Inflection points are pivotal moments immediately preceding self-directed violence (SDV; i.e., self-injury and suicide). This study qualitatively examined factors that contributed to halting SDV during inflection points. Participants (N = 166) completing an online survey were community-dwelling adults in the United Kingdom with some form of SDV lived experience. Thematic analysis yielded the following results. The most common themes across SDV inflection points were (in descending order): concern for the negative impact on others (e.g., fear of hurting loved ones), use of adaptive coping methods (e.g., general use of coping skills), physical deterrents (e.g., scarring, pain), social contact (sense of connection in the moment), and concern for negative consequences on oneself (e.g., fear of punishment). Healthy coping skill use contributed to halting both self-injury and suicide. Self-injury inflection points were largely characterized by intrapersonal factors, whereas suicide inflection points were highly interpersonal in nature. Implications for clinical practice, theory, and research are discussed.
The intertwining of religion and sex, particularly sexual shame, is a pertinent but underexplored phenomenon among survivors of nonconsensual sexual experiences (NSEs). Sexual shame, defined as shame related to one's sexual self, experiences, thoughts, and desires, is a commonly reported outcome of sexual violence and is known to negatively impact future sexual well-being. Purity culture - a strict sexual ethic rooted in Evangelical Christianity - may independently exacerbate sexual shame. The present online study examined associations between childhood purity culture exposure, adulthood acceptance of purity culture beliefs, and sexual shame in child sexual abuse survivors (n = 100), adult NSE survivors (n = 101), and controls (n = 100). Data were analyzed using General Additive Models with bootstrapped confidence intervals. As hypothesized, sexual shame was significantly higher among both NSE groups. Adulthood acceptance of purity culture beliefs independently predicted sexual shame for both men (β = 0.01, p < .001) and women (β = 0.004, p < .001), whereas childhood exposure to purity culture was a significant predictor only for men (F(2.11, 114) = 4.313, p = .01). These findings underscore sexual shame as a clinically relevant outcome of NSEs and highlight the influential role of religious sexual messaging in shaping that shame.
This study aimed to determine the factors associated with feeling ashamed of disclosing HIV-positive status among females who self-reported to health facilities for HIV testing in Kenya. This study used the Kenya Demographic Health Survey data set for 2022. A total of 18,506 women aged 15-49 years were selected from the sample clusters; 13,815 had ever tested for HIV and 332 had positive results for HIV. The chi-squared test was applied to determine the association between the selected variables of interest and the outcome variable. Furthermore, to identify the explanatory variables that were associated with the outcome variable of interest, logistic binary regression was performed. A p > 0.05 and all statistical analyses were conducted using Microsoft Excel (xlsx) and STATA15. The analysis included 332 women who had tested positive during the survey out of which 125(38%) women agreed to have felt ashamed to disclose their HIV+ status. Agreed to stigma (AOR = 1.92, 95% CI: 1.15, 3.22; p < 0.05) and being intimidated by health workers (AOR = 2.49, 95% CI: 1.05, 5.93; p < 0.05) were significantly associated with feeling ashamed of disclosing HIV+ status. The remaining variables, such as age category, residence, marital status, educational attainment, total number of children born, access to information, sex partners excluding spouses in the last 12 months, and number of lifetime sex partners, were not associated with feeling ashamed. Health stigmatization and intimidation Stigmatization had an almost two-fold likelihood of causing shame in the disclosure of HIV status among females with HIV who were studied.
Chronic hepatitis B infection (CHB) causes over 1 million deaths annually, with a large burden of morbidity and mortality in the WHO-African Region (WHO-AFRO) where <5% of people are diagnosed and 0.2% are on treatment. Studies have shown that understanding of hepatitis B virus (HBV) here is often poor, and people living with HBV (PLWHB) can experience stigma and discrimination. However there has been little documentation on the impact of an HBV diagnosis on the lives of PLWHB in the WHO-AFRO region or community involvement in improving care provision. We undertook two focus group discussions (FGDs) with PLWHB and two with healthcare workers (HCWs) providing HBV care at Kilifi County Referral Hospital (KCRH), Kenya to explore experiences of living with HBV and barriers to accessing care. FGDs were conducted primarily in Kiswahili, transcribed verbatim and translated into English. The data were analysed thematically using NVivo version 14. PLWHB and HCWs at KCRH had a good understanding of HBV which was likely influenced by a concurrent research study on HBV, however they reported low awareness in the general community, and there is no local name for the infection. Many PLWHB were shocked at their initial diagnosis with mixed reactions from friends and family. Costs of transport and concerns about lost employment were the biggest barriers to care. Many people suggested decentralised clinics would reduce loss to follow up, however others would rather be treated far from home to preserve anonymity. Stigma was highlighted as a major issue, leading to feelings of isolation, rejection and discrimination. Community education, wider testing and advocacy by well-respected community members were mentioned as key methods to reduce HBV transmission. Decentralisation of clinics may improve access to care; however, this needs to be developed in careful consultation with PLWHB to ensure they are acceptable and accessible to all.
There is high post-hospital discharge mortality among persons with HIV who are hospitalized, and post-hospital survival is strongly associated with early HIV clinic linkage, clinic attendance, and antiretroviral therapy adherence. The Daraja intervention, a context-tailored case management strategy implemented and tested through a randomized trial in Tanzania, was associated with improved HIV clinic linkage, retention, and ART initiation and adherence. We conducted in-depth interviews (IDIs) in a sub-sample of 40 study participants (20 control and 20 intervention) 12 months after enrollment into the trial to gain an in-depth understanding of the barriers to HIV care engagement and the perceived mechanisms through which the Daraja intervention impacted these barriers. We also conducted IDIs with 20 health care providers. We used a thematic analysis approach to generate themes following the Gelberg-Andersen behavioral model for vulnerable population domains. Perceived stigma, coupled with the mistrust of healthcare providers, underemployment or lack of reliable income, unreliable transport, and a lack of social support, were identified as key barriers to HIV clinic attendance and ART adherence. Perceived stigma complicated not only linking to and attending an HIV clinic but also decision-making regarding the choice of the clinic's location. The Daraja intervention was reported to help normalise HIV diagnosis, plug the social support gap, increase patients' self-efficacy and their capacity of participants to navigate the HIV clinic during HIV clinic linkage. These qualitative research results identified several important barriers to engaging in HIV care and provide insights into the mechanisms through which the Daraja intervention operated to affect the perceived stigma, social support, self-efficacy, and increased capacity of participants to navigate the HIV clinic during HIV clinic linkage. ClinicalTrials.gov, NCT03858998. Registered on 01 March 2019.
The authors of this research explored community perspectives on women's mental health in rural Pakistan, using a qualitative approach to identify beliefs hindering women's access to mental healthcare. Data were collected through 15 Focus Group Discussions (FGDs) and 15 Key Informant Interviews (KIIs) with stakeholders in Gilgit-Baltistan, using purposive sampling. The researchers revealed low community awareness of mental health and a lack of diagnostic and treatment services for women. Financial, sociocultural, and environmental factors, along with gender discrimination, poverty, and violence, worsened women's mental health. The COVID-19 pandemic further escalated issues due to lockdowns, school closures, increased workload, and reduced income. The authors' results suggest that women living in rural Pakistan face a significant burden of mental health challenges, coupled with obstacles that limit their access to treatment. The authors underscored the need for both universal and targeted interventions to address mental health challenges among rural women.
Abortion is a common reproductive healthcare process that is often stigmatised. Research on abortion stigma has grown significantly since the last major review over a decade ago, and there is a pressing need for an updated, comprehensive systematic review. The purpose of this review is to examine the extent and subjective experiences of abortion stigma among those seeking an abortion in high-income countries. We aim to explore the theoretical conceptualisations of abortion stigma in relevant studies. We conducted a mixed-method systematic review following the JBI and PRISMA guidelines. PubMed, CINHAL, PsychINFO, LIVIVO, and the Cochrane Library were searched for peer-reviewed articles. Quantitative studies were summarised narratively. Qualitative studies were synthesised using the JBI meta-aggregative approach. We included 41 qualitative, nine quantitative, and three mixed methods studies. Most studies lacked a substantial theoretical conceptualisation of abortion stigma. Quantitative studies reported prevalence rates of perceived abortion stigma ranging from 37% to 60%, suggesting that stigma remains a common experience among abortion seekers. Findings also indicate associations between abortion stigma and various sociodemographic factors (e.g., religion, race, age), as well as adverse mental health outcomes. In the qualitative studies, people seeking abortion care reported experiencing and anticipating judgment from healthcare professionals, anti-abortion activists, and their close social circle. Their experiences also centered on the internalisation of shame and guilt. Some studies highlighted the mitigating effect of social support. Longitudinal and mixed methods approaches with consistent assessment would be useful to better understand the developmental pathways of abortion stigma. This understanding is necessary to provide individual and structural support for people seeking abortion care. Abortion is a common healthcare procedure, but it often faces stigma. Despite many recent studies on this topic, there hasn't been an updated overview since 2016. We reviewed 53 research articles to understand how and to what extent abortion stigma is experienced in high-income countries. Quantitative studies mainly looked at how common abortion stigma can be and how it relates to mental health and decision-making. Qualitative studies provided a more profound insight. They showed that people seeking abortions often feel judged by healthcare workers, anti-abortion activists, and their friends and family. Qualitative studies underline how people who seek an abortion feel ashamed and guilty. However, having support from loved ones could help lessen these feelings. In conclusion, we found that abortion is a stigmatised process. Future research should explore the support systems available to people seeking abortions. Understanding these supports can help improve structural-level care and ensure better assistance for people navigating abortion access.
Menstrual stigma, characterized by negative beliefs, attitudes, and practices surrounding menstruation, often leads to the social exclusion and discrimination of menstruators. The intersection of menstrual stigma and period poverty, which is marked by limited access to menstrual hygiene products and safe sanitation has a profound impact on the mental health and well-being of adolescent girls, particularly in low- and middle-income countries. This study aimedto examine the associations between menstrual stigma and mental health (Mood and Feelings Questionnaire) among female adolescents aged 10-20 in primary schools in Panyijar County, South Sudan. Cross-sectional baseline data were analyzed from a school safety evaluation using unadjusted and adjusted linear regression models In unadjusted analyses, knowing whether female classmates had their period was significantly associated with poorer mental health (β = 1.75, p < 0.001). Feeling ashamed if boys knew about one's period was also associated with poorer mental health (β = 1.49, p = 0.05). In individually adjusted models, ajusting for demographic characteristics, feeling the need to hide one's period was associated with better mental health (β = -1.80, p = 0.02). In fully adjusted models, which included all stigma variables and demographic controls, hiding one's period remained significantly associated with mental health (β = -1.99, p = 0.04), while knowing when a classmate had their period showed a marginal association with poorer mental health (β = 0.88, p = 0.08). Disability was significantly associated with poorer mental health (β = 2.52, p < 0.01), while displacement showed a marginal association (β = 0.84, p = 0.06). No other demographic variables retained significance. These findings highlight the need for comprehensive strategies that address menstrual stigma and its impact on mental health, including interventions that challenge harmful social norms, promote safe latrine environments, and ensure access to hygiene products and menstrual education.
Fearlessness about death (FAD) reflects a reduced fear of dying that enables individuals to act on suicidal thoughts. Understanding how FAD changes in real time is critical because suicide risk can escalate within hours. However, little is known about processes that influence FAD within brief time periods. Painful and provocative events (PPEs), affective lability and impulsivity have each been linked to suicidal behavior and may shape momentary increases in FAD, but prior studies have been largely cross-sectional. To address this gap, we enrolled 148 young adults with past year suicidal thoughts and/or behaviors to complete ecological momentary assessments five times per day for 21 days. Using multi-level modeling, we tested the impact of daily fluctuations in affective states (happy, sad, anxious, angry, ashamed, and hopeless) and impulsivity on same-day FAD, with daily engagement in PPEs as a mediator. Results indicated that greater daily lability in impulsivity, anger, sadness and shame was associated with increased same-day FAD. Contrary to hypotheses, these effects were not mediated by PPE engagement. Short-term increases in FAD may arise from rapid shifts in emotions and impulsivity, rather than experiences such as PPEs. Capturing these dynamic, within-person changes can refine suicide theory and improve real-time suicide risk assessment.
Disordered eating (DE) is common among patients attending primary health care settings. However, the prevalence of DE among patients who receive care in nutrition practice settings has yet to be estimated. We aimed to determine the prevalence of DE and its correlates among outpatients in a nutrition service. A cross-sectional survey was conducted using a convenience sample of outpatients (N = 502) who received care from 2022 to 2024 at the Nutrition Care Offices, which is a university nutrition service in Mexico City. A screening questionnaire was created to identify DE. Items were derived from existing DE screening tools and patients' experiences. Linear regression models were estimated, with the outcomes being the three indicators of DE (negative body image, binge eating-compensation, and exercise as a negative experience). The most common DE behaviours and cognitions were feeling uncomfortable or insecure about their body fat (74.7%), feeling ashamed of their weight (57.6%), feeling uncomfortable or insecure about their muscles (57.2%), feeling bad when their weight is measured (54.0%), and feeling they have lost control of what they eat (51.0%). Binge eating-compensation and negative body image scores were higher among women, younger individuals, those with higher body weight, and those with very light or light leisure-time physical activity (PA). The practice of leisure-time PA was positively associated with exercise as a negative experience but negatively related to negative body image. Our findings suggest that DE is a problem that arises recurrently in weight-related nutrition consultations. Higher risk groups deserved special attention.
Intimate partner violence (IPV) during the perinatal period is a significant public health issue. Persons with disabilities (PWD) experience higher rates of IPV yet are less likely to be screened, and little is known about their experiences with screening and interventions. This study explored perinatal IPV screening experiences among PWD in the United States. As part of a mixed method study on psychosocial risks and maternal-infant outcomes among PWD, we conducted semi-structured interviews with 45 pregnant or recently pregnant PWD. Twenty-two participants reported experiencing or having experienced current or recent IPV. Interviews addressed pregnancy health, healthcare experiences, IPV screening, interventions, and care recommendations. Reflexive thematic analysis was used to identify key themes. Analysis revealed three key themes. First, participants described silence, fear, and stigma as barriers to disclosure, often minimizing abuse or feeling ashamed, particularly in the absence of direct and empathetic assessment by healthcare providers. Second, participants reported missed opportunities and gaps in healthcare provider response, including superficial screening, limited follow-up, and experiences of bias or discrimination, which reinforced isolation and hindered access to support. Third, participants highlighted the transformative power of supportive care, noting that providers who listened attentively, validated their experiences, and connected them to resources promoted safety, empowerment, and engagement with care. Persons with disabilities face unique barriers to IPV disclosure during the perinatal period, and current screening practices are often insufficient. Embedding IPV screening within trauma-informed and disability-informed care can enhance disclosure, improve access to resources, and promote maternal and infant health. Health systems should implement tailored screening approaches, healthcare provider training, and systemic supports to ensure appropriate IPV identification and response for PWD.
Women experiencing homelessness have complex needs. Although participation and shared decision-making are legal rights, meaningful involvement remains challenging. The study was conducted with a Women Advisory Board (WAB). To investigate professionals' perceptions of prerequisites and opportunities for participation and shared decision-making for women with comorbidities experiencing homelessness, regarding collaboration to provide care and support - and to ascertain the Women's Advisory Board's reasoning about the professionals' perceptions. Twelve interviews with professionals in social services, healthcare and non-governmental organisations in Sweden were conducted and analysed with content analysis. Professionals reported that collaboration for women with comorbidities experiencing homelessness often fails. Organisations work in isolation, lack a holistic perspective, and avoid responsibility. Women are seldom heard, while bureaucratic language and professional control dominate. Meetings overlook lived experiences of illness, substance use disorder, and homelessness, hindering participation. These women are vulnerable, ashamed, and exposed to violence. Effective collaboration requires a woman-centred approach, adaptation, preparation, and follow-up. The WAB's reasoning confirmed these perceptions. Professionals and the WAB agree that collaboration requires committed and flexible professionals, who work together acknowledging the individual woman's circumstances-not their own organisational framework. It is questionable whether user participation is possible under the prevailing conditions.
Disclosure of AI use is seen as a sign of the author's honesty and commitment to the principle of transparency. However, existing discussions have paid little attention to a special case: authors who honestly disclose their use of AI feel ashamed because of their honesty. The main issue discussed in this paper is why authors experience shame in the process of responsible disclosure of AI use. We redefine this emotion and its causes from the perspective of moral emotions. We argue that current disclosure policies only emphasize honesty but do not address how this honesty should be fairly treated. Current disclosure guidelines should ensure that authors feel more secure when disclosing AI use honestly in academic papers, thereby promoting an effective and responsible culture of disclosure. This requires more constructive narrative support. Expressing appreciation and respect for the honesty represented by disclosure is an appropriate way to address the issues discussed in this paper.
Understanding how women navigate induced abortion care pathways is critical to ensuring person-centred, quality reproductive health services. Evidence indicates that persistent abortion stigma, the lack of choices of abortion methods and respectful care during abortion remain a global challenge to reproductive healthcare. Yet there is minimal evidence regarding abortion care pathways. This study explored induced abortion care pathways in Addis Ababa healthcare facilities. We used a descriptive qualitative approach, adopting purposive sampling techniques to recruit women who sought induced abortion care from seven facilities. The data were collected from May to July 2024. In-depth semi-structured interviews with sixteen women were digitally recorded and transcribed into the local language before being translated into English. Data were coded, organised, and analysed using inductive thematic analysis. Five main themes and their corresponding subthemes were developed through data analysis. Themes were: (i) social and emotional support, (ii) moral and social meanings shaping abortion care, (iii) accessibility and service delivery, (iv) perceived competency of abortion providers, and (v) physical and emotional effects of abortion. Many women attended the clinic alone, without their families, and received no support. Women often sought care at clinics away from their community due to concerns related to fear of stigma and social pressure. This study found long waiting times to receive abortion care, a lack of medicine and ultrasound at some facilities and limited availability of second-trimester abortions. Women reported that many providers were welcoming and competent, while others reported poor communication, the use of medical jargon, and stigmatising behaviours. Participant reported pressure to accept methods they did not want during contraceptive counselling and fear of breaches in privacy and confidentiality. Participants also described physical symptoms such as bleeding and pain, and felt ashamed and upset after the abortion, which could be associated with negative experiences. Inadequate social support, abortion stigma, and barriers to accessing abortion services, such as long waiting times and insufficient resources, were identified as significant gaps. These findings emphasised the need to strengthen person-centred abortion care and address systemic and socio-cultural barriers that undermine the quality of care. Abortion care should be easy to access, fair for everyone, and respectful of women’s needs. Kind communication and emotional support during abortion enhance the quality of care. This study explored abortion care experiences in healthcare facilities in Addis Ababa.We spoke with women who came for abortion care. We conducted face-to-face interviews employing open-ended questions. We analysed the data by thoroughly reading and checking the information to identify common patterns in women’s experiences.Women had varied experiences of support. Some received strong support from family or friends, which made them feel less worried and more confident. Some went through the abortion procedure alone as they feared pressure or shame. Many women felt abortion was a “sin” or morally wrong, while others felt confident that they had made the best decision for their lives. Women reported waiting times and service availability as challenges to accessing quality care. In addition, negative experiences such as feeling judged and ignored, as well as poor communication from providers, are reported. Women explained physical symptoms such as bleeding, fatigue and emotional outcomes including anxiety, guilt and self-blame after abortion. At the same time, some felt relieved after the abortion and satisfied with the care received.This study found that women faced challenges such as stigma and judgment, long waiting times, and limited availability of abortion services in some places. Improving the quality of abortion care can help women feel supported, reduce emotional distress, and protect their health and dignity.
Peer norms play a key role in shaping adolescents' sexuality. While research has focused primarily on adolescents' sexual experiences, little is known about how peer norms influence emotional responses to these sexual experiences. This study examined the longitudinal associations between three types of (perceived) sexual peer norms: descriptive norms (sexual peer behavior), injunctive norms (peer sexual approval), and peer pressure (to have sex), and adolescents' positive (happy, proud, loved) and negative (ashamed, guilty, dirty) emotional responses to sexual experiences, across gender and age. Data were drawn from Project STARS, a Dutch longitudinal study on adolescent sexuality, which followed 240 sexually experienced adolescents (12-18 years old, Mage = 14.73, SD = 1.24) over 18 months. Results showed that descriptive norms were associated with less negative emotions over time, while injunctive norms and peer pressure showed no such relationship. None of the three peer norms were significantly related to positive emotions. Although no significant differences emerged between adolescent boys and girls, the relation between sexual peer behavior and positive emotions differed by age: a negative relation was found for younger adolescents (13-15 years at T4), and a positive one for older adolescents (16-19 years at T4). These findings highlight the importance of acknowledging both positive and negative emotional responses to sexual experiences, as well as developmental differences in peer norm influence, to better support adolescents' emotionally healthy sexual development.
Existential suffering is widely acknowledged in palliative care, but it remains inconsistently recognized and unevenly addressed in long-term care. This critical essay argues that the gap is not caused by clinician indifference, but by a persistent mismatch between whole-person ideals and care systems organized around measurable symptoms, risk management, task completion, and professional uncertainty. Drawing on literature on suffering, existential loneliness, dignity, spiritual care, and recent critiques of impersonal care systems, the essay identifies three interrelated shortcomings: the reduction of suffering to medically actionable symptoms; the depersonalizing effects of institutional routines on frail older adults; and the absence of shared existential literacy across interdisciplinary teams. The essay also cautions against romanticizing suffering or treating meaning-making as a clinical expectation. It proposes a practical framework of recognition, dignity, and witness: recognizing biography and identity as clinically relevant; protecting dignity in the ordinary details of care; and enacting witness through disciplined presence, documentation, referral, and team accountability. Long-term care cannot resolve every existential wound, but it can reduce existential neglect by treating personhood as a core quality indicator of palliative care. Palliative care is meant to support the whole person, not only treat disease or physical symptoms. However, people who are nearing the end of life may experience suffering that is not only physical. They may feel lonely, dependent, ashamed, afraid, forgotten, or no longer recognized as the person they once were. This kind of suffering is often called existential suffering. This essay focuses on older adults living in long-term care settings, where many people spend the last stage of life. In these settings, care is often organized around safety, medication, hygiene, nutrition, monitoring, and symptom control. These are all important. However, they may not be enough. A person can receive good physical care and still feel unseen, powerless, or deeply alone. The essay argues that existential suffering should not be treated as a vague, secondary, or optional concern. It should be recognized as a real part of end-of-life care. The essay identifies several problems. First, healthcare systems often respond more easily to suffering that can be measured, such as pain or breathing difficulty. Second, staff may not always have enough training or confidence to recognize and respond to emotional, spiritual, and existential distress. Third, responsibility for this type of suffering may be unclear, with nurses, doctors, social workers, psychologists, and spiritual care providers all involved but not always working from a shared approach. The essay suggests that long-term care teams need better “existential literacy.” This means the ability to notice, name, discuss, document, and respond to signs of existential suffering. Care should include attention to the person’s life story, values, relationships, dignity, and need for human presence.
Examining the relationship of HIV stigmatisation in different social settings with internalised HIV stigma, loneliness and depression among people with HIV, may help in further understanding HIV stigma and informing approaches and interventions to help to mitigate the impacts. The aim of this paper was to investigate among heterosexual men and women, a devised conceptual model of hypothesized causal connections between socio-demographic, HIV-related and psychosocial factors, measures of HIV stigmatisation, and depressive symptoms, in which feelings of loneliness because of HIV are theorised to mediate the relationship between internalised HIV stigma and depression. This was investigated using structural equation modelling (SEM) and data from Positive Voices, a national cross-sectional study of people living with HIV in the UK (2022-2023). The analysis is based on participants who identified as heterosexual and were cis-gender (N = 1232). The mean age was 52 years; 48.5% were Black African, and 39.0% of white ethnicity. Twenty percent of participants were diagnosed with HIV within the last decade (2014-2022). Overall, 51.6% and 35.2% agreed or strongly agreed with the statements 'I am ashamed of my HIV status' and 'I have poor self-esteem because of my HIV status' respectively; 57.9% (n = 713/1232) agreed/strongly agreed with either item and were classified as positive for internalised HIV stigma. For the measure of having felt isolated/lonely because of HIV, the prevalence of responding with 'yes, in the last year' or 'yes, but not in the last year' was 14.2% and 11.7% respectively. The prevalence of depressive symptoms was 18.6% (PHQ-9 score ≥10). The data were consistent with the devised conceptual model. Of the factors investigated to be directly associated with internalised HIV stigma, the largest Beta coefficient was for the association with HIV stigmatisation in healthcare (Beta = 0.600; p < 0.001). The second largest was for having felt scared to be in public places because of HIV in the last year (Beta = 0.271; p < 0.001), closely followed by HIV stigmatisation from family (Beta = 0.269; p < 0.001). Of the factors investigated to be directly associated with depression, the largest Beta coefficient was for the association with having felt isolated/lonely because of HIV (Beta = 0.492; p < 0.001). The second largest was for the inverse association with resilience (Beta = -0.288; p < 0.001), followed closely by financial hardship (Beta = 0.267; p < 0.001), having 'told most people in my life that I have HIV' (Beta = 0.267; p < 0.001), and the inverse association with supportive network (Beta = -0.202; p < 0.001). The largest Beta coefficient for direct effects was for the association between internalised HIV stigma and having felt isolated/lonely because of HIV (Beta = 0.842; p < 0.001). Internalised HIV stigma was associated with depression indirectly through having felt isolated/lonely because of HIV (indirect Beta = 0.415; p < 0.001). Our findings add to existing literature by implicating a number of key factors that upon intervention may help prevent or attenuate symptoms of depression in people living with HIV, including reducing stigmatisation in healthcare, internalised HIV stigma, and loneliness/social isolation.
The stigma attached to substance use disorder (SUD) can prevent entry into, and engagement with, treatment services. This paper provides an initial exploration into what could be an emerging trend using a case study approach. Semi-structured interviews were conducted with 15 women who have used, or were currently using, residential or community-based addiction services in Cork (Ireland). Some participants reported the well documented stigma attached to SUD as a barrier for entry into, and engaging with, the recovery process. Two participants reported feeling ashamed of being unable to identify specific traumas that could account for their substance use. They felt the stereotype of 'the addict' having had a traumatic life did not map onto their experiences, and felt stigmatised by others within recovery for this. Consequently, they questioned whether they had a SUD and should access treatment, and this initially prevented them from engaging in therapy. This paper does not refute the association between trauma and SUD. Rather it argues that common misunderstandings of trauma and substance use, and increased use of trauma talk, may have contributed to a new form of stereotype that some with SUDs must navigate.
The measurement of health-related quality of life (HRQoL) is essential in dermatology, with the DLQI and Skindex-29 being popular tools for assessment. However, the literature comparing the measuring features of these two questionnaires is lacking. This study aims to provide a comparison of the measurement properties of DLQI and Skindex-29 in patients with common dermatology conditions such as psoriasis vulgaris (PV), vitiligo vulgaris (VV), leprosy, and acne vulgaris (AV). In this cross-sectional study, the HRQoL of 301 patients with the four dermatological conditions was measured using the DLQI and Skindex-29 questionnaires at a tertiary care centre located in Dehradun, Uttarakhand, India. Statistical analysis included determining ceiling and floor effects, informativity, and criterion validity. The mean DLQI total scores were: PV (11.03 ± 0.89), VV (4.73 ± 0.78), leprosy (8.97 ± 1.09), and AV (7.79 ± 0.63), and the mean Skindex-29 scores were: PV (37.98 ± 2.82), VV (27.92 ± 2.93), leprosy (45.12 ± 3.63), and AV (27.6 ± 1.08), with a 95% confidence interval. Of the patients with a DLQI score of 0 (n = 66), 64 (96%) had a total score greater than 0 on the Skindex-29. The most troubled areas of HRQoL among patients with a DLQI score of 0 according to the Skindex-29 were item 17 (showing affection; 12.1%), item 9 (worry about scars; 9.1%), item 12, item 13, and item 14 (being ashamed, worrying about worsening, and tending to do things oneself; 7.6%). The ceiling effect was observed in 4.7% of patients for DLQI and 0% for Skindex-29. The floor effect was high for the DLQI total score (22%), whereas Skindex-29 observed only 0.7%. The absolute informativity value of Skindex-29 was 1.66, and that of the DLQI was 1.92. The typical relative informativity value for both was 0.83. Skindex-29 showed better sensitivity to clinical severity, less floor effect, higher absolute informativity, and better coverage of the 'emotion' domain. Skindex-29 was found to be more effective in detecting minor HRQoL impairment than DLQI.
HIV/AIDS in Bangladesh has historically remained below 0.01% prevalence in the general population; however, recent provisional epidemiological data indicate a concerning shift, with the highest annual increase recorded between November 2024 and October 2025 (1891 new cases; 254 AIDS-related deaths), signaling evolving transmission dynamics. Despite an overall low national prevalence, the epidemic remains highly concentrated among key populations, including people who inject drugs (PWID), men who have sex with men (MSM), female sex workers (FSW), transgender individuals, and migrant workers, where prevention and service coverage gaps have been documented. This narrative review synthesizes evidence published between 2015 and 2025 on HIV epidemiology, prevention strategies, testing infrastructure, treatment outcomes, and structural barriers in Bangladesh. Data were drawn from peer-reviewed studies identified through systematic searches of PubMed/MEDLINE, Google Scholar, and Bangladesh-specific repositories, supplemented by national surveillance reports (National AIDS/STD Programme; Integrated Biological and Behavioral Surveys), international agency documents (UNAIDS, WHO, Global Fund), and recent programmatic reports. Both peer-reviewed and grey literature sources were included to capture the full range of available evidence. Findings reveal significant deficiencies across the HIV response cascade. Geographic availability of testing services is limited to 23 of 64 districts, and prevention coverage is suboptimal, reaching just 26% of MSM and male sex workers. Progress along the treatment cascade shows 82% of people living with HIV diagnosed (approximately 14,334 of an estimated 17,480), 74% of those diagnosed receiving antiretroviral therapy, and 91% of those on ART achieving viral suppression, all falling short of global 95-95-95 targets. Behavioral indicators highlight ongoing vulnerabilities; only 14.4% of MSM report condom use with commercial partners in the past 6 months and 27% of female sex workers reporting no condom use at last sexual encounter. Stigma and discrimination continue to undermine the response, with 68% of people living with HIV reporting feelings of shame and 54% reporting guilt related to their diagnosis, adversely affecting testing, disclosure, and care engagement. Despite these challenges, harm reduction programs and a pilot pre-exposure prophylaxis (PrEP) initiative demonstrate substantial promise. Strengthening targeted prevention, expanding testing and treatment access, and addressing stigma, funding constraints, and structural barriers are essential to sustaining Bangladesh's low-prevalence status and advancing toward the goal of ending AIDS as a public health threat by 2030. HIV/AIDS in Bangladesh: recent trends, prevention challenges, and community involvement HIV/AIDS has remained at a very low level in Bangladesh for many years, affecting less than 0.01% of the general population. However, recent data show a worrying increase in new cases, especially between November 2024 and October 2025. Although the overall number of cases is still low, HIV mainly affects certain high-risk groups such as people who inject drugs, men who have sex with men, sex workers, transgender people, and migrant workers. This review examined research published from 2015 to 2025 on HIV in Bangladesh, including trends in infection, prevention programs, testing services, treatment success, and social challenges. The findings show major gaps in the country’s HIV response. HIV testing services are available in only 23 of the 64 districts, and prevention programs reach only a small portion of people at highest risk. For example, only about one-quarter of men who have sex with men and male sex workers are covered by prevention services. Treatment results show mixed progress. While most people with HIV who receive treatment achieve good control of the virus, Bangladesh has not yet met the global targets for diagnosis, treatment, and viral suppression. Risky behavior remains common, with low condom use among both men who have sex with men and female sex workers. In addition, stigma remains a serious problem. Many people living with HIV feel ashamed or guilty about their condition, which discourages them from getting tested, sharing their status, or continuing care. Despite these challenges, some programs—such as harm reduction services and pilot projects for preventive medicines—have shown strong success. To protect Bangladesh’s low HIV rate and move toward ending AIDS by 2030, the country must expand testing and treatment services, improve prevention programs for high-risk groups, reduce stigma, and address funding and structural barriers.