Thesis (M.SP)--Unitec New Zealand, 2009. / Includes bibliographical references (leaves 114-118).

Magister Artium - MA / This research explored cultural perceptions of HIV & AIDS with students at the University of the Western Cape and attempted to understand how these perceptions of the disease reinforce stigma and stigmatising attitudes towards people living with HIV/AIDS. This study investigated HIV/AIDS stigma as a social phenomenon and analysed the socio-cultural and historical roots of HIV/AIDS stigma. / South Africa

The individualization and medicalization of the emotional distress of those given psychiatric diagnoses deny the social, political, and economic context in which the presenting behaviours arose and leads away from making changes to society. Some people who are psychiatrically labelled join in groups for solidarity in the face of being stigmatized. In these groups the members can resist the disempowerment and helplessness learned in the psychiatric system. With co-researchers from a self-help group this study gives expression to the usually silenced voices of psychiatrized people. Feminist and standpoint theories, co-cultural and living systems theories form a framework for this narrative study. A structural narrative method is used to analyze the stories, found in the transcripts of six individual interviews, told by the co-researchers about their experiences in psychiatric services and in the recovery process. The stories reveal how the ideology and practices of psychiatry use stigma, oppression and the creation of the identity of psychiatric patient for control and management. The stories also reveal the reality of hope for recovery through the support of peers and from the role models of those who have significantly recovered their mental health. Two focus group interviews were conducted with members of the self-help group where suggestions for programs were developed to address issues raised within the groups and in the individual interviews. The findings of the research will be reported to the self-help group who will use the study to back proposals for the funding of recovery-oriented programs. When social workers and other mental health professsionals recognize the importance of supporting the process of recovery, consumer/survivor-run programs will be acknowledged as effective and integral parts of any mental health system / Arts, Faculty of / Social Work, School of / Graduate

This project explores the history of Germans in Canada: their experiences prior to, during, and after the Second World War. The primary focus of this project will be on the construction of the German Canadian identity in the years after the Second World War. I contend that German Canadian immigrants from the post-war years experienced discrimination and negativity which forced them to submerge their true identities. This submersion has left us with a weak German Canadian culture today-it is one based on the outdated notion of "oom-pa-pa" bands and Schuhplattler dancers. As this culture-and the people who perpetuate it-die off, we are left with a German Canadian culture and identity that is more and more Canadian. This project is primarily composed of a literature review and will use Erving GofFman's theory on stigma and spoiled identities. / Arts, Faculty of / Sociology, Department of / Graduate

This study uses survey data collected from a convenience sample of undergraduate students (N=89). A vignette survey design is employed to measure social rejection of striptease performers compared to a control group. Data is also collected on negative stereotypes held about striptease performers, which are correlated with social rejection. Link and Phelan's conceptualization of the stigma process provides the theoretical framework for this analysis. Findings suggest that striptease performers experience higher levels of social rejection and are perceived more negatively than the control group and that endorsement of negative stereotypes is associated with social rejection.

Studies consistently find sexual orientation disparities in tobacco, alcohol and marijuana use among adolescents in the United States (Goldbach, Tanner-Smith, Bagwell, & Dunlap, 2014; Hatzenbuehler, Jun, Corliss, & Austin, 2015; Kann et al., 2018; Marshal et al., 2008; Mustanski, Van Wagenen, Birkett, Eyster, & Corliss, 2014). Having documented this elevated risk, the field has turned to identifying mediators that may explain the sexual orientation disparity in substance use behaviors. There is growing evidence that one of the mediators of sexual orientation-based health disparities is structural stigma—defined as “societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized” (Hatzenbuehler & Link, 2014, p.2). Structural stigma can in turn lead to greater stress and subsequent negative coping behaviors among sexual minorities (Hatzenbuehler et al., 2015; Hatzenbuehler & Link, 2014; Hatzenbuehler & McLaughlin, 2014; Pachankis, Hatzenbuehler, & Starks, 2014). However, most of this work has been conducted among adults and has focused on mental health outcomes (e.g., suicide attempts, psychiatric morbidity, mental distress) as opposed to specific substance use behaviors; further, if structural factors are found to affect sexual orientation health disparities and these can be altered, the gap between sexual minority and heterosexual substance use can be narrowed through policy change. State-level substance use policy (e.g., levels of taxation of cigarettes and alcohol, policies that remove adolescent access to driving upon substance use infractions) may also explain the gap in substance use prevalence between sexual minority and heterosexual youth because tobacco, alcohol and marijuana are also stigmatized substances and restrictive substance use environments may enhance the stigma attached to sexual minority youth. However, only one study has explored this research question, and it was conducted with an adult sample (Hatzenbuehler, Keyes, Hamilton, & Hasin, 2014). This project aims to address these gaps in the literature. It uses multi-level modeling to test the association between (1) state-level sexual minority structural stigma (SMSS) and (2) state-level substance use policy environments (SUPEs) and sexual orientation disparities in recent substance use as measured in the Youth Risk Behavior Surveillance Survey (YRBSS). Analyses were also conducted to assess the size and direction of the association between SMSS and SUPE and state-level prevalence of substance use within heterosexual and sexual minority youth subpopulations. Analyses were conducted in subpopulations of female and male youth. Support was found for the structural stigma hypothesis among girls but not boys. Higher overall measures of sexual minority structural stigma were associated with larger disparities in tobacco use, alcohol use, and marijuana use among girls. Higher scores on the SMSS scale were associated with tobacco use among sexual minority girls but not heterosexual girls. Individual indicators of structural stigma (e.g., specific state-level policies) were also associated with disparities in these outcomes, as well as with the other outcomes tested (binge drinking and drunk driving). No such associations were found among male youth. Very little support was found for the hypotheses that restrictive substance use policy environments would be associated with larger sexual orientation disparities in substance use and that heterosexual but not sexual minority youth would demonstrate lower prevalence of substance use in restrictive states. Among girls, no associations were found between scales measuring the restrictiveness of substance use and sexual orientation disparities in substance use. A smaller sexual orientation disparity in recent cigarette smoking was associated with one indicator of restrictiveness: state enforcement of underage tobacco sale laws. Among boys, no associations were found between scales measuring the restrictiveness of substance use and sexual orientation disparities in substance use; two indicators of restrictiveness were associated with smaller sexual orientation disparities in binge drinking and three indicators were associated with smaller sexual orientation disparities in drunk driving. Among heterosexual but not sexual minority boys, higher tobacco taxes were associated with lower prevalence of smoking. This study raises several questions for future research on structural factors that may explain sexual orientation disparities in substance use behaviors among youth. For instance, future work is needed to understand the gender differences in response to structural stigma among sexual minorities. Sexual minority girls may have greater rejection sensitivity than sexual minority boys and thus may be more likely to use substances in response to structural stigma; however, further research is needed to test this hypothesis. In addition, the current study lacked data on the implementation of substance use policy environments, which may have masked important effects. A study of SUPE that includes measures of implementation of restrictive substance use policies is therefore needed to expand the work reported herein. Finally, a better understanding of gender identity and expression is needed; while the YRBSS measures “sex” and not gender or gender expression in these datasets, more information about these topics will help to understand how these factors may play into experiences of structural stigma and substance use policy environments.

Thesis (MPH.) -- University of Limpopo, 2019 / Virological failure occurs when the viral load fails to supress to undetectable limit and immunological failure is when the immune system fails to improve with the CD4 count remaining low on clients on antiretroviral drugs. These being markers of poor adherence to antiretroviral drugs or treatment failure. Upon routine blood-monitoring of students on antiretroviral drugs, the researcher noticed that some students’ viralload levels were not suppressing and their immune system was not improving. The purpose of the study was to identify the experiences of those students whose viral load is not suppressing and their immune system not improving. The objective was to identify and describe the experiences of students with immunological and virological failure on antiretroviral drugs at the University of Limpopo. A qualitative, explorative and descriptive study design was used. Convenience purposive sampling method was adopted. Using a semi-structured interview guide, face-toface interviews were conducted on 10 students on antiretroviral drugs at the Student Health and Wellness Centre, University of Limpopo. Techs’ method was used to analyse data. Guba’s model for establishing trustworthiness was used. The study yielded the following themes: Disclosure, stigma, antiretroviral drugs packaging, side effects of antiretroviral drugs and service delivery. The study concluded that students are afraid to take their treatment for fear of stigmatisation and disclosure is still a problem. Students tend to forfeit taking drugs when studying for examinations due to side effects of the drugs. It is recommended that service delivery and antiretroviral drugs packaging be user friendly. Key words: Disclosure, stigma, side effects, antiretroviral drugs packaging and antiretroviral drugs.

Building on prior work on status-based rejection sensitivity, I propose a social-cognitive model of criminal-status-based rejection sensitivity (RS-criminal record) to account for differences in how people perceive and respond to threats of rejection based on their criminal histories. Study 1 develops a measure of criminal-status-based rejection sensitivity, defined as a tendency to anxiously expect, readily perceive, and negatively react to rejection based on one’s criminal status. Study 2 tests the predictions of the RS-criminal record model that anxious expectations of criminal-status-based rejection are associated with heightened perceptions of criminal-status-based rejection threat and responding to criminal-status-based stressors through self-silencing and anger. Together, Studies 1 and 2 show that RS-criminal record is distinct from general interpersonal rejection sensitivity (RS-personal), race-based rejection sensitivity (RS-race), and other relevant stigma constructs. Study 3 tests the predictions of the RS-criminal record model experimentally, establishing evidence of the negative effects of criminal record disclosure, RS-criminal record, and symptoms of post-traumatic stress disorder (PTSD) on interpersonal effectiveness in an interview (as assessed by an interaction partner and outside observers) and subsequent affective states. The three studies also test the prediction, based on the dynamics of our model and evidence from focus groups, that higher levels of RS-criminal record should predict greater PTSD symptom severity. Together, these studies provide evidence of the utility of RS-criminal record to illuminate the psychological and structural pathways through which stigma can undermine the task of social integration after being released from prison.

The HIV care continuum captures the proportion of people who engage in various steps of the treatment cascade from the time of HIV diagnosis to the achievement of viral load suppression. Viral load suppression is the ultimate goal of HIV treatment as it is the best way to mitigate the spread of HIV and contain the epidemic. The best pathway to viral load suppression is not always clear. There are several factors that aid or hinder HIV patients from engaging in every step of the care continuum until they achieve and sustain viral load suppression. This dissertation aims to measure the underlying enablers of engagement in HIV care, relate them to potential barriers, and assess the effect of each enabler and barrier on future engagement in care and viral load suppression using data collected from people living with HIV (PLHIV) in Eswatini. Firstly, a systematic review was conducted to summarize the methodologies used to measure and analyze barriers and enablers of engagement in HIV care. A search of all peer-reviewed articles published in English globally since 1996 yielded a final selection of 228 articles. The vast majority of the studies were qualitative and descriptive, and there was a scarcity of quantitative studies utilizing predictive methods that can measure the effect of a barrier or enabler on future engagement in care. Secondly, an empirical analysis was conducted to assess the dimensionality (factor structure) of enablers of engagement in care using a sample largely representative of HIV patients in care in Eswatini. This analysis demonstrated the use of psychometric techniques that can capture underlying latent enablers. These techniques are useful for standardizing the measurements of enablers across studies and programs and can be used to predict future engagement in care. This analysis found financial and access enablers to be the most prominent underlying factors supporting engagement in care in Eswatini, suggesting that these should be an important consideration when designing interventions to retain HIV patients in care in resource-limited settings similar to Eswatini. Thirdly, in an additional empirical analysis, the latent enablers previously identified were used to select potential barriers and assess their effect on linkage to care, retention in care, and viral load suppression. The analysis also involved an assessment of the mediational pathway from the potential barriers to care to viral load suppression that goes through retention in care. Only perceived HIV stigma was related to any step of the care continuum, with low perceived stigma being marginally associated with less viral load suppression. Retention in care did not mediate the relationship between perceived stigma and viral load suppression. More psychometric studies are needed to standardize the measurement of underlying factors affecting engagement in HIV care. This dissertation demonstrated their utility by measuring latent enablers of engagement in care, assessing the downstream effects of the latent enablers and corresponding barriers, and assessing the mechanisms by which the barriers affect viral load suppression.

The purpose of the present study is to understand how interpersonal and structural ethnic stigma uniquely and collectively confer risk for adverse mental health outcomes in Latinx individuals living in the U.S. Employing a minority stress mediation framework with 639 self-identified Latinxs, the current study utilized manifest and latent variable correlations and latent variable structural equation modeling to examine distal stressors (interpersonal ethnic stigma, structural ethnic stigma) as predictors of mental health outcomes (psychological distress, psychological well-being), with proximal stressors (expectations of stigma, internalized stigma, perceptions of structural stigma) and a general psychological process (rumination) as potential mechanisms through which stigma experiences confer mental health risk. Findings were mixed in terms of their support for study hypotheses. Overall, results indicate that a minority stress mediation framework is applicable with a Latinx population. Interpersonal ethnic stigma yielded direct and indirect associations with proximal stressors, psychological processes, and mental health outcomes, and both proximal stressors and psychological processes emerged as potential pathways through which stigma experiences confer risk. However, associations among structural ethnic stigma and study variables were mostly nonsignificant. Findings are discussed in terms of their implications for clinical practice, education of mental health practitioners, and immigration policy, along with limitations and future directions.