Associations between HIV Stigma and Social Support for People with HIV in Hyderabad, India

Overview: The current study expands on previous HIV stigma research by exploring the following two questions: (1) How are HIV stigma and social support associated with each other? (2) Does this association differ by gender identity or mental health status?Proposal text: Background/Purpose

HIV stigma not only impacts health and well-being but also prohibits people from accessing medical care and other services. Studies have shown a protective role of social support in reducing HIV stigma. However, there remains a lack of research investigating the relationship between social support and HIV stigma in the Indian context. More specifically, little is known about how this association varies by gender and mental health status. The current study expands on previous HIV stigma research by exploring the following two questions: (1) How are HIV stigma and social support associated with each other? (2) Does this association differ by gender identity or mental health status?

Methods

A cross-sectional survey was conducted with 150 people living with HIV (PLWH). Participants were recruited using both simple random and snowball sampling in collaboration with local community-based organizations. To ensure gender variation, we included roughly equal subgroups by gender: 51 cisgender women, 49 cisgender men, and 50 third-gender people. Inclusion criteria were: (1) self-report as being HIV-positive, (2) resident in Hyderabad or Secunderabad, India; (3) proficient in speaking Hindi or Telugu; and (4) between the ages of 18 and 50. Survey items to assess social support were adapted from the HIV Cost Services and Utilization Survey. HIV stigma was measured using two scales (Zelaya and Jeyaseelan) that had been previously validated in India.

Results

Multiple linear regression analysis revealed an inverse association between HIV stigma and social support that was significant in the regression model for both HIV stigma scales (ß= 0.78, 95% CI, 1.20-0.37 Zelaya scale; ß =1.25, 95% CI, 1.91-0.61Jeyaseelan scale). Across gender groups, third gender individuals experienced a statistically significantly higher degree of HIV stigma compared to cisgender men (ß= 9.31, 95% CI, 0.81-19.45 Zelaya scale; ß= 17.31, 95% CI, 1.56-33.07 Jeyaseelan scale). Depression was significantly associated with all types of HIV stigma on both the Zelaya and Jeyaseelan stigma scales. Heterosexual PLWH faced 3.01 points less stigma on the Zelaya scale (p=0.05) and 4.99 points less stigma on the Jeyaseelan scale (p=0.10) compared to participants who were gay, lesbian and bisexual orientation. The positive effect of depression on the association between social support and HIV stigma further intensified the level of stigma faced by PLWH; this was especially true for third gender PLWH.

Conclusions and implications

Findings highlight the need to address the lack of social support for PLWH in existing HIV care interventions. Adopting a gender-sensitive social support framework in current HIV care policies will assist in better addressing HIV stigma in the Indian context, where informal social support form an essential part of daily living. The study expands our knowledge on improving social support networks for PLWH as a priority within stigma reduction interventions. Social security and public entitlement programs in India need to be socially inclusive of third gender people and focus on ensuring equitable access to services utilized by third gender people.