@article {5091,
	title = {Stigma, activism, and well-being among people living with HIV.},
	journal = {AIDS care},
	year = {2016},
	month = {2016 Feb 6},
	pages = {1-5},
	abstract = {Evidence demonstrates that HIV stigma undermines the psychological and physical health of people living with HIV (PLWH). Yet, PLWH describe engaging in HIV activism to challenge stigma, and research suggests that individuals may benefit from activism. We examine associations between experiences of HIV stigma and HIV activism, and test whether HIV activists benefit from greater well-being than non-activists. Participants include 93 PLWH recruited from drop-in centers, housing programs, and other organizations providing services to PLWH in the Northeastern USA between 2012 and 2013 (mean age = 50 years; 56\% Black, 20\% White, 18\% Other; 61\% non-Latino(a), 39\% Latino(a); 59\% male, 38\% female, 3\% transgender; 82\% heterosexual, 15\% sexual minority). Participants completed a cross-sectional written survey. Results of regression analyses suggest that PLWH who experienced greater enacted stigma engaged in greater HIV activism. Anticipated, internalized, and perceived public stigma, however, were unrelated to HIV activism. Moreover, results of a multivariate analysis of variance suggest that HIV activists reported greater social network integration, greater social well-being, greater engagement in active coping with discrimination, and greater meaning in life than non-activists. Yet, HIV activists also reported somewhat greater depressive symptoms than non-activists, suggesting that the association between HIV activism and well-being is complex. By differentiating between HIV stigma mechanisms, the current study provides a more nuanced understanding of which experiences of HIV stigma may be associated with HIV activism. It further suggests that engagement in activism may offer benefits to PLWH, while raising the possibility that activists could experience greater depressive symptoms than non-activists. Given the preliminary nature of this study, future research should continue to examine these complex associations between HIV stigma, activism, and well-being among PLWH. As this work continues, PLWH, as well as interventionists and clinicians invested in improving well-being among PLWH, should carefully weigh the benefits and potential costs of activism.},
	issn = {1360-0451},
	doi = {10.1080/09540121.2015.1124978},
	author = {Earnshaw, Valerie A and Rosenthal, Lisa and Lang, Shawn M}
}
@article {5160,
	title = {Substance use stigma: Reliability and validity of a theory-based scale for substance-using populations.},
	journal = {Drug and alcohol dependence},
	year = {2016},
	month = {2016 Feb 26},
	abstract = {Substance use disorders consistently rank among the most stigmatized conditions worldwide. Thus, substance use stigma fosters health inequities among persons with substance use disorders and remains a key barrier to successful screening and treatment efforts. Current efforts to measure substance use stigma are limited. This study aims to advance measurement efforts by drawing on stigma theory to develop and evaluate the Substance Use Stigma Mechanisms Scale (SU-SMS). The SU-SMS was designed to capture enacted, anticipated, and internalized Substance Use Stigma Mechanisms among persons with current and past substance use disorders, and distinguish between key stigma sources most likely to impact this target population.},
	issn = {1879-0046},
	doi = {10.1016/j.drugalcdep.2016.02.019},
	author = {Smith, Laramie R and Earnshaw, Valerie A and Copenhaver, Michael M and Cunningham, Chinazo O}
}
@article {5134,
	title = {Framing HIV Pre-Exposure Prophylaxis (PrEP) for the General Public: How Inclusive Messaging May Prevent Prejudice from Diminishing Public Support.},
	journal = {AIDS and behavior},
	year = {2016},
	month = {2016 Feb 19},
	abstract = {Strategic framing of public messages about HIV pre-exposure prophylaxis (PrEP) may influence public support for policies and programs affecting access. This survey study examined how public attitudes toward PrEP differed based on the social group PrEP was described as benefiting ("beneficiary") and the moderating effect of prejudice. Members of the general public (n~=~154) recruited online were randomly assigned to three beneficiary conditions: general population, gay men, or Black gay men. All participants received identical PrEP background information before completing measures of PrEP attitudes (specifying beneficiary), racism, and heterosexism. Despite anticipating greater PrEP adherence among gay men and Black gay men and perceiving PrEP as especially beneficial to the latter, participants expressed lower support for policies/programs making PrEP affordable for these groups vs. the general population. This disparity in support was stronger among participants reporting greater prejudice. Inclusive framing of PrEP in public discourse may prevent prejudice from undermining implementation efforts.},
	issn = {1573-3254},
	doi = {10.1007/s10461-016-1318-9},
	author = {Calabrese, Sarah K and Underhill, Kristen and Earnshaw, Valerie A and Hansen, Nathan B and Kershaw, Trace S and Magnus, Manya and Krakower, Douglas S and Mayer, Kenneth H and Betancourt, Joseph R and Dovidio, John F}
}
@article {4838,
	title = {Stigma Toward Men Who Have Sex with Men Among Future Healthcare Providers in Malaysia: Would More Interpersonal Contact Reduce Prejudice?},
	journal = {AIDS and behavior},
	year = {2015},
	month = {2015 Sep 1},
	abstract = {Men who have sex with men (MSM) living in countries with strong stigma toward MSM are vulnerable to HIV and experience significant barriers to HIV care. Research is needed to inform interventions to reduce stigma toward MSM in these countries, particularly among healthcare providers. A cross-sectional survey of 1158 medical and dental students was conducted at seven Malaysian universities in 2012. Multivariate analyses of variance suggest that students who had interpersonal contact with MSM were less prejudiced toward and had lower intentions to discriminate against MSM. Path analyses with bootstrapping suggest stereotypes and fear mediate associations between contact with prejudice and discrimination. Intervention strategies to reduce MSM stigma among healthcare providers in Malaysia and other countries with strong stigma toward MSM may include facilitating opportunities for direct, in-person or indirect, media-based prosocial contact between medical and dental students with MSM.},
	issn = {1573-3254},
	author = {Earnshaw, Valerie A and Jin, Harry and Wickersham, Jeffrey A and Kamarulzaman, Adeeba and John, Jacob and Lim, Sin How and Altice, Frederick L}
}
@article {4954,
	title = {Exploring Group Composition among Young, Urban Women of Color in Prenatal Care: Implications for Satisfaction, Engagement, and Group Attendance.},
	journal = {Women{\textquoteright}s health issues : official publication of the Jacobs Institute of Women{\textquoteright}s Health},
	year = {2015},
	month = {2015 Nov 2},
	abstract = {Group models of prenatal care continue to grow in popularity. However, little is known about how group composition (similarity or diversity between members of groups) relates to care-related outcomes. The current investigation aimed to explore associations between prenatal care group composition with patient satisfaction, engagement, and group attendance among young, urban women of color.},
	issn = {1878-4321},
	doi = {10.1016/j.whi.2015.09.011},
	author = {Earnshaw, Valerie A and Rosenthal, Lisa and Cunningham, Shayna D and Kershaw, Trace and Lewis, Jessica and Rising, Sharon Schindler and Stasko, Emily and Tobin, Jonathan and Ickovics, Jeannette R}
}
@article {4505,
	title = {Everyday discrimination and physical health: Exploring mental health processes.},
	journal = {Journal of health psychology},
	year = {2015},
	month = {2015 Mar 2},
	abstract = {Goals of this study were to examine the mental health processes whereby everyday discrimination is associated with physical health outcomes. Data are drawn from a community health survey conducted with 1299 US adults in a low-resource urban area. Frequency of everyday discrimination was associated with overall self-rated health, use of the emergency department, and one or more chronic diseases via stress and depressive symptoms operating in serial mediation. Associations were consistent across members of different racial/ethnic groups and were observed even after controlling for indicators of stressors associated with structural discrimination, including perceived neighborhood unsafety, food insecurity, and financial stress.},
	issn = {1461-7277},
	doi = {10.1177/1359105315572456},
	author = {Earnshaw, Valerie A and Rosenthal, Lisa and Carroll-Scott, Amy and Santilli, Alycia and Gilstad-Hayden, Kathryn and Ickovics, Jeannette R}
}
@article {4824,
	title = {Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis.},
	journal = {The Journal of the Association of Nurses in AIDS Care : JANAC},
	year = {2015},
	month = {2015 Jul 31},
	abstract = {In Indonesia, the syndemic nature of HIV, drug use, and incarceration may influence experiences of stigma for HIV-infected prisoners. This mixed-method study explores HIV stigma in prisoners living with HIV in Indonesia. Randomly selected male HIV-infected prisoners (n~=~102) from two large prisons in Jakarta completed in-depth interviews and a structured HIV stigma survey. Quantitative results found four groups of HIV-infected prisoners with significantly higher HIV stigma levels, including those: (a) with drug-related offenses, (b) seeking help to decrease drug use, (c) diagnosed with HIV before the current incarceration, and (d) who had not disclosed their HIV status to family members or friends. Qualitative results highlighted the prominent role of HIV stigma in decisions to disclose HIV status to family members, partners, and other prisoners. Interventions should address HIV stigma in HIV-infected prisoners in Indonesia to achieve HIV treatment as prevention goals.},
	issn = {1552-6917},
	doi = {10.1016/j.jana.2015.07.006},
	author = {Culbert, Gabriel J and Earnshaw, Valerie A and Swasti Wulanyani, Ni Made and Wegman, Martin P and Waluyo, Agung and Altice, Frederick L}
}
@article {4486,
	title = {Bullying, internalized hepatitis (Hepatitis C virus) stigma, and self-esteem: Does spirituality curtail the relationship in the workplace.},
	journal = {Journal of health psychology},
	year = {2015},
	month = {2015 Jan 20},
	abstract = {The objective of this study was to examine the impact of workplace bullying on self-esteem, including the mediating effect of internalized stigma and the moderating effect of spirituality, among hepatitis C virus patients. Data were collected from 228 employed hepatitis C virus patients who had been admitted to Gastroenterology and Hepatology wards in Pakistani hospitals. We found support for the hypothesis that workplace bullying is associated with low self-esteem via internalized stigma. In addition, spirituality moderated the association such that participants with greater spirituality were buffered from the impact of stigma on self-esteem.},
	issn = {1461-7277},
	doi = {10.1177/1359105314567211},
	author = {Noor, Ayesha and Bashir, Sajid and Earnshaw, Valerie A}
}
@article {4502,
	title = {Re-Validation of the Van Rie HIV/AIDS-Related Stigma Scale for Use with People Living with HIV in the United States.},
	journal = {PloS one},
	volume = {10},
	year = {2015},
	month = {2015},
	pages = {e0118836},
	abstract = {There is little consensus about which of the many validated human immunodeficiency virus (HIV) stigma scales should be regularly used, with few being re-validated in different contexts or evaluated for how they compare to other, existing HIV stigma scales. The purpose of this exploratory study was to re-validate the Van Rie HIV/AIDS-Related Stigma Scale, originally validated in Thailand and using a third-person wording structure, for use with people living with HIV in the United States. Adult HIV clinic patients completed a survey including the Berger and Van Rie scales, and measures of social support and depression. Eighty-five of 211 (40\%) eligible participants provided data for both stigma scales. Exploratory factor analyses identified three factors to the Van Rie scale: Loss of Social Relationships (new subscale), Managing HIV Concealment (new subscale), and Perceived Community Stigma (original subscale). These subscales were moderately inter-related (r = 0.51 to 0.58) with acceptable to excellent reliability (Cronbach{\textquoteright}s alpha = 0.69 to 0.90). The Van Rie subscales were also moderately inter-correlated with the Berger subscales (r = 0.44 to 0.76), had similar construct validity, and tended to have higher mean stigma scores when compared with Berger subscales that were conceptually most similar. The revised Van Rie HIV-related Stigma Scale demonstrates good validity and internal consistency, offering a valid measure of HIV stigma with a three-factor structure. The third-person wording may be particularly suitable for measuring stigmatizing attitudes during an individual{\textquoteright}s transition from at-risk and undergoing HIV testing to newly diagnosed, a time when experiences of discrimination and processing issues of disclosure have not yet occurred. The stigma mechanisms for individuals making this transition have not been well explored. These scenarios, combined with the observed non-response to the Berger Enacted Stigma subscale items (a surprise finding), highlight gaps in our understanding of HIV stigma and how best to measure it.},
	issn = {1932-6203},
	doi = {10.1371/journal.pone.0118836},
	author = {Kipp, Aaron M and Audet, Carolyn M and Earnshaw, Valerie A and Owens, Jared and McGowan, Catherine C and Wallston, Kenneth A}
}
@article {4333,
	title = {Housing Instability and Birth Weight among Young Urban Mothers.},
	journal = {Journal of urban health : bulletin of the New York Academy of Medicine},
	year = {2014},
	month = {2014 Oct 25},
	abstract = {Housing instability is an understudied social condition that may be a severe stressor during pregnancy. Aims of this study are to identify correlates of housing instability and to explore the association between housing instability and birth weight among pregnant teens and young mothers. Participants included pregnant women ages 14-21 from seven community hospitals and health centers in New York City (N = 623). Data were collected via structured surveys during the second trimester of pregnancy (14 to 24 weeks gestation, M = 19.35, SD = 3.20). Birth weight was obtained through labor and delivery logs. Housing instability was operationalized as two or more moves within the past year. More than one in four (28.5 \%) pregnant teens and young women in this sample reported housing instability. Women who reported housing instability were less likely to be enrolled in school, have parents as main source of financial support, live in a single-family home or apartment, or be food secure; they were more likely to smoke (all p < 0.05). After adjusting for important clinical, behavioral, and demographic factors typically associated with lower birth weight, housing instability remained a significant predictor of lower birth weight (B (SE) = -83.96(35.47), p = 0.018). Results highlight the importance of housing stability during pregnancy for infant health. Future interventions and policies should ensure that women are housing stable before, during, and after pregnancy.},
	issn = {1468-2869},
	author = {Carrion, Bianca V and Earnshaw, Valerie A and Kershaw, Trace and Lewis, Jessica B and Stasko, Emily C and Tobin, Jonathan N and Ickovics, Jeannette R}
}
@article {4068,
	title = {Changes in Experiences With Discrimination Across Pregnancy and Postpartum: Age Differences and Consequences for Mental Health.},
	journal = {American journal of public health},
	year = {2014},
	month = {2014 Jun 12},
	pages = {e1-e8},
	abstract = {Objectives. We aimed to contribute to growing research and theory suggesting the importance of examining patterns of change over time and critical life periods to fully understand the effects of discrimination on health, with a focus on the period of pregnancy and postpartum and mental health outcomes. Methods. We used hierarchical linear modeling to examine changes across pregnancy and postpartum in everyday discrimination and the resulting consequences for mental health among predominantly Black and Latina, socioeconomically disadvantaged young women who were receiving prenatal care in New York City. Results. Patterns of change in experiences with discrimination varied according to age. Among the youngest participants, discrimination increased from the second to third trimesters and then decreased to lower than the baseline level by 1 year postpartum; among the oldest participants, discrimination decreased from the second trimester to 6 months postpartum and then returned to the baseline level by 1 year postpartum. Within-subjects changes in discrimination over time predicted changes in depressive and anxiety symptoms at subsequent points. Discrimination more strongly predicted anxiety symptoms among participants reporting food insecurity. Conclusions. Our results support a life course approach to understanding the impact of experiences with discrimination on health and when to intervene. (Am J Public Health. Published online ahead of print June 12, 2014: e1-e8. doi:10.2105/AJPH.2014.301906).},
	issn = {1541-0048},
	author = {Rosenthal, Lisa and Earnshaw, Valerie A and Lewis, Ten{\'e} T and Reid, Allecia E and Lewis, Jessica B and Stasko, Emily C and Tobin, Jonathan N and Ickovics, Jeannette R}
}
@article {4166,
	title = {HIV stigma and unprotected sex among PLWH in KwaZulu-Natal, South Africa: a longitudinal exploration of mediating mechanisms.},
	journal = {AIDS care},
	year = {2014},
	month = {2014 Jul 21},
	pages = {1-8},
	abstract = {Social and structural factors including HIV stigma are theorized to drive global disparities in HIV prevalence. This study tests whether HIV self-stigma, or experiences of stigma at the individual level, is associated with engagement in unprotected sex among people living with HIV (PLWH) in KwaZulu-Natal, South Africa, where 37.4\% of adults are living with HIV compared with 0.8\% worldwide. It further explores whether depressive symptoms, HIV status disclosure to sex partners, and/or condom use attitudes mediate potential associations between HIV self-stigma and unprotected sex. Participants, including 924 PLWH, were recruited from primary care clinics and completed baseline, 6-, 12-, and 18-month survey assessments between 2008 and 2011. Hierarchical linear modeling analyses were used to examine longitudinal within-subjects associations between HIV self-stigma, mediators, and unprotected sex with both HIV-negative/unknown and HIV-positive partners. Results demonstrate that HIV self-stigma was prospectively associated with greater likelihood of unprotected sex with HIV-negative/unknown partners. None of the variables explored significantly mediated this association. HIV self-stigma was also prospectively associated with greater likelihood of unprotected sex with HIV-positive partners via the mediators of greater depressive symptoms and more negative condom use attitudes. The current study suggests that HIV self-stigma undermines HIV secondary prevention and care efforts among PLWH in KwaZulu-Natal. It is therefore critical to address HIV stigma at the social/structural level to reduce HIV self-stigma at the individual level and ultimately curb global disparities in HIV prevalence. In the absence of widespread social/structural change, interventions that treat depressive symptoms and encourage more positive condom use attitudes despite the existence of HIV stigma may buffer associations between HIV self-stigma and unprotected sex with HIV-positive partners among PLWH in KwaZulu-Natal.},
	issn = {1360-0451},
	doi = {10.1080/09540121.2014.938015},
	author = {Earnshaw, Valerie A and Smith, Laramie R and Shuper, Paul A and Fisher, William A and Cornman, Deborah H and Fisher, Jeffrey D}
}
@article {3792,
	title = {Pregnancy-Specific Stress, Preterm Birth, and Gestational Age Among High-Risk Young Women.},
	journal = {Health psychology : official journal of the Division of Health Psychology, American Psychological Association},
	year = {2014},
	month = {2014 Jan 20},
	abstract = {Objective: There is evidence that pregnancy-specific stress is associated with preterm birth. The purpose of this study is to examine the association between change in pregnancy-specific stress over the course of pregnancy and birth outcomes (i.e., preterm birth and gestational age) in an understudied but vulnerable group using a theoretically derived model. Methods: Multivariate linear and logistic regression techniques were used to examine the association between pregnancy-specific stress (measured in second and third trimester) and length of gestation (i.e., preterm birth and gestational age) among a sample of 920 Black and/or Latina adolescent and young women. Results: Second trimester pregnancy-specific stress was not associated with preterm birth or gestational age. Third trimester pregnancy-specific stress was associated with preterm birth but not with gestational age. Change in pregnancy-specific stress between second and third trimester was significantly associated with increased likelihood of preterm delivery and shortened gestational age, even after controlling for important biological, behavioral, psychological, interpersonal, and sociocultural risk factors. Conclusions: Findings emphasize the importance of measuring pregnancy-specific stress across pregnancy, as the longitudinal change from second to third trimester was significantly associated with length of gestation measured both as a dichotomous variable (preterm birth) and a continuous variable (gestational age). Furthermore, this is the first study to observe the association of pregnancy-specific stress with length of gestation in this understudied population-unique in age, race, and ethnicity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).},
	issn = {1930-7810},
	doi = {10.1037/a0034586},
	author = {Cole-Lewis, Heather J and Kershaw, Trace S and Earnshaw, Valerie A and Yonkers, Kimberly Ann and Lin, Haiqun and Ickovics, Jeannette R}
}
@article {3935,
	title = {Discrimination and sexual risk among young urban pregnant women of color.},
	journal = {Health psychology : official journal of the Division of Health Psychology, American Psychological Association},
	volume = {33},
	year = {2014},
	month = {2014 Jan},
	pages = {3-10},
	abstract = {Discrimination predicts increased risk for many negative health outcomes, helping explain a variety of racial and socioeconomic health disparities. Recent research suggests discrimination may play a role in disparities in HIV and other sexually transmitted infections (STIs); however, this research has focused on risk behaviors and has yet to establish a link between discrimination and STI diagnosis specifically. This investigation tested whether discrimination predicted condom use, risky sexual partners, and self-reported STI diagnosis among a population disproportionately affected by HIV and STIs in the U.S.: young, pregnant, socioeconomically disadvantaged, women of color.},
	keywords = {Adolescent, African Americans, Condoms, Female, Hispanic Americans, HIV Infections, Humans, New York City, Pregnancy, Prejudice, Qualitative Research, Risk-Taking, Self Report, Sexual Behavior, Sexual Partners, Sexually Transmitted Diseases, Urban Population, Young Adult},
	issn = {1930-7810},
	doi = {10.1037/a0032502},
	author = {Rosenthal, Lisa and Earnshaw, Valerie A and Lewis, Jessica B and Lewis, Ten{\'e} T and Reid, Allecia E and Stasko, Emily C and Tobin, Jonathan N and Ickovics, Jeannette R}
}
@article {4011,
	title = {The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications for access.},
	journal = {AIDS and behavior},
	volume = {18},
	year = {2014},
	month = {2014 Feb},
	pages = {226-40},
	abstract = {Antiretroviral pre-exposure prophylaxis (PrEP) has received increasing recognition as a viable prescription-based intervention for people at risk for HIV acquisition. However, little is known about racial biases affecting healthcare providers{\textquoteright} willingness to prescribe PrEP. This investigation sought to explore medical students{\textquoteright} stereotypes about sexual risk compensation among Black versus White men who have sex with men seeking PrEP, and the impact of such stereotypes on willingness to prescribe PrEP. An online survey presented participants (n~=~102) with a clinical vignette of a PrEP-seeking, HIV-negative man with an HIV-positive male partner. Patient race was systematically manipulated. Participants reported predictions about patient sexual risk compensation, willingness to prescribe PrEP, and other clinical judgments. Bootstrapping analyses revealed that the Black patient was rated as more likely than the White patient to engage in increased unprotected sex if prescribed PrEP, which, in turn, was associated with reduced willingness to prescribe PrEP to the patient.},
	keywords = {Adult, African Continental Ancestry Group, Anti-HIV Agents, Antibiotic Prophylaxis, Attitude of Health Personnel, Cultural Competency, Decision Making, Drug Prescriptions, European Continental Ancestry Group, Health Care Surveys, Health Knowledge, Attitudes, Practice, Health Personnel, Health Services Accessibility, HIV Infections, Homosexuality, Male, Humans, Male, Prejudice, Questionnaires, Racism, Socioeconomic Factors, Students, Medical},
	issn = {1573-3254},
	doi = {10.1007/s10461-013-0675-x},
	author = {Calabrese, Sarah K and Earnshaw, Valerie A and Underhill, Kristen and Hansen, Nathan B and Dovidio, John F}
}
@article {3934,
	title = {HIV Stigma and Physical Health Symptoms: Do Social Support, Adaptive Coping, and/or Identity Centrality Act as Resilience Resources?},
	journal = {AIDS and behavior},
	year = {2014},
	month = {2014 Apr 9},
	abstract = {Despite efforts to eliminate it at the societal level, HIV stigma persists and continues to threaten the health of people living with HIV (PLWH). We tested whether social support, adaptive coping, and/or HIV identity centrality act as resilience resources by buffering people from the negative impact of enacted and/or anticipated stigma on stress and ultimately HIV symptoms. Ninety-three PLWH completed a survey, and data analyses tested for evidence of mediation and moderation. Results demonstrated that instrumental social support, perceived community support, and HIV identity centrality buffered participants from the association between anticipated stigma and HIV symptoms. That is, anticipated stigma was associated with HIV symptoms via stress only at low levels of these resources. No resources buffered participants from the impact of enacted stigma. Identifying and enhancing resilience resources among PLWH is critical for protecting PLWH from the harmful effects of stigma.},
	issn = {1573-3254},
	doi = {10.1007/s10461-014-0758-3},
	author = {Earnshaw, Valerie A and Lang, Shawn M and Lippitt, Margaret and Jin, Harry and Chaudoir, Stephenie R}
}
@article {3924,
	title = {Social-structural indices and between-nation differences in HIV prevalence.},
	journal = {International journal of STD \& AIDS},
	year = {2014},
	month = {2014 Apr 2},
	abstract = {Research emphasises the role that social structures play in shaping national HIV prevalence. This study examined how social, economic, and political contexts that may represent the confluence of individual capabilities and environmental affordances or constraints are associated with national HIV prevalence. Based on social-ecological perspectives, we examined social-structural dimensions in relation to national HIV prevalence. The study identified six publicly available nation-level social, political, and economic indices and examined their associations with national 2009 HIV prevalence across 225 nations. National indices, (a) education expenditures, (b) unemployment rate, (c) homicide rate, (d) freedom of religion, and (e) women{\textquoteright}s social rights, altogether explained 43\% of the variability in national HIV prevalence. Education expenditures, homicide rate, and freedom of religion were significant predictors of national HIV prevalence in the multivariate analysis. The present study identified nation-level factors that capture social, economic, and political contexts to explain between-nation differences in HIV prevalence. Findings extend current literature on the social-structural foundation of HIV-risk and the relationship between human rights and health. National safeguards that afford individuals the power to promote general quality of life and protection from structural violence may be most important to lowering overall rates of HIV transmission.},
	issn = {1758-1052},
	author = {Tan, Judy Y and Earnshaw, Valerie A and Pratto, Felicia and Rosenthal, Lisa and Kalichman, Seth}
}
@article {4521,
	title = {An assessment of health-care students{\textquoteright} attitudes toward patients with or at high risk for HIV: implications for education and cultural competency.},
	journal = {AIDS care},
	volume = {26},
	year = {2014},
	month = {2014},
	pages = {1223-8},
	abstract = {Stigma perpetuated by health-care providers has been found to be a barrier to care for vulnerable populations, including HIV-infected, people who inject drugs (PWIDs), and men who have sex with men (MSM) in multiple clinical contexts and remains unexamined among professional health-care students in Malaysia. This cross-sectional, anonymous, and Internet-based survey assessed the attitudes of medical and dental students toward HIV-infected, PWID, and MSM patients. Survey invitation was emailed to 3191 students at 8 professional schools; 1296 (40.6\%) responded and scored their attitudes toward these patient groups using a feeling thermometer, indicating their attitudes on a sliding scale from 0 (most negative) to 100 (most positive). Compared to general patients (mean = 76.50), the mean scores for HIV-infected (mean = 54.04; p < 0.001), PWID (mean = 37.50; p < 0.001), and MSM (mean = 32.13; p < 0.001) patients were significantly lower and significantly different between each group comparison. Within group differences, most notably religion, ethnicity, and personally knowing someone from these populations were associated with significant differences in attitudes. No differences were noted between pre-clinical and clinical year of training. Health-care students represent the next generation of clinicians who will be responsible for future HIV prevention and treatment efforts. Our findings suggest alarmingly negative attitudes toward these patients, especially MSM, necessitating prompt and effective interventions designed to ameliorate the negative attitudes of health-care students toward vulnerable populations, specifically HIV-infected, PWID, and MSM patients in Malaysia.},
	keywords = {Analysis of Variance, Cross-Sectional Studies, Cultural Competency, Female, Health Knowledge, Attitudes, Practice, HIV Infections, Homosexuality, Male, Humans, Malaysia, Male, Social Stigma, Students, Dental, Students, Health Occupations, Students, Medical, Substance Abuse, Intravenous, Young Adult},
	issn = {1360-0451},
	doi = {10.1080/09540121.2014.894616},
	author = {Jin, Harry and Earnshaw, Valerie A and Wickersham, Jeffrey A and Kamarulzaman, Adeeba and Desai, Mayur M and John, Jacob and Altice, Frederick L}
}
@article {4009,
	title = {Examining effects of anticipated stigma, centrality, salience, internalization, and outness on psychological distress for people with concealable stigmatized identities.},
	journal = {PloS one},
	volume = {9},
	year = {2014},
	month = {2014},
	pages = {e96977},
	abstract = {Understanding how stigmatized identities contribute to increased rates of depression and anxiety is critical to stigma reduction and mental health treatment. There has been little research testing multiple aspects of stigmatized identities simultaneously. In the current study, we collected data from a diverse, urban, adult community sample of people with a concealed stigmatized identity (CSI). We targeted 5 specific CSIs - mental illness, substance abuse, experience of domestic violence, experience of sexual assault, and experience of childhood abuse - that have been shown to put people at risk for increased psychological distress. We collected measures of the anticipation of being devalued by others if the identity became known (anticipated stigma), the level of defining oneself by the stigmatized identity (centrality), the frequency of thinking about the identity (salience), the extent of agreement with negative stereotypes about the identity (internalized stigma), and extent to which other people currently know about the identity (outness). Results showed that greater anticipated stigma, greater identity salience, and lower levels of outness each uniquely and significantly predicted variance in increased psychological distress (a composite of depression and anxiety). In examining communalities and differences across the five identities, we found that mean levels of the stigma variables differed across the identities, with people with substance abuse and mental illness reporting greater anticipated and internalized stigma. However, the prediction pattern of the variables for psychological distress was similar across the substance abuse, mental illness, domestic violence, and childhood abuse identities (but not sexual assault). Understanding which components of stigmatized identities predict distress can lead to more effective treatment for people experiencing psychological distress.},
	issn = {1932-6203},
	doi = {10.1371/journal.pone.0096977},
	author = {Quinn, Diane M and Williams, Michelle K and Quintana, Francisco and Gaskins, Jennifer L and Overstreet, Nicole M and Pishori, Alefiyah and Earnshaw, Valerie A and Perez, Giselle and Chaudoir, Stephenie R}
}
@article {3443,
	title = {Stigma and racial/ethnic HIV disparities: Moving toward resilience.},
	journal = {The American psychologist},
	volume = {68},
	year = {2013},
	month = {2013 May-Jun},
	pages = {225-36},
	abstract = {Prior research suggests that stigma plays a role in racial/ethnic health disparities. However, there is limited understanding about the mechanisms by which stigma contributes to HIV-related disparities in risk, incidence and screening, treatment, and survival and what can be done to reduce the impact of stigma on these disparities. We introduce the Stigma and HIV Disparities Model to describe how societal stigma related to race and ethnicity is associated with racial/ethnic HIV disparities via its manifestations at the structural level (e.g., residential segregation) as well as the individual level among perceivers (e.g., discrimination) and targets (e.g., internalized stigma). We then review evidence of these associations. Because racial/ethnic minorities at risk of and living with HIV often possess multiple stigmas (e.g., HIV-positive, substance use), we adopt an intersectionality framework and conceptualize interdependence among co-occurring stigmas. We further propose a resilience agenda and suggest that intervening on modifiable strength-based moderators of the association between societal stigma and disparities can reduce disparities. Strengthening economic and community empowerment and trust at the structural level, creating common ingroup identities and promoting contact with people living with HIV among perceivers at the individual level, and enhancing social support and adaptive coping among targets at the individual level can improve resilience to societal stigma and ultimately reduce racial/ethnic HIV disparities. (PsycINFO Database Record (c) 2013 APA, all rights reserved).},
	issn = {1935-990X},
	doi = {10.1037/a0032705},
	author = {Earnshaw, Valerie A and Bogart, Laura M and Dovidio, John F and Williams, David R}
}
@article {2893,
	title = {HIV Stigma Mechanisms and Well-Being Among PLWH: A Test of the HIV Stigma Framework.},
	journal = {AIDS and behavior},
	year = {2013},
	month = {2013 Mar 3},
	abstract = {The current work evaluates the HIV Stigma Framework in a sample of 95 people living with HIV recruited from an inner-city clinic in the Bronx, NY. To determine the contributions of each HIV stigma mechanism (internalized, enacted, and anticipated) on indicators of health and well-being, we conducted an interviewer-delivered survey and abstracted data from medical records. Results suggest that internalized stigma associates significantly with indicators of affective (i.e., helplessness regarding, acceptance of, and perceived benefits of HIV) and behavioral (i.e., days in medical care gaps and ARV non-adherence) health and well-being. Enacted and anticipated stigma associate with indicators of physical health and well-being (i.e., CD4 count less than 200 and chronic illness comorbidity respectively). By differentiating between HIV stigma mechanisms, researchers may gain a more nuanced understanding of how HIV stigma impacts health and well-being and better inform targeted interventions to improve specific outcomes among people living with HIV.},
	issn = {1573-3254},
	doi = {10.1007/s10461-013-0437-9},
	author = {Earnshaw, Valerie A and Smith, Laramie R and Chaudoir, Stephenie R and Amico, K Rivet and Copenhaver, Michael M}
}
@article {2853,
	title = {Targeting cessation: understanding barriers and motivations to quitting among urban adult daily tobacco smokers.},
	journal = {Addictive behaviors},
	volume = {38},
	year = {2013},
	month = {2013 Mar},
	pages = {1639-42},
	abstract = {Many people continue to smoke tobacco products despite known negative health consequences, including increased risk of chronic disease and death. Disparities exist in rates of smoking and chronic disease, underscoring the importance of understanding the barriers and motivations to smoking cessation among vulnerable populations, such as socioeconomically disadvantaged people of color.},
	issn = {1873-6327},
	doi = {10.1016/j.amepre.2009.08.027},
	author = {Rosenthal, Lisa and Carroll-Scott, Amy and Earnshaw, Valerie A and Sackey, Naa and O{\textquoteright}Malley, Stephanie S and Santilli, Alycia and Ickovics, Jeannette R}
}
@article {2900,
	title = {Development and psychometric evaluation of the Chronic Illness Anticipated Stigma Scale.},
	journal = {Journal of behavioral medicine},
	volume = {36},
	year = {2013},
	month = {2013 Jun},
	pages = {270-82},
	abstract = {The Chronic Illness Anticipated Stigma Scale (CIASS) was developed to measure anticipated stigma (i.e., expectations of prejudice, stereotyping, and discrimination) among people living with chronic illnesses. The CIASS is a 12-item scale with three subscales differentiating among sources of anticipated stigma, including friends and family members, work colleagues, and healthcare workers. Results support the reliability, validity, and generalizability of the CIASS in two samples of people living with chronic illnesses. The CIASS was correlated with other stigma-related constructs as well as indicators of mental health, physical health, and health behaviors. The CIASS can help researchers gauge the degree to which people living with chronic illnesses anticipate stigma, better understand the processes by which anticipated stigma contributes to the health and behavior of people living with chronic illnesses, and compare the extent to which people living with different types of chronic illnesses anticipate stigma.},
	issn = {1573-3521},
	doi = {10.1016/j.amepre.2009.08.027},
	author = {Earnshaw, Valerie A and Quinn, Diane M and Kalichman, Seth C and Park, Crystal L}
}
@article {2894,
	title = {Maternal experiences with everyday discrimination and infant birth weight: a test of mediators and moderators among young, urban women of color.},
	journal = {Annals of behavioral medicine : a publication of the Society of Behavioral Medicine},
	volume = {45},
	year = {2013},
	month = {2013 Feb},
	pages = {13-23},
	abstract = {Racial/ethnic disparities in birth weight persist within the USA.},
	issn = {1532-4796},
	doi = {10.1016/j.amepre.2009.08.027},
	author = {Earnshaw, Valerie A and Rosenthal, Lisa and Lewis, Jessica B and Stasko, Emily C and Tobin, Jonathan N and Lewis, Ten{\'e} T and Reid, Allecia E and Ickovics, Jeannette R}
}
@article {3751,
	title = {Preventive discussions with health care providers: exploring differences by race/ethnicity and place.},
	journal = {Journal of health care for the poor and underserved},
	volume = {24},
	year = {2013},
	month = {2013 Feb},
	pages = {185-96},
	abstract = {The goal of the current investigation was to explore differences in discussions of health topics with health care providers by race/ethnicity and place to identify who is receiving this preventive care and where it is being received in a low-income urban area in which people are at increased risk of chronic disease. 1,147 adults responded to a health survey in New Haven, Connecticut. Black and Latino participants reported that their health care providers discussed more topics with them than White participants reported. Participants who received care at community health centers and hospital primary care centers discussed more topics than participants who received care at hospital emergency departments and private doctors{\textquoteright} offices. Findings suggest that community health centers are important sources of preventive care in low-income urban settings, thereby supporting the goals of the Patient Protection and Affordable Care Act and the community health center model of care delivery.},
	keywords = {Adolescent, Adult, African Continental Ancestry Group, Aged, Communication, Community Health Centers, Continental Population Groups, Emergency Service, Hospital, Ethnic Groups, European Continental Ancestry Group, Female, Healthcare Disparities, Hispanic Americans, Humans, Male, Middle Aged, Office Visits, Physician-Patient Relations, Preventive Medicine, Young Adult},
	issn = {1548-6869},
	doi = {10.1353/hpu.2013.0008},
	author = {Earnshaw, Valerie A and Carroll-Scott, Amy and Rosenthal, Lisa and Chwastiak, Lydia and Santilli, Alycia and Ickovics, Jeannette R}
}
@article {3560,
	title = {Perceived Stigma of Purchasing Sex Among Latino and Non-Latino Male Clients of Female Sex Workers in Tijuana, Mexico.},
	journal = {Journal of immigrant and minority health / Center for Minority Public Health},
	year = {2013},
	month = {2013 Aug 25},
	abstract = {HIV prevention efforts must be comprehensive in their understanding of the factors involved in HIV risk. Male clients, who have received less research attention than female sex workers (FSWs), may experience stigma as a function of purchasing sex. Perceived stigma may be related to poor psychological outcomes, risky psychosexual characteristics, and higher drug and sexual risk behavior among male clients of FSWs. However, perceived stigma of purchasing sex may differ between clients of different ethnic groups. In the present study, we examine the correlates of perceived stigma of purchasing sex among Latino versus non-Latino male clients of FSWs in Tijuana, Mexico. Using time-location sampling, we recruited 375 male clients (323 Latino, 52 non-Latino) in Tijuana who completed a computerized survey on various measures. We measured perceived stigma of purchasing sex using three items we developed for this study. Using linear regression analyses we found that perceived stigma was associated with greater guilt, a greater feeling of escape from everyday life, and more negative condom attitudes among Latino clients. This was not found among non-Latino clients. Features of Latino culture, like machismo, and how they may relate to stigma of purchasing sex are discussed.},
	issn = {1557-1920},
	doi = {10.1016/j.annepidem.2013.07.018},
	author = {Pitpitan, Eileen V and Strathdee, Steffanie A and Semple, Shirley J and Wagner, Karla D and Chavarin, Claudia V and Earnshaw, Valerie A and Patterson, Thomas L}
}
@article {2895,
	title = {Internalized stigma and HIV status disclosure among HIV-positive black men who have sex with men.},
	journal = {AIDS care},
	volume = {25},
	year = {2013},
	month = {2013},
	pages = {466-71},
	abstract = {Black men who have sex with men (BMSM) are severely affected by the HIV epidemic, yet research on the relationship between HIV stigma and status disclosure is relatively limited among this population. Within this epidemic, internalized HIV stigma, the extent to which people living with HIV/AIDS endorse the negative beliefs associated with HIV as true of themselves, can negatively shape interpersonal outcomes and have important implications for psychological and physical health. In a sample of HIV-positive BMSM (N=156), the current study examined the effect of internalized stigma on HIV status disclosure to sexual partners, which can inform sexual decision-making in serodiscordant couples, and HIV status disclosure to family members, which can be beneficial in minimizing the psychological distress associated with HIV. Results revealed that greater internalized stigma was associated with less HIV status disclosure to participants{\textquoteright} last sexual partner and to family members. Findings from this study provide evidence that internalized negative beliefs about one{\textquoteright}s HIV status are linked to adverse interpersonal consequences. Implications of these findings are discussed with regard to prevention and intervention efforts to reduce HIV stigmatization.},
	issn = {1360-0451},
	doi = {10.1016/j.amepre.2009.08.027},
	author = {Overstreet, Nicole M and Earnshaw, Valerie A and Kalichman, Seth C and Quinn, Diane M}
}
@article {2897,
	title = {Coping with HIV stigma: do proactive coping and spiritual peace buffer the effect of stigma on depression?},
	journal = {AIDS and behavior},
	volume = {16},
	year = {2012},
	month = {2012 Nov},
	pages = {2382-91},
	abstract = {Although HIV stigma is a significant predictor of depression, little is known about which factors might most effectively buffer, or attenuate, this effect. We examined whether two coping-related factors-proactive coping and spiritual peace-modified the effect of HIV stigma on likelihood of depression among a sample of 465 people living with HIV/AIDS (PLWHA). In a cross-sectional analysis, we conducted hierarchical logistic regressions to examine the effect of HIV stigma, proactive coping, spiritual peace, and their interactions on likelihood of significant depressive symptoms. Spiritual peace moderated the effect of HIV stigma on depression at high-but not low-levels of HIV stigma. No such effect was observed for proactive coping. Findings suggest that spiritual peace may help counteract the negative effect of HIV stigma on depression. Intervention components that enhance spiritual peace, therefore, may potentially be effective strategies for helping PLWHA cope with HIV stigma.},
	keywords = {Adaptation, Psychological, Adult, Alabama, Cross-Sectional Studies, Depression, Female, Health Surveys, HIV Infections, Humans, Interviews as Topic, Likelihood Functions, Male, Middle Aged, Quality of Life, Questionnaires, Regression Analysis, Residence Characteristics, Self Efficacy, Social Stigma, Social Support, Spirituality, Stereotyping, Young Adult},
	issn = {1573-3254},
	doi = {10.1016/j.amepre.2009.08.027},
	author = {Chaudoir, Stephenie R and Norton, Wynne E and Earnshaw, Valerie A and Moneyham, Linda and Mugavero, Michael J and Hiers, Kathie M}
}
@article {2851,
	title = {The importance of full-time work for urban adults{\textquoteright} mental and physical health.},
	journal = {Social science \& medicine (1982)},
	volume = {75},
	year = {2012},
	month = {2012 Nov},
	pages = {1692-6},
	abstract = {Unemployment and underemployment have adverse mental and physical health consequences, such as increased stress and depression. Health damaging behaviors like unhealthy eating, smoking, and alcohol use may be used to cope, contributing to chronic disease risk. In this adverse economic climate, it is vital to understand the health implications of unemployment and underemployment as well as underlying mechanisms. A randomized household survey of adults in six low resource communities was conducted in New Haven, Connecticut in 2009, yielding a sample of 1205 (73\% participation) racially diverse adults (61\% Black, 20\% Latino, 12\% White) ages 18-65 (61\% women). We used ANOVA to test group differences and structural equation modeling to test mediation. 14.5\% were unemployed and looking for work, 18.4\% worked part-time, 38.2\% worked full-time. Those employed full-time reported the least damaging psychological factors and health behaviors: lowest levels of stress and depression, most healthy and least unhealthy eating, most physical activity, and lowest levels of smoking and drinking. Those employed part-time fell in the middle, and those unemployed fell on the unhealthy end of all psychological and behavioral factors. Stress significantly mediated the associations of full-time employment with frequency of unhealthy eating and physical activity, and amount of cigarette smoking and alcohol consumption. Depression significantly mediated the association of full-time employment with frequency of healthy eating. Compared to <10\% nationwide, rates of unemployment in this sample were high. Both those unemployed and employed part-time reported adverse health behaviors as compared to those employed full-time, partially mediated by heightened stress and depression. It is vital for the health and well-being of the nation to increase not simply employment, but specifically full-time employment. Provision of mental health services to those unemployed and underemployed should be a priority to promote healthier lifestyles and prevent costly future chronic disease.},
	keywords = {Adolescent, Adult, Aged, Alcohol Drinking, Connecticut, Cross-Sectional Studies, Depression, Diet, Employment, Exercise, Female, Health Behavior, Health Surveys, Humans, Male, Middle Aged, Smoking, Stress, Psychological, Time Factors, Urban Health, Young Adult},
	issn = {1873-5347},
	doi = {10.1016/j.amepre.2009.08.027},
	author = {Rosenthal, Lisa and Carroll-Scott, Amy and Earnshaw, Valerie A and Santilli, Alycia and Ickovics, Jeannette R}
}
@article {2901,
	title = {The impact of stigma in healthcare on people living with chronic illnesses.},
	journal = {Journal of health psychology},
	volume = {17},
	year = {2012},
	month = {2012 Mar},
	pages = {157-68},
	abstract = {Approximately half of adults are living with a chronic illness, many of whom may feel stigmatized by their chronic illness in different contexts. We explored the impact of internalized, experienced, and anticipated stigma within healthcare settings on the quality of life of 184 participants living with chronic illnesses (e.g. diabetes, inflammatory bowel disease, asthma). Results of a path analysis demonstrate that participants who internalized stigma and experienced stigma from healthcare workers anticipated greater stigma from healthcare workers. Participants who anticipated greater stigma from healthcare workers, in turn, accessed healthcare less and experienced a decreased quality of life.},
	keywords = {Adolescent, Adult, Attitude of Health Personnel, Chronic Disease, Female, Humans, Male, Professional-Patient Relations, Quality of Life, Questionnaires, Stereotyping, Young Adult},
	issn = {1461-7277},
	doi = {10.1177/1359105311414952},
	author = {Earnshaw, Valerie A and Quinn, Diane M}
}
@article {2899,
	title = {Anticipated stigma and quality of life among people living with chronic illnesses.},
	journal = {Chronic illness},
	volume = {8},
	year = {2012},
	month = {2012 Jun},
	pages = {79-88},
	abstract = {We examined the process by which anticipated stigma relates to quality of life among people living with chronic illnesses. We hypothesized that stress, social support and patient satisfaction mediate the relationships between three sources of anticipated stigma and quality of life.},
	keywords = {Adolescent, Adult, Aged, Anticipation, Psychological, Chronic Disease, Female, Humans, Male, Middle Aged, Patient Satisfaction, Quality of Life, Social Stigma, Social Support, Stereotyping, Stress, Psychological},
	issn = {1745-9206},
	doi = {10.1177/1742395311429393},
	author = {Earnshaw, Valerie A and Quinn, Diane M and Park, Crystal L}
}
@article {2898,
	title = {Postpartum sexually transmitted disease: refining our understanding of the population at risk.},
	journal = {Sexually transmitted diseases},
	volume = {39},
	year = {2012},
	month = {2012 Jul},
	pages = {509-13},
	abstract = {Scant literature exists on sexually transmitted disease (STD) risk specific to pregnancy and postpartum. The objective of this prospective study is to examine risk factors for incident postpartum STDs among young mothers (ages, 14-25).},
	keywords = {Adolescent, Adult, Educational Status, Female, Health Knowledge, Attitudes, Practice, Humans, Infant, Newborn, Postpartum Period, Pregnancy, Pregnancy Complications, Infectious, Pregnancy in Adolescence, Prenatal Care, Prevalence, Prospective Studies, Risk Factors, Sexual Behavior, Sexual Partners, Sexually Transmitted Diseases, Socioeconomic Factors, Substance-Related Disorders, United States, Young Adult},
	issn = {1537-4521},
	doi = {10.1016/j.amepre.2009.08.027},
	author = {Wheeler, Rebekah and Earnshaw, Valerie A and Kershaw, Trace and Ickovics, Jeannette R}
}
@article {3821,
	title = {Social Dominance Orientation Relates to Believing Men Should Dominate Sexually, Sexual Self-Efficacy, and Taking Free Female Condoms Among Undergraduate Women and Men.},
	journal = {Sex roles},
	volume = {67},
	year = {2012},
	month = {2012 Dec},
	pages = {659-669},
	abstract = {Gendered-based power affects heterosexual relationships, with beliefs in the U.S. prescribing that men dominate women sexually. We draw on social dominance theory to examine whether women{\textquoteright}s and men{\textquoteright}s level of support for group-based hierarchy (i.e., social dominance orientation; SDO) helps explain gender-based power beliefs and dynamics in heterosexual relationships. We conducted a laboratory study at a Northeastern U.S. university among 357 women and 126 men undergraduates who reported being heterosexual and sexually active, testing three sets of hypotheses. First, as hypothesized, women endorsed SDO and the belief that men should dominate sexually less than men did. Second, as hypothesized, among women and men, SDO was positively correlated with the belief that men should dominate sexually, and negatively correlated with sexual self-efficacy (confidence in sexual situations) and number of female condoms (a woman-controlled source of protection) taken. Third, structural equation modeling, controlling for age, family income, number of sexual partners in the past month, and perceived HIV/AIDS risk, supported the hypothesis that among women and men, the belief that men should dominate sexually mediates SDO{\textquoteright}s association with sexual self-efficacy. The hypothesis that the belief that men should dominate sexually mediates SDO{\textquoteright}s association with number of female condoms taken was supported for women only. The hypothesis that sexual self-efficacy mediates SDO{\textquoteright}s association with number of female condoms taken was not supported. Results suggest SDO influences power beliefs and dynamics in heterosexual relationships. Although female condoms are an important woman-controlled source of protection, power-related beliefs may pose a challenge to their use.},
	issn = {0360-0025},
	author = {Rosenthal, Lisa and Levy, Sheri R and Earnshaw, Valerie A}
}
@article {2896,
	title = {Stereotypes about people living with HIV: implications for perceptions of HIV risk and testing frequency among at-risk populations.},
	journal = {AIDS education and prevention : official publication of the International Society for AIDS Education},
	volume = {24},
	year = {2012},
	month = {2012 Dec},
	pages = {574-81},
	abstract = {Although research continues to demonstrate that HIV stigma is associated with decreased HIV testing, the psychological processes implicated in this association remain unclear. The authors address this gap by differentiating between the HIV stigma mechanisms of stereotypes, prejudice, and discrimination. They hypothesize that HIV stereotypes specifically, more so than prejudice or discrimination, are associated with HIV testing among at-risk populations. Ninety-three HIV-negative people receiving methadone maintenance therapy at a clinic in the northeastern United States participated by completing a survey. Results demonstrated that HIV stereotypes are associated with HIV testing via the mediator of perceived HIV risk. As hypothesized, prejudice, discrimination, and objective HIV risk were not associated with perceived HIV risk. Differentiating between HIV stigma mechanisms in future work can provide critical insight into how to intervene in HIV stigma to increase HIV testing and improve HIV prevention among at-risk populations.},
	keywords = {Adolescent, Adult, Age Factors, Cross-Sectional Studies, Female, Health Behavior, Health Knowledge, Attitudes, Practice, HIV Infections, Humans, Male, Middle Aged, Models, Theoretical, New England, Patient Acceptance of Health Care, Perception, Prejudice, Regression Analysis, Risk Reduction Behavior, Social Discrimination, Social Stigma, Socioeconomic Factors, Stereotyping, Young Adult},
	issn = {1943-2755},
	doi = {10.1016/j.amepre.2009.08.027},
	author = {Earnshaw, Valerie A and Smith, Laramie R and Chaudoir, Stephenie R and Lee, I-Ching and Copenhaver, Michael M}
}
@article {2184,
	title = {Anticipated stigma and quality of life among people living with chronic illnesses.},
	journal = {Chronic illness},
	year = {2011},
	month = {2011 Nov 11},
	abstract = {OBJECTIVES: We examined the process by which anticipated stigma relates to quality of life among people living with chronic illnesses. We hypothesized that stress, social support and patient satisfaction mediate the relationships between three sources of anticipated stigma and quality of life. METHODS: Data were collected from adults living with chronic illnesses recruited from support groups and online communities, and were analysed with path analysis. RESULTS: RESULTs demonstrated that stress mediated the relationships between anticipated stigma from friends and family, and work colleagues with quality of life; social support mediated the relationships between anticipated stigma from friends and family, and work colleagues with quality of life; and patient satisfaction mediated the relationship between anticipated stigma from healthcare providers with quality of life. The final path model fit the data well (χ (2) (8) = 8.66, p = 0.37; RMSEA = 0.02; CFI = 0.99; SRMR = 0.03), and accounted for 60\% of the variance in participants{\textquoteright} quality of life. DISCUSSION: This work highlights potential points of intervention to improve quality of life. It calls attention to the importance of differentiating between sources of anticipated stigma in clinical settings, interventions and research involving people living with chronic illnesses.},
	issn = {1745-9206},
	doi = {10.1007/s11904-011-0095-3},
	author = {Earnshaw, Valerie A and Quinn, Diane M and Park, Crystal L}
}
@article {3333,
	title = {From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures.},
	journal = {AIDS and behavior},
	volume = {13},
	year = {2009},
	month = {2009 Dec},
	pages = {1160-77},
	abstract = {Recent analyses suggest that lack of clarity in the conceptualization and measurement of HIV stigma at an individual level is a significant barrier to HIV prevention and treatment efforts. In order to address this concern, we articulate a new framework designed to aid in clarifying the conceptualization and measurement of HIV stigma among individuals. The HIV Stigma Framework explores how the stigma of HIV elicits a series of stigma mechanisms, which in turn lead to deleterious outcomes for HIV uninfected and infected people. We then apply this framework to review measures developed to gauge the effect of HIV stigma since the beginning of the epidemic. Finally, we emphasize the utility of using three questions to guide future HIV stigma research: who is affected by, how are they affected by, and what are the outcomes of HIV stigma?},
	keywords = {Concept Formation, HIV Infections, HIV-1, Humans, Models, Theoretical, Prejudice, Research, Social Alienation, Stereotyping},
	issn = {1573-3254},
	doi = {10.1007/s11904-011-0095-3},
	author = {Earnshaw, Valerie A and Chaudoir, Stephenie R}
}
