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 |