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Social stigma is linked to improper HIV treatment adherence, but how stigma impairs adherence outcomes is poorly understood. This study included 93 people living with HIV in the United States who participated in focus groups or one-on-one interviews regarding how stigma might affect medication management. Latent content analysis and constant comparative techniques of participant responses that were produced three thematic groupings that described how participants (a) orient to HIV stigma, (b) manage HIV stigma in ways that directly impair treatment adherence, and (c) manage HIV stigma in ways that may indirectly impair adherence. These findings illustrate the need to understand how patients orient to HIV stigma when prescribing medications and the complications that are inherent to such assessments. In addition, these findings provide a simple framework for organizing the different ways in which stigma management strategies may disrupt treatment adherence. Conceptually, these findings also offer a paradigm shift to extent theories on disclosure and concealment, in which only disclosure has been cast as an active process. These findings demonstrate how concealment is far from a passive default, often requiring enormous effort. Ultimately, these findings may guide intervention programs that help to entirely eliminate HIV by promoting optimized counseling and subsequent treatment adherence.

HIV creates substantial uncertainty for people infected with the virus, which subsequently affects a host of psychosocial outcomes critical to successful management of the disease. This study assessed the efficacy and durability of a theoretically driven, one-on-one peer support intervention designed to facilitate uncertainty management and enhance psychosocial functioning for patients newly diagnosed with HIV. Using a pretest-posttest control group design, 98 participants received information and training in specific communication strategies (e.g., disclosing to friends and family, eliciting social support, talking to health care providers, using the Internet to gather information, and building social networks through AIDS service organizations). Participants in the experimental group attended six 1-hour sessions, whereas control participants received standard of care for 12 months (after which they received the intervention). Over time, participants in the intervention fared significantly better regarding (a) illness uncertainty, (b) depression, and (c) satisfaction with social support than did those in the control group. Given the utility and cost-effectiveness of this intervention and the uncertainty of a multitude of medical diagnoses and disease experiences, further work is indicated to determine how this program could be expanded to other illnesses and to address related factors, such as treatment adherence and clinical outcomes.

This study advances the Extended Parallel Process Model through the inclusion of response cost measures, which are drawbacks associated with a proposed response to a health threat. A sample of 502 college students completed a questionnaire on perceptions regarding sexually transmitted infections and condom use after reading information from the Centers for Disease Control and Prevention on the health risks of sexually transmitted infections and the utility of latex condoms in preventing sexually transmitted infection transmission. The questionnaire included standard Extended Parallel Process Model assessments of perceived threat and efficacy, as well as questions pertaining to response costs associated with condom use. Results from hierarchical ordinary least squares regression demonstrated how the addition of response cost measures improved the predictive power of the Extended Parallel Process Model, supporting the inclusion of this variable in the model.

Research indicates that positive social support leads to positive results in the health of individuals managing eating disorders (e.g., Bertera [J Soc Pers Relat 22:33-48, 2005]). The current study set out to understand the specific qualities of supportive interactions those with eating disorders receive from their health care practitioners and report as beneficial as well as the types of support perceived as unhelpful. Through one-on-one interviews with 34 individuals managing eating disorders, the transcribed data indicate recurring forms of helpful and unhelpful social support received from health care professionals. Helpful forms of social support identified include facilitating treatment, encouraging elaboration, holding accountable, demonstrating compassion, and conveying acceptance. Unhelpful forms of support include lecture, use of coercion, discouragement, and criticism. Descriptive explanations of coded findings and implications for application are discussed.

This article investigates pathways between the exposure to an entertainment-education (E-E) television drama called Three Rivers and positive discussion of organ donation among viewers of the drama in the United States. A cross-sectional survey was conducted using an online advertising for a period of one week. Survey participants included 1325 adults living in the United States, who had viewed the first episode of Three Rivers on television. Data were collected on recall of events in the storyline, perceived entertainment value, perceived accuracy of the presented health information, rejection of organ donation myths and positive discussion of organ donation and the storyline. Covariates were registration for organ donation, membership to the donation or transplant community and demographic variables. Results show that viewers with high recall of the storyline were more likely to reject myths about organ donation and engage in pro-donation discussions with others. Perceived entertainment value and perceived accuracy acted as mediators in such relationships. The insertion of accurate health information in television drama may be effective in promoting positive discussions about organ donation and myth rejection. Recall of events from the televised E-E drama Three Rivers, entertainment value and accuracy perception were associated with positive discussion.

This study investigated why and how individuals avoid health information to support the development of models of uncertainty and information management and offer insights for those dealing with the information and uncertainty inherent to health and illness. Participants from student (n = 507) and community (n = 418) samples reported that they avoided health information to (a) maintain hope or deniability, (b) resist overexposure, (c) accept limits of action, (d) manage flawed information, (e) maintain boundaries, and (f) continue with life/activities. They also reported strategies for avoiding information, including removing or ignoring stimuli (e.g., avoiding people who might provide health advice) and controlling conversations (e.g., withholding information, changing the subject). Results suggest a link between previous experience with serious illness and health information avoidance. Building on uncertainty management theory, this study demonstrated that health information avoidance is situational, relatively common, not necessarily unhealthy, and may be used to accomplish multiple communication goals.

Research has indicated that HIV service providers commonly use humor to cope with work-related stress; however, little is known about the forms and functions of humor used by these professionals. In this study, 25 HIV service providers from five AIDS service organizations were interviewed about their use of humor. Participants described five primary types of humor as prevalent within AIDS service organizations and noted that humor served a variety of functions, which were either adaptive or maladaptive. Adaptive functions included boosting morale and reducing tension, whereas maladaptive functions ranged from masking emotions to alienating certain groups. Results emphasized the importance of context in the study of humor use and the need for continued investigations of the stress and coping of HIV service providers.

Coding transcripts of focus groups is considered standard practice, but transcription is labor intensive and often expensive. In the context of coding answers to specific questions, we compared the feasibility and reliability of reviewing videos and transcripts of focus group discussions. Two teams, each composed of one faculty member and two experienced research assistants, completed the coding. One team watched DVDs of the focus groups, while the other worked with transcripts. Both teams analyzed the same three focus groups of African American adults discussing influenza vaccination and coded responses to questions about the flu and the flu shot. The teams identified 121 unique responses and agreed on the coding of 104 (86% agreement, Kn = .72). Discrepancies were due to coder error, transcription errors, and inability to decipher the tone of the statement from the transcripts. Findings suggest that coding directly from video is a feasible option that provides high-quality data and may reduce time and e...

OBJECTIVES: To assess the long-term effects of the prisoner of war (POW) experience on U.S. World War II (WWII) veterans. DESIGN: Exploratory study. SETTING: Participants were recruited through the Hines Veterans Affairs Hospital; a POW reunion in Orlando, Florida; and the WWII veterans periodical, “The QUAN.” PARTICIPANTS: One hundred fifty-seven American military veterans who were former WWII POWs. MEASURMENTS: Participants completed a mailed survey describing their POW experiences, POW effects on subsequent psychological and physical well-being, and ways in which these experiences shaped major decisions in their lives. RESULTS: Participants from the European and Pacific theaters reported that their captivity during WWII affected their long-term emotional well-being. Both groups reported high rates of reflection, dreaming, and flashbacks pertaining to their POW experiences, but Pacific theater POWs did so at higher rates in the present than in the past. Large portions of both groups reported greater rumination on POW experiences after retirement. Finally, 16.6% of participants met the requirements of a current, clinical diagnosis of posttraumatic stress disorder (PTSD) based on the Mississippi PTSD scale, with PTSD rates in Pacific theater POWs (34%) three times those of European theater POWs (12%). CONCLUSION: Traumatic memories and clinical levels of PTSD persist for WWII POWs as long as 65 years after their captivity. Additionally, rumination about these experiences, including flashbacks and persistent nightmares, may increase after retirement, particularly for those held in the Pacific theater. These findings inform the current therapeutic needs of this elderly population and future generations of POWs from other military conflicts.

African American seniors (65 and older) are less likely to be vaccinated against influenza than are non-Hispanic White seniors. There is a clear need for targeted messages and interventions to address this disparity. As a first step, 6 focus groups of African American seniors (N = 48) were conducted to identify current perceptions about influenza and influenza vaccination. Emergent thematic categories were organized using the 4 main constructs of the extended parallel process model. Susceptibility varied based on perceptions of individual health status, background knowledge, and age-related risk. Some participants saw influenza as a minor nuisance; others viewed it as threatening and potentially deadly. Participants discussed issues related or antecedent to self-efficacy, including vaccine accessibility and affordability. Regarding response efficacy, some participants had confidence in the vaccine, some questioned its preventive ability or believed that the vaccine caused influenza, and others noted expected side effects. Implications and recommendations for message development are discussed.

Prior studies have linked limited literacy to poorer HIV medication adherence, although the precise causal pathways of this relationship have only been initially investigated.To examine whether social stigma is a possible mediator to the relationship between literacy and self-reported HIV medication adherence.Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while stigma was measured using items taken from the Patient Medication Adherence Questionnaire (PMAQ).Two hundred and four consecutive patients participated.Approximately one-third of the patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal (7th-8th grade) or low (or = 6th grade) literacy. In multivariate analyses, patients with low literacy were 3.3 times more likely to be non-adherent to antiretroviral regimens (95% CI 1.3-8.7; p0.001). Perceived social stigma was found to mediate the relationship between literacy and medication adherence (AOR 3.1, 95% CI 1.3-7.7).While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, perceived social stigma mediated this relationship. Low literacy HIV intervention strategies may also need to incorporate more comprehensive psychosocial approaches to overcome stigma barriers.

The threat of social stigma may prevent people living with HIV from revealing their status to others and serve as a barrier to HIV treatment adherence. We evaluated the effect of such concerns on self-reported treatment adherence using a short, three-item measure among 204 people living with HIV. Overall, the mean age of participants was 40.1 years, 45% were African American, and 80% were male. People with high HIV stigma concerns were 2.5 times less likely to define and interpret the meaning of CD4 count correctly and 3.3 times more likely to be nonadherent to their medication regimen than those with low concerns. Concern over revealing HIV status was the only statistically significant, independent predictor of adherence in multivariate analysis. Clinical care directed to individuals living with HIV should therefore include considerations for patient sensitivity to social stigma, such as modifications to medication schedules and referrals for counseling prior to enrollment in antiretroviral therapies.

Activist organizations are a relatively unique collective setting for people living with an HIV infection or AIDS. Communication within these organizations includes educational and motivational practices designed to facilitate change for the group and for its individual members. In this study, we examined differences between activist and nonactivist individuals (N = 174) with HIV or AIDS. Results demonstrated that, in comparison with nonactivists, activists (i) used more problem-focused coping and less emotion-focused coping, (ii) had greater knowledge of HIV-treatment information sources, and (iii) had greater HIV social network integration. We speculate that there are two reasons for these differences: (i) there are behavioral and psychological predisposing factors that lead to membership in an activist group, and (ii) the educational and motivational environments established through the relationships of activist group members (i.e., the social tasks of the collective) lead to changes in individuals.

Transgender individuals, or those who cross or transcend sex categories, commonly experience stigma and discrimination. Anecdotal evidence indicates that this transphobia manifests in health care settings, but few studies address the forms of mistreatment experienced in this context. This study was designed to explore transgender patients' experiences with health care. This brief report focuses on their negative experiences.A total of 152 transgender adults were recruited to complete an online questionnaire about their health care. Participants were asked if and how they had been mistreated, and responses were analyzed by qualitative content analysis.Participants' descriptions of mistreatment coalesced around 6 themes: gender insensitivity, displays of discomfort, denied services, substandard care, verbal abuse, and forced care.These findings provide insight into transgender patients' perceptions of and sensitivity to mistreatment in health care contexts. This information might be used to increase providers' cultural competency and inform their interactions with transgender patients.

Background Eating disorders have the highest mortality rates of any psychiatric diagnosis ( Sullivan, 1995 ). Understanding what prevents people from seeking or accessing that which can help them manage these disorders is critical to improving eating disorder outcomes. This study identifies specific barriers and deterrents individuals living with eating disorders perceive when deciding if and when they will seek eating disorder-specific social support. Methods 34 men and women living with eating disorders were recruited and interviewed regarding their experiences with managing their disorders, including reasons why they may forego seeking social support to help cope with these conditions. Results Participant-reported reasons as to why they would forego seeking social support for the management of their eating disorders were framed against the five main constructs of the Health Belief Model. These include (a) perceived susceptibility to a health threat, (b) perceived severity of the health threat, (c) perceived benefit of protective health behaviors, (d) perceived self-efficacy with these protective behaviors, and (e) perceived barriers to performing these behaviors. Limitations It could be argued that since this study does not focus solely on one type of eating disorder, such as anorexia or bulimia, the barriers to social support may differ depending upon the characteristics inherent to the specific disorders. Conclusions Findings can be used to inform and improve therapeutic interventions to produce better long-term outcomes among people struggling with eating disorders.

Research indicates that information seekers often turn to the Internet for health information; however, little is known about how Deaf people perceive, access, and utilize the Internet as a health information source. In this study, eight focus groups with Deaf participants (n = 39) were conducted to explore how Deaf people make use of (or avoid) the Internet as a health information source. Focus-group transcripts were analyzed using latent content and constant comparative techniques. Findings are presented using the model of online health information seeking and illustrate the reasons reported for both avoiding and utilizing the Internet as a health information source. In addition, findings illustrate the processes Deaf people navigate when accessing online health information, as well as the strategies they employ when doing so. This research underscores the need for continued investigation of access to and use of e-health resources by Deaf people.

Peers may be important sources of coping assistance, but their impact can be better understood if we examine their influence across various contexts. Although social support studies focused on people living with HIV have examined peer support in various contexts, they do not comprehensively account for situations in which peer support might be provided. The specific aims of this study were to (a) describe the various forms and functions of peer support for people living with HIV and (b) validate the Dennis (2003) concept analysis of peer support within health contexts. Results indicate that peer support is a potentially important adjunct to clinical care for enhancing coping skills, thereby improving the psychosocial functioning of people living with HIV. It is important to (a) assess patient access to peer support, (b) provide opportunities for peer support in the clinical setting, and (c) enhance disclosure and support-seeking skills to facilitate this benefit.

On July 5, 2010, Dale E. Brashers, head of the Departmentof Communication at the University of Illinois at Urbana-Champaign and key figure in the field of health commu-nication, passed away in his university office. He was 50years old.Theimpactofthislossisstillexpanding,ripplingthroughthe field and the vast network of people who knew him ascolleague, mentor, or friend. For some, his death was noless painful than losing a parent, so special was this manto them. Equally severe is the loss to the field of healthcommunication, in which Brashers was a central and highlyvisible figure. His scholarly contributions, applied clinicalwork, mentorship of junior health communication scholars,and leadership in our national and international professionalorganizations all helped advance our discipline, broaden-ing its reach and increasing its visibility among the healthsciences. Although Brashers held some interest in groupsand argumentation (Jacobs, Brashers, & Dawson, 1996;Meyers & Brashers, 1999; Meyers, Brashers, & Hanner,2000; Rintamaki & Brashers, 2010), he is best known forhis methodological research and theoretical advancement ofuncertainty management. For these reasons, the 100

To assess the long-term effects of the prisoner of war (POW) experience on U.S. World War II (WWII) veterans.Exploratory study.Participants were recruited through the Hines Veterans Affairs Hospital; a POW reunion in Orlando, Florida; and the WWII veterans periodical, "The QUAN."One hundred fifty-seven American military veterans who were former WWII POWs.Participants completed a mailed survey describing their POW experiences, POW effects on subsequent psychological and physical well-being, and ways in which these experiences shaped major decisions in their lives.Participants from the European and Pacific theaters reported that their captivity during WWII affected their long-term emotional well-being. Both groups reported high rates of reflection, dreaming, and flashbacks pertaining to their POW experiences, but Pacific theater POWs did so at higher rates in the present than in the past. Large portions of both groups reported greater rumination on POW experiences after retirement. Finally, 16.6% of participants met the requirements of a current, clinical diagnosis of posttraumatic stress disorder (PTSD) based on the Mississippi PTSD scale, with PTSD rates in Pacific theater POWs (34%) three times those of European theater POWs (12%).Traumatic memories and clinical levels of PTSD persist for WWII POWs as long as 65 years after their captivity. Additionally, rumination about these experiences, including flashbacks and persistent nightmares, may increase after retirement, particularly for those held in the Pacific theater. These findings inform the current therapeutic needs of this elderly population and future generations of POWs from other military conflicts.

There exist many subcultures of men who have sex with men (MSM), all with differing values and health behaviors. The Leathermen comprise one such subculture, which is characterized by a heightened valuation of hypersexuality and adherence to sexual control dynamics (i.e., submission and dominance). No previous research has specifically examined this community for differences in sexual health (e.g., HIV rates) and sexual health behaviors (e.g., condom use). We conducted a large survey of men (N = 1,554) at one leather and non-leather event, collecting data from 655 Submissives, Dominants, Switches, and non-orienting Leathermen. Leathermen were 61% more likely to be HIV-positive than non-Leathermen. Decreased condom use found in HIV-positive Leathermen (relative to HIV-positive non-Leathermen) was a potential factor contributing to heightened HIV rates. Universal low condom use in Submissives engaging in receptive, and Dominants engaging in insertive, anal intercourse was an additional trend that potentially contributed to increased numbers of HIV-positive Leathermen. Our recommendation is for heightened awareness of the risks associated with sex among Leathermen, especially unprotected anal intercourse with sero-uncertain Submissives.

Advances in antiretroviral treatments have dramatically increased the life spans of those infected with the Human Immunodefi ciency Virus (HIV), such that clinicians now treat it as a chronic condition rather than terminal disease (e.g., Burgoyne, Rourke, Behrens, & Salit, 2004). Clinical and social scientifi c emphasis subsequently has expanded beyond the study of purely biomedical concerns to now encompass the complete gamut of issues inherent to the HIV experience. Guided by the biopsychosocial model of health (Engel, 1977, 1980), researchers are now striving to better understand factors that may infl uence the psychological and social well-being of people living with HIV (PLWHIV).

Individuals living with HIV may have a heightened sensitivity to the behaviors of others that may signal bias or discrimination. Identifying and avoiding these potentially problematic behaviors may be especially important for service providers, such as health care personnel, who regularly interact with HIV-positive clientele. This study examines the experiences of 50 male American military veterans living with HIV and their perceptions of HIV stigma within health care contexts. Participants described a variety of behaviors performed by health care personnel that they perceived to be indicative of HIV stigma, ranging from ambiguous nonverbal cues (e.g., minimal eye contact) to blatant discrimination (e.g., physical abuse of HIV-positive patients). These findings extend previous research on HIV stigma in health care settings by (1) focusing on health care personnel's actual behaviors rather than their attitudes and beliefs about HIV-positive patients, (2) including patients' perceptions regarding the behaviors of both clinical and nonclinical health care personnel, and (3) identifying behaviors patients perceive as stigmatizing that are unique to health care contexts. Combined, these findings provide health care personnel a tangible list of behaviors that should either be avoided or further explained to HIV-positive patients, as they may be interpreted as stigmatizing.