Skip to main content

Table 1 Research on HIV and stigma in LMICs, 2008–2017

From: A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries

Study (First author, year [ref.])

Location

Sampling characteristics

Sample size

Study design

Type of stigma assessed

Description of stigma association (strength, significance)

Significant mediators/moderators

Abboud, 2010 [59]

Lebanon

Convenience sample of PLWHA obtaining care at two hospitals

41

Cross-sectional

Experienced

Anticipated

Internalized

Strong inverse correlation between stigma scale score and QoL-HIV

None

Bitew, 2016 [56]

Ethiopia

PLWHA seeking care from a hospital

393

Cross-sectional

Perceived stigma

Perceived stigma was associated with suicide attempts

None

Breet, 2013 [36]

South Africa

Convenience sample of PLWHA

210

Cross-sectional

Experienced

Anticipated

Internalized

HIV stigma and PTSD (p < 0.001)

Med: Social support

Calabrese, 2016 [26]

Russia

Respondent-driven sampling among individuals who were HIV-positive and reported using injection drugs in past 4 weeks

383

Cross-sectional

Internalized

Anticipated

HIV stigma not associated with subjective health rating, but associated with subjective symptom count

Med: Injection drug stigma

Carlucci, 2008 [53]

Zambia

PLWHA initiating ART

409

Cross-sectional survey with perceived stigma vs. none assessed at baseline

Adherence data obtained over time on ART

Not specified

Perceived stigma present vs. absent (35% vs. 65%; p = 0.9)

None

Cluver, 2009 [157]

South Africa

AIDS-orphaned youth vs. non-AIDS orphaned and non-orphaned recruited from schools

1025

Cross-sectional

Not specified

Stigma associated with increased depression, anxiety, PTSD

Mod: Food insecurity

Colombini, 2014 [47]

Kenya

Randomly selected from a larger study of HIV+ women obtaining care

48

Qualitative

Not specified

Participants reported that anticipated stigma limited disclosure

None

Denison, 2015 [158]

Tanzania, Uganda, Zambia

PLWHA seeking care at 18 ART facilities

4495

Cross-sectional

Anticipated

Internalized

High internalized stigma associated with incomplete adherence

Mod: Social support, depression, alcohol abuse

Deribew, 2009 [159]

Ethiopia

HIV and TB patients obtaining clinical care

591

Cross-sectional

Perceived

Negative correlations between stigma and with spiritual, psychological, and social QoL

Mod: TB co-infection

Deribew, 2010 [29]

Ethiopia

TB/HIV co-infected patients and HIV non-co-infected patients in three hospitals

620

Cross-sectional

Experienced

Anticipated

Internalized

Stigma score associated with common mental disorders

None

Dlamini, 2009 [54]

Lesotho, Malawi, South Africa, Swaziland, Tanzania

HIV support groups, clinics, flyers

1457

Cohort

Enacted

Internalized

Greater stigma among participants missing medications

Mod: Fewer medication worries decreases stigma score

Dow, 2016

Tanzania

Youth (12–24 years) living with HIV attending HIV focused youth clinic

182

Cross-sectional

Experienced

Anticipated

Internalized

Stigma associated with worse mental health

None

Duff, 2010 [160]

Uganda

Women with HIV attending a PMTCT program

45

Qualitative

Not specified

Stigma cited as common barrier to taking medication

None

Earnshaw, 2014 [5]

South Africa

PLWHA obtaining care at 16 primary care clinics

924

Cohort

Internalized

Self-stigma associated with increased depression, negative condom use attitude, and increased unprotected sex with HIV-positive partners

Med: Depression and condom use attitudes mediate association between self-stigma and unprotected sex

Endeshaw, 2014 [30]

Ethiopia

Convenience sampling of PLWHA obtaining care at a clinic

55

Cross-sectional

Internalized

Perceived

Stigma associated with depression

None

Erku, 2016 [55]

Ethiopia

Patients on ART and obtaining care from one ART clinic

548

Cohort

Not specified

Perceived stigma associated with decreased adherence

Individuals who adhere to ART report decreased stigma over time

None

Garrido-Hernansaiz, 2016 [161]

India

PLWHA recruited through flyers in healthcare settings and NGOs

961

Cross-sectional

Internalized

Experienced

Internalized and enacted stigma negatively associated with HQoL

None

Greeff, 2010 [162]

Lesotho, Malawi, South Africa, Swaziland, Tanzania

Purposive sample of PLWHA

1454

Cohort

Experienced

Anticipated

Internalized

Life satisfaction negatively associated with reported stigma

None

Holzemer, 2009 [60]

Kenya, USA

Convenience sample of HIV infected adults

726

Cross-sectional

Experienced

Anticipated

Internalized

Stigma accounted for 5.3% of variance in HQoL

None

Kalomo, 2017 [31]

Namibia

PLWHA obtaining care at a clinic

124

Cross-sectional

Experienced

Anticipated

Internalized

Stigma was significantly associated with depression

None

Kingori, 2012 [24]

Kenya

PLWHA recruited while obtaining care

370

Cross-sectional

Internalized

Felt stigma associated with self-reported poor health, reduced disclosure, and decreased adherence

None

Li, 2009 [33]

Thailand

Hospital-recruited PLWHA

408

Cross-sectional

Internalized

Perceived

Depression associated with internalized shame and perceived shame

Med: Emotional support

Li, 2014 [163]

Thailand

Convenience sample of PLWHA obtaining care

128

Cross-sectional

Experienced

Anticipated

Internalized

Stigma negatively associated with adherence

Mod: Social support was measured but not significant

Li, 2015 [164]

China

PLWHA recruited from clinics

114

Cross-sectional

Internalized

Enacted

Stigma not associated with HQoL

Med: Relationship fully mediated by depression

Li, 2016 [165]

China

MSM who were HIV-infected were recruited by local NGO

321

Cross-sectional

Enacted

Enacted stigma associated with increased depression

None

Li, 2017 [35]

China

MSM who were HIV-infected were recruited by local NGO

321

Cross-sectional

Internalized

Self-stigma was associated with depression

Med: Positive affect, negative affect, and social support

Liu, 2014 [41]

China

PLWHA who had registered with the CDC

290

Cross-sectional

Experienced

Anticipated

Internalized

Stigma associated with anxiety

None

Lyimo, 2014 [50]

Tanzania

PLWHA obtaining care at two clinics and on ART for 6 months

158

Cross-sectional

Experienced

Anticipated

Internalized

Denial of HIV status associated with perceived stigma

Self-stigmatization negatively associated with adherence

None

Makin, 2008 [48]

South Africa

Pregnant women living with HIV attending antenatal clinics

293

Cohort (interviews at enrolment and 3 months after giving birth)

Perceived Internalized

Stigma associated with lower likelihood of disclosure

None

Mekuria, 2015 [166]

Ethiopia

PLWHA obtaining care at selected health facilities; selected from national ART-registrar, then randomly selected

664

Cross-sectional

Internalized

HIV-stigma directly associated with all domains of HQoL except physical domain

Med: Depression mediates association between stigma and physical HRQoL

Mohite, 2015 [34]

India

Purposive sample of women with HIV attending a care center

50

Cross-sectional

Perceived

Correlation between perceived stigma and depression

None

Nyamathi, 2017 [167]

India

Women with HIV at primary care clinics

400

Cross-sectional

Internalized

Internalized stigma associated with HQoL (p < 0.0001)

None

Ojikutu, 2016 [49]

Thailand, Brazil, Zambia

Women with HIV receiving care

299

Cohort

Anticipated

Decreased disclosure associated with anticipated stigma

Mod: Cohabitation and marital status

Olley, 2016 [46]

Nigeria

PLWHA obtaining follow-up care at one hospital

139

Cross-sectional

Experienced

Anticipated

Internalized

Perceived stigma associated with decreased self-disclosure

Med: Anticipated discrimination

Olley, 2017 [43]

Nigeria

PLWHA obtaining care at two hospitals

502

Cross-sectional

Experienced

Anticipated

Internalized

Stigma associated with severe depression

None

Peitzmeier, 2015 [25]

Gambia

PLWHA attending support groups

317

Cross-sectional

Experienced

Internalized

Enacted stigma in healthcare setting associated with avoiding or delaying care and not using ART

Enacted stigma in household and internalized stigma associated with poorer self-reported health status

None

Peltzer, 2011 [168]

South Africa

Treatment-naïve patients from three public hospitals

735

Cohort

Internalized

HQoL not predictive of stigma

None

Rael, 2017 [37]

Dominican Republic

Purposive sample of women with HIV, female sex workers and control group of women without HIV and non-female sex workers

876

Cross-sectional

Internalized

Internalized stigma associated with increased depression

None

Robinson, 2015 [44]

Turks and Caicos

Data analyzed from 2011 Knowledge, Attitudes, Practices and Behaviors Survey

837

Cross-sectional

Enacted

Self-reported HIV discrimination related to willingness to disclose HIV status

None

Rodriguez, 2017 [57]

South Africa

Pregnant women with HIV obtaining care at a clinic

673

Cross-sectional

Internalized

Stigma associated with suicidality

Med: Physical intimate partner violence

Sanjobo, 2008 [169]

Zambia

PLWHA obtaining care at ART centers

60

Cross-sectional

Not specified

HIV stigma was a barrier to adherence

None

Shrestha, 2017 [38]

Malaysia

Prisoners with HIV and opioid dependence who are prisoners

301

Cross-sectional

Experienced

Anticipated

Internalized

HIV-related stigma was associated with depression (p < 0.001); no direct association between stigma and HQoL

Med: Depression mediated stigma and HQoL

Mod: Social support moderated stigma and HQoL

Steward, 2008 [62]

India

PLWHA on ART obtaining care at a large, urban, private hospital

229

Cross-sectional

Enacted

Enacted stigma associated with disclosure avoidance and depression

Med: Stigma and depression mediated by use of coping strategies to avoid disclosure of HIV status

Subramanian, 2009 [170]

India

PLWHA obtaining care at one government clinic

646

Cross-sectional

Experienced

Anticipated

Internalized

All stigma domains (perceived stigma, internalized stigma, and actual stigma) associated with all domains of HQoL instrument (physical, psychological, social and environmental)

None

Takada, 2014 [171]

Uganda

Selected sample of PLWHA from ongoing cohort study

422

Cohort

Internalized

Lagged internalized stigma associated with depression

None

Tao, 2017 [39]

China

MSM newly diagnosed with HIV

367

Cross-sectional

Experienced

Anticipated

Internalized

Stigma associated with depression; strongest associated was between internalized stigma and depression

None

Tesfaw, 2016 [42]

Ethiopia

PLWHA obtaining care from one hospital

417

Cross-sectional

Perceived

Stigma associated with depression

None

Tesfay, 2015 [61]

Ethiopia

Randomly selected PLWHA on ART with regular follow up at an HIV clinic

594

Cross-sectional

Perceived

Stigma associated with psychological HQoL

Med: Gender

Tsai, 2013 [45]

Uganda

Treatment-naïve patients obtaining care at a clinic

259

Cohort

Internalized

Stigma associated with decreased disclosure to household members

Med: Social distance

Turan, 2015 [172]

Kenya

Pregnant women with HIV obtaining care at an antenatal clinic

135

Cohort

Experienced

Anticipated

Internalized

Decreased linkage to care predictive of increased stigma

Increased stigma associated with increased depression

None

Valencia-Garcia, 2017 [52]

Peru

Pregnant women with HIV

15

Qualitative

Enacted

Healthcare stigma reduced participants’ willingness to return for care

None

Valenzuela, 2015 [51]

Peru

Patients initiating care at a national referral center

Cases: out of care for > 12 months, Controls: those in care

176

Case–control

Experienced

Anticipated

Internalized

Enacted stigma associated with and being out of care

None

Wu, 2008 [40]

Peru

Women with HIV initiating ART

78

Cross-sectional

Experienced

Anticipated

Internalized

Stigma associated with depression

Mod: Food scarcity

Wu, 2015 [173]

China

PLWHA obtaining care at two hospitals

190

Cross-sectional

Experienced

Anticipated

Internalized

Higher QoL associated with lower levels of stigma

None

Wu, 2015 [174]

China

MSM with HIV listed in the CDC register

184

Cross-sectional

Experienced

Anticipated

Internalized

Stigma associated with suicidal ideation

None

Yi, 2015 [27]

Cambodia

PLWHA recruited through cluster sampling method of provinces and HIV clinics

1003

Cross-sectional

Perceived

HIV-related stigma and discrimination associated with higher levels of mental disorders

None

Zhang, 2015 [23]

China

Persons living with HIV were randomly selected for participation from a parent study

2987

Cross-sectional

Experienced

Anticipated

Internalized

Internalized stigma negatively associated with self-rated health status

Med: Resilience

Zhang, 2016 [32]

China

Persons living with HIV were randomly selected for participation from a parent study

2987

Cross-sectional

Experienced

Anticipated

Internalized

Enacted perceived and internalized stigma were associated with anxiety, depression, decreased resilience, and decreased self-esteem

Perceived stigma associated was associated with increased drug use

Mod: Income

Zhou, 2017 [58]

China

Persons living with HIV were randomly selected for participation from a parent study

2987

Cross-sectional

Experienced

Anticipated

Internalized

Stigma negatively associated with QoL

Med: HIV symptom management self-efficacy

  1. ART antiretroviral therapy, CDC Centers for Disease Control, HQoL health-related quality of life, Med mediators, Mod moderators, MSM men who have sex with men, NGO non-governmental organization, PLWHA persons living with HIV and aids, PMTCT prevention of mother-to-child transmission, PTSD post-traumatic stress disorder, QoL quality of life, TB tuberculosis