The Relationship of HIV-related Stigma and Health Care Outcomes in the US Deep South


HIV-related stigma is prevalent in the US Deep South; however, information regarding the types of stigma and their effects on HIV-related outcomes is limited. This study examined the prevalence of different forms of stigma and the association of stigma with medication and medical visit adherence in the Deep South. Survey participants included 201 individuals living with HIV recruited from Infectious Diseases Clinics (ID) and AIDS Service Organizations (ASOs) in four Deep South states. Study participants reported high levels of experienced, perceived, and internalized stigma. Multivariable analysis revealed that internalized stigma and recent stigmatizing experiences were significantly associated with poorer HIV medication adherence. Internalized stigma was also associated with having missed an HIV medical care visit in the last 6 months. These findings suggest the need to identify and develop effective interventions to address internalized HIV-related stigma and to address community HIV stigma to improve outcomes for individuals living with HIV.

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    Alabama, Florida, Louisiana, Mississippi, North Carolina, South Carolina, Mississippi, Tennessee, and Texas.


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This study was supported through the Ford Foundation (1115–1373). We wish to thank all of our partners at infectious diseases clinics and community-based organizations in Alabama, Mississippi, South Carolina and North Carolina that assisted in bringing this study to fruition. The collection of research data at the University of Mississippi Medical Center was approved through the External Request Review Committee (ERRC).

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Correspondence to Susan Reif.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Duke Medical Center institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Reif, S., Wilson, E., McAllaster, C. et al. The Relationship of HIV-related Stigma and Health Care Outcomes in the US Deep South. AIDS Behav 23, 242–250 (2019).

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  • HIV
  • Southern US
  • HIV-related stigma
  • Medication adherence