HIV Stigma and Treatment Interruptions among People Living with HIV in Zimbabwe: An Age-Stratified Analysis

Introduction HIV stigma negatively impacts antiretroviral therapy (ART) adherence in adults, but this relationship remains underexplored within the context of early adulthood. We examined manifestations of stigma and their associations with ART interruptions among young (18–24 years) and older (25 + years) people living with HIV (PLHIV) in Zimbabwe. Methods This analysis utilized cross-sectional data from the 2021 PLHIV Stigma Index 2.0, implemented by the Zimbabwe National Network of PLHIV in partnership with Global Network of People Living with HIV, The International Community of Women Living with HIV, and UNAIDS. Treatment interruptions were defined as ever interrupting or stopping HIV treatment. Internalized and anticipated stigma scores were categorized as “no”, “low”, “moderate” and “high”. Modified Poisson regression models estimated associations between categorized stigma scores and treatment interruptions, with age-stratified analyses among young and older adults. Results Among 1347 PLHIV who ever initiated ART, 20.9% (36/172) of young adults and 10.3% (121/1175) of older adults reported treatment interruptions. Increasing levels of internalized stigma were associated with higher prevalence of treatment interruptions compared to no stigma (low:adjusted prevalence ratio(aPR) 1.7, 95%CI 1.1–2.6, moderate:aPR 2.6, 95%CI 1.7–3.9, high:aPR 3.5, 95%CI 2.1–5.9). Similar associations were observed with anticipated stigma (low:aPR 2.2, 95%CI 1.5–3.4, moderate:aPR 3.2, 95%CI 1.8–5.7, high:aPR 4.9, 95%CI 2.8–8.7). Among young adults, anticipated stigma was more strongly associated with treatment interruptions compared to older adults, while internalized stigma showed a weaker association. Conclusion Different relationships observed between stigma and treatment interruption across age groups highlight the opportunity for tailored interventions for young adults. Addressing stigma at the interpersonal level may optimize treatment adherence and engagement in care during early adulthood.