Cognitive processing of HIV stigma and its association with posttraumatic growth: a reflexive thematic analysis

ABSTRACT

Objective

The current study explored the cognitive strategies related to experiences of stigma and how these strategies might contribute to posttraumatic growth (PTG) in people with HIV (PWH) in New Zealand (NZ).

Method

Data were collected by means of semi-structured interviews with 16 participants and were analysed using reflexive thematic analysis.

Results

Six themes were generated: reevaluation, reaffirmation, connective comparison, disclosing, avoidance, and reflection. These processes were found to be influenced by participants’ personal and social contexts.

Conclusions

The findings support current theories of PTG in general, providing a more in-depth picture of cognitive processing of stigma related to HIV and PTG, and highlighting the interactions of social support with experiences of stigma.

Key Points

What is already known about this topic:

1. People can develop PTG through struggling with highly stressful events and may become “sadder but wiser”.

2. Studies have found that PWH can experience PTG as a result of coping with a medical condition.

3. PWH may suffer more distress due to HIV stigma than to HIV’s physical impacts since the invention of antiretroviral therapy.

What this topic adds:

1. The current study generated six cognitive strategies that PWH might use to cope with stigma and which might contribute to PTG. These strategies are: reevaluation, reaffirmation, connective comparison, disclosing, avoidance, and reflection.

2. The current study found that stigma and social support did not counterbalance each other for PWH, but reshaped participants’ assumptions in different ways. These rebuilt assumptions could be negative as well as positive.

3. The current study found that PWH could experience PTG and increased well-being, which might be related to reflection and self-transcendence.

KEYWORDS:

• Coping
• cognitive processing
• social support
• stigma
• posttraumatic growth
• HIV

Acknowledgements

We would like to thank all participants of this study. The study could not have been possible without their participation.

Disclosure statement

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

Authors’ contributions

This paper is based on Danni Chi’s PhD thesis, supervised by Ian de Terte and Dianne Gardner. Chi developed the study aims and literature review, collected and transcribed the data, and wrote the thesis and paper de Terte and Gardner contributed to study design, advised on methodology, reviewed, and edited the thesis and manuscript, and assisted with finalising the paper. The three authors worked as a team, analysed, and developed the themes together.

Ethics approval

The study was approved by the Massey University Human Ethics Committee (SOA-18/61).

Consent to participate

Written consent for participation and publication was obtained from all participants in this study.

Data availability statement

Data available on request due to privacy/ethical restrictions.

Additional information

Funding

The work was supported by the Massey University [PhD student funding].