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HIV-related stigma: Adapting a theoretical framework for use in India

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  • Steward, Wayne T.
  • Herek, Gregory M.
  • Ramakrishna, Jayashree
  • Bharat, Shalini
  • Chandy, Sara
  • Wrubel, Judith
  • Ekstrand, Maria L.

Abstract

Stigma complicates the treatment of HIV worldwide. We examined whether a multi-component framework, initially consisting of enacted, felt normative, and internalized forms of individual stigma experiences, could be used to understand HIV-related stigma in Southern India. In Study 1, qualitative interviews with a convenience sample of 16 people living with HIV revealed instances of all three types of stigma. Experiences of discrimination (enacted stigma) were reported relatively infrequently. Rather, perceptions of high levels of stigma (felt normative stigma) motivated people to avoid disclosing their HIV status. These perceptions often were shaped by stories of discrimination against other HIV-infected individuals, which we adapted as an additional component of our framework (vicarious stigma). Participants also varied in their acceptance of HIV stigma as legitimate (internalized stigma). In Study 2, newly developed measures of the stigma components were administered in a survey to 229 people living with HIV. Findings suggested that enacted and vicarious stigma influenced felt normative stigma; that enacted, felt normative, and internalized stigma were associated with higher levels of depression; and that the associations of depression with felt normative and internalized forms of stigma were mediated by the use of coping strategies designed to avoid disclosure of one's HIV serostatus.

Suggested Citation

  • Steward, Wayne T. & Herek, Gregory M. & Ramakrishna, Jayashree & Bharat, Shalini & Chandy, Sara & Wrubel, Judith & Ekstrand, Maria L., 2008. "HIV-related stigma: Adapting a theoretical framework for use in India," Social Science & Medicine, Elsevier, vol. 67(8), pages 1225-1235, October.
  • Handle: RePEc:eee:socmed:v:67:y:2008:i:8:p:1225-1235
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    1. Aaron M Kipp & Carolyn M Audet & Valerie A Earnshaw & Jared Owens & Catherine C McGowan & Kenneth A Wallston, 2015. "Re-Validation of the Van Rie HIV/AIDS-Related Stigma Scale for Use with People Living with HIV in the United States," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-16, March.
    2. Maria H Lindberg & Lena Wettergren & Maria Wiklander & Veronica Svedhem-Johansson & Lars E Eriksson, 2014. "Psychometric Evaluation of the HIV Stigma Scale in a Swedish Context," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-16, December.
    3. Dallas Swendeman & Anne E Fehrenbacher & Soma Roy & Rishi Das & Protim Ray & Stephanie Sumstine & Toorjo Ghose & Smarajit Jana, 2018. "Gender disparities in depression severity and coping among people living with HIV/AIDS in Kolkata, India," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-20, November.
    4. Tsai, Alexander C. & Bangsberg, David R. & Frongillo, Edward A. & Hunt, Peter W. & Muzoora, Conrad & Martin, Jeffrey N. & Weiser, Sheri D., 2012. "Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda," Social Science & Medicine, Elsevier, vol. 74(12), pages 2012-2019.
    5. Tsai, Alexander C. & Venkataramani, Atheendar S., 2015. "The causal effect of education on HIV stigma in Uganda: Evidence from a natural experiment," Social Science & Medicine, Elsevier, vol. 142(C), pages 37-46.
    6. Ryan, Martha S. & Nambiar, Devaki & Ferguson, Laura, 2019. "Sex work-related stigma: Experiential, symbolic and structural forms in the health systems of Delhi, India," Social Science & Medicine, Elsevier, vol. 228(C), pages 85-92.
    7. Kathryn P Derose & Denise D Payán & María Altagracia Fulcar & Sergio Terrero & Ramón Acevedo & Hugo Farías & Kartika Palar, 2017. "Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study," PLOS ONE, Public Library of Science, vol. 12(7), pages 1-19, July.
    8. Aranka Anema & Sarah J Fielden & Susan Shurgold & Erin Ding & Jennifer Messina & Jennifer E Jones & Brian Chittock & Ken Monteith & Jason Globerman & Sean B Rourke & Robert S Hogg & Canada Food Securi, 2016. "Association between Food Insecurity and Procurement Methods among People Living with HIV in a High Resource Setting," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-20, August.
    9. Logie, Carmen H. & Newman, Peter A. & Chakrapani, Venkatesan & Shunmugam, Murali, 2012. "Adapting the minority stress model: Associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India," Social Science & Medicine, Elsevier, vol. 74(8), pages 1261-1268.
    10. Tsai, Alexander C. & Bangsberg, David R. & Emenyonu, Nneka & Senkungu, Jude K. & Martin, Jeffrey N. & Weiser, Sheri D., 2011. "The social context of food insecurity among persons living with HIV/AIDS in rural Uganda," Social Science & Medicine, Elsevier, vol. 73(12), pages 1717-1724.

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    Keywords

    India HIV Stigma Depression Coping;

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