HIV-related stigma and academic outcomes: the mediating role of mental health among adolescents living with HIV in Uganda.

Among Adolescents living with HIV (ALHIV) in Uganda, pathways linking HIV-related stigma to mental health (depression, hopelessness and self-esteem) and academic engagement (school satisfaction and self-concept) are under-examined. Using cross-sectional data from 833 ALHIV (ages 10-17), we first estimated a fully latent structural equation model to assess these pathways. Model fit was excellent (χ²[21] = 45.16, p = .002; CFI = .987; RMSEA = .037; SRMR = .028). Stigma was associated with poorer mental health (β = -.214, SE = .058, p < .001); positive mental health predicted academic engagement (β = .956, SE = .262, p < .001), while the direct stigma to academic path was small and marginally non-significant (β = -.089, SE = .046, p = .052). Next, we examined the roles of social support and family cohesion, using an observed-variable path model with composite scores. Higher stigma predicted lower perceived social support (β = -.445, SE = .041, p < .001) and family cohesion (β = -.311, SE = .048, p < .001). Perceived social support significantly buffered mental health (β = -.184, SE = .025, p < .001), and poorer mental health strongly predicted lower academic engagement (β = -.491, SE = .037, p < .001). The findings indicate that HIV stigma undermines academic engagement primarily by eroding mental well-being, while social support is a key upstream protective factor. Interventions for ALHIV should, therefore, prioritise stigma reduction alongside integrated mental health services and programmes to strengthen social support in educational settings.Trial Registration: ClinicalTrials.gov NCT05307250; https://clinicaltrials.gov/ct2/show/NCT05307250.