Understanding how internalized HIV stigma affects messaging about adherence to antiretroviral treatment in women living with HIV in the southern United States: an application of segmentation, perceptual mapping and vector message modeling

Women living with HIV (WLWH) in the Southern United States face barriers to sustained adherence to antiretroviral therapy (ART). 114 Southern WLWH were surveyed to assess perceptions about medication adherence and marketing techniques used to create potential intervention messaging. A cluster analysis using a modified Internalized HIV-related Stigma Scale was conducted, followed by perceptual mapping and vector message modeling to create 3D representations of relationships among study variables. Three clusters were identified by levels of HIV stigma. Perceptual maps highlighted conceptual differences in facilitators to ART adherence among high and medium stigma groups. The high stigma group would respond to messages associating taking ART with feeling "in charge" and like a "role model." The medium stigma group associated ART adherence with "staying undetectable" and "avoiding getting sick." No persuasive messaging was identified for the low HIV stigma group. However, all groups would respond to messaging to address fears around disclosure and the psychological impact of ART as a reminder of HIV status. Findings suggest that internalized HIV stigma levels are an important psychographic variable for understanding concerns and motivations for sustained ART adherence for Southern WLWH. Integrating stigma-informed insights into intervention message strategies could address these diverse needs.