Abstract
Abstract
Background
Internalized HIV stigma remains a major psychosocial challenge for women living with HIV (WLHIV) and may adversely affect antiretroviral therapy (ART) adherence and health-related quality of life (HRQoL). However, fewer studies in sub-Saharan Africa have examined how internalized stigma and ART adherence jointly relate to multidimensional HRQoL among WLHIV receiving routine HIV care. This study examined the associations of internalized HIV stigma and ART adherence with HRQoL among WLHIV in Lagos, Nigeria, and explored whether the relationship between stigma and HRQoL varied by ART adherence status.
Methods
This was a baseline analytical study nested within a quasi-experimental study among WLHIV receiving care at the HIV Treatment Centre of the Nigerian Institute of Medical Research, Lagos, Nigeria. The analysis included 1,005 women with complete baseline data on internalized stigma, ART adherence, HRQoL, and selected covariates. Internalized stigma was assessed using the 10-item Internalized Stigma of HIV/AIDS Tool and categorized as low or high using the sample median. ART adherence was measured using pharmacy refill adherence and self-reported adherence, which were combined into a composite overall adherence variable. HRQoL was assessed using the WHOQOL-HIV BREF, and the primary outcome was the total domain-based quality-of-life score derived from the six WHOQOL-HIV domains. Linear regression was used to examine associations between stigma and adherence and the total domain-based QoL score, and an interaction term between internalized stigma and overall ART adherence was included to assess effect modification.
Results
The mean age of participants was 47.8 years (SD 12.5), and 56.0% had high levels of internalized stigma. Overall, 73.3% were classified as adherent using the composite ART adherence measure. HRQoL was consistently poorer among women with high internalized stigma across all WHOQOL-HIV BREF domains. Women with high internalized stigma had a substantially lower total domain-based QoL score than those with low stigma (106.5; SD 11.0 vs 117.8; SD 10.6; p
Conclusions
Internalized HIV stigma and ART non-adherence were independently associated with poorer HRQoL among WLHIV in Lagos, Nigeria. Internalized stigma emerged as the strongest correlate of poorer well-being, underscoring the need to move beyond narrowly biomedical models of HIV care. Interventions that integrate stigma reduction, adherence support, and psychosocial strengthening may be particularly valuable for improving patient-centered outcomes among WLHIV in routine HIV care settings.