Addressing stigma, coping behaviors and mechanisms in persons living with HIV could lead to better health outcomes

April 21, 2017 by Alicia Rohan
Credit: Ernie Eldredge

Investigators from the University of Alabama at Birmingham have developed a new conceptual framework highlighting how unique dimensions of individual-level HIV-related stigma might affect the health of those living with HIV. According to the paper's authors, little is known about the mechanisms through which stigma leads to worse health behaviors or outcomes.

The framework, published in the American Journal of Public Health, looks at perceived community stigma, experienced stigma, internalized stigma and anticipated stigma as barriers to both HIV prevention and engagement in care. An intersectional framework looks at how multiple social statuses intersect at an individual level, such as HIV status, race, gender or sexual orientation, and a broader level, such as structural stigmas in society including racism, sexism, HIV-related stigma and classism, to produce inequalities.

The conceptual framework suggests that individual-level dimensions of HIV-related stigma operate through interpersonal factors, mental health, psychological resources and biological stress pathways.

"Those living with HIV often fight fear and experiences of HIV-related stigma, affecting their quality of life and mental health, as well as engaging poorly in their HIV care and treatment," said Janet Turan, Ph.D., professor in the UAB School of Public Health Department of Health Care Organization and Policy. "Our proposed conceptual framework for individual-level dimensions of stigma and potential individual and interpersonal mechanisms explains how stigma affects each individual's HIV-related health."

HIV-infected individuals may be judged by others to be in marginalized social groups, causing social stress because of their minority social position, which could lead to important implications for their health.

"People living with HIV may be stigmatized by their partner, family members and members of the community," said Bulent Turan, assistant professor in the UAB College of Arts and Sciences Department of Psychology. "Those who are close to the individual and who place them in a minority status may cause more harm to their overall mental and physical health. In fact, health care workers who stigmatize people living with HIV can be detrimental to treatment outcomes."

People living with HIV may have a lack of physician trust, poor adherence to care and lower quality of life if stigmatized by those involved in their care. They may experience social stress in various ways, including externally by discrimination of others, anticipation of discrimination by others, internalizing negative attitudes from those around them and/or hiding their sexual orientation. Each of these can adversely affect health behaviors, physical health, and outcomes such as depression, adherence to care and HIV health outcomes.

According to the study, stigma can worsen HIV-related health both directly through physiology and indirectly through engagement in care behaviors. The suggests that stigma at a structural level may also affect individuals living with HIV directly or through individualized-level dimensions, such as internalized stigma, and individual-level mechanisms, such as depression.

The encompasses recent advances in stigma science that can inform future research and interventions aiming to address stigma as a driver of HIV-related health.

"By targeting appropriate coping behaviors and mechanisms associated with HIV stigma, future policy and programs can be better developed to reduce and provide a healthy life for those living with HIV," Turan said.

Explore further: Stigma can hinder access to health care for the poor

More information: Bulent Turan et al. Mechanisms Linking HIV-Related Stigma, Adherence to Treatment, and Health Outcomes: A Conceptual Framework, American Journal of Public Health (2017). DOI: 10.2105/AJPH.2017.303744

Related Stories

Stigma can hinder access to health care for the poor

October 6, 2014
In a study of 574 low-income adults, many felt stigmatized when receiving medical care. This stigma was most often the result of interactions with clinicians that felt demeaning, rather than an internalized sense of shame ...

Stigma among HIV-positive women complex and overlapping

November 22, 2011
In this week's PLoS Medicine, Mona Loutfy of the University of Toronto, Canada and colleagues report their study examining experiences of stigma and coping strategies among HIV-positive women in Ontario, Canada.

Stigma 'key deterrent' in accessing mental health care

February 25, 2014
Mental health stigma is a key factor preventing people from accessing the care they need, according to new research from King's College London.

Depression's stigma can be a barrier to African-Americans seeking treatment, study finds

July 20, 2016
The stigma attached to mental illness creates a barrier for many seeking treatment, but it has a particularly negative impact on the help-seeking behaviors of black Americans, a small in-depth qualitative study by researchers ...

Stigma of mental illness in India linked to poverty

March 5, 2015
The stigma surrounding people with severe mental illness in India leads to increased poverty among them, especially women, according to new research led by Jean-Francois Trani, PhD, assistant professor at the Brown School ...

Recommended for you

Expert: Be concerned about how apps collect, share health data

October 20, 2017
As of 2016 there were more than 165,000 health and wellness apps available though the Apple App Store alone. According to Rice University medical media expert Kirsten Ostherr, the Food and Drug Administration (FDA) regulates ...

More teens than ever aren't getting enough sleep

October 19, 2017
If you're a young person who can't seem to get enough sleep, you're not alone: A new study led by San Diego State University Professor of Psychology Jean Twenge finds that adolescents today are sleeping fewer hours per night ...

Across Asia, liver cancer is linked to herbal remedies: study

October 18, 2017
Researchers have uncovered widespread evidence of a link between traditional Chinese herbal remedies and liver cancer across Asia, a study said Wednesday.

Eating better throughout adult years improves physical fitness in old age, suggests study

October 18, 2017
People who have a healthier diet throughout their adult lives are more likely to be stronger and fitter in older age than those who don't, according to a new study led by the University of Southampton.

Global calcium consumption appears low, especially in Asia

October 18, 2017
Daily calcium intake among adults appears to vary quite widely around the world in distinct regional patterns, according to a new systematic review of research data ahead of World Osteoporosis Day on Friday, Oct. 20.

New study: Nearly half of US medical care comes from emergency rooms

October 17, 2017
Nearly half of all US medical care is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine (UMSOM). And in recent years, the percentage of care delivered ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.