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HIV stigma and unprotected sex among PLWH in KwaZulu-Natal, South Africa: a longitudinal exploration of mediating mechanisms.

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Title: HIV stigma and unprotected sex among PLWH in KwaZulu-Natal, South Africa: a longitudinal exploration of mediating mechanisms.
Authors: Earnshaw, Valerie A. (AUTHOR), Smith, Laramie R. (AUTHOR), Shuper, Paul A. (AUTHOR), Fisher, William A. (AUTHOR), Cornman, Deborah H. (AUTHOR), Fisher, Jeffrey D. (AUTHOR)
Source: AIDS Care. Dec2014, Vol. 26 Issue 12, p1506-1513. 8p.
Subjects: Mental depression, HIV infections, Longitudinal method, Research funding, Statistics, Social stigma, Surveys, Time, Data analysis, Unsafe sex
Geographic Terms: South Africa
Abstract: Social and structural factors including HIV stigma are theorized to drive global disparities in HIV prevalence. This study tests whether HIV self-stigma, or experiences of stigma at the individual level, is associated with engagement in unprotected sex among people living with HIV (PLWH) in KwaZulu-Natal, South Africa, where 37.4% of adults are living with HIV compared with 0.8% worldwide. It further explores whether depressive symptoms, HIV status disclosure to sex partners, and/or condom use attitudes mediate potential associations between HIV self-stigma and unprotected sex. Participants, including 924 PLWH, were recruited from primary care clinics and completed baseline, 6-, 12-, and 18-month survey assessments between 2008 and 2011. Hierarchical linear modeling analyses were used to examine longitudinal within-subjects associations between HIV self-stigma, mediators, and unprotected sex with both HIV-negative/unknown and HIV-positive partners. Results demonstrate that HIV self-stigma was prospectively associated with greater likelihood of unprotected sex with HIV-negative/unknown partners. None of the variables explored significantly mediated this association. HIV self-stigma was also prospectively associated with greater likelihood of unprotected sex with HIV-positive partners via the mediators of greater depressive symptoms and more negative condom use attitudes. The current study suggests that HIV self-stigma undermines HIV secondary prevention and care efforts among PLWH in KwaZulu-Natal. It is therefore critical to address HIV stigma at the social/structural level to reduce HIV self-stigma at the individual level and ultimately curb global disparities in HIV prevalence. In the absence of widespread social/structural change, interventions that treat depressive symptoms and encourage more positive condom use attitudes despite the existence of HIV stigma may buffer associations between HIV self-stigma and unprotected sex with HIV-positive partners among PLWH in KwaZulu-Natal. [ABSTRACT FROM PUBLISHER]
Copyright of AIDS Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: HIV stigma and unprotected sex among PLWH in KwaZulu-Natal, South Africa: a longitudinal exploration of mediating mechanisms.
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  Data: <searchLink fieldCode="AR" term="%22Earnshaw%2C+Valerie+A%2E%22">Earnshaw, Valerie A.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Smith%2C+Laramie+R%2E%22">Smith, Laramie R.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Shuper%2C+Paul+A%2E%22">Shuper, Paul A.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fisher%2C+William+A%2E%22">Fisher, William A.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cornman%2C+Deborah+H%2E%22">Cornman, Deborah H.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fisher%2C+Jeffrey+D%2E%22">Fisher, Jeffrey D.</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22AIDS+Care%22">AIDS Care</searchLink>. Dec2014, Vol. 26 Issue 12, p1506-1513. 8p.
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  Data: <searchLink fieldCode="DE" term="%22Mental+depression%22">Mental depression</searchLink><br /><searchLink fieldCode="DE" term="%22HIV+infections%22">HIV infections</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Statistics%22">Statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Social+stigma%22">Social stigma</searchLink><br /><searchLink fieldCode="DE" term="%22Surveys%22">Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Time%22">Time</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis%22">Data analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Unsafe+sex%22">Unsafe sex</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22South+Africa%22">South Africa</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Social and structural factors including HIV stigma are theorized to drive global disparities in HIV prevalence. This study tests whether HIV self-stigma, or experiences of stigma at the individual level, is associated with engagement in unprotected sex among people living with HIV (PLWH) in KwaZulu-Natal, South Africa, where 37.4% of adults are living with HIV compared with 0.8% worldwide. It further explores whether depressive symptoms, HIV status disclosure to sex partners, and/or condom use attitudes mediate potential associations between HIV self-stigma and unprotected sex. Participants, including 924 PLWH, were recruited from primary care clinics and completed baseline, 6-, 12-, and 18-month survey assessments between 2008 and 2011. Hierarchical linear modeling analyses were used to examine longitudinal within-subjects associations between HIV self-stigma, mediators, and unprotected sex with both HIV-negative/unknown and HIV-positive partners. Results demonstrate that HIV self-stigma was prospectively associated with greater likelihood of unprotected sex with HIV-negative/unknown partners. None of the variables explored significantly mediated this association. HIV self-stigma was also prospectively associated with greater likelihood of unprotected sex with HIV-positive partners via the mediators of greater depressive symptoms and more negative condom use attitudes. The current study suggests that HIV self-stigma undermines HIV secondary prevention and care efforts among PLWH in KwaZulu-Natal. It is therefore critical to address HIV stigma at the social/structural level to reduce HIV self-stigma at the individual level and ultimately curb global disparities in HIV prevalence. In the absence of widespread social/structural change, interventions that treat depressive symptoms and encourage more positive condom use attitudes despite the existence of HIV stigma may buffer associations between HIV self-stigma and unprotected sex with HIV-positive partners among PLWH in KwaZulu-Natal. [ABSTRACT FROM PUBLISHER]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of AIDS Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=98883433
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      – Type: doi
        Value: 10.1080/09540121.2014.938015
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 8
        StartPage: 1506
    Subjects:
      – SubjectFull: Mental depression
        Type: general
      – SubjectFull: HIV infections
        Type: general
      – SubjectFull: Longitudinal method
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Statistics
        Type: general
      – SubjectFull: Social stigma
        Type: general
      – SubjectFull: Surveys
        Type: general
      – SubjectFull: Time
        Type: general
      – SubjectFull: Data analysis
        Type: general
      – SubjectFull: Unsafe sex
        Type: general
      – SubjectFull: South Africa
        Type: general
    Titles:
      – TitleFull: HIV stigma and unprotected sex among PLWH in KwaZulu-Natal, South Africa: a longitudinal exploration of mediating mechanisms.
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              M: 12
              Text: Dec2014
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              Y: 2014
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