In this manuscript, “Intersectional Structural Stigma, Community Priorities, and Opportunities for Transgender Health Equity,” Poteat and Simmons outline the legal and policy barriers that impede efforts to end the HIV epidemic among transgender people in the South. They present qualitative and quantitative data from a community engaged research study conducted with transgender adults and other key stakeholders as well as finding from an analysis of policies impacting transgender people in both states. Violence prevention and decriminalization are highlighted as (...) key policy initiatives that would advance health equity for transgender people. (shrink)

The primary claim of this paper is that COVID-19 stigma must be understood as a structural phenomenon. Doing so will inform the interventions we select and prioritize for the amelioration of such stigma. Thinking about stigma as a macrosocial determinant of health driven by structural factors suggests that downstream remedies are unlikely to be effective in significantly reducing stigma. This paper develops and defends this claim, setting up a recommendation to use a “bundle” of (...) legal and policy levers at meso- and macro- levels to reduce the adverse and inequitable impact of COVID-19 stigma.Historians of public health have long pointed out that outbreaks of communicable disease track social fault lines (Rosenberg... (shrink)

This paper addresses the need for, and ultimately proposes, an educational framework to develop competencies in attending to ethical issues in mental health and substance use health (MHSUH) in healthcare ethics consultation (HCEC). Given the prevalence and stigma associated with MHSUH, it is crucial for healthcare ethicists to approach such matters skillfully. A literature review was conducted in the areas of bioethics, health professions education, and stigma studies, followed by quality improvement interviews with content experts to gather feedback (...) on the framework’s strengths, limitations, and anticipated utility. The proposed framework describes three key concepts: first, integrating self-reflexive practices into formal, informal, and hidden curricula; second, embedding structural humility into teaching methods and contexts of learning; and third, striking a balance between critical consciousness and compassion in dialogue. The proposed educational framework has the potential to help HCEC learners enhance their understanding and awareness of ethical issues related to structural stigma and MHSUH. Moreover, context-specific learning, particularly in MHSUH, can play a significant role in promoting competency-building among healthcare ethicists, allowing them to address issues of social justice effectively in their practice. Further dialogue is encouraged within the healthcare ethics community to further develop the concepts described in this framework. (shrink)

This article analyzes the relationship between the structure of federal Title IX investigations and the existing evidence addressing the emotional and mental health needs of sexual harassment and sexual assault victims. The article argues that federal requirements for investigating sexual harassment should be restructured so as to address the challenges stigma poses for the realization of Title IX's objectives.

Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders. FASD is a spectrum of structural, functional, and neurodevelopmental problems with often lifelong implications, affecting communities worldwide. It is a leading preventable form of intellectual disabilities and therefore warrants effective prevention approaches. However, well-intended FASD prevention can increase stigmatization of individuals with FASD, women who consume or have consumed alcohol during pregnancy, and non-biological parents and guardians of individuals with FASD. This narrative review surveyed the literature on stigmatization (...) related to FASD. Public stigma appears to be the most common form of stigma studied. Less is known about FASD-related self-stigma, stigma by association, and structural stigma. Accordingly, the current literature on FASD-related stigma does not appear to provide sufficient guidance for effectively reducing FASD-related stigma. However, lessons can be learned from other related health topics and the use of a systematic approach for the development of health promotion programs, namely Intervention Mapping. (shrink)

In this article I read textual metaphors of ‘untouchability’ in ‘post-AIDS’ representation as an erasure of structures that condition HIV stigmatization in India. Throughout, my discussion is contextualised by the political economy of HIV and AIDS, which has been productive of particular modern sexual subjects. In the film My Brother…Nikhil, the stigmatization of Nikhil, a gay Indian man living with HIV, is constituted through visual and verbal caste metaphors, which draw on existing subject positions that are elided as ‘traditional’, residual, (...) and receding. This stigma is resolved textually through parental acceptance of the gay protagonist and his partner, projecting stigma as traditional and modernity as the resolution. Such metaphors of ‘untouchability’ prevent the representation of queer Dalit subjects in contexts of HIV and AIDS. Yet if addressing shame and social stigma are key to HIV treatment and prevention programmes, caste cannot be set aside simply as a metaphor. Expanding to include textual representations of queer Dalit subjectivity, the article reads a novel, The Boyfriend, and a poem, “Gandu Bagicha,” to show ways in which caste stigma and homophobia intersect in contexts of seroconversion risk. (shrink)

In many parts of sub-Saharan Africa, mothers impacted by the genetic condition of albinism, whether as mothers of children with albinism or themselves with albinism, are disproportionately impacted by a constellation of health-related stigma, social determinants of health, and human rights violations. In a critical ethnographic study in Tanzania, we engaged with the voices of mothers impacted by albinism and key stakeholders to elucidate experiences of stigma. Their narratives revealed internalized subjective stigma, social stigma such as (...) being ostracized by family and community, and structural stigma on account of lack of access to SDH. An analysis of health systems as SDH revealed stigmatizing attitudes and behaviours of healthcare providers, especially at the time of birth; a lack of access to timely quality health services, in particular skin and eye care; and a lack of health-related education about the cause and care of albinism. Gender inequality as another SDH featured prominently as an amplifier of stigma. The findings pose implications for research, policy, and practice. A concrete avenue to de-stigmatization of mothers impacted by albinism exists by the application of principles of human rights, particularly equality and non-discrimination; contextual analysis of cultural dynamics including relevant ontology; meaningful participation of rights-claimants, such as peer groups of mothers; and accountability of governments and their obligation to ensure access to health information as a key social determinant of the right to health. (shrink)

This study uses an integrated model of resource conservation theory and social learning theory to explore the antecedents of hotel interns’ perceptions of occupational stigma and to explore the mechanisms inherent to retention willingness. This study first manipulated relevant subjects’ experimental materials through a contextual experiment and used a one-way ANOVA to test the effects of competence stereotypes and occupational stereotypes on hotel interns’ stigma perceptions, respectively, and then used partial least squares structural equation modeling as a (...) statistical tool and the SmartPLS 3.0 program to validate the model of hotel interns’ occupational stigma perceptions-intention. The effects of both competence stereotypes and occupational stereotypes on hotel interns’ perceptions of occupational stigma were significant. The results of the partial least squares structural equation model showed that hotel interns’ perceptions of occupational stigma significantly contributed to emotional exhaustion and that emotional exhaustion significantly influenced hotel interns’ retention willingness, hotel interns’ perceptions of occupational stigma had a significant effect on their retention willingness, while the role of emotional exhaustion as a mediating variable and occupational commitment as a moderator. The inner psychological and behavioral linkage mechanisms of hotel interns’ occupational stigma perceptions and their retention willingness under COVID-19 were explored, and the resource dynamics operating mechanism and professional commitment were also confirmed. (shrink)

Since its foundation in 2010, the annual philosophy thematic edition of this journal has been a forum for authors from a wide range of disciplines and backgrounds, enabling contributors to raise questions of an urgent and fundamental nature regarding the most pressing problems facing the delivery and organization of healthcare. Authors have successfully exposed and challenged underlying assumptions that framed professional and policy discourse in diverse areas, generating productive and insightful dialogue regarding the relationship between evidence, value, clinical research and (...) practice. These lively debates continue in this thematic edition, which includes a special section on stigma, shame and respect in healthcare. Authors address the problems with identifying and overcoming stigma in the clinic, interactional, structural and phenomenological accounts of stigma and the ‘stigma-shame nexus’. Papers examine the lived experience of discreditation, discrimination and degradation in a range of contexts, from the labour room to mental healthcare and the treatment of ‘deviancy’ and ‘looked-after children’. Authors raise challenging questions about the development of our uses of language in the context of care, and the relationship between stigma, disrespect and important analyses of power asymmetry and epistemic injustice. The relationship between respect, autonomy and personhood is explored with reference to contributions from an important conference series, which includes analyses of shame in the context of medically unexplained illness, humour, humiliation and obstetric violence. (shrink)

Conflicts of interest in health and medicine have been the source of considerable public and professional debate. Much of this debate has focused on financial, rather than non-financial COI, which is a significant lacuna because non-financial COI can be just as influential as financial COI. In an effort to explore the nature and effects of non-financial, as well as financial COI, we conducted semi-structured interviews with eleven Australian medical professionals regarding their experiences of, and attitudes towards, COI. We found that (...) this group of medical professionals saw non-financial interests—most notably the pursuit of status and respect and the avoidance of stigma—as potentially conflicting with other important interests. (shrink)

This article comments on a collection of remarkable narratives authored by fat writers addressing the American Medical Association’s decision to label obesity a disease. Endeavoring to avoid what has been termed “thinsplaining,” the commentary examines the voices of the writers in the hopes of identifying key themes and points that emerge from these fat narratives. The commentary canvasses the writers’ perspectives on topics such as the medicalization and pathologization of fat, the Western and especially American tendency to emphasize individual culpability (...) for fatness, and, of course, the horrific commonality and intensity of fat stigma. Stigma is a particular focus for the commentary, both because it is a principal theme in the collection, and also because it is important to understand precisely what stigma is and its deep connections to larger macrosocial structures. The commentary concludes with a simple admonition, gleaned from the narratives: we should strive to do better. (shrink)

Individuals who are overweight or obese encounter frequent weight-related stigma experiences, which are associated with negative health outcomes. In this regard, the Brief Coping Responses Inventory was developed as a measure of core coping responses to weight stigma, with 10 items loading on two subscales of reappraisal and Disengagement coping. The current study aimed to examine the psychometric properties of the Persian BCRI with 253 Iranian school-attending youth who had BMI score over 30. The results of the confirmatory (...) factor analysis supported the originally proposed two-factor model, which yielded acceptable internal consistency based on various reliability measures such as Cronbach’s alpha coefficients and demonstrated the expected convergent and divergent associations with external correlates of interest. This study was also the first one worldwide to examine and report that the originally proposed two-factor model of the BCRI is invariant across gender groups, which allows for examining mean differences in BCRI scores across gender groups. Overall, our results indicated that the BCRI is a valid and reliable measure with a solid factor structure, which could be used to examine the coping reactions to weigh related stigma experiences among youth samples in Iran. Our results may encourage future studies on the psychometrics of the BCRI with other Iranian samples. (shrink)

Recent literature has suggested that generics can harbor and propagate worrying ideologies in a manner which is often not appreciated by speakers. In this article, I argue that the use of generics to convey information about mental illness is unhelpful, whether the knowledge structure conveyed by the generic is 'accurate' or not. Inaccurate generics contribute to insidious forms of social stereotyping and stigma by encouraging us to simplistically generalize characteristics found in very few category members to other members of (...) that kind.Yet, even where the knowledge structure underlying the generic is accurate, generics remain an unhelpful way of talking about mental illness. This is because... (shrink)

_ Source: _Volume 5, Issue 2, pp 273 - 289 The impact of the stigma often associated with chronic illness cannot be explained by sociology alone, yet sociology has a significant contribution to make, most obviously through the analysis of stigma relations as social structures. This paper draws on critical realist philosophy and advances a _jigsaw model_ comprising _logics, relations_ and _figurations_ to assist empirical enquiry. A case is made for focusing on interrelations between the logic of shame (...) and the relations of stigma it gives rise to and other logics/relations across a range of figurations. A new framework for understanding and explaining stigmatising illness is put forward and subsequently applied to contemporary programmes of stigma reduction. The principal thesis of the paper is that across many of the figurations in which chronic illness features the logic of shame and its relations of stigma have lost ground to the logic of culpability and its relations of deviance. In short, people with chronic illness are increasingly being held culpable for their condition. (shrink)

HIV stigma, a social-medical problem, continues to confound researchers and health professionals, while undermining outcomes. Empathy may reduce stigma; its absence may predict stigma. This research investigates: How does Kafka’s _Metamorphosis_ advance understandings of HIV stigma in medical health education? _Metamorphosis_ amplifies the sociological-relational mechanisms fostering HIV stigma. It offers a multi-disciplinary, responsive space for ethical, humanistic and clinical inquiry to meet: enabling students to consider how social structures shape health inequities, moral, social experience, and (...) their professional identity within. _Metamorphosis_ may ultimately promote medical health humanities’ social mission—allowing literature to unfold such revelations towards greater equity in health. (shrink)

O’BYRNE P and WATTS J. Nursing Inquiry 2012 [Epub ahead of print] Include, differentiate and manage: gay male youth, stigma and healthcare utilizationIn Canada, there has been a recent increase in HIV incidence among young men who have sex with men. However, gay male youth (GMY) may forego HIV testing due to fear of stigmatization. Therefore, the aim of this research was to explore the perceptions of stigma in health care within this population. The research was conducted through (...) a series of semi‐structured interviews with eight GMY aged 20–29, who frequented a gay‐friendly clinic in downtown Ottawa, Canada. In a sub‐analysis of the interviews utilizing the work of Hardt and Negri’s three‐part sequence – inclusion, differentiation and management – we found that homosexuality‐related stigmatization affects the interaction between GMY and health professionals. Interview participants perceived HIV‐related risk counselling as a manifestation of stigma. These findings reveal that the experience of stigma and stigmatization is not necessarily based on health professionals’ intentions, but rather, on patients’ perceptions of the interactions they have with health professionals. Specific modifications to the delivery of health care may help to overcome stigmatization. (shrink)

Social work is underpinned by values of anti-oppressive practice and social justice. Our professional standards require social workers to consider their personal and professional development. Thus, this article combines a reflection on both our professional role as academics and our existential identity as social workers in challenging racism and mental health stigma. To progress equality of opportunity, we argue it is necessary to understand first what we mean by an ‘integrated society’ before we can secondly challenge diverse forms of (...) oppression. We conclude by positing that a community free of interpersonal, institutional and structural oppression may only be possible within a virtual world. (shrink)

The phenomenon and implications of stigma have been recognized across many contexts and in relation to many discrete issues or conditions. The notion of spatial stigma has been developed within stigma literature, although the importance and relevance of spatial stigma for rural places and rural people have been largely neglected. This is the case even within fields of inquiry like public and rural health, which are expansively tasked with addressing the socio-structural drivers of health inequalities. (...) In this paper, we argue that developing a better understanding of rural place stigma is critical for addressing contemporary patterns of spatial injustice and health inequalities affecting rural communities globally. Drawing on international literature and examples from the reported experiences of rurally living Australians and news and other media, we present an analysis highlighting the power in rural place stigma. In doing so, we build a case for the relevance and importance of interrogating rural place stigma, especially in the fields of public and rural health, for changing the conditions within—and the broader positioning of—the rural in the public and political landscapes. (shrink)

We examine stigma and how it operates, then develop a novel framework to classify the range of positions that are conceptually possible regarding how stigma ought to be handled from a public health perspective. In the case of weight stigma, the possible positions range from encouraging the intentional use of weight stigma as an obesity prevention and reduction strategy to arguing not only that this is harmful but that weight stigma, independent of obesity, needs to (...) be actively challenged and reduced. Using weight stigma as an illustrative example, we draw on prior theoretical work on stigma mechanisms and intervention strategies to develop a framework for improving the understanding, evaluation, and planning of anti-stigma interventions. This framework has the potential to help public health actors to map out how protest, contact, education, and regulation strategies can be used to reduce direct discrimination, structural discrimination, and internalized stigma. (shrink)

This study explored perceived benefits and risks of participation in HIV research among 33 female sex workers in Tecún Umán, Guatemala. Stigma associated with sex work and HIV was a critical barrier to research participation. Key benefits of participation included access to HIV/sti prevention and testing, as well as positive and trusting relationships between sex workers and research teams. Control exerted by managers had mixed influences on perceived research risks and benefits. Results underscore the critical need for HIV investigators (...) to develop population-tailored procedures to reduce stigma; engage managers; and reinforce trusting, reciprocal relationships between sex work communities and researchers. (shrink)

This research used a semi-structured interview method and Smith and Osborn's interpretive phenomenological analysis to investigate a female prostitute's experiences of stigma associated with her work. To structure the interview schedule, Seidman's in-depth phenomenologically based interviewing method, which comprises three areas of focus, “focused life history,” “details of the experience” under investigation, and “reflection of the meaning” of the experience, was used as a general guide. Ten broad psychological themes were identified: 1) awareness of engaging in what people think (...) is bad; negative labeling by people who discover she is a prostitute; 3) hiding and lying about her identity as a prostitute to avoid being labeled negatively; 4) hiding and lying about her prostitution identity result in stress, anxiety, and exhaustion; 5) wishing she did not have to hide and lie about being a prostitute; 6) questioning and objecting to the stigmatization of prostitution; 7) managing the sense of stigmatization by persons who know about her prostitution by shifting focus away from devaluing and toward valuable qualities of prostitution; 8) developing occupational esteem and self-esteem through reflection of values; 9) compassion towards other people who suffer from stigma; and 10) resiliency. (shrink)

Blasphemy law has become a central issue for the international community in various parts of the world in the last three decades. In almost every case involving the BL, especially in Muslim countries, such as Pakistan, Malaysia, and Indonesia, they are always responded with violence or threats of attack that cause many victims, loss of homes, damage to places of worship, evictions, stigma of being heretical, severe punishments, or extra-judicial killings. When international human rights law and declaration of the (...) right to peace are adopted by the international community, at the same time, the number of violence related to the application of BL continues to increase. This paper aims to examine the ambiguity of the concept of the BL in Pakistan, Indonesia, and Malaysia, and how its lead to the weak of enforcement that creates social injustice and inequality. Then, referring to Galtung’s theory of structural violence and other experts of peace studies, this paper argues that blasphemy law should be included as a form of structural violence. Therefore its challenges these States to reform their BL in which its provisions accommodate the state’s neutrality and content high legal standards. Thus, through guarantee the fully enjoyment of human rights for everyone may support the States to achieve sustainable peace. (shrink)

Every year millions of people suffer minor brain injuries, many of which occur in collision sports. While there has been substantial commentary and debate about the nature of this public health crisis, it is clear that the scientific and clinical arguments reflect values preferences and judgments that are often invisible in documents which combine artful language with undue focus paid to sources of uncertainty at the cost of clarity and transparency. This essay gives a brief history of these patterns and (...) proposes a remedy. (shrink)

Introduction: Despite being considered as a contravention under some countries’ legislation, the therapeutic use of Cannabis sativa has been growing in Brazil, due to the promising results observed in many pathologies. Such a scenario has fostered the need to deepen discussions on the subject and possibly revise legislation governing the substance use and access. Objectives: Identify the types of stigma related to the therapeutic use of Cannabis and describe the strategies people use to overcome stigma. Methods: This integrative (...) review was carried out in the databases PubMed, Scopus, CINAHL, MEDLINE, PsycINFO, Web of Science, and Cochrane Library, with 565 articles being retrieved. Triads’ cross-check were done, first maintaining the “cannabis” and “therapeutic use” pair, added by “stigma,” “bioethics,” “ethics,” “social consequences,” and “legal consequences.” The final selection resulted in six articles. Ethical Consideration: However, the ethical issues that pervade and regulate decisions on this subject must be considered. Results: Different dimensions and types of stigma related to the therapeutic use of Cannabis have been identified. The bioethical principle of autonomy was an expression of citizenship and human rights, mitigating internal conflicts related to self-stigma and the effects of external stigma on the person’s life. Conclusion: It was possible to identify the types of stigma related to the therapeutic use of Cannabis is an internal dimension represented (self-stigma) and an external dimension, represented (social and structural stigmas) and to identify strategies adopted to face this stigma: skills training group for users, elaboration of laws and specific programs to clarify the therapeutic use of Cannabis with a greater social scope, and support for family members. Thus, contributing to the building of people’s autonomy in a broader context of decision-making autonomy and executive autonomy will provide the development of people’s capacity to perform complex tasks of self-management and, consequently, to continue promoting and preserving their decision-making process and their capacity to plan and perform tasks associated with managing their lives and their treatments. (shrink)

Background: Stigma is considered a major barrier to accessing healthcare services by female sex workers. Current knowledge of nurses’ attitudes appears to imply a stigma toward female sex workers. But in-depth understanding of their perceptions is scarce. Furthermore, factors that inform a conceptual understanding of how this occurs are lacking. Objectives: The study aimed to explore nurses’ attitudes toward female sex workers and factors affecting caring for female sex workers. Research design: This was a qualitative study. A content (...) analysis approach was adopted in analyzing the data. Participants and research context: Thirty-three practicing nurses participated in seven semi-structured focus group interviews and three key informants participated in three individual interviews in Hong Kong. Ethical considerations: This study was approved by the Ethics Committee of one university in Hong Kong. Findings: The findings revealed three themes: (1) accept, stigmatize, or against sex work; (2) reluctance, hesitation, or willingness to care for female sex workers; and (3) factors affecting the care of female sex workers. Discussion and conclusion: This study found that nurses held different attitudes toward female sex workers, and they experienced feelings of reluctance, hesitation, or willingness to care for female sex workers. Multi-level factors could affect their level of comfort of caring for female sex workers. Intervention should be developed to encourage health professionals to examine their personal views toward female sex workers introspectively, how their attitude may have affected the provision of quality services, and to enhance the provision of sensitive non-discriminative services to female sex workers. (shrink)

Globally, parents and children in same-sex parent families are impacted by many laws related to the parental sexual orientation. These laws vary considerably from one country to another, ranging from full legal recognition to criminalization. The psychological consequences of living in an ambiguous or hostile legal climate likely interfere with parental health, family functioning, and child development. However, a systematic evidence synthesis of the pertinent literature and its placement within a broader psychological model are currently lacking. The aims of this (...) review were thus (1) to systematically review qualitative and quantitative evidence on the impact of sexual orientation laws on same-sex parent families in key domains and (2) to place these findings within a broader model informed by minority stress and family theories. Our review was preregistered and conducted in line with PRISMA guidelines. We searched for qualitative, quantitative, and mixed methods studies on the impact of sexual orientation laws on target outcomes (parental health, family functioning, child outcomes) via systematic database search (PubMed, Scopus, Web of Science) and forward-backward searches. Fifty-five studies published between 1999 and 2020 were eligible for inclusion and were synthesized using a data-based convergent synthesis design. Thirteen descriptive and three overarching analytical themes were identified through thematic synthesis. Linking our findings with minority stress and family theories, we propose a novel legal vulnerability model for same-sex parent families. The model posits that legal vulnerability constitutes an increased risk for parental and child health as well as family functioning through individual and shared pathways between family members. Additionally, the model introduces counteractions that families engage in on the personal, familial, and systemic level to mitigate the impact of legal vulnerability, as well as moderators on the contextual, familial, couple, and individual level that modulate this impact. Implications for research and clinical practice are discussed. (shrink)

The text examines the article 11 of the Universal Declaration on Bioethics and Human Rights of UNESCO that deals with the principle of non-discrimination and non-stigmatization. Both concepts are related to the theme of human dignity, while discrimination is an inherent part of stigma: stigma does not exist if there is no discrimination. In this context, this paper aims to study the relationship between stigma, discrimination and HIV / AIDS. The study argues that to loosen the bonds (...) that hold the subjects that are attached to them is necessary questioning the broader forces - social, cultural, political and economic - that structure stigma, stigmatization and discrimination as social processes directly linked to production and reproduction of structural inequalities. (shrink)

This article uncovers the current discursive practices concerning socially vulnerable people in Danish society. A discourse analytical approach inspired by Michel Foucault, along with contributions from Erving Goffmann's work ‘Stigma’, is utilized throughout the analysis. First, the dominant discursive formations are described across the data material, consisting of sociopolitical and health policy documents. Second, we uncover how problematizations and mechanisms of power along with the emergence of the competition state push socially vulnerable people out into the periphery of society. (...) Finally, we discuss responsibility regarding social vulnerability and the structural injustice that follows. Our aim is to facilitate critical awareness of how socially vulnerable people are constructed and contribute to destabilizing accepted meanings and perceptions of social vulnerability. This study shows that being categorized as socially vulnerable is associated with poor health behavior and perceived as being in a dependent relationship with superior systems. The analysis points to a focus on strengthening and developing the work capacity of socially vulnerable people. Thus, the objective of the analyzed documents revolves around securing socially vulnerable people's contribution to society's economy. This article contributes with a perspective on how society, and therefore also healthcare professionals, perceive and interact with socially vulnerable people. (shrink)

This essay argues that the discrimination that fat patients face is an issue of health justice. Insofar as this is the case, bioethicists and health care providers should not only care about it but also work to dismantle the systematic, institutional, social, and individual factors that are contributing to it to ensure that fat patients receive high‐quality health care, free of stigma and discrimination. The essay discusses a variety of ways in which fat patients are discriminated against and considers (...) the false assumptions that fuel such discrimination. It concludes by considering the structural and social issues that contribute to fatness and pushes health care providers to abandon the assumption that being fat is an individual moral failing. Ultimately, the paper argues, “fat” is not necessarily a bad word, nor one that health care providers should avoid. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. The study (...) investigated the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the genomics (...) revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health. (shrink)

Depression is a widespread concern in the United States. Neuromodulation treatments are becoming more common but there is emerging concern for racial disparities in neuromodulation treatment utilization. This study focuses on Transcranial Magnetic Stimulation (TMS), a treatment for depression, and the structural and attitudinal barriers that racialized individuals face in accessing it. In January 2023 participants from the Twin Cities, Minnesota engaged in focus groups, coupled with an educational video intervention. Individuals self identified as non-white who had no previous (...) TMS exposure but had tried at least one treatment for their depression. Results revealed that the intervention did not notably change knowledge or stigma about TMS, but attitudes surrounding traveling for treatment changed. Notably, barriers like affordability, frequency of treatment, and lack of knowledge persist. Participants expressed a desire for more information, personal connection, and a tailored educational approach. The study suggests a need for multifaceted strategies to reduce disparities, focusing on education, community-based resources, and policy interventions. Immediate actions that can be taken include the creation of a TMS education program focused on patient engagement and awareness about TMS. (shrink)

For over 20 years, the concept of “food deserts” has served as an evocative metaphor, signifying spatialized patterns of injustice associated with low access to nutritious foods through retail and social exclusion. Yet in spite of its pithy appeal, scholars and activists increasingly critique the food desert concept as stigmatizing, inaccurate, and insufficient to characterize entrenched structural inequities. These well-founded critiques demonstrate a convincing need to reframe approaches to spatialized food injustice. We argue that food desert maps, which aim (...) to visually illustrate food inequality, can reproduce problematic assumptions, stigmas, and inaccuracies that form the crux of scholarly critiques. For example, food desert maps typically overlook community assets and also utilize decontextualized and overdetermined indicators, such as proximity to supermarkets and transportation access. Although we acknowledge the contributions of food desert maps, in this paper we propose a reimagining of food access mapping. To illustrate our argument, we present a course-based food justice mapping study in Providence, Rhode Island. Our project draws inspiration from studies that interrogate the deficit-oriented framing of food deserts, as well as several alternative mapping practices: critical cartography and counter-mapping, community asset mapping, participatory geographic information systems, and radical cartography. We suggest these alternative mapping approaches have potential to move practitioners and viewers beyond the desolate “desert” vantage point and toward a more textured understanding of community food access that inspires engaged exploration. (shrink)

The article proposes a critical approach to the notion of interculturality in the context of the geopolitical and social transformations that marked the transition from the nation-state system to the birth of a common European identity.In the European society the demarginalisation of territorial and identification borders raises the question of cultural differences and the need to redefine the new criteria for social inclusion. In this perspective, the process of European integration finds its own testing ground in social policies designed to (...) cultural minority. The article focuses precisely on the case of Gypsy communities, exploring the symbolic and political mechanisms that have historically compromised public image of Gypsies through the ‘nomad theory’ by considering nomadism as part of an inherent identity. The reproduction of this stereotype is at the basis of a social stigma of Gypsy groups, perceived as a public order problem that is reflected in national and supranational politics according to the tendency to consider Gypsies as incapable of decision making and not interlocutors on issues such as health, education and housing. In this text, the author aims to examine these aspects of social exclusion of Gypsy communities and the fault lines of their Europeanisation process, emphasizing their deep roots in the historical and social structure of Europe and their political migration as a creative adaptation strategy to the historical-economic conjunctures. In this framework of reference, interculturality becomes an analytical and political tool that is capable of overcoming the conflicts between the majority society and minorities and a project able to oppose to the ideologies of difference that transform the cultures into abstract and incommunicable entities.El artículo propone un acercamiento crítico a la noción de interculturalidad en el cuadro de las transformaciones sociales y geopolíticas que han caracterizado el paso del sistema estado-nación al nacimiento de una identidad comunitaria europea. En la actual sociedad europea la desmarginalización de los confines identitarios y territoriales se eleva la cuestión de las diferencias culturales y la necesidad de redefinir nuevos criterios de inclusión social. En esta perspectiva el proceso de integración europea encuentra uno de sus bancos de prueba en las políticas sociales dirigidas a aquellas comunidades consideradas minorías culturales. El artículo se centra en particular en el caso de las comunidades gitanas, examinando los mecanismos simbólicos y políticos que han determinado históricamente una representación negativa suya por la teoría de un nomadismo consustancial a la identidad gitana. La reproducción de este estereotipo es la base de un estigma social de los gitanos, percibidos como un problema de orden público y se refleja en las políticas nacionales y supranacionales que continúan sin considerarlos interlocutores activos en la elección de estrategias pertenecientes a la esfera de la salud, de la educación y de la vivienda. En el texto se discuten estos aspectos unidos a la exclusión social de los gitanos y los puntos débiles de su integración europea, subrayando su pertenencia histórica a Europa y valorando su política migratoria como expresión de una modalidad creativa de adaptación a las coyunturas histórico-económicas. En este marco de referencia, la interculturalidad se convierte en un instrumento analítico y político capaz de superar los conflictos entre sociedad mayoritaria y ‘minoría cultural’ y a su vez en un proyecto capaz de oponerse a aquellas ideologías de la diferencia que transforman las culturas en entidades abstractas e incomunicables. (shrink)

The notion of refugees as a viable source of labor to address skill shortages in the destination country’s labor market has rarely been the dominant discourse on refugee entrants. Bella’s1 lived experience as a professional woman who arrived as a Syrian conflict refugee to Australia in 2017 presents an outlier in refugee research and challenges conventional scholarly wisdom and public discourse. A combination of human capital, a purposeful use of networks, supported by her desire for recognition and a deep sense (...) of self-worth allowed her to navigate the formalized and structured Australian business landscape. Accordingly, she was able to overcome the stigma of being a refugee: Less worthy of employment status in a position representative of her overseas skills and qualifications. In drawing on an outlier methodology and critical theory, we develop a more nuanced understanding of the agency of skilled and qualified refugee women drawing attention to lessons for business which typically takes a “one size fits all” approach to labor integration. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. The study (...) investigated the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

Background: Studies have established that negative perceptions of people living with HIV/AIDS exist among nursing students throughout the world, perceptions which can be detrimental to the delivery of high-quality nursing care. Objectives: The purpose of this research was to explore socio-cultural influences on the perceptions of nursing students towards caring for people living with HIV/AIDS. Research design: The study was guided by stigma theory, a qualitative descriptive research approach was adopted. Data collected via semi-structured interviews were thematically analysed. Participants (...) and research context: Participants were 21 international and Australian undergraduate nursing students enrolled in a Bachelor of Nursing programme at an Australian university. Ethical considerations: Ethical approval was granted by the Social and Behavioural Research Ethics Committee at the study university. Participation was entirely voluntary; informed consent was obtained before the study commenced; confidentiality and anonymity were assured. Findings: Three major themes were found: blame, othering and values. Complex and interrelated factors constructed participant perceptions of people living with HIV/AIDS, perceptions underscored by the prevailing culturally construed blame and othering associated with HIV/AIDS. The study found discordance between the negative personal beliefs and perceptions some nursing students have towards people living with HIV/AIDS, and the professional values expected of them as Registered Nurses. Discussion: There was considerable commonality between this and previous studies on how homosexuality and illicit drug use were perceived and stigmatised, correlating with the blame directed towards people living with HIV/AIDS. These perceptions indicated some nursing students potentially risked not fulfilling the ethical and professional obligations the Registered Nurse. Conclusion: Nursing curriculum should be strengthened in relation to comprehending the meaning of being stigmatised by society. Educational institutions need to work towards enhancing strategies that assist nursing students to reconcile any incongruity between their personal beliefs and requisite professional nursing values. (shrink)

Developmental origins of health and disease and epigenetics have expanded understanding of how the environment affects the health of women before and during pregnancy—with lifelong health consequences for the fetus. This has translated to a narrow focus on women’s lifestyle during pregnancy, especially for women classified as obese. In this study, we show that psychosocial harms such as distress or shame felt by pregnant women are rarely countenanced in these endeavors. To demonstrate this, we examine published documents about a large (...) set of trials of lifestyle interventions united through an international consortium. Yet there is now a literature in which pregnant women with large bodies report feeling humiliated and a wider literature on the stigma of obesity. We argue that shame is produced and reproduced through the discursive and material knowledge-making scientific practices of DOHaD translation. Interventions that intensify the shame of large body size in pregnancy may be stressful, and neurophysiological stress pathways are well-known within DOHaD to have consequences for fetal development, so these interventions potentially undermine the very processes they set out to protect. A feminist response may protect women from shame and redirect attention to the social and structural determinants of health. (shrink)

With the Internet’s integration into mainstream society, online technologies have become a significant economic factor and a central aspect of everyday life. Thus, it is not surprising that news providers and social scientists regularly offer media-induced visions of a nearby future and that these horizons of expectation are continually expanding. This is true not only for the Web as a traditional media technology but also for 3D printing, which has freed modern media utopianism from its stigma of immateriality. Our (...) article explores the fundamental semantic structures and simplification patterns of popular media utopias and unfolds the thesis that their resounding success is based on their instantaneous connectivity and compatibility to societal discourses in a broad variety of cultural, political, or economic contexts. Further, it addresses the social functions of utopian concepts in the digital realm. (shrink)

This paper analyses self-declared aims and representation of dementia patient organizations and advocacy groups in relation to two recent upheavals: the critique of social stigmatization and biomedical research focusing on prediction. Based on twenty-six semi-structured interviews conducted in 2016–2017 with members, service recipients, and board representatives of POs in Germany and Israel, a comparative analysis was conducted, based on a grounded theory approach, to detect emerging topics within and across the POs and across national contexts. We identified a heterogeneous landscape, (...) with the only Israeli PO focusing strongly on caretakers, whereas in Germany several POs claim to represent this patient collective. Shared aims of all POs were fighting social stigma, balancing the loss of patients’ individual autonomy, and the well-being of caretakers. By highlighting the emergence of new groups of dementia self-advocacy against the more traditional advocacy by others, this study highlights how advocacy and representation in the context of AD are embedded in the discursive context of stigmatization and revised disease conception. Future developments in early diagnosis and prediction of dementia, with more affected people likely to conduct dementia self-advocacy, might challenge existing representation structures even more. (shrink)

Background: Coercion in mental healthcare has led to ethical debate on its nature and use. However, few studies have explicitly explored patients’ moral evaluations of coercion. Aim: The purpose of this study is to increase understanding of patients’ moral views and considerations regarding coercion. Research design: Semi-structured focus-group and individual interviews were conducted and data were analysed through a thematic content analysis. Participants and research context: A total of 24 adult participants with various mental health problems and experiences with coercion (...) were interviewed in 2012–2013 in three regions of Norway. Ethical considerations: Ethical approval and permissions were obtained according to required procedures. Informed consent and confidentiality were also secured. Findings: Ethical considerations regarding coercion included seven main themes: the need for alternative perspectives and solutions, the existence of a danger or harm to oneself or others, the problem of paternalism, the problem of discrimination and stigma, the need for proportionality, the importance of the content and consequences of coercion and concerns about way that coercion is carried out in practice. Discussion: The participants’ views and considerations are in line with previous research and reflect the range of normative arguments commonly encountered in ethical and legal debates. The study accentuates the significance of institutional factors and alternative voluntary treatment opportunities, as well as the legal and ethical principles of proportionality and purposefulness, in moral evaluations of coercion. Conclusion: Broader perspectives on coercion are required to comprehend its ethical challenges and derive possible solutions to these from a patient perspective. (shrink)

Little research has explored the possible effects of government institutions in emerging economies on ethical reviews of multinational research. We conducted semi-structured, in-depth telephone interviews with 15 researchers, Research Ethics Committees personnel, and a government agency member involved in multinational HIV Prevention Trials Network research in emerging economies. Ministries of Health or other government agencies often play pivotal roles as facilitators or barriers in the research ethics approval process. Government agency RECs reviewing protocols may face particular challenges, as they can (...) lack resources, be poorly organized, have inconsistent review processes and limited expertise, and use differing definitions of national interests, including upholding national reputation and avoiding potential exploitation and stigma of the country's population. The MOH/governmental review body may be affected by power dynamics and politics in study reviews; may consider issues both related and unrelated to research ethics as understood elsewhere; and may prioritize particular diseases, treatments, or interventions over other topics/types of research. Poor communication and deeply-rooted tensions may exist between sponsor and host countries, impeding optimal interactions and reviews. Investigators must understand and plan for the potential effects of governmental agencies on multinational collaborative research, including preserving adequate time for agency review, and contacting these agencies beforehand to address issues that may arise. Better understanding of these issues can aid and advance appropriate global scientific collaboration. (shrink)

While Chile's partial decriminalization of abortion in 2017 was a long overdue recognition of women's sexual and reproductive rights, nearly four years later the caseload remains well below expectations. This pattern is the product of standing barriers in access to abortion‐related health services, especially at the primary care point of entry. This study seeks to identify and describe these barriers. The findings presented here were obtained through a qualitative, exploratory study based on 19 semi‐structured interviews with relevant actors identified through (...) non‐random sampling and snowballing techniques. Coding was inductive and complemented by semantic content analysis. The authors find that the key barriers in primary care to accessing legal abortion are unfamiliarity with the law, insufficient practitioner training, intersectoral discrimination, and the stigma surrounding abortion. They conclude that the government needs to exercise its constitutional mandate as guarantor of public health and act promptly to safeguard and guarantee the abortion rights of Chilean women. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Organizational Ethics and Health Care: Expanding Bioethics to the Institutional Arena **Laura Jane Bishop (bio), M. Nichelle Cherry (bio), and Martina Darragh* (bio)In 1995, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical. Renamed “Patient Rights and Organization Ethics,” these standards are based on the realization that a hospital’s obligation to its (...) patients is derived from two relationships: the patient-provider relationship governed by “clinical ethics,” and the customer-supplier relationship governed by “business ethics.” “[This] boundary between ‘clinical’ ethics and ‘business’ ethics is not clear and in many cases is nonexistent. While marketing and admission practices are seen as issues related to ‘business’ ethics, they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications. Likewise, underutilization of needed services is likely to lead to less than optimal health outcomes” (I. Schyve 1996, p. 17). “These new standards arose out of well-publicized concerns about abuses in which patients were admitted to hospitals unnecessarily and were discharged or transferred only after their insurance expired” (I. Schyve 1996, pp. 15–16).These abuses also sparked eloquent protests against threats to patient well-being and to the nature of the patient-provider relationship in the bioethics literature. The fiduciary responsibility of the provider to inform and to protect the patient was fragmented by insurer business practices such as gag clauses and economic credentialing of providers (VII. Scope Note 31, 1996). The background role that the institution plays, though poorly articulated historically, has been brought sharply into focus by the explosive growth of the managed practice of medicine. The context of medical ethics is no longer limited to the resolution of individual cases, but instead encompasses the adoption of institutional structures to protect and promote patient welfare (IV. Emanuel 1995, p. 335). In this new configuration, the institution and the providers are co-fiduciaries for populations [End Page 189] of patients, and the medicine that is practiced is “appropriately economically disciplined.” The expression “My patient always comes first” is no longer “... intellectually serious or morally responsible.” But, “... to be sure, both conceptually and in practice, being an economically disciplined fiduciary professional or institution is ethically unstable.... The task is to identify the boundaries outside of which institutional policy and behavior will not count as an ethically defensible form of being... [a] fiduciary.” (IV. McCullough 1997, pp. 143–44). This process of delimiting and enforcing boundaries requires the development of “... a language for talking about the ethical values of the organization. If such a language does not exist, discussions about ethics become cumbersome and unlikely to occur” (IV. Cleveland Clinic Foundation 1998, p. 2).As with bioethics generally, the literature addressing organizational ethics is multidisciplinary. JCAHO’s compliance guide for its revised standards, Ethical Issues and Patient Rights, draws on a wealth of ideas from both clinical ethics and business ethics. This is often an awkward alliance. “Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff” (I. Boyle 1998, p. 2). The fact that “... there is an ancient history that reflects widespread doubt about the moral probity of business” (II. Frederick 1995, p. 209) does not help. To begin, “Aristotle had rude things to say about business” (II. Jackson 1998, p. 401). A brief review of introductions to several of the business ethics textbooks cited in this bibliography reveals that a rebuttal of “business ethics as an oxymoron” is the standard opening paragraph. This stigma is unfounded, and “increased stability” has characterized the state of business ethics literature during the 1990s (II. Beauchamp and Bowie 1997, p. ix). Significant attention has been given to elaborating two often overlapping theories—stakeholder and social contractarian.Originating in the 1960s as a pun on “stockholder,” proponents of stakeholder theory claim that a corporation’s fiduciary responsibility extends beyond increasing its profitability to protecting the rights of individuals or groups affected by its actions. Popular as a strategic planning tool in the... (shrink)

D.G. Brown’s revisionist interpretation, despite its interest, misrepresents Mill’s moral theory as outlined in Utilitarianism . Mill’s utilitarianism is extraordinary because it explicitly aims to maximize general happiness both in point of quality and quantity. It encompasses spheres of life beyond morality, and its structure cannot be understood without clarification of his much-maligned doctrine that some kinds of pleasant feelings are qualitatively superior to others irrespective of quantity. This doctrine of higher pleasures establishes an order of precedence among conflicting kinds (...) of enjoyments, including moral as well as non-moral kinds. In particular, as he indicates in Utilitarianism , Chapter V, the higher kind of pleasure associated with the moral sentiment of justice, namely, a feeling of ‘security’ for vital personal concerns that everyone has and that ought to be recognized as equal rights, is qualitatively superior to any competing kinds of pleasures regardless of quantity. Justice (more generally, morality) is conceived as a social system of rules and dispositions which has as its ultimate end the maximization of this pleasant feeling of security for everyone. The upshot is that an optimal social code that distributes and sanctions particular equal rights and correlative duties has absolute priority over competing considerations within his utilitarianism. The code seeks to prevent conduct that, in the judgment of suitably competent majorities, causes grievous kinds of harm to other people by injuring their vital personal concerns. To prevent the acts and omissions which are judged to cause such undue harm, the code assigns equal duties not to perform them, and authorizes due punishment of anyone who fails to fulfill his duties. Punishment is always expedient to condemn and deter wrongdoing. But it is properly a separate issue which particular ways of inflicting punishment are expedient in any particular situation. Given that feelings of guilt are a way of inflicting punishment, coercion is not necessary for punishment. Thus, Mill’s claim that wrongdoing always deserves to be punished in some way does not imply that coercive legal sanctions and public stigma are always expedient for the enforcement of moral duties. (shrink)

The sexual exploitation of children in Indonesia is a serious crime that threatens the fundamental rights of children and their physical, emotional, and mental development. Cases of child sexual exploitation continue to rise, whether in the form of human trafficking, pornography, or sexual abuse, yet the response remains far from optimal. Although regulations and prevention programs are in place, the lack of coordination among law enforcement agencies and the low level of public awareness are major obstacles to resolving these cases.This (...) study employs a qualitative approach using a normative-empirical method, involving an analysis of the legal framework as well as in-depth interviews with legal practitioners and relevant stakeholders. The results indicate that although there is a strong legal foundation, policy implementation is often hindered by bureaucracy, limited human resources, and low legal awareness in society. Additionally, social stigma against victims exacerbates the situation, especially in rural areas.The study recommends an interconnected approach involving substantive law, legal structure, and legal culture as an effective solution to address the escalation of child sexual exploitation. These findings imply the need for improved inter-agency coordination, law enforcement training, and more extensive public awareness campaigns. (shrink)

During recovery from psychosis (diagnosed as schizophrenia) things must often be done slower than normally expected. The tempo of the socially shared reality is often experienced as being too fast for the recovering person. We will describe how this impairment stems from the pre-reflective mental structure underlying psychosis and how it can be transferred into an active skill supporting recovery, often including social retreat. In this paper, co-written by a psychiatrist and a person experienced in psychosis (= participatory health research), (...) we will draw on personal experiences, (participatory) qualitative research and first-hand accounts for our arguments. We will sketch out the process and three crucial building blocks of recovery: laid-back situations, switch-off skills, places to talk. We will then describe the acquired skill of slowing-down as an amalgam of the building blocks ‘switch-off skill’ and ‘laid-back situation’, since slowing-down answers the situation in a laid-back manner and enforces a slow behavioral pace on it. While this might be okay in private and in some situations shared with others (i.e. during serene situations), it may be tantalizing for others in many everyday situations resulting in stigma or exclusion (i.e. during work). Slowing-down therefore challenges the surrounding others and demonstrates the necessity to synchronize private and public tempos. This is most challenging while living in two realities at once, being the second and often a long-lasting stage of recovery (stage of double realities). (shrink)

Research shows people confront social marginalization through work, yet this scholarship largely ignores people working in illicit markets. We address this gap by investigating how and to what end men in street prostitution “borrow” privilege from their more structurally advantaged clients. Drawing from interviews with men of color in street sex work, we show how they “status maneuver” to offset stigmatized identities tied to prostitution and to construct a masculinity that offers a greater sense of social worth within constrained circumstances. (...) These men ironically rely on status differences between themselves and their white, wealthy men clients to undermine their own oppression and to create possibilities for momentary associations with hegemonic masculine privilege. This research shows how barriers between the powerful and powerless are permeable, and how social hierarchies serve as resources to cope with the inequitable conditions and stigma under which some people live and work. (shrink)

BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania. MethodsAn exploratory descriptive qualitative (...) design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania. (shrink)

This paper explores why ethical issues associated with mental illness have been generally neglected in the literature and texts of the discipline of bioethics. I argue that the reasons for this are both philosophical and structural, involving the philosophical framework of principlism in bioethics, in particular the privileging of the principle of autonomy, and the institutional location and disciplinary boundaries of bioethics as a profession. Other contributing factors include developments outside of bioethics, in medicine and law and in the (...) delivery patterns and funding sources of mental health services, and above all the pervasive stigma that attaches to mental illness. My goal is to show both how the attention bioethics could bring would benefit this neglected area of health care, and why attending to the issues surrounding mental illness would benefit bioethics in meeting its professional obligations as the public voice on matters of ethical significance in health care. (shrink)