Previous research has shown that HIV stigma in India can be characterized by a framework dividing manifestations into enacted (discrimination), vicarious (hearing stories of discrimination), felt normative (perceptions of stigma's prevalence) and internalized stigma (personal endorsement of stigma beliefs). We examined if this framework could explain associations among stigma, efforts to avoid HIV serostatus disclosure, and depression symptoms in a cohort of 198 HIVinfected individuals from southern India who were followed for one year as part of a study of antiretroviral adherence. Prior studies had suggested that disclosure avoidance was a primary outcome of stigma and that impaired well-being was a primary outcome of disclosure avoidance. Analyses from our longitudinal research revealed that the pattern of associations among stigma, disclosure avoidance, and depression symptoms remained consistent over time. Enacted and vicarious stigmas were correlated with felt normative stigma beliefs. In turn, felt normative stigma was correlated with disclosure avoidance. And enacted stigma, internalized stigma, and disclosure avoidance were all associated with depression symptoms. However, even though the overall framework held together, internalized stigma and depression symptoms dropped significantly over time while other components remained unchanged. These findings suggest that, although HIV stigma may limit disclosure, it does not invariably lead to psychological maladjustment. Amidst ongoing perceptions and experiences of stigma, HIV-positive individuals can achieve significant improvements in their acceptance of the disease and in mental wellbeing.Stigma has profound effects on the lives of people living with HIV. It results in prejudice, discounting, discrediting, and discrimination toward individuals perceived to have the disease (Herek, Capitanio, & Widaman, 2002;Herek et al., 1998;Mahajan et al., 2008;Tewksbury & McGaughey, 1997). Our research team previously reported that a multicomponent framework was appropriate for characterizing stigma-related experiences among HIV-infected individuals in India instances of hostility and discrimination (Scambler, 1989;Steward et al., 2008). Vicarious stigma is embodied in knowledge of stories and events that illustrate how others with HIV have been mistreated . The final two categories are intrapersonal manifestations. Felt normative stigma refers to people's beliefs about the prevalence of prejudicial attitudes in the local community (Scambler, 1989;Steward et al., 2008).Internalized stigma is the degree to which HIV-infected individuals personally endorse stigmatizing beliefs (Herek, 2008;Jones et al., 1984;Steward et al., 2008).Our prior work showed that all forms of stigma are ultimately associated with symptoms of depression ( Figure 1). The focus of these earlier cross-sectional analyses was testing the pathway by which interpersonal forms (enacted, vicarious) shape felt-normative stigma beliefs that, in turn, promote efforts to avoid disclosure of HIV sta...

Food insecurity (FI) and its link with depression and quality of life (QOL) among people living with HIV (PLHIV) in India are not well-documented. We analyzed cohort data from 243 male and 129 female PLHIV from Bengaluru, and found 19% of men and 26% of women reported moderate or severe FI over a six-month period. Women reported higher mean depression than men, and lower mean QOL. In multivariate analyses adjusting for HIV stigma and demographic covariates, both male and female PLHIV with moderate to severe FI showed lower mean QOL than those reporting mild to no FI. Male but not female food insecure participants also had higher depression scores in adjusted regression analyses. As ART has improved the physical health of PLHIV, more effort is being invested in improving their psychological well-being. Our results suggest such interventions could benefit from including nutritional support to reduce FI among PLHIV.

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