title: Are psychological consequences of stigma enduring or transitory? A longitudinal study of HIV stigma and distress among Asians and Pacific Islanders living with HIV illness.
abstract: Cross-sectional findings have shed considerable light on the relationships between illness stigma and psychological outcomes among persons living with HIV/AIDS in the United States. However, no studies have examined the possible long-term consequences of illness stigma on mental health among Asians and Pacific Islanders living with HIV/AIDS, a group particularly vulnerable to HIV stigma due to ingrained sociocultural norms. This 2-year longitudinal study examined the relationship between five HIV-stigma factors (social rejection, negative self-worth, perceived interpersonal insecurity, financial insecurity, discretionary disclosure) and changes in psychological distress dimensions (self-esteem, hopelessness, dread, confused thinking, sadness, anxiety) among a convenience sample of 44 HIV-seropositive Asians and Pacific Islanders in New York City from 2002 to 2004. Undocumented Asians independently endorsed higher levels of perceived interpersonal insecurity and lower levels of self-esteem than documented participants at both baseline and 2-year follow-up. Results from hierarchical multiple regression analyses indicated that baseline social rejection and perceived interpersonal insecurity were significantly associated with changes in self-esteem at 2-year follow-up, controlling for baseline self-esteem and physical symptoms at follow-up. An interaction effect between baseline financial insecurity and discretionary disclosure was significantly associated with dread at 2-year follow-up. Findings highlight the importance of stigma reduction interventions that: (1) recognize multiple layers of stigma based sexual orientation, gender, and immigration status; and (2) address both individual and structural constraints that perpetuate HIV-stigma among Asians and Pacific Islanders in the United States.
authors.affiliation: Columbia-Presbyterian Center of New York Presbyterian Hospital, Department of Pediatric Psychiatry, 622 West 68th Street, VC4, New York, New York 10032, USA. eek34@columbia.edu
authors.forename: Ezer
authors.initials: E
authors.lastname: Kang
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Rapkin
authors.forename: Chrystianne
authors.initials: C
authors.lastname: DeAlmeida
mesh_terms: D000328:Adult; D001208:Asia / Q000208:ethnology; D001213:Asian / Q000523:psychology*; D015658:HIV Infections / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000523:psychology*; D010139:Pacific Islands / Q000208:ethnology; D011788:Quality of Life; D012649:Self Concept; D013240:Stereotyping; D013997:Time Factors