Trajectories of HIV-Related Internalized Stigma and Disclosure Concerns Among ART Initiators and Non-initiators in South Africa

Authors

Brian T. Chan
Brendan G. Maughan-Brown, University of Cape Town
Laura M. Bogart, RAND Corporation
Valerie A. Earnshaw, University of Delaware
Gugulethu Tshabalala, University of the Witwatersrand
Ingrid Courtney, University of Cape Town
Janan J. Dietrich, University of the Witwatersrand
Catherine Orrell, University of Cape TownFollow
Glenda Gray, University of the Witwatersrand
David R. Bangsberg, OHSU-PSU School of Public HealthFollow
Alexander C. Tsai, Harvard UniversityFollow
Ingrid T. Katz, Harvard Medical School

Published In

Stigma and Health

Document Type

Post-Print

Publication Date

1-1-2020

Subjects

HIV -- Case studies, AIDS (Disease) -- Treatment -- South Africa, AIDS (Disease) -- South Africa -- Clinical trials, Antiretroviral therapy, AIDS (Disease) -- Patients -- Counseling of

Abstract

HIV-related stigma among people living with HIV (PLHIV) is associated with worse health outcomes. We used longitudinal data from a multisite cohort in South Africa to assess changes over time in stigma after HIV diagnosis and determine whether antiretroviral therapy (ART) initiation is associated with stigma reduction. We administered the Internalized AIDS-Related Stigma Scale (IARSS, a six-item dichotomous scale questionnaire) at baseline, 3 months, and 6 months to newly diagnosed ART-eligible participants between 2014 and 2015. A confirmatory factor analysis indicated that the IARSS contained a four-item internalized stigma factor (α = .80) and a two-item disclosure concerns factor (α = .75). We fitted multiple logistic regression models specifying internalized stigma/disclosure concerns at 6 months as the outcome and ART initiation as the predictor of interest. Of the 500 participants (187 men and 313 women) enrolled, 308 (62%) initiated ART. Internalized stigma declined among people entering care (mean score, 1.0 to 0.7, p < .01); however, disclosure concerns remained unchanged (percentage endorsing either disclosure concern item, 78% to 77%, p = .23). These findings were similar between ART initiators and noninitiators. We estimated a statistically significant positive association between ART initiation and disclosure concerns at 6 months (odds ratio [OR] = 1.88; 95% CI [1.20, 2.94]) but not between ART initiation and internalized stigma at 6 months (OR = 1.15; 95% CI [0.75, 1.78]). Among ART-eligible South African PLHIV entering into HIV care, internalized stigma modestly declined over time but disclosure concerns persisted. PLHIV who initiated ART were more likely to have persistent disclosure concerns over time as compared with those who did not start ART. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Description

©American Psychological Association, 2020. This paper is not the copy of record and may not exactly replicate the authoritative document published in the APA journal. Please do not copy or cite without author's permission. The final article is available, upon publication, at: http://doi.org/10.1037/sah0000159

Locate the Document

http://doi.org/10.1037/sah0000159

DOI

10.1037/sah0000159

Persistent Identifier

https://archives.pdx.edu/ds/psu/32400

Citation Details

Chan, B. T., Maughan-Brown, B. G., Bogart, L. M., Earnshaw, V. A., Tshabalala, G., Courtney, I., ... & Tsai, A. C. (2020). Trajectories of HIV-related internalized stigma and disclosure concerns among art initiators and noninitiators in South Africa. Stigma and Health.