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 on November 13, 2015

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

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

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.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.