Abstract
Using data collected from the Florida Medical Monitoring Project, we sought to compare the prevalence of overall HIV-related stigma, including its subdimensions among persons with HIV and disability(s) and persons with HIV without disability in Florida. Disability was classified as having difficulty in one or more areas: activity limitations, participation restrictions, and functional or sensory activities. HIV-related stigma was assessed using the HIV Stigma Scale, which measures (1) overall stigma (2) negative self-image, (3) personalized, and (4) anticipated stigma. Multivariate analysis indicates that the crude prevalence ratios of overall stigma, including negative self-image, personalized, and anticipated stigma among persons with HIV and disability(s) were 1.43, 1.24, 1.20, and 1.23 compared to persons with HIV without disability, respectively. After adjusting for confounders, the prevalence ratios of HIV-related stigma ranged from 1.33–1.07 among persons with HIV and disability(s) compared to persons with HIV without disability. The implications of these findings reveal that persons with HIV and disability(s) are more vulnerable to HIV-related stigma. Researchers could consider distinct stigma interventions tailored towards persons with HIV and disability(s) in Florida.
Keywords: HIV, disability, HIV-related stigma, personalized stigma, anticipated stigma, negative self-image stigma, medical monitoring project
Introduction
Approximately 1 billion people are living with a disability, including persons with HIV (Joint United Nations Programme on HIV and AIDS [UNAIDS], 2014). Since the advent of antiretroviral therapy, persons with HIV live longer lives with effective treatment, but may also develop disabling conditions as a result of side effects of antiretroviral medications or progression of HIV (UNAIDS, 2014). According to the World Health Organization (WHO), dimensions of disability include: activity limitations (e.g., Difficulty hearing, seeing, mobility), participation restrictions (i.e., Unable to engage in normal activities such as social or recreational activities), and sensory or functional impairment (e.g., Loss of limb, memory loss, cognitive deficit), which increases the complexity of chronic HIV infection (2020). These challenges may be compounded by stressors that exacerbate disability, one of which is HIV-related stigma (O’Brien et al., 2009).
Stigma, is a social process that devalues and discredits an individual based on their attributes (Goffman, 2009). There is evidence that HIV-related stigma (i.e., Persons who are assumed to possess a discrediting attribute due to their HIV status) affects persons with HIV and disability(s) uniquely (O’Brien et al., 2008). According to the Episodic Disability framework, persons with HIV may experience disability, which is defined as unpredictable phases of wellness and illness (O’Brien et al., 2008). HIV-related stigma may exacerbate these phases of disability when individuals accept negative beliefs about HIV (i.e., Internalized stigma), expect negative reactions from others in the future because of their HIV status (i.e., Anticipated stigma), or experience unfair treatment from others (i.e., Enacted stigma) (Earnshaw & Chaudoir, 2009; O’Brien et al., 2009; Turan et al., 2017). As a result, HIV-related stigma may impact major dimensions of disability including impairments (e.g., Anxiety, depression) and/or participation restrictions (O’Brien et al., 2009).
A surveillance study in Florida found significant associations between stigmatized identities and HIV-related stigma (Williams et al., 2020). Specifically, higher HIV-related stigma scores were more likely to be endorsed by persons living with disability(s), depression and/or alcohol misuse (Williams et al., 2020). Higher HIV-related stigma scores in persons with disability(s) may be explained by their vulnerability to poverty, sexual violence, and abuse (AVERT, 2017; O’Brien et al., 2008; Whittle et al., 2017). Moreover, persons with HIV and disability(s) are found in all marginalized populations (e.g., Sex workers; women; injection drug users; lesbian, gay, bisexual, and transgender) and therefore may be susceptible to other forms of stigma (National Alliance on Mental Illness [NAMI], 2018). Several cross-sectional studies concur there are significant associations between intersectional stigma (i.e., Convergence of multiple stigmatized social statuses) and poor HIV-related outcomes, but more work is needed to elucidate these findings, especially in populations that are understudied such as persons with disability(s) (Turan et al., 2017; Whittle et al., 2017).
Despite evidence that HIV-related stigma has a negative impact on persons with HIV and disability (s), few studies have explored its prevalence. In 2017, the largest study of the prevalence of HIV-related stigma was reported by Baugher et al., Who found approximately 80% of persons with HIV in the U.S. experienced internalized stigma. However, the prevalence of other subdimensions of stigma have yet to be explored and could vary in certain groups. Radcliffe et al. found HIV-related stigma was experienced differently among men and women in New York City (2017). Men experienced higher levels of anticipated stigma, while women experienced higher levels of internalized stigma. Internalized, anticipated, and enacted stigma may also affect persons with HIV and disability(s) differently in Florida. Florida has the third highest rate of HIV infection in the U.S. and only 68% of individuals are virally suppressed (FDOH, 2021). The intersections of stigma, poverty, impoverished communities, and discriminatory HIV laws have likely made it difficult for people at risk for HIV to access care and achieve viral suppression (Stringer et al., 2016).
No studies to our knowledge have examined the prevalence of HIV-related stigma overall, and across its subdimensions simultaneously in Florida. It may be useful to clarify the prevalence of subdimensions of HIV-related stigma among persons with HIV and disability(s) to direct stigma reduction efforts. To this end, we aim to compare the prevalence of overall HIV-related stigma, including its subdimensions, among persons with HIV and disability(s) and persons with HIV without disability in Florida.
Materials and methods
Data for this cross-sectional analysis came from the combined 2015 and 2016 Florida Medical Monitoring Project (MMP), a representative supplemental surveillance project funded by the U.S. Centers for Disease Control and Prevention (CDC) (2019). The goal of the MMP is to monitor clinical and behavioral characteristics of adults living with HIV in the U.S. and Puerto Rico through face-to-face and telephone interviews (CDC, 2019). Strict protocols were in place to keep patient information confidential, and names of selected participants were not sent to the CDC. Eligible participants were diagnosed with HIV, 18 years of age or older, and residents of Florida for the 2015 and 2016 data collection cycles, respectively. Informed consent was obtained from all interview participants. Data were weighted to account for nonresponse based on variables determined to be significant predictors of nonresponse in Florida. A complete description of the MMP interview data weighting methods and sampling approach is described by the CDC on their website (CDC, 2019). We received approval from the University of Florida and Florida Department of Health (FDOH) Institutional Review Boards to conduct our study.
Measures
Individual characteristics
Table 1 represents individual characteristics including age, education, gender, race, sexual orientation, poverty, country of birth, depression, and anxiety. A person’s race was dichotomized as White or Black/Other. Other race included Asian, Native American/Alaskan Native, and Native Hawaiian/Pacific Islander. Sexual orientation was categorized as heterosexual or homosexual/Other, which included persons who identified as bisexual or “something else”. Poverty was determined based on the Department of Health and Human Services (DHHS) guidelines as “at or above poverty level” or “below poverty level” (2015). Moreover, depression and anxiety symptoms in the past two weeks were assessed using the eight-item Patient Health Question-naire and the seven-item Generalized Anxiety Disorder Scale, respectively (Kroenke et al., 2009; Spitzer et al., 2006). Depression was a binary variable classified as “no depression” or “depression”. Respondents who had depressive symptoms were defined as having a total score of 10 or greater. Similarly, anxiety was categorized as “no anxiety” or “anxiety”. A cut-off score of 10 or greater was used to classify respondents who had anxiety symptoms.
Table 1.
Characteristics of adults living with HIV in Florida who experience high HIV-related stigma in 2015–2016.
| Characteristics | n (weighted %) (n = 603) | Overall Stigma (n = 324) | Negative Self Image Stigma (n = 208) | Personalized Stigma (n = 345) | Anticipated Stigma (n = 324) |
|---|---|---|---|---|---|
| Disability Status | |||||
| Persons with disability | 295 (48%) | 180 (57%) | 112 (54%) | 184 (53%) | 168 (53%) |
| Persons without disability | 307 (51%) | 143 (43%) | 95 (46%) | 160 (47%) | 155 (47%) |
| Gender | |||||
| Female | 216 (30%) | 143 (38%) | 82 (35%) | 133 (33%) | 143 (38%) |
| Male | 387 (70%) | 181 (62%) | 126 (65%) | 212 (67%) | 181 (62%) |
| Race | |||||
| White | 267 (46%) | 127 (39%) | 90 (44%) | 151 (46%) | 118 (36%) |
| Black/Othera | 335 (54%) | 197 (61%) | 118 (56%) | 194 (54%) | 205 (64%) |
| Sexual Orientation | |||||
| Heterosexual | 373 (59%) | 221 (66%) | 136 (64%) | 218 (61%) | 228 (67%) |
| Homosexual/Otherb | 229 (41%) | 102 (34%) | 71 (36%) | 126 (39%) | 95 (33%) |
| Age (years) | |||||
| 18–49 | 282 (46%) | 173 (53%) | 113 (53%) | 170 (47%) | 178 (55%) |
| 50+ | 321 (54%) | 151 (47%) | 95 (47%) | 175 (53%) | 146 (45%) |
| Education | |||||
| High School Diploma or Less | 295 (47%) | 163 (50%) | 108 (51%) | 163 (47%) | 167 (51%) |
| Greater than High school Diploma | 308 (53%) | 161 (50%) | 100 (49%) | 182 (53%) | 157 (49%) |
| Poverty | |||||
| Above Poverty Level | 285 (49%) | 139 (48%) | 88 (47%) | 160 (52%) | 144 (50%) |
| At or below poverty Level | 275 (43%) | 163 (52%) | 102 (53%) | 163 (48%) | 156 (50%) |
| Country of Birth | |||||
| Non-foreign Born | 468 (79%) | 262 (83%) | 166 (80%) | 290 (84%) | 251 (80%) |
| Foreign Born | 128 (20%) | 62 (17%) | 42 (20%) | 55 (16%) | 73 (20%) |
| Anxiety | |||||
| No anxiety | 502 (84%) | 255 (81%) | 154 (76%) | 278 (83%) | 257 (81%) |
| Anxiety | 95 (15%) | 68 (19%) | 53 (24%) | 66 (17%) | 66 (19%) |
| Depression | |||||
| No Depression | 512 (85%) | 260 (81%) | 154 (77%) | 281 (83%) | 261 (82%) |
| Depression | 87 (14%) | 63 (19%) | 54 (23%) | 63 (17%) | 62 (18%) |
The category of Other race included Asian, Native American/Alaskan Native, or/and Native Hawaiian/Pacific Islander.
Other sexual orientation includes “bisexual” or “something else”.
Disability
Disability in this study was a binary measure of six questions from the American Community Survey to assess whether a person had serious difficulty in one or more of the following areas: (1) concentrating, remembering, or making decisions, (2) walking or climbing stairs, (3) dressing or bathing, (4) doing errands alone such as visiting a doctor’s office or shopping, and/or (5) deaf or serious difficulty hearing, (6) blind or serious difficulty seeing even with glasses (US Census Bureau, n.d.; CDC, 2019).
HIV-related stigma
Stigma was assessed using the modified 10-item HIV Stigma Scale. (Wright et al., 2007). According to Earnshaw and Chaudoir (2009), the HIV Stigma Scale assesses negative self-image, personalized stigma, and anticipated stigma in addition to generating an overall stigma score. Negative self-image represents self-blame or guilt related to HIV status, personalized stigma represents the stereotypes or discrimination enacted upon persons with HIV, and anticipated stigma represents expectations of negative treatment due to HIV status (Earnshaw & Chaudoir, 2009). All items used a 5-point Likert scale ranging from 1 = “strongly disagree” to 5 = “strongly agree”. An overall stigma score ranging from 0–100 was created by rescaling each item. Each subdimension had a continuous score in increments of ten, which depended on the number of items for each subdimension. For example, if a subdimension (i.e., Negative self-image, personalized stigma) has three items, the score would range from 0–30. If a subdimension has four items (i.e., Anticipated stigma), the score would range from 0–40. A categorical measure was created for overall stigma and each subdimension based on the median, resulting in a dichotomous measure of higher stigma and lower stigma, as previously done in other investigations (Lunze et al., 2017; Williams et al., 2020).
Statistical analysis
Descriptive statistics were conducted to summarize participant characteristics and types of disability. Weighted log binomial regression models were conducted to assess the prevalence ratios for the HIV-related stigma subdimensions (i.e., Overall stigma, negative self-image, personalized, and anticipated stigma). We assessed for confounding by conducting weighted bivariate analyses using the modified Rao Scott Chi-square test to identify individual characteristics independently associated with both disability status and HIV-related stigma subdimensions. Bivariate results significant at p ≤ 0.25 were included in the multivariate logistic regression model. The unadjusted and adjusted prevalence ratios were estimated along with their corresponding 95% confidence intervals (CI) and p-values. All statistical analyses were conducted using SAS 9.4.
Results
Description of individual characteristics, disability, and HIV-related stigma
Individual characteristics
Table 1 summarizes the proportion of persons with HIV with higher overall, negative self-image, personalized, and anticipated stigma by individual characteristics. Of the 603 persons in our sample, the mean age was 49 years old (SD ) and mostly male (70%), Black/Other (54%), born in the U.S. (79%), and heterosexual (59%). Fifty-three percent had greater than a high school diploma and 49% were living above the poverty level. Lastly, 14% reported symptoms of major depression and 15% reported severe anxiety symptoms preceding two weeks from their interview.
Disability
Table 2 represents the frequency of disability types among persons with HIV and disability(s). Forty-eight percent of the sample (n = 295) reported at least one disability type. Approximately 28% of our sample reported having serious difficulty concentrating, remembering, and making decisions and/or walking or climbing stairs. Fourteen percent reported blindness or serious difficulty seeing even with glasses. Ten percent reported deafness or serious difficulty hearing and/or reported difficulty doing errands alone. Lastly, six percent had difficulty dressing or bathing.
Table 2.
Frequency and proportions of disability types for persons with HIV and disability.
| Persons with Disability* n (weighted %) (n = 295) | |
|---|---|
| Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions? | 168 (28%) |
| Do you have serious difficulty walking or climbing stairs? | 173 (28%) |
| Are you blind or do you have serious difficulty seeing even when wearing glasses? | 90 (14%) |
| Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping? | 61 (10%) |
| Are you deaf or do you have serious difficulty hearing? | 63 (10%) |
| Do you have difficulty dressing or bathing? | 37 (6%) |
column adds to greater than 100%. Respondents may have chosen one or more disability types
Overall stigma
Among respondents who reported higher overall stigma (n = 324), a greater proportion were male (62%), Black/Other (54%), heterosexual (66%), 18–49 years old (53%), living at or below the poverty level (52%), born in U.S. (83%), reported a disability (57%), had no anxiety (81%), and no depression (81%). An equal proportion (50%) earned greater than a high school diploma or earned a high school diploma or less.
Negative self-Image stigma
A greater proportion of respondents who endorsed high negative self-image stigma (n = 208) were male (65%), Black/Other (56%), heterosexual (66%), 18–49 years old (53%), earned a high school diploma or less (51%), were living at or below the poverty level (53%), born in U.S. (80%), reported a disability (54%), and no anxiety (76%) or depression (77%).
Personalized stigma
Among those who reported higher personalized stigma (n = 345), more than half of the sample were male (67%), Black/Other (54%), heterosexual (61%), older than 50 years old (53%), earned greater than a high school diploma (53%), lived above the poverty level (52%), were born in U.S. (84%), reported a disability (53%), and no anxiety (84%) or depression (53%).
Anticipated stigma
Higher anticipated stigma (n = 324) was greater among those who were male (62%), Black/Other (64%), heterosexual (67%), 18–49 years old (55%), earned a high school diploma or less (51%), were born in U.S. (80%), reported a disability (53%), and had no anxiety (81%) or depression (82%). An equal proportion (50%) of persons lived above and below the poverty level.
Crude and adjusted prevalence ratios
Crude prevalence ratios
Table 3 represents the crude prevalence ratios of overall HIV-related stigma and its three subdimensions among persons with HIV and disability(s). The crude prevalence rate of overall stigma was 1.43 (P < 0.0001; CI: 1.41–1.46) times higher in persons with HIV and disability(s) compared to persons with HIV without a disability. Specifically, the crude prevalence rates of negative self-image [1.24 (P < 0.0001; CI: 1.22–1.27)], personalized [1.20 (P < 0.0001; CI: 1.19–1.21)], and anticipated stigma [1.23 (P < 0.0001; CI: 1.21–1.24)] were higher in persons with HIV and disability(s) compared to persons with HIV without a disability.
Table 3.
Crude prevalence ratios of HIV-related stigma among adults living with HIV and disability (N = 603).
| Overall | Negative Self-Image Stigma | Personalized Stigma | Anticipated Stigma |
|---|---|---|---|
| Crude PR (95% CI) | Crude PR (95% CI) | Crude PR (95% CI) | Crude PR (95% CI) |
| 1.43 (1.41–1.46)* | 1.24 (1.22–1.27)* | 1.20 (1.19–1.21)* | 1.23 (1.21–1.24)* |
p values ≤ 0.0001.
Adjusted prevalence ratios
Different individual characteristics met our criteria for confounding for each HIV-related stigma subdimension. Table 4 depicts the adjusted prevalence ratios of overall stigma, including negative self-image, personalized, and anticipated stigma. In the multivariate analysis, confounding variables significantly associated with overall stigma were race, sexual orientation, education, poverty status, and depression. After adjusting for confounders, the prevalence rate of overall stigma was 1.33 times (P < 0.0001; CI: 1.31–1.35) higher in persons with HIV and disability(s) compared to persons with HIV without a disability.
Table 4.
Prevalence ratios of HIV-related stigma and disability status, adjusted for correlates among persons with HIV.
| Characteristics | Overall Adjusted Prevalence Ratio PR (95% CI) | Negative Self-Image Adjusted Prevalence Ratio PR (95% CI) | Personalized Stigma Adjusted Prevalence Ratio PR (95% CI) | Anticipated Stigma Adjusted Prevalence Ratio PR (95% CI) |
|---|---|---|---|---|
| Disability | ||||
| Persons without a disability | Ref | Ref | Ref | Ref |
| Persons living with a disability | 1.33 (1.31–1.35)* | 1.07 (1.05–1.10)* | 1.13 (1.11–1.14)* | 1.12 (1.10–1.13)* |
| Gender | ||||
| Female | Ref | Ref | Ref | Ref |
| Male | 0.90 (0.89–0.92)* | 0.90 (0.88–0.92)* | 0.90 (0.89–0.91)* | 0.94 (0.92–0.95)* |
| Race | ||||
| White | Ref | Ref | Ref | Ref |
| Black/Othera | 1.03 (1.01–1.04)** | 0.92 (0.90–0.94)* | 0.94 (0.93–0.95)* | 1.23 (1.22–1.25)* |
| Age (years) | ||||
| 18–49 | Ref | Ref | Ref | Ref |
| 50+ | 0.73 (0.72–0.74)* | 0.77 (0.76–0.79)* | 0.90 (0.88– 0.91)* | 0.71 (0.71–0.72)* |
| Sexual Orientation | ||||
| Heterosexual | Ref | n/s | n/s | Ref |
| Homosexual/Otherb | 0.83 (0.82–0.85)* | 0.80 (0.79–0.81)* | ||
| Education | ||||
| High school or less | Ref | n/s | n/s | Ref |
| Greater than High School | 0.97 (0.97–0.98)* | 0.95 (0.94–0.95)* | ||
| Country of Birth | ||||
| Non-foreign Born | n/s | n/s | Ref | n/s |
| Foreign Born | 1.33 (1.31–1.35)* | |||
| Poverty | ||||
| Above Poverty Level | Ref | Ref | n/s | n/s |
| At or below poverty Level | 1.02 (1.00–1.03)*** | 1.24 (1.22–1.26)* | ||
| Anxiety | ||||
| No anxiety | n/s | Ref | n/s | n/s |
| Anxiety | 1.05 (1.02–1.09)*** | |||
| Depression | ||||
| No Depression | Ref | Ref | Ref | Ref |
| Depression | 1.21 (1.19–1.22)* | 1.61 (1.56–1.66)* | 1.20 (1.18–1.21)* | 1.18 (1.17–1.19)* |
The category of Other race included Asian, Native American/Alaskan Native, or/and Native Hawaiian/Pacific Islander.
Other sexual orientation includes “bisexual” or “something else”.
n/s = not significant to both HIV-related stigma subdimensions and disability status in bivariate analyses.
p values ≤ 0.0001.
p values ≤ 0.0005.
p values ≤ 0.01.
HIV-related stigma subdimensions were also adjusted for confounders in our multivariate analysis. Gender, race, age, poverty status, anxiety, and depression were confounders statistically significant with negative self-image stigma. After adjusting for confounding variables, the prevalence ratio of negative self-image stigma was 1.07 (P < 0.0001; CI: 1.05–1.10) times higher in persons with HIV and disability(s) compared to persons with HIV without a disability. Secondly, the prevalence rate of personalized stigma among persons with HIV and disability(s) was 1.13 (P < 0.0001; CI:1.11–1.14) times higher than persons with HIV without a disability after adjusting for confounders. Confounding variables statistically significant with personalized stigma were gender, race, age, country of birth, and depression. Lastly, confounding variables statistically significant with anticipated stigma were gender, race, age, education, and sexual orientation. After adjusting for confounders, the prevalence rate of anticipated stigma was 1.12 (P < 0.0001; CI: 1.10–1.13) times higher in persons with HIV and disability(s) compared to persons with HIV without a disability.
Discussion
To our knowledge, no previous study has used validated HIV-related stigma measures to identify the prevalence of HIV-related stigma among persons with HIV and disability(s) in Florida. Results suggest the prevalence of HIV-related stigma is higher among persons with HIV and disability(s) compared to persons with HIV without disability, even after adjusting for potential confounders. The risk of experiencing higher overall stigma was 33% higher among persons with HIV and disability (s) compared to persons with HIV without a disability. Negative self-image, personalized, and anticipated stigma was approximately 7–13% higher among persons with HIV and disability(s) compared to persons with HIV without disability. This suggests that persons with HIV and disability(s) may be more vulnerable to HIV-related stigma.
Our findings reinforced the notion that overall stigma is higher among persons with HIV and disability(s). This is consistent with the literature, which suggest HIV-related stigma is a burden that may affect individuals beyond any impairment they may have (Hatzenbuehler et al., 2013; Whittle et al., 2017). Given that other marginalized identities also had a greater proportion of stigma, disparities in HIV-related health outcomes may be better explained by intersectional stigma rather than HIV-specific stigma (Hatzenbuehler et al., 2013; Parsons et al., 2015). The implications of these findings are important, as the consequences of intersectional stigma can lead to healthcare avoidance and poor medication adherence. (Whittle et al., 2017).
Notably, persons with HIV and disability(s) had a higher risk of experiencing negative self-image compared to persons with HIV without a disability. It is plausible that persons with HIV and disability(s) may experience HIV-related stigma, then, after internalizing these negative thoughts and actions, disability may be exacerbated through anxiety or depression (O’Brien et al., 2008). However, resisting stigma has been shown to improve health in marginalized groups (Parsons et al., 2015). Prior research posit that African American women who actively resisted HIV-related stigma were more likely to engage, practice, and seek help in activities that promote health (Rao et al., 2018). Likewise, persons with HIV and disability(s) who develop a resilience to stigma may be more likely to engage in health seeking behaviors however, further research is needed to clarify the relationship between resiliency, health, and disability. Additionally, the role of personalized stigma and its relationship with health outcomes among persons with HIV and disability(s) raises new questions. Our findings support the hypothesis that losing friendships, being hurt, and not socializing with others due to HIV are more prevalent among persons with HIV and disability(s), but also highlights the need for additional research to better understand how these factors impact HIV-related health outcomes over time.
Lastly, despite advancements in HIV treatment and care that have allowed people with HIV to live longer lives, many Americans still perceive HIV as a death sentence (Kaiser Family Foundation, 2011). Increased levels of anticipated stigma may be experienced as generalizations are made about persons with HIV and persons with disability(s). Both HIV and disability stigma may have layered effects that lead to higher levels of anticipated stigma as previous studies have shown (Whittle et al., 2017; Williams et al., 2020). The implications of these findings are particularly important as anticipated stigma have significant associations with concealment of HIV and poorer psychological functioning–a major component of disability (Shamburger-Rousseau et al., 2016). An important next step is to employ longitudinal designs to provide stronger evidence for the causal effects of anticipated stigma on HIV-related health in persons with HIV and disability (s).
Our study has several limitations. First, HIV-related stigma was self-reported, and therefore susceptible to social desirability bias. The prevalence of HIV-related stigma among persons with HIV and disability(s) may be over or underestimated. Second, given that the disability items were not time-bound, we were unable to assess whether the condition reported was temporary (e.g., Occurred in the last three months) or permanent. Third, our results may not be generalizable to women, multiracial, or transgender persons with HIV due to the small sample size. Finally, our study is cross sectional, therefore causal relationships could not be determined. Despite these limitations, the MMP revised methods in 2015 to include persons with HIV who are engaged in care and persons who are not currently in medical care (CDC, 2019). This has increased the capacity to monitor and understand the needs of persons with HIV who are less likely to be included in population-based samples.
Overall stigma, including negative self-image, personalized, and anticipated stigma substantially affected persons with HIV and disability(s) greater than persons with HIV without disabilities in our sample, suggesting a need for individual and community-level stigma reduction interventions. Further understanding of how HIV-related stigma and its underlying subdimensions impact disability(s), are needed to help tailor strategies to mitigate its effects among persons with HIV.
Acknowledgments
The authors want to thank the Florida Department of Health HIV/AIDS Section for data collection as well as their contributions and collaboration on this project AWD04074. We also acknowledge the contributions of the Southern HIV and Alcohol Research Consortium (SHARC), the University of Florida Translational Science Training to Reduce the Impact of Alcohol on HIV Infection (T32AA025877), and the University of Miami Multidisciplinary Training in Substance Abuse Research grant (5T32DA045734-02) for their contributions and collaboration on this project.
Funding
This study was funded by the Florida Department of Health HIV/AIDS Section (grant number AWD04074).
Footnotes
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability
The data that support the findings of this study are available from the Florida Department of Health, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available with permission of the Florida Department of Health.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the Florida Department of Health, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available with permission of the Florida Department of Health.