A Moderated Mediation Analysis of HIV and Intersectional Stigmas and Antiretroviral Adherence in People Living with HIV in the Dominican Republic.

Experiencing HIV and intersectional stigmas in healthcare settings may affect antiretroviral treatment (ART) adherence among people with HIV (PWH), given their need for frequent interactions with clinical settings and healthcare providers. Considering the importance of reducing stigmas to promote well-being and the need to elucidate how stigma influences health across various settings, we examined how experienced HIV stigma in Dominican Republic healthcare settings impacts ART adherence through internalized HIV stigma and whether race or sexual orientation stigma moderates this relationship. Participants were 471 PWH (aged 17-71) who were recruited from two HIV clinics in the Dominican Republic in 2021-2022. Results revealed a significant mediation effect (B=-0.10, SE = 0.05, CI [-0.234, - 0.014]) after adjusting for effect of age and time since HIV diagnosis, suggesting that experienced HIV stigma in healthcare settings was associated with more internalized HIV stigma (B = 0.39, SE = 0.11, p = .001), subsequently linked to lower ART adherence (B=-0.26, SE = 0.11, p = .016). The indirect effect was significant at low levels of race stigma (B=-0.16, SE = 0.09, CI [-0.369, - 0.001]) but not at high levels of race stigma (B=-0.06, SE = 0.05, CI [-0.175, 0.038]). This indirect effect was also significant at low levels of sexual orientation stigma (B=-0.19, SE = 0.10, CI [-0.401, - 0.023]) but not at high levels of sexual orientation stigma (B=-0.04, SE = 0.06, CI [-0.160, 0.074]). These findings suggest that addressing experienced HIV stigma in Dominican Republic healthcare settings, along with various dimensions of HIV-related stigma (e.g., internalized stigma) and intersecting stigmas (e.g., race, sexual orientation), is vital for improving health outcomes, such as optimal ART adherence.

RESUMEN: Experimentar estigmas relacionados con el VIH e interseccionales en entornos de atención médica puede afectar la adherencia al tratamiento antirretroviral (TAR) entre las personas que viven con VIH (PVVIH), dado que necesitan interacciones frecuentes con entornos clínicos y proveedores de atención médica. Considerando la importancia de reducir los estigmas para promover el bienestar y la necesidad de esclarecer cómo el estigma influye en la salud en diversos contextos, examinamos cómo el estigma del VIH experimentado en entornos de atención médica en la República Dominicana impacta la adherencia al TAR a través del estigma internalizado del VIH y si el estigma racial o de orientación sexual modera esta relación. Los participantes fueron 471 PVVIH (de 17 a 71 años) que fueron reclutados de dos clínicas de VIH en la República Dominicana en 2021­2022. Los resultados revelaron un efecto de mediación significativo (B=-0.10, SE = 0.05, CI [-0.234, − 0.014]) después de ajustar por el efecto de la edad y el tiempo desde el diagnóstico de VIH, sugiriendo que el estigma del VIH experimentado en entornos de atención médica estaba asociado con un mayor estigma internalizado del VIH (B = 0.39, SE = 0.11, p = .001), vinculado posteriormente a una menor adherencia al TAR (B=-0.26, SE = 0.11, p = .016). El efecto indirecto fue significativo en niveles bajos de estigma racial (B=-0.16, SE = 0.09, CI [-0.369, − 0.001]) pero no en niveles altos de estigma racial (B=-0.06, SE = 0.05, CI [-0.175, 0.038]). Este efecto indirecto también fue significativo en niveles bajos de estigma por orientación sexual (B=-0.19, SE = 0.10, CI [-0.401, − 0.023]) pero no en niveles altos de estigma por orientación sexual (B=-0.04, SE = 0.06, CI [-0.160, 0.074]). Estos hallazgos sugieren que abordar el estigma del VIH experimentado en entornos de atención médica en la República Dominicana, junto con diversas dimensiones del estigma relacionado con el VIH (por ejemplo, estigma internalizado) y estigmas interseccionales (por ejemplo, raza, orientación sexual), es vital para mejorar los resultados de salud, como la adherencia óptima al TAR.

Socio-Behavioural Barriers to Viral Suppression in the Older Adult Population in Rural South Africa.

South Africa has the largest share of people living with HIV in the world and this population is ageing. The social context in which people seek HIV care is often ignored. Apart from clinical interventions, socio-behavioural factors impact successful HIV care outcomes for older adults living with HIV. We use cross-sectional data linked with demographic household surveillance data, consisting of HIV positive adults aged above 40, to identify socio-behavioural predictors of a detectable viral load. Older adults were more likely to have a detectable viral load if they did not disclose their HIV positive status to close family members (aOR 2.56, 95% CI 1.89-3.46), resided in the poorest households (aOR 1.98, 95% CI 1.23-3.18), or were not taking medications other than ART (aOR 1.83, 95% CI 1.02-1.99) likely to have a detectable. Clinical interventions in HIV care must be supported by understanding the socio-behavioural barriers that occur outside the health facility. The importance of community health care workers in bridging this gap may offer more optimum outcomes for older adults ageing with HIV.

Quality of life in people with epilepsy: Associations with resilience, internalized stigma, and clinical factors in a low-income population.

INTRODUCTION: Epilepsy is a common neurological disorder associated with comorbidities and a reduced quality of life (QoL). Internalized stigma is negatively correlatedwiththe QoL, whereas high levels of resilience are associated with increased QoL. Although the stigma towards people with epilepsy (PWE) is expected to be higher in low-income settings than in high-income settings, further research is needed. This study aimed to examine the extent to which resilience and internalized stigma correlatewith the QoL in PWE from a low-income population. MATERIAL AND METHODS: A cross-sectional, observational, descriptive study was conducted on 60 PWE who visited the Neurology Department of the Hospital de Clinicas (Buenos Aires, Argentina) between May and September 2022. Demographic and clinical data were collected. Participants completed the Quality of Life, Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), the Chronic Illness Anticipated Stigma Scale (CIASS), and the Resilience Scale (RS). Variables that showed a significant association with the QoL in the univariate analysis were included in a multiple regression model. RESULTS: Participants had a low overall QoL score, with a median of 59 (95 %CI: 57.2-61.8). They had an average level of education and a high rate of unemployment. Perceived stigma was higher in the workplace than in the medical or family settings. Univariate analysis revealed that the QoL was associated with internalized stigma score, resilience score, seizure frequency, seizure etiology, work status, and educational level. The multiple regressionrevealed a significant decrease in the QoL when perceived stigma increased (p = 0.0016) or when the cause of epilepsy was structural (p = 0,006) and a significant increase in the QoL when the resilience score was higher (p = 0.0004). CONCLUSION: The QoL of PWE in a low-income context is strongly associated with their levels of resilience and internalized stigma. When addressing the social burden of epilepsy, resilience support should be increased in the care of PWE to reduce internalized stigma and improve the QoL.

Development and Initial Validation of Measures of Proximal Stigmas and Experiences of Discrimination for Minor Attracted People.

Stigma-related stressors are central to understanding psychopathology, distress, and coping in stigmatized groups; individuals who experience attractions to children are a highly stigmatized group. Currently, few validated self-report measures exist to assess stigma-related stressors in minor attracted people (MAPs) and the current research describes the development and initial validation of two measures of internalized stigma and experiences of discrimination. A sample of MAPs (n = 289; mean age = 31.8 years, SD = 12.2) was recruited online and completed a set of self-report measures assessing stigma-related stress, negative mental health outcomes, substance use, and coping. Exploratory factor analyses of the two newly developed stigma-related stress measures were conducted and convergent associations with other constructs were examined for validity evidence. Exploratory factor analyses indicated a two-factor solution to both the measure of internalized stigma and experiences of discrimination. The total scale scores and factors scores generally demonstrated the anticipated patterns of correlations with mental health concerns, distress, coping, and substance use. Clinical intervention with MAPs may benefit from an exploration of stigma-related stressors in clients' lives to improve mental health outcomes. The relatively large sample that was recruited from multiple online forums is a strength of the current study. The use of a self-report measurement modality for all measures used in the study weakens that strength of the validation evidence presented here. These results provide initial validity evidence for the measures of stigma-related stress in MAPs and the promise of stigma processes in understanding negative outcomes in this population.

Themes Associated with Suicidal Ideation and Behavior Among People Attracted to Children.

Suicide represents a significant public health problem, with around 800,000 deaths per year worldwide and up to 20 times as many episodes of self-harm and suicide attempts. Members of stigmatized groups may experience increased risk of suicide due in part to stigma-related factors, such as expectations of rejection, internalization of negative stereotypes, or potential for greater social isolation. Research suggests that adults who are attracted to children face extreme stigma, even those who do not commit sexual crimes involving children. Adults who are attracted to children also experience significantly increased risk for suicidal ideation and behavior (SIB) compared to general population samples. The current study sought to explore experiences with SIB among adults attracted to children to better understand factors underlying suicidality in this population. The lead author conducted semi-structured interviews in a community sample of 15 adults attracted to children who self-reported some form of SIB in their lifetime. Using interpretative phenomenological analysis, the lead author explored and interpreted interview data to generate themes driven by respondents' characterizations of their SIB. Superordinate themes related to suicidality in this sample included low self-esteem or self-worth, cumulative impacts of the attraction and other stressors, and concerns about the ability to have a positive future due to the attraction. Findings underscore the importance of addressing internalized stigma, treating problems like depression and social isolation, and instilling hope for the future to promote mental health and prevent SIB among adults attracted to children.

The Relationships among Internalized Stigma, Sense of Coherence, and Personal Recovery of Persons with Schizophrenia Living in the Community.

We investigated (i) the relationships among internalized stigma (IS), sense of coherence (SOC), and the personal recovery (PR) of persons with schizophrenia living in the community, and (ii) how to improve the support for these individuals. A questionnaire survey on IS, SOC, and PR was sent by mail to 270 persons with schizophrenia living in the community who were using psychiatric daycare services, of whom 149 responded and 140 were included in the analysis. We established a hypothetical model in which IS influences PR, and SOC influences IS and PR, and we used structural equation modeling to examine the relationships among these concepts. The goodness of fit was acceptable. Our findings suggest that rather than directly promoting PR, SOC promotes PR by mitigating the impact of IS. It is important for nurses/supporters to support individuals with schizophrenia living in the community so that they have opportunities to reflect on their own experiences through their activities and to share their experiences with peers. Nurses/supporters themselves should also reflect on their own support needs. Our findings suggest that this will lead to a reduction of IS and the improvement of SOC, which will in turn promote personal recovery.

Experienced discrimination and internalized stigma among people infected with SARS-CoV-2 and surviving COVID-19: Association with anxiety, depression, and insomnia symptoms.

People surviving COVID-19 may experience social stigma related to their condition even after clinical recovery. This study aimed to: (1) investigate COVID-19-related experienced discrimination and internalized stigma, and (2) explore their association with symptoms of anxiety, depression, and insomnia. We conducted an online survey of people who survived COVID-19. Perception of stigma was assessed using the COVID-19 Experienced Discrimination Scale and the COVID-19 Internalized Stigma Scale. Depression, anxiety, and insomnia were assessed using, respectively, the Patient Health Questionnaire-9, the General Anxiety Disorder Scale-7, and the Insomnia Severity Index. Multivariable logistic regression analyses for each psychopathological domain were performed. A total of 579 participants participated in this study. Overall, 25% reported some degree of experienced discrimination, and 23% reported some degree of internalized stigma. Adjusted odds ratio showed that scoring higher on internalized stigma related significantly to higher symptoms of depression (2.14; 95% confidence interval [CI], 1.35-3.39), anxiety (2.30; 95% CI, 1.48-3.59), and insomnia (2.54; 95% CI, 1.64-3.95), whereas experienced discrimination was associated to anxiety (1.55; 95% CI, 1.06-2.28) and insomnia (1.82; 95% CI, 1.24-2.69). Experiences of social stigmatization are frequent among people surviving COVID-19 and seem to be associated with levels of psychological disturbances. Further research is required to elucidate the direction of these relationships to implement effective treatment strategies.

Internalized Stigma Measurement in Substance Use Treatment Settings: A Narrative Review.

Stigma relating to substance use disorders is one of the many barriers to enrolling in substance use treatment. Stigma is also related to poorer substance use treatment outcomes, yet few studies of substance use and substance use treatment outcomes include measures of stigma. Stigma is a multi-level experience occurring as a result of discrimination within a systematic power structure promoting inequities among marginalized populations. Several domains of stigma are manifested among individuals seeking treatment for a substance use disorder, with internalized stigma being the most commonly measured. The current paper is a narrative review of measures that have been developed to measure internalized stigma related to substance use in treatment settings. Measures of stigma (n=8) in substance use treatment settings were identified using PubMed and PsycINFO databases. The review identified various strengths of existing measures, including a broad range of measures with mostly excellent internal consistency. The review also identified limitations including the general lack of consideration for multiple domains and intersecting forms of stigma, samples with limited racial and ethnic diversity, and the lack of assessments of polysubstance use. The development of measures of stigma that assess multiple domains of stigma and that are tested in a wide range of substance use treatment settings with racially and ethnically diverse participants is needed. This is of particular importance because stigma remains a crucial barrier to successful initiation and completion of substance use treatment.

Internalized stigma, disease severity, quality of life, anxiety and depression in axillary hyperhidrosis.

BACKGROUND: Axillary hyperhidrosis (AH) is characterized by excessive underarm sweating. It is a chronic autonomic disorder that can lead to social embarrassment, impaired quality of life (QoL), anxiety and depression. Internalized stigma (IS), defined as the acceptance of negative societal attitudes and stereotypes about an individual's illness, has not been previously studied in AH. The aim of this study was to evaluate the level of IS in patients with AH and the relationships between IS, disease severity, quality of life, anxiety, and depression. PATIENTS AND METHODS: One hundred and four patients with AH were included in the study. Demographic and clinical characteristics of the patients were recorded. The Hyperhidrosis Disease Severity Scale (HDSS) was used to define disease severity. Assessment was made using the Internalized Stigma Scale (ISS) (between 29 and 116, the higher the score the greater the stigma), Hospital Anxiety and Depression Scale (HADS) and Dermatology Life Quality Index (DLQI). RESULTS: The mean age of the patients was 34.1 ±â€¯10.9 years. The HDSS grade was mostly moderate to severe. The mean ISS score was 57.5 ±â€¯6.5. Median HADS scores were 7 [interquartile range (IQR) 2-12] and 5 [IQR 2-10], respectively. HADS scores ≥ 8 were observed respectively in 39.4% and 8.7% of patients. The median DLQI score was 14 [IQR 4-24]. A DLQI score ≥ 11 was observed in 75% of patients. Significant correlation was found between ISS score and HDSS (r = 0.445, p < 0.001), HADS-A (r = 0.455, p < 0.001), DLQI (r = 0.478, p < 0.001) scores and symptom duration (r = 0.207, p = 0.035). The relationship between ISS and HADS depression scores was not statistically significant. CONCLUSION: IS is common in patients with AH. Disease severity, symptom duration and anxiety increased IS. Patient's quality of life is reduced in AH.

Perceived and Internalized Stigma Towards Suicide and Their Roles in Suicidal Thoughts and Behaviors Among Chinese College Students.

Although perceived and internalized suicide stigma are considered risk factors for suicidal thoughts and behaviors (STBs), their specific roles in STBs are not well understood. This study examined the relationships among perceived and internalized suicide stigma, hopelessness, unbearable pain, suicidal desire, and suicide attempts in college students. A total of 1,387 Chinese college students (mean age: 22.22 years) completed the relevant scales. Structural equation modeling was used to determine the relationships of interest. The results showed that perceived stigma primarily had indirect impacts on suicidal desire through internalized stigma, which subsequently affected unbearable pain and hopelessness. The findings of this study suggest that the internalization of suicide stigma is an important predictor of STBs. These findings advocate for stigma interventions aimed at reducing internalized stigma as a potentially effective strategy for suicide prevention, as it may alleviate unbearable pain and hopelessness, which are significant contributors to suicidal desire and attempts.

Characterization of HIV-Related Stigma in Myanmar.

Characterizing HIV-related stigma and its impacts are important for interventions toward their elimination. A cross-sectional study was conducted in 2016 to evaluate enacted and internalized stigma among adult people living with HIV (PLWH) across four cities in Myanmar using the India Stigma Index questionnaire. Multivariable regression analyses were performed to determine differences in measured enacted and internalized stigma outcomes. Among 1,006 participants, 89% reported any stigma indicator, 47% enacted stigma, and 87% internalized stigma. In regression analysis, city and duration of illness were associated with higher enacted stigma, and younger age was associated with higher internalized stigma. Those with HIV duration > 7.4 years had mean enacted stigma nearly 2 units higher than the overall mean. Internalized stigma increased with duration of illness and leveled off at 5 years. PLWH from smaller cities experienced lower stigma. In Myanmar, nearly 90% of PLWH experience stigma, results that reflect a unique transition point.

Impact of Community Support Workers in Rural Ethiopia on Emotional and Psychosocial Health of Persons Living with HIV: Results of a Three-Year Randomized Community Trial.

People living with HIV face multiple psychosocial challenges. In a large, predominantly rural Ethiopian region, 1799 HIV patients new to care were enrolled from 32 sites in a cluster randomized trial using trained community support workers with HIV to provide individual health education, counseling and social support. Participants received annual surveys through 36 months using items drawn from the Centre for Epidemiologic Studies Depression Scale-10, Medical Outcome Study Social Support Survey, and HIV/AIDS Stigma Instrument-PLWA. At 12 months (using linear mixed effects regression models controlling for enrollment site clustering), intervention participants had greater emotional/informational and tangible assistance social support scores, and lower scores assessing depression symptoms and negative self-perception due to HIV status. A significant treatment effect at 36 months was also seen on scores assessing emotional/informational social support, depression symptoms, and internalized stigma. An intervention using peer community support workers with HIV to provide individualized informational and psychological support had a positive impact on the emotional health of people living with HIV who were new to care.(ClinicalTrials.gov protocol ID: 1410S54203, May 19, 2015).

Prevalence and correlates of internalized stigma among adults with HIV and major depressive disorder in rural Malawi.

Internalized stigma is common among individuals with sexually transmitted infections such as HIV and among those with mental health conditions such as major depressive disorder (MDD). As part of a cluster randomized trial, we investigated the prevalence and correlates of internalized stigma among adults living with comorbid HIV and MDD in rural Malawi (n = 339). We found heightened stigma toward HIV and mental illness among those in the cohort: more than half of respondents (54%) endorsed negative perceptions associated with each health condition. Internalized HIV-related stigma was higher among those with no education (p = 0.04), younger adults (p = 0.03), and those with less social support (p = 0.001). Mental illness-related stigma was elevated among those with no source of income (p = 0.001), and it was also strongly associated with HIV-related stigma (p < 0.001). Our findings highlight potential avenues for reducing internalized stigma associated with high-prevalence health conditions in Malawi.Trial registration: ClinicalTrials.gov identifier: NCT04777006.

Low quality of life, increased number of anti-seizure drugs, and the lack of caregiver support are associated with internalized stigma in adult Mexican patients with epilepsy.

BACKGROUND: People with epilepsy (PWE) have been subject to stigma throughout history, a factor that could compromise their performance in daily life. In Mexico, little is known about the factors that may be affecting internalized stigma. OBJECTIVE: To evaluate the internalized stigma in adult PWE, its relationship with the quality of life, cognitive and depressive symptomatology, and clinical-demographic characteristics. MATERIAL AND METHODS: We conducted a cross-sectional study with a consecutive sampling approach in patients with epilepsy treated at the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez (NINNMVS). Sociodemographic and clinical data, depressive symptomatology (Beck's depression inventory, DBI), cognition (MoCA test), quality of life (QOLIE-31 scale), and internalized stigma (King's internalized stigma scale, ISS) were evaluated. Correlations were made between the continuous variables and the ISS to select those with statistical significance and include them in a multiple linear regression model, along with the dummy variables, to explain internalized stigma. RESULTS: Of 128 patients, 74 (58%) were women; 38% of the patients had more than 20 years of epilepsy evolution. In addition, 39% presented depressive symptoms, and around 60% manifested a possible cognitive impairment. The variables that showed statistical significance concerning the ISS were selected along with dummy variables for multiple linear regression analysis. The resultant model considers the QOLIE-31 total score (ß = -0.489), the number of anti-seizure drugs (ASD, ß = 0.253), and those patients without caregiver support (ß = -0.166) with an adjusted R2 value of 0.316. CONCLUSIONS: A diminishing quality of life, an increased number of ASD, and patients without caregiver support influence a slight to moderate variation of internalized stigma in Mexican PWE. Therefore, it is necessary to continue studying other possible factors that influence internalized stigma to generate effective strategies to reduce its negative effects on PWE.

Internalized Stigma in Hidradenitis Suppurativa: A Multicenter Cross-Sectional Study.

BACKGROUND: Hidradenitis suppurativa (HS) causes significant physical, social, and psychological burdens. Internalized stigma, acceptance of negative attitudes and stereotypes of society regarding a person's illness, has not been studied previously in HS. OBJECTIVES: The objective of this study was to investigate the internalized stigma state of HS patients and identify the factors affecting it. METHODS: This multicenter, prospective, cross-sectional study included 731 patients. Internalized Stigma Scale (ISS), Hurley staging, Physician Global Assessment, Dermatology Life Quality Index (DLQI), Skindex-16, Beck Depression Inventory-II (BDI-II), and Visual Analog Scale (VAS)-pain score were used in the study. RESULTS: The mean ISS value (57.50 ± 16.90) was comparable to the mean ISS values of studies in visible dermatological and various psychiatric diseases. A significant correlation was found between the mean values of ISS and all disease activity scores, quality of life measures, BDI-II, and VAS-pain scores. Obesity, family history, low education and income level, vulva/scrotum involvement and being actively treated are significant and independent predictive factors for high internalized stigma in multivariate analysis. CONCLUSIONS: HS patients internalize society's negative judgements, which may create a profound negative effect on access to health care. Therefore, in addition to suppressing disease activity, addressing internalized stigma is fundamental for improving health care quality.

The impact of stigma on engaged living and life satisfaction among people with mental illness in Hong Kong.

PURPOSE: The present study aimed to investigate how the interpersonal (experienced discrimination) and intrapersonal (anticipated stigma and internalized stigma) manifestations of psychiatric stigma may affect engaged living and life satisfaction among people with mental illness. In this study, we developed and evaluated a conceptual model to clarify how experienced discrimination may lead to anticipated stigma and internalized stigma and thereby impede engaged living and reduce life satisfaction. METHODS: A total of 205 Hong Kong Chinese people with mental illness completed standardized questionnaire measures of experienced discrimination, anticipated stigma, internalized stigma, engaged living, and life satisfaction. The associations among these variables were analyzed using path analyses and bootstrap analyses. RESULTS: Path analyses showed that experienced discrimination was related to higher levels of anticipated stigma and internalized stigma, which were, in turn, linked to lesser engaged living and consequently lower life satisfaction. Bootstrap analyses further revealed that experienced discrimination had significant indirect effects on life satisfaction via anticipated stigma and engaged living and via internalized stigma and engaged living. CONCLUSIONS: Theoretically, our study uncovers how the interpersonal and intrapersonal manifestations of psychiatric stigma may adversely affect engaged living and life satisfaction among people with mental illness. Practically, our study points to the importance of developing and implementing stigma-related interventions at societal and individual levels in order to enable people with mental illness to live fulfilling and satisfying lives.

Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana.

Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated [1] what was the range of sexual stigma manifestations, and [2] how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana.

Does the peer-led Honest, Open, Proud program reduce stigma's impact for everyone? An individual participant data meta-regression analysis.

PURPOSE: Many people with mental illness experience self-stigma and stigma-related stress and struggle with decisions whether to disclose their condition to others. The peer-led Honest, Open, Proud (HOP) group program supports them in their disclosure decisions. In randomized controlled trials, HOP has shown positive effects on self-stigma and stigma stress on average. This study examined individual predictors of HOP outcomes and tested the hypothesis that stigma stress reduction at the end of HOP mediates positive HOP effects at follow-up. METHODS: Six RCTs were included with data at baseline, post (after the HOP program) and at 3- or 4-week follow-up. Baseline variables were entered in meta-regression models to predict change in self-stigma, stigma stress, depressive symptoms and quality of life among HOP participants. Mediation models examined change in stigma stress (post) as a mediator of HOP effects on self-stigma, depressive symptoms, and quality of life at follow-up. RESULTS: More shame at baseline, and for some outcomes reduced empowerment, predicted reduced HOP effects on stigma stress, self-stigma, depressive symptoms, and quality of life. Younger age was related to greater improvements in stigma stress after the HOP program. Stigma stress reductions at the end of HOP mediated positive effects on self-stigma, depressive symptoms and quality of life at follow-up. CONCLUSION: Participants who are initially less burdened by shame may benefit more from HOP. Stigma stress reduction could be a key mechanism of change that mediates effects on more distal outcomes. Implications for the further development of HOP are discussed.

Factors associated with internalized stigma in people with common mental disorders using services of Family Health Strategy.

PURPOSE: To identify factors associated with the presence of internalized stigma in people with Common Mental Disorders (CMD) using Family Health Strategy. METHOD: Quantitative study carried out with 529 users with CMD answered the sociodemographic questionnaire and the scales Self-Reporting Questionnaire and scale on Internalized Stigma of Mental Illness. RESULTS: Internalized stigma was associated with education level, medication use, treatment for mental disorders, suicidal ideation, attendance at a psychosocial care center and psychiatric hospital. CONCLUSION: The adequate identification and treatment of psychological distress constitute effective prevention strategies to safeguard life and ensure the stigma reduction and better quality of life.

The relationship between internalized weight stigma and physical and mental health-related quality of life in a large sample of women: a structural equation modeling analysis.

PURPOSE: Health-related quality of life (HRQOL) refers to an individual's perception of their physical and mental health status over time. Although emerging evidence has documented a negative association between weight stigma (i.e., negative weight-related attitudes and beliefs towards individuals with overweight or obesity) and mental HRQOL, its influence on physical HRQOL still needs to be fully clarified. This study aims to investigate the impact of internalized weight stigma on mental and physical HRQOL by employing a structural equation modeling (SEM) approach. METHODS: The Short Form Health Survey 36 (SF-36) and the Weight Bias Internalization Scale (WBIS) were administered to a sample of 4450 women aged 18-71 (Mage = 33.91 years, SD = 9.56) who self-identified in a condition of overweight or obesity (MBMI = 28.54 kg/m2; SD = 5.86). Confirmatory factor analysis (CFA) was conducted to assess the dimensionality of the scales before testing the proposed structural model. RESULTS: After establishing the adequacy of the measurement model, SEM results revealed that internalized weight stigma was significantly and negatively associated with both mental (ß = - 0.617; p < 0.001) and physical (ß = - 0.355, p < 0.001) HRQOL. CONCLUSION: These findings offer additional support to prior research by confirming the association between weight stigma and mental HRQOL. Moreover, this study contributes to the existing literature by strengthening and extending these associations to the physical HRQOL domain. Although this study is cross-sectional in nature, it benefits from a large sample of women and the use of SEM, which offers advantages over traditional multivariate techniques, e.g., by explicitly accounting for measurement error. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.