, simultaneous pathways of risk. Prevalence of any internalised HIV stigma among adolescents living with HIV was 26.5%. As hypothesized, significant associations between internalised stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, violence victimization, and enacted stigma were not directly associated with internalised stigma. Rather, indirect pathways via intrapersonal risks were observed. <b>Conclusions:</b> More than a quarter of adolescents living with HIV in this study reported experiencing some level of internalised stigma. Findings suggest a need to expand programmatic responses to internalised HIV stigma, from individualistic, clinic-based programmes to integrative, community-based approaches. Providing mental health support and reducing the maltreatment of adolescents living with HIV might interrupt pathways from HIV-related disability to internalised stigma. This highlights the potential for interventions that do not necessarily target HIV-positive adolescents but are sensitive to their needs. Such efforts must be coupled with rigorous process and outcome evaluations, and longitudinal data is urgently needed. It is hoped that the adolescent-friendly stigma scale developed within this DPhil will enable further research with this understudied population. Prior to this thesis, there were no known epidemiological studies of internalised HIV stigma among adolescents living with HIV. Moreover, the broader, adult-focused corpus of research has overlooked interpersonal risk factors. This thesis highlights the relevance of power inequalities and domination for the study of internalised HIV stigma.

Magister Artium - MA / People's attitudes towards people living with HIV/AIDS remain a major community challenge. There is a need to generate a climate of understanding, compassion and dignity in which people living with HIV/AIDS (PLWHA) will be able to voluntarily disclose their status and receive the support and respect all people deserve. However, many people expereince discrimination because they have HIV/AIDS. In a certain area in Khayelitsha, a township in Cape Town, a young woman was killed after disclosing the HIV status after being raped by five men. While many previous studies have focused on the external stigma in the general population, there is a dearth of studies on stigma among PLWHA themselves and hence the aim of the present study was to investigate stigma attached to HIV/AIDS from the perspective of PLWHA. / South Africa

Magister Psychologiae - MPsych / South Africa has one of the highest HIV and AIDS prevalence rates and the pandemic shows no signs of abating. Challenges facing South Africa in combating this pandemic include the social responses of fear, denial, stigma and discrimination. Stigma related to HIV and AIDS poses a major barrier to treating and managing HIV and AIDS. Stigma is defined as involving an attribute which significantly discredits an individual in the eyes of others or society. This attribute is therefore seen by others as being negative, something which devalues, spoils or flaws an individual. Perceived or felt stigma is described as being the anticipation of rejection and the shame of having the stigma, whereas enacted stigma refers to actual incidents of discrimination. The aim of this study was to determine, from the experiences of people living with HIV and AIDS, whether stigma manifests within the South African primary health care system. / South Africa

D.Litt. et Phil. / This study explores the process of meaning-making for parents who have lost an adult child where the cause of death was a stigmatised illness. In order to shed light on the phenomenon under review, an investigation of existing research literature was undertaken. A particular focal point in respect of the review as a whole, is the exploration of how the experience of parental bereavement motivates the search for meaning and the possible significance of this meaning in the continued life of the bereaved parent. The review comprises an overview of theoretical approaches to bereavement and the various factors which determine the grief experience. These include an examination of factors surrounding the loss, personal factors and coping skills, as well as an outline of familial, cultural and social aspects. A further focus of the review, is on the process of meaning making especially with regard to death and suffering. The review explores the issues of stigma and the process of stigmatisation. How stigma attaches to an attribute and issues of disclosure are areas of focus, in particular the effect of stigma in respect of HIV/AIDS. The focus of the study is on the world of the lived experienced as it is interpreted by participants in order to produce an understanding of the participants’ experience. Hence the study is sited within a phenomenological framework. Six participants were interviewed with the intention to act as informants who are able to give rich and abundant descriptions of their experience. All participants have experienced the loss of an adult offspring as a result of a long-term illness. The children of three of the participants died as a result of an AIDS-related illness, which is currently a stigmatised illness in South Africa, and the children of three participants have died as a result of cancer, which is a long-term terminal illness which is not currently stigmatised in South Africa. The interviews were recorded and transcribed. An interwoven analysis was presented in order to identify the themes and experiences of such bereavement which emerged from the transcripts. An attempt was made to understand how the various phenomena relating to parental bereavement were reflected by participants in the interviews. The study also sought to compare areas of commonality and divergence between participants whose children have died from cancer and those who have died as a result of AIDS, so as to present an integrated delineation of themes. Finally the study presents a reflection of the experience of the researcher and recommendations for therapeutic practice which arise from the conclusions of the study. There is an evaluation as regards the strengths and limitations of the study and recommendations for future research. The unique contribution of the study to the field of psychology is also addressed.

The purpose of this pilot study was to determine the effect of vignettes about Alzheimer’s dementia (AD) on stigma and attitudes toward people with Alzheimer’s dementia (PWAD) in a sample of community residents of adults 65 years and older. The specific aims of this study were: (1) to determine the effect of vignettes on AD- related stigma and negative attitudes toward people with AD among adults age 65 years and over, and (2) to describe AD- related stigma and negative attitudes in ethnically and racially diverse groups of older adults. A convenience sampling design was used to recruit 50 participants from a medical office in Boca Raton. The sample included adults age 65 years and older from the community, who understood English and scored 25 or higher on Mini Mental State Exam (MMSE). Participants were randomly assigned to the control group (n=22) who received standard AD education or to the intervention (n=28) who received vignettes and standard AD education. Independent t-test was used to analyze the pretest- posttest change scores in the measures of DAS and STIG-MA survey. The significance (p value) was set at .05. In research question two, the samples were divided into 1) white non- Hispanic and 2) other diverse groups. Descriptive statistics were used to explore racial or ethnic differences in stigma and attitudes. The intervention used vignettes and AD education to decrease stigma and attitudes toward people with dementia and showed statistical significance as compared to the control group who received only the AD education. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2021. / FAU Electronic Theses and Dissertations Collection

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Thesis (DPhil (Psychology))—University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Since the 1970s, the international disability movement has galvanised around the "social model" of disability, as an adversarial response to traditional, individualising "medical" accounts of disablement. The model foregrounds "disablist ideology", identifying systematic exclusion and discrimination as central mediators of disabled life. Latterly, feminist authors within disability studies have problematised the "arid" materialist orientation of the social model, for its eschewing of personal and psychological aspects of disability, and poor theorising of embodiment. Social model orthodoxy construes the psychological as epiphenomenal, diversionary, and potentially misappropriated in the buttressing of pathologising accounts of disablement. A legacy of "traditional" psychoanalytic theorising on disability implies causal links between bodily difference and psychopathology, eliding a critical interrogation of oppression in mediating the severely marginal social and economic destiny of the disabled minority. The new "critical" psychoanalytic approach to disability interprets broad social responses to disablement as the enactment of defences engaged in reaction to the universal unconscious existential conflicts evoked by disability images. The present work seeks to elaborate the integration of psychoanalysis into disability studies, towards development of a politically situated psychology of disability oppression, which creates theoretical links connecting ideology with the nature of individual subjectivity. Conceptual ideas to begin describing the psycho-emotional aspects of disablist oppression and impairment were developed via an integration of clinical data with a renewed, psychoanalytically informed critical synthesis of disability-related research from a range of disciplines. Clinical data was gathered via psychoanalytically oriented group psychotherapy with severely physically impaired university students. Full transcriptions and in-depth fieldnotes were utilised as a record of data, which was then analysed via interpretive, psychoanalytic and "interpretive auto-ethnographic" methods. Follow-up interviews were held to assess the resonance and utility of new concepts. A range of theoretical contributions was combined in illuminating the modernist cultural and political underpinnings of oppressive responses to the impaired body, and integrated with accounts of the psychological and relational predicaments of disablism gleaned from the clinical record. Topics drawn from literature, critically evaluated, developed and re-synthesised included narcissistic culture, the family, "medicalisation", social mirroring, internalised oppression, liminality, and representations of disability in charity, art and modern bioethics. The nature of countertransference dynamics in therapeutic work with disabled people was considered. Key concepts from the clinical data were developed and progressively reformulated; these included the distortion of boundaries, the discourse of loss, control, independence, identity, complicity, trauma, and the imperative to silencing the subjective experience of disabled life. / AFRIKAANSE OPSOMMING: Die internasionale gestremdheidsbeweging mobiliseer sedert die 1970’s rondom die “sosiale model” van gestremdheid - in afwysende reaksie op tradisionele individualiserende, “mediese” diskoerse. Dié model plaas die kollig op “gestremdheidsideologie”, en identifiseer sistematiese uitsluiting en diskriminasie as die sentrale bemiddelaars van die gestremde lewe. In die laaste tyd word die “droëe” materialistiese benadering van die sosiale model egter deur feministiese outeurs binne gestremdhiedsstudies geproblematiseer, spesifiek as synde ontwykend van die persoonlike en sielkundige aspekte van gestremdheid, en vanweë die model se swak teoretisering van beliggaming. Die ortodokse sosiale model beskou die sielkundige as ‘n epifenomeen, ’n afleiding, en potensieël kaapbaar in diens van patologiserende narratiewe oor gestremdheid. ‘n Nalatenskap van “tradisionele” psigoanalitiese teoretisering oor gestremdheid impliseer kousale verbande tussen liggaamlike alteriteit en psigopatologie, wat lei tot die weglating van ‘n kritiese ondervraging van verdrukking in die bemiddeling van die uiters marginale sosiale en ekonomiese lotsbestemming van die gestremde minderheidsgroep. Die nuwe “kritiese” psigo-analitiese benadering tot gestremdheid interpreteer breë sosiale response op gestremdheid as die aktivering van verdedigingsmeganismes in reaksie op universele onbewuste eksistensiële konflikte wat deur beelde van gestremdheid na vore geroep word. In hierdie verhandeling word daar gepoog om die integrasie van psigo-analise binne gestremdheidstudies uit te dy, en ‘n aanset te lewer tot die ontwikkelling van ’n polities-gesitueerde sielkunde van gestremdheidsverdrukking, waardeur teoretiese verbande tussen ideologie en die aard van individuele subjektiwiteit gelê word. ‘n Aanvanklike begripsapperatuur ten einde die beskrywing van die psigo-affektiewe aspekte van gestremdheidsverdrukking en –benadeling aan die gang te sit, is deur middel van ’n integrasie van kliniese data met ’n hernude, psigoanalities skatpligtige kritiese sintese van gestremdheidsgeoriënteerde navorsing in ‘n verskeidenheid van vakdissiplines ontwikkel. Kliniese data is met behulp van psigo-analitiesgerigde groepspsigoterapiesessies met fisiek swaar gestremde universiteitstudente versamel. Volledige transkripsies en uitgebreide veld-aantekeninge is gebruik as data-rekord, wat dan vervolgens deur middel van interpretatiewe, psigo-analitiese en “interpretatiewe autoetnografiese” metodes geanaliseer is. Opvolg-onderhoude is gehou ten einde die mate van weerklank en bruikbaarheid van die nuwe konsepte te evalueer. ’n Verskeidenheid teoretiese bydrae is gekombineer ten einde die modernistiese kulturele en politieke stutte van verdrukkende response tot die belemmerde liggaam te belig, en is voorts geïntegreer met beskrywings van die sielkundige en verhoudingsmatige verknorsings van gestremdheid wat uit die kliniese rekord vergader is. Onderwerpe wat uit die literatuur ontleen, krities geëvalueer, ontwikkel en hersintetiseer is, sluit in die kultuur van narcisme, die gesin, “medikalisering”, sosiale spieëling, geïnternaliseerde verdrukking, liminaliteit, sowel as uitbeeldings van gestremdheid in barmhartigheidsdiens, kuns en bio-etiek. Die aard van teenoordrag-dinamieke in terapeutiese werk met gestremdes is ook in oorweging geneem. Sleutelbegrippe ontleen aan die kliniese data is ontwikkel en vootdurend herformuleer; hierdie sluit in die verwringing van grenslyne, die diskoers van verlies, van beheer, onafhanklikheid, identiteit, medepligtigheid, trauma, en die imperatief tot stilswye oor die subjektiewe ervaring van die gestremde lewe.

Thesis (MA)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: While every Botswana national can claim to be a citizen legally within the framework of the modern nation-state, some (minority groups in the main) are perceived by others (among the majority Tswana groups especially), as less authentic nationals or citizens. There is a hierarchy of citizenship fostered by political, economic, social and cultural inequalities, such that it makes some individuals and groups much more able to claim and articulate their rights than others. Ethnic identities seem stronger than ‘national identities’ as they work at the very macro level and on an immediate and daily basis. Thus the multicultural and linguistic diversity of Taung compels us to view every group as heterogeneously unique and important in its own ways, since students become marginalised as a result of individual circumstances, by being members of historically oppressed social groups. The main aim of this study was to explore visual art as a learning platform to negotiate social and cultural meanings and inform understandings of self. A qualitative approach towards the study was considered the most suitable way for conducting the research. An interpretive analysis was used to gain insight into how students made sense of their experiences and the significance of art as a platform to negotiate stigmas and stereotypes in class and school. Using the case study drawn from Taung Junior Secondary School comprising of twelve students from different ethnic groups, two major themes of difference and discrimination were identified. The sub-theme discussed under difference includes sub themes race, ethnicity and nationality, and language; while stereotyping and stigma, feelings of discomfort and feeling outcast, and Othering and marginalisation were discussed under the theme discrimination. My study revealed that art can be an especially effective catalyst for developing a critical awareness of issues of race, immigration, difference, and privilege. Art practices can become a platform for the negotiation and construction of meaning and lobby for removing the historic inequalities and injustices created by a stratified society. For this reason, it is important to understand culture and cultural diversity because culture provides beliefs, values, and the patterns that give meaning and structure to life. It enables individuals within the multiple social groups of which they are a part to function effectively in their social and cultural environments, which are constantly changing. Groups try to maintain social hierarchies and individuals maintain their position within such hierarchies by excluding others, to deny difference and try and enforce homogeneity and reproduce current social relations. As such if forces such as, differences in race, culture, gender, language, and religion are well understood, the students will engage in the process of identifying ways to manage them to shape their own educational practices. / AFRIKAANSE OPSOMMING: Terwyl elke Botswana burger wetlik aanspraak kan maak op burgerskap binne die raamwerk van die moderne volkstaat, word sommige (hoofsaaklik minderheidsgroepe) deur ander (veral Tswana groepe) as minder egte burgers beskou. Daar bestaan ‘n hierargie van burgerskap wat deur politieke, ekonomiese, sosiale en kulturele ongelykhede bevorder word; tot die mate dat sommige individue en groepe meer geredelik hulle regte kan verwoord as ander. Etniese identiteite blyk sterker te wees as ‘nasionale identiteite’ omdat dat dit op makrovlak funksioneer sowel as op ‘n onmiddellike en daaglikse basis. Gevolglik dring die multikulturele en linguistiese diversiteit van Taung ons om elke groep as heterogeen uniek en belangrik op sy eie manier te beskou, aangesien studente gemarginaliseerd raak weens individuele omstandighede, deurdat hulle lede van geskiedkundigonderdrukte sosiale groepe is. Die hoofdoel van hierdie studie was om ondersoek in te stel na die visuele kunste as ‘n leerplatform om oor sosiale en kulturele betekenisse te onderhandel en selfbeskouings toe te lig. Daar is besluit dat ‘n kwalitatiewe benadering tot die studie die mees geskikte manier is om die navorsing uit te voer. ‘n Verklarende analise is gevolg om insig te verkry ten opsigte van hoe studente sin maak uit hulle ervarings en die betekenisvolheid van kuns as ‘n platform om oor stigmas en stereotipes in die klas en skool te onderhandel. Deur van Taung Junior Sekondêre Skool, met twaalf studente van verskillende etniese groepe, as gevallestudie gebruik te maak, is twee hooftemas, nl verskil en diskriminasie, geidentifiseer. Die subtemas wat onder verskil bespreek word, sluit ras, etnisiteit en burgerskap en taal in; terwyl stereotipering en stigma, gevoelens van ongemak en verwerping en ‘Othering’ en marginalisering onder die tema diskriminasie bespreek word. My studie het getoon dat kuns ‘n besonder effektiewe katalisator is vir die ontwikkeling van ‘n kritiese bewustheid ten opsigte van kwessies soos ras, immigrasie, verskil en voorreg. Kunspraktyke kan ‘n platform word vir die onderhandeling en konstruksie van betekenis en selfs druk uitoefen ten opsigte van die opheffing van historiese ongelykhede en ongeregtighede wat deur ‘n gestratifiseerde samelewing geskep is. Dit is vir hierdie rede belangrik om kultuur en kulturele diversiteit te verstaan omdat kultuur die oortuigings, waardes en die patrone voorsien wat betekenis en struktuur aan die lewe gee. Dit gee vir individue binne die verskeie sosiale groepe waarvan hulle deel vorm, die vermoë om effektief in hul sosiale en kulturele omgewings, wat deurlopend verander, te funksioneer. Groepe poog om sosiale hierargië te handhaaf en individue handhaaf op hulle beurt hul posisie binne hierdie hierargië deur ander uit te sluit, verskille te ontken en homogeniteit af te dwing en huidige sosiale verhoudings te herproduseer. Indien daar ‘n goeie begrip is van magte, soos verskille in ras, kultuur, geslag, taal en godsdiens, sal studente betrokke raak by die proses om maniere te identifiseer om dit te bestuur en sodoende hule eie opvoedkundige praktyke te vorm.