Back in My Hands: The Role of Self-Forgiveness and Stigma in HIV-Positive Adults

While advancements in treatment have made HIV a more manageable disease, only recently have psychosocial variables associated with the health of persons living with HIV (PLH) began to receive increased scrutiny. HIV-related stigma, considered by some researchers to be a “second epidemic,” is one such psychosocial variable and is associated with negative physiological and psychological health outcomes. In an effort to alleviate the effects of stress, increased research attention has focused on forgiveness as a teachable coping strategy. Current forgiveness interventions demonstrate encouraging results in decreasing anger and neutralizing stress but have not been applied to HIV-positive populations. In this study, Lazarus and Folkman’s transactional model of stress and coping (1984) and Prochaska and Velicer’s transtheoretical model of health behavior (1997) were utilized as theoretical frameworks to inform a randomized clinical trial that examines coping skills, particularly forgiveness, in PLH and perceived HIV-related stigma. An ethnically diverse sample of HIV-positive adults (n = 57) was randomized into a treatment or control group. The treatment group participated in six weeks of cognitive-behavioral group therapy that focused on the teaching of forgiveness as an effective coping tool while the control group was psychoeducational in nature and did not involve mention of forgiveness. Data was obtained on a variety of medical and psychosocial variables, including types of forgiveness (dispositional forgiveness, forgiveness of self, forgiveness of others, and forgiveness of situations) and perceived HIV-related stigma. Data were collected at three time points: at baseline (Time 1) prior to randomization of participants to the treatment or control group, immediately post intervention (Time 2), and at six-month follow-up (Time 3). Importantly, forgiveness was shown to be a teachable skill that PLH can use to potentially improve mental health. Men in the treatment group reported significantly higher levels of dispositional forgiveness and self-forgiveness than men in the control group at six-month follow up. Additionally, self-forgiveness at Time 1 and self-forgiveness at Time 3 significantly accounted for 34% and 28% of the variance, respectively, in HIV-related stigma at Time 3. Though self-forgiveness was shown to be better than forgiveness of others in predicting HIV-related stigma, the forgiveness intervention was not effective in reducing overall HIV-related stigma in PLH. HIV-related stigma is likely more complex than originally conceptualized. Implications and future directions in improving interventions to mitigate HIV-related stigma are discussed