HIV-related stigmatization and medication adherence: Indirect effects of disclosure concerns and depression.

Abstract

Stigmatization due to HIV status may interfere with disease management among persons living with HIV/AIDS (PLWHA) by heightening serostatus disclosure concerns and vulnerability to depressive symptoms. In this cross-sectional study, indirect effects of disclosure concerns and depressive symptoms were examined for the association of stigma to treatment adherence (medication and clinic appointment adherence) in an outpatient sample of PLWHA. Participants (N ϭ 179; 47% White, 41% African American; 35% MSM) completed measures of stigma-related experiences, concerns about disclosing HIV status, depression, and medication adherence; clinic appointment attendance was obtained from chart data. Stigma had an indirect effect on medication adherence (but not clinic attendance) via disclosure concerns. Stigma had indirect effects on both medication adherence and clinic attendance via depressive symptoms. In path analyses including both disclosure concerns and depressive symptoms, combined indirect effects emerged for both medication adherence and clinic attendance. There was a significant indirect pathway from stigma to disclosure concerns to depression to clinic attendance, whereas the positioning of the mediators was swapped for the significant indirect pathway from stigma to medication adherence. These analyses provide evidence that stigmatizing experiences negatively affect treatment adherence through the indirect effects of disclosure concerns and depressive symptoms. Disclosure concerns and depressive symptoms are two mechanisms worthy of further research to enhance understanding of the association between stigma and treatment adherence difficulties.

HIV Preexposure Prophylaxis and Treatment as Prevention — Beliefs and Access Barriers in Men Who Have Sex with Men (MSM) and Transgender Women: A Systematic Review

“…32 Findings from HIV-related stigma studies indicate that the ability to take care of one's self through medication and the use of antiretroviral therapies can decrease with the increase of HIV stigmatization, resulting in lifethreatening consequences. 34 It is not unreasonable to assume that this form of HIV-related stigma also would negatively impact adherence to PrEP treatment in both MSM and transgender women.…”

HIV-related enacted stigma and increase frequency of depressive symptoms among Thai and Cambodian adolescents and young adults with perinatal HIV

“…Despite successful antiretroviral treatment and improved health outcomes among AYA-PHIV, HIV remains a stigmatizing condition in many communities with potential to influence mental health outcomes and long-term survival. 27 In this study, a quarter of AYA-PHIV experienced HIV-related enacted stigma, and a two-fold increase in frequency of depressive symptoms was observed. In addition, around 10% of study participants experienced HIV-related social problems.…”

Temporal and Spatial Analysis Techniques as Potential Tools for Combating the HIV Epidemic among Young Brazilian Amazonian People: An Ecological Study

“…Additionally, it is necessary to combat stigma and social prejudice to promote accessibility for all. In the United States, among men who have sex with men, HIV stigma was directly associated with a difficulty in adherence to antiretroviral therapy [ 44 ]. Among young Africans, stigma and social prejudice were related to low HIV-testing rates, and self-testing was one strategy indicated as a possible solution [ 45 ].…”