HIV: a Sexually Transmitted Disease

Hypothesis:  HIV is a sexually transmitted disease that can be passed via bodily fluids from one sexual partner to the next after unsafe sexual practices. HIV causes a compromise of the immune system over time but, the stigma from having an STD appears to be even more life altering. Patients become often withdrawn, ostracized from society and socially devalued due to their health status causing their mental (depressive symptoms, emotional toll, anxiety) and physical health (lower CD4 counts) to decline rapidly and if left uncheck may increase the chances of development of worsening strains of HIV/AIDS. Two main hypotheses were tested in this experiment; the first was whether social stigma from a diagnosis and disclosure of HIV/AIDS to friends and family brought about through exclusion and discrimination from the community results in depressive symptoms as well as, lower CD4 counts.  Secondly, whether there is a correlation between socially stigmatized HIV/AIDS patients, who have been discriminated against for disclosing their condition and the likelihood for those patients to fail to adhere to medical treatment (i.e. antiretroviral therapies) which could help reduce the spread of HIV/AIDS and improve their well-being.

Participants: All participants were recruited from a University-based infectious disease clinic located in Syracuse University. The mean age of participants was 41.29 and ranged from 22 to 63; participants had been living with HIV for an average of 8.28 years. Nearly half (47%) of participants identified as White and 41% as African American. Seventy-nine participants were female (44%), and 35% of participants identified as MSM. Sixty-four (36%) participants had completed less than a high school education. Per chart data, half of the sample (50%) had received an AIDS diagnosis and less than half (45%) of participants had an undetectable viral load. The study was conducted over a 16-month period during Outpatient visits and it utilized data from a cross-sectional study designed to identify mental/social barriers and defensive factors for PWLHA (People Living With HIV/AIDS) related to adherence and risky behavior (unprotected sex).  The study involved 221 eligible participants who were 18 years of age and older (both men and women) who were diagnosed with HIV and living with the disease, who spoke English and could provide informed consent to the available staff. Out of the 221 participants only 179 were on antiretroviral medications and thus, only those candidates were retained for the study. The study consisted of a written questionnaire which featured your background (age, ethnicity, gender and so forth), disease characteristics (how far long is the spread), medical adherence, HIV related stigma perceived, depressive symptoms and lastly, serostatus disclosure concerns. A few members of the 179 participants were administered an audio-based computer interview and an in-person interview to take in to account participants who possessed reading abilities hence, eliminating any feature bias in the administration of the study. As an incentive, participants were given $10 for participation and were lacking their medical data were used to supplement any medical attendance reported during clinical appointments.

Results: The study sought to provide empirical evidence that the hypothesis of social stigma having an unconscious effect on medical adherence resulting from HIV disclosure was true. Among the 179 clinical participants observed, most results showed a strong positive correlation between disclosure of patient status with the stigma they received and their subsequent lower degree of medical adherence. These results were consistent with the ideology and formed notion that disclosing of one's HIV status could be a barrier in their likelihood to adhere to their daily medical treatments. Results showed that even though social stigma increased the likelihood for patients to skip clinic attendance however, there was not any indirect effect of stigma brought by disclosure concerns during clinic attendance as, family members appeared to be supportive and engaged in care. However, studies also showed that patients who showed the most depressive symptoms had disclosed of their status at a higher rate than those who showed mild or no symptoms. Furthermore, disclosing of HIV status does lead to increase chances of stigma prior to clinical attendance and especially during more susceptible times such as under high stress. The current study looks at the vulnerability depressive symptoms have on the clinical attendance of participants prior to their treatment and after disclosing of their condition. The results show that disclosure concerns and depressive symptoms do not work in a vacuum but do go hand-in-hand in explaining the relationship between stigma and medical adherence. The present findings highlight our observation in qualitative research, namely that stigmatizing experiences, disclosure concerns, and depressive symptoms frequently co-occur (in the current sample, correlations ranged from .37 to .45; p values < .001. These three variables may interact to influence or deter medication and clinical adherence. Cognitive-behavioral Interventions for depressive symptoms and medical adherence may be geared towards reinforcing the patient's ability to cope with stigmatization and challenges of inadvertent disclosure. This may involve careful screening and problem skills management to ensure that only family members and friends who will be supportive are involved in the treatment process. Furthermore, interventions could be also modeled to involve medical adherence and clinic attendance specifically as the first step to a clean bill of health begins with attending clinical sessions and taking required medications. Peer mentors seem to be the way to go in making sure that there is always a supportive environment present to ensure minimal stigma during treatment and increase retention rates for patient clinical appointment attendance. Peer mentors can be beneficial in managing the disclosure of HIV status and reducing the risk of depressive symptoms amongst patients as they could act as a support group as well.

Methods: I was asked to join the study after been diagnosed for HIV/AIDS a couple of months ago at a Syracuse clinic. I am a gay man over the age of 18 and of African-American descent who speaks English. I was asked to fill out a questionnaire which was divided into varying sections from my background to my present mental state (depressive symptoms) and whether I have received any HIV-stigma since I was diagnosed. A lot of the questions seemed rather personal but I answered them any ways and gave them my consent since, I needed the $10 participation incentive. I noticed upon arriving at the facility that their different participants had various racial backgrounds (47% Whites and 41% African-American) with a majority of us having at least earned a high school education. From talking to a couple of participants around my table I quickly concluded that about half of us on the table had been diagnosed with HIV/AIDS recently. Most of the men on my table identified as MSM (Men who had Sex with Men) so we did get along easily. To determine stigma-related experiences five measures were assessed to determine instances of stigma since diagnoses. This were measures such as, "How often are you treated unfairly by others when they learn of your HIV/AIDS status?" I responded to options ranging from 1 (Never) to 4 (Often) since HIV diagnosis. Item responses were averaged to create a summary score (Cronbach's alpha = .89). For disclosure concerns, six-items were assessed based on efforts aimed at the likelihood of disclosing their HIV status items such as "How often do you hide your illness from others out of fear that they might say or do something that will hurt you?" I responded to options ranging from 1 (Never) to 4 (Often) since HIV diagnosis. Item responses were averaged to form a summary score (Cronbach's alpha = .86). Next for depressive symptoms, I reported my symptoms based on a Center for Epidemiological Studies Depression Scale, this involved 20-items that included things like, "I was bothered by things that usually don't bother me." Response options ranged from 0 (Rarely or none of the time) to 3 (Most or all of the time) in the past week, with scores of 16 or greater indicating clinically significant risk for depression. A sum score was computed for each participant (Cronbach's alpha = .91). Lastly, for HIV medical adherence and medical clinic appointments I was measured based on four-items assessing how often I skipped taking an HIV medication, stopped taking a medication due to side-affects or not followed the proper dosage and perfect vs non=perfect attendance in the past year respectively. In all the measures assessed previously, the data showed the maximum responses for any person was just 3. Factors such as, age, gender, race, ethnicity, employment status and years since been diagnosed for HIV were analyzed as covariates for the primary hypothesis initially made using a two-step system. Whether variables such as depressive symptoms and disclosure concerns varied linearly with the co-variate or were related to the co-variate. Results identified employment status as a co-variate for a clinic attendance outcome and HIV diagnosis as a co-variate for medical adherence outcome.

Conclusions:  The author concluded that, stigmatizing experiences are somewhat linked to medical adherence and clinical appointment attendance signs of depression and inadvertent effects of disclosure concerns. Stigma did have indirect effects on both variates however, there was an indirect pathway from stigma to disclosure of concerns to depression and then to clinic attendance the positions of the mediators were changed in this case. Disclosure concerns and depressive symptoms are two variables that merit more research as to how they really relate to stigma and a person's adherence to medication. Discrimination based on racial minority status, gender and age were correlated with the levels of depression certain participants felt which in turn played a role on the degree of stigma they reported in the surveys.

Reaction: The study was important because it sheds a light on a marginalized section of our population. PWLHA's who are struggling with the stigma of the disease and how depression and can affect their chances to seek continues treatment and adherence to a plan. More stigmatized participants were the greater the chances they failed to attend clinical appointments hence, another aspect of the study could be to measure the effects or levels of stigma felt in between MSM and others who identified themselves as lesbians or women who engaged with other women in sex. Will the different genders be exposed to stigma and disclosure concerns alike, and how will they react to perceived stigma? Will clinical attendance remain the same in both genders or will there be stack differences in the mediators measured? 

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