title: HIV stigma as a barrier to retention in HIV care at a general hospital in Lima, Peru: a case-control study.
abstract: HIV stigma as a barrier to retention in HIV care has not been well-studied outside the United States. We conducted a case-control study in Lima, Peru to examine this issue. Cases were out-of-care for ≥12 months (n = 66) and controls were recruited from patients in active care presenting for a clinic visit (n = 110). A previously validated HIV stigma scale with four domains was used. Associations between being out-of-care and each stigma domain were assessed using multivariable logistic regression. Stigma scores were highest for disclosure concerns. Modest associations were found for greater disclosure concerns (OR 1.16; 95 % CI 0.99, 1.36) and concerns with public attitudes (OR 1.20; 95 % CI 1.03, 1.40). Enacted stigma and negative self-image showed non-linear associations with being out-of-care that plateaued or declined, respectively, at higher levels of stigma. The threshold effect for enacted stigma warrants further exploration, while disclosure concerns may be especially amenable to intervention in this population.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Valenzuela
authors.forename: Cesar
authors.initials: C
authors.lastname: Ugarte-Gil
authors.forename: Jorge
authors.initials: J
authors.lastname: Paz
authors.forename: Juan
authors.initials: J
authors.lastname: Echevarria
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Kipp
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006769:Hospitals, General; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010568:Peru; D011287:Prejudice; D012649:Self Concept; D057545:Social Stigma; D013240:Stereotyping; D011795:Surveys and Questionnaires
chemical_list: D019380:Anti-HIV Agents