@article{5984ec96da9444858ce45ecf147dad27,
title = "Evaluating layered stigma from comorbid HIV and epilepsy among Zambian adults",
abstract = "Background and purpose: Stigma hinders care for patients with neurologic illness. Layered stigma due to comorbid disease is common yet poorly characterized due to lack of instruments. Epilepsy and HIV are prototypical stigmatized conditions widespread in sub-Saharan Africa. Methods: We assessed layered stigma among people with HIV and epilepsy (n = 21), epilepsy only (n = 88), and HIV only (n = 40) in Zambia. Epilepsy-associated stigma was assessed using the Stigma Scale of Epilepsy and Jacoby's Stigma Scale. HIV-related stigma was assessed using the HIV/AIDS Stigma Instrument-People Living with HIV/AIDS and Jacoby's Stigma Scale. Stigma was compared across groups using χ2 tests. Results: 55% (60/109) with epilepsy reported some epilepsy-associated stigma and 20% (12/61) with HIV reported HIV self-stigmatization. Those with HIV and epilepsy were more likely to associate seizures with fear (OR 6.1 [95% CI: 1.3–27.9]) and epilepsy with dependence (OR 4.6 [1.1–19.6]), controlling for age, gender, marital status, and employment. Those with comorbid disease were more likely to report they were “no longer a person” and felt “blamed” for their HIV. Controlling for age and gender, the difference in depersonalization remained (OR: 6.4 [1.1–36.1]). Conclusion: Individuals carrying the burden of one stigmatized condition may be more vulnerable to stigma from a comorbid disease.",
keywords = "Double stigma, Intersectional stigma, Resource-limited setting, Sub-Saharan Africa, Vulnerable populations",
author = "Elafros, {Melissa A.} and Gardiner, {Joseph C.} and Izukanji Sikazwe and Okulicz, {Jason F.} and Nigel Paneth and Elwyn Chomba and Birbeck, {Gretchen L.}",
note = "Funding Information: The project described was supported by the Fogarty International Center and the National Institute of Neurological Disorders and Stroke (NINDS) [joint grant number 1R21NS073509]. MAE was supported in part by an MD/PhD Fellowship from Spectrum Health, the American Medical Association (AMA) Foundation, and the Lois C. Walker Endowed Fund for Student Research at the College of Human Medicine, Michigan State University. The funding sources were not involved in study design; data collection; analysis and interpretation; or writing and decision to submit for publication. The content of this publication is the sole responsibility of the authors and does not necessarily reflect the official views or policies of the National Institutes of Health, Department of Defense, or the Departments of the Army, Navy or Air Force. Funding Information: The project described was supported by the Fogarty International Center and the National Institute of Neurological Disorders and Stroke (NINDS) [joint grant number 1R21NS073509 ]. MAE was supported in part by an MD/PhD Fellowship from Spectrum Health, the American Medical Association (AMA) Foundation, and the Lois C. Walker Endowed Fund for Student Research at the College of Human Medicine, Michigan State University. The funding sources were not involved in study design; data collection; analysis and interpretation; or writing and decision to submit for publication. The content of this publication is the sole responsibility of the authors and does not necessarily reflect the official views or policies of the National Institutes of Health, Department of Defense, or the Departments of the Army, Navy or Air Force. Publisher Copyright: {\textcopyright} 2017",
year = "2018",
month = dec,
doi = "10.1016/j.ensci.2017.12.001",
language = "English",
volume = "13",
pages = "56--62",
journal = "eNeurologicalSci",
issn = "2405-6502",
}