HIV-Related Stigma, Social Support, and Psychological Distress Among Individuals Initiating ART in Ethiopia

• Published in: AIDS and behavior Vol. 22; no. 12; pp. 3815 - 3825
• Main Authors: Parcesepe, Angela, Tymejczyk, Olga, Remien, Robert, Gadisa, Tsigereda, Kulkarni, Sarah Gorrell, Hoffman, Susie, Melaku, Zenebe, Elul, Batya, Nash, Denis
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2018; Springer Nature B.V
• Subjects: Acquired immune deficiency syndrome; Adaptation, Psychological; Adult; Adults; AIDS; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Cross-Sectional Studies; Data processing; Ethiopia - epidemiology; Female; Health Psychology; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - psychology; Human immunodeficiency virus; Humans; Infectious Diseases; Internalization; Male; Medical treatment; Medicine; Medicine & Public Health; Mental Health; Original Paper; Prescription drugs; Psychological distress; Public Health; Social interactions; Social Stigma; Social Support; Stigma; Stress, Psychological; Time Factors; Training; Ethiopia; Psychological distress; Stigma; Ethiopia; Social support
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-018-2059-8

Recent World Health Organization HIV treatment guideline expansion may facilitate timely antiretroviral therapy (ART) initiation. However, large-scale success of universal treatment strategies requires a more comprehensive understanding of known barriers to early ART initiation. This work aims to advance a more comprehensive understanding of interrelationships among three known barriers to ART initiation: psychological distress, HIV-related stigma, and low social support. We analyzed cross-sectional interview data on 1175 adults initiating ART at six HIV treatment clinics in Ethiopia. Experience of each form of HIV-related stigma assessed (e.g., anticipatory, internalized, and enacted) was associated with increased odds of psychological distress. However, among those who reported enacted HIV-related stigma, there was no significant association between social support and psychological distress. Interventions to improve mental health among people living with HIV should consider incorporating components to address stigma, focusing on strategies to prevent or reduce the internalization of stigma, given the magnitude of the relationship between high internalized stigma and psychological distress. Interventions to increase social support may be insufficient to improve the mental health of people living with HIV who experienced enacted HIV-related stigma. Future research should examine alternative strategies to manage the mental health consequences of enacted HIV-related stigma, including coping skills training.