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PWH Internalizing HIV Stigma, Depression
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One important finding of this study is that perceived community stigma was associated with internalized stigma, which in turn was associated with depression symptoms, resulting in sub-optimal ART adherence and lower odds of viral suppression. We also found that experienced stigma was associated with internalized stigma, which was associated with depression symptoms, which in turn were associated with poor ART adherence and lower odds of viral suppression.
Depression symptoms emerged as a mediating mechanism of the association between experienced or perceived community stigma and ART adherence through the pathway of internalized stigma. This finding is in accord with previous studies indicating that PWH are at great risk for having depressive symptoms because of stigmatization and/or discrimination33,34 and that depression and/or internalized stigma mediates the relationship between perceived or experienced stigma and health outcomes.16,18,22,35 PWH may internalize stigma, particularly when they experience actual acts of discrimination and abuse (i.e., experienced stigma), and when they perceive negative attributions and attitudes in the community (i.e., perceived community stigma) AGING & [HIV stigma]. In turn, the experience of internalizing stigma leads to depression symptoms, ultimately resulting in undesired health outcomes, such as poor ART adherence and detectable viral load. At this point, our findings suggest that focusing upon or prioritizing depression symptom management in addition to stigma dimensions can maximize the effectiveness of adherence interventions, particularly considering overlapping aspects of internalized stigma and depression, such as negative self-image, self-blame, worthlessness, self-devaluation, and feelings of negativity.
Longitudinal Associations of Experienced and Perceived Community Stigma with ART Adherence and Viral Suppression in New-to-care People with HIV: Mediating Roles of Internalized Stigma and Depression Symptoms
JAIDS January 01, 2024
Abstract
Background:
While cross-sectional studies have suggested that HIV-related stigma and depression symptoms may result in poor HIV treatment and health outcomes, few studies have investigated potential longitudinal mechanisms in these relationships. Furthermore, longitudinal effects of HIV-related stigma on health outcomes have not been examined in people with HIV (PWH) newly initiating HIV clinical care. We examined longitudinal associations between experienced and perceived community stigma and health outcomes (ART adherence and viral load), mediated by internalized stigma and depression symptoms among new-to-care PWH in the United States.
Setting
/Methods: Data were obtained from 371 PWH who initiated HIV medical care at four HIV sites at baseline and 48 weeks later between December 2013 and 2018. Validated measures were used to assess experienced stigma, perceived community stigma, internalized stigma, depression symptoms, and ART adherence; and viral load was obtained from medical records at final study visit.
Results:
Serial mediation models revealed significant indirect effects of experienced stigma and perceived community stigma on ART adherence and on viral suppression, first through internalized stigma, and then through depression symptoms.
Conclusions:
These results suggest that PWH may tend to internalize HIV-related stigma when they experience acts of stigmatization or perceive negative attitudes in society, which in turn may result in negative effects on psychological and physical well-being. These findings about how stigma in society may be an antecedent mechanism for PWH to develop internalized stigma, which in turn affects individual health outcomes, can be used to tailor both individual-level and community-level interventions.
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