Impact of HIV-related stigma on medication adherence among persons living with HIV

• Recent research suggests that HIV-related stigma has the potential to interfere with medication adherence.
• Anticipated and internalized stigmas may exert a more proximal influence on medication adherence than enacted stigma.
• Depressive symptoms and concerns about inadvertent disclosure of HIV status may mediate the stigma and adherence relationship.
• Multidimensional assessment of both stigma and adherence constructs is needed to further future research.

This paper reviews recent studies on HIV-related stigma and medication adherence, including: (1) summary of the empirical evidence linking stigma to adherence, (2) discussion of proposed causal mechanisms of the stigma and adherence relationship, (3) examination of studies that have empirically tested causal mechanisms, and (4) methodological critique and directions for future research. Although there is substantial empirical evidence linking stigma to adherence difficulties, few studies provide data on psychosocial mechanisms that may account for this relationship. Two proposed causal mechanisms include (a) concerns about inadvertent disclosure of HIV status and (b) depressive symptoms. Future research should assess the multiple domains of stigma, address the multidimensionality of adherence, and include prospective analyses to test mediating variables.