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PubMed2006

Measuring HIV stigma: existing knowledge and gaps.

The growing recognition of the reduction of HIV stigma as central to effective programs across the HIV/AIDS prevention to care and treatment continuum is leading to an increasing number of programs focused on stigma reduction. Correctly evaluating the impact of these programs depends on having a good set of measures that effectively capture and distinguish the complexities of HIV stigma. This paper reviews the existing literature on HIV stigma measurement and identifies key gaps that remain. There is a need for measures at the general population level that are unambiguous about the cause of the stigmatizing behavior, that capture enacted stigma (discrimination), and that can distinguish compound (layered) stigma. In addition, studies are needed in a wider variety of contexts and on a larger scale that include a comprehensive set of measures to capture the complexity of HIV-related stigma and ensure appropriate evaluation of stigma-reduction programs.

HIV Seropositivity↗
PubMed2002

Areca nut-abuse liability, dependence and public health.

To define a dependence syndrome may convey attention upon a public health problems hitherto relatively ignored. It may, however, stigmatize substance use, especially when western diagnostic criteria are applied to essentially culture-bound substances. However, when the pattern of use of a substance results in significant personal harm, then whether dependence exists or not is less important than developing an appropriate response, if its use is associated with significant morbidity and mortality. Such is the case with areca nut, the fourth most commonly used drug in the world after tobacco, alcohol and caffeine. In this paper I will explore its use and properties with respect to its abuse and dependence liability and consider the associated implications for public health.

Areca↗
PubMedDate not supplied

The psychosocial effects of landmines in Cambodia.

The widespread use of landmines in conflict situations around the world and their continuing legacy for the civilian population in injuries, amputations, disabilities and economic costs has been recognized as a major problem. However, the psychosocial consequences for landmine victims are still to be realized. Although there are some facilities for the medical, orthopaedic and long-term rehabilitative care of landmine victims, hardly any exist for their psychosocial needs. This study considers the mental costs in terms of post-traumatic stress disorder, depression and anxiety. Individual difficulty in relationships and daily functioning is considerable, and the landmine victim faces social stigmatization, rejection and unemployment. Suggestions are made for brief training in relatively simple mental health care for staff working in already functioning programmes.

Adult↗
PubMed2005

Patterns of resistance and transgression in Eastern Indonesia: single women's practices of clandestine courtship and cohabitation.

This paper explores how single women in the regional Indonesian city of Mataram express sexual desire in a social, cultural and political climate that idealizes the confinement of female sexuality within marriage. It is based on 21 months of ethnographic fieldwork conducted with single women, their families and health care providers. Success for young women in negotiating sexual desire is dependent upon their ability to maintain a faultless public reputation and mediate between their desires and those of men. Many single women find ways to pursue their desires by bending the rules of courtship conventions, performing sexual purity in public, while resisting from within the hegemonic sexual culture. However, women who visibly transgress dominant sexual ideals (and in doing so offend the status quo) are stigmatized and ostracized. Single women's practice of resistance and sexual transgression in premarital relationships are represented using the examples of pacaran backstreet (clandestine courtship) and cohabitation prior to marriage.

Courtship↗
PubMedDate not supplied

Who's right? Human rights, sexual rights and social change in Barbados.

Currently, in a number of public and semi-public forums in Barbados, the idea of 'sexual rights' is being discussed and debated. However, different meanings are attached to 'rights'. This paper examines how these meanings demonstrate that different interpretations of sexuality, society, and morality are circulating through Barbados today. It also addresses whether or not sexual rights discourses are the best way to advocate for social justice or bring about changes to socio-sexual attitudes in the Caribbean. It is argued that framing justice and equality through rights talk may have deleterious effects for its advocates, as there is no 'clear' or transparent universality as to what rights means. It is suggested that it may be more efficacious for groups who are stigmatized based on sexual orientation to develop vernacular strategies with values and/or logics stressing elements of justice, equality, dignity and respect for personhood, which include but also move beyond sexual orientation as a principal identification.

Barbados↗
PubMedDate not supplied

Dispelling "heterosexual African AIDS" in Namibia: same-sex sexuality in the township of Katutura.

This paper questions international public health theories that characterize AIDS in Africa as an unambiguous heterosexual epidemic. It does so by describing the daily sexual lives of a community of Namibian youth who engage in same-sex sexual practices. The author outlines how the ongoing vilification of "homosexuals" by ruling State officials serves as a stigmatizing backdrop against which young people experience and practice their sexuality. Drawing upon 20 months of ethnographic research, the paper discusses the HIV sexual risk perceptions and practices of young men, highlighting the complexities in sexual subjectivity that form within the cultural politics of competing masculinities, state-sponsored anti-homosexual rhetoric and transnational queer rights protest. Bounded and monolithic notions of gender and sexual identity do not lend themselves to HIV risk and vulnerability analysis in this community.

Acquired Immunodeficiency Syndrome↗
PubMed2005

From oppression towards empowerment in clinical practice--offering doctors a model for reflection1.

OBJECTIVES: This article aims to present an Oppression Model describing how and explaining why doctors sometimes take up the role of oppressor in clinical practice, and to furthermore create change by proposing alternatives. The model is intended to increase awareness of power issues in medical practitioners, thus creating an urge for empowering practices. DESIGN: The Oppression Model is constructed by theoretical reasoning, inspired by empirical findings of doctor-as-oppressor from a Norwegian research project with users of psychiatric services. The model is composed of the chosen theoretical elements, assembled as a staircase model. The model is intended to give descriptions and explanations and foster change relevant to oppressive processes in clinical practice, and is mainly relevant when meeting patients from vulnerable or stigmatized groups. An Empowerment Track is conceptualized in a similar way by theoretical reasoning. RESULTS: The Oppression Model describes a staircase built on a foundation of objectifying, proceeding by steps of stereotypes, prejudice, and discrimination up to the final step of institutionalized oppression. An Empowerment Track is proposed, built on a foundation of acknowledgement, proceeding by steps of diversity, positive regard, and solidarity towards empowerment. It represents, however, only one of several possible ways of proceeding in developing empowering practices. CONCLUSION: Keeping the Oppression Model in mind during patient encounters may help the busy clinician to counteract oppressive attitudes and actions.

Attitude of Health Personnel↗
PubMed2004

Translating emerging research on the genetics of smoking into clinical practice: ethical and social considerations.

Despite decades of research aimed at improving the effectiveness of smoking treatment, available treatments are only modestly effective, and smoking remains the leading cause of preventable deaths in the United States. Recent research on genetic factors related to smoking behavior eventually may lead to the design of new tobacco dependence treatments and to the individualization of treatment based on genetic factors. Although this research is in its infancy, and data on the analytic and clinical validity of genetic tests to tailor smoking treatment are not yet available, it is not too soon to begin identifying and addressing key ethical issues associated with genetic testing in the context of tobacco dependence treatment. Key concerns include (a) potential harm (e.g., stigmatization, discrimination) to patients related to inappropriate use of genetic information, (b) implications of pleiotropic associations, (c) differential prevalence of risk-conferring genotypes among racial or ethnic subpopulations, (d) preparedness of primary care physicians to incorporate genetic testing into smoking treatment, (e) informed consent, and (f) ensuring an appropriate balance between individually tailored treatment by genotype and broad-based interventions that focus on social and environmental factors affecting smoking behavior. Additional research on these ethical and social issues must be conducted simultaneously with the scientific work currently under way. Failure to address these concerns will likely undermine efforts to translate knowledge emerging from the United States' substantial investment in genetic research on smoking into clinical practice and improved patient outcomes.

Adult↗
PubMed2003

A group-work approach in family building by donor insemination: empowering the marginalized.

Family building with donor insemination (DI) is often perceived as stigmatizing and the secrecy surrounding the practice contributes to this perception. In recent years, patient organizations in several countries have started to challenge this stigma and marginalization. This paper reports on a professional group-work approach for couples in Germany using DI. Participants of four seminars with a total of 74 participants and a return rate of 89% were asked to report on their expectations of and experiences during the seminars. Participants were asked to comment on their views and perspectives regarding DI practice. The results indicate a need for more information on DI and for the opportunity to meet other couples in the same situation. Participants also argued for normalization and social acceptance for families built by DI. The group-work approach described in this paper contributes significantly towards fulfilling the needs of couples involved in DI.

Adult↗
PubMedDate not supplied

Routine screening: informed consent, stigma and the waning of HIV exceptionalism.

The Centers for Disease Control and Prevention (CDC) recently recommended that HIV screening should become routine for all adults in the United States. Implicit in the CDC proposal is the notion that pre-test counseling would be more limited than at present, and that written informed consent to screening would no longer be required. If widely implemented, routine testing would mark a tremendous shift in the US HIV screening strategy. There are a number of considerations used to determine what screening tests should be routine, and HIV fits the bill in almost every regard. Yet the stigma associated with HIV infection remains, making the CDC's recommendation highly controversial. Will minimizing requirements for pre-test counseling and special written informed consent lead to unexpected or unwanted HIV testing, or do these stringent counseling and consent requirements needlessly scare people away? Will widespread and routine testing be associated with declining stigmatization, or will it drive some patients away from seeking desperately needed health care? These are high stakes questions, and we're about to find out the answers.

Adult↗
PubMed2004

Toward a new prevention of suicide in schizophrenia.

Suicide is the primary cause of death among schizophrenic patients; follow-up studies suggested that 10-13% of schizophrenic patients die by suicide. Preventive measures based on early recognition of risk factors and the establishment of drug treatment protocols are no doubt of great help but have not resulted in a significant reduction of the number of suicides among these patients. Schizophrenia is a chronic disorder affecting all aspects of the individual's life. Prevention should therefore be addressed to various areas. This paper overviews studies dealing with major fields of interest in the prevention of suicide among patients with schizophrenia. The authors focus on the role of pharmacological treatment, psychosocial interventions and psychotherapy, the struggle against stigmatization and the role of GPs. Prevention of suicide among inpatients with schizophrenia is also analysed. It is concluded that those integrated strategies already in use and the implementation of less known interventions should constitute a more effective prevention of self-inflicted deaths among these patients.

Antipsychotic Agents↗
PubMed1999

Hemochromatosis: a "simple" genetic trait.

With the discovery of the causative gene, the disorder stands revealed as America's single most common mendelian disease. Unlike other genetic diseases, it is already curable. Indeed, genetic screening makes it potentially preventable. Yet a finding of disease-related genotype can also lead to stigmatization. Hemochromatosis therefore presents the issues surrounding genetic testing in especially stark form.

Chromosomes, Human, Pair 6↗
PubMed1997

Perceptions of children and community members concerning the circumstances of orphans in rural Zimbabwe.

Focus group discussions and interviews were held with 40 orphans, 25 caretakers and 33 other community workers from a rural area near Mutare, Zimbabwe. Orphan concerns included feeling different from other children, stress, stigmatization, exploitation, schooling, lack of visits and neglect of support responsibilities by relatives. Many community members, while recognizing their limitations due to poverty, were already actively helping orphans and caretakers. Extended family networks are the primary resource for orphans, though some relatives exploit orphans or fail to fulfil their responsibilities. Interventions are suggested which support community coping mechanisms by strengthening the capacities of families to care for orphans. Outside organizations can develop partnerships with community groups, helping them to respond to the impact of AIDS, by building upon existing concern for orphan families. They can help affected communities to develop orphan support activities which encourage caring responses by community leaders and relatives and which discourage property-grabbing and orphan neglect. Material support channelled through community groups to destitute families at critical times can strengthen family coping mechanisms. Income-generating activities should build upon communities' existing capabilities and benefit the most vulnerable orphan households. Some communities are responding to the AIDS disaster by adaptations to cope with devastating changes taking place in their communities.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Accessibility, usability and universal design--positioning and definition of concepts describing person-environment relationships.

PURPOSE: The aim of this paper is to position, define and discuss three concepts crucial for research and practice concerning person-environment relationships, viz. accessibility, usability and universal design. METHODS: Literature review, synthesized with the authors' research and practice experiences. RESULTS: The authors suggest an instrumental, three-step definition to accessibility, highlighting that accessibility comprises a personal as well as a environmental component, and that accessibility must be analysed by an integration of both. Suggesting the introduction of an activity component, accessibility should partly be replaced by the more complex term usability. Universal design is highlighted as a more process-oriented but less stigmatizing concept. CONCLUSION: This paper contributes to the positioning and definition of concepts describing person-environment relationships. The definitions suggested challenge current terminology, but can support in developing more efficient research and practice strategies. In order to develop theory for application to societal planning issues, the definition of concepts is a necessary step.

Architectural Accessibility↗
PubMed2005

People never see us living well: an appraisal of the personal stories about mental illness in a prospective print media sample.

OBJECTIVE: Having found no discussions of self-depictions offered by psychiatric patients in the mass media we sought such items in a prospective national sample of print media and analysed how those speakers portrayed themselves. METHOD: As part of a larger study of media depictions of mental illnesses in print media all items with any mental health or illness aspect that appeared in a New Zealand publication over a four-week period were collected. The resulting collection of 600 items ranged from news briefs to full-page newspaper articles. From that set we selected and analysed items in which a person identified as having been a psychiatric patient or as having a mental disorder was either quoted by the reporter who had interviewed them, or personally described their experiences. Employing both propositional analyses and discourse analysis we explored how the speakers were positioned and identified patterns or themes in their construction of living with a mental illness. RESULTS: Only five articles (0.8%) met our criteria for a person with a mental disorder being reported directly. In those items the journalists had positioned the speakers as credible, expert sources who, in representing their lives and experiences, drew on five clusters of resources, that we titled: Ordinariness/Living Well; Vulnerability; Stigma; Crisis; and Disorder/Treatment. Ordinariness/Living Well foregrounded the role of personal strengths in living well and in overcoming adversity, particularly that associated with being stigmatized. We identified that theme as central to the ways in which these speakers depicted themselves as recognizably human and understandable. CONCLUSION: The findings are preliminary but these depictions are different from those reported by most researchers. Unlike those depictions, these speakers provided accessible and recognizably human self-portrayals. That finding intensifies our concern that most researchers appear to be unaware that these consumer voices are largely absent from mass media depictions of mental illnesses.

Adult↗
PubMed2004

Barriers to enrollment in drug abuse treatment and suggestions for reducing them: opinions of drug injecting street outreach clients and other system stakeholders.

Alcohol and other drug abuse (AOD) treatment is a major means of HIV/AIDS prevention, yet clients of street outreach programs (SOP) who are injection drug users (IDU), and outreach workers and staff as well, report various obstacles to enrolling clients in AOD programs. This study assessed the barriers to AOD enrollment facing high risk street outreach clients and obtained suggestions for reducing them. Data were obtained from semistructured field interviews with: 1) IDU outreach clients (N = 144) of the six SOPs in New York City (NYC) and northern suburbs supported by the Office of Alcoholism and Substance Abuse Services (OASAS), the single state agency in New York State for AOD prevention and treatment, 2) outreach workers and staff of the six SOPs (N = 55), 3) staff of detox and AOD treatment programs in major modalities treating IDUs (N = 71), and 4) officials and administrators (N = 11) in OASAS, the AIDS Institute of the Department of Health (addresses all aspects of the HIV/AIDS epidemic in New York State), and the agency for public assistance in New York City, the Human Resources Administration (HRA). Principal barriers for street outreach clients included personal-family issues, lack of insurance/Medicaid, ignorance, suspicion, and/or aversion to AOD treatment (methadone maintenance especially), "hassles" with Medicaid, lack of personal ID, lack of "slots," limited access to intake, homelessness, childcare-child custody issues. Further, about 18% had no desire for AOD services, reported no barriers, or were too enmeshed in addiction to enroll. Outreach staff cited prospective client's lack of ID and lack of Medicaid, lack of "slots," and stakeholder agency bureaucracy. Treatment staff cited lack of client readiness, "hassles" posed by welfare reform, AOD programs' own "red tape," waiting lists, and near exclusionary preference for the Medicaid-eligible. Finally, agency managers cited client factors, inadequate funding and lack of appropriate programs, treatment program requirements, and societal stigmatization of addicts. Proposed remedies included dropping ID and insurance requirements for admission, major increases in resources, funding the transporting of outreach client treatment candidates to AOD services sites, education and training initiatives, increased inter-agency cooperation, and the need for stakeholder agencies, OASAS especially, to more effectively integrate abstinence-oriented AOD services with harm reduction and the public health aspects of AOD problems.

Adult↗
PubMed2005

Interpersonal discrimination and the health of illicit drug users.

Although discrimination has been shown to adversely affect the health of marginalized populations, there is a paucity of research on the health impacts of discrimination experienced by illicit drug users. The purpose of this study was to examine the association between interpersonal discrimination and the mental and physical health of illicit drug users taking into account several potential confounding factors. A sample of 1,008 active illicit substance users (defined as having used cocaine, crack, or heroin in the previous 2 months) were recruited in three New York City neighborhoods between August 2000 and January 2001 using street-outreach techniques. Discrimination due to illicit drug use was the most common form of interpersonal discrimination experienced and more than one-half the study participants reported experiencing discrimination due to more than one attribute. Discrimination was significantly associated with poor mental health (measured by the SF-36 mental health score), depression (measured by the CES-D), and the number of self-reported chronic physical health conditions. The presence of multiple stigmatizing characteristics was associated with poorer mental and physical health. Discrimination may contribute to poor mental and physical health in this marginalized population, potentially complicating the provision of substance abuse treatment.

Adult↗
PubMed2001

"You become really close... you talk about the silly things you did, and we laugh": the role of binge drinking in female secondary students' lives.

In Australia, negative attitudes regarding young women's drinking have eased, drinking is on the increase, and there are heightened concerns about 'heavy' or 'binge' drinking. In a climate where underage drinking is frequently considered undesirable, campaigns aimed at reducing 'heavy' alcohol use have failed. This article takes as its departure point the notion that alcohol plays a meaningful role in social lives and relationships. It is through the use of narrative that these young women make sense of their drinking, which is still stigmatized. Any harm encountered along the way tends to be filtered through the 'good story,' brimming with tales of fun, adventure, bonding, sex, gender transgressions, and relationships. Nevertheless, these women implemented their own practical harm minimization strategies, and it is here that professionals can gain a foothold and assist young people and help them to drink more safely.

Adolescent↗