Stigma in People Living with HIV/AIDS in Brazil: Implications for Treatment Adherence

The stigma associated with HIV hinders prevention and treatment efforts, with individual and collective repercussions. This study explores the relationships between different forms of stigma experienced by people with HIV/AIDS (PWHA) and their implications for treatment adherence. This is a community-based study with a sample of 1784 people (µ = 40.14 ± 12.95). Participants responded to the Stigma Index 2.0, including measures of stigma and discrimination, internalized stigma, and treatment adherence. Data were analyzed using descriptive and inferential statistics (i.e., association tests, group comparisons, and predictive models). The prevalence of individuals reporting missing one or more doses of antiretroviral therapy (ART) was 25.45% (95% CI 23.43-27.55%). Factors independently associated with non-adherence included age (OR^a = 0.982; 95% CI 0.966-0.998), internalized (OR^a = 1.334; 95% CI 1.214-1.467), and general HIV-related stigma (OR^a = 1.049; 95% CI 1.004-1.097). PWHA between 1 and 5 and 6 to 9 years were more likely to miss ART doses due to stigma-related concerns (OR^a = 1.854; 95% CI 1.094-3.140; OR^a = 1.889; 95% CI 1.078-3.309, respectively). Individuals reporting fair health were more likely to miss a dose compared to those with good self-reported health (OR^a = 1.636; 95% CI 1.140-2.347). Finally, those who delayed starting medication were significantly more likely to miss doses in the last year (OR^a = 1.940; 95% CI 1.190-3.162) compared to those who started treatment immediately. In summary, this study showed that the risk of missing ART medication is influenced by several demographic, clinical, and psychosocial factors, and the results can be useful for HIV services and policies in a myriad of ways.