Internalized poverty-related stigma and interpersonal violence among women living with HIV in the US

Abstract

Background: Interpersonal violence (IPV) affects half of women living with HIV (WLHIV) in the US and has important consequences for mental health and HIV outcomes. While different types of stigmas (e.g., HIV- or sexual identity-related) are associated with increased risk of IPV, the relationship between poverty-related stigma and IPV is unclear, even though poverty frequently co-occurs with IPV. Methods: Data from up to four annual visits (2016-2020) were collected from 374 WLHIV enrolled in a sub-study of the Women’s Interagency HIV Study (WIHS; now known as MACS/WIHS Combined Cohort Study) at four sites across the US. A validated measure of the perceived stigma of poverty was used, along with questions on recent experiences of IPV. We used a mixed-effects model to assess the association between internalized poverty stigma and IPV. Results: The unadjusted model with internalized poverty-stigma and recent IPV as independent and dependent variables, respectively, suggested that the two were associated (prevalence ratio 1.29 [95% CI 1.02-1.62, p=0.033]). After adjusting for income and education, we found an independent association between internalized poverty-related stigma and recent IPV, with a prevalence ratio of 1.35 (95% CI 1.07-1.71, p=0.011). Conclusion: Our findings suggest that reducing the psychological consequences of poverty may better situate WLHIV to escape or avoid IPV. The usefulness of screening WLHIV who may be experiencing poverty-related stigma for IPV should be investigated. Interventions that address internalized poverty-related stigma may provide an avenue for reducing the harms caused by IPV in addition to interventions aiming to reduce violence itself.