BACKGROUND: Internalization of HIV-related stigma may affect a person's disease management and his\her accessibility to services. However, little is known about HIV-related stigma in HIV-infected patients. We aimed to estimate the internalized HIV-related stigma in Mississippi and its associated factors.
METHODS:
In this study, we used Mississippi Medical Monitoring Project (MMP) data from 2011 to 2014 (n=793). MMP is an ongoing, nationally representative, cross-sectional surveillance system designed to assess and monitor the behavioral and clinical characteristics of HIV-infected adults at least 18 years of age receiving outpatient medical care in the United States. Dependent variable was internalized HIV-related stigma (score range from 0-6, with higher scores indicating greater stigma). Our independent variables were gender (male, female), sexual orientation (heterosexual, homosexual, other), race (black, white), age (18-24, 25-44, 45-64, ≥65), education (<high school education, ≥high school education), poverty level (above, below, at), current smoking (yes, no), binge drinking (yes, no), drug abuse (yes, no), length of time diagnosed with HIV (<5 years ago, 5-9 years ago, ≥10 years ago), and insurance (private, public, uninsured). Descriptive analysis, t-tests, one-way ANOVA and multiple linear regression were conducted using complex sampling procedures (p<0.05).
RESULTS: Overall, 75% of respondents reported at least one internalized HIV-related stigma experience. The most common internalized stigma included having difficulty to tell people about HIV status (63.6%), followed by hiding HIV status from others (55%) and feeling ashamed because of HIV (34.2%).The average internalized HIV-related stigma score was 2.3 (out of 6), with a standard error of 0.07. Our findings showed that internalized HIV-related stigma was significantly higher among females (M=2.6, t=2.9, p=0.003), patients aged 18-24 (M=2.9, F=4.6, p=0.003),those with less than high school education (M=2.7, t=2.4, p=0.02), binge drinker (M=2.8, t=2.3, p=0.02), drug abuser (M=2.7, t=2.3, p=0.02 ), those who have been diagnosed with HIV since <5 years ago (M=2.6, F=6.6, p=0.001), and those who had private insurance (M=2.8, F=5.5, p=0.004). Differences in internalized HIV-related stigma mean were not significant by sexual orientation, current smoking, and poverty level. Multiple linear regression analysis showed that being female (β=0.52), having less than high school education (β=0.55), drug abusing (β=0.66), and having private insurance (β=0.77) contribute positively to predict experiencing internalized HIV-related stigma after entering all variables together.
CONCLUSIONS: The findings indicate that HIV-related stigma is very common in Mississippi, and is significantly associated with gender, education, drug abuse and insurance status, highlighting a need for stigma reduction interventions, with a focus on population at risk.