AIDS and Behavior

, Volume 21, Issue 4, pp 1059–1069 | Cite as

A Moderated Mediation Model of HIV-Related Stigma, Depression, and Social Support on Health-Related Quality of Life among Incarcerated Malaysian Men with HIV and Opioid Dependence

  • Roman Shrestha
  • Michael Copenhaver
  • Alexander R. Bazazi
  • Tania B. Huedo-Medina
  • Archana Krishnan
  • Frederick L. Altice
Original Paper


Although it is well established that HIV-related stigma, depression, and lack of social support are negatively associated with health-related quality of life (HRQoL) among people living with HIV (PLH), no studies to date have examined how these psychosocial factors interact with each other and affect HRQoL among incarcerated PLH. We, therefore, incorporated a moderated mediation model (MMM) to explore whether depression mediates the effect of HIV-related stigma on HRQoL as a function of the underlying level of social support. Incarcerated HIV-infected men with opioid dependence (N = 301) were recruited from the HIV units in Kajang prison in Malaysia. Participants completed surveys assessing demographic characteristics, HIV-related stigma, depression, social support, and HRQoL. Results showed that the effect of HIV-related stigma on HRQoL was mediated via depression (a1:β = 0.1463, p < 0.001; b1:β = −0.8392, p < 0.001), as demonstrated by the two-tailed significance test (Sobel z = −3.8762, p < 0.001). Furthermore, the association between social support and HRQoL was positive (β = 0.4352, p = 0.0433), whereas the interaction between HIV-related stigma and depression was negatively associated with HRQOL (β = −0.0317, p = 0.0133). This indicated that the predicted influence of HIV-related stigma on HRQoL via depression had negative effect on HRQoL for individuals with low social support. The results suggest that social support can buffer the negative impact of depression on HRQoL and highlights the need for future interventions to target these psychosocial factors in order to improve HRQoL among incarcerated PLH.


Prisoners HIV-related stigma Depression Social support Health-related quality of life 



This work was supported by Grants from the National Institute on Drug Abuse for research (R01 DA025943 and R01 DA041271 to FLA), for career development (NIDA K24 DA017072 to FLA; K02 DA033139 to MMC), and for training (T32GM07205, F30DA039716 to ARB).

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest to disclose.

Ethical Approval

The protocol for the parent study was approved by institutional review boards at the University Malaya Medical Centre and Yale University. The protocol was also reviewed and approved by the Office of Human Research Protection at the US Department of Health and Human Services (DHHS) as it involved federally-funded research with prisoners. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Community Medicine & Health CareUniversity of Connecticut Health CenterFarmingtonUSA
  2. 2.Institute for Collaboration on Health, Intervention and PolicyUniversity of ConnecticutStorrsUSA
  3. 3.Department of Allied Health SciencesUniversity of ConnecticutStorrsUSA
  4. 4.Department of Internal Medicine, Section of Infectious Diseases, AIDS ProgramYale University School of MedicineNew HavenUSA
  5. 5.Department of Epidemiology of Microbial DiseasesYale University School of Public HealthNew HavenUSA
  6. 6.Department of CommunicationUniversity at Albany, State University of New YorkAlbanyUSA

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