The impact of living with HIV: differences in experiences of stigma for heterosexual and homosexual people living with HIV in Australia
Loren Brener A C , Hannah Wilson A , Sean Slavin B and John de Wit AA National Centre in HIV Social Research, University of New South Wales, Level 3, Goodsell Building Sydney, Sydney, NSW 2035, Australia.
B National Association of People Living with HIV/AIDS, Sydney, NSW 2052, Australia.
C Corresponding author. Email: l.brener@unsw.edu.au
Sexual Health 10(4) 316-319 https://doi.org/10.1071/SH12170
Submitted: 10 October 2012 Accepted: 2 April 2013 Published: 17 May 2013
Abstract
Background: HIV in Australia has been closely aligned with the gay community and continues to disproportionately affect members of this community. Although heterosexual transmission remains low, recently there has been an increase in new HIV diagnoses attributable to heterosexual sex. This highlights the need to address the health and social consequences for heterosexual people living with HIV (PLHIV). This subanalysis of a larger study compared the experiences of stigma, health and wellbeing of a sample of gay and heterosexual PLHIV. Methods: Data were drawn from a study of experiences of stigma among PLHIV in Australia. All 49 participants who reported being heterosexual were included, as were 49 participants randomly selected from the 611 gay participants. The samples were compared on perceived HIV stigma, HIV treatment-related stigma, perceived negative reactions of others, HIV status disclosure, and health and wellbeing measures. Results: The findings illustrate that heterosexual PLHIV have more negative experiences in terms of both general HIV stigma and treatment-related stigma than gay PLHIV. The heterosexual PLHIV also perceived greater negative reactions in relation to their HIV status by different people in their social environment and were less likely to access treatment than the gay PLHIV. There were no differences between the two groups in any of the health and wellbeing measures. Conclusions: This study shows that in the Australian context, heterosexual PLHIV may feel more stigmatised than gay PLHIV. In view of lower HIV treatment uptake in heterosexual PLHIV, addressing HIV-related stigma could contribute to increasing access to HIV treatment.
Additional keywords: gay, negative reactions, treatment uptake, wellbeing.
References
[1] Persson A. The undoing and doing of sexual identity among heterosexual men with HIV in Australia. Men Masculinities 2012; 15 311–28.| The undoing and doing of sexual identity among heterosexual men with HIV in Australia.Crossref | GoogleScholarGoogle Scholar |
[2] Kippax S, Race K. Sustaining safe practice: twenty years on. Soc Sci Med 2003; 57 1–12.
| Sustaining safe practice: twenty years on.Crossref | GoogleScholarGoogle Scholar | 12753812PubMed |
[3] Guy R, McDonald A, Bartlett M, Murray J, Giele C, Davey T, et al HIV diagnoses in Australia: diverging epidemics within a low-prevalence country. Med J Aust 2007; 187 437–40.
| 17937639PubMed |
[4] The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia annual surveillance report 2012. Sydney: The Kirby Institute, the University of New South Wales; 2011.
[5] Jones E, Farina A, Hastorf A, Markus H, Miller DT, Scott R. Social stigma: the psychology of marker relationships. New York: Freeman; 1984.
[6] Link BG, Phelan JC. Stigma and its public health implications. Lancet 2001; 27 363–85.
[7] Buseh A, Stevens P. Constrained but not determined by stigma: resistance by African American women living with HIV. Women Health 2006; 44 1–18.
| 17255063PubMed |
[8] Berger B, Ferrans C, Lashley R. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health 2001; 24 518–29.
| Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MnpslensQ%3D%3D&md5=7e79cf7bcae059846d2cddf58a474badCAS | 1:STN:280:DC%2BD3MnpslensQ%3D%3D&md5=7e79cf7bcae059846d2cddf58a474badCAS | 11746080PubMed |
[9] Vanable P, Carey M, Blair D, Littlewood R. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav 2006; 10 473–82.
| Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women.Crossref | GoogleScholarGoogle Scholar | 16604295PubMed |
[10] Bunn J, Solomon S, Miller C, Forehand R. Measurement of stigma in people with HIV: a re-examination of the HIV stigma scale. AIDS Educ Prev 2007; 19 198–208.
| Measurement of stigma in people with HIV: a re-examination of the HIV stigma scale.Crossref | GoogleScholarGoogle Scholar | 17563274PubMed | 17563274PubMed |
[11] Logie C, Gadalla T. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care 2009; 21 742–53.
| Meta-analysis of health and demographic correlates of stigma towards people living with HIV.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MnntFClug%3D%3D&md5=b1187cf6b676f85b6f6acd01b590d2e8CAS | 1:STN:280:DC%2BD1MnntFClug%3D%3D&md5=b1187cf6b676f85b6f6acd01b590d2e8CAS | 19806490PubMed | 19806490PubMed |
[12] Tzemis D, Forrest J, Pukas C, Zhang W, Orchard T, Palmer A, et al Identifying self-percieved HIV-related stigma in a population accessing antiretroviral therapy. AIDS Care 2012;
| 22672228PubMed |
| 22672228PubMed |
[13] Peretti-Watel P, Spire B, Obadia Y, Moatti J. Discrimination against HIV-infected people and the spread of HIV: some evidence from France. PLoS ONE 2007; 2 e411
| Discrimination against HIV-infected people and the spread of HIV: some evidence from France.Crossref | GoogleScholarGoogle Scholar | 17476333PubMed | 17476333PubMed |
[14] Rosmond R. Role of stress in the pathogenesis of the metabolic syndrome. Psychoneuroendocrinology 2005; 30 1–10.
| Role of stress in the pathogenesis of the metabolic syndrome.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXnsVyru78%3D&md5=d6a291f2007c4423fdf82a239f6d65b0CAS | 1:CAS:528:DC%2BD2cXnsVyru78%3D&md5=d6a291f2007c4423fdf82a239f6d65b0CAS | 15358437PubMed | 15358437PubMed |
[15] Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull 2004; 130 601–30.
| Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry.Crossref | GoogleScholarGoogle Scholar | 15250815PubMed | 15250815PubMed |
[16] Pascoe EA, Smart Richman L. Perceived discrimination and health: a meta-analytic review. Psychol Bull 2009; 135 531–54.
| Perceived discrimination and health: a meta-analytic review.Crossref | GoogleScholarGoogle Scholar | 19586161PubMed | 19586161PubMed |
[17] Butt L. Silence speaks volumes: elite responses to AIDS in Highlands Papua. In Butt L, Eves R, editors. Making sense of AIDS: culture, sexuality, and power in Melanesia. Honolulu: University of Hawaii Press; 2008. pp. 116–32.
[18] Lee R, Kochman A, Sikkema K. Internalized stigma among people living with HIV-AIDS. AIDS Behav 2002; 6 309–319.
| Internalized stigma among people living with HIV-AIDS.Crossref | GoogleScholarGoogle Scholar |
[19] Antoniou T, Loutfy M, Glazier R, Strike C. ‘Waiting at the dinner table for scraps’: a qualitative study of the help-seeking experiences of heterosexual men living with HIV infection. BMJ 2012; 2 e000697
[20] Persson A, Richards W. From the closet to heterotopias: a conceptual exploration of disclosure and passing among heterosexuals living with HIV. Cult Health Sex 2008; 10 73–86.
| From the closet to heterotopias: a conceptual exploration of disclosure and passing among heterosexuals living with HIV.Crossref | GoogleScholarGoogle Scholar | 18038282PubMed |
[21] Phinney JS. Ethnic identity in adolescents and adults: review of research. Psychol Bull 1990; 108 499–514.
| Ethnic identity in adolescents and adults: review of research.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M7gt1Wltg%3D%3D&md5=0bdc48162f1d3a659ba238a0469083f1CAS | 1:STN:280:DyaK3M7gt1Wltg%3D%3D&md5=0bdc48162f1d3a659ba238a0469083f1CAS | 2270238PubMed |
[22] Sellers R, Shelton J. The role of racial identity in perceived racial discrimination. J Pers Soc Psychol 2003; 84 1079–92.
| The role of racial identity in perceived racial discrimination.Crossref | GoogleScholarGoogle Scholar | 12757150PubMed |
[23] Tzemis D, Forrest J, Puskas C, Zhang W, Orchard T, Palmer A, et al Identifying self-perceived HIV related stigma in a population accessing antiretroviral therapy. AIDS Care 2013; 25 95–102.
| 22672228PubMed |
[24] Varni S, Miller C, McCuin T, Solomon S. Disengagement and engagement coping with HIV/AIDS stigma and psychological well-being of people with HIV/AIDS. J Soc Clin Psych 2012; 31 123–50.
| Disengagement and engagement coping with HIV/AIDS stigma and psychological well-being of people with HIV/AIDS.Crossref | GoogleScholarGoogle Scholar |
[25] Brener L, Callander D, Slavin S, de Wit J. Experiences of HIV stigma: the role of visible symptoms, HIV centrality and community attachment for people living with HIV. AIDS Care 2013;
| Experiences of HIV stigma: the role of visible symptoms, HIV centrality and community attachment for people living with HIV.Crossref | GoogleScholarGoogle Scholar | 23311451PubMed |
[26] Stutterheim S, Bos A, Pryor J, Brands R, Liebregts M, Schaalma H. Psychological and social correlates of HIV status disclosure: the significance of stigma visibility. AIDS Educ Prev 2001; 23 382–92.
| Psychological and social correlates of HIV status disclosure: the significance of stigma visibility.Crossref | GoogleScholarGoogle Scholar |
[27] Rosenberg M. Conceiving the self. New York: Basic Books; 1979.
[28] Lovibond S, Lovibond P. Manual for the depression anxiety stress scales. 2nd. edn. Sydney: Psychology Foundation; 1995.
[29] Zimet G, Dahlem N, Zimet S, Farley G. The multidimensional scale of perceived social support. J Pers Assess 1988; 52 30–41.
| The multidimensional scale of perceived social support.Crossref | GoogleScholarGoogle Scholar |
[30] Connor K, Davidson J. Development of a new resilience scale: the Conner–Davidson resilience scale (CD-RISC). Depress Anxiety 2003; 18 76–82.
| Development of a new resilience scale: the Conner–Davidson resilience scale (CD-RISC).Crossref | GoogleScholarGoogle Scholar | 12964174PubMed |
[31] Meyer IH, Schwartz S, Frost DM. Social patterning of stress and coping: does disadvantaged social statuses confer more stress and fewer coping resources? Soc Sci Med 2008; 67 368–79.
| Social patterning of stress and coping: does disadvantaged social statuses confer more stress and fewer coping resources?Crossref | GoogleScholarGoogle Scholar | 18433961PubMed |
[32] Lekas H, Siegel K, Schrimshaw EW. Continuities and discontinuities in the experiences of felt and enacted stigma among women with HIV/AIDS. Qual Health Res 2006; 16 1165–90.
| Continuities and discontinuities in the experiences of felt and enacted stigma among women with HIV/AIDS.Crossref | GoogleScholarGoogle Scholar | 17038751PubMed |
[33] McDonald K. ‘You don’t grow another head’: the experience of stigma among HIV-positive women in Australia. HIV Australia 2012; 9 14–7.
[34] Sandelowski M, Lambe C, Barroso J. Stigma in HIV-positive women. J Nurs Scholarsh 2004; 36 122–8.
| Stigma in HIV-positive women.Crossref | GoogleScholarGoogle Scholar | 15227758PubMed | 15227758PubMed |
[35] Lawless S, Kippax S, Crawford J. Dirty, diseased and undeserving: The positioning of HIV positive women. Soc Sci Med 1996; 43 1371–7.
| Dirty, diseased and undeserving: The positioning of HIV positive women.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s%2FntVShtA%3D%3D&md5=0434ce4b143ec6c38d430a2a8ac10f8fCAS | 8913006PubMed | 8913006PubMed |
[36] Manavi K, McMillan A, Ogilvie M, Scott G. Heterosexual men and women with HIV test positive at a later stage of infection than homo- or bisexual men. Int J STD AIDS 2004; 15 811–4.
| Heterosexual men and women with HIV test positive at a later stage of infection than homo- or bisexual men.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2cnisFOktA%3D%3D&md5=dd36fb0dccae9f41300224884f260104CAS | 15601487PubMed | 15601487PubMed |
[37] Chadborn TR, Delpech VC, Sabin CA, Sinka K, Evans BG. The later diagnosis and consequent short-term mortality of HIV-infected heterosexuals (England and Wales, 2000–2004). AIDS 2006; 20 2371–9.
| The later diagnosis and consequent short-term mortality of HIV-infected heterosexuals (England and Wales, 2000–2004).Crossref | GoogleScholarGoogle Scholar | 17117024PubMed | 17117024PubMed |