Management of HIV-related stigma and adherence to HAART: Evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA 2003)

Abstract

This study investigated patterns of HIV disclosure to significant others (parents, siblings, children, other relatives, friends and colleagues) and describe them in terms of socio-demographic background and other characteristics, including experiences of AIDS-related discrimination. It also assessed the relationship between disclosure patterns and adherence to HAART. We used a cross-sectional survey conducted among a national representative sample of 2,932 HIV-infected people recruited in French hospitals. HIV disclosure patterns were both selective and cumulative: disclosure was more frequent for friends and siblings, while concealment prevailed concerning children, other relatives, and colleagues; but patients who disclosed their seropositivity to one significant other were also more likely to disclose it to other significant others. Patients reporting experiences of discrimination from sexual partners were less likely to be highly adherent, and we also found a significant relationship between uncontrolled disclosure and non-adherence. Patients who have opted for concealment probably consider non-adherence and uncontrolled disclosure as competing risks, but among them a significant minority loses on both counts. Counselling provided to HIV-infected people should not separate the adherence and disclosure issues, and adherence interventions should seek to help patients to manage concurrently disclosure/concealment of their seropositivity and its consequences.

Health Care Provider Attitudes and Beliefs About People Living with HIV: Initial Validation of the Health Care Provider HIV/AIDS Stigma Scale (HPASS)

“…HIV stigma reduces quality of life for individuals living with HIV [2], reduces positive social interaction [3,4] and may decrease access to health care services and adherence to medication regimes [5][6][7]. Health care providers are more likely to believe HIV stigma is not a concern if they have not had contact with patients living with HIV [8], and perceived stigma from health care providers decreases the likelihood people living with HIV will access health care [7].…”

Advancing methodology in the study of HIV status disclosure: The importance of considering disclosure target and intent

“…Many studies have examined the causes and consequences of disclosure in PLWH (e.g., Chandra et al, 2003;Chaudoir & Fisher, 2010;Pachankis, 2007;Sandelowski et al, 2004). Some studies suggest that disclosing one's HIV status can have beneficial effects such as increased social support, decreased experienced stigma, improved treatment adherence, greater well-being, and healthier behaviors (Peretti-Watel et al, 2006;Skogmar et al, 2006;Smith et al, 2008). Other studies point out that disclosure may also result in stigmatization Valle & Levy, 2009) manifest as, for example, avoidance, rejection, exclusion, blaming, physical distance, and awkward social interaction (Shamos et al, 2009;Stutterheim et al, 2009Stutterheim et al, , 2012.…”

The Impact of Anticipated HIV Stigma on Delays in HIV Testing Behaviors: Findings from a Community-Based Sample of Men Who Have Sex with Men and Transgender Women in New York City

“…34 Many studies have documented associations between stigma, discrimination, delays in seeking care when testing HIV positive, and poor HIV treatment adherence. [52][53][54] One of potential reasons that people may not take an HIV test result is fear. This fear is not surprising, as there are real social consequences of acquiring HIV, such as rejection by, and isolation and discrimination from significant others and providers.…”