40 research outputs found

    The Global Reach of HIV/AIDS: Science, Politics, Economics, and Research

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    Stigma in the workplace: Employer attitudes about people with HIV in Beijing, Hong Kong, and Chicago

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    Studies of HIV stigma in China are becoming more prevalent, but these studies have seldom involved direct cross-cultural comparisons. Moreover, although researchers consider employers to be a key power group whose practices can significantly impact the adjustment and recovery of people with HIV, the attitudes of employers in China towards people with HIV have rarely been studied. The present study sought to investigate employers' attitudes and hiring practices towards people with HIV across three culturally and linguistically distinct cities: Chicago, Beijing, and Hong Kong. One hundred employers from a broad spectrum of firm types were interviewed across the three cities, and their qualitative data were analyzed for information about the processes behind employer practices in hiring people with HIV. Employers from all three cities showed reluctance to hire people with HIV, but this trend was most pronounced with employers from Beijing and Hong Kong. Concerns about biological contagion were apparent in all three cities. Social contagion, or the belief that people with HIV could morally corrupt those around them, was a particular concern of employers from Beijing and Hong Kong. The concerns about hiring people with HIV in Hong Kong and Beijing may be related to specific cultural dynamics related to loss of 'face', level of contact and knowledge about people with HIV, and the psychological interconnectedness between people in society. In sum, employers in all three cities showed concerns about hiring people with HIV, but at the same time, their attitudes about discriminating against people with HIV differed widely across the cities.China Hong Kong HIV Stigma Cross-cultural Employment USA Workplace

    Use of Leverage to Improve Adherence to Psychiatric Treatment in the Community

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    OBJECTIVES: A variety of tools are being used as leverage to improve adherence to psychiatric treatment in the community. This study is the first to obtain data on the frequency with which these tools are used in the public mental health system. Patients\u27 lifetime experience of four specific forms of leverage—money (representative payee or money handler), housing, criminal justice, and outpatient commitment—was assessed. Logistic regression was used to examine associations between clinical and demographic characteristics and receipt of different types of leverage. METHODS: Ninety-minute interviews were conducted with approximately 200 adult outpatients at each of five sites in five states in different regions of the United States. RESULTS: The percentage of patients who experienced at least one form of leverage varied from 44 to 59 percent across sites. A fairly consistent picture emerged in which leverage was used significantly more frequently for younger patients and those with more severe, disabling, and longer lasting psychopathology; a pattern of multiple hospital readmissions; and intensive outpatient service use. Use of money as leverage ranged from 7 to 19 percent of patients; outpatient commitment, 12 to 20 percent; criminal sanction, 15 to 30 percent; and housing, 23 to 40 percent. CONCLUSIONS: Debates on current policy emphasize only one form of leverage, outpatient commitment, which is much too narrow a focus. Attempts to leverage treatment adherence are ubiquitous in serving traditional public-sector patients. Research on the outcomes associated with the use of leverage is critical to understanding the effectiveness of the psychiatric treatment system

    At the Intersection of Epistemics and Action: Responding with I Know

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    We examine I know as a responding action, showing that it claims to accept the grounds of the initiating action but either resists that action as unnecessary or endorses it, depending on the epistemic environment created by the initiating action. First, in responding to actions that presume an unknowing addressee (e.g., correcting, advising), speakers deploy I know to resist the action as unnecessary while accepting its grounds. Second, in responding to actions that presume a knowing addressee (e.g., some assessments), speakers use I know to endorse the action, claiming an independently reached agreement (in this way, doing “being on the same page”). Data are in American and British English

    A cross-cultural study of employers' concerns about hiring people with psychotic disorder: implications for recovery

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    Introduction Employment discrimination is considered as a major impediment to community integration for people with serious mental illness, yet little is known about how the problem manifests differently across western and non-western societies. We developed a lay model based on Chinese beliefs and values in terms of Confucianism, Taoism, Buddhism, and folk religions which may be used to explain cross-cultural variation in mental illness stigma, particularly in the arena of employment discrimination. In this study, we tested this lay approach by comparing employers' concerns about hiring people with psychotic disorder for entry-level jobs in US and China. Method One hundred employers ( 40 from Chicago, 30 from Hong Kong, and 30 from Beijing) were randomly recruited from small size firms and interviewed by certified interviewers using a semi-structured interview guide designed for this study. Content analysis was used to derive themes, which in turn were compared across the three sites using chi-square tests. Results Analyses reveal that employers express a range of concerns about hiring an employee with mental illness. Although some concerns were raised with equal frequency across sites, comparisons showed that, relative to US employers, Chinese employers were significantly more likely to perceive that people with mental illness would exhibit a weaker work ethic and less loyalty to the company. Comparison of themes also suggests that employers in China were more people-oriented while employers in US were more task-oriented. Conclusion Cultural differences existed among employers which supported the lay theory of mental illness.Introduction Employment discrimination is considered as a major impediment to community integration for people with serious mental illness, yet little is known about how the problem manifests differently across western and non-western societies. We developed a lay model based on Chinese beliefs and values in terms of Confucianism, Taoism, Buddhism, and folk religions which may be used to explain cross-cultural variation in mental illness stigma, particularly in the arena of employment discrimination. In this study, we tested this lay approach by comparing employers' concerns about hiring people with psychotic disorder for entry-level jobs in US and China. Method One hundred employers ( 40 from Chicago, 30 from Hong Kong, and 30 from Beijing) were randomly recruited from small size firms and interviewed by certified interviewers using a semi-structured interview guide designed for this study. Content analysis was used to derive themes, which in turn were compared across the three sites using chi-square tests. Results Analyses reveal that employers express a range of concerns about hiring an employee with mental illness. Although some concerns were raised with equal frequency across sites, comparisons showed that, relative to US employers, Chinese employers were significantly more likely to perceive that people with mental illness would exhibit a weaker work ethic and less loyalty to the company. Comparison of themes also suggests that employers in China were more people-oriented while employers in US were more task-oriented. Conclusion Cultural differences existed among employers which supported the lay theory of mental illness

    From Adherence to Self-Determination: Evolution of a Treatment Paradigm for People with Serious Mental Illnesses

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    Treatment adherence and nonadherence is the current paradigm for understanding why people with serious mental illnesses have low rates of participation in many evidence-based practices. The authors propose the concept of self-determination as an evolution in this explanatory paradigm. A review of the research literature led them to the conclusion that notions of adherence are significantly limited, promoting a value-based perspective suggesting people who do not opt for prescribed treatments are somehow flawed or otherwise symptomatic. Consistent with a trend in public health and health psychology, ideas of decisions and behavior related to health and wellness are promoted. Self-determination frames these decisions as choices and is described herein via the evolution of ideas from resistance and compliance to collaboration and engagement. Developments in recovery and hope-based mental health systems have shepherded interest in self-determination. Two ways to promote self-determination are proffered: aiding the rational actor through approaches such as shared decision making and addressing environmental forces that are barriers to choice. Although significant progress has been made toward self-determination, important hurdles remain. (Psychiatric Services 63:169–173, 2012; doi: 10.1176/appi.ps.201100065) Many people with serious mental illnesses do not seem to adhere to treatments as prescribed. In this Open Forum we propose that the concepts of self-determination and choice make greater sense of this phenomenon than the concept of treatment adherence and nonadherence. In 1990, one of us (PWC) coauthored an article published in this journal titled “From Noncompliance to Collaboration in the Treatment of Schizophrenia” (1). The article noted that many people with serious mental illnesses did not benefit from recommended practices, in part because they did not fully participate in them. The 1990 article sought to expand on outdated notions of resistance and compliance by framing treatment decisions about evidence-based practices as a collaborative partnership. Although the model described in the 1990 article was a substantial improvement over ideas of the time, it was nevertheless limited, and further shifts in conceptualizing this phenomenon were required. To support such shifts, we formed the Center on Adherence and Self-Determination (www.casd1.org), which is funded by the National Institute of Mental Health. The first five authors of this paper are co-principal investigators of the center. Self-determination is the crux of the new model, and choice is at the heart of self-determination. We begin this Open Forum by briefly recapping what research has shown—that many people with serious mental illnesses do not fully benefit from available evidence-based care. To make sense of this shortfall, we then consider the evolution of ideas in psychiatric practice, from resistance through collaboration to self-determination. The evolution paralleled a significant change in the mental health system, with themes of recovery, hope, and empowerment becoming more salient. The evolution also informs strategies for helping people decide which services will benefit them, and this Open Forum ends by describing decision-making processes
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