Mediating Roles of Social Support and Spiritual Coping between Internalized Stigma and Psychological Well Being among People Living with HIV in Asia

Background The psychological well-being of people living with HIV (PLHIV) in Asia is profoundly compromised by internalized stigma. While this negative association is established, there is a significant gap in understanding the protective mechanisms that can buffer this detrimental effect. This study aimed to investigate the mediating roles of social support and spiritual coping in the relationship between internalized HIV stigma and psychological well-being in a diverse Asian context. Methods A mixed-methods sequential explanatory design was employed across multiple Asian countries. The quantitative phase involved a cross-sectional online survey with 375 PLHIV. Standardised instruments, including the Internalized AIDS-Related Stigma Scale, the WHO-5 Well-Being Index, the Multidimensional Scale of Perceived Social Support, and the Brief RCOPE Scale, were used. Data were analysed using descriptive statistics, Pearson's correlation, and parallel mediation analysis with the PROCESS macro for SPSS. The qualitative phase comprised semi-structured interviews with a purposive subsample (n = 22) to explore the lived experiences underlying the statistical findings, analysed via thematic analysis. Results Quantitative analysis revealed that internalized stigma was significantly and negatively associated with psychological well-being (β = -0.48, p < .001). Parallel mediation analysis demonstrated significant indirect effects of internalized stigma on psychological well-being through both social support (Effect = -0.15, 95% CI [-0.22, -0.09]) and spiritual coping (Effect = -0.07, 95% CI [-0.12, -0.03]). The direct effect of stigma on well-being remained significant (β = -0.26, p < .001), indicating partial mediation. Qualitative analysis yielded six core themes that elucidated these pathways: (1) 'The Internal Shadow: Living with Self-Blame and Shame', detailing the internal experience of stigma; (2) 'Fear of Judgment: Navigating Social Disclosure'; (3) 'The Sanctuary of Support: Finding Unconditional Acceptance'; (4) 'The Double-Edged Sword of Family'; (5) 'Faith as a Foundation: Seeking Divine Strength and Meaning'; and (6) 'Spirituality as a Personal Journey: Cultivating Inner Peace'. Conclusion Social support and spiritual coping are crucial protective resources that partially mediate the pernicious relationship between internalized stigma and the psychological well-being of PLHIV in Asia. These findings underscore the necessity of moving beyond individual-level interventions to foster supportive social environments and integrate culturally congruent spiritual care into HIV service provision. Interventions designed to bolster these two coping mechanisms are vital for improving mental health outcomes and promoting holistic well-being in this population.