HIV-related stigma and academic outcomes

The mediating role of mental health among adolescents living with HIV in Uganda

Bibliographic Data

ID19440647
AuthorsMassy Mutumba (0000-0002-0636-891X, University of Michigan, corresponding author), Fred M Ssewamala (0000-0002-4849-5650), Proscovia Nabunya (0000-0002-9088-5839), Jennifer Nattabi (0000-0002-8300-1791), Rashida Namirembe (0000-0002-2795-5099, ICF International (United States)), Francis Matovu (0000-0002-9241-6761, ICF International (United States)), Phionah Namatovu (0000-0001-6197-4413, ICF International (United States)), Abel Mwebembezi (0000-0003-2425-8498, Reach the Youth)
Year2026
Volume38
Issue3
Pages571-582
Publication date2026-03-04
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAIDS Care (JOURNAL)
Journal identifiersISSN: 0954-0121 • E-ISSN: 1360-0451
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540121.2025.2606202
PMID41457981
OpenAlexW7117488574
LanguageEN
References cited26

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

Mental health · Psychological intervention · Social stigma · Social support · Structural equation modeling · Adolescent Sexual and Reproductive Health · HIV Research and Treatment · HIV/AIDS Research and Interventions