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HIV Stigma and Its Associations with Longitudinal Health Outcomes Among Persons Living with HIV with a History of Unhealthy Alcohol Use

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Abstract

This study examined the demographic and clinical correlates of HIV stigma and evaluated how HIV stigma was associated with physical and mental health outcomes one year later in a primary-care based cohort of persons living with HIV (PLHIV; N = 584). HIV stigma was measured using a modified Berger HIV stigma scale, which includes four subscales: (1) personalized stigma; (2) disclosure concerns; (3) negative self-image; and (4) concerns around public attitudes towards PLHIV. Physical and mental health were assessed using the 12-item short form survey (SF-12). Compared to whites, African Americans were more likely to have higher personalized stigma scores (adjusted prevalence ratio [aPR] 1.54 [95% confidence interval 1.10–2.15]), disclosure concerns (aPR 1.40 [1.03–1.92]), and concerns with public attitudes about PLHIV (aPR 1.61 [1.11–2.34]). Hispanic/Latinx participants were more likely to have concerns around public attitudes towards PLHIV (aPR 1.50 [1.11–2.02]) than whites. Compared to men, women were more likely to have higher negative self-image scores (aPR 1.50 [1.08–2.08]). Higher stigma scores were associated with poorer subsequent self-reported physical and mental health functional status. Our findings highlight the substantial need for addressing HIV stigma, particularly among minority subgroups.

Resumen

El objetivo de este estudio era examinar la correlación del estigma del VIH con aspectos demográficos y clínicos. Se buscaba evaluar la asociación del estigma del VIH con los efectos de la salud física y mental luego de un año en un cohorte de personas viviendo con VIH (PVV; N = 584) provenientes de una clínica de servicios primarios. El estigma del VIH se midió utilizando la escala modificada de estigma del VIH de Berger que incluye cuatro sub-escalas: (1) estigma personalizado; (2) preocupaciones por revelación de diagnóstico; (3) auto-imagen negativa; y (4) preocupaciones acerca de actitudes hacia PVV. La salud física y mental fue evaluada utilizando una encuesta corta de 12 ítems. En comparación con las personas blancas, entre las personas Afroamericanas había más probabilidad de obtener una mayor puntuación en las escalas de estigma personalizado (razón de prevalencia ajustada [aRP] 1.54 [95% intervalo de confianza 1.10–2.15]), preocupaciones por revelación de diagnóstico (aRP 1.40 [1.03–1.92]), y preocupacionespor actitudes negativas hacia PVV (aRP 1.61 [1.11–2.34]). Participantes Hispanos/Latinos tenían más probabilidad de tener preocupaciones por las actitudes negativas hacia PVV (aRP 1.50 [1.11–2.02]) en comparación con personas blancas. En comparación con los hombres, las mujeres tenían mayor probabilidad de tener un resultado más alto en la escala de auto-imagen negativa (aRP 1.50 [1.08–2.08]). Resultados mayores estuvieron asociados a estatus más pobres de funcionalidad de salud física y mental. Nuestros resultados destacan la necesidad substancial de atender asuntos de estigma por el VIH, particularmente en grupos minoritarios.

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Acknowledgements

This study was supported by the National Institute on Alcohol Abuse and Alcoholism (U01 AA021997 and K24 AA025703), the National Institute on Drug Abuse (T32 DA007250), and the National Institute of Mental Health (T32 MH19105).

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Author notes

  1. Michael J. Silverberg and Derek D. Satre contributed equally to this work.

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA

    J. Carlo Hojilla & Derek D. Satre

  2. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    J. Carlo Hojilla, Stacy Sterling, Wendy Leyden, Michael J. Silverberg & Derek D. Satre

  3. Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA

    Edda I. Santiago-Rodriguez

  4. Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA

    C. Bradley Hare

  5. Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA

    Emily C. Williams

  6. Department of Health Services, University of Washington, Seattle, WA, USA

    Emily C. Williams

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  1. J. Carlo Hojilla
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Hojilla, J.C., Santiago-Rodriguez, E.I., Sterling, S. et al. HIV Stigma and Its Associations with Longitudinal Health Outcomes Among Persons Living with HIV with a History of Unhealthy Alcohol Use. AIDS Behav 25, 215–224 (2021). https://doi.org/10.1007/s10461-020-02963-6

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