Gender, HIV-Related Stigma, and Health-Related Quality of Life Among Adults Enrolling in HIV Care in Tanzania

  • Angela M. ParcesepeEmail author
  • Denis Nash
  • Olga Tymejczyk
  • William Reidy
  • Sarah Gorrell Kulkarni
  • Batya Elul
Original Paper


HIV-related stigma has been associated with worse health-related quality of life (HRQoL) among people living with HIV (PLWH). Little is known about how different types of HIV-related stigma (i.e., anticipatory, internalized, or enacted HIV-related stigma) influence HRQoL and whether these relationships differ by gender. The sample included 912 PLWH aged 18 years or older enrolling in HIV care at four health facilities in Tanzania. HRQoL was assessed with the life satisfaction and overall function subscales of the HIV/AIDS-Targeted Quality of Life (HAT-QoL) instrument. Sex-stratified multivariable logistic regression modeled the association of anticipatory, internalized, and enacted HIV-related stigma on poor HRQoL. Across all participants, the mean life satisfaction score was 63.4 (IQR: 43.8, 81.3) and the mean overall function score was 72.0 (IQR: 58.3, 91.7). Mean HRQoL scores were significantly higher for women compared to men for overall function (5.1 points higher) and life satisfaction (4.3 points higher). Fourteen percent of respondents reported recent enacted HIV-related stigma and 13% reported recent medium or high levels of internalized stigma. In multivariable models, high internalized and high anticipatory stigma were significantly associated with higher odds of poor life satisfaction and poor overall function in both men and women. Psychosocial interventions to prevent or reduce the impact of internalized and anticipatory stigma may improve HRQoL among persons in HIV care. Future research should longitudinally examine mechanisms between HIV-related stigma, poor HRQoL, and HIV care outcomes.


HIV Stigma Quality of life Tanzania 



This project was supported by a research grant from the National Institute of Mental Health (Supplement to Grant Number R01MH089831). The clinics included in this analysis received support from ICAP at Columbia University through funding from the President’s Emergency Plan for AIDS Relief. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Angela M. Parcesepe
    • 1
    • 2
    Email author
  • Denis Nash
    • 2
    • 3
  • Olga Tymejczyk
    • 2
    • 3
  • William Reidy
    • 4
  • Sarah Gorrell Kulkarni
    • 2
  • Batya Elul
    • 4
  1. 1.Department of Maternal and Child Health, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Institute for Implementation Science in Population HealthCity University of New YorkNew YorkUSA
  3. 3.Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkUSA
  4. 4.Department of EpidemiologyColumbia UniversityNew YorkUSA

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