The impact of social determinants of health on the relationship between stigma and health in people living with HIV: A two-wave panel study

Abstract

Abstract Background HIV stigma is still prevalent and negatively impacts the health of people living with HIV. Social determinants of health also have a significant impact on health, yet there is little work examining how these determinants play a role in the relationship between stigma and health. This study uses moderation analysis to examine how social determinants of health affects the relationship between different types of stigma (enacted, internalized, and anticipated) and physical and mental health. Methods The study used a two-wave panel design with quantitative survey data collected on 339 participants in Ontario, Canada at baseline (t1) between August 2018 and September 2019 and at follow-up (t2) between February 2021 and October 2021. Moderation models were constructed with each type of stigma at t1 as antecedents predicting physical and mental health at t2 as the outcome. Separate models were created with each social determinant of health (age, years since HIV diagnosis, gender, sexual orientation, ethnicity, geographic region, education, employment, and basic needs) acting as the moderator. Results We found the relationship between internalized stigma and lower mental health was stronger for those with older age (b = -5.20, 95% CI: -7.81, -2.59). The relationship between enacted stigma and lower mental health was stronger for those with older age (b = -3.31, 95% CI: -5.87, -0.75), those who live in the Greater Toronto Area (b = -3.96, 95% CI: -6.56, -1.37), and those who never lacked basic needs (b = -4.43, 95% CI: -7.25, -1.62). Lastly, the relationship between anticipated stigma and lower mental health was stronger for those identifying as gay/lesbian (b = -3.43, 95% CI: -6.60, -0.26), those who live in the Greater Toronto Area (b = -5.26, 95% CI: -8.60, -1.94), and those who never lacked basic needs (b = -4.17, 95% CI: -7.38, -0.95). None of the models with physical health as the outcome had significant moderators. Conclusions Our findings demonstrate that the relationship between stigma and mental health can change based on social determinants of health. This suggests that targeting certain population groups based on their social determinants of health could be an effective strategy for developing stigma reduction initiatives.