Framing Mechanisms Linking HIV-Related Stigma, Adherence to Treatment, and Health Outcomes

• DOI: 10.2105/ajph.2017.303744
• Publication Date: 2017-04-20T19:42:09Z
• Authors: Bulent Turan; Abigail M. Hatcher; Sheri D. Weiser; Mallory O. Johnson; Whitney S. Rice; Janet M. Turan
• Keywords: Social Stigma; HIV Infections; Medication Adherence; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Adaptation, Psychological; Outcome Assessment, Health Care; Humans; 10. No inequality; Attitude to Health; Prejudice

We present a conceptual framework that highlights how unique dimensions of individual-level HIV-related stigma (perceived community stigma, experienced stigma, internalized stigma, and anticipated stigma) might differently affect the health of those living with HIV. HIV-related stigma is recognized as a barrier to both HIV prevention and engagement in HIV care, but little is known about the mechanisms through which stigma leads to worse health behaviors or outcomes. Our conceptual framework posits that, in the context of intersectional and structural stigmas, individual-level dimensions of HIV-related stigma operate through interpersonal factors, mental health, psychological resources, and biological stress pathways. A conceptual framework that encompasses recent advances in stigma science can inform future research and interventions aiming to address stigma as a driver of HIV-related health.