The Effect of Stigma on Treatment Adherence Among HIV-Positive Alcohol Users in Haiti

Muni Balakrishnan Rubens, Florida International University


Haiti reports the second highest prevalence of HIV among the Caribbean nations. People living with HIV/AIDS (PLWH) report stigmatic experiences, inadequate social support, depression, and anxiety, thereby affecting treatment adherence. This study examined the relationship between HIV-related stigma and treatment adherence, considering the effects of depression, anxiety, social support, and coping. The current study is a secondary analysis of baseline data collected from 362 PLWH from Haiti. The measures included: Community Programs for Clinical Research on AIDS (CPCRA) adherence questionnaire; Perceived Stigma scale; Brief COPE questionnaire; State-Trait Anxiety Inventory (STAI); Centers for Epidemiological Studies Depression Scale (CES-D); and modified Medical Outcome Study Social Support Survey (mMOS-SSS). Descriptive statistics were used for demographic characteristics. T tests, Person correlations, multivariable linear regressions and structural equation modeling (SEM) were used for estimating the strength of associations and mediating effects. Mean age of the sample was 35.72±8.50 years and 37.0% were men. The mean self-reported treatment adherence was 93.1 percent. About 50.2% reported high levels of perceived stigma, 58.1% reported high levels of social support, 51.1% reported high levels of coping, 45.6% reported depression and 47.2% reported anxiety. Multivariable regression showed that treatment adherence was directly associated with quality of care satisfaction scores (Beta = .032, p = .041) and inversely associated with perceived stigma (Beta = -0.049, p = .031). Depression was directly associated with perceived stigma-public view (Beta = 1.877, p = .037) and inversely associated with tangible/informational social support (Beta = 1.877, p = .020). SEM analyses showed significant associations between perceived sigma and coping (Beta = .175, p = .003), perceived sigma and anxiety (Beta = .164, p = .005), coping and anxiety (Beta = .229, p < 001), and anxiety and treatment adherence (Beta = -.140, p = .018). Maladaptive coping mediated the relationship between stigma and anxiety levels which in turn adversely affected treatment adherence. In summary, HIV-related stigma was associated with lower levels of treatment adherence, and higher levels of depression and anxiety. These findings could be informative for future large scale studies on stigma, coping, anxiety and depression and planning effective interventions for improving treatment adherence.

Subject Area

Public health

Recommended Citation

Balakrishnan Rubens, Muni, "The Effect of Stigma on Treatment Adherence Among HIV-Positive Alcohol Users in Haiti" (2016). ProQuest ETD Collection for FIU. AAI10259357.