Experiences of Stigma and Spirituality of Older Black Men Living with HIV

Abstract

Previous research on HIV stigma and the use of spirituality by people living with HIV/AIDS is scarce. Moreover, the research with older Black men who have sex with men is scant. This study aimed to investigate experiences of HIV stigma and the use of spirituality among older HIV positive Black men who sleep with men. In-depth interviews were conducted with a sample of ten men. Data were analyzed utilizing to the modified van Kaam data analysis method. Three major themes were identified that explores the participants lived experiences with HIV stigma and use of spirituality: experiences of stigma reinforcing the use of spirituality; defining spirituality as a functional concept; and self-empowerment through the use of spirituality. The findings could guide social workers and other helping professionals in developing informed assessments and interventions regarding HIV stigma and the use of spirituality. Future qualitative and quantitative research is needed to achieve generalizable knowledge about the relationship between stigma on the use of spirituality.     

HIV/AIDS treatments

Although fewer people are being diagnosed with AIDS in the U.S. and deaths continue to decline, the number of adults age 50 and older who are living with HIV/AIDS is larger than ever. It is likely that older people will continue to comprise an increasingly larger proportion of individuals diagnosed with HIV/AIDS, reflecting both the ineffective prevention efforts targeting older adults and the highly effective antiretroviral therapies that allow many people to live for significantly longer periods of time. These recent trends have created two distinct populations of older persons with HIV/AIDS: those who were infected later in life and those infected earlier and now aging with HIV disease. Aging with HIV/AIDS presents unique psychosocial challenges that may be exacerbated by the aging process. HIV-related stigma, social support and coping issues and evidence-based psychosocial interventions for older adults with HIV/AIDS are reviewed in this paper and suggestions for future research are discussed.     

Ethical challenges in international HIV prevention research

Members of an HIV-prevention research network were asked to describe ethical challenges faced in their work. Major themes included acceptable standards of care for participants, defining research of relevance to host countries, reducing risks related to stigma, designing research that meets local needs without contributing to an inadequate status quo, and ensuring informed consent for complex research with potentially vulnerable participants. The challenges are interrelated and highlight the need for innovative, practical strategies to be incorporated into the planning, design, and conduct of HIV prevention trials. Research in applied ethics to support decision-making about HIV prevention research is needed, along with ethics training, mechanisms to support community-wide benefit from research, and expanded dialog on ethics surrounding HIV prevention and public health research.     

Ethical Challenges in International HIV Prevention Research

Members of an HIV-prevention research network were asked to describe ethical challenges faced in their work. Major themes included acceptable standards of care for participants, defining research of relevance to host countries, reducing risks related to stigma, designing research that meets local needs without contributing to an inadequate status quo, and ensuring informed consent for complex research with potentially vulnerable participants. The challenges are interrelated and highlight the need for innovative, practical strategies to be incorporated into the planning, design, and conduct of HIV prevention trials. Research in applied ethics to support decision-making about HIV prevention research is needed, along with ethics training, mechanisms to support community-wide benefit from research, and expanded dialog on the ethics surrounding HIV prevention and public health research.     

HIV Diagnosis Disclosure: Stigma Management and Stigma Resistance

This article reports diagnosis disclosure decision comments arising serendipitously in five focus group discussions with 34 HIV-infected New Yorkers over age 50. Three overarching disclosure themes demonstrate the complexity of diagnosis disclosure decision-making: (a) hiding or selectively disclosing, or stigma management; (b) partial disclosure because of the perception of partial control of the information; and (c) widespread or complete voluntary diagnosis disclosure, representing stigma resistance. Social workers and other human services practitioners should remember the diversity in the HIV population, the aging population, and the HIV-positive aging population. Experiences of HIV stigma and choices about diagnosis disclosure and stigma management or resistance are individual, reciprocal, and dynamic.     

How close is too close?: The negative relationship between knowledge of HIV transmission routes and social distancing tendencies

Data measuring respondents’ knowledge of HIV's transmission routes was obtained via a statewide RDD sample of 603 Nevadans to determine if disease knowledge influences respondent efforts to socially and physically distance themselves from a hypothetical HIV-positive person. Four separate dependent variables (scenarios) are created in which the geographic distance between the respondent and a hypothetical HIV-positive person decreases; while, at the same time, physical personal contact, or potential for contact, increases. Findings show 84.2% of the respondents had sufficient knowledge of HIV transmission routes, and the majority felt comfortable across all four social scenarios. However, multiple logistic regression analyses indicate that respondents with sufficient knowledge of how HIV is transmitted are significantly more comfortable with casual social interactions than those respondents with insufficient knowledge. The results from this study confirm the importance of HIV-knowledge as a tool to combat AIDS-related stigma.     

Attached to Income Support Programs for the Elderly:

Although there is every evidence that the degree of stigma attached to income support programs for the elderly has been decreasing, only about one-half of the elderly individuals who are eligible participate currently in the Supplemental Security Income program (SSI). The present study explores issues of stigma as perceived by low-income elderly persons who were not receiving Old Age Assistance payments in 1973-a year before SSI went into effect. The results of regression analysis indicate that their attitudes toward issues of stigma are statistically nonsignificant predictors of whether they would contact social security ofiice in 1974 to inquire about their eligibility for SSI benefits. The data source for the present study is the Survey of the Low-Income Aged and Disabled (SLIAD) conducted in 1973 and 1974 by the Social Security Administration with the cooperation of the Bureau of the Census.     

Beneath the Mask: A Group Therapy Model Supporting Children Infected With and Affected by HIV/AIDS

In 2007 a study was conducted to identify the outcomes of an activity-based psychosocial intervention called Leading the Way, a program designed for children infected with and/or affected by HIV/AIDS, based in Toronto, Canada. Qualitative and quantitative data showed that children who were unaware of the HIV status of their families experienced heightened anxiety and depression when compared to children who were aware of the presence of HIV in their families. Furthermore, data indicated that though the intervention positively influenced children's senses of self and their ability to cope and problem solve, deep social stigma surrounding HIV continued to profoundly affect the lives of these children. The ethical dilemmas involved in serving populations of children who have not been disclosed to regarding their own or a family members' HIV status came to light in the development of the program and are discussed in the analysis of data.     

Impacts of HIV/AIDS on poor and socially marginalised former commercial plasma donors in rural central China: social work implications

Little is known about the impact of HIV/AIDS on people who acquired the virus through former commercial plasma donations in the mid-1990s in rural Central China. The objective of this study was to examine socioeconomic impacts associated with HIV/AIDS on poor farm workers and their families, with a particular focus on economic hardships and social exclusion. The findings from 30 interviews reveal the profound effects of deteriorating health on labour power loss. The well-being of people living with HIV/AIDS was immensely affected by the loss of income, debts due to health-related expenses and a lack of alternate sources of income. Social exclusion and HIV/AIDS-related stigma remain significant issues in a workplace, funerals, and weddings. This article highlights the economic impacts of HIV/AIDS on China’s rural population and provides recommendations for social workers to mitigate the impacts of social exclusion on vulnerable rural households in China.     

How does immigration affect welfare support in Korea?

This study explored the association between the perceived presence of immigrants and support for social spending in a non-Western context, particularly Korea, so far relatively under-researched. Using the Korean General Social Survey data, specifically, it analysed whether and how native Koreans' attitudes toward government spending on (each area of) social security are influenced by the perceived presence of immigrant populations in Korean society, and furthermore, whether the degree and direction of the relationship may depend not only on the type of social benefits, but also on the type of immigration, that is, whether the share of certain groups of immigrants in the population is perceived to be high or low. The results suggest that the association between (perceived) immigration and support for social spending exists in Korea, and its degree and direction differs when the types of social benefits and immigration are considered.     

HIV-infected African families living in Stockholm/Sweden: their social network, level of disclosure and knowledge about HIV

Most HIV-infected parents in Stockholm are of African origin. Many of them have several children, but their social network is often limited. This article looks at the networks of these families in relation to different aspects of HIV in order to improve the support strategies. The theoretical basis of the study rests on network and ecological systems theory. The social networks of the families in the study were found to be generally of similar size in Sweden and in the home country. However, of 47 HIV-infected parents only 21 (45%) had disclosed their HIV status to friends and relatives in Sweden. The lack of a social network was especially prominent among single women. Contact with counsellors at the HIV clinic and the social welfare office increased the probability of disclosure about HIV infection. The lack of knowledge about HIV transmission and about whom to inform about the infection stresses the importance of improved counselling. The support strategies aimed at broadening the patient's network and breaking their isolation need to be continued and strengthened.     

Supporting HIV/AIDS affected families and children: the case of four Chinese counties

This article focuses on the impact that HIV/AIDS has on children in China and the social support provided to these children. The research finds that the consequences of HIV/AIDS are serious: the entire environment in which children develop is adversely affected by the disease. These negative socio-economic effects are due not only to HIV/AIDS, but also to the social discrimination and exclusion experienced by affected communities and families. Local governments and societies have started to provide support to HIV/AIDS-affected children and work to reduce the social exclusion they suffer. However, many challenges and problems still lie ahead.     

FEMALE SEX WORK,NON-WORK SEX AND HIV IN PERTH

This study is based on repeated interviews with twelve heterosexual female commercial sex workers (SWs) in Perth. These informants deploy, with various degrees of success, strategies to demarcate ‘work-sex’, with its socially ascribed stigma, from ‘non-work sex’. Such strategies inhibit the spread of HIV at work but, ironically, increase the risk of HIV transmission during non-work sex. SWs recognise this risk and construct a variety of rationales to reduce their fear of contracting HIV and justify their strategies of demarcating work-sex from non-work sex. Efforts to reduce the risk of HIV infection among Perth SWs would seem to depend upon addressing not only these strategies of demarcation but these rationales in a supportive environment that recognises the creative complexities of their lives.     

SOME DEMOGRAPHIC CORRELATES OF HIV/AIDS-RELATED DISCRIMINATION

In late 1991, a survey was made of HIV/AIDS-related discrimination in the Australian community. Structured telephone interviews were conducted with a random sample of 2,053 respondents. Twenty-one questions provided an index of expressed discrimination. Social contact with HIV-positive people was a significant predictor of low levels of discrimination. Other important predictors of (lower) levels of discrimination were: social contact with gay men, education, sex, age, sexual identity, and sexual experience. Social contact with gay men was the single best predictor of positive attitudes towards people with HIV/AIDS.     

Learning from the Experiences of Ethnic Minorities Accessing HIV Services in Ireland

Since the mid-1990s, Ireland has become a more culturally diversesociety. To ensure equitable, culturally sensitive services,social workers need to consult with and listen to views of serviceusers. This paper reports on findings of two recent studiesby social workers in Ireland with migrants living with HIV.It highlights how many of those newly diagnosed with HIV arefrom sub-Saharan African countries and still in the asylum processand discusses barriers to accessing support and integratinginto Irish society. The paper points out that unless properlysupported, those living with HIV may find it difficult to disclosetheir HIV status and highlights the importance of tackling HIVstigma. It concludes with the need to provide training for healthcare workers to provide culturally appropriate services, andargues against immigration policies which inhibit integration.     

Education and Social Desirability Bias: The Case of a Black Presidential Candidate*

Objective. Survey research consistently reports a positive association between educational attainment and socially tolerant attitudes, but critics hold that respondents with high levels of education may simply purport to hold attitudes seen as socially desirable. In this article, we seek to adjudicate between the claim that the association between education and social tolerance is simply an artifact of sophisticated social desirability reporting on the part of well‐educated respondents and the competing theory that education has a real impact on increasing forms of social tolerance. Methods. Using support for a black presidential candidate as our measure of social tolerance, we utilize an innovative online list experiment to test whether high levels of support are inflated because of social desirability reporting among the educational elite. Results. We find no evidence of systematic overreporting of support for a black presidential candidate among respondents with high levels of education, and note that social desirability bias declines as educational attainment increases. Conclusions. This research bolsters arguments about the liberalizing effect of education on socially tolerant attitudes, and challenges evidence that attributes this relationship to high levels of social desirability bias.     

Measuring Children's Church‐Based Social Support: Development and Initial Validation of the Kids’ Church Survey

Given the importance of considering context in development, the goal of the present study was to develop and provide initial validity evidence for the Kids’ Church Survey (KCS), a new measure of children's church‐based social support. Data were collected from 1253 children ages 6–14 attending mainline Protestant, evangelical Protestant, and Catholic churches. Parallel and exploratory factor analyses supported a three‐factor solution: received (emotional) church support, perceived church support from peers, and perceived church support from adults. Confirmatory models conducted with independent samples provided an excellent fit for the data. All three scales evidenced acceptable internal (.78–.92) and test–retest (.88–.95) reliability. Measurement invariance was demonstrated across genders and age groups, with the exception of the perceived peer support scale, which was not invariant across ages. The KCS was sensitive to between‐church differences in children's programs and incrementally predicted self‐esteem, prosocial behavior, and spirituality. Applications for researchers, mental health practitioners, and clergy are discussed.     

The HOPE Family Project: A Family-Based Group Intervention to Reduce the Impact of Homelessness on HIV/STI and Drug Risk Behaviors

The HOPE Family Project (HIV Prevention for Parents and Early Adolescents) is an eight- session, family-based group intervention modeled on three evidence-based curricula targeting HIV/AIDS and alcohol and drug abuse prevention. The design and implementation of the HOPE Family Project was carried out by an established community collaborative board. The project aims to educate and provide tailored support to families and their youth (ages 11–14), residing in homeless shelters, regarding HIV and alcohol abuse prevention. The group model proved successful in offering an informal social support network for families living in homeless shelters and improving family functioning and youth mental health outcomes.     

Paternal Multiple Partner Fertility and Environmental Chaos Among Unmarried Nonresident Fathers

This study examined the association between paternal multiple partner fertility (MPF; having children with two or more partners) and indicators of environmental chaos (partnership instability, residential instability, work stability, material hardship, and perceived social support) among unmarried, nonresident fathers. Survey data from the Fragile Families and Child Wellbeing Study (N = 873) were used to compare unmarried nonresident fathers who experienced MPF to those who had children with one partner. Results show that paternal MPF is associated with most indicators of environmental chaos (greater partnership instability, residential instability, work instability, material hardship) but not social support. Results suggest that fathers who experience MPF face challenges beyond those of other nonresident fathers. Policies and interventions should address aspects of instability and hardship that are unique to paternal MPF in order to encourage fathers’ positive contributions to children and families. Directions for future research are discussed.     

The Buffering Role of Social Support on the Psychosocial Wellbeing of Orphans in Rwanda

Little is known about the buffering role of social support among orphans living in Africa. This study examined (1) how perceived social support (PSS) varied across orphan‐related characteristics (e.g., orphan status, such as single, maternal or paternal, and their living environments, such as in child‐headed households, on the street, in an orphanage or in a foster home) and (2) the relative importance of sources of PSS (relatives/community/adults and peers) and functional social support (emotional/informational/instrumental and social) and its association with emotional well‐being and mental distress. The participants included 430 orphaned Rwandan children and youth aged between 10 and 25 years (Mean age= 17.74), of whom (n =179, 41.6 percent) were females and (n = 251, 58.4 percent) were males. Result showed that children living in an orphanage exhibited a higher level of PSS from all sources of social support than did children in other living environments. A higher level of PSS from relatives, communities and adults was associated with high level of emotional well‐being, and only adult support was associated with low level of mental distress. Furthermore, the functional PSS indicated that emotional support and companionship support were equally important in their association with higher levels of emotional well‐being and lower levels of mental distress. The findings highlight the importance of having different sources of social support and their functions in relation to psychosocial well‐being.