Turan, B., Hatcher, A.M., Weiser, S.D., et al. American Journal of Public Health (April 2017), 20: e1–e7, e-publication ahead of print, doi:10.2105/AJPH.2017.303744.
Addressing HIV and reaching 90-90-90 goals require addressing structural factors such as stigma, which affect the wellbeing of people living with HIV (PLHIV) and impede their access and adherence to treatment. However, it is not fully understood how stigma leads to worse health behaviors or outcomes. This article presented a conceptual framework that highlights how individual-level HIV-related stigma (perceived community stigma, experienced stigma, internalized stigma, and anticipated stigma) might affect the health of those living with HIV. The framework was based on research on stigma and existing models and theories. It described how structurally embedded stigma could affect individuals in terms of interpersonal factors, mental health, psychological resources, and biological stress—and subsequently, could affect PLHIV directly (physiologically) and indirectly (in terms of engagement in care and HIV-related health). A conceptual framework such as this one, the authors said, could inform future research and interventions aiming to address stigma as a driver of HIV-related health. As a next step, they recommended longitudinal studies to strengthen evidence on the causal effects and pathways of stigma, and development of improved measurement strategies.