AIDS and Behavior

, Volume 18, Issue 6, pp 1054–1062 | Cite as

Vicious Circle of Perceived Stigma, Enacted Stigma and Depressive Symptoms Among Children Affected by HIV/AIDS in China

  • Peilian ChiEmail author
  • Xiaoming Li
  • Junfeng Zhao
  • Guoxiang Zhao
Original Paper


Previous research has found a deleterious impact of stigma on the mental health of children affected by HIV/AIDS. Little is known about the longitudinal relationship of stigma and children’s mental health. This study explores the longitudinal reciprocal effects of depressive symptoms and stigma, specifically enacted stigma and perceived stigma, among children affected by HIV/AIDS aged 6–12. Longitudinal data were collected from 272 children orphaned by AIDS and 249 children of HIV-positive parents in rural China. Cross-lagged panel analysis was conducted in the study. Results showed that the autoregressive effects were stable for depressive symptoms, perceived stigma and enacted stigma suggesting the substantially stable individual differences over time. The cross-lagged effects indicated a vicious circle among the three variables in an order of enacted stigma → depressive symptom → perceived stigma → enacted stigma. The possibility of employing equal constraints on cross-lagged paths suggested that the cross-lagged effects were repeatable over time. The dynamic interplay of enacted stigma, perceived stigma and depressive symptoms suggests the need of a multilevel intervention in stigma reduction programming to promote mental health of children affected by HIV/AIDS.


Children HIV/AIDS Enacted stigma Perceived stigma Depressive symptoms Cross-lagged Longitudinal 



This study reported in this article was supported by NIH Research Grant from the National Institute of Mental health (R01MH76488) and the National Institute of Nursing Research (R01NR13466). The content of the article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental health and the National Institute of Nursing Research. The authors wish to thank Joanne Zwemer for help in preparing the manuscript.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Peilian Chi
    • 1
    Email author
  • Xiaoming Li
    • 1
  • Junfeng Zhao
    • 2
  • Guoxiang Zhao
    • 2
  1. 1.Pediatric Prevention Research CenterWayne State University School of MedicineDetroitUSA
  2. 2.Institute of Behavior and PsychologyHenan UniversityKaifengChina

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