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Despite high hepatitis B (HBV) prevalence among people of Vietnamese ethnicity in Australia and elsewhere, there is limited research on levels of HBV knowledge and factors associated with such knowledge. The aim of this study was to examine HBV knowledge and associated demographic and attitudinal factors among people of Vietnamese ethnicity in Australia. People of Vietnamese ethnicity (n = 966) were recruited through community events and social media groups to complete online surveys measuring HBV knowledge, attitudes towards HBV, levels of mistrust in Western medicine, and demographic characteristics. Findings of this study indicate that levels of knowledge are mixed, with gaps in knowledge related to transmission and treatment of the virus. Those with greater knowledge of HBV tended to be older, have higher levels of formal education, have been tested for HBV, and know someone living with HBV. Those with lower levels of knowledge tended to have more negative attitudes towards the virus and greater levels of mistrust in Western medicine. Given that health literacy is connected to effective communication from health providers, we suggest that there is a need for the development of health promotion and education resources targeted at people of Vietnamese ethnicity and translated into Vietnamese. We propose that such resources be developed in consultation with Vietnamese communities and health providers to ensure that they are culturally appropriate and sensitive to people of Vietnamese ethnicity living in Australia. [ABSTRACT FROM AUTHOR]

Introduction: Research into stigma and injecting drug use has typically involved predominantly male participants, with limited research about the unique experience of women who inject drugs. Methods: This study used survey methods to assess reduced access to health care due to stigma among a sample of women who inject drugs. Women (n = 232) completed a survey as part of a broader national study of people who inject drugs. Results: Only 46 (19.9%) women reported that they had not experienced any injecting drug use‐related stigma in the past year and most commonly noted 'sometimes' experiencing injecting‐related stigma (36.8%) with more than 75% of women reporting that health workers had treated them negatively because of their injecting drug use. Most women undertook strategies to prevent experiencing stigma, such as not disclosing drug use to a health worker (81.3%), not attending follow‐up appointments (76.7%) and delaying accessing health care (76.8%). Women with lower levels of personal wellbeing, who had experienced poorer treatment by health workers, had engaged in greater past month injecting, were employed and identified as lesbian, gay, bisexual, transgender or queer (LGBTQ) reported more reduced access to health care. Discussion and Conclusions: Stigma has concerning health care implications for women who inject drugs and this research highlights the importance of understanding the impact of stigma in impeding health care access. Public health interventions should focus on addressing the systemic factors that reduce health care access for women who inject and take account of the impact of stigma in diminishing the quality and accessibility of health care for this group. [ABSTRACT FROM AUTHOR]

Introduction: Contact interventions have shown short‐term effectiveness in reducing stigmatising attitudes and behaviours of the public towards marginalised population groups, including people who inject drugs. We theorised that the effectiveness of an intervention differs according to peoples' underlying social values and undertook a study to test this. Methods: We recruited participants from the Australian public by social media and measured their attitudes, desire to maintain personal distance, and support for structural stigma towards people who inject drugs before and after a brief online video intervention (n = 314). We divided participants into tertile groups according to their responses to a conservatism scale and compared group differences in post‐intervention stigma scores (n = 242–244), controlling for pre‐intervention scores and demographic variables. Results: Adjusting for baseline levels, the post‐intervention scores in all measures showed significant improvement but scores of the moderate group were consistently most improved. Stigmatising attitudes in the moderate group were significantly reduced when compared with the conservative and progressive groups. However, reductions in desire for personal distance and support for structural stigma did not significantly differ by conservatism group. Discussion and Conclusions: A brief online contact intervention showed immediate effectiveness in reducing stigma towards people who inject drugs. As people with moderate values were found to be more amenable to changing their perspectives, audience social values may need consideration when designing and evaluating stigma interventions. More research is needed to understand how to influence people with more conservative values, and how to increase public support for policies and practices that reduce stigma. [ABSTRACT FROM AUTHOR]

Introduction: Sharing injecting equipment is a major route of transmission for blood borne viruses such as hepatitis C and HIV. Although needle and syringe programs are widely available throughout metropolitan Australia, rates of sharing equipment have not significantly changed in recent years. This study aimed to identify factors associated with recent equipment sharing among people who inject drugs in Australia. Methods: A paper‐based survey was distributed via peer‐based organisations between June and November 2018 and was completed by 603 participants. Survey questions addressed recent injecting experiences, equipment sharing, community attachment, stigma and wellbeing. Participants who had recently shared injecting equipment were compared with those who had not shared any equipment using multivariable logistic regression. Results: Recent equipment sharing was associated with recent heroin use, experiencing any past‐year stigma related to injecting drug use, and higher levels of attachment to a community of people who inject drugs. An interaction effect showed increased community attachment was associated with increased odds of sharing equipment among young participants, but with decreased odds of sharing equipment among older participants. Discussion and Conclusions: Community networks of people who inject drugs can play important roles in harm reduction initiatives. While being connected with a community of people who inject drugs increased the odds of sharing injecting equipment, this community connection also increases opportunities for social support, sharing information and mitigating the negative effects of stigma. Collaboratively and meaningfully engaging with communities of people who inject drugs has the potential to increase the reach and effectiveness of health promotion services. [ABSTRACT FROM AUTHOR]

Issue addressed: Hepatitis B (HBV) is a major public health issue with over 250 million people chronically infected worldwide. In Australia, prevalence is higher among migrant communities and these groups may be reticent to attend health care services due to concerns about experiencing stigma and discrimination. The way health workers perceive their clients, particularly those of migrant backgrounds, may influence the way they treat these clients and the quality of care provided. This study investigated and compared the attitudes and concerns health workers and health students have towards working with clients living with HBV. Methods: Health workers (n = 551) and students (n = 199) completed an online survey which investigated attitudes towards people living with HBV, comfort with providing care for these clients and concerns they have about working with them. Results: Health students expressed less comfort (U = 47 611, z = −2.73, P =.006) and reported more concerns about working with people with HBV than qualified health workers (U = 61611.50, z = 2.64, P =.008). Students' concerns were centred around their own ability to provide care rather than issues related to clients. There were no differences in overall attitudes towards people living with HBV between health workers and students. Conclusion: To address concerns that health workers and students may have in working with people living with HBV, particularly those from migrant communities, and to ensure that health workers feel comfortable and confident, HBV workforce development should be included in undergraduate and postgraduate training programmes as well as in continuing professional education. So what?: This will assist the health workforce to develop competency in the treatment of people living with HBV, with the ultimate aim of providing best quality, non‐judgemental care to all people living with HBV. [ABSTRACT FROM AUTHOR]

There is established literature on health workers' attitudes towards working with people living with stigmatised health conditions and behaviours, such as HIV, hepatitis C and injecting drug use. Less is known about health workers' attitudes and concerns around providing care to people living with hepatitis B virus (HBV), which is concerning as research indicates that negative attitudes may impact on the quality of care provided to these populations, with adverse health outcomes for clients. The aim of this paper is to examine health and medical workers' concerns about providing care to people living with HBV, and the factors that may influence these concerns. Australian health and medical workers (n = 551) completed an online survey measuring their concerns about providing care to people living with HBV, stigmatising attitudes towards this group, perceived comfort of themselves and colleagues in providing care towards clients with HBV, and witnessing their colleagues behaviour in a discriminatory way towards clients with HBV. Multiple regression was used to ascertain factors predictive of health workers' concerns about working with clients with HBV. Results showed that older participants and those who had spent less time working in the health and medical field had greater concerns about caring for people living with HBV. Workers who did not know someone living with HBV, who were less comfortable around clients with HBV, who perceived their colleagues to be less comfortable working with clients with HBV, and who had more negative attitudes towards this group also had greater concerns around providing care to people living with HBV. Efforts should be made to improve health and medical workers' attitudes towards working with people with HBV. This may also improve workers' level of comfort with people with HBV and reduce the reported reticence they have towards working with this client group. [ABSTRACT FROM AUTHOR]

Discourse on sex work is replete with narratives of risk and danger, predominantly focused on violence and disease. However, the risks instigated by police, maintained by the criminal justice system and sanctioned by the state--criminal laws, licensing laws and targeted policing--receive far less attention. This paper responds to this gap in three ways. First, we examine how stigma manifests in sex workers' experiences of Australian policing, which act to disincentivise sex workers from accessing criminal legal mechanisms. Second, we illustrate how sex workers are denied victim status as they are seen by law as 'irresponsible citizens' and blamed for their experiences of crime. Third, we argue that these factors create conditions in which sex workers must constantly assess risks to access safety and legal redress while structural sex work stigma persists unabated. We conclude that 'whore stigma' is entrenched in the criminal legal system and requires a systematic response that necessitates but goes beyond the decriminalisation of sex work. [ABSTRACT FROM AUTHOR]

This report examines rates of HIV status disclosure and negative responses to disclosure among people living with HIV in Australia. Among 697 people living with HIV, most (>90%) had disclosed their status to friends, sexual partners and health providers. Almost a third had not disclosed to family, and half had not told any work colleagues. Negative responses to disclosure (e.g. blame, rejection) by all groups were associated with increased HIV-related stigma, psychological distress and diminished social support and health satisfaction. These results shed light on rates of disclosure among people living with HIV in Australia and the adverse health impacts of negative responses to disclosure. [ABSTRACT FROM AUTHOR]

Although the adverse impacts of health-related stigma are well established, there is growing evidence to suggest that some people reject stigma and become empowered through involvement in education and advocacy. C-een and Heard ( C& H) is a positive speaking programme in Sydney, Australia, using educational presentations by people living with hepatitis C to increase understanding of the illness among health and community workers. This study explored C& H speakers' experiences of and responses to stigma, as well as their motivations to participate in the C& H programme. Semi-structured interviews were conducted with nine C& H positive speakers. Transcripts were analysed using an inductive thematic approach. Experiences of discrimination were common especially in healthcare and were linked to misinformation and negative attitudes towards injecting drug use. Although discriminatory experiences were distressing, many participants reacted with anger and challenged their stigmatised identity, ultimately leading participants to take part in positive speaking. Speakers reported feeling empowered by participation in the C& H programme and by the support received from audience members, peers and programme organisers. Findings highlight the potential benefits of positive speaking programmes for people with chronic illness in relation to overcoming stigma and experiencing empowerment. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

HIV-related stigma has been linked to avoidance of health care services and suboptimal adherence to antiretroviral therapy (ART). However, less is known about concerns of stigma related specifically to the taking of ART in uptake of treatment. This study examines experiences of HIV treatment-related stigma and assesses if these experiences are associated with ART uptake, independent of general HIV-related stigma. People living with HIV (PLHIV;n= 697) were targeted to complete an online questionnaire measuring perceived HIV- and treatment-related stigma, social support, self-esteem, resilience, psychological distress, health satisfaction and quality of life. Findings suggest that experiences of general and treatment-related stigma were common, and that participants appear to experience greater stigma related to taking HIV treatment than general stigma associated with HIV. Neither general nor treatment-related stigma uniquely impacted HIV treatment uptake. Instead, treatment uptake was associated with being older (adjusted OR 1.05; 95% CIs: 1.03, 1.08), greater duration of HIV infection (adjusted OR 1.07; 95% CIs: 1.03–1.11) and having greater health satisfaction (adjusted OR 1.28; 95% CIs: 1.03, 1.59). Findings highlight that concerns around taking HIV treatment can be an added source of stigma for PLHIV, however other factors may be greater contributors to the likelihood of taking HIV treatment. [ABSTRACT FROM AUTHOR]

Objectives. People with mental illness are at significantly higher risk of acquiring hepatitis C virus (HCV) compared with the general population. This study assessed knowledge of and attitudes towards people with HCV and people who inject drugs (PWID) among support workers of clients with mental illness. Methods. Support workers from a community managed organisation (CMO) in Australia were recruited to complete an online cross-sectional survey. The survey collected data about their knowledge of HCV and attitudes towards PWID and people with HCV. Results. Valid responses were received from 117 support workers. Although HCV knowledge was moderate, there were significant knowledge gaps around transmission and treatment of HCV. Higher HCV knowledge was significantly associated with more positive attitudes towards PWID, but not with attitudes towards people with HCV. Participants had more positive attitudes towards people with HCV than towards PWID. Additionally, those with more positive attitudes towards HCV tended to also have more positive attitudes towards PWID. Conclusions. Given that people with mental illness are at higher risk of acquiring HCV, these results point to the need for education targeted at support workers of clients with mental illness to increase HCV knowledge and promote positive attitudes towards PWID and people with HCV. [ABSTRACT FROM AUTHOR]

Sex workers may experience stigma both related to their occupation as well as to mental health issues that they face. There is limited research on the lived experience of sex workers managing mental health and stigma. This study examined the experiences of sex workers in Australia in relation to stigma surrounding sex work, and sex workers' mental health, including self-management and experiences of accessing mental health services. Six focus groups and two interviews were conducted with 31 sex workers. Data collection was co-moderated by a sex worker and a university-based researcher. Analysis was informed by an approach which positioned sex workers as agential and capable, and which drew attention to structural aspects of stigma. Sex workers identified that the stigma surrounding their profession had a significant impact on their mental health. The need to manage risks through selective disclosure of sex work was a pervasive experience. Management of mental health and the stigma associated with sex work was described as a responsibility primarily of the individual through self-care activities and occasional access to mental health services. Participants reported poor treatment from mental health practitioners who saw sex workers as victims lacking agency, imposed beliefs that sex work was the pathological root cause of mental health issues, or approached the issue with fascination or voyeurism. Other presenting issues (especially mental health) were lost or obscured in therapeutic encounters resulting in suboptimal care. The threat of stigma is pervasive and has mental health implications for sex workers. Our findings point to the need for increased training and capacity development for mental health practitioners, funding for peer support services to ameliorate internalised stigma, and action from governments to introduce enabling legal environments, stigma reduction programs and structural protections from sex work stigma. • Sex work stigma is pervasive and has mental health implications for sex workers. • Mental health professionals need training to engage appropriately with sex workers. • Peer support services are important in ameliorating internalised stigma. • Decriminalisation is necessary but not sufficient alone to reduce sex work stigma. • Reducing sex work stigma requires additional, specific interventions. [ABSTRACT FROM AUTHOR]

Despite extensive evidence regarding the negative effects of stigma experienced by people living with HIV (PLHIV) and people who inject drugs within health care settings, comparatively little evidence exists regarding the effectiveness of initiatives to reduce this stigma. This study developed and assessed brief online interventions based on social norms theory with a sample of Australian health care workers (n=653). Participants were randomly allocated to either 1) HIV intervention group, or 2) injecting drug use intervention group. They completed baseline measures of their attitudes towards either PLHIV or people who inject drugs, matching measures of their perceptions of their colleagues' attitudes, plus a series of items reflecting behavioural intentions and agreement with stigmatising behaviour towards PLHIV or people who inject drugs. Participants were presented with a social norms video before completing the measures again. At baseline, participants' agreement with stigmatising behaviour was correlated with their perceptions of how many of their colleagues would agree. After watching the video, participants reported more positive perceptions of their colleagues' attitudes towards PLHIV and people who inject drugs, as well as more positive personal attitudes towards people who inject drugs. Changes in perceptions of colleagues' support for stigmatising behaviour independently predicted changes in participants' personal agreement with that behaviour. Findings suggest that interventions based on social norms theory that address health care workers' perceptions of their colleagues' attitudes can play an important role in contributing to broader initiatives to reduce stigma in health care settings. • Interventions based on social norms theory immediately improved health care workers' own attitudes and perceptions of colleagues' attitudes. • Improved attitudes towards people living with HIV and people who inject drugs predicted improvements in behavioural intentions. • Perceptions of colleagues' agreement with stigmatising behaviour strongly influenced participants' own agreement. • Social norms interventions may contribute to broader stigma reduction initiatives within health care settings. [ABSTRACT FROM AUTHOR]

Background: Stigmatising attitudes and behaviours by others can have a range of negative effects for population groups and individual people affected by blood borne viruses. The reduction of stigma is a major goal within current Australian national health strategies, however, there is a lack of evidence regarding effective interventions to achieve this goal. Drawing on Allport's (1954) intergroup contact theory, this study aimed to evaluate the effectiveness of an online stigma reduction intervention implemented with the Australian public.Methods: The study was conducted between February and May 2020. Australian adults recruited via Facebook advertising were randomly allocated to a control group (n=316) or one of five intervention groups: people living with HIV (n=320), people living with hepatitis C (n=347), people living with hepatitis B (n=333), people who inject drugs (n=316), or sex workers (n=296). Participants viewed a short video depicting lived experiences of their assigned group. Participants completed attitudinal measures about the group before and immediately after the video, and then at three-month follow-up. These measures related to overall attitudes towards the group, controllability of the stigmatised condition/behaviour, desire to maintain personal distance from the group, and opinions regarding treatment of the group in health care and public policy. Longitudinal changes in attitudes were analysed using a mixed effects regression model with maximum likelihood estimation.Results: Across each of the intervention groups, reductions in negative attitudes were found immediately after watching the videos on almost all outcome measures. By three-month follow-up, the HIV intervention group demonstrated long-term improvements in relation to personal distance compared to the control group, and the hepatitis B intervention group demonstrated long-term improvements in relation to attitudes and personal distance compared to the control group. Across intervention and control groups, long-term reductions in negative attitudes were found in relation to HIV controllability, hepatitis B controllability and opinions, hepatitis C controllability and opinions, and injecting drug use attitudes and opinions.Conclusion: Brief online videos depicting priority populations groups demonstrated positive results in terms of reducing some stigmatising attitudes towards those groups amongst members of the Australian public. Online contact interventions have the potential to be scaled up and rolled out across jurisdictions at national and international levels. These findings suggest that these interventions could be an effective way to contribute to the reduction of stigma and discrimination towards populations affected by blood borne viruses. [ABSTRACT FROM AUTHOR]