The Impact of Shame on Health-Related Quality of Life Among HIV-Positive Adults with a History of Childhood Sexual Abuse

Abstract

Childhood sexual abuse is prevalent among people living with HIV, and the experience of shame is a common consequence of childhood sexual abuse and HIV infection. This study examined the role of shame in healthrelated quality of life among HIV-positive adults who have experienced childhood sexual abuse. Data from 247 HIV-infected adults with a history of childhood sexual abuse were analyzed. Hierarchical linear regression was conducted to assess the impact of shame regarding both sexual abuse and HIV infection, while controlling for demographic, clinical, and psychosocial factors. In bivariate analyses, shame regarding sexual abuse and HIV infection were each negatively associated with health-related quality of life and its components (physical wellbeing, function and global well-being, emotional and social well-being, and cognitive functioning). After controlling for demographic, clinical, and psychosocial factors, HIV-related, but not sexual abuse-related, shame remained a significant predictor of reduced health-related quality of life, explaining up to 10% of the variance in multivariable models for overall health-related quality of life, emotional, function and global, and social wellbeing and cognitive functioning over and above that of other variables entered into the model. Additionally, HIV symptoms, perceived stress, and perceived availability of social support were associated with health-related quality of life in multivariable models. Shame is an important and modifiable predictor of health-related quality of life in HIV-positive populations, and medical and mental health providers serving HIV-infected populations should be aware of the importance of shame and its impact on the well-being of their patients.

Shame, Guilt, and Stress: Community Perceptions of Barriers to Engaging in Prevention of Mother to Child Transmission (PMTCT) Programs in Western Kenya

“…Persons et al describe a theoretical model in which HIV-related shame manifests as avoidant behavior, negative self-image, and poor mental health functioning; leading to avoidance of health care or other social support networks, decreased motivation for self-care, and feelings of inadequacy in managing one's own health. 26 This theoretical model is supported by literature demonstrating similar findings between shame and other HIV-related health behaviors such as condom use, 27 retention in care, 28,29 and adherence to medication. [30][31][32][33] This also suggests that shame, unlike more culturally or socially rooted values of stigma, is potentially modifiable and should be a target for intervention at the individual level.…”

Examining the relationship between childhood victimization, health risk behaviors, and adult physical health outcomes among women on probation and parole.

“…Dickerson, 2011;Persons, Kershaw, Sikkema, & Hansen, 2010;Phanichrat & Townshend, 2010;Schuck & Widom, 2001;Simoni, & Ng, 2002).…”

“…These beliefs are: shame, self-blame, attributional style, health perception, self-esteem and self-efficacy (Kendall-Tackett, 2013; Koss, 1990;Persons et al, 2010;Webb, Heisler, Call, Chikering, & Colburn, 2007). All of these beliefs guide an individual's actions and aids in considering and weighing the correct factors in the decisional balance process.…”

“…Shame is a response to a negative social evaluation or rejection and threatens the "social self" through damaging one's self-respect. It often results in a person feeling vulnerable, exposed and/or "defective", and with an individual concluding they have lost social value (Kessler & Bieschke, 1999;Persons et al, 2010).…”

“…Shame can develop due to exposure to early victimization and can reduce health-related quality of life (Kessler & Bieschke, 1999;Persons et al, 2010). Further, research has demonstrated that continued exposure to social threat (i.e.…”