Research Review

Stigmatization May Stop Patients With HIV From Proper Care

The feeling of stigmatization that people living with HIV often experience doesn't only exact a psychological toll—new UCLA research suggests it can also lead to quantifiably negative health outcomes.

In a study published in the Journal of General Internal Medicine, researchers found that a large number of HIV-positive individuals who reported feeling stigmatized also reported poor access to care or suboptimal adherence to antiretroviral therapy. In fact, individuals who experienced high levels of internalized stigma were four times as likely as those who didn't to report poor access to medical care; they were three times as likely to report suboptimal adherence to HIV medications.

These findings were due, at least in part, to the poor mental health found among many of the participants. Researchers found that HIV stigma was one of the strongest predictors of poor access to medical care and that both HIV stigma and poor mental health predicted suboptimal adherence to medication. Adherence to HIV medications is already known to lead to better health outcomes, including survival, among people living with HIV.

"We were surprised to find that in our models, experiencing high levels of internalized HIV stigma was one of the strongest predictors of poor access to medical care, even after controlling for sociodemographics such as gender, race and ethnicity, income, insurance status, and clinical variables such as T-cell count and years since HIV diagnosis," says the study's lead investigator, Jennifer Sayles, MD, an assistant professor of medicine at the David Geffen School of Medicine at UCLA.

The two-year study focused on 202 men and women who were HIV-positive in Los Angeles County, many of them minorities and many with limited incomes and limited education. Study participants completed anonymous surveys assessing internalized HIV stigma, self-reported access to medical care, their regular source of HIV care, and antiretroviral therapy adherence.

Overall, one third of the participants reported experiencing high levels of stigma, and, on average, participants described experiencing or perceiving stigma slightly less frequently than "some of the time." Additionally, 77% of participants said they had poor access to care, 42.5% reported suboptimal adherence to antiretroviral therapy, and 10.5% reported having no regular source of HIV care.

— Source: UCLA Health Sciences