BACKGROUND:
Despite the fact that human immunodeficiency virus (HIV) infection has become a manageable condition owing to care and treatment advances, HIV-related stigmatization is still prevalent and remains a potent stressor for HIV-positive people and may negatively impact their mental health. We therefore conducted this study to examine the association of HIV-related stigma with depression among HIV-infected persons receiving care in Mississippi.
METHODS:
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 and Puerto Rico.Dependent variable was depression measured using eight-item Patient Health Questionnaire in MMP. A PHQ severity score of ≥10 was considered the cut off point for depression. Main independent variable was stigma measured by a modified 6-item internalized HIV-related stigma scale from MMP survey. Descriptive analysis and multivariate logistic regression models were conducted to assess relationships between depression with HIV-related stigma, adjusting for covariates (age, gender, sexual orientation, race,education, poverty level, and smoking). Variables were included in the multivariable logistic regression model if their p-value was less than 0.20 on bivariate analysis. All analyses accounted for the complex sample design and unequal selection probabilities.
RESULTS: The overall total weighted percentage of HIV-infected persons receiving care with major depression was 16.4%. Females (22%), those who had less than high school education (23.8%), current smokers (22.1%) had significantly greater prevalence of depression. Similarly, those who reported at least one stigma experience had significantly higher prevalence of depression (20.8%) compared to those who did not (5.5%). Approximately 75% of HIV-infected persons receiving care had at least one HIV-related stigma experience. The proportion of HIV-infected persons receiving care who reported stigma ranged from 21.9% for feeling worthless because of HIV to 63.6% for having difficulty to tell people about HIV status. Multiple logistic regression analysis showed that HIV-infected persons receiving care who reported at least one stigma experience were significantly more likely to have depression compared to those who never had HIV-related stigma experience after controlling for the covariates (aOR=5.4, 95% CI=2.5-11.5).
CONCLUSIONS: HIV-related stigma among HIV-infected persons receiving care in Mississippi is common and predicts depression in this population. These findings indicate a need for community-based interventions to reduce stigma in the general public.