Perceived stigma may lead to increased experienced stigma among people living with HIV

A transactional approach to relationships over time between perceived HIV stigma and the psychological and physical well-being of people with HIV.

Miller CT, Solomon SE, Varni SE, Hodge JJ, Knapp FA, Bunn JY. Soc Sci Med. 2016 Jun 16;162:97-105. doi: 10.1016/j.socscimed.2016.06.025. [Epub ahead of print]

Rationale: Cross-sectional studies demonstrate that perceived discrimination is related to the psychological and physical well-being of stigmatized people. The theoretical and empirical foci of most of this research is on how racial discrimination undermines well-being. The present study takes a transactional approach to examine people with HIV, a potentially concealable stigma.

Hypothesis: The transactional approach posits that even as discrimination adversely affects the psychological well-being of people with HIV, psychological distress also makes them more sensitive to perceiving that they may be or have been stigmatized, and may increase the chances that other people actually do stigmatize them.

Methods: This hypothesis was tested in a longitudinal study in which 216 New England residents with HIV were recruited to complete measures of perceived HIV stigma and well-being across three time points, approximately 90 days apart. This study also expanded on past research by assessing anticipated and internalized stigma as well as perceived discrimination.

Results: Results indicated that all of these aspects of HIV stigma prospectively predicted psychological distress, thriving, and physical well-being. Equally important, psychological distress and thriving also prospectively predicted all three aspects of HIV stigma, but physical well-being did not.

Conclusion: These findings suggest that people with HIV are ensnared in a cycle in which experiences of stigma and reduced psychological well-being mutually reinforce each other.

Abstract access [1]

Editor’s notes: Stigma can act as a barrier to the delivery and uptake of HIV care. This study investigated the transactional approach to understanding stigma. The authors sought to determine whether psychological stress due to perceptions of discrimination causes people living with HIV to be more sensitive to perceiving stigma. Then in turn whether this makes it more likely that they will be stigmatized. The authors examined data from a longitudinal study of 216 participants in New England in the United States. The study was embedded within a larger study protocol that sought to answer a broad range of research questions. Participants responded to a questionnaire which asked questions about participants’ perceived stigma based on the HIV Stigma Scale developed by Berger and colleagues in 2001. The authors used three subscales to measure enacted, anticipated, and internalized stigma. Participants responded to questions on a 5-point subscale of strongly disagree (scored as 1) to strongly agree (scored as 5) to questions about the three different types of stigma. The authors analysed associations between perceived, internalized, and experienced stigma. The authors concluded that understanding the transactional relationship between HIV-associated stigma and psychological stress is important for developing and implementing effective HIV-associated stigma programmes. Perceptions of stigma may lead to increases in perceived and experienced stigma among people living with HIV. This study suggests that future programmes that seek to address HIV-associated stigma should incorporate an understanding of the transactional relationship between psychological stress and perceived and experienced stigma.

Northern America [6]
United States of America [7]
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