The moderating effect of healthcare empowerment on the relationship between stigma and self-rated health in people living with HIV in Canada

Abstract

Objective To determine the moderating effect of healthcare empowerment on the relationship between enacted, internalized and anticipated stigma and self-rated health.Methods Participants (n = 1318) were recruited to complete the People Living with HIV Stigma Index, a community-based cross-sectional survey administered across all provinces in Canada from August 2018 to October 2024. The survey contained externally validated quantitative scales measuring stigma, healthcare empowerment and health. Healthcare empowerment was broken down into subscales of Informed, Committed, Collaborative, and Engaged (ICCE) and Tolerance of Uncertainty (TU). Moderation models were created for each type of stigma as the antecedent, healthcare empowerment (total, ICCE and TU) as the moderator, and self-rated health as the outcome.Results Total healthcare empowerment was a significant moderator for the relationship between enacted (b = 0.11, 95% CI: 0.00, 0.23) and internalized (b = 0.23, 95% CI: 0.09, 0.37) stigma and self-rated health. The ICCE subscale was a significant moderator for the relationship between internalized (b = 0.20, 95% CI: 0.08, 0.33) and anticipated (b = 0.17, 95% CI: 0.04, 0.31) stigma and self-rated health. Overall, for those with low levels of healthcare empowerment, greater enacted and internalized stigma resulted in worse self-rated health; however, high levels of healthcare empowerment buffered the negative impact of stigma.Conclusion Healthcare empowerment may have the potential to buffer or mitigate the negative effect of stigma. Understanding how to bolster levels of healthcare empowerment, specifically dimensions of ICCE, may be important for the development of interventions aiming to reduce the impact of stigma for people living with HIV.