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Query: UMLS:C0277787 (stigma)
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The portrait of HIV-affected children and youth that emerges from this policy overview is still one of children obscured from view by the shadow of their parents' and siblings' illness and policies that only address the needs of HIV-infected individuals. In addition, the secrecy and stigma that still surround HIV and AIDS make it difficult for HIV-affected children and youth to benefit as fully as they might from policies and programs that provide more generic types of care and assistance. Our failure as a nation to better illuminate the plight of HIV-affected children and youth can only leave us with a generation of children who are at greater risk of psychiatric illness, involvement with the criminal justice system, substance abuse, and contracting HIV. To avoid these consequences, both public and private sectors must place the spotlight on the development of new policies and programs designed to specifically meet their needs. Because the solutions defy traditional disciplinary and administrative boundaries, we also need to become more skilled at interagency planning and collaboration. No one system alone can be responsive to the many social, mental health, legal, and support needs of these children and their caretakers. More specifically, recommendations for improved systems of care to HIV-affected children, youth, and their families are as follows: To promote and fund cross-disciplinary initiatives among agencies that administer child welfare services, income supports, AIDS care, and children's mental health services at the national, state, and local levels to specifically meet the mental health, psychosocial, and permanency planning needs of HIV-affected children and youth. To provide training opportunities for Ryan White Title I, II, and III case managers on assessing the needs of HIV-affected children and youth, developmental theories and concepts, principles of family-centered care, and child welfare issues. To increase funding of the Ryan White CARE Act to permit a more family-centered approach to care across Titles. To establish clearer guidelines for establishing a proportional basis for funding services to infants, children, and women under the Ryan White CARE Act. To support legislative, educational, and advocacy efforts to make managed care and welfare reform more responsive to the needs of HIV-affected children, youth, and their families. To encourage states to provide additional funding for mental health services specifically targeted to HIV-affected children and youth that are sufficiently flexible and of a long enough duration to adequately meet their needs. Surely, as we move into a new millennium with the capacity to map the human genome and clearly view distant galaxies, we should be able to marshal the will and resources necessary to formulate a sufficiently focused effort to respond compassionately and effectively to the needs of a generation of AIDS-affected children and youth.
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PMID:National and state policies influencing the care of children affected by AIDS. 1076 76

Stigma is a social devaluation of a person because of personal attribute leading to an experience of sense of shame, disgrace and social isolation. The nature of stigma in schizophrenia and its relationship to attribution was studied in one hundred and fifty-nine urban patients of Madras, India who fulfilled DSM-IV criteria for schizophrenia. The response of the primary care givers to fourteen questions on stigma and 14 on what they thought attributed to the illness was elicited. Based on the mean stigma score, the entire sample was divided into two groups- those with high and low stigma. Marriage, fear of rejection by neighbour, and the need to hide the fact from others were some of the more stigmatising aspects. Many care givers reported feelings of depression and sorrow. Discriminant function analysis showed that female sex of the patient and a younger age of both patient and caregiver were related to higher stigma. Among attribution items, having no explanation to offer, and attributions to faulty biological functioning, character of life style, substance abuse and intimate interpersonal relationship discriminated between the two groups. The relevance of stigma in the cultural context is described.
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PMID:How stigmatising is schizophrenia in India? 1095 Mar 61

Suicide and suicide attempts occur at a significantly greater rate in schizophrenia than in the general population. Common estimates are that 10% of people with schizophrenia will eventually have a completed suicide, and that attempts are made at two to five times that rate. Demographically associated with suicidality in schizophrenia are being young, being early in the course of the illness, being male, coming from a high socioeconomic family background, having high intelligence, having high expectations, not being married, lacking social supports, having awareness of symptoms, and being recently discharged from the hospital. Also associated are reduced self-esteem, stigma, recent loss or stress, hopelessness, isolation, treatment non-compliance and substance abuse. Clinically, the most common correlates of suicidality in schizophrenia are depressive symptoms and the depressive syndrome, although severe psychotic and panic-like symptoms may contribute as well. This review specifically explores the issue of depression in schizophrenia, in relation to suicide, by organizing the differential diagnosis of this state and highlighting their potentially treatable or correctable causes. This differential diagnosis includes both acute and chronic disappointment reactions, the prodrome of an acute psychotic episode, neuroleptic induced akinesia and akathisia, the possibility of direct neuroleptic-induced depression, negative symptoms of schizophrenia, and the possible co-occurrence of an independent depressive diathesis. The potential beneficial roles of 'atypical' antipsychotic agents, including both clozapine and more novel agents, and adjunctive treatment with other psychopharmacological medications are considered, and the important roles of psychosocial factors and interventions are recognized.
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PMID:Suicide and schizophrenia. 1144 86

Employment status is commonly used as a sign of stability in recovery and an outcome variable for substance abuse treatment and research. However, there has been little attention in the literature on the topic of work for the dually diagnosed (i.e., persons diagnosed with both substance use and mental health disorders). Data collected in 1999 are presented on expressed interest in and perceived barriers to pursuing work and on the utilization of vocational rehabilitation (voc-rehab) services among unemployed members of a dual recovery self-help fellowship (N= 130). While members generally expressed high interest in working, they also cited multiple obstacles to attaining and maintaining employment. A path model was specified and tested. Significant contributors to interest in working were substance use status and physical health rating. Consistent with our hypotheses, mental health symptoms and greater perceived obstacles (e.g., stigma, fear of failure, and insufficient skills) were significant contributors to perceived difficulty in pursuing work, whereas substance use, physical health, and recency of employment were not. Finally, those who perceived less difficulty in pursuing work were more likely to utilize voc-rehab services, and men were more likely than women to use these facilities; interest in work was not significantly associated with utilizing voc-rehab services. The roles of mental health disorders and substance use in relation to pursuit of employment are discussed, as well as that of perceived obstacles such as stigma. The paper addresses the setting of realistic vocational goals and possible strategies to mitigate barriers to increased employment of dually diagnosed individuals.
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PMID:Interest in and obstacles to pursuing work among unemployed dually diagnosed individuals. 1186 73

Despite advances in the pharmaceutical treatment of HIV disease, there are still an increasing number of people living with the disease, and an increasing number of children and adolescents are personally affected by the epidemic. The psychological effects on these children are significant and relate not only to a parent's degree of illness and the threat of death but also to the association of the disease with substance abuse and the pervasive effects of the stigma that surround it. To intervene optimally on behalf of these children, programs must be multidisciplinary and take a holistic approach to address specific social and psychological issues and ensure stability in a child's care giving.
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PMID:Psychological aspects of HIV infection in children. 1291 Aug 16

People living with addiction endure many hardships, and this may be especially true for women who face distinct clinical and significant psychologic and socioeconomic repercussions of addictive disorders and their companion stresses. Clinicians who work with women with addictions are confronted by many challenges, particularly in the care of pregnant and parenting women. The dilemmas faced by patients with addictions and their providers often arise directly from tensions among core ethical principles, from inconsistencies in the way these principles are applied, and from the pervasive effects of stigma. Although difficult issues are to be expected in the arena of substance abuse treatment, consideration of principles of voluntarism, beneficence, respect for persons and justice, confidentiality and truth-telling, and informed consent are invaluable in shaping clinical ethical decision making. Furthermore, proactive steps can be taken to enhance the ethical caliber of care. These steps involve policy-level and systemic actions, such as the development and expansion of programs serving women's unique needs, empiric research into the most effective treatments for women with various disorders, and reexamination of legal and societal stances toward pregnant and parenting women who have addictions. In addition, local and individual steps are needed, including addressing gaps or inherent biases in programs, training counselors and clinicians in effective strategies or counseling styles, and developing awareness of one's own attitudes when dealing with difficult patients and challenging disorders. Such efforts will help ensure that women who have addictions will be cared for in a manner that is respectful, beneficent, compassionate, honest, and just.
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PMID:Ethical considerations in caring for women with substance use disorders. 1466 27

Attitudes toward problem gambling treatment were investigated in a telephone survey of 1,203 persons in Central Queensland Australia (598 women and 605 men, mean age = 45.8 years). Survey items were compiled from existing substance abuse questionnaires (Center on Alcoholism, Substance Abuse and Addictions, 1995; Sobell et al., 1991). An exploratory factor analysis identified five potential barriers to treatment, including: availability, stigma, cost, uncertainty, and avoidance. Relative to those with few problems, respondents who had numerous gambling problems were more concerned about treatment costs, and the availability and effectiveness of treatment. In addition to the above concerns, older persons more often negatively judged the treatment seeker. In contrast, educated respondents had generally more positive attitudes towards problem gamblers and treatment seeking.
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PMID:Factor analysis of barriers to treatment for problem gambling. 1506 Mar 29

Many individuals newly infected with HIV struggle with psychosocial influences, such as poverty, stigma, depression, substance abuse, domestic violence, and/or cultural beliefs, which can affect their quality of life (QoL), willingness to seek medical care, and motivation to adhere to therapy, ultimately influencing health outcomes. The Health Resources and Services Administration established the Ryan White Care Act (RWCA) to provide health care to people living with HIV/AIDS (PLWH). Part F of the RWCA, the Special Projects of National Significance (SPNS) Program, focuses on identifying issues affecting care for PLWH. One cohort of SPNS grantees has identified numerous needs and vulnerabilities of underserved HIV-infected patients and supports the development of innovative HIV/AIDS ancillary services for them. In this article, a review of the underlying psychosocial sequelae of HIV infection and their impact on QoL is presented, and recommendations for providers to assist in improving the QoL of PLWH are discussed.
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PMID:Quality of life in the HIV-positive patient: implications and consequences. 1558 5

People living with HIV/AIDS who have both a co-occurring mental health diagnosis and a substance use disorder (individuals with triple diagnoses) frequently do not receive adequate treatment for one or more of their illnesses. Poverty, risky behaviours, vacillating motivation, and cognitive impairments are additional problems facing many individuals with triple diagnoses. In many communities the service system is inadequately prepared to serve this population. Treatment barriers include stigma associated with the three illnesses, separate funding streams, and lack of co-ordination between medical, mental health, and substance abuse treatment facilities. This paper discusses strategies for recruiting, engaging, and retaining individuals with triple diagnoses in both treatment and research. Recruitment strategies should be directed at both professionals and individuals with triple diagnoses themselves. Recruiting and engaging these individuals in treatment requires that comprehensive services be provided on a 24-hour basis in a flexible and culturally competent manner. A team approach is often the most effective way of providing such services. Retaining individuals with triple diagnoses in a longitudinal research study requires multiple strategies including the collection of detailed tracking information, outreach workers, and financial incentives for completing the interviews.
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PMID:Recruitment, engagement, and retention of people living with HIV and co-occurring mental health and substance use disorders. 1573 22

Despite their huge health toll, substance abuse disorders remain underappreciated and underfunded. Reasons include stigma, tolerance of personal choices, acceptance of youthful experimentation, pessimism about treatment efficacy, fragmented and weak leadership, powerful tobacco and alcohol industries, underinvestment in research, and difficult patients. Positive signs include declining prevalence rates, successful counter-marketing campaigns, changing public attitudes, new scientific discoveries that could yield new treatments, and effective new organizations. Further progress will require better treatment, more research, better education of health professionals, more nongovernmental support, and stronger leadership. Policy changes regarding each of the three substance groups are indicated, as are reforms in the criminal justice and educational systems.
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PMID:An agenda to combat substance abuse. 1601 40


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