BACKGROUND: Reducing stigma is part of the National HIV/AIDS Strategy and is a primary goal of the End AIDS Washington Initiative. Internalized stigma is when individuals believe negative views of people living with HIV are true of themselves. There were three primary objectives of this analysis: (1) Measure the prevalence of stigma among HIV positive persons in Washington State, (2) Explore the relationships between stigma and various behavioral and clinical outcomes and (3) Assess the association between stigma and durable viral load suppression, which was defined as having all viral loads in a 12-month period being <=200 copies per ml.
METHODS: The Medical Monitoring Project (MMP) is a national surveillance system used to learn about people living with HIV. Clinical and behavioral information is gathered from a locally and nationally representative annual interview and medical record abstraction. Patient demographics, stigma scores, risk information and behavioral and clinical outcomes were obtained for all individuals that answered at least one stigma question in the Washington State MMP in 2011 through 2014 (n=921). Six questions were used to measure stigma and responses were coded to disagree=0 and agree=1. A stigma score was calculated by summating the six questions, with a range of 0 (low) to 6 (high). Mean stigma scores were analyzed by demographic, behavior and clinical outcomes using one-way ANOVA. Multivariate analyses were conducted to predict durable viral load suppression accounting for stigma, time since diagnosis and ART adherence.
RESULTS: 76% of HIV-infected adults living in Washington agreed with one or more of the internalized stigma questions, with over 50% reporting they had difficulty telling people about their HIV status and hid their status. About a quarter of people reported feeling dirty, guilty, ashamed or worthless. People that did not engage in discussion of HIV status with sexual partners, had depression and had been diagnosed with HIV for less than 5 years had significantly higher mean stigma scores. ART adherence and time since diagnoses were significant predictors of durable viral load suppression in a multivariate model, while stigma was not a significant predictor.
CONCLUSIONS: Internalized stigma due to HIV-positive status was high among persons living with in HIV in Washington State. While stigma was not a statistically significant predictor of durable viral load suppression, the association may be mediated by time since diagnosis and ART adherence. Efforts to address stigma could help reduce negative behavioral and clinical outcomes.