How Does Antiretroviral Treatment Attenuate the Stigma of HIV? Evidence from a Cohort Study in Rural Uganda
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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.
KeywordsSocial stigma Depression Antiretroviral therapy Highly active HIV Uganda
We thank the Uganda AIDS Rural Treatment Outcomes (UARTO) study participants who made this study possible by sharing their experiences; Nozmo F.B. Mukiibi for his contributions to study design and implementation; and Annet Kembabazi and Annet Kawuma for providing study coordination and administrative support. While these individuals are acknowledged for their assistance, no endorsement of manuscript contents or conclusions should be inferred. A preliminary version of this analysis was presented in part at the 20th Conference on Retroviruses and Opportunistic Infections, Atlanta, Georgia, USA, March 4, 2013. This study was funded by U.S. National Institutes of Health R01 MH-054907, K23 MH-079713, K23 MH-079713-03S1, and P30 AI-027763. Additionally, the authors acknowledge the following sources of salary support: K23 MH-096620 (Tsai), K24 MH-087227 (Bangsberg), K23 MH-087228 (Haberer), and the Burke Family Foundation (Weiser).
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