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      Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses

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          Abstract

          Objective

          To conduct a systematic review and series of meta-analyses on the association between HIV-related stigma and health among people living with HIV.

          Data sources

          A structured search was conducted on 6 electronic databases for journal articles reporting associations between HIV-related stigma and health-related outcomes published between 1996 and 2013.

          Study eligibility criteria

          Controlled studies, cohort studies, case-control studies and cross-sectional studies in people living with HIV were considered for inclusion.

          Outcome measures

          Mental health (depressive symptoms, emotional and mental distress, anxiety), quality of life, physical health, social support, adherence to antiretroviral therapy, access to and usage of health/social services and risk behaviours.

          Results

          64 studies were included in our meta-analyses. We found significant associations between HIV-related stigma and higher rates of depression, lower social support and lower levels of adherence to antiretroviral medications and access to and usage of health and social services. Weaker relationships were observed between HIV-related stigma and anxiety, quality of life, physical health, emotional and mental distress and sexual risk practices. While risk of bias assessments revealed overall good quality related to how HIV stigma and health outcomes were measured on the included studies, high risk of bias among individual studies was observed in terms of appropriate control for potential confounders. Additional research should focus on elucidating the mechanisms behind the negative relationship between stigma and health to better inform interventions to reduce the impact of stigma on the health and well-being of people with HIV.

          Conclusions

          This systematic review and series of meta-analyses support the notion that HIV-related stigma has a detrimental impact on a variety of health-related outcomes in people with HIV. This review can inform the development of multifaceted, intersectoral interventions to reduce the impact of HIV-related stigma on the health and well-being of people living with HIV.

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          Most cited references60

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          The MOS social support survey.

          This paper describes the development and evaluation of a brief, multidimensional, self-administered, social support survey that was developed for patients in the Medical Outcomes Study (MOS), a two-year study of patients with chronic conditions. This survey was designed to be comprehensive in terms of recent thinking about the various dimensions of social support. In addition, it was designed to be distinct from other related measures. We present a summary of the major conceptual issues considered when choosing items for the social support battery, describe the items, and present findings based on data from 2987 patients (ages 18 and older). Multitrait scaling analyses supported the dimensionality of four functional support scales (emotional/informational, tangible, affectionate, and positive social interaction) and the construction of an overall functional social support index. These support measures are distinct from structural measures of social support and from related health measures. They are reliable (all Alphas greater than 0.91), and are fairly stable over time. Selected construct validity hypotheses were supported.
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            Regional alcohol consumption and alcohol-related mortality in Great Britain: novel insights using retail sales data

            Background Regional differences in population levels of alcohol-related harm exist across Great Britain, but these are not entirely consistent with differences in population levels of alcohol consumption. This incongruence may be due to the use of self-report surveys to estimate consumption. Survey data are subject to various biases and typically produce consumption estimates much lower than those based on objective alcohol sales data. However, sales data have never been used to estimate regional consumption within Great Britain (GB). This ecological study uses alcohol retail sales data to provide novel insights into regional alcohol consumption in GB, and to explore the relationship between alcohol consumption and alcohol-related mortality. Methods Alcohol sales estimates derived from electronic sales, delivery records and retail outlet sampling were obtained. The volume of pure alcohol sold was used to estimate per adult consumption, by market sector and drink type, across eleven GB regions in 2010–11. Alcohol-related mortality rates were calculated for the same regions and a cross-sectional correlation analysis between consumption and mortality was performed. Results Per adult consumption in northern England was above the GB average and characterised by high beer sales. A high level of consumption in South West England was driven by on-trade sales of cider and spirits and off-trade wine sales. Scottish regions had substantially higher spirits sales than elsewhere in GB, particularly through the off-trade. London had the lowest per adult consumption, attributable to lower off-trade sales across most drink types. Alcohol-related mortality was generally higher in regions with higher per adult consumption. The relationship was weakened by the South West and Central Scotland regions, which had the highest consumption levels, but discordantly low and very high alcohol-related mortality rates, respectively. Conclusions This study provides support for the ecological relationship between alcohol-related mortality and alcohol consumption. The synthesis of knowledge from a combination of sales, survey and mortality data, as well as primary research studies, is key to ensuring that regional alcohol consumption, and its relationship with alcohol-related harms, is better understood.
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              From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures.

              Recent analyses suggest that lack of clarity in the conceptualization and measurement of HIV stigma at an individual level is a significant barrier to HIV prevention and treatment efforts. In order to address this concern, we articulate a new framework designed to aid in clarifying the conceptualization and measurement of HIV stigma among individuals. The HIV Stigma Framework explores how the stigma of HIV elicits a series of stigma mechanisms, which in turn lead to deleterious outcomes for HIV uninfected and infected people. We then apply this framework to review measures developed to gauge the effect of HIV stigma since the beginning of the epidemic. Finally, we emphasize the utility of using three questions to guide future HIV stigma research: who is affected by, how are they affected by, and what are the outcomes of HIV stigma?
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2016
                13 July 2016
                : 6
                : 7
                Affiliations
                [1 ]Institute for Mental Health Policy Research, Centre for Addiction and Mental Health , Toronto, Ontario, Canada
                [2 ]Department of Psychiatry, University of Toronto , Toronto, Ontario, Canada
                [3 ]Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Ontario, Canada
                [4 ]Institute for Work and Health , Toronto, Ontario, Canada
                [5 ]The Ontario HIV Treatment Network , Toronto, Ontario, Canada
                [6 ]School of Social Work, McMaster University , Hamilton, Ontario, Canada
                [7 ]Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Ontario, Canada
                [8 ]McMaster Health Forum, McMaster University , Hamilton, Ontario, Canada
                [9 ]Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
                [10 ]Centre for Research on Inner City Health, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto, Ontario, Canada
                Author notes
                [Correspondence to ] Dr Sergio Rueda; ruedagento@ 123456gmail.com
                Article
                bmjopen-2016-011453
                10.1136/bmjopen-2016-011453
                4947735
                27412106
                d25b32d4-9d71-45c5-a129-b46a68c3af09
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                Product
                Funding
                Funded by: Canadian Institutes of Health Research, http://dx.doi.org/10.13039/501100000024;
                Categories
                HIV/AIDS
                Research
                1506
                1842
                1724

                Medicine
                social medicine
                Medicine
                social medicine

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