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.
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.
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.
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.
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.
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.
Priapism, a persisting erection not associated with sexual stimulation, can be ischaemic, with the risk of permanent erectile dysfunction, or nonischaemic. Drugs-e.g., injection therapies for erectile dysfunction, as well as neuroleptics, antidepressants and various other medicines-can also cause priapism. This study aimed to describe presentations due to priapism and provide insights into specific causes, clinical presentations, diagnostic strategies and emergency management. A single-centre, retrospective, observational study of patients (≥ 16 years old) presenting to the University Hospital of Bern, Switzerland, between January 2010 and June 2023 due to priapism. The cases were retrieved from the electronic health records using full-text search. During the study period, 40 cases corresponding to 32 patients were included. The mean ± SD age was 48 ± 15 years, and pain was present in 21 cases (53%) on presentation. Median time of erection was 15 h (range: 1-80, n = 23). A penile blood gas analysis was performed in 32 cases (80%), and 29 of these (91%) were of the low-flow type. Most commonly suspected causes were idiopathic (n = 25, 63%) and drug-induced (n = 10, 25%). Suspected agents in the drug-induced cases were corpus cavernosum autoinjection therapy (n = 4), trazodone (n = 3), sildenafil (n = 2) and urapidil (n = 1). Puncture of the corpus cavernosum and injection of noradrenalin and adrenalin were the therapeutic measure in 35 cases (88%). In 13 cases, there was at least one recurrence, including 10 within one week. Drugs given as recurrence prophylaxis included tadalafil (n = 9) and diazepam (n = 4). Presentations due to priapism appear to be rare, but the majority of the cases presented with ischaemic priapism, which is a medical emergency. The findings can be used to identify areas requiring further research (e.g., drugs used as recurrence prophylaxis) and raise awareness of this potentially severe complication-which patients are often ashamed to report.
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.
Many students who need mental health support do not receive it. We examined associations between perceived barriers and university mental health service access. Participants: First-year Oxford University undergraduates (n = 443) with unmet mental health needs. Logistic regression tested which perceived practical, attitudinal, and stigma-related barriers predicted service use. Subgroup analyses targeted screen-positives for anxiety (GAD-7) and/or depression (PHQ-9). Reduced service use was linked to attitudinal barriers, minimizing problems (OR = 0.64; CI = 0.42-0.98) and difficulty discussing problems (OR = 0.59; CI = 0.38-0.91), especially among screen positives for the latter (OR = 0.49; CI = 0.27-0.89); practical barriers, uncertainty about how to get help (OR = 0.64; CI = 0.42-0.97) and time limitations (OR = 0.66; CI = 0.44-0.98), especially in screen-positives for both (OR = 0.46; CI = 0.26-0.79; OR = 0.47; CI = 0.27-0.79); and stigma-related barriers, feeling ashamed (OR = 0.63; CI = 0.40-0.98), appearing weak (OR = 0.65; CI = 0.42-0.98), and friends' reactions (OR = 0.58; CI = 0.38-0.88). Multiple perceived barriers were associated with a reduced likelihood of accessing university mental health services. Developing mental health literacy and streamlined pathways may improve timely support access for students with unmet needs.
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.
This study was aimed at assessing the attitudes of professional nurses providing healthcare services in hospitals towards homosexuals from an ethical aspect by determining the influencing factors and the problems they experience during the provision of healthcare services. This descriptive cross-sectional study was conducted between May and September 2022 with 206 nurses working in a public hospital. Data were collected using the 'Nurse Information Form' and 'The Hudson-Ricketts Index of Homophobia'. 'The Independent Sample-t test', 'Mann-Whitney U', 'ANOVA' and 'Kruskal-Wallis H' test were used to compare three or more independent groups. Among participating nurses, 50.5% perceived homosexuality as a disease, 68.4% reported no difficulty communicating with homosexual individuals, 71.4% believed that homosexuality is not something to be ashamed of, and 80.1% stated that they lacked adequate knowledge about homosexuality. The mean total Hudson-Ricketts Index of Homophobia (HRIH) score was 99.90 ± 26.21. The findings indicate that nurses' prejudices contribute to negative discrimination. Enhancing societal acceptance of sexual diversity and fostering tolerant attitudes are essential to reducing prejudice. Comprehensive integration of sexual and gender minority health care into nursing education curricula is therefore imperative.
BackgroundMental health stigma remains a significant barrier to treatment and recovery, particularly among adolescents. This study explores perceived stigma in previously hospitalized adolescents, their perceptions of inpatient psychiatric care, and parental self-stigma.MethodsWe employed a cross-sectional, mixed-methods design with 82 adolescents (n = 67 females), aged 12-17 years (M = 15.5, SD = 1.2) and their parents. Quantitative measures included the Adolescent's Stigma Scale, Parents' Self-Stigma Scale, and Strengths and Difficulties Questionnaire. Qualitative data were collected via open-ended questions and analyzed using content analysis.ResultsFindings indicated notable perceived stigma, especially among older adolescents (15-17 years) and those two hospitalizations, with secrecy, self-stigma, and rejection associated with emotional and behavioural difficulties. Parental self-stigma correlated with child's age and length of hospitalization, and inversely with adolescent secrecy. Qualitative findings revealed that hospitalization offered emotional support and opportunities for personal growth, yet also posed challenges to autonomy, social and educational stability, and psychological well-being.ConclusionsFindings highlight the need for flexible hospital policies, improved discharge communication, mental health literacy initiatives, and peer-support programs. Future research should examine cultural influences, stigma trajectories, and effective family-based interventions for adolescents. Mental health stigma—stereotypes, prejudice, and discrimination related to mental illness—can make it harder for adolescents to get the care and support they need. This study explored how teens experience stigma and psychiatric inpatient care. It also examined how parents feel about having a child with mental health challenges. We included 82 adolescents aged 12 to 17, along with their parents. Teens answered questions about their emotions, behaviours, and stigmatizing experiences, while parents completed a questionnaire that measured self-stigma—how much they blamed themselves or felt ashamed because of their child’s condition. Our findings revealed that many adolescents experienced significant stigma, particularly older teens and those who had been hospitalized twice. Negative self-perceptions were common. Many reported personal rejections, including disrespect, criticism, and bullying due to mental health issues. Feelings of shame, secrecy, or rejection were linked to more severe emotional and behavioural difficulties. Interestingly, when parents experienced heightened self-stigma, their children were less secretive about their mental health problems. Despite these challenges, several adolescents stated that hospitalization helped them feel supported, understand themselves better, and foster personal growth. However, many struggled with losing independence, staying connected with friends, keeping up with school, and feeling anxious about not knowing when they’d be discharged. These findings suggest that inpatient clinical settings should adopt more flexible policies and improve communication about discharge planning. Programs that help adolescents and their families better understand mental health and reduce stigma could make a big difference.
Research suggests autistic people experience greater post-traumatic stress disorder symptom severity than non-autistic people following traumatic events. Post-trauma appraisals are fundamental in cognitive models of post-traumatic stress disorder, but have not been explored in autistic people. We aimed to explore whether we could replicate effects of heightened trauma exposure and post-traumatic stress disorder symptom severity in autistic adults, and examine how post-traumatic appraisals affect the association between autism and post-traumatic stress disorder symptom severity. Two hundred forty-two autistic (n = 148) and non-autistic adults (n = 94) completed a survey measuring trauma exposure, post-traumatic stress disorder symptom severity and post-trauma appraisals. Exposure to types of traumatic events did not differ significantly between the groups, but the autistic group endorsed more events that 'happened to me' directly. Post-traumatic stress disorder symptom severity and endorsement of negative post-traumatic appraisals were significantly higher in the autistic group, specifically alienation, shame and fear appraisals. These appraisals mediated the association between autism and post-traumatic stress disorder symptom severity. Therefore, as in the general population, greater endorsement of negative post-traumatic appraisals may be a risk factor for post-traumatic stress disorder symptom development in autistic adults, particularly appraisals of shame, fear and alienation. Longitudinal designs are required to confirm the direction of these effects and to elucidate factors underlying these negative appraisals in autistic people.Lay SummaryMany people experience intrusive memories and anxiety after a traumatic event. However, for some, these symptoms last longer and they might be diagnosed with post-traumatic stress disorder. Research suggests that autistic people might be more likely to develop post-traumatic stress disorder and experience more severe symptoms compared to non-autistic people after traumatic events. One factor that is important in post-traumatic stress disorder development is how people think about the trauma. These might be thoughts like 'It was my fault', 'I'm not safe', 'I'm disconnected from other people'. There has not been research into how autistic people think about traumatic events compared to non-autistic people, and this could be important for making post-traumatic stress disorder treatments more effective for them, as many of these focus on thoughts. In this study, we asked 148 autistic people and 94 non-autistic people in the United Kingdom to complete an online survey about their trauma history, post-traumatic stress disorder symptoms and thoughts about a traumatic event. We found that autistic people experienced more types of traumatic events directly (it happened to them), but they did not experience more types of traumatic events overall. Interestingly, both groups reported events like bullying or the death of a loved one as traumatic, but these events would not meet the official diagnostic criteria for post-traumatic stress disorder. As expected, autistic people reported worse post-traumatic stress disorder symptoms than non-autistic people and were more likely to meet the cut-off for post-traumatic stress disorder diagnosis. Autistic people also reported more negative thoughts about the trauma, especially feeling unsafe, disconnected, ashamed or that the trauma was their fault. Having more thoughts like this was associated with being autistic and experiencing more severe post-traumatic stress disorder symptoms. Our findings suggest that therapies focusing on these negative thoughts could be helpful for autistic people with post-traumatic stress disorder. Future research should explore why autistic people have more of these thoughts after traumatic events and should use longitudinal or experimental designs to explore how these factors influence one another over time. Efforts to prevent negative experiences, challenge negative attitudes in society towards autism and support positive autistic identity and well-being will be helpful for changing this in the future. It is also important that mental health services offer support for post-traumatic stress disorder even when events do not meet the current diagnostic criteria, as this might prevent autistic and non-autistic people who need support with post-traumatic stress disorder getting help.
In Victoria, Australia, children who are reported to authorities to have experienced very recent sexual assault routinely undergo a forensic medical examination and receive psychosocial care. There is very little known about how children and their families experience this process and whether current practices are meeting their needs. This study seeks to understand these experiences by undertaking a thematic analysis of in-depth interviews with 10 children/young people (aged between 4 and 16) and 8 mothers (n = 18). The study draws on constructivist grounded theory methodology and incorporates the contextual-embedded perspective of the clinician/researcher. The study identified three stages participants navigated in the hours following the assault: (a) reaching out for help, (b) hospital processes and procedures, and (c) discharge. Nested within these stages, five key themes emerged: confusion, distress, and minimization when reporting; valuing a caring presence; feeling exposed, vulnerable, and ashamed; being lost in space and time; and going home alone. The need for a sensitive, trauma-informed, accessible, and consistent response to acute sexual assault is discussed; one that acknowledges the experiences and centralizes the priorities and psychosocial needs of the child and their family.
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.
Menstrual poverty (MP) defines the lack of access to menstrual health management (MHM) due to financial barriers, and there are limited data regarding its effects on youth mental health. The purpose of this study was to assess MHM practices among adolescents, determine the prevalence of MP according to socioeconomic status and examine its association with depressive symptoms (DS). We conducted a survey on a nationally drawn sample (N = 1241) of adolescents aged 10-19 years. Data were collected from 12 provinces, which were classified into three (Tiers 5-6 having the lowest ranking) based on socioeconomic development rankings. Information regarding demographics, use and knowledge of menstrual products, menstrual hygiene, and MP was collected. The PHQ-9 scale was used to assess DS. Overall, 15% of the cohort encountered challenges in obtaining MH products due to financial constraints, with a higher proportion in Tiers 5-6 (25%). Overall percentages of using improvised menstrual products (toilet paper, diapers, handmade pads, cloth etc.), MP-related school absenteeism, longer use due to an unsuitable school environment, and feeling ashamed to purchase menstrual products were 17.4%, 8.9%, 52% and 10.7%, respectively, with significantly higher proportions in Tiers 5-6. Individuals with MP were three times more likely to experience moderate-to-severe DS. The study indicates the significance of MP in relation to MHM across all socioeconomic levels, especially lower tiers, and its link with DS. It is imperative to establish cost-effective and sustainable health policies to improve the accessibility of MHM for menstruating individuals, starting with adolescents in poor socioeconomic conditions.
Stigmatization and discrimination toward people living with HIV/AIDS (PLWHA) continue to be significant hurdles to successful treatment and social integration, especially in Nigeria. These barriers have a negative impact on mental health, deter disclosure, and reduce access to healthcare. The purpose of this study was to determine the prevalence, types, and causes of stigma and discrimination among PLWHA receiving antiretroviral therapy (ART) in Ikeja, Lagos State, Nigeria. A cross-sectional study of 400 PLWHA on ART was done at three randomly chosen treatment centers. Structured questionnaires and the Berger HIV Stigma Scale were used to collect information about individualized stigma, disclosure concerns, negative self-image, and public attitudes. The statistical study used descriptive statistics, chi-square tests, and logistic regression, with a significance level of p < 0.05. Overall, 37.7% of individuals reported stigma in hospital settings, 41.5% received negative attitudes from family or friends, and 48.7% felt ashamed or condemned because of their situation. Fear of revelation was widespread, with 65% refusing to declare their status. Stigma had a major impact on mental health (64.3%) and reduced ART access for 39.7% of responders. Younger age (20-39 years), poor income, HIV-positive partners, and disclosure of status were all significant predictors of stigmatization. Discrimination was highly related to occupation, gender, and socioeconomic status. Stigma and discrimination continue to be pervasive in Ikeja, limiting PLWHA access to healthcare and negatively impacting their psychological well-being. To establish a more inclusive and supportive environment, it is necessary to enhance anti-discrimination regulations, train healthcare providers, educate the public, and implement socioeconomic empowerment activities.
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.
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.