Exploring differences in HIV stigma and treatment interruptions between young and older adults in Zimbabwe

HIV stigma negatively impacts antiretroviral therapy (ART) adherence in adults, but this relationship remains underexplored within the context of early adulthood. We examined manifestations of stigma and their associations with ART interruptions among young (18-24 years) and older (25 + years) people living with HIV (PLHIV) in Zimbabwe.

This analysis utilized cross-sectional data from the 2021 PLHIV Stigma Index 2.0, implemented by the Zimbabwe National Network of PLHIV in partnership with Global Network of People Living with HIV, The International Community of Women Living with HIV, and UNAIDS. Treatment interruptions were defined as ever interrupting or stopping HIV treatment. Internalized, anticipated, and enacted stigma scores were categorized as "no", "low", "moderate" and "high". Modified Poisson regression models estimated associations between categorized stigma scores and treatment interruptions, with age-stratified analyses among young and older adults.

Among 1347 PLHIV who ever initiated ART, 20.9% of young adults and 10.3% of older adults reported treatment interruptions. Experiences of internalized stigma (56.3% versus 41.7%, p < 0.01) and anticipated stigma (73.9% versus 51.8%, p < 0.01) were higher among young adults compared to older adults. Increasing levels of internalized stigma were associated with higher lifetime incidence of treatment interruptions compared to no stigma (low: adjusted risk ratio(aRR)1.67, 95%CI 1.08-2.58, moderate: aRR2.58, 95%CI 1.72-3.87, high: aRR3.54, 95%CI 2.11-5.94). Similar associations were observed with anticipated stigma (low: aRR2.24, 95%CI 1.49-3.36, moderate: aRR3.21, 95%CI 1.82-5.66, high: aRR4.88, 95%CI 2.75-8.67). Treatment interruptions were associated with high (versus no) enacted stigma (aRR 2.75, 95%CI 1.19-6.32).

Young adults living with HIV in Zimbabwe reported twice the lifetime incidence of treatment interruptions and greater levels of internalized and anticipated stigma compared to older adults. The associations between stigma and treatment interruptions highlight the opportunity for interventions that address stigma for young adults, which may optimize treatment adherence during early adulthood.