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PubMed2006

Management of stigma and disclosure of HIV/AIDS status in healthcare settings.

PURPOSE: This paper aims to examine the management strategies adopted by older people living with HIV/AIDS (PHAs) to conceal their positive status in healthcare settings, and their responses taken and means used to cope with the stigmatizing and exclusionary effects as a result of the disclosure of their status by/to healthcare workers. DESIGN/METHODOLOGY/APPROACH: Under the auspices of a local NGO in Hong Kong, a total of seven male older PHAs aged 55 or above from pre-existing HIV/AIDS self-help groups were recruited for two separate focus groups. A thematic approach was adopted for data analysis and specific themes identification. FINDINGS: An analysis of the data revealed that older PHAs did exercise their own agency in preventing against and managing stigma in their access to and use of health care services. Two more specific themes around "sign of disapproval" and "discriminatory practice" as barriers to access were also identified. RESEARCH LIMITATIONS/IMPLICATIONS: Because of the small sample size, the pattern of stigmatization experiences and coping strategies cannot claim to be representative of the complete picture of the stigma associated with HIV/AIDS. ORIGINALITY/VALUE: This is the first exploratory study of the stigmatization and devaluation suffered by older PHAs in healthcare settings in the context of Hong Kong. It also explored in details the pros and cons of the stigma management strategies employed by this vulnerable group of patients. The implications for practice both on the side of healthcare workers and policy makers and that of PHAs were discussed.

Adaptation, Psychological↗
PubMed1994

Reporting recent sexual practices: gay men's disclosure of HIV risk by questionnaire and interview.

AIDS-related research relies primarily on self-reports of sexual practices. Therefore, determining which data collection methods yield more candid information is critical. Data from a study of gay men's sexual adaptations to the AIDS epidemic provided an opportunity to explore the congruence of data collected using a self-administered questionnaire with data from an unstructured face-to-face interview designed to facilitate report of sexual risk behavior. We examined (i) the concordance of questionnaire and unstructured interview risk ratings when the two data sources are scored for the same 16 sexual behaviors; (ii) the concordance of questionnaire ratings and ratings obtained when all information on recent sexual practices available from the unstructured interview is considered; (iii) the relationship between serostatus and both concordance patterns between methods; and (iv) the difference by serostatus of reported risk level within method. Riskiest behaviors were reported on the questionnaire for all serostatus groups. Riskier behaviors were more likely to be reported on the questionnaire while more characteristic, safer behaviors were discussed in interview, regardless of HIV serostatus. The advantages of a combined methods--questionnaire/interview--strategy for sexual practice research are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Keeping and disclosing a secret among people with HIV in Israel.

This study examined the association of key variables with the intention to disclose and actual disclosure to an additional significant other of being HIV-infected. Sixty-five participants were recruited from five AIDS/HIV centers in Israeli hospitals. Participants completed questionnaires at entry to the study. They were asked about the extent to which they had already disclosed being HIV-infected, their intentions regarding future disclosure, and their emotional state; six months later their disclosure was examined. Depression and shame affected the intention to disclose the secret. Disclosure was associated with being male, having a high level of depression and shame, and having a low level of education. Participants with high levels of guilt who stated that they intended to disclose the secret were most likely to have done so. Implications for practice are discussed.

Adult↗
PubMed1995

Managing occupational HIV exposures: a Canadian study.

The findings reported in this paper are part of a larger study that explored how nurses cope with the risk of acquiring HIV infection while caring for persons with AIDS (PWAs). The data were collected through in-depth interviews with 13 nurses who cared for PWAs in a large Western Canadian hospital. Seven of these nurses perceived that they had been exposed to HIV-infected blood or body fluids. This paper describes how these seven nurses coped with actual exposures to HIV-infected blood or body fluids. Data were analyzed using the methodology of grounded theory. Nurses' coping efforts after exposure were grouped into four categories: minimizing the effect of exposures, reducing a sense of vulnerability, selective disclosure to others, and assigning meaning. Nurses minimized the physical effects of exposure through measures such as 'bleeding' the needlestick injury and immersing the affected area in bleach solution. Nurses reduced their sense of vulnerability by assessing the possibility of harm, avoiding situations that aroused fear, and confronting the decision for HIV testing. Nurses limited their disclosures to co-workers to avoid rejection and to preserve professional self-esteem. Disclousre to significant others was influenced primarily by the support nurses perceived they would receive. Finally, nurses attempted to assign meaning to the exposure by determining why the event occurred and by evaluating the implications it has had on their lives. The article concludes with implications for nursing practice.

Adaptation, Psychological↗
PubMed1999

Heterosexual couples confronting the challenges of HIV infection.

Couples confronted with HIV infection face significant challenges. Little is known about the impact of HIV on heterosexual couples who account for the vast majority of cases worldwide and an increasing proportion of cases in the USA, especially among women. In this study, analysis of data collected on HIV-discordant couples participating in a ten-week support group revealed four major groups of issues: (1) dealing with the emotional and sexual impact on the relationship; (2) confronting reproductive decisions; (3) planning for the future of children and the surviving partner; and (4) disclosure of the HIV infection to friends and family. These findings have implications for the design of interventions to enhance adaptation to HIV for discordant couples.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Disclosure of sexual abuse and psychological adjustment in female undergraduates.

The relationship between reported unwanted sexual experiences (USE) and psychological disturbance is now widely recognized. However, the factors that mediate between USE and psychopathology are not adequately understood. One factor that has been suggested to be important is the way in which any attempt at disclosure is received. This study investigates how different perceived responses to attempted disclosure of abuse are related to psychological function in a nonclinical sample. A perceived adverse response to disclosure was associated with greater levels of psychopathology, particularly oral control, dissociation, and self-denigration. Suggestions are made for further research, and the clinical implications of the findings are discussed.

Adaptation, Psychological↗
PubMed1993

Lesbian, gay, and bisexual youth in community settings: personal challenges and mental health problems.

Studied 194 lesbian, gay, and bisexual youth aged 21 and younger who attended programs in 14 community centers to determine the personal challenges they face due to their sexual orientation and their responses to these stresses. First awareness of sexual orientation typically occurred at age 10, but disclosure to another person did not occur until about age 16. There was much variability in sexual behavior, and many youths reported both same-sex and opposite-sex sexual experiences. Although most had told at least one family member about their sexual orientation, there remained much concern about family reactions. Suicide attempts were acknowledged by 42% of the sample. Attempters significantly differed from nonattempters on several milestones of sexual orientation development, social aspects of sexual orientation, parents' knowledge of sexual orientation, and mental health problems.

Adaptation, Psychological↗
PubMed2006

Being silenced: the impact of negative social reactions on the disclosure of rape.

Rape survivors who speak out about their assault experiences are often punished for doing so when they are subjected to negative reactions from support providers. These negative reactions may thereby serve a silencing function, leading some rape survivors to stop talking about their experiences to anyone at all. The current study sought to examine this worst case scenario. Focusing on the qualitative narratives of eight rape survivors who initially disclosed the assault but then stopped disclosing for a significant period of time, this study sought to provide an in-depth description of how negative reactions silenced these survivors. Three routes to silence were identified: 1) negative reactions from professionals led survivors to question whether future disclosures would be effective; 2) negative reactions from friends and family reinforced feelings of self-blame; and 3) negative reactions from either source reinforced uncertainty about whether their experiences qualified as rape. Implications for future research and practice are discussed.

Adult↗