The cost of anticipating stigma: a longitudinal examination of HIV stigma and health

ABSTRACT

Levels of HIV stigma remain high, however there is a limited understanding around how different types of stigma interact to impact health. This study uses data from two time points to examine how enacted and internalized stigma lead to worse health through anticipated stigma as a mediator. We recruited 341 participants in Ontario, Canada to complete the HIV Stigma Index survey at baseline (t₁) from September 2018 to August 2019 and follow up (t₂) approximately two years later. Mediation models were created with enacted and internalized stigma at t₁ as the antecedents, anticipated stigma at t₂ as the mediator, and physical health, mental health, and overall health at t₂ as the outcomes. Only the model with internalized stigma (t₁) as the antecedent had anticipated stigma (t₂) as a significant mediator contributing to both decreased mental and overall health. This highlights the need to address internalized stigma and the potential for anticipated stigma interventions to be effective at improving the health and wellbeing of people living with HIV.

KEYWORDS:

• HIV
• stigma
• quality of life
• mental health
• follow-up studies
• Canada

Acknowledgements

The study team wishes to acknowledge and thank the people living with HIV who conducted and participated in this study. A special thank you to the Peer Researchers (Antoine, A. McGee, George Da Silva, James Gough, Keith Showers, Lynne Cioppa, Michael Murphy, Murray, Monisola Ajiboye, S. Smith, Wayne Bristow). In addition, the team also wants to recognize the expertise of the Ontario Regional Advisory Committee (Ana Sophia Demetrakopoulos, Apondi Judith Odhiambo, Bridget Hall, Carlisle Robinson, Evana Ortigoza, Jasmine Cotnam, Joanne Lindsay, Joanne Lush, Michelle Sumner-Williams, Molly Bannerman, Muluba Habanyama, Phillip Banks, Rene Boucher, Sean LeBlanc, Ted Geatros, Trevor Stratton).

Disclosure statement

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

Author contributions

JML conducted data analyses, interpreted findings, and created the manuscript. SBR and JRW conceived, designed, and implemented the study. AM, JRW, JAP, RGM, AM, ARB, MA, LC, and SBR guided data analysis, interpretation of findings, and manuscript creation. All authors have read, provided critical review, and approved the final manuscript.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This study was supported by the Public Health Agency of Canada (1718HQ-000778), Canadian Institutes of Health Research (FRN 165644, FRN 151186), CANFAR Strategic Initiatives Fund, and TD Bank.