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HIV-related stigma and psychological distress: the harmful effects of specific stigma manifestations in various social settings

Stutterheim, Sarah Ea; Pryor, John Bb; Bos, Arjan ERa; Hoogendijk, Robertc; Muris, Peterc; Schaalma, Herman Pa,*

doi: 10.1097/QAD.0b013e3283320dce
Epidemiology and Social:Concise Communications

Objectives: Recent research has shown that experiences of stigmatization have an adverse impact on the psychological well being of people living with HIV/AIDS (PLWHA). Most studies investigating this relationship employ an aggregate measure of stigma. Although this approach provides useful information about the psychological implications of HIV-related stigma in general, it neglects to acknowledge the possibility that some manifestations in specific settings may be psychologically more detrimental than others. The present study examines which specific stigma experiences are most strongly related to psychological distress across a number of social settings.

Methods: A cross-sectional survey was administered to 667 PLWHA in the Netherlands. We examined participants' experiences of 11 manifestations of HIV-related stigma in six social settings. Linear regression analyses were conducted to determine which setting-specific manifestations best predict psychological distress after controlling for marital status, education and health status.

Results: Three manifestations in family settings, namely receiving advice to conceal one's status, being avoided and being treated with exaggerated kindness, and one manifestation in healthcare settings, namely awkward social interaction, best predicted psychological distress in PLWHA.

Conclusion: Manifestations of HIV-related stigma vary according to setting. Certain manifestations in specific social settings impact the psychological well being of PLWHA more than others. In this study, certain experiences of stigmatization with PLWHA's families and in healthcare settings were more strongly related to psychological distress than experiences occurring in other social settings. These findings suggest that stigma reduction interventions focusing on these influential settings may benefit the psychological well being of PLWHA.

aDepartment of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands

bDepartment of Psychology, Illinois State University, Normal, Illinois, USA

cInstitute of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands.

* deceased.

Received 24 April, 2009

Revised 10 August, 2009

Accepted 19 August, 2009

Correspondence to Sarah E. Stutterheim, Department of Work and Social Psychology, Maastricht University, 6200 MD Maastricht, The Netherlands. Tel: +31 43 3881401; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.