Date of Award

Fall 2022

Document Type

Open Access Thesis



First Advisor

Sayward E. Harrison


People living with HIV (PLHIV) experience numerous psychosocial stressors, including HIV-related stigma and heightened prevalence of mental health disorders such as depression, substance use disorders, and anxiety. However, limited research has investigated predictors of anxiety within this population. This study aimed to explore the relationship between HIV-related stigma and anxiety symptoms among PLHIV in South Carolina (SC) and to examine the role of social support as a mediator for this relationship. A total of 402 PLHIV receiving HIV care at large immunology center in SC completed a paper and pencil survey, reporting sociodemographic variables, as well as experiences of HIV-related stigma (i.e., enacted, anticipated, and internalized stigmas), social support, and anxiety. A multivariate analysis of variance was conducted to assess differences in reported HIV-related enacted, anticipated, and internalized stigma by gender, sexual identity, and age. An analysis of variance was conducted to assess differences in reported anxiety by gender, sexual identity, and age. A multiple mediation model was conducted to determine whether social support mediated the relationships between the three types of HIV-related stigma (i.e., enacted, anticipated, and internalized) and anxiety. Experiences of HIV-related anticipated and internalized stigma but not enacted stigma differed by participants’ gender, sexual identity, and age. Anxiety symptoms were not predicted by gender, sexual identity, or age. The multiple mediation model indicated that while HIV-related enacted and internalized stigma predicted anxiety, anticipated stigma did not predict anxiety. Social support did not mediate the relationship between enacted and internalized stigma on anxiety. These findings highlight the importance of completing mental health screeners within HIV care clinics. In addition, mental health practitioners should be aware of the specific stressors such as HIV-related stigma experienced by PLHIV. Beyond individual interventions, community-based stigma reduction efforts must be made to improve the mental health outcomes of PLHIV.


© 2022, Sarah J. Miller