title: The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature.
abstract: This paper provides a review of the quantitative literature on HIV-related stigma and medication adherence, including: (1) synthesis of the empirical evidence linking stigma to adherence, (2) examination of proposed causal mechanisms of the stigma and adherence relationship, and (3) methodological critique and guidance for future research. We reviewed 38 studies reporting either cross-sectional or prospective analyses of the association of HIV-related stigma to medication adherence since the introduction of antiretroviral therapies (ART). Although there is substantial empirical evidence linking stigma to adherence difficulties, few studies provided data on psychosocial mechanisms that may account for this relationship. Proposed mechanisms include: (a) enhanced vulnerability to mental health difficulties, (b) reduction in self-efficacy, and (c) concerns about inadvertent disclosure of HIV status. Future research should strive to assess the multiple domains of stigma, use standardized measures of adherence, and include prospective analyses to test mediating variables.
authors: Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244-2340, USA. smsweene@syr.edu.
authors: Shannon M
authors: SM
authors: Sweeney
authors: Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244-2340, USA. pvanable@syr.edu.
authors: Peter A
authors: PA
authors: Vanable
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D004192:Discrimination, Psychological; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D020377:Self Efficacy; D057545:Social Stigma
chemical_list: D044966:Anti-Retroviral Agents
keywords: Antiretroviral therapy; HIV; Medication adherence; Stigma