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Prevalence of Internalized HIV-Related Stigma Among HIV-Infected Adults in Care, United States, 2011–2013

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Abstract

HIV-infected U.S. adults have reported internalized HIV-related stigma; however, the national prevalence of stigma is unknown. We sought to determine HIV-related stigma prevalence among adults in care, describe which socio-demographic groups bear the greatest stigma burden, and assess the association between stigma and sustained HIV viral suppression. The Medical Monitoring Project measures characteristics of U.S. HIV-infected adults receiving care using a national probability sample. We used weighted data collected from June 2011 to May 2014 and assessed self-reported internalized stigma based on agreement with six statements. Overall, 79.1% endorsed ≥1 HIV-related stigma statements (n = 13,841). The average stigma score was 2.4 (out of a possible high score of six). White males had the lowest stigma scores while Hispanic/Latina females and transgender persons who were multiracial or other race had the highest. Although stigma was associated with viral suppression, it was no longer associated after adjusting for age. Stigma was common among HIV-infected adults in care. Results suggest individual and community stigma interventions may be needed, particularly among those who are <50 years old or Hispanic/Latino. Stigma was not independently associated with viral suppression; however, this sample was limited to adults in care. Examining HIV-infected persons not in care may elucidate stigma’s association with viral suppression.

Resumen

Individuos viviendo con el VIH en los EEUU experimentan internalización de estigma asociado con el VIH. No obstante, la prevalencia del estigma asociado con el VIH en los EEUU es desconocida. Este estudio intenta: determinar la prevalencia del estigma asociada con el VIH entre adultos recibiendo cuidado médico, describir cuales grupos socio-demográficos experimentan la carga mayor de estigma, y evaluar la asociación entre el estigma y la continua supresión viral del VIH. El Proyecto de Monitoreo Medico evalúa las características de adultos viviendo con VIH en los EEUU y que reciben atención médica. MMP utiliza una muestra probabilística con representatividad nacional. Los datos fueron coleccionados de junio 2011–mayo 2014. Medimos el estigma utilizando un cuestionario enfocado en los diferentes aspectos del estigma que sufren las personas viviendo con VIH. Todas las estimaciones fueron calculadas utilizando pesos estadísticos. En general, 79.1% estuvieron de acuerdo con ≥1 afirmaciones de estigma asociada con el VIH. El puntaje promedio de estigma fue 2.4 (de un puntaje posible de six). Hombres de raza blanca tuvieron el puntaje de estigma más bajo mientras mujeres Hispanas/Latinas y personas transgénero multirraciales o de otra raza tuvieron el puntaje de estigma más alto. Se detectó una asociación ente el nivel de estigma y la supresión viral del VIH, pero esta asociación dejó de ser significativa después de ajustar para la edad. Experiencias de estigma fueron comunes entre los adultos recibiendo cuidado médico para el VIH. Los resultados sugieren que intervenciones comunitarias e individuales pueden ser necesarias, especialmente entre aquellos <50 años de edad o entre Hispanos/Latinos. No hubo relación independiente entre la supresión viral y estigma. Sin embargo, nuestro muestreo está limitado a personas recibiendo cuidado médico. Esta asociación podría ser más clara en individuos viviendo con VIH que no tienen acceso a cuidados médicos.

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Acknowledgements

We thank participating MMP patients, facilities, project areas, and Provider and Community Advisory Board members. We thank Mabel Padilla for translating the abstract into Spanish. We also acknowledge the contributions of the Clinical Outcomes Team and Behavioral and Clinical Surveillance Branch at CDC and the MMP Study Group Members (http://www.cdc.gov/hiv/statistics/systems/mmp/resources.html#StudyGroupMembers).

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention (CDC).

Funding

The Medical Monitoring Project (MMP) is funded by the Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. Division of HIV/AIDS Prevention, Centers for Disease Control, 1600 Clifton Road NE, MS E-46, Atlanta, GA, 30329, USA

    Amy R. Baugher, Linda Beer, Jennifer L. Fagan, Christine L. Mattson, Mark Freedman, Jacek Skarbinski & R. Luke Shouse

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Correspondence to Amy R. Baugher.

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Ethical Approval

The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention determined that MMP was a public health surveillance activity and not subject to federal institutional review board review. However, some jurisdictions obtained approval from local Institutional Review Boards.

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All participants provided informed consent.

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Baugher, A.R., Beer, L., Fagan, J.L. et al. Prevalence of Internalized HIV-Related Stigma Among HIV-Infected Adults in Care, United States, 2011–2013. AIDS Behav 21, 2600–2608 (2017). https://doi.org/10.1007/s10461-017-1712-y

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