Stigma-Related Disclosure Concerns and Negative Self-Image Have Not Improved Over a Decade in Older People With HIV

Stigma impedes the HIV care continuum and contributes to problematic mental health outcomes, nonadherence, and reduced quality of life. We prospectively analyzed changes in HIV stigma measures for 10 years among older people with HIV (PWH).

PWH participating in the AGE h IV Cohort Study completed the full Berger HIV Stigma Scale (HSS) between 2012 and 2014 (T0) and 2 of the HSS subscales-that is, disclosure concerns and negative self-image (range per subscale: 3 to 12)-10 years later (T1) as part of routine clinical care.

We assessed changes in scores over time using paired samples t-tests. We assessed sociodemographic and clinical factors associated with these changes at T1 using linear regression, and factors associated with higher or lower scores over time using linear mixed models.

Disclosure concerns scores decreased significantly, albeit minimally, between T0 and T1; negative self-image scores remained stable. No factors were associated with changes in disclosure concerns scores. Higher disclosure scores were positively associated with living in households with 3 or more people. Women experienced significantly higher increases in negative self-image scores. Higher negative self-image scores were associated with being attracted to both men and women, compared with only men, and having moderate-to-severe depressive symptoms. Both HSS domains were negatively associated with more years since HIV diagnosis.

In this cohort of predominately older, White, Dutch male PWH mostly with suppressed HIV, disclosure concerns and self-image did not improve over time. HIV stigma worsened in women and was worse for those in large households and with moderate-to-severe depression.