Evaluating experiences of HIV-related stigma among people living with HIV diagnosed in different treatment eras in British Columbia, Canada

ABSTRACT

There is mixed evidence on whether experiences of HIV-related stigma are mitigated with lived experience. We sought to examine whether people living with HIV (PLWH) with longer living experience reported varying levels of HIV-related stigma. Between January 2016-September 2018, we used purposive sampling to enrol PLWH aged ≥19 across British Columbia, Canada, where participants completed the 10-item Berger HIV Stigma Scale. We conducted bivariate analyzes examining key sociodemographic characteristics and HIV-related stigma scores. Multivariable linear regression modelled the association between year of HIV diagnosis by treatment era and HIV-related stigma scores. We enrolled 644 participants; median age at enrolment was 50 years (Q1–Q3: 42–56), with 37.4% (n = 241) diagnosed before the year 2000. The median HIV-stigma scores of all participants (19.0, Q1–Q3: 13–25, range 0–40) stratified by treatment era were: 17.0 (pre-1996), 20.0 (1996–1999), 20.0 (2000–2009), 19.0 (2010–2018) (p = 0.03). While there was a significant association at the univariate level, year of HIV diagnosis by treatment era was not associated with stigma scores after controlling for age, gender, HIV key populations, ethnicity, relationship status, social support, and ever having a mental health disorder diagnosis. This suggests that PLWH still experience HIV-related stigma today, compared to those diagnosed in earlier time periods.

KEYWORDS:

• Stigma
• highly-active antiretroviral therapy (HAART)
• treatment eras
• HIV
• Treatment as Prevention (TasP)
• aging

Acknowledgements

We respectfully acknowledge that our work takes place on the traditional, ancestral, and unceded territories of the Coast Salish peoples. We would like to thank all those who contributed their time and expertise to this project, especially SHAPE participants who shared their life experiences with us, participants who have passed away since the study began, the SHAPE team of peer research associates, co-investigators, collaborators, the BC-CfE, and all partnering community organizations and clinics that assisted with recruitment and data collection, and for their ongoing support and guidance. RB and RH conceptualized and established the SHAPE study. CT, DM, KS conceptualized the manuscript, and CT drafted the manuscript with contributions from KS, DM, TW, and SG. TW, SG, and RP collected data, LW conducted statistical analysis, JB conducted data analysis. All authors reviewed and approved the final manuscript. The SHAPE study welcomes any feedback and proposals for collaborations on data analyzes or knowledge translation activities.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The British Columbia Centre for Excellence in HIV/AIDS (BC-CfE) is prohibited from making individual-level data available publicly due to provisions in our service contracts, institutional policy, and ethical requirements. In order to facilitate research, we make such data available via data access requests. Some BC-CfE data is not available externally due to prohibitions in service contracts with our funders or data providers. For more information or to make a request, please contact Mark Helberg, Senior Director, Internal and External Relations, and Strategic Development: [email protected]. All data related to this manuscript are provided in the main body of the paper and Supporting Information files.

Additional information

Funding

The SHAPE study and the BC-CfE HIV Drug Treatment Program are funded by the BC Ministry of Health and BC Centre for Excellence in HIV/AIDS. DM is supported by a Scholar Award from the Michael Smith Foundation for Health Research.