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Meta-Analysis
. 2021 Nov 25;12(1):1990527.
doi: 10.1080/20008198.2021.1990527. eCollection 2021.

HIV/AIDS stigma and psychological well-being after 40 years of HIV/AIDS: a systematic review and meta-analysis

Marcin Rzeszutek  1 , Ewa Gruszczyńska  2 , Małgorzata Pięta  1 , Paula Malinowska  2
Affiliations
Meta-Analysis

HIV/AIDS stigma and psychological well-being after 40 years of HIV/AIDS: a systematic review and meta-analysis

Marcin Rzeszutek et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: In June 2021, 40 years have passed since the first cases of HIV infection were detected. Nonetheless, people living with HIV (PLWH) still suffer from intense HIV-related distress and trauma, which is nowadays mostly linked to the still-existing stigmatization of PLWH.

Objectives: The aim of this systematic review and meta-analysis was to examine the association between HIV/AIDS stigma and psychological well-being among PLWH. We also explored whether this association varies as a function of sociodemographic and clinical characteristics as well as study publication year and stigma measurement.

Method: A structured literature search was performed on Web of Science, Scopus, PsyARTICLES, MedLine, ProQuest, and Google Scholar databases. The inclusion criteria were quantitative, peer-reviewed articles published in English between 1996 and 2020.

Results: After selection, 64 articles were accepted for further analysis (N = 25,294 participants). The random-effects pooled estimate revealed an overall negative and medium-strength association between stigma and well-being (r = -.31, 95% CI [-.35; -.26]). The participants' age modified this effect with a stronger association for older PLWH. Other sociodemographic and clinical variables as well as publication year and stigma measurement did not explain the variation in association between stigma and well-being across studies.

Conclusions: The present meta-analysis and systematic review not only showed an expected negative relationship between stigma and well-being but also revealed a substantial heterogeneity between studies that suggests a strong role of context of a given study. This finding calls for more advanced theoretical and analytical models to identify protective and vulnerability factors to effectively address them in clinical practice and interventions.

Antecedentes: En junio de 2021 pasaron cuarenta años desde que fueron detectados los primeros casos de infección por VIH. No obstante, las personas que viven con el VIH (PVCV) todavía sufren de angustia intensa y trauma relacionados con el VIH, que en la actualidad se vinculan principalmente con la estigmatización aún existente de las PVCV.Objetivos: El propósito de esta revisión sistemática y metanálisis fue examinar la asociación entre el estigma del VIH/SIDA y el bienestar psicológico entre las PVCV. También exploramos si esta asociación varía en función de las características sociodemográficas y clínicas, así como del año de publicación del estudio y la medición del estigma.Método: Se realizó una búsqueda estructurada de literatura en las bases de datos Web of Science, Scopus, PsyARTICLES, MedLine, ProQuest y Google Scholar. Los criterios de inclusión fueron artículos cuantitativos, revisados por pares, publicados en inglés entre 1996 y 2020.Resultados: Después de la selección, se aceptaron 64 artículos para análisis adicionales (N = 25.294 participantes). La estimación combinada de efectos aleatorios reveló una asociación general negativa y de intensidad media entre el estigma y el bienestar (r = −.31, IC del 95% [−.35; −.26]). La edad de los participantes modificó este efecto con una asociación más fuerte para las PVCV mayores. Otras variables sociodemográficas y clínicas, así como el año de publicación y la medición del estigma, no explicaron una variación de la asociación entre el estigma y el bienestar entre los estudios.Conclusiones: El presente metanálisis y revisión sistemática mostró una relación negativa esperada entre el estigma y el bienestar, pero también reveló una heterogeneidad sustancial entre los estudios que sugiere un papel importante del contexto de cada estudio dado. Este hallazgo requiere modelos teóricos y analíticos más avanzados para identificar factores protectores y de vulnerabilidad, para abordarlos de manera efectiva en la práctica clínica y las intervenciones.

背景: 2021 年 6 月, 距离发现第一例 HIV 感染病例已经过去了 40 年。尽管如此, HIV感染者 (PLWH) 仍然遭受着强烈的HIV相关痛苦和创伤, 如今这主要与仍然存在的 PLWH 污名化有关。目的: 本系统综述和元分析旨在考查PLWH 中HIV/AIDS污名与心理幸福感之间的关联。我们还探讨了这种关联是否因社会人口统计学和临床特征以及研究发表年份和污名测量而异。方法: 在 Web of Science, Scopus, PsyARTICLES, MedLine, ProQuest 和 Google Scholar 数据库上进行了结构化文献搜索。纳入标准是 1996 年至 2020 年间以英文发表的同行评审的定量文章。结果: 筛选之后, 纳入了64 篇文章进行进一步分析 (N = 25,294 名参与者) 。随机效应汇总估计显示, 污名和幸福感之间总体呈中强度负相关 (r = −.31, 95% CI [−.35; −.26]) 。参与者的年龄调节了这种效应, 年龄更大的 PLWH 有更强的关联。其他社会人口统计学和临床变量以及出版年份和污名测量并不能解释跨研究的污名和幸福感之间关联的变异。结论: 本元分析和系统综述表明, 污名和幸福感之间存在预期的负相关关系, 但也揭示了研究之间的巨大异质性, 这表明给定研究背景的重要作用。这一发现需要更先进的理论和分析模型来识别保护和易感因素, 以便在临床实践和干预中有效解决这些问题。.

Keywords: HIV/AIDS stigma; meta-analysis; systematic review; well-being.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of the study selection process for inclusion in the systematic review
Figure 2.
Figure 2.
Heterogeneity diagnostics on Baujat plot. The numbers of the studies correspond to the numbers assigned in Table 1
Figure 3.
Figure 3.
Graphic Display of Heterogeneity (GOSH) plot analysis
Figure 4.
Figure 4.
Heterogeneity diagnostics using a contour-enhanced funnel plot. The effects in the white zone are greater than p = .10; the effects in the adjacent light blue zone are between p = .10 and p = .05; the effects in the darker blue zone are between p = .05 and p = .01; the effects outside this zone are smaller than p = .01
Figure 5.
Figure 5.
Forest plot of effect sizes for individual studies, overall estimated effect, and 95% prediction interval. The numbers of the studies correspond to the numbers assigned in Table 1. τ2: between-study variance I2: I-squared statistic of heterogeneity
Figure 6.
Figure 6.
Moderating effect of mean participants’ age on the relationship between HIV/AIDS stigma and well-being of PLWH. The circle sizes are proportional to the weights of individual studies in the meta-analysis. The numbers of the studies correspond to the numbers assigned in Table 1
See this image and copyright information in PMC

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