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AIDS Behav. 2018 Dec;22(12):3815-3825. doi: 10.1007/s10461-018-2059-8.

HIV-Related Stigma, Social Support, and Psychological Distress Among Individuals Initiating ART in Ethiopia.

Author information

1
HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA. angela_parcesepe@unc.edu.
2
Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA. angela_parcesepe@unc.edu.
3
Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7445, Chapel Hill, NC, 27599-7445, USA. angela_parcesepe@unc.edu.
4
Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.
5
Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
6
HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
7
ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA.
8
Department of Epidemiology, Columbia University, New York, NY, USA.

Abstract

Recent World Health Organization HIV treatment guideline expansion may facilitate timely antiretroviral therapy (ART) initiation. However, large-scale success of universal treatment strategies requires a more comprehensive understanding of known barriers to early ART initiation. This work aims to advance a more comprehensive understanding of interrelationships among three known barriers to ART initiation: psychological distress, HIV-related stigma, and low social support. We analyzed cross-sectional interview data on 1175 adults initiating ART at six HIV treatment clinics in Ethiopia. Experience of each form of HIV-related stigma assessed (e.g., anticipatory, internalized, and enacted) was associated with increased odds of psychological distress. However, among those who reported enacted HIV-related stigma, there was no significant association between social support and psychological distress. Interventions to improve mental health among people living with HIV should consider incorporating components to address stigma, focusing on strategies to prevent or reduce the internalization of stigma, given the magnitude of the relationship between high internalized stigma and psychological distress. Interventions to increase social support may be insufficient to improve the mental health of people living with HIV who experienced enacted HIV-related stigma. Future research should examine alternative strategies to manage the mental health consequences of enacted HIV-related stigma, including coping skills training.

KEYWORDS:

Ethiopia; Psychological distress; Social support; Stigma

PMID:
29453552
PMCID:
PMC6095827
[Available on 2019-12-01]
DOI:
10.1007/s10461-018-2059-8
[Indexed for MEDLINE]

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