The Combination of HIV and Alcohol Use Internalized Stigmas Are Associated With Greater Symptoms of Depression in a South African Sample Living With HIV

Approximately one third of people living with human immunodeficiency virus (PLWH) in South Africa present to human immunodeficiency virus (HIV) care with unhealthy alcohol use (UA); depression is highly prevalent among this population. Internalized HIV and UA stigma have been associated with greater depressive symptoms when examined in isolation. Yet, prior research has rarely examined how internalized HIV and UA stigmas together relate to depressive symptoms and related outcomes. This study examined how internalized stigma around HIV and UA together are associated with depressive symptoms, related social and work/school impairments, and cognitive and behavioral processes associated with depression (activation, rumination). Data were drawn from the baseline assessment (N = 64) of a behavioral intervention trial focused on improving UA and antiretroviral therapy (ART) adherence. Participants were categorized based on combined internalized alcohol and HIV stigma scores (low vs. high on each). Regression models examined associations between each stigma category with the following outcomes: depressive symptoms, work/school impairment, and activation/rumination Compared to participants low in both stigmas, being high in both HIV and alcohol internalized stigmas was significantly associated with greater depressive symptoms (B = .38, p = .01), lower activation (B = -4.19, p = .04), greater rumination (B = 5.72, p = .02), and greater work/school impairment (B = 3.94, p = .01). High internalized alcohol (B = -5.97, p = .009) or HIV stigma (B = -5.25, p = .02) alone was significantly associated with lower activation. This study provides preliminary understanding how multiple layers of internalized stigma together relate to psychosocial outcomes among PLWH in SA.