Experienced HIV-related stigma in healthcare and community settings: Mediated associations with psychosocial and health outcomes

INTRODUCTION: There are multiple dimensions of HIV-related stigma that can compromise the mental and physical health of people living with HIV (PLWH). We focused on the dimension of experienced stigma, defined as exposure to acts of discrimination, devaluation, and prejudice, and investigated its relationship with HIV health and psychosocial outcomes. METHODS: We examined associations between experienced stigma in the community and healthcare settings and psychosocial and health outcomes for PLWH (N=203) receiving care at an urban HIV clinic in the Southeastern United States. We also investigated whether those effects are unique to experienced stigma or are mediated by other dimensions of HIV-related stigma. RESULTS: Experienced stigma was associated with suboptimal clinical outcomes like viral non-suppression, as well as poor affective, cognitive, and mental health outcomes (self-esteem, depressive symptoms, avoidance coping, and blame coping) and interpersonal outcomes like social support and physician trust. Furthermore, serial mediation models suggested significant indirect effects of experienced stigma through internalized stigma and anticipated stigma from various theoretically expected sources of stigma (e.g., community members, friends and family, and healthcare workers), with varying effects depending on the source. CONCLUSIONS: These findings suggest nuanced mechanisms for the effects of experienced HIV-related stigma, especially in healthcare settings, and may be used to inform stigma-reduction interventions. Interventions designed to address experienced stigma in healthcare settings might be more tailored to specific outcomes, like depression and physician trust, than interventions designed to address experienced stigma in the community.