Buffering Internalization of HIV Stigma: Implications for Treatment Adherence and Depression

Bulent Turan; Kaylee B. Crockett; Asuman Buyukcan-Tetik; Mirjam Colette Kempf; Deborah Konkle-Parker; Tracey E. Wilson; Phyllis C. Tien; Gina Wingood; Torsten B. Neilands; Mallory O. Johnson; Sheri D. Weiser; Janet M. Turan

doi:10.1097/QAI.0000000000001915

Buffering Internalization of HIV Stigma: Implications for Treatment Adherence and Depression

Bulent Turan^*, Kaylee B. Crockett, Asuman Buyukcan-Tetik, Mirjam Colette Kempf, Deborah Konkle-Parker, Tracey E. Wilson, Phyllis C. Tien, Gina Wingood, Torsten B. Neilands, Mallory O. Johnson, Sheri D. Weiser, Janet M. Turan

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background:One mechanism through which social stigma of HIV affects health outcomes for people living with HIV (PLWH) is through internalization of stigma. However, this transformation of social stigma in the community into internalized stigma may not be of the same magnitude for all PLWH. We examined the moderating effects of 3 personality traits - fear of negative social evaluation, attachment-related anxiety, and dispositional resilience - in transforming perceived stigma in the community into internalized stigma. Furthermore, we investigated downstream effects of these moderated associations on depressive symptoms and antiretroviral treatment (ART) adherence.Setting/Methods:In study 1, data from 203 PLWH in the Southeast United States were analyzed controlling for age, sex, education, race, and time on ART. In study 2, data from 453 women in a multisite study were analyzed controlling for age, education, race, time on ART, and substance use.Results:In both studies, fear of negative evaluation and attachment-related anxiety moderated the effect of perceived HIV stigma in the community on internalized HIV stigma: People higher on those moderating variables had stronger associations between perceived stigma in the community and internalized stigma. In study 2, resilience was assessed and also moderated the effect of perceived HIV stigma in the community on internalized stigma. In moderated mediation models, fear of negative evaluation, attachment-related anxiety, and resilience moderated the indirect effect of perceived HIV stigma in the community on ART adherence and depression through internalized stigma.Conclusions:Interventions to assuage internalization of HIV stigma should focus on bolstering attachment-related security, social competence, and resilience.

Original language	English
Pages (from-to)	284-291
Number of pages	8
Journal	Journal of Acquired Immune Deficiency Syndromes
Volume	80
Issue number	3
DOIs	https://doi.org/10.1097/QAI.0000000000001915
Publication status	Published - 1 Mar 2019
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc.

Funding

Supported by Women’s Interagency HIV Study (WIHS) substudy grants from the National Institute of Mental Health, R01MH104114 and R01MH095683. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). WIHS (Principal Investigators): UAB-MS WIHS (M-C.K. and D. K.-P.), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and G.W.), U01-AI-103408; Bronx WIHS (Kathryn Anastos and Anjali Sharma), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam), U01-HD-032632 (WIHS I–WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional cofunding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR000454 (Atlanta CTSA), and P30-AI-050410 (UNC CFAR). This research was also supported by the University of Alabama at Birmingham (UAB) Center for AIDS Research CFAR, an NIH funded program (P30 AI027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIA, NIDDK, NIGMS, and OAR. Trainee support was provided by the Agency for Healthcare Research and Quality (AHRQ 2T32HS013852-16).

Funders	Funder number
Center for AIDS Research CFAR
NIH Office of Research on Women’s Health	UL1-TR000004
National Institutes of Health	P30 AI027767
National Institute of Mental Health	R01MH104114, R01MH095683
National Institute on Drug Abuse
National Institute on Alcohol Abuse and Alcoholism
National Institute on Aging, National Institutes of Health
National Heart, Lung, and Blood Institute
National Cancer Institute Thailand
National Institute on Deafness and Other Communication Disorders
National Institute of General Medical Sciences
National Institute of Allergy and Infectious Diseases
National Institute of Diabetes and Digestive and Kidney Diseases
National Institute of Dental and Craniofacial Research
Agency for Healthcare Research and Quality	2T32HS013852-16
University of California at San Francisco	P30-AI-050410, UL1-TR000454
University of Alabama at Birmingham
Section of Intercellular Interactions, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892.
Center for AIDS Research, University of North Carolina at Chapel Hill
Office for the Advancement of Research, John Jay College of Criminal Justice

Keywords

adherence
attachment
HIV
negative evaluation
resilience
stigma

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/QAI.0000000000001915

Cite this

Turan, B., Crockett, K. B., Buyukcan-Tetik, A., Kempf, M. C., Konkle-Parker, D., Wilson, T. E., Tien, P. C., Wingood, G., Neilands, T. B., Johnson, M. O., Weiser, S. D., & Turan, J. M. (2019). Buffering Internalization of HIV Stigma: Implications for Treatment Adherence and Depression. Journal of Acquired Immune Deficiency Syndromes, 80(3), 284-291. https://doi.org/10.1097/QAI.0000000000001915

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title = "Buffering Internalization of HIV Stigma: Implications for Treatment Adherence and Depression",

abstract = "Background:One mechanism through which social stigma of HIV affects health outcomes for people living with HIV (PLWH) is through internalization of stigma. However, this transformation of social stigma in the community into internalized stigma may not be of the same magnitude for all PLWH. We examined the moderating effects of 3 personality traits - fear of negative social evaluation, attachment-related anxiety, and dispositional resilience - in transforming perceived stigma in the community into internalized stigma. Furthermore, we investigated downstream effects of these moderated associations on depressive symptoms and antiretroviral treatment (ART) adherence.Setting/Methods:In study 1, data from 203 PLWH in the Southeast United States were analyzed controlling for age, sex, education, race, and time on ART. In study 2, data from 453 women in a multisite study were analyzed controlling for age, education, race, time on ART, and substance use.Results:In both studies, fear of negative evaluation and attachment-related anxiety moderated the effect of perceived HIV stigma in the community on internalized HIV stigma: People higher on those moderating variables had stronger associations between perceived stigma in the community and internalized stigma. In study 2, resilience was assessed and also moderated the effect of perceived HIV stigma in the community on internalized stigma. In moderated mediation models, fear of negative evaluation, attachment-related anxiety, and resilience moderated the indirect effect of perceived HIV stigma in the community on ART adherence and depression through internalized stigma.Conclusions:Interventions to assuage internalization of HIV stigma should focus on bolstering attachment-related security, social competence, and resilience.",

keywords = "adherence, attachment, HIV, negative evaluation, resilience, stigma",

author = "Bulent Turan and Crockett, {Kaylee B.} and Asuman Buyukcan-Tetik and Kempf, {Mirjam Colette} and Deborah Konkle-Parker and Wilson, {Tracey E.} and Tien, {Phyllis C.} and Gina Wingood and Neilands, {Torsten B.} and Johnson, {Mallory O.} and Weiser, {Sheri D.} and Turan, {Janet M.}",

note = "Publisher Copyright: {\textcopyright} 2018 Wolters Kluwer Health, Inc.",

year = "2019",

month = mar,

day = "1",

doi = "10.1097/QAI.0000000000001915",

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volume = "80",

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Turan, B, Crockett, KB, Buyukcan-Tetik, A, Kempf, MC, Konkle-Parker, D, Wilson, TE, Tien, PC, Wingood, G, Neilands, TB, Johnson, MO, Weiser, SD & Turan, JM 2019, 'Buffering Internalization of HIV Stigma: Implications for Treatment Adherence and Depression', Journal of Acquired Immune Deficiency Syndromes, vol. 80, no. 3, pp. 284-291. https://doi.org/10.1097/QAI.0000000000001915

TY - JOUR

T1 - Buffering Internalization of HIV Stigma

T2 - Implications for Treatment Adherence and Depression

AU - Turan, Bulent

AU - Crockett, Kaylee B.

AU - Buyukcan-Tetik, Asuman

AU - Kempf, Mirjam Colette

AU - Konkle-Parker, Deborah

AU - Wilson, Tracey E.

AU - Tien, Phyllis C.

AU - Wingood, Gina

AU - Neilands, Torsten B.

AU - Johnson, Mallory O.

AU - Weiser, Sheri D.

AU - Turan, Janet M.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background:One mechanism through which social stigma of HIV affects health outcomes for people living with HIV (PLWH) is through internalization of stigma. However, this transformation of social stigma in the community into internalized stigma may not be of the same magnitude for all PLWH. We examined the moderating effects of 3 personality traits - fear of negative social evaluation, attachment-related anxiety, and dispositional resilience - in transforming perceived stigma in the community into internalized stigma. Furthermore, we investigated downstream effects of these moderated associations on depressive symptoms and antiretroviral treatment (ART) adherence.Setting/Methods:In study 1, data from 203 PLWH in the Southeast United States were analyzed controlling for age, sex, education, race, and time on ART. In study 2, data from 453 women in a multisite study were analyzed controlling for age, education, race, time on ART, and substance use.Results:In both studies, fear of negative evaluation and attachment-related anxiety moderated the effect of perceived HIV stigma in the community on internalized HIV stigma: People higher on those moderating variables had stronger associations between perceived stigma in the community and internalized stigma. In study 2, resilience was assessed and also moderated the effect of perceived HIV stigma in the community on internalized stigma. In moderated mediation models, fear of negative evaluation, attachment-related anxiety, and resilience moderated the indirect effect of perceived HIV stigma in the community on ART adherence and depression through internalized stigma.Conclusions:Interventions to assuage internalization of HIV stigma should focus on bolstering attachment-related security, social competence, and resilience.

AB - Background:One mechanism through which social stigma of HIV affects health outcomes for people living with HIV (PLWH) is through internalization of stigma. However, this transformation of social stigma in the community into internalized stigma may not be of the same magnitude for all PLWH. We examined the moderating effects of 3 personality traits - fear of negative social evaluation, attachment-related anxiety, and dispositional resilience - in transforming perceived stigma in the community into internalized stigma. Furthermore, we investigated downstream effects of these moderated associations on depressive symptoms and antiretroviral treatment (ART) adherence.Setting/Methods:In study 1, data from 203 PLWH in the Southeast United States were analyzed controlling for age, sex, education, race, and time on ART. In study 2, data from 453 women in a multisite study were analyzed controlling for age, education, race, time on ART, and substance use.Results:In both studies, fear of negative evaluation and attachment-related anxiety moderated the effect of perceived HIV stigma in the community on internalized HIV stigma: People higher on those moderating variables had stronger associations between perceived stigma in the community and internalized stigma. In study 2, resilience was assessed and also moderated the effect of perceived HIV stigma in the community on internalized stigma. In moderated mediation models, fear of negative evaluation, attachment-related anxiety, and resilience moderated the indirect effect of perceived HIV stigma in the community on ART adherence and depression through internalized stigma.Conclusions:Interventions to assuage internalization of HIV stigma should focus on bolstering attachment-related security, social competence, and resilience.

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KW - HIV

KW - negative evaluation

KW - resilience

KW - stigma

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JO - Journal of Acquired Immune Deficiency Syndromes

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ER -

Buffering Internalization of HIV Stigma: Implications for Treatment Adherence and Depression

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

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