Fazeli Pariya L, Turan Janet M, Budhwani Henna, Smith Whitney, Raper James L, Mugavero Michael J, Turan Bulent
Department of Family, Community and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL.
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
Stigma Health. 2017 Aug;2(3):216-228. doi: 10.1037/sah0000051. Epub 2016 Aug 8.
Internalized stigma related to HIV is associated with poorer outcomes for people living with HIV (PLWH). However, little is known about the association between experiences of daily acts of discrimination by others and the activation of internalized stigma, including factors that may moderate this association. One hundred nine men living with HIV responded to experience sampling method (ESM) questions 3 times a day for 7 days via smart-phones. ESM questions included experiences of recent acts of discrimination, internalized HIV stigma, avoidance coping with HIV, and recent social support. We also administered several traditional questionnaire measures assessing psychosocial constructs. In Hierarchical Linear Modeling analyses controlling for age, race, socioeconomic status, and time on antiretroviral therapy, experiencing discrimination predicted internalized stigma within-persons. Individuals higher on attachment-related avoidance, attachment-related anxiety, avoidance coping, perceived community stigma, and helplessness, and individuals lower on social support, had stronger associations between discrimination and current internalized stigma. Similarly, results from two state moderator variables supported our trait analyses: State-level (ESM) social support and avoidance coping were significant moderators. Thus, when PLWH experience incidents of discrimination due to HIV, this may lead to increased feelings of internalized stigma. We extend the literature by demonstrating that the associations between experienced and internalized stigma are not just at the generalized trait level, but also occur at the state-level, accounting for within person variability. Results provide implications for interventions aiming to modify maladaptive interpersonal traits as well as interventions to increase social support to reduce the impact of discrimination on PLWH.
与艾滋病毒相关的内化耻辱感与艾滋病毒感染者（PLWH）的较差预后相关。然而，对于他人日常歧视行为的经历与内化耻辱感的激活之间的关联，包括可能调节这种关联的因素，我们知之甚少。109名艾滋病毒感染者通过智能手机，连续7天每天3次回答经验取样法（ESM）问题。ESM问题包括近期歧视行为的经历、艾滋病毒内化耻辱感、应对艾滋病毒的回避策略以及近期的社会支持。我们还进行了几项传统问卷调查，以评估心理社会结构。在控制了年龄、种族、社会经济地位和抗逆转录病毒治疗时间的分层线性模型分析中，经历歧视可预测个体内部的内化耻辱感。在依恋相关回避、依恋相关焦虑、回避应对、感知到的社区耻辱感和无助感方面得分较高的个体，以及在社会支持方面得分较低的个体，歧视与当前内化耻辱感之间的关联更强。同样，两个状态调节变量的结果支持了我们的特质分析：状态水平（ESM）的社会支持和回避应对是显著的调节因素。因此，当艾滋病毒感染者因艾滋病毒而经历歧视事件时，这可能会导致内化耻辱感的增加。我们通过证明经历的耻辱感和内化耻辱感之间的关联不仅存在于广义特质水平，也存在于状态水平，解释了个体内部的变异性，从而扩展了相关文献。研究结果为旨在改变适应不良人际特质的干预措施以及增加社会支持以减少歧视对艾滋病毒感染者影响的干预措施提供了启示。
