HIV Concealment and Victimization Among Adolescents with HIV (AWH): The Moderating Role of Emotional Social Support.

Adolescents with HIV (AWH) often conceal HIV due to stigma and fear of rejection. Stress-buffering and social embeddedness theory suggest that HIV concealment can increase victimization due to a decline in emotional social support (ESS). Understanding the moderating role of ESS between HIV concealment and victimization may help inform interventions to reduce victimization among AWH. A cross-sectional survey including egocentric social network data was conducted among 129 AWH (10–19 Years) at a tertiary care centre in Pune, India between September 2021 and December 2023. The association between HIV concealment and victimization was examined by using a Generalized Linear Model for Negative Binomial (GLMNB) and incidence rate ratios (IRR) were calculated. Moderation was assessed by introducing ESS as a two-way interaction term in the subsequent models between HIV concealment and victimization. A one standard deviation increase in proportion of network members from whom HIV was concealed was associated with a 17% decline in exposure to verbal abuse (IRR = 0.83, 95% CI: 0.66–1.03, p-value = 0.09). A one standard deviation increase in ESS was associated with a 36% decline in physical abuse (IRR = 0.64, 95% CI: 0.44–0.92, p-value = 0.02) and a 22% decline in bullying victimization (IRR = 0.78, 95% CI: 0.63–0.96, p-value = 0.02). ESS moderated the relationship between HIV concealment and victimization, such that high ESS was protective for verbal abuse and low ESS was protective for bullying victimization. Findings highlight the importance of strengthening ESS while addressing stigma to reduce victimization among AWH.