The cost of anticipating stigma: a longitudinal examination of HIV stigma and health.

Levels of HIV stigma remain high, however there is a limited understanding around how different types of stigma interact to impact health. This study uses data from two time points to examine how enacted and internalized stigma lead to worse health through anticipated stigma as a mediator. We recruited 341 participants in Ontario, Canada to complete the HIV Stigma Index survey at baseline (t 1 ) from September 2018 to August 2019 and follow up (t 2 ) approximately two years later. Mediation models were created with enacted and internalized stigma at t 1 as the antecedents, anticipated stigma at t 2 as the mediator, and physical health, mental health, and overall health at t 2 as the outcomes. Only the model with internalized stigma (t 1 ) as the antecedent had anticipated stigma (t 2 ) as a significant mediator contributing to both decreased mental and overall health. This highlights the need to address internalized stigma and the potential for anticipated stigma interventions to be effective at improving the health and wellbeing of people living with HIV.