Is BMI Associated with HIV Stigma in a Sample of People with HIV Living in Lebanon?

Abstract

Background: Advances in antiretroviral therapy have transformed HIV into a chronic manageable condition. However, people with HIV are still experiencing psychosocial outcomes including HIV related stigma, depression, and anxiety despite achieving sustained viral suppression. Changes in body weight are also common among people with HIV, yet the association between anthropometric indicators and psychosocial outcomes is neither well understood nor studied, especially in the Lebanese context.

Methods: This is a secondary analysis with a cross-sectional design using data from 45 virally suppressed people with HIV living in Lebanon. Perceived HIV-related stigma, depression, and anxiety were measured by the HIV stigma scale, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) respectively. Anthropometric indicators were measured by body mass index (BMI) and waist circumference (WC). Unadjusted and adjusted linear regression, with bootstrapping, controlling for level of education, nadir CD4, and time since HIV diagnosis were conducted to examine associations.

Results: The overall perceived HIV stigma was low [median score on Likert scale was 1.61 (1.31-2.46), median of continuous score of 21 (17-32). Median depression score was 5 (2.5-8.5), and median anxiety score was 4 (2-9.5). BMI was found to be inversely associated with overall HIV stigma B=-0.06, 95% percentile bootstrap CI (-0.093, -0.013), and with the discrimination subscale B=-0.09, 95% percentile bootstrap CI (-0.140, -0.033). Education was inversely associated with HIV stigma and depression. WC was not associated with HIV stigma, depression or anxiety in the adjusted models.

Conclusion: This study reveals low overall HIV stigma in PWH living in Lebanon who are virally suppressed. Despite viral suppression, PWH may still experience depression and anxiety, likely exacerbated by the overarching sociopolitical and economic crisis. The inverse association of BMI and HIV stigma suggests that a fuller physique may serve as a protective social factor against HIV stigma in the Lebanese. Furthermore, education is a protective factor against HIV stigma and depression. Future studies, particularly with larger sample size, will help better examine the association of anthropometric measures and psychosocial outcomes.