Stigma, Disclosure, and Psychological Functioning Among HIV-Infected and Non-Infected African-American Women

Abstract

HIV is on the rise among African-American women. AIDS-related stigma plays an important role in the lives of HIV-infected and non-infected African-American women. Among HIV-infected women, the decision to disclose HIV seropositive status is likely affected by perceived stigma. The first purpose of the study is to examine perceived AIDS-related stigma over a six year period and across two groups of African-American women: HIV-infected and non-infected. The second purpose of the study examines whether disclosure of HIV seropositive status moderates the relationship between stigma and psychological functioning. Participants were 98 HIV-infected and 146 non-infected African-American women, between the ages of 18 and 50. Data were collected at four points across six years. Results indicated that HIV-infected women perceived a significantly higher level of AIDS-related stigma than non-infected women at all four assessments. Perceptions of stigma did not significantly change over time for the entire sample or within either HIV group. Among HIV-infected women, as the level of perceived stigma increased, the level of disclosure and psychological functioning decreased. Regarding the hypothesized moderating relationship, at high, but not low, levels of disclosure, the relationship between stigma and distress was significant. Implications for health professionals' work with HIV-infected African-American women around the issue of disclosure and stigma are discussed.

Impact of HIV-Related Stigma on Health Behaviors and Psychological Adjustment Among HIV-Positive Men and Women

“…Although the cross-sectional design of this study precludes causal interpretations, it is reasonable to hypothesize that HIV-related stigma heightens vulnerability to depressed mood and other forms of distress rather than vice-versa. A link between stigma and poor psychological adjustment is consistent with recent empirical reports (Clark et al, 2003;Lee et al, 2002) and conceptual models of adjustment to HIV disease (Heckman, 2003;Schmitz & Crystal, 2000). By increasing patients' vulnerability to depression, stigma may also effect longer term health outcomes, as depressive symptoms may further compromise immune functioning (Leonard, 2000) and contribute to more rapid progression to AIDS and mortality (Ickovics et al, 2001).…”

“…Further, findings from a U.S. probability sample indicate that an estimated 21% of women and 12% of MSM living with HIV have experienced physical violence since learning of their diagnosis (Zierler et al, 2000). Collectively, these stigmarelated experiences may contribute to stress and adjustment difficulties among persons living with HIV (Clark, Lindner, Armistead, & Austin, 2003;Lee, Kochman, & Sikkema, 2002). Indeed, findings from a two-city sample of HIV-positive men and women point to an association between internalized stigma and self-reported symptoms of depression, anxiety, and hopelessness (Lee et al, 2002).…”

“…Similar concerns may inhibit condom use negotiation because discussions about the need for safer sex often lead to questions about a partner's serostatus. Although a few studies suggest an association between stigma and disclosure (Clark et al, 2003;van der Straten, Vernon, Knight, Gomez, & Padian, 1998), the association of stigma to condom use and negotiation has not yet been well characterized in the literature.…”

Disparities in Reported Reasons for Not Initiating or Stopping Antiretroviral Treatment Among a Diverse Sample of Persons Living with HIV

“…Among those who reporting having stopped a previous ART regimen, African Americans were more likely to endorse wanting to hide their HIV status as a reason for discontinuing ART. Such a difference suggests that HIV-related stigma may be a more salient barrier to successful maintenance of care for African Americans than for others living with HIV 12,13 . It may be that this pattern reflects a larger mistrust about HIV and HIV treatment that has been reported among African Americans in the US.…”

HIV-related stigma as perceived by HIV-positive individuals in Singapore

“…There is a general consensus that HIV-related stigma poses a major barrier to the control of the HIV pandemic. Fears of stigmatization heighten feelings of denial and the need for concealment [1][2][3]. These result in various social and medical repercussions, increase the complexity of managing the disease.…”