The aims of the proposed project emerged from the findings of our current project (MH R01 066848) and are guided by a theoretical model that melds approaches that conceptualize stigma as a stressor with an approach that describes prejudice from the perspective of its perpetrators. The integrated model suggests that the consequences of HIV/AIDS stigma (e.g., psychological symptoms and sexually risky behavior) depend on both the manner in which community members express prejudice (subtle or blatant) and on individual differences in vulnerability to stigma and coping with stigma among people with HIV/AIDS living in these communities. This model, which was used to interpret the findings of the current project, suggests three hypotheses that will be examined in the proposed project. The first is that coping with high levels of perceived HIV/AIDS stigma with disengagement (i.e., avoidance) coping will be related to the social integration of people with HIV/AIDS into their communities and their sexual behavior. The second hypothesis is that psychological symptoms may be both a consequence of perceived HIV/AIDS stigma and/or may make people with HIV/AIDS vulnerable to perceiving that they are stigmatized. The third hypothesis is that perceived HIV/AIDS stigmatization by people with HIV/AIDS will depend on the type of prejudice (implicit/subtle or blatant) that is expressed by the community in which they live, and on their individual vulnerability to stigmatization. These hypotheses will be tested with 250 participants with HIV/AIDS who will complete a longitudinal study to assess perceived stigma, coping with stigma, psychological symptoms, and sexual risk behavior, a diary measure in which they record their daily experiences with stigmatization, and an experiment in which they interpret how prejudiced people from the community are based on a sample of their behavior. Community subtle and blatant prejudice toward people with HIV/AIDS will be assessed by a survey of residents of the communities in which participants with HIV/AIDS live. Findings of this project will be useful in designing interventions by increasing understanding of the type and the amount of HIV/AIDS stigma people with HIV/AIDS face in their communities, the role that individual vulnerability plays in the experience of HIV/AIDS stigmatization, and the role that coping with stigma plays in influencing the relationship between experienced stigma and important outcomes (e.g., sexually risky behavior and psychological symptoms). Findings also will indicate whether reductions in stigma may have unintended results (i.e., paradoxical increases in risky sexual behavior) unless there is a better understanding of how community context, individual vulnerabilities to stigmatization, and coping with stigma affect the outcomes of people with HIV/AIDS.
HIV/AIDS stigma has been identified as a critical issue for people with HIV/AIDS, particularly those living outside of metropolitan areas. The goal is to identify individual differences and community level variables that make people with HIV/AIDS vulnerable or resilient to the adverse consequences of HIV/AIDS stigma. The public health consequences to be examined are psychological symptoms, including clinical levels of anxiety and depression that characterize the study population, and sexual behaviors that risk the transmission of the virus.
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