Exposure to Violence & Psychological Well-Being Over Time in Children Affected by HIV/AIDS in South Africa & Malawi

Many of the risk factors for violence against children are particularly prevalent in families and communities affected by HIV/AIDS. Yet, in sub-Saharan Africa, where HIV rates are high, efforts to prevent or address violence against children and its long-lasting effects are hampered by a lack of evidence. 

We assessed the relationship between violence exposure and mental health among HIV-affected children attending community-based organisations in South Africa (n = 834) and Malawi (n = 155, total sample n = 989) at baseline and 12-15-month follow-up. Exposure to violence in the home and in the community was high. HIV-negative children who lived with an HIV-positive person experienced most violence overall, followed by HIV-positive children. Children unaffected by HIV experienced least violence (all p < .05). 

Interpersonal violence in the home predicted child depression, trauma symptoms, lower self-esteem, and internalising and externalising behavioural problems, while exposure to community violence predicted trauma symptoms and behavioural problems. Harsh physical discipline predicted lower self-esteem and behavioural problems for children. Exposure to home and community violence predicted risk behaviour. Over time, there was a decrease in depressed mood and problem behaviours, and an increase in self-esteem for children experiencing different types of violence at baseline. This may have been due to ongoing participation in the community-based programme. 

These data highlight the burden of violence in these communities and possibilities for programmes to include violence prevention to improve psychosocial well-being in HIV-affected children.

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By:  Skeen S1,2, Macedo A3, Tomlinson M1, Hensels IS3, Sherr L3.

• 1 Department of Psychology , Stellenbosch University , Stellenbosch , South Africa.
• 2 Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa.
• 3 Department of Infection and Population Health , University College London , London , UK.
• AIDS Care. 2016 Mar;28 Suppl 1:16-25. doi: 10.1080/09540121.2016.1146219.

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Victimization, Mental Health & Well-Being among Trans Youths in the Province of Quebec

Introduction 
Trans youths are more likely to experience negative social and parental reactions suggesting reprehension, from disapproving looks to physical violence. While victimization increases the likelihood of poor mental health outcomes, little is known about potential mediating factors between mental health and victimization. Self-esteem is one of the factors that may mediate the impact of homophobic victimization on mental health. Yet, data on trans youths are scarce.

Objectives 
The objectives of this paper are: 

1. to compare trans youths to cisgender heterosexual male and female youths regarding two different forms of victimization (victimization based on gender nonconformity and parental verbal abuse), self-esteem, and psychological distress, as well as 
2. to test a path model of the impact of these two forms of victimization on self-esteem and psychological distress.

Methods 
Data for this study are drawn from the Quebec Youths' Romantic Relationships survey. Data were collected among youth aged 14 to 22 years old recruited either in schools or online. Thirty-seven participants endorsed being trans or questioning their gender identity. They were paired to 74 cisgender heterosexual youths (37 male and 37 female) using propensity scores based on socio-demographic characteristics.

Results 
Results showed that verbal parental abuse and victimization based on gender nonconformity were more prevalent among trans participants. Parental verbal abuse and victimization based on gender nonconformity were both directly and negatively associated with self-esteem (explained variance: 36%). Sexual status explains 19.6% of the variance of parental victimization and 50.6% of the variance of victimization on the basis of gender nonconformity. A higher self-esteem was associated with decreased psychological distress (explained variance: 66.9%). Moreover, parental verbal abuse was also directly associated with higher psychological distress. Although there was no direct relationship between trans status and psychological distress and self-esteem, its total indirect effects on these two indicators of mental health and wellbeing status were significant (p-value < 0.001), suggesting that the impact of sexual status on them is mediated by the victimization.

Conclusion 
This study showed the high vulnerability of trans youths to poor mental health and wellbeing outcomes because of the victimization they experience. The results highlight the importance of preventing victimization based on sexual-minority status and to educate people, including parents, to sexual and gender diversity.

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By:  Raymond G1, Blais M2, Bergeron FA2, Hébert M2.

• 1Département de psychologie, Université du Québec à Trois-Rivières.
• 2Département de sexologie, Université du Québec à Montréal.
• Sante Ment Que. 2015 Fall;40(3):77-92. 

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Finding Meaning: HIV Self-Management and Wellbeing among People Taking Antiretroviral Therapy in Uganda

The health of people living with HIV (PLWH) and the sustained success of antiretroviral therapy (ART) programmes depends on PLWH's motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH's self-management of HIV and their wellbeing are likely to be interrelated. 

Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH's self-management processes on ART in resource-limited settings. This paper presents findings from a study of PLWH's self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. 

The majority were managing their condition well across three broad domains of self-management. 

• First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. 
• Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. 
• Third, participants were psychologically adjusting to their condition and their new 'self': they saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. 

Our study demonstrates the centrality of social relationships and other non-medical aspects of wellbeing for self-management which ART programmes might explore further and encourage.

Below:  Adjusting to life with HIV on ART

Full article at:   http://goo.gl/VqWsp6

By:  Russell S1, Martin F2, Zalwango F3, Namukwaya S3, Nalugya R3, Muhumuza R3, Katongole J3, Seeley J3,4.

• 1School of International Development, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
• 2External Research Associate, School of International Development, University of East Anglia, Norwich, United Kingdom.
• 3Medical Research Council / Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.
• 4London School of Hygiene and Tropical Medicine, London, United Kingdom.
• PLoS One. 2016 Jan 25;11(1):e0147896. doi: 10.1371/journal.pone.0147896. eCollection 2016. 

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The Relationship of Internalized Homonegativity to Sexual Health and Well-Being among Men in 38 European Countries Who Have Sex With Men

The objective of this article is to examine internalized homonegativity (IH) in relation to aspects of well-being and several measures of clinical importance among men-who-have-sex-with-men (MSM) in 38 countries. The data were collected as part of the EMIS project. 

The multivariable regression analysis identified independent associations with IH for nongay identity, younger age, being closeted, limited gay social affiliation, and sexual unhappiness. IH was also positively associated with loneliness, inability to decline unwanted sex, and being less knowledgeable about HIV and HIV testing. 

These results provide evidence that homonegative internalization merits consideration as a predisposing factor in several aspects of ill health. There are also several clinical implications of this project, including: (1) Treatment of lesbian, gay, and bisexual (LGB) persons should address gay self-acceptance, as internalized homonegativity seems to be a predisposing factor in several aspects of ill health among this population, and (2) therapy that is used to help LGB persons accept and integrate a gay or lesbian identity seems particularly important for younger, nongay identified persons.

Full article at:   http://goo.gl/mMZFAC

By:   Rigmor C. Berg, PhD, a , * Peter Weatherburn, PhD, b Michael W. Ross, PhD, c and Axel J. Schmidt, MD b

aNorwegian Knowledge Center for the Health Services, Oslo, Norway

bDepartment of Social & Environmental Health ResearchLondon School of Hygiene and Tropical Medicine, London, England

cMalmö University, Sweden; and Department of Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota,USA

Address correspondence to Rigmor C. Berg, PhD, Norwegian Knowledge Center for the Health Services, PO Box 7004, St Olavsplass, OsloN-0130, Norway. E-mail:on.ckon@greb.romgir

 

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Acceptance of Sexual Minorities, Discrimination, Social Capital and Health and Well-Being: A Cross-European Study among Members of Same-Sex and Opposite-Sex Couples

Below:  Multilevel structural equation model with self-rated health as dependent variable. Solid lines represent significant relationships with standardized β coefficients; Interrupted lines represent non-significant relationships with standardized β coefficients and p values. *P value is smaller than or equal to 0.05; **P value is smaller than or equal to 0.01; ***P value is smaller than or equal to 0.001

Below:  Multilevel structural equation model with subjective well-being as dependent variable. Solid lines represent significant relationships with standardized β coefficients; Interrupted lines represent non-significant relationships with standardized β coefficients and p values. *P value is smaller than or equal to 0.05; **P value is smaller than or equal to 0.01; ***P value is smaller than or equal to 0.001

LGB acceptance was significantly related to better self-rated health and subjective well-being among all individuals, and these associations were partially mediated by individual social capital. No differences in these associations were found between individuals living in same-sex and opposite-sex couples. Sexuality-based discrimination had an additional significantly negative effect on self-related health and subjective well-being.

The findings of this study suggest a negative association between exposure to discrimination based on sexual orientation and both health and well-being of individuals living in same-sex couples. Members of same-sex couples and opposite-sex couples alike may benefit from living in societies with a high level of LGB acceptance to promote better health and well-being.

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