Negotiating and Struggling for a New Life: Stigma, Spirituality, and Coping Strategies of People Living with HIV in Myanmar.

Although enacted and internalized stigma is a continuing problem for people living with HIV (PLWH) in Southeast Asia, there is little understanding of how PLWH cope with discrimination, exclusion, and other negative outcomes caused by HIV-related stigmatization. This article aims to bridge this gap by analyzing the lived experiences of HIV-related stigmatization and coping strategies among 30 people with HIV in Myanmar, a country heavily influenced by religion, especially Buddhism. Among the 30 study participants, 20 were female and 10 were male, with ages ranging from 18 to 50 years. Through the lens of Bourdieu's concepts of habitus, field, and capital, this article first elucidates the various forms of stigmatization in family, work, social, and other settings as symbolic violence on people with HIV. The present article shows that spirituality serves as a perceptual and action framework for people with HIV to generate reflexivity toward their HIV infection and related stigmatization and to further engage in agentic responses. More importantly, this article demonstrates how people with HIV draw on spirituality to support peers in reclaiming control over their lives and how they are perceived by society. The findings indicate that the local context, especially cultural and religious resources, should be considered when developing interventions to mitigate HIV-related stigmatization in Southeast Asia.

Can social support mediate stigma and perceived stress in people live with human immunodeficiency virus?

Stigma has heavily impacted People Living with HIV (PLWH). Limited studies report on how social support affects HIV-related stigma and perceived stress, especially in Myanmar. During first seven months of 2020, a random sample of 248 eligible PLWH were contacted from a private, closed Facebook group with more than 18,000 Myanmar people, where 90% of the members were PLWH. Variables collected included demographics data, perceived stress, social support, and HIV stigma. After controlling for the effects of demographic variables, the path from HIV stigma to perceived stress (direct effect ß = 0.40) and though the mediation of social support was significant (indirect effect ß = 0.014). However, the mediating effect of social support was non-significant between HIV stigma and perceived stress. This exploratory study shows that social support did not have the expected effect of decreasing perceived stress in PLWH in Myanmar. Interventions to reduce HIV stigma to decrease perceived stress should consider other strategies, e.g., spirituality-based practice, to reduce perceived stress in Myanmar PLWH.

Psychometric Evaluation of a Myanmar Version of the Perceived Stress Scale for People Living with HIV/AIDS.

Background and Purpose: Reliable instruments for the measurement of perceived stress in people living with HIV (PLHIV) are crucial. However, there is no Myanmar version of such an instrument. Methods: We adapted the 35-item Perceived Stress Scale for People Living with HIV/AIDS (PSSHIV) into a Myanmar version (PSSHIV-M), and 150 PLHIV completed the survey. Results: The 31-item PSSHIV-M with a five-factor structure has a Cronbach's alpha of .85 to .95. Construct validity was demonstrated for the instrument, and the findings of Rasch analysis also suggest evidence of reliability and validity. Conclusions: The psychometric properties of the 31-item PSSHIV-M with a five-factor structure support its efficacy in ascertaining how HIV perceived stress affects Myanmar PLHIV. It could also facilitate the development of stress management interventions for that population.

The Mediating Effects of Mindfulness on Perceived Stress From HIV Stigma in People Living With HIV in Myanmar: A Cross-sectional Study.

ABSTRACT: HIV is a highly stigmatized and stressful condition for people with HIV (PWH). As a country heavily influenced by religion, especially Buddhism, we explore how the perceived stress from HIV stigma interacts with the mediator of mindfulness on PWH in Myanmar. From January to July 2020, a sample of 248 eligible PWH was recruited by quasi-random sampling methods from a private Facebook group in Myanmar. Data on demographics, HIV stigma, mindfulness, and perceived stress were collected. The bias-corrected percentile bootstrap method was used to test multiple mediation analyses. The path from perceived HIV stigma to perceived stress (direct effect ß = 0.16) and the mediating effect of mindfulness on that stress were significant (indirect effect accounts for 45.15% of total effect). The findings indicate that interventions enhancing mindfulness-based practice should be considered to reduce HIV stigma and, therefore, lower perceived stress among PWH in Myanmar.

Adaptation and Validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) in People Living with HIV in Myanmar.

Objectives: Valid and reliable instruments for the measurement of mindfulness are crucial for people living with HIV. However, there was no Myanmar version of such an instrument. Methods: We adapted the English version of the 12-item Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) based on standard cross-cultural procedures. By randomly sampling methods, a sample of 248 eligible people living with HIV was contacted from a closed Myanmar Facebook group; 159 PLHIV completed the initial 12-item version of the adapted survey. Results: Three items were removed due to low item-to-total correlations of the corrected item-total correlation as well as having infit and outfit mean squares outside the range of 0.6 to 1.4. After deleting the 3 items, the three-factor structure was confirmed by confirmatory factor analysis, which indicated good model fit. The resultant 9-item CAMS-R in Myanmar (CAMS-R-M-2) achieved good internal reliability (Cronbach's α of 0.75 to 0.87, and the corrected item-total correlation ranged from 0.44 to 0.81). Construct validity of the scale was demonstrated by significant association with self-reported HIV stigma and social support levels (r = 0.63, and - 0.53). In Rasch analysis, the infit and outfit mean squares for each item ranged from 0.49 to 1.24, and the person reliability was 2.17 and the separation index was 0.83. Conclusions: The 9-item CAMS-R-M-2 with a three-factor structure has good reliability and validity. Higher total scores and subscale score reflected greater mindfulness qualities in people living with HIV in Myanmar.

Translation, Adaption, and Psychometric Testing of the Myanmar Version of the Medical Outcomes Study Social Support Survey for People Living With HIV/AIDS.

Introduction: Valid and reliable instruments are crucial for measuring perceived social support among people living with HIV (PLHIV). We aimed to investigate the psychometric properties of the English version of the 19-item Medical Outcomes Study Social Support Survey (MOS-SSS) adapted for PLHIV in Myanmar. Methods: Based on a standard cross-cultural procedure, we adapted the MOS-SSS and formed a Myanmar version of the scale (MOS-SSS-M), and then tested its validity and reliability. A sample of 250 eligible PLHIV was collected from a closed Facebook group that included more than 10,000 Myanmars, most of whom were PLHIV. Results: The MOS-SSS-M achieved a Cronbach's α of 0.82-0.95. Confirmatory factor analysis revealed an acceptable fit index for the four-factor structure. Construct validity was demonstrated by significant association with self-reported HIV stigma and stress levels, and further confirmed by the findings of Rasch analysis. Conclusion: The MOS-SSS-M with a four-factor structure can be used to measure the level and categories of perceived social support among PLHIV in Myanmar.

Adaptation and validation of a culturally adapted HIV stigma scale in Myanmar.

BACKGROUND: HIV stigma is a common barrier to HIV prevention, testing, and treatment adherence, especially for low- and middle-income countries such as Myanmar. However, there was no validated Myanmar version of a stigma scale. Therefore, we adapted the English version of the 40-item Berger's HIV stigma scale and the 7-item Indian HIV stigma scale into a 47-item Myanmar HIV stigma scale and then evaluated the scale's psychometric properties. METHOD: From January 2020 to May 2020, using random sampling methods, 216 eligible Myanmar people living with HIV/AIDS (PLWHA) were contacted from a closed Facebook group that included more than 10,000 PLWHA. A sample of 156 Myanmar PLWHA completed the online self-reported survey. RESULTS: A six-factor structure for the scale was determined through exploratory factor analysis, explaining 68.23% of the total variance. After deleting 12 items, the 35-item HIV stigma scale achieved Cronbach 's α of 0.72 to 0.95. Construct validity of the scale was demonstrated by significant association with self-reported depression and social support levels (r = 0.60, and - 0.77, p < 0.01). In Rasch analysis, the scale achieved person reliability of 3.40 and 1.53 and a separation index of 0.92 and 0.70. The infit and outfit mean squares for each item ranged from 0.68 to 1.40. No differential item functioning across gender or educational level was found. CONCLUSIONS: The psychometric properties of the 35-item Myanmar version of the HIV stigma scale support it as a measure of stigma among PLWHA in Myanmar. This instrument could help healthcare providers to better understand how stigma operates in PLWHA and to develop tailored stigma-reduction interventions in Myanmar.