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. 2017 Jan;21(1):283-291.
doi: 10.1007/s10461-016-1451-5.

How Does Stigma Affect People Living with HIV? The Mediating Roles of Internalized and Anticipated HIV Stigma in the Effects of Perceived Community Stigma on Health and Psychosocial Outcomes

Bulent Turan  1 , Henna Budhwani  2 , Pariya L Fazeli  3 , Wesley R Browning  4 , James L Raper  5 , Michael J Mugavero  5 , Janet M Turan  2
Affiliations

How Does Stigma Affect People Living with HIV? The Mediating Roles of Internalized and Anticipated HIV Stigma in the Effects of Perceived Community Stigma on Health and Psychosocial Outcomes

Bulent Turan et al. AIDS Behav. 2017 Jan.

Abstract

Few researchers have attempted to examine the mechanisms through which HIV-related stigma in the community is processed and experienced at an individual level by people living with HIV. We examined how the effects of perceived HIV stigma in the community on health outcomes for people living with HIV are mediated by internalized stigma and anticipated stigma. Participants (N = 203) from an HIV clinic completed self-report measures and their clinical data were obtained from medical records. Results suggested that the association between perceived community stigma and affective, cognitive, and mental health outcomes (self-esteem, depressive symptoms, avoidance coping, self-blame) are mediated by internalized stigma. Furthermore, a serial mediation model suggested that perceived community stigma leads to internalized stigma, which leads to anticipated community stigma, which in turn leads to lower medication adherence. The associations between perceived community stigma and interpersonal outcomes (social support, trust in physicians) were mediated by internalized stigma and anticipated stigma, again in a serial fashion (perceived community stigma leads to internalized stigma, which leads to anticipated stigma, which in turn leads to interpersonal outcomes). These results suggest that perceived HIV-related stigma in the community may cause people living with HIV to internalize stigma and anticipate stigmatizing experiences, resulting in adverse health and psychosocial outcomes-information that can be used to shape interventions.

Keywords: Anticipated stigma; HIV; Internalized stigma; Mechanisms; Mediation; Perceived community stigma; Stigma.

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Conflict of interest statement

Bulent Turan, Henna Budhwani, Pariya L. Fazeli, Wesley R. Browning, James L. Raper, Michael J. Mugavero, and Janet M. Turan, declares that they has no conflict of interest.

Figures

Fig. 1
Fig. 1
The health stigma framework (HSF) originally proposed by Earnshaw, modified by adding perceived community stigma as an additional stigma mechanism
Fig. 2
Fig. 2
Internalized stigma mediates the effect of perceived community stigma on self-esteem. Path coefficients are unstandardized (B). Sex, race, age, socio-economic status, and time on ART are also controlled. aWhen internalized stigma is in the model. *p < 0.05; ** p < 0.01
Fig. 3
Fig. 3
Internalized stigma and anticipated community stigma mediate the effect of perceived community stigma on medication adherence (serial mediation). Path coefficients are unstandardized (B). Sex, race, age, socio-economic status, and time on ART are also controlled. aWhen internalized stigma and anticipated community stigma are in the model. *p < 0.05; **p <0.01
Fig. 4
Fig. 4
Internalized stigma and anticipated stigma from friends and family mediate the effect of perceived community stigma on social support (serial mediation). Path coefficients are unstandardized (B). Sex, race, age, socio-economic status, and time on ART are also controlled. aWhen internalized stigma and anticipated stigma from friends and family are in the model. *p < 0.05; **p < 0.01
Fig. 5
Fig. 5
Internalized stigma and anticipated stigma from healthcare workers mediate the effect of perceived community stigma on trust in physicians (serial mediation). Path coefficients are unstandardized (B). Sex, race, age, socio-economic status, and time on ART are also controlled. When internalized stigma and anticipated stigma from healthcare workers are in the model. *p < 0.05; **p < 0.01
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