HIV is a potentially fatal and highly stigmatized disease such that diagnosis with the disease is often met with high anxiety. Many people who test positive for HIV may not receive sufficient linkage to HIV care or do not remain engaged in continuous HIV medical care once they have entered care. While a considerable amount of research exists on referral, access, personal characteristics, and mental illness barriers associated with engagement in HIV medical care, far less attention has been given to psychosocial factors, specifically denial and perceived HIV stigma as important barriers to engaging in HIV medical care.

The purpose of this study was to determine whether denial and/or perceived HIV stigma are associated with engagement in HIV medical care for African-American people living with HIV/AIDS (PLWHA). Data were collected as part of a peer-based community health worker program (CHW), based in Washington DC, designed to link PLWHA to HIV medical care and services. Logistic regression analyses were performed to determine whether the psychosocial variables were predictors of engagement in HIV medical care.Results indicated that disclosure is a major issue for this population, as 46% of the participants had not disclosed their HIV status to others. Separate analyses were conducted for the total sample (n=262) and with the disclosed sample (n=120). Results in the total sample revealed that disclosure of HIV status was associated with engagement in HIV status. PLWHA who disclosed HIV status to others were 2.2 times more likely to engage in HIV medical care than persons who had not disclosed HIV status. In the disclosed sample, gender, educational level and employment status were also associated with engagement in HIV medical care. Women and persons with low educational level and unemployed were less likely to engage in HIV medical care. Denial and perceived HIV stigma were not found to be independent predictors of engagement in HIV medical care when other covariates were included in the model. Disclosure of HIV status, gender and educational level were predictors of engagement in HIV medical care for this population. These obstacles to care may be amenable to disclosure and gender-specific interventions; and, therefore, warrant better understanding to improve outreach interventions to PLWHA who are not engaged in HIV medical care.