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HIV-related microaggressions and depressive symptoms among people living with HIV: the mediating roles of internalised stigma and coping with shame
  1. Aliye Canan Taşlıoğlu Sayıner1,2,
  2. Bulent Turan2,
  3. Arzu Nazlı3,
  4. Deniz Özer2,
  5. Hamed Abdollahpour Ranjbar2,4,
  6. Salih Atakan Nemli5,
  7. Ahmad Nejat Ghaffari3,
  8. Merve Mert Vahabi6,
  9. Nur Miray Ayhan7,
  10. Deniz Gokengin6,
  11. Andrea Norcini Pala8
  1. 1Department of Psychology, Faculty of Economics, Administrative and Social Sciences, Bahçeşehir University, Istanbul, Turkey
  2. 2Department of Psychology, College of Social Sciences and Humanities, Koç University, Istanbul, Turkey
  3. 3Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University, Izmir, Turkey
  4. 4Department of Psychology, Faculty of Humanities and Social Sciences, Istinye University, Istanbul, Turkey
  5. 5Department of Infectious Diseases and Clinical Microbiology, Izmir Katip Celebi University, Izmir, Turkey
  6. 6Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Turkey
  7. 7Department of Infectious Diseases, Izmir Atatürk Training and Research Hospital, Izmir, Turkey
  8. 8Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
  1. Correspondence to Professor Bulent Turan; bturan{at}ku.edu.tr

Abstract

Objectives Overtly experienced HIV-related stigma is associated with depressive symptoms for people living with HIV (PLWH). Research suggests that an important mediating mechanism in this association is internalised stigma, where PLWH accept negative societal views about HIV, apply them to themselves and develop a negative view of themselves. Microaggressions are subtle and indirect discriminatory behaviours and, like overtly experienced stigma, may also contribute to depressive symptoms. We tested this hypothesis and examined the mediating roles of internalised stigma and maladaptive ways of coping with shame in the association between microaggressions and depressive symptoms among PLWH in Türkiye.

Methods This study examines the serial mediating roles of internalised HIV stigma and shame-related coping strategies (ie, withdrawal and self-attack) in the association between HIV-related microaggressions and depressive symptoms among PLWH. PLWH in Izmir, Türkiye (N=308) completed validated scales measuring experiences of microaggressions, internalised HIV stigma, coping strategies related to shame and depression symptoms.

Results Structural equation modelling results suggest that internalised HIV stigma significantly mediates the relationship between HIV-related microaggressions and depression symptoms. Furthermore, serial mediation analysis suggests that withdrawal and self-attack strategies of coping with shame mediate the association between internalised HIV stigma and depressive symptoms. Thus, internalised HIV stigma and shame-related coping strategies may partially stem from experiencing HIV-related microaggressions and may negatively affect the mental health of PLWH.

Conclusions Findings highlight the importance of assessing subtle forms of discrimination (ie, microaggressions) given their negative impact on the self-concept of PLWH. In addition to addressing negative attitudes and behaviours against PLWH in society, interventions that help PLWH cope with shame-related experiences might improve their mental health.

  • HIV
  • PSYCHOLOGY
  • Social Sciences

Data availability statement

Data are available upon reasonable request. The data used and analysed in this study are available from the corresponding author upon reasonable request.

https://doi.org/10.1136/sextrans-2024-056354

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    Data availability statement

    Data are available upon reasonable request. The data used and analysed in this study are available from the corresponding author upon reasonable request.

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    Footnotes

    • Handling editor Adam DN Williams

    • Contributors Guarantor: BT. Conceptualisation: AN, DG, BT, ANP. Data curation and investigation: AN, SAN, ANG, MMV, NMA, DG. Formal analysis and manuscript drafting: ACTS, DÖ, HAR, BT, ANP. Methodology, supervision and validation: AN, DG, BT. Project administration and resources: AN, DG.

    • Funding BT’s time for this research was supported by the Scientific and Technological Research Council of Türkiye (TÜBİTAK) under Project Number 121C088, titled 'Stigma in the Lives of Refugees Living in Turkey'.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.