Associations Between Experienced and Internalized HIV Stigma, Adversarial Growth, and Health Outcomes in a Nationwide Sample of People Aging with HIV in Germany

Abstract

HIV-related stigmatization and adversarial growth are known to influence health outcomes in people living with HIV. But not much is known how these psychosocial factors are related to each other and how they interact to influence health outcomes. We tested whether the effect of experienced and internalized stigma on mental health and self-rated health is mediated by adversarial growth, and whether each of these factors is uniquely associated with health outcomes. In our sample of 839 people aging with HIV in Germany based on a cross-sectional study design we did not find an indirect effect of experienced HIV stigma on health outcomes and a very small indirect effect of internalized HIV stigma. All variables were significant predictors of health outcomes in multiple regression analyses.

A Moderated Mediation Effect of Stress-Related Growth and Meaning in Life in the Association Between Coronavirus Suffering and Satisfaction With Life: Development of the Stress-Related Growth Measure

“…It incorporates an improved level of positive psychosocial functioning by the occurrence of positive changes and developments in one's life in comparison with a previous level. In relevant literature, similar terms such as post-traumatic growth, adversarial growth, benefit finding, and thriving as well as stress-related growth were found to be related to coping strategies and perceived stress (Schuettler and Boals, 2011), resilience (Lepore and Revenson, 2006), intrusion (Helgeson et al, 2006), psychological distress (Viegas and Henriques, 2020), and mental health and self-rated health outcomes (Drewes et al, 2020). In particular, stress-related growth was found to be associated with better psychological adjustment by increasing personal resources and positive states of mind over time (Park and Fenster, 2004).…”

Comorbidities and psychosocial factors as correlates of self-reported falls in a nationwide sample of community-dwelling people aging with HIV in Germany

“…Possible pathways how HIV-related stigma influences falling include maladaptive coping strategies, like alcohol and drug use, chronic stress that is associated with adverse physiological responses and depression, and social isolation which is associated with low social support and depression (see [ 43 ]), with each mechanism being linked to fall risk. The stronger relationship between experienced HIV stigma and fall risk compared to the relationship between internalized HIV stigma and fall risk can be seen as further evidence for the hypothesis that experienced HIV stigma is stronger related to physical health outcomes than internalized HIV stigma [ 22 , 45 ].…”

“…Internal consistency for this 6-item scale was good: Cronbach’s α = .80. For more information on this scale and the original items see [ 22 ].…”

“…We assessed internalized HIV stigma with an adapted version of the negative self-image subscale of the HIV Stigma Scale [ 23 , 24 ]. See [ 22 ] for more information of the adaptation process. Possible scores of our internalized HIV stigma scale range between 1 and 4 (expressing the highest possible extent of internalized HIV stigma).…”

“…We selected eight items from the original 38-item instrument and used a 4-point Likert scale, with higher scores indicating more adversarial growth. The procedure is described in detail elsewhere [ 22 ]. Our 8-item scale showed excellent internal consistency with Cronbach’s alpha = .90.…”