Date of Award

January 2023

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Frederick L. Altice

Second Advisor

Jorge Sanchez

Abstract

HIV stigma is a social determinant of health that can influence adherence to antiretroviraltherapy (ART) and engagement in HIV care that impacts viral suppression levels for people with HIV (PWH). In Peru, a country which lags behind 95-95-95 targets for HIV outcomes, LGBTQ-affirming clinics have the potential to mitigate these negative health effects of stigma and discrimination among men who have sex with men (MSM) and transgender women (TGW), two populations that continue to be disproportionately affected by HIV. Using a validated HIV stigma scale and multivariate logistic regression models, this study assessed the magnitude and types of stigma present among MSM and TGW living with HIV in Lima and their association with self-reported measures of ART adherence and retention in HIV care. At two clinics specializing in care for LGBTQ+ communities, 400 MSM and TGW completed electronic surveys collecting data on factors related to HIV care. Following model optimization and multivariate adjustment, there was no statistically significant association between total stigma scores and optimal self-reported ART adherence (≥90%) during the last month (aOR=0.99, 95% CI 0.92-1.06, p=0.739) or retention in HIV care (aOR=0.99, 95% CI 0.931-1.05, p=0.634) over the last six months. The lack of association between stigma and HIV treatment outcomes may occur due to the LGBTQ+ affirming environments of these clinics, which provide specialized care and emotional support that potentially allowed participants to overcome the effects of stigma on related HIV care outcomes. Future studies should focus on modifiable patient-level and clinician-level factors like economic barriers and physician mistrust, which respectively undermined retention in HIV care and ART adherence in this sample.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/22/2026

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