Stigma, depression, and poor expectations regarding aging among older adults with HIV in Brazil.

Abstract

INTRODUCTION: HIV stigma negatively impacts multiple outcomes for persons living with HIV (PLHIV). Among older PLHIV, stigma may influence mental health and aging expectation. We aimed to evaluate factors related to HIV stigma and whether depression mediates its association with expectations regarding aging (ERA-12). DESIGN: Cross-sectional study of PLHIV ≥ 50 years, on antiretroviral therapy with suppressed viral load, enrolled in the Longitudinal Study of HIV & Aging in Brazil (ELEA-Brasil). METHODS: We assessed factors related to HIV stigma (12-item Berger, range:12–48, higher = higher stigma) and associated with ERA-12 (range: 0–100, lower = more negative aging expectation). Mediation analysis was performed to evaluate depression (Patient Health Questionnaire-9 [PHQ-9]; range:0–27, higher = higher symptoms) as a mediator of the association between stigma and ERA-12. Univariable and multivariable Poisson and linear regression models were applied, adjusted for demographics, time since HIV diagnosis, and substance use. RESULTS: We enrolled 702 PLHIV (median age 62 years; 64.9% men). Median and interquartile range (IQR) of HIV stigma, ERA-12 and PHQ-9 were 30 (25–35); 36 (22–47) and 3 (1–7) respectively. In adjusted analyses, older age (≥ 70 vs. 50–55 years) and shorter time since HIV diagnosis (10–19 years vs. ≥ 20 years) were significantly associated with lower HIV stigma. In adjusted models, higher HIV stigma (Coefficient = − 12.05 [95%CI − 17.84, − 6.26]) and lower education (Coefficient = − 7.60 [95%CI: − 13.40, − 1.81]) were associated with worse ERA-12. Depressive symptoms may reflect 25% of the overall effect of stigma on ERA-12. CONCLUSION: We observed a high prevalence of HIV stigma, with depressive symptoms consistent with a potential mediating role in aging expectations.