The Dynamic Relationship Between Social Support and HIV-Related Stigma in Rural Uganda
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ORIGINAL ARTICLE
The Dynamic Relationship Between Social Support and HIV-Related Stigma in Rural Uganda Sae Takada, Ph.D., M.H.S. & Sheri D. Weiser, M.D., M.A., M.P.H. & Elias Kumbakumba, M.D. & Conrad Muzoora, M.D. & Jeffrey N. Martin, M.D., M.P.H. & Peter W. Hunt, M.D. & Jessica E. Haberer, M.D., M.S. & Annet Kawuma, M.D. & David R. Bangsberg, M.D., M.P.H. & Alexander C. Tsai, M.D., Ph.D.
# The Society of Behavioral Medicine 2013
Abstract Background Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support. Purpose The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma. Methods 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. Results Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged Electronic supplementary material The online version of this article (doi:10.1007/s12160-013-9576-5) contains supplementary material, which is available to authorized users. S. Takada (*) : J. E. Haberer : D. R. Bangsberg : A. C. Tsai Harvard Medical School, Boston, MA, USA e-mail: [email protected] S. D. Weiser : P. W. Hunt Division of HIV/AIDS and Positive Health Program, University of California at San Francisco, San Francisco, CA, USA E. Kumbakumba : C. Muzoora : A. Kawuma : D. R. Bangsberg Mbarara University of Science and Technology, Mbarara, Uganda J. N. Martin Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA J. E. Haberer : D. R. Bangsberg : A. C. Tsai Center for Global Health, Massachusetts General Hospital, Boston, MA, USA A. C. Tsai Chester M. Pierce MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
instrumental social support was negatively correlated with enacted stigma. Internalized stigma and emotional social support had reciprocal lagged associations. Conclusions 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. Keywords HIV/AIDS . Stigma . Social support . Uganda
Introduction Human immunodeficiency virus (HIV) stigma is a welldocumented barrier to the health and well-being of people living with HIV. As described by Goffman [1], stigma is a discrediting attribute that reduces a person from a whole person to a tainted or discounted person. HIV stigma has been associated with delaying or avoidance of HIV testing [2–4], poor adherence to antiretroviral therapy (ART) [5, 6], increased risk behaviors [7], and poor engagement with care [8]. In addition, people living with HIV experience numerous mental and psychological sequelae of stigma, including stress, fear, anxiety,
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