Academic journal article The Qualitative Report

Qualitative Contributions to a Randomized Controlled Trial Addressing HIV/AIDS-Stigma in Medical Students

Academic journal article The Qualitative Report

Qualitative Contributions to a Randomized Controlled Trial Addressing HIV/AIDS-Stigma in Medical Students

Article excerpt

HIV/AIDS stigma (HAS) has been documented as having negative consequences for people living with HIV/AIDS (PLWHA). Adverse effects include lack of access to treatment, problematic adherence to treatment, social isolation, and negative mental health consequences (Herek, 1999; Kuang, Li, Ma, & Liao, 2005; Phelan, Lucas, Ridgeway, & Taylor, 2014; Stangl, Lloyd, Brady, Holland & Baral, 2013). HAS remains one of the most challenging barriers to maintaining the overall health of PLWHA (Varas-Díaz et al., 2013). From a public health framework, HAS fosters and increase gaps in health disparities including negative outcomes (e.g., lack of social support, problems with medication adherence) for individuals who live with the virus (Hatzenbuehler & Link, 2014).

Theoretical perspectives on social stigma have been deeply influenced by Erving Goffman's work on the subject during the 1980's. He defined stigma as an attribute that is deeply discrediting to the individual and classified their sources as physical, character or tribal. Goffman's contributions, although extremely valuable and influential, have been criticized for emphasizing the individual's characteristics in conceptualizations of stigma (Ainlay, Becker, & Coleman, 1986). The emphasis of the micro-level one on one interaction has been criticized in the literature for its limitations regarding understanding how stigma is (also) created and manifested at a macro-level, particularly via social institutions (Hatzenbuehler & Link, 2014).

In addition to institutional influences, approaches to HAS reduction strategies have integrated socio-structural factors to gain a better understanding of stigma as a social phenomenon (Parker & Aggleton, 2002; Stangl, Lloyd, Brady, Holland, & Baral, 2013). Hatzenbuehler and Link (2014) define structural stigma as "societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and wellbeing of the stigmatized." (Hatzenbuehler & Link, 2014, p. 2).

This dimension of stigma includes structural discrimination, which result in unfair health policies that can create and increase health disparities among affected populations (Angermeyer, Matschinger, Link, & Schomerus, 2014; Link & Phelan, 2014). HAS has historically encompassed both dimensions. One the one hand it has hindered one on one social interactions, but more importantly it has also become a structural problem reflected in restrictive health policies and the worldwide response to the disease.

HIV/AIDS Stigma among Healthcare Providers

Global efforts are in effect to reduce HAS (Apinundecha, Laohasiriwong, Cameron, & Lim, 2007; Barroso et al., 2014; Li et al., 2010; Li et al., 2013; Neema et al., 2012; Stangl et al., 2013). Reducing HAS among health professionals is considered a priority in order to foster better services for PLWHA (U.S. Department of Health & Human Services, 2010; Varas-Díaz, Neilands, Malavé-Rivera, & Betancourt, 2010). HAS that emanates from health care professionals is a potential obstacle for the linkage to and retention in care among PLWHA (Li et al., 2007; Nyblade, Stangl, Weiss, & Ashburn, 2009; Varas-Díaz et al., 2013; Varas-Díaz et al., 2012). The current literature indicates there is a scarcity of HAS reduction interventions targeted to health professionals, and even less that focus on socio-structural approaches to stigma reduction (Parker & Aggleton, 2002; Stangl et al., 2013). Therefore, it is critical to identify interventions that effectively reduce HAS among health professionals while they are still in training and eager to learn new perspectives on health (Brown, Trujillo, & Mcintyre, 2008; Stangl et al, 2013).

The SPACES Project

In recent years, HAS interventions have been tested in different populations of healthcare providers included doctors and nurses with positive results on stigma reduction (Varas-Díaz et al. …

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