Association of HIV Stigma and Sexual Behavior

Date of Completion

January 2010

Keywords

Health Sciences, Mental Health|Psychology, Behavioral|Social Work|Health Sciences, Public Health

Degree

Ph.D.

Abstract

Stigma affects the life chances of People Living with HIV/AIDS (PLWHA) through reduced opportunities, and through rejection from families, friends, and communities. Several conditions are associated with HIV stigma, among which are the development of negative self-image, depression, avoidance of health care, and non-disclosure of HIV status to sexual partners and injection equipment sharing partners. Layered stigma, where a second stigma is encountered for someone with a pre-existing stigma, may intensify the sense of stigmatization. ^ Qualitative studies have reported an association between HIV stigma and continued sexual risk behaviors by PLWHA. A small number of studies have researched the hypothesized association in specific sub-groups, such as gay men or racial minority populations. Lack of consistency in measurement instruments complicated direct comparisons between studies, making further quantitative investigation warranted. For this dissertation, research on HIV stigma and sexual risk behavior was conducted using a diverse sample of 84 participants from a general HIV clinic population to assess whether: (1) there was an association between HIV stigma and sexual risk behavior, and (2) whether HIV stigma was higher for PLWHA who had pre-existing stigmas, men who have sex with men and injection drug users, than for heterosexuals. ^ Methods. The research design was cross sectional employing a convenience sample. Self-report data were collected using demographic variables, the HIV Stigma Scale (four sub-scales and a composite score), the CES-D depression scale, the HIV Risk Behavior Scale (2 sub-scales), and the AUDIT-3 alcohol screen, all of which have been widely used in research. The participants were predominantly male (N= 54, 64.3%) with a mean age of 45.9 years ( SD 8.7), who had known of their HIV infection for a mean of 14.5 years (SD 7.12). Whites (N = 37, 44%) were the largest racial group followed by African Americans (N = 29 34.5%), Native Americans (N= 6, 7.1%), More than one race (N= 8, 9.5%), Other (N = 1, 1.2%), and four who did not identify a race. There were 18 (21.4%) people of Hispanic ethnicity. ^ Results. Weak support was found for an association between personal HIV stigma and sexual risk behavior. There was no association for the other three sub-scales (disclosure concern, negative self-image, public attitudes concern) or for the composite HIV stigma score. Depression was pervasive for the participants, especially for people of Hispanic ethnicity who also experienced greater perceived HIV stigma. Women were found to be more susceptible to HIV stigma when having less than optimal social support. The presence of a committed relationship seemed to mitigate HIV stigma effects. Layered stigma was not supported, perhaps the result of a ceiling effect, as nearly all participants had one or more preexisting stigmas. The participants knew their HIV serostatus on average for nearly fifteen years, may have adjusted to the disease and its associated stigma, and may have reduced the risk of sexual transmission to others. ^

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