Chengbo Zeng

Date of Award

Summer 2021

Document Type

Open Access Dissertation


Health Promotion, Education and Behavior

First Advisor

Xiaoming Li

Second Advisor

Shan Qiao


Background: HIV clinical outcomes including CD4 count, viral suppression, and health-related quality of life (HRQoL), are important indicators reflecting immunologic functioning, treatment efficacy, and overall health quality. However, due, in part, to HIV-related stigma, many people living with HIV (PLWH) experience suboptimal clinical outcomes. The Health Stigma Framework introduced the potentially distinct mechanisms underlying internalized, anticipated, enacted stigma and health outcomes through psycho-behavioral pathways. Based on this framework, this dissertation investigated the impacts and mechanisms of HIV-related stigma on clinical outcomes among PLWH in Guangxi, China from a longitudinal perspective. Methods: Data at baseline, 6-, 12-, 18- month follow-ups were derived from a prospective cohort study among 1,198 in Guangxi, China. Hierarchical generalized linear mixed model was employed to test the separate impacts of internalized, anticipated, and enacted stigma on each clinical outcome after accounting for psycho-behavioral factors (i.e., antiretroviral therapy [ART] self-efficacy, HIV symptom management self-efficacy, ART adherence) and covariates. Latent growth curve modelling and mediation analysis were employed to examine the mediating effects of psycho-behavioral factors between stigma and each clinical outcome.

Results: In hierarchical generalized linear mixed models, internalized, anticipated, and enacted stigma showed negative impacts on HRQoL but these impacts were not found in CD4 count and viral suppression. Mediation analyses revealed that ART self-efficacy and ART adherence mediated the indirect pathways from HIV-related stigma to viral suppression but these effects were not found in CD4 count. ART self-efficacy consistently mediated the impacts of the three types of stigma on HRQoL but the mediating effect of HIV symptom management self-efficacy was only found in the pathway between anticipated stigma and HRQoL.

Conclusions: This dissertation provided support for the different psycho-behavioral mechanisms of HIV-related stigma on clinical outcomes. Future stigma research should consider the characteristics of each type of HIV-related stigma and clinical outcomes and use the relevant theoretical knowledge to frame the pathways between them. Interventions aiming to improve clinical outcomes should be tailored to internalized, anticipated, and enacted stigma, target relevant psycho-behavioral pathways, and promote the resilience of PLWH.