Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use

  • Tiffany R. Glynn
  • Maria M. Llabre
  • Jasper S. Lee
  • C. Andres Bedoya
  • Megan M. Pinkston
  • Conall O’Cleirigh
  • Steven A. SafrenEmail author



Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic non-terminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA.


The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV.


Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use.


It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease progression risk factors beyond ART adherence is important to be able to design adjuvant interventions, particularly because treatment means that people living with HIV have markedly improved life expectancy and that successful treatment means that HIV is not transmittable to others.


HIV-related stigma Stressful life events HIV Depression Substance use 


Funding Information

The project described was supported by R01MH084757 (Safren) from the National Institute of Mental Health. Some of the author time was funded by 9K24DA040489 (Safren) from the National Institute on Drug Abuse.

Compliance with Ethical Standards


The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, or any of the other funders.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

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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Copyright information

© International Society of Behavioral Medicine 2019

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of MiamiCoral GablesUSA
  2. 2.Department of Psychiatry, The Fenway InstituteMassachusetts General Hospital/Harvard Medical SchoolBostonUSA
  3. 3.Department of Psychiatry and Human Behavior, The Miriam Hospital, Clinical Behavioral Medicine Service of the Immunology CenterWarren Alpert Medical School of Brown UniversityProvidenceUSA

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