Date of Completion


Embargo Period



HIV, stigma, stress, coping, health

Major Advisor

Dean Cruess, PhD

Associate Advisor

Seth Kalichman, PhD

Associate Advisor

Amy Gorin, PhD

Field of Study



Doctor of Philosophy

Open Access

Open Access


Objective – HIV-related stigma and discrimination are drivers of health disparities among people living with HIV (PLWH). The U.S. South bears much of the burden of the domestic HIV epidemic. This study seeks to explore the dynamic effects of HIV-related stigma on health outcomes in a population of PLWH in middle Georgia. Experiences of enacted HIV stigma in the past year were assessed and participants indicated how stressful these events were and how they coped with the most impactful event. The primary study aim tested a moderated serial mediation model of HIV stigma on health in this population.

Method – A total of 199 people living with HIV completed surveys via audio computer-assisted self-interviews (ACASI) while they attended their regular clinic appointment at a Ryan White clinic located in Macon, GA. Measures included demographics, health information, experiences of enacted stigma in the past year, stress and coping with the most impactful enacted stigma event. Medical information (viral load, CD4 count, clinic attendance, and medications) was abstracted from patient charts for a period of 6 months prior to their survey date.

Results – A total of 96 individuals endorsed experiencing enacted stigma in the past year, and the sample endorsed moderate levels of internalized HIV stigma. Individuals who endorsed enacted stigma tended to have more negative psychosocial and mental health outcomes. Internalized stigma related to stress indexed on the most salient event of enacted stigma in the past year as well as maladaptive coping strategies used to cope with discriminatory experiences. There was not evidence in multivariate analyses that stress or maladaptive coping mediated effects of internalized stigma on medication adherence. There was also not a moderating effect of adaptive coping strategies on medication adherence in this sample.

Conclusion – HIV stigma appears to have short-term effects on mental health, which could lead to long-term effects on physical health. Longitudinal investigations are indicated to uncover the mediating and attenuating mechanisms of HIV stigma on health. Stigma should be addressed in the context of health promotion interventions for PLWH given its implications on mental health and wellbeing.

Available for download on Monday, April 09, 2018