Associations Between Experienced and Internalized HIV Stigma, Adversarial Growth, and Health Outcomes in a Nationwide Sa
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ORIGINAL PAPER
Associations Between Experienced and Internalized HIV Stigma, Adversarial Growth, and Health Outcomes in a Nationwide Sample of People Aging with HIV in Germany Jochen Drewes1 · Phil C. Langer2 · Jennifer Ebert1 · Dieter Kleiber1 · Burkhard Gusy1 Accepted: 5 October 2020 © The Author(s) 2020
Abstract HIV-related stigmatization and adversarial growth are known to influence health outcomes in people living with HIV. But not much is known how these psychosocial factors are related to each other and how they interact to influence health outcomes. We tested whether the effect of experienced and internalized stigma on mental health and self-rated health is mediated by adversarial growth, and whether each of these factors is uniquely associated with health outcomes. In our sample of 839 people aging with HIV in Germany based on a cross-sectional study design we did not find an indirect effect of experienced HIV stigma on health outcomes and a very small indirect effect of internalized HIV stigma. All variables were significant predictors of health outcomes in multiple regression analyses. Keywords HIV stigma · Posttraumatic growth · Mental health · Self-rated health · Mediation Resumen Se sabe que el estigma y el crecimiento postraumático asociados al VIH influyen en los indicadores del estado de salud de las personas que viven con el virus. Sin embargo, se desconoce cómo estos factores psicosociales se relacionan entre sí, y cómo interactúan sobre los indicadores del estado de salud. En este estudio comprobamos si los efectos de la experiencia e internalización del estigma sobre la salud mental y la evaluación subjetiva del estado salud están mediados por el crecimiento postraumático, así como el impacto único de cada uno de estos factores sobre los indicadores de salud. Usando un diseño de estudio transversal en una muestra de 839 personas que viven con VIH en Alemania, no encontramos un efecto indirecto del estigma experimentado en los indicadores de salud, pero sí, un efecto indirecto muy pequeño del estigma internalizado. Todas las variables se mostraron predictores significativos de los resultados de salud en un análisis de regresión múltiple.
Introduction Even in the era of antiretroviral treatment (ART), living with an HIV infection is characterized by impaired mental and physical health, and negative and positive psychosocial factors are known to influence health outcomes among people living with HIV (PLWH) [1, 2]. HIV-related stigmatization * Jochen Drewes jochen.drewes@fu‑berlin.de 1
Public Health: Prevention and Psychosocial Health Research, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
International Psychoanalytic University, Stromstr. 3b, 10555 Berlin, Germany
2
and growth processes after a ‘traumatic’ HIV diagnosis are two of these factors. Not much is known about how these two factors are related to each other and whether they interact to influence health outcomes.
HIV‑related Stigma and Health Outcomes Since it was first described HIV infection i
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