A moderated serial mediation analysis of the association between HIV stigma and sleep quality in people living with HIV: a cross-sectional study

Lay Summary People living with HIV (PLWH) may experience various kinds of prejudice and discrimination from others, anticipate experiencing social discrimination in the future, and hold negative beliefs about themselves, which may have a far-reaching negative impact on their mental health and physical health. Most of the studies have focused on the relationship between HIV-related stigma and mental health. In this study, we focused on the relationship between HIV-related stigma and sleep quality, one common symptom among people living with HIV, and found that HIV-related stigma may be associated with worse sleep quality via more depressive symptoms and loneliness feelings. Moreover, we found that social support, as one kind of resilience resource or "psychological lubricant", may buffer the detrimental influence of HIV-related stigma, especially for experiences of discrimination from others and negative self-image. Our preliminary findings highlight that future interventions targeting improving sleep quality among people living with HIV may consider offering social support services in combination with other biomedical services to reduce HIV-related stigma. With the wide use of antiretroviral therapy in people living with HIV (PLWH), the mortality and morbidity rates among this community are dramatically decreasing. However, sleep disorder is still one of the prominent health issues among PLWH, and it lowers their quality of life. Although we already know the potential biological pathway that links poor sleep quality among PLWH, the potential contribution of the psychosocial pathway (e.g., stigma) is far from understood. In this study, we aimed to explore the potential serial mediating effects (HIV stigma-loneliness-depression-sleep quality) and potential moderating effects of perceived social support. We recruited a consecutive sample of 139 participants from voluntary counseling testing (VCT) clinics of Beijing Youan Hospital and participant referrals. Then, we used serial mediation models and moderated serial mediation models to fit our data. We found significant serial mediation effects between three types of HIV stigma (enacted, anticipated, and internalized) and sleep quality via depression and loneliness. Perceived social support also significantly moderated this serial mediation between enacted stigma, internalized stigma, and sleep quality. Our results highlight the potential role of perceived social support in moderating the negative effects of enacted and internalized stigma on sleep quality and identify potential psychosocial pathways.