HIV Stigma Affects Medication Adherence

Stigma remains a serious concern for patients living with HIV.

Real or perceived stigma can cause HIV-infected patients to feel inferior or ashamed, and it appears that these feelings influence medication adherence.

A recent study published in AIDS Behavior specifically looked at how stigma affects medication-taking behaviors. The investigators found that patients’ interpersonal concerns about their HIV status jeopardizing their existing relationships could affect their adherence behaviors.

The study, which was conducted over roughly 2 years in Birmingham, Alabama, enrolled patients from an outpatient HIV clinic at the University of Alabama. The study involved 180 patients who were taking antiretroviral medications and had no drug abuse issues.

Patients who reported higher levels of HIV-related internalized stigma, attachment-related anxiety (eg, fear of abandonment by relationship partners), and concerns about being seen taking HIV medication had poorer medication adherence than others.

The investigators found a spiraling effect, as patients who felt stigma most acutely tended to develop attachment-related anxiety. Once attachment-related anxiety developed, patients developed concerns about being seen while taking HIV medication, and having to hide while taking medications decreased adherence.

Based on their results, the study authors advised clinicians to target interpersonal factors when they design interventions for HIV patients, which might include coping strategies designed to increase self-esteem and reduce interpersonal relationship anxiety.

The researchers pointed out that previous studies have shown that cognitive behavioral therapy reduces perceived stigma because it can help patients think about their responses to it. Patients also find group therapy helpful, as it provides social support.

Involving patients’ partners is also a useful approach that increases understanding and decreases real or perceived stigma.

Helping partners understand the HIV-infected partner’s relationship insecurities can stabilize the relationship. In turn, the infected partner may be more willing to be open about his or her illness and medication needs.