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Psychological Mechanisms of Internalized HIV Stigma Affect Sleep Impairment among People Living with HIV in China: A follow-up Study

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Abstract

Prior studies have demonstrated that HIV-related stigma (e.g., internalized HIV stigma) is detrimental to the physical and mental health (e.g., sleep impairment and depressive symptoms) of people living with HIV (PLWH). However, follow-up data are limited regarding the longitudinal relationships between internalized HIV stigma, future orientation, self-esteem, depressive symptoms, and sleep impairment. The present study attempted to examine a mediation model involving these variables among Chinese PLWH. A two-wave follow-up design (6 months intervals) was employed in a final sample of 1,140 Chinese PLWH (Mage = 41.63, SD = 9.29, age range: 21–67 years; 64.6% men). Participants completed Internalized HIV Stigma Scale, Optimism About the Future Scale, Rosenberg Self-Esteem Scale, Center of Epidemiological Studies Depression Scale, and an adapted version of Pittsburgh Sleep Quality Index. Results revealed that internalized HIV stigma at baseline had a significant direct relationship with sleep impairment over time, and a significant indirect relationship with increased sleep impairment over time via future orientation and depressive symptoms. Furthermore, the linkage between internalized HIV stigma and sleep impairment was serially mediated via self-esteem and depressive symptoms. This study highlights the deleterious effects of internalized HIV stigma on the physical and psychological health of PLWH. The findings suggest that interventions targeting internalized HIV stigma and related factors such as future orientation, self-esteem, and depressive symptoms may facilitate improvements in sleep quality and overall well-being among PLWH.

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The research was supported by National Institutes of Health (NIH)/National Institutes of Mental Health (NIMH) (Grant No. R01MH0112376).

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  1. School of Education Science, Leshan Normal University, Leshan, Sichuan, China

    Guangzhe Frank Yuan

  2. Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Guangzhe Frank Yuan, Shan Qiao & Xiaoming Li

  3. South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Guangzhe Frank Yuan, Shan Qiao & Xiaoming Li

  4. Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China

    Yuejiao Zhou & Zhiyong Shen

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Contributions

GFY designed the study, performed data analysis, and wrote the initial manuscript. SQ, XL, YZ, and ZS performed data collection and interpretation, editing, and gave critical review. All authors contributed to and approved the final manuscript for submission.

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Correspondence to Guangzhe Frank Yuan.

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Yuan, G.F., Qiao, S., Li, X. et al. Psychological Mechanisms of Internalized HIV Stigma Affect Sleep Impairment among People Living with HIV in China: A follow-up Study. AIDS Behav 28, 439–449 (2024). https://doi.org/10.1007/s10461-023-04236-4

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  • DOI: https://doi.org/10.1007/s10461-023-04236-4

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