Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa

Simbayi, Leickness C.; Kalichman, Seth C.; Strebel, Anna; Cloete, Allanise; Henda, Nomvo; Mqeketo, Ayanda

doi:10.1016/j.socscimed.2007.01.006

Cited by 531 publications

(526 citation statements)

References 23 publications

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“…Structural barriers include financial cost of services (15–18) and lack of availability of services (19,20). Attitudinal barriers include lack of perceived need for treatment (21–23), the belief that the disorder will get better on its own (24), the view that mental illness is a result of personal weakness (25), stigma (20,24–29), and the desire to deal with the problem on one's own (11,30). Attitudinal barriers have emerged as the more critical type of barrier in many studies in developed countries (11,24,25,30).…”

mentioning

confidence: 99%

Barriers to Mental Health Care and Predictors of Treatment Dropout in the South African Stress and Health Study

Bruwer

Sorsdahl²,

Harrison³

et al. 2011

Psychiatric Services

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Objective This study used data from the South African Stress and Health Study (SASH) to examine both structural and attitudinal barriers to treatment initiation among South Africans with mental disorders and to investigate predictors of treatment dropout. Methods Face-to-face interviews were conducted with 4,315 adult South Africans living in households or hostel quarters. The interview included a core diagnostic assessment of past-12-month mental disorders and assessments of disorder severity, service use, and barriers to treatment. Multivariate logistic regression models were used to determine predictors of not seeking treatment in relation to disorder severity and sociodemographic characteristics, as well as factors that were predictive of premature treatment discontinuation by participants who had received mental health treatment in the previous 12 months. Predictors of dropout were identified by cross-tabulation and discrete-time survival analysis. Results Of the 4,315 adults, 729 (16.9% weighted) met criteria for a mental disorder in the past 12 months. Across all levels of severity, the most frequently cited reason for not seeking professional treatment was a low perceived need for treatment. Among those who recognized the need but did not access treatment during the past 12 months (7.2%), attitudinal barriers to treatment seeking were reported more commonly than structural barriers (100% and 34%, respectively). Of the 182 respondents who received treatment (25% weighted), 20% discontinued prematurely. Various factors, such as substance use disorders and absence of health insurance, increased the odds of treatment dropout. Conclusions Low rates of treatment seeking and high treatment dropout rates for common mental disorders among South Africans are a major concern. Public health efforts to improve treatment of mental disorders should consider the multiple influences on treatment initiation and discontinuation.

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mentioning

confidence: 99%

Barriers to Mental Health Care and Predictors of Treatment Dropout in the South African Stress and Health Study

Bruwer

Sorsdahl²,

Harrison³

et al. 2011

Psychiatric Services

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“…A partir da leitura dos objetivos dos estudos observou-se que o estudo da relação entre estigma internalizado e suporte social constituiu um dos focos principais de investigação em apenas quatro estudos (Brohan, Elgie, Sartorius, Th ornicroft, & GAMIAN-Europe Study Group, 2010;Mak et al, 2007;Peltzer & Ramlagan, 2011;Vyavaharkar et al, 2010). Os demais nove estudos apresentaram dados dessa relação como um resultado secundário da pesquisa (Adewuya, Owoeye, Erinfolami, & Ola, 2011;Cerit, Filizer, Tural, & Tufan, 2012;Ersoy & Varan, 2007;Kalichman et al, 2009;Lv, Wolf & Wang, 2012;Person, Bartholomew, Gyapong, Addiss, & van den Borne, 2009;Sayles et al, 2008;Simbayi et al, 2007;Zafran, Tallant, & Gelinas, 2012).…”

Section: Análise Qualitativa Dos Estudosunclassified

“…Quanto à forma de recrutamento dos participantes, a maioria dos estudos (n = 8) optou por amostragem não-probabilís-tica, sendo que destes, sete estudos tiveram amostras por conveniência (Ersoy & Varan, 2007;Kalichman et al, 2009;Lv et al, 2012;Mak et al, 2007;Sayles et al, 2008;Simbayi et al, 2007;Vyavaharkar et al, 2010), enquanto apenas um estudo optou pela amostragem intencional de caso típico (Zafran et al, 2012). Quanto aos demais, três estudos optaram pela amostragem probabilística, sendo que dois pelo método de amostragem aleatória simples (Adewuya et al, 2011;Brohan et al, 2010) e um pelo método de amostragem sistemática (Peltzer & Ramlagan, 2011).…”

Section: Análise Qualitativa Dos Estudosunclassified

“…Ainda, no que se refere aos efeitos protetores do suporte social, Zafran, Tallant e Gelinas (2012) encontraram que maior suporte social esteve associado com maior engajamento em atividades diárias, crença na capacidade pessoal e maior aceitação dos limites da condição de saúde para uma melhor reinserção no ambiente social entre pacientes com transtorno mental. Já os estudos de Vyavaharkar et al (2010) e de Simbayi et al (2007) revelaram que altos níveis de estigma internalizado e baixo suporte social atuam como preditores signifi cativos de depressão entre pessoas que vivem com HIV/AIDS e de funcionamento pobre de pacientes com transtorno bipolar, como descrevem Cerit, Filizer, Tural e Tufan (2012). Vyavaharkar et al (2010) discutem ainda que o estigma internalizado pode infl uenciar a avaliação que os indivíduos fazem das fontes de suporte social disponíveis, sendo que uma avaliação negativa poderia atuar como preditora signifi cativa de depressão.…”

Section: Análise Qualitativa Dos Estudosunclassified

“…Considerando o processo de internalização do estigma, variáveis sociodemográfi cas como desemprego (Adewuya et al, 2011;Brohan et al, 2010;Lv et al, 2012), baixa renda (Ersoy & Varan, 2007;Peltzer & Ramlagan, 2011;Sayles et al, 2008;), ser do sexo masculino (Ersoy & Varan, 2007;Simbayi et al, 2007), maiores anos de duração da doença (Adewuya et al, 2011;Simbayi et al, 2007), e baixa escolaridade (Brohan et al, 2010;Sayles et al, 2008) estiveram associadas a maiores níveis de estigma internalizado. Em relação ao suporte social, o sexo foi a principal variável sociodemográfi ca associada a maior nível de suporte social, o que signifi ca que mulheres tendem a perceber maior apoio social do que homens (Cerit et al, 2012;Simbayi et al, 2007).…”

Section: Análise Qualitativa Dos Estudosunclassified

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Implicações da relação entre estigma internalizado e suporte social para a saúde: uma revisão sistemática da literatura

Ferreira

Silveira

Noto

et al. 2014

Estud. psicol. (Natal)

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ResumoConsiderando os impactos negativos da internalização do estigma para a vida do indivíduo, e as possíveis caracterís-ticas protetoras do suporte social para o enfrentamento da condição, objetivou-se realizar uma revisão sistemática da literatura acerca da relação entre estigma internalizado e suporte social, e suas implicações para a saúde. As buscas foram realizadas nas bases PsycInfo, Pubmed, Scopus e Web of Science. A amostra foi composta por 13 estudos que preencheram os critérios de inclusão. Os resultados apresentaram evidências de uma relação negativa entre estigma internalizado e suporte social, considerando o suporte social como uma possível estratégia de enfrentamento ao estigma internalizado, destacando o seu efeito protetor ao amenizar as consequências negativas de eventos estressantes sobre o bem-estar físico e psicológico.Palavras-chave: estigma; suporte social; saúde. AbstractImplications of the relationship between internalized stigma and social support for health: A systematic review of the literature. Considering the negative impact of the internalization of stigma for the life of an individual, and the possible protective characteristics of social support for coping with the condition, the aim of this study was to conduct a systematic review of the literature about the relationship between internalized stigma and social support, and its implications for health. Searches were conducted in PsycInfo, Pubmed, Scopus and Web of Science databases. Th e sample consisted of 13 studies that met the inclusion criteria. Results showed evidence of a negative relationship between internalized stigma and social support, presenting social support as a possible coping strategy for internalized stigma, highlighting its protective eff ect to mitigate the negative consequences of stressful events on physical and psychological well-being.Keywords: stigma; social support; health. ResumenImplicaciones de la relación entre el estigma internalizado y apoyo social para la salud: Una revisión sistemática de la literatura. Teniendo en cuenta los efectos negativos de la internalización de lo estigma para la vida del individuo, y las posibles características de protección de lo apoyo social para hacer frente a la situación, este artículo tiene como objetivo revisar sistemáticamente la literatura sobre la relación entre el estigma internalizado y el apoyo social y sus implicaciones para la salud. Las búsquedas se realizaron en las bases de datos PsycInfo, Pubmed, Scopus y Web of Science. La muestra consistió en 13 estudios que cumplían los criterios de inclusión. Los resultados mostraron evidencia de una relación negativa entre el estigma internalizado y el apoyo social, teniendo en cuenta el apoyo social como una posible estrategia para hacer frente al estigma internalizado, destacando sus efectos protectores para mitigar el impacto negativo de los acontecimientos estresantes en el bienestar físico y psicológico.Palabras clave: estigma; apoyo social; salud.

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How Should Clinicians Respond if Patient HIV Denial Could Exacerbate Racial Health Inequities?

Lahey

2021

AMA Journal of Ethics

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This commentary examines the appropriateness of a clinician's deceiving a patient who will not discuss lifesaving therapy through the lens of solidarity, a key professional ethical value. Clinicians' awareness of social determinants of many patients' increased vulnerability to HIV infection is needed to promote equitable HIV intervention outcomes at both individual and community levels.To claim one AMA PRA Category 1 Credit TM for the CME activity associated with this article, you must do the following: (1) read this article in its entirety, (2) answer at least 80 percent of the quiz questions correctly, and (3) complete an evaluation. The quiz, evaluation, and form for claiming AMA PRA Category 1 Credit TM are available through the AMA Ed Hub TM . Case M is a 56-year-old Black man with human immunodeficiency virus (HIV) who is hospitalized with failure to thrive and dyspnea. Prior to hospitalization, M did not have an infectious disease or a primary care physician, and he was not taking antiretroviral therapy (ART). In the past 20 years, when physicians have tried to speak to M about his HIV diagnosis and benefits of ART, he has said, "I don't have HIV," or "I don't talk about that." M has a CD4+ count of 3 cells/μL. He is diagnosed with Pneumocystis jirovecii pneumonia, norovirus diarrhea, and acquired immune deficiency syndrome (AIDS) wasting syndrome. During hospitalization, his relationships with clinicians worsen; if a clinician mentions HIV, M breaks eye contact, becomes silent, and interacts minimally.An infectious disease specialist, Dr D, visits M to talk about his pneumonia. M consents to antibiotics to treat this infection and appears interested in strengthening his immune system "in other ways," as Dr D suggests. Dr D continues to use M's positive response as an opportunity to motivate M to take ART and is tempted to give M ART without saying it is HIV treatment. She is worried about deceiving M, taking unfair advantage of his lower health literacy, and upsetting him if he discovers that "immunity booster pills" are actually ART. Since low engagement with health care and worse health outcomes are prevalent in some communities of color and sometimes accompanied by

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Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa

Cited by 531 publications

References 23 publications

Barriers to Mental Health Care and Predictors of Treatment Dropout in the South African Stress and Health Study

Barriers to Mental Health Care and Predictors of Treatment Dropout in the South African Stress and Health Study

Implicações da relação entre estigma internalizado e suporte social para a saúde: uma revisão sistemática da literatura

How Should Clinicians Respond if Patient HIV Denial Could Exacerbate Racial Health Inequities?

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