Illness Perception Clusters Moderated the Association Between HIV-related Stigma and Resilience in Mother–Child Dyads Living with HIV: An Actor–Partner Interdependence Moderation Approach

Abstract

Illness perceptions (beliefs about illness identity, impact, understanding, and control) are connected with clinical and psychological outcomes. According to the relationship-oriented model of HIV-related stigma, stigma affects individuals and their significant others. Among mothers living with HIV and their children with perinatally acquired HIV (PHIV) who experience stigma, adaptive or maladaptive illness perception clusters could play a moderating role. This study investigated the extent to which illness perception clusters moderate the dyadic stigma-resilience associations among such mothers and children. In this cross-sectional survey, 123 Chinese dyads of mothers living with HIV and children with PHIV completed measures of illness perceptions, HIV-related stigma, and resilience. For both mothers and children, hierarchical cluster analyses identified an adaptive cluster (lower perceived impact and higher control; mothers: 37.4%, children: 56.9%) and a maladaptive cluster (higher perceived impact and lower control; mothers: 62.6%, children: 43.1%). Mothers and children in the adaptive cluster reported lower stigma and higher resilience. Actor-partner interdependence models (APIM) examined dyadic stigma-resilience associations, showing that higher maternal and child stigma predicted lower child resilience. APIM moderation models showed that illness perception clusters moderated the dyadic stigma-resilience associations: only among dyads with mothers in the maladaptive cluster, mothers' and children's higher stigma predicted their own lower resilience. Only among children in the adaptive cluster, children's higher stigma predicted their lower resilience. These findings extend the relationship-oriented model to mothers and their children living with HIV and call for consideration of both members' illness perceptions and mothers' HIV-related stigma.