Examining Mechanisms Linking Stigma and Health-Related Quality of Life in People Living with HIV

HIV stigma continues to be one of the biggest barriers to good health and wellbeing for people living with HIV in Canada. While research has demonstrated the negative impact of stigma on a variety of important health outcomes, there is less understanding around exactly how this happens. This dissertation aims to shed light on this phenomenon by quantitatively modelling potential pathways through which stigma affects health-related quality of life for people living with HIV. This work uses data from the People Living with HIV Stigma Index in Ontario, a survey tool designed by and for people living with HIV that contains externally validated quantitative scales to measure stigma and health factors. Data was collected at baseline (t1) and at follow-up (t2) approximately one to two years later using the same measures. This work is built on a series of studies centered around mediation and moderation analyses that examine how stigma affects health-related quality of life and the factors that may alter this relationship. The first two studies examined how the impact of enacted stigma on health was mediated by internalized stigma and depression (Chapter 4) and anticipated stigma (Chapter 5). The next two studies examined the moderating effect of various determinants of health (Chapter 6) and social support (Chapter 7) on the relationship between stigma and health. These empirical analyses were accompanied by a description of the process of greater and meaningful engagement of people living with HIV that was implemented throughout the work (Chapter 8). This dissertation culminates in the Stigma and Health-Related Quality of Life Framework which describes the path from initial stigma marking to how individuals react through a selection of stigma mechanisms (internalized, enacted, and anticipated stigma) and the role of depression, different types of social support, and various determinants of health (age, sexual orientation, region, basic needs) in mediating or moderating the relationship between stigma and health. Outlining these pathways through which stigma acts to affect health can help in identifying targets for stigma reduction interventions that will be efficient and effective at improving the health and wellbeing of people living with HIV.

Department dc:contributor.department

Medical Science

Year dc:date.issued

2024

Author dc:creator

• Lo Hog Tian, Jason Michael

Advisor dc:contributor.advisor

• Rourke, Sean B

• Health-Related Quality of Life
• HIV/AIDS
• Mental Health
• Path Analysis
• Social Determinants of Health
• Stigma

Statement dc:rights

• Attribution 4.0 International

Licence dc:rights.uri

• http://creativecommons.org/licenses/by/4.0/

Handle dc:identifier.uri

http://hdl.handle.net/1807/140552

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/140552