Abstract
HIV-related stigmatization and adversarial growth are known to influence health outcomes in people living with HIV. But not much is known how these psychosocial factors are related to each other and how they interact to influence health outcomes. We tested whether the effect of experienced and internalized stigma on mental health and self-rated health is mediated by adversarial growth, and whether each of these factors is uniquely associated with health outcomes. In our sample of 839 people aging with HIV in Germany based on a cross-sectional study design we did not find an indirect effect of experienced HIV stigma on health outcomes and a very small indirect effect of internalized HIV stigma. All variables were significant predictors of health outcomes in multiple regression analyses.
Highlights
Even in the era of antiretroviral treatment (ART), living with an HIV infection is characterized by impaired mental and physical health, and negative and positive psychosocial factors are known to influence health outcomes among people living with HIV (PLWH) [1, 2]
We eliminated all participants with missing data on one of the study variables we used for the mediation and regression analyses (n = 68)
The highest correlations are found between mental health and self-rated health (r = 0.514; p < 0.001) and between internalized HIV stigma and mental health (r = 0.480; p < 0.001)
Summary
Even in the era of antiretroviral treatment (ART), living with an HIV infection is characterized by impaired mental and physical health, and negative and positive psychosocial factors are known to influence health outcomes among people living with HIV (PLWH) [1, 2]. Since it was first described HIV infection is a highly stigmatized condition [3] and PLWH are exposed to more stigmatization than people living with other diseases [4]. While stigma can manifest on the level of the stigmatizer, the stigmatized and the society, we will focus here on the perspective of the target of stigmatization. In their HIV Stigma Framework, Earnshaw and Chaudoir [8] differentiated between three manifestations or mechanism of stigma that affect the stigmatized: 1) experienced stigma (ES; the actual experience of discrimination), 2) anticipated stigma (AS; the expectation of experiencing discrimination in the future), and 3) internalized stigma (IS; the endorsement of stigmatizing beliefs and feelings about oneself like feelings of guilt, shame and self-blaming). An innovative study, using an experience sample approach could demonstrate that the experience of discriminative acts predicted increases in IS among PLWH [10]
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