Although evidence indicates that HIV-related stigma appears to be a barrier to engagement in care, large-scale, nationally representative studies prospectively evaluating the effect of stigma on retention in HIV care in the United States are lacking. To assess stigma, researchers added a validated, four-item assessment of internalized HIV stigma (1 = strongly disagree to 5 = strongly agree) to patient surveys administered every 4-6 months at primary care visits for patients seen at seven academic HIV clinics across the US. Among more than 5,800 patients who completed the stigma assessment, the median age was 49, 80% were male, 39% were black, 15% were Hispanic, and 32% identified as heterosexual. The study team controlled for age, gender, race/ethnicity, sexual orientation, time since enrollment in the study cohort, and site of care. The mean stigma level was 1.9, with each unit increase in mean stigma associated with decreased odds of keeping the next primary care appointment (adjusted odds ratio [aOR], 0.93) and decreased odds of keeping all primary care appointments (median of 3) in the subsequent year (aOR, 0.91). The study authors write, “This is the first study to demonstrate prospectively the effect of stigma on retention in care, thereby providing support for the need to address HIV stigma in efforts to optimize retention in HIV care and virologic control.”
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