Stigma and Psychological Distress in People With HIV/AIDS

Abstract

Using a community sample of 197 people living with HIV/AIDS, we examined how awareness of societal stigma (felt stigma) and negative feelings toward oneself as a member of a stigmatized group (self-stigma) are related to psychological well-being. Both felt stigma and self-stigma were significantly correlated with symptoms of depression and anxiety, but controlling for felt stigma reduced self-stigma's association with depressive symptoms to nonsignificance. Global self-esteem and social avoidance fully mediated the associations between self-stigma and distress but only partially mediated the associations between felt stigma and distress. Felt stigma mediated the relationship between distress and HIV-related changes in physical appearance.

ACKNOWLEDGMENTS

We gratefully acknowledge the invaluable contributions made to this study by Jamie Mandelke, RN, and Lance Smith, who directed data collection at the project's two clinical sites. We also thank Kieran Foster Melody, Melissa Kew, Claudia Vargas, Rachelle Callenback, Jennifer Lyman, and Charles Sims for their assistance with collecting and coding the data. The project would not have been possible without the cooperation and support of Steve O'Brien, M.D., Vice President for Medical Affairs, Alta Bates Summit Medical Center, and Silver Sisneros, D.O., formerly Chief of HIV Medicine at the Alameda County Medical Center. Finally, we express our appreciation to Janet Malvin, Ph.D., who was instrumental in the initial development of the project. The research was made possible by a grant to Gregory Herek from the University of California's Universitywide AIDS Research Program (ID04-D-025).

Notes

¹Because stigmatized and nonstigmatized individuals alike can internalize stigma, self-stigma is preferred over “internalized stigma” (e.g., Lee, Kochman, & Sikkema, 2002; Phillips et al., 2011).

Note. N = 197.

Note. Higher scores indicate higher levels of the construct named by the scale. N/A = Coefficient alpha not applicable to measure; CES-D = Center for Epidemiologic Studies Depression Scale.

Note. SSS = self-stigma; FSS = felt-stigma; CES-D = Center for Epidemiologic Studies Depression Scale; ESI = enacted stigma.

*p < .05. **p < .01. ***p < .001.

²Some questionnaires were missing a response to one item from the FSS (n = 14) or the SSS (n = 22). To increase statistical power, scale scores were computed for these respondents with the missing value replaced by the respondent's mean score on the remaining six scale items. This procedure had practically no effect on the variable means and standard deviations.

³Data were missing for several respondents on the measures of sense of HIV community membership, changes in physical appearance, and number of years since testing HIV-positive. In preliminary regression analyses, these variables were not significant predictors of depression or anxiety with the other variables entered. To increase statistical power, they were excluded from the analyses reported in Tables 3 and 4. Their omission did not affect the general pattern of results.

Note. Table reports standardized regression coefficients (β) for each variable.

*p ≤ .05. **p ≤ .01. ***p ≤ .001.

Note. Table reports standardized regression coefficients (β) for each variable.

*p ≤ .05. **p ≤ .01. ***p ≤ .001.

Note. IV = independent variable; DV = dependent variable; SSS = self-stigma; FSS = felt stigma; Esteem = self-esteem; Avoid = social avoidance; DEP = depression symptoms; ANX = state anxiety. For paths, a = IV to mediator; b = direct effect of mediator on DV; a × b = indirect effect of IV on DV through mediator; c' = direct effect of IV on DV; c = Total effect of IV on DV (= c' +ab).

*p ≤ .05. **p ≤ .01. ***p ≤ .001. (ns: p > .05).

Note. DV = dependent variable; FSS = felt stigma; Changes = perceived bodily changes related to HIV; DEP = depression symptoms; ANX = state anxiety. For paths, a = IV (changes) to mediator (FSS); b = direct effect of mediator (FSS) on DV; a × b = indirect effect of IV (changes) on DV through mediator (FSS); c' = direct effect of IV (changes) on DV; c = total effect of IV (changes) on DV (= c' +ab).

**p ≤ .01. ***p ≤ .001. (ns: p > .05).

Additional information

Notes on contributors

Gregory M. Herek

Sona Saha is now at the Program Development and Evaluation Section, California Department of Public Health.