The Correlation Between Stigma and Mental Health Disorders in People Living with HIV/AIDS
Abstract
Stigma remains a significant challenge for people living with HIV/AIDS(PLWHA) despite the advances that have been made in HIV care and treatment. It is known to affect health care outcomes including care seeking habits and medication adherence. In addition to contributing to poor health outcomes, stigma is known to increase the risk of developing mental health disorders. Various researchers have found a correlation between stigma and mental health disorders including depression, anxiety, mental distress, stress, post-traumatic stress disorder (PTSD), and suicidal ideation. The aim of this review is to explore the association between stigma and mental health disorders in PLWHA. It identifies common mental health disorders found in people living with HIV and how these disorders are linked to stigma. The review also identifies how stigma and mental health disorders affect healthcare outcomes of PLWHA. The review concludes by providing a number of measures that can help to end stigma and improve overall health outcomes of PLWHA.
Keywords: stigma, HIV-related stigma, HIV/AIDS, mental health disorders, people living with HIV/AIDS
Keywords:
stigma, HIV-related stigma, HIV/AIDS, mental health disorders, people living with HIV/AIDSDOI
https://doi.org/10.22270/jddt.v14i3.6490References
Global Network of People Living with HIV (GNP+). The People Living with HIV Stigma Index. Secondary The People Living with HIV Stigma Index. 2023. Accessed March 1 2024. https://www.stigmaindex.org/wp-content/uploads/2023/11/PLHIV-Stigma-Index-Global-Report-2023-2.pdf
Goffman E. Stigma: Notes on the Management of Spoiled Identity. Garden City, NY: Anchor Books; 1963.
Mahajan AP, Sayles JN, Patel VA, et al., Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. Aids. 2008; 22:S67-79. https://doi.org/10.1097/01.aids.0000327438.13291.62 PMid:18641472 PMCid:PMC2835402
Turan B, Budhwani H, Fazeli PL, et al. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS and Behavior. 2017;21:283-91. https://doi.org/10.1007/s10461-016-1451-5 PMid:27272742 PMCid:PMC5143223
Rueda S, Mitra S, Chen S, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;6(7):e011453. https://doi.org/10.1136/bmjopen-2016-011453 PMid:27412106 PMCid:PMC4947735
Gray AJ. Stigma in psychiatry. Journal of the Royal Society of Medicine. 2002;95(2):72-6. https://doi.org/10.1258/jrsm.95.2.72 PMid:11823548 PMCid:PMC1279314
Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS and Behavior. 2013; 17:1785-95. https://doi.org/10.1007/s10461-013-0437-9 PMid:23456594 PMCid:PMC3664141
Fauk NK, Hawke K, Mwanri L, Ward PR. Stigma and discrimination towards people living with HIV in the context of families, communities, and healthcare settings: a qualitative study in Indonesia. International Journal of Environmental Research and Public Health. 2021;18(10):5424. https://doi.org/10.3390/ijerph18105424 PMid:34069471 PMCid:PMC8159085
Yi S, Chhoun P, Suong S, Thin K, Brody C, Tuot S. AIDS-related stigma and mental disorders among people living with HIV: a cross-sectional study in Cambodia. PloS one. 2015;10(3):e0121461. https://doi.org/10.1371/journal.pone.0121461 PMid:25806534 PMCid:PMC4373790
MacLean JR, Wetherall K. The association between HIV-stigma and depressive symptoms among people living with HIV/AIDS: A systematic review of studies conducted in South Africa. Journal of Affective Disorders. 2021;287:125-37. https://doi.org/10.1016/j.jad.2021.03.027 PMid:33780828
Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742-53. https://doi.org/10.1080/09540120802511877 PMid:19806490
Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS and Behavior. 2009;13:1160-77. https://doi.org/10.1007/s10461-009-9593-3 PMid:19636699 PMCid:PMC4511707
Lee RS, Kochman A, Sikkema KJ. Internalized stigma among people living with HIV-AIDS. AIDS and Behavior. 2002;6:309-19. https://doi.org/10.1023/A:1021144511957
Valverde E, Rodriguez A, White B, Guo Y, Waldrop-Valverde D. Understanding the association of internalized HIV stigma with retention in HIV care. Journal of HIV and AIDS. 2018;4(3). https://doi.org/10.16966/2380-5536.159 PMid:31341949 PMCid:PMC6656404
Mak WW, Poon CY, Pun LY, Cheung SF. Meta-analysis of stigma and mental health. Social Science & Medicine. 2007;65(2):245-61. https://doi.org/10.1016/j.socscimed.2007.03.015 PMid:17462800
Lo Hog Tian JM, Watson JR, Ibáñez-Carrasco F, Tran B, Parsons JA, Maunder RG, Card KG, Baral S, Hui C, Boni AR, Ajiboye M. Impact of experienced HIV stigma on health is mediated by internalized stigma and depression: results from the people living with HIV stigma index in Ontario. BMC Public Health. 2021;21:1-0. https://doi.org/10.1186/s12889-021-11596-w PMid:34496825 PMCid:PMC8427956
Kimera E, Vindevogel S, Engelen AM, De Maeyer J, Reynaert D, Kintu MJ, Rubaihayo J, Bilsen J. HIV-related stigma among youth living with HIV in Western Uganda. Qualitative Health Research. 2021; 31(10):1937-50. https://doi.org/10.1177/10497323211012347 PMid:33980098
Earnshaw VA, Quinn DM, Park CL. Anticipated stigma and quality of life among people living with chronic illnesses. Chronic Illness. 2012; 8(2):79-88. https://doi.org/10.1177/1742395311429393 PMid:22080524 PMCid:PMC3644808
Bernard C, Dabis F, de Rekeneire N. Prevalence and factors associated with depression in people living with HIV in sub-Saharan Africa: a systematic review and meta-analysis. PloS One. 2017;12(8):e0181960. https://doi.org/10.1371/journal.pone.0181960 PMid:28783739 PMCid:PMC5544236
Algarin AB, Sheehan DM, Varas-Diaz N, Fennie K, Zhou Z, Spencer EC, Cook CL, Cook RL, Ibanez GE. Enacted HIV-related stigma's association with anxiety & depression among people living with HIV (PLWH) in Florida. AIDS and Behavior. 2021;25(1):93-103. https://doi.org/10.1007/s10461-020-02948-5 PMid:32564164 PMCid:PMC7749818
Abebe H, Shumet S, Nassir Z, Agidew M, Abebaw D. Prevalence of depressive symptoms and associated factors among HIV-positive youth attending ART follow-up in Addis Ababa, Ethiopia. AIDS Research and Treatment. 2019;2019. https://doi.org/10.1155/2019/4610458 PMid:30719348 PMCid:PMC6334359
Tran BX, Ho RC, Ho CS, Latkin CA, Phan HT, Ha GH, Vu GT, Ying J, Zhang MW. Depression among patients with HIV/AIDS: research development and effective interventions (GAPRESEARCH). International Journal of Environmental Research and Public Health. 2019;16(10):1772. https://doi.org/10.3390/ijerph16101772 PMid:31109139 PMCid:PMC6571985
Deshmukh NN, Borkar AM, Deshmukh JS. Depression and its associated factors among people living with HIV/AIDS: Can it affect their quality of life?. Journal of Family Medicine and Primary Care. 2017;6(3):549. https://doi.org/10.4103/2249-4863.222016 PMid:29417006 PMCid:PMC5787953
Casale M, Boyes M, Pantelic M, Toska E, Cluver L. Suicidal thoughts and behaviour among South African adolescents living with HIV: Can social support buffer the impact of stigma?. Journal of Affective Disorders. 2019;245:82-90. https://doi.org/10.1016/j.jad.2018.10.102 PMid:30368074
Evangeli M, Wadley AL, Pincus T. A preliminary analysis of the association between perceived stigma and HIV-related pain in South Africans living with HIV. African Journal of Primary Health Care and Family Medicine. 2019;11(1):1-5. https://doi.org/10.4102/phcfm.v11i1.1647 PMid:30843417 PMCid:PMC6407439
Smallheer BA, Vollman M, Dietrich MS. Learned helplessness and depressive symptoms following myocardial infarction. Clinical Nursing Research. 2018;27(5):597-616. https://doi.org/10.1177/1054773816689752 PMid:28129708
Ivanova EL, Hart TA, Wagner AC, Aljassem K, Loutfy MR. Correlates of anxiety in women living with HIV of reproductive age. AIDS and Behavior. 2012;16:2181-91. https://doi.org/10.1007/s10461-011-0133-6 PMid:22246517
Wagner AC, Hart TA, Mohammed S, Ivanova E, Wong J, Loutfy MR. Correlates of HIV stigma in HIV-positive women. Archives of Women's Mental Health. 2010;13:207-14. https://doi.org/10.1007/s00737-010-0158-2 PMid:20372948
Varni SE, Miller CT, McCuin T, Solomon S. Disengagement and engagement coping with HIV/AIDS stigma and psychological well-being of people with HIV/AIDS. Journal of Social and Clinical Psychology. 2012;31(2):123-50. https://doi.org/10.1521/jscp.2012.31.2.123 PMid:22611302 PMCid:PMC3355931
Gonzalez A, Solomon SE, Zvolensky MJ, Miller CT. The interaction of mindful-based attention and awareness and disengagement coping with HIV/AIDS-related stigma in regard to concurrent anxiety and depressive symptoms among adults with HIV/AIDS. Journal of Health Psychology. 2009;14(3):403-13. https://doi.org/10.1177/1359105309102193 PMid:19293302 PMCid:PMC3434880
Kang E, Rapkin BD, Remien RH, Mellins CA, Oh A. Multiple dimensions of HIV stigma and psychological distress among Asians and Pacific Islanders living with HIV illness. AIDS and Behavior. 2005;9:145-54. https://doi.org/10.1007/s10461-005-3896-9 PMid:15933834
Rongkavilit C, Wright K, Chen X, Naar-King S, Chuenyam T, Phanuphak P. HIV stigma, disclosure and psychosocial distress among Thai youth living with HIV. International Journal of STD & AIDS. 2010;21(2):126-32. https://doi.org/10.1258/ijsa.2009.008488 PMid:20089999
Tesfaye SH, Bune GT. Generalized psychological distress among HIV-infected patients enrolled in antiretroviral treatment in Dilla University Hospital, Gedeo zone, Ethiopia. Global health action. 2014;7(1):23882. https://doi.org/10.3402/gha.v7.23882 PMid:24852246 PMCid:PMC4030443
Anakwa NO, Teye-Kwadjo E, Kretchy IA. Effect of HIV-related stigma and HIV-related stress on HIV disclosure concerns: a study of HIV-positive persons on antiretroviral therapy at two urban hospitals in Ghana. Applied Research in Quality of Life. 2021;16:1249-64. https://doi.org/10.1007/s11482-020-09813-6
Zhu M, Guo Y, Li Y, Zeng C, Qiao J, Xu Z, Zeng Y, Cai W, Li L, Liu C. HIV-related stigma and quality of life in people living with HIV and depressive symptoms: Indirect effects of positive coping and perceived stress. AIDS Care. 2020;32(8):1030-5. https://doi.org/10.1080/09540121.2020.1752890 PMid:32290681
Glynn TR, Llabre MM, Lee JS, et al. Pathways to health: An examination of HIV-related stigma, life stressors, depression, and substance use. International Journal of Behavioral Medicine. 2019;26:286-96. https://doi.org/10.1007/s12529-019-09786-3 PMid:31065930 PMCid:PMC6563607
Gonzalez A, Locicero B, Mahaffey B, Fleming C, Harris J, Vujanovic AA. Internalized HIV stigma and mindfulness: associations with PTSD symptom severity in trauma-exposed adults with HIV/AIDS. Behavior Modification. 2016;40(1-2):144-63. https://doi.org/10.1177/0145445515615354 PMid:26584609
Breet E, Kagee A, Seedat S. HIV-related stigma and symptoms of post-traumatic stress disorder and depression in HIV-infected individuals: does social support play a mediating or moderating role?. AIDS Care. 2014;26(8):947-51. https://doi.org/10.1080/09540121.2014.901486 PMid:24666226
Adewuya AO, Afolabi MO, Ola BA, et al. Post-traumatic stress disorder (PTSD) after stigma related events in HIV infected individuals in Nigeria. Social Psychiatry and Psychiatric Epidemiology. 2009;44:761-6. https://doi.org/10.1007/s00127-009-0493-7 PMid:19225704
Tsai YT, Padmalatha S, Ku HC, et al. Suicidality among people living with HIV from 2010 to 2021: a systematic review and a meta-regression. Psychosomatic Medicine. 2022;84(8):924. https://doi.org/10.1097/PSY.0000000000001127 PMid:36162070 PMCid:PMC9553271
Orsolini L, Latini R, Pompili M, et al. Understanding the complex of suicide in depression: from research to clinics. Psychiatry Investigation. 2020;17(3):207. https://doi.org/10.30773/pi.2019.0171 PMid:32209966 PMCid:PMC7113180
Ferlatte O, Salway T, Oliffe JL, Trussler T. Stigma and suicide among gay and bisexual men living with HIV. AIDS Care. 2017;29(11):1346-50. https://doi.org/10.1080/09540121.2017.1290762 PMid:28278571
Wei L, Yan H, Guo M, et al. Perceived HIV stigma, depressive symptoms, self-esteem, and suicidal ideation among people living with HIV/AIDS in China: A moderated mediation modeling analysis. Journal of Racial and Ethnic Health Disparities. 2023;10(2):671-9. https://doi.org/10.1007/s40615-022-01255-0 PMid:35165837 PMCid:PMC8853186
Fu J, Chen X, Dai Z, et al. HIV-related stigma, depression and suicidal ideation among HIV-positive MSM in China: a moderated mediation model. BMC Public Health. 2023 Oct 27;23(1):2117. https://doi.org/10.1186/s12889-023-17047-y PMid:37891525 PMCid:PMC10612198
Armoon B, Fleury MJ, Bayat AH, et al. HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis. International Journal of Mental Health Systems. 2022 Dec;16(1):1-7. https://doi.org/10.1186/s13033-022-00527-w PMid:35246211 PMCid:PMC8896327
Pelton M, Ciarletta M, Wisnousky H, et al. Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis. General Psychiatry. 2021;34(2). https://doi.org/10.1136/gpsych-2020-100247 PMid:33912798 PMCid:PMC8042999
Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. Journal of Antimicrobial Chemotherapy. 2009;63(4):636-40. https://doi.org/10.1093/jac/dkp006 PMid:19153077 PMCid:PMC2654041
Mayston R, Kinyanda E, Chishinga N, Prince M, Patel V. Mental disorder and the outcome of HIV/AIDS in low-income and middle-income countries: a systematic review. Aids. 2012;26:S117-35. https://doi.org/10.1097/QAD.0b013e32835bde0f PMid:23303434
Yehia BR, Stephens-Shield AJ, Momplaisir F, et al. Health outcomes of HIV-infected people with mental illness. AIDS and Behavior. 2015 Aug;19:1491-500. https://doi.org/10.1007/s10461-015-1080-4 PMid:25931243 PMCid:PMC4527875
Nel A, Kagee A. Common mental health problems and antiretroviral therapy adherence. AIDS Care. 2011;23(11):1360-5. https://doi.org/10.1080/09540121.2011.565025 PMid:22022846
Rao D, Nainis N, Williams L, Langner D, Eisin A, Paice J. Art therapy for relief of symptoms associated with HIV/AIDS. AIDS Care. 2009;21(1):64-9. https://doi.org/10.1080/09540120802068795 PMid:19085221
Treves-Kagan S, Steward WT, Ntswane L, et al. Why increasing availability of ART is not enough: a rapid, community-based study on how HIV-related stigma impacts engagement to care in rural South Africa. BMC Public Health. 2015;16:1-3. https://doi.org/10.1186/s12889-016-2753-2 PMid:26823077 PMCid:PMC4730651
Steward WT, Bharat S, Ramakrishna J, Heylen E, Ekstrand ML. Stigma is associated with delays in seeking care among HIV-infected people in India. Journal of the International Association of Providers of AIDS Care (JIAPAC). 2013;12(2):103-9. https://doi.org/10.1177/1545109711432315 PMid:22282878 PMCid:PMC3482419
Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS patient care and STDs. 2007;21(8):584-92. https://doi.org/10.1089/apc.2006.0202 PMid:17711383
Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS (London, England). 2006;20(12):1571. https://doi.org/10.1097/01.aids.0000238402.70379.d4 PMid:16868437 PMCid:PMC2801555
Remien RH, Stirratt MJ, Nguyen N, Robbins RN, Pala AN, Mellins CA. Mental health and HIV/AIDS: the need for an integrated response. AIDS (London, England). 2019;33(9):1411. https://doi.org/10.1097/QAD.0000000000002227 PMid:30950883 PMCid:PMC6635049
Senn TE, Greenwood GL, Rao VR. Global mental health and HIV care: gaps and research priorities. Journal of the International AIDS Society. 2021;24(Suppl 2). https://doi.org/10.1002/jia2.25714 PMid:34164945 PMCid:PMC8222835
Coleman SM, Blashill AJ, Gandhi RT, Safren SA, Freudenreich O. Impact of integrated and measurement-based depression care: clinical experience in an HIV clinic. Psychosomatics. 2012;53(1):51-7. https://doi.org/10.1016/j.psym.2011.07.004 PMid:22221721
Farber EW, Shahane AA, Brown JL, Campos PE. Perceived stigma reductions following participation in mental health services integrated within community-based HIV primary care. AIDS Care. 2014;26(6):750-3. https://doi.org/10.1080/09540121.2013.845285 PMid:24093931
Chuah FL, Haldane VE, Cervero-Liceras F, et al. Interventions and approaches to integrating HIV and mental health services: a systematic review. Health Policy and Planning. 2017;32(suppl_4):iv27-47. https://doi.org/10.1093/heapol/czw169 PMid:29106512 PMCid:PMC5886062
Pulerwitz J, Michaelis A, Weiss E, Brown L, Mahendra V. Reducing HIV-related stigma: lessons learned from Horizons research and programs. Public Health Reports. 2010;125(2):272-81. https://doi.org/10.1177/003335491012500218 PMid:20297756 PMCid:PMC2821857
Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV‐related stigma and discrimination from 2002 to 2013: how far have we come?. Journal of the International AIDS Society. 2013;16:18734. https://doi.org/10.7448/IAS.16.3.18734 PMid:24242268 PMCid:PMC3833106
Feyissa GT, Lockwood C, Woldie M, Munn Z. Reducing HIV-related stigma and discrimination in healthcare settings: A systematic review of quantitative evidence. PloS one. 2019 Jan 25;14(1):e0211298. https://doi.org/10.1371/journal.pone.0211298 PMid:30682131 PMCid:PMC6347272
Reis RK, Galvao MT, Gir E. Challenges to an effective response for addressing stigma and discrimination related to HIV: from denial of rights to construction of support networks. Journal of the International AIDS Society. 2013;16(1). https://doi.org/10.7448/IAS.16.1.18931 PMid:24314399 PMCid:PMC3854119
Mburu G, Ram M, Skovdal M, Bitira D, Hodgson I, Mwai GW, Stegling C, Seeley J. Resisting and challenging stigma in Uganda: the role of support groups of people living with HIV. Journal of the International AIDS Society. 2013;16:18636. https://doi.org/10.7448/IAS.16.3.18636 PMid:24242256 PMCid:PMC3833188
Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works?. Journal of the International AIDS Society. 2009;12:1-7. https://doi.org/10.1186/1758-2652-12-15 PMid:19660113 PMCid:PMC2731724
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