Original Research

A preliminary analysis of the association between perceived stigma and HIV-related pain in South Africans living with HIV

Antonia L. Wadley, Tamar Pincus, Michael Evangeli
African Journal of Primary Health Care & Family Medicine | Vol 11, No 1 | a1647 | DOI: https://doi.org/10.4102/phcfm.v11i1.1647 | © 2019 Antonia L. Wadley, Tamar Pincus, Michael Evangeli | This work is licensed under CC Attribution 4.0
Submitted: 09 October 2017 | Published: 13 February 2019

About the author(s)

Antonia L. Wadley, Brain Function Research Group, School of Physiology, University of the Witwatersrand, South Africa
Tamar Pincus, Department of Psychology, Royal Holloway University of London, United Kingdom
Michael Evangeli, Department of Psychology, Royal Holloway University of London, United Kingdom


Background: Stigma related to the human immunodeficiency virus (HIV) remains common and has been associated with severity of HIV-related symptoms. Associations between HIV stigma and HIV-related pain, one of the most common symptoms in HIV, have however not been investigated. Data from low back pain populations suggest that stigma is associated with worse pain intensity and so we hypothesised that the same would be the case in HIV.

Aim: The goal of this study was to assess the association between HIV stigma and pain intensity in people living with HIV (PLWH) with chronic pain whilst controlling for depression, a well-established correlate of pain.

Setting: The study took place at an HIV clinic in Johannesburg, South Africa.

Methods: Mediation analysis was used to assess the effect of depression on the relationship between stigma and pain intensity in a cross-sectional cohort of 50 PLWH and chronic pain (pain most days of the week for > 3 months). All participants were assessed using the HIV/AIDS Stigma Instrument – PLWA, an 11-point numerical pain rating scale and the Beck Depression Inventory II.

Results: In all, 88% (44/50) of participants reported experiencing some form of HIV stigma (HIV stigma scale score ≥ 1). Worst pain intensity and depressive symptoms individually correlated with total stigma score (Spearman’s r = 0.33, p = 0.02 for both). The mediation analysis highlighted that mediation of the relationship by depression was equivocal (b = -0.002, bootstrapped confidence interval -0.02 to 0.00).

Conclusion: Whilst these preliminary data are marginal, they do suggest that associations between HIV stigma and HIV-related pain warrant further investigation. Future study should also include potential mechanisms, which may include mediation through depression.


HIV; pain; stigma; depression, South Africa


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Crossref Citations

1. Slow and Steady But Not Related to HIV Stigma: Physical Activity in South Africans Living with HIV and Chronic Pain
Antonia Wadley, Peter Kamerman, Tamar Pincus, Michael Evangeli, Tapiwa Chinaka, W. D. Francois Venter, Godspower Akpomiemie, Michelle Moorhouse, Romy Parker
AIDS and Behavior  vol: 27  issue: 6  first page: 1950  year: 2023  
doi: 10.1007/s10461-022-03928-7