Forgoing antiretroviral therapy to evade stigma among people living with HIV, Cape Town, South Africa.

Stigma impedes HIV treatment in multiple ways, including diminished engagement in care, refusing ART, and concealing ART to evade stigma. This study disentangled the degree to which intentionally not taking ART to evade stigma influences overall non-adherence to ART. Patients receiving ART at a community clinic in Cape Town, South Africa (N = 288) completed confidential surveys of demographic and health characteristics, stigma-avoidance non-adherence, and non-stigma-related predictors of non-adherence. Results found nearly half of participants (48%) had forgone taking their ART in social settings. Hierarchically structured regression models showed that alcohol use, medication concerns, and internalized HIV stigma significantly predicted ART non-adherence, accounting for 9.9% of the variance. Stigma-avoidance non-adherence explained an additional 2.6% of the variance in ART non-adherence. The current findings extend previous research to show that stigma-avoidance independently contributes to ART non-adherence, including over and above depression and alcohol use.