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. 2018 Dec;22(12):3795-3806.
doi: 10.1007/s10461-018-2041-5.

The Relationship Between Stigma and Health-Related Quality of Life in People Living with HIV Who Have Full Access to Antiretroviral Treatment: An Assessment of Earnshaw and Chaudoir's HIV Stigma Framework Using Empirical Data

Maria Reinius  1 , Maria Wiklander  2 , Lena Wettergren  2 , Veronica Svedhem  3   4 , Lars E Eriksson  5   3   6
Affiliations

The Relationship Between Stigma and Health-Related Quality of Life in People Living with HIV Who Have Full Access to Antiretroviral Treatment: An Assessment of Earnshaw and Chaudoir's HIV Stigma Framework Using Empirical Data

Maria Reinius et al. AIDS Behav. 2018 Dec.

Abstract
in English, Spanish

The aim was to empirically test the tenets of Earnshaw and Chaudoir's HIV stigma framework and its potential covariates for persons living with HIV in Sweden. Partial least squares structural equation modelling was used on survey data from 173 persons living with HIV in Sweden. Experiencing stigma was reported to a higher extent by younger persons and by women who had migrated to Sweden. As expected, anticipated stigma was related to lower Physical functioning, and internalized stigma to lower Emotional wellbeing. In contrast to that hypothesized by the HIV stigma framework, enacted stigma was not related to Physical functioning and no relationships were found between HIV-related stigma and antiretroviral adherence. These results indicate that the HIV stigma framework may need to be revised for contexts where a very high proportion of persons living with HIV are diagnosed and under efficient treatment.

El objetivo fue probar empíricamente los postulados del marco teórico del estigma del VIH (HSF) de Earnshaw y Chaudoir y sus covariables para personas con el VIH en Suecia. Se empleó el modelo de ecuaciones estructurales con la escala PLS (Partial least squares), sobre datos obtenidos en 173 encuestas a personas con el VIH en Suecia. El estigma experimentado fue más frecuente en jóvenes y mujeres emigrantes. Como se esperaba, el estigma anticipado estuvo asociado a bajo funcionamiento físico, y el internalizado a bajo bienestar emocional. En contra de las hipótesis del HSF, el estigma declarado no tuvo relación con el funcionamiento físico y no se encontró ninguna relación entre el estigma relacionado con el VIH y la adherencia a los antirretrovirales. Estos resultados sugieren que el marco teórico HSF debería ser ajustado para contextos en los que un alto porcentaje de las personas con el VIH están diagnosticadas y bajo tratamiento eficaz.

Keywords: Adherence to ART; HIV stigma framework; HIV-related stigma; Health-related quality of life.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and were approved by the Regional Ethical Review Board of Stockholm (2008/1:12 with amendment 2013/335-32).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
A hypothesized path model of the relationships between HIV stigma mechanisms and measures of health and wellbeing for persons living with HIV in Sweden based on Earnshaw and Chaudoir’s [10] HIV stigma framework, as further elaborated in Earnshaw et al. [13]. Age and a combined measure of gender and origin were included as potential covariates, hypothesized to be correlated to HIV stigma mechanisms and related to measures of health and wellbeing (presented schematically in this figure)
Fig. 2
Fig. 2
Results from the partial least squares structural equation modelling (PLS-SEM) analysis of the hypothesized path model presented in Fig. 1, empirically evaluated with self-reported and clinical data from persons living with HIV in Sweden. This figure illustrates the relationships with further data presented in Tables 4 and 5. The model depicts the relationships between measures of HIV stigma mechanisms (large boxes to the left), covariates (small boxes) and measures of health and wellbeing: Physical functioning, Antiretroviral adherence and Emotional wellbeing (boxes to the right). The estimates next to each arrow represent correlation coefficients and standardized direct effects. Black lines represent relationships that are statistically significant at a significance level of p < 0.05. Grey lines represent non-significant paths. Estimates for non-significant paths regarding covariates are not shown
See this image and copyright information in PMC

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