Perspectives of HIV-related stigma in a community in Vietnam: a qualitative study.

BACKGROUND: While HIV/AIDS is increasing in Vietnam, very few published studies focus on HIV-related stigma in Vietnam. This study reports on findings from a community development project to reduce HIV-related stigma within one community in Vietnam. OBJECTIVES AND DESIGN: The purpose of this qualitative study is to describe HIV-related stigma from the perspective of three groups within one community in Vietnam: people living with HIV, their family members, and community members and leaders, including health care professionals. SETTING, PARTICIPANTS AND METHODS: Fifty-eight individuals from a poor, industrial district on the outskirts of a large city participated in the study and were asked to describe HIV-related stigma. Interviews were conducted with 10 people living with HIV, 10 family members of a person living with HIV, and 10 community members and 5 community leaders including health care professionals. We also conducted three focus groups, one with people living with HIV (n=8), one with family members of people living with HIV (n=8), and one with community leaders including health care professionals (n=7). FINDINGS: Stigma across the three groups is characterized by four dimensions of HIV-related stigma: feeling shamed and scorned, behaving differently, stigma due to association, and fear of transmission. The manifestation of these dimensions differs for each group. Four themes of HIV-related stigma as described by people living with HIV are: being avoided, experiencing anger and rejection, being viewed as a social ill, and hiding the illness. Seven themes of HIV-related stigma as described by family members are: shunned by neighbors, viewed as poor parents, discriminated by health professionals, overhearing discussions about people with HIV, maintaining the secret, financial hardship for family, and fear of contracting HIV. Four themes of HIV-related stigma as described by community members and leaders including health professionals are: stigma as a fair reward, avoidance and shunning by neighbors, ruined family reputation, and fear of contracting HIV. CONCLUSIONS: HIV-related stigma is experienced in a different manner by each of these groups, a finding that should help in developing culturally sensitive strategies to reduce HIV-related stigma in Vietnam.

Developing culturally sensitive interventions for Vietnamese health issues: an action research approach.

This article describes an action research approach to community development in Vietnam. An advisory committee worked with the researchers and identified the stigma of HIV/AIDS as a health issue of importance to it. The advisory committee consisted of representatives from the community. The selected issue was then explored in greater depth by individually interviewing infected persons, their family members, community members, and leaders. At the same time, focus groups were conducted for additional members of each of the above three cohorts. Through open-ended questions, the participants described the impacts of the stigma on their life, the possible causes of the stigma, and the relevant strategies to reduce these causes. Based on the findings, the advisory committee suggested interventions to reduce the stigma. This project demonstrated an effective way in which nurses can work with communities to help them to identify local solutions to their identified health issues.

Poverty reduction by improving health and social services in Vietnam.

This article describes the development and implementation of a five-year plan for the reduction of poverty and the enhancement of human development through improving public health and social services in rural Vietnam. This plan was achieved by training the trainers and building capacity for the social workers. The project was a collaborative effort between the Schools of Nursing and Social Work at Memorial University, Newfoundland and Labrador, Canada and the University of Labor and Social Affairs, Hanoi, Vietnam. The collaboration was also committed to improving the quality of social work education and training in Vietnam. All the project's objectives were achieved beyond original expectations. The actual outcomes are sustainable and in addition gender equality has been a cross-cutting theme.

Sense of coherence among unemployed nurses.

AIMS: This paper reports a study assessing Finnish unemployed nurses' sense of coherence and the factors relating to it. BACKGROUND: During the 1990s, due to the widespread economic downturn in Finland, the nursing profession suffered from a high level of unemployment. Previous research has clearly indicated that unemployment is detrimental to health. It creates stress by disturbing a person's sense of identity and self-esteem and by disrupting social networks. In Finland, many studies have been conducted on the impact of unemployment, but have not examined the sense of coherence of unemployed nurses. METHODS: Data were collected in one Employment and Economic Development Centre area in Finland in 1998. Structured questionnaires were used to collect data among Finnish unemployed nurses (n = 183), and included the General Health Questionnaire, measuring nurses' mental health; socio-demographic questions; and the 13-item version of the Sense of Coherence scale based on Antonovsky's salutogenic model to measure sense of coherence. RESULTS: Although the majority of unemployed nurses had a strong sense of coherence, many felt that during their period of unemployed they did not feel at ease, did not know what to do and had a sense of being unfairly treated. Daily household chores, on the whole, were perceived as meaningful. Income and the state of mental health were positively correlated with nurses' sense of coherence: the better the family income and state of mental health, the stronger was their sense of coherence. Because of the low response rate (less than 50%), the results might be skewed by those whose higher sense of coherence made them more motivated to complete the questionnaires. CONCLUSIONS: Many of the nurses reported low sense of coherence and poor general health. Special interventions should be designed to improve their sense of coherence and high motivation level, and to maintain their professional competence when they return to work. This kind of support may prevent further out-migration and nursing shortages from Finland and other industrialized countries.

A comparison of the mental health of employed and unemployed women in the context of a massive layoff.

The purpose of this study was to assess the impact of unemployment on the mental health of women in the context of massive unemployment. Comparisons were made between the level of mental distress experienced by unemployed and employed women, in two areas of Newfoundland, Canada that were affected by the northern cod moratorium. In addition, the relationships between women's mental distress and a number of variables were explored. Questionnaires were administered to 112 unemployed and 112 employed women three years after the moratorium began. The unemployed women reported significantly poorer mental well-being in the year prior to data collection. At the time of the study, however, both groups of women were experiencing high levels of distress. The moratorium, financial problems, and feelings of uncertainty were identified as key stressors for all the women, but especially for those without work. Among the working women, past experience with unemployment and level of education had significant correlations with their mental well-being.