AIDS and Behavior

, Volume 10, Issue 5, pp 473–482 | Cite as

Impact of HIV-Related Stigma on Health Behaviors and Psychological Adjustment Among HIV-Positive Men and Women

  • Peter A. VanableEmail author
  • Michael P. Carey
  • Donald C. Blair
  • Rae A. Littlewood

HIV-related stigmatization remains a potent stressor for HIV-positive people. This study examined the relationships among stigma-related experiences and depression, medication adherence, serostatus disclosure, and sexual risk among 221 HIV-positive men and women. In bivariate analyses that controlled for background characteristics, stigma was associated with depressive symptoms, receiving recent psychiatric care, and greater HIV-related symptoms. Stigma was also associated with poorer adherence and more frequent serostatus disclosure to people other than sexual partners, but showed no association to sexual risk behavior. In a multivariate analysis that controlled for all correlates, depression, poor adherence, and serostatus disclosure remained as independent correlates of stigma-related experiences. Findings confirm that stigma is associated with psychological adjustment and adherence difficulties and is experienced more commonly among people who disclose their HIV status to a broad range of social contacts. Stigma should be addressed in stress management, health promotion, and medication adherence interventions for HIV-positive people.


Stigma HIV sexual behavior adherence depression disclosure 



This work was supported by the National Institute of Mental Health Grant R21-MH65865. The authors thank the staff at University Hospital for their support of this work. Special thanks are extended to Missy Albert, Linda Bartlett, Mary Beth Cavalieri, Kelley Flood, Lois Needham, Paul Preczewski, Pamela Wickham, Judy Rees, Craig Withers, Jennifer Lewis, and Jennifer Brown for their assistance.


  1. Angermeyer, M., Beck, M., Dietrich, S., and Holzinger, A. (2004). The stigma of mental illness: Patients’ anticipations and experiences. International Journal of Social Psychiatry, 50, 153–162.CrossRefPubMedGoogle Scholar
  2. Arnsten, J. H., Demas, P. A., Farzadegan, H., Grant, R. W., Gourevitch, M. N., Chang, C. J., et al. (2001). Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: Comparison of self-report and electronic monitoring. Clinical Infectious Diseases, 33, 1417–1423.CrossRefPubMedGoogle Scholar
  3. Brown, L., Macintyre, K., and Trujillo, L. (2003). Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Education and Prevention, 15, 49–69.CrossRefPubMedGoogle Scholar
  4. Catz, S. L., Kelly, J. A., Bogart, L. M., Benotsch, E. G., and McAuliffe, T. L. (2000). Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology, 19, 124–133.CrossRefPubMedGoogle Scholar
  5. Catz, S. L., McClure, J. B., Jones, G. N., and Brantley, P. J. (1999). Predictors of outpatient medical appointment attendance among persons with HIV. AIDS Care, 11, 361–373.CrossRefPubMedGoogle Scholar
  6. Centers for Disease Control and Prevention (2000). HIV-related knowledge and stigma—United States. Morbidity and Mortality Weekly Report, 49, 1062–1064.Google Scholar
  7. Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., et al. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. AIDS Care, 12, 255–266.CrossRefPubMedGoogle Scholar
  8. Chesney, M. A., and Smith, A. W. (1999). Critical delays in HIV testing and care: The potential role of stigma. American Behavioral Scientist, 42, 1162–1174.CrossRefGoogle Scholar
  9. Clark, H. J., Lindner, G., Armistead, L., and Austin, B. J. (2003). Stigma, disclosure, and psychological functioning among HIV-infected and non-infected African-American women. Women and Health, 38, 57–71.CrossRefGoogle Scholar
  10. Eisenman, D. P., Cunningham, W. E., Zierler, S., Nakazono, T. T., and Shapiro, M. F. (2003). Effect of violence on utilization of services and access to care in persons with HIV. Journal of General Internal Medicine, 18, 125–127.CrossRefPubMedGoogle Scholar
  11. Fortenberry, J. D., McFarlane, M., Bleakley, A., Bull, S., Fishbein, M., Grimley, D. M., et al. (2002). Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health, 92, 378–381.PubMedGoogle Scholar
  12. Gonzales, V., Washienko, K. M., Krone, M. R., Chapman, L. I., Arredondo, E. M., Huckeba, H. J., et al. (1999). Sexual and drug-use risk factors for HIV and STDs: A comparison of women with and without bisexual experiences. American Journal of Public Health, 89, 1841–1846.PubMedGoogle Scholar
  13. Gostin, L. O., and Webber, D. W. (1998). The AIDS Litigation Project: HIV/AIDS in the courts in the 1990s, Part 2. AIDS Public Policy Journal, 13, 3–19.PubMedGoogle Scholar
  14. Hader, S. L., Smith, D. K., Moore, J. S., and Holmberg, S. D. (2001). HIV infection in women in the United States: Status at the Millennium. Journal of the American Medical Association, 285, 1186–1192.CrossRefPubMedGoogle Scholar
  15. Heckman, B. D., Catz, S. L., Heckman, T. G., Miller, J. G., and Kalichman, S. C. (2004). Adherence to antiretroviral therapy in rural persons living with HIV disease in the United States. AIDS Care, 16, 219–230.CrossRefPubMedGoogle Scholar
  16. Heckman, T. G. (2003). The chronic illness quality of life (CIQOL) model: Explaining life satisfaction in people living with HIV disease. Health Psychology, 22, 140–147.CrossRefPubMedGoogle Scholar
  17. Heckman, T. G., Anderson, E. S., Sikkema, K. J., Kochman, A., Kalichman, S. C., and Anderson, T. (2004). Emotional distress in nonmetropolitan persons living with HIV disease enrolled in a telephone-delivered, coping improvement group intervention. Health Psychology, 23, 94–100.CrossRefPubMedGoogle Scholar
  18. Heckman, T. G., Somlai, A. M., Kalichman, S. C., Franzoi, S. L., and Kelly, J. A. (1998). Psychosocial differences between urban and rural people living with HIV/AIDS. Journal of Rural Health, 14, 138–145.PubMedCrossRefGoogle Scholar
  19. Herek, G. M., and Capitanio, J. P. (1999). AIDS stigma and sexual prejudice. American Behavioral Scientist, 42, 1130–1147.CrossRefGoogle Scholar
  20. Herek, G. M., Capitanio, J. P., and Widaman, K. F. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92, 371–377.PubMedGoogle Scholar
  21. Ickovics, J. R., Hamburger, M. E., Vlahov, D., Schoenbaum, E. E., Schuman, P., Boland, R. J., et al. (2001). Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: Longitudinal analysis from the HIV Epidemiology Research Study. Journal of the American Medical Association, 285, 1466–1474.CrossRefPubMedGoogle Scholar
  22. Justice, A. C., Holmes, W., Gifford, A. L., Rabeneck, L., Zackin, R., Sinclair, G., et al. (2001). Development and validation of a self-completed HIV symptom index. Journal of Clinical Epidemiology, 54, S77–S90.CrossRefPubMedGoogle Scholar
  23. Kalichman, S. C., and Rompa, D. (2000). Functional health literacy is associated with health status and health- related knowledge in people living with HIV-AIDS. Journal of Acquired Immune Deficiency Syndrome, 25, 337–344.CrossRefGoogle Scholar
  24. Lee, R. S., Kochman, A., and Sikkema, K. J. (2002). Internalized stigma among people living with HIV-AIDS. AIDS and Behavior, 6, 309–319.Google Scholar
  25. Leonard, B. (2000). Stress, depression and the activation of the immune system. World Journal of Biological Psychiatry, 1, 17–25.PubMedCrossRefGoogle Scholar
  26. Major, B., and O’Brien, L. T. (2005). The social psychology of stigma. Annual Review of Psychology, 56, 393–421.CrossRefPubMedGoogle Scholar
  27. Mansergh, G., Marks, G., and Simoni, J. M. (1995). Self-disclosure of HIV infection among men who vary in time since seropositive diagnosis and symptomatic status. AIDS, 9, 639–644.PubMedCrossRefGoogle Scholar
  28. Moskowitz, J. T. (2003). Positive affect predicts lower risk of AIDS mortality. Psychosomatic Medicine, 65, 620–626.CrossRefPubMedGoogle Scholar
  29. Murphy, D. A., Durako, S. J., Moscicki, A. B., Vermund, S. H., Ma, Y., Schwarz, D. F., et al. (2001). No change in health risk behaviors over time among HIV infected adolescents in care: Role of psychological distress. Journal of Adolescent Health, 29, 57–63.CrossRefPubMedGoogle Scholar
  30. Preston, D. B., D’Augelli, A. R., Kassab, C. D., Cain, R. E., Schulze, F. W., and Starks, M. T. (2004). The influence of stigma on the sexual risk behavior of rural men who have sex with men. AIDS Education and Prevention, 16, 291–303.CrossRefPubMedGoogle Scholar
  31. Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  32. Rosman, S. (2004). Cancer and stigma: Experience of patients with chemotherapy-induced alopecia. Patient Education and Counseling, 52, 333–339.CrossRefPubMedGoogle Scholar
  33. Schmitz, M. F., and Crystal, S. (2000). Social relations, coping, and psychological distress among persons with HIV/AIDS. Journal of Applied Social Psychology, 30, 665–683.CrossRefGoogle Scholar
  34. Simoni, J. M., Mason, H. R., Marks, G., Ruiz, M. S., Reed, D., and Richardson, J. L. (1995). Women’s self-disclosure of HIV infection: Rates, reasons, and reactions. Journal of Consulting and Clinical Psychology, 63, 474–478.CrossRefPubMedGoogle Scholar
  35. Stall, R., Hoff, C., Coates, T. J., Paul, J., Phillips, K. A., Ekstrand, M., et al. (1996). Decisions to get HIV tested and to accept antiretroviral therapies among gay/bisexual men: Implications for secondary prevention efforts. Journal of Acquired Immune Deficiency Syndrome, 11, 151–160.Google Scholar
  36. Vanable, P. A., Ostrow, D. G., McKirnan, D. J., Taywaditep, K. J., and Hope, B. A. (2000). Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychology, 19, 134–145.CrossRefPubMedGoogle Scholar
  37. van der Straten, A., Vernon, K. A., Knight, K. R., Gomez, C. A., and Padian, N. S. (1998). Managing HIV among serodiscordant heterosexual couples: Serostatus, stigma and sex. AIDS Care, 10, 533–548.CrossRefPubMedGoogle Scholar
  38. Weiser, S., Wolfe, W., Bangsberg, D., Thior, I., Gilbert, P., Makhema, J., et al. (2003). Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. Journal of Acquired Immune Deficiency Syndrome, 34, 281–288.CrossRefGoogle Scholar
  39. Wilson, I. B., Tchetgen, E., and Spiegelman, D. (2001). Patterns of adherence with antiretroviral medications: An examination of between-medication differences. Journal of Acquired Immune Deficiency Syndrome, 28, 259–263.Google Scholar
  40. Zierler, S., Cunningham, W. E., Andersen, R., Shapiro, M. F., Nakazono, T., Morton, S., et al. (2000). Violence victimization after HIV infection in a US probability sample of adult patients in primary care. American Journal of Public Health, 90, 208–215.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Peter A. Vanable
    • 1
    • 3
    Email author
  • Michael P. Carey
    • 1
  • Donald C. Blair
    • 2
  • Rae A. Littlewood
    • 1
  1. 1.Department of Psychology and Center for Health and BehaviorSyracuse UniversitySyracuseUSA
  2. 2.Department of MedicineSUNY Upstate Medical UniversitySyracuseUSA
  3. 3.Department of Psychology and Center for Health and Behavior, 430 Huntington HallSyracuse UniversitySyracuseUSA

Personalised recommendations