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Abstract: Self-stigma–negative self-judgements resulting in shame, worthlessness and self-blame–may play a crucial role in emotional reactions and cause emotional distress among many people living with HIV and other chronic illnesses. Furthermore, self-stigma negatively impacts on self-agency, quality of life, adherence to treatment, and access to services. High levels of self-stigma have been reported across many countries, however few programmes or interventions exist to specifically tackle this phenomenon. This paper reports the findings of a pilot study carried out in Zimbabwe using a programme incorporating “Inquiry-Based Stress Reduction (IBSR): The Work of Byron Katie”–a guided form of self-inquiry which helps users to overcome negative thoughts and beliefs (2019)
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Abstract: Sex workers are among the most stigmatised people globally, with sex workers in Vietnam being no exception. Self-stigma affects sex workers adversely, harming psychological health and acting as a barrier to seeking health care. To inform programmes and interventions to improve well-being, identifying unhelpful or negative core beliefs may provide the basis from which individuals can be supported. With this in mind, this study aimed to gain the perspective of sex workers in Vietnam on the contexts of their working lives. Data were collected in Hanoi. Fourteen semi-structured interviews were conducted with Vietnamese sex workers over the age of 18 who were working or formerly worked in Vietnam. Data were analysed manually, informed by theoretical models of self-stigma using inductive thematic analysis. The analysis identified negative/unhelpful core beliefs (disclosure, self-stigma and shame, sexuality, sexual pleasure relationships, health care); contextual life circumstances (sex work, violence, traditional education); and coping mechanisms (problem-focused coping, emotion-focused coping). Findings identify the importance of core beliefs in understanding self-stigma, paving the way for programmes and interventions to address self-stigma among sex workers (2019)
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PRINCIPLES: Human immunodeficiency virus (HIV) related self-stigma – negative self-judgements resulting in shame, worthlessness and self-blame – negatively influences access to care and treatment, and overall quality of life for people living with HIV (PLHIV). Despite evidence that high levels of self-stigma exist among PLHIV, and is experienced to a far greater extent than stigma received from the broader community, there is a paucity of research aimed at understanding causes and functions of self-stigma, and an absence of interventions to mitigate its harmful effects. Understanding the core beliefs underlying self-stigma is therefore essential.
METHODS: This pilot study used a qualitative approach to analyse interviews and written statements to uncover core beliefs underlying self-stigma, the functions thereof, and strategies used to overcome it, among a heterogeneous group of PLHIV in Ireland.
RESULTS: Core beliefs underlying HIV-related self-stigma were uncovered and grouped into four categories: disclosure; sexuality and sexual pleasure; self-perception; and body, illness and death. Reported functions of self-stigma included contributing to maintaining a “victim” status; providing protection against stigma received from others; and justifying non-disclosure of HIV status. To cope with self-stigma, participants highlighted: community involvement and professional development; personal development; and connection to others and sense of belonging. Findings were also used to create a conceptual framework.
CONCLUSIONS: This study helps fill identified gaps in knowledge about self-stigma as experienced by PLHIV. By understanding the core beliefs driving self-stigma, it will be possible to create targeted interventions to challenge and overcome such beliefs, supporting PLHIV to achieve improved wellbeing and lead productive lives free of self-limitation and self-judgement (2015)
The theoretical framework for this work can be seen from the figures below:
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Figure 1 Framework for qualitative analysis of interview data. Three main areas of analysis are shown: Categories of core beliefs (A, red), Functions of self-stigma (B, magenta) and Coping strategies (C, blue). Emergent themes were organised into categories (solid boxes), and subcategories where required (open boxes).
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Figure 2 Conceptual framework of self-stigma. Designed using concepts from Morrison (2006) [52], the framework comprises three interacting groups of factors (factors listed are non- exhaustive) which influence self-stigma: social factors, contextual factors and self factors. The complex interaction between these factors influences the development and perpetuation of self-stigma.
References to other research using IBSR: The Work of Byron Katie for health:
1. Nye FA. The Work of Byron Katie: The effect of applying principles of inquiry on the reduction of perceived stress. Dissertation Institute of Transpersonal Psychology. 2011.

2. Leufke R, Zilcha-Mano S, Feld A, Lev-Ari S. Effects of “The Work” Meditation on
Psychopathologic Symptoms: A Pilot Study. Journal of Alternative and Complementary Therapies. 2013; 147-152. (doi: 10.1089/act.2013.19303).

3. Lev-ari S, Zilcha-Mano S, Rivo L, Geva R , Ron I. A prospective pilot clinical trial of "The Work" meditation technique for survivors of breast cancer. European Journal of Integrative Medicine. 2013; 5(6): 487-494.  [doi:10.1016/j.eujim.2013.07.003).

4. Landau C, Lev-Ari S, Cohen-Mansfield J, Tillinger E, Geva R, Tarrasch R, Mitnik I, Friedman E. Randomized controlled trial of Inquiry-Based Stress Reduction (IBSR) technique for BRCA1/2 mutation carriers. Psychooncology. 2014 Oct 18. (doi: 10.1002/pon.3703).

5. Smernoff E, Mitnik I, Kolodner K, Lev-Ari S. The Effects of "The Work" Meditation (Byron Katie) on Psychological Symptoms and Quality of Life-A Pilot Clinical Study. Explore (NY). 2014 Oct 22. pii: S1550-8307(14)00206-7. (doi: 10.1016/j).

6. Mitnik I, Lev-Ari S. The Effects of The Work meditation technique on psychological scales among a non-clinical sample, Harefuah. January 2015.