Bulent Turan - Academia.edu (original) (raw)
Papers by Bulent Turan
Neuro endocrinology letters, 2015
OBJECTIVES Subordinate status and submissiveness are stressful and are often associated with ill-... more OBJECTIVES Subordinate status and submissiveness are stressful and are often associated with ill-health. However, when there is a physical or social threat posed by more powerful others, showing submissiveness may be a good strategy to avoid or terminate conflict. One way to show submissiveness is to assume a subordinate body posture, which may also help regulate one's own stress responses by making one feel safer, and by diverting attention away from one's negative emotions and positive expectations. METHODS 85 male participants were randomly assigned to assume either a dominant posture (expansive, taking up more space with open limbs) or a subordinate posture (constrictive, taking up less space with closed limbs) while delivering a speech and performing difficult arithmetic tasks in front of two critical evaluators. Cortisol levels were assessed from saliva samples obtained before and after these stressful tasks. RESULTS Dominant posture resulted in a larger cortisol respo...
AIDS Patient Care and STDs
PeerJ
Purpose In variety of settings cortisol and testosterone are positively “coupled.” That is, withi... more Purpose In variety of settings cortisol and testosterone are positively “coupled.” That is, within-person fluctuations of cortisol and testosterone levels occur in parallel—increases and decreases in one hormone are associated with corresponding increases and decreases in the other. The present report explored hormone coupling in women athletes in two studies selected because they included measurements of salivary levels of cortisol, testosterone, and estradiol—a hormone that has been only infrequently studied in the context of competitive athletics. Methods Consenting members of Emory University’s varsity volleyball and soccer teams gave saliva samples on multiple occasions in the run-up to and over the course of two different intercollegiate contests. Results Volleyball and soccer players showed remarkably similar hormone-specific patterns of increase in relationship to the different stages of competition—before warm-up, after warm-up, and after competition. For both the volleybal...
JAIDS Journal of Acquired Immune Deficiency Syndromes
Journal of the Association of Nurses in AIDS Care
AIDS Patient Care and STDs
AIDS Patient Care and STDs
JAIDS Journal of Acquired Immune Deficiency Syndromes
Journal of acquired immune deficiency syndromes (1999), 2018
People living with HIV (PLWH) have higher levels of tobacco use compared with the general populat... more People living with HIV (PLWH) have higher levels of tobacco use compared with the general population, increasing their risk of morbidity and mortality. PLWH also face potential chronic stressors related to the stigma and discrimination associated with HIV and other characteristics (eg, race and sexual orientation). These experiences may be associated with harmful health behaviors, such as tobacco use. The purpose of the current study is to explore the psychosocial context of tobacco use in PLWH, examining avoidance coping as a mediator in the relationship between multiple forms of discrimination and tobacco use. Participants included 202 PLWH recruited from an HIV primary care clinic in Birmingham, AL, between 2013 and 2015. Participants responded to parallel items assessing experiences of discrimination related to HIV status, race, and sexual orientation, as well as items assessing avoidance coping. Data on current tobacco use were obtained from participants' clinic records. Me...
American journal of preventive medicine, 2018
This study assessed longitudinal relationships between patient healthcare empowerment, engagement... more This study assessed longitudinal relationships between patient healthcare empowerment, engagement in care, and viral control in the Women's Interagency HIV Study, a prospective cohort study of U.S. women living with HIV. From April 2014 to March 2016, four consecutive 6-month visits were analyzed among 973 women to assess the impact of Time 1 healthcare empowerment variables (Tolerance for Uncertainty and the state of Informed Collaboration Committed Engagement) on Time 2 reports of ≥95% HIV medication adherence and not missing an HIV primary care appointment since last visit; and on HIV RNA viral control across Times 3 and 4, controlling for illicit drug use, heavy drinking, depression symptoms, age, and income. Data were analyzed in 2017. Adherence of ≥95% was reported by 83% of women, 90% reported not missing an appointment since the last study visit, and 80% were categorized as having viral control. Logistic regression analyses revealed a significant association between the ...
JAIDS Journal of Acquired Immune Deficiency Syndromes
Treatment adherence and viral suppression remain sub-optimal in the US. Attachment insecurity may... more Treatment adherence and viral suppression remain sub-optimal in the US. Attachment insecurity may be one understudied factor affecting adherence. According to attachment theory, people develop generalized internal working models of interpersonal relationships, which shape their perceptions of the availability of others at times of stress and how they handle stressors as an individual. Two dimensions of attachment insecurity are attachment-related avoidance (avoidance of intimacy with others and avoidance of negative emotions) and attachment-related anxiety (feeling unable to deal with stressors without others' help). For people living with chronic stressful health conditions that require life-long self-management, attachment-related avoidance and attachment-related anxiety may diminish the ability to cope with stressors as an individual leading to negative health outcomes. We examined cross-sectional associations of the two attachment-related insecurity dimensions with ART adherence, HIV visit adherence, CD4 cell counts, and viral suppression. Survey and clinical data from 453 women living with HIV in four US cities were analyzed controlling for age, education, income, time on ART, illicit drug use, and race. Attachment-related avoidance was the only unique predictor of sub-optimal ART adherence, viral failure, and low CD4 count, and attachment-related anxiety was the only unique predictor of missed HIV care visits. These effects were over and above the effects of all covariates. ART adherence mediated the association of attachment-related avoidance with both viral failure and low CD4 counts. Interventions may need to focus on the vulnerable sub-population with high attachment insecurity and incorporate existing strategies that address insecure attachment models.
PAIN
Research suggests that people living with HIV experience levels of pain disproportionate to the g... more Research suggests that people living with HIV experience levels of pain disproportionate to the general population. Pain is a stressor that can negatively impact health-related quality of life. As the number of people aging with HIV increases, we must understand the dynamics of pain experiences among people living with HIV and how to effectively harness evidence-based treatments and supportive resources to enhance adaptive coping. We used an experience sampling method (also called Ecological Momentary Assessment) to assess moment-to-moment experiences of pain and social support 3 times a day for 7 days in a sample of 109 men living with HIV. Participants also responded to questionnaires assessing attachment-related insecurity and social support. In hierarchical linear modeling analyses controlling for age, race, sexual orientation, and socioeconomic status, we found that experiences of social support were associated with lower subsequent pain within-persons. On the other hand, experiences of pain were not associated with later experiences of social support. Men with higher levels of attachment-related avoidance reported more pain on average. Attachment-related avoidance also moderated the association between moment-to-moment experiences of felt social support on pain. Results suggest that within-persons, experiences of daily social support reduce experiences of pain. Between-persons, attachment style may influence how individuals make use of social support in coping with experiences of pain. These findings imply a need to assess social well-being at the clinic level and also support tailored biopsychosocial approaches to pain management in HIV care settings.
The Journal of infectious diseases, Jan 27, 2018
Chronic inflammation is associated with AIDS-defining and non-AIDS-defining conditions. Limited r... more Chronic inflammation is associated with AIDS-defining and non-AIDS-defining conditions. Limited research has considered how food insecurity influences chronic inflammation among people living with HIV. We examined whether food insecurity was associated with higher levels of inflammation among women living with HIV (WWH) in the United States. We analyzed cross-sectional data collected in 2015 from 421 participants on antiretroviral therapy from the Women's Interagency HIV Study. The exposure was any food insecurity. The outcome was inflammation, measured by both pro-inflammatory cytokine IL-6 and by tumor necroses factor 1 (TNFR1) levels. We conducted multivariable linear regressions, adjusting for sociodemographic, clinical, and nutritional factors. Nearly one-third of participants (31%) were food insecure and 79% were virally suppressed (<20 copies/ml). In adjusted analyses, food insecurity was associated with 1.23 times the level of IL-6 (95% CI: 1.06, 1.44) and 1.13 times ...
Social science & medicine (1982), Jul 1, 2018
Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) ... more Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) are barriers to HIV prevention, treatment, and wellbeing among women living with HIV. Other coexisting forms of stigma (e.g., racism, sexism) may worsen the effects of HIV-related stigma, and may contribute to persistent racial and gendered disparities in HIV prevention and treatment. Few studies examine perceptions of intersectional stigma among women living with HIV. From June to December 2015, we conducted 76 qualitative interviews with diverse women living with HIV from varied socioeconomic backgrounds enrolled in the Women's Interagency HIV Study (WIHS) in Birmingham, Alabama; Jackson, Mississippi; Atlanta, Georgia; and San Francisco, California. Interview guides facilitated discussions around stigma and discrimination involving multiple interrelated identities. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis. Interviewees shared perceptio...
Women & health, Jan 14, 2017
The role of unintended pregnancy norms and stigma in contraceptive use among young women is under... more The role of unintended pregnancy norms and stigma in contraceptive use among young women is understudied. This study investigated relationships between anticipated reactions from others, perceived stigma, and endorsed stigma concerning unintended pregnancy, with any and dual contraceptive use in this population. From November 2014 to October 2015, young women aged 18-24 years (n = 390) and at risk for unintended pregnancy and sexually transmitted infections participated in a survey at a university and public health clinics in Alabama. Multivariable regression models examined associations of unintended pregnancy norms and stigma with contraceptive use, adjusted for demographic and psychosocial characteristics. Compared to nonusers, more any and dual method users, were White, nulliparous, and from the university and had higher income. In adjusted models, anticipated disapproval of unintended pregnancy by close others was associated with greater contraceptive use (adjusted Odds Ratio [...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 14, 2017
We hypothesized exercise training-induced improvements in ease of walking would associate with fa... more We hypothesized exercise training-induced improvements in ease of walking would associate with favorable changes in objectively measured physical activity (PA) and self-reported depressive symptoms following a PA behavior-change intervention in non-metastatic breast cancer survivors (BCS). Twenty-seven BCS received random assignment to an intervention (INT) or control group (CON). INT included counseling/group discussions coupled with supervised exercise tapered to unsupervised exercise. PA, depressive symptoms, and ease of walking were evaluated pre-/post-intervention using 10-day accelerometry, HADS depression subscale, and indirect calorimetry during a standardized treadmill test, respectively. PA composite score was calculated by converting weekly minutes of moderate-to-vigorous PA and average steps/day to z-scores then dividing the sum by 2. Cardiac efficiency was determined by dividing steady-state oxygen uptake by heart rate to evaluate the volume of oxygen consumed per heart...
JAIDS Journal of Acquired Immune Deficiency Syndromes
Internalized HIV-related stigma acts as a barrier to antiretroviral therapy (ART) adherence, but ... more Internalized HIV-related stigma acts as a barrier to antiretroviral therapy (ART) adherence, but its effects on other HIV care continuum outcomes is unclear. Among 196 HIV clinic patients in Birmingham, Alabama, we assessed internalized HIV-related stigma and depressive symptom severity using validated multi-item scales, and assessed ART adherence using a validated single-item measure. HIV visit adherence (attended out of total scheduled visits) was calculated using data from clinic records. Using covariateadjusted regression analysis, we investigated the association between internalized stigma and visit adherence. Using path analytic methods with bootstrapping, we tested the mediating role of depressive symptoms in the association between internalized stigma and visit adherence, and the mediating role of visit adherence in the association between internalized stigma and ART adherence. Higher internalized stigma was associated with lower visit adherence (B=-0.04, p=0.04). Black (versus white) race and depressive symptoms were significant predictors within this model. Mediation analysis yielded no effect by depression in the association between internalized stigma and visit adherence (B = -0.18, SE = .11, 95% CI [-0.44, -0.02]) in the whole sample. Supplemental mediated moderation analyses revealed gender-specific effects. Additionally, the indirect effect of internalized stigma on sub-optimal ART adherence was mediated by lower visit adherence (B = -0.18, SE = .11, 95% CI [-0.44, -0.02]). Results highlight the importance of internalized HIV stigma to multiple and sequential HIV care continuum outcomes. Also, findings suggest multiple intervention targets, including addressing internalized stigma directly, reducing depressive symptoms, and promoting consistent engagement in care.
American Journal of Public Health
We present a conceptual framework that highlights how unique dimensions of individual-level HIV-r... more We present a conceptual framework that highlights how unique dimensions of individual-level HIV-related stigma (perceived community stigma, experienced stigma, internalized stigma, and anticipated stigma) might differently affect the health of those living with HIV. HIV-related stigma is recognized as a barrier to both HIV prevention and engagement in HIV care, but little is known about the mechanisms through which stigma leads to worse health behaviors or outcomes. Our conceptual framework posits that, in the context of intersectional and structural stigmas, individual-level dimensions of HIV-related stigma operate through interpersonal factors, mental health, psychological resources, and biological stress pathways. A conceptual framework that encompasses recent advances in stigma science can inform future research and interventions aiming to address stigma as a driver of HIV-related health.
Neuro endocrinology letters, 2015
OBJECTIVES Subordinate status and submissiveness are stressful and are often associated with ill-... more OBJECTIVES Subordinate status and submissiveness are stressful and are often associated with ill-health. However, when there is a physical or social threat posed by more powerful others, showing submissiveness may be a good strategy to avoid or terminate conflict. One way to show submissiveness is to assume a subordinate body posture, which may also help regulate one's own stress responses by making one feel safer, and by diverting attention away from one's negative emotions and positive expectations. METHODS 85 male participants were randomly assigned to assume either a dominant posture (expansive, taking up more space with open limbs) or a subordinate posture (constrictive, taking up less space with closed limbs) while delivering a speech and performing difficult arithmetic tasks in front of two critical evaluators. Cortisol levels were assessed from saliva samples obtained before and after these stressful tasks. RESULTS Dominant posture resulted in a larger cortisol respo...
AIDS Patient Care and STDs
PeerJ
Purpose In variety of settings cortisol and testosterone are positively “coupled.” That is, withi... more Purpose In variety of settings cortisol and testosterone are positively “coupled.” That is, within-person fluctuations of cortisol and testosterone levels occur in parallel—increases and decreases in one hormone are associated with corresponding increases and decreases in the other. The present report explored hormone coupling in women athletes in two studies selected because they included measurements of salivary levels of cortisol, testosterone, and estradiol—a hormone that has been only infrequently studied in the context of competitive athletics. Methods Consenting members of Emory University’s varsity volleyball and soccer teams gave saliva samples on multiple occasions in the run-up to and over the course of two different intercollegiate contests. Results Volleyball and soccer players showed remarkably similar hormone-specific patterns of increase in relationship to the different stages of competition—before warm-up, after warm-up, and after competition. For both the volleybal...
JAIDS Journal of Acquired Immune Deficiency Syndromes
Journal of the Association of Nurses in AIDS Care
AIDS Patient Care and STDs
AIDS Patient Care and STDs
JAIDS Journal of Acquired Immune Deficiency Syndromes
Journal of acquired immune deficiency syndromes (1999), 2018
People living with HIV (PLWH) have higher levels of tobacco use compared with the general populat... more People living with HIV (PLWH) have higher levels of tobacco use compared with the general population, increasing their risk of morbidity and mortality. PLWH also face potential chronic stressors related to the stigma and discrimination associated with HIV and other characteristics (eg, race and sexual orientation). These experiences may be associated with harmful health behaviors, such as tobacco use. The purpose of the current study is to explore the psychosocial context of tobacco use in PLWH, examining avoidance coping as a mediator in the relationship between multiple forms of discrimination and tobacco use. Participants included 202 PLWH recruited from an HIV primary care clinic in Birmingham, AL, between 2013 and 2015. Participants responded to parallel items assessing experiences of discrimination related to HIV status, race, and sexual orientation, as well as items assessing avoidance coping. Data on current tobacco use were obtained from participants' clinic records. Me...
American journal of preventive medicine, 2018
This study assessed longitudinal relationships between patient healthcare empowerment, engagement... more This study assessed longitudinal relationships between patient healthcare empowerment, engagement in care, and viral control in the Women's Interagency HIV Study, a prospective cohort study of U.S. women living with HIV. From April 2014 to March 2016, four consecutive 6-month visits were analyzed among 973 women to assess the impact of Time 1 healthcare empowerment variables (Tolerance for Uncertainty and the state of Informed Collaboration Committed Engagement) on Time 2 reports of ≥95% HIV medication adherence and not missing an HIV primary care appointment since last visit; and on HIV RNA viral control across Times 3 and 4, controlling for illicit drug use, heavy drinking, depression symptoms, age, and income. Data were analyzed in 2017. Adherence of ≥95% was reported by 83% of women, 90% reported not missing an appointment since the last study visit, and 80% were categorized as having viral control. Logistic regression analyses revealed a significant association between the ...
JAIDS Journal of Acquired Immune Deficiency Syndromes
Treatment adherence and viral suppression remain sub-optimal in the US. Attachment insecurity may... more Treatment adherence and viral suppression remain sub-optimal in the US. Attachment insecurity may be one understudied factor affecting adherence. According to attachment theory, people develop generalized internal working models of interpersonal relationships, which shape their perceptions of the availability of others at times of stress and how they handle stressors as an individual. Two dimensions of attachment insecurity are attachment-related avoidance (avoidance of intimacy with others and avoidance of negative emotions) and attachment-related anxiety (feeling unable to deal with stressors without others' help). For people living with chronic stressful health conditions that require life-long self-management, attachment-related avoidance and attachment-related anxiety may diminish the ability to cope with stressors as an individual leading to negative health outcomes. We examined cross-sectional associations of the two attachment-related insecurity dimensions with ART adherence, HIV visit adherence, CD4 cell counts, and viral suppression. Survey and clinical data from 453 women living with HIV in four US cities were analyzed controlling for age, education, income, time on ART, illicit drug use, and race. Attachment-related avoidance was the only unique predictor of sub-optimal ART adherence, viral failure, and low CD4 count, and attachment-related anxiety was the only unique predictor of missed HIV care visits. These effects were over and above the effects of all covariates. ART adherence mediated the association of attachment-related avoidance with both viral failure and low CD4 counts. Interventions may need to focus on the vulnerable sub-population with high attachment insecurity and incorporate existing strategies that address insecure attachment models.
PAIN
Research suggests that people living with HIV experience levels of pain disproportionate to the g... more Research suggests that people living with HIV experience levels of pain disproportionate to the general population. Pain is a stressor that can negatively impact health-related quality of life. As the number of people aging with HIV increases, we must understand the dynamics of pain experiences among people living with HIV and how to effectively harness evidence-based treatments and supportive resources to enhance adaptive coping. We used an experience sampling method (also called Ecological Momentary Assessment) to assess moment-to-moment experiences of pain and social support 3 times a day for 7 days in a sample of 109 men living with HIV. Participants also responded to questionnaires assessing attachment-related insecurity and social support. In hierarchical linear modeling analyses controlling for age, race, sexual orientation, and socioeconomic status, we found that experiences of social support were associated with lower subsequent pain within-persons. On the other hand, experiences of pain were not associated with later experiences of social support. Men with higher levels of attachment-related avoidance reported more pain on average. Attachment-related avoidance also moderated the association between moment-to-moment experiences of felt social support on pain. Results suggest that within-persons, experiences of daily social support reduce experiences of pain. Between-persons, attachment style may influence how individuals make use of social support in coping with experiences of pain. These findings imply a need to assess social well-being at the clinic level and also support tailored biopsychosocial approaches to pain management in HIV care settings.
The Journal of infectious diseases, Jan 27, 2018
Chronic inflammation is associated with AIDS-defining and non-AIDS-defining conditions. Limited r... more Chronic inflammation is associated with AIDS-defining and non-AIDS-defining conditions. Limited research has considered how food insecurity influences chronic inflammation among people living with HIV. We examined whether food insecurity was associated with higher levels of inflammation among women living with HIV (WWH) in the United States. We analyzed cross-sectional data collected in 2015 from 421 participants on antiretroviral therapy from the Women's Interagency HIV Study. The exposure was any food insecurity. The outcome was inflammation, measured by both pro-inflammatory cytokine IL-6 and by tumor necroses factor 1 (TNFR1) levels. We conducted multivariable linear regressions, adjusting for sociodemographic, clinical, and nutritional factors. Nearly one-third of participants (31%) were food insecure and 79% were virally suppressed (<20 copies/ml). In adjusted analyses, food insecurity was associated with 1.23 times the level of IL-6 (95% CI: 1.06, 1.44) and 1.13 times ...
Social science & medicine (1982), Jul 1, 2018
Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) ... more Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) are barriers to HIV prevention, treatment, and wellbeing among women living with HIV. Other coexisting forms of stigma (e.g., racism, sexism) may worsen the effects of HIV-related stigma, and may contribute to persistent racial and gendered disparities in HIV prevention and treatment. Few studies examine perceptions of intersectional stigma among women living with HIV. From June to December 2015, we conducted 76 qualitative interviews with diverse women living with HIV from varied socioeconomic backgrounds enrolled in the Women's Interagency HIV Study (WIHS) in Birmingham, Alabama; Jackson, Mississippi; Atlanta, Georgia; and San Francisco, California. Interview guides facilitated discussions around stigma and discrimination involving multiple interrelated identities. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis. Interviewees shared perceptio...
Women & health, Jan 14, 2017
The role of unintended pregnancy norms and stigma in contraceptive use among young women is under... more The role of unintended pregnancy norms and stigma in contraceptive use among young women is understudied. This study investigated relationships between anticipated reactions from others, perceived stigma, and endorsed stigma concerning unintended pregnancy, with any and dual contraceptive use in this population. From November 2014 to October 2015, young women aged 18-24 years (n = 390) and at risk for unintended pregnancy and sexually transmitted infections participated in a survey at a university and public health clinics in Alabama. Multivariable regression models examined associations of unintended pregnancy norms and stigma with contraceptive use, adjusted for demographic and psychosocial characteristics. Compared to nonusers, more any and dual method users, were White, nulliparous, and from the university and had higher income. In adjusted models, anticipated disapproval of unintended pregnancy by close others was associated with greater contraceptive use (adjusted Odds Ratio [...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 14, 2017
We hypothesized exercise training-induced improvements in ease of walking would associate with fa... more We hypothesized exercise training-induced improvements in ease of walking would associate with favorable changes in objectively measured physical activity (PA) and self-reported depressive symptoms following a PA behavior-change intervention in non-metastatic breast cancer survivors (BCS). Twenty-seven BCS received random assignment to an intervention (INT) or control group (CON). INT included counseling/group discussions coupled with supervised exercise tapered to unsupervised exercise. PA, depressive symptoms, and ease of walking were evaluated pre-/post-intervention using 10-day accelerometry, HADS depression subscale, and indirect calorimetry during a standardized treadmill test, respectively. PA composite score was calculated by converting weekly minutes of moderate-to-vigorous PA and average steps/day to z-scores then dividing the sum by 2. Cardiac efficiency was determined by dividing steady-state oxygen uptake by heart rate to evaluate the volume of oxygen consumed per heart...
JAIDS Journal of Acquired Immune Deficiency Syndromes
Internalized HIV-related stigma acts as a barrier to antiretroviral therapy (ART) adherence, but ... more Internalized HIV-related stigma acts as a barrier to antiretroviral therapy (ART) adherence, but its effects on other HIV care continuum outcomes is unclear. Among 196 HIV clinic patients in Birmingham, Alabama, we assessed internalized HIV-related stigma and depressive symptom severity using validated multi-item scales, and assessed ART adherence using a validated single-item measure. HIV visit adherence (attended out of total scheduled visits) was calculated using data from clinic records. Using covariateadjusted regression analysis, we investigated the association between internalized stigma and visit adherence. Using path analytic methods with bootstrapping, we tested the mediating role of depressive symptoms in the association between internalized stigma and visit adherence, and the mediating role of visit adherence in the association between internalized stigma and ART adherence. Higher internalized stigma was associated with lower visit adherence (B=-0.04, p=0.04). Black (versus white) race and depressive symptoms were significant predictors within this model. Mediation analysis yielded no effect by depression in the association between internalized stigma and visit adherence (B = -0.18, SE = .11, 95% CI [-0.44, -0.02]) in the whole sample. Supplemental mediated moderation analyses revealed gender-specific effects. Additionally, the indirect effect of internalized stigma on sub-optimal ART adherence was mediated by lower visit adherence (B = -0.18, SE = .11, 95% CI [-0.44, -0.02]). Results highlight the importance of internalized HIV stigma to multiple and sequential HIV care continuum outcomes. Also, findings suggest multiple intervention targets, including addressing internalized stigma directly, reducing depressive symptoms, and promoting consistent engagement in care.
American Journal of Public Health
We present a conceptual framework that highlights how unique dimensions of individual-level HIV-r... more We present a conceptual framework that highlights how unique dimensions of individual-level HIV-related stigma (perceived community stigma, experienced stigma, internalized stigma, and anticipated stigma) might differently affect the health of those living with HIV. HIV-related stigma is recognized as a barrier to both HIV prevention and engagement in HIV care, but little is known about the mechanisms through which stigma leads to worse health behaviors or outcomes. Our conceptual framework posits that, in the context of intersectional and structural stigmas, individual-level dimensions of HIV-related stigma operate through interpersonal factors, mental health, psychological resources, and biological stress pathways. A conceptual framework that encompasses recent advances in stigma science can inform future research and interventions aiming to address stigma as a driver of HIV-related health.