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

Specialized training for healthcare professionals (HCP) in order to reduce HIV/AIDS related stigma must be part of a public health model for HIV/AIDS. Tested interventions to reduce HIV/AIDS related stigma among HCP have been mostly absent from these efforts. A qualitative approach was used to assess stigma reduction within a traditional randomized controlled design in order to better understand how our current stigma intervention worked and was understood by 2nd year medical students. After conducting a quantitative follow up survey one-year post intervention we conducted 20 in-depth qualitative interviews with a subsample of our intervention group participants as part of the overall evaluation process. Once the interviews were finished, we transcribed them and used NVivo (v.8) to organized the qualitative data. In the process of analyzing the qualitative data we identified core intervention areas participants described as useful for their training and development: (1) acquiring more HIV/AIDS-related knowledge, (2) increased skills for management of high stigma situations, and (3) the ability to identify socio-structural factors that foster HIV infection among clients. The gathered information is important in order to have a deep understanding of how attitudinal change happens as part of our intervention strategies

Las dificultades de sentir: el rol de las emociones en la estigmatización del VIH/SIDA

Der Virus HIV und die erworbene Immunschwäche-Krankheit AIDS führen häufig zur Stigmatisierung der Betroffenen. Sozialwissenschaftliche Untersuchungen dieser Stigmatisierungsprozesse zielen zumeist auf Meinungen, sehr viel weniger jedoch auf Gefühle. In unserer Studie haben wir uns deshalb mit der Rolle von Emotionen im Prozess der Stigmatisierung von Menschen, die mit HIV/AIDS leben, durch Professionelle im Gesundheitsbereich beschäftigt. Hierzu wurden im Rahmen eines explorativen und qualitativen Designs halbstrukturierte Tiefeninterviews durchgeführt. Das Sample setzte sich zusammen aus 80 Professionellen und Studierenden aus Psychologie, Sozialarbeit, Medizin und Pflegewissenschaft. In den Ergebnissen unserer Untersuchung wurden mit HIV/AIDS assoziierte Gefühle wie Mitleid, Ekel und Angst sichtbar, wobei die Forschungsteilnehmer(innen) das Bedürfnis artikulierten, diese Gefühle im Umgang mit Betroffenen kontrollieren zu wollen. Die Ergebnisse verwiesen auch auf die Erfordernis, Faktoren weiter zu untersuchen, die den Umgang mit Emotionen vermitteln – so z.B. die jeweiligen sozialen Kontexte, in denen sie ausgelöst werden, oder die Frage, wem gegenüber solche Gefühle offenbart werden –, und um so Prozesse der HIV/AIDS-bezogenen Stigmatisierung besser verstehen zu können. URN: urn:nbn:de:0114-fqs060428The human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) have been a source of stigma for people who live with the disease. This stigmatization has been frequently studied from the perspective of stigmatizing agents focusing on opinions. This focus has systematically avoided exploring the role of emotions in the stigmatization process. We carried out this study in order to identify the role of emotions in the process of stigmatization of the people living with HIV and AIDS (PLWHA) by health professionals. In order to achieve this objective we implemented an exploratory and qualitative design using in-depth semi-structured interviews. The sample consisted of 80 health professionals and health profession students from the following specialties: psychology, social work, medicine and nursing. The results reflected the existence of emotions associated to HIV/AIDS such as pity, compassion, disgust, and fear. Participants expressed the need to control their emotions when interacting with PLWHA. The results point to the need to explore factors that mediate emotions, such as the social context in which they are manifested and before whom they are revealed. This is a vital step in order to better understand the stigma surrounding HIV/AIDS. URN: urn:nbn:de:0114-fqs060428El Virus de Inmunodeficiencia Humana (VIH) y el Síndrome de Inmunodeficiencia Adquirida (SIDA) han sido motivo de estigmatización para las personas que viven con ellos. Esta estigmatización se ha estudiado consecuentemente desde la perspectiva de opiniones de agentes estigmatizantes. Estas opiniones han obviado sistemáticamente el rol de las emociones en el proceso de estigmatización. Llevamos a cabo este estudio con el propósito de identificar el rol de las emociones en el proceso de estigmatización de las personas que viven con el virus (PVVS) por parte de profesionales de la salud. Para lograr este objetivo utilizamos un diseño exploratorio y cualitativo en el cual utilizamos la técnica de entrevistas semiestructuradas a profundidad. La muestra estuvo compuesta por 80 profesionales de la salud y estudiantes de las siguientes especialidades: psicología, trabajo social, medicina y enfermería. Los resultados reflejaron la existencia de emociones asociadas al VIH/SIDA tales como pena, lástima, compasión, asco, fobia y miedo entre los/as profesionales y estudiantes que participaron. Las personas participantes evidenciaron la necesidad de controlar sus emociones al interactuar con PVVS. Los resultados apuntan a la necesidad de explorar aquellos factores que mediatizan las emociones, tales como el contexto social en que se manifiestan y ante quiénes se revelan, para lograr entender a cabalidad el estigma que rodea al VIH/SIDA. URN: urn:nbn:de:0114-fqs06042

Las dificultades de sentir: el rol de las emociones en la estigmatización del VIH/SIDA

Der Virus HIV und die erworbene Immunschwäche-Krankheit AIDS führen häufig zur Stigmatisierung der Betroffenen. Sozialwissenschaftliche Untersuchungen dieser Stigmatisierungsprozesse zielen zumeist auf Meinungen, sehr viel weniger jedoch auf Gefühle. In unserer Studie haben wir uns deshalb mit der Rolle von Emotionen im Prozess der Stigmatisierung von Menschen, die mit HIV/AIDS leben, durch Professionelle im Gesundheitsbereich beschäftigt. Hierzu wurden im Rahmen eines explorativen und qualitativen Designs halbstrukturierte Tiefeninterviews durchgeführt. Das Sample setzte sich zusammen aus 80 Professionellen und Studierenden aus Psychologie, Sozialarbeit, Medizin und Pflegewissenschaft. In den Ergebnissen unserer Untersuchung wurden mit HIV/AIDS assoziierte Gefühle wie Mitleid, Ekel und Angst sichtbar, wobei die Forschungsteilnehmer(innen) das Bedürfnis artikulierten, diese Gefühle im Umgang mit Betroffenen kontrollieren zu wollen. Die Ergebnisse verwiesen auch auf die Erfordernis, Faktoren weiter zu untersuchen, die den Umgang mit Emotionen vermitteln – so z.B. die jeweiligen sozialen Kontexte, in denen sie ausgelöst werden, oder die Frage, wem gegenüber solche Gefühle offenbart werden –, und um so Prozesse der HIV/AIDS-bezogenen Stigmatisierung besser verstehen zu können.The human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) have been a source of stigma for people who live with the disease. This stigmatization has been frequently studied from the perspective of stigmatizing agents focusing on opinions. This focus has systematically avoided exploring the role of emotions in the stigmatization process. We carried out this study in order to identify the role of emotions in the process of stigmatization of the people living with HIV and AIDS (PLWHA) by health professionals. In order to achieve this objective we implemented an exploratory and qualitative design using in-depth semi-structured interviews. The sample consisted of 80 health professionals and health profession students from the following specialties: psychology, social work, medicine and nursing. The results reflected the existence of emotions associated to HIV/AIDS such as pity, compassion, disgust, and fear. Participants expressed the need to control their emotions when interacting with PLWHA. The results point to the need to explore factors that mediate emotions, such as the social context in which they are manifested and before whom they are revealed. This is a vital step in order to better understand the stigma surrounding HIV/AIDS.El Virus de Inmunodeficiencia Humana (VIH) y el Síndrome de Inmunodeficiencia Adquirida (SIDA) han sido motivo de estigmatización para las personas que viven con ellos. Esta estigmatización se ha estudiado consecuentemente desde la perspectiva de opiniones de agentes estigmatizantes. Estas opiniones han obviado sistemáticamente el rol de las emociones en el proceso de estigmatización. Llevamos a cabo este estudio con el propósito de identificar el rol de las emociones en el proceso de estigmatización de las personas que viven con el virus (PVVS) por parte de profesionales de la salud. Para lograr este objetivo utilizamos un diseño exploratorio y cualitativo en el cual utilizamos la técnica de entrevistas semiestructuradas a profundidad. La muestra estuvo compuesta por 80 profesionales de la salud y estudiantes de las siguientes especialidades: psicología, trabajo social, medicina y enfermería. Los resultados reflejaron la existencia de emociones asociadas al VIH/SIDA tales como pena, lástima, compasión, asco, fobia y miedo entre los/as profesionales y estudiantes que participaron. Las personas participantes evidenciaron la necesidad de controlar sus emociones al interactuar con PVVS. Los resultados apuntan a la necesidad de explorar aquellos factores que mediatizan las emociones, tales como el contexto social en que se manifiestan y ante quiénes se revelan, para lograr entender a cabalidad el estigma que rodea al VIH/SIDA

The Difficulties of Feeling: The Role of Emotions in the Stigmatization of HIV/AIDS

The human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) have been a source of stigma for people who live with the disease. This stigmatization has been frequently studied from the perspective of stigmatizing agents focusing on opinions. This focus has systematically avoided exploring the role of emotions in the stigmatization process. We carried out this study in order to identify the role of emotions in the process of stigmatization of the people living with HIV and AIDS (PLWHA) by health professionals. In order to achieve this objective we implemented an exploratory and qualitative design using in-depth semi-structured interviews. The sample consisted of 80 health professionals and health profession students from the following specialties: psychology, social work, medicine and nursing. The results reflected the existence of emotions associated to HIV/AIDS such as pity, compassion, disgust, and fear. Participants expressed the need to control their emotions when interacting with PLWHA. The results point to the need to explore factors that mediate emotions, such as the social context in which they are manifested and before whom they are revealed. This is a vital step in order to better understand the stigma surrounding HIV/AIDS. URN: urn:nbn:de:0114-fqs06042

Título en español.

Men who have sex with men (MSM) are one of the most affected populations by HIV/AIDS. Over the last years an increase of cases has been reported in younger groups. The Center for Disease Control and Prevention has stated that stigma and homophobia may have a profound impact on the lives of MSM, and could influence them to engage in HIV risky behaviors. In the U.S and Puerto Rico, an increase in HIV cases among young MSM has been reported. For the period of 2005-2009 an increase of HIV cases was reported with 4.3% in the age group of 13-24 and 55.6% in the age group of 25-34. Understanding the dynamics related HIV risk behaviors among young MSM requires transcending traditional individual behavior oriented perspectives in order to adopt a more comprehensive socio-structural approach. In this manuscript we present a critical analysis of HIV prevention issues among young MSM in Puerto Rico.Los hombres que tienen relaciones sexuales con hombres (HSH) son uno de los grupos más afectados por el VIH/SIDA. Durante los últimos años se ha observado un aumento en los casos reportados entre grupos de HSH más jóvenes. El Centro para el Control y Prevención de Enfermedades sostiene que el estigma y la homofobia pueden tener un efecto profundo en las vidas de hombres HSH y esto puede traducirse en prácticas de alto riesgo de contagio con VIH. En Estados Unidos y Puerto Rico, se ha reportado un aumento en los casos de jóvenes HSH contagiados con VIH. Para el período de 2005-2009 se reportó un aumento en los casos de jóvenes con VIH entre las edades de 13 a 24 años (4.3%) y para las edades de 25-34 años (55.6%). Entender las dinámicas relacionadas a las conductas de riesgo asociadas al VIH entre los jóvenes HSH requiere transcender las perspectivas individualistas tradicionales para adoptar un acercamiento socio-estructural más comprensivo. En este manuscrito presentamos un análisis sobre asuntos relacionados a la prevención del VIH entre los jóvenes HSH

Religion and HIV/AIDS Stigma in Puerto Rico

HIV/AIDS stigma continues to be a challenge for HIV prevention and treatment. When health professionals manifest stigma it can limit access to quality treatment. With an ever-growing epidemic among Latinos, including Puerto Ricans living on the Caribbean Island, the social and structural factors that foster HIV/AIDS stigma need to be understood. In this study, we documented the association of religion with HIV/AIDS stigma in a sample of medical students in Puerto Rico. Findings suggest that importance placed on religion, and participation in religious activities, is associated with HIV/AIDS stigma for this population

A Qualitative Approach to Explore Perceptions, Opinions and Beliefs of Communities who Experienced Health Disparities towards Chronic Health Conditions

The prevalence of chronic medical conditions is associated with biological, behavioral, and social factors. In Puerto Rico (PR), events such as budget cuts to essential services in recent years have contributed to deepening health disparities. This study aimed to explore community perceptions, opinions, and beliefs about chronic health conditions in the southern region of Puerto Rico. Framed by a Community-Based Participatory Research (CBPR) approach, this qualitative study developed eight focus groups (n = 59) with adults (age of 21 or older) from southern Puerto Rico, in person and remotely, during 2020 and 2021. Eight open-ended questions were used for discussions, which were recorded, transcribed, and analyzed via computer analysis. Content analysis revealed four main dimensions: knowledge, vulnerabilities, barriers, and identified resources. Relevant topics included: concerns about mental health—depression, anxiety, substance use, and suicide; individual vulnerabilities—risk behaviors, and unhealthy habits; economic factors—health access and commercialization of health. Resource identification was also explored, and participants discussed the importance of alliances between public and private sectors. These topics were addressed across all focus groups, with various recommendations. The results highlight the importance of prioritizing identified community needs, evaluating available resources, and promoting tailored-made interventions to reduce risk factors for chronic health conditions