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Research has documented the negative impact of stigma on health outcomes for people living with HIV (PLHIV). How central HIV is to the identity of the individual may increase the negative effects of stigma, including greater psychological distress, while having strong social supports may play a buffering role. This study aimed to establish whether internalised stigma mediates the relationship between the centrality of HIV identity and psychological distress, while also assessing the role of social support as a moderator. PLHIV (n = 181) responded to a survey assessing experiences of living with HIV focussed on centrality of HIV identity, internalised stigma, and wellbeing. After controlling for age and education, findings from the mediation analysis show that the more central HIV is to an individual's identity, the more stigma is internalised and the greater the negative impact on psychological wellbeing. However, this is only the case for people with low levels of social support. Regardless of how central HIV is to identity, social support appears to act as a buffer and promote positive wellbeing. For those working with PLHIV, promoting the importance of good social support systems may be one way to address some of the negative impacts of stigma.

The mental health of gay and bisexual men in mixed-orientation marriages is poorly understood. In this article, the authors explore the development of anxiety and depression among gay and bisexual men in heterosexual marriages. Sixteen men, living in the Australian states of New South Wales, Queensland, Victoria, and Tasmania were interviewed throughout 2016 and 2017. An analysis of interviews identified four main themes, namely, compulsory heterosexuality, existential distress, compartmentalization, and integration and resolution. Participants reported experiencing anxiety and depression, which were exacerbated by the stigmatization of same-sex attraction and by an overwhelming distress from feelings of shame and guilt regarding their marital infidelity. Findings indicate that gay and bisexual men in mixed-orientation marriages develop anxiety and depression in response to the exigencies of compulsory heterosexuality and the compartmentalizing of same-sex attraction and identity during heterosexual marriage. Coming-out as same-sex attracted resolved men's distress by facilitating an integrative self-structure.

Complex lifestyle issues associated with injecting drug use may make it difficult to provide care to people who inject drugs (PWID). Negative attitudes towards PWID can undermine the provision of good quality care, hence, it is important to explore the impact of health workers' attitudes in the delivery of care to PWID. An online survey was administered to 336 health workers assessing contact with and attitudes towards PWID, concerns about these clients as well as whether health workers feel stigmatised by working with PWID. Health workers were also asked whether they supported the discriminatory behaviour of a colleague in a series of hypothetical scenarios about working with PWID. In correlational analyses, negative attitudes towards PWID, greater concerns about the behaviour of PWID, not feeling stigmatised by colleagues and seeing fewer clients who inject were associated with greater support for discriminatory actions in the hypothetical scenarios. Multiple regression analysis results showed that only attitudes towards PWID and concerns about the behaviour of injecting clients remain independent predictors of participant support for the hypothetical scenarios. This research highlights the role of attitudes toward PWID in understanding health workers' decisions, practices and potential behaviour.

In Australia, there are five strategies that set out a national response to HIV, viral hepatitis and sexually transmissible infections.1-5 Each strategy contains a set of objectives that work towards reducing the transmission, morbidity and mortality associated with these infections, with progress monitored via a set of related indicators. A clear objective exists within each of the five strategies to “eliminate the negative impact of stigma, discrimination, and legal and human rights issues on people's health”.1-5 However, until recently, there has been no indicator to measure stigma and monitor progress against these objectives. This commentary outlines an approach taken to develop a stigma indicator and lessons learned from its implementation in surveys of priority population groups.

In Australia, there are five strategies that set out a national response to HIV, viral hepatitis and sexually transmissible infections.1-5 Each strategy contains a set of objectives that work towards reducing the transmission, morbidity and mortality associated with these infections, with progress monitored via a set of related indicators. A clear objective exists within each of the five strategies to “eliminate the negative impact of stigma, discrimination, and legal and human rights issues on people's health”.1-5 However, until recently, there has been no indicator to measure stigma and monitor progress against these objectives. This commentary outlines an approach taken to develop a stigma indicator and lessons learned from its implementation in surveys of priority population groups.

Supplementary Material, JHP_supplementary_material_case_studies_Oct_2015 for Health workers’ support for hepatitis C treatment uptake among clients with a history of injecting by Loren Brener, Courtney von Hippel, Hannah Wilson and Max Hopwood in Journal of Health Psychology

BACKGROUND: Gay and bisexual men typically report high rates of illicit drug use, including methamphetamine use. This paper aimed to analyse trends in crystal methamphetamine ('crystal') and powder methamphetamine ('speed') use among gay and bisexual men in Australia, and characterise the sociodemographic, drug use, and sexual risk practices of men who reported crystal use. METHODS: The Gay Community Periodic Surveys, routinely conducted behavioural surveillance surveys of gay men in Australia, were analysed to examine trends in recent crystal and speed use during 2005-14 (any use in the previous 6 months), and trends in regular crystal and speed use during 2007-14 (at least monthly use in the previous 6 months). Covariates of recent and regular crystal use were analysed using 2014 data. RESULTS: Speed use declined from 25.0% to 10.2% during 2005-14 (p-trend