A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

Abstract

Introduction Women living with HIV (WLHIV) experience stigma and elevated exposure to violence in comparison with HIV‐negative women. We examined the mediating role of experiencing recent violence in the relationship between stigma and depression among WLHIV in Canada. Methods We conducted a cohort study with WLHIV in three Canadian provinces. Recent violence was assessed through self‐reported experiences of control, physical, sexual or verbal abuse in the past three months. At Time 1 (2013‐2015) three forms of stigma were assessed (HIV‐related, racial, gender) and at Time 2 (2015‐2017) only HIV‐related stigma was assessed. We conducted structural equation modelling (SEM) using the maximum likelihood estimation method with Time 1 data to identify direct and indirect effects of gender discrimination, racial discrimination and HIV‐related stigma on depression via recent violence. We then conducted mixed effects regression and SEM using Time 1 and Time 2 data to examine associations between HIV‐related stigma, recent violence and depression. Results At Time 1 (n = 1296), the direct path from HIV‐related stigma (direct effect: β = 0.200, p < 0.001; indirect effect: β = 0.014, p < 0.05) to depression was significant; recent violence accounted for 6.5% of the total effect. Gender discrimination had a significant direct and indirect effect on depression (direct effect: β = 0.167, p < 0.001; indirect effect: β = 0.050, p < 0.001); recent violence explained 23.15% of the total effect. Including Time 1 and Time 2 data (n = 1161), mixed‐effects regression results indicate a positive relationship over time between HIV‐related stigma and depression (Acoef: 0.04, 95% CI: 0.03, 0.06, p < 0.001), and recent violence and depression (Acoef: 1.95, 95% CI: 0.29, 4.42, p < 0.05), controlling for socio‐demographics. There was a significant interaction between HIV‐related stigma and recent violence with depression (Acoef: 0.04, 95% CI: 0.01, 0.07, p < 0.05). SEM analyses reveal that HIV‐related stigma had a significant direct and indirect effect on depression over time (direct effect: β = 0.178, p < 0.001; indirect effect: β = 0.040, p < 0.001); recent violence experiences accounted for 51% of the total effect. Conclusions Our findings suggest that HIV‐related stigma is associated with increased experiences of recent violence, and both stigma and violence are associated with increased depression among WLHIV in Canada. There is an urgent need for trauma‐informed stigma interventions to address stigma, discrimination and violence.

Stigma and COVID‐19 crisis: A wake‐up call

“…Stigma has also intertwined with other structural issues and ills of the society such as poverty, illiteracy and social exclusion to increase the risk of community transmission of SARS-COV-2. 5 Stigmatization of frontline health and social workers and volunteers can lead to higher rates of stress and burnout and potentially result in a lack of interest in fighting the outbreak. 22 Stigmatizing people with COVID-19 and health workers is tantamount to social isolation and could seriously undermine the fight against the pandemic.…”

“…Emerging evidence from many parts of sub-Saharan Africa (SSA) shows that many people who have recovered and those recovering from COVID-19 as well as their families and close relevant others have been thrust into extreme stigmatization. 5,[7][8][9] Diverse media reports document instances where COVID-19 suspected persons have been ejected from their rented apartments and turned away from shops especially after completing mandatory quarantine. 10,11 Such behaviors and actions may likely cause not only hostility and social disruptions but also interfere vehemently with the countermeasures against COVID-19.…”

<p>Perceived Stigma and Associated Factors Among People Living with HIV Attending ART Clinics in Public Health Facilities of Dessie City, Ethiopia</p>

“…5 A study conducted in Amhara, Ethiopia showed that those who felt stigmatized were more likely to develop distress and depression. 7,[28][29][30] A study also indicated that stigma affects access to health care. 31 Some studies have shown that aspects of stigma have been reported as factors constituting a serious obstacle for HIV counseling and testing (VCT) service utilization and HIV prevention.…”

Lessons learned from HIV can inform our approach to COVID‐19 stigma

“…We urgently need to examine the gendered nature of COVID‐19 stigma, particularly in light of HIV‐related stigma research that shows its associations with gender‐based violence [e.g. 20]. Age is another identity that may shape COVID‐19 stigma manifestations.…”