Bulent Turan1, Kaylee B Crockett1, Asuman Buyukcan-Tetik2, Mirjam-Colette Kempf3, Deborah Konkle-Parker4, Tracey E Wilson5, Phyllis C Tien6,7, Gina Wingood8, Torsten B Neilands6, Mallory O Johnson6, Sheri D Weiser9, Janet M Turan10. 1. Department of Psychology, University of Alabama at Birmingham, Birmingham, AL. 2. Psychology Program, Sabanci University, Istanbul, Turkey. 3. Schools of Nursing, Public Health, and Medicine, University of Alabama at Birmingham, Birmingham, AL. 4. Department of Medicine/Infectious Diseases, University of Mississippi Medical Center, Jackson, MS. 5. Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY. 6. Department of Medicine, University of California, San Francisco, San Francisco, CA. 7. Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA. 8. Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY. 9. Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA. 10. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
Abstract
BACKGROUND: One mechanism through which social stigma of HIV affects health outcomes for people living with HIV (PLWH) is through internalization of stigma. However, this transformation of social stigma in the community into internalized stigma may not be of the same magnitude for all PLWH. We examined the moderating effects of 3 personality traits-fear of negative social evaluation, attachment-related anxiety, and dispositional resilience-in transforming perceived stigma in the community into internalized stigma. Furthermore, we investigated downstream effects of these moderated associations on depressive symptoms and antiretroviral treatment (ART) adherence. SETTING/ METHODS: In study 1, data from 203 PLWH in the Southeast United States were analyzed controlling for age, sex, education, race, and time on ART. In study 2, data from 453 women in a multisite study were analyzed controlling for age, education, race, time on ART, and substance use. RESULTS: In both studies, fear of negative evaluation and attachment-related anxiety moderated the effect of perceived HIV stigma in the community on internalized HIV stigma: People higher on those moderating variables had stronger associations between perceived stigma in the community and internalized stigma. In study 2, resilience was assessed and also moderated the effect of perceived HIV stigma in the community on internalized stigma. In moderated mediation models, fear of negative evaluation, attachment-related anxiety, and resilience moderated the indirect effect of perceived HIV stigma in the community on ART adherence and depression through internalized stigma. CONCLUSIONS: Interventions to assuage internalization of HIV stigma should focus on bolstering attachment-related security, social competence, and resilience.
BACKGROUND: One mechanism through which social stigma of HIV affects health outcomes for people living with HIV (PLWH) is through internalization of stigma. However, this transformation of social stigma in the community into internalized stigma may not be of the same magnitude for all PLWH. We examined the moderating effects of 3 personality traits-fear of negative social evaluation, attachment-related anxiety, and dispositional resilience-in transforming perceived stigma in the community into internalized stigma. Furthermore, we investigated downstream effects of these moderated associations on depressive symptoms and antiretroviral treatment (ART) adherence. SETTING/ METHODS: In study 1, data from 203 PLWH in the Southeast United States were analyzed controlling for age, sex, education, race, and time on ART. In study 2, data from 453 women in a multisite study were analyzed controlling for age, education, race, time on ART, and substance use. RESULTS: In both studies, fear of negative evaluation and attachment-related anxiety moderated the effect of perceived HIV stigma in the community on internalized HIV stigma: People higher on those moderating variables had stronger associations between perceived stigma in the community and internalized stigma. In study 2, resilience was assessed and also moderated the effect of perceived HIV stigma in the community on internalized stigma. In moderated mediation models, fear of negative evaluation, attachment-related anxiety, and resilience moderated the indirect effect of perceived HIV stigma in the community on ART adherence and depression through internalized stigma. CONCLUSIONS: Interventions to assuage internalization of HIV stigma should focus on bolstering attachment-related security, social competence, and resilience.
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