A preliminary analysis of the association between perceived stigma and HIV-related pain in South Africans living with HIV.

Antonia L Wadley,Tamar Pincus,Michael Evangeli

doi:10.4102/phcfm.v11i1.1647

Abstract

BackgroundStigma related to the human immunodeficiency virus (HIV) remains common and has been associated with severity of HIV-related symptoms. Associations between HIV stigma and HIV-related pain, one of the most common symptoms in HIV, have however not been investigated. Data from low back pain populations suggest that stigma is associated with worse pain intensity and so we hypothesised that the same would be the case in HIV.AimThe goal of this study was to assess the association between HIV stigma and pain intensity in people living with HIV (PLWH) with chronic pain whilst controlling for depression, a well-established correlate of pain.SettingThe study took place at an HIV clinic in Johannesburg, South Africa.MethodsMediation analysis was used to assess the effect of depression on the relationship between stigma and pain intensity in a cross-sectional cohort of 50 PLWH and chronic pain (pain most days of the week for > 3 months). All participants were assessed using the HIV/AIDS Stigma Instrument – PLWA, an 11-point numerical pain rating scale and the Beck Depression Inventory II.ResultsIn all, 88% (44/50) of participants reported experiencing some form of HIV stigma (HIV stigma scale score ≥ 1). Worst pain intensity and depressive symptoms individually correlated with total stigma score (Spearman’s r = 0.33, p = 0.02 for both). The mediation analysis highlighted that mediation of the relationship by depression was equivocal (b = -0.002, bootstrapped confidence interval -0.02 to 0.00).ConclusionWhilst these preliminary data are marginal, they do suggest that associations between HIV stigma and HIV-related pain warrant further investigation. Future study should also include potential mechanisms, which may include mediation through depression.

Highlights

Stigma towards people living with human immunodeficiency virus (HIV) remains prevalent
Stigma against people living with HIV (PLWH) can take different forms including enacted stigma, which refers to acts perceived as stigmatising such as social exclusion or violence, or internalised stigma, whereby prevalent negative attitudes surrounding HIV are internalised and deemed valid by people living with HIV (PLWH).[2,3]
In contrast to behaviours seen in many other chronic pain states, patients with chronic HIV-related pain reported not disclosing their pain to friends and family.[8]

Summary

Introduction

Stigma towards people living with human immunodeficiency virus (HIV) remains prevalent. Greater perceived enacted stigma has been associated with increased HIV symptom severity.[4] Associations between perceived HIV stigma and the experience of pain have not been investigated, . Pain is one of the most common symptoms associated with HIV, affecting between 50% and 80% of PLWH.[5] The pain frequently is of moderate to severe intensity and occurs concurrently at multiple body sites.[5] About half of the pain is chronic (pain on most days for > 3 months).[6,7]. Stigma related to the human immunodeficiency virus (HIV) remains common and has been associated with severity of HIV-related symptoms. Associations between HIV stigma and HIV-related pain, one of the most common symptoms in HIV, have not been investigated.

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Discussion

Conclusion