Abstract
In the context of HIV-related stigma and discrimination, people living with HIV (PLHIV) might be vulnerable to a ‘syndemic’ of co-occurring psychosocial challenges that can affect sexual behavior. The present study examined how HIV-related discrimination contributes to co-occurring psychosocial syndemic problems and results in inconsistent condom use among PLHIV in Hong Kong. Two-hundred and ninety-one PLHIV were recruited to complete a self-report questionnaire. More than one-quarter of the sample experienced two or more psychosocial syndemic problems, and 74.1% of the participants who had sex with steady partners reported inconsistent condom use over the past three months. The results indicated that HIV-related discrimination was positively predictive of the number of psychosocial syndemic problems. HIV-related discrimination and psychosocial syndemics were associated with increased odds of inconsistent condom use with steady partners (AOR = 5.40 and AOR = 3.09 respectively). Findings from structural equation modeling showed that psychosocial syndemics mediated the effect of HIV-related discrimination on condom use consistency with steady partners. PLHIV in Hong Kong suffered from the syndemic effects of stigma, social isolation, and poor mental health, which rendered them vulnerable to condomless sex. In order to curb the rapidly increasing incidence of HIV, multi-level strategies should be adopted to concurrently address the structural inequities and psychosocial syndemics faced by PLHIV.
Highlights
Despite the increasing knowledge of the prevention and control of HIV infections, HIV remains a highly stigmatized condition in most parts of the world
The results indicated that the indirect effect of HIV-related discrimination on inconsistent condom use via psychosocial syndemics was significant (B = 0.26, 95% confidence intervals (CIs) = 0.02, 0.68)
One-third of the sample reported experiencing discrimination based on their HIV status during the past year, and one-third reported two or more adverse psychosocial conditions, which indicated the presence of a psychosocial syndemic in this population
Summary
Despite the increasing knowledge of the prevention and control of HIV infections, HIV remains a highly stigmatized condition in most parts of the world. HIV-related discrimination is so rampant and pervasive that people living with HIV (PLHIV) often face rejection and unequal treatment in multiple domains of life, including family and social networks [1], work and educational settings [2], as well as healthcare and social service settings [3]. PLHIV who face discrimination often internalize negative societal stereotypes and develop self-stigma toward their identity [10]. They are likely to disengage from social interaction and withdraw from their community, resulting in social isolation [11,12]
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