HIV-related stigma, racial discrimination, and gender discrimination: Pathways to physical and mental health-related quality of life among a national cohort of women living with HIV

Logie, Carmen H.; Wang, Ying; Lacombe‐Duncan, Ashley; Wagner, Anne Catherine; Kaida, Angela; Conway, Tracey; Webster, Kath; Pokomandy, Alexandra de; Loutfy, Mona

doi:10.1016/j.ypmed.2017.12.018

Cited by 88 publications

(74 citation statements)

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“…Davis argues in the 2008 “Intersectionality as Buzzword” article that it may be in part due to its non‐prescriptive nature that the concept of intersectionality has been so widely taken up and applied across disciplines and methodological approaches. There are calls for innovation in quantitative intersectional stigma measurement , using strategies such as structural equation modelling (SEM) that has been applied in prior intersectional stigma research . SEM allows the assessment of correlations between variables, including multiple forms of stigma.…”

Section: Methodsmentioning

confidence: 99%

“…Intersectionality is a particularly salient framework for understanding the HIV epidemic, as race, class and gender disparities are structural drivers of HIV An emerging field of research on intersectional stigma assesses the effects of exposure to co‐occurring forms of stigma among WLHIV . Previous Canadian research with WLHIV highlights associations between racial discrimination , HIV‐related stigma , gender discrimination and depression . Less known are the associations between multiple forms of stigma and violence exposure among WLHIV.…”

Section: Introductionmentioning

confidence: 99%

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A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

et al. 2019

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Introduction Women living with HIV (WLHIV) experience stigma and elevated exposure to violence in comparison with HIV‐negative women. We examined the mediating role of experiencing recent violence in the relationship between stigma and depression among WLHIV in Canada. Methods We conducted a cohort study with WLHIV in three Canadian provinces. Recent violence was assessed through self‐reported experiences of control, physical, sexual or verbal abuse in the past three months. At Time 1 (2013‐2015) three forms of stigma were assessed (HIV‐related, racial, gender) and at Time 2 (2015‐2017) only HIV‐related stigma was assessed. We conducted structural equation modelling (SEM) using the maximum likelihood estimation method with Time 1 data to identify direct and indirect effects of gender discrimination, racial discrimination and HIV‐related stigma on depression via recent violence. We then conducted mixed effects regression and SEM using Time 1 and Time 2 data to examine associations between HIV‐related stigma, recent violence and depression. Results At Time 1 (n = 1296), the direct path from HIV‐related stigma (direct effect: β = 0.200, p < 0.001; indirect effect: β = 0.014, p < 0.05) to depression was significant; recent violence accounted for 6.5% of the total effect. Gender discrimination had a significant direct and indirect effect on depression (direct effect: β = 0.167, p < 0.001; indirect effect: β = 0.050, p < 0.001); recent violence explained 23.15% of the total effect. Including Time 1 and Time 2 data (n = 1161), mixed‐effects regression results indicate a positive relationship over time between HIV‐related stigma and depression (Acoef: 0.04, 95% CI: 0.03, 0.06, p < 0.001), and recent violence and depression (Acoef: 1.95, 95% CI: 0.29, 4.42, p < 0.05), controlling for socio‐demographics. There was a significant interaction between HIV‐related stigma and recent violence with depression (Acoef: 0.04, 95% CI: 0.01, 0.07, p < 0.05). SEM analyses reveal that HIV‐related stigma had a significant direct and indirect effect on depression over time (direct effect: β = 0.178, p < 0.001; indirect effect: β = 0.040, p < 0.001); recent violence experiences accounted for 51% of the total effect. Conclusions Our findings suggest that HIV‐related stigma is associated with increased experiences of recent violence, and both stigma and violence are associated with increased depression among WLHIV in Canada. There is an urgent need for trauma‐informed stigma interventions to address stigma, discrimination and violence.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

et al. 2019

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“…same-sex sexual relations, injection drug use) to the lack of universal protection supplies in health facilities. Key populations for HIV include men who have sex with men, people with histories of injection drug use, racial and ethnic minorities, and sex workers, and therefore stigmas that intersect with HIV include those associated with sexual orientation, substance use, race, and occupation [36, 109].…”

Section: Practical Applicationsmentioning

confidence: 99%

“…Institutional outcomes include stigmatizing policies such as those that criminalize PLHIV who do not disclose their HIV status to their partners or prohibit PLHIV from traveling. Finally, HIV-related stigma has downstream effects on HIV incidence as well as morbidity, mortality, and quality of life for PLHIV [3, 109].…”

Section: Practical Applicationsmentioning

confidence: 99%

The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas

Stangl

Earnshaw

Logie

et al. 2019

BMC Med

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Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.

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“…As social positioning decreases, the higher the concentration of harms from illicit substance use, poor mental health, unmet health care needs, and di culties accessing health care (5,6). These harms often intersect with, and are exacerbated by, the stigma and discrimination associated with drug use, mental illness, poverty, and marginalized social location further affecting health and well-being (7)(8)(9)(10)(11). In such situations, the promotion of health equity raises questions of justice related to the structural conditions that create inequities, such as who has access to resources for health and how structural disadvantages limit access (12).…”

Section: Introductionmentioning

confidence: 99%

“The Health Equity Curse”: Ethical Tensions in Promoting Health Equity

Pauly

Revai

Marcellus

et al. 2020

Preprint

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Background: Public health (PH) practitioners have a strong moral commitment to health equity and social justice. However, PH values often do not align with health systems values, making it challenging for PH practitioners to promote health equity. In spite of a growing range of PH ethics frameworks and theories, little is known about ethical concerns related to promotion of health equity in PH practice. The purpose of this paper is to examine the ethical concerns of PH practitioners in promoting health equity in the context of mental health promotion and prevention of harms of substance use.Methods: As part of a broader program of public health systems and services research, we interviewed 32 PH practitioners. Results: Using constant comparative analysis, we identified four systemic ethical tensions: [1] biomedical versus social determinants of health agenda; [2] systems driven agendas versus situational care; [3] stigma and discrimination versus respect for persons; and [4] trust and autonomy versus surveillance and social control.Conclusions: Naming these tensions provides insights into the daily ethical challenges of PH practitioners and an opportunity to reflect on the relevance of PH frameworks. These findings highlight the value of relational ethics as a promising approach for developing ethical frameworks for PH practice.

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HIV-related stigma, racial discrimination, and gender discrimination: Pathways to physical and mental health-related quality of life among a national cohort of women living with HIV

Cited by 88 publications

References 60 publications

A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas

“The Health Equity Curse”: Ethical Tensions in Promoting Health Equity

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