People who feel stigmatised less likely to access HIV care

HIV-related stigma is associated with poor access to specialist HIV medical care, US investigators report in the online edition of the Journal of General Internal Medicine. The research also showed that a large proportion of HIV-positive individuals report "internalised" stigma.

“Our study provides important information about the association between internalized stigma and self-reported access to medical care”, comment the investigators.

There have been dramatic improvements in HIV treatment, thanks to which the prognosis of many HIV-infected individuals is now considered normal.

Nevertheless, HIV remains a stigmatised illness and this can threaten the emotional, mental and physical health of HIV-infected individuals.

Stigma is a complex concept, but is generally accepted to be rooted in perceived deviance from the values and social norms of a community. Internalised stigma can develop should an individual accept such societal norms but deviate from them.

Investigators from Los Angeles hypothesised that internalised HIV stigma would be associated with three key aspects of HIV care:

• Self-reported access to HIV care.
• Having a regular source of HIV care.
• Adherence to HIV treatment.

A total of 202 individuals were recruited to the research from HIV clinics and support services in Los Angeles. The research was undertaken in 2007.

Most (56%) were women and an equal proportion African American. The mean age was 43 years and 31% were gay men.

Internalised stigma was assessed using a questionnaire which scored individual’s responses on a scale of 0 to 100. The overall score was 41, suggesting that well over a third of participants had significant internalised HIV-associated stigma.

Overall, 77% of individuals reported having poor access to healthcare, 11% having no regular source of HIV care, and 43% poor adherence to their HIV treatment.

The investigators’ first set of statistical analyses showed that individuals reporting a high level of internalised stigma were more likely to report poor access to HIV care (odds ratio [OR] = 4.97; 95% CI, 2.54-9.72), to lack a regular source of HIV care (OR = 2.48, 95% CI, 1.00-6.19), and to have low levels of adherence to their HIV medication (OR = 2.45, 95% CI, 1.23-4.91).

However, when the investigators adjusted their results to take into account possible confounding factors, they found that internalised stigma only remained significantly associated with poor access to HIV care (adjusted OR = 4.42, 95% CI, 1.88-10.37). They also established that poor mental health, rather than internalised stigma per se explained suboptimal adherence to HIV treatment.

“Approximately one-third of participants reported experiencing high levels of internalized HIV stigma”, comment the investigators, adding “we found that respondents experiencing high levels of stigma had over four times the odds of reporting poor access to care.”

They note that their study was limited by its cross-sectional design and that further prospective studies are needed to better determine the relationship between stigma and access to HIV care. “Such studies could enable us to examine changes in stigma and its contribution to health care and health outcomes throughout the disease trajectory”, conclude the researchers.