HIV Stigma, Mental Health, and Alcohol Use Disorders among People Living with HIV/AIDS in New Orleans

  • Erica A. Felker-KantorEmail author
  • Maeve E. Wallace
  • Aubrey Spriggs Madkour
  • Dustin T. Duncan
  • Katherine Andrinopoulos
  • Katherine Theall


Evidence suggests that HIV-related stigma is a contributing factor to mental health and substance use problems among people living with HIV (PLWH). Limited research, however, has examined the differential effects that multiple stigma constructs, specifically, anticipated, enacted, and internalized stigma may have on mental health and alcohol use disorders among PLWH. Furthermore, no studies have examined this relationship within the larger context of urban life stressors. The purpose of this study was to examine associations of an overall HIV-related stigma measure and four HIV stigma subscales on depression, anxiety, and hazardous drinking among a sample of 380 PLWH in New Orleans. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by urban life stressors. Overall, higher levels of HIV-stigma were associated with depressive symptoms (RR 1.67, 95% CI 1.25, 2.23), anxiety symptoms (RR 1.91, 95% CI 1.17, 3.12), and hazardous drinking (RR 1.45, 95% CI 1.02, 2.05). Internalized HIV-stigma (measured using the negative self-image subscale) was associated with all three outcomes and had the highest magnitude point estimates across the four stigma subscales. Urban life stressors, measured by the Urban Life Stressors Scale (ULSS), modified the association between HIV-related stigma and mental health and alcohol use disorders (P < 0.2), highlighting the importance for examining the larger urban environmental context. Findings from this study may inform interventions to reduce HIV-related stigma operating at the individual and structural level.


HIV stigma Mental health Alcohol use Urban life stressors People living with HIV 



We thank the research subjects for their willingness to participate. We acknowledge the hard work and time devoted by study staff, and referring clinicians. They are key to the success of the study. The authors recognize the contributions of study personnel Mary Meyaski-Schluter, RN, and Virginia Garrison, RN. The study was supported by grants from the National Institutes of Health (NIH, P60AA009803). This study was approved by the Tulane University and Louisiana State University Health Sciences Center Institutional Review Boards. The data were collected in compliance with ethical standards regarding the treatment of human participants. All authors have contributed significantly to the manuscript, approved the submission of this version, and consent to having their names on the manuscript. No form of payment was given to anyone to produce the manuscript.

Funding Information

The study was supported by grants from the National Institutes of Health (NIH, P60AA009803). This study was approved by the Tulane University and Louisiana State University Health Sciences Center Institutional Review Boards.

Compliance with Ethical Standards

Protocols were approved by the Louisiana State University Health Science Center (LSUHSC) and Tulane University Institutional Review Boards and all subjects provided informed consent.


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Copyright information

© The New York Academy of Medicine 2019

Authors and Affiliations

  1. 1.Department of Global Community Health and Behavioral SciencesTulane School of Public Health and Tropical MedicineNew OrleansUSA
  2. 2.NYU Spatial Epidemiology Lab, Department of Population HealthNew York University School of MedicineNew YorkUSA

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