Diminished social support as an explanatory mechanism in the relationship between stigma and engagement HIV care

HIV-related stigma experiences impede healthcare engagement and adversely impact people living with HIV. However, the mechanisms that account for the association between stigma and poor health are not fully known. Grounded in contemporary theories of stigma and health, we conducted a 16-month prospective cohort study of 435 younger people living with HIV (ages 18-36), with 352 (81%) retained over 16 months. We tested two primary hypotheses: (a) in cross-sectional analyses, perceived social support would mediate for the association between HIV stigma experiences and missing recent HIV care appointments; and (b) in prospective analyses, the association between stigma and HIV viral load would be serially mediated by perceived social support and missed care appointments. We tested these associations for both past stigma experiences (e.g., enacted stigma) and expectancies for future stigma (e.g., anticipated stigma). Results confirmed both hypotheses: perceived social support mediated the association between both enacted and anticipated stigma and recently missed care appointments; and the association between both enacted and anticipated stigma and viral load were serially mediated by perceived social support and missed care appointments. These findings affirm that diminished social support may explain the association between HIV-related stigma and poor health outcomes in younger people living with HIV. Results are discussed in the context of interventions designed to mitigate the adverse effects of stigma by building sustainable support networks among younger people living with HIV.