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1.
AIDS Educ Prev ; 33(2): 143-157, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33821677

RESUMO

Black sexual minority men (BSMM) and Black transgender women (BTW) have disproportionately high HIV prevalence, making HIV testing critical for treatment and prevention. Racism and homophobia may be barriers to testing among BSMM/BTW, particularly in the context of previous incarceration. We analyzed a subsample (n = 655) of HIV-negative, previously incarcerated BSMM/BTW in the HIV Prevention Trials Network 061 study, generating prevalence ratios and interaction terms testing associations between experienced racism and homophobia with past-year HIV testing. Both racism (aPR = 0.83, 95% CI [0.70, 0.98]) and homophobia (aPR: 0.68, 95% CI [0.48, 0.98]) were associated with lower testing, although their interaction was associated with unexpectedly higher testing (Interaction aPR = 1.77, 95% CI [1.25, 2.49]). Among BSMM/BTW with a history of incarceration, racism and homophobia are barriers to HIV testing. Positive interactions between racism and homophobia could be explained by numerous factors (e.g., resilience, coping) and warrants further study.


Assuntos
Afro-Americanos/psicologia , Infecções por HIV/diagnóstico , Homofobia , Homossexualidade Masculina/psicologia , Racismo , Pessoas Transgênero/psicologia , Adaptação Psicológica , Adulto , Estudos de Coortes , Discriminação Psicológica , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Homossexualidade Masculina/etnologia , Humanos , Masculino , Resiliência Psicológica
2.
Epidemiol Psychiatr Sci ; 30: e26, 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33729113

RESUMO

AIMS: The theory of 'what matters most' (WMM) has been developed to understand differences in mental illness stigma between cultures, postulating that stigma becomes most pervasive in situations that matter most in a specific cultural context. The rise of populism in Western societies demonstrates that also within one cultural context, different values 'matter most' to different groups. We expand the WMM framework to explore the spectrum of stigma manifestations within Western societies, relating it to both conservative/authoritarian and liberal/modern values. From our findings, we will develop hypotheses on how further research into value orientations and stigma might address potential blind spots in stigma research. METHODS: Based on a narrative review of the literature on mental illness stigma and value orientations, we apply the WMM framework to cultural mechanisms of stigma within modern Western societies. RESULTS: There are several studies showing an association between traditional, authoritarian, conservative values with stronger mental illness stigma, while studies examining the stigma within liberal, modern value orientations are scarce. We hypothesise on situations where encountering a person with mental illness could threaten liberal values and thus might provoke stigma among persons with such value orientations. For example, living with a person with mental illness could be seen as consuming energy and time, thereby jeopardising 'self-actualisation', the modern value of realising one's own full potential. As a result, a person highly valuing self-actualisation might try to avoid contact with persons with mental illness. Instances of potential 'liberal stigma' also include structural stigma or self-stigma, when, e.g. changing assumptions of what is considered 'normal' increase perceptions of being fundamentally different when experiencing mental illness. CONCLUSIONS: 'WMM' appears to be a useful framework to direct research to potential blind spots within the field of stigma research. Looking at instances where liberal values conflict with dealing with a person with mental illness could provide a more comprehensive understanding of stigma experiences among persons with mental illness. However, for measuring stigma, tapping into liberal variations of mental illness stigma is methodologically challenging. Qualitative work could be the first step to elicit potential stigma experiences based on conflicts with liberal values.


Assuntos
Discriminação Psicológica , Transtornos Mentais/psicologia , Estigma Social , Características Culturais , Humanos
3.
AIDS Educ Prev ; 33(1): 1-15, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33617319

RESUMO

HIV discrimination has served as a barrier to addressing the HIV epidemic and providing effective HIV treatment and care. Measuring HIV discrimination, particularly covert HIV discrimination, has proven to be complex. Adapted from a previous scale, we developed a perpetuated HIV micro-aggressions scale to assess covert forms of discriminatory beliefs among HIV-negative/unknown HIV status individuals. Factor analysis resulted in three subscales, explaining 73.58% of the scale's variance. The new scale demonstrated both convergent validity (HIV prejudice, HIV stereotypes) and discriminant validity (alcohol use, depressive symptomology). Perpetuated HIV microaggressions were significantly associated with HIV conspiracy beliefs, HIV prejudice, and HIV stereotypes. This new scale can serve as an important tool in evaluating perpetuated HIV microaggressions among HIV-negative individuals.


Assuntos
Agressão/psicologia , Discriminação Psicológica , Infecções por HIV/psicologia , Estigma Social , Inquéritos e Questionários/normas , Adulto , Feminino , Infecções por HIV/prevenção & controle , Acesso aos Serviços de Saúde , Humanos , Masculino , Preconceito , Reprodutibilidade dos Testes , Apoio Social , Estereotipagem
4.
Artigo em Inglês | MEDLINE | ID: mdl-33567567

RESUMO

Efficiency in the early ability to switch attention toward competing visual stimuli (spatial attention) may be linked to future ability to detect rapid acoustic changes in linguistic stimuli (temporal attention). To test this hypothesis, we compared individual performances in the same cohort of Italian-learning infants in two separate tasks: (i) an overlap task, measuring disengagement efficiency for visual stimuli at 4 months (Experiment 1), and (ii) an auditory discrimination task for trochaic syllabic sequences at 7 months (Experiment 2). Our results indicate that an infant's efficiency in processing competing information in the visual field (i.e., visuospatial attention; Exp. 1) correlates with the subsequent ability to orient temporal attention toward relevant acoustic changes in the speech signal (i.e., temporal attention; Exp. 2). These results point out the involvement of domain-general attentional processes (not specific to language or the sensorial domain) playing a pivotal role in the development of early language skills in infancy.


Assuntos
Desenvolvimento da Linguagem , Fala , Percepção Auditiva , Discriminação Psicológica , Humanos , Lactente , Itália
5.
Neurology ; 96(10): e1470-e1481, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33408146

RESUMO

OBJECTIVE: To determine whether memory tasks with demonstrated sensitivity to hippocampal function can detect variance related to preclinical Alzheimer disease (AD) biomarkers, we examined associations between performance in 3 memory tasks and CSF ß-amyloid (Aß)42/Aß40 and phosopho-tau181 (p-tau181) in cognitively unimpaired older adults (CU). METHODS: CU enrolled in the Stanford Aging and Memory Study (n = 153; age 68.78 ± 5.81 years; 94 female) completed a lumbar puncture and memory assessments. CSF Aß42, Aß40, and p-tau181 were measured with the automated Lumipulse G system in a single-batch analysis. Episodic memory was assayed using a standardized delayed recall composite, paired associate (word-picture) cued recall, and a mnemonic discrimination task that involves discrimination between studied "target" objects, novel "foil" objects, and perceptually similar "lure" objects. Analyses examined cross-sectional relationships among memory performance, age, and CSF measures, controlling for sex and education. RESULTS: Age and lower Aß42/Aß40 were independently associated with elevated p-tau181. Age, Aß42/Aß40, and p-tau181 were each associated with (1) poorer associative memory and (2) diminished improvement in mnemonic discrimination performance across levels of decreased task difficulty (i.e., target-lure similarity). P-tau mediated the effect of Aß42/Aß40 on memory. Relationships between CSF proteins and delayed recall were similar but nonsignificant. CSF Aß42 was not significantly associated with p-tau181 or memory. CONCLUSIONS: Tests designed to tax hippocampal function are sensitive to subtle individual differences in memory among CU and correlate with early AD-associated biomarker changes in CSF. These tests may offer utility for identifying CU with preclinical AD pathology.


Assuntos
Doença de Alzheimer/líquido cefalorraquidiano , Biomarcadores/líquido cefalorraquidiano , Hipocampo/fisiopatologia , Transtornos da Memória/líquido cefalorraquidiano , Transtornos da Memória/psicologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/psicologia , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Aprendizagem por Associação , Estudos Transversais , Sinais (Psicologia) , Discriminação Psicológica , Feminino , Humanos , Masculino , Memória , Transtornos da Memória/fisiopatologia , Memória Episódica , Rememoração Mental , Pessoa de Meia-Idade , Testes Neuropsicológicos , Fragmentos de Peptídeos/líquido cefalorraquidiano , Desempenho Psicomotor , Proteínas tau/líquido cefalorraquidiano
6.
Epidemiol Psychiatr Sci ; 30: e15, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33504412

RESUMO

AIMS: To develop recommendations for strategies and interventions to reduce stigma and discrimination related to coronavirus disease 2019 (COVID-19), through reviewing and synthesising evidence in relation to COVID-19 and other disease outbreaks and infectious/stigmatised conditions from systematic reviews and primary studies and recommendations from additional materials. METHODS: Rapid review, drawing on the World Health Organization's (WHO) methodology for developing interim guidelines during health emergencies. PubMed/MEDLINE, PsycINFO, Cochrane Central and Campbell Collaboration searched up to mid-April 2020. Searches were supplemented by reference-searching and expert recommendations. Searches were designed to identify: (1) systematic reviews (<10 years), or (2) primary intervention studies (no date limit) reporting evidence on anti-stigma interventions (in relation to COVID-19 or other infectious/stigmatised conditions) or (3) additional relevant materials. Data were extracted on population, intervention, outcome and results. These data were compiled into evidence summary tables and narrative overviews. Recommendations on strategies for COVID-19 stigma-reduction were developed using the WHO 'Evidence to Decision' framework approach. The review protocol was registered with PROSPERO (registration ID: CRD42020177677). RESULTS: The searches identified a total of 4150 potentially relevant records, from which 12 systematic reviews and 29 additional articles were included. Overarching considerations and specific recommendations focus on: (1) language/words used in relation to COVID-19 and affected people; (2) media/journalistic practices; (3) public health interventions; (4) targeted public health interventions for key groups and (5) involving communities and key stakeholders. CONCLUSIONS: These recommendations represent the first consolidated evidence-based guidance on stigma and discrimination reduction in relation to COVID-19. Mitigating the impact of stigma is critical in reducing distress and negative experiences, and strengthening communities' resolve to work together during exceptional circumstances. Ultimately, reducing stigma helps addressing structural inequalities that drive marginalisation and exacerbate both health risks and the impact of stigma. Administrations and decision makers are urged to consider integrating these recommendations into the ongoing COVID-19 response.


Assuntos
/psicologia , Discriminação Psicológica , Discriminação Social , Estigma Social , Surtos de Doenças , Humanos , Pandemias , Saúde Pública
7.
J Neurosci ; 41(4): 757-765, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-33380471

RESUMO

Our ability to compare sensory stimuli is a fundamental cognitive function, which is known to be affected by two biases: choice bias, which reflects a preference for a given response, and contraction bias, which reflects a tendency to perceive stimuli as similar to previous ones. To test whether both reflect supervised processes, we designed feedback protocols aimed to modify them and tested them in human participants. Choice bias was readily modifiable. However, contraction bias was not. To compare these results to those predicted from an optimal supervised process, we studied a noise-matched optimal linear discriminator (Perceptron). In this model, both biases were substantially modified, indicating that the "resilience" of contraction bias to feedback does not maximize performance. These results suggest that perceptual discrimination is a hierarchical, two-stage process. In the first, stimulus statistics are learned and integrated with representations in an unsupervised process that is impenetrable to external feedback. In the second, a binary judgment, learned in a supervised way, is applied to the combined percept.SIGNIFICANCE STATEMENT The seemingly effortless process of inferring physical reality from the sensory input is highly influenced by previous knowledge, leading to perceptual biases. Two common ones are contraction bias (the tendency to perceive stimuli as similar to previous ones) and choice bias (the tendency to prefer a specific response). Combining human psychophysical experiments with computational modeling we show that they reflect two different learning processes. Contraction bias reflects unsupervised learning of stimuli statistics, whereas choice bias results from supervised or reinforcement learning. This dissociation reveals a hierarchical, two-stage process. The first, where stimuli statistics are learned and integrated with representations, is unsupervised. The second, where a binary judgment is applied to the combined percept, is learned in a supervised way.


Assuntos
Discriminação Psicológica/fisiologia , Julgamento/fisiologia , Aprendizagem/fisiologia , Percepção/fisiologia , Adulto , Algoritmos , Teorema de Bayes , Comportamento de Escolha/fisiologia , Retroalimentação Psicológica , Feminino , Humanos , Masculino , Redes Neurais de Computação , Desempenho Psicomotor/fisiologia
8.
Proc Natl Acad Sci U S A ; 117(52): 33161-33169, 2020 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-33328275

RESUMO

There is considerable support for the hypothesis that perception of heading in the presence of rotation is mediated by instantaneous optic flow. This hypothesis, however, has never been tested. We introduce a method, termed "nonvarying phase motion," for generating a stimulus that conveys a single instantaneous optic flow field, even though the stimulus is presented for an extended period of time. In this experiment, observers viewed stimulus videos and performed a forced-choice heading discrimination task. For nonvarying phase motion, observers made large errors in heading judgments. This suggests that instantaneous optic flow is insufficient for heading perception in the presence of rotation. These errors were mostly eliminated when the velocity of phase motion was varied over time to convey the evolving sequence of optic flow fields corresponding to a particular heading. This demonstrates that heading perception in the presence of rotation relies on the time-varying evolution of optic flow. We hypothesize that the visual system accurately computes heading, despite rotation, based on optic acceleration, the temporal derivative of optic flow.


Assuntos
Percepção de Movimento , Fluxo Óptico , Aceleração , Adulto , Discriminação Psicológica , Feminino , Humanos , Masculino , Rotação , Tempo
9.
Nature ; 585(7824): 245-250, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32884146

RESUMO

Adaptive behaviour crucially depends on flexible decision-making, which in mammals relies on the frontal cortex, specifically the orbitofrontal cortex (OFC)1-9. How OFC encodes decision variables and instructs sensory areas to guide adaptive behaviour are key open questions. Here we developed a reversal learning task for head-fixed mice, monitored the activity of neurons of the lateral OFC using two-photon calcium imaging and investigated how OFC dynamically interacts with primary somatosensory cortex (S1). Mice learned to discriminate 'go' from 'no-go' tactile stimuli10,11 and adapt their behaviour upon reversal of stimulus-reward contingency ('rule switch'). Imaging individual neurons longitudinally across all behavioural phases revealed a distinct engagement of S1 and lateral OFC, with S1 neural activity reflecting initial task learning, whereas lateral OFC neurons responded saliently and transiently to the rule switch. We identified direct long-range projections from lateral OFC to S1 that can feed this activity back to S1 as value prediction error. This top-down signal updated sensory representations in S1 by functionally remapping responses in a subpopulation of neurons that was sensitive to reward history. Functional remapping crucially depended on top-down feedback as chemogenetic silencing of lateral OFC neurons disrupted reversal learning, as well as plasticity in S1. The dynamic interaction of lateral OFC with sensory cortex thus implements computations critical for value prediction that are history dependent and error based, providing plasticity essential for flexible decision-making.


Assuntos
Plasticidade Neuronal/fisiologia , Córtex Pré-Frontal/citologia , Córtex Pré-Frontal/fisiologia , Reversão de Aprendizagem/fisiologia , Córtex Somatossensorial/citologia , Córtex Somatossensorial/fisiologia , Percepção do Tato/fisiologia , Adaptação Psicológica , Animais , Mapeamento Encefálico , Sinalização do Cálcio , Tomada de Decisões/fisiologia , Discriminação Psicológica/fisiologia , Masculino , Camundongos , Estimulação Física , Células Receptoras Sensoriais/metabolismo
10.
Nat Commun ; 11(1): 4007, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32782282

RESUMO

Everyday life unfolds continuously, yet we tend to remember past experiences as discrete event sequences or episodes. Although this phenomenon has been well documented, the neuromechanisms that support the transformation of continuous experience into distinct and memorable episodes remain unknown. Here, we show that changes in context, or event boundaries, elicit a burst of autonomic arousal, as indexed by pupil dilation. Event boundaries also lead to the segmentation of adjacent episodes in later memory, evidenced by changes in memory for the temporal duration, order, and perceptual details of recent event sequences. These subjective and objective changes in temporal memory are also related to distinct temporal features of pupil dilations to boundaries as well as to the temporal stability of more prolonged pupil-linked arousal states. Collectively, our findings suggest that pupil measures reflect both stability and change in ongoing mental context representations, which in turn shape the temporal structure of memory.


Assuntos
Nível de Alerta/fisiologia , Memória Episódica , Pupila/fisiologia , Percepção do Tempo/fisiologia , Adulto , Percepção Auditiva/fisiologia , Discriminação Psicológica/fisiologia , Feminino , Humanos , Masculino , Tempo de Reação , Adulto Jovem
11.
AIDS Educ Prev ; 32(3): 243-259, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32749879

RESUMO

Qualitative data were collected from 34 Indonesian female sex workers to understand their engagement with HIV treatment. Influences that enhanced treatment initiation and adherence included women's desires to stay healthy to continue working to provide for families; awareness of the biomedical benefits of treatment; support from bosses, outreach workers, and peer support groups; and flexible, nonjudgmental HIV service provision. Influences inhibiting treatment initiation and adherence included concerns about unwanted disclosure in the workplace and side effects of medication on women's capacity to earn money through sex work; geographical location of services; discrimination and confidentiality concerns in HIV care services. To improve HIV treatment initiation and adherence among Indonesian female sex workers, future responses should explore health promotion messages that engage with women's family and livelihood obligations; increased funding for community-based peer outreach workers; community-based treatment initiation and supply; and advocacy in work environments to secure support for treatment initiatives.


Assuntos
Família , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Profissionais do Sexo/psicologia , Estigma Social , Apoio Social , Adulto , Cidades , Confidencialidade , Revelação , Discriminação Psicológica , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Humanos , Indonésia/epidemiologia , Grupo Associado , Pesquisa Qualitativa , Trabalho Sexual , Adulto Jovem
12.
AIDS Patient Care STDS ; 34(8): 356-366, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32757978

RESUMO

Resilience is defined as the ability and process to transform adversity into opportunities for growth and adaptation. Resilience may be especially important for people living with HIV (PLWH), who are susceptible to anxiety and depressive disorders, which are commonly linked to risk behaviors (i.e., alcohol and drug abuse), poor adherence to medical regimens, increased risk of morbidity and mortality, and related stigma and discrimination. To date, few studies have examined the impact of resilience on health-related behaviors and outcomes among PLWH, particularly among minority women living with HIV (WLWH) who are dealing with multiple stressors impacting their health. This study used a convergent parallel mixed-methods design to collect, analyze, and integrate qualitative and quantitative data from a subsample of WLWH enrolled in the Women's Interagency HIV Study (WIHS). The aims of the study were to (1) qualitatively examine the resilience perspectives of 76 marginalized WLWH, and; (2) quantitatively assess the associations of resilience with HIV health outcomes-adherence to antiretroviral therapy and viral suppression-in the context of differing levels of internalized HIV-related stigma and depressive symptoms (n = 420). Findings from this mixed-methods study suggest that resilience is an important resource that can aid WLWH in coping constructively with adversity by capitalizing on intrapersonal traits and states, interpersonal and institutional resources, and spiritual and/or religious practices. Given the complex medical and social needs of marginalized WLWH, intervention strategies should focus on mitigating psychosocial burdens of stigma and depression, in addition to building resilience.


Assuntos
Adaptação Psicológica , Discriminação Psicológica , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Resiliência Psicológica , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Ansiedade/epidemiologia , Ansiedade/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Grupos Minoritários , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento , Estados Unidos/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-32722563

RESUMO

Providing sexual and reproductive health (SRH) services to migrant workers is key to fulfilling sustainable developmental goals. This study aims to explore key informants' views on the provision of SRH services for migrant women in Malaysia, exploring the provision of SRH education, contraception, abortion, antenatal and delivery, as well as the management of gender-based violence. In-depth interviews of 44 stakeholders were conducted from July 2018 to July 2019. Data were thematically analysed. Migrant workers that fall pregnant are unable to work legally and are subject to deportation. Despite this, we found that insufficient SRH information and contraceptive access are provided, as these are seen to encourage promiscuity. Pregnancy, rather than sexually transmitted infection prevention, is a core concern among migrant women, the latter of which is not adequately addressed by private providers. Abortions are often seen as the only option for pregnant migrants. Unsafe abortions occur which are linked to financial constraints and cultural disapproval, despite surgical abortions being legal in Malaysia. Pregnant migrants often delay care-seeking, and this may explain poor obstetric outcomes. Although health facilities for gender-based violence are available, non-citizen women face additional barriers in terms of discrimination and scrutiny by authorities. Migrant women face extremely limited options for SRH services in Malaysia and these should be expanded.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Migrantes , Atitude do Pessoal de Saúde , Anticoncepção , Comportamento Contraceptivo/etnologia , Discriminação Psicológica , Feminino , Grupos Focais , Disparidades em Assistência à Saúde , Humanos , Entrevistas como Assunto , Malásia , Gravidez , Pesquisa Qualitativa , Refugiados/psicologia , Saúde Reprodutiva , Comportamento Sexual , Saúde Sexual
14.
AIDS Patient Care STDS ; 34(7): 316-326, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32639208

RESUMO

Among people living with HIV (PLWH) in Florida, <2/3 are virally suppressed (viral load <200 copies/mL). Previous theoretical frameworks have pointed to HIV-related stigma as an important factor for viral suppression; an important outcome related to the HIV continuum of care. This study aims to analyze the association between enacted HIV-related stigma and antiretroviral therapy (ART) adherence and viral suppression among a sample of PLWH in Florida. The overall sample (n = 932) was male (66.0%), majority greater than 45 years of age (63.5%), black (58.1%), and non-Hispanic (79.7%). Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were estimated using logistic regression models. The odds of nonadherence to ART was not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 1.30, CI: (0.87-1.95), p = 0.198; AOR = 1.17, CI: (0.65-2.11), p = 0.600, respectively]. Moreover, the odds of nonviral suppression were not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 0.92, CI: (0.60-1.42), p = 0.702; AOR = 1.16, CI: (0.64-2.13), p = 0.622, respectively]. However, ever experiencing health care-specific enacted HIV-related stigma was associated with both nonadherence [AOR = 2.29, CI: (1.25-4.20), p = 0.008] and nonsuppression [AOR = 2.16, CI: (1.19-3.92), p = 0.011]. Despite limitations, the results suggest that the perpetuation of stigma by health care workers may have a larger impact on continuum of care outcomes of PLWH than other sources of enacted stigma. Based on the results, there is a need to develop and evaluate interventions for health care workers intended to reduce experienced stigma among PLWH and improve health outcomes.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Discriminação Psicológica , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adesão à Medicação/psicologia , Estigma Social , Carga Viral/efeitos dos fármacos , Adulto , Fármacos Anti-HIV/administração & dosagem , Antirretrovirais/uso terapêutico , Atitude do Pessoal de Saúde , Estudos de Coortes , Continuidade da Assistência ao Paciente , Feminino , Florida/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Preconceito
15.
AIDS Patient Care STDS ; 34(7): 303-315, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32639210

RESUMO

Despite successful implementation of anonymous voluntary human immunodeficiency virus (HIV) counseling and testing (aVCT) in Taiwan, the trend of late HIV presentation in sexually active populations has remained unchanged in Taiwan over the past decade. We evaluated the effect and acceptance of an aVCT cascade program among Taiwanese individuals by surveying 572 participants (mean age: 29.6 years; 99.3% men; and 79.5% same-sex sexual contact) diagnosed with HIV/acquired immune deficiency syndrome (AIDS) from 2015 to 2019. We designed a five-stage continuum based on acceptance of the program before HIV diagnosis: at high risk of HIV infection (Stage 1), heard of aVCT (Stage 2), wants to receive aVCT (Stage 3), has received aVCT (Stage 4), and regularly receives aVCT (Stage 5). Four domains established from exploratory factor analysis described reasons for inability to reach the next aVCT stage: low perceived HIV risk, fear of testing positive because of discrimination/stigmatization, and structural barriers to aVCT. Regular aVCT (vs. never receiving aVCT) protected against AIDS on diagnosis (p < 0.001). There were no significant differences in program acceptance across 2015-2019. However, uptake reduced markedly across the program; the largest reduction (37.4.0-61.0%) occurred from Stage 4 to Stage 5. Fear of testing positive because of discrimination/stigmatization was the main reason for not proceeding to the next aVCT stage. Although the findings indicate the benefits of regular aVCT for early HIV diagnosis, additional strategies to reduce fear of negative social consequences of HIV infection are prioritized to optimize aVCT in Taiwan.


Assuntos
Aconselhamento/métodos , Diagnóstico Tardio/estatística & dados numéricos , Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Estigma Social , Síndrome de Imunodeficiência Adquirida , Adulto , Atitude do Pessoal de Saúde , Aconselhamento/estatística & dados numéricos , Discriminação Psicológica , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Comportamento Sexual , Taiwan/epidemiologia
17.
BMC Psychiatry ; 20(1): 288, 2020 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-32513133

RESUMO

BACKGROUND: Employment holds many benefits for people living with psychosis. However, significant barriers to employment for this cohort appear to exist, notably stigma and discrimination against people living with serious mental health conditions. We asked: Would a qualitative sample including multiple stakeholder groups reveal similar results and if so, what would be the main impacts of such stigma and discrimination? METHOD: This analysis used data from a qualitative study that had employed focus groups and interviews to investigate the employment barriers and support needs of people living with psychosis, including views of the multiple stakeholders (those living with mental health conditions, health professionals, care-givers, employments consultants and community members and employers). RESULTS: The impacts of workplace stigma and discrimination on people living with psychosis included work avoidance, reluctance to disclose mental health conditions to employers, work-related stress, and reduced longevity of employment. CONCLUSIONS: Significant impacts from such stigma and discrimination were found in this study. The findings indicate a need to provide support mechanisms and to change the culture of workplaces to improve employment opportunities and outcomes for people living with psychosis.


Assuntos
Discriminação Psicológica , Transtornos Psicóticos/psicologia , Estigma Social , Local de Trabalho/psicologia , Emprego , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa
18.
AIDS Care ; 32(8): 1052-1060, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32500722

RESUMO

ABSTRACT The inability to access health services when needed is a critical barrier to HIV prevention, treatment and care among men who have sex with men (MSM) and transgender women (TGW). Using data collected in HPTN 075, we explored factors associated with any experienced healthcare-related stigma. HPTN 075 was a cohort study to assess the feasibility of recruiting and retaining MSM and TGW in clinical trials in sub-Saharan Africa. Of 401 MSM and TGW enrolled at four sites (Kisumu, Kenya; Blantyre, Malawi; Cape Town, Soweto, South Africa) 397 contributed to the analysis (79.9% cis-gender and 20.1% TGW). Of these, (45.3%; 180/397) reported one or more of healthcare-related stigma experiences. Most frequently reported experiences included fear to seek healthcare services (36.3%) and avoiding seeking such services because of the discovery of MSM status (29.2%). Few men and TGW (2.5%) reported having been denied health services because of having sex with men. In multivariable analysis, more participants in Soweto [adjusted odds ratio (AOR) = 2.60] and fewer participants in Blantyre (AOR = 0.27) reported any healthcare-related stigma experiences, in comparison to participants in Kisumu. MSM and TGW that did not have a supportive gay community to rely on were more likely to report any healthcare-related stigma experiences (AOR = 1.46), whereas MSM and TGW who reported high social support and who never had engaged in transactional sex were less likely to report such experiences (AOR = 0.76 and AOR = 0.43, respectively). Our results suggest that encouraging support groups for MSM and TGW as well as training and sensitizing healthcare staff, and the general community, on MSM and TGW health issues and cultural competence may reduce stigma, improve access to healthcare, which could ultimately reduce HIV transmission.


Assuntos
Atitude do Pessoal de Saúde , Discriminação Psicológica , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Pessoal de Saúde/psicologia , Homossexualidade Masculina/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estigma Social , Pessoas Transgênero/psicologia , Adulto , Idoso , Estudos de Coortes , Medo , Feminino , Infecções por HIV/diagnóstico , Acesso aos Serviços de Saúde , Humanos , Quênia , Malaui , Masculino , Pessoa de Meia-Idade , Retenção nos Cuidados , Minorias Sexuais e de Gênero , África do Sul
19.
J Vis ; 20(6): 5, 2020 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-32511666

RESUMO

Perceptual learning (PL), often characterized by improvements in perceptual performance with training that are specific to the stimulus conditions used during training, exemplifies experience-dependent cortical plasticity. An improved understanding of how neuromodulatory systems shape PL promises to provide new insights into the mechanisms of plasticity, and by extension how PL can be generated and applied most efficiently. Previous studies have reported enhanced PL in human subjects following administration of drugs that increase signaling through acetylcholine (ACh) receptors, and physiological evidence indicates that ACh sharpens neuronal selectivity, suggesting that this neuromodulator supports PL and its stimulus specificity. Here we explored the effects of enhancing endogenous cholinergic signaling during PL of a visual texture discrimination task. We found that training on this task in the lower visual field yielded significant behavioral improvement at the trained location. However, a single dose of the cholinesterase inhibitor donepezil, administered before training, did not significantly impact either the magnitude or the location specificity of texture discrimination learning compared with placebo. We discuss potential explanations for discrepant findings in the literature regarding the role of ACh in visual PL, including possible differences in plasticity mechanisms in the dorsal and ventral cortical processing streams.


Assuntos
Inibidores da Colinesterase/farmacologia , Donepezila/farmacologia , Percepção de Forma/efeitos dos fármacos , Aprendizagem/efeitos dos fármacos , Percepção Visual/efeitos dos fármacos , Adulto , Aprendizagem por Discriminação/fisiologia , Discriminação Psicológica , Feminino , Percepção de Forma/fisiologia , Humanos , Aprendizagem/fisiologia , Masculino , Campos Visuais , Percepção Visual/fisiologia , Adulto Jovem
20.
AIDS Educ Prev ; 32(2): 169-179, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32539482

RESUMO

This study compared community health workers' (CHW) stigma towards people living with HIV (PLH) and people who use drugs (PWUD) and explored the relationship between stigma and CHWs' confidence level in providing HIV/drug-related services. Using two sets of identically worded questions, levels of stigma towards PWUD and PLH were measured among 120 CHW from 60 communes in Vietnam. The associations between CHWs' confidence in service provision and stigma towards PWUD and PLH were examined using a linear mixed-effects regression model. The majority of the CHW reported higher levels of stigma towards PWUD than towards PLH. Compared to the CHW reporting higher stigma towards PWUD, those with higher stigma towards PLH were significantly less confident in service provision. Social opprobrium attached to drug-using behaviors can be a major driver behind the overall HIV stigma. CHWs' fear of HIV infection should be tackled to boost their confidence in HIV/drug-related care provision.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Agentes Comunitários de Saúde/psicologia , Discriminação Psicológica , Infecções por HIV/terapia , Relações Profissional-Paciente , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Serviços de Saúde Comunitária/organização & administração , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Vietnã
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