Internalized stigma, social distance, and disclosure of HIV seropositivity in rural uganda

Alexander C. Tsai; David R. Bangsberg; Susan M. Kegeles; Ingrid T. Katz; Jessica E. Haberer; Conrad Muzoora; Elias Kumbakumba; Peter W. Hunt; Jeffrey N. Martin; Sheri D. Weiser

doi:10.1007/s12160-013-9514-6

Internalized stigma, social distance, and disclosure of HIV seropositivity in rural uganda

Alexander C. Tsai
, David R. Bangsberg
, Susan M. Kegeles
, Ingrid T. Katz
, Jessica E. Haberer
, Conrad Muzoora
, Elias Kumbakumba
, Peter W. Hunt
, Jeffrey N. Martin
, Sheri D. Weiser

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

133 Scopus citations

Abstract

Background: HIV is highly stigmatized, compromising both treatment and prevention in resource-limited settings. Purpose: We sought to study the relationship between internalized HIV-related stigma and serostatus disclosure and to determine the extent to which this association varies with the degree of social distance. Methods: We fit multivariable Poisson regression models, with cluster-correlated robust estimates of variance, to data from 259 persons with HIV enrolled in an ongoing cohort study in rural Uganda. Results: Persons with more internalized stigma were less likely to disclose their seropositivity. The magnitude of association increased with social distance such that the largest association was observed for public disclosures and the smallest association was observed for disclosures to sexual partners. Conclusions: Among persons with HIV in rural Uganda, internalized stigma was negatively associated with serostatus disclosure. The inhibiting effect of stigma was greatest for the most socially distant ties.

Original language	English (US)
Pages (from-to)	285-294
Number of pages	10
Journal	Annals of Behavioral Medicine
Volume	46
Issue number	3
DOIs	https://doi.org/10.1007/s12160-013-9514-6
State	Published - Dec 2013
Externally published	Yes

Funding

Source of Funding This study was funded by U.S. National Institutes of Health R01 MH-054907, K23 MH-079713 and MH-079713-03S1, and P30 AI-027763. Additionally, the authors acknowledge the following sources of salary support: K23 MH-096620 (Tsai); K24 MH-087227 (Bangsberg); a Scholar Award through the Harvard University Center for AIDS Research (P30 AI-060354), the Eleanor and Miles Shore 50th Anniversary Fellowship Program for Scholars in Medicine, the Harvard Global Health Institute, and K23 MH-097667 (Katz); K23 MH-087228 (Haberer); and the Burke Family Foundation (Weiser).

Funders	Funder number
Burke Family Foundation
Eleanor and Miles Shore
Harvard Global Health Institute	K23 MH-087228, K23 MH-097667
U.S. National Institutes of Health	K24 MH-087227, P30 AI-027763, K23 MH-079713, MH-079713-03S1, K23 MH-096620, R01 MH-054907
National Institutes of Health National Institute of Mental Health	K23MH079713
Harvard University Center for AIDS Research	P30 AI-060354

Keywords

Disclosure
HIV
Social stigma
Uganda

ASJC Scopus subject areas

General Medicine

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10.1007/s12160-013-9514-6

Cite this

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title = "Internalized stigma, social distance, and disclosure of HIV seropositivity in rural uganda",

abstract = "Background: HIV is highly stigmatized, compromising both treatment and prevention in resource-limited settings. Purpose: We sought to study the relationship between internalized HIV-related stigma and serostatus disclosure and to determine the extent to which this association varies with the degree of social distance. Methods: We fit multivariable Poisson regression models, with cluster-correlated robust estimates of variance, to data from 259 persons with HIV enrolled in an ongoing cohort study in rural Uganda. Results: Persons with more internalized stigma were less likely to disclose their seropositivity. The magnitude of association increased with social distance such that the largest association was observed for public disclosures and the smallest association was observed for disclosures to sexual partners. Conclusions: Among persons with HIV in rural Uganda, internalized stigma was negatively associated with serostatus disclosure. The inhibiting effect of stigma was greatest for the most socially distant ties.",

keywords = "Disclosure, HIV, Social stigma, Uganda",

author = "Tsai, \{Alexander C.\} and Bangsberg, \{David R.\} and Kegeles, \{Susan M.\} and Katz, \{Ingrid T.\} and Haberer, \{Jessica E.\} and Conrad Muzoora and Elias Kumbakumba and Hunt, \{Peter W.\} and Martin, \{Jeffrey N.\} and Weiser, \{Sheri D.\}",

note = "Funding Information: Source of Funding This study was funded by U.S. National Institutes of Health R01 MH-054907, K23 MH-079713 and MH-079713-03S1, and P30 AI-027763. Additionally, the authors acknowledge the following sources of salary support: K23 MH-096620 (Tsai); K24 MH-087227 (Bangsberg); a Scholar Award through the Harvard University Center for AIDS Research (P30 AI-060354), the Eleanor and Miles Shore 50th Anniversary Fellowship Program for Scholars in Medicine, the Harvard Global Health Institute, and K23 MH-097667 (Katz); K23 MH-087228 (Haberer); and the Burke Family Foundation (Weiser).",

year = "2013",

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doi = "10.1007/s12160-013-9514-6",

language = "English (US)",

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journal = "Annals of Behavioral Medicine",

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AU - Tsai, Alexander C.

AU - Bangsberg, David R.

AU - Kegeles, Susan M.

AU - Katz, Ingrid T.

AU - Haberer, Jessica E.

AU - Muzoora, Conrad

AU - Kumbakumba, Elias

AU - Hunt, Peter W.

AU - Martin, Jeffrey N.

AU - Weiser, Sheri D.

N1 - Funding Information: Source of Funding This study was funded by U.S. National Institutes of Health R01 MH-054907, K23 MH-079713 and MH-079713-03S1, and P30 AI-027763. Additionally, the authors acknowledge the following sources of salary support: K23 MH-096620 (Tsai); K24 MH-087227 (Bangsberg); a Scholar Award through the Harvard University Center for AIDS Research (P30 AI-060354), the Eleanor and Miles Shore 50th Anniversary Fellowship Program for Scholars in Medicine, the Harvard Global Health Institute, and K23 MH-097667 (Katz); K23 MH-087228 (Haberer); and the Burke Family Foundation (Weiser).

PY - 2013/12

Y1 - 2013/12

N2 - Background: HIV is highly stigmatized, compromising both treatment and prevention in resource-limited settings. Purpose: We sought to study the relationship between internalized HIV-related stigma and serostatus disclosure and to determine the extent to which this association varies with the degree of social distance. Methods: We fit multivariable Poisson regression models, with cluster-correlated robust estimates of variance, to data from 259 persons with HIV enrolled in an ongoing cohort study in rural Uganda. Results: Persons with more internalized stigma were less likely to disclose their seropositivity. The magnitude of association increased with social distance such that the largest association was observed for public disclosures and the smallest association was observed for disclosures to sexual partners. Conclusions: Among persons with HIV in rural Uganda, internalized stigma was negatively associated with serostatus disclosure. The inhibiting effect of stigma was greatest for the most socially distant ties.

AB - Background: HIV is highly stigmatized, compromising both treatment and prevention in resource-limited settings. Purpose: We sought to study the relationship between internalized HIV-related stigma and serostatus disclosure and to determine the extent to which this association varies with the degree of social distance. Methods: We fit multivariable Poisson regression models, with cluster-correlated robust estimates of variance, to data from 259 persons with HIV enrolled in an ongoing cohort study in rural Uganda. Results: Persons with more internalized stigma were less likely to disclose their seropositivity. The magnitude of association increased with social distance such that the largest association was observed for public disclosures and the smallest association was observed for disclosures to sexual partners. Conclusions: Among persons with HIV in rural Uganda, internalized stigma was negatively associated with serostatus disclosure. The inhibiting effect of stigma was greatest for the most socially distant ties.

KW - Disclosure

KW - HIV

KW - Social stigma

KW - Uganda

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Internalized stigma, social distance, and disclosure of HIV seropositivity in rural uganda

Abstract

Funding

Keywords

ASJC Scopus subject areas

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