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2.
Artículo en Inglés | MEDLINE | ID: mdl-32878180

RESUMEN

Infectious disease control is a crucial public health issue. Although it is important to urgently perform public health measures in order to reduce the risk of spread, it could end up stigmatizing entire groups of people rather than offering control measures based on sound scientific principles. This "us" versus "them" dynamic is common in stigmatization, in general, and indicates a way in which disease stigma can be viewed as a proxy for other types of fears, especially xenophobia and general fear of outsiders. The pandemic risk associated with SARS-CoV-2 infection led us to consider, among other related issues, how stigma and discrimination remain serious barriers to care for people suspected of being infected, even more if they are assisting professions, such as health workers, employed in emergency response. The purpose of this review is to evaluate and promote the importance of psychological aspects of the stigma and social discrimination (SAD) in pandemic realities and, more specifically, nowadays, in the context of SARS-CoV-2/COVID-19. Just as it happened with HIV, HCV, tuberculosis, and Zika, stigma and discrimination undermine the social fabric compromising the ethics and principles of civilization to which each individual in entitled. Recognizing disease stigma history can give us insight into how, exactly, stigmatizing attitudes are formed, and how they are disbanded. Instead of simply blaming the ignorance of people espousing stigmatizing attitudes about certain diseases, we should try to understand precisely how these attitudes are formed so that we can intervene in their dissemination. We should also look at history to see what sorts of interventions against stigma may have worked in the past. Ongoing research into stigma should evaluate what has worked in the past, as above-mentioned, providing us with some clues as to what might work in the current pandemic emergency, to reduce devastating discrimination that keeps people from getting the care they need. We propose a systematic and historical review, in order to create a scientific and solid base for the following SAD analysis. The aim is to propose a coping strategy to face stigma and discrimination (SAD) related to SARS-CoV-2/COVID-19 pandemic outbreak, borrowing coping strategy tools and solutions from other common contagious diseases. Furthermore, our study observes how knowledge, education level, and socioeconomic status (SES) can influence perception of SARS-CoV-2/ COVID-19 risk in a digital world, based on previous research, best practices, and evidence-based research.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Discriminación Social , Estigma Social , Betacoronavirus , Humanos , Pandemias
4.
BMC Infect Dis ; 20(1): 663, 2020 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-32907539

RESUMEN

BACKGROUND: Studies have demonstrated that health care students and practitioners are not immune to stigma towards people living with HIV (PLHIV). This attitude could lead to poor quality of care if it remains uncorrected. However, little is known about dietetic students' acceptance of PLHIV despite their substantial role in treatment. This study aimed to measure the extent of knowledge and stigma towards PLHIV among dietetic students and to determine the associated factors using the attribution theory. METHODS: Students from three dietetics schools in Indonesia (n = 516) were recruited to participate in this cross-sectional study. Survey questions covered demographic information, interaction with PLHIV, access to information sources, cultural values, and beliefs as predictor variables. The outcome variables were comprehensive knowledge of HIV, HIV and nutrition-specific knowledge, and attitudes. Analyses with linear regression and the stepwise selection were performed to determine factors related to the outcome. RESULTS: The levels of HIV comprehensive knowledge and HIV-nutrition specific knowledge among dietetic students were low, as indicated by the average score of 19.9 ± 0.19 (maximum score = 35) and 8.0 ± 0.11 (maximum score = 15), respectively. The level of negative attitudes towards PLHIV was high, with 99.6% of participants reported having a high stigma score. Types of university affiliation (public or private), beliefs and values, exposure to HIV discourse, access to printed media, and years of study were significantly related to HIV comprehensive knowledge (p < 0.05). Nutrition-specific knowledge was also correlated with university affiliation, beliefs and values, participation in HIV discussion, and years of study (p < 0.05). HIV comprehensive knowledge, university affiliation, discussion participation, and ethnicities were associated with attitudes (p < 0.05). CONCLUSIONS: Awareness and acceptance of PLHIV must be further improved throughout dietetic training to ensure patients' quality of care since students represent future dietary care providers. Considering the consistent findings that affiliation to education institution correlates with HIV knowledge and attitude, some examinations concerning the curriculum and teaching conduct might be necessary.


Asunto(s)
Dietética/educación , Infecciones por VIH/psicología , VIH , Conocimientos, Actitudes y Práctica en Salud , Estigma Social , Estudiantes/psicología , Estudios Transversales , Femenino , Infecciones por VIH/virología , Educación en Salud/métodos , Humanos , Indonesia , Modelos Lineales , Masculino , Encuestas y Cuestionarios , Universidades , Adulto Joven
5.
Artículo en Inglés | MEDLINE | ID: mdl-32916996

RESUMEN

This study aimed to explore changes in psychological responses (perceived stress, traumatic stress, stigma, coping) over time in residents, as well as their predictors. The level of perceived stress, traumatic stress, stigma, and coping responses were assessed using the Perceived Stress Scale, Impact of Event-Revised, Healthcare Workers Stigma Scale, and Brief Coping Orientation to Problems Experienced (COPE) Inventory, respectively. We collected responses from 274 residents at baseline and 221 residents at 3 months follow-up (timepoint 2) from the National Healthcare Group (NHG) residency programs in Singapore. All residents reported lower perceived stress and lower perceived stigma compared to baseline. Use of avoidance coping was associated with all three psychological responses (perceived stress, traumatic stress, and stigma) across the two timepoints. Compared to baseline, specific factors associated with perceived stress and traumatic stress at timepoint 2 were living alone, less problem solving, and seeking social support. Residency programs should encourage active coping strategies (e.g., seeking social support, positive thinking, problem solving) among residents, and proactively identify residents who may be at higher risk of psychological sequelae due to circumstances that contribute to isolation.


Asunto(s)
Adaptación Psicológica , Infecciones por Coronavirus/psicología , Internado y Residencia/estadística & datos numéricos , Médicos/psicología , Neumonía Viral/psicología , Estigma Social , Trastornos de Estrés Traumático/psicología , Estrés Psicológico/psicología , Adulto , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Humanos , Estudios Longitudinales , Pandemias , Neumonía Viral/epidemiología , Singapur , Estrés Psicológico/etnología
6.
Int J Public Health ; 65(7): 1205-1216, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32888048

RESUMEN

OBJECTIVES: During a pandemic, healthcare workers (HCWs) are essential to the health system response. Based on our knowledge, little information is available regarding the psychosocial impact on HCWs or interventions for supporting them during pandemics. Therefore, the study aimed to assess available literature on perceived stress and psychological responses to influenza pandemics in HCWs and identify implications for healthcare practice and future research. METHODS: This is a rapid review of the literature. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis. RESULTS: Across all the studies-both qualitative and quantitative-HCWs working during the epidemic reported frequent concerns regarding their own health and the fear of infecting their families, friends and colleagues. Moreover, social isolation, uncertainty, fears of stigmatization and reluctance to work or considering absenteeism were frequently reported. Moreover, many studies highlighted a high prevalence of high levels of stress, anxiety and depression symptoms, which could have long-term psychological implications in HCWs. CONCLUSIONS: This rapid review offers an overview of the major concerns regarding HCWs' psychosocial well-being and possible preventive strategies, which could be useful for the current COVID-19 outbreak and similar future pandemics. Studies suggested to invest on preventive psychological, social, family and physical support and to guaranteeing reasonable work conditions and others in order to protect HCWs from the long-lasting psychological effect of the COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Personal de Salud/psicología , Gripe Humana/epidemiología , Gripe Humana/psicología , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Absentismo , Ansiedad/epidemiología , Betacoronavirus , Brotes de Enfermedades , Humanos , Pandemias , Aislamiento Social/psicología , Estigma Social , Incertidumbre
7.
Epidemiol Psychiatr Sci ; 29: e164, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32883399

RESUMEN

AIMS: To identify and categorise core components of effective stigma reduction interventions in the field of mental health in low- and middle-income countries (LMICs) and compare these components across cultural contexts and between intervention characteristics. METHODS: Seven databases were searched with a strategy including four categories of terms ('stigma', 'mental health', 'intervention' and 'low- and middle-income countries'). Additional methods included citation chaining of all papers identified for inclusion, consultation with experts and hand searching reference lists from other related reviews. Studies on interventions in LMICs aiming to reduce stigma related to mental health with a stigma-related outcome measure were included. All relevant intervention characteristics and components were extracted and a quality assessment was undertaken. A 'best fit' framework synthesis was used to organise data, followed by a narrative synthesis. RESULTS: Fifty-six studies were included in this review, of which four were ineffective and analysed separately. A framework was developed which presents a new categorisation of stigma intervention components based on the included studies. Most interventions utilised multiple methods and of the 52 effective studies educational methods were used most frequently (n = 83), and both social contact (n = 8) and therapeutic methods (n = 3) were used infrequently. Most interventions (n = 42) based their intervention on medical knowledge, but a variety of other themes were addressed. All regions with LMICs were represented, but every region was dominated by studies from one country. Components varied between regions for most categories indicating variation between cultures, but only a minority of studies were developed in the local setting or culturally adapted. CONCLUSIONS: Our study suggests effective mental health stigma reduction interventions in LMICs have increased in quantity and quality over the past five years, and a wide variety of components have been utilised successfully - from creative methods to emphasis on recovery and strength of people with mental illness. Yet there is minimal mention of social contact, despite existing strong evidence for it. There is also a lack of robust research designs, a high number of short-term interventions and follow-up, nominal use of local expertise and the research is limited to a small number of LMICs. More research is needed to address these issues. Some congruity exists in components between cultures, but generally they vary widely. The review gives an in-depth overview of mental health stigma reduction core components, providing researchers in varied resource-poor settings additional knowledge to help with planning mental health stigma reduction interventions.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Trastornos Mentales/psicología , Atención Primaria de Salud/métodos , Discriminación Social , Estigma Social , Estereotipo , Humanos
8.
Psychiatr Danub ; 32(Suppl 1): 130-134, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32890375

RESUMEN

Mental health problems are over-represented in doctors and medical students. However, stigma and 'a culture of shame' are formidable barriers to mental health services and consequently many doctors and medical students with mental health difficulties continue to suffer in silence despite the availability of effective treatment. Indeed, a recent study on over 2100 female physicians who met the diagnostic criteria for a mental disorder revealed that 50% were reluctant to seek professional help due to fear of exposure to stigma. Left untreated or undertreated, mental health problems in doctors can result in impairment of occupational functioning, compromise patient safety and place considerable strain on the economy (by increasing the amount of sick leave taken). Moreover, the consequences of mental health stigma in the medical profession can be fatal. Dr Daksha Emson, a psychiatrist with bipolar affective disorder, tragically killed herself and her baby daughter during a psychotic episode. An independent inquiry into Dr Emson's death concluded that she was the victim of stigma in the National Health Service. The mental health of medical students and doctors, in all of its aspects, must therefore be addressed with the urgency that it demands. Stephanie Knaak and colleagues conducted a data synthesis of evaluative studies on anti-stigma programmes for healthcare providers and identified six key ingredients one of which was a personal testimony from a trained speaker who has lived experience of mental illness. In this paper we outline a study protocol with the aim of answering the following research question, 'Does attending an anti-stigma programme comprised of a medic with first-hand experience of a mental health condition cause immediate and sustained reductions in mental health stigma from medical students and doctors towards their peers with mental health difficulties?'


Asunto(s)
Trastornos Mentales , Salud Mental , Médicos , Estigma Social , Estudiantes de Medicina , Femenino , Humanos , Médicos/psicología , Medicina Estatal , Estudiantes de Medicina/psicología
9.
N Z Med J ; 133(1522): 18-29, 2020 09 25.
Artículo en Inglés | MEDLINE | ID: mdl-32994613

RESUMEN

AIMS: To evaluate how New Zealand newsprint media shapes discourse about dementia through its framing of the causes, effects and solutions, and who bears responsibility for the disease. METHODS: Using New Zealand's three largest daily newspapers, we examined i) the coverage of dementia between 2012-2016, ii) the framing of causes and effects of dementia, and iii) the most frequent associations of causes and effects of dementia. We integrated the findings to assess the moral evaluation of dementia in New Zealand newsprint media. RESULTS: Of the 361 articles extracted all presented effects of dementia, 35% discussed causes and 7% mentioned solutions for dementia. Medical causes dominated over health behavioural and societal causes, and effects were mostly the negative impact on the individual, family and society. Modifiable medical causes were more likely to be associated with adverse outcomes for society whereas non-modifiable medical causes were more likely to be associated with adverse outcomes for the individual and/or their family. CONCLUSIONS: Between 2012-16 New Zealand newsprint media largely portrayed dementia from a 'powerless victim' frame. Further research is required to assess whether, since 2016, there has been a shift towards media framing of dementia as potentially preventable and a social justice issue.


Asunto(s)
Demencia/psicología , Conocimientos, Actitudes y Práctica en Salud , Medios de Comunicación de Masas , Opinión Pública , Humanos , Principios Morales , Nueva Zelanda , Estigma Social
10.
Rev Med Suisse ; 16(704): 1582-1585, 2020 Sep 02.
Artículo en Francés | MEDLINE | ID: mdl-32880117

RESUMEN

Our medical practice brings us to meet people from all walks of life. Some of our patients experience multiple vulnerabilities and are at greater risk of stigma and discrimination. In the field of asylum, they are often firstly designated by words reflecting their socio-administrative reality. These words are supposed to define their identity. The individual is dehumanized because reduced to an administrative status. These terms carry a denotative meaning, valuable in understanding the context in which the patient evolves ; but also a connotative meaning, which through implicit bias leads the caregiver to adopt attitudes that may be detrimental to the proper care of the patient. Words must be carefully chosen and brought in a timely manner, because words matter.


Asunto(s)
Hospitales Psiquiátricos , Lenguaje , Salud Mental , Prejuicio , Humanos , Vergüenza , Estigma Social
11.
PLoS One ; 15(9): e0238314, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32886693

RESUMEN

BACKGROUND: Globally, the prevalence of HIV among transgender women remains much higher than that of the general population, and a large proportion of them are unaware of their HIV status. Transgender women are exposed to gender-based violence and social stigma and discrimination in different settings that may create significant barriers to receiving HIV prevention and care services. This study aimed to identify factors associated with recent HIV testing among transgender women in Cambodia. METHODS: We conducted a cross-sectional survey in 2016 among 1375 transgender women recruited from 13 provinces using a peer-based social network recruitment method. We used a structured questionnaire for face-to-face interviews and performed rapid HIV/syphilis testing onsite. We used a multiple logistic regression analysis to identify factors associated with recent HIV testing. RESULTS: Of the total, 49.2% of the participants reported having an HIV test in the past six months. After controlling for other covariates, the odds of having an HIV test in the past six months was significantly lower among students (AOR 0.36, 95% CI 0.20-0.65), participants who perceived that they were unlikely to be HIV infected (AOR 0.50, 95% CI 0.32-0.78), and participants who reported always using condoms with male non-commercial partners in the past three months (AOR 0.65, 95% CI 0.49-0.85) relative to their respective reference group. The odds of having an HIV test in the past six months was significantly higher among participants who had been reached by community-based HIV services (AOR 5.01, 95% CI 3.29-7.65) and received HIV education (AOR 1.65, 95% CI 1.06-2.58) in the past six months relative to their respective reference group. CONCLUSIONS: Despite the widely available free HIV testing services, more than half of transgender women in this study had not received an HIV test in the past six months. Our findings suggest that a tailored and comprehensive combination prevention program, in which HIV testing is linked to care continuum and beyond, maybe an essential next step. Social media may have the potential to be promoted and utilized among transgender women populations in order to improve HIV testing and other prevention measures.


Asunto(s)
Infecciones por VIH/diagnóstico , VIH/aislamiento & purificación , Tamizaje Masivo/estadística & datos numéricos , Conducta Sexual , Parejas Sexuales/psicología , Encuestas y Cuestionarios , Personas Transgénero/psicología , Adolescente , Adulto , Cambodia/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Prevalencia , Factores de Riesgo , Estigma Social , Personas Transgénero/estadística & datos numéricos , Adulto Joven
12.
PLoS One ; 15(9): e0237021, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32915800

RESUMEN

The recent introduction of prolonged grief disorder (PGD) as a diagnostic category may cause negative social reactions (i.e. public stigma). Vignette experiments demonstrate that persons with both PGD symptoms and a PGD diagnosis elicit more public stigma than persons who experience integrated grief. However, the strength of the influence of the diagnosis itself remains unclear: We aimed to clarify if the diagnostic label PGD produces additional public stigma beyond PGD symptoms. We further compared whether public stigma varies between the label PGD and the label major depressive episode (MDE) (when PGD symptoms are present) and if gender of the bereaved person influences public stigma or moderates the aforementioned effects. Eight-hundred fifty-two participants (77% female; Mage = 32.6 years, SD = 13.3) were randomly assigned to read online one of eight vignettes describing either a bereaved male or female, with PGD symptoms and PGD diagnosis; PGD symptoms and MDE diagnosis; PGD symptoms and no diagnosis, or no PGD symptoms and no diagnosis (i.e., integrated grief). Following the vignettes, participants indicated which negative characteristics they ascribed to the person, their emotional reactions, and preferred social distance from the person. People with PGD symptoms and PGD (or MDE) diagnosis were attributed more negative characteristics, and elicited more negative emotions and a stronger desire for social distance than people with integrated grief. However, public stigma did not differ for people with both PGD symptoms and diagnosis compared to people only experiencing PGD symptoms. Gender of the bereaved only had an influence on desired social distance, which was larger towards men. Helping severely distressed bereaved people (regardless of diagnostic status) cope with negative social reactions may help them adapt to bereavement. Results demonstrate that the experience of severe grief reactions, yet not a diagnostic label per se, causes public stigma.


Asunto(s)
Trastornos de Adaptación/psicología , Pesar , Estigma Social , Adulto , Femenino , Humanos , Masculino
13.
Artículo en Inglés | MEDLINE | ID: mdl-32961702

RESUMEN

This study focuses on stigma communication about COVID-19 on Twitter in the early stage of the outbreak, given the lack of information and rapid global expansion of new cases during this period. Guided by the model of stigma communication, we examine four types of message content, namely mark, group labeling, responsibility, and peril, that are instrumental in forming stigma beliefs and sharing stigma messages. We also explore whether the presence of misinformation and conspiracy theories in COVID-19-related tweets is associated with the presence of COVID-19 stigma content. A total of 155,353 unique COVID-19-related tweets posted between December 31, 2019, and March 13, 2020, were identified, from which 7000 tweets were randomly selected for manual coding. Results showed that the peril of COVID-19 was mentioned the most often, followed by mark, responsibility, and group labeling content. Tweets with conspiracy theories were more likely to include group labeling and responsibility information, but less likely to mention COVID-19 peril. Public health agencies should be aware of the unintentional stigmatization of COVID-19 in public health messages and the urgency to engage and educate the public about the facts of COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/psicología , Difusión de la Información/métodos , Neumonía Viral/psicología , Salud Pública/normas , Medios de Comunicación Sociales , Estigma Social , Comunicación , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Comunicación en Salud , Humanos , Pandemias , Neumonía Viral/epidemiología
14.
Ann Behav Med ; 54(10): 738-746, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-32909031

RESUMEN

BACKGROUND: Weight stigma is common for people with obesity and harmful to health. Links between obesity and complications from COVID-19 have been identified, but it is unknown whether weight stigma poses adverse health implications during this pandemic. PURPOSE: We examined longitudinal associations between prepandemic experiences of weight stigma and eating behaviors, psychological distress, and physical activity during the COVID-19 pandemic in a diverse sample of emerging adults. METHODS: Participants (N = 584, 64% female, mean age = 24.6 ± 2.0 years, mean body mass index [BMI] = 28.2) in the COVID-19 Eating and Activity over Time (C-EAT) study were cohort members of the population-based longitudinal study EAT 2010-2018. Weight stigma reported by participants in 2018 was examined as a predictor of binge eating, eating to cope, physical activity, depressive symptoms, and stress during COVID-19. Data were collected via online surveys during the U.S. outbreak of COVID-19 in 2020. RESULTS: Prepandemic experiences of weight stigma predicted higher levels of depressive symptoms (ß = 0.15, p < .001), stress (ß = 0.15, p = .001), eating as a coping strategy (ß = 0.16, p < .001), and an increased likelihood of binge eating (odds ratio = 2.88, p < .001) among young adults during the COVID-19 pandemic but were unrelated to physical activity. Although associations remained after accounting for demographic characteristics and BMI, the magnitude of longitudinal associations was attenuated after adjusting for prior levels of the outcome variables. CONCLUSIONS: Young adults who have experienced weight stigma may have increased vulnerability to distress and maladaptive eating during this pandemic. Public health messaging could be improved to support people of diverse body sizes and reduce the harmful consequences of weight stigma.


Asunto(s)
Peso Corporal , Infecciones por Coronavirus/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Neumonía Viral/psicología , Distrés Psicológico , Estigma Social , Betacoronavirus , Ejercicio Físico/psicología , Femenino , Humanos , Estudios Longitudinales , Masculino , Obesidad/psicología , Pandemias , Adulto Joven
15.
BMC Public Health ; 20(1): 1337, 2020 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-32878612

RESUMEN

BACKGROUND: People who are houseless (also referred to as homeless) perceive high stigma in healthcare settings, and face disproportionate disparities in morbidity and mortality versus people who are housed. Medical students and the training institutions they are a part of play important roles in advocating for the needs of this community. The objective of this study was to understand perceptions of how medical students and institutions can meet needs of the self-identified needs of the houseless community. METHODS: Between February and May 2018, medical students conducted mixed-methods surveys with semi-structured qualitative interview guides at two community-based organizations that serve people who are houseless in Portland, Oregon. Medical students approach guests at both locations to ascertain interest in participating in the study. Qualitative data were analyzed using thematic analysis rooted in an inductive process. RESULTS: We enrolled 38 participants in this study. Most participants were male (73.7%), white (78.9%), and had been houseless for over a year at the time of interview (65.8%). Qualitative themes describe care experiences among people with mental health and substance use disorders, and roles for medical students and health-care institutions. Specifically, people who are houseless want medical students to 1) listen to and believe them, 2) work to destigmatize houselessness, 3) engage in diverse clinical experiences, and 4) advocate for change at the institutional level. Participants asked healthcare institutions to use their power to change laws that criminalize substance use and houselessness, and build healthcare systems that take better care of people with addiction and mental health conditions. CONCLUSIONS: Medical students, and the institutions they are a part of, should seek to reduce stigma against people who are houseless in medical systems. Additionally, institutions should change their approaches to healthcare delivery and advocacy to better support the health of people who are houseless.


Asunto(s)
Prestación de Atención de Salud , Personas sin Hogar , Trastornos Mentales , Defensa del Paciente , Relaciones Profesional-Paciente , Estigma Social , Estudiantes de Medicina , Adulto , Actitud Frente a la Salud , Conducta Adictiva , Femenino , Necesidades y Demandas de Servicios de Salud , Personas sin Hogar/psicología , Vivienda , Humanos , Masculino , Trastornos Mentales/complicaciones , Salud Mental , Persona de Mediana Edad , Oregon , Salud Poblacional , Investigación Cualitativa , Cambio Social , Apoyo Social , Trastornos Relacionados con Sustancias/complicaciones , Encuestas y Cuestionarios
17.
PLoS One ; 15(8): e0238232, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32853233

RESUMEN

INTRODUCTION: Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. METHODS: We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. RESULTS: We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement. CONCLUSION: In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment.


Asunto(s)
Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Adulto , Estudios de Cohortes , Consejo/métodos , Revelación , Femenino , Humanos , Estudios Longitudinales , Madres/psicología , Aceptación de la Atención de Salud/psicología , Periodo Posparto/fisiología , Periodo Posparto/psicología , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Complicaciones Infecciosas del Embarazo/psicología , Investigación Cualitativa , Estigma Social , Apoyo Social , Tanzanía , Carga Viral/fisiología , Adulto Joven
18.
Psychiatry Res ; 292: 113365, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32862107

RESUMEN

The impact of COVID-19 on mental health has begun to be widely recognized, but there is an absence of studies on how the mental health of lesbian, gay, and bisexual (LGB) people have been affected by the COVID-19 pandemic. A total of 857 LGB people in Hong Kong participated in a community-based survey study. Over one-fourth of them met the criteria for probable clinical depression (31.5%) and generalized anxiety disorder (27.9%). Besides general stressors, we identified sexual minority-specific stressors during the pandemic. 4.2% of the participants indicated that they had frequently experienced family conflict related to sexual orientation. One-third responded that they had largely reduced connection to the lesbian, gay, bisexual, and transgender plus (LGBT+) community (34.7%). The results showed that sexual minority-specific COVID-19-related stressors explained significant variance in depressive and anxiety symptoms, above and beyond the contribution of general COVID-19-related stressors. Since LGB people are particularly vulnerable to poor mental health during the COVID-19 pandemic, LGB people-targeting organizations need to understand more about family, space, and privacy concerns in order to provide better support, and LGB safe spaces and shelters may be needed as a policy response.


Asunto(s)
Infecciones por Coronavirus/psicología , Salud Mental/estadística & datos numéricos , Neumonía Viral/psicología , Conducta Sexual , Minorías Sexuales y de Género/psicología , Adulto , Ansiedad , Betacoronavirus , Bisexualidad/psicología , Infecciones por Coronavirus/epidemiología , Femenino , Homosexualidad Femenina , Homosexualidad Masculina , Hong Kong/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Distrés Psicológico , Estigma Social , Estrés Psicológico , Encuestas y Cuestionarios , Adulto Joven
19.
PLoS One ; 15(7): e0236270, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32735616

RESUMEN

BACKGROUND: An integrated chronic disease management (ICDM) model was introduced by the National Department of Health in South Africa to tackle the dual burden of HIV/AIDS and non-communicable diseases. One of the aims of the ICDM model is to reduce HIV-related stigma. This paper describes the viewpoints of service users and providers on HIV stigma in an ICDM model in rural South Africa. MATERIALS AND METHODS: A content analysis of HIV stigmatisation in seven primary health care (PHC) facilities and their catchment communities was conducted in 2013 in the rural Agincourt sub-district, South Africa. Eight Focus Group Discussions were used to obtain data from 61 purposively selected participants who were 18 years and above. Seven In-Depth Interviews were conducted with the nurses-in-charge of the facilities. The transcripts were inductively analysed using MAXQDA 2018 qualitative software. RESULTS: The emerging themes were HIV stigma, HIV testing and reproductive health-related concerns. Both service providers and users perceived implementation of the ICDM model may have led to reduced HIV stigma in the facilities. On the other hand, service users and providers thought HIV stigma increased in the communities because community members thought that home-based carers visited the homes of People living with HIV. Service users thought that routine HIV testing, intended for pregnant women, was linked with unwanted pregnancies among adolescents who wanted to use contraceptives but refused to take an HIV test as a precondition for receiving contraceptives. CONCLUSIONS: Although the ICDM model was perceived to have contributed to reducing HIV stigma in the health facilities, it was linked with stigma in the communities. This has implications for practice in the community component of the ICDM model in the study setting and elsewhere in South Africa.


Asunto(s)
Enfermedad Crónica/epidemiología , Manejo de la Enfermedad , Infecciones por VIH/epidemiología , VIH/aislamiento & purificación , Atención Primaria de Salud/normas , Enfermedad Crónica/psicología , Anticoncepción , Femenino , Grupos Focales/estadística & datos numéricos , VIH/patogenicidad , Infecciones por VIH/psicología , Infecciones por VIH/terapia , Infecciones por VIH/virología , Humanos , Cuidados a Largo Plazo , Masculino , Tamizaje Masivo , Enfermeras y Enfermeros , Embarazo , Población Rural , Estigma Social , Sudáfrica/epidemiología
20.
BMC Infect Dis ; 20(1): 591, 2020 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-32778057

RESUMEN

BACKGROUND: Men who have sex with men (MSM) bear a disproportionate burden of HIV in Malawi. Early prevention efforts in Malawi have been largely focused on preventing heterosexual and vertical transmission of HIV, and MSM have rarely been the specific benefactors of these efforts, despite facing both higher prevalence of HIV coupled with multiple barriers to prevention and care. To better facilitate the design of culturally relevant HIV prevention programs and prioritize resources among MSM in resource limited settings, the objective of this analysis was to estimate the relationship between social factors and HIV related risk behaviors and mental health. METHODS: 338 MSM were recruited using respondent-driven sampling in Blantyre, Malawi from April 2011 to March 2012. Structural equation models were built to test the association between six latent factors: participation in social activities, social support, stigma and human rights violations, depression symptomatology, condom use, and sexual risk behaviors, including concurrent sexual partnerships and total number of partners. RESULTS: The mean age of participants was 25 years old. Almost 50% (158/338) of the participants were unemployed and 11% (37/338) were married or cohabiting with women. More than 30% (120/338) of the participants reported sexual behavior stigma and 30% (102/338) reported depression symptomatology. Almost 50% (153/338) of the participants reported any kind of HIV-related risk behaviors and 30% (110/338) participated in one of the recorded social activities. Significant associations were identified between stigma and risk behaviors (ß = 0.14, p = 0.03); stigma and depression symptomatology (ß = 0.62, p = 0.01); participation in social activities and depression symptomatology (ß = 0.17, p = 0.01). CONCLUSION: Results suggest MSM reporting stigma are more likely to report sexual risk practices associated with HIV/STI transmission and depressive symptoms, while those reporting participation in social activities related to HIV education are less likely to be depressed. Furthermore, interventions at the community level to support group empowerment and engagement may further reduce risks of HIV transmission and improve mental health outcomes. Taken together, these results suggest the potential additive benefits of mental health services integrated within comprehensive HIV prevention packages to optimize both HIV-related outcomes and general quality of life among MSM in Malawi.


Asunto(s)
Infecciones por VIH/patología , Homosexualidad Masculina/psicología , Modelos Teóricos , Adulto , Depresión/patología , Infecciones por VIH/epidemiología , Humanos , Malaui , Masculino , Salud Mental , Prevalencia , Asunción de Riesgos , Conducta Sexual , Estigma Social , Adulto Joven
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