The Effects of HIV Stigma on Health, Disclosure of HIV Status, and Risk Behavior of Homeless and Unstably Housed Persons Living with HIV

Abstract

HIV-related stigma negatively affects the lives of persons living with HIV/AIDS (PLWHA). Homeless/unstably housed PLWHA experience myriad challenges and may be particularly vulnerable to the effects of HIV-related stigma. Homeless/unstably housed PLWHA from 3 U.S. cities (N = 637) completed computer-assisted interviews that measured demographics, self-assessed physical and mental health, medical utilization, adherence, HIV disclosure, and risk behaviors. Internal and perceived external HIV stigma were assessed and combined for a total stigma score. Higher levels of stigma were experienced by women, homeless participants, those with a high school education or less, and those more recently diagnosed with HIV. Stigma was strongly associated with poorer self-assessed physical and mental health, and perceived external stigma was associated with recent non-adherence to HIV treatment. Perceived external stigma was associated with decreased HIV disclosure to social network members, and internal stigma was associated with drug use and non-disclosure to sex partners. Interventions are needed to reduce HIV-related stigma and its effects on the health of homeless/unstably housed PLWHA.

Measuring HIV- and AIDS-Related Stigma and Discrimination in Nicaragua: Results From a Community-Based Study

“…On the other hand, HIV VCT will contribute to reduce HIV-related stigma and discrimination because it provides information that may reduce misconceptions about HIV, encourage changes in behavior, and decrease the likehood of becoming infected by or transmitting HIV. HIV-and AIDS-related stigma and discrimination have previously been identified as key obstacles to the disclosure of HIV-positive status (Chen et al, 2005;Wolitski et al, 2009). Thus, stigma was found to be a mediator in the trajectory from misconception to unwillingness to disclose among female respondents (Yang et al, 2006).…”

“…Negative attitudes affect people living with HIV (PLHIV) by making them unwilling to reveal their status. This, in turn, deprives them of support they might have sought and the benefit of information, counseling, and treatment services (Gruskina & Tarantola, 2008; Joint United Nations Programme on HIV/AIDS, 2007; Link & Phelan, 2006;Pollini, Blanco, Crump, & Zúñiga, 2011;Wolitski, Pals, Kidder, Courtenay-Quirk, & Holtgrave, 2009;Yang et al, 2006). Stigma may also interfere with the investigation of HIV by discouraging PLHIV to join the research initiative (Nyblade, Singh, Ashburn, Brady, & Olenja, 2011).…”

Advancing methodology in the study of HIV status disclosure: The importance of considering disclosure target and intent

“…Other studies point out that disclosure may also result in stigmatization Valle & Levy, 2009) manifest as, for example, avoidance, rejection, exclusion, blaming, physical distance, and awkward social interaction (Shamos et al, 2009;Stutterheim et al, 2009Stutterheim et al, , 2012. High levels of perceived, anticipated, or internalized stigma, in turn, have been found to yield lower levels of disclosure (Stutterheim, Shiripinda et al, 2011;Tsai et al, 2013;Wolitski et al, 2009). Recent reviews of HIV disclosure research describe a complex and often inconsistent picture of the relationships between disclosure acts, antecedents and outcomes (Chaudoir & Fisher, 2010;Chaudoir et al, 2011;Smith et al, 2008).…”

Social Networks, Interpersonal Social Support, and Health Outcomes: A Health Communication Perspective

“…Social network members may avoid communicating with a person or fail to provide satisfying support when it is needed most. Research has found that this often happens when an individual is seeking support for a stigmatized health condition (Wolitski et al, 2008;Wright and Miller, 2010;Wright and Rains, 2013). For example, cancer and HIV sometimes frighten people into silence or avoidance.…”