Association of experienced stigma in healthcare settings with health outcomes among Black women living with HIV: Mediating roles of internalized stigma, anticipated stigma, and trust in HIV care

Ibrahim Yigit; Tracey E Wilson; Tonya N Taylor; Seble G Kassaye; Sheri D Weiser; Mardge H Cohen; Stephen Gange; Brian W Pence; Igho Ofotokun; Gina M Wingood; Lisa R Metsch; Janet Brown-Friday; Michelle Floris-Moore; Mirjam-Colette Kempf; Janet M Turan; Bulent Turan

doi:10.1016/j.socscimed.2025.117699

Association of experienced stigma in healthcare settings with health outcomes among Black women living with HIV: Mediating roles of internalized stigma, anticipated stigma, and trust in HIV care

Soc Sci Med. 2025 Jan 11:366:117699. doi: 10.1016/j.socscimed.2025.117699. Online ahead of print.

Authors

Ibrahim Yigit¹, Tracey E Wilson², Tonya N Taylor², Seble G Kassaye³, Sheri D Weiser⁴, Mardge H Cohen⁵, Stephen Gange⁶, Brian W Pence⁷, Igho Ofotokun⁸, Gina M Wingood⁹, Lisa R Metsch⁹, Janet Brown-Friday¹⁰, Michelle Floris-Moore⁷, Mirjam-Colette Kempf¹¹, Janet M Turan¹², Bulent Turan¹³

Affiliations

¹ Florida State University, Tallahassee, FL, USA. Electronic address: [email protected].
² Downstate Health Sciences University, Brooklyn, NY, USA.
³ Georgetown University, Washington, DC, USA.
⁴ University of California, San Francisco, San Francisco, CA, USA.
⁵ Stroger Hospital of Cook County, Chicago, IL, USA.
⁶ Johns Hopkins University, Baltimore, MD, USA.
⁷ University of North Carolina at Chapel Hill, NC, USA.
⁸ Emory University School of Medicine, Atlanta, GA, USA.
⁹ Columbia University, New York, NY, USA.
¹⁰ Albert Einstein College of Medicine-Montefiore Medical Center, New York, NY, USA.
¹¹ University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
¹² University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Koc University, Istanbul, Turkey.
¹³ Koc University, Istanbul, Turkey.

PMID: 39823813
DOI: 10.1016/j.socscimed.2025.117699

Abstract

Background: Black women living with HIV (WLHIV) often have suboptimal ART adherence due to a multitude of social and structural barriers, including HIV-related stigma. Trust in healthcare providers plays a significant role in adhering to ART and is likely lower among Black WLHIV compared to their White counterparts. This study examined the relationship between experienced stigma in healthcare settings and ART adherence and viral suppression through anticipated stigma in healthcare settings, internalized stigma, and medical mistrust.

Participants/procedures: Participants included Black WLHIV from the Women's Interagency HIV Study (WIHS). We conducted serial mediation analyses where experienced HIV stigma in healthcare settings is associated with higher anticipated or internalized HIV stigma, leading to higher mistrust in HIV care providers, and ultimately, to lower ART adherence and viral suppression, adjusting for demographic and clinical covariates.

Results: Of the 1,060 WLHIV, approximately 84% achieved optimal ART adherence, and 65% had an undetectable viral load. Serial mediation analyses suggested significant indirect associations between experienced stigma in healthcare settings and ART adherence or viral suppression. Specifically, experienced stigma was associated with higher anticipated or internalized stigma, which was associated with mistrust in HIV care providers, resulting in lower ART adherence and reduced likelihood of undetectable viral load.

Conclusions: Interventions could focus on training healthcare providers to address implicit biases and create supportive healthcare environments. Integrating mental health support to reduce internalized stigma and using community engagement and education to address anticipated stigma may further improve trust in providers, leading to better health behaviors and outcomes.

Keywords: Experienced stigma; HIV; Health outcomes; Internalized stigma; Trust.