AIDS and Behavior

, Volume 9, Issue 2, pp 145–154

Multiple Dimensions of HIV Stigma and Psychological Distress Among Asians and Pacific Islanders Living With HIV Illness

  • Ezer Kang
  • Bruce D. Rapkin
  • Robert H. Remien
  • Claude Ann Mellins
  • Alina Oh
Article

Abstract

Asians and Pacific Islanders (APIs) living with HIV/AIDS in the US are particularly vulnerable to HIV-related stigma largely due to ingrained socio-cultural norms that strongly associate HIV transmission with activities perceived to be immoral. This cross-sectional study examined the relationship between five HIV-stigma factors and psychological distress among 54 HIV-seropositive APIs. Social Rejection, Negative Self-Worth, Perceived Interpersonal Insecurity, and Financial Security were all significantly associated with psychological distress. Results from hierarchical multiple regression analyses indicated that Social Rejection, Negative Self-Worth, and Perceived Interpersonal Insecurity significantly predicted psychological distress after control for physical symptoms and country of birth. Undocumented Asians endorsed higher levels of Social Rejection, Negative Self-Worth and Perceived Interpersonal Insecurity than documented APIs. Future studies examining mechanisms of psychological distress among HIV-seropositive APIs are needed.

Key words

stigma Asians Pacific Islanders HIV/AIDS 

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References

  1. Alonzo, A. A., and Reynolds, N. R. (1995). Stigma, HIV and AIDS: An exploration and elaboration of a stigma trajectory. Social Science and Medicine, 41, 303–315.PubMedGoogle Scholar
  2. Bunting, S. M. (1996). Sources of stigma associated with women with HIV. Advance Nursing Science, 19, 64–73.Google Scholar
  3. Busza, J. R. (2001). Promoting the positive: Responses to stigma and discrimination in Southeast Asia. AIDS Care, 13, 441–456.PubMedGoogle Scholar
  4. Centers for Disease Control and Prevention. (2001). HIV/AIDS Surveillance Report: US HIV and AIDS cases reported through december 2001. Rep. No. 13(2).Google Scholar
  5. Chang, A. M., Chau, J. P., and Holroyd, E. (1999). Translation of questionnaires and issues of equivalence. Journal of Advanced Nursing, 29, 316–322.PubMedGoogle Scholar
  6. Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., and Wu, A. W. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. Patient Care Committee and Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care, 12, 255–266.PubMedGoogle Scholar
  7. Chin, D., and Kroesen, K. W. (1999). Disclosure of HIV infection among API American women: Cultural stigma and support. Cultural Diversity Ethnic Minority Psychology, 5, 222–235.Google Scholar
  8. Chin, J. J., Kang, E., Kim, J. H., and Martinez, J. (2003). Serving Asians and Pacific Islander with HIV/AIDS: Challenges and lessons learned. Unpublished Manuscript.Google Scholar
  9. Dohrenwend, B. P., Shrout, P. E., Egri, G., and Mendelsohn, F. S. (1980). Nonspecific psychological distress and other dimensions of psychopathology. Measures for use in the general population. Archives of General Psychiatry, 37, 1229–1236.PubMedGoogle Scholar
  10. Eckholdt, H., and Chin, J. (1997). Pneumocystis carinii Pneumonia in Asians and Pacific Islanders. Clinical Infectious Disease, 24, 1265–1267.Google Scholar
  11. Eckholdt, H. M., Chin, J. J., Manzon-Santos, J. A., and Kim, D. D. (1997). The needs of Asians and Pacific Islanders living with HIV in New York City. AIDS Education and Prevention, 9, 493–504.PubMedGoogle Scholar
  12. Fife, B. L., and Wright, E. R. (2000). The dimensionality of stigma: A comparison of its impact on the self of persons with HIV/AIDS and cancer. Journal of Health Social Behavior, 41, 50–67.Google Scholar
  13. Fleishman, J. A., Sherbourne, C. D., Crystal, S., Collins, R. L., Marshall, G. N., Kelly, M., Bozzette, S. A., Shapiro, M. F., and Hays, R. D. (2000). Coping, conflictual social interactions, social support, and mood among HIV-infected persons. HCSUS Consortium. American Journal of Community Psychology, 28, 421–453.PubMedGoogle Scholar
  14. Fullilove, M. T. (1989). Anxiety and stigmatizing aspects of HIV infection. Journal of Clinical Psychiatry, 50(Supplement), 5–8.Google Scholar
  15. Gock, T. (1994). Acquired immunodeficiency syndrome. In D. T. Takeuchi and K. J. Young (Eds.), Confronting critical issues of Asians and Pacific Islanders (pp. 247–265). London: Sage Publications.Google Scholar
  16. Goffman, I. (1963). Stigma: Notes on the management of a spoiled identity. New York: Simon and Schuster.Google Scholar
  17. Golub, E. T., Astemborski, J. A., Hoover, D. R., Anthony, J. C., Vlahov, D., and Strathdee, S. A. (2003). Psychological distress and progression to AIDS in a cohort of injection drug users. Journal of AIDS, 32, 429–434.PubMedGoogle Scholar
  18. Griffin, K. W., and Rabkin, J. G. (2000). Psychological distress in people with HIV/AIDS: Prevalence rates and methodological issues. AIDS and Behavior, 1, 29–42.Google Scholar
  19. Herek, G. M. (1999). AIDS and stigma. American Behavioral Scientist, 42, 1106–1116.Google Scholar
  20. Herek, G. M., and Glunt, E. K. (1988). An epidemic of stigma. Public reactions to AIDS. American Psychologist, 43, 886–891.PubMedGoogle Scholar
  21. Hudson, A. L., Lee, K. A., Miramontes, H., and Portillo, C. J. (2001). Social interactions, perceived support, and level of distress in HIV-positive women, Journal of the Association of Nurses AIDS Care, 12, 68–76.Google Scholar
  22. Ironson, G., Solomon, G. F., Balbin, E. G., O’Cleirigh, C., George, A., Kumar, M., Larson, D., and Woods, T. E. (2002). The Ironson-woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS. Annals of Behavioral Medicine, 24, 34–48.PubMedGoogle Scholar
  23. Kalichman, S. C., DiMarco, M., Austin, J., Luke, W., and DiFonzo, K. (2003). Stress, social support, and HIV-status disclosure to family and friends among HIV-positive men and women. Journal of Behavioral Medicine, 26(4), 315–332.PubMedGoogle Scholar
  24. Kang, E., Rapkin, B., Springer, C., and Kim, J. H. (2003). The “demon plague” and access to care among Asian undocumented immigrants living with HIV disease in New York City. Journal of Immigrant Health, 5, 49–58.PubMedGoogle Scholar
  25. Kang, E., and Rapkin, B. D. (2003). Adherence to antiretroviral medication among undocumented Asians living with HIV disease in New York City. The Community Psychologist, 36(2), 35–38.Google Scholar
  26. Kawachi, I., and Berkman, L. F. (2001). Social ties and mental health. Journal of Urban Health, 78, 458–467.PubMedGoogle Scholar
  27. Lichtenstein, B., Laska, M. K., and Clair, J. M. (2002). Chronic sorrow in the HIV-positive patient: Issues of race, gender, and social support. AIDS Patient Care and STDs, 16(1), 27–38.PubMedGoogle Scholar
  28. Matsudaira, T. (2003). Cultural influences on the use of social support by Chinese immigrants in Japan: “Face” as a keyword. Quality of Health Research, 13, 343–357.Google Scholar
  29. Miles, M. S., Burchinal, P., Holditch-Davis, D., Wasilewski, Y., and Christian, B. (1997). Personal, family, and health-related correlates of depressive symptoms in mothers with HIV. Journal of Family Psychology, 11, 23–34.Google Scholar
  30. Nemoto, T., Operario, D., Soma, T., Bao, D., Vajrabukka, A., and Crisostomo, V. (2003). HIV risk and prevention among Asian/ Pacific Islander men who have sex with men: Listen to our stories. AIDS Education and Prevention, 15(1 Suppl. A), 7–20.PubMedGoogle Scholar
  31. New York State Department of Health. (2003). Cumulative AIDS Cases diagnosed through December 31, 2001 among Asian/PI who were NYC residents at the time of diagnosis by selected characteristics, New York.Google Scholar
  32. Parker, R. G., Easton, D., and Klein, C. H. (2000). Structural barriers and facilitators in HIV prevention: A review of international research. AIDS, 14(Suppl. 1), S22–S32.PubMedGoogle Scholar
  33. Parker, R., and Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science and Medicine, 57(2003), 13–24.PubMedGoogle Scholar
  34. Pounds, M. B., Conviser, R., Ashman, J. J., and Bourassa, V. (2002). Ryan White CARE Act service use by Asian/Pacific Islanders and other clients in three California metropolitan areas (1997–1998). Journal of Community Health, 27, 403–417.PubMedGoogle Scholar
  35. Pugh, K., Riccio, M., Jadresic, D., Burgess, A. P., Baldeweg, T., Catalan, J., Lovett, E., Hawkins, D. A., Gruzelier, J., and Thompson, C. (1994). A longitudinal study of the neuropsychiatric consequences of HIV-1 infection in gay men. II. Psychological and health status at baseline and at 12-month follow-up. Psychological Medicine, 24, 897–904.PubMedGoogle Scholar
  36. Scott, J. (2001, July). In population ranks, an ascent of Asians. New York Times.Google Scholar
  37. Smith, M. Y., and Rapkin, B. D. (1996). Social support and barriers to family involvement in caregiving for persons with AIDS: Implications for patient education. Patient Education Counseling, 27, 85–94.Google Scholar
  38. Songwathana, P., and Manderson, L. (2001). Stigma and rejection: Living with AIDS in villages in southern Thailand. Medical Anthropology, 20, 1–23.PubMedGoogle Scholar
  39. Sue, S., and Zane, N. (1987). The role of culture and cultural techniques in psychotherapy. A critique and reformulation. American Psychologist, 42, 37–45.PubMedGoogle Scholar
  40. Sy, F. S., Chng, C. L., Choi, S. T., and Wong, F. Y. (1998). Epidemiology of HIV and AIDS among Asian and Pacific Islander Americans. AIDS Education and Prevention, 10, 4–18.PubMedGoogle Scholar
  41. Triplet, R. G., and Sugarman, D. B. (1987). Reactions to AIDS victims: Ambiguity breeds contempt. Personality and Social Psychological Bulletin, 13, 265–274.Google Scholar
  42. Tuck, I., McCain, N. L., and Elswick, R. K., Jr. (2001). Spirituality and psychosocial factors in persons living with HIV. Journal of Advanced Nursing, 33, 776–783.PubMedGoogle Scholar
  43. US Bureau of the Census. (1993). 1990 census of population and housing: Asian and Pacific Islanders in the United States. Washington DC: US Department of Commerce. Publication DP-3-5.Google Scholar
  44. Valdiserri, R. O. (2002). HIV/AIDS stigma: An impediment to public health. American Journal of Public Health, 92, 341–342.PubMedGoogle Scholar
  45. Vogl, D., Rosenfeld, B., Breitbart, W., Thaler, H., Passik, S., McDonald, M., and Portenoy, R. K. (1999). Symptom prevalence, characteristics, and distress in AIDS outpatients. Journal of Pain Symptom Management, 18, 253–262.Google Scholar
  46. Yoshikawa, H., Kang, E., Wilson, P., Hseuh, J., Rosman, E., and Park, T. (2001). HIV prevention needs assessment of API MSMs in New York City. Report submitted to the New York City Department of Health.Google Scholar
  47. Yoshioka, M. R., and Schustack, A. (2001). Disclosure of HIV Status: Cultural issues of Asian patients. AIDS Patient Care and STDs, 15, 77–82.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Ezer Kang
    • 1
    • 2
    • 5
  • Bruce D. Rapkin
    • 3
  • Robert H. Remien
    • 1
  • Claude Ann Mellins
    • 1
    • 2
  • Alina Oh
    • 4
  1. 1.HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute, Columbia UniversityNew York
  2. 2.Department of Pediatric PsychiatryColumbia-Presbyterian Center of New York Presbyterian HospitalNew York
  3. 3.Department of Psychiatry and Behavioral ScienceMemorial Sloan-Kettering Cancer CenterNew York
  4. 4.Department of Professional Psychology and Family TherapySeton Hall UniversityNew York
  5. 5.Research ScientistHIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia UniversityNew YorkUSA

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