title: Stigma is associated with delays in seeking care among HIV-infected people in India.
abstract: BACKGROUND
  Stigma shapes the lives of people living with HIV and may affect their willingness to seek medical care. But treatment delays can compromise health and increase the risk of transmission to others.
  
  
  OBJECTIVE
  To examine whether the 4 stigma manifestations--enacted (discrimination), vicarious (hearing stories of discrimination), felt normative (perceptions of stigma's prevalence), and internalized (personal endorsement of stigma beliefs)--were linked with delays in seeking care among HIV-infected people in India.
  
  
  METHODS
  A cross-sectional survey was conducted with 961 HIV-positive men and women in Mumbai and Bengaluru.
  
  
  RESULTS
  Enacted and internalized stigmas were correlated with delays in seeking care after testing HIV positive. Depression symptoms mediated the associations of enacted and internalized stigmas with care-seeking delays, whereas efforts to avoiding disclosing HIV status mediated only the association between internalized stigma and care-seeking delays.
  
  
  CONCLUSIONS
  It is vital to develop stigma reduction interventions to ensure timely receipt of care.
authors.affiliation: Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA 94105, USA. wayne.steward@ucsf.edu
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Steward
authors.forename: Shalini
authors.initials: S
authors.lastname: Bharat
authors.forename: Jayashree
authors.initials: J
authors.lastname: Ramakrishna
authors.forename: Elsa
authors.initials: E
authors.lastname: Heylen
authors.forename: Maria L
authors.initials: ML
authors.lastname: Ekstrand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012649:Self Concept; D057545:Social Stigma; D012959:Socioeconomic Factors; D014342:Truth Disclosure; D055815:Young Adult