From social stigma to physical health: mediation effect of internalized stigma and mental health among people with HIV in rural China

People with HIV (PWH) in rural China continue to experience multiple forms of stigma that threaten their overall wellbeing. This study explored how internalized stigma and mental health distress mediate the relationship between social stigma and physical health using baseline data from 800 PWH (42% women; mean age 54.8 years) from the Rise-Up Project in Guangxi, China. Social stigma was modeled as a latent construct composed of perceived and anticipated stigma, while mental health distress was represented by depressive, anxiety symptoms and perceived stress. Physical health included general health perception, physical functions, role limitations, and pain interference. Structural equation modeling revealed that social stigma was positively associated with internalized stigma (β = .465, <i>p</i> < .001), which in turn heightened mental health distress (β = .396, <i>p</i> < .001), and reduced physical health (β = -.505, <i>p</i> < .001). The indirect effect was significant (β = -.093, <i>p</i> < .001), and model fit was good (RMSEA = .027; CFI = .968; TLI = .934; SRMR = .020). Multi-group SEM indicated consistency across men and women. These results suggest that social stigma impairs physical health through internalized stigma and psychological distress, highlighting the need for resilience-based interventions to improve PWH well-being.