The association between HIV-stigma and depressive symptoms among people living with HIV/AIDS: A systematic review of studies conducted in South Africa

BACKGROUND: People living with HIV/AIDS (PLWHA) are at increased risk of stigma and mental illness, and this appears to be a particular issue in South Africa, which is home to 19% of the world’s HIV-positive population. This paper aims to systematically review the literature investigating the relationship between HIV-stigma and depressive symptoms among PLWHA in South Africa. METHODS: A keyword search of four bibliographic databases (CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science) and two grey literature websites was conducted. The quality of eligible studies was assessed using established criteria. RESULTS: Fourteen quantitative studies were included in the review. PLWHA in South Africa experience high levels of HIV-stigma and depressive symptoms. All forms of stigma were found to be associated with depressive symptoms amongst PLWHA. Prospective findings were mixed, with one study finding that stigma did not predict depressive symptoms over 36 months, and another that depressive symptoms predicted stigma 12 months later, suggesting a potentially bidirectional relationship. Females and young adults may be particularly vulnerable to HIV-stigma and its negative psychological effects. Some support was found for the moderating role of social support in the relationship between stigma and depressive symptoms across different sub-populations. LIMITATIONS: Few studies conducted prospective analyses or tested mediation/moderation. CONCLUSIONS: Despite limitations, this study highlights the importance of understanding the mechanisms underlying HIV-stigma across different sub-populations in South Africa. This may lead to more effective and context-specific interventions to combat adverse mental health outcomes.

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Stigma/discrimination
• Population(s)
  • General HIV+ population
• Mental Health
  • Depression