AIDS and Behavior

, Volume 21, Issue 1, pp 238–247 | Cite as

Interpersonal Mechanisms Contributing to the Association Between HIV-Related Internalized Stigma and Medication Adherence

  • C. Blake Helms
  • Janet M. Turan
  • Ghislaine Atkins
  • Mirjam-Colette Kempf
  • Olivio J. Clay
  • James L. Raper
  • Michael J. Mugavero
  • Bulent TuranEmail author
Original Paper


Previous research suggests that people living with HIV (PLWH) sometimes internalize HIV-related stigma existing in the community and experience feelings of inferiority and shame due to their HIV status, which can have negative consequences for treatment adherence. PLWH’s interpersonal concerns about how their HIV status may affect the security of their existing relationships may help explain how internalized stigma affects adherence behaviors. In a cross-sectional study conducted between March 2013 and January 2015 in Birmingham, AL, 180 PLWH recruited from an outpatient HIV clinic completed previously validated measures of internalized stigma, attachment styles, and concern about being seen while taking HIV medication. Participants also self-reported their HIV medication adherence. Higher levels of HIV-related internalized stigma, attachment-related anxiety (i.e., fear of abandonment by relationship partners), and concerns about being seen by others while taking HIV medication were all associated with worse medication adherence. The effect of HIV-related internalized stigma on medication adherence was mediated by attachment-related anxiety and by concerns about being seen by others while taking HIV medication. Given that medication adherence is vitally important for PLWH to achieve long-term positive health outcomes, understanding interpersonal factors affecting medication adherence is crucial. Interventions aimed at improving HIV treatment adherence should address interpersonal factors as well as intrapersonal factors.


HIV Attachment Attachment-related anxiety Stigma Adherence Interpersonal 



This research was supported by the University of Alabama at Birmingham (UAB) Center for AIDS Research CFAR, an NIH funded program (P30 AI027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIA, NIDDK, NIGMS, and OAR. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). We would like to thank Maria Lechtreck, Wesley Browning, Christy Thai, and all the research assistants for their help in data collection. This article is based in part on an undergraduate honors thesis conducted by C. Blake Helms under the supervision of Dr. Bulent Turan at the University of Alabama at Birmingham.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • C. Blake Helms
    • 1
  • Janet M. Turan
    • 2
  • Ghislaine Atkins
    • 1
  • Mirjam-Colette Kempf
    • 3
  • Olivio J. Clay
    • 1
  • James L. Raper
    • 4
  • Michael J. Mugavero
    • 4
  • Bulent Turan
    • 1
    Email author
  1. 1.The Department of PsychologyUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Department of Health Care Organization and PolicyUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Department of Family, Community and Health Systems and Department of Health BehaviorUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.The Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA

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