High levels of stigma are experienced by people with HIV, and this is consistently associated with lack of social support, poor physical and mental health, poverty and younger age, according to the results of a meta-analysis published in the June edition of AIDS Care. A total of 24 studies conducted since 2000, involving a wide range of people with HIV, were included in the analysis.
The authors suggest “health professionals caring for people living with HIV as well as HIV-related stigma interventions and support programmes could benefit from an enhanced understanding of correlates of HIV-related stigma”.
Stigma has been associated with HIV since the beginnings of the epidemic and is experienced by individuals in different ways.
HIV-positive people are often blamed for their infection, on occasion even by healthcare providers. HIV also disproportionately affects groups that are already stigmatised, including gay men, injecting drugs users and migrant populations.
Earlier research has shown that HIV-related stigma is associated with mental health needs, social exclusion, lower quality of life, and poor physical health. Moreover, studies have also indicated that age, gender, income, race/ethnicity, and sexual orientation are associated with stigma.
However, studies examining HIV-related stigma have varied by their sample size and population, measures of stigma, data collection and statistical analysis. It has therefore been difficult to compare their findings, or generalise them to wider populations of individuals living with HIV.
Investigators therefore conducted a meta-analysis of recently published studies that measured HIV-related stigma. Their aims were to establish the strength and direction of the association between HIV-related stigma and physical, mental and emotional health, and also to determine the associations between stigma and a number of demographic characteristics.
A total of 24 studies published in peer-reviewed journals since 2000 were included in this analysis. These studies involved a total of 5600 HIV-positive individuals from diverse backgrounds.
The investigators found that a wide variety of factors were associated with stigma.
These included having more advanced HIV disease (p
Experiencing discrimination was another significant factor (p
However, adequate social support and good mental health were both significantly associated with less reported stigma.
Although there was considerable variability in the way the included studies assessed individuals’ experiences of stigma and their health and well-being, the investigators nevertheless found that “high stigma levels were consistently and significantly associated with lack of social support, poor physical health, poor mental health, lower income and younger age.”
The authors recommend that “effective interventions to challenge HIV-related stigma should operate on multiple levels and target several populations.” Wider-ranging structural interventions are also needed, and the authors suggest these should provide “legal protection from HIV-related stigma and discrimination as well as address poverty through increasing access to employment for people living with HIV and ensuring adequate disability insurance”.
Reference
Logie C et al. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care 21: 742-53, 2009.