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Table 1 Research on HIV and stigma in LMICs, 2008–2017

From: A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries

Study (First author, year [ref.]) Location Sampling characteristics Sample size Study design Type of stigma assessed Description of stigma association (strength, significance) Significant mediators/moderators
Abboud, 2010 [59] Lebanon Convenience sample of PLWHA obtaining care at two hospitals 41 Cross-sectional Experienced
Anticipated
Internalized
Strong inverse correlation between stigma scale score and QoL-HIV None
Bitew, 2016 [56] Ethiopia PLWHA seeking care from a hospital 393 Cross-sectional Perceived stigma Perceived stigma was associated with suicide attempts None
Breet, 2013 [36] South Africa Convenience sample of PLWHA 210 Cross-sectional Experienced
Anticipated
Internalized
HIV stigma and PTSD (p < 0.001) Med: Social support
Calabrese, 2016 [26] Russia Respondent-driven sampling among individuals who were HIV-positive and reported using injection drugs in past 4 weeks 383 Cross-sectional Internalized
Anticipated
HIV stigma not associated with subjective health rating, but associated with subjective symptom count Med: Injection drug stigma
Carlucci, 2008 [53] Zambia PLWHA initiating ART 409 Cross-sectional survey with perceived stigma vs. none assessed at baseline
Adherence data obtained over time on ART
Not specified Perceived stigma present vs. absent (35% vs. 65%; p = 0.9) None
Cluver, 2009 [157] South Africa AIDS-orphaned youth vs. non-AIDS orphaned and non-orphaned recruited from schools 1025 Cross-sectional Not specified Stigma associated with increased depression, anxiety, PTSD Mod: Food insecurity
Colombini, 2014 [47] Kenya Randomly selected from a larger study of HIV+ women obtaining care 48 Qualitative Not specified Participants reported that anticipated stigma limited disclosure None
Denison, 2015 [158] Tanzania, Uganda, Zambia PLWHA seeking care at 18 ART facilities 4495 Cross-sectional Anticipated
Internalized
High internalized stigma associated with incomplete adherence Mod: Social support, depression, alcohol abuse
Deribew, 2009 [159] Ethiopia HIV and TB patients obtaining clinical care 591 Cross-sectional Perceived Negative correlations between stigma and with spiritual, psychological, and social QoL Mod: TB co-infection
Deribew, 2010 [29] Ethiopia TB/HIV co-infected patients and HIV non-co-infected patients in three hospitals 620 Cross-sectional Experienced
Anticipated
Internalized
Stigma score associated with common mental disorders None
Dlamini, 2009 [54] Lesotho, Malawi, South Africa, Swaziland, Tanzania HIV support groups, clinics, flyers 1457 Cohort Enacted
Internalized
Greater stigma among participants missing medications Mod: Fewer medication worries decreases stigma score
Dow, 2016 Tanzania Youth (12–24 years) living with HIV attending HIV focused youth clinic 182 Cross-sectional Experienced
Anticipated
Internalized
Stigma associated with worse mental health None
Duff, 2010 [160] Uganda Women with HIV attending a PMTCT program 45 Qualitative Not specified Stigma cited as common barrier to taking medication None
Earnshaw, 2014 [5] South Africa PLWHA obtaining care at 16 primary care clinics 924 Cohort Internalized Self-stigma associated with increased depression, negative condom use attitude, and increased unprotected sex with HIV-positive partners Med: Depression and condom use attitudes mediate association between self-stigma and unprotected sex
Endeshaw, 2014 [30] Ethiopia Convenience sampling of PLWHA obtaining care at a clinic 55 Cross-sectional Internalized
Perceived
Stigma associated with depression None
Erku, 2016 [55] Ethiopia Patients on ART and obtaining care from one ART clinic 548 Cohort Not specified Perceived stigma associated with decreased adherence
Individuals who adhere to ART report decreased stigma over time
None
Garrido-Hernansaiz, 2016 [161] India PLWHA recruited through flyers in healthcare settings and NGOs 961 Cross-sectional Internalized
Experienced
Internalized and enacted stigma negatively associated with HQoL None
Greeff, 2010 [162] Lesotho, Malawi, South Africa, Swaziland, Tanzania Purposive sample of PLWHA 1454 Cohort Experienced
Anticipated
Internalized
Life satisfaction negatively associated with reported stigma None
Holzemer, 2009 [60] Kenya, USA Convenience sample of HIV infected adults 726 Cross-sectional Experienced
Anticipated
Internalized
Stigma accounted for 5.3% of variance in HQoL None
Kalomo, 2017 [31] Namibia PLWHA obtaining care at a clinic 124 Cross-sectional Experienced
Anticipated
Internalized
Stigma was significantly associated with depression None
Kingori, 2012 [24] Kenya PLWHA recruited while obtaining care 370 Cross-sectional Internalized Felt stigma associated with self-reported poor health, reduced disclosure, and decreased adherence None
Li, 2009 [33] Thailand Hospital-recruited PLWHA 408 Cross-sectional Internalized
Perceived
Depression associated with internalized shame and perceived shame Med: Emotional support
Li, 2014 [163] Thailand Convenience sample of PLWHA obtaining care 128 Cross-sectional Experienced
Anticipated
Internalized
Stigma negatively associated with adherence Mod: Social support was measured but not significant
Li, 2015 [164] China PLWHA recruited from clinics 114 Cross-sectional Internalized
Enacted
Stigma not associated with HQoL Med: Relationship fully mediated by depression
Li, 2016 [165] China MSM who were HIV-infected were recruited by local NGO 321 Cross-sectional Enacted Enacted stigma associated with increased depression None
Li, 2017 [35] China MSM who were HIV-infected were recruited by local NGO 321 Cross-sectional Internalized Self-stigma was associated with depression Med: Positive affect, negative affect, and social support
Liu, 2014 [41] China PLWHA who had registered with the CDC 290 Cross-sectional Experienced
Anticipated
Internalized
Stigma associated with anxiety None
Lyimo, 2014 [50] Tanzania PLWHA obtaining care at two clinics and on ART for 6 months 158 Cross-sectional Experienced
Anticipated
Internalized
Denial of HIV status associated with perceived stigma
Self-stigmatization negatively associated with adherence
None
Makin, 2008 [48] South Africa Pregnant women living with HIV attending antenatal clinics 293 Cohort (interviews at enrolment and 3 months after giving birth) Perceived Internalized Stigma associated with lower likelihood of disclosure None
Mekuria, 2015 [166] Ethiopia PLWHA obtaining care at selected health facilities; selected from national ART-registrar, then randomly selected 664 Cross-sectional Internalized HIV-stigma directly associated with all domains of HQoL except physical domain Med: Depression mediates association between stigma and physical HRQoL
Mohite, 2015 [34] India Purposive sample of women with HIV attending a care center 50 Cross-sectional Perceived Correlation between perceived stigma and depression None
Nyamathi, 2017 [167] India Women with HIV at primary care clinics 400 Cross-sectional Internalized Internalized stigma associated with HQoL (p < 0.0001) None
Ojikutu, 2016 [49] Thailand, Brazil, Zambia Women with HIV receiving care 299 Cohort Anticipated Decreased disclosure associated with anticipated stigma Mod: Cohabitation and marital status
Olley, 2016 [46] Nigeria PLWHA obtaining follow-up care at one hospital 139 Cross-sectional Experienced
Anticipated
Internalized
Perceived stigma associated with decreased self-disclosure Med: Anticipated discrimination
Olley, 2017 [43] Nigeria PLWHA obtaining care at two hospitals 502 Cross-sectional Experienced
Anticipated
Internalized
Stigma associated with severe depression None
Peitzmeier, 2015 [25] Gambia PLWHA attending support groups 317 Cross-sectional Experienced
Internalized
Enacted stigma in healthcare setting associated with avoiding or delaying care and not using ART
Enacted stigma in household and internalized stigma associated with poorer self-reported health status
None
Peltzer, 2011 [168] South Africa Treatment-naïve patients from three public hospitals 735 Cohort Internalized HQoL not predictive of stigma None
Rael, 2017 [37] Dominican Republic Purposive sample of women with HIV, female sex workers and control group of women without HIV and non-female sex workers 876 Cross-sectional Internalized Internalized stigma associated with increased depression None
Robinson, 2015 [44] Turks and Caicos Data analyzed from 2011 Knowledge, Attitudes, Practices and Behaviors Survey 837 Cross-sectional Enacted Self-reported HIV discrimination related to willingness to disclose HIV status None
Rodriguez, 2017 [57] South Africa Pregnant women with HIV obtaining care at a clinic 673 Cross-sectional Internalized Stigma associated with suicidality Med: Physical intimate partner violence
Sanjobo, 2008 [169] Zambia PLWHA obtaining care at ART centers 60 Cross-sectional Not specified HIV stigma was a barrier to adherence None
Shrestha, 2017 [38] Malaysia Prisoners with HIV and opioid dependence who are prisoners 301 Cross-sectional Experienced
Anticipated
Internalized
HIV-related stigma was associated with depression (p < 0.001); no direct association between stigma and HQoL Med: Depression mediated stigma and HQoL
Mod: Social support moderated stigma and HQoL
Steward, 2008 [62] India PLWHA on ART obtaining care at a large, urban, private hospital 229 Cross-sectional Enacted Enacted stigma associated with disclosure avoidance and depression Med: Stigma and depression mediated by use of coping strategies to avoid disclosure of HIV status
Subramanian, 2009 [170] India PLWHA obtaining care at one government clinic 646 Cross-sectional Experienced
Anticipated
Internalized
All stigma domains (perceived stigma, internalized stigma, and actual stigma) associated with all domains of HQoL instrument (physical, psychological, social and environmental) None
Takada, 2014 [171] Uganda Selected sample of PLWHA from ongoing cohort study 422 Cohort Internalized Lagged internalized stigma associated with depression None
Tao, 2017 [39] China MSM newly diagnosed with HIV 367 Cross-sectional Experienced
Anticipated
Internalized
Stigma associated with depression; strongest associated was between internalized stigma and depression None
Tesfaw, 2016 [42] Ethiopia PLWHA obtaining care from one hospital 417 Cross-sectional Perceived Stigma associated with depression None
Tesfay, 2015 [61] Ethiopia Randomly selected PLWHA on ART with regular follow up at an HIV clinic 594 Cross-sectional Perceived Stigma associated with psychological HQoL Med: Gender
Tsai, 2013 [45] Uganda Treatment-naïve patients obtaining care at a clinic 259 Cohort Internalized Stigma associated with decreased disclosure to household members Med: Social distance
Turan, 2015 [172] Kenya Pregnant women with HIV obtaining care at an antenatal clinic 135 Cohort Experienced
Anticipated
Internalized
Decreased linkage to care predictive of increased stigma
Increased stigma associated with increased depression
None
Valencia-Garcia, 2017 [52] Peru Pregnant women with HIV 15 Qualitative Enacted Healthcare stigma reduced participants’ willingness to return for care None
Valenzuela, 2015 [51] Peru Patients initiating care at a national referral center
Cases: out of care for > 12 months, Controls: those in care
176 Case–control Experienced
Anticipated
Internalized
Enacted stigma associated with and being out of care None
Wu, 2008 [40] Peru Women with HIV initiating ART 78 Cross-sectional Experienced
Anticipated
Internalized
Stigma associated with depression Mod: Food scarcity
Wu, 2015 [173] China PLWHA obtaining care at two hospitals 190 Cross-sectional Experienced
Anticipated
Internalized
Higher QoL associated with lower levels of stigma None
Wu, 2015 [174] China MSM with HIV listed in the CDC register 184 Cross-sectional Experienced
Anticipated
Internalized
Stigma associated with suicidal ideation None
Yi, 2015 [27] Cambodia PLWHA recruited through cluster sampling method of provinces and HIV clinics 1003 Cross-sectional Perceived HIV-related stigma and discrimination associated with higher levels of mental disorders None
Zhang, 2015 [23] China Persons living with HIV were randomly selected for participation from a parent study 2987 Cross-sectional Experienced
Anticipated
Internalized
Internalized stigma negatively associated with self-rated health status Med: Resilience
Zhang, 2016 [32] China Persons living with HIV were randomly selected for participation from a parent study 2987 Cross-sectional Experienced
Anticipated
Internalized
Enacted perceived and internalized stigma were associated with anxiety, depression, decreased resilience, and decreased self-esteem
Perceived stigma associated was associated with increased drug use
Mod: Income
Zhou, 2017 [58] China Persons living with HIV were randomly selected for participation from a parent study 2987 Cross-sectional Experienced
Anticipated
Internalized
Stigma negatively associated with QoL Med: HIV symptom management self-efficacy
  1. ART antiretroviral therapy, CDC Centers for Disease Control, HQoL health-related quality of life, Med mediators, Mod moderators, MSM men who have sex with men, NGO non-governmental organization, PLWHA persons living with HIV and aids, PMTCT prevention of mother-to-child transmission, PTSD post-traumatic stress disorder, QoL quality of life, TB tuberculosis