Yale University

Assessing and Addressing Stigma towards PLWHA in Connecticut to Strengthen the Implementation of Evidence-Based Interventions

Funder: CIRA
Project period: 10/16/2012 - 10/15/2013
Grant Type: Research

Abstract Text:

Interventions and clinical services delivered within community settings can enhance health and health behaviors among people living with HIV/AIDS (PLWHA). However, social devaluation and discrediting associated with HIV, or HIV stigma, is a barrier to the implementation of these interventions and services. PLWHA experience poor health outcomes as a result of previous experiences of discrimination due to HIV (enacted stigma), expectations of future discrimination due to HIV (anticipated stigma), and feeling badly about themselves due to their HIV (internalized stigma). It is critical to understand and enhance aspects of individuals, interpersonal relationships, and communities that provide a buffer to PLWHA from the negative impact of stigma to strengthen the implementation of interventions and services. This project aimed to identify stigma protective factors held by PLWHA residing in Hartford, New Britain, and New Haven.

Outcome(s):

How much stigma did people experience?

  • We examined the mean scores and standard deviations of stigma measures to determine how much stigma participants experienced. See Table 1 in Appendix for statistical results. 
  • Experiences in past: On average, participants reported that they “never / not often” experienced discrimination from others in the past. They reported experiencing slightly more discrimination from family members than from AIDS service and housing staff and health care workers. 
  • Expectations for future: On average, participants thought that it was “very unlikely / unlikely” that they would be discriminated against by others in the future. They thought that it was slightly more likely that family members and employers would discriminate against them than AIDS service and housing staff and health care workers. 
  • Internalization: On average, participants did not feel very badly about themselves, or feel very shameful about having HIV. 
  • However, there was variability in these experiences: Some participants reported that they did not experience stigma whereas others reported that they experienced a lot of stigma.

Was stigma related to poor health?

  • We examined correlations between measures of stigma and health outcomes to determine whether they were related, and have reported statistically significant correlations. See Table 2 in Appendix for statistical results.
  • HIV symptoms: Participants who reported more experiences of discrimination in the past and who felt worse about themselves experienced more severe HIV symptoms.
  • Stress: Participants who reported more experiences of discrimination in the past, who expected more discrimination in the future, and who felt worse about themselves experienced greater stress.
  • Depression: Participants who felt worse about themselves experienced more depressive symptoms.
  • HIV medication adherence: Participants who felt worse about themselves were more likely to miss 2 or more doses of their HIV medication in a row.
  • Feeling badly about oneself, or internalization, was related to the greatest number of poor health outcomes. This suggests internalization may be particularly harmful to health.

What protected participants from stigma?

  • We conducted regression analyses to determine which factors protected participants from stigma. We looked for evidence of moderation of the relationship between experiences of stigma and health outcomes by stigma protective factors (i.e., a statistically significant interaction between a stigma experience and a protective factor).4 See Tables 3 and 4 in Appendix for statistical results.

Stigma Protective Factors

  • We found several stigma protective factors: Participants did better despite stigma if they possessed the following factors:
  • Instrumental social support: Having someone to rely on for meals, accompany to doctor, etc.
  • Perceiving community support structures: Agreeing that there are groups/ services in community that are accepting of PLWHA.
  • Optimism: Believing in a good future.
  • Community involvement: Being involved in community clubs, sports, organizations, etc.

Stigma Exacerbating Factors

  • Unexpectedly, we found stigma exacerbating factors: People did worse because of stigma if they possessed the following factors:
  • Venting to cope with stigma: Talking about discrimination to “let off steam”.
  • Managing feelings about HIV: Feeling like can cope with one’s emotions about HIV.
  • Outness about HIV: More people know about one’s HIV.
  • Identification with PLWHA: Feeling similar to other PLWHA.

Centrality

  • Feeling like HIV is a central part of one’s identity was protective for people who expected stigma in the future. However, it was exacerbating if they felt badly about themselves due to their HIV.

RECOMMENDATIONS

  • Social support emerged as particularly protective. Bolstering instrumental social support (e.g., having others help by driving to doctor, preparing meals) from friends/family at the interpersonal level and increasing knowledge of support structures (e.g., housing, healthcare, legal services) at the community level may help buffer PLWHA from the negative impact of stigma.
  • Internalized stigma was especially harmful for health outcomes. Encouraging positive community involvement may buffer PLWHA from internalized stigma by reinforcing other, positive aspects of the self. It may be helpful to encourage PLWHA to become involved in community churches, sports teams, clubs, and/or organizations.
  • Surprisingly, venting to cope with enacted stigma made the effect of stigma on health outcomes worse. It may be worthwhile to encourage PLWHA to cope with enacted stigma in other ways.