The Dynamic Relationship Between Social Support and HIV-Related Stigma in Rural Uganda
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Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support.
The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma.
We collected quarterly data from a cohort of 422 people living with HIV in Uganda, followed for a median of 2.1 years. We used multilevel regression to model the contemporaneous and 3-month-lagged associations between social support and both enacted and internalized stigma.
Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged instrumental social support was negatively correlated with enacted stigma. Internalized stigma and emotional social support had reciprocal lagged associations.
Interventions to reduce enacted stigma may strengthen social support for people living with HIV. Improved social support may in turn have a protective influence against future enacted and internalized stigma.
KeywordsHIV/AIDS Stigma Social support Uganda
We thank the Uganda AIDS Rural Treatment Outcomes study participants who made this study possible by sharing their experiences; and Anna Baylor and Nozmo Mukiibi for study coordination and support. We also thank James O'Malley for statistical advice. While these individuals are acknowledged for their assistance, no endorsement of manuscript contents or conclusions should be inferred.
This study was funded by US National Institutes of Health K23MH079713, R01MH054907, and P30AI27763. The authors also acknowledge the following additional sources of salary support: the Walker Foundation, the Burke Family Foundation, T32AI007433, K23MH087228, K24MH087227, and K23MH096620.
Conflict of Interest
The authors have no conflict of interest to disclose.
- 1.Goffman E. Stigma; notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall; 1963.Google Scholar
- 6.Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bangsberg DR, Tsai AC. Impact of HIV-related stigma on HIV treatment adherence: Systematic review, meta-synthesis, and conceptual model. J Int AIDS Soc. 2013;16:18640.Google Scholar
- 7.Siedner MJ, Tsai AC, Muzoora C, et al. Treatment as long-term prevention: Sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda. AIDS. 2013, in press.Google Scholar
- 16.Cohen S, McKay G. Social support, stress, and the buffering hypothesis: A theoretical analysis. In: Baum A, Singer JE, Taylor SE, eds. Handbook of Psychology and Health. Hillsdale: Erlbaum, 1984: 253-267.Google Scholar
- 25.Allport GW. The Nature of Prejudice: Reading: Addison-Wesley; 1979.Google Scholar
- 28.Scheff TJ. Being mentally ill: A sociological theory. Chicago: Aldine, 1966.Google Scholar
- 37.Tsai AC, Bangsberg DR, Kegeles SM, et al. Internalized stigma, social distance, and disclosure of HIV seropositivity in rural Uganda. Ann Behav Med. 2013;46:285–294.Google Scholar
- 42.Siedner MJ, Lankowski A, Tsai AC, et al. GPS-measured distance to clinic, but not self-reported transportation factors, are associated with missed HIV clinic visits in rural Uganda. AIDS. 2013;27:1503–1508.Google Scholar
- 48.Nyblade L, & MacQuarrie, K. Can we measure HIV/AIDS-related stigma and discrimination? Current knowledge about quantifying stigma in developing countries. Washington: US Agency for International Development; 2006.Google Scholar
- 52.Bolton P, & Ndogoni L. Cross-cultural assessment of trauma-related mental illness (phase II): A report of research conducted by World Vision Uganda and The Johns Hopkins University; 2001.Google Scholar
- 55.Winokur A, Winokur DF, Rickels K, Cox DS. Symptoms of emotional distress in a family planning service: stability over a four-week period. Brit J Psych. 1984; 144: 395-399.Google Scholar
- 63.Tsai AC, Bangsberg DR, Bwana M, et al. How does antiretroviral treatment attenuate the stigma of HIV? Evidence from a cohort study in rural Uganda. AIDS Behav. 2013; 17: 2725-2731.Google Scholar