Perceived discrimination, self-exclusion and well-being among people with HIV as a function of lipodystrophy symptoms

This study examined the effects of perceived discrimination on the well-being of people with HIV and the mediating role of self-exclusion as a function of the participants' symptoms of lipodystrophy. An ex post facto study with a sample of 706 people with HIV was conducted. Self-perception of lipoatrophy and lipohypertrophy, perceived discrimination, self-exclusion and psychological well-being were measured. Results of hierarchical cluster analysis showed participants could be categorized into three groups: no lipodystrophy, mixed syndrome with predominant lipoaccumulation and lipoatrophy. Results of structural equation modeling revealed that the negative effects of perceived discrimination on well-being were mediated to a large extent by self-exclusion. Invariance analysis revealed that the mediating role of self-exclusion was not the same in the three clusters. Complete mediation of self-exclusion in the groups without lipodystrophy and with predominant lipoaccumulation was confirmed. Regarding lipoatrophy, the negative effects of perceived discrimination were greater and only partly mediated by self-exclusion. In conclusion, having lipodystrophy exposed people to more discrimination; lipoatrophy was the most stigmatizing condition.