Stigma and Discrimination: Threats to Living Positively with Human Immunodeficiency Virus.

Antiretroviral therapy and care advances have resulted in people with human immunodeficiency virus (HIV) living longer and enjoying a higher level of physical well-being. Despite such advances, individuals with HIV continue to confront challenges to living positively, including facing the secondary epidemic of stigma and discrimination. Following is a historical overview of the concept of stigma and an exploration of the causes and consequences of multilevel stigma for individuals with HIV. Strategies used by individuals and societies to manage stigma and avoid negative experiences also are examined.

Exploring Experiences and Perceptions of Older African American Males Aging With HIV in the Rural Southern United States.

The HIV (human immunodeficiency virus) epidemic in the United States remains a serious public health concern. Despite treatment and prevention efforts, approximately 50,000 new HIV cases are transmitted each year. Estimates indicate that 44% of all people diagnosed with HIV are living in the southern region of the United States. African Americans represent 13.2% of the United States population; however, 44% (19,540) of reported new HIV cases in 2014 were diagnosed within this ethnic group. The majority of cases were diagnosed in men (73%, 14,305). In the United States, it is estimated that 21% of adults living with HIV are 50 years or older. There exists limited data regarding how well African American men are aging with HIV disease. The purpose of this study was to explore the perceptions and experiences of older African American men living with HIV in rural Georgia. Data were collected from 35 older African American men living with HIV using focus groups and face-to-face personal interviews. Qualitative content analysis revealed six overlapping themes: (1) Stigma; (2) Doing Fine, Most of the Time; (3) Coping With Age-Related Diseases and HIV; (4) Self-Care; (5) Family Support; and (6) Access to Resources. The findings from this study provide new insights into the lives of rural HIV-infected African American men, expands our understanding of how they manage the disease, and why many return to or remain in rural communities.

"Out of All of this Mess, I Got a Blessing": Perceptions and Experiences of Reproduction and Motherhood in African American Women Living With HIV.

HIV disproportionately impacts African American women of childbearing age residing in the southern United States. Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N = 42) participated in in-depth interviews. Our respondents held positive views about pregnancy and motherhood, despite nonsupportive pregnancy messages from interpersonal influences, including health care providers. Study findings uncovered the need for programs and interventions to support women's reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners.

A quantitative study of factors influencing quality of life in rural Mexican women diagnosed with HIV.

This quantitative study explored the level of Quality of Life (QoL) in indigenous Mexican women and identified psychosocial factors that significantly influenced their QoL, using face-to-face interviews with 101 women accessing care in an HIV clinic in Oaxaca, Mexico. Variables included demographic characteristics, levels of depression, coping style, family functioning, HIV-related beliefs, and QoL. Descriptive statistics were used to analyze participant characteristics, and women's scores on data collection instruments. Pearson's R correlational statistics were used to determine the level of significance between study variables. Multiple regression analysis examined all variables that were significantly related to QoL. Pearson's correlational analysis of relationships between Spirituality, Educating Self about HIV, Family Functioning, Emotional Support, Physical Care, and Staying Positive demonstrated positive correlation to QoL. Stigma, depression, and avoidance coping were significantly and negatively associated with QoL. The final regression model indicated that depression and avoidance coping were the best predictor variables for QoL.

Correction: Diagnostic Potential of the NMDA Receptor Peptide Assay for Acute Ischemic Stroke.

[This corrects the article DOI: 10.1371/journal.pone.0042362.].

Diagnostic potential of the NMDA receptor peptide assay for acute ischemic stroke.

BACKGROUND: The acute assessment of patients with suspected ischemic stroke remains challenging. The use of brain biomarker assays may improve the early diagnosis of ischemic stroke. The main goal of the study was to evaluate whether the NR2 peptide, a product of the proteolytic degradation of N-methyl-D-aspartate (NMDA) receptors, can differentiate acute ischemic stroke (IS) from stroke mimics and persons with vascular risk factors/healthy controls. A possible correlation between biomarker values and lesion sizes was investigated as the secondary objective. METHODS AND FINDINGS: A total of 192 patients with suspected stroke who presented within 72 h of symptom onset were prospectively enrolled. The final diagnosis was determined based on clinical observations and radiological findings. Additionally gender- and age-matched healthy controls (n = 52) and persons with controlled vascular risk factors (n = 48) were recruited to compare NR2 peptide levels. Blinded plasma was assayed by rapid magnetic particles (MP) ELISA for NR2 peptide within 30 min and results for different groups compared using univariate and multivariate statistical analyses. There was a clinical diagnosis of IS in 101 of 192 (53%) and non-stroke in 91 (47%) subjects. The non-stroke group included presented with acute stroke symptoms who had no stroke (n = 71) and stroke mimics (n = 20). The highest NR2 peptide elevations where found in patients with IS that peaked at 12 h following symptom onset. When the biomarker cut off was set at 1.0 ug/L, this resulted in a sensitivity of 92% and a specificity of 96% to detect IS. A moderate correlation (r(s) = 0.73) between NR2 peptide values and acute ischemic cortical lesions (<200 mL) was found. CONCLUSIONS: This study suggests that the NR2 peptide may be a brain specific biomarker to diagnose acute IS and may allow the differentiation of IS from stroke mimics and controls. Additional larger scale clinical validation studies are required.

Oaxacan women with HIV/AIDS: resiliency in the face of poverty, stigma, and social isolation.

ISSUES: HIV infection among Mexican women continues to increase. The purpose of the authors in this study was to explore the psychosocial issues of HIV-infected Mexican women's lives, and to support a request from the Mexican federal government for data to support the need for funding for the psychological care of these women. METHODS: A Spanish-speaking researcher conducted private, in-depth, face-to-face interviews with 21 women receiving health services at the HIV/AIDS clinic, COESIDA, near Oaxaca City, Mexico. Data were collected during the time period of January 17 through 21st, 2011. The authors ascertained socio-demographic characteristics for all study participants. They transcribed audio-taped interviews verbatim, translated them into English, and analyzed transcribed interviews using content analysis, identifying consistent themes across the interviews. They also conducted language and cultural verification of the translation, and a third person, a master's prepared native Mexican woman, conducted content analysis. RESULTS: Ages of participants ranged from 20 to 48 years, with most having a third grade education. Most women lived at least two hours from the clinic. Themes emerging from the interview transcript analysis included: (1) resiliency; (2) fear; (3) social isolation; (4) anger/rage; and (5) availability of resources and support. CONCLUSION: Despite facing a variety of adverse factors, the Oaxacan women with HIV/AIDS who were interviewed demonstrated a sense of resiliency and hope for the future. Yet, a critical need remains for mental health support services to be provided to women to assist them in managing the psychological consequences of their HIV/AIDS diagnosis.

Making decisions: the process of HIV disclosure for rural African American men.

The purpose of this study was to identify and describe the process of HIV disclosure for rural African American men-a population disproportionately affected by HIV/AIDS. Forty men were interviewed about their experience of making an HIV disclosure. Grounded theory methodology guided data collection and analysis. The core category or variable that emerged from the data was a process-Making Decisions: The Process of HIV Disclosure. Five categories accounted for variations in disclosures: (a) beliefs and knowledge about HIV/AIDS, (b) influencing factors, (c) disclosure decisions, (d) disclosure efficacy, and (e) outcomes of disclosure. Most of the men had disclosed to others; however, the disclosures were selective, and the decisions were iterative. The majority of the men did not disclose their diagnosis for several months to several years. The findings provide a framework of the many factors related to HIV disclosure that can guide health care providers in counseling persons living with HIV/AIDS in making disclosure decisions.

Exploration of commonalities and variations in health related beliefs across four Latino subgroups using focus group methodology: implications in care for Latinos with type 2 diabetes.

Latinos, now the largest U.S. ethnic minority, have a high risk for type 2 diabetes. The Latino population is a heterogeneous group of individuals from many countries with a variety of beliefs and cultures. The purpose of this study was to explore similarities and differences in beliefs and attitudes related to health and healthcare practices across our Latino subgroups (Mexican, Colombian, Puerto Rican, and Mayan). The study used a qualitative research design employing focus groups and participant questionnaires. Data analysis revealed four themes: 1) View of health; 2) Access to care; 3) Acculturation; and 4) Stress and worry.

Reasons for HIV disclosure and non-disclosure: an exploratory study of rural African American men.

Disclosure of one's HIV status to others is an important decision. There are benefits and risks to be considered. Also decisions must be made about the recipients of the disclosure. This study explored reasons for disclosure and non-disclosure among rural African American men in the south. Audiotaped interviews were conducted with 40 men. The most common reasons for disclosure were to relieve stress, satisfy the need to tell, help others, and to receive support. The most common reasons for non-disclosure were the fear of negative reaction or stigma, the fear of the disclosure recipient telling others, a belief that there was no need to tell, not being ready to tell, and not wanting to burden others with the disclosure.

"Get them while they're young": reflections of young gay men newly diagnosed with HIV infection.

Thirty years into the epidemic, young men who have sex with men (YMSM) continue to be the largest at-risk group for HIV infection in the United States. In this qualitative study, face-to-face confidential interviews were conducted with 10 recently diagnosed YMSM. The purpose of the study was to explore the factors that may have contributed to each young man's recent HIV diagnosis and to solicit his perspectives on the design and efficacy of existing HIV prevention programs. Content analysis of the interview data revealed four major themes: personal risks, lack of relevant education, accessing the Internet, and the need for mentors. The informants in this study recommended the formulation of age-specific education interventions and the development of HIV prevention interventions that match the sophistication level and needs of today's gay youth to reduce the number of new HIV infections in YMSM.

Understanding and responding to HIV/AIDS stigma and disclosure: an international challenge for mental health nurses.

Stigma and discrimination are challenges in the care and treatment of persons with HIV infection worldwide. Fear of negative social consequences often causes persons with HIV/AIDS to keep their infection secret, resulting in negative psychological and physical outcomes and continued spread of the disease. Mental health nurses have a unique opportunity to influence the trajectory of HIV/AIDS though counseling and interventions that address HIV/AIDS stigma with clients, communities, and society. This article provides an in-depth examination of HIV/AIDS stigma and its relationship to nondisclosure as well as strategies to deal with these issues at individual and group levels.

Men seeking sex on an intergenerational gay Internet website: an exploratory study.

OBJECTIVE: This study explored the characteristics and sexual behaviors reported by men who have sex with men (MSM) seeking sex on an intergenerational website. Of special interest was to determine whether and how seeking sex on the Internet contributed to risky sex behaviors. METHODS: This descriptive exploratory study extracted data from a stratified random sample of 1,020 profiles posted by men seeking sex on a gay intergenerational website. Frequencies and percentages were calculated for all categorical variables. Analysis of variance was used to test for differences in subgroup categories. RESULTS: The men in the sample were primarily Caucasian (92.3%) with a mean age of 50 years (range: 18-88 years). More than one-fourth of the men (28.5%) reported being married. Of the married men, 76.0% indicated they would engage in receptive anal intercourse. Only a small number of men in the total sample expressed interest in safe sex (17.5%), while 91 men (8.9%) directly stated that they wanted unsafe sex. Most men in the sample were seeking intergenerational sexual encounters, with 71.0% of younger men expressing a preference for older men. CONCLUSIONS: The Internet can play a significant role in seeking same-sex encounters across generational groups. Safe sex was not a stated priority for most men in this study, and the Internet provides an effective method of seeking unsafe sex. A number of MSM seeking sex on the Internet were married and Caucasian. This finding suggests the need for greater attention to married and/or publicly identified Caucasian, heterosexual men in human immunodeficiency virus prevention efforts. Effective Internet-based prevention programs need to be implemented and researched.

HIV infection returning to Mexico with migrant workers: an exploratory study.

Men migrating to the United States are at high risk of acquiring HIV and spreading it to their wives and children in Mexico. Yet there is limited understanding of this phenomenon from the perspective of these men and their wives. This exploratory study used face-to-face interviews to gain insight into factors influencing the increased risk of Mexican men migrating to the United States for contracting HIV as well as the consequences of their infections on returning to Mexico. Transcripts from audiotaped interviews provided the data for analysis. Thematic analysis revealed two overall categories and six interrelated themes. Categories were HIV Risk and Living with HIV. Study themes included social isolation, lack of knowledge/denial, machismo, powerlessness, and making the best of it. Results provide new insight into the spread of HIV in rural Mexico.

A model of HIV disclosure: disclosure and types of social relationships.

PURPOSE: The purpose of this study was to assess perceptions of HIV positive (+) persons regarding disclosure of their serostatus to others with the goal of developing a model of HIV disclosure that could be used by healthcare providers (HCPs) in HIV prevention. DATA SOURCES: Data were collected through 13 focus groups from 104 HIV+ participants. The groups were formed based on three HIV risk exposure categories--men who have sex with men, high-risk heterosexuals, and substance users. CONCLUSIONS: Data analysis revealed three themes: disclosure of one's HIV+ serostatus depends on type of social relationships, fear, and stigma, with social relationships being the major theme. A model of HIV disclosure emerged from the data analysis of social relationships. In the model, social relationships were categorized as sexual and nonsexual, with varying degrees of HIV disclosure-depending on the social relationship with the person to whom one did or did not disclose. Results indicated that HIV is still a fearful and stigmatizing disease, and disclosure of HIV status is a complex phenomenon embedded in various types of social relationships. IMPLICATIONS FOR PRACTICE: Results of this study provide a "Model of HIV Disclosure" that can be utilized by nurse practitioners and other HCPs in clinical practice when providing treatment, counseling, and prevention education for HIV+ clients and for prevention education for HIV negative clients--especially for family, friends, sexual partners, and employers of HIV+ clients.