Abstract
OBJECTIVES: Overtly experienced HIV-related stigma is associated with depressive symptoms for people living with HIV (PLWH). Research suggests that an important mediating mechanism in this association is internalised stigma, where PLWH accept negative societal views about HIV, apply them to themselves and develop a negative view of themselves. Microaggressions are subtle and indirect discriminatory behaviours and, like overtly experienced stigma, may also contribute to depressive symptoms. We tested this hypothesis and examined the mediating roles of internalised stigma and maladaptive ways of coping with shame in the association between microaggressions and depressive symptoms among PLWH in Türkiye. METHODS: This study examines the serial mediating roles of internalised HIV stigma and shame-related coping strategies (ie, withdrawal and self-attack) in the association between HIV-related microaggressions and depressive symptoms among PLWH. PLWH in Izmir, Türkiye (N=308) completed validated scales measuring experiences of microaggressions, internalised HIV stigma, coping strategies related to shame and depression symptoms. RESULTS: Structural equation modelling results suggest that internalised HIV stigma significantly mediates the relationship between HIV-related microaggressions and depression symptoms. Furthermore, serial mediation analysis suggests that withdrawal and self-attack strategies of coping with shame mediate the association between internalised HIV stigma and depressive symptoms. Thus, internalised HIV stigma and shame-related coping strategies may partially stem from experiencing HIV-related microaggressions and may negatively affect the mental health of PLWH. CONCLUSIONS: Findings highlight the importance of assessing subtle forms of discrimination (ie, microaggressions) given their negative impact on the self-concept of PLWH. In addition to addressing negative attitudes and behaviours against PLWH in society, interventions that help PLWH cope with shame-related experiences might improve their mental health.