Abstract
Capitalising further on the benefits of antiretroviral therapy (ART) for individual treatment requires an improved understanding of the psychological processes that may affect optimal ART adherence among people living with HIV. We examined internalised HIV/AIDS-related stigma and body appreciation as mediators of the association between self-esteem and ART adherence among young people living with HIV (YPLHIV). A sample of 76 YPLHIV (Mage = 19.36, s.d.age = 2.56; male 56.58%) residing in an HIV hyperendemic region of South Africa completed self-report measures of self-esteem, internalised HIV/AIDS-related stigma, body appreciation, and ART adherence. Path-analytic mediation modelling was performed to test for direct and indirect effects linking self-esteem with ART adherence. Results of serial mediation analyses indicated that self-esteem and ART adherence were indirectly associated through a two-step path of internalised HIV/AIDS-related stigma and then body appreciation, as well as a one-step path through internalised HIV/AIDS-related stigma. The results provide preliminary support for internalised HIV/AIDS-related stigma and body appreciation as mechanisms underlying the association between self-esteem and ART adherence. Implications of the findings for promoting ART adherence among YPLHIV are discussed.Significance: Self-esteem and ART adherence were indirectly related through internalised HIV/AIDS-related stigma followed by body appreciation. Outcomes of intervention initiatives designed to promote ART adherence among young people living with HIV may be further improved by integrating components that target internalised HIV/AIDS-related stigma and body appreciation.
Highlights
Increased availability and uptake of antiretroviral therapy (ART) among people living with HIV (PLHIV) have played an important role in the decline of new HIV infections.[1]
Patient-related factors are closest in proximity to the individual, many of which appear amenable to change through targeted efforts that are directed towards harnessing and developing personal resources of young people living with HIV (YPLHIV)
We examine associations between self-esteem, internalised HIV/AIDS-related stigma, body appreciation, and ART adherence in YPLHIV who reside in an HIV hyperendemic country within the eastern and southern African region
Summary
Increased availability and uptake of antiretroviral therapy (ART) among people living with HIV (PLHIV) have played an important role in the decline of new HIV infections.[1] ART promotes viral suppression, improves physical and emotional well-being, and reduces mortality.[2] In regions of HIV hyperendemicity where it has been challenging to stay on track with global treatment and prevention targets, ART uptake represents a key avenue for reducing the burden of HIV. Patient-related factors are closest in proximity to the individual, many of which appear amenable to change through targeted efforts that are directed towards harnessing and developing personal resources of young people living with HIV (YPLHIV). Various psychological resources (e.g. self-efficacy, resilience) have been linked to better ART adherence[10,11], one underexplored avenue that has the potential to promote ART adherence among YPLHIV is self-esteem
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