Social Network Characteristics Moderate the Association Between Stigmatizing Attributions About HIV and Non-Adherence Among Black Americans Living with HIV

A Longitudinal Assessment

Published in: Annals of Behavioral Medicine, v. 49, no. 6, Dec. 2015, p. 865-872

Posted on RAND.org on November 13, 2015

by Laura M. Bogart, Glenn Wagner, Harold D. Green, Matt G. Mutchler, David J. Klein, Bryce W. McDavitt

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Research Questions

  1. Does HIV stigma relate to medication adherence?
  2. Do supportive social networks buffer the effects of stigma?

BACKGROUND: Stigma may contribute to HIV-related disparities among HIV-positive Black Americans. PURPOSE: We examined whether social network characteristics moderate stigma's effects. METHODS: At baseline and 6 months post-baseline, 147 HIV-positive Black Americans on antiretroviral treatment completed egocentric social network assessments, from which we derived a structural social support capacity measure (i.e., ability to leverage support from the network, represented by the average interaction frequency between the participant and each alter). Stigma was operationalized with an indicator of whether any social network member had expressed stigmatizing attributions of blame or responsibility about HIV. Daily medication adherence was monitored electronically. RESULTS: In a multivariate regression, baseline stigma was significantly related to decreased adherence over time. The association between stigma and non-adherence was attenuated among participants who increased the frequency of their interactions with alters over time. CONCLUSIONS: Well-connected social networks have the potential to buffer the effects of stigma.

Key Findings

  • HIV stigma appears to be related to lower adherence to HIV medication over time.
  • On average, 33% of participants reported that at least one person in their social network expressed stigma against people with HIV, including that they are responsible for their illness and have done something deserving of punishment.
  • Social networks with a stronger capacity for social support may help to buffer the relationship between stigma and non-adherence. In particular, people living with HIV who increase the frequency of their interactions with social network members over time may be less vulnerable to the effects of HIV stigma.

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