Document Type



Doctor of Philosophy (PhD)


Public Health

First Advisor's Name

Gladys E Ibanez

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Diana M Sheehan

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Kristopher P Fennie

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Nelson Varas-Diaz

Fourth Advisor's Committee Title

Committee Member


HIV-related stigma, antiretroviral therapy adherence, viral suppression, anxiety, depression, preexposure prophylaxis-related stigma

Date of Defense



Persistent increases of HIV incidence in Florida has made it essential to study ways to improve HIV prevention strategies. Treatment as Prevention (TasP) and Preexposure Prophylaxis (PrEP) are two recent methods in HIV prevention; however, their success may be limited due to barriers such as stigma. This dissertation explored the relationship between HIV-related stigma and 1) antiretroviral therapy adherence and viral suppression and 2) symptoms of anxiety and depression. Additionally, it sought to develop and validate a scale to measure community PrEP-related stigma.

We used data from the Florida Cohort Study which include 932 people living with HIV (PLWH). The odds of non-adherence to ART was not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs no stigma) (p=0.198 and p=0.600, respectively). Moreover, the odds of non-viral suppression was not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs no stigma) (p=0.702 and p=0.622, respectively). However, ever experiencing healthcare specific enacted HIV-related stigma was associated with both non-adherence [p=0.008] and non-suppression [p=0.011]. Between HIV-related stigma and symptoms of anxiety and depression, we found that higher levels of enacted HIV-related stigma was significantly associated with higher levels of both anxiety (vs no stigma) (p=0.006 and p

To develop and validate the community PrEP-related stigma scale (community-PSS) we used data from an ongoing study among 108 sexual and gender minority men in Florida. The scale was found to have high internal consistency (α=0.86) and had 4 factors (stigma of actions outside of sex, stigma of sexual actions, extreme stigma perceptions, and positive community perception). The community-PSS was valid; meeting 4/5 hypotheses and in the expected direction.

Research that focuses on specific constructs of HIV-related stigma can better inform future stigma reduction interventions. The community-PSS is a valid and reliable tool with potential of assessing stigma’s impact on PrEP knowledge, uptake, and adherence. Future research should focus on the intersectionality of stigma on HIV risk outcomes.



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