UMass Amherst study finds gender differences in HIV stigma in the Dominican Republic

In a University of Massachusetts Amherst study recently published in PLOS ONE, researchers explored and described gender differences in HIV-related stigma and social support among people living with HIV (PLHIV) experiencing food insecurity in the Dominican Republic.

“Men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence,” says lead author and postdoctoral researcher Alane Celeste-Villalvir.

For people living with HIV, stigma associated with the disease continues to be a significant barrier to receiving timely care. HIV-related stigma has been linked to lower rates of HIV testing, denial and lack of disclosure of HIV status, delays in HIV-related treatment and poor antiretroviral therapy (ART) initiation and adherence. 

Gender differences in HIV-related stigma and social support have not been well examined, especially in the Caribbean, which has the highest adult HIV prevalence in the world outside of sub-Saharan Africa. 

The research team, including senior author Kathryn Derose, a professor of community health education in the School of Public Health and Health Sciences, conducted interviews with patients at two HIV clinics, identifying themes surrounding stigma experiences and social support, which were then compared across men and women participants to identify gender differences.

“The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches,” says Derose, who was lead investigator for an NIH-funded community-partnered study that began when she was at the RAND Corporation and included this research. “This study provides valuable insight for development of targeted health promotion interventions to reduce stigma and improve HIV health outcomes.”

Partner institutions on the overall and ongoing research include UC-Irvine, UC-San Francisco, the Universidad Autónoma de Santo Domingo, the Dominican Ministries of Agriculture and Public Health, the Dominican National HIV/AIDS Council and the World Food Program. 

Participants were asked about their experiences with diagnosis, physical and mental health changes, social relationship changes, social support, feelings of guilt or shame and whether they have been victims of verbal or physical violence. Responses were catalogued across three categories: experienced stigma, such as interpersonal or community stigma (verbal abuse); anticipated stigma (anticipated rejection such as losing job); and internalized stigma (feelings of shame and guilt). 

“While these types of stigma have been found to cause delays in HIV treatment, poor ART initiation and adherence, cause social isolation and lower HIV resilience, it was not well known how these different types of stigma may be differentially experienced by gender,” Celeste-Villalvir explains. “Our study found several differences between men and women in their experiences of HIV-related stigma with important implications for addressing this pervasive and persistent barrier to optimal HIV outcomes.”

Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and/or decrease in income. 

Men and women both described modifying their behavior due to anticipated stigma, but only women discussed isolating themselves and having discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented them from seeking healthcare and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” 

Further, while both men and women described receiving community support, women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. 

The researchers conclude that while “community-level and systems-level interventions are needed for all PLHIV, specific interventions should consider the discrimination, violence, and stigma faced by women.” They recommend largescale educational and health promotion campaigns to help reduce stigma and provide knowledge about how HIV can be prevented, transmitted and adequately treated.