Marija Pantelic|Mark Boyes|Lucie Cluver|Franziska Meinck
HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV
International HIV/AIDS Alliance|Oxford Policy Management|University of Oxford|Curtin University|Oxford Policy Management|University of Oxford|Oxford Policy Management|University of Oxford|University of Cape Town|Oxford Policy Management|University of Oxford|North-West University
internalized hiv stigma key risk factor negative outcomes amongst adolescents living hiv alhiv including nonadherence antiretroviral treatment losstofollowup morbidity study tested theoretical model multilevel risk pathways internalized hiv stigma among south african alhivfrom 2013 2015 survey using total population sampling alhiv ever initiated antiretroviral treatment art 53 public health facilities eastern cape south africa conducted communitytracing ensured inclusion alhiv defaulting art lost followup 901 eligible alhiv interviewed n 1060 55 female mean age 138 21 living rural locations hiv stigma mechanisms internalized enacted anticipated hivrelated disability violence victimization physical emotional sexual abuse bullying victimization assessed using wellvalidated selfreport measures structural equation modelling used test theoretically informed model risk pathways hivrelated disability internalized hiv stigma model controlled age gender urbanrural addressprevalence internalized hiv stigma 265 hypothesized significant associations internalized stigma anticipated stigma well depression obtained unexpectedly hivrelated disability victimization enacted stigma directly associated internalized stigma instead significant pathways identified via anticipated hiv stigma depression model fitted data well rmsea 023 cfi 94 tli 95 wrmr 1070these findings highlight complicated nature internalized hiv stigma whilst seemingly psychological process indirect pathways suggest multilevel mechanisms leading internalized hiv stigma findings suggest protection violence within homes communities schools may interrupt risk pathways hivrelated health problems psychological distress internalized hiv stigma highlights potential interventions explicitly target adolescents living hiv sensitive needs