AIDS and Behavior

, Volume 17, Issue 8, pp 2725–2731

How Does Antiretroviral Treatment Attenuate the Stigma of HIV? Evidence from a Cohort Study in Rural Uganda

  • Alexander C. Tsai
  • David R. Bangsberg
  • Mwebesa Bwana
  • Jessica E. Haberer
  • Edward A. Frongillo
  • Conrad Muzoora
  • Elias Kumbakumba
  • Peter W. Hunt
  • Jeffrey N. Martin
  • Sheri D. Weiser
Original Paper

DOI: 10.1007/s10461-013-0503-3

Cite this article as:
Tsai, A.C., Bangsberg, D.R., Bwana, M. et al. AIDS Behav (2013) 17: 2725. doi:10.1007/s10461-013-0503-3

Abstract

Program implementers and qualitative researchers have described how increasing availability of HIV antiretroviral therapy (ART) is associated with improvements in psychosocial health and internalized stigma. To determine whether, and through what channels, ART reduces internalized stigma, we analyzed data from 262 HIV-infected, treatment-naïve persons in rural Uganda followed from ART initiation over a median of 3.4 years. We fitted Poisson regression models with cluster-correlated robust estimates of variance, specifying internalized stigma as the dependent variable, adjusting for time on treatment as well as socio-demographic, clinical, and psychosocial variables. Over time on treatment, internalized stigma declined steadily, with the largest decline observed during the first 2 years of treatment. This trend remained statistically significant after multivariable adjustment (χ2 = 28.3; P = 0.03), and appeared to be driven by ART-induced improvements in HIV symptom burden, physical and psychological wellbeing, and depression symptom severity.

Keywords

Social stigma Depression Antiretroviral therapy Highly active HIV Uganda 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Alexander C. Tsai
    • 1
    • 2
    • 3
  • David R. Bangsberg
    • 2
    • 3
    • 4
  • Mwebesa Bwana
    • 4
  • Jessica E. Haberer
    • 2
    • 3
  • Edward A. Frongillo
    • 5
  • Conrad Muzoora
    • 4
  • Elias Kumbakumba
    • 4
  • Peter W. Hunt
    • 6
  • Jeffrey N. Martin
    • 7
  • Sheri D. Weiser
    • 6
    • 8
  1. 1.Chester M. Pierce, MD Division of Global Psychiatry, Department of PsychiatryMassachusetts General Hospital (MGH), Center for Global HealthBostonUSA
  2. 2.MGH Center for Global HealthBostonUSA
  3. 3.Harvard Medical SchoolBostonUSA
  4. 4.Mbarara University of Science and TechnologyMbararaUganda
  5. 5.Department of Health Promotion, Education, and BehaviorArnold School of Public Health, University of South CarolinaColumbiaUSA
  6. 6.Division of HIV/AIDSSan Francisco General Hospital, University of California at San Francisco (UCSF)San FranciscoUSA
  7. 7.Department of Epidemiology and BiostatisticsUCSFSan FranciscoUSA
  8. 8.Center for AIDS Prevention Studies, UCSFSan FranciscoUSA

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