The causes and consequences of HIV-related enacted and internalized stigma: a comment on Takada et al.
The causes and consequences of HIV-related enacted and internalized stigma: a comment on Takada et al.
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DOI：
10.1007/s12160-014-9620-0
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发表时间：
2014-08
影响因子：
3.8
通讯作者：
Kalichman, Seth C.
中科院分区：
文献类型：
--
作者：
Kalichman, Seth C.
与全球艾滋病毒/艾滋病危机同时发生的是对艾滋病的污名化。偏见、歧视和社会孤立是由污名化的信仰驱动的，对艾滋病毒感染者的生活产生不利影响，并助长病毒的传播。艾滋病毒作为一种污名化疾病的社会建构和心理表征为艾滋病毒检测、保护性行为、治疗获取、药物依从性和疾病管理创造了障碍。对歧视和排斥的恐惧导致人们隐瞒自己的艾滋病毒感染状况，即使不披露是有压力的、非法的或使他人处于危险之中。耻辱感从被诊断者延伸到他们的社会社区、网络和亲密关系，加剧了艾滋病的负担。就对全球卫生的影响而言，艾滋病污名化的程度和后果是前所未有的。然而，除了欧文·戈夫曼（Erving Goffman）最早提出的耻辱感理论之外，几乎没有概念模型可以解释与艾滋病相关的耻辱感的社会过程，这一理论早在第一例艾滋病感染病例出现之前的100多年就提出了。缺乏研究艾滋病毒相关耻辱的当代模型也阻碍了研究设计和方法的创新。自艾滋病的第一次行为研究和Goffman的开创性工作以来已有30多年，直到现在，我们才看到与艾滋病相关的耻辱研究中出现了新的想法、新的模型和突破性的方法[3-5]。在本期中，Takada等人发表了一项来自乌干达艾滋病毒感染者队列的研究结果，证明了歧视经历或制定的耻辱与艾滋病毒感染者关系中获得的情感和工具支持之间的时间关联。Takada等人还报告说，缺乏工具支持与随后发生的病耻感增加有关。此外，当艾滋病毒感染者接受社会持有的污名化信念或内化污名时，他们的情感支持就会减少。内化污名与情绪支持之间的相互决定关系令人想起抑郁与社会支持之间的动态过程。然而，这些关系以前没有在与艾滋病毒相关的耻辱方面进行过测试。事实上，就任何健康状况而言，很少有关于耻辱经历与社会支持之间关系的纵向研究。因此，艾滋病毒感染者国际化耻辱的社会和关系后果可能反映了抑郁和社会支持的既定互惠关系，并可能推广到其他耻辱性疾病。虽然在概念上不同，但内化的耻辱和抑郁有一些重要的共同特征，包括自嘲、羞耻和社会关系的减少。Takada等人提供了内化耻辱的潜在机制的证据，这可能与抑郁症共有。这一重要发现推动了我们对精神健康、情绪调节和应对污名化患者的理解。除了概念上的贡献外，Takada等人还利用了时间滞后模型，探讨了与hiv相关的污名的制定和内化维度与情感和工具性社会支持之间的因果关系。这种前所未有的测量精度与数据分析策略相结合，为迄今为止一直处于猜测状态的问题提供了答案。现在经验验证的耻辱、社会支持和适应之间的相互关系必须转化为……
Alongside of the global HIV/AIDS crisis runs a parallel pandemic of AIDS stigma. Prejudice, discrimination, and social isolation are driven by stigmatizing beliefs, adversely impact the lives of people living with HIV infection, and propagate the spread of the virus. The social construction and mental representations of HIV as a stigmatized condition create barriers to HIV testing, protective behaviors, treatment access, medication adherence, and disease management. Fears of discrimination and rejection stemming from stigma lead people to conceal their HIV status, even when non-disclosure is stressful, illegal, or places others at risk [1]. Stigmas extend beyond the diagnosed person to their social communities, networks, and close relationships, contributing to the burden of AIDS. The extent and ramifications of AIDS stigma are unprecedented in terms of impact on global health. And yet, there are few conceptual models to explain the social processes of HIV-related stigma that extend beyond the earliest theory of stigma offered by Erving Goffman [2] decades before the first cases of HIV infection. The lack of contemporary models for studying HIV-related stigma has also stymied innovation in research design and methodology. More than 30 years since the first behavioral studies in AIDS and 50 years since Goffman’s seminal work, we are only now seeing the emergence of new ideas, new models, and ground breaking methodologies in the study of HIV-related stigma [3–5]. In this issue, Takada et al.[6] present findings from a Ugandan cohort of people living with HIV that demonstrates temporal associations between discrimination experiences, or enacted stigma, and emotional and instrumental support garnered from the relationships of people living with HIV. Takada et al. also report that a lack of instrumental support is associated with increased experiences of subsequent enacted stigma. Furthermore, when people with HIV adopt societyheld stigmatizing beliefs, or internalized stigma, they experience diminished emotional support. The reciprocally determinant associations between internalized stigma and emotional support are reminiscent of the dynamic processes between depression and social support. However, these relationships have not previously been tested in relation to HIV-related stigma. Indeed, there are surprisingly few longitudinal studies of the relationship between stigma experiences and social support in reference to any health condition. The social and relational consequences of internationalized stigma in people living with HIV therefore may mirror the well-established reciprocity of depression and social support and may generalize to other stigmatized illnesses. Although conceptually distinct, internalized stigma and depression share important common features including self-deprecation, shame, and diminished social relations. Takada et al. provide evidence for the mechanisms underlying internalized stigma, which may be shared with depression. This important finding pushes forward our understanding of mental health, emotional adjustment, and coping in people living with a stigmatized condition.In addition to their conceptual contributions, Takada et al.[6] exploit the use of time-lagged modeling, approaching a causal relationship between enacted and internalized dimensions of HIV-related stigma and emotional and instrumental social support. This unprecedented precision in measurement is coupled with data-analytic strategies that offer answers to questions that have until now been left to speculation. The now empirically validated reciprocal relationship between stigma, social support, and adjustment must be translated into …
影响因子：
3.8
作者：
Takada, Sae;Weiser, Sheri D.;Kumbakumba, Elias;Muzoora, Conrad;Martin, Jeffrey N.;Hunt, Peter W.;Haberer, Jessica E.;Kawuma, Annet;Bangsberg, David R.;Tsai, Alexander C.
通讯作者：
Tsai, Alexander C.
影响因子：
4.4
作者：
Chaudoir, Stephenie R.;Norton, Wynne E.;Hiers, Kathie M.
通讯作者：
Hiers, Kathie M.
影响因子：
4.4
作者：
Earnshaw, Valerie A.;Smith, Laramie R.;Chaudoir, Stephenie R.;Amico, K. Rivet;Copenhaver, Michael M.
通讯作者：
Copenhaver, Michael M.