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Internalized HIV stigma decreases for newly-diagnosed people living with HIV in Rwanda during their first 6 months in care

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BACKGROUND: Stigma remains a key barrier to care engagement for people living with HIV (PLHIV), particularly early in the disease course. There are limited data characterizing trajectories of HIV stigma for newly-diagnosed PLHIV. We aimed to describe change in anticipated, enacted, and internalized HIV stigma after diagnosis among PLHIV in three health centers in Kigali, Rwanda.
METHODS: We included data from the baseline and 6 month visits of an ongoing pilot study comparing differentiated HIV care models (NCT04567693). Participants were newly-diagnosed, adult PLHIV on antiretroviral therapy (ART) who enrolled between October 2020-May 2021. The HIV Stigma Scale and HIV/AIDS Stigma Instrument were used to measure anticipated (expectation of negative actions related to HIV-status), enacted (experience of negative actions related to HIV-status), and internalized (application of negative HIV-related feelings and beliefs to self) stigmas. We used paired t-tests to assess significance of change in stigma scores from baseline to 6 months and Chi-squared tests to examine associations between demographic and clinical factors and decrease in internalized stigma (vs. no decrease).
RESULTS: Among 90 participants, 60% were female, mean age was 31, and 93% initiated ART within 7 days of enrollment in care. Among 85 participants with baseline and 6 month data, there was no significant change in mean anticipated stigma score (Baseline 2.40, 6 Month 2.49, p = 0.33), a small decrease in mean enacted stigma score (Baseline 1.05, 6 Month 1.02, p=0.04), and a substantial decrease in internalized stigma score (Baseline 1.93, 6 Month 1.35, p <0.001). A higher proportion of participants who were formally employed had a decrease in internalized stigma, compared to those who were self or unemployed (71% vs. 42%, p=0.01); no other factors were associated with a decrease in internalized stigma.
CONCLUSIONS: In this cohort of newly-diagnosed PLHIV, we observed a significant decrease in internalized stigma over the first 6 months in care. These findings suggest early engagement in HIV care and use of ART may contribute to a reduction in internalized stigma. Subsequent studies should further explore the relationship between formal employment and internalized stigma as well as other mechanisms of change in internalized stigma over time.

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