Trajectories of HIV-related internalized stigma and disclosure concerns among ART initiators and non-initiators in South Africa

• Published in: Stigma and health (Washington, D.C.) D.C.), 2019-11, Vol.4 (4), p.433-441
• Main Authors: Chan, Brian T, Maughan-Brown, Brendan G, Bogart, Laura M, Earnshaw, Valerie A, Tshabalala, Gugulethu, Courtney, Ingrid, Dietrich, Janan J, Orrell, Catherine, Gray, Glenda E, Bangsberg, David R, Tsai, Alexander C, Katz, Ingrid T
• Format: Article
• Language: English
• ISSN: 2376-6972; 2376-6964
• DOI: 10.1037/sah0000159

HIV-related stigma among people living with HIV (PLHIV) is associated with worse health outcomes. We used longitudinal data from a multi-site 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, three months, and six months to newly diagnosed ART-eligible participants between 2014-2015. A confirmatory factor analysis indicated that the IARSS contained a four-item internalized stigma factor (α=0.80) and a two-item disclosure concerns factor (α=0.75). We fitted multiple logistic regression models specifying internalized stigma/disclosure concerns at six 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