Christine Tagliaferri Rael

Identifying Strategies to Cope with HIV-Related Stigma in a Group of Women Living with HIV/AIDS in the Dominican Republic: A Qualitative Study

Internalized HIV-related stigma negatively impacts the mental and physical health of women living with HIV/AIDS (WLWHA). Yet, some women can successfully confront stigma. The present work uses qualitative methods to investigate the successful stigma coping strategies displayed by 19 WLWHA who reported the least internalized stigma possible on the Internalized AIDS-Related Stigma Scale out of a larger pool of 233 WLWHA in San Felipe de Puerto Plata, Dominican Republic. Such strategies included, HIV disclosure control; preemptive disclosure of HIV-status; educating oneself/others about HIV; viewing HIV as a manageable condition; and looking to family, friends and partners for support. Our findings add to current knowledge about how WLWHA successfully manage internalized stigma, particularly in the context of the Dominican Republic. Clinicians should work closely with WLWHA to counsel them about the stigma coping strategies that best fit their life context.

Depression and key associated factors in female sex workers and women living with HIV/AIDS in the Dominican Republic:

Little is known about the mental health of female sex workers and women living with HIV/AIDS in the Dominican Republic, which impedes HIV prevention, testing, and treatment. This project estimates the prevalence of depression and identifies key contributing factors to this outcome in female sex workers, women living with HIV/AIDS, and a comparison group. Participants were female sex workers (N = 349), women living with HIV/AIDS (N = 213), and a comparison group of HIV-negative women who were not sex workers (N = 314) from the Dominican Republic. Participants completed questionnaires assessing demographic characteristics and depression. Female sex workers and women living with HIV/AIDS completed additional questionnaires ascertaining HIV or sex work-related internalized stigma. Depression was prevalent among female sex workers (70.2%), women living with HIV/AIDS (81.1%), and the comparison group (52.2%). Adjusted logistic regressions showed that internalized stigma was associated with depression for female sex workers (OR = 2.73; 95% CI = 1.95–3.84) and women living with HIV/AIDS (OR = 3.06; 95% CI = 1.86–5.05). Permanent income was associated with this outcome for female sex workers (OR = 0.08; 95% CI = 0.01–0.80) and the comparison group (OR = 0.04; 95% CI = 0.00–0.45).

Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City

Transgender women may face a disparate risk for HIV/AIDS compared to other groups. In 2012, Truvada was approved for daily use as HIV pre-exposure prophylaxis (PrEP). However, there is a dearth of research about barriers and facilitators to PrEP in transgender women. This paper will shed light on transgender women living in New York City’s perceived and actual challenges to using PrEP and potential strategies to overcome them. After completing an initial screening process, four 90-min focus groups were completed with n = 18 transgender women. Participants were asked what they like and dislike about PrEP. Participants identified the following barriers: uncomfortable side effects, difficulty taking pills, stigma, exclusion of transgender women in advertising, and lack of research on transgender women and PrEP. Facilitators included: reducing pill size, increasing the types of available HIV prevention products, and conducting scientific studies to evaluate PrEP in transgender women.

HIV Status Disclosure Among Postpartum Women in Zambia with Varied Intimate Partner Violence Experiences

HIV-positive pregnant and postpartum women’s status disclosure to male sexual partners is associated with improved HIV and maternal and child health outcomes. Yet, status disclosure remains a challenge for many women living with HIV in sub-Saharan Africa, particularly those who are fearful of violence. The objective of the present study is to advance the current understanding of the relationship between intimate partner violence against women and their HIV status disclosure behaviors. We specifically evaluate how the severity, frequency, and type of violence against postpartum HIV-positive women affect status disclosure within married/cohabiting couples. A cross-sectional survey was administered by trained local research assistants to 320 HIV-positive postpartum women attending a large public health center for pediatric immunizations in Lusaka, Zambia. Survey data captured women’s self-reports of various forms of intimate partner violence and whether they disclosed their HIV status to the current male partner. Multiple logistic regression models determined the odds of status disclosure by the severity, frequency, and type of violence women experienced. Our findings indicate a negative dose–response relationship between the severity and frequency of intimate partner violence and status disclosure to male partners. Physical violence has a more pronounced affect on status disclosure than sexual or emotional violence. Safe options for women living with HIV who experience intimate partner violence, particularly severe and frequent physical violence, are urgently needed. This includes HIV counselors’ ability to evaluate the pros and cons of status disclosure among women and support some women’s decisions not to disclose.

Understanding internalized HIV/AIDS-related stigmas in the Dominican Republic: a short report

ABSTRACT HIV/AIDS-related stigmas can become internalized, resulting in declines in physical and mental health. Pathways to internalized HIV-related stigma (IS), characterized by persistently negative, self-abasing thoughts, are not well established among women living with HIV/AIDS (WLWHA) in the Dominican Republic (DR). Identifying factors involved in self-directed shaming and blaming is important, given the high HIV prevalence in the DRs most vulnerable populations. The present study sheds light on factors involved in negative and self-abasing thoughts in WLWHA in the DR by examining the relationship between depression, perceived HIV-related stigma from the community (PSC), perceived HIV-related stigma from family (PSF), and IS. The Internalized AIDS-Related Stigma Scale (IA-RSS), the Center for Epidemiologic Studies Short Depression Scale (CES-D 10), and an instrument designed to measure perceived HIV-related stigma from the community and family was administered to 233 WLWHA in Puerto Plata, DR. Data were analyzed using descriptive statistics and ordered multiple logistic regression. Results showed that depression (OR = 1.60; p < .05), PSC (OR = 3.68; p < .001), and PSF (OR = 1.60; p < .01) were positively associated with IS. These findings indicate that IS-reducing interventions should address HIV-related depression. Additionally, HIV-related treatment and care services should work with WLWHA to adopt healthier attitudes about how community members view people living with HIV/AIDS in the DR.

Factors Supporting and Hindering Adherence to Rectal Microbicide Gel Use with Receptive Anal Intercourse in a Phase 2 Trial

Adherence to product use in biomedical HIV prevention trials is essential to success. In MTN-017, a Phase 2 rectal microbicide gel trial, participants discussed applicator-inserted gel use in the context of receptive anal intercourse (RAI) with adherence counselors. We analyzed counseling session data to identify barriers to and facilitators of gel use for 26 participants in the United States who used gel with RAI as their first of three study regimens. The most common barriers were finding the gel application process cumbersome, physical discomfort after applying gel, difficulty with BAT-24 dosage regimen, and negative effects of gel on sex. The most common facilitators were incorporating gel use into routines, using gel in anticipation of sex, carrying gel when going out, reminders received via short message service, and ease of gel use. These findings can inform product development and future adherence counseling interventions for rectal gel trials to improve adherence outcomes.ResumenLa adherencia al uso de los productos en los ensayos biomédicos de prevención del VIH es esencial. En MTN-017, un ensayo fase 2 de un gel microbicida por vía rectal, los participantes hablaron con consejeros de adherencia sobre el uso de un gel insertado con un aplicador en el contexto del sexo anal receptivo (SAR). Analizamos las sesiones de consejería para identificar tanto las barreras como los facilitadores del uso del gel para 26 participantes en los Estados Unidos, quienes usaron el gel con SAR durante el primero de tres regímenes para el estudio. Las barreras más comunes fueron: encontrar que el proceso de aplicar el gel fue difícil; sentir molestías después de aplicar el gel; tener dificultad con el régimen de dósis BAT-24; y percebir efectos negativos del gel sobre el sexo. Los facilitadores más comunes fueron: incorporar el uso del gel en las rutinas; usar el gel con anticipación antes del sexo; llevar el gel consigo al salir; recibir mensajes de texto como recordatorios; y sentir que el uso del gel fue fácil. Estos resultados pueden informar tanto el desarrollo del producto como las intervenciones de consejería de adherencia para ensayos de un gel rectal en el futuro.

Examining the Unique Characteristics of a Non-Probability Sample of Undocumented Female Sex Workers with Dependent Children: The Case of Haitians in the Dominican Republic

Haitians in the Dominican Republic (DR) are increasingly marginalized due to recent legislation that stripped Haitian-Dominicans of their citizenship and increased Haitian migrants’ deportation risk. Haitian female sex workers (FSWs) are particularly vulnerable, though little is known about them. This study will help public health efforts targeted at sex workers to better reach Haitian FSWs and address their needs by identifying a profile of characteristics unique to this group compared to Dominican FSWs. Data were collected in 2014 among Haitian and Dominican FSWs in Puerto Plata, DR. Surveys assessed respondents’ demographics, health consciousness, depression, and stigma. Adjusted logistic regressions showed that Haitian FSWs were disadvantaged: they had significantly lower rates of education, more children, and less permanent income. Furthermore, Haitian FSWs were more likely to work independently and for fewer hours. Interestingly, Haitian FSWs internalized less stigma than Dominicans. Though we can only speculate, this could be due to migration for sex work, or the lack of formal employment for Haitians. Initiatives to alleviate poverty, create formal jobs, and overturn discriminatory legislation may have the most impact for Haitian FSWs.

Validation of the Minority Stress Scale among Italian gay and bisexual men.

The experience of sexual orientation stigma (e.g., homophobic discrimination and physical aggression) generates minority stress, a chronic form of psychosocial stress. Minority stress has been shown to have a negative effect on gay and bisexual men’s (GBM’s) mental and physical health, increasing the rates of depression, suicidal ideation, and HIV risk behaviors. In conservative religious settings, such as Italy, sexual orientation stigma can be more frequently and/or more intensively experienced. However, minority stress among Italian GBM remains understudied. The aim of this study was to explore the dimensionality, internal reliability, and convergent validity of the Minority Stress Scale (MSS), a comprehensive instrument designed to assess the manifestations of sexual orientation stigma. The MSS consists of 50 items assessing (a) Structural Stigma, (b) Enacted Stigma, (c) Expectations of Discrimination, (d) Sexual Orientation Concealment, (e) Internalized Homophobia Toward Others, (f) Internalized Homophobia toward Oneself, and (g) Stigma Awareness. We recruited an online sample of 451 Italian GBM to take the MSS. We tested convergent validity using the Perceived Stress Questionnaire. Through exploratory factor analysis, we extracted the 7 theoretical factors and an additional 3-item factor assessing Expectations of Discrimination From Family Members. The MSS factors showed good internal reliability (ordinal &agr; > .81) and good convergent validity. Our scale can be suitable for applications in research settings, psychosocial interventions, and, potentially, in clinical practice. Future studies will be conducted to further investigate the properties of the MSS, exploring the association with additional health-related measures (e.g., depressive symptoms and anxiety). L’esperienza dello stigma sessuale (ad esempio, discriminazione e aggressioni fisiche) genera stress da minoranza (minority stress), una forma di stress psicosociale cronico. Lo stress da minoranza ha un effetto negativo sulla salute mentale e fisica dei gay e uomini bisessuali (GUB) ed è una delle cause degli elevati tassi di depressione, ideazioni suicidarie e comportamenti sessuali a rischio di HIV. In ambienti religiosi e conservativi come l’Italia, l’esperienza dello stigma sessuale può essere più frequente e intenso. Nonostante ciò, lo stress da minoranza fra i GUB italiani rimane poco investigato. Lo scopo di questo studio era di esaminare la dimensionalità, l’attendibilità interna, e la validità convergente del Minority Stress Scale (MSS), uno strumento Italiano in grado di misurare le manifestazioni dello stigma sessuale. L’MSS è composto da 50 item che misurano (a) lo Stigma Strutturale, (b) lo Stigma Manifesto, (c) le Aspettative di Essere Discriminato, (d) l’Occultamento dell’Orientamento Sessuale, (e) l’Omofobia Interiorizzata Diretta Verso gli Altri, (f) l’Omofobia Interiorizzata Diretta Verso Se Stessi, e (g) la Consapevolezza dello Stigma. Abbiamo reclutato un campione di 451 GUB Italiani online che hanno compilato l’MSS. La validità convergente è stata valutata utilizzando il Perceived Stress Questionnaire. Attraverso l’analisi fattoriale esplorativa, abbiamo estratto sette fattori teorici e un fattore aggiuntivo composto da 3-item “Aspettative di Discriminazione dai propri Familiari.” I fattori del MSS hanno dimostrato una buona attendibilità interna (ordinal &agr; > .81) e una buona validità convergente. La nostra scala può essere utilizzata nell’ambito della ricerca, interventi psicosociali e, potenzialmente, nella pratica clinica. Ulteriori studi verranno condotti per valutare le proprietà psicometriche dell’MSS come l’associazione con altri fattori legati alla salute (ad esempio, sintomi depressivi e ansia).