title: HIV-related stigma and psychological distress: the harmful effects of specific stigma manifestations in various social settings.
abstract: OBJECTIVE
  Recent research has shown that experiences of stigmatization have an adverse impact on the psychological well being of people living with HIV/AIDS (PLWHA). Most studies investigating this relationship employ an aggregate measure of stigma. Although this approach provides useful information about the psychological implications of HIV-related stigma in general, it neglects to acknowledge the possibility that some manifestations in specific settings may be psychologically more detrimental than others. The present study examines which specific stigma experiences are most strongly related to psychological distress across a number of social settings.
  
  
  METHODS
  A cross-sectional survey was administered to 667 PLWHA in the Netherlands. We examined participants' experiences of 11 manifestations of HIV-related stigma in six social settings. Linear regression analyses were conducted to determine which setting-specific manifestations best predict psychological distress after controlling for marital status, education and health status.
  
  
  RESULTS
  Three manifestations in family settings, namely receiving advice to conceal one's status, being avoided and being treated with exaggerated kindness, and one manifestation in healthcare settings, namely awkward social interaction, best predicted psychological distress in PLWHA.
  
  
  CONCLUSIONS
  Manifestations of HIV-related stigma vary according to setting. Certain manifestations in specific social settings impact the psychological well being of PLWHA more than others. In this study, certain experiences of stigmatization with PLWHA's families and in healthcare settings were more strongly related to psychological distress than experiences occurring in other social settings. These findings suggest that stigma reduction interventions focusing on these influential settings may benefit the psychological well being of PLWHA.
authors.affiliation: Department of Work and Social Psychology, Maastricht University, 6200 MD Maastricht, The Netherlands. s.stutterheim@psychology.unimaas.nl
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Stutterheim
authors.forename: John B
authors.initials: JB
authors.lastname: Pryor
authors.forename: Arjan E R
authors.initials: AE
authors.lastname: Bos
authors.forename: Robert
authors.initials: R
authors.lastname: Hoogendijk
authors.forename: Peter
authors.initials: P
authors.lastname: Muris
authors.forename: Herman P
authors.initials: HP
authors.lastname: Schaalma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011788:Quality of Life / Q000523:psychology*; D012931:Social Environment; D013240:Stereotyping; D055815:Young Adult