Relationships between HIV-related Stigma, Coping, Social Support and Health-related Quality of Life in People Living with HIV/AIDS Pubblico

Abstract

Background: HIV/AIDS disproportionately affects African Americans. The proportion of foreign-born black people living with HIV/AIDS (PLWHA) is significant and will continue to increase with the repeal of travel ban in 2010. The perception of and coping with HIV-related stigma and its consequence may vary as well. There is lack of comparative study in this area.

Purpose: This study examines the relationships between perceived HIV-related stigma, coping strategies, perceived availability of social support and health-related quality of life (HRQoL) and compares native-born and foreign-born black PLWHA.

Methods: This is a cross-sectional comparative study guided by the Transactional model of Stress and Coping. Multidimensional measure of internalized HIV stigma scale, the Brief COPE scale, medical outcomes study social support survey , and the second version of short form health survey were used to assess key variables. Data were analyzed using descriptive statistics and bootstrap method to examine the mediation effects of avoidance coping and moderation effect of nativity and social support.

Findings: Thirty seven English-speaking foreign born and 63 native born blacks living with HIV participated. Compared with native participants, foreign-born participants were more likely to be female, heterosexual, a non-drinker and non-smoker, to live with someone, be diagnosed with AIDS and not to disclose their HIV status. Foreign-born patients had significantly higher HIV-related stigma and lower social support and had lower mental summary scores of HRQoL (MCS) than native patients. However, no significant differences were found in their use of coping strategies and physical summary scores of HRQoL. The relationship between HIV-related stigma and MCS was mediated by avoidance coping for native-born participants, but it was not for foreign-born groups. The relationship between HIV-related stigma and MCS was mediated by avoidance coping for those who perceived low social support group, but it was not for those who perceived high social support.

Discussion: These findings highlight the significant differences between native and foreign-born HIV-infected blacks. Interventions targeting coping strategy and social support need to consider differences and similarities between native and foreign-born groups. This study contributes toward developing a sound understanding of the growing population of foreign-born blacks living with HIV/AIDS.

Table of Contents

Table of Contents
CHAPTER ONE: INTRODCUTION........................................................................................ 1
Introductio..................................................................................................................... 1
Statement of the problem ................................................................................................ 3
Theoretical Framework...................................................................................................... 8
CHAPTER TWO: LITTRATURE REVIEW................................................................................16
HIV/AIDS Epidemic in the United States.............................................................................. 16
HIV-related Stigma......................................................................................................... 18
Status Disclosure and HIV-related Stigma........................................................................... 25
Coping .........................................................................................................................27
Social Support............................................................................................................... 30
Health-related Quality of Life............................................................................................ 34
Relationships of HIV-related Stigma and Health-related Quality of Life...................................... 38
CHAPTER THREE: METHODOLOGY ...................................................................................41
Design ..........................................................................................................................41
Population, Sample, Sample Size and Inclusion Criteria........................................................... 42
Recruitment and Procedure ...............................................................................................42
Study Instruments.......................................................................................................... 43
Data Management and Analysis......................................................................................... 50
Protection of Human Subjects ...........................................................................................57
CHAPTER FOUR: RESULTS AND FINDINGS......................................................................... 60
Sample Characteristics ....................................................................................................61
Preliminary Analysis .........................................................................................................64
Independent T-test........................................................................................................ 67
Mediation Test of Avoidance Coping................................................................................... 70
Moderated Mediation Tests.............................................................................................. 73
Nativity as a Moderator................................................................................................... 73
Perceived Social Support as a Moderator ............................................................................75
CHAPTER FIVE: DISCUSSION .........................................................................................79
Sample Characteristics.................................................................................................... 80
Nativity and Associated Factors with Major Variables............................................................ 86
HIV-related Stigma......................................................................................................... 86
Coping Strategies ...........................................................................................................92
Perceived Social Support................................................................................................. 95
Health-related Quality of Life............................................................................................ 96
Mediation Model ............................................................................................................100
Moderation Mediation Model............................................................................................ 103
Nativity as a Moderator.................................................................................................. 103
Perceived Social Support as a Moderator ...........................................................................105
Summary and Conclusions ...............................................................................................108
Strengths of the study.................................................................................................. .109
Limitations of the study...................................................................................................109
Research Directions ...................................................................................................... 111
Implications...................................................................................................................112
References .................................................................................................................114
Appendix.....................................................................................................................139
IRB approvals................................................................................................................ 139
Recruitment Flye........................................................................................................... 142
Consent Form............................................................................................................... 143
Study Instruments......................................................................................................... 145
Debriefing Form............................................................................................................. 158

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School	Laney Graduate School
Department	Nursing
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health Psychology, Social Health Sciences, Nursing
Parola chiave	HIV-related Stigma Foreign-born Mediation Moderation Health-related Quality of Life Model of Stress and Coping Social Support Immigrants Coping Bootstrap HIV/AIDS Black
Committee Chair / Thesis Advisor	Holstad, Marcia McDonnell, Emory University
Committee Members	Rogers, Martha, Emory University Diiorio, Colleen K, Emory University

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