Disclosure concerns moderate the association between internalized stigma and antiretroviral medication adherence among people with HIV in the Dominican Republic

Abstract

HIV-related stigma remains a significant barrier to antiretroviral therapy (ART) adherence among people with HIV (PWH). Internalized stigma has been consistently linked to poorer ART adherence. However, the role of disclosure concerns, worries or fears about revealing one’s HIV status, remains unclear. This study examines whether disclosure concerns moderate the relationship between internalized stigma and ART adherence among PWH in the Dominican Republic. Data were drawn from 471 PWH recruited from two HIV clinics as part of a cluster-randomized pilot trial. Using moderation analyses, we found that internalized stigma was significantly associated with lower ART adherence (B = −2.30, p =.002), while disclosure concerns alone were not. However, disclosure concerns significantly moderated the relationship between internalized stigma and adherence (B = 1.68, p =.023), such that internalized stigma was significantly associated with poorer ART adherence at low levels of disclosure concerns (B = −4.18, p =.002, CI [−6.815, −1.546]) but not at high levels (B = −.59, p =.437, CI [−2.076,.898]). These findings suggest that, in certain contexts, higher disclosure concerns may buffer against the adverse effects of internalized stigma on medication adherence, possibly by motivating individuals to maintain viral suppression to avoid disclosure. Stigma-reduction interventions should target internalized stigma while addressing the complex role of disclosure concerns in HIV care. Trial registration:ClinicalTrials.gov identifier: NCT04491539. © 2025 Elsevier B.V., All rights reserved.