Skip to main content

Advertisement

SpringerLink
Log in

Physician–Patient Interaction Quality Mediates the Association Between HIV-Related Stigma and HIV-Prevention Behaviors Among Sexual Minority Men in Zambia

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

HIV-related stigma is a major challenge to HIV prevention for sexual minority men (SMM) in Zambia, but little is known about the underlying mechanisms. This study aimed to investigate whether physician–patient interaction quality mediates the relationship between HIV-related stigma and HIV-prevention behaviors among SMM. Data were collected using a cross-sectional survey from 194 SMM (aged: mean = 24.08, SD = 4.27) across four districts in Zambia between February and November 2021. Participants were asked about their demographic characteristics, HIV-related stigma, SMM-related stigma, physician–patient interaction quality, HIV-testing intention, and use of pre-exposure prophylaxis (PrEP). Path analysis was used to test the mediation effect of physician–patient interaction quality in the associations of HIV-related stigma/SMM-related stigma with HIV-testing intention and current PrEP use. Higher self-reported physician–patient interaction quality was negatively associated with HIV-related stigma (β = − 0.444, z = − 2.223, p < 0.05), and positively associated with HIV-testing intention (β = 0.039, z = 5.121, p < 0.001) and current PrEP use (β = 0.008, z = 2.723, p < 0.01). HIV-related stigma among SMM had a significant and negative indirect effect on HIV-testing intention (β = − 0.017, z = − 2.006, p < 0.05), and current PrEP use (β = − 0.004, z = − 2.009, p < 0.05) through physician–patient interaction quality. Contrary to our expectations, SMM-related stigma did not have a significant and negative indirect effect on HIV prevention behaviors through physician–patient interaction quality. Health interventions need to improve physician–patient interaction quality by offering healthcare provider training, targeting HIV-related stigma in healthcare settings, and devising inclusive healthcare policies to promote HIV prevention efforts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Zambia Statistics Agency (ZSA). Ministry of Health (MOH) Zambia, and ICF. Zambia Demographic and Health Survey 2018. Maryland: Zambia Statistics Agency; 2018.

  2. Hessou PHS, Glele-Ahanhanzo Y, Adekpedjou R, Ahouada C, Johnson RC, Boko M, et al. Comparison of the prevalence rates of HIV infection between men who have sex with men (MSM) and men in the general population in sub-saharan Africa: a systematic review and meta-analysis. BMC Public Health. 2019;19:1634. https://doi.org/10.1186/s12889-019-8000-x.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zambia National AIDS Council (ZNAC). Country progress report—Zambia 2020. In Global AIDS Monitoring. Washington:UNAIDS; 2020.

  4. ICAP. Biobehavioral survey among men who have sex with men in Zambia. New York: ICAP at Columbia University; 2021.

  5. UNAIDS. 90–90–90: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.

    Google Scholar 

  6. WHO. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations–2016 update. Geneva: World Health Organization; 2016.

    Google Scholar 

  7. Sandfort TGM, Dominguez K, Kayange N, Ogendo A, Panchia R, Chen YQ, et al. HIV testing and the HIV care continuum among sub-saharan african men who have sex with men and transgender women screened for participation in HPTN 075. PLoS ONE. 2019;14:e0217501. https://doi.org/10.1371/journal.pone.0217501.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Link BG, Phelan JC. Conceptualizing stigma. Ann Rev Sociol. 2001;27:363–85. https://doi.org/10.1146/annurev.soc.27.1.363.

    Article  Google Scholar 

  9. National Alliance of State and Territorial AIDS Directors Zambia (NASTAD). The legal, policy and socio-cultural barriers to HIV-related prevention, treatment, care, and support for key populations in Zambia. Lusaka: NASTAD; 2015.

    Google Scholar 

  10. Phiri L. Canaries in the coal mines: an analysis of spaces for LGBTI Activism in Zambia. Johannesburg: The Other Foundation; 2017.

    Google Scholar 

  11. Braveman P, Gottlieb L. The Social Determinants of Health: it’s time to consider the Causes of the Causes. Public Health Rep. 2014;129:19–31. https://doi.org/10.1177/00333549141291S206.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Armstrong R, Zulu J. Applying the social determinants of health lens to the situation of young key populations in Zambia: what can it tell us about what we could do? J Global Health Rep. 2019;3:e2019008. https://doi.org/10.29392/joghr.3.e2019008.

    Article  Google Scholar 

  13. Baral S, Sifakis F, Cleghorn F, Beyrer C. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: a systematic review. PLoS Med. 2007;4:e339. https://doi.org/10.1371/journal.pmed.0040339.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Republic of Zambia (ROZ), National AIDS Council (NAC). Zambia Country Report: monitoring the declaration of commitment on HIV and AIDS and the Universal Access. Lusaka: United Nations General Assembly Special Session on HIV and AIDS; 2014.

    Google Scholar 

  15. Joint United Nations Programme (UNP) on HIV/AIDS. Knowledge is Power Knowledge is power: know your status, know your viral load. Geneva: Joint United Nations Programme on HIV/AIDS; 2018.

    Google Scholar 

  16. WHO. Towards universal access scaling up priority HIV/AIDS interventions in the health sector. Geneva: World Health Organization; 2011.

    Google Scholar 

  17. Jürgensen M, Tuba M, Fylkesnes K, Blystad A. The burden of knowing: balancing benefits and barriers in HIV testing decisions. A qualitative study from Zambia. BMC Health Serv Res. 2012;12:2. https://doi.org/10.1186/1472-6963-12-2.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jürgensen M, Sandøy IF, Michelo C, Fylkesnes K, Mwangala S, Blystad A. The seven cs of the high acceptability of home-based VCT: results from a mixed methods approach in Zambia. Soc Sci Med. 2013;97:210–9. https://doi.org/10.1016/j.socscimed.2013.07.033.

    Article  PubMed  Google Scholar 

  19. Jürgensen M, Sandøy IF, Michelo C, Fylkesnes K, ZAMACT Study Group. Effects of home-based voluntary counselling and testing on HIV-related stigma: findings from a cluster-randomized trial in Zambia. Soc Sci Med. 2013;81:18–25. https://doi.org/10.1016/j.socscimed.2013.01.011.

    Article  PubMed  Google Scholar 

  20. Kelley AL, Karita E, Sullivan PS, Katangulia F, Chomba E, Carael M, et al. Knowledge and perceptions of couples’ Voluntary Counseling and Testing in Urban Rwanda and Zambia: a cross-sectional Household Survey. PLoS ONE. 2011;6:e19573. https://doi.org/10.1371/journal.pone.0019573.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Qiao S, Zhang Y, Li X, Menon JA. Facilitators and barriers for HIV-testing in Zambia: a systematic review of multi-level factors. PLoS ONE. 2018;13:e0192327. https://doi.org/10.1371/journal.pone.0192327.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. WHO. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: WHO; 2015.

    Google Scholar 

  23. Claassen CW, Mumba D, Njelesani M, Nyimbili D, Mwango LK, Mwitumwa M, et al. Initial implementation of PrEP in Zambia: health policy development and service delivery scale-up. BMJ Open. 2021;11:e047017. https://doi.org/10.1136/bmjopen-2020-047017.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bhatta DN, Hecht J, Facente SN. Factors associated with stigma related to HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM). Sex Transm Infect. 2022;98:592–4. https://doi.org/10.1136/sextrans-2021-055296.

    Article  PubMed  Google Scholar 

  25. Fast-Track Cities Initiative (FTCI). About fast track cities: International Association of Providers of AIDS Care. Pittsburgh: Fast-Track Cities Initiative (FTCI); 2023.

  26. UNAIDS. Global agenda for zero discrimination in health-care settings. Geneva: UNAIDS; 2017.

    Google Scholar 

  27. UNAIDS. Global partnership for action to eliminate all forms of HIV-related stigma and discrimination. Geneva: Joint United Nations Programme on HIV/AIDS; 2018.

    Google Scholar 

  28. Micheni M, Kombo BK, Secor A, Simoni JM, Operario D, van der Elst EM, et al. Health provider views on improving antiretroviral therapy adherence among Men who have sex with men in coastal Kenya. AIDS Patient Care STDS. 2017;31:113–21. https://doi.org/10.1089/apc.2016.0213.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pilgrim N, Musheke M, Raymond HF, Keating R, Mwale J, Banda L, et al. Quality of care and HIV service utilization among key populations in Zambia: a qualitative comparative analysis among female sex workers, men who have sex with men and people who use drugs. AIDS Care. 2019;31:460–4. https://doi.org/10.1080/09540121.2018.1524119.

    Article  PubMed  Google Scholar 

  30. Ammon N, Mason S, Corkery JM. Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: a systematic review. Public Health. 2018;157:20–31. https://doi.org/10.1016/j.puhe.2017.12.010.

    Article  CAS  PubMed  Google Scholar 

  31. Clair-Sullivan NS, Mwamba C, Whetham J, Moore CB, Darking M, Vera J. Barriers to HIV care and adherence for young people living with HIV in Zambia and mHealth. mHealth. 2019. https://doi.org/10.21037/mhealth.2019.09.02.

  32. Mbeda C, Ogendo A, Lando R, Schnabel D, Gust DA, Guo X, et al. Healthcare-related stigma among men who have sex with men and transgender women in sub-saharan Africa participating in HIV Prevention trials Network (HPTN) 075 study. AIDS Care. 2020;32:1052–60. https://doi.org/10.1080/09540121.2020.1776824.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Nnko S, Kuringe E, Nyato D, Drake M, Casalini C, Shao A, et al. Determinants of access to HIV testing and counselling services among female sex workers in sub-saharan Africa: a systematic review. BMC Public Health. 2019;19:15. https://doi.org/10.1186/s12889-018-6362-0.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Musheke M, Bond V, Merten S. Couple experiences of provider-initiated couple HIV testing in an antenatal clinic in Lusaka, Zambia: lessons for policy and practice. BMC Health Serv Res. 2013;13:97. https://doi.org/10.1186/1472-6963-13-97.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kohi TW, Makoae L, Chirwa M, Holzemer WL, RenéPhetlhu D, Uys L, et al. HIV and AIDS stigma violates human rights in five African countries. Nurs Ethics. 2006;13:404–15. https://doi.org/10.1191/0969733006ne865oa.

    Article  PubMed  Google Scholar 

  36. Naidoo JR, Uys LR, Greeff M, Holzemer WL, Makoae L, Dlamini P, et al. Urban and rural differences in HIV/AIDS stigma in five african countries. Afr J AIDS Res. 2007;6:17–23. https://doi.org/10.2989/16085900709490395.

    Article  PubMed  Google Scholar 

  37. Dlamini PS, Kohi TW, Uys LR, Phetlhu RD, Chirwa ML, Naidoo JR, et al. Verbal and physical abuse and neglect as manifestations of HIV/AIDS stigma in five african countries. Public Health Nurs. 2007;24:389–99. https://doi.org/10.1111/j.1525-1446.2007.00649.x.

    Article  PubMed  Google Scholar 

  38. Uys L, Chirwa M, Kohi T, Greeff M, Naidoo J, Makoae L, et al. Evaluation of a health setting-based stigma intervention in five african countries. AIDS Patient Care STDS. 2009;23:1059–66. https://doi.org/10.1089/apc.2009.0085.

    Article  PubMed  PubMed Central  Google Scholar 

  39. van der Elst EM, Gichuru E, Omar A, Kanungi J, Duby Z, Midoun M, et al. Experiences of kenyan healthcare workers providing services to men who have sex with men: qualitative findings from a sensitivity training programme. J Int AIDS Soc. 2013;16:18741. https://doi.org/10.7448/IAS.16.4.18741.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Adane B, Yalew M, Damtie Y, Kefale B. Perceived stigma and associated factors among people living with HIV attending ART clinics in public health facilities of Dessie City, Ethiopia. HIV AIDS (Auckl). 2020;12:551–7. https://doi.org/10.2147/HIV.S274019.

    Article  PubMed  Google Scholar 

  41. Mulubale S, Clay S, Squire C, Bond V, Kasoka K, Stackpool-Moore L, et al. Situating HIV stigma in health facility settings: a qualitative study of experiences and perceptions of stigma in ‘clinics’ among healthcare workers and service users in Zambia. J Int Assoc Provid AIDS Care. 2022;21:23259582221100452. https://doi.org/10.1177/23259582221100453.

    Article  Google Scholar 

  42. Stangl AL, Lilleston P, Mathema H, Pliakas T, Krishnaratne S, Sievwright K, et al. Development of parallel measures to assess HIV stigma and discrimination among people living with HIV, community members and health workers in the HPTN 071 (PopART) trial in Zambia and South Africa. J Int AIDS Soc. 2019;22:e25421. https://doi.org/10.1002/jia2.25421.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Shangani S, Genberg B, Harrison A, Pellowski J, Wachira J, Naanyu V, et al. Cultural adaptation and validation of a measure of prejudice against men who have sex with men among healthcare providers in western Kenya. Glob Public Health. 2022;17:150–64. https://doi.org/10.1080/17441692.2020.1860248.

    Article  PubMed  Google Scholar 

  44. Wachira J, Middlestadt S, Reece M, Peng C-YJ, Braitstein P. Psychometric assessment of a physician–patient communication behaviors scale: the perspective of adult HIV patients in Kenya. AIDS Res Treat. 2013;2013:e706191. https://doi.org/10.1155/2013/706191.

    Article  Google Scholar 

  45. Suh Y. The performance of maximum likelihood and weighted least square mean and variance adjusted estimators in testing differential item functioning with nonnormal trait distributions. Struct Equ Model Multidiscip J. 2015;22:568–80. https://doi.org/10.1080/10705511.2014.937669.

    Article  Google Scholar 

  46. Meyers LS, Gamst G, Guarino AJ. Applied multivariate research: design and interpretation. 2nd ed. Thousand Oaks: SAGE; 2013.

    Google Scholar 

  47. Parker R, Aggleton P. HIV-and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Culture, society and sexuality. London: Routledge; 2007. p. 459–74.

  48. Rich C, Mavhu W, France NF, Munatsi V, Byrne E, Willis N, et al. Exploring the beliefs, experiences and impacts of HIV-related self-stigma amongst adolescents and young adults living with HIV in Harare, Zimbabwe: a qualitative study. PLoS ONE. 2022;17:e0268498.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Smit PJ, Brady M, Carter M, Fernandes R, Lamore L, Meulbroek M, et al. HIV-related stigma within communities of gay men: a literature review. AIDS Care. 2012;24:405–12.

    Article  PubMed  Google Scholar 

  50. Logie CH, Lacombe-Duncan A, Wang Y, Kaida A, Conway T, Webster K, et al. Pathways from HIV-related stigma to antiretroviral therapy measures in the HIV care cascade for women living with HIV in Canada. JAIDS J Acquir Immune Defic Syndr. 2018;77:144–53.

    Article  PubMed  Google Scholar 

  51. Spencer SJ, Logel C, Davies PG. Stereotype threat. Ann Rev Psychol. 2016;67:415–37.

    Article  Google Scholar 

  52. Schmader T, Johns M, Forbes C. An integrated process model of stereotype threat effects on performance. Psychol Rev. 2008;115:336.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Earnshaw VA, Smith LR, Cunningham CO, Copenhaver MM. Intersectionality of internalized HIV stigma and internalized substance use stigma: implications for depressive symptoms. J Health Psychol. 2015;20:1083–9.

    Article  PubMed  Google Scholar 

  54. Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, et al. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med. 2019;17:1–15.

    Article  Google Scholar 

  55. Ferrand J, Walsh-Buhi E, Dodge B, Svetina D, Herbenick D. Variations in pre-exposure prophylaxis (PrEP) awareness and healthcare provider interactions in a nationally representative sample of American men aged 15–49 years: a cross-sectional study. AIDS Behav. 2023. https://doi.org/10.1007/s10461-023-04016-0.

    Article  PubMed  Google Scholar 

  56. Golub SA, Gamarel KE. The impact of anticipated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS Patient Care STDs. 2013;27:621–7. https://doi.org/10.1089/apc.2013.0245.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Wei C, Cheung DH, Yan H, Li J, Shi L, Raymond HF. The impact of homophobia and HIV stigma on HIV testing uptake among Chinese men who have sex with men: a mediation analysis. J Acquir Immune Defic Syndr. 2016;71:87–93. https://doi.org/10.1097/QAI.0000000000000815.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Lorenc T, Marrero-Guillamón I, Aggleton P, Cooper C, Llewellyn A, Lehmann A, et al. Promoting the uptake of HIV testing among men who have sex with men: systematic review of effectiveness and cost-effectiveness. Sex Transm Infect. 2011;87:272–8.

    Article  PubMed  Google Scholar 

  59. Mimiaga MJ, Goldhammer H, Belanoff C, Tetu AM, Mayer KH. Men who have sex with men: perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication. Sex Transm Dis. 2007;34(2):113–9.

    Article  PubMed  Google Scholar 

  60. Rolle C-P, Rosenberg ES, Siegler AJ, Sanchez TH, Luisi N, Weiss K, et al. Challenges in translating PrEP interest into uptake in an observational study of young black MSM. J Acquir Immune Defic Syndr. 2017;76:250.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Noar SM, Zimmerman RS. Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction? Health Educ Res. 2005;20:275–90.

    Article  PubMed  Google Scholar 

  62. Rosenstock IM. Health Belief Model. In: Encyclopedia of psychology. Vol. 4. Washington, DC: American Psychological Association; 2000. p. 78–80. https://doi.org/10.1037/10519-035.

  63. Fishbein M, Ajzen I. Predicting and changing behavior: the reasoned action approach. New York: Psychology Press; 2011.

    Book  Google Scholar 

  64. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211.

    Article  Google Scholar 

  65. Armitage CJ, Conner M. Efficacy of the theory of planned behaviour: a meta-analytic review. Br J Soc Psychol. 2001;40:471–99.

    Article  CAS  PubMed  Google Scholar 

  66. Montano DE, Kasprzyk D. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. Health Behav Theory Res Pract. 2015;70:231.

    Google Scholar 

  67. Gkiouleka A, Huijts T, Beckfield J, Bambra C. Understanding the micro and macro politics of health: inequalities, intersectionality & institutions—a research agenda. Soc Sci Med. 2018;200:92–8. https://doi.org/10.1016/j.socscimed.2018.01.025.

    Article  PubMed  Google Scholar 

  68. Kalichman SC, Shkembi B, Eaton LA. A novel psychometric approach to assessing intersectional hiv stigma: the geometric intersectional stigma scales. J Behav Med. 2022. https://doi.org/10.1007/s10865-022-00331-4.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Bowleg L. The problem with the phrase women and minorities: intersectionality—an important theoretical framework for public health. Am J Public Health. 2012;102:1267–73. https://doi.org/10.2105/AJPH.2012.300750.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13:1160–77. https://doi.org/10.1007/s10461-009-9593-3.

    Article  PubMed  PubMed Central  Google Scholar 

  71. National HIV/AIDS/STI/TB Council (NAC). Zambia’s National HIV and AIDS Strategic Framework (NASF) 2017–2021. Lusaka: NAC; 2017.

    Google Scholar 

  72. Wachira J, Genberg B, Mwangi A, Chemutai D, Braitstein P, Galarraga O, et al. Impact of an enhanced patient care intervention on viral suppression among patients living with HIV in Kenya. J Acquir Immune Defic Syndr. 2022;90:434–9. https://doi.org/10.1097/QAI.0000000000002987.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Das MC, Zakaria M, Cheng F, Xu J. Appointment length with patients in medical consultations in Bangladesh: a hospital-based cross-sectional study. Healthcare (Basel). 2021;9:1164. https://doi.org/10.3390/healthcare9091164.

    Article  PubMed  Google Scholar 

  74. Wachira J, Mwangi A, Chemutai D, Nyambura M, Genberg B, Wilson IB. Higher clinician–patient communication is associated with greater satisfaction with HIV care. J Int Assoc Provid AIDS Care. 2021;20:23259582211054936. https://doi.org/10.1177/23259582211054935.

    Article  Google Scholar 

  75. Laurenzi CA, Melendez-Torres GJ, Page DT, Vogel LS, Kara T, Sam-Agudu NA, et al. How do psychosocial interventions for adolescents and young people living with HIV improve adherence and viral load? A realist review. J Adolesc Health. 2022;71:254–69. https://doi.org/10.1016/j.jadohealth.2022.03.020.

    Article  PubMed  Google Scholar 

  76. Towbes LC, Cohen LH. Chronic stress in the lives of college students: scale development and prospective prediction of distress. J Youth Adolescence. 1996;25:199–217. https://doi.org/10.1007/BF01537344.

    Article  Google Scholar 

  77. Forero CG. Cronbach’s alpha. In: Michalos AC, editor. Encyclopedia of quality of life and well-being research. Dordrecht: Springer; 2014. p. 1357–9. https://doi.org/10.1007/978-94-007-0753-5_622.

    Chapter  Google Scholar 

Download references

Funding

This work was supported by the NIH/FIC under Grant R21TW011064.

Author information

Authors and Affiliations

  1. Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA

    Abhishek Aggarwal, Ran Zhang, Shan Qiao & Xiaoming Li

  2. Population and Quantitative Health Sciences, University of Massachusetts, Boston, USA

    Bo Wang

  3. Department of Psychology, University of Zambia, Lusaka, Zambia

    Clementina Lwatula & Anitha Menon

  4. Department of Health Service Policy and Management, University of South Carolina, Columbia, USA

    Jan Ostermann

  5. Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, USA

    Gary Harper

Authors
  1. Abhishek Aggarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ran Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shan Qiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bo Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Clementina Lwatula
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anitha Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jan Ostermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiaoming Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gary Harper
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shan Qiao.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest regarding the publication of this paper.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary Material 1—Appendix 1 (DOCX 46 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aggarwal, A., Zhang, R., Qiao, S. et al. Physician–Patient Interaction Quality Mediates the Association Between HIV-Related Stigma and HIV-Prevention Behaviors Among Sexual Minority Men in Zambia. AIDS Behav (2023). https://doi.org/10.1007/s10461-023-04171-4

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10461-023-04171-4

Keywords

Search

Navigation