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Bar and hotel workers (n=519) in Moshi, Tanzania were interviewed to obtain information about potential predictors of condom use. Samples were collected for the diagnosis of sexually transmitted diseases (STDs), including HIV. Consistent condom use was defined as always using condoms with sexual partners in the past five years. Overall consistent condom use in this population was 14.1%. In multivariate analyses, consistent condom use was inversely associated with low condom self-efficacy (adjusted odds ratio [AOR], 0.20; 95% confidence interval (CI), 0.06-0.71), low condom knowledge (AOR, 0.11; CI, 0.01-0.80), and having more than three children (AOR, 0.23; 95% CI, 0.09-0.54). Other significant predictors included perceived condom acceptability and using condoms when last exchanged sex for money or gift. These results indicate that increased specific condom knowledge, improved self-efficacy, and reduced social stigma could be effective strategies in the promotion of condom use in this population.
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PMID:Social and behavioural determinants of consistent condom use among hotel and bar workers in Northern Tanzania. 1459 73

To provide understanding of social and psychological factors that affect disclosure of HIV status among women diagnosed HIV-positive in pregnancy, 438 HIV positive women attending antenatal al clinics in Pretoria, South Africa were invited to participate in a longitudinal study. A total of 293 (62%) women were enrolled from June 2003 to December 2004. Questionnaires assessing sociodemographics and psychological measures were administered during pregnancy and at 3 months postdelivery. At enrollment, 59% had disclosed to their partners and 42% to others. This rose to 67% and 59%, respectively, by follow-up. Logistic regression analysis identified being married (adjusted odds Ratio [AOR] 2.32; 95% confidence interval [CI] 1.20-4.47), prior discussion about testing (AOR 4.19; CI 2.34-7.49), having a partner with tertiary education (AOR 2.76; CI 1.29-5.88) and less experience of violence (AOR 0.48; CI 0.24-0.97) as factors associated with having disclosed to partners prior to enrollment. Better housing (AOR 1.26; CI 1.06-1.49), less financial dependence on partners (AOR 0.46; CI 0.25-0.85), and knowing someone with HIV (AOR 2.13; CI 1.20-3.76) were associated with prior disclosure to others. Increased levels of stigma at baseline decreased the likelihood of disclosure to partners postenrollment (AOR 0.91; CI 0.84-0.98) and increased levels of avoidant coping decreased subsequent disclosure to others (AOR 0.84; CI 0.72-0.97). These results provide understanding of disclosure for women diagnosed as HIV positive in pregnancy, and identify variables that could be used to screen for women who require help.
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PMID:Factors affecting disclosure in South African HIV-positive pregnant women. 1902 85

Telephone surveys with national probability samples of English-speaking adults have suggested that popular support for punitive policies toward people living with HIV/AIDS (PLWHA) declined in the 1990s, but AIDS-related stigma persists in the United States. Our aim was to assess the prevalence and impact of AIDS-related stigma in non-Hispanic Black and Hispanic communities. A cross-sectional computer-assisted telephone-interview survey was conducted in summer 2003 with African-American, Afro-Caribbean, Haitian, and Hispanic 18-39 year-old residents of 12 high AIDS-incidence areas in Broward County, Florida. Stigma items were adopted from national surveys, but interviews were conducted in Spanish and Haitian Creole as well as in English. Stigma scores were higher than those reported for national samples, especially among Haitians interviewed in Creole. AIDS-related stigma was associated with never receiving an HIV-antibody test (adjusted odds ratio [AOR] = 0.78, 95% confidence interval [CI]: 0.62-0.99, P = .046), an elevated perception of HIV risk (AOR = 1.32, 95% CI: 1.01-1.73, P = .045) and a failure to participate in HIV-prevention efforts (AOR = 0.53, 95% CI: 0.34-0.85, P = .008). Interventions are needed to mitigate the pernicious effects of AIDS-related stigma.
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PMID:AIDS-related stigma among Black and Hispanic young adults. 1968 Aug

Timely diagnosis of HIV is essential to improve survival rates and reduce transmission of the virus. Insufficient progress has been made in effecting earlier HIV diagnoses. The Mexican border city of Tijuana has one of the highest AIDS incidence and mortality rates in all of Mexico. This study examined the prevalence and potential correlates of late HIV testing in Tijuana, Mexico. Late testers were defined as participants who had at least one of: (1) an AIDS-defining illness within 1 year of first positive HIV test; (2) a date of AIDS diagnosis within 1 year of first positive HIV test; or (3) an initial CD4 cell count below 200 cells per microliter within 1 year of first positive HIV test. Medical charts of 670 HIV-positive patients from two HIV/AIDS public clinics in Tijuana were reviewed and abstracted; 362 of these patients were interviewed using a cross-sectional survey. Using multivariate logistic regression, we explored potential correlates of late HIV testing based on the Behavioral Ecological Model. From 342 participants for whom late testing could be determined, the prevalence of late testing was 43.2%. Multivariate logistic regression results (n = 275) revealed five significant correlates of late testing: "I preferred not to know I had HIV" (adjusted odds ratio [AOR] = 2.78, 1.46-5.31); clinic (AOR = 1.90, 1.06-3.41); exposure to peers engaging in high-risk sexual behavior (AOR = 1.14, 1.02-1.27); stigma regarding HIV-infected individuals (AOR = 0.65, 0.47-0.92); and stigma regarding HIV testing (AOR = 0.66, 0.45-0.97). These findings may inform the design of interventions to increase timely HIV testing and help reduce HIV transmission in the community at large.
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PMID:Determinants and prevalence of late HIV testing in Tijuana, Mexico. 2043 74

HIV-infected prisoners face an inordinate number of community re-entry challenges. In 2007, 102 HIV-infected prisoners in Malaysia were surveyed anonymously within six months prior to release to assess the prevalence and correlates of community re-entry challenges. Staying out of prison (60.8%), remaining off drugs (39.2%), finding employment (35.3%) and obtaining HIV care (32.4%) were the re-entry challenges reported most frequently. Global stigma, negative self-image and public attitudes-related stigma were independently associated with challenges to obtaining HIV care. In multivariate analyses, those with previous incarcerations (adjusted odds ratio [AOR], 3.2; 95% confidence interval [CI], 1.4-7.6), higher HIV-related symptoms (AOR, 2.0; 95% CI, 1.0-4.1) and higher public attitudes-related stigma (AOR, 2.5; 95% CI, 1.2-5.1) had a significantly higher likelihood of identifying more re-entry challenges. Targeted interventions, such as effective drug treatment, HIV care and public awareness campaigns, are crucial for stemming the HIV epidemic and improving health outcomes among HIV-infected prisoners in Malaysia.
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PMID:Prevalence and correlates of community re-entry challenges faced by HIV-infected male prisoners in Malaysia. 2060 22

The objective of this study is to investigate workers' perceptions of HIV testing in the workplace in Indonesia. In a cross-sectional study, we used a self-administered questionnaire in Surabaya, Indonesia. A convenient sample of 536 workers was chosen from two factories with similar sample characteristics from March through June 2008. Of these workers, 433 (response rate: 80.8%) answered questions about their willingness to undergo HIV testing. More than 40% of workers were willing to undergo HIV testing. Not knowing where to get tested (adjusted odds ratio [AOR] = 0.40, confidence interval [CI] = 0.18-0.89) and not feeling the need to be tested for HIV (AOR = 0.02, CI = 0.01-0.04) were negatively associated with willingness to undergo HIV testing. HIV prevention in the workplace needs to reach out to individuals who are not willing to undergo HIV testing - workers unaware of where to get tested for HIV and not feeling the need to get tested - through education, information, and communication in the workplace in light of the stigma and discrimination associated with HIV. High-impact voluntary counseling and testing (VCT) strategies need to be quickly developed to improve HIV prevention and access to care in the workplace.
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PMID:Willingness to undergo HIV testing among factory workers in Surabaya, Indonesia. 2154 54

With significant reductions in AIDS-related morbidity and mortality, HIV is increasingly viewed as a chronic condition. However, people on antiretroviral therapy (ART) are experiencing new challenges such as metabolic and morphological body changes, which may affect self-perceived body image. The concept of body image is complex and encompasses an individual's perception of their existential self, physical self and social interpretation of their body by others. The Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) cohort is a prospective study of HIV-positive persons on ART. An interviewer-administered survey collects socio-demographic and health information including body image, stigma, depression, food insecurity, and quality of life (QoL). In bivariate analyses, Chi-squared or Wilcoxon rank sum tests were used to compare individuals reporting positive body image with those reporting negative body image. Multivariate logistic regression was used to examine associations between negative body image and covariates. Of 451 LISA participants, 47% reported negative body image. The adjusted multivariate analysis showed participants who reported high stigma in the presence of depressive symptoms were more likely to have negative body image compared to people reporting low stigma and no depressive symptoms (adjusted odds ratio [AOR]: 2.41, confidence interval [CI]: 1.24-4.68). The estimated probability of a person having positive body image without stigma or depression was 68%. When stigma alone was included, the probability dropped to 59%, and when depression was included alone the probability dropped to 34%. Depressive symptoms and high stigma combined resulted in a probability of reporting positive body image of 27%. Further efforts are needed to address body image among people living with HIV. In order to lessen the impacts of depression on body image, such issues must be addressed in health care settings. Community interventions are also needed to address stigma and negative body image to improve the lives of people living with HIV.
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PMID:"The way I see it": the effect of stigma and depression on self-perceived body image among HIV-positive individuals on treatment in British Columbia, Canada. 2176 9

Arts-based programs have improved HIV-related knowledge, attitudes, and behavior in general and at-risk populations. With HIV transformed into a chronic condition, this study compares patients at consecutive stages of receiving antiretroviral treatment, coinciding with exposure to a radio-and-theater-based educational program (unexposed [N = 120], just exposed [N = 77], Exposed a month ago [N = 60]). Exposure was associated with significantly higher HIV-related knowledge (15-20%, all p < .01), lower levels of stigma (2-7% lower, all p < .10), and over four times the adjusted odds of asking doctors questions about HIV (p = .07). Higher dose of exposure was associated with lower felt stigma (28% reduction per message recalled), greater odds of consistent condom use (adjusted odds ratio [AOR]: 1.12, p = .01), doctor-patient communication (AOR: 1.20, p = .003), peer advice-giving (AOR: 1.18, p = .03) and HIV-related advocacy (AOR: 2.35, p = .07). Similar partnerships between arts-based nongovernmental organizations and government hospitals may improve patient outcomes in HIV treatment settings.
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PMID:Knowledge, stigma, and behavioral outcomes among antiretroviral therapy patients exposed to Nalamdana's radio and theater program in Tamil Nadu, India. 2186 9

Timely treatment of HIV infection is a public health priority, yet many HIV-positive persons delay treatment initiation. We conducted a community-based study comparing HIV-positive persons who received an HIV diagnosis at least 3 months ago but had not initiated care (n=100) with a reference population of HIV-positive persons currently in care (n=115) to identify potential barriers to treatment initiation. Study participants were mostly male (78.0%), and persons of color (54.9% Latino, 26.3% black), with median age 37.8 years. Median time since HIV diagnosis was 3.7 years. Univariate analysis revealed that those never in care differed substantially from those currently in care with regard to sociodemographics; HIV testing and counseling experiences; perceived barriers to care; and knowledge, attitudes, and beliefs regarding HIV. Factors independently associated with never initiating HIV care were younger age (adjusted odds ratio [AOR]=0.93; 95% confidence interval [CI]: 0.88, 0.99), shorter time since diagnosis (AOR=0.87; 95% CI: 0.77, 0.98), lacking insurance (AOR=0.11; 95% CI: 0.03, 0.35), not knowing someone with HIV/AIDS (AOR=0.09; 95% CI: 0.03, 0.30) not disclosing HIV status (AOR=0.13; 95% CI: 0.02, 0.70), not receiving help making an HIV care appointment after diagnosis (AOR=0.04; 95% CI: 0.01, 0.14), and not wanting to think about being HIV positive (AOR=3.57; 95% CI: 1.22, 10.46). Our findings suggest that isolation and stigma remain significant barriers to initiating HIV care in populations consisting primarily of persons of color, and that direct linkages to HIV care at the time of diagnosis are critical to promoting timely care initiation in these populations.
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PMID:A community-based study of barriers to HIV care initiation. 2195 75

A better exploration of factors associated with sexual compulsivity (SC) among various subpopulations may help to explain its etiology, development, and course, as well as provide implications for treatment. Criticisms of SC highlight the need to have a better understanding of SC that takes into account both behavioral and psychosocial variables such as stigma, particularly stigma related to sexual orientation and HIV status. The purpose of this study was to investigate the association of SC with sexual behavior and stigma in a sample of HIV-positive gay and bisexual men. A cross-sectional, street-intercept method was adapted to survey a sample of 127 HIV-positive gay and bisexual males at two large-scale LGBT community events in the fall of 2008 and spring of 2009. We found that the number of recent male sexual partners (AOR = 1.05) and internalized HIV stigma (AOR = 8.20) were significantly associated with SC symptomology, while internalized homonegativity and interpersonal HIV stigma were not. These findings contradict many prominent criticisms of SC while highlighting the need to better understand the mechanisms related to the development of SC symptomology and the potential role stigma may have for the psychosexual well-being of HIV-positive gay and bisexual men.
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PMID:Stigma and sexual compulsivity in a community-based sample of HIV-positive gay and bisexual men. 2196 77


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